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Aim: Vitamin D deficiency has a high prevalence in the population and is highly associated with cardiovascular diseases. The aim of this study was to evaluate subclinical left ventricular (LV) function using strain analysis in healthy individuals with vitamin D deficiency., Material and Methods: 113 healthy volunteers were enrolled in the study (age, 44.1±7 yrs, 34 male). All volunteers underwent two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography after conventional echocardiographic evaluation. The subjects were divided into two groups according to their vitamin D concentrations. 61 subjects with vitamin D less than 20 ng / ml were included in the vitamin D deficiency group. The baseline clinical characteristics, laboratory measurements, echocardiographic data, including 2D and 3D global longitudinal strain (GLS) values, were compared between the groups., Results: The 2D GLS values of the subjects with vitamin D deficiency were lower (mathematically less negative) than subjects with normal vitamin D (-16.1±3.4 vs -19.3±4.2, p<0.001). Similarly, the 3D GLS results were lower in subjects with vitamin D deficiency (-18.3±5.2 vs -24.1±6.9, p<0.001). A significant correlation was detected between the vitamin D concentrations and the 2D and 3D GLS measurements. (r=0.765 and r=0.628, respectively, p<0.001). Vitamin D was found to be an independent predictor of impaired 2D and 3D LV GLS (p=0.031, p=0.023, respectively)., Conclusion: Subclinical LV dysfunction in healthy individuals with vitamin D deficiency was demonstrated by 3D and 2D strain analysis. Due to potential negative effects of vitamin D deficiency on cardiac function, more attention should be paid to healthy individuals with vitamin D deficiency.

A majority of the primary contributors of carbon dioxide (CO 2 ) emissions into the environment have really been out of human-made activities. The levels of CO 2 in the atmosphere have increased substantially since the time of the industrial revolution. This has been linked to the use of fossil fuels for energy production, as well as the widespread production of some industrial components like cement and the encroaching destruction of forests. An extreme approach is now necessary to develop the right policies and address the local and global environmental issues in the right way. In this regard, CO 2 capturing, utilization, and storage are reliable options that industrial facilities can initiate to overcome this problem. Therefore, we have evaluated the two leading technologies that are used for carbon capture: direct (pre-combustion, post-combustion, and oxy-combustion) and indirect carbon (reforestation, enhanced weathering, bioenergy with carbon capture, and agricultural practices) capturing to provide their current status and progresses. Among the considered processes, the post-combustion techniques are widely utilized on a commercial scale, especially in industrial applications. Technology readiness level (TRL) results have showed that amine solvents, pressure-vacuum swing adsorption, and gas separation membranes have the highest TRL value of 9. In addition, the environmental impact assessment methods have been ranked to evaluate their sustainability levels. The highest global warming potential of 219.53 kgCO 2 eq./MWh has been obtained for the post-combustion process. Overall, through this comprehensive review, we have identified some critical research gaps in the open literature in the field of CO 2 -capturing methods where there are strong needs for future research and technology development studies, for instance, developing stable and cost-effective liquid solvents and improving the adsorption capacity of commercialized sorbents. Furthermore, some research areas, like novel process design, environmental and economic impact assessment of capturing methods with different chemicals and modeling and simulation studies, will require further effort to demonstrate the developed technologies for pilot and commercial-scale applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

As energy crisis is recognized as an increasingly serious concern, the topic on biohydrogen (bioH 2 ) production, which is renewable and eco-friendly, appears to be a highly-demanding subject. Although bioH 2 production technologies are still at the developmental stage, there are many reported works available on lab- and pilot-scale systems with a promising future. This paper presents various potential methods of bioH 2 production using biomass resources and comparatively assesses them for environmental impacts with a special emphasis on the specific biological processes. The environmental impact factors are then normalized with the feature scaling and normalization methods to evaluate the environmental sustainability dimensions of each bioH 2 production method. The results reveals that the photofermentation (PF) process is more environmentally sustainable than the other investigated biological and thermochemical processes, in terms of emissions, water-fossil-mineral uses, and health issues. The global warming potential (GWP) and acidification potential (AP) for the PF process are then found to be 1.88 kg-CO 2 eq. and 3.61 g-SO 2 eq., which become the lowest among all processes, including renewable energy-based H 2 production processes. However, the dark fermentation-microbial electrolysis cell (DF-MEC) hybrid process is considered the most environmentally harmful technique, with the highest GWP value of 14.6 kg-CO 2 eq. due to their superior electricity and heat requirements. The water conception potential (WCP) of 84.5 m 3 and water scarcity footprint (WSF) of 3632.9 m 3 for the DF-MEC process is also the highest compared to all other processes due to the huge amount of wastewater formation potential of the system. Finally, the overall rankings confirm that biological processes are primarily promising candidates to produce bioH 2 from an environmentally friendly point of view., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.)

Hydrogen is recognized as a critical substance for diversifying the global energy supply, providing new economic opportunities and realizing a carbon-free energy sector. In the current study, a life cycle assessment is conducted on a photoelectrochemical hydrogen production process of a newly developed photoelectrochemical reactor. With a photoactive electrode area of 870 cm 2 , the hydrogen production rate of the reactor is 47.1 μg/s while operating with the energy and exergy efficiencies of 6.3% and 6.31%, respectively. For a Faradaic efficiency of 96%, the produced current density is evaluated as 3.15 mA/cm 2 . A comprehensive study is conducted for a cradle-to-gate life cycle assessment of the proposed hydrogen photoelectrochemical production system. The life cycle assessment results of the proposed photoelectrochemical system are further evaluated within a comparative analysis by considering a total of four key hydrogen generation processes, namely steam-methane reforming, photovoltaics-based and wind electricity-driven proton exchange membrane water electrolysis and the current photoelectrochemical system and studying five environmental impact categories. The global warming potential of hydrogen production via the proposed photoelectrochemical cell is evaluated as 1.052 kg CO 2 equivalent per kg of produced hydrogen. In the normalized comparative life cycle assessment results, the PEC-based hydrogen production is found to be the most nature-friendly option among the considered pathways., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Marine transportation via the world's oceans is a critical way to convey goods and fuels between continents that cannot be performed cost-effectively by any other means. However, big ships heavily rely on fossil fuels, aggravating global carbon emissions. A key resolution to this dilemma is to employ clean fuels to reduce carbon emissions. This research paper introduces a new hybrid compound marine engine comprising a gas turbine, a solid oxide fuel cell, and a steam Rankine cycle. Three types of analyses, such as exergy, exergoeconomic, and exergoenvironmental analyses, are conducted on this proposed engine. It is found that the engine can produce a power of 15.5 MW, which is more than 48% compared to the traditional marine engine power, and the engine performance has up to 61% energy efficiency and 43% exergy efficiency. However, the exergetic efficiency of this engine based on fuel and product principal is 60%, which is more than 17% compared to its exergy efficiency. This engine has a 218 $/h Levelized cost rate and 139 mPt/h environmental rate. Finally, the average overall specific product exergy cost and environment are obtained to be 59 $/GJ and 20 mPt/MJ. By comparing five fuel blends, methane and hydrogen are the most economical and have the least impact on the environment; the second option is ethanol blend., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

