Effect of main pancreatic duct suture ligation on the prevention of clinically relevant pancreatic fistula after distal pancreatectomy: analysis of 82 consecutive patients

OBJECTIVE

This study aimed to examine the factors linked to the development of clinically significant pancreatic fistulas following distal pancreatectomy (DP) and to assess the efficacy of suture ligation of the main pancreatic duct.

PATIENTS AND METHODS

A single-center retrospective study was performed on the medical records of 82 patients who underwent DP in our institution between January 2011 and December 2019.

RESULTS

There were 28 males (34.1%) and 54 females (65.9%). The patients' age ranged from 18 to 86 years (median: 55.5 years). Indications for DP included primary pancreatic disease (n=63, 76.8%) and non-pancreatic disease (n=19, 23.2%). Postoperative mortality and morbidity rates were 3.7% and 48%, respectively. Pancreatic parenchymal closure was accomplished by a hand-sewn technique or mechanical stapling in 89 and 13 patients, respectively. Identification of the pancreatic duct and suture ligation was performed in 46 patients (56.1%). Pancreatic fistula was developed in 20 patients (24.4%); 12 fistulas were classified as Grade B, and 8 as Grade C. Biochemical leaks (Grade A) were identified in 8 patients (9.8%). Multivariate analysis indicated that failure to ligate the main pancreatic duct was the only variable associated with an increased risk for pancreatic leak (p=0.031; odds ratio=0.233; 95% confidence interval, 0.062-0.879).

CONCLUSIONS

Pancreatic leak remains a common complication after DP. The incidence of leaks is reduced significantly when the main pancreatic duct is identified and directly ligated during DP.

The association between allergic rhinitis and airway dysfunction and nasal endothelial damage and oxidative stress

BACKGROUND

Although lower airway hyperresponsiveness is present in approximately one in three patients with allergic rhinitis (AR), the underlying mechanism remains unclear. To evaluate nasal patency and pulmonary functions in AR independently of the presence of asthma and to investigate the relationships between these and nasal oxidative stress parameters and endothelial damage.

METHODOLOGY

Seventy adolescents with AR (AR group - 27 with asthma and 43 without asthma) and 30 healthy controls (HC group) were included in this prospective, cross-sectional study. Endocan and oxidative biomarkers [total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI)] in nasal lavage fluid specimens; peak nasal inspiratory flow (PNIF); fractional exhaled nitric oxide (FeNO), and impulse oscillometry (zR5, zR20, and R5-20 for resistance and zX5 and zX20 for reactance) were investigated.

RESULTS

Nasal endocan, TOS, and OSI values were higher in the AR group and TAS in the HC group. There was no difference between AR groups with and without asthma in terms of nasal endocan and oxidative biomarkers. FeNO levels and airway resistance (zR5, zR20, and R5-20) were higher in the AR group than in the HC group. However, there was no difference between the groups in PNIF. X5 was higher among the AR without asthma than in the other groups. Correlation between OSI and R5-20 was observed in the AR group. In the linear regression model, (logged) OSI was significantly predicted (logged) R5-20.

CONCLUSIONS

The airways of adolescents with AR without asthma were as much affected as those of the AR with asthma, and this effect was associated with nasal endothelial damage and an increase in oxidative stress.

The association between allergic rhinitis and airway dysfunction and nasal endothelial damage and oxidative stress

BACKGROUND

Although lower airway hyperresponsiveness is present in approximately one in three patients with allergic rhinitis (AR), the underlying mechanism remains unclear. To evaluate nasal patency and pulmonary functions in AR independently of the presence of asthma and to investigate the relationships between these and nasal oxidative stress parameters and endothelial damage.

METHODOLOGY

Seventy adolescents with AR (AR group - 27 with asthma and 43 without asthma) and 30 healthy controls (HC group) were included in this prospective, cross-sectional study. Endocan and oxidative biomarkers [total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI)] in nasal lavage fluid specimens; peak nasal inspiratory flow (PNIF); fractional exhaled nitric oxide (FeNO), and impulse oscillometry (zR5, zR20, and R5-20 for resistance and zX5 and zX20 for reactance) were investigated.

