The Use of Precision Epigenetic Methods for the Diagnosis and Care of Stable Coronary Heart Disease Reduces Healthcare Costs

INTRODUCTION

The cost of secondary prevention of coronary heart disease (CHD) is continuing to increase, with a substantial portion of this acceleration being driven by the expense of confirmatory diagnostic testing. Conceivably, newly developed precision epigenetic technologies could drive down these costs. However, at the current time, their impact on overall expense for CHD care is poorly understood. We hypothesized that the use of a newly developed, highly sensitive, and specific epigenetic test, PrecisionCHD, could decrease the costs of secondary prevention.

METHODS

To test this hypothesis, we constructed a budget impact analysis using a cost calculation model that examined the effects of substituting PrecisionCHD for conventional CHD diagnostic tests on the expenses of the initial evaluation and first year of care of stable CHD using a 1-year time horizon with no discounting.

RESULTS

The model projected that for a commercial insurer with one million members, full adoption of PrecisionCHD as the primary method of initial CHD assessment would save approximately $113.6 million dollars in the initial year.

CONCLUSION

These analyses support the use of precision epigenetic methods as part of the initial diagnosis and care of stable CHD and can meaningfully reduce cost. Real-world pilots to test the reliability of these analyses are indicated.

The relationship between hemoglobin-RDW ratio and clinical outcomes in patients with advanced pancreas cancer

OBJECTIVE

The prognostic significance of hemoglobin (HGB) -red cell distribution width (RDW) ratio (HRR) has been indicated in various cancer types. However, its clinical significance in patients with metastatic pancreas cancer (MPC) is unknown. In this study, we aimed to investigate the prognostic importance of pre-treatment HRR in patients with metastatic pancreas cancer.

PATIENTS AND METHODS

MPC patients (≥18 years of age) who received at least one course of chemotherapy between January 2001 and January 2021, were evaluated retrospectively in terms of pre-treatment HRR values.

RESULTS

Of 111 patients, the mean HRR value was 0.84, and the patients were divided into low HRR and high HRR groups. The median follow-up was 8.7 months (95% CI 1.8-51.6). The median duration of first-line treatment was 4.4 months (95% CI 0.5-31.3). The median overall survival (OS) was 7.6 months (95% CI 3.4-11.8) in the low HRR group and 8.7 months (95% CI 5.7-11.8 months) in the high HRR group (p=0.276) (Figure 1). The median progression-free survival (PFS) was 4.2 months (95% CI 2.7-5.6 months) in the low HRR group and 5.1 months (95% CI 2.8-7.4 months) in the high HRR group (p=0.044) It was found that high HRR decreased progression event in both univariate (HR 0.67, 95% CI 0.45-0.99, p=0.046) and multivariate (HR 0.62, 95% CI 0.42-0.93, p=0.022) analysis.

CONCLUSIONS

The present study emphasized that low HRR was a poor prognostic factor for PFS in patients with MPC. There was no statistically significant difference between the HRR groups regarding OS. This is the first study evaluating the prognostic significance of HRR in MPC.

Can transcription factors in the intervertebral disc of lopinavir/ritonavir prevent degeneration in the nucleus pulposus by mediating the regulation of inflammation through signaling pathways?

OBJECTIVE

This study was conducted to examine whether lopinavir/ritonavir (Lop/r), an HIV protease inhibitor, can improve disc physiology and slow down intervertebral disc (IVD) degeneration through in vitro experimental methods, as well as whether it can suppress inflammation with interleukin-1 beta (IL-1β) and sex-determining region Y (SRY) protein-related high-mobility group box genes-9 (SOX9) through hypoxia-inducible factor 1-alpha (HIF-1α) and the nuclear factor kappa B (NF-κB) signaling pathway. The aim was to investigate whether Lop/r application is toxic to IVD cells and the microenvironment simultaneously.

PATIENTS AND METHODS

Human primary cell cultures were prepared using herniated IVD tissues obtained from patients with lumbar disc hernia who were unresponsive to conservative and medical treatment, and thereby, were operated on. The untreated culture samples served as control group, and the samples treated with Lop/r served as study group. Microscopic evaluations were performed simultaneously using fluorescent and supravital dyes in all groups. In addition to cell viability, toxicity, and proliferation analysis through a commercial kit, IL-1β, SOX9, HIF-1α, and NF-κB protein expressions were evaluated using Western blotting. In the statistical comparison of the obtained data, an alpha value less than 0.05 was considered significant.

