Objectives: Garlic (Allium sativum) has a well-established reputation as a protective agent against cardiovascular disease, while nearly nothing is known about its cousin Allium ursinum. The aim of this study was to evaluate the antiaggregatory mechanism of garlic and to compare the effects of A. ursinum and A. sativum. Methods: In a prospective study, extracts were prepared from A. sativum powder made from fresh A. sativum bulbs and fresh A. ursinum leaves by maceration. The extracts were characterized by thin layer chromatography. Their in vitro effects on human platelet aggregation were examined by light transmission aggregometry after induction by adenosine diphosphate (ADP), collagen, A23187, epinephrine and arachidonic acid (ARA) in platelets from healthy volunteers. Results:A. ursinum and A. sativum exert similar antiaggregatory effects: they inhibit platelet aggregation induced via the ADP pathway and to a lesser extent aggregation induced by epinephrine, whereas ARA-, collagen- and A23187-induced aggregation was not affected. It became clear that the alcoholic extract of A. ursinum is the potent form, while the aqueous extract exerted an unspecific activity. The effects were strictly dose related. A. ursinum and A. sativum extracts exhibited similar potencies. Conclusion: Both A. ursinum and A. sativum exert antiaggregatory effects. Garlic extracts are acting by inhibition of the ADP pathway; their mechanisms of action are comparable to that of the clinically used drug clopidogrel. The pharmacologically active component of the extracts appears to be lipophilic rather than hydrophilic, but the precise chemical substance is still unknown. This is the first report on the antiplatelet activity of A. ursinum.

Aims: We wanted to investigate the possible antithrombotic effects and elucidate the chemical identity of the active principles involved in inhibitory effects against adenosine diphosphate (ADP)-induced aggregation of human platelets by wild garlic, Allium ursinum L. Methods: For this purpose, a bioassay-guided isolation procedure was used followed by spectrometric identification of pure active compounds. For the bioassay, blood was taken from healthy human volunteers and platelet-rich plasma was prepared for turbidimetric platelet aggregation tests. Platelet-rich plasma, stimulated with 20 µmol/l of ADP, was treated with extracts of different polarities, fractions and isolated single compounds from A. ursinum. The extracts were investigated by thin-layer chromatography (TLC), HPLC, mass spectroscopy, electrospray ionization mass spectrometry (ESI-MS) and 1/2-dimensional ¹H/¹³C-nuclear magnetic resonance (NMR) spectroscopic techniques. Results: Fresh A. ursinum leaves were extracted with ethanol, which was the potent form that effectively inhibited ADP-induced aggregation of human platelets. This ethanolic extract was subjected to liquid-liquid partition. Whilst the aqueous phase, containing the moiety of cysteine sulphoxide and thiosulphinate derivatives, showed only weak activity on platelet aggregation, the ethyl-acetate and particularly the chloroform partitions showed the highest aggregation-inhibiting potency. Thus, in our bioassay, the effects of alliins/allicins could be neglected. The chloroform phase, possessing the strongest activity, was separated into 28 fractions by gradient-elution open column chromatography on silica gel. The most active fractions 11–17 were separated again, yielding 10 subfractions. This afforded 1,2-di-O-α-linolenoyl-3-O-β-D-galactopyranosyl-sn-glycerol and β-sitosterol-3-O-β-D-glucopyranoside, the structures of which were determined by ESI-MS and 1/2-dimensional ¹H/¹³C NMR spectroscopic techniques. Furthermore, the minute amounts of volatile oil of A. ursinum leaves obtained by steam distillation according to Ph. Eur. could be evaluated as a third aggregation-inhibiting principle. Conclusion: In our study, for the first time, 2 active, non-sulphur-containing constituents of wild garlic, namely a galactolipid and a phytosterol, could be identified exhibiting inhibitory action on ADP-induced aggregation in human blood platelets. As a major constituent, the galactolipid, 1,2-di-O-α-linolenoyl-3-O-β-D-galactopyranosyl-sn-glycerol, not yet found in Allium sp., appears as a new, highly useful marker substance for A. ursinum drugs, or their pharmaceutical or food preparations, as shown by our orientating TLC analyses.

Background-Left ventricular (LV) dyssynchrony may occur as a result of right ventricular (RV) pacing and is a known risk factor for the development of heart failure. In children with complete atrioventricular block, pacing-induced dyssynchrony lasting for decades might be especially deleterious for LV function. To determine the hemodynamic and ultrastructural remodeling after either RV free wall or LV apical pacing, we used a chronic minipig model. Methods and Results-Fourteen piglets 8 weeks of age underwent atrioventricular node ablation and were paced from either the RV free wall or the LV apex at 120 bpm for 1 year (7 age-matched minipigs served as controls with spontaneous heart rates of 104Ϯ5 bpm). Echocardiographic examinations, pressure-volume loops, patch-clamp investigations, and examinations of connexin43, calcium-handling proteins, and histomorphology were carried out. RV free wall-paced minipigs exhibited significantly more LV dyssynchrony than LV apex-paced animals, which was accompanied by worsening of LV function (maximum LV mechanical delay/LV ejection fraction: RV free wall pacing, 154Ϯ36 ms/28Ϯ3%, LV apical pacing, 52Ϯ19 ms/45Ϯ2%, control 47Ϯ14 ms/62Ϯ1%; Pϭ0.0001). At the cellular level, both pacemaker groups exhibited a significant reduction in L-type calcium and peak sodium current, shortening of action potential duration and amplitude, increased cell capacity, and alterations in the calcium-handling proteins that were similar for RV free wall-and LV apex-paced animals. Conclusions-The observed molecular remodeling seemed to be more dependent on heart rate than on dyssynchrony. LV apical pacing is associated with less dyssynchrony, a more physiological LV contraction pattern, and preserved LV function as opposed to RV free wall pacing. (Circulation. 2012;125:2578-2587.)Key Words: cardiac pacing, artificial Ⅲ myocardial contraction Ⅲ pediatrics Ⅲ ventricular remodeling T raditionally, permanent cardiac pacing has been carried out from the endocardial right ventricular (RV) apex. In smaller children, epicardial RV pacing sites were commonly used. Several larger adult [1][2][3] and smaller pediatric studies 4 -9 so far have shown that RV pacing may result in significant left ventricular (LV) dyssynchrony and impaired LV function, including the induction of progressive LV remodeling and failure. Alternative pacing sites have been looked for, including the RV septum and epicardial LV apex or free wall. Better preservation of LV synchrony and function could be shown in small observational studies in both mentioned LV pacing sites and in 1 recently published larger retrospective pediatric survey. 10 -14 Choosing an optimal pacing position may be of special importance in children subjected to cardiac pacing lasting for decades. However, until today, a prospective long-term study comparing the effects of RV or LV pacing on LV performance and ultrastructural morphology of the heart muscle has not been performed. Our aim was to examine the effects of RV free wall as opposed to LV apical pacing on LV...

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This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix