Overcoming the challenge of venous occlusion for lead implantation

Vein stenosis or occlusion is a frequent finding in patients with previously-implanted transvenous leads. This editorial describes the different techniques that may be used to overcome this hurdle in case a new lead needs to be implanted, and discusses two case reports in this issue of the journal.     

Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation

Cryoballoon ablation (CBA) is an established therapy for atrial fibrillation (AF). Pulmonary vein (PV) occlusion is essential for achieving antral contact and PV isolation and is typically assessed by contrast injection. We present a novel method of direct pressure monitoring for assessment of PV occlusion.Transcatheter pressure is monitored during balloon advancement to the PV antrum. Pressure is recorded via a single pressure transducer connected to the inner lumen of the cryoballoon. Pressure curve characteristics are used to assess occlusion in conjunction with fluoroscopic or intracardiac echocardiography (ICE) guidance. PV occlusion is confirmed when loss of typical left atrial (LA) pressure waveform is observed with recordings of PA pressure characteristics (no A wave and rapid V wave upstroke). Complete pulmonary vein occlusion as assessed with this technique has been confirmed with concurrent contrast utilization during the initial testing of the technique and has been shown to be highly accurate and readily reproducible.We evaluated the efficacy of this novel technique in 35 patients. A total of 128 veins were assessed for occlusion with the cryoballoon utilizing the pressure monitoring technique; occlusive pressure was demonstrated in 113 veins with resultant successful pulmonary vein isolation in 111 veins (98.2%). Occlusion was confirmed with subsequent contrast injection during the initial ten procedures, after which contrast utilization was rapidly reduced or eliminated given the highly accurate identification of occlusive pressure waveform with limited initial training.Verification of PV occlusive pressure during CBA is a novel approach to assessing effective PV occlusion and it accurately predicts electrical isolation. Utilization of this method results in significant decrease in fluoroscopy time and volume of contrast.     

dsRNA-mediated resistance to Beet Necrotic Yellow Vein Virus infections in sugar beet (Beta vulgaris L. ssp. vulgaris)

Rhizomania, one of the most devastating diseases in sugar beet, is caused by Beet Necrotic Yellow Vein Virus (BNYVV) belonging to the genus Benyvirus. Use of sugar beet varieties with resistance to BNYVV is generally considered as the only way to maintain a profitable yield on rhizomania-infested fields. As an alternative to natural resistance, we explored the transgenic expression of viral dsRNA for engineering resistance to rhizomania. Transgenic plants expressing an inverted repeat of a 0.4 kb fragment derived from the BNYVV replicase gene displayed high levels of resistance against different genetic strains of BNYVV when inoculated using the natural vector, Polymyxa betae. The resistance was maintained under high infection pressures and over prolonged growing periods in the greenhouse as well as in the field. Resistant plants accumulated extremely low amounts of transgene mRNA and high amounts of the corresponding siRNA in the roots, illustrative of RNA silencing as the underlying mechanism. The transgenic resistance compared very favourably to natural sources of resistance to rhizomania and thus offers an attractive alternative for breeding resistant sugar beet varieties.     

Balloon Venoplasty of Subclavian Vein and Brachiocephalic Junction to Enable Left Ventricular Lead Placement for Cardiac Resynchronisation Therapy

This report describes the successful implantation of a LV lead using balloon venoplasty to overcome a very tight stenosis of the right subclavian vein / brachiocephalic junction for cardiac resynchronisation therapy (CRT-P) in a patient with a right sided CRT-P system and a failed epicardial LV lead. It is important for device implanters to be familiar with interventional equipments and techniques such as balloon venoplasty to overcome difficult venous access.     

Stem cells: Insights into the secretome

Stem cells have been considered as possible therapeutic vehicles for different health related problems such as cardiovascular and neurodegenerative diseases and cancer. Secreted molecules are key mediators in cell–cell interactions and influence the cross talk with the surrounding tissues. There is strong evidence supporting that crucial cellular functions such as proliferation, differentiation, communication and migration are strictly regulated from the cell secretome. The investigation of stem cell secretome is accumulating continuously increasing interest given the potential use of these cells in regenerative medicine. The scope of the review is to report the main findings from the investigation of stem cell secretome by the use of contemporary proteomics methods and discuss the current status of research in the field. This article is part of a Special Issue entitled: An Updated Secretome.     

大鼠颈部自体静脉移植模型两种吻合方法的比较

目的比较间断吻合和连续吻合法建立静脉桥狭窄动物模型的优劣。方法SD大鼠20只,分成两组（间断吻合组和连续吻合组）,取颈外静脉与颈总动脉行端端吻合。术后4周取下静脉桥,观察桥管通畅性,分析新生内膜与中膜的厚度、面积比。结果连续组与间断组相比手术时间更短,出血更少,但桥管通畅率低,两组内膜增生程度没有显著差异。结论连续吻合用时短,出血少,对术者要求更高,较易形成吻合口狭窄。两者造模效果一样。     

脱氧胆酸钠对人脐静脉内皮细胞凋亡的影响

目的:探讨脱氧胆酸钠(SD)对体外培养的人脐静脉内皮细胞(HUVEC)凋亡的影响。方法:(1)以不同终浓度(0、0.015mg/mL、0.05 mg/mL、0.15 mg/mL、0.5 mg/mL、1.0 mg/mL)的脱氧胆酸钠分别作用于人脐静脉血管内皮细胞,使用CCK-8检测细胞活力、TUNEL荧光染色检测细胞凋亡;(2)以终浓度为0.15 mg/mL的SD作用于HUVEC4、8、12 h后用Western blot检测Caspase-3、7、9蛋白及PARP活化情况;(3)观察Caspase-3抑制剂Z-DEVD-FMK对0.15 mg/mL脱氧胆酸钠组的影响。结果:CCK8结果显示随SD浓度(0~1.0 mg/mL)及作用时间(0~12 h)增加,HUVEC活力降低,0.15 mg/mL时活力为80%,1.0 mg/mL时细胞活力仅不到10%;Tunel检测示随着SD浓度的增加HUVEC凋亡明显增多;Western Blot结果示SD作用于HUVEC后Caspase-3、7、9蛋白及PARP活化明显增加;Z-DEVD-FMK明显抑制了0.15 mg/mLSD引起的PARP活化。结论:脱氧胆酸钠(SD)通过启动Caspase级联反应介导了人脐静脉内皮细胞的凋亡。