The determinants of ecological footprint in the UK: The role of transportation activities, renewable energy, trade openness, and globalization.

The objective of this study is to explore the interaction between transportation energy consumption, GDP, renewable energy, trade, globalization and ecological footprint in the United Kingdom over the period 1990-2020. To achieve this aim, the study uses the autoregressive distributed lag (ARDL) approach and Fourier Toda-Yamamoto causality test. The research findings demonstrate that an increase in transportation energy consumption, renewable energy, and globalization is associated with a reduction in environmental pollution. On the contrary, GDP and trade contribute to worsening the environment. Moreover, there exists a unidirectional causal relationship from transportation energy consumption, GDP, renewable energy, trade, and globalization towards the ecological footprint. The findings of the study recommend that the policymakers should implement strategies and provide incentives to increase the deployment of renewables in the transportation sector, specifically focusing on electric vehicles (EVs) and the necessary charging infrastructure. Overall, the UK government should prioritize sustainable environmental development when planning its economic development strategies.

Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction. / O Escore de Selvester QRS é um Preditor de Mortalidade na Insuficiência Cardíaca com Fração de Ejeção Preservada.

BACKGROUND: The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE: This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. METHODS: 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. RESULTS: Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). CONCLUSIONS: We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

FUNDAMENTO: O escore Selvester QRS (S-QRS) em um eletrocardiograma (ECG) de 12 derivações está associado tanto à quantidade de cicatriz miocárdica quanto ao mau prognóstico em pacientes com infarto do miocárdio. Entretanto, seu valor prognóstico na insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEp) é desconhecido. OBJETIVO: Este estudo tem como objetivo investigar o valor preditivo do escore S-QRS para mortalidade na ICFEp. MÉTODOS: 359 pacientes foram incluídos retrospectivamente neste estudo. As características eletrocardiográficas, ecocardiográficas e laboratoriais dos pacientes foram registradas. O escore S-QRS simplificado foi medido e registrado. O tempo médio de seguimento dos pacientes foi de 38,1±9,5 meses. A significância estatística foi estabelecida em p < 0,05. RESULTADOS: Dos 359 pacientes, 270 estavam no grupo sobrevivente e 89 no grupo falecido. Idade, PCR-us, troponina, pro-BNP, diâmetro do átrio esquerdo (AE), índice de volume do AE, duração do QRS, Tpe e escore do S-QRS foram estatisticamente altos no grupo falecido. Na análise de regressão logística multivariada, idade, PCR-us, NT-proBNP, diâmetro do AE, índice de volume do AE, Tpe e escore S-QRS mostraram-se fatores de risco independentes para mortalidade. Na análise da característica operacional do receptor (ROC), o valor de corte do escore S-QRS foi de 5,5, a sensibilidade foi de 80,8% e a especificidade foi de 77,2% (AUC: 0,880, p:0,00). Na análise de Kaplan-Meier, verificou-se que a mortalidade foi maior no grupo com escore S-QRS ≥ 5,5 do que no grupo com escore S-QRS < 5,5. (Long-rank, p:0,00). CONCLUSÃO: Acreditamos que o escore S-QRS pode ser usado como um indicador prognóstico de mortalidade a longo prazo em pacientes com ICFEp.

Efficacy and safety of Hyadex for treatment of vesicoureteral reflux: a multicenter experience.

OBJECTIVE: This study was performed to evaluate the efficacy and safety of dextranomer/cross-linked hyaluronic acid (Hyadex) in patients with a clinical diagnosis of vesicoureteral reflux (VUR). METHODS: In this cross-sectional multicenter observational study, Hyadex was used in four different centers for the endoscopic treatment of VUR from 2020 to 2022. The study involved 74 patients (93 renal units) who were diagnosed with VUR according to voiding cystourethrography (VCUG) findings and were considered suitable for subureteric endoscopic treatment. The follow-up time (control VCUG time) was 3 months. RESULTS: In the VCUG evaluation, grade I VUR was found in 13 renal units, grade II in 23 renal units, grade III in 42 renal units, and grade IV in 12 renal units. The success rates of Hyadex treatment according to the degree of VUR were as follows: 84.6% for grade I, 82.6% for grade II, 71.4% for grade III, and 66.0% for grade IV. No major complications were observed. CONCLUSION: Endoscopic subureteric Hyadex injection had high success rates in appropriately selected patients with VUR and may be used as the first-line treatment for children with VUR.

Assessment of left atrial morphological and functional differences in professional male football players: a prospective, case-control study.

