Left atrial overload detection in ECG using frequency domain features with convolutional neural network

Background/Introduction

Volume and pressure alterations in the left atrium (LA) are utilized as important biomarkers due to their association with numerous cardiac pathologies. Because of the anatomical peculiarities of the LA, echocardiographic evaluation is quite challenging. There are many conducted studies to determine LA hemodynamic biomarkers using ECG signals, however, the low specificity has been seen as a common problem.

Purpose

Within the scope of this study, we aimed to develop a fully automatic artificial intelligence algorithm. Therefore, the frequency domain properties of the ECG signal were examined by wavelet transform and deep learning algorithm to detect the left atrial overload (LAO) from the ECG signal. We also compared the effectiveness of lead selection (Lead II and V1 Lead) to detect LAO.

Methods

Physionet-PTB-XL database was used for ECG inputs. 10 s ECG waveform of 403 healthy people and 352 LAO patients used for feature extraction after carefully filtering. Each signal was segmented to a 1.5 s epoch and in total 4530 ECG was used for training (70%) and test (30%) of deep learning algorithms. Two different deep learning models were developed for the automatic detection of LAO. In the first approach (1D convolutional neural network, 1D-CNN) segmented raw ECG was used, and in the second approach (2D convolutional neural network, 2D-CNN) each segmented ECG was transformed to scalograms with continuous wavelets transform. All models were tested for both leads.

Results

Our results show that frequency-domain features are highly capable to detect LAO compared to time-domain features and either Lead II and V1 Lead can be used for the detection of LAO. The success rate of 1D-CNN is 72% for Lead-II and 75% for V1 Lead while the success rate of 2D-CNN is 92% for both leads.

Conclusions

The most important limitation in the diagnosis of LAO by ECG is the low specificity. In this study, a model that eliminates this limitation has been developed by using the frequency characteristics of the ECG and artificial intelligence algorithms and tested with a large population. Considering its high success rate, 2D-CNN model has the potential to help the clinician by detecting the pathology with a cheaper, operator-independent method, and a short-term measurement.

Funding Acknowledgement

Type of funding sources: None.

Acute effect of thymoquinone on action potential and ionic currents of rat cardiac myocytes

OBJECTIVES

This study aims to investigate the acute effects of thymoquinone (TQ) which has been suggested to be a cardioprotective agent, on ventricular myocytes.

METHODS

Freshly isolated rat ventricular myocytes were exposed to TQ and using standard whole-cell patch-clamp technique action potential (AP), sodium current (INa), L-type calcium current (ICaL) and transient outward potassium current (Ito) were measured.

RESULTS

TQ prolonged the duration of AP and decreased the peak value compared to that of control myocytes. Consistently, it inhibited INa in a concentration-dependent manner and shifted the channel kinetics to more hyperpolarized voltages. Besides, TQ not only inhibited Ito and ICaL but also significantly attenuated the isoproterenol-induced increase in ICaL.

CONCLUSION

The effect of TQ on cardiomyocytes has been demonstrated for the first time. TQ changes AP morphology along with ionic currents and alleviates β-adrenergic response in adult ventricular myocytes. These results indicate that TQ may be considered as a therapeutic agent in cases such as diabetic cardiomyopathy and cardiac hypertrophy, wherein the β-adrenergic system is over-activated (Tab. 2, Fig. 6, Ref. 30).

The relevance between graft preservation solutions and QTc interval during living donor kidney transplantation and rat cardiomyocytes sampling

BACKGROUND

The purpose of the retrospective study was to identify the impacts of different solutions on the electrocardiogram and cardiovascular changes. Moreover, the differences between these solutions were analyzed by examining their impacts on rat ventricular cardiomyocytes.

METHODS

Eighty renal transplant patients were evaluated retrospectively. The patients were divided into two groups: Group UW (n =40) used the University of Wisconsin solution, and Group HTK (n =40) used the Histidine-Tryptophan-Ketoglutarate solution. Electrocardiograms of the subjects were obtained three times at different periods; during the pre-perfusion, intraoperative kidney reperfusion, and postperfusion phase at the end of the surgery. Any Electrocardiogram or cardiovascular alterations were noted and analyzed. Adult male Wistar rats were used for in vitro experiments. Myocyte contractility, action potentials, and membrane current were recorded in enzymatically isolated ventricular myocytes.

RESULTS

Sinus bradycardia was detected in 19 patients of Group UW, while there was short-term asystole in eight patients. However, no cardiac changes were observed in Group HTK patients. In both Groups, reperfusion and postperfusion corrected QT (QTc) intervals were different from pre-perfusion QTc intervals. Group UW patients' reperfusion and postperfusion QTc's values were higher than those of the Group HTK patients. In rat myocytes, prominent asystole episodes were observed at specific concentrations of the UW solution compared to the HTK solution. The UW solution depolarized the resting membrane potential significantly and decreased the peak value of action potential, whereas the HTK solution did not elicit a significant change in those parameters. Accordingly, the UW solution elicited a significant inward current at -70 mV, while the HTK solution activated only a modest current, which may not change the membrane potential.

CONCLUSION

Prolongation of QTc intervals was detected with reperfusion in both groups according to electrocardiography analysis. However, the QTc interval was observed to be longer in cases using the UW solution and required intervention intraoperatively. HIPPOKRATIA 2021, 25 (1):22-30.

