Search

We compared the efficacy and complication rates of quantitative radiofrequency ablation guided by ablation index (RFCA-AI) with those of second-generation cryoballoon ablation (CBA-2). Consecutive patients (n = 230) with symptomatic atrial fibrillation (AF) undergoing a first ablation CBA-2 (92 patients) or RFCA-AI (138 patients) procedure were enrolled in this study. The late recurrence rate in the CBA-2 group was higher than that in the RFCA-AI group (P =.012). Subgroup analysis showed the same result in patients with paroxysmal AF (PAF) (P =.039), but no difference was found in patients with persistent AF (P =.21). The average operation duration in the CBA-2 group (85 [75-99.5] minutes) was shorter than that in the RFCA-AI group (100 [84.5-120] minutes) (P <.0001), but the average exposure time (17.36(13.87-22.49) vs 5.49(4.00-8.24) minutes) in the CBA-2 group and X-ray dose (223.25(149.15-336.95) vs 109.15(80.75-168.7) mGym) were significantly longer than those in RFCA-AI group (P <.0001). Multivariate logistic regression analysis showed that left atrial diameter (LAD), early recurrence, and methods of ablation (cryoballoon ablation) were independent risk factors for late recurrence after AF ablation. Early recurrence of AF and LAD were independent risk factors for predicting late recurrence after AF ablation. [ABSTRACT FROM AUTHOR]

Telmisartan is an angiotensin II receptor blocker that displays unique PPAR-γ modulating activity. PPAR-γ Agonists have been shown to decrease susceptibility to atrial fibrillation through their antioxidant and antiapoptotic effects. The aim of this study was to determine whether telmisartan would have a greater effect on susceptibility to atrial arrhythmia in a hypertensive rat model than valsartan, which is a traditional angiotensin II receptor blocker. In this study, spontaneously hypertensive rats were treated with 10 mg *[(kg body mass).sup.-1]*[d.sup.-1] telmisartan (TEL group), 10 mg-[(kg body mass).sup.-1]*[d.sup.-1] valsartan (VAL group), or vehicle (saline; SHR group) for 4 weeks. Age-matched Wistar-Kyoto rats (WKY) were used as normotensive controls. After 4 weeks of treatment, we performed echocardiographic assessment, electrophysiological analysis, histological evaluation, and Western blot analysis. Telmisartan decreased systolic blood pressure to a similar extent as valsartan. Relative to the WKY controls, atrial arrhythmia susceptibility was significantly increased in the SHR group, and was significantly decreased by both telmisartan and valsartan, albeit to a greater extent with telmisartan. Arrhythmogenic atrial remodeling, including enlargement of the left atrium, myocyte hypertrophy, interstitial fibrosis, and myocyte apoptosis, was observed in the SHR group, and was accompanied by activated RAS-ERK signaling and suppressed PI3K-Akt-eNOS signaling. The results suggest that telmisartan reduced susceptibility to atrial arrhythmia to a greater extent than valsartan, ameliorated atrial remodeling, and reversed imbalances in the RAS-ERK and PI3K-Akt-eNOS pathways. Key words: hypertension, atrial fibrillation, structural remodeling, angiotensin receptor blockers, signaling pathway. Le telmisartan est un antagoniste du recepteur de l'angiotensine II qui exerce une activite modulatrice PPAR-γ unique. Les agonistes du PPAR-γ se sont averes diminuer la susceptibilite a la fibrillation auriculaire grace a leurs proprietes antioxydantes et anti-apoptose. Le but de cette etude etait de determiner si le telmisartan exercerait un effet sur la susceptibilite a l'arythmie auriculaire superieur a celui du valsartan, un antagoniste du recepteur de l'angiotensine II traditionnel, dans un modele de rats hypertendus. Dans cette etude, des rats spontanement hypertendus (SHR) ont ete traites avec 10 mg x [(kg de masse corporelle).sup.-1] x [jour.sup.-1] de telmisartan (TEL), 10 mg-[(kg de masse corporelle).sup.-1] x [jour.sup.-1] de valsartan (VAL) ou le vehicule (saline) pendant 4 semaines. Des rats Wistar-Kyoto (WKY) appareilles suivant l'age ont ete utilises comme controles normotensifs. Apres 4 semaines de traitement, des evaluations par echocardiographie, des analyses par electrophysiologie, des evaluations histologiques et des buvardages Western ont ete realises. Le telmisartan diminuait la pression sanguine systolique au meme degre que le valsartan. Comparativement aux controles WKY, la susceptibilite a l'arythmie auriculaire etait significativement accrue chez les rats SHR et significativement diminuee par le telmisartan et la valsartan, quoique le telmisartan ait ete plus efficace (TEL vs VAL). Un remodelage auriculaire arythmogenique, incluant l'elargissement de l'oreillette gauche, l'hypertrophie des myocytes, la fibrose interstitielle et l'apoptose des myocytes, etait observe chez les animaux SHR et il etait accompagne d'une activation de la signalisation RAS-ERK et d'une suppression de la signalisation PI3K-Akt-eNOS. Ces resultats suggerent que le telmisartan a reduit la susceptibilite a l'arythmie auriculaire dans une plus large mesure que le valsartan, a ameliore le remodelage auriculaire et a renverse les debalancements entre les voies de signalisation RAS-ERK et PI3K-Akt-eNOS. [Traduit par la Redaction] Mots-cles : hypertension, fibrillation auriculaire, remodelage structural, antagonistes du recepteur de l'angiotensine, voie de signalisation., Introduction Atrial fibrillation (AF), an important risk factor for stroke and mortality, is the most prevalent arrhythmia diagnosed in clinical practice (Wilhelmsen et al. 2001). Hypertension is a strong and [...]