RESULTS

Cell proliferation decreased in the Lop/r group, but no cell death was observed (p < 0.05). Moreover, at the end of 72 hours after Lop/r application, IL-1β and NF-kB protein expressions decreased by 40% and 52%, respectively, while HIF-1α and SOX9 protein expressions increased by 4% and 59%, respectively (p< 0.05).

CONCLUSIONS

Although these data were obtained from an in vitro experimental study, it is believed that these findings could make significant contributions to the pharmaco-regenerative treatment modalities of IVD degeneration. Lop/r suppresses the IL-1β and NF-κB and induces SOX9 and HIF-1α, since these signaling pathways may be related to human IVD degeneration.

Intervention for Hepatic and Pulmonary Metastases in Breast Cancer Patients: Prospective, Multi-institutional Registry Study-IMET, Protocol MF 14-02

BACKGROUND

One fourth of early-stage breast cancer cases become metastatic during the follow-up period. Limited metastasis is a metastatic disease condition in which the number of metastatic sites and the extent of the disease both are limited, and the disease is amenable to metastatic intervention. This prospective study aimed to evaluate intervention for limited metastases in the lung, liver, or both.

METHODS

The study enrolled luminal A/B and/or human epidermal growth factor receptor 2 (HER2)-neu+ patients with operable lung and/or liver metastases in the follow-up assessment after completion of primary breast cancer treatment and patients with a diagnosis of metastasis after 2014. Demographic, clinical, tumor-specific, and metastasis detection-free interval (MDFI) data were collected. Bone metastasis in addition to lung and liver metastases also was included in the analysis. The patients were divided into two groups according to the method of treatment for metastases: systemic therapy alone (ST) group or intervention (IT) group.

RESULTS

Until June 2020, 200 patients were enrolled in the study. The demographic data were similar between the two groups. The median follow-up time was 77 months (range 55-107 months) in the IT group (n = 119; 59.5%) and 57 months (range 39-84) in the ST-only group (n = 81; 40.5%). The median MDFI was 40 months (range 23-70 months) in the IT group, and 35 months (range 13-61 months) in the ST-only group (p = 0.47). The groups had similar surgeries for the primary tumor and axilla. Most of the patients had liver metastases (49.5%, n = 99), and 42% (n = 84) of the patients had lung metastases. Both lung and liver metastases were found in 8.5% (n = 17) of the patients. The primary tumor was estrogen receptor/progesterone receptor-positive in 75% (n = 150) of the patients, and 32% (n = 64) of the patients had HER2-neu+ tumors. Metastatic-site resection was performed for 32% (n = 64) of the patients, and 27.5% (n = 55) of the patients underwent metastatic ablative interventions. In the Kaplan-Meier survival analysis, the hazard of death (HoD) was 56% lower in the IT group than in the ST-only group (hazard ratio [HR], 0.44; 95% confidence interval [CI] 0.26-0.72; p = 0.001). The HoD was lower in the IT group than in the ST-only group for the patients younger than 55 years (HR, 0.32; 95% CI 0.17-0.62; p = 0.0007). In the multivariable Cox regression model, HoD was significantly lower for the patients who underwent intervention for metastases and had an MDFI longer than 24 months, but their liver metastases doubled the risk of death compared with lung metastases.

CONCLUSION

Metastasis-directed interventions have reduced the risk of death for patients with limited lung/liver metastases who are amenable to interventions after completion of primary cancer treatment. For a select group of patients, such as those with luminal A/B or HER2-neu+ breast cancer who are younger than 55 years with limited metastases to the lung and liver or an MDFI longer than 24 months, surgical or ablative therapy for metastases should be considered and discussed on tumor boards.

Quantitative OCT angiography of the retina and choroid in non-ocular sarcoidosis

OBJECTIVE

The aim of the study was to evaluate retinal and choroidal microvascular morphological changes in non-ocular sarcoidosis (NOS) patients using optical coherence tomography angiography (OCTA) and compare the results to age- and gender-matched healthy individuals.

PATIENTS AND METHODS

This study included 37 NOS patients (group 1, 37 right eyes) referred to the Ophthalmology Department between 2019 and 2021, as well as 31 healthy individuals (group 2, 31 right eyes). Non-ocular sarcoidosis was defined as sarcoidosis confirmed by a positive lung X-ray and biopsy without ocular manifestation. All participants underwent a comprehensive ophthalmic examination. The SPECTRALIS® OCT was used for both fundus photography and macular analysis. All OCTA procedures were performed in the Angio Retina mode (6.0x6.0 mm) to assess retinal and choroidal microvascular morphology.

