Fast mass spectrometry search and clustering of untargeted metabolomics data

The throughput of mass spectrometers and the amount of publicly available metabolomics data are growing rapidly, but analysis tools such as molecular networking and Mass Spectrometry Search Tool do not scale to searching and clustering billions of mass spectral data in metabolomics repositories. To address this limitation, we designed MASST+ and Networking+, which can process datasets that are up to three orders of magnitude larger than those processed by state-of-the-art tools.

HypoRiPPAtlas as an Atlas of hypothetical natural products for mass spectrometry database search

Recent analyses of public microbial genomes have found over a million biosynthetic gene clusters, the natural products of the majority of which remain unknown. Additionally, GNPS harbors billions of mass spectra of natural products without known structures and biosynthetic genes. We bridge the gap between large-scale genome mining and mass spectral datasets for natural product discovery by developing HypoRiPPAtlas, an Atlas of hypothetical natural product structures, which is ready-to-use for in silico database search of tandem mass spectra. HypoRiPPAtlas is constructed by mining genomes using seq2ripp, a machine-learning tool for the prediction of ribosomally synthesized and post-translationally modified peptides (RiPPs). In HypoRiPPAtlas, we identify RiPPs in microbes and plants. HypoRiPPAtlas could be extended to other natural product classes in the future by implementing corresponding biosynthetic logic. This study paves the way for large-scale explorations of biosynthetic pathways and chemical structures of microbial and plant RiPP classes.

An interpretable machine learning approach to identify mechanism of action of antibiotics

As antibiotic resistance is becoming a major public health problem worldwide, one of the approaches for novel antibiotic discovery is re-purposing drugs available on the market for treating antibiotic resistant bacteria. The main economic advantage of this approach is that since these drugs have already passed all the safety tests, it vastly reduces the overall cost of clinical trials. Recently, several machine learning approaches have been developed for predicting promising antibiotics by training on bioactivity data collected on a set of small molecules. However, these methods report hundreds/thousands of bioactive molecules, and it remains unclear which of these molecules possess a novel mechanism of action. While the cost of high-throughput bioactivity testing has dropped dramatically in recent years, determining the mechanism of action of small molecules remains a costly and time-consuming step, and therefore computational methods for prioritizing molecules with novel mechanisms of action are needed. The existing approaches for predicting bioactivity of small molecules are based on uninterpretable machine learning, and therefore are not capable of determining known mechanism of action of small molecules and prioritizing novel mechanisms. We introduce InterPred, an interpretable technique for predicting bioactivity of small molecules and their mechanism of action. InterPred has the same accuracy as the state of the art in bioactivity prediction, and it enables assigning chemical moieties that are responsible for bioactivity. After analyzing bioactivity data of several thousand molecules against bacterial and fungal pathogens available from Community for Open Antimicrobial Drug Discovery and a US Food and Drug Association-approved drug library, InterPred identified five known links between moieties and mechanism of action.

MolDiscovery: learning mass spectrometry fragmentation of small molecules

Identification of small molecules is a critical task in various areas of life science. Recent advances in mass spectrometry have enabled the collection of tandem mass spectra of small molecules from hundreds of thousands of environments. To identify which molecules are present in a sample, one can search mass spectra collected from the sample against millions of molecular structures in small molecule databases. The existing approaches are based on chemistry domain knowledge, and they fail to explain many of the peaks in mass spectra of small molecules. Here, we present molDiscovery, a mass spectral database search method that improves both efficiency and accuracy of small molecule identification by learning a probabilistic model to match small molecules with their mass spectra. A search of over 8 million spectra from the Global Natural Product Social molecular networking infrastructure shows that molDiscovery correctly identify six times more unique small molecules than previous methods.

Oxidative stress parameters and antioxidant enzyme levels in patients with central serous chorioretinopathy

Background

Central serous chorioretinopathy (CSC) is a posterior segment disease caused by macular serous detachment as a result of inflammation and oxidative stress due to hypoperfusion of choriocapillaris.

Aims

The aim of the study was to assess the oxidant/antioxidant balance in CSC.s.

Materials and Methods

The plasma levels of malonyl dialdehyde (MDA), glutathione peroxidase (GSH-Px), myeloperoxidase (MPO), catalase (CAT), and xanthine oxidase (XO) were assessed in 21 patients with CSC (group S) and in 23 individuals without any eye pathology as the control group (group C). Furthermore, the disease was staged through routine opthalmologic examination as well as optic coherence tomography (OCT).

