Combination anticoagulation strategy in pregnancy with mechanical valves: The KYBELE study.

BACKGROUND: Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin. This multicenter prospective study aims to determine the optimal anticoagulation regimens for pregnant patients with MHVs. METHODS: All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH + 2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT). Any fetal loss was determined as primary fetal outcome. RESULTS: The study included 78 pregnancies in 65 women with MHVs. Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively. The rates of primary maternal outcome (44 vs 3.5%, P < .001), obstructive MVT (16 vs 0%, P = .04), MVT requiring treatment (28 vs 0%, P = .003), and cerebral embolism (24 vs 3.4%, P = .041) were found to be significantly higher in lone LMWH group compared to LMWH + 4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, P = .015) and treatment for MHV thrombus (4.2 vs 28%, P = .049) were significantly lower in LMWH + 2.5 mg warfarin group compared to lone LMWH group. The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH + 2.5 mg warfarin group, and 11 (37.9%) in LMWH + 4 mg warfarin group (P = .890 for 3-group).Warfarin related-embryopathy was not observed in any case. CONCLUSIONS: The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs. CONDENSED ABSTRACT: Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women (median age 32 [27-35] years) were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.

Renal artery flow alterations in neonates with hypoxic ischemic encephalopathy.

BACKGROUND: To compare kidney blood flow and kidney function tests in infants with hypoxic ischemic encephalopathy (HIE), and the effects of therapeutic hypothermia (TH) during the first 7 days of life. METHODS: Fifty-nine infants with HIE were prospectively evaluated. Infants with moderate-severe HIE who required TH were classified as group 1 (n = 36), infants with mild HIE were classified as group 2 (n = 23), and healthy infants were classified as group 3 (n = 60). Kidney function tests were evaluated on the sixth hour, third and seventh days of life in Group 1 and Group 2, and on the sixth hour and third day of life in group 3. Renal artery (RA) Doppler ultrasonography (dUS) was performed in all infants on the first, third, and seventh days of life. RESULTS: Systolic and end diastolic blood flow in RA tended to increase and RA resistive index (RI) tended to decrease with time in group 1 (p = 0.0001). While end diastolic blood flow rates in RA on the third day were similar in patients with severe HIE and mild HIE, it was lower in patients with mild-moderate-severe HIE than healthy newborns. On the seventh day, all three groups had similar values (p > 0.05). Serum blood urea nitrogen (BUN), creatinine, uric acid, and cystatin C levels gradually decreased and glomerular filtration rate (GFR) gradually increased during TH in group 1 (p = 0.0001). Serum creatinine levels gradually decreased while GFR gradually increased during the study period in group 2. CONCLUSIONS: Therapeutic hypothermia seems to help restore renal blood flow and kidney functions during the neonatal adaptive period with its neuroprotective properties.

All Gauged Curvature-Squared Supergravities in Five Dimensions.

We present a complete basis to study gauged curvature-squared supergravity in five dimensions. We replace the conventional ungauged Riemann-squared action with a new log invariant, offering a comprehensive framework for all gauged curvature-squared supergravities. Our findings address long-standing challenges and have implications for precision tests in the AdS/CFT correspondence.

COVID-19 and SLE: Infection and autoimmunity at its best.

If one had any doubts before the pandemic regarding the correlation between infections and autoimmunity, COVID-19 left us fascinated on the strong bond between the two entities. The immune and autoimmune reactions seen in patients infected with SARS-CoV-2 have served as a base for this assumption. Later on, the use of immunosuppressants such as systemic glucocorticoids, among other biological agents, turned this assumption to a fact. This was no different when it comes to the vaccines against COVID-19. Through several postulated mechanisms these vaccines, although generally considered safe, are thought to have the potential to result in autoimmune reactions making them not more innocent than the infection itself. When systemic lupus erythematous (SLE) is viewed as a classical autoimmune multisystemic disorder, the connection with SARS-CoV-2 infection and COVID-19 vaccination is of extreme importance. This is because early reports during the pandemic have shown increased rates of SARS-CoV-2 infection among patients known previously to have SLE and much more interestingly, cases of new-onset SLE after COVID-19 have been documented in the literature. Subsequently vaccines against COVID-19, those mRNA-based and adenovirus-vector based, were reported to induce new SLE cases, trigger immune thrombocytopenia or lupus nephritis, two common presentations of SLE, or exacerbate flares. In our paper, we concluded various aspects of available and recent data regarding SLE and COVID-19 as both an infection and vaccination.

