Echocardiographic Parameters Associated with Bendopnea in Patients with Systolic Heart Failure.

Background: Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters. Methods: In this study, patients with left ventricular ejection fraction (LVEF) ≤45% and decompensated HF referred to our clinics were prospectively recruited. All the patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings were compared between the patients with or without bendopnea. Results: A total of 120 patients at a mean age of 65.19±12.62 years were evaluated, and 74.8% were men. Bendopnea was observed in 44.2% of the patients. The etiology of HF was ischemic in most patients (81.9%), and the functional class of most patients (85.9%) was III or IV. The mortality rate at the 6-month follow-up was comparable between the patients with or without bendopnea (6.1% vs 9.5%; P=0.507). The waist circumference (odds ratio [OR], 1.037, 95% confidence interval [CI], 1.005 to 1.070; P=0.023), paroxysmal nocturnal dyspnea (OR, 0.338, 95% CI, 0.132 to 0.866; P=0.024), and right atrial size (OR, 1.084, 95% CI, 1.002 to 1.172; P=0.044) were associated with bendopnea. Conclusion: Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrial size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients.

Experimental data on the removal of acid orange 10 dye from aqueous solutions using TiO2/Na-Y zeolite and BiVO4/Na-Y zeolite nanostructures: A comparison study.

The increase of textile factories, along with the continuous development of industrialization has led to excessive discharge of high toxicity wastewater along with a diverse range of contaminants in wastewater. In this regard, to reduce their operating costs and treatment time, in this work, two synthesized nanostructures, TiO2/Na-Y zeolite and BiVO4/Na-Y zeolite was compared to remove acid orange 10 (AO10) from the aqueous solutions. The obtained optimum operating conditions including initial dye concentration, initial pH, contact time, catalyst dosage and AO10 removal efficiency were 20 mg/L, 3, 7 min, 0.2 g/100 mL, and 99.77% for TiO2/Na-Y zeolite and 20 mg/L, 3, 200 min, 0.2 g/100 mL and 46.13% for BiVO4/Na-Y zeolite composite, respectively. The structural characteristics of the synthetized materials were also determined by X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and fourier-transform infrared spectroscopy (FTIR).

Comparison of Outcomes with Midodrine and Fludrocortisone for Objective Recurrence in Treating Syncope (COMFORTS trial): Rationale and design for a multi-center randomized controlled trial.

BACKGROUND: The cornerstone of the treatment of vasovagal syncope (VVS) is lifestyle modifications; however, some patients incur life-disturbing attacks despite compliance with these treatments which underscores the importance of pharmacological interventions. METHODS: In this open-label multi-center randomized controlled trial, we are going to randomize 1375 patients with VVS who had ≥2 syncopal episodes in the last year into three parallel arms with a 2:2:1 ratio to receive midodrine, fludrocortisone, or no medication. All patients will be recommended to drink 2 to 3 liters of fluids per day, consume 10 grams of NaCl per day, and practice counter-pressure maneuvers. In medication arms, patients will start on 5 mg of midodrine TDS or 0.05 mg of fludrocortisone BD. After one week the dosage will be up-titrated to midodrine 30 mg/day and fludrocortisone 0.2 mg/day. Patient tolerance will be the principal guide to dosage adjustments. We will follow-up the patients on 3, 6, 9, and 12 months after randomization. The primary outcome is the time to first syncopal episode. Secondary outcomes include the recurrence rate of VVS, time interval between first and second episodes, changes in quality of life (QoL), and major and minor adverse drug reactions. QoL will be examined by the 36-Item Short Form Survey questionnaire at enrollment and 12 months after randomization. CONCLUSION: The COMFORTS trial is the first study that aims to make a head-to-head comparison between midodrine and fludrocortisone, against a background of lifestyle modifications for preventing recurrences of VVS and improving QoL in patients with VVS.

A novel ternary heterogeneous TiO2/BiVO4/NaY-Zeolite nanocomposite for photocatalytic degradation of microcystin-leucine arginine (MC-LR) under visible light.