RESULTS

Nasal endocan, TOS, and OSI values were higher in the AR group and TAS in the HC group. There was no difference between AR groups with and without asthma in terms of nasal endocan and oxidative biomarkers. FeNO levels and airway resistance (zR5, zR20, and R5-20) were higher in the AR group than in the HC group. However, there was no difference between the groups in PNIF. X5 was higher among the AR without asthma than in the other groups. Correlation between OSI and R5-20 was observed in the AR group. In the linear regression model, (logged) OSI was significantly predicted (logged) R5-20.

CONCLUSIONS

The airways of adolescents with AR without asthma were as much affected as those of the AR with asthma, and this effect was associated with nasal endothelial damage and an increase in oxidative stress.

Popliteal Fossa Sarcomas

PURPOSE OF THE STUDY Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%-5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample. MATERIAL AND METHODS Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes. The minimum follow-up was 24 months. RESULTS The mean age of the patients was 48 ± 21.23 (range 3-72) years at the time of diagnosis. The mean follow-up was 41.79 ± 16.97 (range 24-120) months. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), unidentified fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (26%). At the latest followup, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease. CONCLUSIONS Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins. Key words: fossa poplitea, sarcoma.

CGRP and Shh Mediate the Dental Pulp Cell Response to Neuron Stimulation

Dental pain is a persistent, detrimental public health issue that requires a better understanding of the mechanisms of tooth pain and inflammation in order to develop more effective treatments. Calcitonin gene-related peptide (CGRP) and dental pulp cells are promising candidates for mediating tooth pain and generating reparative dental tissues, respectively, but their behavior in the context of pulpitis remains elusive. The mouse incisor requires Sonic hedgehog (Shh) secreted from sensory nerves to continuously regenerate. However, it is unknown whether sensory nerves also regulate the comparatively nonregenerative mouse molar through CGRP and Shh. This is an important knowledge gap to fill since mouse incisors differ biologically from human teeth, while mouse and human molars are similar. In this work, we identified that molar pulp cells express CGRP receptor and Gli1, a Hedgehog (Hh) signaling protein found to label a dental stem cell population in the mouse incisor. We also observed in a mouse molar injury model that Hh signaling was activated and Shh expression was upregulated in vivo. We then determined in vitro that Shh and CGRP regulate differentiation of primary mouse molar and incisor pulp cells and a human dental pulp stem cell line. Furthermore, conditioned media from stimulated sensory neurons induced Hh signaling activation and inflammatory gene expression in primary molar pulp cells, which was abolished by inhibition of either Shh or CGRP. Our results suggest that CGRP and Shh signaling may promote an inflammatory response after injury in the molar and that activated sensory nerves secrete CGRP and Shh to regulate molar pulp cell expansion and differentiation into odontoblast-like cells for dentin repair. Thus, CGRP/Shh signaling should be considered for new strategies that seek to manage pain or dentin regeneration in the molar.

Non-invasive ductal carcinoma within malignant phyllodes tumor of the breast

Phyllodes tumors are uncommon breast neoplasms that constitute of 1-2% of breast malignancies. The tumor can mimic fibroadenoma clinically, radiologically and histologically. Ductal carcinoma in-situ in the epithelial component of phyllodes tumor is very rare. When ductal carcinoma in-situ is detected within the specimen, the management of treatment changes completely. We report a rare case of low grade ductal carcinoma in-situ arising in a malignant phyllodes tumor in a 55-year-old female patient.

Comparison of the use of piezosurgery expander and conventional instruments on primary implant stability

Objective

To compare the use of a piezosurgery expander and conventional chisel/osteotome on primary implant stability.

Materials and Methods

Twenty fresh ribs were divided into two main groups; group P and group C. In group P, bone expansion was performed using piezosurgery. In group C, bone expansion was performed using conventional chisel osteotomy. In both groups, the implants were inserted into the ribs after bone expansion. After implant placement, primary stability values were evaluated from the bucco-lingual (B-L) and mesio-distal (M-D) sides of the implant.

Results

The primary stability values on the B-L side of both implants in group P were significantly higher than in group C (P < 0.05).

Conclusion

The use of piezo-expanders in the alveolar split technique has better effects on primary implant stability compared with the conventional technique.

