Index of cardio-electrophysiological balance and Parkinson disease

Neurodegeneration of the autonomic nervous systems due to Parkinson disease (PD) may lead to increase in the QT duration. In recent years, a new parameter index of cardio-electrophysiological balance (ICEB) was found. ICEB is a significant parameter of medicine related dysrhythmia. The purpose of this research is to assess ICEB in PD. Twenty-eight PD cases and 26 controls participated in our investigation. First diagnosed PD patients were registered in the research. The symptom progression of PD was assessed Modified Hoehn and Yahr Scale. Analyzed ECG variables are QRS, PR, QT, corrected QT (QTc) interval, ICEB and corrected index of cardio-electrophysiological balance (ICEBc). All cases had sinus rhythm. ICEB was analyzed by the ratio of QT/QRS. ICEBc was analyzed by the ratio of QTc/QRS. Twenty-eight PD cases participated in this research. Among PD cases, 15 patients were female (53.5%). The mean age of PD patients are 59.03 ± 9.94 years. There was no important difference between groups with respect to the clinical variables. The Modified Hoehn and Yahr Scale was appreciably higher in the PD group than the Control group. The heart rate of the PD group was significantly lower than that of the control group. PR intervals and QRS duration were similar in both groups. QT and QTc duration were significantly longer in PD patients. Also, the ICEB and ICEBc variables were appreciably higher in PD cases. The findings of our investigation suggest that ICEB is related to PD. ICEB can help to evaluate arrhythmia risk in patients with PD.

Assessment of Myocardial Function by Speckle Tracking Echocardiography in Patients with Acute Ischemic Stroke

Background

Acute stroke is an important cause of morbidity and mortality. Myocardial injury is an important complication of acute cerebrovascular events. Neurogenic stress cardiomyopathy (NSC) is a condition of acute myocardial systolic dysfunction that can be observed after acute cerebrovascular events.

Objective

In this study, we aimed to investigate the relationship between myocardial function assessed by two-dimensional speckle-tracking echocardiography and National Institutes of Health Stroke Scale (NIHSS) score in patients with acute ischemic stroke.

Materials and Methods

This cross-sectional study screened 97 patients (males, 42; females, 55; 65 ± 16 years) with acute ischemic stroke. Around 17 patients were excluded and 80 patients were studied. Patients were divided into two groups based on the calculated NIHSS score (Group 1, NIHSS score <16; Group 2, NIHSS score ≥16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac function was evaluated by two-dimensional speckle tracking echocardiography within 48 h of admission to the neurology care unit.

Results

There were no significant differences in the demographic parameters of patients. The absolute value of global longitudinal systolic strain (GLS) was significantly higher in Group 1 patients than in Group 2 patients (21.4 ± 2.2 vs 15.9 ± 2.7, P = 0.0281). We found that thirteen patients (22%) had normal LVEF and abnormal LV GLS in Group 1 (P = 0.036). Eight patients (36%) had normal LVEF and abnormal LV GLS in Group 2 (P = 0.042). E/e', QT on ECG, and serum troponin levels were significantly higher in Group 2 patients than in Group 1 patients (P < 0.05).

Conclusions

Our results suggest that GLS is associated with stroke severity on admission in patients with acute ischemic stroke. GLS is an indicator of myocardial deformation with a different from LVEF. GLS can detect early myocardial dysfunction despite preserved LVEF.

The impact of the COVID-19 pandemic on the orthopaedics outpatient clinic

OBJECTIVE

The COVID-19 pandemic has significantly impacted orthopaedic practice since it started. In our study, we aimed to examine these effects on outpatient services.

PATIENTS AND METHODS

The patients who applied to the orthopedic outpatient clinic (n=1,518) in six months period under the effect of the COVID-19 pandemic (September 2020-March 2021) and patients (n=1,207) who applied during the same period before the pandemic (September 2019-March 2020) were analyzed according to the demographic characteristics (age, gender), reasons for admission, duration of complaints, treatments applied, surgical acceptance rate, and compliance with treatment.

