Prenatal diagnosis and postnatal follow-up of congenitally corrected transposition of the great arteries and recurrent supraventricular tachycardia

The prenatal sonographic diagnosis of congenitally corrected transposition of the great arteries (ccTGA), a rare form of congenital heart disease is very difficult. A24-year-old woman was referred to our center at 28 weeks’ gestation because of suspected fetal cardiac anomalies. This article reports a case of ccTGA with supraventricular tachycardia, ventricular septal defect, pulmonary valve stenosis, tricuspid valvar displacement and moderate tricuspid regurgitation during her pregnancy. The combined presence of SVT and ccTGA are occasionally present in the literature.peer-reviewe

Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach

The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed “screening and diagnostic” algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN

Machine Learning-based Silence Detection in Call Center Telephone Conversations

This study presents the development of a voice activity detection (VAD) system tested on call center telephony data obtained from our local site. The concept of bag of audio words (BoAW) combined with a naive Bayes classifier was applied to achieve the task. It was formulated as a binary classification problem with speech as the positive class and silence/background noise as the negative class. All the processing was performed on the Mel-frequency cepstral coefficients (MFCCs) extracted from the audio recordings. The results which are presented as accuracy score and receiver operating characteristics (ROC) indicate an excellent performance of the developed model. The system is to be deployed within our call center to aid data analysis and improve overall efficiency of the center

The Impact of Non-tariff Barriers on Trade: The Gravity Model on Turkish Agri-Food Products

The competition between the U.S. and the E.U. agricultural subsidies during 1980s decreased the world prices in agricultural and food markets but caused an extensive distortion in the international trade of agricultural and food products. Under these circumstances, World Trade Organization (WTO) was founded in 1995 as an institute responsible for executing and auditing 1994 Uruguay Agricultural Agreement (UAA) to regulate agricultural subsidies and international trade measures. Import quotas in international trade were repealed or converted into tariff rates, and with time tariff rates were reduced gradually first by UAA initiatives and later by those of the WTO. However, WTO policies allow countries to have rights to take precautions and to impose measures necessary to protect human, animal or plant life or health. In addition, countries continue to have rights to secure quality assurance in production, to protect environment, to regulate information transparency and accessibility, as well as to protect consumers against misleading labeling. These rights do not count as tariffs or quotas and are confirmed by international regulations, also referred to as technical regulations (Maskus et al. 2001). There is evidence that these technical regulations are now being used as political means in bilateral, regional and global trade in place of diminished tariffs and quotas. These regulations are called non-tariff barriers or technical barriers to trade. Developing countries are mostly affected by these regulations since they bear additional expenses to fulfill a mandatory standard imposed by the developed countries (Beghin and Bureau 2001)

Down-Regulation Of Mirna 145 And Up-Regulation Of Mirna 4516 May Be Associated With Primary Hypertension

Complex mechanisms including genetic factors have been proposed in the pathogenesis of primary hypertension (HT). Micro RNAs (miRNAs) are single-stranded RNA molecules that are not converted into protein products. However, it has been established that genes regulate conversion into protein products. The primary aim of this study was to investigate the roles of miRNA 4516, miRNA 145, miRNA 24, and miRNA 181a in the pathogenesis of HT. The secondary aim was to investigate the relation between these miRNAs and renin, aldosterone, norepinephrine, renalase, and NOS. Fifty-two hypertensive and 51 control normotensive individuals under observation in the Cappadocia cohort were included in the study. miRNA 4516, miRNA 181a, miRNA 24, and miRNA 145 levels were measured using the ddPCR method. miRNA 4516 and norepinephrine levels were significantly higher in the HT group (P < .005 for both), while miRNA 145 levels were significantly lower (<.05). miRNA 4516 up-regulation (P < .05) and miRNA 145 down-regulation (P < .05) were identified as independent predictors of HT. Renalase exhibited negative correlation with miRNA 4516 and positive correlation with miRNA 145 in the patient and control group. In addition, negative correlation was present between miRNA 24 and NE and NOS and between miRNA 181a and NOS in the patient group. Our study identified, for the first time in the literature, miRNA 4516 up-regulation and miRNA 145 down-regulation as independent determinants of HT. Further studies performed in the light of our findings may lead to a better understanding of the pathogenesis and new therapeutic possibilities.WoSScopu

The Effect Of Intermittent Fasting On Blood Pressure Variability In Patients With Newly Diagnosed Hypertension Or Prehypertension