The Relationship between Serum Ischemia-Modified Albumin Levels and Uterine Artery Doppler Parameters in Patients with Primary Dysmenorrhea

OBJECTIVE

 Primary dysmenorrhea occurs due to abnormal levels of prostanoids, uterine contractions, and uterine blood flow. However, the reasons for pain in primary dysmenorrhea have not yet been clarified. We examined the blood flow alterations in patients with primary dysmenorrhea and determined the relationship between ischemia-modified albumin (IMA) levels, as an ischemia indicator, and primary dysmenorrhea.

METHODS

 In the present study, 37 patients who had primary dysmenorrhea and were in their luteal and menstrual phase of their menstrual cycles were included. Thirty individuals who had similar demographic characteristics, who were between 18 and 30 years old and did not have gynecologic disease were included as control individuals. Their uterine artery Doppler indices and serum IMA levels were measured.

RESULTS

 Menstrual phase plasma IMA levels were significantly higher than luteal phase IMA levels, both in the patient and in the control groups (p < 0.001). Although the menstrual phase IMA levels of patients were significantly higher than those of controls, luteal phase IMA levels were not significantly different between the two groups. Menstrual uterine artery pulsatility index (PI) and resistance index (RI) of primary dysmenorrhea patients were significantly different when compared with luteal uterine artery PI and RI levels. There was a positive correlation between menstrual phase IMA and uterine artery PI and RI in the primary dysmenorrhea.

CONCLUSION

 Ischemia plays an important role in the etiology of the pain, which is frequently observed in patients with primary dysmenorrhea. Ischemia-modified albumin levels are considered as an efficient marker to determine the severity of pain and to indicate ischemia in primary dysmenorrhea.

Preoperative appendix diameter obtained by computerized tomography scanning predicts conversion from laparoscopic to open appendectomy

Background

Open appendectomy (OA) has been the gold standard for a long time. Laparoscopic appendectomy (LA) has gained wide acceptance and popularity, outdoing open approach. Yet, conversion may be required when laparoscopic approach fails.

Aims

To predict conversion from laparoscopic appendectomy to open appendectomy sing Oreo-ratio radiological appendices diameter.

Materials and Methods

This is a retrospective cohort study conducted on 320 (included) patients who underwent appendectomy between January 2018 and August 2018 in the General Surgery departmentof Haseki Training and Research Hospital, Istanbul, Turkey. Appendiceal diameter obtained during preoperative radiological screening was evaluated about its relationship to conversion from LA to OA. Age, sex, inflammatory serum parameters and pathology reports were also investigated.

Results

A total of 269 (84%) cases were started LA and 17 (6,3%) laparoscopic cases were converted to open. The appendix diameter, the grade of inflammation (perforated or gangrenous), age, and c-reactive protein (CRP) were found to have significant importance in conversion, P = 0.003, P = 0.000, P = 0.042, and P = 0.018, respectively. When a cutoff of 50 years was chosen for age, the odds ratio (OR) was 3. For the appendiceal diameter of 14 mm, the OR was 3.0286.

Conclusion

Preoperative evaluation of appendix diameter is a quick and useful method for a surgeon to distinguish cases with risk of conversion in the emergency department. The other risk factors associated with conversion of LA to OA are grade of inflammation, age and CRP levels.

Using PVA and TPGS as combined emulsifier in nanoprecipitation method improves characteristics and anticancer activity of ibuprofen loaded PLGA nanoparticles

In the preparation of nanoparticles (NPs) by the nanoprecipitation method, emulsifiers play a key role for NPs' characteristics. The present study aimed to investigate the combined emulsifier effect on ibuprofen loaded poly(lactic-co-glycolic acid) (PLGA) NPs' characteristics and anticancer activity. Ibuprofen loaded PLGA NPs were prepared by nanoprecipitation using different concentrations of PVA (poly(vinyl alcohol)) or PVA-TPGS (d-α-tocopherol polyethylene glycol 1000 succinate) combination as emulsifier. It was found that encapsulation efficiencies of NPs varied between 17.9 and 41.9 % and the highest encapsulation efficiency was obtained with 0.5% PVA + 0.1% TPGS (coded as PLGA PVA/TPGS NPs). PLGA PVA/TPGS NPs were characterized and compared with PLGA PVA NPs, which was obtained by 0.5% PVA alone. Polydispersity index of PLGA PVA/TPGS and PLGA PVA NPs were found to be 0.08 and 0.15, respectively. Incorporation of TPGS with PVA slightly decreased the initial ibuprofen release. Transmission electron microscopy analyses demonstrated a nearly uniform particle size distribution and spherical particle shape of the PLGA PVA/TPGS NPs. Additionally, PLGA PVA/TPGS NPs were significantly more cytotoxic than PLGA PVA NPs on the MCF-7 (human breast adenocarcinoma cells) and Caco-2 (human epithelial colorectal adenocarcinoma) cells (p<0.05). Also PLGA PVA/TPGS NPs were not cytotoxic on normal cells (L929, mouse healthy fibroblast cells) (p>0.05). In conclusion, these results indicated that using a combination of TPGS and PVA as an emulsifier in nanoprecipitation could be a promising approach for preparing ibuprofen loaded PLGA NPs because of their improved characteristics and anticancer activity.

Is fibroblast growth factor 23 a new cardiovascular risk marker in gestational diabetes?

OBJECTIVE

This study was designed to compare the serum levels of fibroblast growth factor 23 (FGF23) among patients with gestational diabetes mellitus (GDM) and healthy pregnant women, and to evaluate the association between hormonal and metabolic parameters.

SUBJECTS AND METHODS

A total of 82 pregnant women were consecutively enrolled in the study. Of these, 46 were diagnosed as having GDM; the remaining 36 healthy pregnant women served as controls in a cross-sectional study design. The womens' ages ranged from 22 to 38 years and gestational ages, from 24 to 28 weeks. Serum samples were analyzed for FGF23 levels using an enzyme-linked immunosorbent assay.

