CRP/albumin ratio in predicting 1-year mortality in elderly patients undergoing hip fracture surgery

OBJECTIVE

In the literature, rates of up to 37.1% have been reported for 1-year mortality after hip fractures. In this study, we aimed to determine whether the C-reactive protein/albumin ratio (CAR) is an independent risk factor for 1-year mortality after hip fracture and whether CAR, neutrophil/lymphocyte ratio (NLR), CRP, albumin level, and other parameters have an effect on mortality and morbidity.

PATIENTS AND METHODS

Over a 3-year period, 480 patients aged 65 years and older who underwent hemiarthroplasty for hip fracture were analyzed. A univariate logistic regression analysis was performed to identify prognostic factors for 1-year mortality. Significant variables were re-evaluated using binary logistic regression analysis.

RESULTS

The number of patients who died within 1 year postoperatively was 95 (27.7%), and the median age was 85 years. In the receiver operating characteristic analysis (ROC) for 1-year mortality after hip fracture, the optimal cut-off value of CAR was found to be 1.03. The area under the curve (AUC) for mortality was 0.843, the sensitivity was 65.3%, and the specificity was 92.7% [95% confidence interval (CI), 0.791-0.895; p < 0.001]. The optimal cut-off value for CRP was 2.85, the AUC was 0.838, the sensitivity was 70%, and the specificity was 89% (95% CI, 0.785-0.890; p < 0.001). The optimal cut-off value of NLR for postoperative intensive care unit (ICU) admission was determined to be 6.64.

CONCLUSIONS

CAR was a predictive factor for 1-year postoperative mortality and postoperative ICU admission, whereas NLR was a predictive factor for postoperative ICU admission.

A novel thiourea derivative for preconcentration of copper(II), nickel(II), cadmium(II), lead(II) and iron(II) from seawater samples for Flame Atomic Absorption Spectrophotometry

A novel adsorbent, 3-phenyl-1-(2-pyridyl)thiourea (PPTU) was synthesized and its adsorption capabilities were studied for Cu(II), Cd(II), Ni(II), Pb(II) and Fe(II) cations in the waters such as tap and polluted seawaters. The kinetics, Langmuir and Freundlich isotherms were discussed related to the adsorptions. The adsorption capacities of PPTU were found 9.4; 12.6; 90.9; 57.1 and 30.4 mg g^-1 and preconcentration with PPTU including the FAAS step yielded the LOQ values 0.46; 2.65; 1.12; 2.65 and 1.72 ng mL^-1 for Cu(II), Cd(II), Ni(II), Pb(II) and Fe(II), respectively. The adsorbent after the elutions and washings could be reused three times in the next adsorptions. The interferences on the adsorptions arising from the major cations of the seawater and the usability of PPTU for interested metals in the seawater were discussed. The proposed method is simple with highly efficient and green preconcentration procedure for trace analysis of the target metal ions.

The role of neutrophil albumin ratio in predicting the stage of non-small cell lung cancer

OBJECTIVE

Inflammation forms the basis of cancer development and progression. It causes changes in complete blood count parameters, such as neutrophil counts. Low albumin levels are associated with poor prognosis in cancer patients. We aimed to investigate the association between neutrophil to albumin ratio (NAR) and the stage of non-small cell lung cancer (NSCLC).

PATIENTS AND METHODS

257 NSCLC patients (24 females and 198 males) were included in the study. Patients were divided into two groups. Group 1 (n=61) included patients with early stage cancer (stage 1 and 2), while group 2  (n=196) included those with advanced stage cancer (stage 3 and 4). Demographic data, neutrophil, lymphocyte, platelet, white blood cell counts (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), ferritin and albumin levels at the time of diagnosis were recorded. The NAR of 2 groups were compared.

RESULTS

There were no significant differences between the lymphocyte count (2.0 vs. 2.0 103/mm3) and platelet count (291 vs. 311 103/mm3) of the two groups (p > 0.05). ESR (38.8 vs. 57.5 mm/h), CRP (158 vs. 57 mg/l), ferritin (85 vs. 261 ng/ml), WBC count (8.6 vs. 10.6 103/mm3), neutrophil count (5.6 vs. 7.5 103/mm3), albumin values (2.9 vs. 3.7 gr/dl), and (p < 0.05) NAR levels (1.6 vs. 2.3) (p < 0.05) were significantly higher in group 2.

CONCLUSIONS

NAR can be used in predicting the stage of NSCLC.