The effect of global longitudinal strain on ımpaired six-minute walk test performance in patients with sarcoidosis

Background:

Sarcoidosis is a multisystem and granulomatous disease associated with impaired functional capacity as a result of pulmonary and cardiac involvement. Factors adversely effecting functional capacity in patients with sarcoidosis have not been systematically assessed including myocardial strain imaging on echocardiography which enable to diagnose subclinical cardiac dysfunction. We aimed to evaluate the effect of left and right ventricular global longitudinal strain (GLS) on submaximal exercise capacity in patients with sarcoidosis who do not have clinically manifest cardiac involvement.

Methods:

Extracardiac biopsy proven 56 patients with sarcoidosis and 26 controls were included consecutively. Submaximal exercise capacity of the subjects was assessed with six-minute walk test (6 MWT). Pulmonary function tests and standard transthoracic and two-dimensional speckle tracking echocardiography were performed to the all subjects. Linear regression analysis was performed to find independent predictors of 6 MWT.

Results:

Fifty-six patients (18% male) with a mean age of 52.5 ± 10.7 years were included. Patients with sarcoidosis had low 6 MWT performance and higher New York Heart Association classes and NT-proBNP levels. There were no significant differences between controls and patients with sarcoidosis in parameters of pulmonary function test. Biventricular GLS levels and biatrial reservoir and conduit function values were lower and systolic pulmonary artery pressure (SPAP) was significantly higher in patients with sarcoidosis as compared with controls. Older age and higher SPAP were found as independent predictors of poor 6 MWT performance.

Conclusion:

Although biventricular GLS levels were lower in the patients with sarcoidosis, only age and SPAP elevations were independent predictors of the submaximal exercise capacity. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 63-73)

An In-vitro study on thermal changes during implant drilling with different irrigation volumes

Objective

Irrigation with saline is one of the essential methods for reducing the heat generated during dental implant osteotomy. High irrigation volume impairs visibility of the surgical field, thus complicates the surgery. In this study, we aimed to determine the optimal irrigation volume for heat reduction during dental implant drilling.

Materials and Methods

Thirty-two implant osteotomies were prepared on four fresh cow ribs. Heat generated during the final implant drilling was measured both with infrared thermography and thermocouple method. Initial and maximum temperatures were measured at four different irrigation volumes; 32, 44, 56, and 68 ml/min.

Results

Both measurement methods showed that the amount of temperature rise is associated with the irrigation volume during implant drilling. There is no further decrease in temperature rise above irrigation volume of 56 ml/min.

Conclusion

Saline irrigation with 56 ml/min provides sufficient heat reduction during dental implant drilling and higher irrigation volumes are not necessary.

The anatomical relationship between the axillary artery and vein investigated by radial coronary angiography

AIMS

To reduce the risk of inadvertent arterial puncture and bleeding, we aimed to define a safe puncture site by demonstrating the relation of the axillary artery and vein.

METHODS

The anatomical course and relation as well as crossover sites of the axillary artery and vein, the presence of small arterial bridges over the axillary vein, and validation of commonly preferred axillary venous puncture sites were determined by simultaneous ipsilateral venography in patients (n  =  111; 80 men, age 60 ± 10 years) who underwent coronary angiography by radial artery access.

RESULTS

The axillary vein was detected at the first costa-clavicular intersection in 62% and at the second anterior and third posterior costal intersection in 60% of the patients. Small arterial bridges over the axillary vein were observed in 77% of the patients and more frequently in females and body mass index ≥25 kg/m2 (P  =  0.034 and P  =  0.03, respectively). The axillary artery crossed the vein in 24% of the patients and almost always within the region close to the first costa-clavicular intersection site.

CONCLUSION

Our study demonstrated a high crossover rate (24%) of axillary artery and vein and a high degree of variation in the course of axillary vein. Small arterial bridges over the axillary vein were observed in 77% of the patients.

Effect of intravenous zoledronic acid infusion on electrocardiographic parameters in patients with osteoporosis

We evaluated the effects of zoledronic acid (ZA) therapy on electrocardiographic (ECG) parameters for the first time in the literature. Measurements were performed on ECGs obtained before and after ZA infusion on the same day as well as 1 month after the infusion. ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.

INTRODUCTION

The aim of the present study was to evaluate the early and late effects of ZA therapy on ECG parameters which might be associated with the tendency for atrial and ventricular arrhythmias.

METHODS

Consecutive patients with osteoporosis who were admitted to our clinic between December 2013 and December 2014 and who were scheduled to receive ZA infusion constituted our study population. Twelve-lead surface ECGs were obtained from all patients before and after ZA infusion on the same day as well as 1 month after the infusion. All ECG parameters were measured and compared with each other for each patient.