BACKGROUND: Intensive physical activity in athletes leads to considerable changes in the morphology and physiology of the left atrium through physiological, exercise-induced remodelling. AIM: This study aimed to assess the mechanical and electrophysiological changes in professional football players using electrocardiographic and echocardiographic assessment tools. METHODS: This prospective, case-control study was performed between February and June 2022. The population consisted of elite male football players (n = 49, group F) as the study group, and healthy male non-athlete individuals of matching age (n = 50, group C) as the control group. All participants underwent electrocardiographic and echocardiographic (two-dimensional and tissue Doppler) examinations. Volumetric and functional assessment of the left atrium was identified as the study's primary outcome. RESULTS: There was no significant difference between the groups in terms of demographic and morphometric characteristics (p > 0.05). Maximum and minimum P waves and PR-interval duration were significantly higher in group F than in group C (p = 0.011, p = 0.005 and p < 0.001). Diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes were significantly increased in group F (p < 0.0). Ejection fraction of the left atrium was significantly lower in group F than in group C (p = 0.001). Pulmonary acceleration time and tricuspid annular plane systolic excursion was significantly higher in the football players (p = 0.023 and p < 0.001). CONCLUSIONS: Increased diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes could be demonstrated in the elite football players. The morphological and functional changes in the left atrium might be a physiological consequence of left atrial cardiac remodelling to intensive and chronic training.

Are impacts of renewable energy and globalization on carbon neutrality targets asymmetric in South Africa? A reconsideration using nonlinear ARDL approach.

In this paper, we deviate from the existing literature by disentangling the independent variables into their positive and negative changes to capture asymmetric and dynamic multiplier effects of renewable energy and globalization on carbon neutrality targets within the framework of the autoregressive distributed lag (ARDL) model. In doing this, the paper uses South African data for the period 1990 to 2018 and the results show that CO2 emissions respond differently to the positive and negative shocks in renewable energy, globalization, and economic growth. The effect of a positive shock in economic growth is inelastic and positively related to CO2 emissions while a negative shock in economic growth has an elastic and negative effect on CO2 emissions. These results hold for both long-run and short-run periods. In the case of globalization, the positive shock increases CO2 emissions while the negative shock decreases CO2 emissions; although the long-run effect of a negative shock is elastic and insignificant while the short-run negative shock exerts an inelastic and significant effect on CO2 emissions. Furthermore, both the upward and downward shocks in renewable energy consumption transmit a negative effect on CO2 emissions in the long-run and short-run periods. Therefore, the paper suggests among others that to effectively decarbonize the South African economy, the use of subsidies, tax credits, tax holidays, and a host of others on green energy activities need to be enhanced as incentives for promoting cleaner energy production and consumption.

O Escore de Selvester QRS é um Preditor de Mortalidade na Insuficiência Cardíaca com Fração de Ejeção Preservada / Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction

Resumo Fundamento O escore Selvester QRS (S-QRS) em um eletrocardiograma (ECG) de 12 derivações está associado tanto à quantidade de cicatriz miocárdica quanto ao mau prognóstico em pacientes com infarto do miocárdio. Entretanto, seu valor prognóstico na insuficiência cardíaca (IC) com fração de ejeção preservada (ICFEp) é desconhecido. Objetivo Este estudo tem como objetivo investigar o valor preditivo do escore S-QRS para mortalidade na ICFEp. Métodos 359 pacientes foram incluídos retrospectivamente neste estudo. As características eletrocardiográficas, ecocardiográficas e laboratoriais dos pacientes foram registradas. O escore S-QRS simplificado foi medido e registrado. O tempo médio de seguimento dos pacientes foi de 38,1±9,5 meses. A significância estatística foi estabelecida em p < 0,05. Resultados Dos 359 pacientes, 270 estavam no grupo sobrevivente e 89 no grupo falecido. Idade, PCR-us, troponina, pro-BNP, diâmetro do átrio esquerdo (AE), índice de volume do AE, duração do QRS, Tpe e escore do S-QRS foram estatisticamente altos no grupo falecido. Na análise de regressão logística multivariada, idade, PCR-us, NT-proBNP, diâmetro do AE, índice de volume do AE, Tpe e escore S-QRS mostraram-se fatores de risco independentes para mortalidade. Na análise da característica operacional do receptor (ROC), o valor de corte do escore S-QRS foi de 5,5, a sensibilidade foi de 80,8% e a especificidade foi de 77,2% (AUC: 0,880, p:0,00). Na análise de Kaplan-Meier, verificou-se que a mortalidade foi maior no grupo com escore S-QRS ≥ 5,5 do que no grupo com escore S-QRS < 5,5. (Long-rank, p:0,00) Conclusão Acreditamos que o escore S-QRS pode ser usado como um indicador prognóstico de mortalidade a longo prazo em pacientes com ICFEp.

