Agradecemos a Junming Yan, consultor da Johnson&Johnoson, responsável pelas bolsas de pesquisa. Este trabalho foi financiado pelo Departamento Provincial de Ciência e Tecnologia de Jilin (20220402076GH).

Este procedimento de pesquisa seguiu rigorosamente as regras do comitê de ética em pesquisa humana do China-Japan Union Hospital da Universidade Jilin. Os pacientes submetidos à ablação por radiofrequência de fibrilação atrial foram pesquisados no sistema Carto (sistema de mapeamento 3D). Em seguida, o sistema PACS foi usado para determinar se o paciente foi submetido a exame de TC de átrio esquerdo antes da cirurgia para verificar se cada paciente selecionado tinha imagens de TC de átrio esquerdo para comparação. O cateter ICE utilizado neste estudo é o Soundstar e um módulo Cartosound está disponível no sistema de mapeamento 3D. Cada paciente forneceu consentimento informado por escrito antes da modelagem 3D da ICE.
1. Preparação antes da digitalização
<ol><li>Verifique as informações do paciente, como frequência cardíaca precisa, ritmo, pressão arterial e saturação de oxigênio. Deixe o paciente em decúbito dorsal com os braços de ambos os lados e as coxas levemente abduzidas.</li>
	<li>Fornecer sedação profunda consciente com fentanil (200 μg/mL) a todos os pacientes durante todo o procedimento. Selecionar a veia femoral direita como ponto de punção, que é desinfetada e pavimentada para anestesia local com lidocaína a 2%.</li>
	<li>Configure o cateter ICE: Conecte a linha de cauda do cateter ICE com o sistema de mapeamento 3D e uma máquina ultrassônica. Abra a interface Estudo no sistema de mapeamento 3D e selecione P500 em Máquinas Conectadas.</li>
	<li>Coloque o cateter ICE (Diâmetro: 10f; modo ultrassom: modo B) dentro da veia femoral. Durante o processo de empurrar, monitore o ultrassom em tempo real para garantir que o cateter esteja em um espaço seguro.</li>
	<li>Passar o cateter de ablação para o átrio direito para desenvolver o modelo de átrio direito e seio coronariano. Colocar o eletrodo do seio coronariano combinando-o com a orientação do EIC.</li>
	<li>Depois que o cateter ICE entrar no átrio direito, certifique-se de que o átrio esquerdo e a estrutura do apêndice atrial esquerdo sejam exibidos na tela de exibição do sistema de mapeamento 3D usando os eixos curto e longo do átrio esquerdo, excluindo o trombo atrial esquerdo.</li>
	<li>Determinar o local ideal de punção sob orientação do EIC após a inserção da agulha de punção do septo interatrial. Em seguida, realizar punção transeptal.<ol><li>Use o modo de exibição Início para confirmar se o ICE atingiu o átrio direito. Em seguida, o software exibe a seção PV esquerda. Clique em Curvatura para a direita para demonstrar a veia cava inferior e o septo atrial.</li>
		<li>Mova a bainha da agulha de punção para apontar na direção das quatro horas. Retrair a bainha da agulha para a fossa oval enquanto monitora o EIC, e o "sinal da tenda" é visível.</li>
		<li>Ajuste o cateter ICE para revelar o PV esquerdo como um "sinal da orelha do coelho". Sob orientação do EIC, retire lentamente a bainha da agulha até a borda inferior da fossa oval.</li>
		<li>Gire a agulha de punção no sentido horário para romper a fossa oval. Em seguida, injetar solução salina de heparina através da agulha de punção do septo atrial. LEGENDA: Observaram-se bolhas de sal no AE, indicando sucesso na punção do septo atrial.</li>
	</ol></li>
</ol>2. 3D modelagem do átrio esquerdo e da veia pulmonar
NOTA: O ICE constrói o modelo de átrio esquerdo em duas direções.
<ol><li>Após empurrar o cateter ICE para a veia femoral, passe-o pelas veias cavas inferior e superior e entre no átrio direito.</li>
	<li>Empurre o cateter de ultrassom para o meio do átrio direito no eixo curto e gire no sentido horário. Agora, o ventilador de ultrassom aponta para a direção de uma hora (vista inicial) representando o átrio direito e o ventrículo direito.</li>