In this study, an experimental investigation is conducted to analyze the effect of adding hydrogen into natural gas on emissions and the burning performance of the obtained blends. Natural gas alone and natural gas-hydrogen blends are burned in identical gas stoves, and the emitted CO, CO 2 , and NO x are measured. The base case with natural gas only is compared with the natural gas and hydrogen blends (including hydrogen additions of 10%, 20% and 30% volumetrically). The experimental results show that the combustion efficiency increases from 39.32% to 44.4% by enhancing the hydrogen blending ratio from 0 to 0.3. While CO 2 and CO emissions are reduced with rising the hydrogen ratio in the blend, NO x emissions have a fluctuating trend. Moreover, a life cycle analysis is performed to determine the environmental impact of the considered blending scenarios. With the blending ratio of 0.3 hydrogen by volume, global warming potential decreases from 6.233 to 6.123 kg CO 2 equivalents per kg blend, and acidification potential reduces from 0.0507 to 0.04928 kg SO 2 equivalents per kg blend in comparison with natural gas. On the other hand, human toxicity, abiotic depletion, and ozone depletion potentials per kg blend show slight augmentation from 5.30 to 5.52 kg 1,4-dichlorobenzene (DCB) eq., 0.0000107 to 0.00005921 kg SB eq., and 3.17 × 10 -8 to 5.38 × 10 -8  kg CFC-11 eq., respectively., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Aims: Atrial fibrillation (AF) is a prevalent arrhythmia and the leading preventable cause of cardioembolic stroke. Scoring systems for predicting AF risk do not use imaging modalities. We sought to determine whether LA longitudinal strain could be used as a single parameter for predicting the risk of AF., Methods and Results: Consecutive patients diagnosed with diastolic dysfunction between December 2019 and March 2020 were included. Two-dimensional, colour flow, continuous pulse-wave, and tissue Doppler transthoracic echocardiography (TTE) were performed using a Vivid E9 imaging system (GE Medical Systems, Chicago, USA). Measurements were obtained in the standard manner recommended by the American Society of Echocardiography. Moreover, LA longitudinal strain was measured using 2D speckle tracking echocardiography in the four-chamber view to evaluate left atrial function. The CHARGE-AF scoring system was used to predict AF risk.A total of 148 patients (mean age: 57.6 ± 11.9; male: 53%) with feasible views for LA strain measurement were divided into two groups based on a 10% CHARGE-AF cut-off score. The >10% group (48 patients; 32%) was defined as having a predicted 5-year AF risk >10%, and the ≤10% group (100 patients; 68%) was defined as having a predicted risk <10%. In the multivariate analysis, LA reservoir strain (LASr) was independently associated with CHARGE-AF score. Furthermore, using the Pearson correlation method, LASr was found to be highly correlated with CHARGE-AF score ( r  = -0.74, p  < 0.0001)., Conclusions: LASr was highly correlated with CHARGE-AF risk score and may be used as a parameter to predict atrial myopathy and hence AF risk.

This study presents an innovative integrated approach for smart cities, aimed at promoting environmentally sustainable economies through novel technological and socio-economic transitions. The proposed model determines the smart city index (SCI) by aggregating 32 distinct performance indicators that significantly transform the environment, economy, energy, social, governance, and transportation sectors. This model is inherently multidisciplinary and is methodologically processed using multi-criteria decision analysis, which is aggregated using four distinct weighting schemes. The model results reveal that based on the equal weighting scheme, Sydney emerges as the city with the highest SCI score of 0.72, whereas Lima is identified as the city with the lowest SCI score of 0.26. On the other hand, based on the sustainability triad scheme, Toronto tops the list with an SCI score of 0.77, whereas Abuja scores the lowest with an SCI score of 0.31. Interestingly, Toronto, Vancouver, and Montreal continue to maintain their position among the top 5 cities across all three schemes: equal weighting, sustainability triad, and energy-focused schemes. Furthermore, the energy-focused scheme identifies Montreal as the top-performing city, scoring 0.7, followed by Oshawa at 0.67, and four Canadian cities top the SCI scores in this scheme. In contrast, Lima still remains at the bottom of the list with an SCI score of 0.27. Finally, based on a smart health-focused scheme, Sydney, Osaka, and Hämeenlinna rank highest in SCI scores. Overall, the proposed approach and model provide valuable insights and guidelines for policy-makers and urban planners to design and implement smart city initiatives that can significantly enhance sustainable development and improve quality of life in urban settings., Competing Interests: The authors declare no conflict of interest., (© 2023 Published by Elsevier Ltd.)

In this study, it was aimed to reveal the potential of using exopolysaccharides (EPS) obtained from Ligilactobacillus salivarius as a prebiotic that regulates chicken intestinal microbiota. Characterization of EPS obtained from L. salivarius BIS312 (EPSBIS312) and BIS722 (EPSBIS722) strains was demonstrated by high performance liquid chromatography (HPLC), nuclear magnetic resonance (NMR), and size-exclusion chromatography (SEC) analyses. It was determined that the molecular weight of both EPS is in the range of 10 4 -10 6 Daltons, and there are 4 types of monomers in their structure. Anti-biofilm and anti-quorum sensing effects of EPSBIS312 and EPSBIS722 were determined. EPSBIS312 and EPSBIS722 showed a strong anti-biofilm effect on Enterococcus faecalis ATCC 29212, Staphylococcus aureus EB-1, and Escherichia coli ATCC 11229. The anti-quorum sensing study revealed that the EPSBIS722 had a higher effect than the EPSBIS312. The effect of different concentrations of EPS (2.5%, 5%, 10%) on lactobacilli growth stimulator (LGS) was evaluated. The highest LGS was promoted at 10% concentration while the lowest LGS was promoted at 2.5% concentration by EPSBIS722. In addition, adhesion abilities of EPSBIS312 and EPSBIS722 in HT-29 colorectal adenocarcinoma cell line were tested. EPSs significantly increased the ability to adhere to HT-29 cells. The characterized EPSs may be an alternative to plant prebiotics such as inulin at poultry., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In this study, a new solar-based fuel cell-powered oxygenation and ventilation system is presented for COVID-19 patients. Solar energy is utilized to operate the developed system through photovoltaic panels. The method of water splitting is utilized to generate the required oxygen through the operation of a proton exchange membrane water electrolyser. Moreover, the hydrogen produced during water splitting is utilized as fuel to operate the fuel cell system during low solar availability or the absence of solar irradiation. Transient simulations and thermodynamic analyses of the developed system are performed by accounting for the changes in solar radiation intensities during the year. The daily oxygen generation is found to vary between 170.4 kg/day and 614.2 kg/day during the year. Furthermore, the amount of daily hydrogen production varies between 21.3 kg/day and 76.8 kg/day. The peak oxygen generation rate attains a value of 18.6 g/s. Moreover, the water electrolysis subsystem entails daily exergy destruction in the range of 139.9-529.7 kWh. The maximum efficiencies of the developed system are found to be 14.3% energetically and 13.4% exergetically., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Hydrogen Energy Publications LLC. Published by Elsevier Ltd. All rights reserved.)

An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction (HFpEF), and LV filling pressure is estimated with an algorithm in the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LA global longitudinal strain to estimate elevated LV filling pressure. Seventy-one consecutive patients (mean age of 63.2  ±  9.75, 70% male) who underwent left ventricular catheterization were included. Transthoracic echocardiography was performed within 24 h before catheterization. The LV filling pressure was estimated using echo parameters based on the 2016 ASE/EACVI algorithm. LA GLS was measured using 2D speckle tracking echocardiography in a four-chamber view (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and > 12 mm Hg was defined as elevated. Invasive LV filling pressure was defined as elevated in 41 (58%) and normal in 30 patients (42%). The LV filling pressure of 9 (13%) of 71 patients was defined as indeterminate based on the 2016 algorithm. Using the ROC method, 25.5% of LA reservoir strain (LASr) had a higher sensitivity (AUC = 0.79, specificity 77%, sensitivity 80%) in estimating LV filling pressure than the 2016 ASE/EACVI algorithm (AUC = 0.75, specificity 77%, sensitivity 70%). LASr, with higher sensitivity than 2016 ASE/EACVI algorithm, may be used as a single parameter to estimate LV filling pressure and hence may add incremental value toHFpEF diagnosis., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

