Web Formation Research Articles

Inhibition of HCV replication by humanized-single domain transbodies to NS4B

NS4B of hepatitis C virus (HCV) initiates membrane web formation, binds RNA and other HCV proteins for viral replication complex (RC) formation, hydrolyses NTP, and inhibits innate anti-viral immunity. Thus, NS4B is an attractive target of a novel anti-HCV agent. In this study, humanized-nanobodies (VHs/VHHs) that bound to recombinant NS4B were produced by means of phage display technology. The nanobodies were linked molecularly to a cell penetrating peptide, penetratin (PEN), for making them cell penetrable (become transbodies). Human hepatic (Huh7) cells transfected with HCV JFH1-RNA that were treated with transbodies from four Escherichia coli clones (PEN-VHH7, PEN-VHH9, PEN-VH33, and PEN-VH43) had significant reduction of HCV RNA amounts in their culture fluids and intracellularly when compared to the transfected cells treated with control transbody and medium alone. The results were supported by the HCV foci assay. The transbody treated-transfected cells also had upregulation of the studied innate cytokine genes, IRF3, IFNβ and IL-28b. The transbodies have high potential for testing further as a novel anti-HCV agent, either alone, adjunct of existing anti-HCV agents/remedies, or in combination with their cognates specific to other HCV enzymes/proteins.

Contribution of Hydrogen Bonds to Paper Strength Properties.

The objective of this work was to investigate the influence of hydrogen bonds between fibres on static and dynamic strength properties of paper. A commercial bleached pinewood kraft pulp was soaked in water, refined in a PFI, and used to form paper webs in different solvents, such as water, methanol, ethanol, n-propanol and n-butanol, to determine the effect of their dipole moment on static and dynamic strength properties of resulting paper sheets. Paper which was formed in water, being the solvent of the highest dipole moment among the tested ones, showed the highest breaking length and tear resistance. When paper webs were formed in n-butanol, which was the least polar among the solvents, these parameters were reduced by around 75%. These results provide evidence of the importance of water in paper web formation and strong impact of hydrogen bonds between fibres on strength properties of paper.

The association between gastroesophageal reflux disease and recurrent respiratory papillomatosis: A systematic review.

Antireflux therapy is incorporated in many treatment protocols for recurrent respiratory papillomatosis (RRP) because gastroesophageal reflux (GERD) is thought to worsen the disease course of RRP. It is unclear if GERD really aggravates the disease course. The aims of this systematic review were to 1) evaluate incidence of GERD among RRP patients and 2) report if GERD changes the clinical course or tissue properties of RRP. A search was conducted in PubMed, Embase, and Google Scholar, following the methods of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Articles with original data, published after January 1, 1990, on RRP with GERD as a determinant were eligible. There was no language restriction. Data on study design, study population, statistics, outcomes (incidence and influence of GERD), and risk of bias were collected and evaluated following PRISMA protocols. Of 1,277 articles, 19 were selected. Gastroesophageal reflux was objectified in 25% to 100% of RRP patients. Subjective GERD was present in 0% to 70% of patients. There is no proof that GERD aggravated the clinical course or tissue properties of RRP, as measured by the number of surgeries, severity scoring systems, or dysplasia. One study did find a higher chance of web formation in patients with anterior or posterior glottic papillomas who did not receive antireflux therapy, but these results should be interpreted with care due to the study's quality. There is insufficient proof that GERD does or does not aggravate the clinical course or tissue properties of RRP. Laryngoscope, 126:2330-2339, 2016.

Simulation and Modeling of Microfibrous Web Formation in Melt Blowing

A novel method to predict accurately the formation of fibrous webs in the melt-blowing process is developed. When an image analysis technique is combined with the Fluent software, the fiber spatial position and consequent landing position on the moving collection screen are predicted. The results include the prediction of fiber deposition patterns in the resulting fibrous web. In addition, to verify the prediction quantitatively, the basis weight distribution and the variation coefficient of the basis weight for both the predicted and experimental fibrous webs are investigated. Comparison of the prediction with the experimental data suggests that the method captures the primary trends rather accurately, not only for the single-orifice experiment but also for commercial multiple-orifice production.

