The Possible Role of NLRP3 Inflammasome in Depression and Myocardial Infarction Comorbidity

It is well-established that cardiovascular disease and depression are highly comorbid. This study aimed to assess the possible role of the NOD-like receptor protein 3 (NLRP3) inflammasome pathway and the high-sensitivity C-reactive protein (hsCRP) in patients with incident myocardial infarction in the presence or absence of depression. Sixty-eight consecutive patients with incident ST-elevation myocardial infarction and twenty healthy subjects were included. The patients were assessed using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version during their 1-4-day-long hospitalization and were divided into two groups: with and without comorbid depression. Blood samples for the determination of NLRP3, interleukin-18 (IL-18), interleukin-1β (IL-1β), and hsCRP levels were analyzed using ELISA. NLRP3, IL-1β, IL-18, and hsCRP levels were significantly higher in myocardial infarction patients compared to the healthy group (p = 0.02, p < 0.001, p < 0.001, and p < 0.001, respectively). No significant difference was found between the myocardial groups with and without depression. However, in the logistic regression analysis, the NLRP3 variable in myocardial infarction patients was found to have a significant contribution to the likelihood of depression (p = 0.015, OR = 1.72, and CI = 1.11-2.66). The likelihood of depression is associated with increasing NLRP3 levels in myocardial infarction patients. However, this potential role should be further explored in a larger sample.

[Evaluation of the operator learning curve for radiofrequency ablation for atrioventricular nodal reentrant tachycardia]

Aim    The aim of this study was to determine the average minimum number of slow pathway ablation procedures required to reach a steady success rate among inexperienced operators.Material and Methods    We analyzed the consecutive AVNRT ablation procedures of three inexperienced operators for the rate of operational success and complications.Results    Operators performed a total of 156 AVNRT ablation procedures. There was no statistical significance between the three operators regarding the rate of success (p=0.69) and complications. There were significant differences between the operators in terms of procedure time, fluoroscopy time, and cumulative air kerma. The variability of procedure time and cumulative air kerma, both among three operators and within each operator, decreased significantly after the 25th case. Each operator was analyzed individually for the probability of success as related to the cumulative number of ablations. All trainee operators reached a success rate of 90 % at the 27th procedure.Conclusion    An average of 27 slow pathway ablation procedures should be performed by a beginner operator to achieve proficiency.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Development of an intranasal formulation containing indomethacin and xylometazoline for rhinosinusitis treatment

OBJECTIVE

Use of the nasal route of drug administration dates back many years and is used both to achieve topical treatments and to allow systemic absorption. The objective was to develop a formulation with novel features which enhance prolonged contact with the nasal and sinusal lining, since this should increase any therapeutic benefit. The anti-inflammatory drug selected was indomethacin, which was combined with xylometazoline, an effective nasal decongestant agent.

MATERIALS AND METHODS

28 Sprague-Dawley rats were used. They were then allocated at random to one of the four groups of equal size. All rats received a nasal application of 50mL of the platelet-activating factor solution at a concentration of 16 µg/mL and had induced rhinosinusitis. Indomethacin or xylometazoline HCl or both were dissolved in the oily phase of the solution and then a magnetic stirrer was used to homogenize the solution for 60 min at room temperature. All the O/W solutions exhibited stability and remained at neutral pH for the entire duration of the experiment. The only intervention was application of inactive 0.9% saline in group 1. The intervention was nasal application of xylometazoline and indomethacin in the combined formulation in group. The intervention was nasal application of xylometazoline only in group 3. The intervention was nasal application of indomethacin only in group 4.

RESULTS

For the animals in group 1 (the controls), the mucosa had sustained a significant level of damage and the vessels were highly congested. Inflammatory cells were extensively infiltrating the mucosa. (Figure 1 - A1, 2, 3). In group 2, by contrast, the vessels were hardly congested and there were very few infiltrates. The epithelium appeared completely intact (Figure 1 - B1, 2, 3). Furthermore, when groups 1 and 2 were compared in terms of congested vessels, inflammatory cellular infiltrates and injury to the epithelium, the differences reached statistical significance, with p-values of <0.01, >0.001 and <0.001, respectively. Comparison of groups 2 and 4 with the control group also revealed statistically significant differences in terms of cellular infiltrates (p<0.001) and damage to the epithelium (p<0.001). For the degree of congestion of the vessels, however, the difference between groups was not at the level of statistical significance (p<0.071). Groups 3 and 4 differed at a statistically significant level in terms of degree of congested vessels, cellular infiltrates, and damage to the epithelium (p<0.025 and p<0.001). The sections from rats in groups 2 and 3 had a lower degree of congested vessels, which may be due to the actions of xylometazoline.

CONCLUSIONS

In the future, topically applied intranasal NSAIDs will be valuable formulations. Innovative types of formulation, such as those demonstrating thixotropic behavior, permit the agent to remain in prolonged contact with the nasal and sinusal lining. Alongside increased efficacy, these preparations will also improve the side effect profile of NSAIDs, largely eliminating systemic effects.