RESULTS

Groups 1 and 2 had mean ages of 46.41±12.52 and 47.55±13.81 years, respectively (p=0.482). Group 1 had significantly increased superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel densities (VDs) in whole (p=0.059, 0.016), parafoveal (p=0.051, 0.015), and perifoveal (p=0.060, 0.010) regions relative to group 2. Group 1 was also associated with increased foveal avascular zone (FAZ) area (p=0.196), FAZ circumference (p=0.262), and foveal VD in 300 μm wide regions surrounding FAZ (p=0.003) relative to group 2. The outer retinal (p=0.712) and choriocapillaris (p=0.684) flows did not differ significantly between the two groups.

CONCLUSIONS

Quantitative OCTA analysis revealed a higher tendency for retinal and choroidal microvascular morphological changes in NOS patients, demonstrating the potential of this novel, non-invasive imaging technology, which may provide sensitive and reliable results without using contrast materials.

Results of the switch from intravitreal ranibizumab to intravitreal aflibercept therapy in patients with neovascular age-related macular degeneration: A 42-month retrospective real-world study

Aim

The study aimed to evaluate the functional and anatomical results of patients treated with intravitreal ranibizumab (IVR) for neovascular age-related macular degeneration (n-AMD) but switched to intravitreal aflibercept (IVA) treatment due to insufficient response treatment.

Material and Methods

At least six doses of n-AMD were administered IVR to 33 patients who were switched to IVA treatment due to insufficient response and were included in the study. The patients were evaluated at the beginning of the IVR treatment during the transition to IVA treatment and at 6, 12, 18, 24, 30, 36, and 42 months of IVA treatment.

Results

After an average of 10.1 ± 5.04 IVR injections, the patients who were accepted as insufficient response were treated with IVA. The central macular thickness of the patients was evaluated at the beginning of the treatment, immediately before, and after the initiation of IVA treatment at 6, 12, 18, 24, 30, 36, 42 months. It was as follows: 325.21 ± 123.04, 351.42 ± 126.09, 284.81 ± 112.65, 296.68 ± 89.17, 282.61 ± 81.58, 292.27 ± 109, 92,269.75 ± 97.14, 267.50 ± 87.56, and 266.82 ± 88.35 μm. According to the best-corrected visual acuity (BCVA), it was initially 0.89 ± 0.65; 1.08 ± 0.53 during the transition to IVA; 0.91 ± 0.46 6 months after IVA; 12^th 1.14 ± 0.59; 0.94 ± 0.55 at 18^th; 1.07 ± 0.49 at 24^th; 1.15 ± 0.57 at 30^th; 1.06 ± 0.45 at 36^th, and 1.13 ± 0.46 LogMAR ( Logarithm of the Minimum Angle of Resolution) at the 42^nd month.

Conclusion

In conclusion, in n-AMD patients with inadequate response to intravitreal ranibizumab or with relapse, and therefore, switched to aflibercept treatment, the anatomical improvement and sustainment were observed, however, functional recovery could not be achieved.

Consequences of seasonal allergic conjunctivitis on ocular parameters of anterior and posterior segments: An up-to-date imaging approach

Aims

To investigate consequences of seasonal allergic conjunctivitis (SAC) on the ocular anterior and posterior segment parameters.

Materials and Methods

Forty healthy participants (mean age: 25.90 ± 5.7 years, 20 females, 20 males) and 40 patients with SAC (mean age: 26.20 ± 5.7 years, 20 females, 20 males) were included in this prospective study. The anterior segment parameters including central corneal thickness (CCT) and anterior chamber depth (ACD) were measured by Scheimpflug imaging system. Axial length (AL) was measured by optical biometry. The posterior segment parameters, including retinal nerve fiber layer (RNFL), subfoveal choroidal thickness, and central macular thickness were measured by optical coherence tomography.

Results

Similar values of the ACD, AL, RNFL as well as central macular thickness between healthy participants and patients with SAC were revealed. Despite the CCT being thinner in SAC, there was no statistically significant difference between the two groups. On the other hand, SAC was found to be associated with an increase in subfoveal choroidal thickness, the condition of which may be attributed to the inflammatory nature of the disease.

Conclusion

The present study has managed to demonstrate non-significant alterations in the ocular anterior and posterior segment parameters of patients with SAC. Yet, the increase in subfoveal choroidal thickness may be linked to the accompanying inflammation of both the conjunctiva and other ocular tissues, particularly the choroidal layer.

Do SGLT2 inhibitors prevent preclinical diabetic retinopathy? A Prospective Pilot Optical Coherence Tomography Angiography Study

PURPOSE

To evaluate the effects of metformin alone and combined treatment with metformin and an SGLT2 inhibitor on retinal microvascular morphology using optical coherence tomography angiography (OCTA) in isolated type 2 diabetes mellitus (DM) patients with HbA1c above the expected target (>7%).