Resolution of Constipation, Anal Stricture, and Fe Deficiency Anemia After Iron Infusion: An Analogy With Plummer Vinson Syndrome: Presidential Poster

Introduction: Anal stricture is an uncommon and disabling condition which can be unresponsive to conservative management and the complications of dilatations and Anoplasty make it a formidable treatment challenge. Here we report the case of a patient with constipation, anal stricture and iron deficiency anemia (IDA) where the triad resolved with IV iron treatment over 3 months. Case Report: A 69-year-old male presented to us with chronic constipation, rectal pain and easy fatigability. Physical examination revealed conjunctival pallor and laboratory findings were consistent with microcytic hypochromic anemia with iron deficiency (Ht- 31.6, Labs-Table 1). An upper endoscopy, CT Abdomen and Capsule endoscopy did not reveal any source of GI bleeding. Celiac panel was normal and there was no evidence suggestive of any other cause of anemia. Digital rectal examination (DRE) could not be completed because of severe rectal pain and markedly narrow anal canal. Under propofol sedation, Colonoscopy with GIF-Q 180 OLYMPUS scope, confirmed anal stricture with non-specific colitis. Conservative management with laxatives, high fiber diet and local anesthetics was initiated but the patient continued to have symptoms. Patient was referred to the hematologist for an evaluation of anemia and was started on IV Iron infusions. After 3 months of treatment, patient's anemia and all of the symptoms resolved (Ht- 38.3, Table 1). A repeat DRE was painless and the anal stricture had resolved.Table 1: Lab Values Pre and Post Iron Replacement TherapyDiscussion: The triad of Constipation, Anal Stricture and IDA in this patient paints a similar picture as PVS which presents as Dysphagia, Esophageal webs and IDA. The patient's symptoms of constipation and anal stricture resolved with iron treatment which has for long been known to resolve dysphagia and esophageal webs in PVS. Iron deficiency leading to loss of iron-dependant enzymes causes web formation and cancer development of the gastrointestinal tract. Tissue iron has been known to play an important role in the proliferation of epithelial cells. The epithelial layer of the alimentary tract is especially susceptible to iron deficiency because of its high cell turnover. Therefore, Iron replacement may provide a promising medical treatment benefit in high cell turnover GI tract and resolve rectal strictures along with the symptoms associated with them. The cause of PVS still remains a mystery. This analogy with PVS serves as a subject of further research and presents as an intriguing intellectual challenge in front of our medical fraternity.

Bilobe Flap for Web Reconstruction in Adult Syndactyly Release

INTRODUCTION: Traditional surgical approaches to syndactyly repair have used flaps from the dorsum of the involved fingers and dorsal and palmar interdigitating flaps.1 However, these flaps are dependent upon skin from syndactylic fingers already insufficient in the surface area. This study describes the use of a bilobed flap for formation of web spaces in the treatment of syndactyly release, which decreases the graft need and also avoids the use of skin grafting in syndactyly release and in web reconstruction cases. The present technique was developed based on a concept for the beneficial use of the dorsal hand skin by lowering or eliminating the need for a skin graft. MATERIALS AND METHODS: A retrospective review of this procedure was performed. Patients were aged 20 to 23 years. The mean follow-up period was 7 ± 3.2 months. The bilobed flap was designed for web formation on the dorsal skin of the proximal phalanx and dorsal skin of the hand. We present 10 patients, of which there were 15 web space syndactyly repairs with a bilobed flap. RESULTS: Surgery was completed without skin grafting in nine cases of 14 web spaces; two of them were complex/complete, and two of them were simple/complete syndactylies. We used a skin graft in one patient because of triangular flap necrosis in a second operation. The use of a bilobed flap allowed the construction of web spaces, providing satisfactory cosmetic outcomes (figure 1 - 2). No partial necrosis or complications were observed in bilobed flaps. Operation time is shorter than the classical technique which needs to use a skin graft. Also, it is possible to reconstruct multiple webs in the same patient with this flap.Figure 1: Bilateral 3rd and 4th web syndactylies. Preoperative view.Figure 2: Post-operative 8-month views of the patient. No skin graft was used for any of the webs.CONCLUSION: The present surgical technique could be a new surgical option for web formation and reconstruction in primary and secondary syndactyly cases. Thus, you may be able to avoid problems related to the skin graft.

Interferon-inducible cholesterol-25-hydroxylase restricts hepatitis C virus replication through blockage of membranous web formation.