An evaluation of the efficacy of indomethacin in experimentally induced acute sinusitis in rats

OBJECTIVE

We evaluated how efficacious indomethacin, at two different doses, is in the treatment of an experimental model of sinusitis in rats.

MATERIALS AND METHODS

Twenty-one Wistar albino rats (all male) were sorted at random into one of three groups: 1st group (n=7) was placebo. 2nd group (n=7). These rats had sinusitis induced experimentally, following indomethacin 3 mg/kg, 5 days was administered to them. 3rd group (n=7). These rats had sinusitis induced experimentally, following indomethacin 6 mg/kg, 5 days was administered to them. The animals' sinonasal mucosae were examined histopathologically by standard light microscopy.

RESULTS

Experimental sinusitis was observed in the 2nd and 3rd groups, but not in the rats administered a placebo. Although the inflammatory features of sinusitis were found to be significantly decreased in the animals administered indomethacin 3 mg/kg (the 2nd group), this anti-inflammatory effect was even greater in the 3rd group, where indomethacin 6 mg/kg had been administered. Indomethacin at either dose was superior to placebo in reducing inflammatory features of sinusitis.

CONCLUSIONS

Topical use of indomethacin nasal drops decreased the inflammatory features in experimentally induced acute sinusitis. Moreover, a higher dose of indomethacin (6 mg/kg) was more efficacious than a lower dose (3 mg/kg). The present study is valuable as an initial step in showing the need to undertake human trials to see the effect of indomethacin nasal drops on sinusitis in humans. In acute rhinosinusitis, the use of topical anti-inflammatory drops may help to decrease the symptoms and may be used adjunctively with antibiotic treatment.

Predictors of positive response to beta-blockers for treatment of premature ventricular complexes

BACKGROUND

The aim of the present study is to investigate the possible factors that might be predictive of effective antiarrhythmic effect of beta-blockers on premature ventricular complexes (PVC).

METHODS

Data of 190 eligible consecutive patients to whom beta-blocker therapy had been initiated for treatment of PVC's were retrospectively evaluated. The Holter recording acquired before beta-blocker initiation and the first Holter acquired after beta blocker initiation during follow up was comprehensively evaluated for each patient. Parameters obtained from pre- and post-beta-blocker 24 h Holter recordings were compared with each other and possible predictors were evaluated for positive response to beta-blocker therapy.

RESULTS

Sixty-one patients (32.1%) were observed to respond beta-blocker therapy with at least 50% reduction of daily PVC burden. Patients who responded to beta-blockers had significantly higher ratio of patients who had positive correlation between hourly heart rate and corresponding hourly PVC number (fast HR-PVC status) compared with non-responders (73.8% vs 48.1%, p < 0.001). Binary logistic regression analysis revealed PVC QRS width (Odds ratio: 0.971; p: 0.037) and fast HR-PVC status (Odds ratio: 2.935; p: 0.007) as the independent predictors of positive response to beta-blockers for treatment of PVC.

CONCLUSION

Positive correlation between hourly heart rate and PVC incidence was found to be independent positive predictor and PVC QRS width was found to be independent negative predictor of beta-blocker success in our study. This observation might have important clinical implications to guide medical treatment of PVCs in clinical practice.

Predictors of adequate intraprocedural premature ventricular complex (pvc) frequency during idiopathic pvc ablation

Funding Acknowledgements

Type of funding sources: None.

Background

The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs.

Methods

A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00–06:00) over day time (06:00–22:00) PVC burden was calculated. Patients were classified into three groups based on the relationship between hourly PVC number and HR. If there was a significant positive correlation between hourly PVC number and corresponding hourly HR, patients were classified into the fast HR-PVC group. If there was a significant negative correlation between hourly PVC number and corresponding hourly HR, patients were classified into the slow HR-PVC group. Patients were classified into the independent HR-PVC group if there was no significant correlation between hourly PVC number and corresponding hourly HR. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping.

Results

In all, 74 patients had frequent intraprocedural PVC that permitted activation mapping (Group 1) and 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure (Group 2). PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate (Fast HR-PVC 42 (56.8%) vs 18 (66.6%); slow HR-PVC  4(5.4%) vs 3 (11.1%); independent HR PVC 28 (37.8%) vs 6 (22.2%) in the respective order for group 1 and group 2; p: 0.26) or the ratio of night/day PVC burden (median 0.99 (IQR 0.4) vs median 0.83 (IQR 0.54) in the respective for group 1 and group 2 ; p: 0.53). Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. A Holter PVC burden ≥ 19.43% had 72% sensitivity and 60% specificity for the prediction of sufficient intraprocedural PVCs that permitted activation mapping and ablation (area under the curve: 0.65; p: 0.02)

Conclusion

The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.

Predictors of adequate intraprocedural premature ventricular complex (PVC) frequency during idiopathic PVC ablation

BACKGROUND

The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs.

METHODS

A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00-06:00) over day time (06:00-22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping.

RESULTS

In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping.