Abstract Background The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. Objective This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. Methods 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. Results Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00) Conclusions We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.

Value of Preoperative Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios in Predicting Postoperative Atrial Fibrillation in Patients Undergoing Lung Resection.

Background: The aim of this study was to investigate the association between the platelet/lymphocyte ratio (PLR) and the neutrophil/lymphocyte ratio (NLR) and postoperative atrial fibrillation (POAF) after lung resection. Methods: After the implementation of the exclusion criteria, 170 patients were retrospectively analyzed. PLR and NLR were obtained from fasting complete blood counts before surgery. POAF was diagnosed using standard clinical criteria. The associations between different variables and POAF, NLR, and PLR were calculated using univariate and multivariate analyses. The receiver operating characteristics (ROC) curve was used to determine the sensitivity and specificity of PLR and NLR. Results: Of the 170 patients, 32 with POAF (mean age =71.28±7.27 y, 28 males and 4 females) and 138 patients without POAF (mean age =64.69±10.31 y, 125 males and 13 females) were identified, and the difference in the mean age was statistically significant (P=0.001). It was found that PLR (157.67±65.04 vs 127.52±56.80; P=0.005) and NLR (3.90±1.79 vs 2.04±0.88; P=0.001) were statistically significantly higher in the POAF group. In the multivariate regression analysis, age, lung resection size, chronic obstructive pulmonary disease, NLR, PLR, and pulmonary arterial pressure were independent risk factors. In the ROC analysis, PLR had a sensitivity of 100% and a specificity of 33% (AUC, 0.66; P<0.001), and NLR had a sensitivity of 71.9% and a specificity of 87.7% (AUC, 0.87; P<0.001). A comparison of AUC between PLR and NLR showed that NLR was statistically more significant (P<0.001). Conclusion: This study showed that NLR was a stronger independent risk factor than PLR for the development of POAF after lung resection.

Marital status and outcomes in chronic heart failure: Does it make a difference of being married, widow or widower?

OBJECTIVE: We aimed to compare the outcomes of chronic heart failure (HF) patients with reduced ejection fraction (CHFrEF) in the Turkish Research Team in HF (TREAT-HF) registry according to marital status with a specific focus on being the widowed (widow/widower) versus the married. METHODS: TREAT-HF is a network, enrolling CHFrEF with a follow up for HF-related hospitalization (HFrH) and all-cause mortality (ACM). In this cohort, the widowed patients were compared with patients who were married before and after propensity score (PS) matching analysis. RESULTS: There were 723 cHFrEF patients with a complete dataset, including reported marital status at baseline for this analysis. Out of 723 patients with HF, 37 "never-married" and "divorced" patients were excluded from the analysis. Then, out of 686 remaining patients with HF, who had at least one reported marriage in the database, widowed patients with HF (n=124) were compared with married patients (n=562). The mean follow up period was 21±12 months up to 48 months. The widowed patients had a higher risk of HFrH (p=0.047), although ACM remained similar compared to married patients (p=0.054). After PS matching, HFrH remained more frequent among the widowed compared with the married (p=0.039) although ACM yielded similar rates. Of note, it was shown that being a widower (p=0.419) was not linked to increased risk of HFrH during follow up contrary to being a widow (p=0.037) despite similar age, ejection fraction, creatinine, NYHA functional class distribution and a similar rate of life-saving medications. CONCLUSION: PS matching analysis yielded that the widowed had increased the risk for HFrH. Of note, widowers did not seem to have an increased risk for HFrH, contrary to widows.