RESULTS

Serum FGF23 levels were increased in patients with GDM compared with controls (median, 65.3 for patients with GDM vs. 36.6 ng/mL for healthy controls; p = 0.019). Mean fasting glucose (105.6 ± 7.4 vs. 70.2 ± 7.2 mg/dL, p < 0.001), HbA1c (5.6 ± 0.5 vs. 4.9 ± 0.5%, p < 0.001), insulin (median, 11.1 vs. 8.7 µIU/mL, p = 0.006) and HOMA-IR (3.0 (1.8) vs 1.4 (0.6), p < 0.001) levels were significantly higher in patients with GDM than in controls. Serum FGF23 level was positively correlated with body mass index (r2 = 0.346, p < 0.05), FPG (r2 = 0.264, p < 0.05), insulin (r2 = 0.388, p < 0.05), HOMA-IR (r2 = 0.384, p < 0.05).

CONCLUSION

Serum FGF23 levels were higher in women with GDM compared with controls. The present findings suggest that FGF23 could be a useful marker of cardiovascular disease in GDM.

Serum ghrelin levels in papillary thyroid carcinoma

OBJECTIVE

Ghrelin plays a role in several processes of cancer progression, and numerous cancer types express ghrelin and its receptor. We aimed to investigate serum levels of ghrelin in patients with papillary thyroid carcinoma (PTC) and its association with the prognostic factors in PTC.

MATERIALS AND METHODS

We enrolled 54 patients with thyroid cancer (7 male, 47 female) and 24 healthy controls (6 male, 18 female) in the study. We compared demographic, anthropometric, and biochemical data, and serum ghrelin levels between the groups. Serum ghrelin levels were measured using as enzyme-linked immunosorbent assay.

RESULTS

Ghrelin levels were similar between the groups, but plasma ghrelin levels were significantly higher in tumors larger than 1 cm diameter compared with papillary microcarcinomas. Serum ghrelin levels also correlated with tumor size (r = 0.499; p < 0.001). Body mass index, thyroid-stimulating hormone, and HOMA-IR levels were similar between the groups. There were no statistically significant differences regarding average age and other prognostic parameters including lymph node invasion, capsule invasion, multifocality and surgical border invasion between patients with microcarcinoma and tumors larger than 1 cm.

CONCLUSION

In our study, no significant difference in serum ghrelin levels was determined between patients with papillary thyroid cancer and healthy controls however, serum ghrelin levels were higher in tumors larger than 1 cm compared to in those with thyroid papillary microcarcinoma.

PENTRAXIN 3 AS A NEW CARDIOVASCULAR MARKER IN ADRENAL ADENOMAS

OBJECTIVE

Pentraxin 3 (PTX3) is an acute-phase glycoprotein, which is increased in patients with cardiovascular disease (CVD) and considered as a predictor of CVD in the general population. Both functional and nonfunctional adrenal tumors are associated with a higher risk of cardiovascular events and mortality. We aimed to investigate plasma PTX3 levels in patients with functioning and nonfunctioning adrenal tumors and determine its relationship with cardiovascular risk factors.

METHODS

Twenty-one patients with functional adrenal tumors (11 pheochromocytomas, 9 Cushing syndrome, and 1 primary hyperaldosteronism), 28 patients with nonfunctional adrenal incidentalomas, and 40 healthy controls were enrolled in the study. Serum PTX3 levels were measured using a human PTX3 enzyme-linked immunosorbent assay.

RESULTS

PTX3 concentrations were significantly higher in the adrenal tumor group compared with the control group (3,001.64 ± 374.64 pg/mL vs. 1,173.59 ± 168.89 pg/mL; P<.001). PTX3 concentrations were positively correlated with carotid intima media thickness (CIMT) (r², 0.464; P<.001), high-sensitivity C-reactive protein (hsCRP) (r², 0.551; P<.001), diastolic blood pressure (r², 0.334; P = .003), systolic blood pressure (r², 0.312; P = .006), and urinary metanephrine concentrations (r², 0.320; P = .041). Serum PTX3 concentrations in patients with functional adrenal tumors and comorbidities including hypertension, diabetes mellitus, or CVD were higher than in those without comorbidities (3,654.54 ± 447 pg/mL vs. 1,026.96 ± 447.97 pg/mL; P = .008).

CONCLUSION

We found that serum PTX3 concentrations increased in both functional and nonfunctional adrenal tumors. PTX3 levels were correlated with cardiovascular risk factors such as CIMT, hsCRP, and blood pressure.

ABBREVIATIONS

BMI = body mass index; CIMT = carotid intima-media thickness; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; FGF2 = fibroblast growth factor 2; hsCRP = high-sensitivity C-reactive protein; PA = primary hyperaldosteronism; PTX3 = pentraxin 3.

SERUM LEVELS OF FIBROBLAST GROWTH FACTOR-23, OSTEOPROTEGERIN, AND RECEPTOR ACTIVATOR OF NUCLEAR FACTOR KAPPA B LIGAND IN PATIENTS WITH PROLACTINOMA

OBJECTIVE

The aim of this study to was to evaluate the effect of fibroblast growth factor-23 (FGF-23), osteoprotegerin (OPG), receptor activator nuclear κB ligand (RANKL), and vitamin D hormones on bone loss in patients with hyperprolactinemia due to pituitary prolactinoma.

