Surgical treatment of atrial fibrillation: the time is now

Atrial fibrillation (AF) is the most common chronic arrhythmia in the United States and is associated with high morbidity rates and significant healthcare costs. Although medical therapy for AF modestly reduces complications, cardiac surgery continues to have an important role in the treatment of AF and is constantly evolving. Cardiothoracic surgeons are uniquely positioned to offer effective operations to patients with lone AF, in addition to those undergoing concomitant elective cardiac surgery. This review discusses (1) the burden of AF, (2) classification and electrophysiology of AF, (3) surgical techniques and outcomes, and (4) future directions in surgical therapy.     

Usefulness of Self-Monitoring of Urinary Salt Excretion in Hypertensive Patients

We investigated the usefulness of measuring urinary salt excretion by using a self-monitoring device. Subjects were 34 hypertensive patients who underwent successful 24-h home urine collection five times and 25 volunteers. Four volunteers were diagnosed as having hypertension based on home blood pressure (BP) readings. All subjects were asked to measure daily urinary salt excretion for 30 days by using a self-monitoring device which estimates 24-h salt excretion by overnight urine. The mean urinary salt excretion during the 30 days was 8.36 ± 1.52 g/day and the range (maximum-minimum value) was 5.47 ± 20.05 g/day in all subjects. Mean urinary salt excretion decreased from 8.52 ± 1.63 g/day for the first 10 days to 8.31 ± 1.54 g/day for the last 10 days (p < 0.05). The mean urinary salt excretion determined by a self-monitoring device using overnight urine was positively associated with that determined by 24-h home urine for five times in the hypertensive subjects (r = 0.63, p < 0.01). Results indicate that a self-monitoring device seems to be useful to monitor daily salt intake and to guide salt restriction.     

Females without reflux symptoms or gastroesophageal reflux disease have less distal esophageal acid exposure than males without reflux symptoms or gastroesophageal reflux disease

Ambulatory 24‐hour esophageal pH monitoring is the gold standard examination to assess esophageal acid exposure. Gender‐related variation is a well‐recognized physiologic phenomenon in health and disease. To date, limited gender‐specific 24‐hour esophageal pH monitoring data are available. The aim of this study was to obtain values of esophageal pH monitoring in males and females without reflux symptoms or gastroesophageal reflux disease (GERD) to determine if gender variation exists in esophageal acid exposure among individuals without these factors. Twenty‐four‐hour dual esophageal pH monitoring was performed in male and female volunteers without reflux symptoms or GERD. Values for total number of reflux episodes, episodes longer than 5 minutes, total reflux time in minutes, % time with pH below 4, and longest reflux episode in the proximal/distal esophagus were obtained and recorded for both groups. The distal channel was placed 5 cm and proximal channel 15 cm above the manometrically determined lower esophageal sphincter. Means were compared using an independent sample t‐test. Sixty‐seven males and 69 females were enrolled. All subjects completed esophageal 24‐hour pH monitoring without difficulty. There was no age or body mass difference between groups. Females had significantly fewer reflux episodes at both esophageal measuring sites and, significantly less total reflux time and % time with pH below 4 in the distal esophagus than males. All other parameters were similar. Significant gender‐related differences exist in esophageal acid exposure, especially in the distal esophagus in individuals without reflux symptoms or GERD. These differences underscore the need for gender‐specific reference values for 24‐hour pH monitoring, allowing for an accurate evaluation of esophageal acid exposure in symptomatic patients.     

姜黄素对人膀胱癌T24细胞凋亡的影响

日的探讨姜黄素对人膀胱癌T24细胞凋亡的影响。方法培养人膀胱癌T24细胞,施加不同浓度姜黄素,观察对细胞凋亡的影响;应用流式细胞仪检测细胞凋亡率（碘化丙啶染色）。结果姜黄素各组较对照组凋亡率升高,存在剂量-效应关系。结论姜黄素促进人膀胱癌T24细胞凋亡。     

The effect of laparoscopic Nissen fundoplication on laryngeal findings and voice quality

Background This study aimed to report the need for an ear, nose, and throat (ENT) specialist to evaluate the laryngeal findings and the voice quality of patients with gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) symptoms before and after surgery. Methods For this study, 38 GERD patients who had a Reflux Symptom Index (RSI) score higher than 14 underwent complete assessment in the ENT department. Standard 24-h pH monitoring, esophageal motility assessment, a detailed ENT examination including the RSI, the Reflux Finding Score (RFS), and objective voice analysis were performed for all the patients before reflux surgery, then 6 to 8 months afterward. Results The subject’s mean RSI scores were 25.45 ± 7.5 before and 16.52 ± 5.06 after surgery (p < 0.05), and the mean RFS scores were, respectively, 10.37 ± 2.7 and 5.5 ± 1.45 (p < 0.05). The pre- and postoperative differences in the RSI and RFS scores and the voice parameters were statistically significant. Conclusions Objective voice analysis, RSI, and RFS can be used to evaluate the postoperative results for GERD patients with LPR symptoms. Examination of these patients by an ENT specialist is necessary before and after the operation.