CONCLUSION

The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.

Radiation furnace for synchrotron dark-field x-ray microscopy experiments

We present a multi-purpose radiation furnace designed for x-ray experiments at synchrotrons. The furnace is optimized specifically for dark-field x-ray microscopy (DFXM) of crystalline materials at beamline ID06 of the European Synchrotron Radiation Facility. The furnace can reach temperatures above 1200 °C with a thermal stability better than 10 °C, with heating and cooling rates up to 30 K/s. The non-contact heating design enables samples to be heated either in air or in a controlled atmosphere contained within a capillary tube. The temperature was calibrated via the thermal expansion of an α-iron grain. Temperature profiles in the y and z axes were measured by scanning a thermocouple through the focal spot of the radiation furnace. In the current configuration of the beamline, this furnace can be used for DFXM, near-field x-ray topography, bright-field x-ray nanotomography, high-resolution reciprocal space mapping, and limited powder diffraction experiments. As a first application, we present a DFXM case study on isothermal heating of a commercially pure single crystal of aluminum.

Mapping of individual dislocations with dark-field X-ray microscopy

This article presents an X-ray microscopy approach for mapping deeply embedded dislocations in three dimensions using a monochromatic beam with a low divergence. Magnified images are acquired by inserting an X-ray objective lens in the diffracted beam. The strain fields close to the core of dislocations give rise to scattering at angles where weak beam conditions are obtained. Analytical expressions are derived for the image contrast. While the use of the objective implies an integration over two directions in reciprocal space, scanning an aperture in the back focal plane of the microscope allows a reciprocal-space resolution of ΔQ/Q < 5 × 10−5 in all directions, ultimately enabling high-precision mapping of lattice strain and tilt. The approach is demonstrated on three types of samples: a multi-scale study of a large diamond crystal in transmission, magnified section topography on a 140 µm-thick SrTiO3 sample and a reflection study of misfit dislocations in a 120 nm-thick BiFeO3 film epitaxially grown on a thick substrate. With optimal contrast, the half-widths at half-maximum of the dislocation lines are 200 nm.

Reciprocal space mapping and strain scanning using X-ray diffraction microscopy

Dark-field X-ray microscopy is a new full-field imaging technique for nondestructively mapping the structure of deeply embedded crystalline elements in three dimensions. Placing an objective in the diffracted beam generates a magnified projection image of a local volume. By placing a detector in the back focal plane, high-resolution reciprocal space maps are generated for the local volume. Geometrical optics is used to provide analytical expressions for the resolution and range of the reciprocal space maps and the associated field of view in the sample plane. To understand the effects of coherence a comparison is made with wavefront simulations using the fractional Fourier transform. Reciprocal space mapping is demonstrated experimentally at an X-ray energy of 15.6 keV. The resolution function exhibits suppressed streaks and an FWHM resolution in all directions of ΔQ/Q = 4 × 10−5 or better. It is demonstrated by simulations that scanning a square aperture in the back focal plane enables strain mapping with no loss in resolution to be combined with a spatial resolution of 100 nm.

An Assessment of Oxidant/Antioxidant Status and Oxidative Stress Index Levels in Patients with Carbon Monoxide Poisoning

Objective

The purposes of this study is to evaluate the variations of total antioxidant status (TAS) and total oxidant status (TOS) levels in the treatment process of carbon monoxide poisoning (COP) and to learn more about the pathophysiology of COP.

Methods

Between 2011 and 2012, 113 patients were admitted to our emergency department with acute COP, and 50 healthy volunteers were used as a control group in this study. Serum, plasma and erythrocyte components were prepared for all the COP patients on admission. They were repeated at the 90th and 180th minute of treatment. The samples were taken once from the control group. Serum oxidant/antioxidant status levels and carboxyhaemoglobin (COHb) were measured. Ratio of TOS to TAS, known as oxidative stress index (OSI) was calculated.

Results

No correlation was observed among age, gender, COHb level, with the levels of TAS, TOS, and OSI. Admission levels of TOS and OSI in patients with COP were higher than that observed at 90th minutes (p<0.001). These values were also higher in COP patients compared to control group (p<0.001). On the other hand, no statistical differences were observed in TAS levels between the study and control groups (p>0.05).

Conclusions

Our results show that serum TOS and OSI levels increase in COP patients. Oxidative stress should play a role in the pathophysiology of COP. (Hong Kong j.emerg.med. 2013;20:352-358)

Factors Affecting Dental Job Satisfaction

In this cross-sectional study, a randomly selected group of dentists (n = 855) from nine provinces of Turkey were interviewed for their levels of intrinsic, extrinsic, and overall job satisfaction. The proportion of overall job satisfaction was computed as the proportion of dentists who had mean general satisfaction scores 4 on a 5-point, Likert-type scale and was found to be 40.8% for the sample as a whole. The significant factors that affected overall satisfaction were age, the type of social insurance possessed, income level, the presence of dental auxiliaries, and the number of patients examined per day. Multivariate analysis of the data revealed that the type of social insurance, the amount of monthly income, and the number of patients examined per day were the most common and statistically significant predictors of intrinsic, extrinsic, and overall satisfaction in Turkish dentists.