	<li>Aperte o botão de tensão para obter ajuste de tensão de travamento. Em seguida, vá para a visualização Início e clique em Antecurvatura (A) para exibir totalmente o anel tricúspide. Anexar ao anel tricúspide para treinamento de gating e usar a modelagem da fase de respiração final.</li>
	<li>Na vista Home , vire no sentido horário para a parede anterior do átrio esquerdo, levando ao aparecimento do apêndice atrial esquerdo.</li>
	<li>Continue no sentido horário vire para o átrio esquerdo, levando ao aparecimento das veias pulmonares superior e inferior esquerdas, exibidas como um "sinal da orelha de coelho". Em seguida, gire no sentido horário e anti-horário para coletar precisamente a imagem das veias pulmonares esquerdas, identificando os limites venosos anterior e posterior.</li>
	<li>Continue a girar no sentido horário para o átrio esquerdo, estabelecendo a parede posterior, e no processo, o esôfago aparece como o "sinal da via dupla".</li>
	<li>Vire para o átrio esquerdo no sentido horário para observar a veia pulmonar inferior direita, exibida como um "sinal de 3 palavras". Em seguida, gire no sentido horário e anti-horário para capturar precisamente a imagem das veias pulmonares direitas, identificando os limites anterior e posterior.</li>
	<li>No eixo longo, clique em Palintrope (P) para fazer a ponta do cateter na mesma altura da boca do seio coronariano. Isso complementa o modelo de átrio esquerdo. Ajuste a Curva Esquerda/Curva Direita (L/R) para observar a parede frontal do eixo longo do átrio esquerdo. Esta imagem captura a parede anterior do átrio esquerdo.</li>
	<li>Marque os locais anatômicos importantes, incluindo óstios das veias pulmonares, apêndice atrial esquerdo e outros locais vitais de acordo (Vídeo 1).</li>
</ol>3. Aquisição de imagens e mensuração da área da veia pulmonar
<ol><li>TC de átrio esquerdo<ol><li>Abra o sistema PACS clicando duas vezes no ícone. Clique em Consulta Avançada para inserir o nome do paciente e o item de inspeção. Clique em OK para localizar a imagem.</li>
		<li>Clique em Tune para transferir a imagem para o sistema vue pacs (sistema de arquivamento e comunicação de imagens).</li>
		<li>Transfira a imagem de reconstrução de volume 3D para a caixa de trabalho e clique em Exportar imagem para salvar as imagens de posição atrial posterior anterior (AP), posterior esquerdo (LL) e lateral direito (RL) dentro da pasta.</li>
		<li>Após retornar ao programa anterior, transferir a sequência de realce da fase arterial atrial esquerda para a caixa de trabalho e clicar na imagem exibida como 3D.</li>
		<li>Clique duas vezes na imagem 3D e, em seguida, clique em 3D na barra de ferramentas. Selecione a Ferramenta de Ressecção para remover as costelas, a coluna, a aorta e outras estruturas para expor o átrio esquerdo e o sistema de veias pulmonares.</li>
		<li>Expor o vestíbulo da veia pulmonar. Clique na Figura na barra de ferramentas e selecione Área para calcular a área de secção transversa do vestíbulo da veia pulmonar.</li>
	</ol></li>
	<li>GELO<ol><li>Abra o sistema de mapeamento 3D. Em seguida, clique em Revisar Estudo e digite o nome do paciente. Por fim, use Procurar paciente atual para identificar a imagem.</li>
		<li>Clique em OK para abrir a interface de trabalho.</li>
		<li>Clique em Estudar > Continuar Estudo e selecione as sequências Modelo e Canal .</li>
		<li>Clique em Preferências de captura, selecione Região e ajuste a imagem para "Póstero-anterior", "Lateral esquerdo", "Lateral direito", "Oblíquo anterior esquerdo (OAE)" e "Oblíquo anterior direito (OAR)".</li>
		<li>Clique em Imagem, selecione a área da foto e clique em OK para salvar a imagem.</li>
		<li>Clique na opção Mapa e selecione Salvar Mapa. Em seguida, use Borracha na barra de ferramentas para remover as veias pulmonares esquerda e direita.</li>
		<li>Clique na imagem, selecione Medida de área e meça a área do vestíbulo da veia pulmonar.</li>
	</ol></li>
</ol>

