Successful low-energy cardioversion using a novel biodegradable gel pad: Feasibility of treating postoperative atrial fibrillation in animals

ObjectivePostoperative atrial fibrillation is one of the most frequent complications of cardiac surgery. We developed a novel biodegradable gel pad consisting of biopolymers that directly attach to the myocardium by electrostatic interaction. The present study examines the feasibility and effectiveness of low-energy internal cardioversion using these pads.MethodsThe hearts of 6 pigs were exposed through a median sternotomy under general anesthesia, and 2 monopolar pacing wires were placed on the left pulmonary veins (chest open group). Two biodegradable cardioversion gel pads were placed on the right appendage and the left atria without suturing. All wires were extruded through the skin and secured with a suture. Sustained atrial fibrillation was induced by burst-pacing from the pulmonary veins in continuous 20-ms cycles. Shock intensity started at 0.5 J, and the energy level was increased in 0.5-J increments until cardioversion occurred. This protocol was repeated 5 times per pig. In a second group of 6 pigs (chest closed group), the epicardial cardioversion electrode gel pads and pacing wire electrodes were positioned as described above. Shock intensity was started at 0.5 J. If the shock was unsuccessful, the energy level was increased in 0.5-J increments until 2 consecutive cardioversions were achieved at a single energy level. At postoperative days 1, 3, 5, and 7, the defibrillation threshold was determined with the chest closed. At postoperative day 10, the cardioversion wires were removed. At predetermined time intervals, the heart was reexposed and the extent of degradation in vivo was visually evaluated and histologically assessed after sacrifice.ResultsAll pigs with induced atrial fibrillation were cardioverted to sinus rhythm on the determined postoperative day. The mean energy and lead impedance in the chest open group were 0.65 ± 0.23 J and 97.6 ± 5.52 Ω, respectively, and the overall values of mean energy and lead impedance in the chest closed group were 1.67 ± 1.00 J and 75.9 ± 13.3Ω, respectively. No complications were observed after wire removal. The gel pads became degraded and decreased in thickness, and signs of mild inflammation were evident on the gel pad. However, the gel pads did not elicit significant severe inflammatory reactions according to both gross and histologic assessments at 1 month after the surgery.ConclusionAtrial cardioversion using novel biodegradable gel pads that are easily affixed may afford a straightforward and effective treatment for atrial fibrillation after cardiac surgery

The first isolation of Aspergillus allahabadii from a cormorant with pulmonary aspergillosis

In this study, we report the first isolation of Aspergillus allahabadii from a Japanese cormorant with pulmonary aspergillosis. We performed molecular identification and antifungal susceptibility testing with the E-test. A 7-month-old male cormorant died because of uric acid deposition secondary to dehydration. Whitish nodular lesions were present on the caudal thoracic air sac in the right thoracic cavity. Histopathology revealed multifocal pyogranulomatous necrotic lesions with numerous fungal hyphae in the thoracic air sac. Identification of the etiologic agent was confirmed by comparative analyses of the sequences of the internal transcribed spacer (ITS) region and β-tubulin-encoding genes. According to the E-test, the minimum inhibitory concentrations of the isolate to amphotericin B, fluconazole, itraconazole, and voriconazole were 0.75 μg/ml, >256 μg/ml, 0.38 μg/ml, and 0.38 μg/ml, respectively

SORL1 Is Genetically Associated with Late-Onset Alzheimer’s Disease in Japanese, Koreans and Caucasians

To discover susceptibility genes of late-onset Alzheimer’s disease (LOAD), we conducted a 3-stage genome-wide association study (GWAS) using three populations: Japanese from the Japanese Genetic Consortium for Alzheimer Disease (JGSCAD), Koreans, and Caucasians from the Alzheimer Disease Genetic Consortium (ADGC). In Stage 1, we evaluated data for 5,877,918 genotyped and imputed SNPs in Japanese cases (n = 1,008) and controls (n = 1,016). Genome-wide significance was observed with 12 SNPs in the APOE region. Seven SNPs from other distinct regions with p-values ,261025 were genotyped in a second Japanese sample (885 cases, 985 controls), and evidence of association was confirmed for one SORL1 SNP (rs3781834, P=7.3361027 in the combined sample). Subsequent analysis combining results for several SORL1 SNPs in the Japanese, Korean (339 cases, 1,129 controls) and Caucasians (11,840 AD cases, 10,931 controls) revealed genome wide significance with rs11218343 (P=1.7761029) and rs3781834 (P=1.0461028). SNPs in previously established AD loci in Caucasians showed strong evidence of association in Japanese including rs3851179 near PICALM (P=1.7161025) and rs744373 near BIN1 (P = 1.3961024). The associated allele for each of these SNPs was the same as in Caucasians. These data demonstrate for the first time genome-wide significance of LOAD with SORL1 and confirm the role of other known loci for LOAD in Japanese. Our study highlights the importance of examining associations in multiple ethnic populations

Meta-analysis of top-ranked association results with <i>SORL1</i> in Japanese, Korean, and Caucasian datasets.

<p>CH:MB, chromosome:position (in megabase pairs, build 19); MA, minor allele; MAF, minor allele frequenc; OR, odds ratio; <i>P</i> P-value.</p