Evaluation of Unidentified Signatures According to Sending Location and Document Type

Amaç İmza, Türk Dil Kurumu (TDK) Sözlüğünde “Bir kimsenin herhangi bir belgeyi yazdığını veya onayladığını belirtmek için her zaman aynı biçimde kullandığı işaret” olarak karşılık bulmaktadır. Adli bilimlerde belge incelemelerinde genellikle imza olarak nitelendirilmeyecek, düz bir çizgi ya da gelişi güzel şekiller oluşturularak atılan imzaların kime ait olduğuna yönelik incelemelerde imzanın aidiyeti hususunda rapor düzenleme açısından zorluklarla karşılaşılmaktadır. Bu çalışma ile Adli Tıp Kurumu Fizik İhtisas Dairesine 2011 yılı içerisinde Mahkemeler ve Cumhuriyet Savcılıkları tarafından inceleme konusu belgelerdeki imza ya da imzaların kime ait olduğu hususuna yönelik verilmiş mütalaalarda, atılan imzanın aidiyeti hususunda görüş bildirilememiş imzaların irdelenmesi amaçlanmıştır. Materyal ve Metod Çalışma 2012 yılında, Adli Tıp Kurumu Fizik İhtisas Dairesine 2011 yılı içerisinde Mahkemeler ve Cumhuriyet Savcılıkları tarafından gönderilen (n=11.872) “dosyadaki inceleme konusu belgelerdeki imza ya da imzaların aidiyetinin tespit edilemedi” şeklinde verilmiş raporların (n=889) retrospektif olarak incelenmesi (geldiği bölge, mahkeme türü, belge türü, belgenin niteliği) ile yapılmıştır. Bulgular Belgelerin 867’sinin (%97.5) orijinal asılları, 22 tanesinin fotokopi ve karbon nüshaları üzerinden görüş bildirilmiştir. Belge türü açısından, 352’si (% 39.6) senet, 182’si (%20.5) çek, 170’i (%19.1) belge başlığı altında düzenlenmiş evrak, 98’i (%11.0) sözleşme, 31’i (%3.5) işe giriş-çıkış bildirgeleri, 25’i (%2.8) tutanak şeklinde düzenlenmiş evrak, 13’ ü ibraname, 18’i diğer ( kira kontratı, vekâletname, bordro vs.) belgelerdi. Belgelerin % 7,5’inde aidiyet saptanamamıştır. Sonuç Her türlü incelemeye rağmen aidiyeti hususunda tespit yapılamayan imzaların oluşturduğu hukuki belirsizliklerin çözümüne ve maddi-manevi kayıpların önlenmesine yönelik katkı sağlaması bakımından toplumda, sağlıklı imza atma alışkanlıklarının geliştirilmesi gerekmektedir.Aim The meaning of the signature is explained as “The mark which is always used identically by a person to indicate that he/she writes or approves any document” in the official dictionary of the Turkish Language Association (TDK). In forensic science documents investigations, it is met with difficulties in regard to preparing a report related to the investigations about the identification of signatures appended by creating a straight line or irrelevant figures that are not generally described as signature. With this study, it was aimed to scrutinize the signatures for which an opinion was not expressed about the identification of appended signatures in the considerations given by the Courts and Public Prosecution Offices regarding the identification of signature or signatures in the questioned documents in 2011 and sent to Physics Specialization Department of the Council of Forensic Medicine. Materials and Methods The study was performed with retrospective examination of the reports (the region sending the document, type of the court, type of the document, characteristic of the document) (n=889) delivered as the signature or signatures in the questioned documents were unidentified in the files (n=11.872) sent to Physics Specialization Department of the Council of Forensic Medicine by the Courts and Public Prosecution Offices in 2011. Results The opinion was expressed on original copies of 867 documents (97,5%), photocopies and carbon copies of 22 documents. Documents were as followings regarding the type of the document: 352 muniments (39,6%), 182 cheques (20,5%), 170 papers prepared as document title (19,1%), 98 contracts (11,0%), 31 statements of employment and dismissal notices (3,7%), 25 papers prepared as record (2,8%), 13 acquittances, 16 other documents (rental contract, letter of attorney, pay roll etc.). 7.5% of documents was unidentified. Conclusion To contribute to solution of judicial uncertainty created by unidentified signatures despite every type of investigation and to prevention of financial and emotional losses, it is essential to develop habits of appending accurate and reliable signatures

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

Abstract Objectives Chronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure’s effectiveness and safety. Methods LAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m2, and subgroups were further analysed (i.e. eGFR < 15, 15–29, and 30–59 mL/min/1.73 m2, respectively). Results Two hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA2DS2-VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p  0.05  vs. eGFR 30–59 mL/min/1.73 m2). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021). Conclusions Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages

