Lesion Width Research Articles

Lesion characteristics of long application time ablation using unipolar half-normal saline irrigation and bipolar normal saline irrigation.

Unipolar radiofrequency (RF) ablation using half-normal saline irrigation (UNIP-HNS) and bipolar RF ablation using normal saline irrigation (BIP-NS) are effective to treat arrhythmias from inside thick myocardium. However, differences between these two ablations when using a long application time had not fully been studied. UNIP-HNS, BIP-NS and unipolar RF ablation using normal saline irrigation (UNIP-NS) were applied for 120 seconds (30 W and 20-g contact) to porcine endocardial wall (≧15.0 mm thickness). All ablations (30 applications each in UNIP-HNS and BIP-NS, and 20 applications in UNIP-NS) were successfully accomplished without steam-pop. Total impedance decline was largest in BIP-NS followed by UNIP-HNS and UNIP-NS. UNIP-HNS created larger surface lesions and greater maximum lesion width under the surface than those by UNIP-NS and BIP-NS. Endocardial lesion depth in UNIP-HNS and BIP-NS were deeper than that in UNIP-NS, but with no difference between UNIP-HNS and BIP-NS, when selecting non-transmural lesions. Similar results were obtained when all lesions (non-transmural and transmural) were included and endocardial lesion depth of the transmural lesions (13/30 applications of BIP-NS) was estimated as 50% of the myocardial thickness. Lesion length in the transverse myocardial wall (endocardial plus epicardial lesions) was greatest in BIP-NS. Longer application time ablation (30 W) targeting the thick myocardium was performable in UNIP-HNS and BIP-NS. Since a transmural lesion and/or a deeper lesion into the myocardial wall are created, BIP-NS is preferable if two ablation catheters can be positioned on either side of the target.

The impedance drop early after energy delivery predicts steam pops during radiofrequency ablation

Abstract Background Steam pops during radiofrequency ablation (RFA) can cause serious complications. However, predictive factors for steam pops remain unclear. Purpose To investigate predictors for steam pops. Methods An in vitro experiment was performed using fresh bovine left ventricular myocardium. A myocardium cut into 4-5 cm slabs was fixed at the bottom of a constant temperature bath with temperature adjusted to 36.5 degrees Celsius, and a non-pulsatile flow rate of 5 L/min was generated. Using the catheter with a laser-cut 8Fr4.0mm flexible tip, RFA was applied at 30W, 60 seconds, perpendicular catheter placement to the tissue at various contact forces (5, 10, 20, 30, 40, 50g). A total of 138 lesions were created by applying RFA 23 times at each setting. Lesion depth and width were measured after RFA. Results Steam pops were observed in 49 of 138 lesions (36%). The higher impedance decrease in the first 5 seconds (-21.0±11.0Ω vs. -7.6±8.5Ω, P<0.0001), the larger impedance drop from initial to minimum impedance (if steam pop occurred, minimum impedance before steam pop was applied) (-28.9±13.0Ω vs. -13.1±12.9Ω, P<0.0001), higher initial impedance (132±48Ω vs. 87±38Ω, P<0.0001), power regulation by temperature control (44.9% vs 4.5%, P<0.0001), higher contact force (31.2±14.9g vs. 22.9±15.9g, P=0.0030), larger LSI (6.8±2.1 vs. 7.5±1.8, P=0.0037) were associated with steam pops. In multivariate analysis, the high impedance drops in the first 5 seconds (OR 2.0 for each 5Ω increase, 95%CI 1.0-1.3; P=0.033) and the power regulation by temperature control (OR 7.3, 95%CI 2.2-29.9; P=0.001) were independently related. In ROC curve analysis of the impedance drops in the first 5 seconds, an optimal cut-off value of steam pops was 8.0Ω (AUC 0.85, sensitivity 88%, specificity 73%) (figure 1). Steam pops were predicted with a sensitivity of 45% and specificity of 97% using both the impedance drop ≥ 8.0Ω in the first 5 seconds and power regulation by temperature control. Lesion depth and width were associated with total impedance reduction in lesions with an impedance drop < 8.0Ω during the first 5 seconds (R²=0.14, P=0.0012 with depth, R²=0.21, P<0.0001 with width), while were not associated with in lesions with an impedance drop ≥ 8.0Ω (figure 2). Conclusion The impedance drop early after RF energy delivery may predict steam pops during RFA.

"Honey pot"-like lesion formation: impact of catheter contact angle on lesion formation by novel temperature controlled ablation catheter in a porcine experimental model