RESULTS

The mean age in the pre-pandemic outpatient clinic admissions was 39.1 years (1-91 years), the gender ratio was 635/572 (Female/Male), the mean age of the patients was 38.1 years (1-95), and the sex ratio was 793/725 (F/M) during the pandemic. Admissions of patients with acute complaints decreased after the pandemic, and applications for subacute or chronic complaints increased. Applications for sports medicine, pediatrics, and hand surgery increased, applications for trauma, foot and ankle surgery decreased, and applications for oncology and spine did not change. Conservative treatment recommendations decreased, the surgical treatment recommendation did not change, and the rate of patients who were given only follow-up decisions increased. There was no significant difference in the treatment rejection and surgical acceptance rate.

CONCLUSIONS

We observed that the number of traumas decreased, and the hospital admission duration extended. The increase in the consultation rate and follow-up preference indicates that the treatment is more conservative in this period. In this process, patients should be adequately informed about the precautions taken, and their treatment should not be interrupted.

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort

Background and objectives

Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity.

Methods

Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation.

Results

We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011).

Conclusion

Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

P-472 Extended oocyte cryostorage period is not associated with decreased post-warm survival rate: a retrospective study of 5208 vitrified/warmed oocytes at a single centre

Study question

Is extended oocyte cryostorage period associated with decreased post-warm survival rate?

Summary answer

There is a weak inverse correlation between oocyte cryostorage duration and post-warm survival (r = 0.09, p = 0.01). This equates clinically to a reduction of 0.0003% survival/day.

What is known already

It is widely reported that extended embryo storage is not associated with reduced post-warm survival rates, however there are no such studies in the literature relating to the effect of extended cryostorage duration on oocytes.

Successful outcomes from oocyte vitrification are related to reduced patient age however UK government regulations only permit those with a medical indication to store and use their gametes over 10 years.

With the intended extension of this 10-year limit, it is therefore fair for clinics to expect an increasing population of younger patients choosing to store their oocytes for longer periods.

Study design, size, duration

A retrospective audit of all vitrified/warmed oocyte cycles at a single centre from 2014-2021. A total of 5208 oocytes were included in the study, from 602 treatment cycles.

Participants/materials, setting, methods

Patients of all ages were included in the study. Data was obtained retrospectively from IDEAS V6.0 at CRGH, UK. All oocytes were vitrified/warmed according to the Irvine Scientific/Kitazato media protocols, with all other protocols excluded. Data was analysed using IBM® SPSS® Statistics V24. Kendall’s tau-b and Spearman’s Rho correlation coefficients measured the strength and direction of association between variables. A linear regression model was used to establish the effect of duration on survival per day.

Main results and the role of chance

The median age at oocyte vitrification was 31 years (range 18-45 years, LQR=25 years, UQR=37 years). There was a median of 8 oocytes thawed per case (LQR=6, UQR 11 oocytes) with a median of 6 oocytes surviving (LQR=3, UQR=9 oocytes). The median survival rate across all ages was 81% (LQR=58%, UQR=100%). There was no significant difference in oocyte survival rate between age categories (&lt;35 years vs &gt; 35 years; p = 0.137, n = 414 & 188 respectively). Increasing age was however, significantly correlated with fewer oocytes vitrified (r = 0.283, p = 0.001).

There is a weak inverse correlation between oocyte cryostorage duration and post-warm survival (r = 0.09). This correlation reaches statistical significance (p = 0.01), however this equates clinically to a reduction of 0.0003% survival rate per day.

No significant difference was observed in post-warm oocyte survival rate across duration of vitrification categories (≤3 years vs 4-5 years vs &gt; 5 years; p = 0.154, n = 416, 141 & 45 cases respectively).

The median duration for which oocytes remained in cryostorage was 565 days (1.6 years) (LQR & UQR=233 days (0.64 years) and 1390 days (3.8 years) respectively).