Results

MDA levels were significantly higher in group S (25.36 ± 4.51 nmol/ml), when compared with group C (22.79 ± 3.23 nmol/ml) (P = 0.035). In addition, the levels of CAT were significantly lower in group S (8.28 ± 5.85 U/ml) when compared to group C (14.02 ± 8.61 (P = 0.014).

Conclusion

Prevention of the oxidative injury may be considered among the associated treatment options under the light of the changes detected in the oxidative/antioxidative parameters.

Use of serum and peritoneal CEA and CA19-9 in prediction of peritoneal dissemination and survival of gastric adenocarcinoma patients: are they prognostic factors?

Introduction To evaluate the impact of serum and peritoneal levels of tumour markers on peritoneal carcinomatosis and survival in gastric adenocarcinoma. Materials and methods Patients with gastric adenocarcinoma were evaluated with regard to serum and peritoneal carcinoembryonic antigen (CEA) and CA19-9. Numeric values and groupings based on serum and peritoneal cutoff values were used. Development of peritoneal carcinomatosis, including positive washing cytology, was regarded as main outcome. Gastric cancer outcomes as disease free and overall survival were analysed. Results There were 67 patients with a mean age of 60 ± 11 years. Positive peritoneal washing cytology was significantly associated with serum CA19-9 and high serum CA 19-9 group (P = 0.033 and P = 0.011, respectively). High peritoneal CEA was shown to be significantly associated with peritoneal carcinomatosis (P = 0.032). After a median follow up of 17 months, 48 patients (71.7%) were alive. Patients with peritoneal carcinomatosis showed significant poorer prognosis as shown by overall survival rate of 28.6%. Only serum CEA was significantly associated with lower disease free and overall survival (P = 0.002 and P = 0.001, respectively). Discussion and conclusion Serum CEA is shown to be significantly associated with poor prognosis for gastric cancer patients. Serum level of CA19-9 and high peritoneal CEA levels are significant predictors for positive peritoneal washing cytology and the development of peritoneal carcinomatosis, respectively. Therefore, the possible impact of serum and peritoneal tumor markers especially on the staging and prognosis of gastric cancer remains to be clarified by future studies.

Alternative medicine usage among solid tumour patients receiving chemotherapy

We aimed to investigate complementary or alternative medicine (CAM) usage and knowledge levels of chemotherapy (CT) receiving cancer patients. Questionnaires about CAM usage and knowledge levels of the patients were completed. A total of 289 patients were included. Median age was 58 (min-max: 21-89) years. Sixty-two of 289 patients (22%) received CAM. Fifty-two patients (18%) thought CAM was beneficial and 237 of them (82%) thought that it was harmful. Sixty-one of them (98%) received CAM orally. Majority of CAMs used were herbal substances. Twenty-eight of the patients (45%) used CAM due to belief of natural products strengthen their body, 16 of them (26%) used CAM due to insistence of their relatives, 8 patients (13%) used CAM with thought of their CT did not benefit and 10 patients (16%) received CAM as a supportive treatment. Thirty-seven patients (60%) received CAM concomitant with CT. Thirty-two patients (52%) did not inform their clinicians while using CAM. Twenty-one (34%) and 45 (73%) of patients had no opinion or knowledge about effects and side effects of CAM they used respectively. Nearly half of the patients did not inform their clinicians about CAM they used. Knowledge level of patients used CAM was poor.

Serum bone markers levels and bone mineral density in familial mediterranean Fever

[Purpose] The aim of this study was to measure bone mineral density, serum and urinary bone turnover parameters, and to evaluate the influence of demographic and genetic factors on these parameters in FMF patients. [Subjects and Methods] Twenty-seven attack-free patients who were diagnosed with FMF (in accordance with Tel Hashomer criteria) were recruited at outpatient rheumatology clinics. We investigated whether there were any differences between the FMF patients and a control group in terms of lumbar and femur bone mineral density (BMD), standard deviation scores (Z scores and T scores) and bone markers. [Results] In terms of the median values of lumbar BMD (p = 0.21), lumbar T (p = 0.098) and Z (p = 0.109) scores, femoral neck BMD, femoral T and Z scores and total femur BMD, T (p = 0.788) and Z scores, there were no significant differences. [Conclusion] In our study, no statistically significant differences were found between FMF patients and a control group in terms of osteoporosis. The 25-OH vitamin D was found to be significantly lower in FMF patients than in the control group.