Abstract Background The DiamondTemp(DT) catheter enables precise temperature-controlled ablation. However, the effects of the DT catheter's contact angle on lesion formation are poorly understood. Purpose This study evaluated lesion formation using the DT catheter at different angles in a porcine experimental model. Methods We used freshly sacrificed porcine hearts, and radiofrequency catheter ablation with DT was performed at 50 watts for 15 seconds at an upper-temperature setting of 60°C. The contact force (5, 10, and 30 grams) and catheter contact angles (30°, 45°, and 90°) were changed in each set (n = 13 each). The surface width (SW), maximum lesion width (MW), lesion depth (LD), surface area (SA), and distance from the distal edge to the widest area (DW) were evaluated. In addition, the generator impedance drop during radiofrequency application was analyzed. Results Figure 1 shows the summarized data in this study. SW and MW were longer at 30° than at 90° (SW 5 g: 6.34 ± 0.91 vs. 5.07 ± 0.87 mm; SW 10 g: 7.46 ± 0.55. vs. 5.60 ± 0.84 mm; SW 30 g: 7.42 ± 0.74. vs. 6.14 ± 0.77 mm; MW 10 g: 8.81 ± 0.55. vs. 7.89 ± 0.84 mm; MW 30 g: 9.24 ± 0.67. vs. 8.03 ± 1.04 mm, p <0.05, respectively). There were no significant differences in LD by catheter angle except at 30 g. SA was larger at 30° than at 90° (SA 5 g: 30.03 ± 0.91. vs. 23.61 ± 0.87; SA 10 g: 29.24 ± 0.55. vs. 21.27 ± 0.84; SA 30 g: 35.86 ± 0.74. vs. 31.74 ± 0.77, p <0.05, respectively). Besides, DW was longer at 30° than at 90° (DW 5 g: 4.28 ± 1.17. vs. 2.50 ± 0.32 mm; DW 10 g: 4.94 ± 0.52. vs. 2.47 ± 0.38 mm; DW 30 g: 5.34 ± 0.26. vs. 2.96 ± 0.40 mm, p <0.05, respectively). There were no significant differences in the impedance drop according to the catheter angle. Conclusion With the DT catheters, the lesion width increased at a shallower contact angle, whereas the LD did not. SA also increased at a shallower contact angle. The DT catheter created a large ablation lesion on the proximal side of the catheter, which looked like a "honey pot." (Figure 2)summarized dataImage of honey pot-like lesion formation

PaLAR3 genotype variability for enhanced resistance against Heterobasidion parviporum in Norway spruce: Insights into allelic frequencies, disease response, and the role of mycoviruses

Heterobasidion parviporum is a destructive forest pathogen causing root and stem rot of Norway spruce (Picea abies) in northern hemisphere. Previous research has suggested that a gene form of PaLAR3 that encodes for the leucoanthocyanidin reductase enzyme, may increase resistance to H. parviporum in Norway spruce, whether heterozygous or homozygous. Our experiment was initially focused on testing this assertion with materials from the Finnish Norway spruce breeding program, comprising 52 full-sib families. Additionally, we investigated the influence of mycoviruses on the growth of H. parviporum. The frequencies of the three PaLAR3 genotypes AA, AB, and BB were 64%, 30%, and 6%, respectively. We found no significant differences in the necrotic response to H. parviporum between the homozygous (BB) and heterozygous (AB) genotypes vs. the homozygous (AA) genotype across the two fungal strains tested, suggesting the gene is rather ineffective as a marker for overall H. parviporum resistance. The two H. parviporum strains used in the study showed significantly different necrosis responses from the control. Mycovirus infection in H. parviporum strains led to a significant reduction in lesion width in phloem and sapwood. Furthermore, the growth of the fungus was notably restricted when hyphae hosted mycoviruses, indicating a high potential of mycoviruses to reduce fungal growth and necrosis development.

In vitro characterization of radiofrequency ablation lesions in equine and swine myocardial tissue

Radiofrequency ablation is a promising technique for arrhythmia treatment in horses. Due to the thicker myocardial wall and higher blood flow in horses, it is unknown if conventional radiofrequency settings used in human medicine can be extrapolated to horses. The study aim is to describe the effect of ablation settings on lesion dimensions in equine myocardium. To study species dependent effects, results were compared to swine myocardium. Right ventricular and right and left atrial equine myocardium and right ventricular swine myocardium were suspended in a bath with circulating isotonic saline at 37 °C. The ablation catheter delivered radiofrequency energy at different-power-duration combinations with a contact force of 20 g. Lesion depth and width were measured and lesion volume was calculated. Higher power or longer duration of radiofrequency energy delivery increased lesion size significantly in the equine atrial myocardium and in equine and swine ventricular myocardium (P < 0.001). Mean lesion depth in equine atrial myocardium ranged from 2.9 to 5.5 mm with a diameter ranging from 6.9 to 10.1 mm. Lesion diameter was significantly larger in equine tissue compared to swine tissue (P = 0.020). Obtained data in combination with estimated wall thickness can improve lesion transmurality which might reduce arrhythmia recurrence. Optimal ablation settings may differ between species.

Comparative effectiveness of two abbreviated rectal MRI protocols in assessing tumor response to neoadjuvant chemoradiotherapy in patients with rectal cancer.