Revealing the role of molecular rigidity on the fragility evolution of glass-forming liquids

If quenched fast enough, a liquid is able to avoid crystallization and will remain in a metastable supercooled state down to the glass transition, with an important increase in viscosity upon further cooling. There are important differences in the way liquids relax as they approach the glass transition, rapid or slow variation in dynamic quantities under moderate temperature changes, and a simple means to quantify such variations is provided by the concept of fragility. Here, we report molecular dynamics simulations of a typical network-forming glass, Ge-Se, and find that the relaxation behaviour of the supercooled liquid is strongly correlated to the variation of rigidity with temperature and the spatial distribution of the corresponding topological constraints, which ultimately connect to the fragility minima. This permits extending the fragility concept to aspects of topology/rigidity, and to the degree of homogeneity of the atomic-scale interactions for a variety of structural glasses.

Delayed diagnosis of Eosinophilic Fasciitis: a case report and review of the literature

Eosinophilic fasciitis is an uncommon entity characterized by edema, skin thickening and hyperpigmentation of extremities. Laboratory findings are variable and may include hypergammaglobulemia, peripheral eosinophilia and elevated acute phase reactants. A full-thickness skin/fascia/muscle biopsy is the gold standart for diagnosis. Since EF is an uncommon disorder and the clinic presentation mimics scleroderma, it takes a long time to make definitive diagnosis. We present a case diagnosed two years after its onset and responded well to the treatment. We also include herein the results of our literature survey regarding delayed diagnosis of Eosinophilic Fasciitis.

Decreased photoreceptor inner segment/outer segment junction reflectivity in patients with idiopathic epimacular membrane

PURPOSE

To assess the effects of idiopathic epimacular membrane (IEMM) on retinal pigment epithelium (RPE), photoreceptor inner segment/outer segment (IS/OS) junction, and external limiting membrane (ELM) reflectivities to determine functional alterations in these layers using optical coherence tomography (OCT) image analysis.

METHODS

Fifty eyes of 50 patients with untreated IEMM and 41 eyes of 41 age- and sex-matched healthy controls with normal OCT scans were retrospectively reviewed. A single masked physician analyzed OCT images randomly. Reflectivity values of RPE, IS/OS junction, and ELM were obtained using 'plot profile' mode of a medical image processing computer software.

RESULTS

The study comprised 50 patients with untreated IEMM and age- and sex-matched 41 control subjects (P > 0.05). Image analysis demonstrated that IS/OS junction and ELM had significantly lower reflectivity in patients with IEMM compared with those of the control eyes (P = 0.008, P = 0.009, respectively). However, RPE reflectivity did not differ between two groups (P = 0.100). Correlation analyses showed no significant associations between reflectivity values and corrected visual acuity (P > 0.05).

CONCLUSION

In patients with IEMM, photoreceptor IS/OS junction and ELM seem to have lower reflectivity, which might indicate impaired functionality even though these layers are not apparently damaged on OCT imaging.

Expanding the phenotypic spectrum of ECEL1-related congenital contracture syndromes

Using a combination of homozygosity mapping and whole-exome sequencing (WES), we identified a novel missense c.1819G>A mutation (G607S) in the endothelin-converting enzyme-like 1 (ECEL1) gene in a consanguineous pedigree of Turkish origin presenting with a syndrome of camptodactyly, scoliosis, limited knee flexion, significant refractive errors and ophthalmoplegia. ECEL1 mutations were recently reported to cause recessive forms of distal arthrogryposis. This report expands on the molecular basis and the phenotypic spectrum of ECEL1-associated congenital contracture syndromes.

Simple calcaneal bone cysts: a pilot study comparing open versus endoscopic curettage and grafting

This pilot study analysed the outcome of open versus endoscopic curettage and bone grafting for the treatment of simple calcaneal bone cysts. A total of 26 patients were evaluated into two equal groups: group 1 was treated with traditional open curettage and bone grafting and group 2 was treated with endoscopic curettage and percutaneous bone grafting. Cyst size, operating time, length of stay, time to healing, complications, further surgery and radiological healing were recorded and differences were statistically compared. The mean age of the patients was 22.9 years (18 to 28) and the mean follow-up was 28.7 months (24 to 36). There were no statistically significant differences in regard to age of patients, cyst size and the follow-up periods in the two groups. The operating time and mean length of stay of group 2 patients was significantly shorter than group 1 patients (p < 0.001). The time to healing was similar in the two groups. The overall success rates for groups 1 and 2 were 92.3% (12 of 13) and 100% (13 of 13), respectively, and there were no statistically significant differences regarding radiological healing. This pilot study suggests that endoscopic curettage and percutaneous grafting is a simple and safe form of treatment, with similar results to those following open treatment.

