Short Sheath Research Articles

TRUST Technique for Neurointervention: A Promising Alternative for Complex Cases.

Neurointervention via Transradial Access (TRA) is becoming increasingly popular as experience with this technique increases. However, approximately 8.6-10.3% of complex TRA cases are converted to femoral access due to a lack of support or radial artery spasm. This study aimed to assess the efficacy and safety of the TRUST (trans-radial coaxial catheter technique using a short sheath, Simmons catheter, and Tethys intermediate catheter) technique in interventional procedures via TRA. This was a single-center retrospective analysis of 16 patients admitted to our institute between January 2023 to May 2023 to undergo endovascular interventions with the TRUST technique via the TRA. The mean age of the study population was 63.8 years, and 62.5% were male (10/16). The most common procedure was intracranial atherosclerotic stenosis (93.75%, 15/16). All procedures were performed successfully, and the most common procedures in our cohort were ballooning (50.0%, 8/16), stenting (18.75%, 3/16), and both procedures combined (31.25%, 1/16). All procedures were performed using the TRA, and the distal and proximal radial arteries were used for access in 31.35% (5/16) and 68.75% (11/16) of the cases, respectively. Technical success was achieved in all patients and most cases demonstrated mTICI ≥2b recanalization (93.75%, 15/16). In this case, no major access-site complications occurred. The TRUST technique is technically safe and feasible and had a high technical success rate and low complication rate in our study. These results demonstrate that the TRUST technique is a promising alternative for patients undergoing complex neurointerventions.

Ultrasound-guided percutaneous retrieval of non-radiopaque radial line using a microsnare

Radial arterial lines are inserted in critically ill patients admitted to hospital intensive care units for continuous monitoring of their blood pressure. On removal the line can rarely become transected, potentially leading to thrombosis of the radial artery. Retrieval of the broken fragment can be achieved by open surgery, however other retrieval methods using ultrasound-guidance have been performed as they are considered safer and less invasive. We describe our technique of ultrasound-guided percutaneous retrieval of a broken non-radioopaque radial line in one patient, which involved the use of a microsnare. Under local anaesthesia and ultrasound guidance, a 6 Fr 5.5 cm short brite tip sheath was introduced into the radial artery, followed by a microsnare which was used to capture the arterial line, track the line back into the sheath and remove it uneventfully. The use of a microsnare under ultrasound-guidance is only one method to retrieve transected radial lines, with other interventional methods described in the literature. It enables a minimally invasive and safer approach to this potentially critical challenge and can help affected patients avoid open surgery to achieve the same management outcome.

Combined Endovascular Antegrade and Direct Retrograde Carotid Artery Stenting for Chronic and Long Segment Common Carotid Artery Occlusion: Technical Note and Review of Literature.

Common carotid artery (CCA) occlusion (CCAO) is a rare cause of ischemic stroke and bypass surgery is the common treatment approach. However, safer alternatives should be developed to treat CCAO. A 68-year-old male was diagnosed with left-sided CCAO with decreased left visual acuity due to neck radiation therapy for laryngeal cancer. Recanalization therapy using a pull-through technique was initiated because cerebral blood flow progressively decreased during the follow-up period. First, after a short sheath was inserted into the CCA, the occluded CCA was retrogradely penetrated through the sheath. Second, a micro-guidewire was guided to the aorta from the femoral sheath where it was caught using a snare wire guided from the cervical sheath. Subsequently, the micro-guidewire was gently pulled out from the cervical sheath, penetrated the occluded lesion, and was secured to the femoral and cervical sheaths. Finally, the occluded lesion was dilated using a balloon, and the stent was placed. Five days postprocedure, the patient was discharged uneventfully and exhibited improved left visual acuity. In terms of reliable penetration of obstructive lesions and reduction of embolic and hemorrhagic complications, combined endovascular antegrade and direct retrograde carotid artery stenting is a versatile and minimally invasive treatment option for CCAO.