The effects of preoperative coronary collateral circulation on cardiac-related events after coronary artery bypass graft surgery

Abstract Introduction: This study aimed to evaluate the effects of coronary collateral circulation (CCC) in patients who had undergone coronary artery bypass grafting (CABG). Methods: A total of 127 patients who had undergone CABG (2011-2013) were enrolled into this study and follow-up was obtained by phone contact. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. Percutaneous coronary intervention (PCI), recurrent myocardial infarction (MI), stroke, heart failure (HF), and mortality rates were compared between groups. Clinical outcome was defined as combined end point including death, PCI, recurrent MI, stroke, and HF. Results: Sixty-two of 127 patients had poor CCC and 65 had good CCC. There were no differences in terms of PCI, recurrent MI, and HF between the groups. Stroke (seven of 62 [11.3%] and one of 65 [1.5%], P=0.026) and mortality (19 of 62 [30.6%] and 10 of 65 [15.4%], P=0.033) rates were significantly higher in poor CCC group than in good CCC group. In Kaplan-Meier analysis, survival time was not statistically different between the groups. Presence of poor CCC resulted in a significantly higher combined end point incidence (P=0.011). Conclusion: Stroke, mortality rates, and combined end point incidence were significantly higher in poor CCC patients than in the good CCC group.

Testing the environmental Kuznets curve with structural breaks: the role of globalization, energy use, and regulatory quality in South Africa.

This study uncovers the role of regulatory quality, energy use, and globalization in the conventional environmental Kuznets curve (EKC) for South Africa by incorporating structural breaks in the series based on quarterly frequency data between 1996:Q1 and 2016:Q4. Applying the autoregressive distributed lag (ARDL) model, we confirm a cointegration between the variables. The empirical results suggest the validity of the EKC hypothesis in South Africa. In addition, while energy use exerts positive pressure on ecological footprint, globalization and regulatory quality exert negative pressure on ecological footprint. However, the effect of globalization is weak in the long run while the effect of regulatory quality is weak in short run. The results further reveal that the structural break years are statistically insignificant. The causality result establishes a causal link flowing from all the variables to ecological footprint in the long run. In the short run, economic growth and energy use Granger-cause regulatory quality. Also, while energy use causes ecological footprint, globalization is a predictor of energy use. The policy implication of this study is that increasing the pace of globalization and strengthening regulatory quality are efficient strategies to improve environmental quality and sustain a stable EKC in South Africa.

Testing the environmental Kuznets curve hypothesis: the role of energy consumption and democratic accountability.

Considering the role democratic structures play in shaping the policies that enhance environmental quality, this paper tests the environmental Kuznets curve (EKC) hypothesis by incorporating the role of energy consumption and democratic accountability for nine countries between 1990 and 2014. The pooled mean group (PMG) methodology and Emirmahmutoglu-Kose Granger causality test are employed. The empirical results validate the EKC hypothesis in the long run. The results also confirm that energy consumption significantly increases CO2 emissions in the long run and short run, while democratic accountability significantly reduces CO2 emissions in the long run. Causality test results indicate a two-way causal relationship between democratic accountability and economic growth, and also between energy consumption and economic growth. The study recommends among others, the need to strengthen democratic accountability and improve access to information that protects the environment.

The Effects of Preoperative Coronary Collateral Circulation on Cardiac-Related Events after Coronary Artery Bypass Graft Surgery.

INTRODUCTION: This study aimed to evaluate the effects of coronary collateral circulation (CCC) in patients who had undergone coronary artery bypass grafting (CABG). METHODS: A total of 127 patients who had undergone CABG (2011-2013) were enrolled into this study and follow-up was obtained by phone contact. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. Percutaneous coronary intervention (PCI), recurrent myocardial infarction (MI), stroke, heart failure (HF), and mortality rates were compared between groups. Clinical outcome was defined as combined end point including death, PCI, recurrent MI, stroke, and HF. RESULTS: Sixty-two of 127 patients had poor CCC and 65 had good CCC. There were no differences in terms of PCI, recurrent MI, and HF between the groups. Stroke (seven of 62 [11.3%] and one of 65 [1.5%], P=0.026) and mortality (19 of 62 [30.6%] and 10 of 65 [15.4%], P=0.033) rates were significantly higher in poor CCC group than in good CCC group. In Kaplan-Meier analysis, survival time was not statistically different between the groups. Presence of poor CCC resulted in a significantly higher combined end point incidence (P=0.011). CONCLUSION: Stroke, mortality rates, and combined end point incidence were significantly higher in poor CCC patients than in the good CCC group.

Increased frequency of occurrence of bendopnea is associated with poor outcomes in heart failure outpatients.

