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Copyright of Electronic Turkish Studies is the property of Electronic Turkish Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The loss of phenolic antioxidants is one of the major problems associated with the food frying process. As temperature increases and heating time is prolonged, losses of both tertiary butylhydroquinone (TBHQ) and butylated hydroxytoluene (BHT) are significantly increased. In this work, the effect of different types of free fatty acids (FFA) and the acid value (AV) of soybean oil (SBO) on TBHQ and BHT losses during heating were systematically studied. The results showed that the higher the AV of SBO at 120 or 180 °C, the greater the TBHQ loss. The type of FFA also had an observable effect on TBHQ losses at both temperatures, whereas FFA type had no effect on BHT losses. Employing high performance liquid chromatography and liquid chromatography-mass spectra (LC-MS analysis, it was determined that esterification of TBHQ with FFA (C, C, C) occurred at 120 or 180 °C, whereas esterification of BHT with FFA (C, C, C) in SBO was not observed. Nuclear magnetic resonance analysis showed that esterification occurred at the 4-position of TBHQ. [ABSTRACT FROM AUTHOR]

In love Masnavi, Heroes generally meet and fall in love with someone in a fun environment or during hunting. In this Masnavies, fun and games are included in case of heroes meeting their lovers, gaining their lovers and celebrating it after they broke up, and giving a banquet in honor of guests or in situation of getting married. Celebrations mostly consists of libation assembly (e.g. alcohol-music, singer, dancer, cupbearer and banquet assemblies), hunting, and some games (e.g. guy u çevgan oyunu, chess, gammon, hand game, and ring and celabration games). Games and celabrations are generally seen as an important part of love mesnavies. In mesnavies, poets employs games and celabrations as a source of casuality while they build events. Sometimes, poets relate games and celabrations with world life in order to provide religious- didactic suggestions. Games and celabrations are designed based on the squence related to people' status and progress of events within appropriate context. In this way, heroes and their earthly characters and related behaviours became integrated with context. Celabration factors are fictionalised based on starting point of a new event or celabrating happinesses of past events. [ABSTRACT FROM AUTHOR]

There has been a long-running debate amongst constitutional engineers between those who favour the proportional representation of parties (usually via PR-Closed List systems) and post-election power-sharing (Lijphart) and those who favour attempting to induce pre-election inter-ethnic ‘vote-pooling’ (Horowitz) as a more effective and stable method of governing divided societies. Less attention has been paid to the fact that other options are available. A leading candidate amongst these is the Single Transferable Vote (STV), a non-categorical ordinal ballot system that may be capable of combining the essential ‘fairness’ of proportionality with the centripetal benefits of some inter-ethnic vote-pooling. Northern Ireland is the only divided society with extensive experience of STV elections. This paper examines the empirical evidence before and after the 1998 Belfast Agreement by examining the operation of the electoral system at the Northern Ireland Assembly elections of 1982, 1998, 2003, 2007 and 2011. The main findings are that prior to the 1998 Agreement inter-ethnic vote-pooling in Northern Ireland was very close to zero. Afterwards (1998–2007) terminal transfers from the moderate unionist UUP to the moderate nationalist SDLP averaged 32 per cent (and 13 per cent in the opposite direction). Although most transfers clearly remain within ethnic blocs, these inter-ethnic terminal transfers are a change with the past and suggest that STV may be an appropriate electoral system choice for some divided societies. [Copyright &y& Elsevier]