METHODS

We recruited 46 premenopausal female patients with prolactinoma and age and sex-matched healthy controls (Group 3, n = 20) for this cross-sectional study. Prolactinoma patients were divided into 2 groups as patients newly diagnosed (Group 1, n = 26) and those under cabergoline treatment (Group 2, n = 20). Anthropometric and metabolic variables; hormonal profiles; and osteocalcin, deoxypyridinoline (DOP), and bone mineral density measurements were performed for all participants. FGF-23, OPG, and RANKL levels were analyzed in all groups.

RESULTS

FGF-23, OPG, calcium, phosphorus, and parathormone levels were similar between all groups despite significantly higher levels in the control group in terms of vitamin D and RANKL levels than in patients. Bone loss was found more in Group 2, particularly observed in Z scores of femur and spinal bone (P<.05). Correlation analysis revealed a negative correlation between FGF-23 and femur neck T score (r = -0.0433, P = .05) in patients with active prolactinoma. A positive correlation was also observed between parameters of DOP and OPG (r = 0.673, P = .02). In patients with remission there were a negative correlation between prolactin and luteinizing hormone (r = -600, P = .08). Additionally, a negative correlation was found between osteocalcin and osteoprotegerin in patients in remission (r = -0.73, P = .01).

CONCLUSION

Our data indicated that FGF-23 and OPG levels do not play a critical role on the development of bone decrease in patients with hyperprolactinemia. However, further prospective studies in larger numbers of participants should be designed to clarify this issue.

ABBREVIATIONS

BFP = body fat percentage BMD = bone mineral density BMI = body mass index CV = coefficient of variation DOP = deoxypyridinoline ELISA = enzyme-linked immunosorbent assay FGF-23 = fibroblast growth factor-23 HOMA-IR = homeostatic model assessment of insulin resistance OPG = osteoprotegerin RANKL = receptor activator nuclear κB ligand.

Comparison of HbA1c analysers: Agilent 1100 HPLC using kits produced by Gordion Diagnostic (Turkey) with Premier Hb9210 using kits produced by Trinity Biotech (USA) in different patient groups

BACKGROUND

The aim of this study was to compare the performance of Agilent 1100 HPLC analyser using HbA1c kits manufactured by Gordion Diagnostic (Turkey) with that of Premier Hb9210 using the original kits for the measurement of HbA1c in different patient groups.

METHODS

Subjects were divided into four groups: Group 1 included 140 diabetic and non-diabetic subjects with normal urea and haemoglobin levels; Group 2 included 84 diabetic and non-diabetic subjects with high urea levels; Group 3 included 44 diabetic and non-diabetic subjects with iron deficiency anaemia; and Group 4 included 52 diabetic and non-diabetic subjects with high haemoglobin levels. EP Evaluator Release 8 program was used to evaluate the resultant data.

RESULTS

According to the comparison results of the two methods in all groups, there was an excellent correlation between the two methods (R>0.98). Moderate-low correlation was found between increased urea concentration and the difference of the two methods (R= -0.374, p = 0.0005). The difference between the methods was found to be increased with increased urea concentrations. This difference, although statistically significant, was within the permitted limits. The observed correlation between the difference of the two methods and the low and high haemoglobin concentrations was statistically non-significant (R = 0.149, p = 0.3343; R = 0.263, p = 0.0594).

CONCLUSIONS

We found that Agilent 1100 HbA1c analyser and Gordions' HbA1c kit comply with the clinical requirements and are suitable for HbA1c analysis at high levels of urea and Hb and low levels of Hb in diabetic and non-diabetic patients.

Vitamin D Levels of Anesthesia Personnel, Office Workers and Outdoor Workers in Ankara, Turkey

BACKGROUND

Vitamin D deficiency or insufficiency is a highly prevalent condition worldwide. Anesthesia providers or support personnel working in operating rooms might be considered at increased risk of vitamin D deficiency. There is a small amount of information about 25(OH)D levels in people who work mainly indoors as an operating room. This study aimed to investigate whether there was a higher vitamin D insufficiency or deficiency rate among anesthesia personnel working indoors when compared with personnel working in an office or outdoors in Ankara, Turkey (39 degrees North, 32 degrees East).

METHODS

This study consisted of 125 volunteer anesthesia personnel and 60 subjects as control groups (30 outdoor workers and 30 office workers). All of the individuals completed a questionnaire. Serum levels of total 25(OH)D were measured by a chemiluminescent immunoassay method.

RESULTS

74.4% of anesthesia personnel and 76.6% of control group 1 (outdoor workers) and 76.6% of control group 2 (office workers) had serum 25(OH)D concentrations < 10 ng/mL. 20.8% of anesthesia personnel and 23.4% of control group 1 and 23.4% of control group 2 had serum 25(OH)D concentrations levels 10 - 20 ng/mL. 4.8% of anesthesia personnel had serum 25(OH)D concentration levels 21 - 30 ng/mL. There was no significant difference in the mean serum 25(OH)D level between the groups (Anesthesia group: 8.98 ± 4.89 ng/mL, Control group 1: 8.18 ± 2.39 ng/mL, Control group 2: 8.37 ± 3.01 ng/mL) (p > 0.05).

CONCLUSIONS

To our knowledge the present study is the first study to investigate the comparison of vitamin D levels of anesthesia personnel with outdoor and office workers. Our findings alarmingly emphasize that vitamin D deficiency is very common at the end of winter in Ankara, regardless of being anesthesia personnel in operating room or a worker in office or an outdoor worker. Vitamin D supplementation may be suggested in all groups in Ankara.

Evaluation of the Tosoh G8 Analyzer and Comparison with the Trinity Biotech Premier Hb9210 Analyzer for the Measurement of HbA₁c

BACKGROUND

The aim of our study was to assess the analytical performance of the Tosoh HLC-723G8 automated analyzer and to compare it with the Trinity Biotech Premier Hb9210 analyzer for the measurement of hemoglobin A₁c (HbA₁c).