Upper extremity problems in doner kebab masters

[Purpose] Doner kebab is a food specific to Turkey; it is a cone-shaped meat placed vertically on a high stand. The doner kebab chefs stand against the meat and cut it by using both of their upper extremities. This work style may lead to recurrent trauma and correspondingly the upper extremity problems. The aim of this study was to investigate the upper extremity disorders of doner chefs. [Subjects and Methods] Doner kebab chefs were selected as the study group, and volunteers who were not doner kebab chefs and didn’t exert intense effort with upper extremities their business lives were selected as the control group. A survey form was prepared to obtain data about the participants’ ages, working experience (years), daily work hours, work at a second job, diseases, drug usage, and any musculoskeletal (lasting at least 1 week) complaint in last 6 months. [Results] A total of 164 individuals participated in the study, 82 doner chefs and 82 volunteers. In 20.6% of the study group and 15.6% of the control group, an upper extremity musculoskeletal system disorder was detected. Lateral epicondylitis was more frequently statistically significant in the work group. [Conclusion] Hand pain and lateral epicondylitis are more frequent in doner chefs than in other forms of business.

Effect of body shape on tragus-to-wall distance in the normal population

Ankylosing spondylitis (AS) may result in a loss of spinal mobility. Therefore, evaluation of spinal mobility is an essential part of follow-up of patients with AS. The tragus-to-wall distance (TWD) is one of the four spinal mobility assessment parameters of the Bath Ankylosing Spondylitis Metrology Index, an index used in the follow-up of patients with AS. The aim of this study was to investigate the effect of body shape on TWD. In total, 465 subjects aged 18 to 65 years with no disorders affecting the spine or any joint or disturbing the normal anatomical posture were included in this study. Their weight, height, hip and chest circumferences, anterior superior iliac crest-to-wall distance (ASIS-WD), and TWD were measured. Correlations between the parameters were calculated. TWD was positively correlated with weight (p < 0.001, r = 0.389), height (p < 0.001, r = 0.174), hip circumference (p < 0.001, r = 0.296), chest circumference (p < 0.001, r = 0.291), and ASIS-WD (p < 0.001, r = 0.292). Weight gain or loss may lead to incorrect interpretations during the patient's follow-up. Comparative studies with unevenly distributed groups in terms of weight and height may also misdirect the TWD results.

Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with multiple sclerosis

OBJECTIVES

The aim of this study is to evaluate the effects of calisthenic exercises on balance, walking speed, fatigue, quality of life, and psychological status in patients with Multiple Sclerosis (MS).

PATIENTS AND METHODS

Forty patients diagnosed with MS were randomized into two exercise groups (group 1 = hospital-based, group 2 = home-based). Outcome measures including the MS International Quality of Life Scale, 10-meter walking test, Berg Balance Scale, Fatigue Severity Scale and the Hospital Anxiety Depression Inventory were assessed at the baseline and at 12-weeks.

RESULTS

Thirty-six participants completed the exercise programme (hospital based = 16, home based = 20). The mean age was 32.83 ± 3.64 years. The mean duration of disease was 6.97 ± 3.15 years. Hospital-based and home-based exercise groups had significant improvements in the balance, 10-meter walking test, anxiety, and the quality of life after the 12-week exercise programme. There was a significant improvement in the hospital-based patients in terms of the depression scores. No significant improvement was observed in terms of fatigue in any of the groups. When both groups were compared, the improvement in the balance and depression scores of the hospital-based patients was significantly higher than the home-based patients.

CONCLUSIONS

Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with MS, calisthenic exercises performed at home or at the hospital may improve the balance, quality of life, and the functional and psychological status, while no significant effect has been observed on fatigue.

Prevalence of rheumatoid arthritis in the eastern Black Sea region of Turkey

AIM

The aim of this study was to estimate the prevalence of rheumatoid arthritis (RA) in the eastern Black Sea region of Turkey.

METHOD

The study was carried out between March 2003 and March 2005 by the Karadeniz Technical University Medical Faculty Department of Physical Medicine and Rehabilitation in the urban area in the eastern Black Sea region of Turkey, which has a population of 459021 (according to the 2000 national census). A total of 6103 subjects, 20 years old or over, were selected by the sampling method; 3023 (49.5%) women and 3080 (50.5%) men were included in the study. The diagnosis of RA was performed based on fulfilling the American College of Rheumatology (ACR) criteria.