METHODS

Fifty patients with isolated DM, 7%<HbA1c<8%, without diabetic retinopathy (DR) using 500mg metformin ×2 for glycemic control were included in the study. OCTA and BMI measurements were obtained at the first evaluation. Treatment was changed to metformin 1000mg ×2. Patients who did not develop side effects due to the metformin were defined as the metformin-tolerant group (group-1). Patients who developed side effects were defined as the metformin-intolerant group (group-2), and their treatment was changed to metformin 500mg ×2 and empagliflozin 10mg. The second evaluation was performed three months after the last treatment change.

RESULTS

HbA1c was lower on the second evaluation in both groups (P<0.001, in both). On the second evaluation in group-1, a decrease was found in superficial perifoveal and deep parafoveal macular vascular plexus densities (P: 0.040 and P: 0.020, respectively). No statistically significant difference was observed in group-2.

CONCLUSION

SGLT2 inhibitors may contribute to preventing the development of preclinical DR. In patients with metformin intolerance, adding SGLT2 inhibitors may be a reasonable choice to protect the retina.

Cost-utility analysis of an integrated genetic/epigenetic test for assessing risk for coronary heart disease

Aim: New epigenetically based methods for assessing risk for coronary heart disease may be more sensitive but are generally more costly than current methods. To understand their potential impact on healthcare spending, we conducted a cost-utility analysis. Methods: We compared costs using the new Epi + Gen CHD™ test with those of existing tests using a cohort Markov simulation model. Results: We found that use of the new test was associated with both better survival and highly competitive negative incremental cost-effectiveness ratios ranging from -$42,000 to -$8000 per quality-adjusted life year for models with and without a secondary test. Conclusion: The new integrated genetic/epigenetic test will save money and lives under most real-world scenarios. Similar advantages may be seen for other epigenetic tests.

The effect of intravitreal dexamethasone implant on central foveal thickness and choroidal thickness in retinal vein occlusion

Aim

To investigate the effect of intravitreal dexamethasone implant on central foveal thickness and choroidal thickness in retinal vein occlusion.

Materials and Methods

Clinical records and optical coherence tomography (OCT) scans of 41 naïve patients with retinal vein occlusion (RVO), who were initially treated with intravitreal dexamethasone (DEX) implant between 2016 and 2017 at Kocatepe University Faculty of Medicine, Department of Ophthalmology were investigated. Collected data included age and sex of the patients, crystalline lens status, baseline and final intraocular pressure, and OCT parameters including central foveal thickness and choroidal thickness.

Results

Twenty-two (53.7%) female and 19 (46.3%) male patients were enrolled in the study. There were 30 phakic and 11 pseudophakic patients. The intraocular pressure increased significantly from 15.19 mmHg to 17.8 mmHg (P = 0.005), and cataract extraction was performed in two patients who developed cataract after the treatment. There was a significant decrease in the central foveal thickness from 556 μm to 288 μm (P < 0.001). In addition, although there was no statistically significant change in choroidal thickness in the patients with branched retinal vein occlusion (P = 0.423), the patients with central retinal vein occlusion had statistically significant decrease in choroidal thickness measurements (P = 0.049).

Conclusion

Therapeutic effect of the DEX implant not only influences retinal layer. Its influence may also extend further to the choroid layer, thereby leading to decrease in the choroidal thickness. Our results were mostly similar to the results of studies in literature which investigated the effects of the DEX implant therapy on the choroidal thickness of the patients with RVO.

A simple, rapid, interpretable, actionable and implementable digital PCR based mortality index

Mortality assessments are conducted for both civil and commercial purposes. Recent advances in epigenetics have resulted in DNA methylation tools to assess risk and aid in this task. However, widely available array-based algorithms are not readily translatable into clinical tools and do not provide a good foundation for clinical recommendations. Further, recent work shows evidence of heritability and possible racial bias in these indices. Using a publicly available array data set, the Framingham Heart Study (FHS), we develop and test a five-locus mortality-risk algorithm using only previously validated methylation biomarkers that have been shown to be free of racial bias, and that provide specific assessments of smoking, alcohol consumption, diabetes and heart disease. We show that a model using age, sex and methylation measurements at these five loci outperforms the 513 probe Levine index and approximates the predictive power of the 1030 probe GrimAge index. We then show each of the five loci in our algorithm can be assessed using a more powerful, reference-free digital PCR approach, further demonstrating that it is readily clinically translatable. Finally, we show the loci do not reflect ethnically specific variation. We conclude that this algorithm is a simple, yet powerful tool for assessing mortality risk. We further suggest that the output from this or similarly derived algorithms using either array or digital PCR can be used to provide powerful feedback to patients, guide recommendations for additional medical assessments, and help monitor the effect of public health prevention interventions.

