Publications by authors named "Shaowen Liu"

88 Publications

Residue changes and processing factors of eighteen field-applied pesticides during the production of Chinese Baijiu from rice.

Food Chem 2021 Oct 29;359:129983. Epub 2021 Apr 29.

Longping Branch, Graduate School of Hunan University, Changsha 410125, China; Hunan Plant Protection Institute, Hunan Academy of Agricultural Science, Changsha 410125, China. Electronic address:

The fate of eighteen pesticides in field-collected rice samples during Chinese Baijiu production was systematically studied. The results indicated that steeping decreased flonicamid residue by 73.2% due to its high water-solubility and low octanol/water partition coefficient. The steaming step reduced pesticide residues by 32.0%-75.3% through evaporation or thermal degradation. After steaming, the pesticide residues were further reduced by 39.8-74.2% in fermentation which might be caused by biological degradation. In addition, distillation was shown to be most effective, responsible for greater than 90% losses of the remaining pesticide residues. The processing factors (PFs) were generally lower than 1 for different processes and the whole procedure. These results revealed that the procedure of Chinese Baijiu production could dramatically decrease residues of all the eighteen pesticides. Overall, this study provide important references for monitoring pesticide residue levels during the production of Chinese Baijiu from rice, and ensuring proper risk assessment from pesticide contamination.
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http://dx.doi.org/10.1016/j.foodchem.2021.129983DOI Listing
October 2021

Sub-pocket small-hole drainage for pocket hematoma after cardiac device implantation.

Herz 2021 Apr 22. Epub 2021 Apr 22.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No 100, Haining Road, 200080, Shanghai, China.

Aims: Pocket hematoma is a common complication associated with cardiac device implantation, but there are limited strategies to deal with this problem. We aimed to evaluate the effectiveness of sub-pocket small-hole drainage (SSD) as a new way to manage severe pocket hematoma.

Methods: A total of 11 patients with severe pocket hematoma were selected for this case series study. The SSD procedure was performed and wound healing was monitored.

Results: The SSD procedure was successfully performed on all 11 patients. The time window for SSD was 10-14 days (mean 12.0 ± 1.3 days) after cardiac device implantation. On average, 18.3 ± 2.3 ml of hematoma was drained , with a mean procedural time of 21.3 ± 2.6 min. The patients were followed up for 4-12 months and all pockets healed well, without any complications such as pocket infection, bleeding, device exposure, and electrode fracture.

Conclusion: Sub-pocket small-hole drainage is an alternative approach for dealing with severe pocket hematoma after cardiac device implantation.
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http://dx.doi.org/10.1007/s00059-021-05037-yDOI Listing
April 2021

Anticoagulation in atrial fibrillation and liver disease: a pooled-analysis of > 20000 patients.

Eur Heart J Cardiovasc Pharmacother 2021 Apr 19. Epub 2021 Apr 19.

Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.

Aims: Anticoagulation for atrial-fibrillation (AF) patients with liver-disease represents a clinical dilemma. We sought to evaluate the efficacy/safety of different anticoagulation, i.e. vitamin-K-antagonist (VKA) and non-VKA oral-anticoagulants (NOACs) in such patient group.

Methods And Results: This was a pooled-analysis enrolling up-to-date clinical data. Two subsets: subset A (VKA vs. Non-Anticoagulation) and subset B (NOACs vs. VKA) were pre-specified. The study outcomes were ischemic-stroke(IS)/thromboembolism(TE), major-bleeding (MB), intracranial-bleeding (ICB), gastrointestinal-bleeding (GIB) and all-cause mortality.A total of 20,042 patients' data were analyzed (subset A: N = 10275, subset B: N = 9767). Overall mean age: 71±11 years, mean CHA2DS2-VASc score: 4.0±1.8, mean HAS-BLED score: 3.6±1.2. The majority of the patients had Child-Pugh category (A-B). As compared with Non-Anticoagulation, VKA seemed to reduce the risk of IS/TE (OR: 0.60, P = 0.05), but heighten the risk of all-bleeding-events including MB (OR: 2.81, P = 0.01), ICB (OR: 1.60, P = 0.01), and GIB (OR: 3.32, P = 0.01). When compared with VKA, NOACs had similar efficacy in reducing the risk of IS/TE (OR: 0.82, P = 0.64), significantly lower risk of MB (OR: 0.54, P = 0.0003) and ICB (OR: 0.35, P < 0.0001), and trend towards reduced risk of GIB (OR: 0.72, P = 0.12) and all-cause mortality (OR: 0.79, P = 0.35). The favorable effects were maintained in subgroups of individual NOAC.

Conclusions: VKA appears to reduce the risk of IS/TE but increase all-bleeding-events. NOACs have similar effect in reducing the risk of IS/TE and have significantly lower risk of MB and ICB as compared with VKA. NOACs seem to be associated with better clinical outcome than VKA in patients with mild-moderate liver disease.
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http://dx.doi.org/10.1093/ehjcvp/pvab032DOI Listing
April 2021

Residue behavior, transfer and risk assessment of tolfenpyrad, dinotefuran and its metabolites during tea growing and tea brewing.

J Sci Food Agric 2021 Apr 13. Epub 2021 Apr 13.

Longping Branch, Graduate School of Hunan University, Changsha, China.

Background: Tolfenpyrad and dinotefuran are two representative pesticides used for pest control in tea gardens. Their application may bring about a potential risk to the health of consumers. Therefore, it is essential to investigate the residue behavior, transfer and risk assessment of tolfenpyrad, dinotefuran and metabolites from tea garden to teacup.