RESULTS

Fifty-nine patients were diagnosed with RA according to the ACR criteria, of which 11 were male and 48 female. The prevalence of RA was 1% (95% CI: 0.75-1.25) in the general population, 1.6% (95% CI: 1.15-2.05) in women and 0.35% (95% CI: 0.14-0.56) in men. The female/male ratio was 4.3 : 1.0, showing that RA prevalence was statistically significantly higher in women (P <0.005).

CONCLUSION

Our study demonstrates that RA is a common disease in Turkish society.

Second and third cardiac valve reoperations: factors influencing death and long-term survival

We retrospectively investigated preoperative and postoperative characteristics in order to determine factors that affected hospital death in patients who underwent 3 or 4 separate cardiac valvular surgeries. The hospital records of 53 such patients who were operated upon from 1985 through 2006 were obtained. The patients were divided into 2 groups according to whether their initial operation was a closed mitral commissurotomy (group C, n = 33) or open-heart surgery with cardiopulmonary bypass (group O, n = 20). In group C, all patients who had initially undergone 1 or 2 closed mitral commissurotomy procedures underwent subsequent reoperations that entailed median sternotomy and cardiopulmonary bypass. Sternotomy and cardiopulmonary bypass had been used in valvular operations of all group O patients. The total early mortality rate was 11.3% (6 of 53 patients). Multivariate analysis revealed that longer aortic cross-clamp times and double valve replacement at last operation significantly increased the risk of death. Herein, we discuss our conclusion that 3rd or 4th cardiac valvular operations incurred acceptable early postoperative mortality rates.

Surgical treatment of post-infarction left ventricular pseudoaneurysm: a two-decade experience

Herein, we present a retrospective analysis of our experience with acquired pseudoaneurysms of the left ventricle over a 20-year period.From February 1985 through September 2004, 14 patients underwent operation for left ventricular pseudoaneurysm in our clinic. All pseudoaneurysms (12 chronic, 2 acute) were caused by myocardial infarction. The mean interval between myocardial infarction and diagnosis of pseudoaneurysm was 7 months (range, 1-11 mo). The pseudoaneurysm was located in the inferior or posterolateral wall in 11 of 14 patients (78.6%). In all patients, the pseudoaneurysm was resected and the ventricular wall defect was closed with direct suture (6 patients) or a patch (8 patients). Most patients had 3-vessel coronary artery disease. Coronary artery bypass grafting was performed in all patients. Five patients died (postoperative mortality rate, 35.7%) after repair of a pseudoaneurysm (post-infarction, 2 patients; chronic, 3 patients). Two patients died during follow-up (median, 42 mo), due to cancer in 1 patient and sudden death in the other. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients. Surgical repair is warranted particularly in cases of large or expanding pseudoaneurysms because of the propensity for fatal rupture.

Cardiovascular Reoperations in Marfan Syndrome

BACKGROUND AND AIM OF THE STUDY

The purpose of this study is to analyze the outcome results of reoperations in Marfan syndrome patients.

METHODS

Between 1985 and December 2004, 49 patients with Marfan syndrome were operated for aortic aneurysms. Of these 49 patients, 9 (18,4%) required > or =1 reoperations after a mean duration of 32.2 +/- 26.6 months. The mean duration of follow-up was 52.0 +/- 46.8 months, a total of 39 patient/years. Survival free of reoperation was calculated by Cox regression analysis.

RESULTS

Surgical indication for operation was a chronic aneurysmal dilatation of the ascending or abdominal aorta in seven patients (77.8%) and aortic dissection in two (22.2%) at the initial operation. In the reoperations, repair of thoracoabdominal aortic aneurysm with separated graft interposition in six patients (66.7%), replacement of ascending aorta in one (11.1%), replacement of ascending and hemiarchus aorta in one (11.1%), and mitral valve replacement in three patients (33.3%) were performed. The hospital mortality was 11.1% with one patient. Among the survivors, one expired in the follow-up five months after the second operation (12.5%). With the Cox regression analysis, survival without reoperation for 13, 24, and 123 months are 95.56 +/- 3.04%, 90.66 +/- 4.40%, and 60.32 +/- 12.63%, respectively. Mean survival for reoperated patients is 99 +/- 14 months (95% confidence interval 72-127 months).

