The environmental field of tropical cyclogenesis over the Bay of Bengal is analyzed for the extended summer monsoon season (approximately May–November) using best-track and reanalysis data. Genesis ...potential index (GPI) is used to assess four possible environmental factors responsible for tropical cyclogenesis: lower-tropospheric absolute vorticity, vertical shear, potential intensity, and midtropospheric relative humidity. The climatological cyclogenesis is active within high GPI in the premonsoon (∼May) and post-monsoon seasons (approximately October–November), which is attributed to weak vertical shear. The genesis of intense tropical cyclone is suppressed within the low GPI in the mature monsoon (approximately June–September), which is due to the strong vertical shear. In addition to the climatological seasonal transition, the authors’ composite analysis based on tropical cyclogenesis identified a high GPI signal moving northward with a periodicity of approximately 30–40 days, which is associated with boreal summer intraseasonal oscillation (BSISO). In a composite analysis based on the BSISO phase, the active cyclogenesis occurs in the high GPI phase of BSISO. It is revealed that the high GPI of BSISO is attributed to high relative humidity and large absolute vorticity. Furthermore, in the mature monsoon season, when the vertical shear is climatologically strong, tropical cyclogenesis particularly favors the phase of BSISO that reduces vertical shear effectively. Thus, the combination of seasonal and intraseasonal effects is important for the tropical cyclogenesis, rather than the independent effects.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Few data are available on gastric hypomotility (GH) after cryoballoon pulmonary vein isolation. Also, the use of esophageal temperature monitoring for the prevention of endoscopically detected ...esophageal lesions (EDELs) is not well established.
The purpose of this study was to investigate GH and the impact of an esophageal probe on EDELs during second-generation cryoballoon ablation.
One hundred four patients with paroxysmal atrial fibrillation undergoing second-generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Temperature probes were used in the first 40 (38.5%) patients, but not in the latter 64 (61.5%). Pulmonary vein isolation was performed with one 28-mm balloon using single 3-minute freeze techniques.
Clinical and procedural characteristics were similar between the groups. Esophagogastroscopy 1.4 ± 0.5 days postablation demonstrated GH and EDELs in 18 (17.3%) and 9 (8.7%) patients. The incidence of GH was similar (7 of 40 vs 11 of 64; P = .967) between the groups, while that of EDELs was significantly higher in the former than in the latter group (8 of 40 vs 1 of 64; P < .0001). In multivariate analyses, the esophagus-right inferior pulmonary vein ostium distance (hazard ratio 0.870; 95% confidence interval 0.798-0.948; P = .002) was the sole predictor of GH, and the optimal cutoff for the prediction was 18.2 mm (sensitivity 88.1%; specificity 77.8%). The use of esophageal probes was the sole predictor of EDELs (hazard ratio 15.750; 95% confidence interval 1.887-131.471; P = .011). All collateral damage was asymptomatic and healed on repeat esophagogastroscopy at a mean of 2 ± 1 months postprocedure.
Second-generation cryoballoon ablation is associated with an increased incidence of silent periesophageal nerve injury even using short freeze times, and anatomical information aids identifying high-risk populations. The use of esophageal probes increases the risk of EDELs.
BACKGROUND—The post–second-generation cryoballoon (CB) ablation isolation area during the chronic phase has not been described. The aim of this study was to quantitatively evaluate the chronic-phase ...isolation area after 28-mm second-generation CB ablation and compare it to the estimated conventional radiofrequency circumferential pulmonary vein isolation (CPVI) line.
METHODS AND RESULTS—Thirty-two patients with paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation using second-generation CB. After a median of 6.0 (4.0–9.0) months, the PV isolation area was evaluated using high-resolution mapping (1-mm electrode, 2-mm interelectrode spacing; 527±99 points per map) and pacing techniques in all patients (17 with and 15 without arrhythmia recurrence beyond blanking period) and compared with estimated conventional radiofrequency CPVI area. PV reconnections were observed in 34 of 126 PVs (27.0%) among 21 of 32 patients (65.6%), which were eliminated by a median of 1.0 (1.0–3.0) focal radiofrequency application. The left- and right-sided PV antrum isolation area and nonablated posterior wall areas were 9.8±1.7, 8.1±2.3, and 17.0±6.1 cm, respectively. The cryoablated areas were significantly smaller than the estimated conventional radiofrequency CPVI areas in all but the right inferior PV. The difference was highest in the left superior PV. In 2 patients (6.3%), recurrent atrial fibrillation originated from the foci identified at the left superior PV antrum outside the CB isolation area but inside the estimated conventional radiofrequency CPVI line.