Upper-limb function in Brachial Plexus birth palsy: Does the Pediatric Outcomes Data Collection Instrument correlate with the Brachial Plexus Outcome Measure?

Functional outcome assessment for children with brachial plexus birth palsy (BPBP) is essential. We aimed to investigate the association between the Brachial Plexus Outcome Measure (BPOM) and the Pediatric Outcomes Data Collection Instrument (PODCI) in children with BPBP and healthy matched controls, and to explore upper-limb function and the discriminative properties of the two tests. Thirty children, aged 6-14 years, diagnosed with BPBP and undergoing shoulder tendon transfer and 20 age-matched healthy controls were included. In both groups, the Turkish version of the PODCI, used to evaluate daily living activities, was implemented. The Turkish version of the BPOM, specifically developed for BPBP, was applied in children with BPBP. Test results, demographic and clinical characteristics were recorded. The mean age of children with BPBP was 8.53 ± 2.53 years and their BPOM Activity scale score was 42.93 ± 8.28. The PODCI Upper Extremity Function score (74.97 ± 23.49 vs. 100) and the PODCI Global Functioning score (89.20 ± 7.73 vs. 99.36 ± 7.73) were significantly lower in the BPBP group (p < 0.01). While there was a significant and very strong relationship between the BPOM Activity and PODCI Global Functioning scores (r = 0.845; p = 0.037), no correlation was found between the BPOM Self-Evaluation scale and PODCI Global Functioning score (r = 0.456; p = -0.141). The PODCI correlated with the BPOM Activity scale, providing an appropriate alternative measurement for upper-limb function in children with BPBP after shoulder tendon transfer.

Genome-wide identification of serine acetyltransferase (SAT) gene family in rice (Oryza sativa) and their expressions under salt stress

BACKGROUND

Assimilation of sulfur to cysteine (Cys) occurs in presence of serine acetyltransferase (SAT). Drought and salt stresses are known to be regulated by abscisic acid, whose biosynthesis is limited by Cys. Cys is formed by cysteine synthase complex depending on SAT and OASTL enzymes. Functions of some SAT genes were identified in Arabidopsis; however, it is not known how SAT genes are regulated in rice (Oryza sativa) under salt stress.

METHODS AND RESULTS

Sequence, protein domain, gene structure, nucleotide, phylogenetic, selection, gene duplication, motif, synteny, digital expression and co-expression, secondary and tertiary protein structures, and binding site analyses were conducted. The wet-lab expressions of OsSAT genes were also tested under salt stress. OsSATs have underwent purifying selection. Segmental and tandem duplications may be driving force of structural and functional divergences of OsSATs. The digital expression analyses of OsSATs showed that jasmonic acid (JA) was the only hormone inducing the expressions of OsSAT1;1, OsSAT2;1, and OsSAT2;2 whereas auxin and ABA only triggered OsSAT1;1 expression. Leaf blade is the only plant organ where all OsSATs but OsSAT1;1 were expressed. Wet-lab expressions of OsSATs indicated that OsSAT1;1, OsSAT1;2 and OsSAT1;3 genes were upregulated at different exposure times of salt stress.

CONCLUSIONS

OsSAT1;1, expressed highly in rice roots, may be a hub gene regulated by cross-talk of JA, ABA and auxin hormones. The cross-talk of the mentioned hormones and the structural variations of OsSAT proteins may also explain the different responses of OsSATs to salt stress.

A retrospective comparison of total versus partial cross-bone resection in surgical management of congenital cleft hand

This study aimed to compare clinical and radiographical results of total or partial resection of the cross-bone in the management of children with cleft hand. Nine children with 10 cleft hands who underwent resection of the cross-bone were retrospectively identified and divided into two groups based on type of resection: Group T (total resection) including 5 children (5 affected hands; 3 boys; mean age = 3.5 (range, 2-5) years), and Group P (partial resection) including 4 children (5 affected hands; 3 boys; mean age = 3.2 (range, 2-5) years). Mean follow-up was 68 (range, 60-85) months in group T and 47 (range, 40-60) months in group P. To assess clinical status, postoperative cosmetic satisfaction was evaluated by asking the parents, and cosmetic appearance was rated using a visual analogue scale (VAS) at the follow-up. In the radiographical evaluation, change in cleft divergence following reconstruction was assessed as the metacarpal divergence angle between the index and the ring finger metacarpals. Overall, cosmetic satisfaction was rated "very satisfied" or "satisfied" in 7 of the 10 hands, and functional satisfaction as "very satisfied" or "satisfied" in all. Mean postoperative cosmetic aspect on VAS was 6.4 (range, 5-8) in group T, and 6.2 (range, 4-8) in group P (p = 0.99). Mean metacarpal divergence angle significantly decreased from 42.2° (range, 35-52°) and 40.2° (range, 36-46°) preoperatively to 21.2° (range, 15-35°) and 19.8° (range = 12-31°) at 3-year follow-up in groups T and P, respectively (p < 0.001 for each group). Both total and partial cross-bone resection provided satisfactory clinical and radiographical medium-term results for of children with cleft hand.