Cardiovascular evaluation of pregnant women with hypertrophic cardiomyopathy.

BACKGROUND: The effect of physiological circulatory changes during pregnancy on hypertrophic cardiomyopathy (HCM) has been reported with limited data. This study aimed to provide information regarding outcomes of pregnant women with HCM and to identify predictors of major adverse cardiac event (MACE). METHODS: A total of 45 pregnancies with HCM were retrospectively reviewed. The primary endpoint was a MACE that occurred within an 8­week period after delivery, including maternal death, heart failure (HF), syncope, and malignant ventricular arrhythmias (VAs). Baseline and outcome data were analyzed for all patients. Patients with and without MACE were compared, and patients with obstructive HCM were compared with those who had non-obstructive HCM. The study population was divided into two subgroups of patients having or not having an implantable cardioverter defibrillator implantation (ICD). RESULTS: At least one MACE occurred in 11 patients (24.4%); six patients developed HF (13.3%), six had a ventricular tachyarrhythmia (13.3%), and two had syncope (4.4%). New York Heart Association functional class of ≥ II, presence of HF signs before pregnancy, increased left ventricular outflow tract (LVOT) gradient were significantly associated with MACE. Fatal VAs were seen during pregnancy in one of five HCM patients with ICD. In the ROC curve analysis, an LVOT gradient higher than 53.5 mm Hg predicted the presence of MACE with a sensitivity of 90.9% and a specificity of 73.5%. This study is the largest series in the literature representing pregnant women who had HCM and ICD. CONCLUSION: The current data suggest that HF and high LVOT gradients are important risk factors for the development of cardiac complications.

Monocyte to HDL ratio may predict thrombosis in patients with mechanical mitral and aortic valve prosthesis.

Increased inflammatory biomarkers have been reported in prosthetic heart valve thrombosis (PHVT). Monocyte to HDL ratio (MHR) and albumin to CRP levels (CAR) are two biomarkers used widely for systemic inflammation but there is a lack of data on prosthetic heart valves. This study aimed to find out the potential predictive value of MHR and CAR for PHVT. Patients who had the diagnosis of mechanical mitral/aortic PHVT and normally functioning prosthesis were retrospectively analyzed. Laboratory data including complete blood count and biochemistry were recorded. Transesophageal echocardiography was performed to diagnose PHVT. The study included 118 patients with mechanical PHVT and 120 patients with normally functioning prosthesis. White blood count, monocyte levels, C-reactive protein, MHR and CAR were significantly higher whereas the lymphocyte, HDL and INR levels on admission were lower in patients with PHVT. Multivariate analysis showed that as well as inadequate anticoagulation, MHR, but not CAR, was found to be an independent predictor of thrombosis in patients with PHVT. Receiver operating characteristic curve analysis was performed to detect the best cut-off value of MHR in the prediction of thrombosis in patients with prosthetic valves. MHR level of > 12.8 measured on admission, yielded an AUC value of 0.791 [(CI 95% 0.733-0.848 p < 0.001) sensitivity 71%, specificity 70%]. Inadequate anticoagulation is the primary cause that leads to thrombosis in mechanical prosthetic valves. Increased MHR, but not CAR, was also shown to be an independent predictor of thrombosis in patients with mechanical mitral and aortic prosthetic valves.

Increase in colour stability of pomegranate juice against 5-hydroxymethylfurfural (HMF) through copigmentation with phenolic acids.