Remodelação 3D baseada em ICE para o átrio esquerdo e veia pulmonar

<ol>
	<li>Xu, Y., Sharma, D., Li, G., Liu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atrial+remodeling:+new+pathophysiological+mechanism+of+atrial+fibrillation.">Atrial remodeling: new pathophysiological mechanism of atrial fibrillation.</a> Medical Hypotheses. 80 (1), 53-56 (2013).</li><li>George, J. C., Varghese, V., Mogtader, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography:+evolving+use+in+interventional+cardiology.">Intracardiac echocardiography: evolving use in interventional cardiology.</a> Journal of Ultrasound in Medicine. 33 (3), 387-395 (2014).</li><li>Jingquan, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography+Chinese+expert+consensus.">Intracardiac echocardiography Chinese expert consensus.</a> Frontiers in Cardiovascular Medicine. 9, 1012731 (2022).</li><li>Anter, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+intracardiac+echocardiography+and+transesophageal+echocardiography+for+imaging+of+the+right+and+left+atrial+appendages.">Comparison of intracardiac echocardiography and transesophageal echocardiography for imaging of the right and left atrial appendages.</a> Heart Rhythm. 11 (11), 1890-1897 (2014).</li><li>Rossillo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Novel+ICE-guided+registration+strategy+for+integration+of+electroanatomical+mapping+with+three-dimensional+CT/MR+images+to+guide+catheter+ablation+of+atrial+fibrillation.">Novel ICE-guided registration strategy for integration of electroanatomical mapping with three-dimensional CT/MR images to guide catheter ablation of atrial fibrillation.</a> Journal of Cardiovascular Electrophysiology. 20 (4), 374-378 (2009).</li><li>Okumura, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three-dimensional+ultrasound+for+image-guided+mapping+and+intervention:+methods,+quantitative+validation,+and+clinical+feasibility+of+a+novel+multimodality+image+mapping+system.">Three-dimensional ultrasound for image-guided mapping and intervention: methods, quantitative validation, and clinical feasibility of a novel multimodality image mapping system.</a> Circulation: Arrhythmia and Electrophysiology. 1 (2), 110-119 (2008).</li><li>Liu, C. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+evolving+utility+of+intracardiac+echocardiography+in+cardiac+procedures.">The evolving utility of intracardiac echocardiography in cardiac procedures.</a> Journal of Atrial Fibrillation. 6 (6), 1055 (2014).</li><li>Bartel, T., Edris, A., Velik-Salchner, C., M&#252;ller, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intracardiac+echocardiography+for+guidance+of+transcatheter+aortic+valve+implantation+under+monitored+sedation:+a+solution+to+a+dilemma.">Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma.</a> European Heart Journal. Cardiovascular Imaging. 17 (1), 1-8 (2016).</li><li>Haissaguerre, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spontaneous+initiation+of+atrial+fibrillation+by+ectopic+beats+originating+in+the+pulmonary+veins.">Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.</a> New England Journal of Medicine. 339 (10), 659-666 (1998).</li><li>Kaseno, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+the+CartoSound&#174;+image+directly+acquired+from+the+left+atrium+for+integration+in+atrial+fibrillation+ablation.">The impact of the CartoSound&#174; image directly acquired from the left atrium for integration in atrial fibrillation ablation.</a> Journal of Interventional Cardiac Electrophysiology. 53, 301-308 (2018).</li><li>Enriquez, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+intracardiac+echocardiography+in+interventional+cardiology:+working+with+the+anatomy+rather+than+fighting+it.">Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it.</a> Circulation. 137 (21), 2278-2294 (2018).</li></ol>

Os autores declaram não haver conflitos de interesse.

A ecocardiografia intracardíaca (EIC) é uma ferramenta de reconstrução tridimensional sem contato. Determina o plano de ablação adequado e reduz a incidência de estenose venosa pulmonar. Além disso, a EIC melhora a efetividade da ablação por cateter ao avaliar a posição distal do cateter de ablação e sua relativa associação com as estruturas anatômicas. Essas estruturas incluem o átrio esquerdo e a veia pulmonar, bem como o diâmetro e a morfologia da veia pulmonar.
A ablaç?...

A fibrilação atrial (FA) é comumente associada ao remodelamento atrial, incluindo remodelamento mecânico, eletrofisiológico e estrutural1. A remodelação estrutural afetará drasticamente a anatomia do átrio. Assim, a avaliação da anatomia do átrio esquerdo em pacientes com FA é essencial para procedimentos de ablação de FA e qualquer procedimento direcionado ao átrio esquerdo. Para a modelagem FAM 3D, a modelagem 3D do coração é reconstruída com base na mudança de posição espacial de sua posição correspondente ao campo magnético fixo, deslocando continuamente o cateter magnético no coração. Em contraste, a modelagem 3D ICE integra a imagem bidimensional na cavidade cardíaca com o sistema de mapeamento eletroanatômico 3D posicionando o sensor na extremidade superior do cateter ICE phase array. Assim, o setor ultra-sônico representa a modelagem 3D para demonstrar a relação anatômica e a posição do cateter em tempo real.
Com base em nossa experiência clínica, a ecocardiografia intracardíaca (ECI) pode identificar o limite da parede atrial e estabelecer ainda mais o remodelamento 3D. No entanto, a maioria do uso de EIC durante a ablação de FA ou remodelamento 3D apenas fornece um breve perfil dos átrios ou veias pulmonares. Originalmente, o ECI foi aplicado para orientar o fechamento intervencionista da comunicação interatrial e do forame ovalpatente2. A EIC pode esclarecer a localização e a forma do septo atrial e tem sido usada para vários procedimentos intervencionistas que requerem punção do septoatrial3. Estes incluem ablação por cateter de radiofrequência de fibrilação atrial, terapia intervencionista da valva mitral, etc. A EIC pode identificar com precisão os limites das veias pulmonares e as paredes atriais para estabelecer um modelo 3D mais detalhado3. Não está claro se esse método poderia fornecer aos operadores uma avaliação anatomática atrial mais precisa, especialmente para o antro da veia pulmonar e locais transeptais. Neste estudo, comparamos a imagem tomográfica de átrio esquerdo e a remodelação 3D estabelecida usando métodos tradicionais e procedimentos precisos de EIC para determinar informações adicionais.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>CARTO V6</td>
			<td>Johnson&#38;Johnson</td>
			<td>6.0.80.45</td>
			<td></td>
		</tr>
		<tr>
			<td>CARTO V7</td>
			<td>Johnson&#38;Johnson</td>
			<td>7.1.80.33</td>
			<td></td>
		</tr>
		<tr>
			<td>PACS system</td>
			<td>Philips(China) Investment Co.,Ltd</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Soundstar</td>
			<td>Johnson&#38;Johnson</td>
			<td>N/A</td>
			<td></td>
		</tr>
	</tbody>
</table>

