Ventricular Tachycardia and Heart Failure

Ventricular tachycardia (VT) is a common arrhythmia seen in patients with heart failure (HF) and is now seen more frequently as these patients survive longer with modern therapies. In patients with HF, half of the deaths are sudden due to life-threatening ventricular arrhythmias, including VT. Although disease modifying drugs, such as beta blockers, mineralocorticoid drugs, and angiotensin receptor neprilysin inhibitors, prevent the occurrence of VT to some extent, the mainstay of therapy is the antiarrhythmic drug therapy, implantable cardioverter-defibrillator (ICD) implantation, and traditional radiofrequency catheter ablation. Autonomic nerve system modulation and stereotactic body radiation therapy have emerged as novel techniques for the management of refractory VT cases. Patients with refractory VT and repetitive ICD shocks should be further evaluated regarding the candidacy for left ventricular assist device and transplantation

Biomarkers and Heart Failure

Heart failure (HF) represents fatal endpoint of all cardiovascular diseases. Acute and chronic HF is a complex, heterogeneous syndrome consisting of many overlapping syndromes making its diagnosis and treatment more challenging. There is no single test for diagnosis of HF, and diagnosis is based on clinical judgment driven by a combination of history, physical examination, and appropriate tests. Despite improvements in clinical management within the last 50 years, it has still been a disease of poor prognosis. Attempts to further improve its prognosis can only be achieved by understanding pathophysiology of HF clearly and finding, developing, and using appropriate and new clinical biochemical markers for diagnosis of each different clinical subtype and hence unique intervention of that specific subtype of HF. This review is an overview of biomarkers, which are either currently used in the clinical practice or hold promise for future use in patients with both chronic and acute HF

Heart Failure with Preserved Ejection Fraction

Heart failure with preserved ejection fraction (HFpEF) is now recognized as a major and growing public health problem worldwide. This heart failure subtype disproportionately affects women and the elderly and is commonly associated with other cardiovascular comorbidities, such as hypertension, diabetes and chronic kidney disease. There are uncertainties and debates regarding the definition, diagnosis and pathophysiology with the consequence that all outcome trials performed so far cannot yield an effective treatment as in heart failure with reduced ejection fraction (HFrEF). Here we present an overview of epidemiology, pathophysiology, diagnosis and therapeutic approaches emerging from large outcome clinical trials

Graves’ Disease and Cardiac Complications

Graves’ disease is an autoimmune thyroid disease and a common cause of hyperthyroidism. Thyroid hormones have multiple adverse effect on cardiovascular system through many direct and indirect mechanisms. They increases heart rate, cardiac contractility, systolic and mean pulmonary artery pressure, cardiac output, diastolic relaxation, and myocardial oxygen consumption, whereas decrease systemic vascular resistance and diastolic pressure. All these hemodynamic changes in cardiovascular system can eventually lead to heart failure, tachyarrhythmias, systemic and pulmonary hypertension, if left untreated. Cardiovascular complications of Graves’ disease are frequent and important cause of increased morbidity and mortality. This chapter reviews the cardiovascular complications of Graves’ hyperthyroidism with underlying mechanisms and treatment

Türkiye’de ayakkabı tasarımında kullanılan ölçüler İle Türk insanının antropometrik ayak ölçülerinin karşılaştırılması: 0-3 Yaş bireyler üzerinden bir analiz

Antropometri Yunanca Antropos (insan) ve Metikos (ölçü) sözcüklerinden oluşan ve insan vücudunun ölçülerini konu edinen bir bilim dalıdır. Bu ölçüler; bireyler veya gruplar arasında, anatomi, coğrafi bölge ve meslek grupları gibi çeşitli faktörlerden kaynaklanan farklılıkları ve benzerlikleri saptayarak daha geniş bir insan kitlesine uygun tasarımlar yapma imkânı sağlar. Ürün tasarımı sürecinde, ürün-kullanıcı ilişkisinin temelini oluşturan bu ölçüler kullanılarak toplumsal standartlar oluşturulmuştur. Her toplumun standart olarak belirlediği ölçüler kendine özgüdür. Belirli bir ürün için oluşturulmuş standartlar başka bir toplumda kullanılamaz, kullanıldığı taktirde toplumda biyolojik deformasyonlar görülmesi kaçınılmazdır. Bebeklik dönemi, ayak gelişiminde en önemli dönem olarak ele alınmaktadır. Bebeklerin ayak gelişimlerinin geç tamamlanması ve kemik yapısının oluşmaması bunun en büyük nedenidir. Bu nedenle proje, Türkiye’de yaşayan 0–3 yaş (0-36 ay) arasındaki kız ve erkek çocukları kapsamaktadır. Bu kapsamda ülke istatistiki olarak olasılıklı tabakalı örnekleme yöntemi ile 7 bölgeye ayrılmış, bu bölgeler dahilinde belirlenen illerde yaşayan bireylerden çeşitli antropometrik ölçümler alınmıştır. Elde edilen veriler; ülkemizde kullanılan ve Fransız insanının ayak ölçülerine göre oluşturulmuş “TS 5553 (1988) Paris Point Sistemi” standartları ile karşılaştırılmıştır.The Comparison of Measurements Used In Shoe Design In Turkey With The Anthropometric Foot Measurements Of Turkish People: An Analysis Of 0-3 Years Old Individuals Anthropometry, which is composed of the words Anthropos (human) and Meticos (scale) in Greek and includes the scale of human body, is a discipline of science. These scales provide suitable designs for large mass of people by determining similarities and differences resulted from various factors such as anatomy, geographical area and occupational groups among individuals and groups. Social standards were formed by the use of these scales which establish the base for the relationship between the product and the consumer. Scales which each society determines are specific to that society. Standards which are established for a particular product can’t be used in any other societies; otherwise, it is inevitable to see the biological deformations in society. Babyhood period is regarded as the most important period in the development of foot. Development of baby foot in later years and insufficiency of bone structure are the most important reasons. For this reason, this research includes children who are boys and girls aged between 0 and 3 (0-36 months). The country was statistically divided into seven parts with Stratified Sampling Method in the scope of this research and various anthropometric measurements were taken from individuals who live in selected cities including these regions. Data obtained were compared with “TS 5553 (1988) Paris Point System” standards which are used in our country and formed in a way which is suitable for the foot of French People

