Protective effects of Panax ginseng against doxorubicin-induced cardiac toxicity in patients with non-metastatic breast cancer: A randomized, double-blind, placebo-controlled clinical trial.

INTRODUCTION: Anthracycline-based chemotherapy increases the risk of cancer therapeutics-related cardiac dysfunction. Recently, evidences from in vitro experiments and animal studies have shown that ginsenosides may exert cardiovascular protection against cancer therapeutics-related cardiac dysfunction. Here, we aimed to evaluate this effect in a clinical situation. METHODS: In this randomized, double-blind, placebo-controlled clinical trial, women with non-metastatic breast cancer whose left ventricular ejection fraction was ≥ 50% were randomly assigned in 1:1 ratio to receive ginseng (1 g/day) or placebo besides standard chemotherapy. Echocardiographic measurements were performed at baseline, after the fourth, and eighth chemotherapy cycles. High-sensitive cardiac troponin I was assessed at baseline and after the 4th cycle. The primary endpoint of the study was change in left ventricular ejection fraction. Cancer therapeutics-related cardiac dysfunction was defined as a drop in left ventricular ejection fraction of ≥ 10% from baseline. RESULTS: Results from 30 patients were included in the final analysis (15 patients in each group). In the intervention and control groups, left ventricular ejection fraction was dropped from 62.0 ± 0.9% to 60.7 ± 1.0% (difference = -1.3 ± 1.1%) and from 63.27 ± 1.1% to 58.0 ± 1.3% (difference = -5.27 ± 0.8%), respectively (difference = 3.97%, p = 0.006) at the end of the fourth cycle of chemotherapy. After the eighth cycle of chemotherapy, the mean left ventricular ejection fraction was increased by 0.8 ± 1.3% from baseline in the intervention group, whereas the placebo group experienced a reduction of -7.3 ± 1.4% (difference = 8.1%, p-value < 0.001). None of the patients in the ginseng group in comparison to 1(6.7%, p-value = 0.5) and 5 (33.3%, p-value = 0.02) patients in the placebo group developed cancer therapeutics-related cardiac dysfunction after the fourth and eighth cycles, respectively. High-sensitive cardiac troponin I levels were not significantly different between groups. CONCLUSIONS: Prophylactic ginseng supplementation may protect against doxorubicin-induced early cancer therapeutics-related cardiac dysfunction and early decline in left ventricular ejection fraction in breast cancer patients.

Impacts of opium addiction on patterns of angiographic findings in patients with acute coronary syndrome.

Opium is one of the most abused substances in the Middle East. The effects of opium use on coronary artery disease (CAD) are a matter of debate. This study aimed to assess the association between opium use and angiographic findings as well as the complexity of CAD in patients with acute coronary syndrome (ACS) diagnosis. In this case-control study, all patients admitted for coronary angiography from 2019 to 2020 were evaluated. After applying the eligibility criteria, they were categorized into two groups opium and non-opium based on their history of opium use. Both groups were matched regarding the demographic features. The prevalence, location, and severity of obstruction of the vessels were compared between the non-opium and opium groups. The SYNTAX score was also calculated and compared between the two groups. The scores ≤ 22 are considered low risk and the higher scores are a non-low risk. P value < 0.05 is considered significant. A total of 170 patients with a mean age of 61.59 ± 9.07 years were finally enrolled in our study. Regarding the severity of vascular involvement, there was a significant difference between the non-opium and opium groups in LAD (P = 0.025), and PLV (P = 0.018) vessels. From the location points of view of obstructive coronary artery involved segments, only in the PDA (P = 0.006), and LCX (P = 0.004) vessels, a significant difference was observed. Moreover, 47.1% of opium and 30.6% of non-opium use group were in the non-low risk SYNTAX score classification which is a statistically significant difference between these two groups (P value = 0.048). Opium, as an independent risk factor for cardiovascular diseases, can have specific effects on angiographic findings in patients with acute coronary syndrome. Likewise, the complexity of CAD in opium users who undergo percutaneous coronary intervention is significantly higher.

AICAR and nicotinamide treatment synergistically augment the proliferation and attenuate senescence-associated changes in mesenchymal stromal cells.