Use of a Repositionable and Fully Retrievable Aortic Valve in Routine Clinical Practice: The RESPOND Study and RESPOND Extension Cohort

Objectives: The authors sought to evaluate 1-year clinical outcomes with the Lotus valve (Boston Scientific, Marlborough, Massachusetts) in a large international, multicenter prospective registry including patients eligible for transcatheter aortic valve replacement (TAVR) based on heart team consensus. Background: TAVR is a safe and effective treatment for severe aortic valve stenosis; however, limited data are available on TAVR with the repositionable and fully retrievable Lotus valve in unrestricted contemporary clinical practice. Methods: The RESPOND (Repositionable Lotus Valve System—Post-Market Evaluation of Real World Clinical Outcomes) study enrolled 1,014 patients; 996 patients were implanted with the Lotus valve (mean age 80.8 years, 50.8% female, mean STS score 6.0 ± 6.9%). The primary endpoint was all-cause mortality in the intent-to-treat population at 30 days and 1 year. An Extension cohort of 50 patients was treated with the Lotus valve with Depth Guard including a modified delivery system. Mortality and stroke were independently adjudicated. An independent core laboratory assessed echocardiographic data. Results: One-year clinical follow-up was available for 99.9% of Lotus valve-treated patients. At 1 year, the all-cause mortality rate was 11.7% and 4.1% of patients had experienced a disabling stroke. The permanent pacemaker implantation rate was 32% (37% among pacemaker-naive patients). Echocardiographic data at 1 year were available for core laboratory assessment in 62.6% of patients. Paravalvular leak was absent or trace in 94.5%, mild in 5.1%, and moderate in 0.4% of patients. Data from the Extension cohort confirmed good clinical outcomes at 30 days with an 18% permanent pacemaker rate (20% among pacemaker-naive patients). Conclusions: One-year outcomes from the RESPOND study confirm the safety and efficacy of the Lotus valve when used in routine clinical practice. (Repositionable Lotus Valve System—Post-Market Evaluation of Real World Clinical Outcomes [RESPOND]; NCT02031302

Two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation

Background: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we examined the accuracy of a novel method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus. Methods: We evaluated the theoretical impact of the measurement of the annulus diameter and area using the circumcircle of a triangle method on the decision to perform the procedure and choice of the prosthesis size. Results: Sixty-three consecutive patients were scheduled for TAVI. Mean age was 82 +/- 4 years, and 25 patients (55.6 %) were female. Mean aortic annulus diameter was 20.3 +/- 2.2 mm assessed by TEE on the mid-esophageal long-axis view and 23.9 +/- 2.3 mm using CT (p < 0.001). There was a tendency for the TEE derived areas using the new method to be higher (p < 0.001). The TEE measurements were on average 42.33 mm(2) higher than the CT measurements without an evidence of a systematic over-or under-sizing (p = 1.00). Agreement between TEE and CT chosen valve sizes was good overall (kappa = 0.67 and weighted kappa = 0.71). For patients who turned out to have no AR, the two methods agreed in 84.6 % of patients. Conclusions: CT remanis the gold standard in sizing of the aortic valve annulus. Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful. The impact of integration of this method in the algorithm of aortic annulus sizing on the outcome of patients undergoing TAVI should be examined in future studies

Comparison of clinical outcomes between Magmaris and Orsiro drug eluting stent at 12 months: Pooled patient level analysis from BIOSOLVE II–III and BIOFLOW II trials

Background: The aim of this study was to compare the 12-month clinical outcomes of patients treated with Magmaris or Orsiro. Second generation drug-eluting absorbable metal scaffold Magmaris (Dreams 2G) has proved to be safe and effective in the BIOSOLVE-II study. Similarly, biodegradable polymer sirolimus-eluting stent, Orsiro has shown notable clinical results even in all-comer populations. Methods: Magmaris group patients were taken from the BIOSOLVE-II and BIOSOLVE-III trials, while the patients from Orsiro group were enrolled in BIOFLOW-II trial. The primary outcome was explored using a time-to-event assessment of the unadjusted clinical outcomes for target lesion failure (TLF) at 12 months, followed by a multivariate analysis adjusting for all the significantly different covariates between the groups. Results: The study population consisted of 482 patients (521 lesions), 184 patients (189 lesions) in Magmaris group and 298 patients (332 lesions) in Orsiro group. The mean age was 65.5 ± 10.8 and 62.7 ± 10.4 years in Magmaris and Orsiro groups, respectively (p = 0.005). Magmaris and Orsiro unadjusted TLF rates were 6.0 and 6.4% with no significant difference between the groups (p = 0.869). In the multivariate analysis, there were no meaningful differences between Magmaris and Orsiro groups. Finally, none of the groups presented device thrombosis cases at 12 months. Conclusion: At 12 months there were no significant differences between Magmaris and Orsiro groups neither in the unadjusted assessment nor in the multivariate analysis for target lesion failure. These results should be taken as hypothesis generating and may warrant a head to head comparison on a randomized fashion

