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Introduction: Cardioversion for atrial fibrillation (AF) is routinely implemented in daily practice; however, it can be associated with the development of recurrent AF. In this study we aimed to evaluate the predictors of AF recurrence after electrical cardioversion, and to compare the outcomes of patients with or without AF recurrence during follow-up. Methods: Patients with persistent AF were enrolled from March 2015 to September 2018. Patients with recurrent AF within 6 months after the index cardioversion were considered as AF recurrence (AFR) group, and those with normal sinus rhythm were defined as normal sinus rhythm (NSR) group. Thereafter, all patients were followed up for the incidence of adverse events, including death, requiring dialysis, coronary artery intervention/surgeries, cerebrovascular events, heart failure, and recurrent AF beyond 6 months. Results: Of 129 patients, 11 patients had failed cardioversion and 7 patients lost to follow-up. So, 34 and 77 patients were categorized as the NSR and the AFR groups. During a median follow-up time of 54 (46-75) months, there was a trend for a higher incidence of major adverse events in the AFR group compared to the NSR group (P=0.063). Lower body mass index (odds ratio [OR] 0.885, 95% confidence interval [CI] 0.794-0.986, P=0.027) and coarse AF before the index cardioversion (OR 3.846, 95% CI 1.189-12.443, P=0.025) were the independent predictors of recurrent AF. Conclusion: In patients with persistent AF undergoing cardioversion, the presence of coarse AF and the lower values of body mass index were found to be associated with the AF recurrence.

Summary: Background: Interventional trials that evaluate treatment effects using surrogate endpoints have become increasingly common. This paper describes four linked empirical studies and the development of a framework for defining, interpreting and reporting surrogate endpoints in trials. Methods: As part of developing the CONSORT (Consolidated Standards of Reporting Trials) and SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) extensions for randomised trials reporting surrogate endpoints, we undertook a scoping review, e-Delphi study, consensus meeting, and a web survey to examine current definitions and stakeholder (including clinicians, trial investigators, patients and public partners, journal editors, and health technology experts) interpretations of surrogate endpoints as primary outcome measures in trials. Findings: Current surrogate endpoint definitional frameworks are inconsistent and unclear. Surrogate endpoints are used in trials as a substitute of the treatment effects of an intervention on the target outcome(s) of ultimate interest, events measuring how patients feel, function, or survive. Traditionally the consideration of surrogate endpoints in trials has focused on biomarkers (e.g., HDL cholesterol, blood pressure, tumour response), especially in the medical product regulatory setting. Nevertheless, the concept of surrogacy in trials is potentially broader. Intermediate outcomes that include a measure of function or symptoms (e.g., angina frequency, exercise tolerance) can also be used as substitute for target outcomes (e.g., all-cause mortality)—thereby acting as surrogate endpoints. However, we found a lack of consensus among stakeholders on accepting and interpreting intermediate outcomes in trials as surrogate endpoints or target outcomes. In our assessment, patients and health technology assessment experts appeared more likely to consider intermediate outcomes to be surrogate endpoints than clinicians and regulators. Interpretation: There is an urgent need for better understanding and reporting on the use of surrogate endpoints, especially in the setting of interventional trials. We provide a framework for the definition of surrogate endpoints (biomarkers and intermediate outcomes) and target outcomes in trials to improve future reporting and aid stakeholders' interpretation and use of trial surrogate endpoint evidence. Funding: SPIRIT-SURROGATE/CONSORT-SURROGATE project is Medical Research Council Better Research Better Health (MR/V038400/1) funded.