Results: An effective analytical method was established and validated to simultaneously determine tolfenpyrad, dinotefuran and its metabolites (DN and UF) in tea. The average recoveries of tolfenpyrad, dinotefuran, DN and UF were in the range 72.1-106.3%, with relative standard deviations lower than 11.8%. On the basis of the proposed method, the dissipation of tolfenpyrad and dinotefuran in fresh tea leaves followed first-order kinetics models with half-lives of 4.30-7.33 days and 4.65-5.50 days, respectively. With application amounts of 112.5-168.75 g a.i. ha once or twice, the terminal residues of tolfenpyrad and total dinotefuran in green tea were lower than 19.6 and 7.13 mg kg , respectively, and below their corresponding maximum residue limits . The leaching rates of tolfenpyrad and total dinotefuran during the tea brewing were in the ranges 1.4-2.3% and 93.7-98.1%, respectively.

Conclusion: Tolfenpyrad and dinotefuran in tea were easily degraded. The RQ and RQ values for tolfenpyrad were 37.6% and 5.4%, which were much higher than for dinotefuran at 24.7% and 0.84%, respectively. The data indicated that there was no significant health risk in tea for consumers at the recommended dosages. The results provide scientific data regarding the reasonable use of tolfenpyrad and dinotefuran aiming to ensure safe tea consuption. © 2021 Society of Chemical Industry.
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http://dx.doi.org/10.1002/jsfa.11253DOI Listing
April 2021

Alternating and gradually changing narrow QRS complex tachycardia in a patient with heart failure: What is the mechanism?

Ann Noninvasive Electrocardiol 2021 Feb 25:e12836. Epub 2021 Feb 25.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shangai, China.

A 23-year-old woman with palpitations for 9 years was referred for catheter ablation. ECG showed an irregular narrow complex tachycardia with alternating and gradually changing QRS morphologies after alternating and changing RR intervals, with a clear pattern of 2 alternating QRS complexes. An electrophysiology study was performed and confirmed that the mechanism of tachycardia was an automatic left-side His-Purkinje system (HPS) ventricular tachycardia. The gradually changing type-2 QRS complexes was the conduction delayed in the left anterior fascicle due to the short RR interval or the short left-side HH interval. Nine months after the index electrophysiology study, the patient encounter a progressive of heart failure with increased heart rate to 130-150 bpm during rest. Radiofrequency ablation was performed at the upper-septum for eliminating the tachycardia and resulted in complete atrioventricular block. A permanent pacemaker with left bundle branch pacing was implanted. Twelve months after the ablation, the enlarged heart shrink to normal with normal left ventricular ejection fraction. In conclusion, careful interpretation of the ECG can identify the sinus P waves followed by irregular narrow complexes, thus avoiding misdiagnosis and unnecessary treatment. Unifocal HPS tachycardia could present with alternating and gradually changing narrow QRS complexes tachycardia and lead to tachycardia cardiomyopathy. Electrophysiology study and catheter ablation were useful for the diagnosis and treatment of HPS tachycardia but with high risk of atrioventricular block. However, successfully elimination the tachycardia would resolve and reverse the enlarged heart and deteriorative heart function.
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http://dx.doi.org/10.1111/anec.12836DOI Listing
February 2021

Anatomical insights into posterior wall isolation in patients with atrial fibrillation: A hypothesis to protect the esophagus.

J Cardiovasc Electrophysiol 2021 Feb 4;32(2):270-278. Epub 2021 Jan 4.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Introduction: Left atrial posterior wall (LAPW) isolation may be performed as an additional atrial fibrillation (AF) ablation strategy based on pulmonary vein isolation. A modified posterior-inferior line (MPL) was proposed for reducing esophageal injury. The aim of this study was to evaluate the anatomical characteristics of the MPL, compared with the conventional posterior line (CPL).

Methods And Results: Multidetector computed tomography was performed in 102 consecutive AF patients (male/female = 60/42) preoperative, and the parameters were evaluated as follows: the distance from MPL and CPL to the esophagus, fat pad presence and thickness in the course of MPL and CPL, and the esophageal route below CPL. The average distance from the MPL to the esophagus was longer than from CPL to the esophagus (3.7 ± 1.5 vs. 1.7 ± 0.4 mm, p < .001). Proportion of fat pad was higher in the course of MPL than CPL. The myocardium tissue and fat pad under MPL was thicker than under CPL (2.9 ± 1.1 vs. 1.6 ± 0.3 mm, p < .001; 1.4 ± 0.6 vs. 0.9 ± 0.2 mm, p < .001), respectively. In patients whose esophagus was unconfined in a triangular space at the left inferior pulmonary vein level, the average distance from MPL to esophagus was longer than the confined patients (4.0 ± 1.7 vs. 3.2 ± 1.0 mm, p = .001).

Conclusion: The MPL was far away from the esophagus with thicker myocardium tissue and more fat pad than the CPL; thus, MPL could serve as a favorable alternative in linear ablation for LAPW isolation.
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http://dx.doi.org/10.1111/jce.14853DOI Listing
February 2021

Tailored ablation index for pulmonary vein isolation according to wall thickness within the ablation circle.

Pacing Clin Electrophysiol 2021 Apr 25;44(4):575-585. Epub 2021 Feb 25.

Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.

Background: Ablation index (AI), a novel lesion quality marker, includes contact force, time, and power of radiofrequency (RF) application, but not regional variation in wall thickness within the wide antral catheter ablation (WACA) circle. This study explored the relationships among AI target value, atrial wall thickness, and gap formation within the WACA circle in patients with paroxysmal atrial fibrillation (PAF).