three-dimensional modeling of the left atrium and pulmonary veins with a precise intracardiac echocardiography approach

A ecocardiografia intracardíaca (EIC) é uma nova ferramenta para estimar a anatomia cardíaca durante procedimentos de isolamento de veias pulmonares, particularmente a anatomia do átrio esquerdo (AE) e as estruturas das veias pulmonares. A EIC é amplamente utilizada para estabelecer um modelo estrutural atrial esquerdo tridimensional (3D) durante procedimentos de ablação. No entanto, não está claro se o uso da EIC em um método preciso de modelagem 3D pode fornecer um modelo 3D de átrio esquerdo mais preciso e a abordagem transeptal. Este estudo propõe um protocolo para modelar o átrio esquerdo e as veias pulmonares com EIC e remodelamento rápido do cateter de mapeamento anatômico (FAM). Avalia a acurácia dos modelos produzidos pelos dois métodos por meio da pontuação por observadores. Foram incluídos 50 pacientes submetidos ao remodelamento 3D baseado em EIC e 45 submetidos ao remodelamento 3D FAM baseado em procedimentos de isolamento das veias pulmonares. O remodelamento do antro da veia pulmonar é estimado comparando-se a área do antro adquirida pelo remodelamento e a angiotomografia (ATC) do átrio esquerdo. Os escores dos observadores para a modelagem nos grupos ICE e FAM foram 3,40 ± 0,81 e 3,02 ± 0,72 (P < 0,05), respectivamente. A área do antro da veia pulmonar obtida pelos métodos ICE e FAM mostrou correlação com a área adquirida pela TC de átrio esquerdo. No entanto, o viés do intervalo de confiança de 95% foi mais estreito nos modelos adquiridos pela ICE do que nos modelos adquiridos pela FAM (-238 cm 2 a 323 cm 2 Vs. -363 cm 2 a 386 cm 2, respectivamente) usando a análise de Bland-Altman. Portanto, a ECI precisa possui alta acurácia na estimativa da estrutura atrial esquerda, tornando-se uma abordagem promissora para futuras estimativas da estrutura cardíaca.

De janeiro de 2021 a junho de 2022, selecionamos 114 pacientes submetidos à ablação por radiofrequência de fibrilação atrial em nosso hospital. Os pacientes foram excluídos com base nos seguintes critérios: ausência de reconstrução volumétrica 3D de TC de átrio esquerdo (n = 11), ausência de punção transeptal com EIC (n = 4) e reconstrução incompleta de imagens de átrio esquerdo e veia pulmonar (n = 4). Finalmente, 50 pacientes com modelagem 3D ICE e 45 com modelagem 3D FAM como grupo controle foram in...

Watch this Scientific Journal Video about Advancements in Intracardiac Echocardiography for Atrial Anatomy Assessment at JoVE.com

Autor em destaque: Avanços na ecocardiografia intracardíaca para avaliação da anatomia atrial 

A ecocardiografia intracardíaca (ECI) precisa mostra acurácia significativa na estimativa da estrutura atrial esquerda, um método prospectivo e promissor de estimativa da estrutura cardíaca. Propomos um protocolo de modelagem tridimensional do átrio esquerdo e das veias pulmonares com EIC e remodelamento rápido do cateter de mapeamento anatômico (FAM).

Modelagem Tridimensional do Átrio Esquerdo e das Veias Pulmonares com Abordagem Precisa do Ecocardiograma Intracardíaco

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left ...