This report explores some properties of 80-200 nm nanoparticles containing 5-aminolevulinic acid ( ALA) and fullerene (C60) for photodynamic therapy (PDT). Compared with ALA, the nanoparticles yielded more protoporphyrin IX (Pp IX) formation in cells and tissues and to a significant improvement in antitumor efficacy in tumor-bearing mice. Maximum levels of Pp IX were obtained 4 h after administration and selective Pp IX formation in tumor was observed. These nanoparticles appear to be a useful vehicle for drug delivery purposes. In this study, a procedure for preparing fullerene nanoparticles containing ALA was developed. The product alone exhibited no detectable toxicity in the dark and was superior to ALA alone in promoting Pp IX biosynthesis and PDT efficacy both in culture and in a murine tumor model. These results suggest that this procedure could be the basis for an improved PDT protocol for cancer control. [ABSTRACT FROM AUTHOR]

Highlights: Abnormal changes in P-wave parameters indicative of atrial electrical remodeling often manifest earlier than changes in other indicators reflecting atrial structural remodeling in paroxysmal atrial fibrillation. Preoperative absolute values of Maximum P Wave Duration, P Wave Dispersion, and P Wave Terminal Force of V1, as well as postoperative absolute values of Maximum P Wave Duration, P Wave Duration, P Wave Dispersion, P Wave Terminal Force of V1, and P Wave Area, demonstrate strong predictive value for recurrence risk of paroxysmal atrial fibrillation after Catheter Ablation. The nomogram model based on P-wave parameters before and after catheter ablation exhibits notably strong predictive performance and offers significant clinical benefits. Objective: The objective of this study is to assess the predictive utility of perioperative P-wave parameters in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation, and to develop a predictive model using these parameters. Methods: A total of 213 patients with PAF undergoing catheter ablation were retrospectively analyzed. P-wave parameters were measured within 3 days preoperatively and on the day postoperatively to determine their predictive significance for postoperative PAF recurrence. Results: Post-ablation, PAF did not recur in 168 patients, while 45 experienced recurrence. Significant differences were observed in preoperative P-wave parameters as Maximum P Wave Duration(Pmax), absolute value of P Wave Terminal Force of V1 (PtfV1) and P Wave Dispersion(Pd), postoperative P-wave parameters as P Wave Duration (PWDII, III, aVF), Pmax, P Wave Area(P-area), absolute value of PtfV1 and Pd, and changes in perioperative P-wave parameters (Delta-Pmax, Delta-PtfV1 absolute value, Delta-Pd, Delta-PWDII, III, aVF). Univariate logistic regression, receiver operating characteristic (ROC) curve analysis, and hazard ratio assessment identified predictive indicators for postoperative recurrence, including Pmax, PtfV1 absolute value, Pd, post-P area, post-PWDII, III, aVF and Delta-pwdII, III, aVF). A personalized nomogram model based on these P-wave parameters was developed. Calibration curve assessment demonstrated that the predictive performance of the nomogram for PAF recurrence following catheter ablation closely matched actual observed outcomes. ROC curve analysis indicated a sensitivity of 89.3% for the model, and decision curve analysis confirmed its significantly favorable predictive use and clinical benefits. Conclusions: P-wave parameters like PWDШ, PWDaVF, Pmax, Pd, and PtfV1 serve as predictors of PAF recurrence following catheter ablation. The nomogram model constructed using these P-wave parameters demonstrates robust predictive performance. [ABSTRACT FROM AUTHOR]