Methods: We evaluated 102 consecutive patients (mean age, 65 ± 9 years) with PAF who underwent AI-guided WACA for ipsilateral pulmonary vein isolation (PVI). Each WACA circle was subdivided into eight segments, and overall 7143 RF applications were delivered, including 125 gaps in PVI ablation lines. For each RF tag within the ablation circle, we collected data on ablation lesion depth surrogates (time of application, delivery power, impedance drop, average contact force, force-time integral [FTI], and AI) and left atrial wall thickness measured by multidetector computer tomography scanning.

Results: The anterior and roof walls were the thickest segments of the ablation circle, in which 85.8% of gaps concentrated, while the posterior and inferior walls were the thinnest. Gap formation was significantly associated with FTI, AI, wall thickness, FTI/wall thickness, and AI/wall thickness. AI/wall thickness had the highest predictive value for gap formation, with a cutoff of 195.6 au/mm for effective ablation.

Conclusions: In AI-guided PVI of PAF, AI/wall thickness by normalizing myocardial thickness variation along the WACA circle was a strong predictor of gap formation, with a target of 195.6 au/mm appearing suitable for effective ablation.
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http://dx.doi.org/10.1111/pace.14125DOI Listing
April 2021

Acute conduction recurrence of mitral isthmus: Incidence, clinical characteristics, and implications.

Pacing Clin Electrophysiol 2020 12 12;43(12):1564-1571. Epub 2020 Nov 12.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Background: Data on the incidence, clinical characteristics, and implications of acute conduction recurrence during mitral isthmus (MI) ablation are scarce.

Methods: MI ablation was performed in patients with atrial fibrillation. After confirming bidirectional conduction block, the acute conduction recurrence of MI was systematically evaluated. Clinical and electrophysiological characteristics were analyzed.

Results: A total of 66 consecutive patients in whom bidirectional conduction block of MI was achieved were prospectively enrolled in a single center. Acute conduction recurrence of MI developed in 12 (18.2%) patients within 14.2 ± 11.5 minutes after the confirmation of bidirectional conduction block. There were two recurrent conduction breakthrough sites of MI along the course of the great cardiac vein (4.5 ± 3.5 min) in two patients and 11 along the course of the ligament of Marshall (LOM) (16.0 ± 11.6 min, P = .035) in 11 patients. LOM accounted for most (84.6%, 11/13) acute MI conduction recurrence. MI length, total ablation time, and procedure time for MI were greater in patients with acute conduction recurrence than in those without acute conduction recurrence. During follow-up, arrhythmia recurrences were less observed in patients with acute conduction when compared to patients without acute conduction recurrence (0% vs 26.4%, P = .055).

Conclusion: Acute conduction recurrence, predominantly due to recurrent LOM conduction, was a common phenomenon during MI ablation, and its evaluation should therefore be the focus to improve MI ablation efficacy and durability.
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http://dx.doi.org/10.1111/pace.14110DOI Listing
December 2020

Study on degradation behaviour, residue distribution, and dietary risk assessment of propiconazole in celery and onion under field application.

J Sci Food Agric 2021 Mar 5;101(5):1998-2005. Epub 2020 Oct 5.

Longping Branch, Graduate School of Hunan University, Changsha, 410125, China.

Background: Propiconazole is widely used to control fungal diseases in field crops, including celery and onion. The potential risk to the environment and human health has aroused much public concern. Therefore, it is significant to investigate the degradation behaviour, residue distribution, and dietary risk assessment of propiconazole in celery and onion.

Results: A sensitive analytical method for determination of propiconazole residue in celery and onion was established and validated through high-performance liquid chromatography tandem mass spectrometry. The average recovery rate of propiconazole ranged from 85.7% to 101.8%, with a relative standard deviation of 2.1-6.3%. For the dissipation kinetics, the data showed that propiconazole in celery and onion was degraded, with half-lives of 6.1-6.2 days and 8.7-8.8 days respectively. In the terminal residue experiments, the residues of propiconazole were below 4.66 mg kg in celery after application two or three times and were below 0.029 mg kg in onion after application of three or four times with an interval of 14 days under the designed dosages. The chronic and acute dietary exposure assessments for propiconazole were valued by risk quotient, with all values being lower than 100%.

Conclusion: Propiconazole in celery and onion was rapidly degraded following first-order kinetics models. The dietary risk of propiconazole through celery or onion was negligible to consumers. The study not only offers a valuable reference for reasonable usage of propiconazole on celery and onion, but also facilitates the establishment of maximum residue limits in China. © 2020 Society of Chemical Industry.
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http://dx.doi.org/10.1002/jsfa.10817DOI Listing
March 2021

QRS complex axis deviation changing in catheter ablation of left fascicular ventricular tachycardia.

Europace 2020 11;22(11):1688-1696

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85, Wujin Road, Shanghai 200080, China.

Aims: The mechanisms of the QRS complex axis deviation changing of idiopathic left fascicular ventricular tachycardia (FVT) during or after radiofrequency catheter ablation were investigated in this study, which were still not well defined.