Limitations, reasons for caution

Although retrospective, the study benefits from many cycles, all of which were carried out at the same unit, using the same vitrification/warming media protocol. Limitations of this study include a relatively short median cryostorage duration time which could be masking the true effect of duration on post-warm oocyte survival.

Wider implications of the findings

Following a public consultation in 2020 regarding the 10-year storage limit for gametes and embryos, the UK Government proposed changes the current legislation which will allow patients to extend cryostorage beyond 10 years without a medical indication. To our knowledge, this is the first study to lend support this movement.

Trial registration number

IRB-001C03-01-22

P-357 Predicting live birth following single euploid frozen blastocyst transfer - does the journey matter?

Study question

Does the number of available euploid embryos affect the success rate of the first single euploid frozen thawed embryo transfer (FTET)?

Summary answer

The live birth rate (LBR) following the first single euploid FTET is independent of the number of available euploid embryos.

What is known already

Preimplantation testing for aneuploidy (PGT-A) is a controversial laboratory technique as an embryo selection tool to increase LBR per transfer and reduce time to pregnancy. There have been many efforts to identify factors predictive of LBR following a euploid embryo transfer. The number of euploid embryos available is known to increase the expected cumulative LBR. However, there is lack of evidence whether the number of available euploid embryos is also significantly associated with chances of live birth for the first euploid FTET cycle. This is important for individualized patient counselling.

Study design, size, duration

A retrospective analysis of the first, single, euploid FTET of 506 women, between January 2015 to March 2020 following PGT-A was carried out. The indication for PGT-A was advanced maternal age, recurrent miscarriage or implantation failure. Embryos were biopsied on day 5 or 6 and tested with array comparative genetic hybridization or next generation sequencing. The FTET outcomes were compared based on the number of euploid embryos available.

Participants/materials, setting, methods

198 women had one euploid embryo available (group 1), 120 women had two (group 2) and 188 women had three or more (group 3). Baseline characteristics were analysed for all participants to adjust for confounders. Reproductive outcomes such as pregnancy rate (PR), clinical miscarriage rate and LBR were compared between the 3 groups for the first euploid FTET. Univariate analysis with Kruskal-Wallis H, chi-square and multivariate logistic regression was performed with SPSS.

Main results and the role of chance

Baseline characteristics were similar between the groups including age at egg collection (EC), body mass index, use of partner or donor sperm, method of insemination, number of ECs, endometrial preparation protocol and endometrial thickness prior to transfer. Women with three or more euploid embryos were younger at the time of EC compared to groups 1 and 2 (mean age 37 vs 39 and 38). The number of oocytes per EC (15 vs 11 and 11, p &lt; 0.001), the total number of oocytes following batching cycles (20 vs 15 and 16, p &lt; 0.001) and the number of blastocysts biopsied (8 vs 4 and 5, p &lt; 0.001) were significantly higher for Group 3 vs Group 1 and Group 2, respectively. Group 1 embryos were less frequently of excellent and very good morphology and less frequently biopsied on day 5 vs 6.

Univariate analysis suggests Group 3 had statistically higher PR and LBR compared to Group 1, but similar miscarriage rate. However, when applying a multivariate logistic regression model, the LBR after first euploid FTET was independent of the number of euploid embryos available but was influenced by age at EC (p = 0.006) and biopsy day (Day 6 vs day 5, OR 0.53, 95% CI 0.33-0.85, p = 0.008).

Limitations, reasons for caution

The main limitation of this study is its retrospective nature performed in a single centre, and therefore vulnerable to bias and confounding factors that may have not been accounted for.

Wider implications of the findings

Our findings suggest that the success rate of the first euploid FTET does not depend on the number of euploid embryos but is influenced by the age at EC and the embryo stage at biopsy. This could be useful when counselling women with a low number of euploid embryos available.

Trial registration number

Not Applicable

Research Burden of Interstitial Lung Diseases in Turkey - RBILD

INTRODUCTION

The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients.

MATERIAL-METHOD

The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally.

RESULTS

In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira.