In this research study, a new solar energy-based integrated system is developed for treating industrial brine wastewater. An integrated solar-powered evaporation and membrane-based water treatment technique is utilized. Both forced convection as well as falling film evaporators are incorporated to treat high-concentration rejected brine. The system performance is assessed through a comprehensive thermodynamic investigation at varying operating parameters. The energetic performance is evaluated to vary from 12.5% to 15.9% across the year. Furthermore, the peak efficiency in terms of exergy is found to be 11.1%. Also, the membrane-based wastewater treatment subsystem is found to entail an energetic performance of 73.3% and an exergetic performance of 34.6% in terms of efficiencies. Moreover, an energetic performance of 15.4% and an exergetic performance of 2.9% is found for the evaporation-based subsystem. The exergy destructions in each system component are evaluated and the power generation subsystem is determined to have the highest exergy destruction rate of 15.4 MW. To investigate the effects of varying design parameters and operating conditions on the system performance, several parametric studies are also performed., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: An elevated left ventricular (LV) filling pressure is the main finding in heart failure patients with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines. In this study, we sought to determine the efficacy of the LV global longitudinal strain (GLS) in predicting an elevated LV filling pressure., Methods and Results: A total of 73 prospectively selected patients undergoing LV catheterization (mean age 63.19 ± 9.64, 69% male) participated in this study. Using the algorithm, the LV filling pressure was estimated using the echocardiographic parameters obtained within 24 hours before catheterization. The LV GLS was measured using an automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to the mean left atrial pressure (LAP) was used as a reference, and a LAP of >12 mm Hg was defined as elevated. Invasive LV filling pressure was elevated in 43 patients (59%) and normal in 30 patients (41%). Nine of 73 (12%) patients were defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS determined the elevated LAP (AUC =0.79; specificity, 73%; sensitivity, 84%) with better sensitivity compared to that by the algorithm (AUC =0.76; specificity, 77%; sensitivity, 72%)., Conclusions: We demonstrated that LV GLS was an independent predictor of elevated LAP as the E/e' ratio and TR jet velocity and may be used as a major criterion for the diagnosis of HFpEF., (© 2021 Wiley Periodicals LLC.)

Carbon capturing technologies are recognized as a cornerstone solution in reducing greenhouse gas emissions to meet the 2050 emissions targets set during the past Paris agreement. Recently, ammonia has become a major carbon-free chemical to absorb CO 2 emissions from flue gases. In this regard, this paper concerns the recently developed novel ammonia-based carbon capturing systems in the open literature and comparatively evaluates them from various perspectives in addition to discussing their advantages and disadvantages. The systems considered are basically classified into three categories, namely renewable energy-based systems, energy savings-focused systems, and Integrated Gasification Combined Cycle (IGCC)-based systems. Then, comparative assessments of the novel systems are conducted to see their advantages and weaknesses as compared to the typical chilled ammonia process. Generally, the novel systems have significantly lower energy requirements. The highest reduction is 37.3%. Another result of the comparative study is that renewable energy-based systems of carbon capturing have higher operational costs that can reach up to C$136 ton -1 of CO 2 captured. Future efforts are expected to focus on reducing these costs since renewable energy-based systems are also used to co-produce chemical commodities, such as urea and ammonium bicarbonate. These high-value commodities have the potential to generate enough economic value to compensate for the operational costs of carbon capturing using ammonia as a chemical solvent., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Currently, COVID-19 is a global pandemic that scientists and engineers around the world are aiming to understand further through rigorous testing and observation. This paper aims to provide safe distance recommendations among individuals and minimize the spread of COVID-19, as well as examine the efficacy of face coverings as a tool to slow the spread of respiratory droplets. These studies are conducted using computational fluid dynamics analyses, where the infected person breathes, coughs, and sneezes at various distances and environmental wind conditions and while wearing a face-covering (mask or face shield). In cases where there were no wind conditions, the breathing and coughing simulations display 1-2 m physical distancing to be effective. However, when sneezing was introduced, the physical distancing recommendation of 2 m was deemed not effective; instead, a distance of 2.8 m and greater was found to be more effective in reducing the exposure to respiratory droplets. The evaluation of environmental wind conditions necessitated an increase in physical distancing measures in all cases. The case where breathing was measured with a gentle breeze resulted in a physical distancing recommendation of 1.1 m, while coughing caused a change from the previous recommendation of 2 m to a distance of 4.5 m or greater. Sneezing in the presence of a gentle breeze was deemed to be the most impactful, with a recommendation for physical distancing of 5.8 m or more. It was determined that face coverings can potentially provide protection to an uninfected person in static air conditions. However, the uninfected person's protection can be compromised even in gentle wind conditions., (© 2021 Author(s).)

This paper provides a unique review of hydrogen production methods with wastewater treatment to depict a clean and sustainable approach. Various methods for hydrogen production from wastewaters are identified and discussed with recent details by discussing the critical challenges, opportunities, and future directions. Five main performance sectors are considered in detail for each hydrogen production method of the recent case studies, including economic, environmental, social, technical, and reliability. Eight hydrogen production methods are reviewed, including anaerobic method, photo fermentation, dark fermentation, electrolysis, electrodialysis, photocatalysis, photoelectrochemical methods, and super water gasification. A comparative assessment of six reviewed methods for hydrogen production, including environmental, economic, energetic, and exergetic impacts, is evaluated. The comparative assessment results indicate that dark fermentation technology is the most economical method, and it is followed by microbial electrolysis and photofermentation. The most environmentally friendly method for the lowest global warming potential (GWP) is the microbial electrolysis method, and it is followed by photocatalysis and photoelectrochemical methods. Furthermore, the highest energy and exergy efficiencies have been recorded for the microbial electrolysis to be 68% and 64.7%, respectively., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

The industrial flue gas emitted to the atmosphere is considered not only harmful to the environment but also a waste of plentiful resources of thermal energy. The thermal energy extracted from the industrial flue gas can be employed for multiple purposes. This study proposes a new configuration to integrate the thermal management of industrial flue gas for thermochemical copper-chlorine (Cu-Cl) cycle based ammonia synthesis. A reverse osmosis desalination unit is employed to supply the freshwater required by the thermochemical Cu-Cl cycle. To recover the heat from high-temperature oxygen stream, thermoelectric generators (TEGs) and organic Rankine cycle (ORC) are integrated with the proposed configuration to utilize the low-grade waste heat for power production. A portion of produced hydrogen through the thermochemical Cu-Cl cycle is supplied to the cascaded system for ammonia production. A double-stage cascaded ammonia synthesis system is integrated with the proposed configuration to achieve high fractional conversion. A multi-objective optimization using genetic algorithm is implemented to the proposed system using the MATLAB to investigate and determine the best-operating temperatures and pressures for the ammonia synthesis system. The proposed configuration produces 518.4 kmol/day of hydrogen and 226.8 kmol/day of ammonia. The overall exergetic and energetic efficiencies are found to be 28.7% and 40.8%. Moreover, the results obtained from the comprehensive sensitivity analyses are presented and discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In this work, three design configurations of a sonoreactor are considered under various operating conditions, and the acoustic characteristics during water sonication are investigated while using an immersed-type ultrasonic flat transducer probe in a sonoreactor model. Numerical models are also developed to simulate the sonication process, and they are successfully validated and compared with available data in the literature. Several sets of numerical investigations are conducted using the finite-element method and solved by the computational acoustics module in the COMSOL Multiphysics. The effects of the acoustical and geometrical parameters are investigated, analyzed, and reported, including the ultrasonic frequency, acoustic intensity, and scaling-up the reactor. The present study includes a parametric investigation examining the change of the ultrasonic frequency, intensity, and probe immersion depth on the performance. The results of the parametric study show that the highest cavitation energy corresponds to the maximum magnitude of negative pressure that takes place in the range of 60-80 kHz. The cavitation energy analyses are conducted under the conditions of 20 kHz of frequency and at 36 W input power. It is found that the cavitation energy of 15.87 W could produce 2.98 × 10 -10 mol/J of sonochemical efficiency. In addition, the effect of altering the transducer probe depth changes the acoustic pressure field insignificantly. Furthermore, a recommendation is made to improve the sonochemical efficiency by introducing more considerable ultrasound input power while operating the sonoreactor at an ultrasonic frequency lower than 60 kHz. The results presented in this paper provide a comprehensive assessment of different sonoreactors and the feasibility of scaling-up their production rate., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.)