Abstract Background Accelerated idioventricular rhythm (AIVR) is a slow ventricular arrhythmia, commonly due to myocardial ischemia in coronary artery disease. It is a transitory rhythm that rarely causes hemodynamic instability or necessitates any specific therapy. Besides, the common predisposing factors for ventricular arrhythmias after open-heart surgery are hemodynamic instability, electrolyte imbalances, hypoxia, hypovolemia, myocardial ischemia and infarction, acute graft closure, reperfusion injury, and administration of inotropes and antiarrhythmic drugs. Here we report a case of AIVR after cardiac surgery, mostly due to hypothermia that to our knowledge, it is the first report. Case presentation We describe a 76-year-old man presenting with typical chest pain. Following routine investigations, the patient underwent coronary artery bypass grafting. Postoperatively, he was transferred to the intensive care unit with good hemodynamic status. However, about 3 h later, he developed rhythm disturbances, leading to hemodynamic instability without response to volume replacement or inotropic support. His rhythm was AIVR, although, at first glance, it resembled the left bundle branch block. Given his unstable hemodynamic status, he was emergently transferred to the operating room. Cardiopulmonary bypass (CPB) was resumed for hemodynamic support. After the patient was rewarmed to about 35 ºC, AIVR returned to normal. He was weaned from CPB successfully and with an uneventful hospital course. Conclusions Hypothermia is a potential cause of rhythm disturbance. Preventing the causes of arrhythmias, including hypothermia, is the best strategy.

The analysis of plant response to water deficits can help us to identify appropriate water-saving and irrigation methods. The goal of this study is to assess the potential of eight indices derived from a modified consumer-grade camera and a thermal camera for monitoring the relative water content (RWC) of maize. The study design was a randomized complete block design with three replications and 16 treatments with four levels of irrigation water percentage based on field capacity (100% Fc, 80% Fc, 60% Fc and 40% Fc), and four levels of nitrogen (without nitrogen, 100 kg N/ha, 200 kg N/ha and 300 kg N/ha) were used. RWC values were used to evaluate the performance of the eight crop water stress indicators. The results showed that the best performance results of the studied vegetation indices were DANS, CTSD and CTCV, respectively. As observed, R2 values were 0.88, 0.76 and 0.67, respectively. HIGHLIGHTS Low-cost modified camera and thermal camera was used to collect images of maize plants.; The performance of Tc-based indicators and vegetation indices for monitoring maize water status was assessed.; High correlations were found between indices based on thermal images with maize water status.; RGRI-Otsu method was used to improve the accuracy of Tc extraction and background elimination.;

The objectives of the current study were to implement affordable and non-invasive measurements of infrared thermometry, leaf relative water content (RWC), crop water stress index (CWSI), leaf area index (LAI) from computer vision analysis and seed yield of sunflowers. The experiment was designed as split-plot based on randomized complete blocks with three replications. Treatments were four different levels of deficit irrigation as the main plots and three fertilization treatments were applied as sub-plots. Results showed a significant effect (P ≤ 0.01) of water stress and fertilizer on CWSI during different stages of sunflower growth. Changes in fertilizer amount and type resulted in a change in lower (dTLL) and upper (dTUL) limits of canopy-air temperature difference. A combination of chemical fertilizer with biofertilizer could help to decrease CWSI. From computer vision analysis, the normalized difference red blue index (NDRBI) had a strong linear relationship with RWC and CWSI for sunflowers (R2 of 0.87 and 0.93, respectively) and the normalized difference green blue index (NDGBI) had a linear relationship with seed yield (R2 = 0.79). Therefore, analysis of digital RGB images and CWSI were efficient, non-destructive and low-cost methods to assess crop water status for sunflowers under different irrigation and fertilizer treatments. HIGHLIGHTS The CWSI values were sensitive not only to different irrigation regimes but also to amount and type of fertilizer.; The CWSI can be derived from the plant index (NDRBI) and used for appropriate irrigation scheduling.; A positive correlation was observed between image indices with CWSI and LAI.; Combination of chemical fertilizer with biofertilizer could help to decrease CWSI.;

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population. Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Results: Of 15,130 students (6–18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers’ low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening.