BACKGROUND: Relationship between the frequency of occurrence of bendopnea during the daily life of heart failure (HF) outpatients and clinical outcomes has never been evaluated before. METHODS: Turkish Research Team-Heart Failure (TREAT-HF) is a network between HF centres, which undertakes multicentric observational studies in HF. Herein, the data including stable 573 HF patients with reduced ejection fraction out of seven HF centres were presented. A questionnaire was filled by the patients, with the question 'Do you experience shortness of breath while tying your shoelace?', assessing the presence and frequency of bendopnea. RESULTS: To the question related to bendopnea, 48% of the patients answered 'yes, every time', 31% answered 'yes, sometimes', and 21% answered 'No'. Patients were followed for an average of 24 ± 14 months, and the patients who answered 'yes, every time' and 'yes, sometimes' to the bendopnea question were found having increased risk for both HF-related hospitalisations (HR:3.2, p < .001- HR:2.8, p = .005) and composite outcome consisting of 'HF-related hospitalisations and all-cause death in the multi-variate analysis (HR:3.1, p < .001- HR:3.0, p < .001). Kaplan Meier analysis for HF-related hospitalisation, all-cause death, and the composite of these were provided for these three groups, yielding significant and graded divergence curves with the best prognosis in 'no' group, with the moderate prognosis in 'sometimes' group, and with the worst prognosis in the 'every time' group. CONCLUSION: For the first time in the literature, our study shows that the increased frequency of bendopnea occurrence in daily life is associated with poor outcomes in HF outpatients.

Environmental implication of offshore economic activities in Indonesia: a dual analyses of cointegration and causality.

Global warming issues have become a pertinent theme for many economies and policy initiatives. The Indonesian economy is no exception as government officials and stakeholder are working seriously to decouple carbon emission from economic growth. It is on this premise that the present study attempts to investigate the nexus between the environmental implication of offshore economic activities, economic growth, energy use, and environment (CO2) with the integration of foreign direct investment (FDI) and trade openness over recent time series data from 1980 to 2017. A series of analysis were conducted with Pesaran's autoregressive distributed lag (ARDL) methodology and the Granger causality test as estimation techniques over the outlined variables. Empirical findings from ARDL long-run (elasticity) shows that economic growth is significantly positively associated with carbon emissions at the initial stage but a negative association is established at lags 1 and 2. A significant positive relationship is witnessed between economic growth and FDI. Also, statistical positive relationship is observed between economic growth and energy use, while an inverse relationship is observed between openness and economic growth. For causality analysis, we observe that a uni-directional causality is running from economic growth to foreign direct investment at 5% significant level. This outcome is in support of the growth-induced FDI hypothesis in Indonesia. Furthermore, a one-way causality is seen from energy to openness, CO2 emissions, and from FDI to CO2 emissions while there is a feedback causality between openness and CO2 emissions. The findings of this study have implications to the environmental quality of Indonesia via economic growth; hence, the higher and better the economic growth of the country, the lesser the carbon emissions and the better the environmental quality. This proposition aligns with the pollution halo hypothesis (PHH), where FDI inflow enhances economic growth as well as impacts energy consumption and reduces carbon emissions in the host country.

Fibulin­1 and fibulin­5 as rule­out tests for non-ST­elevation myocardial infarction in the emergency setting.

BACKGROUND: Fibulin­1 and fibulin­5 are extracellular glycoproteins from the fibulin family. Both are expressed in the vessel wall and protect against vascular damage. AIMS: We aimed to investigate whether fibulin­1 and ­5 may be used to exclude non-ST­segment elevation myocardial infarction (NSTEMI) in the emergency setting. METHODS: The study included 48 patients in the NSTEMI group and 42 controls who presented with chest pain of noncardiac origin as confirmed by a comprehensive evaluation including coronary angiography. Blood samples for fibulin­1, fibulin­5, and troponin I measurements were drawn on admission to the emergency department. RESULTS: Demographic characteristics were similar in patients with NSTEMI and controls. The median levels of both glycoproteins were lower in patients with NSTEMI as compared with controls: fibulin­1, 96.9 µg/ml (interquartile range [IQR], 20-503 µg/ml) vs 111.5 (IQR, 71-457 µg/ml), P = 0.01, and fibulin­5, 38 ng/ml (IQR, 15-509 ng/ml vs 57 ng/ml (IQR, 26-631 ng/ml), P <0.001. The receiver operating characteristic curve analysis revealed the cutoff value of 105.6 µg/ml for fibulin­1 and of 49.4 ng/ml for fibulin­5 to exclude NSTEMI on admission. CONCLUSIONS: The present study demonstrated that fibulin­1 and -5 measurements might be used to exclude NSTEMI in patients admitted to the emergency department with acute chest pain.

[Snapshot evaluation of heart failure in Turkey: Baseline characteristics of SELFIE-TR]. / Türkiye'de kalp yetersizliginin anlik görüntüsü: SELFIE-TR bazal karakteristik özellikleri.

