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Sink J, Nimmagadda K, Zhao M, Andrei A, Gay H, Kaplan RM, Gao X, Pfenniger A, Patil KD, Arora R, Kim SS, Chicos AB, Lin AC, Passman RS, Knight BP, Verma N. Esophageal temperature management during cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2560-2566. [PMID: 36317453 PMCID: PMC10100377 DOI: 10.1111/jce.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/01/2022] [Accepted: 09/21/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Esophageal thermal injury (ETI) is a well-recognized complication of atrial fibrillation (AF) ablation. Previous studies have demonstrated that direct esophageal cooling reduces ETI during radiofrequency AF ablation. The purpose of this study was to evaluate the use of an esophageal warming device to prevent ETI during cryoballoon ablation (CBA) for AF. METHODS This prospective, double-blinded study enrolled 42 patients with symptomatic AF undergoing CBA. Patients were randomized to the treatment group with esophageal warming (42°C) using recirculated water through a multilumen, silicone tube inserted into the esophagus (EnsoETM®; Attune Medical) (WRM) or the control group with a luminal single-electrode esophageal temperature monitoring probe (LET). Patients underwent upper endoscopy esophagogastroduodenoscopy (EGD) the following day. ETI was classified into four grades. RESULTS Baseline patient characteristics were similar between groups. Procedural characteristics including number of freezes, total freeze time, early freeze terminations, coldest balloon temperature, procedure duration, posterior wall ablation, and proton pump inhibitor and transesophageal echocardiogram use before procedure were not different between groups. The EGD was completed in 40/42 patients. There was significantly more ETI in the WRM group compared to the LET group (n = 8 [38%] vs. n = 1 [5%], p = 0.02). All ETI lesions were grade 1 (erythema) or 2 (superficial ulceration). Total freeze time in the left inferior pulmonary vein was predictive of ETI (360 vs. 300 s, p = 0.03). CONCLUSION Use of a luminal heat exchange tube for esophageal warming during CBA for AF was paradoxically associated with a higher risk of ETI.
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Affiliation(s)
- Joshua Sink
- Department of Internal MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Kiran Nimmagadda
- Division of GastroenterologyNorthwestern UniversityChicagoIllinoisUSA
| | - Manyun Zhao
- Department of Preventative Medicine and BiostatisticsNorthwestern UniversityChicagoIllinoisUSA
| | - Adin‐Cristian Andrei
- Department of Preventative Medicine and BiostatisticsNorthwestern UniversityChicagoIllinoisUSA
| | - Hawkins Gay
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | | | - Xu Gao
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Anna Pfenniger
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | | | - Rishi Arora
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Susan S. Kim
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | | | - Albert C. Lin
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | - Rod S. Passman
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
| | | | - Nishant Verma
- Division of CardiologyNorthwestern UniversityChicagoIllinoisUSA
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Martinez-Camarillo JC, Spee CK, Chen M, Rodriguez A, Nimmagadda K, Trujillo-Sanchez GP, Hinton DR, Giarola A, Pikov V, Sridhar A, Humayun MS, Weitz AC. Sympathetic Effects of Internal Carotid Nerve Manipulation on Choroidal Vascularity and Related Measures. Invest Ophthalmol Vis Sci 2019; 60:4303-4309. [PMID: 31618767 DOI: 10.1167/iovs.18-25613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate specific effects of denervation and stimulation of the internal carotid nerve (ICN) on the choroid and retina. Methods Female Sprague Dawley rats underwent unilateral ICN transection (n = 20) or acute ICN electrical stimulation (n = 7). Rats in the denervation group were euthanized 6 weeks after nerve transection, and eyes were analyzed for changes in choroidal vascularity (via histomorphometry) or angiogenic growth factors and inflammatory markers (via ELISA). Rats in the stimulation group received acute ICN electrical stimulation with a bipolar cuff electrode over a range of stimulus amplitudes, frequencies, and pulse widths. Choroidal blood flow and pupil diameter were monitored before, during, and after stimulation. Results Six weeks after unilateral ICN transection, sympathectomized choroids exhibited increased vascularity, defined as the percentage of choroidal surface area occupied by blood vessel lumina. Vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR-2) protein levels in denervated choroids were 61% and 124% higher than in contralateral choroids, respectively. TNF-α levels in denervated retinas increased by 3.3-fold relative to levels in contralateral retinas. In animals undergoing acute ICN electrical stimulation, mydriasis and reduced choroidal blood flow were observed in the ipsilateral eye. The magnitude of the reduction in blood flow correlated positively with stimulus frequency. Conclusions Modulation of ICN activity reveals a potential role of the ocular sympathetic system in regulating endpoints related to neovascular diseases of the eye.