Abstract Introduction Fragmented QRS (fQRS) complex on routine 12‐lead electrocardiogram (ECG) predicts adverse outcomes in patients with cardiovascular diseases. In addition, it has been found to be associated with subclinical myocardial dysfunction in chronic diseases. We sought to investigate the relationship between the presence of fQRS with the myocardial functions in individuals free from known systemic cardiovascular diseases. Methods In a case‐control study, we evaluated normal individuals from March 2017 to February 2018. All participants underwent a 2‐dimensional transthoracic echocardiographic examination using tissue Doppler imaging (TDI) and speckle‐tracking echocardiography. In addition, all participants were examined using a 12‐lead surface ECG, and patients with fQRS and a group of age‐ and sex‐matched controls without fQRS were enrolled in our study. Results The patients' mean age was 40.3 ± 10.7 and 35.4 ± 11.2 years in fQRS‐positive and fQRS‐negative groups, respectively (P = .110). Patients with fQRS had significantly lower values of apical left ventricular global longitudinal strain (LV GLS) in 2‐chamber (16.9 ± 2.5 vs. 20.5 ± 3.3, P

BackgroundThe introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.AimsThe scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.MethodsWe conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.ResultsThoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.ConclusionThe FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.

Aim of study: To develop non-destructive and rapid monitoring of water and nitrogen status in maize crops. Area of study: Bu-ali Sina University, Hamedan province, Iran. Material and methods: We used a low-cost modified consumer-grade camera to extract 40 vegetation indices for monitoring leaf N concentrations, SPAD values and relative water content (RWC). In this regard, 528 images taken by the low-cost camera in two consecutive years (2017 and 2018) from maize plants cultivated in a greenhouse under different irrigation and N treatments were evaluated. Main results: Results showed that the best performance outcomes regarding the studied vegetation indices were MCARI, CTVI and CR for SPAD values; MCARI, HUE and CTVI for leaf N concentrations; and TRVI, NDVI and DVI for RWC. In order to increase accuracy of estimated measured data, multiple linear regression equations with combinations of the MCARI, TRVI, NDVI and EVI indices were used. As observed, R2 value was 0.91, 0.60 and 0.90 for SPAD, leaf N concentration and RWC estimation, respectively. Research highlights: The combination of MCARI, TRVI, NDVI and EVI indices provided more accuracy to most of the previous single variable regression models.

Introduction: Cardioembolic events are accompanied by left atrial appendage (LAA) in patients suffering from atrial fibrillation (AF); therefore, the LAA closure is implemented as a preventive strategy. The detection of LAA morphologies and function is a paramount step before establishing the LAA closure. Herein, we sought to determine the morphologic features of the LAA in an Iranian population using echocardiographic evaluation. Methods: Seventy-two near-normal heart patients were investigated by conducting a cross-sectional study. All patients were examined using the 2-dimensional and 3-dimensional transesophageal echocardiography (2D- and 3D-TEE) method. The anatomical features and functions of LAA were examined. All images were stored and analyzed offline. Results: The patients’ mean age was 39 ± 15.5 year and 33 (45.8%) were female. The most frequent shape of LAA was wind sock. More LAA lobes was observed in patients with AF compared to those with NSR. In comparison with AF group, the NSR had higher LAA flow velocity (P < 0.01). The paroxysmal AF had greater LAA flow velocity and LAA ejection fraction in comparison with the chronic AF (39 ± 19 vs. 75 ± 22, P < 0.01; and 49±4 vs. 72±14, P < 0.003; respectively). The paroxysmal AF had smaller systolic LAA orifice area in comparison with the chronic AF (P < 0.02). Conclusion: The morphologic features of LAA in Iranian population were within the range of other studies and LAA length and orifice diameters in 2D- and 3D-TEE were consistent. In addition, AF influenced the morphologies and functions of LAA compared to sinus rhythm.