Hepatitis C virus (HCV) is a positive-strand RNA virus that primarily infects human hepatocytes. Infections with HCV constitute a global health problem, with 180 million people currently chronically infected. Recent studies have reported that cholesterol 25-hydroxylase (CH25H) is expressed as an interferon-stimulated gene and mediates antiviral activities against different enveloped viruses through the production of 25-hydroxycholesterol (25HC). However, the intrinsic regulation of human CH25H (hCH25H) expression within the liver as well as its mechanistic effects on HCV infectivity remain elusive. In this study, we characterized the expression of hCH25H using liver biopsies and primary human hepatocytes. In addition, the antiviral properties of this protein and its enzymatic product, 25HC, were further characterized against HCV in tissue culture. Levels of hCH25H messenger RNA were significantly up-regulated both in HCV-positive liver biopsies and in HCV-infected primary human hepatocytes. The expression of hCH25H in primary human hepatocytes was primarily and transiently induced by type I interferon. Transient expression of hCH25H in human hepatoma cells restricted HCV infection in a genotype-independent manner. This inhibition required the enzymatic activity of CH25H. We observed an inhibition of viral membrane fusion during the entry process by 25HC, which was not due to a virucidal effect. Yet the primary effect by 25HC on HCV was at the level of RNA replication, which was observed using subgenomic replicons of two different genotypes. Further analysis using electron microscopy revealed that 25HC inhibited formation of the membranous web, the HCV replication factory, independent of RNA replication. Infection with HCV causes up-regulation of interferon-inducible CH25H in vivo, and its product, 25HC, restricts HCV primarily at the level of RNA replication by preventing formation of the viral replication factory.

Novel Metal-Matrix Composites Prepared by Paper Manufacturing Technology

The current contribution deals with metal-matrix composites prepared by paper manufacturing technology. In contrast to conventional techniques, this technology is an energy-and cost-efficient process for the shaping of thin sheets using solid powder mixtures. Conventional and pre-ceramic as well as pre-metallic paper-manufacturing have in common that cellulose (pulp) fibres are loaded with inorganic fillers. The present study is focused on the paper web formation using a metastable austenitic steel powder (16-7-3 %Cr-%Mn-%Ni) and a magnesia partially stabilised zirconia powder as inorganic fillers. The paper web formation was investigated. During filtration of the aqueous fibre-filler suspension the steel particles were incorporated in-between the fibre network and steel clusters were formed. Thus, solid retentions of > 90 wt.% were achieved. Calendering had a positive influence on porosity, bulk density, and tensile strength of the green paper sheets. The development of an optimized debinding process is presented and the microstructural changes as well as phase formations during firing are discussed in response to the residual carbon content. The sintered composites attained ultimate tensile strengths of up to 177 N/ mm2 at a total porosity of 66 %. These metal-matrix composites are promising materials for the shaping of light-weight structures.

Soraphen A: A broad-spectrum antiviral natural product with potent anti-hepatitis C virus activity

Soraphen A (SorA) is a myxobacterial metabolite that inhibits the acetyl-CoA carboxylase, a key enzyme in lipid biosynthesis. We have previously identified SorA to efficiently inhibit the human immunodeficiency virus (HIV). The aim of the present study was to evaluate the capacity of SorA and analogues to inhibit hepatitis C virus (HCV) infection. SorA inhibition capacity was evaluated in vitro using cell culture derived HCV, HCV pseudoparticles and subgenomic replicons. Infection studies were performed in the hepatoma cell line HuH7/Scr and in primary human hepatocytes. The effects of SorA on membranous web formation were analysed by electron microscopy. SorA potently inhibits HCV infection at nanomolar concentrations. Obtained EC50 values were 0.70 nM with a HCV reporter genome, 2.30 nM with wild-type HCV and 2.52 nM with subgenomic HCV replicons. SorA neither inhibited HCV RNA translation nor HCV entry, as demonstrated with subgenomic HCV replicons and HCV pseudoparticles, suggesting an effect on HCV replication. Consistent with this, evidence was obtained that SorA interferes with formation of the membranous web, the site of HCV replication. Finally, a series of natural and synthetic SorA analogues helped to establish a first structure-activity relationship. SorA has a very potent anti-HCV activity. Since it also interferes with the membranous web formation, SorA is an excellent tool to unravel the mechanism of HCV replication.