Single center experience with the novel rotating dilator sheath TightRailTM Sub-C in transvenous lead extraction.

Transvenous lead extraction has become a frequent procedure in the context of device lead management and various tools are available. The aim of this study was to investigate the efficacy and safety of the novel short rotating dilator sheath TightRailTM Sub-C (Sub-C) in transvenous lead extraction. For this retrospective single-center analysis, we included consecutive patients undergoing transvenous lead extraction using the Sub-C from January 2018 until February 2020 at the University Heart Center Zurich. A total of 87 leads were extracted within 45 patients using the Sub-C extraction sheath. The mean dwell time of the leads was 112 ± 9.1 months. Complete procedural success was achieved in 95.6% (43/45) and clinical procedural success in 97.8% (44/45). Two major complications (4.4%, 2/45) occurred, but neither was directly related to the Sub-C. This retrospective single-center analysis suggests that transvenous lead extraction with a routine use of the TightRailTM Sub-C extraction sheath is a safe strategy resulting in high success rates that may offer useful theoretical benefits. Future studies are needed to evaluate the incremental benefit of a routine use of short extraction sheaths including the Sub-C during TLE procedures.

Cortical stimulation leads to shortened myelin sheaths and increased axonal branching in spared axons after cervical spinal cord injury.

Neural activity and learning lead to myelin sheath plasticity in the intact central nervous system (CNS), but this plasticity has not been well-studied after CNS injury. In the context of spinal cord injury (SCI), demyelination occurs at the lesion site and natural remyelination of surviving axons can take months. To determine if neural activity modulates myelin and axon plasticity in the injured, adult CNS, we electrically stimulated the contralesional motor cortex at 10 Hz to drive neural activity in the corticospinal tract of rats with sub-chronic spinal contusion injuries. We quantified myelin and axonal characteristics by tracing corticospinal axons rostral to and at the lesion epicenter and identifying nodes of Ranvier by immunohistochemistry. Three weeks of daily stimulation induced very short myelin sheaths, axon branching, and thinner axons outside of the lesion zone, where remodeling has not previously been reported. Surprisingly, remodeling was particularly robust rostral to the injury which suggests that electrical stimulation can promote white matter plasticity even in areas not directly demyelinated by the contusion. Stimulation did not alter myelin or axons at the lesion site, which suggests that neuronal activity does not contribute to myelin remodeling near the injury in the sub-chronic period. These data are the first to demonstrate wide-scale remodeling of nodal and myelin structures of a mature, long-tract motor pathway in response to electrical stimulation. This finding suggests that neuromodulation promotes white matter plasticity in intact regions of pathways after injury and raises intriguing questions regarding the interplay between axonal and myelin plasticity.

Escalation from intra-aortic balloon pump to axillary impella 5.5 support: Staged removal of the femoral access.

Background: With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing. Here, we report an effective strategy of removing the intra-aortic balloon pump (IABP) in the setting of escalation of support to Impella 5.5.Results: From January 1, 2022 to June 30, 2022, a total of 6 patients have undergone IABP removal during Impella 5.5 insertion. The IABP was subsequently removed over the long wire with manual compression on the femoral artery to control bleeding. An 8 or 9 Fr short sheath is inserted over the wire. Staged hemostasis was successfully performed in 4 patients, and the remaining two patients required escalation of support to veno-arterial membrane oxygenation as EC-PELLA utilizing the femoral arterial sheath.Conclusion: This does not only achieve secured hemostasis but also enables a smooth transition to further escalate support such as extracorporeal membrane oxygenation support, if necessary.

Retrieval of Embolized Atrial Septal Defect Device from Left Atrium using Innovative Techniques

We report a technically difficult retrieval of embolized Atrial Septal Defect device from left atrium. Device was captured after multiple attempts using different types of snares and was brought to inferior vena cava without delivery sheath. As we were unable to slenderize the device into short sheath, it was finally retrieved using an unconventional and innovative technique.We emphasize the importance of safe improvised methods during challenging catheterization procedures resulting in successful outcomes.