Background: The frequency of left ventricular diastolic dysfunction (DD) is overestimated by earlier recommendations. We compared the 2009 and 2016 guidelines regarding the detection of DD and explored the potential of adding left atrial (LA) strain to the current guideline. Methods: Consecutive patients with heart failure were enrolled. All the patients were examined using 2-dimensional speckle-tracking echocardiography (2D-STE) and tissue Doppler imaging. DD was evaluated in terms of E/eʹ, eʹ velocity, E, A, tricuspid regurgitation velocity, LA volume, and LA strain. Results: This study evaluated 147 patients (101 males, 68.7%) at a mean age of 54.73±14.42 years. LA strain decreased with increasing grades of DD in both guidelines. The rate of reclassification between the 2 guidelines was 41%. The detection rate of normal diastolic function increased after the implementation of the 2016 guideline. LA strain discriminated individuals with normal diastolic function from those with DD more accurately than did LA volume index (area under the curve [AUC] =0.816 vs AUC=0.759, respectively). When LA strain

Background: Ankylosing spondylitis (AS) is a chronic inflammatory condition associated with more cardiac manifestations than those in the normal population. In this study, we sought to determine the prevalence of cardiac involvement in patients suffering from AS without cardiovascular risk factors. Methods: The present case-control study, conducted in 2 university hospitals in Tehran from January 2016 to December 2017, recruited 67 patients with AS and 40 age- and sex-matched healthy controls. The diagnosis of AS was based on the classification criteria of the Assessment of SpondyloArthritis International Society. All the participants were examined using transthoracic echocardiography and a standard 12-lead ECG. Baseline characteristics, echocardiographic findings, and ECG features were compared between the AS and control groups using univariate analyses. Results: The median age was 33.5 (IQR25-75%: 20.5–59) years in the AS group and 35 (IQR25-75%: 26–59) years in the control group (P=0.301). The number of patients with left ventricular systolic and diastolic dysfunction was significantly higher in the patients with AS than in the controls (7.5% vs. 20.9%; P=0.067, and 22.9% vs. 5.0%; P=0.026, respectively). The number of individuals with a left-axis deviation and a left anterior fascicular block was significantly higher in the patients suffering from AS than in the control group. The number of patients with aortic valve involvement was comparable between the groups (P=0.332). Conclusion: The most common cardiac involvement in our patients with AS was left ventricular dysfunction, followed by rhythm disturbances and aortic valve insufficiency. These findings were independent of age, AS severity, and disease duration. Therefore, the implementation of cardiovascular screening can be recommended for patients with AS.

BACKGROUND: Double-orifice mitral valve (DOMV) is an extremely rare cardiac malformation. It has been found to be accompanied by congenital anomalies (CAs), however, it can be detected as an isolated anomaly. The clinical findings of a DOMV are variable and depend predominantly on the associated cardiac abnormalities, particularly atrioventricular septal defects or mitral valve (MV) regurgitation and/or stenosis. CASE REPORT: In this regard, we describe an isolated DOMV in an 18-year-old young girl who complained of a short-term nonspecific chest pain. She underwent transthoracic and transesophageal echocardiographic examinations. The examinations revealed a DOMV without any valvular or structural malformations. Other examinations were unremarkable. The patient did need neither medical nor surgical interventions. CONCLUSION: The isolated cases of DOMV do not need therapy and might be only followed up using echocardiographic examinations. However, a careful echocardiographic examination for detection of concomitant structural malformations would be of great importance in the management of such cases.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac malformation. We report three cases of ALCAPA who survived to adulthood. The first case was a 51-year-old woman who complained of typical chest pain that was diagnosed with ALCAPA using cardiac catheterization and coronary computed tomographic angiography (CTA). The second case was a 30-year-old woman with a history of surgery for atrial septal defect at 10 years old who presented with progressive exertional dyspnea. Cardiac catheterization confirmed the diagnosis of ALCAPA. The third case was a 19-year-old man who was brought to our clinic due to aborted sudden cardiac death on the previous day. Cardiac catheterization and coronary CTA confirmed the diagnosis. They underwent the closure of orifice of the anomalous left coronary artery and grafting the left anterior descending artery concomitantly with mitral valve repair. All patients were followed up during a mean of 8.7 months and they were asymptomatic.

