Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (the Achieve Plus study).

BACKGROUND: Validation of pulmonary vein (PV) isolation (PVI) using only the Achieve catheter following cryoballoon ablation (CBA) is imperfect since pulmonary vein potentials (PVP) can be recorded in only 50-85% of the veins and residual PVP are found in up to 4.3-7.6% of the isolated veins in remapping studies. OBJECTIVE: To study if addition of electroanatomical mapping to Achieve catheter-guided CBA is superior for PVI. METHODS: One hundred patients were randomized between Achieve catheter-guided CBA (control group; N = 50) and Achieve catheter-guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Achieve Plus group; N = 50). Confirmation of PVI was done by circular mapping catheter (CMC) and EnSite mapping by a second blinded operator. RESULTS: Despite apparent PVI in all PVs after CBA, incomplete PVI was present in 0 out of 50 patients (0%) and 0 out of 204 PVs in the Achieve Plus group versus 6 patients out of 50 (12%; P = 0.012) and 6 out of 203 PVs (3%; P = 0.013) in the control group. All 6 non-isolated PVs could be successfully isolated by additional cryoapplications. Procedure time was longer in the Achieve Plus group (75.76 ± 21.65 vs 66.06 ± 16.83 min; P = 0.014) with equal fluoroscopy times (14.85 ± 6.41 vs 14.33 ± 8.55; P = 0.732). CONCLUSION: The addition of electroanatomical EnSite mapping to the Achieve catheter improves the PVI rate of CBA and could be considered for future use. Design and Results of the Achieve Plus study. The Achieve Plus study shows that the addition of electro-anatomical EnSite mapping to the Achieve catheter improves PVI rate of CBA and could be considered for future use. See text for further explanation. ABBREVIATIONS: CBA: cryoballoon ablation; PVI: pulmonary vein isolation.

Vascular phenotype at 35-37 weeks' gestation in women with gestational diabetes mellitus.

OBJECTIVES: To examine the vascular phenotype at 35-37 weeks' gestation of women with gestational diabetes mellitus (GDM) and compare it to that in women without GDM, using ophthalmic artery Doppler and carotid-femoral pulse-wave velocity. METHODS: This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 37 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ophthalmic artery Doppler for calculation of the peak systolic velocity (PSV) ratio and assessment of cardiac output, stroke volume, total peripheral resistance, central systolic and diastolic blood pressure, carotid-femoral pulse-wave velocity and augmentation index. All measurements were standardized to remove the effects of maternal characteristics and elements from the medical history, and the adjusted values in the GDM group were compared with those in the non-GDM group. RESULTS: The study population of 2018 pregnancies contained 218 (10.8%) that developed GDM, including 78 (35.8%) that were treated with diet alone, 81 (37.2%) treated with metformin and 59 (27.1%) treated with insulin with or without metformin. In the GDM group, compared with the non-GDM group, there were significantly higher ophthalmic artery PSV ratio, carotid-femoral pulse-wave velocity and central systolic blood pressure, but there was no significant difference in cardiac output, stroke volume, total peripheral resistance, central diastolic blood pressure or augmentation index. In the GDM group, women treated with metformin or insulin had a higher ophthalmic artery PSV ratio compared with those treated with diet alone. Additionally, compared with the diet group, the metformin group had higher central systolic blood pressure and the insulin group had a higher carotid-femoral pulse-wave velocity. CONCLUSION: Women with GDM have evidence of early vascular disease, and this may contribute to their long-term cardiovascular risk. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Identification of the unculturable bacteria Candidatus arthromitus in the intestinal content of trouts using Dot blot and Southern blot techniques.