Methods And Results: In the index procedure, FVTs characterized by right bundle branch block configuration and left-axis deviation (LAD-FVT) were ablated at the VT exit site guided by the earliest ventricular activation with fused presystolic Purkinje potential (PP) in 234 consecutive patients. A new type of FVT characterized by right-axis deviation (RAD-FVT) was identified after successful elimination of the LAD-FVT in 12 patients, including 9 patients during the index procedure and 3 patients during follow-up. The QRS duration of RAD-FVT was shorter than that of LAD-FVT (115.3 ± 15.2 vs. 125.3 ± 16.4 ms, P = 0.006). The RAD-FVTs showed an earliest ventricle activation site localized at anterior fascicle area in 11 patients and anterior-median fascicle area in 1. However, the earliest PP during the RAD-FVT was still identified within the posterior fascicular network. Elimination of the RAD-FVTs was successfully achieved by applying radiofrequency current at a more proximal site within the left posterior fascicular network guided by the earliest PP. After a mean of 1.6 ± 0.8 ablation procedures and median follow-up of 132 (range 19-216) months since the last procedure, no recurrence was observed in any patients.

Conclusion: The axis deviation changing of QRS complex in FVT may be attributed to the different exit sites of the reentry.
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http://dx.doi.org/10.1093/europace/euaa175DOI Listing
November 2020

Coexistence of sinus bradycardia and junctional tachycardia in a patient with fibrotic atrial cardiomyopathy.

Pacing Clin Electrophysiol 2021 01 1;44(1):189-191. Epub 2020 Sep 1.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

A 65-year-old woman was referred for catheter ablation in the treatment of persistent tachycardia after surgery for atrial fibrillation and mitral regurgitation. Bipolar voltage mapping of both atria revealed that severe and extensive atrial fibrosis isolated the sinoatrial node from the atrioventricular junction and led to the coexistence of sinus bradycardia and persistent junctional tachycardia.
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http://dx.doi.org/10.1111/pace.14028DOI Listing
January 2021

Rationale and study design for ablation of paroxysmal atrial fibrillation guided by ablation index: a multi-center, prospective randomized trial (PAF-AI trial).

J Interv Card Electrophysiol 2021 Apr 11;60(3):439-444. Epub 2020 May 11.

Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Zhejiang, 310016, Hangzhou, People's Republic of China.

Background: Pulmonary vein isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation, but long-term success rates remains suboptimal, due in large part to late PV reconnection and insufficient ostial substrate modification.

Objective: To evaluate whether ablation index (AI)-guided PVI with electrical isolation and quantified ostial substrate modification improves clinical outcomes when compared with contact force (CF)-guided ablation in patients with paroxysmal atrial fibrillation (PAF).

Methods: The PAF-AI trial (ChiCTR1900022041) is a prospective, multi-center, randomized controlled clinical trial enrolling patients with PAF with an indication for catheter ablation. Patients are randomized into a 2:1 fashion to two treatment arms: AI-guided PVI (n = 151) and CF-guided PVI (n = 75). In the AI-guided PVI group, real-time automated display of radiofrequency applications (Visitag™) is used with AI ≥ 500 recommended at the anterior/superior/inferior walls and 350-400 at the posterior wall. In CF-guided PVI group, the value and direction of CF are displayed, with the lesion dots manually annotated. The primary endpoint is the freedom from AF recurrence at 12 months following ablation, without antiarrhythmic drug. The primary pre-specified secondary endpoints include intraprocedural efficiency and peri-procedural complications.

Conclusions: PAF-AI trial compares the effectiveness and safety of two different strategies of PVI in patients with PAF, AI-guided PVI versus more established CF-guided PVI. This prospective, multi-center, randomized controlled trial, with comparative data evaluating procedural and long-term follow-up results, aims to evaluate the impact of AI-guided strategy on AF ablation compared with the current standard of care RF ablation approach.
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http://dx.doi.org/10.1007/s10840-020-00763-5DOI Listing
April 2021

Clinical efficacy and safety of radiofrequency catheter ablation for atrial fibrillation in patients aged ≥80 years.

Pacing Clin Electrophysiol 2020 08 20;43(8):814-821. Epub 2020 Jul 20.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Aim: To evaluate the clinical safety and efficacy of radiofrequency catheter ablation for atrial fibrillation (AF) in patients aged ≥80 years.

Methods: A total of 333 AF patients aged ≥60 years were enrolled, who underwent contact force-guided radiofrequency catheter ablation with uninterrupted anticoagulation. All patients were followed-up for at least 12 months. Success was defined by the absence of episodes of AF/atrial tachycardia lasting more than 30 seconds after a 3-month blanking period, without antiarrhythmic drugs.

Results: Compared to patients aged 60-79 years (Group 2, n = 244), patients aged ≥80 years (Group 1, n = 89) were presented with higher rate of diabetes (36.0% vs 22.1%, P = .011), lower body mass index (23.4 ± 3.1 vs 24.9 ± 3.4 kg/m , P = .001), lower creatinine clearance (56.9 ± 16.5 vs 83.3 ± 24.5 mL/min, P < .001), higher CHA DS -VASc score (4.3 ± 1.3 vs 3.3 ± 1.4, P < .001), and HAS-BLED score (2.2 ± 0.8 vs 1.8 ± 0.8, P < .001). Wide antral pulmonary vein isolation was achieved in all patients, and there was no significant difference in procedure time, ablation time, fluoroscopy time, and complications rate between two age groups (P > .05). After a mean follow-up of 24.4 ± 9.6 months, the overall success rate was 78.2% in Group 1 and 78.9% in Group 2 (P = .622).

Conclusions: Radiofrequency ablation with contact force sensing catheters for AF is safe and effective in selected patients aged ≥80 years.
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http://dx.doi.org/10.1111/pace.13932DOI Listing
August 2020

Activated CD4 T cells-derived exosomal miR-142-3p boosts post-ischemic ventricular remodeling by activating myofibroblast.

Aging (Albany NY) 2020 04 23;12(8):7380-7396. Epub 2020 Apr 23.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Hongkou District, Shanghai 201620, China.