P096: Interferon‐inducible cholesterol‐25‐hydroxylase restricts hepatitis C virus replication via blockage of membranous web formation

Journal of Viral HepatitisVolume 22, Issue S2 p. 69-69 Poster PresentationFree Access P096: Interferon-inducible cholesterol-25-hydroxylase restricts hepatitis C virus replication via blockage of membranous web formation First published: 25 June 2015 https://doi.org/10.1111/jvh.91_12425AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume22, IssueS2Special Issue: 15th International Symposium on Viral Hepatitis and Liver Diseases (ISVHLD) held from June 26th to 28th, 2015, in Berlin, GermanyJune 2015Pages 69-69 RelatedInformation

Novel experimental rabbit model of anterior glottic web formation

Conclusion: The rabbit model of anterior glottic web (AGW) formation using the laryngofissure technique resulted in reproducible and stable AGW formation that may facilitate research into this area. Objective: To introduce and validate a novel experimental animal model of AGW formation using the rabbit. Methods: The inner larynges of eight New Zealand white rabbits were exposed through the laryngofissure technique. The mucosa of the bilateral true vocal fold was stripped off using the bevel of a needle tip. On the basis of the laryngoscopic findings at 8 weeks postoperatively, the extent of AGW was measured, and the success of this procedure was validated. Laryngeal specimens were sampled at 8 weeks for high-speed recording and histological analysis. Results: In seven (87.5%) rabbits, laryngoscopic examination revealed the formation of a scar band involving the anterior commissure. The mean extent of AGW ratio on the left and right sides was 0.58 ± 0.073 and 0.55 ± 0.075, respectively. The symmetric formation of AGW (p = 0.655, p = 0.128) and stability of the AGW procedure (p = 0.491, left; p = 0.501, right) were statistically validated. On high-speed recording, the vocal mucosal wave was hindered by AGW formation. Histologically, fibro-connective tissue, especially collagen fiber, was observed in the anterior commissure.

Metal-Matrix Composites Prepared by Paper-Manufacturing Technology

In this work, metal-matrix composites were prepared via paper-manufacturing technology using metastable austenitic steel powder of type 16-7-3 (Cr-Mn-Ni in wt pct) and magnesia partially stabilized zirconia reinforcing particles. The influence of the process parameters on the paper web formation and the resulting properties of the MMCs were studied and solids retention of >90 wt pct was achieved. During filtration of the aqueous fiber-filler suspension, the steel particles were incorporated in the fiber network, and steel clusters were formed. Calendering had a positive influence on the porosity, bulk density, and tensile strength of the green paper sheets. Within this contribution, the debinding process for the metal-matrix paper sheets was in focus. A debinding rate of 0.5 K/min to 733 K (460 °C) with a dwell time of 90 minutes was sufficient to completely remove cellulose fibers. The sintered composites attained a tensile strength of up to 177 N/mm2 at a total porosity of 66 pct.

Imaging evaluation of the inferior vena cava.

The inferior vena cava (IVC) is an essential but often overlooked structure at abdominal imaging. It is associated with a wide variety of congenital and pathologic processes and can be a source of vital information for referring clinicians. Initial evaluation of the IVC is most likely to occur at computed tomography performed for another indication. Many routine abdominal imaging protocols may result in suboptimal evaluation of the IVC; however, techniques to assist in specific evaluation of the IVC can be used. In this article, the authors review the spectrum of IVC variants and pathologic processes and the relevant findings from magnetic resonance imaging, angiography, sonography, and positron emission tomography. Embryologic development of the IVC and examples of congenital IVC variants, such as absence, duplication, left-sided location, azygous or hemiazygous continuation, and web formation, are described. The authors detail IVC involvement in Wilms tumor, leiomyosarcoma, adrenal cortical carcinoma, testicular carcinoma, hepatocellular carcinoma, renal cell carcinoma, and other neoplasms, as well as postsurgical, traumatic, and infectious entities (including filter malposition, mesocaval shunt, and septic thrombophlebitis). The implications of these entities for patient treatment and instances in which specific details should be included in the dictated radiology report are highlighted. Furthermore, the common pitfalls of IVC imaging are discussed. The information provided in this review will allow radiologists to detect and accurately characterize IVC abnormalities to guide clinical decision making and improve patient care.

Aminoterminal amphipathic α-helix AH1 of hepatitis C virus nonstructural protein 4B possesses a dual role in RNA replication and virus production.