Low risk stage I endometrial carcinoma: prognostic factors and outcomes

OBJECTIVES

The aim of the study is to evaluate clinical features of patients with low-risk stage I endometrium cancer, who received adjuvant therapy or followed with observation only and to analyse the effects of known prognostic factors in this group of patients.

MATERIALS AND METHODS

A total of 246 patients (median age: 53, range: 31-77) with low-risk stage I endometrial cancer, who were just followed postoperatively (156 patients) or received adjuvant radiotherapy (90 patients) between 1996 and 2007 were reviewed retrospectively.

RESULTS

Local recurrence was detected in four patients, distant metastasis occurred in seven patients, and two patients had both local recurrence and distant metastasis. The 83.3% of recurrences were on the vaginal stump. Five- and ten-year local control (LC) and overall survival (OS) rates are 97.6%, 97.6% and 96.4%, 93.5% in the observation and adjuvant therapy groups, respectively, whereas distant control rates are 96.7% and 96.3%. In multivariate analysis, only age and lymphovascular invasion (LVI) were found to affect OS and disease-free survival (DFS).

CONCLUSIONS

LC and OS rates are high in the low-risk group of patients; however, current adjuvant therapies did not improve the outcomes. Age over 60 years and the presence of LVI have negative effects on outcomes in this group of patients.

Prognostic factors and treatment outcomes in patients with operated endometrial cancer: analysis of 674 patients at a single institution

PURPOSE

Endometrial carcinoma is the most prevalent gynecologic tumor in developed countries. The aim of the present study was to evaluate the clinical characteristics of the patients with endometrial cancer.

METHODS

Six hundred and seventy-four patients who had received postoperative therapy were retrospectively investigated. Of the cases, 186 were only monitored, whereas 43 received intracavitary radiotherapy (ICRT) and 54 external beam radiotherapy (EBRT). Two hundred and fifty-nine patients received both EBRT plus ICRT. Eight patients received chemotherapy (CT), whereas 24 patients received both CT and EBRT plus ICRT.

RESULTS

Statistical analyses revealed that age, menopausal status, tumor histology, stage, grade, tumor diameter, myometrial invasion, lymphovascular space invasion (LVI), positive cytology of abdominal fluid/washings, omental involvement, adnexal involvement and the type of the therapy significantly affected both the overall survival (OS) and disease- free survival (DFS). Survival was poor in patients over 60 years of age, who had advanced stage (higher than FIGO stage 2a), grade III tumor and myometrial invasion >50%.

CONCLUSION

Age was the most important factor associated with local relapse while survival was affected by age, grade, myometrial invasion and stage.

Insulin inhibits tissue factor expression in monocytes

OBJECTIVES

Platelets from healthy subjects are inhibited by insulin but type 2 diabetes mellitus (T2DM) platelets have become insulin-resistant, which might explain their hyperactivity. In the present study we investigated whether monocytes are responsive to insulin.

METHODS AND RESULTS

LPS-induced tissue factor (TF) upregulation was measured in human monocytes and monocytic THP-1 cells in a factor Xa generation assay. Insulin (0.1-100 nmol L(-1)) induced a dose-dependent inhibition in both cell types and in monocytes 100 nmol L(-1) insulin inhibited cytosolic, membrane-bound and microparticle TF by 32 +/- 2, 27 +/- 3 and 52 +/- 4% (n = 3). Insulin induced Tyr phosphorylation of the insulin receptor (INS-R) and formation of an INS-R - G(i)alpha(2) complex, suggesting interference with LPS-induced cAMP control. Indeed, insulin interfered with LPS-induced cAMP decrease and TF upregulation in a manner similar to an inhibitor of G(i) (pertussis toxin) and agents that raise cAMP (iloprost, forskolin, IBMX) reduced TF upregulation. Although LPS failed to raise cytosolic Ca(2+), quenching of Ca(2+) increases (BAPTA-AM) reduced and induction of Ca(2+) entry (ionophore, P2X7 activation) enhanced upregulation of TF mRNA and procoagulant activity. Insulin interfered with MCP-1-induced Ca(2+) mobilization but not with ATP-induced Ca(2+) rises.

CONCLUSIONS

Insulin inhibits TF expression in monocytes and monocyte-derived microparticles through interference with G(i)alpha(2)-mediated cAMP suppression, which attenuates Ca(2+)-mediated TF synthesis.

Long-Term Pulmonary Histopathologic Changes in Rats Following Acute Experimental Exposure to Chlorine Gas

In this study, we aimed to investigate the long-term histopathologic changes in the lungs of rats exposed to a high concentration of chlorine gas. Twenty-four Sprague-Dawley rats were divided into three groups: the control group (group I) (n = 8), early-examined group (group II) (n = 8), and late-examined group (group III) (n = 8). In group II the lungs of rats were taken out just after the exposure, whereas in group III the lungs were taken out 45 days after the exposure. Eosinophilic liquid accumulation in alveoli and bronchi, diffuse intraalveolar edema, vascular congestion, severe perivascular edema, and free bleeding in intraalveolar and interstitial area were observed in the lungs of rats in group II. Interstitial fibrosis and thickening of the alveolar septa were observed in group III. These findings suggest that the people using these cleaning agents are at risk of harming themselves, and the victims of chlorine gas injury should be reexamined at a later period since they may have pulmonary damage even after 45 days of exposure.