Objectives: The purpose of this study was to enhance understanding of the working mechanism of cardiac resynchronization therapy by comparing animal experimental, clinical, and computational data on the hemodynamic and electromechanical consequences of left ventricular pacing (LVP) and biventricular pacing (BiVP).Background: It is unclear why LVP and BiVP have comparative positive effects on hemodynamic function of patients with dyssynchronous heart failure.Methods: Hemodynamic response to LVP and BiVP (% change in maximal rate of left ventricular pressure rise [LVdP/dtmax]) was measured in 6 dogs and 24 patients with heart failure and left bundle branch block followed by computer simulations of local myofiber mechanics during LVP and BiVP in the failing heart with left bundle branch block. Pacing-induced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode electrocardiographic mapping technique.Results: LVP and BiVP similarly increased LVdP/dtmax in dogs and in patients, but only BiVP significantly decreased electrical dyssynchrony. In the simulations, LVP and BiVP increased total ventricular myofiber work to the same extent. While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofiber work, the BiVP-induced increase was due to enhanced myofiber work of both the left ventricle (LV) and RV. Overall, LVdP/dtmax correlated better with total ventricular myofiber work than with LV or RV myofiber work alone.Conclusions: Animal experimental, clinical, and computational data support the similarity of hemodynamic response to LVP and BiVP, despite differences in electrical dyssynchrony. The simulations provide the novel insight that, through ventricular interaction, the RV myocardium importantly contributes to the improvement in LV pump function induced by cardiac resynchronization therapy. [ABSTRACT FROM AUTHOR]

Ortaçağ İslam dünyasında avlanma ve savaş gündelik hayatın adeta bir parçası olarak karşımıza çıkmaktadır. Bu araştırmada birbiriyle ilintisiz gibi görünen her iki sanatın tesadüfe dayanmayacak kadar bir birini tamamlayıcı yönü kanıtları ile ortaya konmaya çalışılmıştır. Av, savaş alanına giden yolda askerin prova saha-sıdır. Tarihe mal olmuş birçok önemli savaşta sayısal dengeleri alt üst eden önemli faktör, takip edilen savaş stratejileridir. Bu savaş stratejileri ise, av sahasında ve sosyal yaşamlarının diğer alanlarında kazandıkları becerilerin sergilenmesi ile uygu-lama alanı bulmuştur. Savaşta da kullanıldığı kanıtlanan av stratejileri ve silahları ava düşkünlüğü ile bilinen Müslüman Arapların ilk dönem fetih hareketlerinde, siyasi ve dini saiklerden daha öte zafere ulaşmalarında kendilerine katkı sağlamıştır. Dolayısıyla zaferlere ne hamasi söylem, ne de henüz elde edilmemiş ganimet arzu-suyla değil, savaşı hayatının bir parçası kabul edenlerin av gibi doğal tatbikat alan-larında kazandıkları yiğitlik, atılganlık, çeviklik ve silahşorluk sayesinde ulaşmışlardır.

Abstract: This study firstly reports the characterization of a functional IκB homologue, FcCactus in Chinese shrimp Fenneropenaeus chinensis. The full length cDNA of FcCactus consists of a 1359bp open reading frame (ORF) encoding a 453 amino acid protein with a predicted molecular weight (MW) of 48.46kDa and theoretical pI of 5.23. Phylogenetic analysis and multiple alignments revealed that the deduced amino acid sequence of FcCactus cDNA had high similarities to Cactus or IκB reported in seven other arthropods. Genomic DNA sequence of FcCactus was also obtained with a length of more than 17698bp and constituted of seven exons and six introns. Analysis on 5′-upstream regulatory region of its DNA sequence revealed that it contained the core promoter sequence with the TATA-box and transcription start site existing in it; furthermore, various transcription factor binding sites (HSF, Hb, BR-C Z, Dfd, CF2-II, Croc, Ttk, Dorsal, and c-Rel) were predicted. Spatial expression profiles showed that FcCactus mRNA had the highest expression level in muscle, hemocytes, heart and lymphoid organ. Gram-positive bacteria (Micrococcus lysodeikticus) and Gram-negative bacteria (Vibrio anguillarium) injection to shrimp caused the modulation of FcCactus at the transcription level. DsRNAi (double-strand RNA interference) approach was used to study the function of FcCactus and the data showed that FcCactus could regulate the expression of different antimicrobial peptides (AMPs) and antiviral factor (AV). The present data showed that FcCactus might play important roles in regulating the immune response of shrimp. [Copyright &y& Elsevier]