Abstract 15603: Simultaneous Suction Debulking of a 3 Cm Lead Vegetation in the Right Ventricle During Extraction

A 49-year-old male with a history of NICM EF 25% with dual-chamber AICD, lupus with nonbacterial endocarditis of aortic valve, IVC filter for recurrent DVT/PE presented with septic shock due to MRSA osteomyelitis and bacteremia. TTE showed 1.8 cm vegetation. The patient had idiopathic thrombocytopenic purpura, for which IVIG was administered. To avoid obligatory systemic exposure to heparin in the setting of ITP with a larger evacuation system and crossing the IVC filter with a large bore cannula, it was decided to proceed with Penumbra evacuation of lead vegetation with simultaneous laser extraction. A short 16F sheath was inserted through the right femoral vein for the procedure. A12F Medtronic Cryo Flex sheath was advanced through the IVC filter under fluoroscopy to provide steerability in the right atrium. TEE-guided Flex sheath positioned abutting the mass/vegetation. Suction only partially retrieved the mass. RA lead was removed using mechanical extraction tools via the left chest pocket. On repeat TEE evaluation, the mass/vegetation was 3 cm on the RV lead. Since we could not aspirate the mass, we used the extraction tools to peel the mass off the lead while providing simultaneous negative suction through the Penumbra cannula. The lead was successfully extracted. TEE showed no residual mass, no significant change in tricuspid regurgitation and no pericardial effusion. Mass biopsy showed calcified blood clots. The patient was discharged on IV antibiotics. Discussion: Most cases to date report using larger systems like AngioVac for extracting larger vegetations/masses with lead extraction. Aspiration tools have been shown to extract malleable masses with lesser procedural-related morbidity. Peeling and aspiration can be used concurrently to remove these masses without significant blood loss, downstream sheading and the need for systemic anticoagulation. Further technique development can benefit in removing under such challenging scenarios.

Abstract 9803: Randomized Comparison of a Radiofrequency Wire versus a Radiofrequency Needle System for Transseptal Puncture

Introduction: Transseptal puncture is a necessary component of many electrophysiology and structural heart procedures. A new technology utilizes a specialized introducer wire to cross the septum with radiofrequency (RF) energy, eliminating the need for a transseptal needle and wire/needle exchanges. The RF wire technique, however, has not been evaluated in a randomized trial. Methods: The Wire Instrumentation with Radiofrequency Energy to Impact Transseptal puncture (WIRE IT, NCT04645342) study was an investigator-initiated and designed trial that enrolled individuals ≥18 years of age undergoing double transseptal puncture for atrial fibrillation or left atrial flutter ablation. Participants were randomized to a transseptal approach with either a RF needle (NRG Transseptal Needle, Baylis Medical) or RF wire (Versacross RF Wire, Baylis Medical). The primary outcome was time to achieve first transseptal puncture. Timing was started at insertion of the guidewire into the short femoral vein sheath and was stopped once the transseptal sheath was positioned in the left atrium and the dilator and guidewire were removed. Secondary outcomes included second and combined transseptal puncture time, fluoroscopy time, number of equipment exchanges, and complications. Results: A total of 75 participants were enrolled between November 30, 2020 and February 2, 2022 (36 RF needle, 39 RF wire). No crossovers occurred. Randomization to the RF wire resulted in a statistically significant reduction in first transseptal time compared to the RF needle (Figure). Second and combined transseptal times and number of equipment exchanges were also reduced with the RF wire. One participant in the RF needle group experienced transient AV block due to mechanical trauma. There were no complications in the RF wire group. Conclusions: The RF wire technique resulted in faster time to transseptal puncture and fewer equipment exchanges compared to an RF needle with no difference in complications.

Sogatella furcifera Saliva Mucin-like Protein Is Required for Feeding and Induces Rice Defences.