Nossa pesquisa tenta avaliar se a construção 3D baseada em ecocardiografia intracardíaca poderia aumentar a acurácia do átrio pulmonar e das avaliações em anatomia arterial. A ecocardiografia intracardíaca é capaz de identificar o limite da parede arterial e criar um modelo 3D de ventos pulmonares. Recentemente, isso tem sido aumentado, o foco no uso de imagens S2 frequentemente detalhadas para determinar com precisão a anatomia arterial.Um dos desafios experimentais atuais é imitar com precisão a estrutura arterial esquerda. No entanto, resultados promissores têm sido obtidos como melhor imagem arterial e desconstrução de segurança, que tem alta acurácia e potencial para futuras imagens de estruturas cardíacas.

three-dimensional-modeling-left-atrium-pulmonary-veins-with-precise

Research

JoVE Journal

Medicine

Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach

703 visualizações.  China-Japan Union Hospital of Jilin University. Nossa pesquisa tenta avaliar se a construção 3D baseada em ecocardiografia intracardíaca poderia aumentar a acurácia do átrio pulmonar e das avaliações em anatomia arterial. A ecocardiografia intracardíaca é capaz de identificar o limite da parede arterial e criar um modelo 3D de ventos pulmonares. Recentemente, isso tem sido aumentado, o foco no uso de imagens S2 frequentemente detalhadas para determinar com precisão a anatomia arterial.Um dos desafios experimentais atuais ?...

Vídeo: Autor em destaque: Avanços na ecocardiografia intracardíaca para avaliação da anatomia atrial 

Bronchial Thermoplasty:  A Novel Therapeutic Approach to Severe Asthma

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks. Bronchial thermoplasty is delivered by the Alair System and is performed in three outpatient procedure visits, each scheduled approximately three weeks apart. The first procedure treats the airways of the right lower lobe, the second treats the airways of the left lower lobe and the third and final procedure treats the airways in both upper lobes. After all three procedures are performed the bronchial thermoplasty treatment is complete.
Bronchial thermoplasty is performed during bronchoscopy with the patient under moderate sedation. All accessible airways distal to the mainstem bronchi between 3 and 10 mm in diameter, with the exception of the right middle lobe, are treated under bronchoscopic visualization. Contiguous and non-overlapping activations of the device are used, moving from distal to proximal along the length of the airway, and systematically from airway to airway as described previously. Although conceptually straightforward, the actual execution of bronchial thermoplasty is quite intricate and procedural duration for the treatment of a single lobe is often substantially longer than encountered during routine bronchoscopy. As such, bronchial thermoplasty should be considered a complex interventional bronchoscopy and is intended for the experienced bronchoscopist. Optimal patient management is critical in any such complex and longer duration bronchoscopic procedure. This article discusses the importance of careful patient selection, patient preparation, patient management, procedure duration, postoperative care and follow-up to ensure that bronchial thermoplasty is performed safely.
Bronchial thermoplasty is expected to complement asthma maintenance medications by providing long-lasting asthma control and improving asthma-related quality of life of patients with severe asthma. In addition, bronchial thermoplasty has been demonstrated to reduce severe exacerbations (asthma attacks) emergency rooms visits for respiratory symptoms, and time lost from work, school and other daily activities due to asthma.

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled manner to reduce excessive airway smooth muscle. Reducing airway smooth muscle decreases the ability of the airways to constrict, thereby reducing the frequency of asthma attacks.

Termoplastia brônquica: uma nova abordagem terapêutica para Asma Grave

Bronchial thermoplasty is a non-drug procedure for severe persistent asthma that delivers thermal energy to the airway wall in a precisely controlled ...

Medicina

Heterotypic Three-dimensional In Vitro Modeling of Stromal-Epithelial Interactions During Ovarian Cancer Initiation and Progression

Epithelial ovarian cancers (EOCs) are the leading cause of death from gynecological malignancy in Western societies. Despite advances in surgical treatments and improved platinum-based chemotherapies, there has been little improvement in EOC survival rates for more than four decades 1,2. Whilst stage I tumors have 5-year survival rates &gt;85%, survival rates for stage III/IV disease are &lt;40%. Thus, the high rates of mortality for EOC could be significantly decreased if tumors were detected at earlier, more treatable, stages 3-5. At present, the molecular genetic and biological basis of early stage disease development is poorly understood. More specifically, little is known about the role of the microenvironment during tumor initiation; but known risk factors for EOCs (e.g. age and parity) suggest that the microenvironment plays a key role in the early genesis of EOCs. We therefore developed three-dimensional heterotypic models of both the normal ovary and of early stage ovarian cancers. For the normal ovary, we co-cultured normal ovarian surface epithelial (IOSE) and normal stromal fibroblast (INOF)&nbsp;cells, immortalized by retrovrial transduction of the catalytic subunit of human telomerase holoenzyme (hTERT) to extend the lifespan of these cells in culture. To model the earliest stages of ovarian epithelial cell transformation, overexpression of the CMYC oncogene in IOSE cells, again co-cultured with INOF cells. These heterotypic models were used to investigate the effects of aging and senescence on the transformation and invasion of epithelial cells. Here we describe the methodological steps in development of these three-dimensional model; these methodologies aren't specific to the development of normal ovary and ovarian cancer tissues, and could be used to study other tissue types where stromal and epithelial cell interactions are a fundamental aspect of the tissue maintenance and disease development.