The present study aimed to compare the effectiveness of two abbreviated magnetic resonance imaging (MRI) protocols in assessing the response to neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. Data from the examinations of 62 patients with rectal cancer who underwent neoadjuvant CRT and standard contrast-enhanced rectal MRI were retrospectively evaluated. Standard contrast-enhanced T2-weighted imaging (T2-WI), post-contrast T1-weighted imaging (T1-WI) and diffusion-weighted imaging (DWI) MRI, as well as two abbreviated protocols derived from these images, namely protocol AB1 (T2-WI and DWI) and protocol AB2 (post-contrast fat-suppressed (FS) T1-WI and DWI), were assessed. Measurements of lesion length and width, lymph node short-axis length, tumor staging, circumferential resection margin (CRM), presence of extramural venous invasion (EMVI), luminal mucin accumulation (MAIN), mucinous response, mesorectal fascia (MRF) involvement, and MRI-based tumor regression grade (mrTRG) were obtained. The reliability and compatibility of the AB1 and AB2 protocols in the evaluation of tumor response were analyzed. The imaging performed according to the AB1 and AB2 protocols revealed significant decreases in lesion length, width and lymph node size after CRT. These protocols also showed reductions in lymph node positivity, CRM, MRF, EMVI.Furthermore, both protocols were found to be reliable in determining lesion length and width. Additionally, compliance was observed between the protocols in determining lymph node size and positivity, CRM involvement, and EMVI after CRT. In conclusion, the use of abbreviated MRI protocols, specifically T2-WI with DWI sequences or post-contrast FS T1-WI with DWI sequences, is effective for evaluating tumor response in patients with rectal cancer following neoadjuvant CRT. The AB protocols examined in this study yielded similar results in terms of lesion length and width, lymph node positivity, CRM involvement, EMVI, MAIN, and MRF involvement.

Primary Open Latarjet Procedure Versus Revision to Open Latarjet Procedure for Anterior Shoulder Instability.

Although the Latarjet operation may be performed as a revision surgery for anterior shoulder instability, the high recurrence rate of anterior shoulder instability after arthroscopic Bankart repair (ABR) has led some to advocate for performing the Latarjet procedure as a primary stabilization surgery. The purpose of this study was to compare the intermediate-term outcomes after primary open Latarjet (PLJ) and revision to open Latarjet (RLJ). This was a single-institution retrospective analysis of patients who underwent either PLJ or RLJ procedures for anterior shoulder instability between 2014 and 2023. Patients with less than 1 year of follow-up, seizure history, multidirectional instability, concurrent rotator cuff repair, or the absence of preoperative imaging were excluded. Glenoid bone loss (GBL), the width of Hill-Sachs lesions, recurrent dislocations, and reoperations were assessed. The study included 29 patients, with 12 undergoing PLJ procedures and 17 undergoing RLJ procedures. The mean duration of follow-up was similar for the two groups (4.7 vs 4.6 years, P=.854). Patients undergoing PLJ procedures demonstrated a higher mean GBL (18.4%) compared with patients undergoing revision (10.5%; P=.035); however, there was no significant difference in Hill-Sachs lesion size (14.2 vs 10.4 mm, P=.374). After stratifying according to GBL, the groups undergoing PLJ and RLJ procedures had similar recurrent dislocation rates (8.3% and 11.8%, respectively; P=1.0) and reoperation frequency (25.0% and 23.5%, respectively; P=1.0). The PLJ and RLJ groups had comparable rates of recurrent dislocations, complications, and reoperations, emphasizing the value of considering Latarjet procedures as revision surgery after unsuccessful primary arthroscopic stabilization. [Orthopedics. 202x;4x(X):xx-xx.].

Extent of Traumatic Spinal Cord Injury Is Lesion Level Dependent and Predictive of Recovery: A Multicenter Neuroimaging Study.

Assessing the extent of the intramedullary lesion after spinal cord injury (SCI) might help to improve prognostication. However, because the neurological level of injury impacts the recovery potential of SCI patients, the question arises whether lesion size parameters and predictive models based on those parameters are affected as well. In this retrospective observational study, the extent of the intramedullary lesion between individuals who sustained cervical and thoracolumbar SCI was compared, and its relation to clinical recovery was assessed. In total, 154 patients with subacute SCI (89 individuals with cervical lesions and 65 individuals with thoracolumbar lesions) underwent conventional clinical magnetic resonance imaging 1 month after injury and clinical examination at 1 and 12 months. The morphology of the focal lesion within the spinal cord was manually assessed on the midsagittal slice of T2-weighted magnetic resonance images and compared between cervical and thoracolumbar SCI patients, as well as between patients who improved at least one American Spinal Injury Association Impairment Scale (AIS) grade (converters) and patients without AIS grade improvement (nonconverters). The predictive value of lesion parameters including lesion length, lesion width, and preserved tissue bridges for predicting AIS grade conversion was assessed using regression models (conditional inference tree analysis). Lesion length was two times longer in thoracolumbar compared with cervical SCI patients (F = 39.48, p < 0.0001), whereas lesion width and tissue bridges width did not differ. When comparing AIS grade converters and nonconverters, converters showed a smaller lesion length (F = 5.46, p = 0.021), a smaller lesion width (F = 13.75, p = 0.0003), and greater tissue bridges (F = 12.87, p = 0.0005). Using regression models, tissue bridges allowed more refined subgrouping of patients in AIS groups B, C, and D according to individual recovery profiles between 1 month and 12 months after SCI, whereas lesion length added no additional information for further subgrouping. This study characterizes differences in the anteroposterior and craniocaudal lesion extents after SCI. The two times greater lesion length in thoracolumbar compared with cervical SCI might be related to differences in the anatomy, biomechanics, and perfusion between the cervical and thoracic spines. Preserved tissue bridges were less influenced by the lesion level while closely related to the clinical impairment. These results highlight the robustness and utility of tissue bridges as a neuroimaging biomarker for predicting the clinical outcome after SCI in heterogeneous patient populations and for patient stratification in clinical trials.