AHRR methylation predicts smoking status and smoking intensity in both saliva and blood DNA

Many existing DNA repositories do not have robust characterizations of smoking, while for many currently ongoing studies, the advent of vaping has rendered traditional cotinine-based methods of determining smoking status unreliable. Previously, we have shown that methylation status at cg05575921 in whole blood DNA can reliably predict cigarette consumption. However, whether methylation status in saliva can be used similarly has yet to be established. Herein, we use DNA from 418 biochemically confirmed smokers or nonsmokers to compare and contrast the utility of cg05575921 in classifying and quantifying cigarette smoking. Using whole blood DNA, a model incorporating age, gender, and methylation status had a receiver operating characteristic (ROC) area under the curve (AUC) for predicting smoking status of 0.995 with a nonlinear demethylation response to smoking. Using saliva DNA, the ROC AUC for predicting smoking was 0.971 with the plot of the relationship of DNA methylation to daily cigarette consumption being very similar to that seen for whole blood DNA. The addition of information from another methylation marker designed to correct for cellular heterogeneity improved the AUC for saliva DNA to 0.981. Finally, in 31 subjects who reported quitting smoking 10 or more years previously, cg05575921 methylation was nonsignificantly different from controls. We conclude that DNA methylation status at cg05575921 in DNA from whole blood or saliva predicts smoking status and daily cigarette consumption. We suggest these epigenetic assessments for objectively ascertaining smoking status will find utility in research, clinical, and civil applications.

A Four Marker Digital PCR Toolkit for Detecting Heavy Alcohol Consumption and the Effectiveness of Its Treatment

Background.-Heavy alcohol consumption (HAC) is a shared concern of the forensic, medical and insurance underwriting communities. Unfortunately, there is a relative lack of clinically employable tools for detecting HAC and monitoring treatment response. Building on the results of 3 genome wide methylation studies, we have previously shown in a small group of samples that methylation sensitive digital PCR assays (MSdPCR) have the potential to accurately classify individuals with respect to HAC in a small set of individuals. Objective.-We now expand on those earlier findings using data and biomaterials from 143 participants with current HAC and 200 abstinent controls. Results.-We show that a set of 4 digital PCR assays that have a receiver operating characteristic (ROC) area under the curve (AUC) of 0.96 for detecting those with HAC. After a mean of 21 days of inpatient enforced abstinence, methylation status at one of these markers, cg04987734, began to revert to baseline values. Re-examination of methylation data from our smaller 2014 study with respect to this locus demonstrated a similarly significant reversion pattern at cg04987734 in association with treatment enforced abstinence. Conclusions.-We conclude that clinically implementable dPCR tools can sensitively detect the presence of HAC and that they show promise for monitoring alcohol treatment results. These dPCR tools could be useful to clinicians and researchers in monitoring those enrolled in substance use disorder treatment, employee wellness programs and insurance underwriting.

Epidemiological profiles of otorhinolaryngological disorders in adults admitted to the emergency room of a tertiary university hospital

Background

The incidence of otorhinolaryngological emergencies has been steadily increasing. With the increasing number of patients admitted to the emergency room, numerous challenges in healthcare have become more prevalent. This study aimed to evaluate the epidemiological profile of otorhinolaryngological disorders in adults admitted to the emergency department of a tertiary university hospital.

Materials and Methods

A total of 7028 adult patients with otorhinolaryngological disorders admitted to the emergency department of a tertiary hospital from January 1 to December 31, 2016, were enrolled in the study. Each patient underwent a comprehensive clinical evaluation by the physicians of the emergency department and was consulted by an otorhinolaryngologist. Age, sex, time of visits, and cost of each patient due to healthcare insurance were recorded.

Results

In total, 3098 patients were male (36.6 ± 16.4 years; 44.1%) and 3930 were female (35.4 ± 16.2 years; 55.9%). The most common otorhinolaryngological disorders were pharyngitis (n = 2713; 38.6%), followed by tonsillitis (n = 1302; 18.5%) and rhinitis (n = 1161; 16.5%). These three infectious diagnoses constituted 73.6% of all otorhinolaryngological disorders. The highest number of medical visits due to otorhinolaryngological disorders was in January, whereas the lowest number of visits was in July. When we excluded the three infection-based diagnoses, otorhinolaryngological disorders were stable at approximately 150 patients per month. The main reason for the increase in the number of visits per month due to otorhinolaryngological disorders appeared to be a result of these three infection-based diagnoses.