Abstract: The paper assesses the influence of electoral rules on vote choice and election outcomes using a quasi-experiment conducted during a recent Canadian provincial election. Respondents were invited to vote under three voting systems (first past the post, alternative voting and proportional representation) and to answer a short questionnaire. We examine how the distribution of votes and seats is affected, and we ascertain how much of the total difference is due to psychological and mechanical effects. We find that a PR system would have increased legislative fractionalization by the equivalent of one effective party and that the mechanical effect is much more important than the psychological effect. As for AV, its mechanical and psychological effects act in opposite directions. [Copyright &y& Elsevier]

In the adult heart, electrophysiological heterogeneity is present to guide activation and contraction. A change in electrophysiological heterogeneity, for example, during disease, can contribute to arrhythmogenesis. During development, spatial and temporal patterns of transcriptional activity regulate the localized expression of ion channels that cause electrophysiological heterogeneity throughout the heart. If we gain insight into the regulating processes that generate the electrophysiological characteristics and factors involved during development, we can use this knowledge in the search for new therapeutic targets. In this review, we discuss which factors guide the electrical patterning of atrioventricular conduction system and ventricles and how this patterning relates to arrhythmogenic disease in patients. [ABSTRACT FROM AUTHOR]

Abstract: Thermal oxidation of tallow was assayed by peroxide value (PV), p-anisidine value (p-AV), and acid value (AV), and the volatile compounds produced at different oxidation conditions were analysed by SPME-GC/MS. The accumulation of characteristic beef flavour precursors, such as hexanal, 1-octen-3-ol, (E,E)-2,4-decadienal and (E,E)-2,4-heptadienal, reached a maximum value when heated at 140°C for 2h with an air flow of 75l/h per 100g tallow, whereas at the same temperature PV and p-AV were both at high levels, and AV was relatively low. A correlation analysis of chemical parameters and volatile compounds showed that the beef flavour precursors were positively related to PV, and the off-flavour compounds were highly correlated to AV. Therefore, a moderate oxidation of tallow could be achieved via controlled thermal treatment. [ABSTRACT FROM AUTHOR]

There are some lacunae in the standard preoperative informed consent process being followed at present. We have formulated guidelines for an audio-visual recording of the consent process for safeguarding the interests of both the doctor and the patient. [ABSTRACT FROM AUTHOR]

Autonomous vehicles (AV) technology is designed for replacing conventional transportation systems ahead of energy conservation, pollution control, accident prevention, etc. The benefits of AV are feasible by the incorporation of information technology and connected infrastructures. These provide seamless support for driving and navigation assistance with the knowledge of the environment. However, the vehicles' independent assistance relies on the cooperative nature of the neighbors and infrastructure units. In this article, assisted cooperative decision-support (ACDS) is proposed for improving the spontaneous decisions for vehicle connectivity and navigation issues. The interrupt due to multiple connectivity issues from a specific infrastructure region is addressed for leveraging the decision support for AVs. In this decision-making process, neural learning is used for improving the analysis of radial inputs. The learning process categorizes connectivity and outage information based on the assisted navigation ratio between the neighbors and infrastructures. This helps to provide flexible, cooperative analysis in different navigation scenarios, promoting accuracy, and reducing the input complexity. The performance of ACDS is verified using outage, complexity, analysis time, and accuracy measures. [ABSTRACT FROM AUTHOR]