Background: Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We sought to evaluate in-hospital and mid-term outcomes of patients with a diagnosis of ALCAPA who underwent surgical repair. Objectives: The objective of this study is to evaluate the mid-term outcomes of surgical repair of ALCAPA at our center and to analyze the surgical techniques used. Materials and Methods: In a retrospective study, we analyzed early and mid-term clinical and echocardiographic data to determine the outcomes of patients who underwent surgical repair of ALCAPA in our institution between 2005 and 2015. Results: Twenty-one patients underwent surgical repair for ALCAPA using aortic reimplantation (n = 10, 47.6%), ostial closure. (n = 8, 38.1%), or ligation. (n = 3, 14.3%). The median age of patients was 24. months. (range 22 days to 51 years). There were 2 (9.5%) in-hospital mortalities in infants undergoing the reimplantation technique. All patients were followed up for a median of 21 months. (range 1–60 months). No patients required reoperation, and there was no mortality from discharge to mid-term follow-up. Severe early postoperative mitral regurgitation. (MR) was associated with composite end-point, defined as a combination of mortality after surgery, moderate to severe MR, and moderate to severe left ventricular dysfunction at late follow-up. (P = 0.019) while mitral valve repair was not. (P = 0.469). Conclusion: The surgical management of ALCAPA can be associated with good in-hospital and mid-term outcomes regardless of the age, at which the patient has been operated.

Pericardial patch has been used to repair cardiac defects; however, its strength as an aortoplasty patch to tolerate systemic pressure is a matter of debate. We report an aneurysmal dilatation of pericardial patch in aortoplasty. Our patient was a 56-year-old female known case of rheumatic heart disease that underwent redoes mitral and aortic valve replacements along with Manouguian aortoplasty at the age of 44 years old. After 2 months, she was readmitted with a diagnosis of endocarditis. Echocardiography revealed a small cavity in the posterior wall of the aorta. She responded to medical therapy and discharged in a good condition. Twelve years later, she was scheduled to undergo reoperation due to a severe paraprosthetic aortic valve leakage and a pericardial patch aneurysm. The leaking prosthetic aortic valve was explanted and the aneurysmal tissue was replaced with a polyethylene terephthalate patch. Keywords: Aortic valve replacement, Manouguian procedure, Pericardial patch aneurysm

Purpose: The initial stage of proliferation of epithelial ovarian carcinoma (EOCa) is usually asymptomatic. Due to the lack of sensitive and reliable markers in majority of patients the disease is widespread at the time of diagnosis. The reliable serum biomarkers currently accepted is CA125 but there is limitation in case of sensitivity of CA125 as it is detectable only in 50% of patients in stage I and 80% of patients with advanced stage. We have investigated a correlation between serum CA125 and ceruloplasmin (as a marker of angiogenesis) in ovarian cancer in pre-treatment and post-treatment patients, compared with controls and found to be a significant marker for diagnosis. Material and Methods: A study was done in age group between 18-45 years diagnosed with ovarian cancer. (cases: n=50, controls: n=50). Cancer was diagnosed based on biopsy and histopathological examination. Serum Ceruloplasmin and CA 125 were estimated in pre-treatment and post-treatment patients and statistically significant decrease of these biomarkers observed in post treatment when compared with pre treatment patients. Result: We found that serum CA 125 to ceruloplasmin ratio was moderately increased in pre-treatment ovarian cancer patient. The serum ceruloplasmin (p