Platelet-rich fibrin as an apical barrier for MTA placement in the treatment of teeth with open apices: a pilot study

ObjectiveThe aim of the present pilot study was to assess the effectiveness of the platelet-rich fibrin (PRF) apical barrier for the placement of MTA for the treatment of teeth with periapical lesions and open apices.MethodsA total of thirty teeth on twenty-eight patients with open apices and periapical periodontitis were enrolled and divided into two groups in the present pilot study. In the PRF group (fourteen teeth in thirteen patients), nonsurgical endodontic treatment was performed using PRF as an apical matrix, after which the apical plug of the MTA was created. For the non-PRF group (fourteen teeth in fourteen patients), nonsurgical endodontic therapy was performed using only the MTA for an apical plug with no further periapical intervention. Clinical findings and periapical digital radiographs were used for evaluating the healing progress after periodic follow-ups of 1, 3, 6, and 9 months. The horizontal dimension of the periapical lesion was gauged, and the changes in the dimensions were recorded each time. The Friedman test, Dunn-Bonferroni post hoc correction, and Mann-Whitney U test were used for statistical analysis, with P < 0.05 serving as the threshold for determining statistical significance.ResultsAll patients in both groups in the present pilot study had no clinical symptoms after 1 month, with a significant reduction in the periapical lesion after periodic appointments. The lesion width of the PRF group was significantly smaller than that of the non-PRF group in the sixth and ninth month after treatment.ConclusionsPRF is a promising apical barrier matrix when combined with MTA for the treatment of teeth with open apices and periapical periodontitis. Small number of study subjects and the short time of follow-up period limit the generalizability of these results.Trial registrationTCTR, TCTR20221109006. Registered 09 November 2022 - Retrospectively registered, https://www.thaiclinicaltrials.org/show/TCTR20221109006.

Comparative study of lesions obtained with radiofrequency between irrigated ablation catheter with flexible tip and non-irrigated catheter in ex vivo porcine heart slices

Abstract Background Lesion formation through radiofrequency (RF) is related to various parameters, including power, contact force, duration of energy delivery and temperature. Notably, the characteristics of the lesions differ when comparing irrigated to non-irrigated catheters. Non-irrigated catheter lesions present a larger surface area and shallower depth, while irrigated catheters induce deeper lesions with higher volumes. Particularly, flexible-tip open-irrigated catheter exhibit unique irrigation characteristics and the resulting lesions may show a reduced surface area but extend deeper into the tissue. Main drawbacks of using non-irrigated catheter are the risk of clot formation and of steam pops, both possibly avoidable with an irrigated catheter. Purpose The aim of the study was to demonstrate that flexible-tip open-irrigated catheter generate lesions with a smaller surface area and deeper extension when compared to non-irrigated catheter. Methods An ex vivo model consisting of porcine heart slices in a warmed saline chamber was used. A flexible-tip open-irrigated ablation catheter and a non-irrigated catheter were positioned with a stable tissue contact weight ranging from 10 to 20 g of force in perpendicular position. RF was delivered at powers of 20, 30 and 40 Watt for 60s. Lesion dimensions were analyzed. The occurrence of steam pop was registered. Results The ablations were conducted using flexible-tip open-irrigated (n=55) and non-irrigated (n=39) catheters in a power-control mode. Superficial length and width of lesions were greater with the non-irrigated catheter than with the irrigated catheter, irrespective of the power delivered (superficial length: p=0,0001 at 20W, p=0,002 at 30 W and p=0,0001 at 40 W; superficial width: p=0,001 at 20 W, p=0,019 at 30 W and p=0,003 at 40 W). When computing superficial areas, lesions performed with the non-irrigated catheter were significantly wider, regardless of the power delivered (p=0,001 at 20 W, p=0,005 at 30 W and p=0,001 at 40 W). The irrigated catheter determined significantly greater values of lesion maximum depth at high power delivery (40 W, p=0.007). No steam pop was observed using the irrigated ablation catheter, while 12 steam pops occurred with the non-irrigated catheter. Conclusions This study highlights that RF ablation using flexible-tip open-irrigated catheter has the potential to generate smaller lesion areas when compared to a non-irrigated tip. Furthermore, it may contribute to decrease steam pops, even with escalating power output. This irrigated catheter might be a preferable choice when precision is crucial, particularly in determining superficial area of lesions. Specifically, it might be advantageous for procedure as atrioventricular nodal reentry tachycardia (AVNRT) ablation, minimizing the risk of iatrogenic conduction disturbance related to RF delivery in the region of the compact AV node, located superficially at a millimeter distance from the ablation site.Experiment setting, lesion measurementsLesion superficial area

