Enhancing motor performance through brief skin cooling: exploring the role of enhanced sympathetic tone and muscle spindle sensitivity.

BACKGROUND: Although brief skin cooling (BSC) is widely used in sports medicine and rehabilitation for its positive effects on motor performance, the mechanism underlying this motor facilitation effect remains unclear. OBJECTIVES: To explore the hypothesis that BSC enhances muscle force generation, with cold-induced sympathetic activation leading to heightened muscle spindle sensitivity, thereby contributing to this effect. METHODS: The study involved two experiments. Experiment 1 included 14 healthy volunteers. Participants submerged their hand in ice water for 3 min. Sympathetic activity was measured via heart rate (HR), muscle force generation was assessed through plantar flexor strength during maximum voluntary contraction (MVC), and cortical contribution to force generation via the volitional wave (V-wave) with and without the cold pressor test (CPT). Experiment-2 involved 11 healthy volunteers and focused on muscle spindle sensitivity and Ia synapse efficacy, assessed using soleus T-reflex and H-reflex recordings before, during, and after CPT. RESULTS: Experiment 1 showed significant increases in HR (7.8%), MVC force (14.1%), and V-wave amplitude (93.4%) during CPT compared to pre-CPT values (p = 0.001, p = 0.03, and p = 0.001, respectively). In Experiment-2, hand skin temperature significantly decreased during CPT and remained lower than pre-CPT after 15 min (p < 0.001). While H-reflex and background EMG amplitudes remained unchanged, T-reflex amplitude (113.7%) increased significantly during CPT and returned to pre-CPT values immediately afterward (p < 0.001). A strong correlation was also observed between HR and T-reflex amplitude (r = 0.916, p = 0.001). CONCLUSION: BSC enhances muscle spindle sensitivity via the sympathetic nervous system, promoting more significant muscle force generation. The method used in this study can be safely applied in clinical practice.

Leigh Syndrome due to MT-ATP6 Variants: A Case Presentation and the Review of the Literature.

Introduction: Leigh syndrome is a rare mitochondrial disorder characterized by subacute necrotizing encephalomyelopathy, resulting from defects in mitochondrial respiratory enzymes or pyruvate dehydrogenase complex. Symptoms can manifest in infancy, childhood, or adulthood. We present a case of a 7-month-old girl initially misdiagnosed with septic shock but was later found to have Leigh encephalomyelopathy due to MT-ATP6 deficiency. Case Presentation: A 7-month-old girl was admitted with fever, drowsiness, and wheezing, initially diagnosed with septic shock. She had a history of parental consanguinity and hypotonia. Physical examination revealed unconsciousness, miotic pupils, and respiratory distress. Initial laboratory tests showed significant metabolic acidosis and elevated lactate, creatine kinase, and ammonia levels. The patient was treated for sepsis and shock, but her condition worsened with elevated lactate and liver transaminases, eventually leading to hypertrophic cardiomyopathy and multiorgan failure. Her basic metabolic scans showed extremely low citrulline levels, whole-exome sequencing analysis did not show any pathologic change in nuclear genome, and mitochondrial genome analysis revealed an MT-ATP homoplasmic variant. She passed away on the 22nd day of hospitalization. Discussion/Conclusion: While mitochondrial disorders are broadly acknowledged for their phenotypic diversity, it is essential to note that specific disorders, such as Leigh syndrome, display distinctive presentations with varying degrees of severity. Factors such as the percentage of homoplasmy contribute to the variability in manifestations. Notably, MT-ATP6-associated Leigh syndrome is predominantly characterized by an early onset, typically occurring before the age of 2 years. Low citrulline levels have been observed in approximately 90% of patients with MT-ATP6-related disorders, distinguishing them from other mitochondrial disorders. The exact mechanisms underlying this specific metabolic alteration are not fully understood, but it could be linked to disruptions in the mitochondrial energy production process. The mitochondria are essential for various metabolic pathways, including the urea cycle, where citrulline is involved. The association between low citrulline levels and MT-ATP6-related disorders raises the possibility of using citrulline as a potential biomarker for disease identification. MT-ATP6 defects should be kept in mind in cases with mitochondrial disease and low plasma citrulline levels.

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.

Management of prosthetic valve thrombosis with unfractionated heparin.