METHODS

A total of 101 patients with pre-diabetes or diabetes mellitus were included in the study. HbA₁c, was measured by both an ion-exchange high-performance liquid chromatography (IE-HPLC) method and a boronate affinity chromatography method. Statistical analysis was performed using Deming regression. Bland-Altman plots were used to calculate mean difference (bias).

RESULTS

The CV% values of IE-HPLC and boronate affinity methods for within run and between days were lower than 2.0%. High correlation was found (y = 1.0045x + 0.2111; r = 0.9941) between the two methods. The method shows no interference from carbamylated hemoglobin.

CONCLUSIONS

Both systems showed acceptable performance and are suitable for clinical application in the analysis of HbA₁c. However, laboratories should be aware of the limitations of their methods and the availability of more accurate and precise HbA₁c, determination methods.

Bone mineralization defects after treatment of acute lymphoblastic leukemia ın children

AIM

Aim of the study was to assess bone metabolism disturbances in children with acute lymphoblastic leukemia following cessation of chemotherapy. For this purpose we measured bone mineral density (BMD) and evaluated bone metabolism markers.

METHODS

Seventy-five patients (37 female, 38 males, mean age 10.77±3.80 years) were included. Lumbar spine BMD was measured by dual energy X-ray absorptiometry and serum calcium, phosphorus, magnesium, alkaline phosphatase, parathyroid hormone and 25OH vitamin D levels were analyzed. For characteristics of all patients at diagnosis data were retreived from hospital records and analyzed retrospectively.

RESULTS

A total of 18.66% (14 patients) of patients were osteoporotic (z score <-2 SD), 22.67% (17 patients) were osteopenic (z-score between -2 and -1 SD) and 58.67% (44 patients) presented normal z-scores (>-1 SD). There were no statisticaly significant differences between normal, osteopenic and osteoporotic groups for mean serum vitamine D (P=0.677), calcium (P=0.280), phosphorus (P=0.179), magnesium (P=0.675), ALP (P=0.092) and serum PTH (P=0.915) levels. According to ages (P=0.745) and gender (P=0.810) there were no significant differences in BMD. There were no significant differences between normal, osteopenic and osteoporotic patients for the total dose of prednisolone (P=0.334), dexamethasone, (P=0.734), methotrexate (P=0.911), granulocyte colony-stimulating factor (P=0.173) and cranial irradiation (P=0.912) they have received during chemotherapy. Bone fracture and aseptic necrosis rates were 12%, 8%, respectively.

CONCLUSION

Osteoporosis and osteopenia are still observed in high rates after chemotherapy. We must be aware of this morbidity and must screen the patients for decreased BMD during the long duration of leukemia treatment. Supportive treatments should be evaluated to minimize these serious complications.

Comprasion of ovarian stromal blood flow measured by color Doppler ultrasonography in polycystic ovary syndrome patients and healthy women with ultrasonographic evidence of polycystic

OBJECTIVE

To compare ovarian stromal artery blood flows measured by Doppler ultrasonography of polycystic ovary syndrome (PCOS) patients and healthy women with polycystic ovarian image in ultrasonography.

METHODS

Forty-two patients diagnosed with PCOS according to the criteria of 2003 Rotterdam Concencus Conferance on PCOS and 38 healthy volunteers with polycystic ovarian image in ultrasonography were included in the study. Ovarian volumes and ovarian stromal artery blood flows were measured by 3-dimensional (3-D) ultrasonography and Doppler ultrasonography in all patients.

RESULTS

In patients with PCOS, ovarian stromal artery pulsatility index (PI) and resistivity index (RI) were found significantly different from healthy women with polycystic ovarian image in ultrasonography (p < 0.05). 3-D ovarian volumes were found significantly higher in patients with PCOS (p < 0.05), and a negative correlation was also obtained between ovarian volumes and ovarian stromal artery resistivity indices.

CONCLUSION

Ovarian stromal artery Doppler examination could have an importance to explain the pathophysiology of PCOS, but there are few publications in the literature about PCOS and the details of ovarian stromal artery Doppler parameters in patients with polycystic ovarian image only. We conclude that Doppler ultrasonography findings of PCOS patients might be helpful in understanding the clinical follow-up and etiology of the disease.

Mining wastewater management and its effects on groundwater and ecosystems

Large-scale mining activities have a huge impact on the environment. Determination of the size of the effect and monitoring it is vital. In this study, risk assessment studies in mining areas and the effect of mining on groundwater and ecosystems were investigated. Best management practices and risk assessment steps were determined, especially in areas with huge amounts of mining wastewater. The pollution of groundwater and its reaching humans is a risk of major importance. Our study showed, using many cases with different parameters and countries, that the management of mining wastewater is vital. Environmental impact assessments and monitoring studies must be carried out before operation and at the closure of the mine. Policies must be in place and ready to apply. Factors of climate, geology, ecology and human health must be considered over a long period. Currently, only the developed countries are applying policies and paying attention to the risk. International assessments and health risk assessments should be carried out according to international standards.