Heterotypic Three-dimensional In Vitro Modeling of Stromal-Epithelial Interactions During Ovarian Cancer Initiation and Progression

We describe methodologies for establishing in vitro heterotypic three-dimensional models comprising ovarian fibroblasts and normal ovarian surface or ovarian cancer epithelial cells. We discuss the use of these models to study stromal-epithelial interactions that occur during ovarian cancer development.

Heterotípica tridimensional<em&gt; In Vitro</em&gt; Modelagem de Estroma-epitelial de ovário Interações durante o início e progressão do câncer

Epithelial ovarian cancers (EOCs) are the leading cause of death from gynecological malignancy in Western societies. Despite advances in surgical ...

Three-Dimensional (3D) Tumor Spheroid Invasion Assay

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in particular (e.g., brain tumors such as glioblastoma multiforme and squamous cell carcinoma of the head and neck &#8211; SCCHN) it is a cause of severe morbidity and can be life-threatening even in the absence of distant metastases. In addition, cancers which have relapsed following treatment unfortunately often present with a more aggressive phenotype. Therefore, there is an opportunity to target the process of invasion to provide novel therapies that could be complementary to standard anti-proliferative agents. Until now, this strategy has been hampered by the lack of robust, reproducible assays suitable for a detailed analysis of invasion and for drug screening. Here we provide a simple micro-plate method (based on uniform, self-assembling 3D tumor spheroids) which has great potential for such studies. We exemplify the assay platform using a human glioblastoma cell line and also an SCCHN model where the development of resistance against targeted epidermal growth factor receptor (EGFR) inhibitors is associated with enhanced matrix-invasive potential. We also provide two alternative methods of semi-automated quantification: one using an imaging cytometer and a second which simply requires standard microscopy and image capture with digital image analysis.

Three-Dimensional 3D Tumor Spheroid Invasion Assay

Invasion of surrounding normal tissues is a defining characteristic of malignant tumors. We provide here a simple, semi-automated micro-plate assay of invasion into a natural 3D biomatrix that has been exemplified with a number of models of advanced human cancers.

Tridimensional (3D) Tumor Esferóide Invasion Assay

Invasion of surrounding normal tissues is generally considered to be a key hallmark of malignant (as opposed to benign) tumors. For some cancers in ...

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic pressure through echocardiography, as well as to obtain measurements of the Aorta and PA diameter in mice.
Mice older than 10 d of age can be analyzed using the present technique. The technique is composed of 3 main steps: set-up, image acquisition, and image analysis. The set-up step consists of getting the mouse anesthetized with 1% isoflurane, shaving it, and taping it in a supine position to a heated EKG board where the image acquisition will take place. The image acquisition step consists of learning to identify the cardiac structures and obtaining all the required images with its correspondent probe and axis in order to be able to calculate volumes and diameters. The image analysis step consists of measuring the previously acquired images with the aid of computer software.
Advantages of the proposed technique include a fast (15 min) procedure that would allow the researcher to evaluate interventions in a non-invasive, non-terminal approach and therefore follow the same mouse over time; each mouse can be used as its own control. This fact plus having the same operator perform all the acquisition and analysis for the entire experiment minimizes the limitation of operator-dependency. The present methodology is useful for mouse researchers in cardiovascular and pulmonary medicine.

The following protocol describes the methodology for the acquisition and analysis of echocardiographic images used to obtain the Left Atrial Volume (LAV), Aorta (Ao) diameter, and Pulmonary Artery (PA) diameter in mice. This technique is a non-invasive, non-terminal procedure that allows assessment of the cardiopulmonary function.

Murino Ecocardiografia de Esquerda Atrium, Aorta, ea artéria pulmonar

The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic ...