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Affiliation(s)
- Juan-Carlos Martinez-Camarillo
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States.,USC Ginsburg Institute for Biomedical Therapeutics of the University of Southern California, Los Angeles, California, United States
| | - Christine K Spee
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | - Michael Chen
- Department of Biomedical Engineering, Viterbi School of Engineering of the University of Southern California, Los Angeles, California, United States
| | - Anthony Rodriguez
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | - Kiran Nimmagadda
- USC Ginsburg Institute for Biomedical Therapeutics of the University of Southern California, Los Angeles, California, United States.,Neuroscience Graduate Program, University of Southern California, Los Angeles, California, United States.,USC - Caltech MD/PhD Program, Los Angeles, California, United States
| | - Gloria Paulina Trujillo-Sanchez
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States.,USC Ginsburg Institute for Biomedical Therapeutics of the University of Southern California, Los Angeles, California, United States
| | - David R Hinton
- USC Ginsburg Institute for Biomedical Therapeutics of the University of Southern California, Los Angeles, California, United States.,Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States
| | | | - Victor Pikov
- Galvani Bioelectronics, Stevenage, United Kingdom
| | - Arun Sridhar
- Galvani Bioelectronics, Stevenage, United Kingdom
| | - Mark S Humayun
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States.,USC Ginsburg Institute for Biomedical Therapeutics of the University of Southern California, Los Angeles, California, United States
| | - Andrew C Weitz
- USC Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, United States.,USC Ginsburg Institute for Biomedical Therapeutics of the University of Southern California, Los Angeles, California, United States
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Nimmagadda K, Weiland JD. Retinotopic Responses in the Visual Cortex Elicited by Epiretinal Electrical Stimulation in Normal and Retinal Degenerate Rats. Transl Vis Sci Technol 2018; 7:33. [PMID: 30402340 PMCID: PMC6213779 DOI: 10.1167/tvst.7.5.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/24/2018] [Indexed: 01/31/2023] Open
Abstract
Purpose Electronic retinal prostheses restore vision in people with outer retinal degeneration by electrically stimulating the inner retina. We characterized visual cortex electrophysiologic response elicited by electrical stimulation of retina in normally sighted and retinal degenerate rats. Methods Nine normally sighted Long Evans and 11 S334ter line 3 retinal degenerate (rd) rats were used to map cortical responses elicited by epiretinal electrical stimulation in four quadrants of the retina. Six normal and six rd rats were used to compare the dendritic spine density of neurons in the visual cortex. Results The rd rats required higher stimulus amplitudes to elicit responses in the visual cortex. The cortical electrically evoked responses (EERs) for both healthy and rd rats show a dose-response characteristic with respect to the stimulus amplitude. The EER maps in healthy rats show retinotopic organization. For rd rats, cortical retinotopy is not well preserved. The neurons in the visual cortex of rd rats show a 10% higher dendritic spine density than in the healthy rats. Conclusions Cortical activity maps, produced when epiretinal stimulation is applied to quadrants of the retina, exhibit retinotopy in normal but not rd rats. This is likely due to a combination of degeneration of the retina and increased stimulus thresholds in rd, which broadens the activated area of the retina. Translational Relevance Loss of retinotopy is evident in rd rats. If a similar loss of retinotopy is present in humans, retinal prostheses design must include flexibility to account for patient specific variability.