The white-backed planthopper (WBPH), Sogatella furcifera, is one of the most important piercing-sucking pests of rice (Oryza sativa) in Asia. Mucin-like salivary protein (SFMLP) is highly expressed in the salivary glands of WBPH, which plays an important role in WBPH feeding. In this study, WBPH injected with dsSFMLP had difficulty in sucking phloem sap from rice plants, which significantly reduced their food intake, weight, and survival. In contrast, the knockdown of the SFMLP gene had only a marginal effect on the survival of WBPH fed an artificial diet. Further studies showed that silencing SFMLP resulted in the short and single-branched salivary sheaths secretion and less formation of salivary flanges in rice. These data suggest that SFMLP is involved in the formation of the salivary sheath and is essential for feeding in WBPH. Overexpression of the SFMLP gene in rice plants promoted the feeding of WBPH, whereas silencing the gene in rice plants significantly decreased WBPH performance. Additionally, it was found that overexpression of SFMLP in rice plants elicited the signalling pathway of SA (salicylic acid) while suppressing JA (jasmonic acid); in contrast, silencing of the SFMLP gene in rice plants showed the opposite results. This study clarified the function of SFMLP in WBPH feeding as well as mediating rice defences.

Direct carotid puncture for endovascular surgery of intracranial aneurysms: Technical note for avoiding complications.

Background: While the most intracranial aneurysms are approachable by femoral or brachial artery puncture during endovascular surgery, in some cases, the lesion is difficult to reach due to complications such as the presence of winding pathways. Direct carotid puncture (DCP) is an alternative access approach, despite the potential risk of fatal neck hematoma. Herein, we describe the DCP technique in a series of five patients with intracranial aneurysms, together with its technical considerations.Methods: Patients with intracranial aneurysms who underwent endovascular surgery using DCP were reviewed retrospectively. We selected the 3F to 6F systems for DCP depending on the necessity of adjunctive techniques. To prevent DCP-associated complications, we (1) conducted a micropuncture before introducing the short sheaths,(2) selected the smallest possible size for the system, (3) reversed heparin postoperatively, and (4) performed perioperative intubation/sedation management.Results: Five out of 535 patients underwent DCP in our hospital between 2015 and 2019; successful vascular access was achieved in all cases. Although a minor neck hematoma occurred in one case, the patient did not require additional treatment. According to a literature review, severe neck hematoma requiring rescue therapy occurs in 5 out of 95 cases (5.3%).Conclusion: Although the potential risk of neck hematoma is not negligible, the DCP technique appears to be a safe and effective approach in treating intracranial aneurysms with challenging access routes in cases where perioperative counter measurements are appropriately performed.

Low-energy electron beam generation in inductively coupled plasma via a DC biased grid

Low-energy electron beam generation using a DC biased grid was investigated in an inductively coupled plasma (ICP). The electron beam was measured in argon gas at various pressures, ICP source powers, and substrate voltages (V sub). At a low ICP source power (50 W), an electron beam was generated even at small values of V sub (10 V), however at a high ICP source power (200 W), an electron beam was only generated when a higher voltage (30 V) was applied due to the short sheath thickness on the grid surface. The sheath on the grid surface is an important factor for generating electron beams because low-energy electrons are blocked. If the sheath thickness to small, a high voltage should be applied to generate an electron beam, as accelerate regions cannot exist without the sheath. At high pressure, since electrons experience numerous neutral collisions, a high substrate voltage is needed to generate an electron beam. However, if the applied substrate voltage becomes too high (40 V) at high pressure, high-energy electrons result in secondary plasma under the grid. Therefore, maintaining a low pressure and low ICP source power is important for generating electron beams.