This paper investigates the impact of COVID-19 and the global pandemic on the energy sector dynamics. Hourly electricity demand data was collected and analyzed for the province of Ontario. It is evident that health-related pandemics have a detrimental and direct influence on the concept of the smart city. This is manifested through various social, economic, environmental, technological and energy-related changes. The overall electricity demand of the province for the month of April of this year amidst pandemic conditions declined by 14%, totaling 1267 GW. A unique trend of reciprocating energy demand exists throughout the week. The post-COVID-19 indicates higher energy demand in the earlier part of the week and a lower demand in the latter part of the week. Pre-pandemic, the days of highest electricity demand were in the latter part of the work week (Wed-Fri) in addition to the weekend. Post-pandemic, the highest electricity demand occurred in the earlier part of the week (Mon-Tue). Hourly electricity demand shows a clear curve flattening during the pandemic, especially during peak hours of 7-11 in the morning and 5-7 in the evening, resulting in significant demand reductions during these periods. Lastly, due to COVID-19, GHG emission reductions of 40,000 tonnes of CO 2 e were achieved along with savings of $131,844 for the month of April., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Elsevier Ltd. All rights reserved.)

This paper analyzes the impact of COVID-19 on the transportation sector and subsequent implications on the sectoral energy savings and greenhouse gas emissions in some selected cities worldwide. A model for smart transportation is proposed by considering four indicators, including transport efficiency, technology integration, traffic congestion rate, and accessibility ratio. While prior health crises, such as SARS, impacted the transportation sector, the COVID-19 pandemic is unprecedented, resulting in exceptional impacts on this sector. Canadian Civil Aviation activities dropped by 71%, compared to business as usual, whereas military aviation activities declined by 27%. As of the end of June 2020, cities with higher than 50% mobility index include Brussels, Singapore, Stockholm, Lyon, Paris, Moscow, and Hong Kong with the highest mobility index of 76%. American cities have the lowest mobility indexes as of the end of June with mobility indexes lower than 20%. It is expected and reasonable to assume that the public's response to COVID-19 will exceed that of SARS. While Britons and Canadians are the biggest supporters of keeping the economy and businesses shut until COVID-19 is fully contained, the Chinese, Russians, Indians, and Italians find it vital to restart the economy regardless. Results show that the majority of the world is in a state of mental distress and will face nervousness and anxiety issues post-COVID-19. This sentiment is strongest in India, Japan, China, the U.K., Brazil and Canada, ranging between 68% and 78%. The trucking industry is the main contributor to the greenhouse gas (GHG) emissions of the Canadian transportation sector, accounting for more than 62% of the total emissions in 2019. Given the impact of COVID-19, forecasted GHG emissions of the Canadian transportation sector for 2020is evaluated to be 93 megatonnes of carbon dioxide equivalents., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 Elsevier Ltd. All rights reserved.)

The galvanizing industry uses the concentrated hydrochloric acid in its metal surface treatment processes known as pickling. Every year tons of waste acid solutions polluted with metals ions are discharged to the environment after neutralization process. In this study, a novel photoelectrochemical reactor is designed and developed for the production of hydrogen and chlorine gas from spent hydrochloric acid generated in the galvanizing industry. The novel reactor design allows all the hydrogen gas to flow from the reactor without any dead zone in the cathode compartment, while chlorine gas is carried out with aqueous 5 M HCl at the surface of the illuminated photoanode without any dissolution. Further, the unique design of the cathode corrosion-resistant high surface area (3 × the anode) results in good proton and H + transfer rate while the TiO 2 coated photoanode further enhances the charge transfer process and chlorine gas production. The characterization of the coated stainless steel is tested by the energy-dispersive X-ray (EDX) analysis and scanning electron microscope (SEM) images. The photoelectrochemical potentiostatic experiments with and without sunlight are performed on the reactor. The hydrogen and chlorine gas production rates are observed as 3 mL/min and 0.5 mL/min, respectively. Also, a comprehensive thermodynamic analysis of the photoelectrochemical reactor is conducted, and energy, exergy, and quantum efficiencies are found as 45.55%, 73.75%, and 6%, respectively. The exergoeconomic assessment study shows that the lowest exergy cost rate is achieved with sunlight illumination for a hydrogen exergy cost of 1.7 $/kg and chlorine exergy cost rate of 0.3 $/kg at an applied potential of 2 V., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Several indications for sutureless aortic valve replacement (SU-AVR) have been a matter of debate. We evaluated our experience with Perceval-S (LivaNova group, Saluggia, Italy) SU-AVR in patients with severe aortic stenosis (AS) involving bicuspid aortic valve (BAV), even though presence of BAV is still considered to be a contraindication for sutureless valves. From January 2013 through March 2018, 13 patients with severe AS involving BAV underwent SU-AVR with the Perceval-S (LivaNova group, Saluggia, Italy) prosthesis in a single center. Preoperative evaluation included coronary catheterization and multisliced computerized tomography was performed in all patients. Three-dimensional transthoracic echocardiography was used to evaluate for obtaining the anatomy and phenotype of BAV. Minimally invasive approach through right anterior thoracotomy from third intercostal space was performed for all patients. The mean age was 72.8 ± 2.26 years ranging from 70 to 77, and 53.8% (n = 7) were male. The mean aortic valve gradient decreased from 46.4 ± 13.8 to 13.6 ± 4.4 mmHg postoperatively. The mean aortic valve area increased from 0.69 ± 0.22 to 1.81 ± 0.38 cm 2 . There was no in-hospital mortality. One patient (7.6%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Mean follow-up was 15.1 ± 6.3 months (maximum 2 years). No major paravalvular leakage or valve migration occurred postoperatively. This study shows that SU-AVR is a technically feasible and safe procedure in patients with severe AS and BAV with acceptable good surgical outcomes. Presence of BAV in AS should not be considered a contraindication to Perceval-S prosthesis (LivaNova group, Saluggia, Italy)., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: Right heart failure (RHF) is an important prognostic factor in continuous-flow left ventricular assist device (LVAD) therapy. We aimed to assess the clinical variables associated with RHF after LVAD implantation and to compare their performance against currently available RHF predictive scoring systems., Methods: The study cohort comprised 57 patients who underwent LVAD therapy between January 2012 and May 2018 in our centre. The mean age of the patients was 39.9 ± 18.3 years, and 43 (81.1%) of them were men. Thirty-eight patients (66.6%) were in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile I or II. The study cohort was divided into the patients with RHF postoperatively (n = 20, 35.1%) and without RHF (n = 37, 64.9%)., Results: Independent predictors for RHF were preoperative right ventricular ejection fraction <25% [odds ratio (OR) 4.68, 95% confidence interval (CI) 1.41-15.5; P = 0.01], right ventricular stroke work index <400 mmHg ml-1 (OR 3.73, 95% CI 1.01-13.7; P = 0.04), right ventricular outflow tract systolic excursion <7 mm (OR 1.55, 95% CI 0.31-0.84; P = 0.002), right ventricular outflow tract fractional shortening <15% (OR 1.62, 95% CI 0.34-0.78; P = 0.02), right ventricular free wall longitudinal strain ≤19% (OR 3.13, 95% CI 1.01-2.43; P = 0.003), right ventricular fractional area change <27% (OR 3.71, 95% CI 1.15-11.9; P = 0.02) and prealbumin <14 mg/dl (OR 3.45, 95% CI 1.07-11.03; P = 0.03). Modest diagnostic performance for RHF was detected in 4 of 7 validated scoring systems with resulting area under the curve values of 0.70 (95% CI 0.55-0.84; P = 0.001) for the Seattle Heart Failure Model; 0.68 (95% CI 0.49-0.81, P = 0.03) for the Fitzpatrick's; 0.68 (95% CI 0.53-0.83, P = 0.028) for the acute physiology and chronic health evaluation (APACHE) II; and 0.66 (95% CI 0.50-0.82, P = 0.04) for the model for end-stage liver disease scoring systems. However, we found best discrimination performance of the score with a resulting area under the curve value of 0.94 (95% CI 0.55-0.89, P = 0.03) for right ventricular free wall longitudinal strain ≥-15.5% and 0.82 for right ventricular stroke work index <400 mmHg ml-1 m-2 in predicting RHF., Conclusions: Right ventricular free wall longitudinal strain ≥-15.5% and right ventricular stroke work index <400 mmHg ml-1 m-2 were independent predictors of RHF following LVAD implantation. Currently available prediction risk scores had the modest power of accuracy in the low INTERMACS profile Turkish population., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Based on available literature, ecology and economy of light emitting diode (LED) lights in plant foods production were assessed and compared to high pressure sodium (HPS) and compact fluorescent light (CFL) lamps. The assessment summarises that LEDs are superior compared to other lamp types. LEDs are ideal in luminous efficiency, life span and electricity usage. Mercury, carbon dioxide and heat emissions are also lowest in comparison to HPS and CFL lamps. This indicates that LEDs are indeed economic and eco-friendly lighting devices. The present review indicates also that LEDs have many practical benefits compared to other lamp types. In addition, they are applicable in many purposes in plant foods production. The main focus of the review is the targeted use of LEDs in order to enrich phytochemicals in plants. This is an expedient to massive improvement in production efficiency, since it diminishes the number of plants per phytochemical unit. Consequently, any other production costs (e.g. growing space, water, nutrient and transport) may be reduced markedly. Finally, 24 research articles published between 2013 and 2017 were reviewed for targeted use of LEDs in the specific, i.e. blue range (400-500 nm) of spectrum. The articles indicate that blue light is efficient in enhancing the accumulation of health beneficial phytochemicals in various species. The finding is important for global food production. © 2017 Society of Chemical Industry., (© 2017 Society of Chemical Industry.)