CONCLUSIONS—Although the PV isolation areas during the chronic phase after the second-generation CB ablation were generally wide, they were significantly smaller than the area encircled by the CPVI line except at the right inferior PV antrum. Recurrent atrial fibrillation could originate from the left superior PV antrum and could be isolated by a CPVI but not by a CB.
Background:Inflammation plays a prominent role in the etiology of the early recurrence of atrial fibrillation (ERAF). We prospectively compared the proportion of ERAF and time-course patterns of ...biomarkers between radiofrequency (RF) and cryoballoon (CB) ablation.Methods and Results:We enrolled 82 consecutive paroxysmal AF patients undergoing pulmonary vein (PV) isolation, performed with either a 28-mm 2nd-generation CB and 3-min freeze technique or point-by-point RF ablation. Each group had 41 patients. In the RF group, all PVs were successfully isolated with 28.9±6.5 min of RF delivery. In the CB group, a mean of 5.3±1.4 applications/patient was delivered. The proportion of ERAF was similar between the groups. The time-course patterns significantly differed between the groups for high-sensitivity C-reactive protein (hs-CRP) value (P=0.006) and myocardial injury markers (P<0.0001). Greater myocardial injury was observed in the CB than in the RF group (P<0.0001), whereas the peak hs-CRP value was comparable between the groups. The 2-day post-procedure hs-CRP value was the sole factor correlating with ERAF as identified by the multivariable analysis (hazard ratio 1.697; 95% confidence interval, 1.005–2.865; P=0.048) in the RF, but not the CB group.Conclusions:The proportion of ERAF was comparable after RF and 2nd-generation CB ablation. Despite CB ablation exhibiting greater myocardial injury than RF ablation, the inflammatory responses were comparable between the groups. The inflammatory response extent predicted ERAF post-RF ablation but not post-CB ablation. (Circ J 2016; 80: 346–353)
We aimed to determine whether acupuncture to the auricular region increases cortical regional cerebral blood flow (rCBF). The rCBF was measured using laser speckle contrast imaging in ...urethane-anesthetized rats. Acupuncture stimulation was performed manually at the auricular concha or abdomen. The former's stimulation significantly increased the rCBF of the bilateral cerebral cortex in the frontal, parietal, and occipital lobes without altering the systemic arterial pressure. In contrast, abdominal stimulation affected neither rCBF nor systemic arterial pressure. The increase in the rCBF was completely abolished by the severance of the somatic nerves that innervated the auricular region, comprising the trigeminal nerve, facial nerve, auricular branch of the vagal nerve, glossopharyngeal nerve, and great auricular nerve. Thus, application of acupuncture to the auricular region increases the rCBF without increasing arterial pressure.
Acupuncture is a non-pharmacological therapy used clinically for mood disorders. Relief of physical symptoms with acupuncture treatment may lead to relief of depressive symptoms and improvement of ...quality of life (QoL). Few studies have examined the effect of acupuncture on the physical symptoms and QoL of patients with mood disorders.
To examine the effect of acupuncture on physical symptoms and QoL of patients with treatment-resistant major depressive disorder (MDD) and bipolar disorder (BD).
This prospective, single-arm, longitudinal study included patients with MDD and BD from an outpatient psychiatric clinic. Acupuncture was performed weekly for 12 weeks in combination with regular treatment, with fixed acupoints and individualized treatment for each patient. Psychiatric symptoms were evaluated using the Himorogi Self-Rating Depression Scale (HSDS) and Himorogi Self-Rating Anxiety Scale (HSAS). Physical symptoms such as physical pain, gastrointestinal symptoms, and sleep disorders were evaluated using the Japanese version of the Somatic Symptom Scale-8 (SSS-8) and Visual Analog Scale (VAS). QoL was evaluated using the 8-item Short-Form (SF-8) Health Survey.