Electron power absorption in micro atmospheric pressure plasma jets driven by tailored voltage waveforms in He/N2

In atmospheric pressure capacitively-coupled microplasma jets, voltage waveform tailoring (VWT) was demonstrated to provide ultimate control of the electron energy distribution function (EEDF), which allows us to enhance and adjust the generation of selected neutral species by controlling the electron power absorption dynamics. However, at the fundamental level, the physical origin of these effects of VWT remained unclear. Therefore, in this work, the electron power absorption dynamics is investigated in a He/N2 jet with a nitrogen concentration of 0.05% driven by a valleys voltage waveform at a base frequency of 13.56 MHz for different numbers of harmonics, using a self-consistent particle-in-cell simulation coupled with a spatio-temporally resolved analysis of the electron power absorption based on moments of the Boltzmann equation. Due to the local nature of the transport at atmospheric pressure, ohmic power absorption is dominant. Increasing the number of harmonics, due to the peculiar shape of the excitation waveform, the sheath collapse at the grounded electrode is shortened relative to the one at the powered electrode. As a consequence, and in order to ensure flux compensation of electrons and positive ions at this electrode, a high current is driven through the discharge at the time of this short sheath collapse. This current is primarily driven by a high ohmic electric field. Close to the grounded electrode, where the electron density is low and the electric field is therefore high, electrons are accelerated to high energies and strong ionization, as well as the formation of a local electron density maximum, are observed. This electron density maximum leads to a local ambipolar electric field that acts as an electric field reversal and accelerates electrons to even higher energies. These effects are understood in detail to fundamentally explain the unique potential of VWT for EEDF control in such plasmas.

Perimembranous ventricular septal defect closure via ultra-minimal trans intercostal incision in children.

This study aimed to investigate the safety, feasibility and, availability of perimembranous ventricular septal defect (PmVSD) closure via a left parasternal ultra-minimal trans intercostal incision in children. From January 2015 to January 2019, 131 children with restrictive PmVSDs were enrolled in this study and successfully done in 126 patients (96.18%). PmVSDs were occluded via an ultra-minimal trans intercostal incision (≤1 cm), and the entire occlusive process was guided and monitored by TEE. A pericardium hanging technique was employed without sternal incision. PmVSDs were closed through a short delivery sheath assembled using a concentric occluder device. All patients were followed up for a period ranging from18 months to 24 months. Thirteen patients with PmVSD had aneurysm of membranous septum (AMS). Multistream (≥2) PmVSDs with AMS were found in 11 cases. After the operation, mild residual shunt beside the amplatzer occluder in one patient was found and had self-healing result during the 5-month follow-up period. Five patients transferred to ventricular septal defect repair operation under direct visualization with a cardiopulmonary bypass. One reason was ventricular fibrillation when guidewire passed the PmVSD, another was device dislocation, and others were the guidewire cannot pass through the PmVSD. PmVSDs closure using a concentric occluder via a left parasternal ultra-minimal trans intercostal incision under TEE guidance is feasible, safe, and effective in children. This approach can be considered as an alternative treatment to open-heart surgery for restrictive PmVSDs.

Long Vascular Sheaths for Transfemoral Neuroendovascular Procedures in Children.

PurposeTo evaluate the safety and efficacy of long vascular sheaths for transfemoral neuroendovascular procedures in children.Materials and MethodsA retrospective evaluation of transfemoral neuroendovascular procedures in children <18 years, using long sheaths was undertaken analyzing procedure type, fluoroscopic times, technical success, access site and systemic complications. Twenty-seven consecutive procedures were included over a 2-year period. Mean age was 8.4 years (standard deviation [SD] 6.3) (range 17.0 months–16.3 years).ResultsPatients were 44% female and mean weight was 35.0 kg (SD 22.8) (range 9.8–72.2 kg). A third of the procedures were performed in ≤15 kg children. The most common procedure was for embolization (n=13, 48.1%) and the most common indication was dual microcatheter technique (52%). The most common device used was the 5 Fr Cook Shuttle sheath. Mean fluoroscopy time was 61.9 minutes (SD 43.1). Of these procedures, 93% were technically successful. Femoral vasospasm, when present, was self-limiting. Complications (3/27, 11.1%) included groin hematoma (n=1), neck vessel spasm that resolved with verapamil (n=1), and intracranial thromboembolism (n=1), with no significant difference between the ≤15 kg and >15 kg subcohorts. There were no aorto-femoro-iliac or limb-ischemic complications.ConclusionLong vascular sheaths without short femoral sheaths can be safely used for pediatric neuroendovascular procedures as they effectively increase inner diameter access without increasing the outer sheath diameter. This property increases the range of devices used and intracranial techniques that can be safely performed without arterial compromise, thus increasing the repertoire of the neurointerventionist.