Objective: Collect the characteristics of patients' baseline data, and explore the predictive factors of late recurrence of atrial fibrillation (AF) after catheter ablation according to whether late recurrence or not. The purpose of this study was to determine the significance of the APPLE score in conjunction with the monocyte-high-density lipoprotein cholesterol ratio (MHR) in predicting the late recurrence of AF after catheter ablation in patients with AF., Methods: Baseline data were collected to explore the predictors of late recurrence after AF catheter ablation. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to compare the predictive value of MHR, the APPLE score and their combined variables in the late recurrence of AF after catheter ablation., Results: This is a retrospective study. A total of 438 patients were followed-up, including 303 cases of paroxysmal AF, 135 cases of persistent AF (28 cases of long-term persistent AF) and 115 cases of late recurrence. The Cox multivariate regression analysis revealed that MHR, the APPLE score and early recurrence were independent predictors of the late recurrence of AF. The AUC of the combined variables for predicting late recurrence after catheter ablation in patients with AF was higher than that of MHR and the APPLE score (p<0.05). The ROC AUC of the combined variables in predicting the late recurrence of AF after catheter ablation was 0.733 (p<0.001, 95% CI: 0.660 to 0.806), and the best cut-off point was 0.2711 (sensitivity: 69.20%, specificity: 68.00%)., Conclusions: Early recurrence, MHR and the APPLE score are independent risk factors for the late recurrence of AF after catheter ablation. The combination of the APPLE score with MHR improved the value of predicting the late recurrence of AF after catheter ablation. The combined variables were a predictor of an increased late recurrence rate after catheter ablation for AF when the value was greater than 0.2711., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Ahead of Print article withdrawn by publisher.

Aim: To review and evaluate the diagnostic dilemma of xanthogranulomatous cholecystitis (XGC) clinically., Methods: From July 2008 to June 2014, a total of 142 cases of pathologically diagnosed XGC were reviewed at our hospital, among which 42 were misdiagnosed as gallbladder carcinoma (GBC) based on preoperative radiographs and/or intra-operative findings. The clinical characteristics, preoperative imaging, intra-operative findings, frozen section (FS) analysis and surgical procedure data of these patients were collected and analyzed., Results: The most common clinical syndrome in these 42 patients was chronic cholecystitis, followed by acute cholecystitis. Seven (17%) cases presented with mild jaundice without choledocholithiasis. Thirty-five (83%) cases presented with heterogeneous enhancement within thickened gallbladder walls on imaging, and 29 (69%) cases presented with abnormal enhancement in hepatic parenchyma neighboring the gallbladder, which indicated hepatic infiltration. Intra-operatively, adhesions to adjacent organs were observed in 40 (95.2%) cases, including the duodenum, colon and stomach. Thirty cases underwent FS analysis and the remainder did not. The accuracy rate of FS was 93%, and that of surgeon's macroscopic diagnosis was 50%. Six cases were misidentified as GBC by surgeon's macroscopic examination and underwent aggressive surgical treatment. No statistical difference was encountered in the incidence of postoperative complications between total cholecystectomy and subtotal cholecystectomy groups (21% vs 20%, P > 0.05)., Conclusion: Neither clinical manifestations and laboratory tests nor radiological methods provide a practical and effective standard in the differential diagnosis between XGC and GBC.