Microcystin-leucine arginine (MC-LR) is a carcinogenic toxin, produced by cyanobacteria. The release of this toxin into drinking water sources can threaten public health and environmental safety. Therefore, effective MC-LR removal from water resources is necessary. In the present study, the hydrothermal method was used to synthesize a novel ternary BiVO4/TiO2/NaY-Zeolite (B/T/N-Z) nanocomposite for MC-LR degradation under visible light. FESEM, FTIR, XRD, and DRS were performed for characterizing the nanocomposite structure. Also, the Response Surface Methodology (RSM) was applied to determine the impact of catalyst dosage, pH, and contact time on the MC-LR removal. High-performance liquid chromatography was performed to measure the MC-LR concentration. Based on the results, independent parameters, including contact time, catalyst dosage, and pH, significantly affected the MC-LR removal (P < 0.05). In other words, increasing the contact time, catalyst dosage, and acidic pH had positive effects on MC-LR removal. Among these variables, the catalyst dosage, with the mean square and F-value of 1041.37 and 162.84, respectively, had the greatest effect on the MC-LR removal efficiency. Apart from the interaction between the catalyst dosage and contact time, the interaction effects of other parameters were not significant. Also, the maximum MC-LR removal efficiency was 99.88% under optimal conditions (contact time = 120 min, catalyst dosage = 1 g/L, and pH = 5). According to the results, the B/T/N-Z nanocomposite, as a novel and effective photocatalyst could be used to degrade MC-LR from polluted water.

Comparison of trinitroglycerin and adenosine as provocative agents for head-up tilt test in patients with unexplained syncope: a semi-crossover randomized clinical trial with prospective follow-up.

PURPOSE: Head-up tilt test (HUTT) is a reasonable diagnostic evaluation for patients with suspected vasovagal syncope; however, its lengthy duration is a remarkable limitation. Although adenosine (AD), as an alternative provocative agent, is a promising option for tackling this shortcoming, it received little appreciation in the literature. We aimed to compare the efficacy and the time to elicit a positive response to HUTT for sublingual trinitroglycerin (TNG) and intravenous AD. Furthermore, we evaluated patients' outcomes in the follow-up. METHODS: Patients with a chief complaint of transient loss of consciousness (TLOC) were evaluated. We randomized patients with the diagnosis of unexplained syncope after diagnostic evaluations, to undergo TNG-augmented HUTT or AD-augmented HUTT. They were crossed over to receive the other medication in case of negative response to the test. In the follow-up, we evaluated traumatic and non-traumatic TLOCs, hospitalization due to syncope, and death in patients. RESULTS: We randomized 132 patients (41.70 ± 19.37 years, 52.3% female) to receive TNG (n = 66) or AD (n = 66). Respectively, the positivity rate of TNG and AD for the first and the crossover-HUTT was 31.1% and 26.7%, and 20.5% and 26.2% with no statistically significant differences in both tests (P ˃ 0.50). The time to positive response was significantly shorter for AD than TNG (P < 0.001). In the follow-up, re-admission was significantly more prevalent in HUTT-negative patients compared to HUTT-positive patients (P = 0.04). CONCLUSIONS: We found that diagnostic yield of TNG and AD in HUTT is comparable, while AD acts 4 times faster than TNG in evoking a vasovagal response.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease.

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS) (EFT in systole) and PLAX (EFTd) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS) (P = 0.05), PLAX (EFTd) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

Genotoxicity and phytotoxicity comparison of cigarette butt with cigarette ash.

The damage potential of cigarette butt and cigarette ash was determined and compared using genotoxicity and phytotoxicity assessments. The concentrations of five heavy metals, As, Cr, Cd, Pb, and Ni, were determined in both cigarette butt and ash leachates to find out if the results of heavy metals are in parallel with toxicity findings. Cigarette ashes and cigarette butts were soaked in distilled water for 7 days. Six leachate butt concentrations, including 200, 100, 50, 25, 12.5, and 6.25 piece/L, were examined. HUVEC cells (human umbilical vein endothelial cells) were exposed to these dilution series for genotoxicity, and Vicia faba seeds were exposed to the same dilution series for phytotoxicity assessments. Three parameters of genotoxicity, including tail length, %DNA in tail, and tail moment, were obtained by the comet assay method, and three parameters of phytotoxicity, including germination rate, root length, and water content percentage, were employed. The results showed that cigarette ash at the concentrations of 50, 25, 12.5, and 6.25 pc/L brings about DNA damage. Meanwhile, cigarette butt causes DNA damage at the concentrations of 100, 50, 25, and 12.5 pc/L. The highest concentrations (200 pc/L for cigarette butt and 200 and 100 pc/L for cigarette ash) were considered lethal for HUVEC cells. Besides, the levels of genotoxicity in the cigarette ash were twice as high as those in the cigarette butt. The Vicia faba phytotoxicity test demonstrated a germination rate restriction from 100 to 52 and 100 to 0% for cigarette butt and cigarette ash, respectively. It also caused a reduction in the length of roots from 35 to 7.85 and 3 mm for cigarette butt and cigarette ash, respectively. The moisture amounts of cigarette remnants had a decline from 93.14 to 44.61 and 36.72% for cigarette butt and cigarette ash, respectively. Concentrations of As, Cr, Cd, Pb, and Ni were 17.45, 2.5, 0.15, 6, and 0.62 ppb in the butt leachate and 7.21, 2.64, 0.29, 13.61, and 1.24 ppb in the ash leachate, respectively, indicating that heavy metals could explain the higher toxicity of cigarette ash. Based on the present study, cigarette ash imposes not only higher levels of genotoxicity and phytotoxicity but also more values of toxic heavy metals on our planet. Thus, cigarette ash plays a major role in environmental pollution, and the importance of cigarette ashes should receive attention even more than cigarette butts. This paper casts new light on the toxic impacts of cigarette ash.