Copyright of Electronic Turkish Studies is the property of Electronic Turkish Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The first part of this study evaluated oxidative stability in high-oleic rapeseed oil, palm olein, refined olive oil, low erucic acid rapeseed oil and sunflower oil. The results showed oxidative stability in the order: palm olein > high-oleic rapeseed oil > refined olive oil > low erucic acid rapeseed oil > sunflower oil, as determined by the Rancimat method. Addition of α-tocopherol at high levels of up to 0.2% increased the oxidative stability of refined olive oil, whereas the opposite effect was generally observed in the other oil samples. In the second part of the study, high-oleic rapeseed oil, palm olein, refined olive oil and refined olive oil containing 0.2% α-tocopherol were heated for 3, 6, 9 and 12 h at 180 °C. The peroxide and p-anisidine values generally increased over time in the samples, including olive oil containing 0.2% α-tocopherol. High-oleic rapeseed oil contained the highest amount of total sterols and total phytosterol oxidation products (POPs), but during heating the total POPs content increased moderately (~10%), in contrast to the threefold increase after 12 h of heating in palm olein and refined olive oil. Very high levels of 6-hydroxy derivatives of brassicastanol, campestanol and sitostanol and of 7-ketobrassicasterol were observed in high-oleic rapeseed oil samples. Addition of 0.2% α-tocopherol during heating significantly decreased POPs formation in refined olive oil (P<0.05). [ABSTRACT FROM AUTHOR]

The library at the University of Alaska Fairbanks offers a unique equipment lending program through its Circulation Desk. The program features a wide array of equipment types, generous circulation policies, and unrestricted borrowing, enabling students, staff, and faculty to experiment with the latest in audio, video, and computer technologies, for both academic and personal enrichment projects. The program enjoys great popularity and significant financial support by the University. The results of a recently conducted online patron survey demonstrate the need for continued support and further development of the equipment lending program. [ABSTRACT FROM AUTHOR]

Copyright of Electronic Turkish Studies is the property of Electronic Turkish Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

: ObjectivesThe aim of this study was to evaluate tecadenoson safety and efficacy during conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm.: BackgroundTecadenoson (CVT-510), a novel adenosine receptor (Ado R) agonist, selectively activates the A1 Ado R and prolongs atrioventricular (AV) nodal conduction at doses lower than those required to cause A2 Ado R-mediated coronary and peripheral vasodilation. Unlike adenosine, which non-selectively activates all four Ado R subtypes and produces unwanted effects, tecadenoson appears to terminate AV node-dependent supraventricular tachycardias without hypotension and bronchoconstriction.: MethodsIn this open-label, multicenter, dose escalation study, tecadenoson was administered to 37 patients (AV node re-entrant tachycardia, n = 29; AV re-entrant tachycardia, n = 8) with inducible PSVT sustained for ≥1 min during an electrophysiology study. Seven regimens (0.3 to 15 μg/kg) of up to two identical tecadenoson intravenous bolus doses were administered.: ResultsAfter the first or second bolus, PSVT converted to sustained sinus rhythm for ≥5 min in 86.5% (32/37) of the patients, with 91% (29/32) of the conversions occurring after the first bolus (most within 30 s), coincident with anterograde conduction block in the AV node. No effects on sinus cycle length (SCL) or systolic blood pressure were observed. The atrial-His (AH), but not the His-ventricular (HV) interval was prolonged up to 5 min after the final tecadenoson bolus, returning to baseline by 10 min. Tecadenoson was generally well tolerated.: ConclusionsIn this study, tecadenoson rapidly terminated sustained PSVT by depressing AV nodal conduction without causing hypotension. After sinus rhythm restoration, there was minimal AH interval prolongation without HV interval or SCL prolongation. [Copyright &y& Elsevier]

: ObjectivesWe investigated possible differences between male and female patients regarding ablation therapy.: BackgroundGender-related differences might have a major impact on different aspects of radiofrequency ablation therapy. Data on this topic are very limited, focusing almost exclusively on success and recurrence rates.: MethodsThe study population consisted of 894 consecutive patients who underwent catheter ablation of accessory pathways (n = 519) and/or atrioventricular nodal re-entrant tachycardia (AVNRT) (n = 379). There were 418 (46.8%) male and 476 (53.2%) female patients.: ResultsFemale patients were referred for ablation later than male patients (185 ± 143 vs. 157 ± 144 months after onset of symptoms, p < 0.001) and after having been given more antiarrhythmic drugs (1.6 ± 1.2 vs. 1.3 ± 1.1, p < 0.001). Women were more symptomatic, with a higher number of patients having >1 tachycardia episode per month (80.3% vs. 70.3% in men, p < 0.001). Fluoroscopy time, radiofrequency applications, and procedure duration were similar in male and female patients undergoing accessory pathway ablation as well as in male and female patients undergoing AVNRT ablation. No difference was seen in success, complication, and recurrence rates between men and women.: ConclusionsPhysicians and/or patients tend toward a more conservative approach in female patients. Women are referred for ablation later than are men, after a longer duration of symptoms, and after having been given more antiarrhythmic drugs. However, potential concerns on behalf of physicians or female patients do not seem to be justified: ablation procedures in women had equally high success, low complication, and low recurrence rates as those procedures in male patients. [Copyright &y& Elsevier]