“Honey pot”-like lesion formation: Impact of catheter contact angle on lesion formation by novel diamond-embedded temperature-controlled ablation catheter in a porcine experimental model

BackgroundNovel diamond-embedded catheter enables precise temperature-controlled ablation. However, the effects of contact angle on lesion formation of this catheter are poorly understood. ObjectiveThe purpose of this study was to evaluate lesion formation using the temperature-controlled ablation catheter embedded with diamond at different angles in a porcine experimental model. MethodsFreshly sacrificed porcine hearts were used. Radiofrequency catheter ablation was performed at 50 W for 15 seconds at an upper temperature setting of 60°C. The contact force (5g, 10g, 30g) and catheter contact angles (30°, 45°, 90°) were changed in each set (n = 13 each). Surface width, maximum lesion width, lesion depth, surface area, distance from the distal edge to the widest area, and impedance drop were evaluated. ResultsSurface width and maximum lesion width were longer at 30° than at 90° (P <.05). There were no significant differences in the lesion depth by catheter angle except at 30g. Surface area was larger at 30° than at 90° (P <.05). Distance from the distal edge to the widest area was longer at 30° than at 90° (P <.05). There were no significant differences in impedance drop according to catheter angle. ConclusionWith diamond-embedded temperature-controlled ablation catheters, lesion width increased at a shallower contact angle, whereas lesion depth did not. Surface area also increased at a shallower contact angle. This catheter created a large ablation lesion on the proximal side of the catheter, which looked like a “honey pot.”

Impact of Contact Force on Pulsed Field Ablation Outcomes Using Focal Point Catheter.

Conventional focal radiofrequency catheters may be modified to enable multiple energy modalities (radiofrequency or pulsed field [PF]) with the benefit of contact force (CF) feedback, providing greater flexibility in the treatment of arrhythmias. Information on the impact of CF on lesion formation in PF ablations remains limited. An in vivo study was performed with 8 swine using an investigational dual-energy CF focal catheter with local impedance. Experiment I: To evaluate atrial lesion formation, contiguity, and width, a point-by-point approach was used to create an intercaval line. The distance between the points was prespecified at 4±1 mm. Half of the line was created with radiofrequency energy, whereas the other half utilized PF (single 2.0 kV application with a proprietary waveform). Experiment II: To evaluate single application lesion dimensions with a proprietary waveform, discrete ventricular lesions were performed with PFA (single 2.0 kV application) with targeted levels of CF: low, 5 to 15 g; medium, 20 to 30 g; and high, 35 to 45 g. Following 1 week of survival, animals underwent endocardial/epicardial remapping, and euthanasia to enable histopathologic examination. Experiment I: Both energy modalities resulted in a complete intercaval line of transmural ablation. PF resulted in significantly wider lines than radiofrequency: minimum width, 14.9±2.3 versus 5.0±1.6 mm; maximum width, 21.8±3.4 versus 7.3±2.1 mm, respectively; P<0.01 for each. Histology confirmed transmural lesions with both modalities. Experiment II: With PF, lesion depth, width, and volume were larger with higher degrees of CF (depth: r=0.82, P<0.001; width: r=0.26, P=0.052; and volume: r=0.55, P<0.001), with depth increasing at a faster rate than width. The mean depths were as follows: low (n=17), 4.3±1.0 mm; medium (n=26), 6.4±1.2 mm; and high (n=14), 9.1±1.4 mm. Using the same focal point CF-sensing catheter, a novel PF ablation waveform with a single application resulted in transmural atrial lesions that were significantly wider than radiofrequency. Lesion depth showed a significant positive correlation with CF with depths of 6.4 mm at moderate CF.

Acquired Vitelliform Lesions in Intermediate Age-Related Macular Degeneration: A Cross Sectional Study

PurposeThis study aims to define the characteristics of acquired vitelliform lesions (AVLs) in patients with intermediate age-related macular degeneration (iAMD). DesignRetrospective, observational, cross-sectional study SubjectsThis study included 217 eyes with AVLs associated with iAMD, and an equivalent number of control patients. MethodsOptical coherence tomography (OCT) scans were evaluated for qualitative and quantitative parameters at both the eye and lesion level. Eye-level parameters included the presence of: hyporeflective core drusen, intraretinal hyperreflective foci (IHRF), subretinal drusenoid deposits, macular pachyvessels, central retinal thickness, and central choroidal thickness (CCT). Lesion-level qualitative parameters included the presence of ellipsoid zone (EZ) and external limiting membrane disruption overlying the AVL, IHRF overlying the AVL, AVL overlying drusen, pachyvessels under the AVL, a solid core within AVL, and AVL location. Lesion-level quantitative characteristics included AVL height and width, AVL distance from the fovea, and sub-AVL choroidal thickness. Main Outcome MeasuresThe primary outcomes assessed included the frequency of iHRF, the presence of macular pachyvessels, CCT, and the dimensions (both height and width) of AVLs. ResultsComparing the AVL and control groups, the frequency of IHRF (AVL: 49.3% vs. control: 26.3%) and macular pachyvessels (37.3% vs. 6.9%) was significantly higher in the AVL case group, and the CCT (256.8 ± 88 μm vs. 207.1± 45 μm) was thicker in the AVL group. AVL lesions located over drusen, with overlying IHRF, or situated subfoveally, and AVL lesions with EZ disruption were found to have a greater lesion height and width compared to AVL lesions lacking these characteristics (P-value < 0.001 for all). Additionally, a significant negative correlation was observed between the distance from the fovea and AVL height (Spearman's rho: -0.19, P = 0.002) and width (Spearman’s rho: -0.30, P = 0.001). ConclusionsThis study represents the largest reported cohort of AVL lesions associated with iAMD. Novel findings include the higher frequency of pachyvessels in addition to the presence of a thicker choroid in these eyes, as well as the greater height and width of AVL closer to the foveal center. These findings may offer insights into pathophysiologic mechanisms underlying the development of AVL.

Transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy versus endoscopic forceps biopsy in the diagnosis of complex rectal lesions.

The preoperative pathological diagnosis of rectal lesions is crucial for formulating treatment plans. For subepithelial lesions (SELs) and larger lesions with necrosis of the rectum, endoscopic forceps biopsy (EFB) cannot provide an accurate pathological diagnosis in most cases. By comparing the efficacy and safety of transrectal contrast-enhanced ultrasound-guided transperineal core-needle biopsy (TRCEUS-TP-CNB) and EFB, this study explored the value of TRCEUS-TP-CNB in the diagnosis of complex rectal lesions, such as SELs. A retrospective, cross-sectional study was conducted with 32 consecutive patients with complex rectal lesions admitted to our hospital from May 2016 to June 2022. Clinical, ultrasound, and pathological data were collected from these patients who underwent EFB followed by TRCEUS-TP-CNB. The success rate of EFB was 21.88% (7/32) and that of TRCEUS-TP-CNB was 93.75% (30/32). No significant complications were observed for either biopsy method. Factors affecting the success rate of EFB included the lesion width (cm) (1.90±0.62 vs. 4.26±2.40, P<0.001) and lesion thickness (cm) (1.29±0.51 vs. 2.96±1.75, P<0.001). The success rate of TRCEUS-TP-CNB was not affected by these factors. In the paired study of TRCEUS-TP-CNB and EFB, the times of samples per person (1 vs. 2.14±0.90, P=0.015), number of specimens per sample (8.27±1.93 vs. 3.31±1.67, P<0.001), lesion width (cm) (3.79±2.42 vs. 1.90±0.62, P=0.001), and lesion thickness (cm) (2.64±1.75 vs. 1.29±0.51, P=0.001) were the factors affecting the difference of the sampling success rate. In the SELs, the success rate of EFB was 10% (1/10) and that of TRCEUS-TP-CNB was 100% (10/10), and the difference between the two groups was statistically significant (P=0.004). TRCEUS-TP-CNB is an effective biopsy method for complex rectal lesions. The success rate of EFB is lower in the larger lesions. Compared with EFB, TRCEUS-TP-CNB required fewer times of samples be taken and obtained more specimens. For larger lesions and SELs of the rectum, TRCEUS-TP-CNB is expected to become one of the preferred biopsy methods.

Location and size of the reverse Hill-Sachs lesion in patients with traumatic posterior shoulder instability

BackgroundIn patients with traumatic posterior shoulder instability, little is known about the precise location and size of the reverse Hill-Sachs lesion. MethodsForty-nine shoulders of 47 patients with traumatic posterior instability were included in this study based on the following inclusion criteria: 1) a primary or recurrent traumatic posterior shoulder dislocation, and 2) the initial event was caused by trauma. Patients were excluded if they had: 1) no history of trauma, 2) prior shoulder surgery, 3) no CT examination, or 4) seizure cases. Three-dimensional images of the humerus reconstructed from CT images were reviewed using an image analysis software. The location and size of the reverse Hill-Sachs lesion were measured and described on a clock face on the humeral head. ResultsThe reverse Hill-Sachs lesion was observed in 25 of 49 shoulders (51%). The reverse Hill-Sachs lesions were located between 1:37 and 2:48. The depth of the reverse Hill-Sachs lesion (mean ± SD) was 5.8 ± 2.2 mm. The extent of the reverse Hill-Sachs lesion was 35° ± 12°. The average orientation of the reverse Hill-Sachs lesion, represented by an angle measured from the 12 o'clock position, was 64° ± 12° and pointing towards 2:09 on a clock face. Length and width of reverse Hill-Sachs lesions were 9.7 ± 4.7 mm, 11.1 ± 3.6 mm, respectively. ConclusionThe reverse Hill-Sachs lesion was a semicircular compression fracture located on the anteromedial aspect of the humeral head. Compared with shoulders with anterior shoulder instability, the humeral defect was smaller and located more inferiorly in shoulders with posterior instability.

Raise-up technique for the creation of left atrial roof lesion: A useful technique with cryoballoon for persistent atrial fibrillation.

