Technology in navigating to peripheral pulmonary nodules has improved in recent years. The recent integration of a robotic platform using shape-sensing technology and mobile cone-beam computed tomography imaging technology has enhanced confidence in sampling lesions with intraprocedural imaging by complimenting the pre-planned navigation to peripheral pulmonary nodules. We present 2 cases using the software integration that improved the robotic catheter positioning to allow for diagnostic specimens to be obtained in the initial biopsies.
57-year-old woman with no significant medical history presented to the emergency department (ED) with acute onset right-sided weakness, sensory loss, and new word-finding difficulties. Her only home medication was a daily multivitamin. She was in her normal state of health until 3 weeks before admission when she developed episodes of weakness and decreased sensation of her right hand. She was evaluated locally and her work-up, including a head computed tomography (CT), was reportedly unrevealing; so she was asked to follow up with her primary care physician as an outpatient. Her symptoms progressively worsened however, and she developed new word-finding difficulties, which prompted her husband to bring her to the ED. There was no loss of consciousness or involuntary movements. There was no family history of strokes or seizures. She was alert, awake, and oriented to time, place, and person. Vital signs were stable. Pertinent physical examination findings included fluent aphasia with frequent paraphasic errors, difficulty with word finding and repetition, no overt dysarthria, right pronator drift, right upper extremity pyramidal distribution weakness, and sensory loss in the right arm. Cardiopulmonary and abdominal examinations were unremarkable. Laboratory studies revealed the following results (reference ranges within parentheses): hemoglobin level, 9.1 g/dL (12.0 to 15.5 g/ dL); white blood cell count, 9.2Â10 9 /L ((3.5 to 10.5)Â10 9 /L); platelet count, 163Â10 9 /L ((150 to 450)Â10 9 /L); and point of care testing glucose level, 106 mg/dL (70-100 mg/dL). Stroke laboratory results included a normal hemoglobin A 1c level of 4.9 g/dL, and a lipid panel revealed a total cholesterol level of 174 mg/dl (desirable <200 mg/dl) and a low-density lipoprotein cholesterol level of 106 mg/dl (desirable <100 mg/dl). Other values for a metabolic panel, including renal function, were within the reference range. An electrocardiogram revealed normal sinus rhythm. Noncontrast CT of the head found no evidence of ischemia or hemorrhage.
BackgroundCardiovascular disease is endemic among patients with chronic kidney disease (CKD). Growing evidence suggests the gut microbiome plays an obligatory role in cardiovascular pathogenesis. TMAO is a downstream byproduct of intestinal microbe metabolism of phosphatidylcholine and L‐carnitine that may directly promote atherosclerosis formation. Since clearance of this uremic metabolite is dependent on urinary excretion, plasma levels of TMAO increase with decrements in kidney function. Association studies have linked plasma levels of TMAO to adverse cardiovascular outcomes in patients with renal dysfunction; however, to our knowledge, we are the first to investigate whether TMAO alone has any direct effect on cardiac contractility. In prior studies, we found TMAO to acutely increase contractile force in mouse hearts ex vivo. The objective of the current investigation was to determine if our findings translated to human heart tissue.MethodsHuman right atrial appendage biopsy tissue was retrieved during cardiopulmonary bypass procedures, prior to cannula placement. The cardiac muscle samples were attached to a force transducer and bubbled with oxygen inside an organ bath. Changes in contractility were measured after treatment with TMAO or vehicle (Ringer's solution).ResultsIn our previous studies using mouse hearts, we found acute treatment with TMAO in the organ bath increased average contraction amplitude 20% and 41% at 300 μM and 3000 μM, respectively (P < 0.05, n = 6–7 animals). Langendorff reverse perfusion of hearts with 300 μM TMAO generated an even greater response than incubation and increased isometric force 32% (P < 0.05, n = 2–3). Consistent with what we observed in the animal model, incubation of human atrial muscle tissue with TMAO at 3,000 μM increased isometric tension 31% compared to vehicle (P < 0.05, n = 4–5).ConclusionsTMAO, at pathological concentrations, directly increases cardiac contractility in both animal and human hearts. Initially, this inotropic effect may be beneficial or adaptive during CKD; however, chronic increases in cardiac contractility can promote cardiac remodeling and left ventricular hypertrophy. Further in vivo studies are needed to determine how chronic exposure to TMAO may contribute to cardiac pathology in CKD and to examine if TMAO represents a therapeutic target for reducing cardiovascular mortality in CKD patients.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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