Fluoroless catheter ablation of atrial fibrillation: a step-by-step workflow.

Catheter ablation is an important therapeutic strategy for patients with atrial fibrillation (AF). While some critical steps of the procedure have traditionally relied on fluoroscopy, advances in electroanatomic mapping and the growing use of intracardiac echocardiography have made non-fluoroscopic AF ablation a reality. This hands-on review provides an overview on how to perform radiofrequency ablation of AF without the use of fluoroscopy, focusing on technical aspects, new technologies, and troubleshooting.

Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: A cost-effectiveness analysis.

BACKGROUND: General anesthesia (GA) is the standard anesthetic approach for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times and to decrease post-procedural pain, all of which could result in a reduction in procedure-related costs. OBJECTIVE: The purpose of this study is to compare the cost-effectiveness of GA and TLA in patients undergoing S-ICD implantation. METHODS: The present study is a prospective, nonrandomized, controlled study of patients who underwent S-ICD implantation between 2019 and 2022. Patients were allocated to either the TLA or the GA group. We performed a cost analysis for each intervention. As an effectiveness measure, the 0-10 point Numeric Pain Rating Scale at 1, 12, and 24 hours post-implantation was analyzed and compared between the groups. A score of 0 was considered no pain; 1-5, mild pain; 6-7, moderate pain; and 8-10, severe pain. Cost-effectiveness was calculated using incremental cost-effectiveness ratios. RESULTS: Seventy patients underwent successful S-ICD implantation. The total cost of the electrophysiology laboratory was higher in the GA group than in the TLA group (median ± interquartile range US$55,824 ± US$29,411 vs US$37,222 ± US$24,293; P < .001), with a net saving of $20,821 when compared with GA for each S-ICD implantation. There was a significant decrease in post-procedural pain scores in the TLA group when compared with the GA group (repeated measures analysis of variance, P = .009; median ± interquartile range 0 ± 3 vs 0 ± 5 at 1 hour, P = .058; 3 ± 4 vs 6 ± 8 at 12 hours, P = .030; 0 ± 4 vs 2 ± 6 at 24 hours, P = .040). CONCLUSION: TLA is a more cost-effective alternative to GA for S-ICD implantation, with both direct and indirect cost reductions. Importantly, these reduced costs are associated with reduced postprocedural pain.

Microalgae bioreactor for nutrient removal and resource recovery from wastewater in the paradigm of circular economy.

Every day, large quantities of wastewater are discharged from various sources that could be reused. Wastewater contains nutrients such as nitrogen or phosphorus, which can be recovered. Microalgae-based technologies have attracted attention in this sector, as they are able to bioremediate wastewater, harnessing its nutrients and generating algal biomass useful for different downstream uses, as well as having other advantages. There are multiple species of microalgae capable of growing in wastewater, achieving nutrient removal efficiencies surpassing 70%. On the other hand, microalgae contain lipids that can be extracted for energy recovery in biodiesel. Currently, there are several methods of lipid extraction from microalgae. Other biofuels can also be obtained from microalgae biomass, such as bioethanol, biohydrogen or biogas. This review also provides information on bioenergy products and products in the agri-food industry as well as in the field of human health based on microalgae biomass within the concept of circular bioeconomy.

Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation.

BACKGROUND: Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to transvenous implantable cardioverter-defibrillator. General anesthesia (GA) is considered the standard sedation approach because of the pain caused by the manipulation of subcutaneous tissue with S-ICD implantation. However, GA carries several limitations, including additional risk of adverse events, prolonged in-room times, and increased costs. OBJECTIVE: The purpose of this study was to define the effectiveness and safety of tumescent local anesthesia (TLA) in comparison to GA in patients undergoing S-ICD implantation. METHODS: We performed a prospective, nonrandomized, controlled, multicenter study of patients referred for S-ICD implantation between 2019 and 2020. Patients were allocated to either TLA or GA on the basis of patient's preferences and/or anesthesia service availability. TLA was prepared using lidocaine, epinephrine, sodium bicarbonate, and sodium chloride. All patients provided written informed consent, and the institutional review board at each site provided approval for the study. RESULTS: Sixty patients underwent successful S-ICD implantation from July 2019 to November 2020. Thirty patients (50%) received TLA, and the rest GA. There were no differences between groups with regard to baseline characteristics. In-room and procedural times were significantly shorter with TLA (107.6 minutes vs 186 minutes; P < .0001 and 53.2 minutes vs 153.7 minutes; P < .0001, respectively). Pain was reported less frequently by patients who received TLA. The use of opioids was significantly reduced in patients who received TLA (23% vs 62%; P = .002). CONCLUSION: TLA is an effective and safe alternative to GA in S-ICD implantation. The use of TLA is associated with shorter in-room and procedural times, less postprocedural pain, and reduced usage of opioids and acetaminophen for analgesia.