RESULTS

Data of 100 patients were used in the analysis (9 male; 70.5 ± 11.6 years of age). There were no significant differences between repeated measurements regarding pmax, pmin, and p dispersion values. QT max and QT min values were significantly increased after infusion; however, there were no significant changes in QT dispersion, Tp-e interval, and Tp-e dispersion values.

CONCLUSIONS

ZA infusion did not affect P wave dispersion both at the immediate post-infusion period and 1 month after infusion. QT values were significantly increased early after ZA infusion; however, there were no significant differences in parameters reflecting disparity of ventricular recovery times and transmural dispersion of ventricular repolarization. Based on these observations, it may be suggested that ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.

Protective effects of amifostine on ischemia-reperfusion injury of rat kidneys

Objectives:

Amifostine is a drug which can eliminate free oxygen radicals that appear in the body after radiation or chemotherapeutic agent exposure. It is used to decrease the renal toxicity of cisplatin. The aim of this study was to determine the role of amifostine in warm ischemia kidney model for prevention of ischemia/reperfusion injury and also to find out the mechanism for prevention from ischemia/reperfusion injury if such an effect does exist.

Materials and Methods:

Adult female rats (n = 40) that used in our study were divided into three groups. Group 1: Control (n = 8), group 2: Ischemia-control (n = 16), group 3: Amifostine treated (n = 16). The effect of amifostine on ischemia/reperfusion injury investigated in rat kidneys.

Results:

At the 7^th day, blood urea nitrogen level was statistically significantly higher in ischemia-control group than all groups (P = 0.001) and mean serum creatinine levels were found to be the highest in ischemia-control group (P = 0.091). Mean malondialdehyde levels in left kidneys removed on the 7^th day were not significantly different (P = 0.105) at all three groups. Between ischemia-control group and amifostine group, there was a significant difference in reduced glutathione (GSH) levels (P = 0.001). In amifostine group, grade 4 necrosis was not detected neither on 7^th day nor day 0.

Conclusion:

Amifostine could decrease the degree and severity of necrosis after reperfusion. Amifostine could not prevent membrane lipid peroxidation caused by superoxide anion radicals in kidney but they could protect tissues from the harmful effects of ischemia/reperfusion injury by increasing the level of reduced GSH which is a well-known oxygen radical eliminator.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up.

METHODS

This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization.

RESULTS

The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average.

CONCLUSION

NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.

Arrhythmogenic epilepsy and pacing need: A matter of controversy

There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guideline-directed therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patients; however, currently, there is no universal agreement on the pacing indications for these patients. In this review, we focus on the pathophysiology and clinical presentation of ictal bradyarrhythmias and then discuss the pacing need based on the available literature data.

Bone fracture in breast cancer patients with isolated bone metastasis

AIM

To analyse the incidence of bone fracture of breast cancer patients with isolated bone metastasis and its effect on survival. We tried to find an answer to the question of "Can the development of bone fracture be predicted?"

METHODS

Between 1993-2006, 139 breast cancer patients with isolated bone metastasis were examined. Patients were divided into two groups depending on the development of pathologic bone fracture.

RESULTS

Fractures were developed in 41 patients (29.5%)within 41 months of follow-up. The locations of pathologic bone fracture were vertebral fracture in 26 patients (63.4%),femur fracture in 11 patients (26.8%), and hip fracture in four patients (9.8%). Fracture rates in hormone sensitive and resistant patients were 31.2% and 14.3%, respectively. The fracture rates in 13 triple negative and non triple negative patients were 7.7% and 31.4%, respectively (p=0.07). High CA 15-3 levels at the time of metastasis in patients with and without fractures were 68.4% and 61.1%, respectively. The risk for fracture was also high in Her2-neu positive patients (38.7% vs. 26.5%). While the incidence of fracture with the presence of one factor mentioned above was 22.2%, it was increased to 36.1% in the presence of two or three factors(p=0.13). Median survivals of the patients with and without fractures were 48 and 39 months, respectively (p= 0.65).

CONCLUSION

Hormone sensitivity, high CA 15-3 levels and positive Her2-neu status are slight risk factors for bone fractures. Survival was not different in patients with or without bone fractures.