Convergence research into the applicability of smart contracts in construction projects

This study presents a new research into the applicability of smart contract approach (SCA) in construction projects, and it consists of two parts, including the identification of limitations and challenges associated with traditional construction contract approach in comparison with the SCA, and the establishment of a conceptual framework to facilitate further research and development in adopting SCA at tactical and operational level in construction projects. The study adopted a systematic literature review first to identify limitations and challenges to adopting SCA in construction projects, and then a system analysis and design to establish a conceptual framework in response to identified limitations and challenges at strategic level. This study shows a list of identified limitations and challenges of traditional construction contract approach in the digital construction era, and a strategic framework as one technical solution to overcome the limitations and to tackle the challenges. This study presents a list of limitations and challenges that traditional construction contract approach has in the digital construction era and a strategic resolution to adopting SCA in construction projects. These research outcomes are practice oriented with connections to further research, development and practice in relation to SCA. This research establishes a connection between the identified limitations and challenges of traditional construction contract approach and the adoption of SCA at strategic level. This connection including the strategic framework can well inform further research into tactical and operational solutions for adopting SCA in the digital construction era

Normal Coronary Artery Patient Presenting with Left Ventricular Aneurysm

Left ventricular aneurysm (LVA) is one of the most important complications of myocardial infarction LVA is strictly defined as a distinct area of abnormal left ventricular diastolic contour with systolic dyskinesia or paradoxical bulging. LVA usually results from myocardial infarction. Other rare aetiologies of LVA include hypertrophic cardiomyopathy, Chagas' disease, sarcoidosis, congenital LVA, and idiopathic However, LVA formation in patients with idiopathic dilated cardiomyopathy is rarely reported, and the incidence, clinical features, and pathogenesis of LVA formation in patients with idiopathic dilated cardiomyopathy is not well understood. Here, we present a 45 years old, idiopathic dilated cardiomyopathy patient with LVA and normal coronary arteries The pathogenesis of LVA formation in patients with idiopathic dilated cardiomyopathy is not clear. One acceptable hypothesis is that coronary artery emboli originate from mural thrombi, present in some patients with idiopathic dilated cardiomyopathy, which develop due to local wall infarction and fibrosis. The local myocardial perfusion differences could be seen in idiopathic dilated cardiomyopathy and predominantly found in the anteroposterior axis of the left ventricle. Local fibrosis occurs more frequently on the anterior wall or posterior wall, and less frequently on the lateral or septal wall. In our patient, LVA existed in the septal segments.We could not define the exact mechanism of the septal aneurysm in our patient but we decided to present this abnormal case, which is different from cases thus far reported in the literature

Use of shear-wave elastography to distinguish complex and complicated fibroadenomas from simple fibroadenomas

PURPOSESimple fibroadenomas (SFAs), complex fibroadenomas (CFAs), and cellular fibroadenomas (CeFAs) are variants of fibroadenomas. Additionally, some degenerative, hyperplastic, and metaplastic changes may occur in fibroadenomas, forming complicated fibroadenomas. Distinctive ultrasonography (US) features in variants of fibroadenomas and complicated fibroadenomas have not been reported. Shear-wave elastography (SWE) can be applied to effectively discriminate between these variants and complicated fibroadenomas. In this study, we aimed to evaluate SWE findings to discriminate between SFAs and other variants.METHODSIn total, 48 patients (26 with SFAs, 16 with CFAs, 3 with CeFAs, and 3 with complicated fibroadenomas) participated in this study. The lesions were classified into two groups according to histopathologic diagnoses. The SWE evaluation and lesion elasticity scores (Emax, Emean, and Emin) were both assessed in m/s and k/Pa, respectively. Two observers measured Emax, Emean, and Emin. Brightness (B)-mode US findings based on the Breast Imaging Reporting and Data System categorization and elasticity scores were recorded. In the statistical analyses, the chi-square test and non-parametric tests were performed. Fisher’s exact test was used to compare independent groups, and Spearman’s correlation coefficients were used to correlate the SWE data between the two observers. Additionally, receiver operating characteristic curves were analyzed to evaluate the diagnostic performance of the elasticity values.RESULTSThe B-mode US features in both groups showed no statistical significance. The set of SWE values of both observers demonstrated strong statistical significance in discriminating between group 1 (SFAs) and Group 2 (CFAs, CeFAs, and complicated fibroadenomas).CONCLUSIONAs the fibroadenoma variants and complicated fibroadenomas have similar US findings, SWE in addition to a conventional B-mode examination can increase the diagnostic performance to discriminate SFAs from other complex and complicated forms of fibroadenomas