In the current study, conventional resources-based ammonia generation routes are comparatively studied through a comprehensive life cycle assessment. The selected ammonia generation options range from mostly used steam methane reforming to partial oxidation of heavy oil. The chosen ammonia synthesis process is the most common commercially available Haber-Bosch process. The essential energy input for the methods are used from various conventional resources such as coal, nuclear, natural gas and heavy oil. Using the life cycle assessment methodology, the environmental impacts of selected methods are identified and quantified from cradle to gate. The life cycle assessment outcomes of the conventional resources based ammonia production routes show that nuclear electrolysis-based ammonia generation method yields the lowest global warming and climate change impacts while the coal-based electrolysis options bring higher environmental problems. The calculated greenhouse gas emission from nuclear-based electrolysis is 0.48 kg CO 2 equivalent while it is 13.6 kg CO 2 per kg of ammonia for coal-based electrolysis method.

Introduction: The cause of exudative pleural effusion cannot be determined in some patients. The longterm outcomes of patients with undiagnosed pleural effusion were analyzed., Methods: Patients with exudative pleural effusion whose diagnostic procedures included pleural biopsy using video-assisted thoracoscopic surgery carried out between 2008 and 2012 were evaluated retrospectively. Patients diagnosed with non-specific pleuritis were included. Fifty-three patients with available follow-up data were included in the study., Results: Forty men and 13 women (mean age 53.9±13.9 years) were included. Median follow-up time was 24 months. No diagnosis was given in 27 patients (51%), and a clinical diagnosis was given in 26 patients (49%) during the follow-up period. Malignant disease (malignant mesothelioma) was diagnosed in 2 (3.7%) patients. Other diseases were parapneumonic effusion in 12, congestive heart failure in 8, and miscellaneous in 4 patients. Volume of effusion at the time of initial examination and re-accumulation of fluid after video-assisted thoracoscopic surgery were associated with malignant disease (P=.004 and .0001, respectively)., Conclusion: Although the probability is low, some patients with exudative pleural effusion undiagnosed after pleural biopsy via video-assisted thoracoscopic surgery may have malignant disease. Patients with an initially large volume of effusion that re-accumulates after examination should be closely monitored., (Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.)

Objective: Myocardial performance index (MPI, Tei index) has been described as a noninvasive measurement of left ventricle (LV) function. Our aim was to investigate the influence of preload on the LV MPI obtained by pulsed-wave tissue Doppler imaging (PWTDI) and determined by flow Doppler waveforms in patients with end-stage chronic renal failure (CRF). The second aim of this study was to investigate the relationship between the Tei indices obtained by both methods., Methods: Eighty-four patients on regular hemodialysis (HD) treatment were included (mean age of 45.3 ± 14.5 years). Standard echocardiographic measurements, the Tei indices obtained by conventional flow Doppler and PWTDI methods, mitral inflow velocities, and mitral lateral annulus tissue Doppler velocities were measured immediately before and after hemodialysis., Results: After HD, weight loss in patients was significantly revealed (predialysis 63.6 ± 13.3 kg; postdialysis 60.9 ± 13.0 kg; P < 0.001). Left ventricle and left atrium diameters were significantly decreased after HD. Transmitral E and A velocities decreased after HD. Although Tei index measuring by conventional flow Doppler method significantly increased, Tei index measuring by PWTDI did not change after HD., Conclusions: The conventional flow Doppler-derived LV Tei index is influenced by hemodialysis. However, PWTDI-derived LV Tei index is not influenced by hemodialysis. The loading status of a patient should be taken into account during the application of the Tei index to the evaluation of myocardial performance., (© 2015, Wiley Periodicals, Inc.)

Background: Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide (NO) synthetase. Elevated ADMA reduces NO formation and is associated with endothelial dysfunction. The aims of this study were to evaluate endothelial function and the cardiovascular risk (CVR) profile in patients with non-alcoholic fatty liver disease (NAFLD), and to determine whether or not an association with metabolic syndrome (MS) increases these parameters., Methods: A total of 100 consecutive patients with NAFLD, who were seen in Liver Disease Outpatient clinic and 45 age- and sex-matched controls were included. Endothelial function was evaluated based on the serum ADMA level measured using a validated ELISA kit (DLD Diagnostika GMBH, Hamburg, Germany) and flow-mediated vasodilatation (FMV) measured via high-resolution external ultrasonography. The CVR profile was calculated according to the Framingham equation., Results: At baseline there weren't any significant differences in brachial artery diameter between the NAFLD and control groups (3.7 ± 0.6 mm vs. 3.6 ± 0.6 mm, respectively). FMV and flow-independent vasodilatation in response to sublingual nitroglycerin did not differ between the NAFLD and control groups (mean: 16% ± 9.4% vs. 17.9% ± 12.4%, and 21.4% ± 14% vs. 17.8% ± 11.3%, respectively, p > 0.05). No significant difference in the serum ADMA concentration between the NAFLD and control groups was observed (mean: 0.8 ± 0.07 μmol L(-1) vs. 0.74 ± 0.2 μmol L(-1), respectively). The CVR profile was significantly higher in the NAFLD group than in the control group (mean: 9% ± 6.9% vs. 4.6% ± 3.8%, P = 0.000). MS associated with NAFLD significantly increased the CVR profile (mean: 11.2% ± 7.4%, P = 0.000). An abnormal serum alanine aminotransferase level (>37 IU L(-1)) and the presence of fibrosis did not increase the CVR profile (p > 0.05)., Conclusions: The risk of cardiovascular events is increased in patients with NAFLD. The association with MS is further increased such risk.