Urodynamic outcome of waterjet-assisted total mesorectal excision

Background

Waterjet dissection has been proposed for total mesorectal excision. The present study investigated its impact on urodynamic function and oncological outcome.

Methods

Thirty patients with rectal cancer were recruited to this prospective study, of whom 25 underwent urodynamic evaluation both before and after surgery.

Results

All patients were capable of spontaneous micturition at a median of 5 months after surgery. Urodynamic measurements revealed a decrease in detrusor pressure of more than 30 mmHg, and residual urine volumes of between 100 and 200 ml, in three patients. No patient had a complete neurogenic voiding disorder. Local recurrences developed in two of 22 patients.

Conclusion

The extent of micturition disorders observed after total mesorectal excision using the waterjet method in this small series is encouraging.

Intraoperative coronary graft flow determination--does it have a prognostic value for midterm graft patency?

OBJECTIVE

To characterise the prognostic value of intraoperative ultrasonic graft flow determination during CABG for mid-term patency.

METHODS

From 01/2000 to 08/2003 3146 CABG procedures were performed at our institution. Graft flow was determined in all patients. Lumen diameter was given in mm and a sclerosis score was applied for the target vessel. 100 of these patients (3.2%) underwent postoperative coronary angiography at a mean time interval of 8.0 +/- 0.5 months.

RESULTS

In 100 patients, 114 LITA and 204 venous anastomoses were performed. At re-angiography 112 LITA (98%) and 174 venous (85%) anastomoses were patent. The amount of occluded LITA grafts was to low to perform statistical analyses. Mean graft flow of patent vein grafts was 48 +/- 2 ml/min vs. 32 +/- 4 ml/min in occluded vein grafts (p = 0.001). After multiple logistic regression analysis, only intraoperative vein graft flow was found to be a predictor for patency at mid-term (p = 0.005, odds ratio 0.97, 95% confidence interval (CI) from 0.95-0.99). No differences were found concerning sclerosis scores or vessel lumen between patent and occluded grafts.

CONCLUSIONS

Significant differences concerning intraoperative graft flow were found between vein grafts patent or occluded at re-angiography. The predictive power of intraoperative vein graft flow for mid-term patency was confirmed by multiple logistic regression analysis.

Reinforcement effect of polyethylene fibre in root-filled teeth: comparison of two restoration techniques

AIM

To compare in vitro two different fibre placement techniques on reinforcement of root-filled molar teeth with mesio-occluso-distal (MOD) cavities.

METHODOLOGY

Fifty sound extracted human mandibular molars were used (n = 10). Group 1 served as control. From group 2-5, endodontic access and standard MOD cavities were prepared. Following root canal treatment, group 2 was kept unrestored. In groups 3 and 4, the teeth were restored with composite resin (AP-X; Kuraray, Japan). A groove was prepared on occlusal surface of the finished restorations in group 4 from buccal to lingual direction. Polyethylene woven fibre (Ribbond; Seattle, WA, USA) was inserted in the groove in combination with flowable resin that was cured for 20 s and covered with composite resin. Cavity surfaces were covered with flowable resin in group 5, and polyethylene fibre was placed into the bed of resin in a buccal to lingual direction before the composite restoration was placed. All specimens were stored in 100% humidity at 37 degrees C for 24 h. Compressive loading of the teeth was performed by a universal testing machine at a crosshead speed of 0.5 mm min(-1) until failure. The data were recorded in Newton and submitted to anova and Tukey post hoc test.

RESULTS

The mean load necessary to fracture the samples in each group was: G1: 1671.57 +/- 131.54(a); G2: 375.21 +/- 34.30(b); G3: 749.47 +/- 124.54(c); G4: 1224.36 +/- 132.17(d); G5: 926.88 +/- 118.28(e). Different superscript letters demonstrate significant difference between groups.

CONCLUSIONS

Polyethylene fibre use over or under MOD composite restorations significantly increased fracture strength. However, when the fibre was placed on the occlusal surface of the restoration in buccal to lingual direction, significantly higher fracture resistance was observed.

Renal infarction mimicking renal colic in patient with a prosthetic aortic valve

A 31 year old man with prosthetic aortic valve replacement presented with sudden onset of colic right flank pain. Analysis of the urine revealed haematuria, and the international normalised ratio was suboptimal. The patient was misdiagnosed as having ureteral colic. On the second day, an ultrasound showed no signs of obstructive uropathy, and there was no evidence of absent function on intravenous pyelogram. Computed tomography with contrast agent was performed and revealed a right renal infarction. Renal angiography demonstrated total occlusion of the right renal artery. Fibrinolytic therapy and angioplasty were unsuccessful. To our knowledge, aortic prosthetic valve thrombus as a source of renal artery embolism mimicking renal colic has not been reported previously. This case underlines the importance of renal colic as a manifestation of renal infarction in patients with prosthetic valves and the need for a high index of suspicion of renal embolism.