Uterus transplantation from a deceased donor

OBJECTIVE

To demonstrate the technique for uterus retrieval and transplantation from a multiorgan donor.

DESIGN

Video presentation of our case report. The video uses animation to demonstrate the technique. Institutional Review Board (IRB) approval was obtained.

SETTING

University hospital.

PATIENT(S)

A 21-year-old woman with complete müllerian agenesis.

INTERVENTION(S)

Uterus allotransplantation has been performed from a deceased donor.

MAIN OUTCOME MEASURE(S)

Acquirement of cyclic menstrual function.

RESULT(S)

This video demonstrates the technique for uterus retrieval, perfusion, and transplantation. The recipient patient has been monitored regularly for vascular flow, immunosuppression, and infection control since the operation.

CONCLUSION(S)

Uterus transplantation requires extensive evaluation of the recipient and donor by an experienced multidisciplinary transplantation team both pre- and postoperatively. It has major risks related to surgery, immunosuppression, and pregnancy. Uterus transplantation might be considered promising only after the birth of a near-term healthy baby.

Torsade de pointes. A rare cause of syncope in severe aortic stenosis

The evaluation of syncope in severe aortic stenosis usually requires intense work-up. Mechanical obstruction should not always be implicated as the underlying cause of syncope. Syncope at rest may be rarely associated with ventricular arrhythmias. We present a patient with severe aortic stenosis who experienced syncopal events due to torsade de pointes.

Takotsubo cardiomyopathy in a patient with lung adenocarcinoma

Takotsubo cardiomyopathy (TC) is a rare and usually physical or emotional stress-induced clinical disorder characterized by transient left ventricular dysfunction and apical segment ballooning. Much is still unknown regarding risk factors and clinical relationships. Recently, an association between TC and malignancies has been proposed. We present a case of lung adenocarcinoma whose initial hospital admission was due to TC. We contribute this case report to the growing set of literature on the association between TC and malignancies.

Preliminary results of the first human uterus transplantation from a multiorgan donor

OBJECTIVE

To describe the first-year results of the first human uterus transplantation case from a multiorgan donor.

DESIGN

Case study.

SETTING

University hospital.

PATIENT(S)

A 21-year-old woman with complete müllerian agenesis who had been previously operated on for vaginal reconstruction.

INTERVENTION(S)

Uterus transplantation procedure consisting of orthotopic replacement and fixation of the retrieved uterus, revascularization, end to site anastomoses of bilateral hypogastric arteries and veins to bilateral external iliac arteries and veins was performed.

MAIN OUTCOME MEASURE(S)

Resumption of menstrual cycles.

RESULT(S)

The patient had menarche 20 days after transplant surgery. She has had 12 menstrual cycles since the operation.

CONCLUSION(S)

We have described the longest-lived transplanted human uterus to date with acquirement of menstrual cycles.

A novel WT1 gene mutation in a newborn infant diagnosed with Denys-Drash syndrome

Denys-Drash syndrome (DDS) is a rare disorder characterized by glomerulopathy, genital abnormalities and predisposition to Wilms' tumor. It is associated with constitutional Wilms'tumor suppressor 1 (WT1) gene mutations, in which the majority being missense mutations in the zinc-finger region. Here, we present a newborn with DDS, associated with a novel heterozygous missense mutation, p.Asp396His, on exon 9 of WT1.

Diagnostic utility of specific electrocardiographical parameters in predicting left ventricular function

BACKGROUND

Changes in electrocardiography (ECG) parameters, including sinus tachycardia, atrial fibrillation, bundle branch blocks, Q waves and left ventricular (LV) hypertrophy, are commonly observed in patients with heart failure (HF).

OBJECTIVES

To determine whether specific ECG parameters have a diagnostic role in predicting LV systolic dysfunction (LVSD) in patients with suspected HF.

METHODS

A total of 123 patients with symptoms or signs of HF and 20 HF patients with New York Heart Association class IV status were consecutively recruited. Several ECG parameters, including QRS duration, dispersion and SV1 or SV2 + RV5 or RV6 ≥3.5 mV (Goldberger's first criterion), QRS amplitude ≤0.8 mV in the limb leads (Goldberger's second criterion) and RV4/SV4 <1 (Goldberger's third criterion), were subsequently determined and correlated with LV ejection fraction (LVEF).