BACKGROUND: Mesenchymal stromal cell (MSC) stemness capacity diminishes over prolonged in vitro culture, which negatively affects their application in regenerative medicine. To slow down the senescence of MSCs, here, we have evaluated the in vitro effects of 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR), an AMPK activator, and nicotinamide (NAM), an activator of sirtuin1 (SIRT1). METHODS: Human adipose-derived MSCs were cultured to passage (P) 5. Subsequently, the cells were grown in either normal medium alone (control group), the medium supplemented with AICAR (1 mM) and NAM (5 mM), or in the presence of both for 5 weeks to P10. Cell proliferation, differentiation capacity, level of apoptosis and autophagy, morphological changes, total cellular reactive oxygen species (ROS), and activity of mTORC1 and AMPK were compared among different treatment groups. RESULTS: MSCs treated with AICAR, NAM, or both displayed an increase in proliferation and osteogenic differentiation, which was augmented in the group receiving both. Treatment with AICAR or NAM led to decreased expression of ß-galactosidase, reduced accumulation of dysfunctional lysosomes, and characteristic morphologic features of young MSCs. Furthermore, while NAM administration could significantly reduce the total cellular ROS in aged MSCs, AICAR treatment did not. Moreover, AICAR-treated cells possess a high proliferation capacity; however, they also show the highest level of cellular apoptosis. The observed effects of AICAR and NAM were in light of the attenuated mTORC1 activity and increased AMPK activity and autophagy. CONCLUSIONS: Selective inhibition of mTORC1 by AICAR and NAM boosts autophagy, retains MSCs' self-renewal and multi-lineage differentiation capacity, and postpones senescence-associated changes after prolonged in vitro culture. Additionally, co-administration of AICAR and NAM shows an additive or probably a synergistic effect on cellular senescence.

Almond oil for patients with hyperlipidemia: A randomized open-label controlled clinical trial.

BACKGROUND: Cardiovascular diseases currently account for nearly half of non-communicable diseases. It was shown that enjoying a handful of nuts every day can significantly reduce the risk of developing heart diseases as they contain a variety of nutrients and other bioactive substances contributing to lowering the risk of heart diseases and controlling the cholesterol. The aim of this study was to determine the effect of almond oil on the lipid profile of patients with hyperlipidemia. METHODS: Ninety-seven patients were divided into the intervention (n = 49) and control (n = 48) groups. The intervention group received 10 ml of almond oil two times daily for 30 days. There was no intervention for the control group. The serum lipoproteins were measured before and after the study. RESULTS: The total cholesterol and LDL levels decreased significantly in the intervention group (treatment difference = -16.12 ± 26.16, P = 0.009; treatment difference = -20.88 ± 18.4, p < 0.001 respectively). But regular almond oil consumption did not significantly affect the triglyceride and HDL in this sample of hyperlipidemic patients. CONCLUSION: Consumption of almond could reduce the total cholesterol and LDL in dyslipidemic patients.

Atrioventricular nodal echoes over a wide echo window as a therapeutic end point for the catheter-guided radiofrequency ablation of atrioventricular nodal reentrant tachycardia: a prospective study.

Aims: In previous retrospective studies, it was shown that the presence of residual single atrioventricular node (AVN) echoes with an echo zone longer than 30 ms may increase the rate of recurrence after radiofrequency ablation (RFA) of slow pathway in patients with AVN reentrant tachycardia (AVNRT). Based on that, some centres perform additional RFA in these patients. However, this opinion has never been tested prospectively and many centres do not perform re-ablation in these patients. The purpose of this study was to test whether persistence of a single AVN echo over a wide echo zone is a valid end point for RFA. Methods and results: In this prospective study, 576 patients who had a non-inducible arrhythmia post-RFA of AVNRT were divided into those with a remnant echo over a wide echo zone (case group) and those reaching classical end points (control group). The primary end point of the study was recurrence and patients were followed for 34.5 ± 18.8 months. In the control group (n = 510), 14 patients (2.7%) had a recurrence while no recurrence was seen in the case group (n = 66) (final cure rate, 97.3 vs. 100%; difference, 2.7%; upper bound of the 98% CI, 0.0488; P < 0.0001 for non-inferiority). Two complete heart blocks (0.4%) happened in the control group and none in the case group (P = 0.784). Conclusion: Non-inducibility in the presence of a wide echo window is non-inferior to non-inducibility in the presence of narrow echo window or no AVN echoes. In general, the presence of a single echo beat is not an indication for further ablation and this applies for both narrow and wide windows.

Comparison of the effect of omega-3 supplements and fresh fish on lipid profile: a randomized, open-labeled trial.

BACKGROUND: Dietary fish is a rich source of Omega-3 poly-unsaturated fatty acids (PUFAs). These compounds may have protective effect against cardiovascular events possibly by modifying lipid profiles. Consequently, fish oil supplements are produced commercially to complement low fish intake. It is not clear if both interventions have similar effects. The aim of this trial was to compare the anti-hyperlipidemic effect of omega3 fatty acid supplements with fresh fish. METHOD: A total of 106 patients with hyperlipidemia were randomized. One group received 2 g/day of omega-3 capsules for a period of 8 weeks and the other group received a mean of 250 g trout fish twice weekly (for dinner and lunch) for the same time period. The effects of these diets on the lipid profile after the intervention were compared between the two groups. RESULTS: Data from 48 patients in fish oil group and 47 patients from fish group was used for final analysis. In both groups, total cholesterol, non-HDL cholesterol, triglyceride (TG) levels, and Castelli I index (total cholesterol/HDL ratio) were reduced significantly following the treatment; however, dietary-fish intake had a more pronounced effect (-85.08 ± 74.82 vs. -30.75 ± 89.00, P < 0.001; 75.06 ± 35.43 vs. -16.93 ± 40.21, P < 0.001; -66.55 ± 30.79 vs. -12.7 ± 35.48, P = 0.003; and -0.77 ± 1.39 vs. -3.02 ± 1.85, P < 0.001; respectively). HDL level was increased in both groups with a higher effect in dietary fish group (4.47 ± 7.83 vs. 8.51 ± 8.79, P = 0.022). Atherogenic (Log [TG/HDL ratio]) and Castelli II (LDL/HDL ratio) indices did not change in fish oil group while were reduced significantly by fresh fish consumption (-0.04 ± 0.27 vs. -0.26 ± 0.17, P < 0.001; and 0.15 ± 0.7 vs. -1.32 ± 1.15, P < 0.001, respectively). LDL level was increased in the supplementation group, while it was significantly reduced in the dietary-fish group (+18.7 ± 24.97 vs. -22.75 ± 27.28, P < 0.001). CONCLUSION: Consumption of fresh fish seems to be superior in positively modifying the lipid profiles which may have important translations in the occurrence of cardiovascular events.

Effect of Amygdalus scoparia kernel oil consumption on lipid profile of the patients with dyslipidemia: a randomized, open-label controlled clinical trial.

BACKGROUND: Amygdalus scoparia kernel (ASK) oil is traditionally used for Hyperlipidemia. Compared to olive oil, it has higher proportion of unsaturated to saturated fatty acid besides exhibiting higher index of oxidative stability. The lipid-lowering effects of ASK oil however, has not been investigated yet. This study is the first one to evaluate such effects in patients with dyslipidemia. RESULTS: Serum triglyceride levels significantly decreased in the intervention compared to control group (24.80 ± 51.70 vs 3.13 ± 44.80, p-value = 0.03). Serum total cholesterol, LDL and HDL cholesterol levels did not change significantly (p = 0.28 and p = 0.68 and p = 0.10 respectively). MATERIALS AND METHODS: In a double arm, open-label, randomized controlled trial,101 hyperlipidemic patients were recruited. The designation of hyperlipidemia was upon meeting either of the three criteria: having serum low-density lipoprotein (LDL) cholesterol level 130-190 (mg/dl), serum triglyceride level 150-400 (mg/dl), and serum high-density lipoprotein (HDL) cholesterol level less than 50 (mg/dl) for women and 40 (mg/dl) for men. Patients who have ever been prescribed with an antihyperlipidemic medication were excluded. They were randomly assigned to intervention group, receiving the ASK oil, for 60 days and control group. Serum lipid measurements were repeated at the end of the intervention period. CONCLUSIONS: ASK oil supplementation may have a positive effect in reducing serum triglyceride level in patients with dyslipidemia without significant effect on serum cholesterol levels.