: ObjectivesA randomized trial was done to compare single-chamber atrial (AAI) and dual-chamber (DDD) pacing in patients with sick sinus syndrome (SSS). Primary end points were changes in left atrial (LA) size and left ventricular (LV) size and function as measured by M-mode echocardiography.: BackgroundIn patients with SSS and normal atrioventricular conduction, it is still not clear whether the optimal pacing mode is AAI or DDD pacing.: MethodsA total of 177 consecutive patients (mean age 74 ± 9 years, 73 men) were randomized to treatment with one of three rate-adaptive (R) pacemakers: AAIR (n = 54), DDDR with a short atrioventricular delay (n = 60) (DDDR-s), or DDDR with a fixed long atrioventricular delay (n = 63) (DDDR-l). Before pacemaker implantation and at each follow-up, M-mode echocardiography was done to measure LA and LV diameters. Left ventricular fractional shortening (LVFS) was calculated. Analysis was on an intention-to-treat basis.: ResultsMean follow-up was 2.9 ± 1.1 years. In the AAIR group, no significant changes were observed in LA or LV diameters or LVFS from baseline to last follow-up. In both DDDR groups, LA diameter increased significantly (p < 0.05), and in the DDDR-s group, LVFS decreased significantly (p < 0.01). Atrial fibrillation was significantly less common in the AAIR group, 7.4% versus 23.3% in the DDDR-s group versus 17.5% in the DDDR-l group (p = 0.03, log-rank test). Mortality, thromboembolism, and congestive heart failure did not differ between groups.: ConclusionsDuring a mean follow-up of 2.9 ± 1.1 years, DDDR pacing causes increased LA diameter, and DDDR pacing with a short atrioventricular delay also causes decreased LVFS. No changes occur in LA or LV diameters or LVFS during AAIR pacing. Atrial fibrillation is significantly less common during AAIR pacing. [Copyright &y& Elsevier]

: ObjectivesWe sought to investigate to what extent intra-ventricular asynchrony (intraVA) and inter-ventricular asynchrony (interVA) determine left ventricular (LV) function in canine hearts with left bundle branch block (LBBB) during ventricular pacing.: BackgroundPacing therapy improves LV pump function in patients with heart failure and abnormal ventricular conduction supposedly due to resynchronization. However, the relationship between LV pump function and measures of asynchrony is not well established.: MethodsIn 15 experiments, LV (various sites) and biventricular (BiV) pacing was performed at atrioventricular (AV) delays of 20 to 140 ms. Measured were the maximum rate of increase (dP/dtmax) of LV pressure and LV stroke work (SW) (conductance catheter), interVA (time delay between the upslope of LV and RV pressures), and intraVA (from endocardial electrical activation maps).: ResultsInduction of LBBB increased interVA (−6.4 ± 8.6 to −28.4 ± 8.5 ms [RV earlier]) and intraVA (4.9 ± 2.4 to 18.0 ± 3.3 ms), whereas LV dP/dtmax and SW decreased (−13 ± 18% and −39 ± 24%, respectively). During LBBB, LV and BiV pacing increased LV dP/dtmax and SW (mean increases 14% to 21% and 11% to 15%, respectively) without changing diastolic function or preload. Optimal improvement in LV function was obtained consistently when intraVA returned to pre-LBBB values, while interVA remained elevated. Normalization of intraVA required AV delays shorter than the baseline PQ time during LV apex and BiV pacing, thus excluding endogenous LV activation, but AV delays virtually equal to the baseline PQ time (difference 4 ± 9 ms, p = NS) during pacing at (mid)lateral LV sites to obtain fusion between pacing-induced and endogenous activation.: ConclusionsIn LBBB hearts, optimal restoration of LV systolic function by pacing requires intra-ventricular resynchronization. The optimal AV delay to achieve this depends on both the site of pacing and baseline PQ time. [Copyright &y& Elsevier]