Impact of COVID-19 Pandemic on TAVR Activity: A Worldwide Registry

Background: The COVID-19 pandemic had a considerable impact on the provision of structural heart intervention worldwide. Our objectives were: 1) to assess the impact of the COVID-19 pandemic on transcatheter aortic valve replacement (TAVR) activity globally; and 2) to determine the differences in the impact according to geographic region and the demographic, development, and economic status of diverse international health care systems. Methods: We developed a multinational registry of global TAVR activity and invited individual TAVR sites to submit TAVR implant data before and during the COVID-19 pandemic. Specifically, the number of TAVR procedures performed monthly from January 2019 to December 2021 was collected. The adaptive measures to maintain TAVR activity by each site were recorded, as was a variety of indices relating to type of health care system and national economic indices. The primary subject of interest was the impact on TAVR activity during each of the pandemic waves (2020 and 2021) compared with the same period pre–COVID-19 (2019). Results: Data were received from 130 centers from 61 countries, with 14 subcontinents and 5 continents participating in the study. Overall, TAVR activity increased by 16.7% (2,337 procedures) between 2018 and 2019 (ie, before the pandemic), but between 2019 and 2020 (ie, first year of the pandemic), there was no significant growth (–0.1%; –10 procedures). In contrast, activity again increased by 18.9% (3,085 procedures) between 2020 and 2021 (ie, second year of the pandemic). During the first pandemic wave, there was a reduction of 18.9% (945 procedures) in TAVR activity among participating sites, while during the second and third waves, there was an increase of 6.7% (489 procedures) and 15.9% (1,042 procedures), respectively. Further analysis and results of this study are ongoing and will be available at the time of the congress. Conclusion: The COVID-19 pandemic initially led to a reduction in the number of patients undergoing TAVR worldwide, although health care systems subsequently adapted, and the number of TAVR recipients continued to grow in subsequent COVID-19 pandemic waves. Categories: STRUCTURAL: Valvular Disease: Aorti

Ototetraploid arpa ve çavdarda, hücre bölünmesi esnasındaki kromozom hareketlerine ilişkin bir inceleme

Diploid ve tetraploid arpa ve çavdar kök uçlarında mitosis, polen ana hücrelerinde de meiosis incelendi; ve bölünmenin muhtelif safhalarında kromozom hareketleri izlendi. Çıkarılan sonuçlar aşağıdaki gibi özetlenebilir. I kromozomların spiralleşmesinde esas unsur, üzerlerindeki elektriksel yüklerin artmasıdır. II yüksek bitkilerde de hayvan hücrelerinde olduğu gibi sentrioller bulunmaktadır. III kromozom hareketlerine, esas itibariyle sentrioller, sentromerler ve hücre zarı üzerindeki elektriksel yükler etkendir. Bunlar benzer elektrik yüklerine sahip olmaktadırlar. IV mitotik hücre bölünmesi şöyle olur: protoplazma hareketinin artması ile sentrioller elektriksel yüklerini arttırır. Birbirlerini iterek kutuplar tayin edilir. Çekirdek zarının erimesiyle kromozomlar stoplazma içine dağılırlar. Fakat sentrioller tarafından itilerek ekvator düzlemine getirilirler. Kromozomlar ve sentromerleri birbirine iterek keza hücre zarı tarafından da etkilenerek metafaz yerleşmesi sağlanır. Kromozomlar her kromatidi bir kutba dönecek şekilde V şeklini alır. Bu zaman zarfında her sentriol ikilenmiştir ve kardeş sentromerler birbirinden uzaklaşmak için müşterek sentrozomlarını kırmaya çalışmaktadırlar. Giderek artan elektriksel yük sayesinde sentrozom yırtılır fakat elektriksel yükler deşarj olur. Neticede sentromerler üzerindeki kutupsal baskı kalktığından kardeş sentromerler birbirini bağlayıcı iplikleri koparırlar ve kromatidleri kutuplara fırlatırlar. Böylece anafaz haraketi sağlanır. Bilahare çekirdek zarları teşekkül eder ve stoplazma bölünür. V iğ ve iğ iplikleri denen yapının iddia edildiği gibi kromozom hareketlerinde etkili olacağı şüphelidir. Bu yapının esas itibariyle stoplazma içindeki bazı molekül ya da organellerin elektriksel alan çizgilerine uygun şekilde dizilmeleriyle oluştuğu iddia edilebilir