Laparoscopic surgery in the old patient: do indications and outcomes differ?

BACKGROUND AND AIMS

In view of the increasing numbers of old and very old people in the general population, we evaluated the short-term outcomes of laparoscopic colorectal surgery for differences between younger and older patients.

METHODS

A total of 4,823 patients with complete data sets from a prospective, clinical observational multicentre study initiated by the "Laparoscopic Colorectal Surgery Study Group" were analysed for this investigation.

RESULTS

Of the patients, 909 (18.8%) were older and 3,914 (81.2%) younger than 75 years. In the older patient group, malignant disease was a significantly more common indication for surgery. As was expected, the rate of general complications (pneumonia, cardiopulmonary problems, urinary tract infection) was significantly higher in the older patient group with its greater prevalence of preoperative comorbidity, but there no differences in terms of intraoperative or postoperative surgical complications or conversion rate between the groups.

CONCLUSION

The higher rate of postoperative complications resulting from preoperative comorbidity in the older patients makes it necessary that the indication for surgery be established with care. In view of the advantages of the laparoscopic approach with regard to the postoperative course, the preferential use of laparoscopy for the treatment of colorectal problems requiring surgery in older patients should receive serious consideration.

Protective effects of antithrombin III on retinal ischemia/reperfusion injury in rats: a histopathologic study

PURPOSE

To investigate the effect of antithrombin III (AT III) on retinal ischemia/reperfusion (I/R) injury in rats.

METHODS

The study was carried out on 10 Wistar albino rats (20 eyes) and four-vessel occlusion method was employed to induce retinal ischemia in this study. Rats were divided into two groups: Group I (control group, 10 eyes) and Group II (AT III, 10 eyes). In both groups, vertebral arteries were occluded bilaterally an electric needle coagulator under an operating microscope. A total of 48 hours after the initial procedure, the rats were re-anesthetized and both common carotid arteries were clamped to interrupt blood flow. In Group II, rats were injected intravenously with 250 U/kg of AT III 5 minutes before the induction of ischemia. Duration of ischemia was 30 minutes. At the end of this period, clamp was removed for the reperfusion of the eye for 4 hours. Following the reperfusion period, the animals were killed by decapitation. Retinal sections were evaluated under light and electron microscope. The signs of I/R injury at the microscopic level, i.e., cellular degeneration, vacuolization between retinal layers, increase in the retinal thickness due to edema, mononuclear cell infiltration, and apoptotic cells, were recorded for each group.

RESULTS

Retinal sections obtained from the rats in the AT III group revealed a well preserved retinal structure. When average thickness values of the two groups were compared to each other, the difference was significant with respect to inner nuclear and inner plexiform layers indicating increased retinal thickness values in Group I due to tissue edema resulting from I/R injury. Similarly, mononuclear cell infiltration and apoptotic cell counts were found to be significantly higher in control group compared to AT III group showing the inhibitory effect of AT III on leukocyte infiltration and apoptotic cell death in rat retina.

CONCLUSIONS

Antithrombin III attenuated I/R injury in rat retina.

Total mesorectal excision with the water-jet-dissection. Technique and results

BACKGROUND

The introduction of total mesorectal excision (TME), in particular, has resulted in a dramatic decrease in postoperative functional disorders. Strict adherence to the dissection planes described above, is the prerequisite for good oncological and functional outcome. To facilitate dissection, we have introduced the high-pressure water jet dissector into our surgical routine for the treatment of rectal cancer. Below, we describe the technique of total mesorectal excision we employ in our department and present our perioperative surgical results.

METHODS

We performed total mesorectal excision for rectal cancer on 49 patients, comprising 32 males and 17 females aged between 34 and 88 years. 38 patients underwent low anterior resection of the rectum and 11 patients abdominoperineal resection.

RESULTS

The mean operating time was 282 min, mean intraoperative administration of red cell concentrates was 0.55 units. The mean postoperative stay in the ICU was 1.92 days. Anastomotic leakage occurred in 6.1%, wound healing disturbances in 12.2%, urinary tract infection in 12.2% intra-abdominal infection in 4.1% and faecal fistula in 4.1%. Urinary tract infections occurred in 12.2%. Postoperative temporary neurogenic voiding disturbances occurred in 14.3%. Persistent neurogenic bladder dysfunction after three months could be observed in 6.1%.

CONCLUSIONS

The perioperative results are comparable to those of centres of excellence in the international literature. The Hydro-Jet dissector significantly facilitated TME. The particular feature of this technical aid is that it permits the rapid early development of the embryological plane between the pelvic nerves and the mesorectal fascia, without doing damage to either of them. This leads to optimal radicality and 1 maximum preservation of the autonomic nerves. Before a definitive pronouncement on voiding disturbances can be made, however, we consider it necessary to carry out a prospective randomised study with preoperative and postoperative urodynamic investigations.