BACKGROUND: Anthocyanins are responsible for both attractive colour of pomegranate juice (PJ) and its health-promoting effects against cancer and coronary heart disease. However, 5-hydroxymethylfurfural (HMF) at some concentrations causes anthocyanin degradation. The present study aimed to reduce the degradation of PJ anthocyanins as a result of HMF at various concentrations (0-20 mg L-1 ) through phenolic acid [PA; ferulic (FA), gallic (GA) and caffeic acids (CA)] copigmentation during storage at 20 °C. RESULTS: A strong correlation (r = 0.872) was found between anthocyanin degradation rate and HMF concentration in PJ without PA addition. An increase in HMF concentration during storage caused faster (< 32%) anthocyanin degradation. However, PA addition reduced (< 60 times) the HMF formation rate. The lowest HMF formation rates (0.07-0.28 day-1 ) were determined in PJ with added GA. Although GA caused an important increase in content of cyanidin-3-glucoside (16-42%), which is major PJ anthocyanin, against HMF at all concentrations, CA (15%) and FA (28%) increased cyanidin-3-glucoside content against 10 mg of HMF L-1 . FA maintained its protection effect against the highest HMF concentration (20 mg of HMF L-1 ), but CA lost its protection effect. Generally, FA increased stabilities of hyperchromic effect (HE) (9.6-27.7%) and colour density (CD) (57.1-74.3%) at all HMF concentrations, although CA increased HE stability (19.8-37.7%) in the presence of 10 and 20 mg of HMF L-1 . Interactions of 'all individual anthocyanins-FA' and 'delphinidin-based anthocyanins-GA/CA' resulted in copigmentation. CONCLUSION: FA addition was recommended to increase CD and HE for PJ containing HMF between 3.1-5.6 mg L-1 , whereas the addition of GA was recommended to increase anthocyanin stability for PJ containing 12.0 mg of HMF L-1 . © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Whole body vibration activates the tonic vibration reflex during voluntary contraction.

[Purpose] The beneficial neuromuscular effects of whole-body vibration are explained by the tonic vibration or bone myoregulation reflex. Depending on factors that remain undefined, whole-body vibration may activate the tonic vibration or bone myoregulation reflex. We aimed to examine whether voluntary contraction facilitates activation of the tonic vibration reflex during whole-body vibration. [Participants and Methods] Eleven volunteers were included in this study. Local and whole-body vibrations were applied in a quiet standing (without voluntary contraction) and a semi-squatting (isometric soleus contraction) position. Local vibration was applied to the Achilles tendon. Surface electromyography was obtained from the soleus muscle. The cumulative average method was used to determine soleus reflex latency. [Results] In the quiet standing position, the bone myoregulation reflex latency was 39.9 ± 4.1 milliseconds and the tonic vibration reflex latency was 35.4 ± 3.6 milliseconds. Whole-body vibration application in the semi-squatting position activated the tonic vibration reflex in four participants and the bone myoregulation reflex in seven participants. Local vibration activated the tonic vibration reflex in both positions for all participants. [Conclusion] Simultaneous whole-body vibration application and voluntary contraction may activate the tonic vibration reflex. Determining the spinal mechanisms underlying the whole-body vibration exercises will enable their effective and efficient use in rehabilitation and sports.

The reflex mechanism underlying the neuromuscular effects of whole-body vibration: Is it the tonic vibration reflex?

OBJECTIVES: Whole-body vibration (WBV) is applied to the sole of the foot, whereas local mechanical vibration (LMV) is applied directly to the muscle or tendon. The time required for the mechanical stimulus to reach the muscle belly is longer for WBV. Therefore, the WBV-induced muscular reflex (WBV-IMR) latency may be longer than the tonic vibration reflex (TVR) latency. The aim of this study was to determine whether the difference between WBV-IMR and TVR latencies is due to the distance between the vibration application point and the target muscle. METHODS: Eight volunteers participated in this study. The soleus reflex response was recorded during WBV, LMVs, and tendon tap. LMVs were applied to the Achilles tendon and sole of the foot. The latencies were calculated using the cumulative averaging technique. RESULTS: The latency (33.4±2.8 ms) of the soleus reflex induced by the local foot vibration was similar to the soleus TVR latency (30.9±3.2 ms) and T-reflex (32.0±2.4 ms) but significantly shorter than the latency of the soleus WBV-IMR (42.3±3.4 ms) (F(3,21)=27.46, p=0.0001, partial η2=0.797). CONCLUSIONS: The present study points out that the neuronal circuitries of TVR and WBV-IMR are different.

Effects of fermentation time and pH on quality of black carrot juice fermented by kefir culture during storage.

BACKGROUND: The effects of fermentation time (17-48 h) and pH (3.37-4.50) on qualities of fermented beverages (FBs) produced from black carrot juice (BCJ) were monitored during storage at 4 °C for 20 weeks. RESULTS: Fermentation and adjusting the pH level provided significant increases (up to 22%) in anthocyanin content and the absorbance value at λmax (Amax ). Moreover, the stability of anthocyanins, color density, and Amax in FBs was somewhat higher than those in BCJ. Lactic acid showed a co-pigmentation effect on cyanidin-3-galactoside-xyloside-glucoside-sinapic acid and cyanidin-3-galactoside-xyloside-glucoside-ferulic acid. Sucrose was degraded much faster at pH 4.50 (17 h) and 4.35 (48 h) than at lower pH levels. During storage, pH 4.35 caused a balanced distribution between counts of lactic acid bacteria (LAB) and yeasts, and antioxidant activity of all FBs increased. Fermented beverages at 4.35 and 3.90 were found to be more palatable by panelists. CONCLUSION: We recommend FB production at pH 4.35 after 48 h fermentation due to the balanced distribution of probiotics, high color enhancement, and consumer preference. © 2021 Society of Chemical Industry.