Antioxidant properties, chemical composition and nutritional value of Terfezia boudieri (Chatin) from Turkey

Our objectives were to investigate the chemical composition, nutritive value and antioxidant activity potentials of Terfezia boudieri Chatin collected from different areas from Southeast of Turkey. The amounts of energy, protein, fat, carbohydrate, crude fibre, moisture and ash were 34.00–65.00 (kcal/100 g), 1.40–2.73, 0.86–1.71, 4.84–11.60, 80.86–90.33 (g/100 g, f.w.) and 1.02–1.98 g/100 g dry mass, respectively. Fatty acids and amino acids analyses revealed that linoleic acid and glutamic acid were, respectively the most abundant. Among the essential amino acids leucine was the highest amount and this was followed by threonine. Magnesium was the most abundant element with a concentration value of 182.30 mg/100 g dry mass. T. boudieri exhibited excellent antioxidant activity when compared with standard compounds. In total antioxidant and chelating effect on ferrous ions activity T. boudieri showed the highest activity against the standards. Additionally, at all studied tests antioxidant activity of the mushroom increased with increasing concentration. The total phenolic content of T. boudieri was found as 8.45 mg/g.

Adjunctive use of mitomycin C in endoscopic revision dacryocystorhinostomy

OBJECTIVES

Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the surgeon's ability to achieve good nasal and lacrimal mucosa apposition. The aims of this study were to assess the long term safety and efficacy of intra-operative use of adjunctive mitomycin C (MMC) treatment in endoscopic revision DCR surgery over 12-24 (mean 17) months.

METHODOLOGY

This was a prospective, nonrandomized consecutive case series that included 20 adult patients (20 eyes) with failed primary external DCR who underwent revision surgery under assisted local anaesthesia. During revision endoscopic DCR, intra-operative adjunctive MMC (0.2 mg/mL) was applied to the osteotomy site of the lacrimal sac and scar tissue surrounding the surgical osteum for 5 minutes.

RESULTS

The surgical success rate was determined based on the patency of the nasolacrimal system by irrigation and resolution of patient symptoms. Endoscopic revision DCR surgery with MMC was successful in 90% of cases (18 of 20 cases). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed.

CONCLUSIONS

Adjunctive intra-operative MMC application with endoscopic DCR surgery had a good success rate in patients with nasolacrimal duct obstruction that required revision surgery. Further large, double blind, placebo controlled, randomized studies are needed to confirm these findings.

Endovascular embolization of intermittent massive epistaxis secondary to posttraumatic carotid artery pseudoaneurysms

Epistaxis is a very common medical problem in otolaryngology practice and can usually be controlled with conservative interventions. Rarely, uncontrolled and life threatening epistaxis occurs. We present the case of a 29-year-old male who developed intractable intermittent epistaxis due to post-traumatic pseudoaneurysms arising from the cavernous segment of the left internal carotid artery. The patient was successfully treated with endovascular embolization.

Imaging findings and clinical features of patients with multiple myeloma with the prognostic effect of bone marrow focal and diffuse infiltration patterns on spine MRI

AIM

Aim of this study was to evaluate the prognostic effect of the magnetic resonance imaging (MRI) infiltration type as diffuse or focal patterns on spine magnetic resonance imaging (MRI), as well as other imaging and clinical features of patients with multiple myeloma.

METHODS

A retrospective analysis of 35 patients with multiple myeloma was performed in this study. Patients were mean of 56.5 ± 12.4 year old, male/female ratio=1.3. Patients were at stage 2 and one at stage 3. Skeletal surveys were obtained in all patients, additionally bone scintigraphy (N.=25), CT (N.=22), and spine MRI (N.=16) were conducted. On imaging, lesion number, size and distribution and characteristics were assessed. On MRI, bone marrow involvements were assessed as focal and diffuse patterns (mild, moderate, and severe). All patients were followed-up with MRI for a median of 8.5 months (range, 1-105). Statistical analysis for bone marrow infiltration on MRI was performed using Kaplan-Meier survival test.

RESULTS

Patients with diffuse infiltration pattern on MRI survived as median 13.0 months (range, 1-105), whereas cases with only focal pattern survived as median 3.5 months (range, 1-27). There was no difference between these groups (P=0.071). The disease-free survivals were not different, either (P=0.118). Scintigraphy, CT, and MRI detected more lesions in flat bones except for cranium where craniography was successful.

CONCLUSION

It was not possible to find any further effect of the diffuse MRI infiltration type beyond focal infiltration on overall and disease-free survivals. Among typical findings of the radiography, spherical, punched-out lesions were seen, but lesion uniformity was not seen.

Evaluation of the Roles of Serum Vitamin B12, Folate and Homocysteine Levels in Laryngeal Squamous Cell Carcinoma

Metabolic changes in head and neck carcinogenesis are often non-specifically correlated with carcinomas. The study of metabolic disorders can improve the understanding of tumourigenesis at the cellular level. This study was designed to evaluate the role of serum homocysteine, folate, and vitamin B12 levels in the pathogenesis of laryngeal squamous cell cancer (LSCC) by measuring serum levels in 60 consecutive untreated patients with LSCC and 60 controls (30 smokers and 30 non-smokers). Compared with smoker and non-smoker control groups, significantly lower levels of vitamin B12 were found in patients with LSCC. Folate levels in patients with LSCC were also significantly lower than in the smoker and non-smoker control groups. There were no significant differences in the homocysteine levels between these three groups. Metabolic alterations in vitamin B12 and folate levels, particularly hypofolataemia, could be associated with the development of LSCC, although further research is required to confirm their roles definitively.

The effects of levothyroxine substitution on body composition and body mass after total thyroidectomy for benign nodular goiter

OBJECTIVE

Many patients who have undergone total thyroidectomy complain about weight gain and changes in body composition. This prospective study was designed to evaluate the effect of thyroxine replacement on body mass index (BMI) and body composition following total thyroidectomy for benign multinodular goiter.