Methodology of Typical Accessory Pathway Catheter Ablation.

Accessory pathways are abnormal electrical conductions between the atrial and ventricular myocardium, bypassing the atrioventricular node and as such are an important substrate for arrhythmias. Ablation is a curative treatment and should always be offered to symptomatic patients and asymptomatic patients with high risk professions. Adequate knowledge and understanding of different mapping and ablation techniques is pivotal to achieve successful outcomes.

Modern mapping and ablation techniques to treat ventricular arrhythmias from the left ventricular summit and interventricular septum.

Managing arrhythmias from the left ventricular summit and interventricular septum is a major challenge for the clinical electrophysiologist requiring intimate knowledge of cardiac anatomy, advanced training and expertise. Novel mapping and ablation strategies are needed to treat arrhythmias originating from these regions given the current suboptimal long-term success rates with standard techniques. Herein, we describe innovative approaches to improve acute and long-term clinical outcomes such as mapping and ablation using the septal coronary venous system and the septal coronary arteries, alcohol ablation, coil embolization, and ablation of all early sites among others.

Antimicrobial Capacity of Plant Polyphenols against Gram-positive Bacteria: A Comprehensive Review.

BACKGROUND: Multi-drug-resistant bacteria such as Methicillin-Resistant Staphylococcus aureus (MRSA) disseminate rapidly amongst patients in healthcare facilities and suppose an increasingly important cause of community-associated infections and associated mortality. The development of effective therapeutic options against resistant bacteria is a public health priority. Plant polyphenols are structurally diverse compounds that have been used for centuries for medicinal purposes, including infections treatment and possess, not only antimicrobial activity, but also antioxidant, anti-inflammatory and anticancer activities among others. Based on the existing evidence on the polyphenols' antibacterial capacity, polyphenols may be postulated as an alternative or complementary therapy for infectious diseases. OBJECTIVE: To review the antimicrobial activity of plant polyphenols against Gram-positive bacteria, especially against S. aureus and its resistant strains. Determine the main bacterial molecular targets of polyphenols and their potential mechanism of action. METHODOLOGY: The most relevant reports on plant polyphenols' antibacterial activity and their putative molecular targets were studied. We also performed virtual screening of thousand different polyphenols against proteins involved in the peptidoglycan biosynthesis to find potential valuable bioactive compounds. The bibliographic information used in this review was obtained from MEDLINE via PubMed. RESULTS: Several polyphenols: phenolic acids, flavonoids (especially flavonols), tannins, lignans, stilbenes and combinations of these in botanical mixtures, have exhibited significant antibacterial activity against resistant and non-resistant Gram-positive bacteria at low µg/mL range MIC values. Their mechanism of action is quite diverse, targeting cell wall, lipid membrane, membrane receptors and ion channels, bacteria metabolites and biofilm formation. Synergic effects were also demonstrated for some combinations of polyphenols and antibiotics. CONCLUSION: Plant polyphenols mean a promising source of antibacterial agents, either alone or in combination with existing antibiotics, for the development of new antibiotic therapies.

Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin.