The relationship between incomplete surgical obliteration of the left atrial appendage and thromboembolic events after mitral valve surgery (from the ISOLATE Registry).

Left atrial appendage (LAA) is a common site of thrombus formation especially in patients with atrial fibrillation (AF). Complete surgical LAA closure (cSLC) is the surgical aim, however incomplete surgical LAA closure (iSLC) is not rare. In this study, we aimed to evaluate the risk of thromboembolic complications (TEC) in AF patients with iSLC after mitral valve surgery. A total of 101 AF patients (mean age: 61.8 ± 11.8 years; male:32), who underwent surgical suture ligation during mitral valve surgery were enrolled in this retrospective study. All patients underwent transthoracic and transesophageal echocardiography (TEE) at least 3 months after surgery. The primary outcome was the occurrence of TEC including any ischemic stroke, transient ischemic attack, coronary or peripheral embolism. TEE examination revealed cSLC in 66 (65.3%) and iSLC in 35 patients (34.6%). A total of 12 TECs (11.9%) occurred during a mean follow-up time of 41.1 ± 15.6 months. TECs were found to be significantly higher in the iSLC group (25.7% vs 4.5%, p = 0.002). The prevalence of iSLC was significantly higher in patients with TEC (75 vs. 29.2%, p = 0.002). High CHA2DS2-VASc Score and iSLC were found to be independent predictors of TEC. Long term TEC free survival was found to be significantly decreased in patients with iSLC. The presence of iSLC was associated with a significantly increased risk of TEC in AF patients after mitral valve surgery. Routine intraoperative and postoperative screening for iSLC by TEE and long-term strict anticoagulation therapy are recommended in these patients.

Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO-DOP-TR Trial.

AIM: Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. METHODS: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. RESULTS: A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity and E/A ratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular lateral e', septal e', and septal s' were higher in younger subjects and in females. E/e' ratio was increased progressively with advancing decades. Right ventricular e' and s' were decreased but a' was increased with increasing age. Septal e' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. The E/e' ratio greater than 15 (and also 13) was not found. CONCLUSION: This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials.

Recurrence of left atrial myxoma mimicking a mitral annuloplasty ring thrombosis.

Cardiac myxomas (CM) is by far the most common type of primary cardiac neoplasm that commonly arise within the left atria and is composed of primitive connective tissue cells and stroma. Despite the benign nature, the CMs are often surgically removed because they can lead to severe complications. Large, thin, and hypermobile forms are unusual. The frequency of recurrence is about 22% for complex forms and 12% for other familial forms and 1% to 3% for sporadic myxomas, which seldom recur after surgery. Although transesophageal echocardiography shows usually accurate imaging capabilities to detect the myxoma, further imaging methods including computed tomography, cardiovascular magnetic resonance imaging, and 18 F-fluorodeoxyglucose positron-emission tomography/computed tomography may be useful to diagnosis for it. Surgery is the mainstay of treatment.

Unitary Extension of Exotic Massive 3D Gravity from Bigravity.

We obtain a new 3D gravity model from two copies of parity-odd Einstein-Cartan theories. Using Hamiltonian analysis, we demonstrate that the only local degrees of freedom are two massive spin-2 modes. Unitarity of the model in anti-de Sitter and Minkowski backgrounds can be satisfied for vast choices of the parameters without fine-tuning. The recent "exotic massive 3D gravity" model arises as a limiting case of the new model. We also show that there exist trajectories on the parameter space of the new model which cross the boundary between unitary and nonunitary regions. At the crossing point, one massive graviton decouples resulting in a unitary model with just one bulk degree of freedom but two positive central charges at odds with the usual expectation that the critical model has at least one vanishing central charge. Given the fact that a suitable nonrelativistic version of bigravity has been used as an effective theory for gapped spin-2 fractional quantum Hall states, our model may have interesting applications in condensed matter physics.

Evaluation of the potential predictors of embolism in patients with left atrial myxoma.