Recent studies have reported the efficacy of the cryoballoon (CB)-guided left atrial roof block line (LARB) creation in patients with persistent atrial fibrillation (AF). However, it can be technically challenging to attach the balloon to the left atrial (LA) roof due to its anatomical variations. We designed a new procedure called the "Raise-up Technique," which may facilitate the firm adhesion of the CB to the LA roof during freezing. This study aimed to evaluate the efficacy of the Raise-up technique in LARB creation. In total, 100 consecutive patients with persistent AF who underwent CB-LARB creation were enrolled. Fifty-seven patients underwent LARB creation using the Raise-up technique (Raise-up group), and the remaining 43 did not use it (control group). The Raise-up technique was performed as follows: An Achieve catheter was inserted as deeply as possible into the upper branch of the right superior pulmonary vein to anchor the CB. The balloon was placed below the targeted site on the LA roof and frozen. When the temperature of the CB reached approximately -10°C and the CB was easier to attach to the LA tissue, the CB was raised and pressed against the LA roof immediately by sheath advancement. Then the balloon could be in firm contact with the target site on the roof. If necessary, additional sheath advancement after sufficient freezing (-20°C to -30°C) was allowed the CB to have more firm and broad contact with the target site. LARB creation without touch-up ablation was achieved in 54 of 57 patients (94.7%) in the Raise-up group and 33 of 43 patients (76.7%) in the control group (p < .05). The lesion size of the LARB in the Raise-up group was significantly larger than that in the control group (15.2 cm2 vs. 12.8 cm2, p < .05). Moreover, the width of the LARB lesion in the Raise-up group was wider than that in the control group (32.0 mm vs. 26.6 mm, p < .05). The Raise-up technique enabled the creation of seamless and thick LARB lesions with a single stroke. In addition, the CB-LARB lesions created using the Raise-up technique tended to be large, resulting in extensive debulking of the LA posterior wall arrhythmia substrates. In CB ablation for persistent AF, the Raise-up technique can be considered one of the key strategies for LARB creation.

Risk Factors for Worsening Morphology and Visual Acuity in Eyes with Adult-Onset Foveomacular Vitelliform Dystrophy

PurposeTo explore clinical risk factors and optical coherence tomography (OCT) features associated with worse visual acuity (VA), progression of disease, choroidal neovascularization (CNV), and atrophy in eyes with adult-onset foveomacular vitelliform dystrophy (AOFVD). DesignSingle-center, retrospective, observational cohort study ParticipantsPatients seen at Duke Eye Center between January 2012 and May 2023 with a diagnosis of AOFVD confirmed via OCT and fundus autofluorescence. MethodsBaseline and final visit images from eyes with AOFVD were examined. Disease stage was assigned, and presence of atrophy or CNV was determined. Clinical and OCT features associated with progression to atrophy and CNV were determined using t-tests and chi-square analysis. Correlation with lower VA was determined using linear regression. Outcome MeasuresAssociation of clinical characteristics and OCT features with worse VA, progression of disease, CNV, and atrophy as determined by independent t-tests, chi-square analysis, and linear regression (p<0.05). Results101 eyes (63 patients) met inclusion criteria for this study, with mean follow-up duration of 48 months (SD 31 months). 51% of eyes progressed beyond baseline staging during follow-up; among baseline stage 1 eyes, incidence of atrophy was 0.068/person-year; incidence of CNV was 0.022/person-year. Risk factors for worse final VA were baseline presence of vitreomacular traction (VMT) (p=0.006), ellipsoid zone attenuation (p=0.024), increased lesion height and width (p<0.001). Predictors of progression include diabetes mellitus (p=0.012), statin use (p=0.031), presence of hyperreflective foci (p=0.012), and increased lesion width and volume (p=0.034, p=0.040). Predictors of atrophy include the baseline presence of VMT (p=0.018), decreased choroidal thickness (p=0.027), and greater maximal height, width, and volume of the lesion (p=0.031, p=0.020, p=0.009, respectively). Lower baseline VA (p=0.031) and increased lesion volume (p=0.042) were associated with CNV. ConclusionsClinical and OCT imaging features at baseline may prove useful in stratifying patient risk for progression, atrophy, CNV, and worse VA. Features such as statin use, diabetes, baseline VA, and laterality should be accounted for. OCT features such as lesion size, VMT, ellipsoid zone attenuation, choroidal thickness and hyperreflective foci may impart greater risk of poor outcomes. Future prospective analysis accounting for the time to development of atrophy and CNV is needed.

Pulsed Field Ablation Index-Guided Ablation for Lesion Formation: Impact of Contact Force and Number of Applications in the Ventricular Model.

The effect of contact force (CF) on lesion formation is not clear during pulsed field ablation (PFA). The aim of this study was to evaluate the impact of CF, PFA, and their interplay through the PFA index (PF index) formula on the ventricular lesion size in swine. PFA was delivered through the CF-sensing OMNYPULSE catheter. Predefined PFA applications (×3, ×6, ×9, and ×12) were delivered maintaining low (5-25 g), high (26-50 g), and very high (51-80 g) CFs. First, PFA lesions were evaluated on necropsy in 11 swine to investigate the impact of CF/PFA-and their integration in the PF index equation-on lesion size (study characterization). Then, 3 different PF index thresholds-300, 450, and 600-were tested in 6 swine to appraise the PF index accuracy to predict the ventricular lesion depth (study validation). In the study characterization data set, 111 PFA lesions were analyzed. CF was 32±17 g. The average lesion depth and width were 3.5±1.2 and 12.0±3.5 mm, respectively. More than CF and PFA dose alone, it was their combined effect to impact lesion depth through an asymptotically increasing relationship. Likewise, not only was the PF index related to lesion depth in the study validation data set (r2=0.66; P<0.001) but it also provided a prediction accuracy of the observed depth of ±2 mm in 69/73 lesions (95%). CF and PFA applications play a key role in lesion formation during PFA. Further studies are required to evaluate the best PFA ablation settings to achieve transmural lesions.