BACKGROUND: The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs) is challenging as activation mapping can reveal similar activation times in different anatomical sites, suggesting an intramural origin. OBJECTIVE: We sought to assess whether in patients with intramural VAs and with multiple early activation sites (EASs), sequential ablation of all the early EASs could improve acute and long-term clinical outcomes. METHODS: A total of 116 patients undergoing catheter ablation for symptomatic LVOT VAs were enrolled in this study. Thirty-nine patients (34%) were referred for a redo procedure, whereas the remaining presented for a first procedure. Mapping was performed manually in 86 cases (74%) and with a magnetic robotic system (Niobe, Stereotaxis, St. Louis, MO) in the remainder of the cases. RESULTS: Of the 116 patients, 15 (13%) were found to have multiple sites of equally early activation. In patients with multiple EASs, the mean pre-QRS activation time was significantly less than in patients with a single EASs (-26 ± 3 ms vs -38 ± 6 ms; P < .005). Sequential ablation of all the EASs was possible in 14 patients (93%), resulting in complete arrhythmia suppression. After a mean follow-up of 21 ± 5 months, all patients with successful ablation of all multiple early EASs remained free from clinical VAs. CONCLUSION: Intramural LVOT VAs manifesting with multiple EASs require ablation at all sites to achieve acute and long-term success, particularly if none of the EASs is > -30ms pre-QRS activation time.

Type C feruloyl esterase from Aspergillus ochraceus: a butanol specific biocatalyst for the synthesis of hydroxycinnamates in a ternary solvent system

Background: Aspergillus ochraceus was isolated from coffee pulp and selected as an interesting hydroxycinnamoyl esterase strain producer, using an activity microplate high-throughput screening method. In this work, we purified and characterized a new type C A. ochraceus feruloyl esterase (AocFaeC), which synthesized specifically butyl hydroxycinnamates in a ternary solvent system. Results: AocFaeC was produced by solid state fermentation, reaching its maximal activity (1.1 U/g) after 48 h of culture. After purification, the monomeric protein (34 kDa) showed a specific activity of 57.9 U/mg towards methyl ferulate. AocFaeC biochemical characterization confirmed its identity as a type C feruloyl esterase and suggested the presence of a catalytic serine in the active site. Its maximum hydrolytic activity was achieved at 40°C and pH 6.5 and increased by 109 and 77% with Ca2+ and Mg2+, but decreased by 90 and 45% with Hg2+ and Cu2+, respectively. The initial butyl ferulate synthesis rate increased from 0.8 to 23.7 nmol/min after transesterification condition improvement, using an isooctane:butanol:water ternary solvent system, surprisingly the synthesis activity using other alcohols was negligible. At these conditions, the synthesis specific activities for butyl p-coumarate, sinapinate, ferulate, and caffeate were 87.3, 97.6, 168.2, and 234 U/µmol, respectively. Remarkably, AocFaeC showed 5 folds higher butyl caffeate synthesis rate compared to type B Aspergillus niger feruloyl esterase, a well-known enzyme for its elevated activity towards caffeic acid esters. Conclusions: Type C feruloyl esterase from A. ochraceus is a butanol specific biocatalyst for the synthesis of hydroxycinnamates in a ternary solvent system

Carbohydrate Esterases: An Overview.

Carbohydrate esterases are a group of enzymes which release acyl or alkyl groups attached by ester linkage to carbohydrates. The CAZy database, which classifies enzymes that assemble, modify, and break down carbohydrates and glycoconjugates, classifies all carbohydrate esterases into 16 families. This chapter is an overview of the research for nearly 50 years around the main groups of carbohydrate esterases dealing with the degradation of polysaccharides, their main biochemical and molecular traits, as well as its application for the synthesis of high added value esters.

Informes acumulados de sensibilidad a los antimicrobianos / Antimicrobial susceptibility cumulative reports

Los informes de datos acumulados de antibiograma son útiles para la selección del tratamiento empírico, como herramienta educativa en los programas de utilización de antimicrobianos y para la definición de puntos de corte de categorías clínicas. Estos informes deben basarse en los datos, verificados por el microbiólogo clínico, de aislamientos obtenidos de muestras diagnósticas (y no las de programas de vigilancia). Para intentar evitar los sesgos derivados de incluir varios aislamientos del mismo paciente, se aconseja considerar, para un marco temporal definido, solamente el primero de ellos. El informe debe incluir un número mínimo de aislados por especie, aceptándose estadísticamente adecuada una cifra ≥ 30. El informe suele presentarse en forma de tablas, en las que en cada celda se presenta la información de microorganismos-antimicrobianos de relevancia clínica. Dependiendo de las necesidades se prepararán múltiples tablas que consideren tipos de pacientes, muestras, servicios o patógenos especiales