Tumor Necrosis Factor-alpha Gene Expression in PBMCs of Iranian Azeri Turkish Patients with Premature Coronary Artery Disease (Age .50 Years).

BACKGROUND: Coronary artery disease is the leading cause of disability and mortality in Iran and worldwide. Tumor necrosis factor-alpha is a pro-inflammatory cytokine that plays a key role in inflammatory cascades and atherosclerosis. It regulates cytokine networks and adhesion molecule expression, and activates several signal transduction pathways, being also known as transducer of cardiovascular diseases, especially premature coronary artery disease. OBJECTIVE: The aim of the present study was to investigate tumor necrosis factor-alpha gene expression in Iranian Azeri Turkish patients with premature coronary artery disease (age ≤50 years). MATERIAL AND METHODS: Eighty four individuals (42 cases and 42 controls) were enrolled in the study. Total RNA was extracted from patients with premature coronary artery disease using RNX-Plus Solution (Cat. No.: RN7713C) and reverse transcribed into cDNA. The tumor necrosis factor-alpha mRNA expression level was evaluated using Real-Time PCR. RESULTS: The mean ± SE of fold in cases and controls were 1.1±1.08 and 1.6±3.4, respectively. The mean expression of tumor necrosis factor-alpha mRNA (fold) was not statistically different between the tested groups (P value 0.4). OUTCOMES: Our outcome failed to find evidence for any association between tumor necrosis factor-alpha mRNA expression and premature coronary artery disease. Large scale, more detailed studies are further needed to prove our results and to propose other mechanisms in the pathophysiology of premature coronary artery disease.

Analysis of the mutations in exon 10 of MEFV gene in patients with premature coronary heart disease in west Azerbaijan province of Iran.

Introduction: Premature coronary heart disease (PCHD) affects public health and leads to death. PCHD has several genetic and environmental risk factors. The aim of this study was to analysis of the mutations in exon 10 of MEFV gene in patients with PCHD in West Azerbaijan province of Iran. Methods: Totally 41 PCHD patients who were admitted to the cardiology unit of Sayedoshohada hospital (Urmia, Iran) enrolled in the study. Selection of the patients was done based on the strict criteria, that is, who had a minimum of one angiographically documented coronary artery with the stenosis of 50%. Mutations in exon 10 of MEFV gene were found by direct sequencing. Results: V726A, M680I, K695R, and A744S mutations with 2.44%, 1.22%, 1.22%, and 1.22%, allelic frequency were found, respectively. Five patients (12.2%) with PCHD carried at least one mutated MEFV allele. Heterozygote V726A was the most frequent mutation among tested cases (4.88%), followed by heterozygote M680I, heterozygote K695R, and heterozygote A744S. Conclusion: The results of the present study imply that the frequency of the MEFV gene exon 10 is significantly high in PCHD patients. This is the first report in its own kind in clinically diagnosed PCHD pa-tients of Iranian Azeri Turkish population.

Short-Term High-Dose Vitamin E to Prevent Contrast Medium-Induced Acute Kidney Injury in Patients With Chronic Kidney Disease Undergoing Elective Coronary Angiography: A Randomized Placebo-Controlled Trial.