Nonstructural protein 4B (NS4B) is a key organizer of hepatitis C virus (HCV) replication complex formation. In concert with other nonstructural proteins, it induces a specific membrane rearrangement, designated as membranous web, which serves as a scaffold for the HCV replicase. The N-terminal part of NS4B comprises a predicted and a structurally resolved amphipathic α-helix, designated as AH1 and AH2, respectively. Here, we report a detailed structure-function analysis of NS4B AH1. Circular dichroism and nuclear magnetic resonance structural analyses revealed that AH1 folds into an amphipathic α-helix extending from NS4B amino acid 4 to 32, with positively charged residues flanking the helix. These residues are conserved among hepaciviruses. Mutagenesis and selection of pseudorevertants revealed an important role of these residues in RNA replication by affecting the biogenesis of double-membrane vesicles making up the membranous web. Moreover, alanine substitution of conserved acidic residues on the hydrophilic side of the helix reduced infectivity without significantly affecting RNA replication, indicating that AH1 is also involved in virus production. Selective membrane permeabilization and immunofluorescence microscopy analyses of a functional replicon harboring an epitope tag between NS4B AH1 and AH2 revealed a dual membrane topology of the N-terminal part of NS4B during HCV RNA replication. Luminal translocation was unaffected by the mutations introduced into AH1, but was abrogated by mutations introduced into AH2. In conclusion, our study reports the three-dimensional structure of AH1 from HCV NS4B, and highlights the importance of positively charged amino acid residues flanking this amphipathic α-helix in membranous web formation and RNA replication. In addition, we demonstrate that AH1 possesses a dual role in RNA replication and virus production, potentially governed by different topologies of the N-terminal part of NS4B.

Preparation of poly(vinyl alcohol)/ZrO2 composite nanofibers via co-axial electrospinning with higher ZrO2 particle content

Poly(vinyl alcohol) (PVA)/zirconium oxide (ZrO2) composite nanofibers with a skin-core structure were prepared and the effect of ZrO2 particle content on uniform web formation was investigated. The optimized polymer concentration, tip to collector distance, and applied voltage for electrospinning were 11 wt%, 12 cm, and 20 kV, respectively. Skin-core PVA/ZrO2 composite nanofibers containing up to 12 wt% ZrO2 were successfully prepared, but it was difficult to obtain PVA/ZrO2 composite nanofiber webs via conventional electrospinning. Increasing the amount of ZrO2 caused the morphology of the PVA/ZrO2 composite nanofibers to become a non-uniform nanoweb with irregular nanofiber diameters. While it was difficult to obtain a uniform nanofiber web containing a content of ZrO2 over 6 wt% for conventional electrospinning, a more uniform nanofiber web could be obtained at up to 9 wt% ZrO2 using a skin-core dual nozzle. More uniform webs could also be obtained when ZrO2 was in the skin rather than the core.

Acquired Glottic Web Formation in a 3-Year-Old Girl: Case Report and Literature Review.

Pediatric glottic webs are most commonly congenital in origin. Acquired webs in children are typically traumatic in nature, primarily from external trauma or intubation. We report a unique variation of this post-traumatic etiology: a web centered at the junction of the anterior one-third and posterior two-thirds of the vocal folds, possibly formed after phonotraumatic stress from severe coughing. Our case suggests that careful attention should be paid to persistent voice changes after acute illness, as this may be a sign of laryngeal web in the setting of phonotraumatic stress.

Pitch Elevation in Trangendered Patients: Anterior Glottic Web Formation Assisted by Temporary Injection Augmentation

Pitch elevation surgery is most often indicated to assist male-to-female transgendered individuals seeking a more feminine voice quality. Behavioral therapy is primary management but if the desired voice quality is not achieved, surgery is offered. Procedures described that raise vocal pitch alter one or more of the main parameters known to physiologically control pitch; vocal fold tension, length, and mass. Web formation with injection augmentation significantly raises vocal pitch in male-to-female transgendered individuals. Retrospective cohort study. This report describes the voice results after anterior web formation with injection augmentation to reduce vocal fold length in a series of 10 transgendered patients. Retrospective review of male-to-female transgendered patients referred to St. Michaels Hospital Voice Clinic, Toronto, Canada for pitch elevation was carried out including demographic data, preoperative and postoperative acoustic data and videostroboscopic evaluation. Comparison between preoperative to postoperative acoustic measures demonstrated a mean increase in fundamental frequency of 110Hz after web formation. Perturbation measures and pitch range were unchanged from before surgery to after surgery. This novel modification for endoscopic anterior web formation has been shown to be a successful procedure for permanent elevation of pitch with little or no morbidity.