CONCLUSIONS

Reoperations can be done with low morbidity and mortality. Patients should be kept under close follow-up using imaging techniques infinitely.

In Which Patients Should Sheathless IABP be Used? An Analysis of Vascular Complications in 1211 Cases

OBJECTIVE

The purpose of our study is to compare the results of the sheathed and sheathless techniques for intraaortic balloon pump (IABP) insertion and to determine the rate of vascular complications in both conditions.

METHODS

A total of 1211 patients were examined representing a period of 19 years. Three hundred five sheathless (Group I) and 906 sheathed (Group II) IABP catheters were evaluated retrospectively. Data were analyzed with univariate analysis and logistic regression. Relative risk (RR) values were calculated in order to examine the effect of sheath.

RESULTS

Limb ischemia was seen in 129 patients (10.9%). Although the incidence of peripheral arterial disease (PAD) was relatively higher in Group I (11.1% vs. 3.6%), the ischemic complication rate was lower in Group I (5.2% vs. 12.4%; p = 0.001). Presence of PAD (p = 0.001) and diabetes mellitus (DM) (p = 0.007) was found to be the risk factors of ischemia related to IABP use in all cases. In logistic regression analysis, presence of PAD, DM, and sheathed method was found to be the risk factors of ischemia. The patients who had all of these risk factors suffered from limb ischemia (RR value: 35.17).

CONCLUSION

PAD, DM, and sheathed insertion technique are the major risk factors of ischemia during IABP use. Among all these risk factors, the only modifiable risk factor is the use of introducer sheath. With the presence of PAD and DM, the choice of sheathed method would increase the probability of ischemia almost 35 times. Sheathless method of insertion should be preferred in patients with DM and PAD.

Risk Factors for Requirement of Permanent Pacemaker Implantation After Aortic Valve Replacement

BACKGROUND

The aim of this study was to evaluate the frequency of requirement for permanent pacing and related risk factors after aortic valve replacement.

METHODS

Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 +/- 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%.

RESULTS

Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors.

CONCLUSION

Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension.

Pedicled right internal mammary artery for reoperative off-pump revascularization of left anterior descending coronary artery

In situ right internal mammary artery is the graft of choice in reoperative off-pump coronary artery bypass grafting, as well as in primary on-pump coronary artery bypass grafting, unless the vessel has been used previously. However, there are not enough data about postoperative angiographic findings of the in situ right internal mammary artery in reoperative coronary artery bypass grafting with the off-pump technique. From September 1993 through January 2004, we reviewed the postoperative course and the graft patency of 12 selected patients who underwent off-pump coronary artery bypass grafting reoperation only for revascularization of the left anterior descending artery, by means of a pedicled right internal mammary artery graft. All patients were evaluated clinically and by postoperative coronary angiography. There were no early or late deaths during the mean follow-up period of 33.08 +/- 30.05 months (range, 1-77 months). The mean interval from the 1st operation to the 2nd operation was 74.1 +/- 57.01 months (range, 4.5-171 months). Postoperative coronary angiograms of all patients showed a 100% patency rate for both in situ grafts and composite grafts. We suggest that use of the in situ right internal mammary artery in off-pump coronary artery bypass grafting is a safe and reliable option for revascularizing the left anterior descending artery, especially in reoperation.

Primary Left Ventricular Angiomatosis First Description of a Rare Vascular Tumor in the Left Heart

A 24 year-old male who presented with palpitations and presyncopal attacks had monomorphic ventricular tachycardia and a well-defined huge mass within the inferoposterior wall of the left ventricle proved by transthoracic echocardiography. The mass was completely resected and shown to be proliferative angiomatosis by histopathologic examination. This is the first reported case of primary left ventricular angiomatosis in the literature.