Conclusion

More than 80% of otorhinolaryngological disorders in adults admitted to the emergency department were not truly emergencies requiring attendance at a tertiary hospital emergency room. New policies should be instituted to reduce the workload of the emergency services and to allow more effort to be spent on real emergencies.

Structural changes of macula and optic disk of the fellow eye in patients with nonarteritic anterior ischemic optic neuropathy

PURPOSE

The aim was to assess the ganglion cell complex (GCC) thickness, retinal nerve fiber layer (RNFL) thickness and optic disk features in the affected eyes (AE) and unaffected fellow eyes (FE) of subjects with unilateral nonarteritic anterior ischemic optic neuropathy (NAION) and to compare with healthy control eyes (CE) using spectral domain-optical coherence tomography (SD-OCT).

METHODS

This study included 28 patients and age, sex and refraction-matched 28 control subjects. Mean GCC thickness and peripapillary RNFL thickness in four quadrants measured by cirrus SD-OCT were evaluated in both AE and FE of patients and CE. In addition, optic disk measurements obtained with OCT were evaluated.

RESULTS

Mean GCC thickness was significantly lower in AE compared with both FE and CE (P < 0.001), and mean GCC thickness in FE was significantly lower than CE (P = 0.022). In addition, mean RNFL thickness in superior and nasal quadrants significantly decreased in FE compared with CE (P = 0.020 and 0.010, respectively). Furthermore, AE had significantly greater optic disk cupping compared with both FE and CE (P < 0.001).

CONCLUSIONS

GCC and RNFL thickness decreased significantly at late stages of NAION, in both AE and FE compared with CE, suggesting that some subclinical structural changes may occur in FE despite lack of obvious visual symptoms. In addition, there was no significant difference in optic disk features between the CE and FE. And significantly greater optic disk cupping in the AE compared with both FE and CE supports the acquired enlargement of cupping after the onset of NAION.

The Effect of Venous Thromboembolism on Survival of Cancer Patients and its Relationship with Serum Levels of Factor VIII and Vascular Endothelial Growth Factor: A Prospective Matched-Paired Study

Background

Venous thromboembolism (VT) increases mortality and morbidity in cancer patients. The primary aim of this study was to evaluate the effect of VT on the survival of cancer patients and its relationship with serum vascular endothelial growth factor (VEGF) and plasma factor VIII levels.

Patients and methods

Eighty-two patients with locally advanced or metastatic cancer were included in this study between September 2001 and March 2004, and 31 of them had VT. Fifty-one matched-paired cancer patients without VT were prospectively selected as a control group in the same period. Criteria for the selection of control group patients were having the same malignancy, stage, metastatic site, performance status and age (±5 years) as patients in the VT group.

Results

Plasma factor VIII and serum D-dimer levels in the VT group were significantly higher than those in the control group (p=0.030 and p=0.016, respectively). However, mean serum VEGF levels were similar in both groups (p=0.199). In the VT group, the median survival of patients who had higher serum VEGF levels (>150 pg/mL) was significantly shorter than that of patients in the same group with lower serum VEGF levels (p=0.005). The median survival of the VT group was 14 months, whereas it was 25 months in the control group (p=0.199).

Conclusion

There was a worse prognostic trend for cancer patients with VT. Nevertheless, the difference in survival was not statistically significant between the groups. Plasma factor VIII and serum D-dimer levels might have prognostic value in cancer patients with VT. Cancer patients with VT and higher serum VEGF levels had a significantly poorer prognosis.

Incarcerated Morgagni Hernia Provoked by Pregnancy

Morgagni hernias are rare diaphragmatic hernias, usually occurring on the right and located in the anterior mediastinum. Herniation of abdominal contents is typically caused by an increase in intraabdominal pressure secondary to trauma, pregnancy or obesity. In this article, a 35-year-old pregnant woman with a Morgagni hernia diagnosed on chest X-ray is presented. Emergency laparotomy was performed with reduction of the herniation and repair of the diaphragmatic defect. To our knowledge, this is the first reported case of hernia in a pregnant woman with incarcerated bowel presenting with respiratory and gastrointestinal symptoms from Turkey.