Cardiac fibrosis is a primary phenotype of cardiac remodeling that contributes to cardiac dysfunction and heart failure. The expansion and activation of CD4 T cells in the heart has been identified to facilitate pathological cardiac remodeling and dysfunction; however, the underlying mechanisms remained not well clarified. Herein, we found that exosomes derived from activated CD4 T cells (CD4-activated Exos) evoked pro-fibrotic effects of cardiac fibroblasts, and their delivery into the heart aggravated cardiac fibrosis and dysfunction post-infarction. Mechanistically, miR-142-3p that was enriched in CD4-activated Exos recapitulated the pro-fibrotic effects of CD4-activated Exos in cardiac fibroblasts, and vice versa. Furthermore, miR-142-3p directly targeted and inhibited the expression of Adenomatous Polyposis Coli (APC), a negative WNT signaling pathway regulator, contributing to the activation of WNT signaling pathway and cardiac fibroblast activation. Thus, CD4-activated Exos promote post-ischemic cardiac fibrosis through exosomal miR-142-3p-WNT signaling cascade-mediated activation of myofibroblasts. Targeting miR-142-3p in CD4-activated Exos may hold promise for treating cardiac remodeling post-MI.
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http://dx.doi.org/10.18632/aging.103084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202529PMC
April 2020

Ablation at Right Coronary Cusp as an Alternative and Favorable Approach to Eliminate Premature Ventricular Complexes Originating From the Proximal Left Anterior Fascicle.

Circ Arrhythm Electrophysiol 2020 05 17;13(5):e008173. Epub 2020 Apr 17.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, China (S.C., X.L., S.P., G.Z., Z.L., Y.W., K.Y., W.F., L.C., J.X., S.L.).

Background: Premature ventricular complex (PVC) with narrow QRS duration originating from proximal left anterior fascicle (LAF) is challenging for ablation. This study was performed to evaluate the safety and feasibility of ablation from right coronary cusp (RCC) for proximal LAF-PVC and to investigate this PVC's characteristics.

Methods: Mapping at RCC and left ventricle and ECG analysis were performed in 20 patients with LAF-PVC.

Results: The earliest activation site (EAS), with Purkinje potential during both PVC and sinus rhythm, was localized at proximal LAF in 8 patients (proximal group) and at nonproximal LAF in 12 patients (nonproximal group). The Purkinje potential preceding PVC-QRS at the EAS in proximal group (32.6±2.5 ms) was significantly earlier than that in nonproximal group (28.3±4.5 ms, =0.025). Similar difference in the Purkinje potentials preceding sinus rhythm QRS at the EAS was also observed between proximal and nonproximal groups (35.1±4.7 versus 25.2±5.0 ms, <0.001). In proximal group, the distance between the EAS to left His bundle and to RCC was shorter than that of nonproximal group (12.3±2.8 versus 19.7±5.0 mm, =0.002, and 3.9±0.8 versus 15.7±7.8 mm, <0.001, respectively). No difference in the distance from RCC to proximal LAF was identified between the 2 groups. PVCs were successfully eliminated from RCC for all proximal groups but at left ventricular EAS for nonproximal groups. The radiofrequency application times, ablation time, and procedure time of nonproximal group were longer than that of proximal group. Electrocardiographic analysis showed that, when compared with nonproximal group, the PVCs of proximal group had narrower QRS duration; smaller S wave in leads I, V, and V; lower R wave in leads I, aVR, aVL, V, V, and V; and smaller q wave in leads III and aVF. The QRS duration difference (PVC-QRS and sinus rhythm QRS) <15 ms predicted the proximal LAF origin with high sensitivity and specificity.

Conclusions: PVCs originating from proximal LAF, with unique electrocardiographic characteristics, could be eliminated safely from RCC.
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http://dx.doi.org/10.1161/CIRCEP.119.008173DOI Listing
May 2020

Phytotoxicity of iron-based materials in mung bean: Seed germination tests.

Chemosphere 2020 Jul 6;251:126432. Epub 2020 Mar 6.

Qingdao Hengli Environmental Technology Research Institute Co., Ltd., Qingdao, Shandong Province, 266000, PR China.

Environmental applications and potential risks of iron-based materials have attracted increasing attention. However, most previous studies focused on a single material. Comparative research using different iron-based materials under the same experimental conditions is still lacking. Here, six iron-based materials, including micro-sized and nanoscale FeO (i.e., mFeO and nFeO), bulk and bare nanoscale zero-valent iron (i.e., mZVI and B-nZVI), starch-supported nZVI (S-nZVI), and activated carbon-supported nZVI (A-nZVI), were studied to compare their phytotoxicity in mung bean grown in suspensions with doses of 0, 300, 600 and 1000 mg/L. Taking the four toxicology parameters (seed germination rate, germination index, seedling elongation and biomass) together, the iron-based materials except mFeO generally produced no significant phytotoxicity to mung bean even at 1000 mg/L. nFeO and B-nZVI showed no higher phytotoxicity than their micro-sized counterparts (mFeO and mZVI). All the materials resulted in increased Fe concentrations in seedlings particularly in roots, and mZVI and B-nZVI produced more significant effects. However, the Fe in the roots was difficultly translocated to the shoots. Compared to B-nZVI, nFeO had lower bioavailability and bioaccumulation potential. XRD results confirmed that most FeO and B-nZVI remained unchanged during seedling growth, while support materials accelerated the corrosion and transformation of S-nZVI and A-nZVI. In conclusion, the tested nanoscale iron-based materials generally possess no obvious phytotoxicity within the dose range, but cause excess Fe accumulation in seedlings. Introduction of support materials may reduce such risk, allowing safer applications of these iron-based materials.
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http://dx.doi.org/10.1016/j.chemosphere.2020.126432DOI Listing
July 2020

Importance of Terminating Pulmonary Vein Fibrillation for Complete Pulmonary Vein Isolation.