METHODS

Thirty-three consecutive patients were enrolled. The patients of those histopathological examination revealed carcinoma (n=5) and who did not present for the 6th month follow-up visit (n=6) were excluded. Thyroxine (T4, 100 μg, dose range 50-200 μg) was started in all patients immediately after the surgery and adjusted according to plasma TSH and FT4-FT3 levels in the postoperative 3rd week and postoperative 3rd and 6th months respectively to achieve optimal TSH within normal reference range (0.5- 4.2 mU/L). Changes in weight, BMI and anthropometric measurements were performed preoperatively and in the postoperative 3rd and 6th months.

RESULTS

The study completed with 22 patients (17 female and 5 male, mean: 45.8 years; range: 26-64 years). Fourteen patients maintained euthyroid status and eight had subclinical hypothyroidism. There were no significant differences between the subclinical hypothyroid and euthyroid patients in BMI and the other anthropometric values (p>0.05). In the comparisons for age, there were significant changes with regarding weight and BMI. Increases in weight were noted as 2.2±2.7 kg in age over 45 (n= 14, mean: 52.7 years, range: 46-64 years), while 0.1±1.3 kg in age under 45 years (mean; 33.8, range: 26-43 years) and BMI as 0.8±1.0 in age over 45 years compared to 0.04±0.5 in age under 45 years, respectively (p=0.025 and p=0.029, respectively). No significant differences were noted in other anthropometric parameters at the end of 6th month compared to the baseline value except the triceps skin fold (p=0.027).

CONCLUSION

Levothyroxine replacement had no effect on their body composition; however, age was found to be an important factor for weight gain and change in BMI during the midterm follow-up period.

Angiotensin II receptor blockage prevents diabetes-induced oxidative damage in rat heart

Current findings suggest a role for the angiotensin II (Ang II) signalling pathway in generation of reactive oxygen species and diabetes-induced cardiac complications. In this study we aimed to investigate the effect of angiotensin II type 1 (AT1) receptor blockage on some antioxidant enzymes such as glucose- 6-phosphate dehydrogenase (G6PD), 6-phoshogluconate dehydrogenase (6PGD), glutathione reductase (GR), glutathione-S-transferase (GST), glutathione peroxidase (GSH-Px), and catalase (CAT) in the heart of streptozotocin (STZ)-induced diabetic rats. The effect of AT1 receptor blocker, candesartan-cilexetil (5 mg/kg/day for 4 weeks) was studied. Diabetes caused hyperglycaemia (4-fold of control) with significant increases in G6PD, 6PGD, GR, GSH-PX, CAT and no effect on GST in heart tissues as compared to normal control rats. Treatment of STZ-induced diabetic rats with candesartan-cilexetil had significant beneficial effects on these parameters without any side effect on control rats. These results suggest that Ang II can take part in induction of oxidative stress in diabetic rat heart and that blockage of its activity by AT1 receptor blocker is potentially protective against diabetes-induced cellular damage.

Critical appraisal of respirometric methods for metal inhibition on activated sludge

This paper evaluates the merit of oxygen uptake rate measurements for the assessment of metal inhibition on activated sludge. For this purpose, experiments are conducted to calculate EC50 levels of nickel and hexavalent chromium using the ISO 8192 procedure, yielding results that are highly variable and difficult to correlate, depending on the type of substrate and the initial food to microorganism ratio. Similar experiments based on continuous respirometric measurements to give the entire oxygen uptake rate profile provide a much better insight on the impact of inhibition on different biochemical processes taking place in the reactor. The results indicate that percent reduction of the amount of dissolved oxygen utilized after an appropriate reaction time is a much better index for the assessment of the inhibitory effects.

The effects of experimental hyperthyroidism on hemorheology and plasma fibrinogen concentration

The present study in female rats determined the effects of experimental hyperthyroidsm on hemorheological parameters and fibrinogen concentration. To induce experimental hyperthyroidism L-thyroxine (0.4 mg/100 g fodder) was added to the fodder of the experimental group rats for 20 d. After experimental duration, T3, T4, and TSH levels, plasma and blood viscosity, hematocrit, erythrocyte rigidity index, and plasma fibrinogen concentration values of both the control and the experimental group animals were determined and evaluated. In the experimental group, T3 and T4 levels were higher and TSH levels lower than that of the control rats (respectively, p < 0.01, p < 0.001, p < 0.001). Plasma viscosity and fibrinogen concentration of hyperthyroid group were found significantly higher than controls (p < 0.01). However there was no significant difference found in blood viscosity, hematocrit, and erythrocyte rigidity index between control and experimental groups. Thus, hyperthyroidism induced increased fibrinogen concentration can alter the rheological structure of blood by inducing increase in plasma viscosity.

The effects of short-term training on platelet functions and total antioxidant capacity in rats

The purpose of the present study was to investigate the effect of short-term endurance training on plasma total antioxidant status (TAS) and on in vitro platelet aggregation and ATP release. Blood samples were collected from the abdominal aorta of rats following short-term treadmill exercise (25 m/min, 0 % grade, 30 min) for three consecutive days, as well as in non-exercised control group. Platelet aggregation and platelet ATP release were evaluated by impedance and bioluminescence techniques, respectively. Plasma TAS was measured spectrophotometrically. Plasma TAS was higher and ADP-induced platelet ATP release was lower in the short-term training group with respect to the control group (p<0.001). Significant negative correlation (r = -0.56, p<0.05) was found between plasma TAS and ADP-induced platelet ATP release. Neither ADP- and collagen-induced maximum aggregation rate nor collagen-induced platelet ATP release were significantly different between the groups. According to these results, short-term training caused an alteration in platelet functions limited to the secretion response, which may be related to the oxidant/antioxidant balance changes favoring the antioxidants. The improved plasma total antioxidant capacity was possibly sufficient to prevent exercise-induced oxidative damage, and the adaptive response of platelets might be associated with enhanced antioxidant status.

