Rare crested rat subfossils unveil Afro-Eurasian ecological corridors synchronous with early human dispersals.

Biotic interactions between Africa and Eurasia across the Levant have invoked particular attention among scientists aiming to unravel early human dispersals. However, it remains unclear whether behavioral capacities enabled early modern humans to surpass the Saharo-Arabian deserts or if climatic changes triggered punctuated dispersals out of Africa. Here, we report an unusual subfossil assemblage discovered in a Judean Desert's cliff cave near the Dead Sea and dated to between ∼42,000 and at least 103,000 y ago. Paleogenomic and morphological comparisons indicate that the specimens belong to an extinct subspecies of the eastern African crested rat, Lophiomys imhausi maremortum subspecies nova, which diverged from the modern eastern African populations in the late Middle Pleistocene ∼226,000 to 165,000 y ago. The reported paleomitogenome is the oldest so far in the Levant, opening the door for future paleoDNA analyses in the region. Species distribution modeling points to the presence of continuous habitat corridors connecting eastern Africa with the Levant during the Last Interglacial ∼129,000 to 116,000 y ago, providing further evidence of the northern ingression of African biomes into Eurasia and reinforcing previous suggestions of the critical role of climate change in Late Pleistocene intercontinental biogeography. Furthermore, our study complements other paleoenvironmental proxies with local-instead of interregional-paleoenvironmental data, opening an unprecedented window into the Dead Sea rift paleolandscape.

Very late recurrences of atrial fibrillation after pulmonary vein isolation.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, accounting for approximately one-third of all hospitalizations from cardiac rhythm disturbances. Over the past decade, catheter ablation (predominantly in the form of pulmonary vein isolation [PVI]) has become an important therapy in the treatment of patients with symptomatic, drug-refractory AF. Despite the improvements in technology, operator experience, and advances in methodology that have led to higher success rates and a reduction in complications, the recurrence rate of AF after PVI is still relatively high. Published studies suggest that approximately 33% to 86% of patients undergoing catheter ablation of AF have freedom from recurrent AF, with 30% to 40% requiring a second procedure. Although most studies looking at the efficacy of PVI are limited by relatively short follow-up, recent data suggest that patients with an initially favorable procedural response may have very late recurrences of AF, even years after PVI. It is likely that the mechanism behind very late recurrences of AF is multifactorial, involving both recurrent pulmonary vein triggers and progressive remodeling of left atrial substrate over time, making it more vulnerable to triggering. These recurrences have important clinical implications in the care of patients, specifically with regard to the increased risk of stroke associated with AF.