Mediastinal lymph node dissection, an important part of surgery for non-small cell lung cancer, is associated with a risk of chylothorax. Although mortality has significantly decreased in recent years, it still worries thoracic surgeons. In this report we reviewed our experience on chylothorax with 26 cases and assessed the outcomes after conservative and surgical approaches. Between January 2000 and June 2010, twenty-six patients developed chylothorax after pulmonary resection performed for non-small cell lung cancer. Initially, all cases were treated conservatively with cessation of oral intake and the application of talc poudrage. If the conservative method failed, a surgical approach was used, which consisted either of suturing the leak or of mass ligation. The mean age of patients was 56 ± 9.05 years, and 3 were female. Chylothorax was more common on the right side, in lobectomy cases, in cases with adenocarcinoma, and in patients with advanced stage lung cancer, but the difference did not reach statistical significance. Conservative treatment was successful in 19 of 26 (73 %) patients, four of whom had undergone pneumonectomy. Seven out of 26 cases (27%) required thoracotomy to control the chylous leak. Though thoracotomy was required mostly for the right side (6 right vs. 1 left, p = 0.15), and in patients who had had pneumonectomy as their first operation (4 patients vs. 3, p = 0.18), this did not reach statistical significance. No patient died as a result of surgical intervention. In conclusion, chylothorax is not rare after pulmonary resection performed for lung cancer. But it is not as dangerous as it used to be. Talc pleurodesis has increased the success of conservative management and minimized the need for surgical intervention. In cases of high output leak the surgeon should not hesitate to perform surgery. VATS can be performed instead of open surgery in suitable cases., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Aims: To compare the effects of nebivolol and ramipril on left ventricular hypertrophy in hypertensive patients., Materials and Methods: The study was conducted with a pre-randomised blinded endpoint (PROBE) design in which 106 patients with mild-to-moderate hypertension and left ventricular hypertrophy were randomised to ramipril (n = 52) or to nebivolol (n = 54) and treated for 39 weeks. The doses of ramipril and nebivolol were 2.5 and 5 mg/day, respectively. After 4-8 weeks, in patients with not normalised diastolic blood pressure, a thiazide diuretic was added (indapamide 2.5 mg or hydrochlorothiazide 12.5 mg/day). In the ramipril group, thiazide diuretic was added in 97% of subjects and in nebivolol group in 92%. The effect of treatment on left ventricular mass was assessed by two-dimensional guided M-mode transthoracic echocardiography, at baseline and at the end of the treatment. Left ventricular mass index (LVMI) was calculated and indexed to body surface area (g/m2) and height2.7 (g/height2.7). Blood pressure (BP) was measured at baseline, after 4, 8, 12, 24 and 39 weeks with a standard mercury sphygmomanometer., Results: Both left ventricular mass (LVM) and mass index (LVMI) decreased significantly after treatment with ramipril (LVMI -14.8 g/m2, -7.3 g/height2.7; p < 0.001), and after treatment with nebivolol (LVMI -31.9 g/m2, -15.6 g/height2.7; p < 0.001). The difference between ramipril and nebivolol (-17.1 g/m2, -8.3 g/height2.7) with regards to reduction of LVMI was statistically significant (p < 0.001). No differences were observed between the two groups in terms of normalization of LVMI. Both drugs decreased BP similarly after 39 weeks of treatment, Conclusions: The present study shows that both nebivolol and ramipril decrease LVMI. Nebivolol 5 mg/daily treatment reduced LVMI significantly more than ramipril 2.5 mg/daily. Both drugs similarly decreased BP during the treatment.

Background: Aim of the study was to identify factors affecting survival in patients with lung cancer and satellite tumors (ST)., Methods: Between 2001 and 2008, there were 102 patients with synchronous multiple lung cancers among the 1355 lung resections performed in lung cancer patients. Satellite tumors were found to be near the primary lung cancer (PLC) in 29 patients., Results: Complete resection was achieved in all patients, and the 5-year survival rate was 52 %. The independent "T" stages of the PLCs and STs did not affect survival ( P = 0.98 and P = 0.54, respectively). A distance between the PLC and ST longer or shorter than 2, 3, or 4 cm also did not affect survival ( P = 0.78, P = 0.57, and P = 0.62, respectively). The survival of patients treated with adjuvant therapy was significantly higher than that of patients who did not receive adjuvant therapy ( P = 0.0043)., Conclusions: Satisfactory survival was achieved after surgical therapy for non-small cell lung cancer associated with ST. While the PLC and ST characteristics and the distance between tumors did not affect survival rates, the introduction of adjuvant chemotherapy with/without radiotherapy positively affected survival., (© Georg Thieme Verlag KG Stuttgart · New York.)

In this paper, a novel biomass-based hydrogen production plant is investigated. The system uses oil palm shell as a feedstock. The main plant processes are biomass gasification, steam methane reforming and shift reaction. The modeling of the gasifier uses the Gibbs free energy minimization approach and chemical equilibrium considerations. The plant, with modifications, is simulated and analyzed thermodynamically using the Aspen Plus process simulation code (version 11.1). Exergy analysis, a useful tool for understanding and improving efficiency, is used throughout the investigation, in addition to energy analysis. The overall performance of the system is evaluated, and its efficiencies become 19% for exergy efficiency and 22% energy efficiency while the gasifier cold gas efficiency is 18%., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Castleman's disease (CD) is a rare disease with unknown aetiology. It is characterised by benign lymph node hyperplasia that may involve all lymph nodes. The most common locations are the mediastinum and abdomen. CD arising from intrapulmonary lymph nodes has been reported in five cases, in the English language literature to date. Tumours in these patients are usually resected during lung surgery. An asymptomatic 29-year-old male patient was evaluated due to a mass lesion with a diameter of 55 mm located in the infrahilar region of the right lung with a high degree of contrast enhancement on thoracic computed tomography (CT). Vascularity of this central lesion was excluded by pulmonary angiography. Thoracotomy was performed due to the inability to obtain a diagnosis with percutaneous fine needle aspiration biopsies. A frozen section examination of the mass revealed a benign lesion, arising from the intrapulmonary lymph nodes and protruding to the lower-lobe parenchyma. The mass was then extracted from the parenchyma. After histopathological evaluation of the mass, CD involving the lymph nodes was diagnosed. CD rarely involves the intrapulmonary lymph nodes. Diagnosis is difficult in these patients, and thoracotomy may be required. After obtaining benign results by mass sampling, limited resection of these masses, while sparing the lung parenchyma, may be possible.

Background: Calcium phosphate deposition is present even in the early phases of the atherosclerotic plaque formation. Calcifying nanoparticles (CNPs), previously known as nanobacteria, have emerged as a potential causative agent for pathological calcification in human vasculature. This study investigates the relationship between the anti-CNPs antibody titers and the extent of coronary calcification., Methods: A total of 197 consecutive patients undergoing multidetector computed tomography were enrolled in this study. The patients with coronary artery calcification (CAC; n=103) were included in the CAC group, and those without calcification (n=94) were determined as controls. The commercially available enzyme-linked immunosorbent assay kits were used to detect IgG antibodies against CNPs in serum samples., Results: Mean titers of anti-CNPs antibodies were higher in individuals with CAC than in the control group (0.4 ± 0.4 vs. 0.19 ± 0.21U; P<0.0001). Multivariate logistic regression analysis revealed that high anti-CNPs antibody levels were an independent correlate of CAC in addition to conventional risk factors such as age, hypertension, diabetes mellitus, and low levels of high-density lipoprotein cholesterol. When the CAC scores were subcategorized: score 0, 1-100, 101-400, and more than 400, they still correlated significantly with the anti-CNPs antibody, especially in the group having CAC scores greater than 400 (P<0.0001)., Conclusion: Anti-CNPs antibodies are an independent risk factor for CAC and the antibody levels correlate with CAC scores.

Background: Longitudinal two-dimensional strain (L2DS) deformation is a novel technique that evaluates global and regional right ventricular (RV) function. The aim of the study was to investigate the systolic function of RV by using this method in patients with pure mitral stenosis (MS)., Methods: Conventional echocardiography and L2DS analysis were performed in 45 MS patients and 21 healthy controls. For strain analysis apical four-chamber views were obtained and by using a software system, peak systolic strain and strain rates were calculated off-line in each segment., Results: The mean global longitudinal strain (GLS) of the whole RV (-20 + or - 7 vs. -24 + or - 6%, P= 0.02) and mean GLS of the septum (-19 + or - 7 vs. -23 + or - 5%, P = 0.03) were significantly reduced in the MS patients. Compared with the control group no significant change was determined in the mean GLS of the RV free wall (RVFW). While the mean global longitudinal strain rates (GLSR) of the entire RV and RVFW were similar between the groups, a significant difference in the mean GLSR of the septum (-1.2 + or - 0.4 vs. -1.5 + or - 0.3 s(-1), P= 0.005) was determined in the patients with MS. A regional analysis demonstrated that MS patients had significantly reduced strain and strain rates in the basal and mid-segments of the septum, whereas only lower strain values in the basal RVFW., Conclusions: RV systolic function evaluated by L2DS analysis in patients with MS has shown decreased global and segmental systolic functions. (ECHOCARDIOGRAPHY 2010;27:525-533).