Toxicity, mutagenicity and stability assessment of simply produced electrolyzed water as a wound healing agent in vitro

Over the last decade, electrolyzed water (EW) produced by salt and tap water has gained importance due to its antimicrobial effects. Regarding to chlorine-based compounds, EW also used in post-harvest safety of food processing and sterilization of surfaces. The latest studies suggested that EW might act as wound healing agent due to anti-infective and cell proliferative properties. In this study, we evaluated acute contact cytotoxicity in L929 mice fibroblast cells and wound healing activity of EWs in vitro. In addition, mutagenic activity was evaluated by Ames test with and without metabolic activation by S9 fraction and the stability profile of freshly prepared EWs has been followed up. According to the results, strong acid (StAEW) and mixed EW (MEW) showed dose-dependent cytotoxicity due to possible high HOCl concentration, while slightly acidic and catholyte EW (CEW) were not cytotoxic even applied directly for 30 sec. Further, StAEW and CEW showed a significant increase in L929 cell migration in scratch assay. Likewise, with/ without metabolic activation, neither of EWs had shown mutagenic profile in TA 98 and TA100 strains of Salmonella typhimurium. Follow-up of ORP (oxidation-reduction potential), pH and FCC (free chlorine concentration) showed that temperature and light were important storage conditions to maintain a stable profile particularly for ORP and FCC, which are the most important indicators for biological activity of EW. According to the present findings, it can be suggested that particularly StAEW, may represent a valuable wound healing agent with an achievable, economical and easy production system when stored under proper conditions.

A new formulae study for the (n,2p) reaction cross-section systematics at 14-15 MeV

The cross-section calculation systematics for nuclear reactions have great importance in describing the particle-induced excitation of nuclei. In this study, for 14-15 MeV of incident neutron energy, it has been suggested new empirical formulae to describe the (n, 2p) reactions cross sections. The new empirical formulae have been obtained for 29≤A≤159, 29≤A≤103 and 133≤A≤159 mass ranges which are dependent on s=(N-Z)/A asymmetry parameter. The asymmetry parameters have been obtained by modifying the original Levkovski formula. Then, EXFOR data has been studied by applying the least square fitting method and (n, 2p) reactions systematics has been revealed. The statistical dependence (R²) of these data was examined in the 29≤A≤159 total mass range. The calculated results from the obtained formulae have been compared with the literature data. The predictions of our formulae are in good agreement with the EXFOR data for 29≤A≤159 and 29≤A≤103 mass range.

The effect of intraurethral dexpanthenol in hypospadias repair: experimental rabbit study

INTRODUCTION

In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity.

OBJECTIVE

The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis.

STUDY DESIGN

In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000 g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500 mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500 mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment.

RESULTS

The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P = 0.018 and P = 0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P = 0.019 and P = 0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P > 0.05).

DISCUSSION

This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed.

CONCLUSIONS

Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.

In vitro biocompatibility study approaches to evaluate the safety profile of electrolyzed water for skin and eye

Electrolyzed water (EW) is a widely used disinfectant agent with high oxidation–reduction potential (ORP). Although EW has been used in many areas, such as food hygiene, agriculture, and animal husbandry, the studies presented in the literature are not enough to clarify the toxic effects of EW. The aim of this study is, therefore, to produce EWs at different pH, ORP, and chlorine concentrations and to assess their safety in terms of toxicology. At the beginning of the study, the antimicrobial activity of the EW types with respect to bacteria and fungus was investigated. EWs below pH 7 were all effective in inactivating Enterococcus hirae, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans completely. In vitro studies of cell cultures revealed that different concentrations of EWs were not cytotoxic for the L929 cells under 10- to 80-fold dilutions. In addition, it has been determined that produced EWs did not have irritation potential, according to the in vitro EpiDerm™, reconstituted skin irritation test in the frames of biocompatibility tests. For the mucous membrane irritation test, the hen’s egg test-chorioallantoic membrane experiment was performed, and EWs were found to have no eye irritation. In conclusion, it has been shown that produced EWs with antimicrobial efficacy were found to be safe for skin and eye according to in vitro biocompatibility study studies. Thus, the establishment of a technological infrastructure for the EW production and the use of produced EW as an effective disinfectant in the food, medical, and agricultural areas should be encouraged.