OBJECTIVE: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. METHODS: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. RESULTS: The mean age of the entire cohort was 63.3+-13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1+-13.3 years vs 67.9+-12.1 years; p<0.001). Among the whole cohort, hypertension was observed in 46%, diabetes mellitus was present in 27.5%, chronic obstructive pulmonary disease was present in 12.8%, and previous myocardial infarction was noted in 45.2%. In patients with HFrEF, the use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a beta blocker, or a mineralocorticoid receptor antagonist was noted in 74.7%, 89.7%, and 60.9%, respectively. CONCLUSION: The SELFIE-TR findings provide important insight, since it is the first study to make a snapshot of HF patients in our country. These data may help to create standardized prevention and treatment strategies.

Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR.

Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.

A new predictor of atrial fibrillation after coronary artery bypass graft surgery: HATCH score.

The aim of this study was to investigate the association between HATCH score and atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. 369 patients (103 patients with AF and 266 patients without AF) undergoing isolated CABG surgery were analyzed. Complete medical records were retrospectively collected to investigate HATCH score. The median age of patients with AF was significantly higher than the median age of non-AF group (60.8±10.0 years vs 67.8±9.5 years, P<0.001). HATCH score was significantly higher in patients who developed AF after CABG surgery than the non-AF group (P=0.017). Multivariate logistic regression analysis showed that HATCH score (OR 1.334; 95% CI 1.022 to 1.741, P=0.034) was an independent predictor of AF after CABG surgery. Receiver operating characteristic curve analysis showed that the cut-off point of HATCH score related to predict AF was >1 (two or more), with a sensitivity of 42% and specificity of 70%. Patients with elevated preoperative HATCH score may have higher risk for AF after CABG surgery.

Effect of polymerization cycles on flexural strengths and microhardness of different denture base materials.

The purpose of this study was to evaluate the effect of different polymerization cycles on the flexural strengths and microhardness of two denture base materials (Meliodent and Paladent). Heat-polymerized acrylic resin specimens (65.0 mm long×10.0 mm wide×2.5 mm in height) were prepared using different short and long polymerization cycles. After the specimens had been polymerized, they were stored in distilled water at 37±1°C for 24 h. Flexural strength test was performed at a cross-head speed of 5 mm/min and Vickers microhardness was measured. Data were analyzed with a 1-way analysis of variance followed by Tukey test, and Student t-test (α=0.05). The flexural strengths and microhardness were significantly different between Meliodent and Paladent (p<0.05). Significant differences were found among the polymerization cycles in terms of flexural strengths and microhardness (p<0.05). Polymerization with G cycle may be suggested for Meliodent and H cycle may be suggested for Paladent.

Association of Preoperative Platelet-to-Lymphocyte Ratio with Atrial Fibrillation after Coronary Artery Bypass Graft Surgery.

OBJECTIVE: The aim of this study was to investigate the association between platelet-to-lymphocyte ratio (PLR) and atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery. SUBJECTS AND METHODS: A total of 125 patients were retrospectively analyzed. AF was diagnosed using standard clinical criteria, and PLR was calculated as the ratio of the platelets to lymphocytes, obtained from the blood samples that were taken in the fasting state before CABG surgery. The association of different variables with postoperative AF and PLR was calculated using univariate and multivariate analysis. The receiver operating characteristics curve was used to determine the sensitivity and specificity of PLR and the optimal cutoff value for predicting post-CABG AF. RESULTS: Of the 125 patients, 50 with AF (mean age: 67.0 ± 9.5 years, 38 males and 12 females) and 75 patients without AF (mean age: 61.1 ± 9.1 years, 58 males and 17 females) were identified, and the difference in the mean age was statistically significant (p = 0.01). PLR was also significantly higher in those with AF (152.8 ± 82.2) than those without AF (118.2 ± 32.9) (p = 0.012). Univariate analysis showed that age and PLR were associated with AF after CABG surgery (p < 0.001 and p = 0.005, respectively). Using a multivariate logistic regression model with the backward elimination method, age and PLR remained as independent predictors of AF after CABG surgery (p < 0.001 and p = 0.005, respectively). PLR levels >119.3 predicted postoperative AF with 64% sensitivity and 56% specificity (AUC: 0.634, p = 0.012). CONCLUSION: In this study, age and PLR level were independent predictors of AF after CABG surgery. Patients with an elevated preoperative PLR were at higher risk of AF after CABG surgery.