Results of laparoscopic treatment of rectal cancer: analysis of 520 patients

BACKGROUND

To evaluate short- and long-term outcomes of laparoscopic resection of rectal carcinoma in curative intent.

METHODS

Within a subgroup analysis of a multicentre study, initiated by the "Laparoscopic Colorectal Surgery Study Group (LCSSG)", 520 patients with rectal cancer were included in a prospective, clinical observational study.

RESULTS

One hundred and ninety patients underwent an abdominoperineal resection (APR) and 330 patients an anterior resection (AR) of the rectum. The demographic parameters, intraoperative complication rates, morbidity and mortality rates were comparable in both groups. In patients undergoing AR a trend towards limited oncologic radicality, and a significant increase in the anastomotic leak rate related to the distance of the tumour from the anal verge were observed. Calculated survival data revealed stage-related survival rates for UICC stages I, II and III of 82.0%, 68.8% and 63.3%, respectively.

CONCLUSIONS

While APR is highly suited to the laparoscopic approach, laparoscopic AR cannot at present be generally recommended.

Prevalence of rheumatoid arthritis in Antalya, Turkey

The aim of this study was to evaluate the prevalence of rheumatoid arthritis (RA) in Antalya, Turkey. A cross-sectional study was performed face-to-face using a structured interview. Subjects were asked whether they had arthritis at present or previously. Subjects suspected of having RA were invited to the hospital for physical examination and laboratory investigations. Diagnosis of RA was confirmed if the patient fulfilled 1987 American College of Rheumatology (ACR) criteria for RA. A total of 3173 subjects were interviewed. The diagnosis of RA was established in 12 subjects. The prevalence of RA was determined as 0.38% [95% confidence interval (CI): 0.16-0.59]. The mean age was 49.92+/-11.56 years in subjects with RA and greater than that of other subjects (p<0.001). Of 12 subjects with RA, 9 had previously been diagnosed with the disease. Rheumatoid factor was detected in the sera of eight subjects. RA is less frequent in Turkey than in Northern Europe. Different genetic and environmental factors may have a role in this result.

Complications in laparoscopic colorectal surgery: results of a multicentre trial

BACKGROUND

We present a prospective observational multicentre study of 4834 consecutive cases undergoing laparoscopic colorectal procedures.

METHODS

The study was initiated on 1 August 1995, with centres from Germany, Austria and Switzerland participating. All patients undergoing laparoscopic colorectal surgery were included, and no selection criteria were applied.

RESULTS

Between August 1995 and April 2004, the participating centres treated 4834 patients. Three thousand, one hundred and sixty-six operations were performed for benign indications, and 1668 for cancer, with most operations being done for diverticulitis (2019, 41.8%). The conversion rate was 5.6%, and the overall morbidity was 20.1%. Intra-operative complications occurred in 5.9%, postoperative complications in 14.0%, and the overall anastomotic leak rate was 3.1% (colon 2.6%, rectum 11.9%). The 30-day mortality rate was 1.3%.

CONCLUSIONS

It has been our experience that laparoscopic surgery for colorectal disease is safe. Morbidity and mortality are comparable to those of conventional colorectal surgery.

The association of milk consumption with the occurrence of symptomatic knee osteoarthritis

OBJECTIVE

To evaluate the association of nutritional factors with symptomatic knee OA.

METHODS

This cross-sectional study was performed face-to-face using a structured interview. Individuals who had a diagnosis of symptomatic knee OA and were aged 50 years or over were included in this study. The frequency of consumption of dairy products, meat/poultry, fish, cereals, vegetables, tea and coffee were also determined. The diagnosis of knee OA was made clinically or clinically and radiologically according to the ACR criteria for knee OA.

RESULTS

A total of 655 subjects was interviewed. The frequency of symptomatic knee OA was significantly lower in daily milk consumers (p < 0.05). Tea consumption was also inversely associated with symptomatic knee OA (p < 0.05), although other nutritional elements showed no significant relationship with OA.

CONCLUSION

Milk consumption may have beneficial effects on symptomatic knee OA.

Utilisation of dental services in Turkey: a cross-sectional survey

AIM

To assess the factors affecting the utilisation of dental service in Turkey.

METHOD

A cross-sectional study using a sample of 866 adults randomly selected from nine provinces, collecting data on socio-demographic characteristics, frequency of dental visits and attitudes toward dental services in face-to-face interviews.

RESULTS

40.4% of adults had visited a dentist within the previous year. Logistic regression analysis showed that gender and educational level were significant factors affecting the utilisation of dental services, with women using dental services significantly more than men and those having higher education compared to those having low education. Satisfaction from the services of the private dental offices and private hospitals was higher than from state hospitals. Age, reasons for dental visit and the place of the last visit were found to be the most significant predictors of satisfaction.

CONCLUSION

Utilisation of dental services is low amongst Turkish adults. Women and individuals with higher levels of education use dental services more than others. The majority of the people prefer private dental offices, where the patient satisfaction is high.