The role of gamma probe activity counts in minimally invasive parathyroidectomy

Aim: The benefit of preoperative gamma probe in the diagnosis of adenoma in patients with histopathologically proven parathyroid (PT) adenomas was examined. Patients, material, methods: 20 patients with positive 99mTc MIBI uptake in PT scintigraphy with primary hyper-parathyroidism were enrolled in this study. 740 MBq 99mTc MIBI were injected 3 h before operation. Counts of four PT regions were obtained with gamma probe before surgery in the operation room. All suspected PT adenomas were resected and histopathologically diagnosed as adenomas. We also obtained counts of the resection region and the resected adenoma with gamma probe after the parathyroidectomy. Preoperative counts of adenoma bearing regions (ABR), non-adenoma bearing regions (NABR), postoperative resection region (PRR), resected adenoma counts (RA) were registered. Statistical analysis was performed by Wilcoxon rank test. Results: The mean counts of ABR, NABR, the PRR and RA were 462 ± 106, 230 ± 66, 164 ± 42, 374 ± 87, respectively. The mean counts from ABR were twofold higher than those of NABR. The PRR mean counts decreased by 64% when compared to the mean counts of ABR and by 55% when compared to the mean counts of RA. The differences in mean counts of ABR and NABR, PRR and ABR, PRR and RA (p <0.01) turned out as statistically significant. Discussion: According to our preliminary results, the region with the highest counts is at least 2 ± 0,4 times higher than the mean of the other three PT regions. Thus, it seems to be significant for PT adenoma. Resection of adenoma may be accepted as successful, if the count of ABR decreased more than 64% with decreased postoperative parathormone levels. Conclusion: This technique should not yet be applied instead of parathormone measurement or frozen technique. But it may replace the frozen technique used for confirmation of the diagnosis during the operation in the future.

Renal Transplantation After Thoracic Endovascular Repair of Type B Aortic Dissection--A Case Report

Because of the strong association between uremia and atherosclerosis, incidence of aortic aneurysms is increasing among renal failure patients awaiting renal transplantation (RT). Successful RTs have been performed in these patients after surgical repair of the aneurysms. Since Parodi et al introduced endovascular aortic aneurysm repair (EVAR) in patients with high risk for conventional surgery, a new era has begun. The 1st successful RT after EVAR was published in 2001. Herein we report the 1st successful RT after thoracic EVAR (TEVAR) reported to date. We performed RT in a 54-year-old man with end-stage renal failure due to diabetic nephropathy, who had undergone TEVAR for type B aortic dissection (TBAD) 6 months earlier. The postoperative period was uneventful and the patient was discharged from the hospital at postoperative day 6 with a serum creatinine of 0.9 mg/dL. At follow-up examination at postoperative 6 months, graft function was stable. Because of its advantages over open surgery, including low mortality and morbidity, TEVAR is becoming more common among renal failure patients with thoracic aortic aneurysms and TBAD. Our case shows that successful RT can be performed in renal failure patients who have undergone TEVAR.

Femoro-femoral Bypass for Graft Salvage in a Renal Transplant Patient With Aorto-iliac Occlusion: A Case Report

As vascular diseases are becoming more prevalent among renal transplant recipients, complications related to renal artery anastomosis are likely to occur more often. Here we report a renal transplant patient treated with femoro-femoral bypass who had renal allograft dysfunction due to aorto-iliac occlusive disease (AIOD) proximal to renal artery anastomosis. We performed living donor renal transplantation in the left iliac fossa of a 41-year-old male. At post-transplant 30 months, he was admitted with hypertension, increase in serum creatinine, and claudication of his left leg. Doppler ultrasonography showed poor flow characteristics of the renal allograft. Total occlusion of the left common iliac artery was diagnosed on angiography. Since endovascular approach was unsuccessful, we performed right-to-left femoro-femoral bypass to provide retrograde blood flow to the renal allograft. The patient was discharged at postoperative day 3 with decreased serum creatinine, normal blood pressure, no claudication, and normal flow characteristics in Doppler ultrasonography. AIOD should be suspected in renal transplant patients in case of hypertension, allograft dysfunction, and ipsilateral leg ischemia. Femoro-femoral bypass is a safe surgical procedure that may be performed in patients who cannot be treated using an endovascular approach.