Cumulative reports on antimicrobial susceptibility tests data are important for selecting empirical treatments, as an educational tool in programs on antimicrobial use, and for establishing breakpoints defining clinical categories. These reports should be based on data validated by clinical microbiologists using diagnostic samples (not surveillance samples). In order to avoid a bias derived from including several isolates obtained from the same patient, it is recommended that, for a defined period, only the first isolate is counted. A minimal number of isolates per species should be presented: a figure of >=30 isolates is statistically acceptable. The report is usually presented in a table format where, for each cell, information on clinically relevant microorganisms-antimicrobial agents is presented. Depending on particular needs, multiple tables showing data related to patients, samples, services or special pathogens can be prepared

[Antimicrobial susceptibility cumulative reports]. / Informes acumulados de sensibilidad a los antimicrobianos.

Cumulative reports on antimicrobial susceptibility tests data are important for selecting empirical treatments, as an educational tool in programs on antimicrobial use, and for establishing breakpoints defining clinical categories. These reports should be based on data validated by clinical microbiologists using diagnostic samples (not surveillance samples). In order to avoid a bias derived from including several isolates obtained from the same patient, it is recommended that, for a defined period, only the first isolate is counted. A minimal number of isolates per species should be presented: a figure of >=30 isolates is statistically acceptable. The report is usually presented in a table format where, for each cell, information on clinically relevant microorganisms-antimicrobial agents is presented. Depending on particular needs, multiple tables showing data related to patients, samples, services or special pathogens can be prepared.

Efecto hipotensor del extracto metanólico de la piel de papa "lomo negro" Solanum tuberosum L (Solanaceae, nativa del Perú) por inhibición de la enzima convertidora de angiotensina en ratas con hipertensión experimental y normotensas: un estudio por métodos invasivos in vivo e in vitro / Hypotensive effect of the methanolic extract of the skin of potato "black loin" Solanum tuberosum L (Solanaceae, native of Peru) by inhibition of the angiotensin-converting enzyme in rats with experimental and normotensive hypertension: a study by invasive methods in vivo and in vitro