Zero-valent aluminum-mediated degradation of Bisphenol A in the presence of common oxidants

The use of a commercial, nano-scale zero-valent aluminum (ZVA) powder was explored for the treatment of aqueous Bisphenol A (BPA). The study focused on the (i) activation of hydrogen peroxide (HP) and persulfate (PS) oxidants with ZVA to accelerate BPA degradation, (ii) comparison of the treatment performance in pure and real surface water (SW) samples, (iii) effects on toxicity and (iv) reuse potential of ZVA nanoparticles after ZVA/HP and ZVA/PS treatments. In pure water, ZVA coupled with HP or PS provided an effective means of BPA treatment particularly when PS was employed as the oxidant. On the other hand, in BPA-spiked SW, the ZVA/HP treatment combination outperformed ZVA/PS oxidation in terms of BPA removal, whereas ZVA/PS oxidation was superior in terms of organic carbon removal. According to the bioassays conducted in pure and real SW samples with the marine photobacteria Vibrio fischeri and the freshwater microalgae Pseudokirchneriella subcapitata, the toxicity response of BPA and its oxidation products was sensitive to the test organism and water matrix. The inhibitory effect of the reaction solution increased at the early stages of ZVA/PS treatment. The reuse potential of the ZVA/HP treatment system was higher than that of the ZVA/PS treatment system.

1kW fiber-coupled pump-module at 976nm with 50% efficiency

We present a fiber-coupled pump-module emitting more than 1kW of mode-stripped power at 976nm from a detachable 225µm, 0.22NA fiber. The electrical-to-optical efficiency at 1kW is ~50%. Six of these pump modules attached to a (6 + 1):1 multimode combiner enable a 5-6kW, single-mode, Yb-doped fiber amplifier.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Ketamine may be related to reduced ejection fraction in children during the procedural sedation

Objective:

Ketamine is a dissociative anesthetic agent with sympathomimetic effects used commonly for procedural sedation in emergency department. The present study aimed to reveal the effect of ketamine on myocardium by measuring ejection fraction (EF).

Methods:

Patients less than 9 years old undergoing procedural sedation with ketamine secondary to minor trauma composed the study population by convenience sampling. Study patients received ketamine at a dose of 1.5 mg/kg. A cardiologist performed the measurements of cardiac contractility pre-ketamine and 10 min after the ketamine administration.

Results:

A total of 22 patients were enrolled into the study. Patient recruitment has been ceased after the 22nd patient because of the thought that more patients would not provide additional information. The study subjects had a mean age of 3.5 ± 2.2 years and 14 (64%) of them were male. EF reduced in 14 (63.6%) patients (mean: 5.6 ± 3.1; median: 5; interquartile range (IQR): 3.75–7; minimum–maximum (min–max): 1–14). Systolic blood pressures reduced in 10 of 14 patients with decreased EF and increased in 8 of 10 patients without decreased EF. The changes in systolic blood pressure in patients with decreased EF ( n = 14) were as follows: −7.6 ± 10.9; median: −7.5; IQR: −16.5 to 1.75; and min–max: −30 to 9. There were two patients with elevated high-sensitive troponin.

Conclusion:

Ketamine may reduce EF and systolic blood pressure in children less than 9 years old undergoing procedural sedation.

Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A prospective study in 154 children

Background:

Biliary lithiasis, or sludge, and nephrolithiasis have been reported as a possible complication of ceftriaxone therapy. However, no study related to cefotaxime-induced biliary pseudolithiasis or nephrolithiasis was observed in the literature. Therefore, we investigated the comparative formation of biliary pseudolithiasis and nephrolithiasis after cefotaxime and ceftriaxone therapies.

Methods:

The patients treated with ceftriaxone or cefotaxime were enrolled during the study period. Ultrasound imaging of the biliary and urinary tract was performed in all patients before and after the treatment. The patients with a positive sonographic finding at the end of treatment were followed up with monthly ultrasonography for 3 months.

Results:

The present study showed that abnormal biliary sonographic findings were demonstrated in 18 children (20.9%) treated with ceftriaxone, 13 (15.1%) had biliary lithiasis, 5 (5.8%) had biliary sludge and 1 (1.2%) had nephrolithiasis. Abnormal biliary sonographic findings were demonstrated in only four (5.9%) children treated with cefotaxime who had biliary sludge and only one (1.5%) had nephrolithiasis. It was observed that older age was at significantly higher risk of developing biliary sludge or stone formation. Receiver operating characteristic analysis was performed to determine the residual risk and analysis found that 4.5 years was the cut-off value for age.

Conclusions:

The present study is unique in the literature for reporting for the first time gall bladder sludge and nephrolithiasis associated with cefotaxime use. Therefore, patients treated with cefotaxime should be monitored for serious complications like patients treated with ceftriaxone. Nevertheless, if third-generation cephalosporin is used, cefotaxime is recommended to be used rather than ceftriaxone.