Coronary artery disease and coronary artery bypass grafting in Behçet's disease

There is a high frequency of pseudoaneurysm formation in patients with Behçet's disease and their inflammed and fragile tissues are difficult to manipulate. Five patients with Behçet's disease were referred to our cardiovascular surgery department for coronary artery bypass grafting (CABG). Three of them were operated and two were treated medically. Patients that were managed medically had left anterior descending (LAD) lesions below 80% and their stable angina pectoris responded well to medication. There was no early mortality and morbidity. One patient developed pseudoaneurysm of ascending aorta and femoral artery. This patient died in the late postoperative period. At follow-up the operated patients were in Canadian Cardiovascular Society (CCS) Class I, while the medically treated patients were in CCS Class II. Mean follow-up period was 41 +/- 36.21 months. Coronary artery disease (CAD) is extremely rare detected in patients with Behçet's disease. The affected patients are usually young males. Coronary artery bypass grafting is also rarely performed in these patients and long-term results of such operations are not available in the literature. We present five patients with Behçet's disease that had CAD, three operated and two medically treated, and report their long-term results. We suggest a conservative approach in patients with Behçet's disease because of the high risk of pseudoaneurysm formation in the postoperative period. If CABG cannot be avoided we recommend operating the patients on the beating heart with minimal aortic manipulation.

Surgical Management of Cardiac Myxoma

OBJECTIVE

Between 1994 and December 2003, 55 patients were operated for cardiac myxoma in Kosuyolu Heart and Research Hospital in Istanbul.

METHODS

We retrospectively analyzed our results according to the preoperative characteristics, operative procedures, and postoperative courses.

RESULTS

Of 55 patients operated, 36 (65.4%) were female and 19 (34.6%) male. The average age of the patients was 48 +/- 15.5 years (range, 12-75). Thirteen patients (23.6%) previously had cerebrovascular accidents. Peripheral arterial emboli had occurred in 11 (20%) patients. The majority of the patients (44.4%) were in NYHA Class II preoperatively. One patient was presented with Carney's complex. Most frequent location was the left atrium (85.2%). Eight patients had concommitant surgery together with myxoma extirpation. Postoperative courses were uneventful. Three patients had a new onset atrial fibrillation, two had transient conduction disturbances. There were two (3.6%) in-hospital deaths. No recurrences have been noted during the 82.4 +/- 40.6 months (a total of 315.75 patient/years) follow-up.

CONCLUSIONS

Surgical management of cardiac myxoma gives excellent results. In selected cases, a conservative approach may be adequate. Despite the scarcity of the neoplastic properties, careful follow-up is necessary.

Coexisting ankylosing spondylitis and Sjogren's syndrome: a case report

Sjogren's syndrome and ankylosing spondylitis can occur either alone or in conjunction with other disorders. In this article we report a female patient afflicted with ankylosing spondylitis and Sjogren's syndrome.

Surgery for Chronic Total Occlusion of the Left Main Coronary Artery- Myocardial Preservation

We report seven patients with chronic total occlusion of the left main coronary artery that were operated in our institution and discuss the myocardial preservation options in these patients. In addition to total occlusion of the left main coronary artery, three patients also had severe lesions of right coronary artery. Prior myocardial infarction history and significantly depressed left ventricle functions were detected in all three patients with right coronary artery lesions. Five patients were operated on cardiopulmonary bypass while two patients were operated off pump. All patients received alternating antegrade/retrograde cardioplegia for myocardial preservation. In patients with simultaneous right coronary artery disease we first established the origin of the collaterals to the left coronary system. For patients with collaterals arising from the right coronary artery segment distal to the right coronary artery lesion, the antegrade component was administered through the saphenous vein graft bypassed to a distal part of right coronary artery segment. Thus we have achieved a more effective distribution of the antegrade cardioplegia. In off-pump-operated patients the left coronary system was revascularized before the right coronary system. Postoperative low cardiac output syndrome occurred in only one patient who was operated off pump. There was no operative and early mortality. Mean follow-up was 32 +/- 21.42 (range, 4 to 60) months. Alternating antegrade/retrograde cardioplegia was used with acceptable results in patients with total occlusion of the left main coronary artery. In patients with simultaneous RCA lesion we recommend regulation of the antegrade component based on the origin of collaterals that supplies the left coronary system. In off-pump-operated patients we suggest avoiding of clamping of right coronary artery at the beginning of the operation while it still supplies all the coronary circulation.