Longitudinal two-dimensional strain deformation is a novel technique which evaluates global and regional left ventricular (LV) function with high reproducibility. The aim of the study was to investigate the global and regional systolic function using this method in patients with pure mitral stenosis (MS). Conventional echocardiography and longitudinal two-dimensional strain analysis were performed in 60 patients (41 +/- 5 years, 48 women) with mild to moderate MS (mitral valve area: 1.9 +/- 0.5 cm(2)), and 52 healthy controls (40 +/- 7 years, 37 women). For strain analysis standard apical views were obtained, and by using a software system peak systolic strain and strain rate were calculated off-line in each segment. In all, 88% of the segments could be optimally tracked by the software system. Despite normal LV systolic function as assessed by ejection fraction (66 +/- 8%), mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) were significantly reduced in patients with isolated MS (GLS -17 +/- 3.3 vs. -19 +/- 2.5%, P = 0.006 and GLSR -1.3 +/- 0.3 vs. -1.5 +/- 0.3 s(-1), P < 0.0001). Regional analysis demonstrated that patients with MS had a significantly reduced longitudinal peak strain and strain rate in all basal, and some mid (inferior, anteroseptal, interventricular septum) segments of the left ventricle. For other segments longitudinal peak strain and strain rate values were similar among the groups. Evaluation of LV systolic function by longitudinal two-dimensional strain deformation identified early abnormalities in MS patients who had apparently normal standard systolic function.

Recurrence rates reported for cardiac myxomas are 4% to 7% for sporadic cases and 10% to 21% for familial cases. Although recurrence rates are high, second recurrences are rare. Familial cardiac myxomas in a mother and daughter are reported, both of whom had their second recurrences within six years. Both had recurrences in uncommon places, such as the left atrial posterior wall, between the left atrial appendage and the pulmonary vein, and the anterior mitral leaflet.

Background: Arterial stiffness and left ventricular hypertrophy (LVH) are major independent risk factors for cardiovascular disease in healthy and renal population. In this study, we aimed to investigate comparative long-term effects of renal transplantation (RTx) and of hemodialysis (HD) on both arterial stiffness and LVH., Methods: Twenty-eight RTx patients, 23 HD patients, and 20 healthy subjects were included in this prospective study. In addition to demographical and laboratory parameters, arterial stiffness [pulse wave velocity (PWV)] and left ventricular mass index (LVMi) were assessed before and one-yr after RTx, and at the baseline and one-yr later in HD patients., Results: There were no differences in the parameters between HD and RTx patients at baseline. PWV was significantly higher than that of healthy controls. After one yr, PWV had significantly decreased in RTx patients, but was unchanged in HD patients. Changes in PWV were significant when both groups were compared (p < 0.0001). Although LVMi significantly decreased after RTx (p = 0.02), changes were not significant between the groups., Conclusions: Renal transplantation markedly improved arterial stiffness, while it remained elevated in HD patients at the one-yr follow-up. There was no difference between maintenance HD and RTx groups with respect to impact on LVMi in the one-yr follow-up.

Ectopic parathyroid adenomas are the cause of approximately one in four cases of primary hyperparathyroidism (pHPT). Most ectopic parathyroid adenomas are located adjacent to the upper thymus gland and can be resected with a collar incision. In rare cases, however, adenomas located in the chest require a transsternalor transthoracic approach. Due to the high rate of morbidity with a sternotomy or thoracotomy, minimally invasive methods such as video-assisted thoracoscopic surgery (VATS) or video-assisted mediastinoscopic surgery (VAMS) are becoming increasingly popular. We present two cases with primary hyperparathyroidism due to mediastinal ectopic parathyroid adenoma that were successfully treated by VATS approach.

The authors undertook this study to see whether highly developed coronary collaterals at an area shed by a totally occluded coronary artery predicts myocardial viability. Percutaneous coronary intervention (PCI) of a totally occluded coronary artery has been debated since its introduction. It is recommended to search for viable myocardium before opening a totally occluded coronary artery; however, there is no practical yet sensitive method of assessing myocardial viability in the catheterization laboratory. Forty-seven consecutive patients (12 women, 25.5%; 35 men, 74.5%), each with 1 totally occluded coronary artery, were prospectively enrolled to the study. After the diagnostic coronary angiography, all patients underwent dobutamine stress echocardiography to determine viable myocardium at the territory of the totally occluded coronary artery, and the status of angiographic coronary collaterals was assessed. Patients were then divided into 2 groups according to the presence (Group A) or absence (Group B) of viable myocardium by stress echocardiography. Eighteen patients (38.3%) had viable myocardium (Group A) in the area shed by the totally occluded coronary artery and 29 patients (61.7%) had nonviable myocardium (Group B). The incidences of significant coronary collateral circulation to the viable (Group A) and nonviable (Group B) areas were 66.7% (12 patients) and 20.7% (6 patients), respectively (p = 0.002). Logistic regression analysis was used to evaluate the independent factors for viable myocardium, and only significant coronary collateral circulation was found to be an independent factor for the detection of viable myocardium (p = 0.006, OR 16.7, 95% CI 2.25 to 124.4). The sensitivity and specificity of good collateral circulation for the detection of viable myocardium were 75% and 65.7%, respectively. The positive predictive and negative predictive values of the good coronary collateral circulation in detecting viable myocardium were 75% and 79%, respectively. The authors conclude that good coronary collaterals have a high sensitivity and positive predictive value for the prediction of viability as shown by dobutamine echocardiography, and only by assessing the coronary collateral circulation can one decide for percutaneous coronary revascularization, if not for coronary artery bypass surgery.

Objective: To investigate the role of angiotensin-converting enzyme (ACE) gene polymorphism in patients with degenerative aortic valve calcification (AVC)., Patients and Methods: Our study consisted of 305 Turkish patients of European descent (139 male, 166 female; mean plus or minus age, 68 plus or minus 9 years) referred to our echocardiography laboratory for aortic valve evaluation between June 2, 2003, and April 29, 2005. The severity of AVC was graded from 1 to 6 by echocardiography. We used polymerase chain reaction to determine ACE gene polymorphism., Results: The ACE insertion/deletion genotype distributions for the study population were in Hardy-Weinberg equilibrium (chi square equals 3.5, P equals .18). The study population was divided into 3 groups based on the severity of AVC: those with grade 1 calcification were in group 1, those with grades 2 to 4 in group 2, and those with grades 5 to 6 in group 3. Group 1 patients were significantly younger, less likely to have hypertension and diabetes, and had higher high-density lipoprotein cholesterol levels. The genotype frequencies were significantly different among groups, with the insertion/insertion genotype being less prevalent in group 3 patients. In multivariate analysis, independent predictors of severe AVC were hypertension (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.8 to 11.0; P less than .001), low high-density lipoprotein cholesterol (OR, 2.7; 95 percent CI, 1.5 to 4.9; P equals .001), and the deletion/deletion and insertion/deletion vs insertion/insertion genotype (OR, 3.2; 95 percent CI, 1.5 to 7.2; P equals .004)., Conclusion: These results suggest that ACE gene polymorphism may be associated with severe AVC.

The aim of the present study is to determine the prevalence and predictors of left ventricular hypertrophy in patients with stage 3 or 4 chronic kidney disease. Thirty-four patients were included. In addition to hematological and biochemical evaluations, echocardiography and ambulatory blood pressure monitoring were performed both at the beginning and at the end of the first year. Echocardiographic left ventricular mass was calculated and indexed to body surface area to calculate left ventricular mass index (LVMI). Left ventricular hypertrophy was diagnosed if LVMI >131 g/m(2) in male and >100 g/m(2) in female patients. During the follow-up period, estimated glomerular filtration rate decreased from 36.6+/-11.7 to 31.0+/-14.0 mL/min (p = 0.03), while LVMI increased from 130.2+/-35.6 to 140.5+/-30.5 g/m(2) (p = 0.055). Left ventricular hypertrophy was detected in 67.6% of the patients at the baseline and in 89.7% at the end of the study (p = 0.011). The independent predictors of the final LVMI were age (p = 0.035), baseline day-time systolic blood pressure (p = 0.01), baseline C-reactive protein (p = 0.001), and the decrease in glomerular filtration rate during the follow-up (p = 0.002). Left ventricular hypertrophy is quite frequent among patients with stage 3 or 4 chronic kidney disease, and its prevalence increases while glomerular filtration rate decreases during the follow-up. The early detection of left ventricular hypertrophy and both prevention of the deterioration of renal function and aggressive blood pressure control may help to achieve a decrease in cardiovascular morbidity and mortality in these patients.