BACKGROUND: Prosthetic valve thrombosis (PVT) is a severe and life-threatening complication. Surgery and thrombolytic therapy (TT) carry a high risk, and in several circumstances, optimal anticoagulation with unfractionated heparin (UFH) infusion may be an alternative treatment. This study aimed to assess the results of UFH in patients diagnosed with both obstructive and non-obstructive PVT. METHODS: This observational retrospective study enrolled patients who had contraindications for TT and surgery underwent UFH therapy. RESULTS: A total of 136 patients were enrolled [male: 55 (40.4%), mean age: 50.3 ± 14.6 years] in the study. In the successful group, 66 patients (48,5%) showed >75% regression in the thrombus burden without facing death or major non-fatal complications.In the unsuccessful group, 56 had less than a 50% reduction in thrombus load and 14 (10.3%) suffered major complications. The presence of obstruction (27.1% vs. 12.1%; p = 0.028), thrombus area 1.1 cm2 vs. 0.8 cm2; p = 0.005] and the duration of UFH treatment (15.1 vs. 11.8 (days); p = 0.005) were significantly higher in the unsuccessful UFH group.In multivariate regression analyses the presence of obstruction (RR: 3.088, p = 0.020), increased thrombus area (RR: 2.400; p = 0.015), and increased duration of UFH therapy (RR: 1.073 95%, p = 0.012) were identified as independent predictive parameters for a failed UFH therapy. CONCLUSIONS: This study suggests that UFH therapy may be considered a relatively beneficial treatment strategy for some patients with PVT. The most significant factors affecting success are the obstructive nature and area of the thrombus.

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.

Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry.

BACKGROUND: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.

Transcatheter mitral paravalvular closure: a single centre experience with techniques and outcomes.

BACKGROUND: In patients with symptomatic mitral PVL, successful transcatheter reduction of the PVL to less than mild is associated with significant improvement in short- and midterm survival. OBJECTIVES: In this study, we present our single-centre, same operators' experience on percutaneous paravalvular leak closure with techniques and outcomes. METHODS: In this retrospective observational designed study, we retrieved hospital records of patients with a surgical history of mechanical or biological prosthetic valve replacement and who subsequently underwent transcatheter mitral paravalvular leak closure (TMPLC). All procedures were performed by the same operators. RESULTS: A total of 45 patients with 58 PVDs underwent TMPLC using 60 devices. All patients had moderate or severe mitral paravalvular regurgitation associated with symptomatic HF (15.6%), clinically significant haemolytic anaemia (57.8%) or both (26.7%). The technical success rate was 91.4%, with 53 defects successfully occluded. The clinical success rate was 75.6%. Among the clinical success parameters, the preprocedural median ejection fraction increased from 45% (35-55) to 50% (40-55) (p = .04). Mitral gradients decreased from max/mean 18/8 mmHg to max/mean 16/7 mmHg; p = .02). Haemoglobin levels increased from 9.9 (8.5-11.1) to 11.1 (3-13); p = .003. LDH levels decreased from 875 (556-1125) to 435 (314-579); p: <.001. All-cause 30-day and in-hospital mortality rates were the same at 8.9%. CONCLUSION: This single-centre study with a limited number of patients confirmed that TMPLC is a safe and effective procedure to improve symptoms and severity of PVL.

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.

A Comprehensive Evaluation of National Cardiology Congresses Abstracts on the Basis of the 2016 Academic Criteria.

OBJECTIVE: This study aimed to describe the effects of new academic criteria established in 2016 on the abstracts of the National Congress of the Turkish Society of Cardiology. METHODS: The abstracts presented at 13 consecutive annual congresses were obtained. A literature search was conducted with PubMed, Google Scholar, and Web of Science databases to analyze whether the abstract was published in a scientific journal. The study was divided into 2 time groups according to the new academic criteria published in 2016. Group 1 included 4828 abstracts accepted at National Congress of the Turkish Society of Cardiology between 2009 and 2016, while Group 2 included 2284 abstracts accepted at National Congress of the Turkish Society of Cardiology between 2017 and 2021. RESULTS: A total of 7112 abstracts were accepted for the 2009-2021 National Congress of the Turkish Society of Cardiology meetings scientific program. The publication rate (43.2% vs. 23.9%, P < 0.001), number of authors [7(5-9) vs. 4(3-6), P < 0.001], and rate of original investigation (72.3 vs. 56.5%, P < 0.001) were significantly lower in group 2 than in group 1. Among the quality parameters of the journals in which the abstracts were published, the impact factor (0.59 ± 1.71 vs. 0.26 ± 1.09, P < 0.001), the rate of journals in science citation index or science citation index-expanded indexes (70.4 vs. 57.9%, P < 0.001), and the rate of the second or third-quartile class (24.2 vs. 16.1%, P < 0.001) were significantly lower in group 2 as compared to group 1. Being in group 1 oral presentation, original investigation, and cardiac imaging were identified as independent predictors for publication in scientific journals. CONCLUSION: This study showed that the 2016 new academic criteria negatively affected the publication processes of accepted abstracts in National Congress of the Turkish Society of Cardiology.