Morphological and Molecular Identification of Limnodrilus Claparede,1862 Species(clitellata: naiDIDAE) IN Tigris River, Baghdad/Iraq

Sludge worm samples were collected from the Tigers River sediment during the period from November 2018 to June 2019 in Al Sarafiya District/ Baghdad- Iraq. Biometric morphological measurements focusing on the form of penis sheath and chaetal morphology were used for species identification, in addition to molecular analysis by amplification of conserved 18s rRNA encoding gene using ITS1 and ITS4 universal primers.According to the morphological measurement records, the results revealed the existence of Limnodrilus hoffmeisteri Claparede 1862, L. claparedeianus Ratzel, 1868 and L. cervix Brinkhurst 1963. Other two groups of specimens, with short penis sheath, were identified by molecular technology as L. hoffmeisteri complex, and L. claparedeianus.-cervix. Both species were considered as new record for Iraqi fauna, and had been registered in NCBI under the accession number LC497073 and LC497074 respectively According to the morphological measurements records, the results revealed the existence of Limnodrilus hoffmeisteri Claparede 1862, L. claparedeianus Ratzel, 1868 and L. cervix Brinkhurst 1963, which identified by molecular analysis using 18S rRNA gene and DNA sequencing recorded L. hoffmeisteri complex, This species is a new record in Iraq, and has been registered in NCBI under the accession number LC497073. There was also specimen identified by molecular analysis using 18S rRNA gene and DNA sequencing recorded L. Claparedeianus –cervix. Also, this species is a new record in Iraq, and has been registered in NCBI under the accession number LC497074. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ Keyword: Limnodrilus hoffmeisteri complex, Iraq, LC497073, NCBI, Limnodrilus hoffmeisteri, L. Claparedeianus, L. cervix, L. Claparedeianus –cervix, LC 497073. *Part of M.Sc. Thesis of Research Sludge worms samples were collected from the Tigers River sediment in Al Sarafiya district, / Baghdad- Iraq. Biometric morphological measurement focusing on the form of penis sheath and chaetal morphology, in addition to molecular analysis using 18s rRNA gene, were used for species identification. According to the morphological measurements records, the results revealed the existence of two groups of Limnodrilus hoffmeisteri Claparède 1862 Individuals have long penis sheath with distal end with symmetrical or asymmetrical hood, while other individuals with short penis sheath with circular plate- like hood, which identified by molecular analysis as L. hoffmeisteri complex, and the isolate 18S rRNA recorded with the accession number LC497073 Two groups of very long penis sheath identified as L. claparedeianus Ratzel, 1868, and L. cervix Brinkhurst 1963, with dorsal and ventral projections. There are also a group of specimens with short penis sheath, which identified by molecular techniques as L. Claparedeianus –cervix 18S rRNA encoding genomic sequence was resented to the NCBI, recorded with the accession number LC497074. Limnodrilus hoffmeisteri complex and L. claparedeianus – cervix were considered as new records for Iraq.

O0006. Evaluation and Quantification of Macrophage Differentiation Markers in Intervertebral Disc Herniations – A Pilot Study

