Pulsed-field ablation versus thermal ablation for atrial fibrillation: A meta-analysis.

Background: Pulsed-field ablation (PFA) is an alternative to thermal ablation (TA) in patients with atrial fibrillation (AF) receiving catheter-based therapy for pulmonary vein isolation (PVI). However, its efficacy and safety have yet to be fully elucidated. Objective: The purpose of this study was to compare the acute and long-term efficacies and safety of PFA and TA. Methods: We performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials comparing PFA and TA in patients with AF undergoing their first PVI ablation. The TA group was divided into cryoballoon (CB) and radiofrequency subgroups. AF patients were divided into paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PersAF) subgroups for further analysis. Results: Eighteen studies involving 4998 patients (35.2% PFA) were included. Overall, PFA was associated with a shorter procedure time (mean difference [MD] -21.68; 95% confidence interval [CI] -32.81 to -10.54) but longer fluoroscopy time (MD 4.53; 95% CI 2.18-6.88) than TA. Regarding safety, lower (peri-)esophageal injury rates (odds ratio [OR] 0.17; 95% CI 0.06-0.46) and higher tamponade rates (OR 2.98; 95% CI 1.27-7.00) were observed after PFA. In efficacy assessment, PFA was associated with a better first-pass isolation rate (OR 6.82; 95% CI 1.37-34.01) and a lower treatment failure rate (OR 0.83; 95% CI 0.70-0.98). Subgroup analysis showed no differences in PersAF and PAF. CB was related to higher (peri)esophageal injury, and lower PVI acute success and procedural time. Conclusion: Compared to TA, PFA showed better results with regard to acute and long-term efficacy but significant differences in safety, with lower (peri)esophageal injury rates but higher tamponade rates in procedural data.

Positive selection in gamete interaction proteins in Carnivora.

The absence of robust interspecific isolation barriers among pantherines, including the iconic South American jaguar (Panthera onca), led us to study molecular evolution of typically rapidly evolving reproductive proteins within this subfamily and related groups. In this study, we delved into the evolutionary forces acting on the zona pellucida (ZP) gamete interaction protein family and the sperm-oocyte fusion protein pair IZUMO1-JUNO across the Carnivora order, distinguishing between Caniformia and Feliformia suborders and anticipating few significant diversifying changes in the Pantherinae subfamily. A chromosome-resolved jaguar genome assembly facilitated coding sequences, enabling the reconstruction of protein evolutionary histories. Examining sequence variability across more than 30 Carnivora species revealed that Feliformia exhibited significantly lower diversity compared to its sister taxa, Caniformia. Molecular evolution analyses of ZP2 and ZP3, subunits directly involved in sperm-recognition, unveiled diversifying positive selection in Feliformia, Caniformia and Pantherinae, although no significant changes were linked to sperm binding. Structural cross-linking ZP subunits, ZP4 and ZP1 exhibited lower levels or complete absence of positive selection. Notably, the fusion protein IZUMO1 displayed prominent positive selection signatures and sites in basal lineages of both Caniformia and Feliformia, extending along the Caniformia subtree but absent in Pantherinae. Conversely, JUNO did not exhibit any positive selection signatures across tested lineages and clades. Eight Caniformia-specific positive selected sites in IZUMO1 were detected within two JUNO-interaction clusters. Our findings provide for the first time insights into the evolutionary trajectories of ZP proteins and the IZUMO1-JUNO gamete interaction pair within the Carnivora order.

A propósito do universal deprimente: estudo de um caso de resistência ameríndia à captura biomédica / About the depressing universal: study of a case of Amerindian resistance to biomedical capture

Objetivo Em meio a investidas assimilacionistas, os Xavante determinaram a migração de crianças para Ribeirão Preto/SP, no intuito de estudarem os brancos. Um dos protagonistas recentes desse intercâmbio experienciou intenso sofrimento psíquico, diagnosticado e tratado pela medicina branca. Apresentou melhoras expressivas, contudo, somente quando retornou em definitivo à aldeia de origem. Objetivou-se, nesse contexto, ultrapassar a narrativa biomédica canônica, evidenciando como a consideração de múltiplas formas de "tradução" permite vislumbrar um fenômeno indígena em sua complexidade. Método Para esse efeito, foram analisadas dez entrevistas não estruturadas realizadas com o jovem e alguns de seus principais interlocutores no meio urbano (família de acolhimento, colegas de escola, espaço religioso). Resultados Emergiram narrativas plurais que incidem sobre o vivenciado, suprimidas pela discursividade universalizante biomédica. Conclusão O jovem experienciou um processo de negociação entre universos de significação, cuja síntese culminou no fortalecimento da autoafirmação Xavante e na apropriação de uma voz própria, de permeio às demais.

Objective In the midst of assimilationist onslaughts, the Xavante determined the migration of children to Ribeirão Preto/SP, where they would grow and observe the white people. One of the recent protagonists of this migration experienced intense psychic suffering, diagnosed and treated by western medicine. He showed significant improvements; however, only when he finally returned to the village of origin he got completely rehabilitated. The objective of this work was to go beyond the canonical biomedical narrative, showing how the consideration of multiple forms of "translation" allows us to glimpse an indigenous phenomenon in its complexity. Method For this purpose, ten unstructured interviews conducted with this young indigenous individual and some of his main interlocutors in the urban environment (host family, schoolmates, religious space) were reviewed. Results Plural narratives have emerged that focus on what is experienced but it is suppressed by the universalizing biomedical discourse. Conclusion The youth experienced a process of negotiation between universes of meaning, whose synthesis culminated in enhancing the Xavante peoples self-assertion and appropriating their own voice, among others.