Alkaloids in food: a review of toxicity, analytical methods, occurrence and risk assessments.

Alkaloids have been utilized by humans for years. They have diverse applications in pharmaceuticals. They have been proven to be effective in treating a number of diseases. They also form an important part of regular human diets, as they are present in food items, food supplements, diet ingredients and food contaminants. Despite their obvious importance, these alkaloids are toxic to humans. Their toxicity is dependent on a range of factors, such as specific dosage, exposure time and individual properties. Mild toxic effects include nausea, itching and vomiting while chronic effects include paralysis, teratogenicity and death. This review summarizes the published studies on the toxicity, analytical methods, occurrence and risk assessments of six major alkaloid groups that are present in food, namely, ergot, glycoalkaloids, purine, pyrrolizidine, quinolizidine and tropane alkaloids.

Left atrial appendage preservation versus closure during surgical ablation of atrial fibrillation.

OBJECTIVE: There is limited evidence regarding the effectiveness of left atrial appendage (LAA) closure during surgical ablation of atrial fibrillation (AF) in yielding superior clinical outcomes. This study aimed to evaluate the association of LAA closure versus preservation with the risk of adverse clinical outcomes among patients undergoing surgical ablation during cardiac surgery. METHODS: We evaluated 1640 patients (aged 58.8±11.5 years, 898 women) undergoing surgical ablation during cardiac surgery (including mitral valve (MV), n=1378; non-MV, n=262) between 2001 and 2018. Of these, 804 had LAA preserved, and the remaining 836 underwent LAA closure. Comparative risks of stroke and mortality between the two groups were evaluated after adjustments with inverse-probability-of-treatment weighting (IPTW). Longitudinal echocardiographic data (n=9674, 5.9/patient) on transmitral A-wave and E/A-wave ratio were analysed by random coefficient models. RESULTS: Adjustment with IPTW yielded patient cohorts well-balanced for baseline profiles. During a median follow-up of 43.5 months (IQR 19.0-87.3 months), stroke and death occurred in 87 and 249 patients, respectively. The adjusted risk of stroke (HR 0.85; 95% CI 0.52-1.39) and mortality (HR 0.80; 95% CI 0.61 to 1.05) did not differ significantly between the two groups. Echocardiographic data demonstrated higher transmitral A-wave velocity (group-year interaction, p=0.066) and lower E/A-wave ratio (group-year interaction, p=0.045) in the preservation group than in the closure group. CONCLUSIONS: LAA preservation during surgical AF ablation was not associated with an increased risk of stroke or mortality. Postoperative LA transport functions were more favourable with LAA preservation than with LAA closure.