A concurrent arterial and venous access is routinely obtained for diagnosis and treatment of various neurovascular diseases. Traditionally, venous access is obtained by accessing the femoral vein or through direct internal jugular puncture. Although complication rates are low, life-threatening severe complications have been reported. Moreover, venous access can be challenging in large body habitus patients through these traditional routes. There is a growing trend of utilizing radial artery access for neuroendovascular procedures. Nevertheless, the use of upper limb veins in neurointerventional procedures is rare. We present 3 cases of the concurrent arterial and venous approach through the radial artery and cephalic or basilic vein of the forearm for diagnostic cerebral arteriography and venography. Radial access was obtained by using the standard technique, and venous access was obtained by cannulating cephalic or basilic vein using ultrasound guidance, and a 5F or 6F short sheath was placed. Venous angiography and catheterization of right and left internal jugular veins were then performed using a Simmons (SIM) 2 catheter alone or using 6F Envoy guide catheter coaxially over the SIM 2 catheter if an additional support for microcatheter was needed. Procedures were successfully completed with no adverse effects, and patients were discharged home the same day. We also describe the technique for the reformation of the SIM 2 catheter in the venous system for catheterization of right and left internal jugular veins through the arm access.

Intracerebral Hemorrhage and Ferroptosis: Something Else that STICH Should Know?

A concurrent arterial and venous access is routinely obtained for diagnosis and treatment of various neurovascular diseases. Traditionally, venous access is obtained by accessing the femoral vein or through direct internal jugular puncture. Although complication rates are low, life-threatening severe complications have been reported. Moreover, venous access can be challenging in large body habitus patients through these traditional routes. There is a growing trend of utilizing radial artery access for neuroendovascular procedures. Nevertheless, the use of upper limb veins in neurointerventional procedures is rare. We present 3 cases of the concurrent arterial and venous approach through the radial artery and cephalic or basilic vein of the forearm for diagnostic cerebral arteriography and venography. Radial access was obtained by using the standard technique, and venous access was obtained by cannulating cephalic or basilic vein using ultrasound guidance, and a 5F or 6F short sheath was placed. Venous angiography and catheterization of right and left internal jugular veins were then performed using a Simmons (SIM) 2 catheter alone or using 6F Envoy guide catheter coaxially over the SIM 2 catheter if an additional support for microcatheter was needed. Procedures were successfully completed with no adverse effects, and patients were discharged home the same day. We also describe the technique for the reformation of the SIM 2 catheter in the venous system for catheterization of right and left internal jugular veins through the arm access.

&lt;strong&gt;&lt;em&gt;Heracleum piliferum&lt;/em&gt; (Apiaceae), a new species from central Nepal&lt;/strong&gt;

A new species, Heracleum piliferum (Apiaceae), is described from the Annapurna mountain massif, central Nepal. The new species is related to H. forrestii and H. hemsleyanum and differs from them in dense pubescence of petioles, short triangular sheaths of stem leaves, 2-pinnate leaf blades, shallow notched terminal leaf segments, crenulate leaf margin, larger terminal umbels, and broadly winged lateral ribs of the mericarps.

Varietal difference in dynamics of non-structural carbohydrates in nodal segments of stem in two varieties of rice (Oryza sativa L.) at pre- and post-heading stages

ABSTRACT The non-structural carbohydrate (NSC) stored in rice stems (culm plus leaf sheaths) at pre-heading stage is one of the major carbon sources for grain filling. In this study, we conducted field experiments in 2018 and 2019 using two varieties, Momiroman (japonica-dominant) and Teqing (indica), which have different accumulation and remobilization patterns of NSC in the stems. We analyzed NSC dynamics of each of the five nodal segments of internodes and leaf sheaths at pre- and post-heading stages. The dynamics of NSC at pre- and post-heading stages differed among segments. The lower segments of internodes and leaf sheaths accumulated more NSC at pre-heading stage compared to the upper segments in both varieties. The lower internodes in Teqing were morphologically larger than in Momiroman and would be able to store more NSC. However, the upper parts of the stems required biomass for development and formation at the stage of NSC accumulation in stems. Momiroman had longer upper internodes and leaf sheaths and required more biomass than Teqing. The NSC remobilization was later in the upper than the lower internodes for both varieties, which led to the delay of NSC remobilization in the entire culm after heading. These results indicated that ideal morphology of stems, to maximize the potential contribution of stem NSC as the carbon source for grain filling, is large lower internodes and short upper internodes and leaf sheaths.