A New Scoring System to Differentiate Bladder Cancer from Intravesical Prostatic Protrusion in the Bladder Neck: BCa-IPP Score

Objective:: The aim of this study was to explore the criteria that can predict bladder cancer among the lesions that could not be differentiated from intravesical prostate protrusion (IPP) and to create a scoring system using these criteria. Methods:: A retrospective analysis was made of patients with an ultrasound report indicating lesions in the bladder neck, for which differentiation between bladder cancer and IPP could not be determined. A total of 174 patients diagnosed with bladder cancer (n=102) or benign prostate lesion (n=72) according to the biopsy results were enrolled in the study. Hemoglobin, prostate-specific antigen (PSA), prostate volume (PV), bladder wall thickness (BWT), lesion height (LH), and the ratio of lesion width to base (LW/B) were compared between the two groups. Results:: ROC analysis revealed an AUC value &gt;0.7 for all factors, and the best cut-off value was identified for each factor. In the multivariate analysis, by determining a score for each factor according to the ORs, the BCa-IPP scoring system was developed to provide a total score in the range of minimum 0 and maximum 15. In the ROC analysis, the AUC value was 0.954 (95% CI: 0.923–0.986) for the BCa-IPP score. The best cut-off value was found to be 10, with sensitivity of 0.93 and specificity of 0.85. Conclusion:: Using simple laboratory and ultrasound findings, the BCa-IPP scoring system was created, which was seen to have high predictive value and can be easily applied in the clinic. The BCa-IPP scoring system is a non-invasive test that can be successfully applied for the differentiation of bladder cancer from benign lesions

Ablation lesion formation after PVI with cryoballoon versus CLOSE-guided RF ablation assessed by late gadolinium enhancement CMR

Abstract Background Durable pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Technological advances like ablation index-guided RF ablation and second generation cryoballoon have substantially improved lesion durability, but PV reconnection remains a key determinant of AF recurrences. Purpose We aimed to compare RF ablation following the CLOSE protocol and latest cryoballoon ablation regarding lesion continuity and durability using late gadolinium enhancement (LGE) CMR. Methods This study was based on a prospective registry in which all patients receive an LGE-CMR at 3 months after AF ablation. LGE-CMRs from consecutive patients that had undergone first-time PVI-only AF ablation, either by CLOSE-guided RF ablation (CLOSE) or cryo-ablation with the arctic front advance balloon (CRYO) were analysed. Gradient echo MR sequences were acquired in sinus rhythm and 3D-reconstruction of left atrium and PVs performed using ADAS-3D software. LGE was quantified based on the signal intensity ratio of each voxel relative to the blood pool, applying a previously validated threshold of &amp;gt;1.2 to define LGE indicative of ablation-induced scarring. LGE discontinuations of &amp;gt;3 mm were considered as gaps, and complete lesions were defined as LGE covering &amp;gt;90% of the peri-antral circumference of ipsilateral PV pairs. The analysis included an assessment of the average number of gaps around PV ostia, the normalized gap length, which was calculated as a percentage of the total gap length and the total PV perimeter. The ablation lesion width was also measured in millimetres. Results Post-ablation LGE-CMR from 87 patients were analysed - 40 patients in the CRYO group (70% paroxysmal AF), 47 in the CLOSE group (47% paroxysmal AF). The post-ablation LGE-lesions encircling ipsilateral PVs covered 74% (CRYO) and 75% (CLOSE) of the peri-antral circumference, obtaining no significant difference in the normalized gap length (26.23% vs 24.74%, p=0.7 ), as presented in figure 1c. Although LGE lesions were significantly wider in the CRYO group (9.33 vs 7.11 mm, p&amp;lt;0.001) as presented in figure 1a and figure 1b; the proportion of PVs with complete circumferential LGE lesions was higher with CLOSE-guided RF ablation (39% vs. 24%, p=0.034). However, the total number of gaps per patient was similar in both groups (2.7 vs 3.2, p=0.16). Of note, in both groups, detectable gaps were more frequent in right vs. left PVs (1.98 vs 1.08, p&amp;lt;0.001). Finally, 12-months arrhythmia-free survival rates did not differ significantly (CRYO 60.0% vs. CLOSE 72.4%; p=0.26), albeit it has to be considered that the study was not powered to detect subtle or moderate between-group differences in clinical endpoints. Conclusion While ablation lesions are significantly wider with cryoballoon ablation, lesions continuity may be better with CLOSE-guided RF ablation.Segmentation and Box plot of RF and CRYO