Engineered Unique Elastic Modes at a BaTiO_{3}/(2×1)-Ge(001) Interface

The strong interaction at an interface between a substrate and thin film leads to epitaxy and provides a means of inducing structural changes in the epitaxial film. These induced material phases often exhibit technologically relevant electronic, magnetic, and functional properties. The 2×1 surface of a Ge(001) substrate applies a unique type of epitaxial constraint on thin films of the perovskite oxide BaTiO_{3} where a change in bonding and symmetry at the interface leads to a non-bulk-like crystal structure of the BaTiO_{3}. While the complex crystal structure is predicted using first-principles theory, it is further shown that the details of the structure are a consequence of hidden phases found in the bulk elastic response of the BaTiO_{3} induced by the symmetry of forces exerted by the germanium substrate.

Evaluation of Potential Donors in Living Donor Liver Transplantation

INTRODUCTION

Correct donor selection in living donor liver transplantation (LDLT) is essential not only to decrease the risks of complications for the donors but also to increase the survival of both the graft and the recipient. Knowing their most frequent reasons of donor elimination is so important for transplantation centers to gain time. In this study we evaluated the effectiveness of potential donors in LDLT and studied the reasons for nonmaturation of potential liver donors at our transplantation center.

PATIENTS AND METHODS

We studied the outcomes of 342 potential living donor candidates for 161 recipient candidates for liver transplantation between January 2013 and June 2014. Donor candidates' gender, age, body mass index (BMI), relationship with recipient, and causes of exclusion were recorded.

RESULTS

Among 161 recipients, 96 had a LDLT and 7 had cadaveric liver transplantation. Twelve of the 342 potential donors did not complete their evaluation; 106 of the remaining 330 donor candidates were accepted as suitable for donation (32%) but 10 of these were excluded preoperatively. The main reasons for unsuitability for liver donation were small remnant liver size (43%) and fatty changes of the liver (38.4%). Other reasons were arterial anatomic variations, ABO incompatibility, and Gilbert syndrome. Only 96 of the candidates (29% of the 330 candidates who completed the evaluation) underwent donation. Effective donors were 29% of potential and 90.5% of suitable donors.

CONCLUSIONS

In our center, 106 of 330 (32%) donor candidates were suitable for donation and the main reasons for unsuitability for liver donation were small remnant liver size and fatty changes of the liver.

The effects of intraperitoneal chemotherapeutic agents on adhesion formation

PURPOSE

Intra-abdominal adhesions are a major complication of healing. Furthermore these adhesions may cause morbidity and sometimes mortality for patients, and also are a financial burden to the health system.

MATERIALS AND METHODS

Cecum abrasion was performed in all rats and solutions containing saline to group 1, 5-fluorouracil to group 2, cisplatin to group 3, paclitaxel to the group 4, and mitomycin-C were administered into the abdomen of the groups, respectively. The intra-abdominal adhesions were scored after the macroscopic evaluation.

RESULTS

Among the chemotherapeutic drugs, paclitaxel significantly increases occurring of intra-abdominal adhesions in comparison with the control group and the other drugs according to the evaluation of scoring and statistical studies.

CONCLUSION

It is suggested to use the drugs which have a proven anti-adhesion feature or barriers to the patients who are going to be applied intraperitoneal chemotherapy with paclitaxel.

Measurement of L(III) Subshell Absorption Jump Parameters of Hafnium

The L(III) subshell absorption jump ratio and jump factor of hafnium have been measured using two different ways which are X-ray attenuation method and Energy Dispersive X-ray Fluorescence technique. The results obtained both ways have been compared with theoretical values. They are in good agreement with each other.

The utility of endometrial thickness measurement in asymptomatic postmenopausal women with endometrial fluid

The aim of this study was to assess the clinical usefulness of sonographic endometrium thickness measurement in asymptomatic postmenopausal women with endometrial fluid collection. Fifty-two asymptomatic postmenopausal women with endometrial fluid, who underwent endometrial sampling were evaluated. Histopathological findings revealed that 25 (48.1%) women had insufficient tissue, 20 (38.4%) had atrophic endometrium and 7 (13.5%) had endometrial polyps. No case of malignancy was found. There was no statistically significant difference between the various histopathological categories (insufficient tissue, atrophic endometrium and polyp) with regard to the mean single-layer endometrial thickness (1.54 ± 0.87, 2.04 ± 1.76 and 1.79 ± 0.69 mm, respectively, p = 0.436). Out of 44 patients with endometrial thickness of less than 3 mm, 38 (86.4%) had atrophic changes or insufficient tissue and 6 (13.6%) had endometrial polyps. In conclusion, if the endometrial thickness is 3 mm or less, endometrial sampling is not necessary in asymptomatic postmenopausal women with endometrial fluid.