: ObjectivesWe sought to assess the cost implications of two investigation strategies in patients with unexplained syncope.: BackgroundEstablishing a diagnosis in patients with unexplained syncope is complicated by infrequent and unpredictable events. The cost-effectiveness of immediate, prolonged monitoring as an alternative to conventional diagnostic strategies has not been studied.: MethodsSixty patients (age 66 ± 14 years; 33 males) with unexplained syncope and LV ejection fraction >35% were randomized to conventional testing with an external loop recorder, tilt and electrophysiologic (EP) testing, or prolonged monitoring with an implantable loop recorder with one-year monitoring. If patients remained undiagnosed after their assigned strategy, they were offered a crossover to the alternate strategy. Cost analysis of the two testing strategies was performed.: ResultsFourteen of 30 patients who were being monitored were diagnosed at a cost of $2,731 ± $285 per patient and $5,852 ± $610 per diagnosis. In contrast, only six of 30 conventional patients were diagnosed (20% vs. 47%, p = 0.029), at a cost of $1,683 ± $505 per patient (p < 0.0001) and $8,414 ± $2,527 per diagnosis (p < 0.0001). After crossover, a diagnosis was obtained in 1 of 5 patients undergoing conventional testing, compared with 8 of 21 patients who completed monitoring (20% vs. 38%, p = 0.44). Overall, a strategy of monitoring followed by tilt and EP testing was associated with a diagnostic yield of 50%, at a cost of $2,937 ± $579 per patient and $5,875 ± $1,159 per diagnosis. Conventional testing followed by monitoring was associated with a diagnostic yield of 47%, at a greater cost of $3,683 ± $1,490 per patient (p = 0.013) and a greater cost per diagnosis ($7,891 ± $3,193, p = 0.002).: ConclusionsA strategy of primary monitoring is more cost-effective than conventional testing in establishing a diagnosis in recurrent unexplained syncope. [Copyright &y& Elsevier]

: ObjectivesThe purpose of this paper is to examine the incidence and determinants of permanent complete heart block (CHB) after nonsurgical septal reduction therapy (NSRT), and to evaluate the clinical impact of permanent pacemaker (PPM) placement.: BackgroundNonsurgical septal reduction therapy with ethanol improves the clinical and hemodynamic parameters in patients with symptomatic hypertrophic obstructive cardiomyopathy. Complete heart block is a common complication after NSRT.: MethodsThe database of 261 consecutive patients who underwent NSRT at Baylor College of Medicine was reviewed. Clinical variables that were considered as possible determinants for CHB after NSRT were: age, gender, New York Heart Association (NYHA) functional class, left ventricular outflow tract (LVOT) gradient at rest or with provocation, septal thickness, and baseline exercise duration. For electrocardiographic (ECG) variables, the presence of first-degree atrioventricular (AV) block, bifascicular block, left bundle branch block, atrial fibrillation, and left ventricular hypertrophy were analyzed. In addition, the volume of ethanol injected, the method of administration of ethanol (i.e., bolus vs. slow injection [over 30 to 60 s]), number of septal arteries occluded, use of myocardial echocardiography, and infarct size as determined by peak creatine kinase level.: ResultsOf 261 consecutive patients, 37 had PPM or automatic implantable cardiac defibrillator placed before NSRT. Of the remaining 224 patients, 31 (14%) developed CHB after the procedure. Multivariate logistic regression analysis showed that female gender (odds ratio [OR] 4.3; p = 0.02), bolus injection of ethanol (OR 51; p = 0.004), injecting more than one septal artery (OR 4.6; p = 0.016), the presence of left bundle branch block (OR 39; p = 0.002), and first-degree AV block (OR 14; p = 0.001) on the baseline ECG are independent predictors of CHB after NSRT. Patients requiring PPM placement had a similar improvement in their NYHA functional class, septal thickness reduction, LVOT gradient reduction, and improvement of exercise capacity when compared with patients who did not require pacing.: ConclusionsMultiple demographic, electrocardiographic, and technical factors seem to increase the risk of CHB after NSRT. Patients with CHB after NSRT derive similar clinical and hemodynamic benefit to patients who did not require permanent pacing. [Copyright &y& Elsevier]