INTRODUCTION: Cardiac myxomas are the most common primary intracardiac tumors. Although myxomas are histologically benign, they are potentially dangerous due to potential risk of systemic and cerebral embolism. In this study, we aimed to investigate the potential predictors of embolism in patients with left atrial myxoma. METHODS: This single-center retrospective study enrolled 93 patients (mean age: 52.9 ± 15.3 years, female: 70 [75.3%]) with left atrial myxomas between 2014 and 2018. The patients were classified into two groups (embolic vs nonembolic) to investigate possible predictors of embolism. Demographic, laboratory, and echocardiographic parameters were recorded into a dataset and compared between patients with and without embolism. RESULTS: The study population was composed of 13 (14%) patients in embolic (11 cerebrovascular and 2 peripheral) and 80 (86%) patients in nonembolic group. Demographic and laboratory parameters were similar between the groups. Tumor sizes were significantly higher in the embolic group than in the nonembolic group (5.59 ± 1.08 vs 4.29 ± 0.61; P = 0.001). By multivariate analysis, increased tumor size, increased left atrial diameter, and the presence of atrial fibrillation and irregular tumor surface were identified as independent predictors of embolism. In ROC curve analyses, tumor size above 4.6 cm predicted embolism with a sensitivity of 77% and a specificity of 73% (AUC: 0.858; 95% CI: 0.752-0.964; P < 0.001). CONCLUSION: The presence of atrial fibrillation, irregular tumor surface, increased tumor size, and increased left atrial diameter is associated with increased risk of embolism in patients with left atrial myxoma. Early surgery should be scheduled for such patients due to increased potential for embolism.

Relationship Between Pulmonary Venous Flow and Prosthetic Mitral Valve Thrombosis.

BACKGROUND: Prosthetic valve thrombosis (PVT) may impair pulmonary venous flow (PVF) and left atrial appendage (LAA) functions. An investigation was conducted to determine the association between left superior PVF and LAA functions and mitral PVT. METHODS: This observational case-control study included 100 consecutive patients (87 females, 13 males; mean age 59 years; range 35-71 years) with mechanical mitral PVT, and 50 age- and gender-matched otherwise healthy controls with normally functioning mitral prostheses. All patients were included after comprehensive transesophageal echocardiography (TEE) examinations for the presence and quantification of PVT, the left atrial diameter, and LAA length. Peak systolic velocity (PSV), velocity-time integral of systolic flow (VTI-s), peak diastolic velocity (PDV), velocity-time integral of diastolic flow (VTI-d), systolic fraction (SFr) of the left upper PVF and the flow of the LAA orifice were each recorded using color-guided pulsed-wave Doppler imaging during TEE. RESULTS: The PSV [30 cm/s (range: 13-77 cm/s) versus 44 cm/s (range: 16-71 cm/s)], respectively (p = 0.002), VTI-s [(2.85 cm (range: 0.5-10.7 cm) versus 5 cm (range: 1.3-12.7 cm)], respectively (p <0.001), VTI-d [(3 cm (range: 0.6-9.7 cm) versus 4.2 cm (range: 1.5-8.3 cm)], respectively (p <0.001), SFr (45.5% (range: 15.66-67.44%) versus 50 % (range: 21.11-82.61%)], respectively (p = 0.008), and LAA orifice velocity [(23 cm/s (range: 11-75 cm/s) versus 34 cm/s (range: 10-112 cm/s)], respectively (p = 0.011) were each significantly lower in patients with PVT compared to controls. The PDV was similar between groups. Patients with obstructive PVT (n = 21) had a lower PDV and a higher VTI-d compared to those with non-obstructive PVT. CONCLUSIONS: Mitral mechanical PVT is associated with decreased systolic PVF and LAA function. The presence of obstructive PVT is associated with further limitations of diastolic flow velocity, and a compensatory prolongation of diastolic flow of the left upper pulmonary vein.

Intermittent malfunction and regurgitation of a mitral prosthetic valve due to entrapment by a residual subvalvular apparatus.

Intermittent malfunction is a rare but potentially serious complication of prosthetic heart valve (PHV) replacement. It may be observed in both mitral and aortic valve prosthesis and may lead to either paroxysmal obstruction or regurgitation, depending on the valve location and on the phase of the cardiac cycle during which the leaflet is entrapped. The most frequently encountered causes of intermittent valve malfunction are pannus formation, prosthetic valve thrombosis, vegetations, and remnants of subvalvular apparatus such as chordae tendineae and suture material. Intermittent severe regurgitation of PHV due to residual chordae tendineae is very rare clinical entity, and transesophageal echocardiography is an indispensable guide in the differential diagnosis. Here, we represent an interesting case of intermittent regurgitation of a mitral prosthetic valve due to entrapment by a residual subvalvular apparatus.