Surgical treatment of aortobronchial and aortoesophageal fistulae due to thoracic aortic aneurysm

We present a review of our single-institution experience, over 19 years, with aortobronchial and aortoesophageal fistulae due to descending thoracic aortic aneurysm. We conducted a retrospective chart review of 10 cases involving surgery for aortobronchial and aortoesophageal fistulae in our clinic from February 1985 through October 2004. Pathologic or predisposing conditions associated with aortobronchial fistula were descending thoracic aortic aneurysm (n=8), previous aortic surgery (n=1), and concomitant aortoesophageal fistula (n=1). Three patients presented emergently with aortobronchial fistula (n=2) and aortoesophageal fistula (n=1). Ages of the 10 patients ranged from 42 to 74 years (median, 63 years). The median cross-clamp time was 34 minutes (range, 27-41 min). Repairs, in 9 patients, involved an inlay of prosthetic tube graft using the clamp-and-sew technique, and in 1 patient repair involved patch aortoplasty. The operative mortality rate was 20%:1 patient had acute concomitant aortoesophageal and aortobronchial fistulae, and another had chronic aortobronchial fistula. There was no embolic stroke or paraplegia. During follow-up (median, 2.5 years), there were no deaths or postoperative morbidity We conclude that repair of aortobronchial and aortoesophageal fistulae using the clamp-and-sew technique can be performed with acceptable operative mortality and long-term results. However, the mortality rate continues to be highly significant in patients with acute bleeding aortobronchial fistula or with aortoesophageal fistula, despite rapid surgical intervention.

Classical and atypical neuroleptics, and bone mineral density, in patients with schizophrenia

There are some reports that classical neuroleptics may lead to osteoporosis or reduced bone mineral density (BMD). However, there is no adequate information about the effects of atypical neuroleptics on BMD. The aim of this study was to measure BMD in schizophrenic patients taking classical and atypical neuroleptics, compared to healthy controls. Seventy-five patients with schizophrenia (40 taking classical neuroleptics [CN], 35 taking atypical neuroleptics [AN]) and 20 healthy controls (HC) were included in the study. Spine (L1-L4) BMD was measured by dual-energy X-ray absorptiometry. ANOVA showed that BMD was higher in HC than AN and CN. In addition, there was a negative correlation between the duration of neuroleptic treatment and BMD and the duration of the illness. These findings suggest that atypical neuroleptics may be safer than the classical neuroleptics in terms of reduced BMD.

Isokinetic muscle performance in major depressive disorder: alterations by antidepressant therapy

The aims of this study were (i) to examine whether patients with major depressive disorder (MDD) differ from healthy control subjects with respect to isokinetic muscle performance (IMP) as measured by a dynamometer; (ii) to investigate the effect of subchronic treatment on the IMP in depressed patients. Thirty-eight patients with MDD, and 41 sex- and age-matched healthy controls participated in this study. The severity of depression and anxiety levels were evaluated by the Hamilton Depression and Anxiety Scales. Quadriceps and hamstring IMPs were determined by using an isokinetic dynamometer before and after subchronic antidepressant treatment. The patients had lower IMP levels than healthy controls. After treatment for three months with selective serotonin reuptake inhibitors, the IMP levels increased significantly. These findings suggest that (i) MDD may be characterized by reduced IMP levels; and (ii) treatment with antidepressants may increase the IMP levels, as a state marker for depression. It was concluded that (i) isokinetic muscle performance may be used as a state marker for monitoring antidepressant drug effects on MDD; (ii) isokinetic exercise increasing IMP may be used in the treatment of depression.

Isokinetic muscle performance in major depressive disorder: alterations by antidepressant therapy

The aims of this study were (i) to examine whether patients with major depressive disorder (MDD) differ from healthy control subjects with respect to isokinetic muscle performance (IMP) as measured by a dynamometer; (ii) to investigate the effect of subchronic treatment on the IMP in depressed patients. Thirty-eight patients with MDD, and 41 sex- and age-matched healthy controls participated in this study. The severity of depression and anxiety levels was evaluated by the Hamilton Depression and Anxiety Scales. Quadriceps and hamstring IMPs were determined by using an isokinetic dynamometer before and after subchronic antidepressant treatment. The patients had lower IMP levels than healthy controls. After treatment for three months with selective serotonin reuptake inhibitors, the IMP levels increased significantly. These findings suggest that (i) MDD may be characterized by reduced IMP levels; and (ii) treatment with antidepressants may increase the IMP levels, being a state marker for depression. It was concluded that (i) isokinetic muscle performance may be used as a state marker for monitoring antidepressant drug effects on MDD; (ii) isokinetic exercise increasing IMP may be used in the treatment of depression.