Circ J 2020 02 14;84(3):529. Epub 2019 Dec 14.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine.

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http://dx.doi.org/10.1253/circj.CJ-19-0679DOI Listing
February 2020

Stroke Risk Status, Anticoagulation Treatment, and Quality-of-Life in Chinese Patients with Atrial Fibrillation: China Registry of Atrial Fibrillation (CRAF).

Cardiovasc Ther 2019 21;2019:7372129. Epub 2019 Mar 21.

Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China.

To investigate the contemporary status of stroke risk profile, antithrombotic treatment, and quality-of-life (QoL) of patients with all types of atrial fibrillation (AF) in China. This is a multicenter, cross-sectional study. Tertiary (80%) and Tier 2 hospitals (20%) were identified in different economic regions (Northeast, East, West, and Middle) by using a simple random sampling. A total of 3562 (85.6%) patients with nonvalvular atrial fibrillation (NVAF) and 599 (14.4%) with rheumatic valvular atrial fibrillation (VAF) were consecutively enrolled from 111 hospitals from July 2012 to December 2012. Patient information was collected and QoL was assessed using Short-Form 36 Health Survey (SF-36) questionnaire. The risk of stroke was assessed using the CHADS and CHADS-VASc. QoL was assessed using Medical Outcomes Study SF-36 questionnaire. Overall, 31.7% of the patients received anticoagulant treatment and 61.2% received antiplatelet treatment. The rate of anticoagulant treatment was higher in patients with VAF than in those with NVAF. The anticoagulant use was the lowest in Northeast and the highest in Middle regions. Independent risk factors associated with underuse of anticoagulants for NVAF were age, systolic blood pressure (SBP), non-Middle regions, nontertiary hospitals, and new-onset or paroxysmal AF. For VAF patients, the independent factors were age, paroxysmal AF, treatment in Tier 2 hospitals, SBP, diastolic blood pressure, history of coronary artery disease, and nonreceipt of antiarrhythmic therapy. Patients receiving anticoagulants fared significantly better in some QoL domains than those who received no antithrombotic therapy. These findings suggest that antiplatelet treatment is overused and anticoagulant treatment is underused both in Chinese patients with VAF and NVAF, even though usage of anticoagulants is associated with better QoL. Risk factors with underuse of anticoagulants were not identical in patients with NVAF and VAF.
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http://dx.doi.org/10.1155/2019/7372129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739760PMC
March 2020

To the Editor- Understanding the complex anatomy of the Marshall bundle might improve the ablation efficacy.

Heart Rhythm 2020 04 7;17(4):e229. Epub 2019 Nov 7.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China. Electronic address:

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http://dx.doi.org/10.1016/j.hrthm.2019.11.001DOI Listing
April 2020

Elaborating endocardial mapping the Marshall bundle revealed a perimitral flutter mediated by ligament of Marshall.

Europace 2020 02;22(2):258

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No 100, Haining Road, Shanghai 200080, China.

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http://dx.doi.org/10.1093/europace/euz240DOI Listing
February 2020

Rate-dependent conduction block: A pitfall in the assessment of mitral isthmus conduction block.

J Cardiovasc Electrophysiol 2019 11 9;30(11):2558-2560. Epub 2019 Sep 9.

Department of Cardiology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

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http://dx.doi.org/10.1111/jce.14147DOI Listing
November 2019

A Novel Preparation of Nano-Copper Chalcogenide (CuS)-based Flexible Counter Electrode.

Sci Rep 2019 Aug 26;9(1):12337. Epub 2019 Aug 26.

State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Wuhan, 430070, P.R. China.

Copper nanowires (CuNWs) are used to prepare flexible, transparent conducting substrates due to their low cost and ease of fabrication on a large area. A CuNW/polymer composite substrate was prepared and vulcanized to create a novel flexible nano-CuS/polymer composite substrate. The physical and photovoltaic properties of the substrate can be controlled by tuning the concentration of CuNW dispersion during the preparation of CuNWs and nano CuS films. The nano-CuS-based composite substrate was used as an effective flexible counter electrode of a quantum-dot-sensitized solar cell (QDSSC) and resulted in a maximum cell efficiency of 1.01%.
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http://dx.doi.org/10.1038/s41598-019-48809-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710431PMC
August 2019

Diagnosis and Management of Resistant Hypertension: A Case Report.

Hypertension 2019 11 19;74(5):1064-1067. Epub 2019 Aug 19.

From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., J.A.S.).

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http://dx.doi.org/10.1161/HYPERTENSIONAHA.119.13206DOI Listing
November 2019

Rhythm control for patients with atrial fibrillation complicated with heart failure in the contemporary era of catheter ablation: a stratified pooled analysis of randomized data.

Eur Heart J 2020 08;41(30):2863-2873

Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany.

Aims: The optimal treatment for patients with atrial fibrillation (AF) and heart failure (HF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of rhythm control strategy in patients with AF complicated with HF regarding hard clinical endpoints.