Background: The coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease and the therapeutic promotion of collateral growth appears to be a valuable treatment strategy in these patients. Although it has been shown in in-vivo studies that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) promote vasculogenesis and accelerate coronary collateral development in ischemic tissues, there are discordant results in clinical studies. Our aim was to investigate the effect of statin therapy, including dosage and duration of treatment, on coronary collateral growth in patients with advanced coronary artery disease., Methods: Study population consisted of 400 (306 men, with the mean age of 62+/-10 years) consecutive patients who have undergone clinically indicated coronary angiography and had at least one major coronary artery stenosis of > or =95%. Coronary collaterals were graded from 0 to 3 according to the Cohen-Rentrop method and patients with grade 0-1 collateral development were regarded as having poor collateral and patients with grade 2-3 collateral development were regarded as having good collateral., Results: Among 400 patients, 196 (48%) were on statin therapy. Patients with good collateral score were more likely to have stable angina pectoris as clinical presentation (P<0.001), and were on statin therapy (P=0.001), and have multivessel disease (P=0.003). Statin therapy for less than 3 months had no effect on collateral development (P=0.19); however, patients who were on statin therapy for more than 3 months had significantly better collateral development (P=0.002). Statin therapy had no effect on coronary collateral development in patients having <10 mg atorvastatin-equivalent dose (P=0.13); however, patients having > or =10 mg atorvastatin-equivalent dose had better collateral development (P<0.001). Diabetes mellitus was the only negative predictor for coronary collateral formation (P=0.03). On multivariate analysis, stable angina pectoris [odds ratio 2.88, 95% confidence interval (1.8-4.7), P<0.001], statin therapy with > or =10 mg atorvastatin-equivalent dose [odds ratio 2.06, 95% confidence interval (1.3-2.6), P<0.001] and having multivessel disease [odds ratio 1.86, 95% confidence interval (1.16-3), P=0.01] were found to be associated with rich collateralization., Conclusion: Statin therapy (> or =10 mg atorvastatin-equivalent dose), stable angina pectoris and having multivessel disease are associated with enhanced coronary collateral development in patients with advanced coronary artery disease.

Introduction: The effects of l-thyroxine (l-T(4)) replacement for subclinical hypothyroidism (SH) on right ventricle (RV) functions has not been previously studied by means of pulsed wave tissue Doppler imaging (PWTDI). We investigated the effects of l-T(4) therapy on RV function in patients with SH using PWTDI., Patients and Methods: Fifty-three patients with newly diagnosed SH and 25 controls were evaluated by standard echocardiography and PWTDI. After euthyroidism was restored by l-T(4), measurements were repeated. Myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial precontraction time (PCT(m)), and PCT(m) to contraction time (CT(m)) ratio were calculated as systolic indices. Early (E(m)) velocity, late (A(m)) velocity, E(m) to A(m) ratio, and myocardial relaxation time (RT(m)) were determined as diastolic measurements., Results: S(m) was similar in patients and controls, whereas IVA was significantly lower in patients with SH (P < 0.001). SH patients had significantly decreased E(m) velocity, whereas A(m) velocity and E(m) to A(m) ratio did not differ. PCT(m) and RT(m) were significantly longer, and PCT(m) to CT(m) ratio was significantly higher in patients (P = 0.002, P = 0.002, P < 0.001, respectively). S(m) velocities were similar before and after l-T(4) replacement, whereas IVA significantly increased after therapy (P < 0.001). E(m) tended to increase (P = 0.05), whereas A(m) and E(m) to A(m) ratio were not changed. PCT(m), PCT(m) to CT(m) ratio, and RT(m) decreased significantly (P < 0.001 for all)., Conclusions: SH is associated with RV systolic and diastolic dysfunction, and l-T(4) treatment improves these abnormalities. PWTDI, especially IVA, may be a suitable tool for the early detection of RV systolic dysfunction.

Background: In vitro studies have shown that C-reactive protein (CRP) attenuates nitric oxide production and inhibits angiogenesis, which may result in impaired collateral development. The aim of this study was to investigate the association between high sensitivity CRP (hsCRP) levels and the extent of coronary collaterals., Materials and Methods: We investigated the association between hsCRP levels and the extent of coronary collaterals according to the Rentrop classification in a cohort of 185 patients who had high-grade coronary stenosis or occlusion on their angiograms., Results: Mean age was 62 years and 80% were males. Subjects with a higher grade of collaterals were significantly less likely to have diabetes mellitus (OR; 0.48, 95% and CI; 0.28, 0.83) or acute coronary syndrome (OR; 0.58, 95% and CI; 0.33, 0.99), but they were more likely to have higher number of vessels with significant stenosis (OR; 1.41, 95% and CI; 1.03, 1.93) and to have received statins (OR; 1.84, 1.09, 3.13). The mean hsCRP values reduced significantly as the Rentrop grades increased (trend, P = 0.0006). After adjusting for age, gender, statin use, clinical presentation with acute coronary syndrome, diabetes mellitus and the number of vessels with significant stenosis, each 10-unit increase in hsCRP values corresponded to a 31% reduced odds of having a higher collateral score (OR; 0.69, 95% and CI; 0.53, 0.90)., Conclusions: Our findings indicate that elevated hsCRP levels are associated with a significant impairment in coronary collateralization. These data suggest a previously unrecognized mechanism through which inflammation may worsen cardiovascular outcomes.

Background: Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, whereas others believe that it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this present study was to evaluate the effects of IOH on target organ damage and cardiovascular risk indices., Methods: Arterial blood pressure (BP) measured in the office and by 24-hour ambulatory blood pressure measurement (ABMP), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), cardiothoracic index (CTI), duration of QTc, 24-hour microalbuminuria, fibrinogen, C-reactive protein (CRP), total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels were evaluated. Thirty-three subjects with IOH (office BP > or = 140/90 mmHg and daytime ambulatory BP <135/85 mmHg), 17 patients with sustained hypertension (office BP > or = 140/90 mmHg and daytime ambulatory BP > or = 135/85 mmHg), and 17 normotensive control subjects were recruited in the study. The three groups were matched for age, sex and body mass index., Results: CIMT was greater in patients with IOH than in normotensive subjects, and it was significantly lower than that of sustained hypertension patients. Significantly higher LVMI was determined in subjects with IOH compared to normotensive subjects. CTI, QTc, microalbuminuria, fibrinogen, CRP, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels did not differ significantly among the three groups., Conclusions: IOH causes significant target organ damage and should not be regarded as a benign condition.

Coronary collateral development is an important compensatory mechanism in advanced coronary artery disease, and patients with diabetes mellitus have impaired coronary collateral development. This study tested the hypothesis that statin treatment may increase coronary collateral development in patients with diabetes mellitus. The study population consisted of 149 consecutive diabetic patients who underwent clinically indicated coronary angiography and had >95% stenosis of > or =1 major coronary artery. Clinical information, including age, gender, history of hypertension, smoking, myocardial infarction, clinical presentation, and medications, was recorded before coronary angiography. Coronary collaterals were graded according to the Cohen-Rentrop method. Collateral grading was classified as poor when the collateral grade was 0 to 1 and good when it was 2 to 3. Among 149 patients (85 men; mean age 62 +/- 10 years), 74 (56%) were receiving statin treatment. In multivariate analysis, among demographic, clinical, and angiographic parameters, only statin therapy (odds ratio 3, 95% confidence interval 1.5 to 6.03, p = 0.002) and stable angina pectoris (odds ratio 3.24, 95% confidence interval 1.42 to 7.41, p = 0.005) were found to be independent predictors of better collateral formation. In conclusion, stable angina pectoris and statin treatment are associated with better coronary collateral development in patients with diabetes mellitus.