Esophageal luminal temperature monitoring using a multi-sensor probe lowers the risk of esophageal injury in cryo and radiofrequency catheter ablation for atrial fibrillation.

BACKGROUND: Esophageal luminal temperature monitoring is a commonly used strategy to reduce esophageal thermal injury in catheter ablation for atrial fibrillation (AFib). OBJECTIVES: We sought to compare the incidence of endoscopically detected esophageal lesions (EDEL) between two commonly used esophageal luminal temperature probes. METHODS: Consecutive patients undergoing ablation with esophageal luminal temperature monitoring and upper endoscopy within 24 h after ablation were included. RESULTS: Four hundred forty-five patients (64 ± 10 years, 44% female) were included. Esophageal temperature monitoring was done with a single-sensor probe in 213 (48%) and multi-sensor probe in 232 (52%). Cryoballoon (CB) ablation was performed in 118 (27%) and radiofrequency (RF) ablation in 327 (73%) of patients. EDEL was present in 94 (22.9%) of which 85 were mild, 8 were moderate, and 1 was severe, and none progressed to atrial-esophageal fistula. The use of the multi-sensor probe during CB ablation was associated with a reduction in EDEL compared to single sensor (6.8% vs 24.3%; P = 0.016). Similarly, in the RF ablation group, EDEL was present in 19.5% of the multi-sensor group vs 32.8% in the single-sensor group (P = 0.001). Logistic regression showed that multi-sensor probe use was associated with reduction in EDEL with an odds ratio of 0.23 in CB ablation (P = 0.024) and 0.44 for RF ablation (P = 0.001). CONCLUSIONS: Esophageal luminal temperature monitoring during AFib ablation using a multi-sensor probe was associated with a significant reduction in EDEL compared to a single-sensor probe.

Single-cell imaging and transcriptomic analyses of endogenous cardiomyocyte dedifferentiation and cycling.

While it is recognized that there are low levels of new cardiomyocyte (CM) formation throughout life, the source of these new CM generates much debate. One hypothesis is that these new CMs arise from the proliferation of existing CMs potentially after dedifferentiation although direct evidence for this is lacking. Here we explore the mechanisms responsible for CM renewal in vivo using multi-reporter transgenic mouse models featuring efficient adult CM (ACM) genetic cell fate mapping and real-time cardiomyocyte lineage and dedifferentiation reporting. Our results demonstrate that non-myocytes (e.g., cardiac progenitor cells) contribute negligibly to new ACM formation at baseline or after cardiac injury. In contrast, we found a significant increase in dedifferentiated, cycling CMs in post-infarct hearts. ACM cell cycling was enhanced within the dedifferentiated CM population. Single-nucleus transcriptomic analysis demonstrated that CMs identified with dedifferentiation reporters had significant down-regulation in gene networks for cardiac hypertrophy, contractile, and electrical function, with shifts in metabolic pathways, but up-regulation in signaling pathways and gene sets for active cell cycle, proliferation, and cell survival. The results demonstrate that dedifferentiation may be an important prerequisite for CM proliferation and explain the limited but measurable cardiac myogenesis seen after myocardial infarction (MI).

The efficacy and safety of herbal medicines used in the treatment of hyperlipidemia; a systematic review.

OBJECTIVE: This review focuses on the efficacy and safety of effective herbal medicines in the management of hyperlipidemia in human. METHODS: PubMed, Scopus, Google Scholar, Web of Science, and IranMedex databases were searched up to 11th May 2010. The search terms were "hyperlipidemia" and ("herbal medicine" or "medicine traditional", "extract plant") without narrowing or limiting search elements. All of the human studies on the effects of herbs with the key outcome of change in lipid profiles were included. RESULTS: Fifty three relevant clinical trials were reviewed for efficacy of plants. This study showed significant decrease in total cholesterol and LDL cholesterol after treatment with Daming capsule (DMC), chunghyul-dan, Glycyrrhiza glabra, garlic powder (Allicor), black tea, green tea, soy drink enriched with plant sterols, licorice, Satureja khuzestanica, Monascus purpureus Went rice, Fenugreek, Commiphora mukul (guggul), Achillea wilhelmsii C. Koch, Ningzhi capsule (NZC), cherry, compositie salviae dropping pill (CSDP), shanzha xiaozhi capsule, Ba-wei-wan (hachimijiogan), rhubarb stalk, Silybum marianum, Rheum Ribes and Jingmingdan granule (primrose oil). Conflicting data exist for red yeast rice, garlic and guggul. No significant adverse effect or mortality were observed except in studies with DMC, guggul, and Terminalia belerica, Terminalia chebula, Emblica officinalis, ginger, and garlic powder (Allium sativum). CONCLUSION: Amongst reviewed studies, 22 natural products were found effective in the treatment of hyperlipidemia that deserve further works to isolate and characterization of their constituents to reach novel therapeutic and more effective agents.