BACKGROUND: Contrast medium-induced acute kidney injury (CIAKI) is a leading cause of acquired renal impairment. The effects of antioxidants have been conflicting regarding the prevention of CIAKI. We performed a study of vitamin E use to decrease CIAKI in patients undergoing elective coronary angiography. METHODS AND RESULTS: In a placebo-controlled randomized trial at 2 centers in Iran, 300 patients with chronic kidney disease-defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2)-were randomized 1:1 to receive 0.9% saline infusion 12 hours prior to and after intervention combined with 600 mg vitamin E 12 hours before plus 400 mg vitamin E 2 hours before coronary angiography or to receive placebo. The primary end point was the development of CIAKI, defined as an increase ≥0.5 mg/dL or ≥25% in serum creatinine that peaked within 72 hours. Based on an intention-to-treat analysis, CIAKI developed in 10 (6.7%) and 21 (14.1%) patients in the vitamin E and placebo groups, respectively (P=0.037). Change in white blood cell count from baseline to peak value was greater in the vitamin E group compared with the placebo group (-500 [-1500 to 200] versus 100 [-900 to 600]×10(3)/mL, P=0.001). In multivariate analysis, vitamin E (odds ratio 0.408, 95% CI 0.170-0.982, P=0.045) and baseline Mehran score (odds ratio 1.257, 95% CI 1.007-1.569; P=0.043) predicted CIAKI. CONCLUSIONS: Prophylactic short-term high-dose vitamin E combined with 0.9% saline infusion is superior to placebo for prevention of CIAKI in patients undergoing elective coronary angiography. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02070679.

Serum CA-125 level in patients with chronic obstructive pulmonary disease with and without pulmonary hypertension.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating disease and is going to be the 3rd most common cause of death worldwide. Pulmonary hypertension (PH) has severely bad influence on prognosis in COPD patients. Hence, early diagnosis of it is important for appropriate therapy. Echocardiography is used for this purpose, which requires cardiologist and expensive equipment which may not be available anywhere. CA-125, a biomarker of ovarian cancer, has shown to be associated with left ventricular failure. We aimed to show the relationship between CA-125 levels and PH in patients with COPD. METHODS: Ninety patients with stable COPD were enrolled into the study. Levels of CA-725 were measured from venous blood, and in the same day systolic pulmonary artery pressure (sPAP) was measured by transthoracic echocardiography. RESULTS: Of 90 Patients 57 had PH and 39 had not. Patients with PH had significantly higher CA- 125 levels compared with controls (mean 39.15 U/ mL vs. 24.22 U/mL, P < 0.04). Levels of CA-125 were correlated with sPAP (r=017, P=0.01). CONCLUSIONS: The CA-125 biomarker can be used to identify COPD patients with pulmonary hypertension. Since it is cheap and easily available it can help in centers with less access to echocardiography.

QT Dispersion after Thrombolytic Therapy.

BACKGROUND: QT dispersion (QTd) is equal to longer QTc minus shorter QTc measured by 12-lead electrocardiogram (ECG). QTd reflects inhomogeneity in repolarization of ventricular myocardium and because of easy and fast measurement of QTd, it can be used to predict high-risk patients for dysrhythmia after Acute Myocardial Infarction (AMI). OBJECTIVES: This study aimed to assess the effect of thrombolytic therapy on QTd before and 1 hour and 4 days after beginning of thrombolytic therapy. PATIENTS AND METHODS: The patients with chest pain and ST Elevated Myocardial Infarction (STEMI) that underwent thrombolytic therapy were enrolled into this study. Streptokinase was the thrombolytic agent in all the patients. Standard 12-lead (ECG) was evaluated before beginning of thrombolytic therapy (QTd 1) and 1 hour (QTd2) and 4 days (QTd3) after thrombolytic therapy. First, ECG was magnified × 10 for exact calculation of QT and QTd. After all, the variables were compared using one-way analysis of variance (ANOVA). Besides, P ≤ 0.05 was considered as statistically significant. RESULTS: This study was conducted on 160 patients. The results revealed no significant differences among QTd 1, QTd 2, and QTd 3 (P > 0.05). At inferior AMI, however, a significant difference was observed among QTd1, QTd2, and QTd3 (P = 0.031). CONCLUSIONS: Thrombolytic therapy had no significant effects on QTd. Thus, thrombolytic therapy does not increase the risk of arrhythmia.