A total of 36 patients (15 MDD and 21 BD patients) were analyzed. After 12 weeks of acupuncture, HSDS and HSAS scores significantly decreased (
< 0.05). Physical symptoms evaluated using SSS-8 and VAS scores also significantly improved (
< 0.05). In particular, neck pain and insomnia improved at an early stage. Among the SF-8 subscales, scores of bodily pain, general health perception, role limitations due to emotional problems, and mental health significantly increased (
< 0.05).
Acupuncture may improve not only psychiatric symptoms but also physical symptoms and QoL in patients with treatment-resistant mood disorders. Further studies are required for confirmation of the preliminary data collected thus far.
To evaluate the available silicon (Si) content in agricultural soils in Japan and to investigate the determining factors of this content, we collected 180 soil samples from the surface layer of ...paddies and upland fields in Japan and determined their available Si contents. A phosphate buffer (PB; 0.02 M, pH 6.9) or an acetate buffer (AB; 0.1 M, pH 4.0) was used to extract available Si from the soil samples, and the Si concentrations in the extracts were determined by inductively coupled plasma-atomic emissions spectroscopy (ICP-AES). The total Si content and selected physicochemical properties were also determined for the soil samples. The median values of the available Si contents by the PB and AB methods were 48.8 and 79.7 mg kg
−1
and corresponded to 0.017% and 0.027% of the total Si content, respectively. The overall data showed log-normal distributions. The available Si content of the upland soils was significantly higher than that of the paddy soils by both the PB (p < 0.01) and AB methods (p < 0.05). The available Si contents by the PB and AB methods had a significant positive correlation (p < 0.01) and they had significant negative correlation with the total Si content (p < 0.01). The values of the available Si contents by the PB and AB methods correlated positively with the pH, total carbon (C) content, and dithionite-citrate bicarbonate extractable iron (Fed) and aluminum (Ald), acid oxalate extractable iron (Feo) and aluminum (Alo), Fed-Feo and Alo+1/2Feo values (p < 0.01). A multi-regression analysis indicated that pH, amorphous minerals and crystalline iron (Fe) oxides were the dominant determining factors of available Si in the soils, and these three variables explained approximately two thirds of the variation of available Si content in agricultural soils in Japan. In terms of soil type, Terrestrial Regosols, Dark Red soils and Andosols had relatively high available Si contents, whereas Sand-dune Regosols, Red soils and Gray Lowland soils had relatively low contents. In terms of region, the soils in the Kanto and Okinawa regions had relatively high available Si contents and those in the Kinki, Shikoku and Chugoku regions had relatively low contents. In conclusion, the available Si content and its determining factors for agricultural soils in Japan were quantitatively elucidated, and this will contribute to the establishment of rational soil management -including the application of silicate materials, taking into account the Si-supplying power of the relevant soils-for sustainable and productive agriculture in Japan.
Esophagus‐Related Complications After Cryoablation
Background
Monitoring luminal esophageal temperatures (LETs) helps predict esophageal thermal lesions (ETLs) after catheter ablation. This study ...aimed to evaluate esophagus‐related complications after second‐generation cryoballoon ablation under simultaneous LETs monitoring from 2 esophageal probes.
Methods
Forty consecutive paroxysmal atrial fibrillation patients undergoing second‐generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Two temperature probes inserted bi‐nasally (both non‐deflectable in 13, non‐deflectable and deflectable in 27 patients) were used for LET monitoring. Pulmonary vein isolation was performed with one 28‐mm balloon using single 3‐minute freeze techniques.