: BackgroundMost vascular surgeons favor an initial radial-cephalic anastomosis at the wrist for dialysis access when possible. As populations age and more chronically ill patients are offered dialysis, this native arteriovenous fistula (NAVF) is less frequently available. A brachial-cephalic anastomosis is generally considered to be the second choice for NAVF site. We report our experience in a series of patients where the proximal radial artery (PRA) serves as the primary inflow vessel.: Study designWe reviewed 139 consecutive dialysis access operations performed by the senior author. One hundred fourteen had an NAVF constructed. Seventy-three of these procedures in 71 patients involved the PRA as arterial inflow and are the subject of this report.: ResultsMean age was 57 years. Thirty-six of the 71 were men. Seventy-one percent of the patients were diabetic and more than half had previous access surgery. Twenty-nine patients underwent preoperative ultrasonographic evaluation for feasibility and planning of the NAVF fistula. The 1-month patency rate for patients undergoing PRA fistula was 98%. Cumulative patency was 80% during the followup period of up to 42 months. No infectious or ischemic complications were noted during the study period.: ConclusionsWe find the anterior position and mobility of the PRA offers a simple and tension-free anastomosis to the median antebrachial vein or one of its tributaries. This anastomotic site frequently allows dialysis in both the forearm and upper arm. The PRA allows for adequate arterial inflow while avoiding the risk of steal syndrome found with brachial artery fistulas. More extensive procedures or use of prosthetic grafts can be avoided. [Copyright &y& Elsevier]

: ObjectivesWe sought to examine the importance of mutations in the cardiac transcription factor gene NKX2-5 in patients with an atrial septal defect (ASD), patent foramen ovale (PFO), or hypoplastic left heart syndrome (HLHS).: BackgroundMutations in NKX2-5 have been found in families showing secundum ASD and atrioventricular (AV) conduction block and in some individuals with tetralogy of Fallot. The prevalence of NKX2-5 mutations in sporadic cases of ASD/PFO and other forms of congenital heart disease is unknown.: MethodsA cohort of 146 individuals with secundum ASD, PFO complicated by paradoxical embolism, or HLHS were evaluated. Patients with ASD or PFO were ascertained irrespective of family history or associated cardiac abnormalities. The coding region of the NKX2-5 locus was amplified by polymerase chain reaction and sequenced.: ResultsAmong 102 ASD and 25 PFO patients screened, 13 patients (10%) had a positive family history and 5 patients (4%) had AV conduction block. We found one previously documented NKX2-5 missense mutation, T178M, in members of a family with ASD without AV conduction block. One NKX2-5 mutation-positive child from this family had HLHS, although no mutations were subsequently found in 18 patients with sporadic or familial HLHS. In a second ASD family without AV conduction block, we found a missense change, E21Q, previously reported as pathogenic. Because this change did not segregate with disease status, we propose that it is a non-disease–causing polymorphism.: ConclusionsOur findings suggest that NKX2-5 mutations are a relatively infrequent cause of sporadic ASD and HLHS. Screening for NKX2-5 mutations may be warranted in individuals with ASD and a positive family history, irrespective of the presence or absence of AV conduction block. [Copyright &y& Elsevier]