The rainbow trout gastroenteritis (RTGE) syndrome is affecting progressively more sites in various European countries causing significant economical losses for the rainbow trout industries. As Candidatus arthromitus, a not yet culturable bacteria, is the microorganism responsible for the RTGE, molecular methods have been identified as an important tool for the identification of this microorganism. An early, fast and specific detection of C. arthromitus using specific primers and probes, are important goals for the aquaculture sector. In the present study were used: a polymerase chain reaction (PCR), using universal primers annealing the 16S rRNA gene, to obtain amplification products representatives of the microbiota present in the intestinal content of trouts, including C. arthromitus when present; a denaturing gradient gel electrophoresis (DGGE) to produce DNA finger printings corresponding to the microbiota present in the intestinal contents of each trout analysed; a specific DNA probe designed within the 16S rDNA that was used both in Dot blot and Southern blot techniques to detect the unculturable bacterium C. arthromitus. Dot blot applied directly onto DNA extracted from the intestinal contents allowed a fast identification of the samples containing C. arthromitus. Southern blotting allowed the identification of the specific DNA band corresponding to C. arthromitus among the various DNA bands obtained by the utilisation of the universal primers and run in DGGE. Molecular methods such as Dot blot and Southern blot are useful methods for a fast identification of the unculturable C. arthromitus.

Phenolic composition and free radical scavenging activity of different apple varieties in relation to the cultivar, tissue type and storage.

The aim of this research was to evaluate the influence of genotype, tissue type and cold storage on the bioactive compounds content and on the antiradical activity (AA) of different apple cultivars (Golden cl. B, Fuji cl. Kiku8, Braeburn cl. Hillwell). The content of analysed phyto-compounds depended on the clone, on the part of fruit, and to a minor extent, on the storage. For EC(50) data, the cultivar represented the main source of variation and the interaction with the type of tissue, was significant. The AA of apples, measured by means of the DPPH test, was highly correlated to the flavan-3-ols content, which represents a good predictor of the apple antiradical power. The new Braeburn's clone, the Hillwell, had the worst AA related to a minor phyto-chemical content. Also, its phenolic content was dramatically reduced after cold storage (flesh: -50%; peels: -20%; p<0.05). Obtained results underlined the key role of the genotype on the content of the nutraceutical power of apples, which is important to improve their quality and consumption benefits, suggesting to the breeders to pay more attention to the potential healthy compounds in the development of new hybrids.

Adipocyte expression and circulating levels of leptin increase in both gynaecological and breast cancer patients.

Leptin is a hormone involved in the regulation of body weight and sexual maturation. We previously reported that cancer cachexia was associated with reduced or normal levels of leptin. Here we investigate whether leptin levels are related to cachetic or hormonal status. Circulating leptin and its mRNA from adipose tissue were measured in 87 patients with gynaecological and breast cancers and related to tumour, cachexia and hormonal markers. We found that leptin protein increased in patients with these tumours due to higher mRNA levels. In patients with ovarian cancer, the increased leptin levels were associated with higher circulating follicle-stimulating hormone (FSH). The higher leptin concentrations in patients with endometrial and portio tumours were related to an increase in tissue estrogen receptor (ER) and progesterone receptor (PGR) and, only in the postmenopause, to an increase in circulating estradiol. Patients with breast cancer showed enhanced blood plasma concentrations of progesterone and estradiol, and enhanced tissue levels of ER and PGR associated with increased leptin levels. The data from the present study indicate that, in gynaecological and breast cancers, leptin is related to hormonal status but not to cachexia. We suggest that leptin stimulates the production of sexual hormones, important risk factors for these tumours, and we propose leptin as a novel prognostic marker.

Enalapril in the treatment of hypertension associated with renal failure: results from a multicenter study.

Forty-eight hypertensive patients affected by various levels of renal failure entered this open, non controlled study, lasting 12 weeks. Patients were divided into two groups according to baseline creatinine clearance: Group I (29 patients): creatinine clearance greater than or equal to 25 ml/min but less than 45 ml/min; Group II (19 patients): creatinine clearance greater than or equal to 10 ml/min but less than 25 ml/min. Patients in Group I started with enalapril 5 mg q.d. and patients in Group II with enalapril 2.5 mg q.d. Enalapril could be titrated up to 20 mg/day. At the end of the study in both groups of patients blood pressure normalization was reached in a high percentage of patients without any significant change in renal function parameters. Plasma potassium showed a significant increase during the study but no patient discontinued treatment due to hyperkaliemia. In conclusion this study shows antihypertensive therapy with enalapril during chronic renal insufficiency to be effective at low dosage (5-10 mg) in lowering blood pressure and to have a good safety profile.