Production cross–section calculations of medical 32P, 117Sn, 153Sm and 186,188Re radionuclides used in bone pain palliation treatment

In this study, production cross–section calculations of 32P, 117Sn, 153Sm and 186,188Re radionuclides used in bone pain palliation treatment produced by 30Si(d,γ)32P, 118Sn(γ,n)117Sn, 116Sn(n,γ)117Sn, 150Nd(α,n)153Sm, 154Sm(n,2n)153Sm, 152Sm(n,γ)153Sm, 186W(d,2n)186Re, 187Re(γ,n)186Re, 185Re(n,γ)186Re and 187Re(n,γ)188Re reactions have been investigated in the different incident energy range of 0.003–34 MeV. Two-component exciton and generalised superfluid models of the TALYS 1.6 and exciton and generalised superfluid models of the EMPIRE 3.1 computer codes have been used to pre-equilibrium (PEQ) reaction calculations. The calculated production cross–section results have been compared with available experimental results existing in the experimental nuclear reaction database (EXFOR). Except the 118Sn(γ,n)117Sn, 150Nd(α,n)153Sm and 185Re(n,γ)186Re reactions, the two-component exciton model calculations of TALYS 1.6 code exhibit generally good agreement with the experimental measurements for all reactions used in this present study.

Development of an immobilization process for heavy metal containing galvanic solid wastes by use of sodium silicate and sodium tetraborate

Heavy metal containing sludges from wastewater treatment plants of electroplating industries are designated as hazardous waste since their improper disposal pose high risks to environment. In this research, heavy metal containing sludges of electroplating industries in an organized industrial zone of Istanbul/Turkey were used as real-sample model for development of an immobilization process with sodium tetraborate and sodium silicate as additives. The washed sludges have been precalcined in a rotary furnace at 900°C and fritted at three different temperatures of 850°C, 900°C and 950°C. The amounts of additives were adjusted to provide different acidic and basic oxide ratios in the precalcined sludge-additive mixtures. Leaching tests were conducted according to the toxicity characteristic leaching procedure Method 1311 of US-EPA. X-ray diffraction (XRD), X-ray fluorescence (XRF), scanning electron microscope-energy dispersive spectrometer (SEM-EDS) and flame atomic absorption spectroscopy (FAAS) have been used to determine the physical and chemical changes in the products. Calculated oxide molar ratios in the precalcined sludge-additive mixtures and their leaching results have been used to optimize the stabilization process and to determine the intervals of the required oxide ratios which provide end-products resistant to leaching procedure of US-EPA. The developed immobilization-process provides lower energy consumption than sintering-vitrification processes of glass-ceramics.

Human brain mercury levels related to exposure to amalgam fillings

The safety of dental amalgam as the primary material in dental restoration treatments has been debated since its introduction. It is widely accepted that amalgam restorations continuously release elemental mercury (Hg) vapor, which is inhaled and absorbed by the body and distributed to tissues, including the brain. The aim of the present study was to investigate whether the presence of amalgam fillings is correlated with brain Hg level. The Hg levels in the parietal lobes of the brains of 32 cadavers were analyzed with an atomic absorption spectrometer with the mercury hydride system. A total of 32 brain samples were tested; of these, 10 were from cadavers with amalgam fillings, while 22 of them were amalgam free. Hg was detected in 60.0% (6 of 10) of the samples in the amalgam group and in 36.3% (8 of 22) in the amalgam-free group. The average Hg level of the amalgam group was 0.97 ± 0.83 µg/g (minimum: 0.3 µg/g and maximum: 2.34 µg/g), and in the amalgam-free group, it was 1.06 ± 0.57 µg/g (minimum: 0.17 µg/g and maximum: 1.76 µg/g). The results of the present study showed no correlation between the presence of amalgam fillings and brain Hg level.

The Effect of Carnitine on Treatment of Familial Chylomicronemia Syndrome Presenting with Acute Pancreatitis

Familial chylomicronemia syndrome is a disease characterised by hypertriglyceridemia and chylomicronemia. In recent years, carnitine has been used in the treatment of hyperlipidemia and it is reported to be highly effective. We report a patient presenting with acute pancreatitis who through testing was diagnosed with familial chylomicronemia syndrome. We found the use of carnitine treatment in familial chylomicronemia syndrome to be highly effective.