: ObjectivesThis study was designed to compare two treatment strategies in patients with atrial fibrillation (AF): rhythm-control (restoration and maintenance of sinus rhythm) and rate-control (pharmacologic or invasive rate-control and anticoagulation).: BackgroundAtrial fibrillation is the most common arrhythmia. It is unclear whether a strategy of rhythm- or rate-control is better in terms of mortality, morbidity, and quality of life.: MethodsThe Strategies of Treatment of Atrial Fibrillation (STAF) multicenter pilot trial randomized 200 patients (100 per group) with persistent AF to rhythm- or rate-control. The combined primary end point was a combination of death, cardiopulmonary resuscitation, cerebrovascular event, and systemic embolism.: ResultsAfter 19.6 ± 8.9 months (range 0 to 36 months) there was no difference in the primary end point between rhythm-control (9/100; 5.54%/year) and rate-control (10/100; 6.09%/year; p = 0.99). The percentage of patients in sinus rhythm in the rhythm-control group after up to four cardioversions during the follow-up period (rate-control group) was 23% (0%) at 36 months. Eighteen primary end points occurred in atrial fibrillation; only one occurred in sinus rhythm (p = 0.049).: ConclusionsThe STAF pilot study showed no differences between the two treatment strategies in all end points except hospitalizations. These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence. It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients, as all but one end point occurred during AF. [Copyright &y& Elsevier]

In 2003, pulmonary venous flow (PVF) evaluation by Doppler echocardiography is being used daily in clinical practice. Twelve years ago, we reviewed the potential uses of PVF in various conditions. Some of its important uses in cardiology have materialized, while others have not and have been supplanted by newer approaches. Current applications of measuring PVF have included: differentiating constrictive pericarditis from restriction, estimation of left ventricular (LV) filling pressures, evaluation of LV diastolic dysfunction and left atrial (LA) function, and grading the severity of mitral regurgitation (MR). However, there have been a number of controversies raised in the use of PVF profiles. Using transthoracic echocardiography, there may be technical issues in measuring the atrial reversal flow velocity. The use of PVF in the evaluation of the severity of MR is not always specific and can be affected by atrial fibrillation (AF) and elevated mean LA pressure. Mitral valvuloplasty and radiofrequency ablation for AF, which are the newer applications of PVF in monitoring invasive procedures, are mentioned. This article reviews the important clinical role of Doppler evaluation of PVF, discusses its limitations and pitfalls, and highlights its newer applications. [Copyright &y& Elsevier]

: ObjectivesWe sought to prospectively assess the diagnostic yielding of a protocol in which electrophysiologic studies (EPS), tilt-table tests (TTTs), and loop recorder implantation are selectively used.: BackgroundThe optimal strategy in the diagnosis of patients with syncope of unknown cause has not been defined.: MethodsA total of 184 consecutive patients with syncope of unknown cause were classified into two groups. Group A consisted of 72 patients fulfilling any of the following criteria: 1) presence of structural heart disease or family history of sudden death; 2) abnormal electrocardiogram; 3) significant non-symptomatic arrhythmia on Holter monitoring; and 4) paroxysmal palpitations immediately before or after syncope. These patients initially underwent an EPS and, if this study was negative, TTT. In the remaining 112 patients (group B), TTT was performed: ResultsThe EPS was positive in 32 patients (44%) in group A. The TTT was positive in 80 patients (71%) in group B. An additional patient had carotid sinus hypersensitivity. In patients of group A with a negative EPS, the TTT was positive in 23 (57%). A loop recorder was implanted in 15 patients from group A with negative conventional testing, and diagnostic activation was obtained in seven patients. Overall, a positive diagnosis was achieved in 143 patients (78%).: ConclusionsIn patients with syncope of unknown cause, selective use of EPS or TTT leads to a positive diagnosis in >70% of the cases. An implantable loop recorder can be useful in non-diagnosed cases. [Copyright &y& Elsevier]