The exclusive capabilities of Geographical Information System (GIS) cab be distinguished in combining diverse and very different information sources, in real-time storage and retrieval of descriptive and local information, in evaluation and analysis of time trend of incidents in form of statistical and spatial modeling and in positional assessment on the effects of development. Above descriptions show that GIS has grown as the most powerful tool for management, decision makings and optimized and rapid access to the information required for the hospitals and ambulance centers. suitable readiness for effective response and rapid reaction to the conditions of the natural disasters like industrial incident and human made incidents, e.g. urban and road accidents is the objectives and responsibilities of hospitals and medical centers. Moreover more than eighty percent of the required information in ambulance centers are positional information or information that are somehow dependent to location. Hence, application of Geographical Information System technology will be very considerable and beneficial for hospitals in order to displaying the location and region coverage and to lead the teams toward the region, to make appropriate decisions in crises and disasters and for emergency management (especially in information related to HSE of industries). Also in the analysis and assessment of hospitals’ information and injured that are referred to hospitals, using GIS technology will be improve applications of Information Technology in hospitals and emergency centers in the following fields:-locating new areas for the construction of hospitals in according to the maps and different layers of data, analyzing reserved equipment and facilities for high risk situations, routing in order to provide the most rapid and timely aid, capitation of population of the region in terms of equipment and hospitals’ beds, appointing places in danger of crisis and for emergency aid and finally creating patterns of diseases dominance and health problems in the field of hospitals for Planning and decision making based on evidence and documents.

Objective: Acute coronary syndrome (ACS) is a challenging issue in cardiovascular medicine. Given platelet role in atherothrombosis, we sought to determine whether platelet indices can be used as diagnostic tests for patients who suffered from an acute chest discomfort. Methods: We prospectively enrolled 862 patients with an acute chest pain and 184 healthy matched controls. They were divided into four groups: 184 controls, 249 of non-ACS, 421 of unstable angina (UA), and 192 of myocardial infarction (MI) cases. Blood samples were collected at admission to the emergency department for routine hematologic tests. Results: The mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) were significantly greater in patients with MI compared with those of non-ACS or control subjects. Negative and significant correlations existed between MPV, PDW, and P-LCR values and platelet count (P

Objective: The aim of this investigation was to assess the efficacy of hydrochlorothiazide as a hypocalciuric diuretic on stone-free rate of renal pelvic calculi after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: A double-blind, placebo-controlled randomized clinical trial was conducted and 52 patients with renal pelvic calculi (diameter ≤2 cm) were enrolled from February 2010 to September 2010. ESWL protocol was performed by 2,500 shocks per session. The patients were randomized into two groups: (1) 26 patients who were given 25 mg hydrochlorothiazide twice daily; and (2) 26 patients who received placebo. The stone-free rate was defined as residual calculus size ≤4 mm in controlled ultrasound on 2 nd week, 1 month and 3 months after ESWL. Results: 19 (78%) of the first group and 9 (42.9%) of the second group were stone-free after one session of ESWL (P = 0.02). 88% of the group 1 and 47.8% of the group 2 were stone-free on 1 month after ESWL (P = 0.003); however, this effect of hydrochlorothiazide was not related to the patients′ body mass index, age and gender. The accessory treatment procedures were applied in 24% of the group 1 compared with 19% of the group 2 during 3 months (P = 0.68). All patients in both groups were stone-free on 3 months following lithotripsy. Conclusions: Hydrochlorothiazide did not impact on the stone-free rate and using accessory procedure within 3 months; however, it decreased duration of stone-free status and number of ESWL sessions.