Relevancia etnofarmacológica: Solanum tuberosum (papa) es una de las especies utilizadas por la tradición popular en Colombia para el tratamiento de la hipertensión arterial; además, la papa morada (cv. Bora Valley) es usado en la medicina tradicional en Korea para la prevención de enfermedades metabólicas. En estudios previos el extracto etanólico de papa (Solanum tuberosum) administrados vía i.v. tanto en ratas hipertensas y normotensas produjo hipotensión arterial; y también el consumo de papa con piel de color morado en humanos hipertensos produjo hipotensión arterial.Objetivos: En el presente trabajo se evaluóin vivo los efectos del extracto metanólico de piel de papa "lomo negro" (Solanum tuberosum L.) (EMPST) administrados vía i.v. en ratas con hipertensión experimental con propranolol y normotensas anestesiadas, sobre los parámetros cardiovasculares (presión arterial media (MAP), presión arterial sistólica (SBP), presión arterial diastólica (DBP) y frecuencia cardiaca (HR)). Además se evaluó in vitroel efecto inhibidor de la enzima convertidora de angiotensina (ACE) por parte del extracto, en anillos aórticos aislados de rata normotensa colocados en una cámara para órgano aislado.Material y Métodos: se indujo hipertensión en veinte ratas (Rattus norvegicus, variedad albina Swiss) (grupo experimental), tratados con una solución de propranolol a una dosis de 0.15 mg/100 g de tejido cada 12 h, vía intraperitoneal (i.p.) durante 21 días; paralelamente a seis ratas (grupo control), se les administró placebo (agua destilada) en el volumen correspondiente vía i.p. la misma cantidad de días. Trascurrido el tratamiento se suspendió el mismo, y se esperó entre veinte a treinta días para el propósito.Las ratas con hipertensión experimental con propranolol (n=6) fueron inyectados vía i.v. con el EMPST (1mg/kg; 5mg/kg, 10mg/kg y 15 mg/kg), en dosis consecutivas. Las ratas normotensas (n= 6) fueron inyectados vía i.v. con EMPST (10 mg/kg; 30 mg/kg y 50 mg/kg), en dosis consecutivas. En ambos experimentos se registró la MAP, SBP, DBP por método invasivo (cateterismo carotideo) y la HR. Finalmente, tras la vasoconstricción inicial con angiotensina I (ANG I 10-8 M), incubación con los inhibidores (EMPST (0.1µg/ml, 1µg/ml, 10µg/ml y 100µ/ml de pozo), Captopril 2x10-4 M y solución de Krebs), posteriormente se indujo una segunda vasoconstricción con ANG I 10-8 M. Resultados: Se produjo hipertensión experimental en ratas normotensas, tras la suspensión entre 20 a 30 días del tratamiento crónico con propranolol a dosis de 0.15mg/100 g de tejido c/12 h vía i.p. por 21 días.El EMPST ejerce efecto hipotensor dosis dependiente (1-15 mg/kg i.v.) en ratas con hipertensión experimental con propranolol anestesiadas, con una duración aproximada de 20 minutos, para la mayor dosis; y un efecto bradicardizante a partir de 5 mg/kg sin diferencia significativa entre las dosis mayores estudiadas.El EMPST ejerce efecto hipotensor dosis dependiente (10-50 mg/kg i.v.) en ratas normotensas anestesiadas, con una duración aproximada de 60 minutos, para la mayor dosis, sin alteración de la frecuencia cardiaca; adicionalmente se observó un efecto hipertensor inicial momentáneo tras los 30 segundos de la administración de las dosis estudiadas con una duración de 30 segundos aproximadamente.Finalmente el EMPST ejerce un efecto inhibidor de la vasoconstricción con ANG I 10-8M en pozo, dosis dependiente (0.1-100 µg/ml de pozo), siendo mayor el efecto a la menor dosis (0.1µg/ml); y de acción similar al Captopril 2x10-4 M (inhibidor de la ACE).Conclusiones: Se obtuvo un modelo de hipertensión experimental, probablemente con renina alto. Además, el efecto hipotensor del EMPST administrado vía i.v. tanto en ratas con hipertensión experimental con propanolol y normotensas en parte seria por inhibición de la ACE.

Hibiscus sabdariffa L. aqueous extract attenuates hepatic steatosis through down-regulation of PPAR-γ and SREBP-1c in diet-induced obese mice.

The growing incidence of obesity is a worldwide public health problem leading to a risk factor for non-alcoholic fatty liver disease, which extends from steatosis to steatohepatitis and cirrhosis. We investigated whether the aqueous extract of Hibiscus sabdariffa L. (Hs) reduces body weight gain and protects the liver by improving lipid metabolism in high fat diet-induced obese C57BL/6NHsd mice. We found that oral administration of the Hs extract reduced fat tissue accumulation, diminished body weight gain and normalized the glycemic index as well as reduced dyslipidemia compared to the obese mice group that did not receive Hs treatment. In addition, Hs treatment attenuated liver steatosis, down-regulated SREBP-1c and PPAR-γ, blocked the increase of IL-1, TNF-α mRNA and lipoperoxidation and increased catalase mRNA. Our results suggest that the anti-obesity, anti-lipidemic and hepatoprotective effects of the Hs extract are related to the regulation of PPAR-γ and SREBP-1c in the liver.