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ischemia and infarction in children. If left untreated, it results in a 90% mortality rate in the first year of life. In patients who survive to the adulthood, the coronary steal phenomenon and retrograde left-sided coronary flow provide a substrate for chronic subendocardial ischemia, which may lead to left ventricular dysfunction, ischemic mitral regurgitation, malignant ventricular arrhythmias, and sudden cardiac death. The average age of life-threatening presentation is 33 years and of sudden cardiac death 31 years. Therefore, surgical correction is highly recommended as soon as the diagnosis is made, regardless of age. In adult-type ALCAPA originating from the right-facing sinus of the pulmonary artery, direct re-implantation of the ALCAPA into the aorta is the more physiologically sound repair technique to re-establish the dual-coronary perfusion system and is recommended. This protocol describes the technique of direct re-implantation of adult-type ALCAPA into the aorta.

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Surgical correction of ALCAPA is highly recommended, regardless of age or the degree of intercoronary collateralization. This protocol presents a technique for the direct re-implantation of adult-type ALCAPA into the aorta to re-establish the dual-coronary perfusion. Whenever feasible, direct re-implantation is preferred to other surgical correction techniques.

Re-implantação direta de Esquerda da Artéria Coronária para a aorta em adultos com Origem Anômala da Coronária Esquerda da Artéria da artéria pulmonar (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

Left Atrial Stenosis Induced Pulmonary Venous Arterialization and Group 2 Pulmonary Hypertension in Rat

The mechanism of mitral stenosis-induced pulmonary venous arterialization and group 2 pulmonary hypertension (PH) is unclear. There is no rodent model of group 2 PH, due to mitral stenosis (MS), to facilitate the investigation of disease mechanisms and potential therapeutic strategies. We present a novel rat model of pulmonary venous congestion-induced pulmonary venous arterialization and group 2 PH caused by left atrial stenosis (LAS). LAS is achieved by constricting the left atrium using a half-closed titanium clip. After the LAS surgery, a rat model with a transmitral inflow velocity greater than or equal to 2.0 m/s on echocardiography gradually develops pulmonary venous arterialization and group 2 PH over an 8- to 10-week period. In this protocol, we provide the step-by-step procedure of how to perform the LAS surgery. The presented LAS rat model mimics MS in humans and is useful for studying the underlying molecular mechanism of pulmonary venous arterialization and for the preclinical evaluation of therapies for group 2 PH.

Left atrial stenosis (LAS) is a novel surgical technique used for studying group 2 pulmonary hypertension (PH) and mechanisms underlying pulmonary venous arterialization. Here, we present a protocol to constrict the left atrium using a titanium clip to cause pulmonary venous arterialization and moderate PH in a rat.

Estenose Atrial Esquerdo induzida Arterialization venoso pulmonar e hipertensão pulmonar do grupo 2 no rato

The mechanism of mitral stenosis-induced pulmonary venous arterialization and group 2 pulmonary hypertension (PH) is unclear. There is no rodent model of ...

The Left Pneumonectomy Combined with Monocrotaline or Sugen as a Model of Pulmonary Hypertension in Rats

In this protocol, we detail the correct procedural steps and necessary precautions to successfully perform a left pneumonectomy and induce PAH in rats with the additional administration of monocrotaline (MCT) or SU5416 (Sugen). We also compare these two models to other PAH models commonly used in research. In the last few years, the focus of animal PAH models has moved towards studying the mechanism of angioproliferation of plexiform lesions, in which the role of increased pulmonary blood flow is considered as an important trigger in the development of severe pulmonary vascular remodeling. One of the most promising rodent models of increased pulmonary flow is the unilateral left pneumonectomy combined with a "second hit" of MCT or Sugen. The removal of the left lung leads to increased and turbulent pulmonary blood flow and vascular remodeling. Currently, there is no detailed procedure of the pneumonectomy surgery in rats. This article details a step-by-step protocol of the pneumonectomy surgical procedure and post-operative care in male Sprague-Dawley rats. Briefly, the animal is anesthetized and the chest is opened. Once the left pulmonary artery, pulmonary vein, and bronchus are visualized, they are ligated and the left lung is removed. The chest then closed and the animal recovered. Blood is forced to circulate only on the right lung. This increased vascular pressure leads to a progressive remodeling and occlusion of small pulmonary arteries. The second hit of MCT or Sugen is used one week post-surgery to induce endothelial dysfunction. The combination of increased blood flow in the lung and endothelial dysfunction produces severe PAH. The primary limitation of this procedure is that it requires general surgical skills.

The rodent left pneumonectomy is a valuable technique in pulmonary hypertension research. Here, we present a protocol to describe the rat pneumonectomy procedure and postoperative care to ensure minimal morbidity and mortality.

A pneumonectomia esquerda combinado com Monocrotaline ou Sugen como modelo de hipertensão pulmonar em ratos

In this protocol, we detail the correct procedural steps and necessary precautions to successfully perform a left pneumonectomy and induce PAH in rats ...