Intermittent fasting is a phenomenon which can be observed in most humans. The effect of intermittent fasting on blood pressure variability (BPV) has not previously been investigated. The purpose of this study was to assess the effect of fasting on blood pressure (BP) (with office, home, central, and ambulatory blood pressure monitoring [ABPM]) and on BPV. Sixty individuals were included in the study. Office, home, ABPM, and central BP measurements were performed before and during intermittent fasting. Standard deviation and coefficient variation were used for office and home BPV measurement, while the smoothness index was used to calculate ABPM variability. Patients' BP and BPV values before and during intermittent fasting were then compared. Intermittent fasting resulted in a significant decrease in office BP values and ABPM measurements but caused no significant change in home and central BP measurements. Twenty-four hour urinary sodium excretion decreased. Smoothness values obtained from ABPM measurements were low; in other words, BPV was greater. BPV was higher in patients who woke up to eat before sunrise, but BPV was low in patients with high body mass index. Intermittent fasting produced a significant decrease in BP values in terms of office and ABPM measurements in this study but caused no significant change in central BP and home measurements. We also identified an increase in BPV during intermittent fasting, particularly in patients who rose before sunrise. (C) 2017 American Society of Hypertension. All rights reserved.WoSScopu

CHANGES IN THE LEVELS OF SALIVARY SODIUM AND POTASSIUM IN PATIENTS WITH ESSENTIAL HYPERTENSION

It has been known that the metabolism of some elements in the body is affected by essential hypertension. However the interaction between essential hypertension and electrolytes in blood and urine samples has been investigated in several studies, this interaction in saliva still requires further studies. The aim of this study is to examine the changes in concentration of some trace elements like sodium, potassium of saliva in patients who have essential hypertension. It is also aimed to search if laboratory findings associated with salivary elements have diagnostic importance. 20 patients with essential hypertension, 20 patients undergoing antihypertensive treatment for 10 years and 20 normotensive patients were included in this study. Mixed saliva secretion samples from all patients were collected for determining concentrations of sodium and potassium. In addition to conventional laboratory techniques, neutron activation analysis and multi-element discriminating techniques were used. As a result sodium levels in patients with hypertension, undergoing antihypertensive treatment and in normotensive patients were found higher than the levels in patients with hypertension who do not undergo any treatment. Potassium level in first two group patients was found statistically less than the last group

The Effect of Swimming and Type of Stroke on Bone Metabolism in Competitive Adolescent Swimmers: A Pilot Study

Background/aim: Physical activity plays a key role in increasing and preserving bone mineral density (BMD). Effects on bone development associated with various nonweight-bearing sporting activities, such as swimming, are controversial. Different strokes used in swimming may also present as another factor. The aim of this study was to evaluate the effect of swimming and type of stroke on BMD in competitive adolescent athletes. Materials and methods: Seventy-nine swimmers between the ages of 10 and 21 years participated in this study. BMD was measured with dual-energy X-ray absorptiometry at the lumbar vertebrae and left proximal femur. Daily calorie intake and calcium consumption, and measurements of calcium, phosphorus, alkaline phosphates, 25-hydroxyvitamin D (25(OH) D), and osteocalcin were evaluated. Results: Preliminary results revealed that the type of stroke had no effect on BMD (P = 0.79). Additionally competitive swimmers did not have augmented bone mineral accretion, and in 13.9% of athletes low BMD was confirmed. Sixty percent of swimmers had either deficient or insufficient 25(OH) D levels and a low mean calorie (P = 0.542) and calcium (P = 0.038) intake was observed. Conclusion: This was the first study to evaluate the effect of swimming stroke on BMD. Although no effect was statistically shown, further studies with a larger series may determine this effect.WoSScopu

Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer

It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO(2)), for the evaluation of risk assessment in lung cancer surgery It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise testing. The purpose of the current investigation was to study the value of the oxygen uptake efficiency slope (OUES), which shows exercise capacity during submaximal testing, in predicting postoperative mortality in patients with bronchogenic carcinoma scheduled for lung resection. Forty-nine patients with bronchogenic carcinoma participated in studies with exercise tests as a preoperative evaluation. The peak VO(2) was calculated for each subject by averaging values obtained during the final 10 s of exercise. The following equation was used to determine OUES: VO(2)/log(10) VE. Peak VO(2) without postoperative complication was 22.8 +/- 3.3 ml/(kg min), however, peak VO(2) in patients with present complications was 19.1 +/- 4.2 ml/(kg min) (p = 0.001). In addition, although the mean OUES in patients with present complications was 11.1 +/- 1.2, the mean OUES in the absent group was 13.3 +/- 2.1 (p < 0.001). Although peak VO(2) is useful in evaluating selected patients with bronchogenic carcinoma, OUES is also a beneficial parameter and should be calculated and recorded with peak VO(2), a better predictor of poor surgical outcome than absolute values, and should be integrated into preoperative decision making. (C) 2009 Elsevier Ireland Ltd. All rights reserved