Low-serum 25(OH)D levels are associated with the severity of coronary artery stenosis. Further studies are warranted to determine whether vitamin D supplementation could prevent progression of CAD.

Background Rosacea may contribute to the development of cardiovascular (CV) diseases by causing endothelial dysfunction (ED), which is known to be the initial step of atherosclerosis, due to its inflammatory features. Objective This study aimed to assess ED in rosacea patients using the flow‐mediated dilatation (=dilation) (FMD) method. Methods Seventy‐three rosacea patients and 73 age, gender‐matched healthy volunteers were enrolled. Individuals with cardiac risk factors, pregnant, and lactating women were excluded. Demographic, clinical data and anthropometric measurements were recorded. FMD measurement was performed ultrasonographically by a cardiologist. Systolic and diastolic blood pressures (BP) were measured and hemogram, erythrocyte sedimentation rate (ESR), C‐Reactive Protein (CRP), total cholesterol, triglyceride, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and fasting blood glucose values were assessed. Results The FMD value was statistically lower in rosacea patients compared with healthy controls (p = 0.000). Metabolic syndrome, systolic and diastolic BPs, and plasma NLR were higher in the rosacea group (p = 0.009, p = 0.000, p = 0.000, p = 0.000, respectively). According to the multivariate linear regression analysis, rosacea type significantly predicted FMD. Conclusions Rosacea is not only a disease limited to the skin, but it may also have systemic involvement. A significant difference was found between FMD values measured in between the case and control groups, suggesting rosacea may have an atherogenic effect. Possible cardiac risks should be considered in rosacea patients, and further evaluation could be warranted.

Background/Aim: Nitric oxide supplementation and antioxidant therapy modulate gut barrier function, but the relationships between enhanced nitric oxide production, antioxidant administration, and biliary obstruction remain unclear. We evaluated the role of nitric oxide and α-tocopherol supplementation in bile duct ligated rats. Methods: Fifty male Wistar albino rats underwent sham operation (group I; control animals) or bile duct ligation (groups II, III, IV, and V). The ligation groups received the following regimens: standard pellet diet (group II), pellet diet plus intramuscularly administerd α-tocopherol (group III), and L-arginine-enriched pellet diet without (group IV) or with (group V) α-tocopherol. Nitric oxide, malondialdehyde, and α-tocopherol concentrations were assessed at the end of 3 weeks. Liver and intestinal samples were scored histologically. Mesenteric lymph node and liver cultures were assessed for bacterial translocation. Results: The liver malondialdehyde concentration was highest in group III. The nitric oxide content in the liver was higher in groups III and V, as were the blood α-tocopherol levels. Bacterial translocation was evident following bile duct ligation, but did not differ among the treatment groups. Intestinal histology revealed that group III had the lowest villus height, that group V had the least villus count, and that group II had the highest mucous cell count. The fibrosis scores were higher in groups IV and V. Conclusions: An obvious effect of α-tocopherol (with or without L-arginine) on the gut barrier could not be demonstrated. Moreover, the L-arginine-enriched diet promoted fibrosis in the liver. Thus, while biliary duct obstruction triggers bacterial translocation, nitric oxide and/or α-tocopherol supplementation did not seem to improve the gut barrier in our model.

A 42-year-old woman presented with a 2-year history of shortness of breath. She was evaluated via transthoracic echocardiography at another institution and diagnosed with ostium primum atrial septal defect and advised to undergo surgery. Transthoracic echocardiography revealed a mildly enlarged right ventricle and mild tricuspid regurgitation with an estimated systolic pulmonary artery pressure of 40 mmHg. However, unroofed coronary sinus (UCS) was suspected when detailed reexamination was performed. Two-and three-dimensional (3D) transesophageal echocardiography (TEE) confirmed the diagnosis. The defect was repaired surgically. Enhanced temporal and spatial resolution 3D imaging enabled us to delineate the complex anatomy of an UCS without additional imaging modalities.A suspicious drop in the roof of the coronary sinus was observed on transthoracic parasternal long axis view (arrow; Figure 1A, Supplementary Video 1). Color Doppler revealed significant flow through the coronary sinus ( Figure 1B, Supplementary Video 2). However, when a probe was angulated, observations suggested the presence of a dilated coronary sinus ostium. Moreover, a silhouette of the coronary sinus was not observed. TEE revealed the UCS (arrow; Korean Circ J. 2018 Jan;48 (1) Conflict of InterestThe authors have no financial conflicts of interest. Author Contributions

Severe aortic regurgitation due to quadricuspid aortic valve in a septuagenarian Yetmişli yaşlarda kuadriküspit aortik kapağa bağlı ileri aort yetersizliğiA 70-year-old male presented to the outpatient clinic with complaint of exertional dyspnea. Physical examination revealed 3/4 diastolic murmur on the right sternal border. Blood pressure and heart rate were 160/70 mm Hg and 95 bpm, respectively. Electrocardiogram was normal. Severe aortic regurgitation and moderately decreased left ventricular systolic function were shown on transthoracic echocardiography. Meticulous evaluation of aortic cusps raised suspicion of quadricuspid valve ( Figure A). Two-dimensional transesophageal echocardiography confirmed degenerated quadricuspid aortic valve causing severe regurgitation (Figures B, C). Three-dimensional transesophageal echocardiography depicted quadricuspid cusps in detail ( Figure D, Video 1 * ). Valve replacement surgery was performed, and intraoperative evaluation confirmed diagnosis of quadricuspid valve ( Figure E). The patient was uneventfully discharged 1 week after surgery. CASE IMAGE