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

The left atrial to femoral artery bypass (LAFAB) system is a mechanical circulatory support (MCS) device used in cardiogenic shock (CS) that bypasses the left ventricle by draining blood from the left atrium (LA) and returning it to the systemic arterial circulation via the femoral artery. It can provide flows ranging from 2.5-5 L/min depending on the size of the cannula. Here, we discuss the mechanism of action of LAFAB, available clinical data, indications for its use in cardiogenic shock, steps of implantation, post-procedural care, and complications associated with the use of this device and their management.
We also provide a brief video of the procedural component of device therapy, including the pre-placement preparation, percutaneous placement of the device via transseptal puncture under echocardiographic guidance and the post-operative management of device parameters.

The following article describes the stepwise procedure for placement of a device (e.g., Tandemheart) in cardiogenic shock (CS) that is a percutaneous left ventricular assist device (pLVAD) and a left atrial to femoral artery bypass (LAFAB) system that bypasses and supports the left ventricle (LV) in CS.

Uso de um dispositivo de assistência ventricular percutâneo/átrio esquerdo para o sistema de bypass da artéria femoral para choque cardiogênico

The left atrial to femoral artery bypass (LAFAB) system is a mechanical circulatory support (MCS) device used in cardiogenic shock (CS) that bypasses the ...

Whole-Kidney Three-Dimensional Staining with CUBIC

Although conventional pathology provided numerous information about kidney microstructure, it was difficult to know the precise structure of blood vessels, proximal tubules, collecting ducts, glomeruli, and sympathetic nerves in the kidney due to the lack of three-dimensional (3D) information. Optical clearing is a good strategy to overcome this big hurdle. Multiple cells in a whole organ can be analyzed at single-cell resolution by combining tissue clearing and 3D imaging technique. However, cell labeling methods for whole-organ imaging remain underdeveloped. In particular, whole-mount organ staining is challenging because of the difficulty in antibody penetration. The present protocol developed a whole-mount mouse kidney staining for 3D imaging with the CUBIC (Clear, Unobstructed Brain/Body Imaging Cocktails and Computational analysis) tissue clearing method. The protocol has enabled visualizing renal sympathetic denervation after ischemia-reperfusion injury and glomerulomegaly in the early stage of diabetic kidney disease from a comprehensive viewpoint. Thus, this technique can lead to new discoveries in kidney research by providing a macroscopic perspective.

The present protocol describes a tissue clearing method and whole-mount immunofluorescent staining for three-dimensional (3D) kidney imaging. This technique can offer macroscopic perspectives in kidney pathology, leading to new biological discoveries.

Coloração tridimensional de rim inteiro com CUBIC

Although conventional pathology provided numerous information about kidney microstructure, it was difficult to know the precise structure of blood ...

Aprimorando o diagnóstico de nódulos pulmonares usando reconstrução 3D de pulmão inteiro

Three-Dimensional Reconstruction for the Whole Lung with Early Multiple Pulmonary Nodules

For patients with early multiple pulmonary nodules, it is essential, from a diagnostic perspective, to determine the spatial distribution, size, location, and relationship with surrounding lung tissue of these nodules throughout the entire lung. This is crucial for identifying the primary lesion and developing more scientifically grounded treatment plans for doctors. However, pattern recognition methods based on machine vision are susceptible to false positives and false negatives and, therefore, cannot fully meet clinical demands in this regard. Visualization methods based on maximum intensity projection (MIP) can better illustrate local and individual pulmonary nodules but lack a macroscopic and holistic description of the distribution and spatial features of multiple pulmonary nodules.
Therefore, this study proposes a whole-lung 3D reconstruction method. It extracts the 3D contour of the lung using medical image processing technology against the background of the entire lung and performs 3D reconstruction of the lung, pulmonary artery, and multiple pulmonary nodules in 3D space. This method can comprehensively depict the spatial distribution and radiological features of multiple nodules throughout the entire lung, providing a simple and convenient means of evaluating the diagnosis and prognosis of multiple pulmonary nodules.

Autor em destaque: Avançando na modelagem 3D para diagnóstico e tratamento aprimorados de nódulos pulmonares no câncer de pulmão em estágio inicial 

This study introduces a three-dimensional (3D) reconstruction method for the entire lung in patients with early multiple pulmonary nodules. It offers a comprehensive visualization of nodule distribution and their interplay with lung tissue, simplifying the assessment of diagnosis and prognosis for these patients.

Reconstrução Tridimensional de Todo o Pulmão com Múltiplos Nódulos Pulmonares Precoces

For patients with early multiple pulmonary nodules, it is essential, from a diagnostic perspective, to determine the spatial distribution, size, location, ...