Bilobed flap for web reconstruction in adult syndactyly release: A new technique that can avoid the use of skin graft

The aim of the study was to describe the use of a bilobed flap for web formation of syndactyly release, which decreases the need for graft and also avoids the use of skin grafting in syndactyly cases. A retrospective review of this procedure was performed for 15 web space reconstructions. Patients were aged 20-23 years. The mean follow-up period was 7-12 months (mean 7 + 3.2). The operations were performed for the beneficial use of the dorsal hand skin by lowering the need for a skin graft. The flap was on the dorsum of the hand and proximal phalanx and was used for web formation. Surgery was completed without skin grafting in nine cases of 14 web spaces; two of them were complex/complete syndactylies, and two of them were simple/complete syndactylies. We used a skin graft in one patient because of triangular flap necrosis in a second operation. The use of a bilobed flap allowed the construction of web spaces, providing satisfactory cosmetic outcomes. No partial necrosis or complications was observed in bilobed flaps. No secondary correction was needed during the follow-up period. The present surgical technique could be a new surgical option for web formation and reconstruction in primary and secondary cases, especially in an adult population in which the skin on the dorsum of the hand is more pliable. IV.

Inhibition of HCV Replication by Cyclophilin Antagonists Is Linked to Replication Fitness and Occurs by Inhibition of Membranous Web Formation

Replication of hepatitis C virus (HCV) requires host cell factors, such as cyclophilin A (CypA). CypA binds to HCV's nonstructural protein (NS)5A to promote replication of viral RNA. CypA antagonists, such as cyclosporines, are potent inhibitors of HCV replication. NS2 modulates sensitivity of HCV to cyclosporines. We investigated why cyclosporines require NS2 to increase their inhibitory effect and how they block HCV replication. We determined replication fitness and sensitivity of various HCV replicons, containing or lacking NS2, to cyclosporine and other direct-acting antiviral agents. We also analyzed the effects of cyclosporine on membranous web formation by electron microscopy. NS2-5B replicons of genotype 2a (JFH1), but not genotype 1b, had increased sensitivity to cyclosporine. This difference was lost with replication-attenuated NS3-5B JFH1 RNAs, showing that cyclosporine sensitivity is linked to reduced replication fitness of NS2-containing HCV RNAs. Fitness also determined sensitivity to a nucleoside analogue and an NS5A inhibitor, but not to telaprevir. Cyclosporine blocked de novo formation of the membranous web, but had little effect on established membranous replication factories. This block was prevented by cyclosporine resistance mutations in NS5A. Cleavage at the NS2/3 junction is a rate-limiting step in replication of particular HCV isolates and determines their sensitivity to CypA inhibitors. These drugs target de novo formation of the membranous web and RNA replication.

The usefulness of a three dimensional roadmap and pressure-wire assisted angioplasty in chronic thromboembolic pulmonary hypertension.

A 78-year old male previously diagnosed with a chronic pulmonary embolism experienced difficulty in breathing. Perfusion scan showed a segmental perfusion defect in the A6-8 area (Fig. 1A and B). Computed tomography could not reveal any massive thrombus in the major pulmonary artery. A pulmonary angiography was performed to detect abnormal lesions in the peripheral pulmonary artery. Rotation angiography using DynaCT cardiac mode protocol (Artis zee BA, Siemens AG, Forchheim, Germany) allowed us to suspect pulmonary artery irregularity and intraluminal stenosis caused by organized thrombus or web formation at a trifurcation of the ostium of A6-8, which is compatible with perfusion scan (Fig. 1C, D, and E). A 6 Fr Judkins-right guiding catheter was used to engage the pulmonary artery with three dimensional roadmap guidance (syngo iPilot software, X-Workplace, Siemens Healthcare, Forchheim, Germany) (Fig. 1F). Pressure wire (Certus Pressure Wire, St. Jude Medical, St. Paul, MN, USA) was advanced into the A8 and confirm pressure differences (Fig. 1G). After angioplasty (7.0 mm balloon dilatation), we confirm no residual pressure gradient across not only A8, but also A6 and A7 (Fig. 1H). After the procedure, the patient's symptoms improved, with no difficulty in breathing. Fig. 1 Several techniques, such as pressure-wire guided intervention, have already shown efficacy in performing percutaneous transluminal pulmonary angioplasty.1) In our case, the three dimensional roadmap allowed for selection of ideal projection angles, to reduce fluoroscopic time and the number of control angiographies compared to those previously reported.2) Pressure-wire was useful to evaluate which pulmonary artery was the culprit, and to determine the endpoint of the procedure as previously reported.1) These recent useful modalities and applications should be used to perform procedures safely and effectively.