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Affiliation(s)
- Kiran Nimmagadda
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.,USC - Caltech MD/PhD Program, Los Angeles, CA, USA
| | - James D Weiland
- Department of Biomedical Engineering, The University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology and Visual Sciences, The University of Michigan, Ann Arbor, MI, USA
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Davuluri NS, Nimmagadda K, Petrossians A, Humayun MS, Weiland JD. Strategies to improve stimulation efficiency for retinal prostheses. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:3133-3138. [PMID: 28324979 DOI: 10.1109/embc.2016.7591393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Retinitis Pigmentosa (RP) is a degenerative disease of the retina that leads to vision loss. Retinal prostheses are being developed in order to restore functional vision in patients suffering from RP. We conducted in-vivo experiments in order to identify strategies to efficiently stimulate the retina. We electrically stimulated the retina and measured electrically evoked potentials (EERs) from the superior colliculus of rats. We compared the strength of EERs when voltage-controlled and current-controlled pulses of varying pulse width and charge levels were applied to the retina. In addition to comparing EER strength, we evaluated improvement in power efficiency afforded by a high surface area platinum-iridium material. Voltage-controlled pulses were more efficient than current-controlled pulses when the pulses have a short duration (<; 1 ms) and current-controlled pulses were more efficient than voltage-controlled pulses when the pulse width was greater than 1 ms. The high surface area platinum-iridium stimulation electrode consumed power significantly lower than a standard platinum-iridium electrode.
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Khare S, Cerda S, Wali RK, von Lintig FC, Tretiakova M, Joseph L, Stoiber D, Cohen G, Nimmagadda K, Hart J, Sitrin MD, Boss GR, Bissonnette M. Ursodeoxycholic acid inhibits Ras mutations, wild-type Ras activation, and cyclooxygenase-2 expression in colon cancer. Cancer Res 2003. [PMID: 12839936 DOI: 10.1016/s0016-5085(03)83066-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
K-ras mutations occur frequently in colon cancer and contribute to autonomous growth. In the azoxymethane (AOM) model of colon cancer, in addition to K-ras mutations, we have shown that wild-type (WT) Ras can be activated by upstream pathways, including, e.g., signaling by ErbB receptors. Tumors with mutant or activated WT Ras had increased cyclooxygenase-2 (Cox-2) expression. We have also shown that ursodeoxycholic acid (UDCA) prevented AOM-induced colon cancer and suppressed Cox-2 induction. In this study, we examined the role of Ras in Cox-2 inhibition by UDCA. Rats were fed AIN-76A chow alone, or supplemented with 0.4% UDCA, and received 20 mg/kg AOM i.p. weekly x 2 weeks. At 40 weeks, rats were sacrificed, and tumors were harvested. K-ras mutations were assessed by primer-mediated RFLP, allele-specific oligonucleotide hybridization, and direct DNA sequencing. Ras was immunoprecipitated and defined as activated if [Ras - GTP/(Ras - GTP + Ras - GDP)] was >3 SD above normal colonocytes. Cox-2 mRNA was determined by reverse transcription-PCR, and protein expression was assessed by Western blotting and immunostaining. In the AOM alone group, Ras was activated by mutations in 8 of 30 (27%) tumors, and WT Ras was activated in 7 of 30 (23%) tumors. UDCA significantly suppressed the incidence of tumors with mutant Ras (1 of 31, 3.2%; P < 0.05) and totally abolished the development of tumors with activated WT Ras (0 of 10; P < 0.05). In the AOM alone group, Cox-2 was up-regulated >50-fold in tumors with normal Ras activity and further enhanced in tumors with mutant or signaling-activated Ras. UDCA significantly inhibited Cox-2 protein and mRNA levels in tumors with normal Ras activity. In summary, we have shown for the first time that UDCA suppressed the development of tumors with Ras mutations and blocked activation of WT Ras. Furthermore, UDCA inhibited Cox-2 induction by Ras-dependent and -independent mechanisms.