Comparison of long-term quality of life after laparoscopic and open cholecystectomy

BACKGROUND

Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of these two cholecystectomy techniques on the quality of life and clinical outcome of the patients during long-term follow-up evaluation.

METHODS

This study evaluated 200 patients who underwent cholecystectomy operations with either technique between 1993 and 1999 in our department. There were 100 patients in each group. Both groups were similar with respect to age, gender, body mass indexes, American Society of Anesthesiology (ASA) scores, and indications for surgery. The Medical Outcome Study Short Form 36 Health survey (SF-36), which includes 36 items, was used for evaluating the quality-of-life index. In addition to this, a system-specific instrument for gastrointestinal diseases was used to investigate clinical outcome.

RESULTS

The mean administration time for the questionnaire was 46.8 +/- 18.7 months in the laparoscopic cholecystectomy (LC) group and 41.5 +/- 16 months in the open cholecystectomy (OC) group. Statistically significant differences were noted in the scores for all eight SF = 36 health status domains in favor of laparospopic surgery. No statistically significant difference was found for abdominal pain, location of the pain, referral to a doctor for the pain, accompanying symptoms, relieving factors for the pain, distention, and dyspeptic complaints, usage of antacid therapy, weight changes, changes in bowel habit, need for a special diet, or sexual functions between the two groups.

CONCLUSIONS

The gastrointestinal clinical symptoms were similar in the two groups during the long-term follow-up evaluation, but laparoscopic cholecystectomy was found to be significantly superior to the open technique with respect to the quality of life over the long term.

Vegetable oils used as vitamin E vehicle affect the electrical activity of the rat heart

The aim of this study is to define the possible effects of vegetable oils used as vitamin E vehicle on the electrical activity of the rat heart. To test the possible effects of vitamin E vehicles we studied the effect of i.p. injected corn oil, hazelnut oil or peanut oil on the action potential parameters recorded in both papillary and left atrial muscle strips. Four experimental groups were used. The control group was injected (i.p.) with distilled water, while the three remaining groups received injections of corn oil, hazelnut oil, or peanut oil for five weeks (in a dose of 0.4 ml/kg/day--minimum amount of oil in which vitamin E could be dissolved). We used borosilicated (15-20 megaohms) capillary electrodes and intracellular action potentials (AP) were recorded in isolated papillary and left atrium muscle strips. While administration of three different types of vegetable oil had no significant effect on AP parameters of papillary muscle, they significantly prolonged the repolarization phase of AP in atrial strips. These results show that vegetable oils used as vitamin E vehicles may alter the electrical activity of the heart in a tissue-dependent manner. The present data indicate that the possible effect of vegetable oil vehicles should be kept in mind while evaluating the possible effects of in vivo vitamin E administration.

Mapping the mesoscale interface structure in polycrystalline materials

A new experimental approach to the quantitative characterization of polycrystalline microstructure by scanning electron microscopy is described. Combining automated electron backscattering diffraction with conventional scanning contrast imaging and with calibrated serial sectioning, the new method (mesoscale interface mapping system) recovers precision estimates of the 3D idealized aggregate function G(x). This function embodies a description of lattice phase and orientation (limiting resolution approximately 1 degree) at each point x (limiting spatial resolution approximately 100 nm), and, therefore, contains a complete mesoscale description of the interfacial network. The principal challenges of the method, achieving precise spatial registry between adjacent images and adequate distortion correction, are described. A description algorithm for control of the various components of the system is also provided.

Effects of excessive copper intake on hematological and hemorheological parameters

Copper plays an important role in the structure and function of metalloproteins and in the absorption of iron. The present study deals with the effects of excessive copper intake on hematological and hemorheological parameters. Drinking water containing 250 microg/mL copper for a period of 9 wk, Wistar albino rats showed increased erythrocyte count, blood viscosity, and hematocrit values (p<0.05) and lower hemoglobin (p<0.05) than controls fed a normal diet. The two groups also had differences in the erythrocyte deformability index. The results suggest that excessive copper intake results in hematological and hemorheological changes affecting both the protein content of the erythrocyte membrane and heme synthesis.

Laparoscopic renal biopsy in bilateral pelvic kidney with chronic glomerulonephritis

Percutaneous needle biopsy under the guidance of ultrasound or computerized tomography is the most valuable method in the diagnosis of parenchymal kidney diseases. However, sometimes it can be difficult to perform in the presence of certain anomalies, anatomic variations, or medical problems. In the presence of bilateral pelvic kidney, which is a rare anomaly, laparoscopy can be used to obtain biopsy. Biopsy of kidney was planned in a 26-year-old woman who presented with a history of hypertension for 7 years and proteinuria with the diagnosis of nephrotic syndrome. For the biopsy, the laparoscopic approach was chosen since the patient had bilateral pelvic kidneys. Under general anesthesia, using three port sites, the right kidney was reached, which was located more anterior than the left one. Three biopsy specimens for histologic evaluation were taken with a Tru-Cut biopsy needle. No complications were encountered during or after the operation. The patient was ceased from urological follow-up after performing an ultrasound on the first postoperative day. This is the first case of pelvic kidney with chronic glomerulonephritis reported in the literature in which the histologic diagnosis was made with the help of laparoscopy. Laparoscopic kidney biopsy is a minimally invasive technique that can be done in cases with anatomic variations, making percutaneous needle biopsy impossible.