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.

The usefulness of transabdominal ultrasound elastography in Helicobacter pylori gastritis in children.

Background: Helicobacter pylori can colonize the submucosal layer as well as the mucosa in the stomach. Inflammation and erosions cause both mucosal and submucosal thickening in patients with Helicobacter pylori gastritis. Elastography is a method for measuring the elasticity and hardness of tissues by visualization of their response to the applied force. Hard tissues respond to applied compression differently compared to soft tissues. Hard tissues displace as a whole without deforming as opposed to soft tissues. In this study, we investigated the diagnostic performance of transabdominal ultrasound elastography in detecting Helicobacter pylori gastritis in children. Methods: Nineteen children (group 1) with Helicobacter pylori gastritis, 33 children (group 2) with Helicobacter pylori (-) gastritis and 37 healthy children (group 3) were included the study. These groups were compared in terms of their strain index values. Ultrasonographic examinations were performed with a single transducer at 1.8-6.2 MHz frequency range. Results: Both group 1 and 2 had significantly higher strain index values compared to the control group (2.7, 2.2 and 1.4 respectively). Additionally, the mean strain index value was significantly higher in group 1 compared to group 2. Conclusion: Transabdominal ultrasound elastography has diagnostic value in differentiating Helicobacter pylori (+) gastritis from Helicobacter pylori (-) gastritis as well as in the diagnosis of gastritis in children.

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.

High-frequency whole-body vibration activates tonic vibration reflex.

Objectives: The aim of this research was to examine whether high-frequency whole-body vibration activates the tonic vibration reflex (TVR). Patients and methods: The experimental study was conducted with seven volunteers (mean age: 30.8±3.3 years; range, 26 to 35 years) between December 2021 and January 2022. To elicit soleus TVR, high-frequency (100-150 Hz) vibration was applied to the Achilles tendon. High-frequency (100-150 Hz) whole-body vibration and low-frequency (30-40 Hz) whole-body vibration were applied in quiet standing. Whole-body vibration-induced reflexes were recorded from the soleus muscle using surface electromyography. The cumulative average method was used to determine the reflex latencies. Results: Soleus TVR latency was 35.6±5.9 msec, the latency of the reflex activated by high-frequency whole-body vibration was 34.8±6.2 msec, and the latency of the reflex activated by low-frequency whole-body vibration was 42.8±3.4 msec (F(2, 12)=40.07, p=0.0001, ƞ2 =0.87). The low-frequency whole-body vibration-induced reflex latency was significantly longer than high-frequency whole-body vibration-induced reflex latency and TVR latency (p=0.002 and p=0.001, respectively). High-frequency whole-body vibration-induced reflex latency and TVR latency were found to be similar (p=0.526). Conclusion: This study showed that high-frequency whole-body vibration activates TVR.

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.

Clarification of pomegranate and strawberry juices: Effects of various clarification agents on turbidity, anthocyanins, colour, phenolics and antioxidant activity.

Effects of clarification on turbidity, anthocyanins (ACNs), colour, phenolics, ascorbic acid and antioxidant activity (AA) of pomegranate (PJ) and strawberry juices (SJ) were investigated. Cold-clarification was applied to PJ using only gelatine. For hot-clarification of both juices, bentonite, gelatine and kieselsol were used. Moreover, pectolytic enzyme was added to SJ that contains pectin. Depectinization caused an increase in colour density of SJ and bentonite treatment resulted in low turbidity (9.5 NTU). However, gelatine and kieselsol significantly reduced ACN content (15%) and increased turbidity (70.1 NTU). In PJ, no step during hot-clarification provided low turbidity (93.2-162.0 NTU), while relatively low turbidity (28.7 NTU) and anthocyanin loss (9.8%) was achieved during cold-clarification. Hot-clarification of SJ showed no effect on AA and phenolics, while cold-clarification of PJ reduced both to a limited extent. Therefore, depectinization and bentonite treatment are recommended for hot-clarification of SJ and gelatine for cold-clarification of PJ.

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.

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.