Methods And Results: Up-to-date randomized data comparing rhythm control using antiarrhythmic drugs (AADs) vs. rate control (Subset A) or rhythm control using catheter ablation vs. medical therapy (Subset B) in AF and HF patients were pooled. The primary outcomes were all-cause mortality, re-hospitalization, stroke, and thromboembolic events. A total of 11 studies involving 3598 patients were enrolled (Subset A: 2486; Subset B: 1112). As compared with medical rate control, the AADs rhythm control was associated with similar all-cause mortality [odds ratio (OR): 0.96, P = 0.65], significantly higher rate of re-hospitalization (OR: 1.25, P = 0.01), and similar rate of stroke and thromboembolic events (OR: 0.91, P = 0.76,); however, as compared with medical therapy, catheter ablation rhythm control was associated with significantly lower all-cause mortality (OR: 0.51, P = 0.0003), reduced re-hospitalization rate (OR: 0.44, P = 0.003), similar rate of stroke events (OR: 0.59, P = 0.27), greater improvement in left ventricular ejection fraction [weighted mean difference (WMD): 6.8%, P = 0.0004], lower arrhythmia recurrence (29.6% vs. 80.1%, OR: 0.04, P < 0.00001), and greater improvement in quality of life (Minnesota Living with Heart Failure Questionnaire score) (WMD: -9.1, P = 0.007).

Conclusion: Catheter ablation as rhythm control strategy substantially improves survival rate, reduces re-hospitalization, increases the maintenance rate of sinus rhythm, contributes to preserve cardiac function, and improves quality of life for AF patients complicated with HF.
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http://dx.doi.org/10.1093/eurheartj/ehz443DOI Listing
August 2020

Association of Preoperative Renin-Angiotensin System Inhibitors With Prevention of Postoperative Atrial Fibrillation and Adverse Events: A Systematic Review and Meta-analysis.

JAMA Netw Open 2019 05 3;2(5):e194934. Epub 2019 May 3.

Cardioangiologisches Centrum Bethanien, Frankfurt Academy for Arrhythmias, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.

Importance: Postoperative atrial fibrillation (POAF) is a well-known complication after cardiac surgery. Renin-angiotensin system inhibitors (RASIs) have been suggested as an upstream therapy for selected patients with AF; however, evidence in the surgical setting is limited.

Objective: To evaluate the role of preoperative RASIs in prevention of POAF and adverse events for patients undergoing cardiac surgery.

Data Sources: The PubMed database and the Cochrane Library from inception until December 31, 2018, were searched by using the keywords renin-angiotensin system inhibitors OR angiotensin-converting enzyme inhibitors OR angiotensin receptor blocker OR aldosterone antagonist AND cardiac surgery. ClinicalTrials.gov was searched from inception until December 31, 2018, by using the keywords postoperative atrial fibrillation.

Study Selection: Randomized clinical trials (RCTs) and observational studies comparing the association between preoperative RASI treatment vs no preoperative RASI treatment (control group) and the incidence of POAF were identified. Eleven unique studies met the selection criteria.

Data Extraction And Synthesis: Pooled analysis was performed using a random-effects model. Sensitivity and subgroup analyses of RCTs were performed to test the stability of the overall effect. Metaregression was conducted to explore potential risk of bias.

Main Outcomes And Measures: The primary outcome was POAF, and the secondary outcomes included rates of stroke and mortality and duration of hospitalization.

Results: Eleven unique studies involving 27 885 unique patients (74.4% male; median age, 65 years [range, 58.5-74.5 years]) were included. Compared with the control group, the RASI group did not have a significantly reduced risk of POAF (odds ratio [OR], 1.04; 95% CI, 0.91-1.19; P = .55; z = 0.60), stroke (OR, 0.86; 95% CI, 0.62-1.19; P = .37; z = 0.90; without significant heterogeneity, P = .11), death (OR, 1.07; 95% CI, 0.85-1.35; P = .56; z = 0.59; without significant heterogeneity, P = .12), composite adverse cardiac events (OR, 1.04; 95% CI, 0.91-1.18; P = .58; z = 0.56), or a reduced hospital stay (weighted mean difference, -0.04; 95% CI, -1.05 to 0.98; P = .94; z = 0.07) using a random-effects model. Pooled analysis focusing on RCTs showed consistent results. The primary overall effect was maintained in sensitivity and subgroup analyses. Metaregression showed that male sex was significantly associated with POAF (τ2 = 0.0065; z = 3.47; Q = 12.047; P < .001) and that use of β-blockers was associated with a significantly reduced risk in developing POAF (τ2 = 0.018; z = -2.24; Q = 5.0091; P = .03).

Conclusions And Relevance: The findings from this study suggest that preoperative RASI treatment does not offer additional benefit in reducing the risk of POAF, stroke, death, and hospitalization in the setting of cardiac surgery. The results provide no support for conventional use of RASIs for the possible prevention of POAF and adverse events in patients undergoing cardiac surgery; further randomized data, particularly among those patients with heart failure, are needed.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.4934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547087PMC
May 2019

Ablation From the Right Coronary Cusp Eliminated Premature Ventricular Contractions Originating From the Proximal Left Anterior Fascicle.

Circ J 2019 10 28;83(11):2327. Epub 2019 May 28.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine.

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http://dx.doi.org/10.1253/circj.CJ-19-0315DOI Listing
October 2019

Circular RNA Ttc3 regulates cardiac function after myocardial infarction by sponging miR-15b.

J Mol Cell Cardiol 2019 05 12;130:10-22. Epub 2019 Mar 12.