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Affiliation(s)
- Sharad Khare
- Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Khare S, Cerda S, Wali RK, von Lintig FC, Tretiakova M, Joseph L, Stoiber D, Cohen G, Nimmagadda K, Hart J, Sitrin MD, Boss GR, Bissonnette M. Ursodeoxycholic acid inhibits Ras mutations, wild-type Ras activation, and cyclooxygenase-2 expression in colon cancer. Cancer Res 2003; 63:3517-23. [PMID: 12839936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
K-ras mutations occur frequently in colon cancer and contribute to autonomous growth. In the azoxymethane (AOM) model of colon cancer, in addition to K-ras mutations, we have shown that wild-type (WT) Ras can be activated by upstream pathways, including, e.g., signaling by ErbB receptors. Tumors with mutant or activated WT Ras had increased cyclooxygenase-2 (Cox-2) expression. We have also shown that ursodeoxycholic acid (UDCA) prevented AOM-induced colon cancer and suppressed Cox-2 induction. In this study, we examined the role of Ras in Cox-2 inhibition by UDCA. Rats were fed AIN-76A chow alone, or supplemented with 0.4% UDCA, and received 20 mg/kg AOM i.p. weekly x 2 weeks. At 40 weeks, rats were sacrificed, and tumors were harvested. K-ras mutations were assessed by primer-mediated RFLP, allele-specific oligonucleotide hybridization, and direct DNA sequencing. Ras was immunoprecipitated and defined as activated if [Ras - GTP/(Ras - GTP + Ras - GDP)] was >3 SD above normal colonocytes. Cox-2 mRNA was determined by reverse transcription-PCR, and protein expression was assessed by Western blotting and immunostaining. In the AOM alone group, Ras was activated by mutations in 8 of 30 (27%) tumors, and WT Ras was activated in 7 of 30 (23%) tumors. UDCA significantly suppressed the incidence of tumors with mutant Ras (1 of 31, 3.2%; P < 0.05) and totally abolished the development of tumors with activated WT Ras (0 of 10; P < 0.05). In the AOM alone group, Cox-2 was up-regulated >50-fold in tumors with normal Ras activity and further enhanced in tumors with mutant or signaling-activated Ras. UDCA significantly inhibited Cox-2 protein and mRNA levels in tumors with normal Ras activity. In summary, we have shown for the first time that UDCA suppressed the development of tumors with Ras mutations and blocked activation of WT Ras. Furthermore, UDCA inhibited Cox-2 induction by Ras-dependent and -independent mechanisms.
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Affiliation(s)
- Sharad Khare
- Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Abstract
BACKGROUND Little is known about differences between gastroenterologists and primary care physicians in their patterns of prescribing proton pump inhibitors. SUBJECTS AND METHODS A survey of practicing primary care physicians from the American Board of Medical Specialties and practicing gastroenterologists from the American Gastroenterological Association was conducted by facsimile. The survey instrument consisted of 13 questions about pharmacokinetics and administration of proton pump inhibitors. RESULTS The overall response rate was 15% (491 of 3273), and 80% (395 of 491) of respondents were nontrainee gastroenterologists or primary care physicians. Approximately 90% (n = 355) of eligible respondents correctly identified proton pump inhibitors as inhibitors of H+,K+-adenosinetriphosphatase. Proton pump inhibitors were prescribed by 80% (n = 314) of each group for reflux esophagitis. They were prescribed by 67% (122 of 182) of gastroenterologists and 27% (58 of 213) of primary care physicians to prevent ulcers induced by nonsteroidal anti-inflammatory drugs (P <0.001). And they were prescribed by 40% (n = 73) of gastroenterologists and 16% (n = 34) of primary care physicians for uncomplicated heartburn (P <0.001). Proton pump inhibitors were prescribed before a meal by 95% (n = 173) of gastroenterologists and 33% (n = 70) of primary care physicians (P <0.001). Nearly 99% (n = 391) of respondents agreed that proton pump inhibitors were safe, but only 15% (n = 59) thought they should be available without prescription. CONCLUSION Our survey suggests that the use of proton pump inhibitors differs between gastroenterologists and primary care physicians. Furthermore, although most physicians believe that proton pump inhibitors are safe, few believe that they should be available without a prescription.
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Affiliation(s)
- A F Barrison
- Section of Gastroenterology, Boston University School of Medicine and Boston Medical Center, 650 Albany Street, Boston, MA 02118-2393, USA
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