Empleo de la crema de propóleos al 5 porciento en afecciones bucofaciales / The use of the propolis cream 5% in the bucofacial affectings

Se realizó un estudio experimental donde se aplicó una crema de propóleos al 5 porciento producida en nuestro centro, en diversas afecciones bucufaciales con resultados alentadores, sobre todo para la economía de nuestro país, dado por su fácil forma de elaboración y bajo costo. Se empleó la crema en 414 pacientes sin que se observara reacción adversa alguna, y se comprobó, al igual que en otros estudios, que es un producto con propiedades analgésicas, cicatrizantes y antiinflamatorias, por lo cual recomendamos su uso (AU)

Incidencia de fractiras maxilofaciales relacionadas con el deporte / Incidence of sports related maxillofacial fractures

Se realiza un estudio para analizar la incidencia de las fracturas maxilofaciales relacionadas con el deporte en los años 1991 al 1993. Se encontró que éstas correspondían al 7,1 por ciento del total; fueron más frecuentes en el sexo masculino y en el grupo de edad de 15 a 24 años. El beisbol fue el deporte que más casos aportó a nuestro estudio; le siguieron el kárate y el baloncesto. La colisión con otro jugador y las caídas fueron las causas más frecuentes. La región nasal fue la más afectada con el 32,5 por ciento. Se recomienda el correcto uso de los medios de prevención de: fracturas faciales, accidentes deportivos, traumatismos faciales y fracturas nasales(AU)

Incidencia de fractiras maxilofaciales relacionadas con el deporte / Incidence of sports related maxillofacial fractures

Se realiza un estudio para analizar la incidencia de las fracturas maxilofaciales relacionadas con el deporte en los años 1991 al 1993. Se encontró que éstas correspondían al 7,1 por ciento del total; fueron más frecuentes en el sexo masculino y en el grupo de edad de 15 a 24 años. El beisbol fue el deporte que más casos aportó a nuestro estudio; le siguieron el kárate y el baloncesto. La colisión con otro jugador y las caídas fueron las causas más frecuentes. La región nasal fue la más afectada con el 32,5 por ciento. Se recomienda el correcto uso de los medios de prevención de: fracturas faciales, accidentes deportivos, traumatismos faciales y fracturas nasales

Efectos del propoleos en los tratamiento quirurgicos y las ulceras bucales / Effects of propolis on surgical treatments and buccal ulcers

Se estudia la efectividad del propoleo para irrigar zonas intervenidas quirurgicamente en pacientes con distintas afecciones bucales. En las ulceras bucales, la disminucion del dolor y la cicatrizacion fue mas rapida que en el grupo donde se aplico el balsamo de Chostakovski. Se concluye que las propiedades antimicrobianas, hemostaticas y antiinflamatorias del propoleo favorecieron una recuperacion mas rapida y mejor de los tejidos en el posoperatorio de los pacientes intervenidos quirurgicamente, que en aquellos del grupo control. Asimismo, se obtuvo una regresion mas rapida de los sintomas dolorosos y una mejor curacion de las ulceras al comparar los resultados en ambos grupos

Efectos del propóleos en los tratamiento quirúrgicos y las úlceras bucales / Effects of propolis on surgical treatments and buccal ulcers

Se estudia la efectividad del propóleo para irrigar zonas intervenidas quirúrgicamente en pacientes con distintas afecciones bucales. En las úlceras bucales, la disminución del dolor y la cicatrización fue más rápida que en el grupo donde se aplicó el bálsamo de Chostakovski. Se concluye que las propiedades antimicrobianas, hemostáticas y antiinflamatorias del propóleo favorecieron una recuperación más rápida y mejor de los tejidos en el posoperatorio de los pacientes intervenidos quirúrgicamente, que en aquellos del grupo control. Asimismo, se obtuvo una regresión más rápida de los síntomas dolorosos y una mejor curación de las úlceras al comparar los resultados en ambos grupos(AU)

El uso de la fibra de henequén en la cirugía bucal / The use of agave fiber in oral surgery

Se realiza un estudio clínico de 300 pacientes intervenidos quirúrgicamente de afecciones bucales en el municipio Artemisa, donde se utilizó como sutura la fibre de henequén (Agave). Las intervenciones en que mayor cantidad se utilizó fueron exéresis de terceros molares retenidos y en las extracciones múltiples con alveoplastía con el 42 y 25 por ciento , respectivamente; a los 7 días sólo 6, 7 por ciento de los pacientes presentó alguna complicación o reacción local ante esta sutura, las cuales habían desaparecido a los 14 días y al mes, lo que nos hace concluir qu el uso de esta fibra como sutura es de gran valor para nuestra economía por su bajo costo y satisfactorios resultados