Reassessment of the electrical connection between the pulmonary veins and the left atrium: A study to determine the different contributions of myocardial fibers along the standard ablation circumference.

Background: Circumferential ablation around the ipsilateral pulmonary veins (PVs) is the standard strategy for atrial fibrillation ablation. The present study seeks to assess which regions of the standard ablation circumference are the main contributors to the venoatrial electrical connection. Methods: A total of 41 patients were included under a specific atrial fibrillation ablation protocol in which the anterior and posterior segments of the standard circumference, between the equatorial line of the superior and the inferior ipsilateral PVs, were ablated first. If PV isolation was not achieved, ablation was extended superiorly or inferiorly, on the basis of the earliest atrial activation recorded during pacing from inside the PV. Complete PV isolation and the length of the areas not requiring ablation (ANRA) at the time of electrical isolation were evaluated. Results: Ablation of the anterior and posterior segments of the standard circumference led to the isolation of 77% left-PV pairs and 51% right-PV pairs (p = 0,015). A superior extension was required in 23% left-PV pairs and in 46% right-PV pairs, while an inferior extension was required only in 10% left-PV pairs and in 11% right-PV pairs. PV isolation was achieved before completing the standard ablation circumference in 97% left-PV pairs and in 94% right-PV pairs, with a median ANRA of 36.9 (IQR: 30.9-42.1) mm in the left PVs [16.0 (IQR: 12.0-19.0) mm superior and 18.8 (IQR: 16.1-24.9) mm inferior, p < 0.01] and 36.9 (IQR: 30.2-41.0) mm in the right PVs [15.1 (IQR: 10.7-19.1) mm superior and 20.6 (IQR: 16.9-23.3) mm inferior, p < 0.01]. Conclusions: The myocardial fibers along the anterior and posterior regions of the standard ablation circumference are the main contributors to the electrical connection between the pulmonary veins and the left atrium. Ablation of these regions results in PV isolation in the majority of patients.

Atrial Fibrillation Originating in the Inferior Vena Cava: A Typical Presentation of an Atypical Location.

Recurrence of atrial fibrillation (AF) despite successful isolation of the pulmonary veins (PVs) represents a great challenge. We present a patient with recurrent episodes of paroxysmal AF despite PV isolation in which a non-PV trigger was identified in the inferior vena cava. (Level of Difficulty: Intermediate.).

Is infertility a risk factor for female sexual dysfunction? A case-control study.

OBJECTIVE: To determine the impact of infertility on female sexual function. DESIGN: A case-control study. SETTING: Academic infertility and gynecology practices. PATIENT(S): One hundred nineteen women with infertility and 99 healthy female controls without infertility between the ages of 18 and 45 years were included in this study. INTERVENTION(S): Anonymous survey and Female Sexual Function Index. MAIN OUTCOME MEASURE(S): Female Sexual Function Index scores, frequency of sexual intercourse and masturbation, and sex-life satisfaction. RESULT(S): Twenty-five percent of our control group had Female Sexual Function Index scores that put them at risk for sexual dysfunction (<26.55), whereas 40% of our patients with infertility met this criterion. Compared with the control group, the patients with infertility had significantly lower scores in the desire and arousal domains and lower frequency of intercourse and masturbation. The patients with infertility retrospectively reported a sex-life satisfaction score that was similar to that of the controls before their diagnosis, whereas their current sex-life satisfaction scores were significantly lower than those of the controls. CONCLUSION(S): Women with a diagnosis of infertility were found to be at higher risk for sexual dysfunction on the basis of their Female Sexual Function Index scores compared with women without infertility. The interaction of sexual function and infertility is complex and deserves further study.

Solanum chrysotrichum hairy root cultures: characterization, scale-up and production of five antifungal saponins for human use.

The production of five antifungal saponins (SC-2 - SC-6) recently extracted from Solanum chrysotrichum leaves was performed using hairy root cultures grown in 250-mL flasks and in 2-L modified draught-tube internal-loop airlift reactors (2-L MR). In both scales, first order growth kinetics were observed, reaching specific growth rates of 0.08 and 0.12 d(-1), respectively. Root density at the end of the culture period was the same for the flasks and for the 2-L MR. In flasks the production of the most active saponin SC-2 was growth-associated, with a maximum yield of 0.04 % dry weight, while in the 2-L MR an SC-2 yield of 0.7 % dry weight was reached, representing a value six times greater than that observed for plant leaves. SC-3 was obtained from root biomasses grown in flasks, while SC-4 was recovered from biomasses at both levels under investigation. SC-5 and SC-6 were only detected in the culture medium of roots grown in 2-L MR. Solanum chrysotrichum hairy root cultures and their scale-up in reactors are feasible strategies for the production of these antifungal compounds for human use.

Novel airlift reactor fitting for hairy root cultures: developmental and performance studies.

In vitro growth of Solanum chrysotrichum hairy roots was carried out in three different types of reactors: shake flasks, a glass-draught internal-loop 2-L basic design airlift reactor (BDR), and a novel modified mesh-draught with wire-helixes 2-L reactor (MR). In each of them, the growth patterns were different, as well as some of the dynamic parameters. The specific growth rates were 0.08, 0.067, and 0.112 d(-1) for shake flasks, BDR, and MR, respectively. In shake flasks and in the MR, growth followed first-order kinetics. In the MR without roots, superficial liquid velocity in the riser and downcomer ranged from 2.1 to 2.7 and 1.4 to 1.7 cm s(-1), respectively (nearly the same as the BDR values). After 42 days in culture, tissue density in the MR was twice that found in the BDR and about the same as that found in the shake flasks. At the tissue densities reached at 42 days, superficial liquid velocities in the MR and BDR downcomers were 4-5 and 7-8 times lower, and mixing times were 11 and 18 times longer than those observed without roots. Tissue densities measured at three points in the MR's downcomer and riser ranged from 10.21 to 12.17 and 4.94 to 5.24 gDW L(-1) respectively. Dynamic gas hold-up dropped faster when roots grew radially in the mesh-draught. In addition, root cultures were scaled-up in a 10-L MR reactor in which some geometric relations were maintained, such as the Q/V radio. Growth in 10-L MR followed first-order kinetics, but despite this, specific growth velocity was 0.09 d(-1) and overall tissue density diminished slightly with respect to that of the 2-L MR. Tissue inoculation, distribution, and harvest were more easily accomplished in the MRs.

Successful pregnancies in the setting of exaggerated endometrial thickness.

OBJECTIVE: To report successful pregnancies in the setting of exaggerated endometrial thickness. DESIGN: Case report. SETTING: Two infertility practices. PATIENT(S): Two IVF patients. INTERVENTION(S): IVF and ET. MAIN OUTCOME MEASURE(S): Endometrial thickness on the days of hCG injection, oocyte retrieval, and ET. RESULT(S): Two successful twin pregnancies, each after the transfer of two embryos, in the setting of an endometrial thickness of 16 mm in one case and 20 mm in the other. CONCLUSION(S): This report illustrates the possibility for a successful outcome in the setting of an exaggerated endometrial thickness, including for the first time a value of 20 mm on the day of egg retrieval.