RESULTS

One hundred six patients had LVEF <50% (LVSD group), while 37 patients had LVEF ≥50% (non-LVSD group). The maximal QRS duration of the LVSD group was significantly longer than that of the non-LVSD group (124.5±20.8 ms versus 109.7±13.1 ms; P<0.001). ROC analysis revealed that a cut-off point of QRS duration ≥124 ms significantly predicted LVSD (OR 4.1 [95% CI 1.7 to 10.2]; P=0.001). The frequencies of Goldberger's first and third criteria were higher in the LVSD group (OR 8.3 [95% CI 1.9 to 36.4]; P=0.001; and OR 8.9 [95% CI 3.4 to 23.2]; P<0.001, respectively). Logistic regression analysis showed that Goldberger's first and third criteria as well as QRS duration ≥124 ms were independent predictors of LVSD.

CONCLUSION

Bedside ECG parameters, such as the Goldberger criteria, may be useful in predicting LVSD before the use of more sophisticated diagnostic tests is considered in patients with suspected HF.

Right ventricular outflow tract pacing: an alternative, safe, and effective pacing site

The right ventricular apex (RVA) has traditionally been preferred for the insertion of permanent cardiac pacemaker leads because of vast experience with their use, their ease of implantation, and the stability of passive fixation leads in the RVA trabeculae. However, prolonged RVA pacing is associated with progressive left ventricular dysfunction due to dysynchronous ventricular activation, and often results in substantial functional, hemodynamic, electrical, and structural changes, as previously demonstrated in many studies. Only in recent years has interest in the use of alternate pacing sites developed. The right ventricular outflow tract (RVOT) is now the preferred site of pacing because of potential advantages such as ease of application, better hemodynamics, synchronous activation, fewer myocardial perfusion defects, and a narrower QRS complex compared with RVA pacing. This review article comprehensively discusses this novel technique in terms of its beneficial effects, long-term safety, and performance measures compared with RVA pacing, and as an alternative method for biventricular pacing.

Persistence and behavior of pesticides in cotton production in Turkish soils

Turkey is the sixth largest producer of cotton in the world. Two of the most commonly applied pesticides used in cotton production are trifluralin and endosulfan. Although both are very effective at controlling pests, their persistence in the environment poses risks to human health and the environment. Four loam soils and one silty-loam soil were studied to evaluate the persistence of trifluralin and endosulfan in relation to soil characteristics. Degradation with trifluralin reached as high as 70% of the applied doses. Soils with the highest organic matter content had the lowest degradation rate, indicating a tighter sorption of trifluralin. Endosulfan degradation was a function of soil type and the specific isomer, with beta-endosulfan depicting the highest degradation.

Fibre type-specific expression patterns of myosin heavy chain genes in adult torafugu Takifugu rubripes muscles

Comprehensive in silico studies, based on the total fugu genome database, which was the first to appear in fish, revealed that torafugu Takifugu rubripes contains 20 sarcomeric myosin heavy chain (MYH) genes (MYH genes) (Ikeda et al., 2007). The present study was undertaken to identify MYH genes that would be expressed in adult muscles. In total, seven MYH genes were found by screening cDNA clone libraries constructed from fast, slow and cardiac muscles. Three MYH genes, fast-type MYH(M86-1), slow-type MYH(M8248) and slow/cardiac-type MYH(M880), were cloned exclusively from fast, slow and cardiac muscles, respectively. Northern blot hybridization substantiated their specific expression, with the exception of MYH(M880). In contrast, transcripts of fast-type MYH(M2528-1) and MYH(M1034) were found in both fast and slow muscles as revealed by cDNA clone library and northern blot techniques. This result was supported by in situ hybridization analysis using specific RNA probes, where transcripts of fast-type MYH(M2528-1) were expressed in fast fibres with small diameters as well as in fibres of superficial slow muscle with large diameters adjacent to fast muscle. Transcripts of fast-type MYH(M86-1) were expressed in all fast fibres with different diameters, whereas transcripts of slow-type MYH(M8248) were restricted to fibres with small diameters located in a superficial part of slow muscle. Interestingly, histochemical analyses showed that fast fibres with small diameters and slow fibres with large diameters both contained acid-stable myofibrillar ATPase, suggesting that these fibres have similar functions, possibly in the generation of muscle fibres irrespective of their fibre types.