Objective: To investigate the time course of myocardial NF-kappaB activation and association with cardiac function and other pro-inflammation cytokines following coronary microembolization (CME)., Methods: CME was induced by homologous microthrombotic particle suspension injection into left ventricle with simultaneous short-term ascending aorta clamping. The CME rats were randomized to untreated group and pyrrolidine dithiocarbamate (PDTC, a specific NF-kappaB inhibitor) treated group (n = 32 respectively). The rats were sacrificed on day 1, 3, 7 and 14 post-operationally (n = 8 each). Twenty-four rats were sham-operated and served as controls. NF-kappaB DNA-binding activity was evaluated by electrophoretic mobility shift assay (EMSA), protein expressions of TNFalpha, IL-6 and ICAM-1 were analyzed by Western blotting, the dynamic alterations of TNFalpha, IL-6 and ICAM-1 mRNA were quantitatively assessed by Real-time PCR post hemodynamic measurements., Results: NF-kappaB DNA-binding activity in CME group was significantly increased than that of sham group on day 1, peaked at day 3 and was similar as that in sham rats on day 14. The protein and mRNA expressions of TNFalpha, IL-6 and ICAM-1 were significantly increased in CME group at various time points compared those in sham rats. NF-kappaB DNA-binding activity positively correlated with mRNA expressions of TNFalpha, IL-6, ICAM-1, respectively (r = 0.72, P < 0.05; r = 0.94, P < 0.01; r = 0.62, P < 0.05). PDTC significantly suppressed protein and mRNA expressions of TNFalpha, IL-6 and ICAM-1 (P < 0.05) and improved left ventricular function., Conclusion: NF-kappaB activation post CME could upregulate the gene transcriptions of TNFalpha, IL-6, ICAM-1 and enhance inflammatory responses and aggravate left ventricular dysfunction.

Objective: To investigate the effects of granulocyte colony stimulating factor (G-CSF) on myocardial apoptosis following coronary microembolization (CME) and possible role of Janus kinase/singnal transducer and activator of transcription (JAK/STAT) pathway in this process., Methods: A total of 92 male Sprague Dawley rats were randomized into CME (n = 24), G-CSF (100 microg x kg(-1) x d(-1) i.p. 2 hours post CME for 5 days, n = 24), JAK2 inhibitor AG490 (G-CSF plus AG490, 5 mg x kg(-1) x d(-1) i.p. 2 hours post CME for 5 days, n = 24), all rats received left ventricular injection of homologous microthrombotic particle suspension post clamping the ascending aorta. Sham-operated group (n = 20) served as control. The rats were sacrificed at day 3, 7, 14 and 28 after operation. The myocardial mRNA expressions of Bcl-2, Bax, Fas, FasL and GAPDH which was used as the intercomparison, were evaluated by real time PCR. The ratio of Bcl-2/Bax was compared. The protein expression of Caspase-3, cleaved PARP, t-JAK2, p-JAK2, t-STAT3 and p-STAT3 were detected by western blot. Myocardial apoptosis were examined by TUNEL staining., Results: Compared with Sham rats, the mRNA of Bcl-2, Bax, Fas and FasL significantly increased whereas the ratio of Bcl-2/Bax (0.28 +/- 0.04 vs. 2.98 +/- 0.49) significantly decreased and the protein expression of Caspase-3 (0.762 +/- 0.129 vs. 0.133 +/- 0.027), PARP (0.992 +/- 0.146 vs. 0.386 +/- 0.074) and the myocardial apoptosis index (17.2 +/- 1.9 vs. 1.2 +/- 0.6) significantly increased in CME hearts (all P < 0.05). rhG-CSF significantly attenuated CME induced changes and cotreatment with JAK2 inhibitor AG490 abolished the effects of rhG-CSF. The protein expressions of t-JAK2 and t-STAT3 among the groups were similar. P-JAK2 and p-STAT3 protein expressions were significantly increased in G-CSF group compared to other groups (P < 0.05)., Conclusion: G-CSF attenuated myocardial apoptosis induced by CME via JAK2/STAT3 pathway.