ST-segment elevation myocardial infarction possibly caused by thromboembolism from left atrial appendage thrombus after incomplete surgical ligation.

Coronary embolism (CE) is the underlying cause of 3% of acute coronary syndromes but is frequently overlooked in the differential diagnoses of acute coronary syndromes. The CE may be direct (left sided from the native or prosthetic heart valve, the left atrium, left atrial appendage or pulmonary venous bed), paradoxical (from the venous circulation through a patent foramen ovale, atrial septal defect, ventricular septal defects, cyanotic congenital heart defects or pulmonary arteriovenous malformations), or iatrogenic (following cardiac interventions. In patients with atrial fibrillation (AF), left atrial appendage (LAA) ligation during mitral valve surgery has long been recommended to decrease the future risk of embolic events such as myocardial infarction or ischemic stroke. Recently, Aryana et al reported that in patients with AF who underwent surgical ligation of LAA, the presence of incomplete ligation was associated with a significantly higher risk of stroke/systemic embolization than complete ligation (24% vs 2%).

Changes in polyphenol profile of dried apricots containing SO2 at various concentrations during storage.

BACKGROUND: Changes in polyphenols have important effects on the quality (especially color) and health benefits of dried apricots. SO2 concentration, storage and the activities of polyphenol oxidase (PPO) and phenylalanine ammonia lyase (PAL) were factors which had significant effects on polyphenols. Polyphenol profile and activities of PPO and PAL in sulfured dried apricots (SDAs, 0, 451, 832, 2112 and 3241 mg SO2 kg-1 ) were monitored during storage at 4, 20 and 30 °C for 379 days for the first time. RESULTS: Even the lowest SO2 concentration (451 mg kg-1 ) was sufficient to inactivate PPO during the entire storage period. However, while SO2 led to the increase in PAL activity of the samples (r = 0.767) before storage, PAL activities of SDAs decreased during storage. After 90 days of storage, PAL activity was determined in only non-sulfured dried apricots (NSDAs) and dried apricots containing 451 mg SO2 kg-1 . Although the major polyphenol in NSDAs was epicatechin (611.4 mg kg-1 ), that in SDAs was chlorogenic acid (455-1508 mg kg-1 ), followed by epicatechin (0-426.8 mg kg-1 ), rutin (148.9-477.3 mg kg-1 ), ferulic acid (23.3-55.3 mg kg-1 ) and gallic acid (2.4-43.6 mg kg-1 ). After storage at 30 °C for 379 days, the major polyphenol in SDAs was gallic acid (706-2324 mg kg-1 ). However, the major polyphenol in NSDAs did not change after storage. The highest total polyphenol content was detected in SDAs containing 2112 mg SO2 kg-1 and stored at 30 °C. CONCLUSION: To produce dried apricots having high polyphenol content, ∼2000 mg SO2 kg-1 should be used. Low storage temperature (<30 °C) was not necessary for the protection of polyphenols. © 2017 Society of Chemical Industry.

Effect of SO2 on sugars, indicators of Maillard reaction, and browning in dried apricots during storage.

BACKGROUND: The effect of sulfur dioxide (SO2 ) concentration was determined on sugars and indicators in the Maillard reaction (MR), and on browning, in sulfured, dried apricots (SDAs) during storage at 4, 20 and 30 °C for 379 days. RESULTS: As SO2 concentration increased, the content of reducing sugars involved in the MR also increased. The preventive effect of SO2 on the MR could not result from the binding of SO2 to reducing sugars. Before storage, furosine was detected in the non-SDAs but 5-hydroxymethylfurfural (HMF) was not detected. Even the lowest SO2 concentration (451 mg kg-1 ) was sufficient to prevent the formation of furosine and HMF during drying of apricots. CONCLUSION: Formation of furosine and HMF in all samples during storage at 20 and 30 °C for 379 days indicated that SO2 could not prevent the first and intermediate stages of MR in SDAs during storage. Thus, the main prevention effect of SO2 on browning in SDAs occurred during drying, not storage. © 2018 Society of Chemical Industry.