Objective To evaluate the effects of terazosin and tolterodine on ureteral stent discomfort. Materials and Methods Of 163 patients assessed for eligibility, 104 patients were randomly assigned to receive placebo, 2 mg of terazosin twice daily, 2 mg of tolterodine daily, or both terazosin plus tolterodine during the stenting period. Prior to stenting and at stent removal, the International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) subscore and the Visual Analog Scale for Pain were determined. The patients also reported their analgesic use during the stenting period. Results Ninety-four patients completed the study. We noted significant decreases in the total IPSS scores (p = 0.002), irritative subscore (p = 0.039), QoL (p = 0.001), flank pain (p = 0.013), voiding pain (p = 0.01) and amount of analgesics used (p = 0.02) in the groups. However, neither the obstructive subscore nor the suprapubic pain improved significantly (p = 0.251 and p = 0.522, respectively). The patients receiving terazosin plus tolterodine experienced significant reductions in the total IPSS, irritative symptoms, QoL, flank pain, voiding pain and decreased analgesics use compared with those patients receiving placebo. However, compared with placebo, terazosin monotherapy did not affect pain levels, and tolterodine monotherapy did not improve QoL, flank pain or analgesics use. Conclusions Terazosin plus tolterodine improves ureteral stent-related complications, including irritative symptoms, the amount of analgesics used, QoL, flank pain and voiding pain but does not decrease obstructive symptoms or suprapubic pain. This trial was registered at www.clinicaltrials.gov as NCT01530243.

The formation of new blood vessels is the ini-tial step in neovascularisation. The first stagein angiogenesis is the activation of endothelialcells. Copper ions stimulate proliferation andimmigration of endothelial cells. It has beenshown that serum copper concentration in-creases as the cancer disease progresses andcorrelates with tumour incidence and burden.Copper ions also activate several proangiogenicfactors, e.g., vascular endothelial growth fac-tor, basic fibroblast growth factor, andinterleukin 1. This review concerns a brief in-troduction into the basics of blood vessel de-velopment as well as the regulatory mecha-nisms of this process. The role of copper ionsin angiogenesis is discussed.

BackgroundContrast medium–induced acute kidney injury (CIAKI) is a leading cause of acquired renal impairment. The effects of antioxidants have been conflicting regarding the prevention of CIAKI. We performed a study of vitamin E use to decrease CIAKI in patients undergoing elective coronary angiography. Methods and ResultsIn a placebo‐controlled randomized trial at 2 centers in Iran, 300 patients with chronic kidney disease—defined as estimated glomerular filtration rate

Right-sided heart thrombus is a life-threatening condition that necessitates immediate therapy. Detection of right-sided heart thrombus is usually via transthoracic echocardiography. Generally, thrombolysis is considered a treatment of choice, but there is currently no consensus about the optimal therapeutic choice. We present a case of multiple right atrial thrombi with concurrent mobile and broad-based in situ thrombi in a patient with a history of chronic obstructive pulmonary disease, which was completely resolved by thrombolysis following a failed Heparin infusion. The patient was sent home in good clinical condition and was stable at 3 months' follow-up.

Background: Left ventricular aneurysm (LVA) is a common complication of myocardial infarction (MI); however, the optimal sur- gical technique for LVA repair has remained controversial. Methods: In this retrospective study, we analyzed the long-term outcomes of 65 patients, who underwent LVA surgical repair be- tween January 2005 and December 2009. The LVA repair approaches comprised of patch plasty (n = 16), linear (n = 23), and plication (n = 26) repair techniques. Results: Male gender was predominant (89%), and the patients’ mean age was 56 ± 7.1 years. The rate of in-hospital mortality was 4.6%, 4.6%, and 9.2% in the plication, linear and patch plasty repair groups, respectively (P = 0.077). The amount of increase in early postoperative LV ejection fraction was 4.5%, 7% and 9.5%, in the plication, linear and patch plasty techniques, correspondingly (P < 0.001). During the follow-up period (50.6 ± 15.6 months), there were seven (16.7%) cardiac deaths: five deaths in the linear repair group, one in the plication, and one in the patch plasty repair group (P= 0.057). There was no significant difference regarding the survival rate between the patients undergoing different surgical repairs (P = 0.098). Conclusions: Despite having relatively high in-hospital and long-term mortality, LVA after MI could be repaired with similar out- comes using different surgical techniques, including linear, patch plasty, and plication techniques.