Map-guided surgery for atrial fibrillation

BackgroundAlthough current surgical procedures result in a high success rate for atrial fibrillation, they are not guided by electrophysiologic findings in individual patients and thus might include unnecessary incisions in some patients or be inappropriate for other patients. We sought to determine whether intraoperative mapping is beneficial for the surgical treatment of atrial fibrillation.MethodsA 256-channel 3-dimensional dynamic mapping system with custom-made epicardial patch electrodes was used to examine the atrial activation during atrial fibrillation and to determine the optimal procedure in 37 patients with continuous and 9 patients with intermittent atrial fibrillation intraoperatively.ResultsSurgical intervention for atrial fibrillation was not indicated in 3 patients in whom the atrial electrograms had a low voltage over a broad area. Concurrent, multiple, and repetitive activations arising from the pulmonary veins or left atrial appendage were observed in all patients. A simple left atrial procedure consisting of pulmonary vein isolation and left atrial incisions without any right atrial incisions was performed in 8 patients in whom the right atrial activation was passive, and all (100%) were cured of atrial fibrillation. The radial procedure was performed in the remaining 35 patients, and 31 (89%) of the patients were cured of atrial fibrillation. In this subset of patients, 10 exhibited reentrant or focal activation in the posterior left atrium between the right and left pulmonary veins and required an additional linear ablation on the posterior left atrium. The total amount of postoperative bleeding after the simple left atrial procedure was significantly less than after the radial procedure (378 ± 135 vs 711 ± 364 mL, P = .03). The right and left atrial transport functions were well preserved after both the radial and simple left atrial procedures.ConclusionIntraoperative mapping facilitates determining the optimal procedure for atrial fibrillation in each patient

Decelerated epigenetic aging associated with mood stabilizers in the blood of patients with bipolar disorder

There is high mortality among patients with bipolar disorder (BD). Studies have reported accelerated biological aging in patients with BD. Recently, Horvath and Hannum et al. independently developed DNA methylation (DNAm) profiles as “epigenetic clocks,” which are the most accurate biological age estimate. This led to the development of two accomplished measures of epigenetic age acceleration (EAA) using blood samples, namely, intrinsic and extrinsic EAA (IEAA and EEAA, respectively). IEAA, which is based on Horvath’s clock, is independent of blood cell counts and indicates cell-intrinsic aging. On the other hand, EEAA, which is based on Hannum’s clock, is associated with age-dependent changes in blood cell counts and indicates immune system aging. Further, Lu et al. developed the “GrimAge” clock, which can strongly predict the mortality risk, and DNAm-based telomere length (DNAmTL). We used a DNAm dataset from whole blood samples obtained from 30 patients with BD and 30 healthy controls. We investigated Horvath EAA, IEAA, Hannum EAA, EEAA, Grim EAA, DNAmTL, and DNAm-based blood cell composition. Compared with controls, there was a decrease in Horvath EAA and IEAA in patients with BD. Further, there was a significant decrease in Horvath EAA and IEAA in patients with BD taking medication combinations of mood stabilizers (including lithium carbonate, sodium valproate, and carbamazepine) than in those taking no medication/monotherapy. This study provides novel evidence indicating decelerated epigenetic aging associated with mood stabilizers in patients with BD

Epigenetic clock analysis of blood samples from Japanese schizophrenia patients

The accelerated aging hypothesis of schizophrenia (SCZ) has been proposed. DNA methylation profiles were developed for determining “epigenetic age.” Here, we assessed intrinsic and extrinsic epigenetic age acceleration (IEAA and EEAA, respectively) in SCZ. We examined two independent cohorts of Japanese ancestry. The first cohort consisted of 80 patients with SCZ under long-term or repeated hospitalization and 40 controls, with the economical DNA pooling technique. The second cohort consisted of 24 medication-free patients with SCZ and 23 controls. Blood of SCZ subjects exhibited decreased EEAA in the first cohort (p = 0.0162), but not in the second cohort. IEAA did not differ in either cohort. We performed replication analyses using publicly available datasets from European ancestry (three blood and one brain datasets). One blood dataset showed increased EEAA in SCZ (p = 0.0228). Overall, our results provide evidence for decreased EEAA in SCZ associated with hospitalization in the Japanese population

Basement Membrane beneath Serous Mesothelial Cells Contains α1(IV), α2(IV), α5(IV), and α6(IV) Chains of Type IV Collagen Demonstrated by Chain-specific Monoclonal Antibodies

Serous membrane (SM) covers inner surface of abdominal, thoracic and pericardial cavities, aswell as outer surface of organs inside the cavities. It consists of surface mesothelial cells andloose connective tissue. Between them, a thim layer of basement membrane (BM) is located. Type IVcollagen is major constituent of BM, and consists of 6 different a(IV) chains, a1(IV) through a6(IV).Chain-specific functions are assumed by a chain-specific manner of localization. The a(IV) chaincomposition of skin, covering outer surface of the body, is demonstrated to have a1(IV), a2(IV), a5(IV),and a6(IV) chains, whereas that of SM, covering inner surface of the body, is yet to be analyzed. Abdominal wall, small intestine, thoracic wall, lung, pericardium and epicardium of humanmaterials were used in this study. Chain-specific monoclonal antibodies (mAbs) used were H11(for a1), H22 (for a2), H31 (fo a3), H43 (for a4), H53 (for a5) and H63 (for a6). Fresh frozen sectionswere stained with indirect immunofluorescence staining using the mAbs. Four out of six a(IV) chains, a1, a2, a5 and a6, were demonstrated in BM beneath themesothelial cells of all types of SMs, whereas only capillary BM consisted of a1 and a2. Besides,epicardial SM expressed a3 and a4 moderately as extra components. The a(IV) chain composition was same as those of epidermal skin BM. Therefore, these a(IV)chains are designated to be essential for BM covering inside and outside of the body

言語聴覚士実習生の臨床実習への満足度に影響する要因 : テキストマイニングによる検討

Objective: We investigated satisfaction with on-the-job training among 129 speech, language, and hearing therapy trainees.Materials and methods: Text mining analysis was performed to analyze factors that influenced trainee satisfaction regarding on-the-job training. Results: Among trainees with higher satisfaction and higher grades, the training opportunity increased their internal locus of control through the knowledge and therapy skills acquired and the exchanges with trainers and other staff. However, trainees with lower satisfaction tended to cite external factors such as the length of training or the training format as the cause. Conclusion: Our results suggest that students with a lower internal locus of control need to experience many successes throughout an intramural simulated on-the-job training curriculum