The detection of renal tumors has increased significantly over recent years resulting in a greater demand for novel, minimally invasive techniques. Cryoablation has emerged as a valuable treatment modality for the management of renal cancer. In an effort to detail the effects of freezing in renal cancer, the human renal cancer (RCC) cell line, 786-O, was evaluated in vitro. 786-O cells were exposed to a range of freezing temperatures from -5 to -40 degrees C and compared to non-frozen controls. The data show that freezing to -5 degrees C did not affect 786-O cell viability, while -10 degrees C, -15 degrees C, and -20 degrees C results in a significant loss of viability (23, 70, and 91%, respectively). A complete loss of cell viability was evident at temperatures of -25 degrees C and colder. Following this analysis, variables involved in the success of cryoablation were investigated. For each of the temperatures tested, extended freeze hold times and passive thawing rates resulted in more extensive cell damage. Additionally, a double freeze-thaw cycle significantly increased cell death compared to a single cycle (62% vs. 22% at -10 degrees C; 89% vs. 63% at -15 degrees C, respectively). While these variables play an important part in the effective application of cryoablation, a molecular understanding of the cell death involved is critical to improving efficacy. Apoptotic inhibition afforded 12% (-10 degrees C), 25% (-15 degrees C), and 11% (-20 degrees C) protection following freezing. Using fluorescence microscopy analysis, the results demonstrated that apoptosis peaked at six hours post-thaw. Next, apoptotic initiating agents including 5-FU and resveratrol (RVT) applied prior to freezing exposure resulted in a significant increase in cell death compared to either application alone. Importantly, the combination of RVT and freezing was noticeably less effective when applied to normal renal cells. The results herein demonstrate the efficacy of freezing and describe a novel therapeutic model for the treatment of renal cancer that may distinguish between cancer and normal cells.
Background: Total anomalous pulmonary venous connection (TAPVC) comprises 2% of congenital heart disease cases. Obstructed TAPVC typically presents with respiratory distress secondary to pulmonary congestion. We report a case of an infant patient who was electively referred to catheterization for stent placement to relieve vertical vein (VV) stenosis. Our objective was to prevent the emergent need for surgical intervention while allowing additional growth before surgery. Case Presentation: A 7-day-old, late pre-term, small for gestational age male infant was transferred from an outside institution. He was initially placed on nasal cannula due to oxygen saturation around 80% but progressed to continuous positive airway pressure and had a chest X-ray suggestive of pulmonary edema. Echocardiography revealed supracardiac TAPVC, a small apical muscular ventricular septal defect, and a moderate secundum atrial septal defect. On admission, the patient was clinically stable with a baseline oxygen saturation of 72% on 40% oxygen. Echocardiography confirmed supracardiac TAPVC and also showed an obstruction with a mean gradient of 22 mmHg in the VV. The desire to optimize the patient's clinical stability led to the decision to undergo cardiac catheterization for stent implantation in the VV. Immediately following the procedure, the patient's hemodynamics improved, with a pressure gradient between the pulmonary venous confluence and the left innominate vein of 4 mmHg. Conclusions: Over the last decade, surgical outcomes IntroductionTotal anomalous pulmonary venous connection (TAPVC) is a rare cardiac defect that comprises 2% of congenital heart disease cases [1]. TAPVC encompasses different anatomic subtypes in which pulmonary veins fail to connect directly to the left atrium and drain to the right atrium via an anomalous venous connection [2,3]. Supracardiac TAPVC is the most common type, comprising about 45% of cases [2]. A left-sided vertical vein (VV) accounts for 70% of the connections between the pulmonary confluence and the right atrium, and stenosis occurs in approximately 40% of cases [3].Obstructed TAPVC typically presents with respiratory distress secondary to pulmonary congestion,
Purpose: CMR derived left ventricular longitudinal and circumferential strain is known to be abnormal in myocarditis. CMR strain is an useful additional tool that can identify subclinical myocardial involvement and may help with longitudinal follow-up. Right ventricular strain derived by CMR in children has not been studied. We sought to evaluate CMR derived biventricular strain in children with acute myocarditis. Methods: Children with acute myocarditis who underwent CMR 2016 - 2022 at our center were reviewed, this group included subjects with COVID-19 myocarditis. Children with no evidence of myocarditis served as controls Those with congenital heart disease and technically limited images for CMR strain analysis were excluded from final analysis. Biventricular longitudinal, circumferential, and radial peak systolic strains were derived using Circle cvi42. Data between cases and controls were compared using an independent sample t-test. One-way ANOVA with post hoc analysis was used to compare COVID-19, non-COVID myocarditis and controls. Results: 38 myocarditis and 14 controls met inclusion criteria (14.4 ± 3 years). All CMR derived peak strain values except for RV longitudinal strain were abnormal in myocarditis group. One-way ANOVA revealed that there was a statistically significant difference with abnormal RV and LV strain in COVID-19 myocarditis when compared to non-COVID-19 myocarditis and controls. Conclusion: CMR derived right and left ventricular peak systolic strain using traditionally acquired cine images were abnormal in children with acute myocarditis. All strain measurements were significantly abnormal in children with COVID-19 even when compared to non COVID myocarditis.
A 67-year-old male with Ebstein's anomaly and a dual-chamber pacemaker due to sick sinus syndrome was admitted to our hospital with cardiogenic shock. Echocardiography revealed severe functional mitral valve regurgitation with preserved ejection fraction. He was referred for percutaneous mitral valve repair (PMVR) for refractory shock in the setting of prohibitive surgical risk. Invasive hemodynamics obtained during PMVR revealed worsening mitral regurgitation due to septal dyssynchrony induced by the patient's permanent pacing. He underwent successful PMVR with subsequent clinical recovery. Dyssynchrony from right ventricular apical pacing may exacerbate mitral regurgitation and heart failure. PMVR with MitraClip may be a safe and effective therapeutic option in patients with refractory cariogenic shock and severe mitral regurgitation.
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