Results
The lowest LETs significantly correlated between different probes; however, deflectable probe showed significantly lower nadir LETs than non‐deflectable probes (14.6 ± 9.2 vs. 20.0 ± 10.6 ℃, P<0.0001). Esophagogastroscopy post‐ablation demonstrated ETLs and gastroparesis in 8 (20%) and 7 (17.5%) patients (total 13 32.5%), respectively. The optimal cutoff for the lowest LET measured on any probe for predicting no ETLs was 12.8 ℃ (sensitivity 78.1%, specificity 100%). When using deflectable and non‐deflectable catheters, the optimal cutoff point for the lowest LET for predicting no ETLs was 11.4 ℃ (sensitivity 70.0%, specificity 100%) and 19.4 ℃ (sensitivity 63.6%, specificity 100%), respectively. No ETLs were detected in 12 (30%) patients with the esophagus located between the left atrium and spine. All esophagus‐related complications were asymptomatic and had healed on repeat esophagogastroscopy by a mean of 53 ± 25 days after the procedure.
Conclusions
The lowest LET highly depended on the temperature probe location. However, if a different cutoff value was applied, LET monitoring, regardless of the probe type, and anatomical information might help predict ETLs during second‐generation cryoballoon ablation.
Background Phrenic nerve injury (PNI) is recognized as an important complication during atrial fibrillation ablation. This study aimed to investigate the incidence and outcome of PNI during superior ...vena cava isolation (SVCI) and circumferential pulmonary vein isolation (CPVI) using radiofrequency (RF) energy and the factors associated with its occurrence. Methods and results Five hundred sixty-seven consecutive patients who underwent SVCI after CPVI without substrate modification who completed a 12-month follow-up were retrospectively analyzed. Point-by-point RF applications were applied with maximum energy settings of 35 W and 30 seconds for the SVCI. In the former 210 patients, sites where pacing captured the PN were avoided whenever possible; however, the maximum power was 35 W. In the latter 357 patients, RF energy was delivered regardless of PN capture; however, the power at PN capture sites was limited to 10 W during continuous diaphragmatic movement monitoring on fluoroscopy. Circumferential pulmonary vein isolation and SVCI were successfully achieved in all. Twelve patients (2.1%) had PNI during SVCI but not during CPVI. Phrenic nerve injury completely recovered in all patients a median of 8.0 months after the procedure. The prevalence was higher in the former period (3.8% vs 1.1%; P = .03). A multivariate logistic regression analysis revealed that the study period (odds ratio 3.546; 95% CI 1.051-11.965; P = .041) was the sole independent predictor for identifying patients with PNI during SVCI. Conclusions Phrenic nerve injury occurred in 2.1% of the patients. All occurred during SVCI but not during contemporary CPVI. Energy titration and continuous diaphragmatic movement monitoring significantly decreased the incidence during SVCI.
Radiofrequency applications around pulmonary vein (PV) ostia often induce vagal reflexes.
This study aimed to evaluate the impact of the order of the targeted PV on the vagal response during ...second-generation cryoballoon ablation.
Eighty-one consecutive paroxysmal atrial fibrillation (AF) patients undergoing cryoballoon ablation were prospectively enrolled. PV isolation was performed with one 28-mm second-generation balloon using a 3-minute freeze technique. In the first 39 patients, the left superior PV (LSPV) was initially targeted. In the second 42, the LSPV was targeted following the right PVs.
Baseline rhythms were sinus rhythm and AF in 34 and 5 patients in the first group, and 34 and 8 in the second group, respectively. In the first group, sinus bradycardia/arrest requiring back-up pacing occurred in 13 patients (38.2%) at a median of 41.0 (10.0-55.5) seconds after balloon deflation (90 60-100 seconds post freezing), and pauses requiring pacing in 1 (20.0%) with AF. In the second group, no sinus bradycardia/arrest occurred throughout the procedure; however, atrioventricular block requiring back-up pacing occurred 21 seconds after balloon deflation in 1 patient in whom right superior PV (RSPV) ablation was performed for only 60 seconds owing to right phrenic nerve injury. The cycle length was similar at baseline and post PV isolation between the 2 groups, and significantly shorter during RSPV ablation (P < .0001) in both. In total, marked vagal responses were significantly higher in the first than second group (14/39 vs 1/42, P < .0001).
LSPV cryoballoon ablation often provoked marked vagal responses; however, preceding RSPV ablation markedly suppressed this response.
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