Department of Cardiology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Hongkou District, Shanghai, China. Electronic address:

The apoptotic death of cardiomyocytes critically contributes to cardiac remodeling after myocardial infarction (MI). Circular RNAs (circRNAs) are important regulators for a variety of biological functions. Circ-Ttc3 represents one of the top highest expressed circRNAs in the heart; however, its role in MI remains unknown. Herein, we found that circ-Ttc3 was markedly upregulated in the ischemic myocardium and the cardiomyocytes subjected to hypoxic insult. Forced expression of circ-Ttc3 in cardiomyocytes counteracted hypoxia-induced ATP depletion and apoptotic death, in sharp contrast to circ-Ttc3 knockdown. Accordingly, experiments with AAV9-cTnt-mediated knockdown of cardiac circ-Ttc3 in a rat model of MI recapitulated the in vitro findings, and showed the deterioration of cardiac dysfunction after MI. Furthermore, we identified that circ-Ttc3 sponged an endogenous miR-15b-5p to sequester and inhibit its activity, leading to the increased Arl2 expression. Conversely, knockdown of Arl2 partially abolished the beneficial effects of circ-Ttc3 overexpression on ATP production and apoptosis of cardiomyocytes. Thus, our findings revealed the cardioprotective role of circ-Ttc3 in MI. The miR-15b-Arl2 regulatory cascade underlies the protection against MI-induced cardiomyocyte apoptosis by circ-Ttc3.
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http://dx.doi.org/10.1016/j.yjmcc.2019.03.007DOI Listing
May 2019

The importance of identifying conduction breakthrough sites across the mitral isthmus by elaborate mapping for mitral isthmus linear ablation.

Europace 2019 Jun;21(6):950-960

Section of Cardiovascular Diseases, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

Aims: Mitral isthmus (MI) ablation is challenging. We hoped to close those conduction breakthrough sites (CBS) across the MI by elaborate mapping.

Methods And Results: After the initial linear ablation, elaborately mapping large areas above and below the MI line and inside the coronary sinus (CS) was sequentially performed to identify the CBS. The shortest distance from the CBS to the MI line was measured. The distant CBS (D-CBS) was identified as those CBS >5.0 mm away from the MI line. We prospectively enrolled 177 consecutive patients. Bidirectional conduction blockage across MI was obtained in 50 (28.2%) patients after the initial linear ablation and was achieved in additional 115 (65.0%) patients following elaborate mapping and reinforcement ablation. After initial linear ablation, 272 CBS (2.14 ± 0.99 CBS/person) were identified, and 226 (83.1%) of them were characterized as D-CBS, including 98 sites (36.0%) >10.0 mm and 39 sites (14.3%) >15.0 mm away. Endocardial and epicardial (CS) reinforcement ablation eliminated 119/272 (43.8%) and 58/272 (21.3%) CBS, respectively. Among the 177 eliminated CBS, 138 D-CBS (78.0%, 11.2 ± 5.6 mm) were confirmed in 95 (74.8%) patients. Moreover, CBS along the course of ligament of Marshall was closed by endocardial ablation more frequently than that along the course of great cardiac vein (52.6%% vs. 35.1%, P = 0.004). Eventually, CS ablation was required only in 64 (38.8%) patients.

Conclusion: Distant CBS, accounted for the majorities of the residual conduction across the MI after initial ablation, could be effectively identified and accurately eliminated by elaborate mapping and ablation around the MI ablation line.
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http://dx.doi.org/10.1093/europace/euy327DOI Listing
June 2019

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

J Cardiovasc Electrophysiol 2019 05 2;30(5):658-667. Epub 2019 Feb 2.

Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt, Germany.

Introduction: Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension.

Methods: Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure.

Results: A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow-up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post-hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan-Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log-rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events.

Conclusions: RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.
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http://dx.doi.org/10.1111/jce.13858DOI Listing
May 2019

Berberine treatment reduces atherosclerosis by mediating gut microbiota in apoE-/- mice.

Biomed Pharmacother 2018 Nov 5;107:1556-1563. Epub 2018 Sep 5.

Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China. Electronic address:

Background: Berberine (BBR) has long been used for treating bacterial diarrhea due to its antimicrobial effect and is currently used to treat obesity, diabetes, hyperlipemia and atherosclerosis. Given the poor oral bioavailability of BBR, the mechanisms through which BBR mediates metabolic disorders are not well understood. The present study was designed to explore the role of BBR-induced gut microbiota modulation in the development of atherosclerosis.

Methods: Male apoE-/- mice were fed a high-fat diet (HFD) with or without the intragastric administration of BBR. Because mice are coprophagic and can transfer their gut microbiota to each other, we cohoused BBR-treated HFD-mice with non-BBR-treated HFD-fed mice.

Results: After 12 weeks of HFD feeding, compared with non-BBR-treated HFD-fed mice, BBR-treated HFD-fed mice exhibited a significant reduction in both atherosclerosis development and inflammatory cytokine expression. In addition, cohousing BBR-treated HFD-fed mice with non-BBR-treated HFD-fed mice decreased atherosclerosis development and inflammatory cytokine expression. The denaturing gradient gel electrophoresis and principal component analyses showed that the gut microbial profiles of BBR-treated HFD-fed mice were significantly different from those of HFD-fed mice but were similar to those of cohoused mice. The abundances ofFirmicutes and Verrucomicrobia in cohoused and BBR-treated mice were different from those in HFD-fed and normal chow-fed mice. Moreover, BBR reduced hepatic FMO3 expression and serum trimethylamine N-oxide levels.

Conclusion: The antiatherosclerotic effect of BBR is related to alterations in gut microbiota compositions, indicating the potential therapeutic value of pharmacological approaches that may modulate the gut microbiota in treating atherosclerosis.
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http://dx.doi.org/10.1016/j.biopha.2018.08.148DOI Listing
November 2018