CONCLUSION

We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Assessment of left atrial function by strain in patients with acute ıschemic stroke left atrial function and acute stroke

OBJECTIVE

Myocardial speckle-tracking echocardiography can detect subtle abnormalities in the left atrial function. In this study, we aimed to investigate the relationship between left atrial myocardium and tissue function n assessed by two-dimensional speckle-tracking echocardiography and the National Institutes of Health Stroke Scale score in patients with acute ischemic stroke.

METHOD

The study was composed of 80 patients (45 men, 35 women, mean age: 67±15 years) with acute ischemic stroke. The patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale score (group 1, National Institutes of Health Stroke Scale score < 16; group 2, National Institutes of Health Stroke Scale score ≥ 16). Demographic, clinical, and laboratory data for all patients were collected. Cardiac functions were evaluated using two-dimensional speckle-tracking echocardiography within 48 hours from admission to the neurology care unit.

RESULTS

There were no significant differences between the patients' clinical parameters. Left ventricular ejection fraction was significantly higher in group 1 than in group 2 (59.2±5.6 to 51.4±6.3, p=0.024). Left atrial longitudinal strain was significantly higher in group 1 than in group 2 (34.48±9.73 to 26.27±7.41, p=0.019). There were no significant differences between other echocardiographic parameters.

CONCLUSION

Our results suggest that left atrial longitudinal strain is associated with stroke severity during admission in patients with acute ischemic stroke. Left atrial longitudinal strain is an indicator of left atrial myocardial function.

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients

The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.

Relation between index of cardioelectrophysiological balance and stroke severity in patients with acute ischemic stroke

Background

The index of cardioelectrophysiological balance (iCEB), measured as QT interval divided by QRS duration, has recently been defined as a new risk marker for arrhythmias. Increased or decreased iCEB is associated with malignant ventricular arrhythmias.

Aim

In this study, we aimed to investigate the relationship between iCEB and stroke severity in patients with acute ischemic stroke.

Methods

The study comprised 105 adult patients (males, 58; females, 47; 69 ± 15 years) with acute ischemic stroke. Nine patients were excluded. Patients were divided into two groups based on the calculated National Institutes of Health Stroke Scale (NIHSS) score (Group 1, NIHSS score <16; Group 2, NIHSS score ≥16). Demographic, clinical, and laboratory data for all patients were collected. Electrocardiography (ECG) was recorded from all patients on admission to the neurology care unit. iCEB (QT/QRS) was calculated from the 12-lead electrocardiogram.

Results

There were no significant differences among the demographic parameters of patients. iCEB score was significantly higher in Group 2 patients than Group 1 patients (3.97 ± 0.61 vs 3.43 ± 0.57, P = 0.0024).

Conclusion

Our results suggested that iCEB is associated with stroke severity on admission in patients with acute ischemic stroke. It is known that high iCEB is associated with torsade de pointes (TdP), ventricular tachycardia.

A Case of Neurocysticercosis in Diyarbakir

Neurocysticercosis is a major parasitic disease of the central nervous system, affecting endemic areas worldwide. It spreads through intermediary hosts, pigs and eventually men to his definitive host: humans. It causes lesions in the CNS which have different evolutive stages and can be asymptomatic or clinically evident. Imaging studies play an important role in the diagnosis of the disease and in its appropriate control.

Protective effects of caffeic acid phenethyl ester and thymoquinone on toluene induced liver toxicity

Toluene is an organic solvent that is toxic to humans. Caffeic acid phenethyl ester (CAPE) and thymoquinone (TQ) exhibit antioxidant and antitoxic effects. We investigated the protective effects of CAPE and TQ on toluene induced hepatotoxicity. Wistar albino rats were divided into seven groups of eight. The animals were injected intraperitoneally (i.p.) with 0.1 ml/10 g/day corn oil (control I), 0.1 ml/10 g/day corn oil + 2 ml/kg/day 10% ethanol (control II), 20 mg/kg/day TQ dissolved in 0.1 ml/10 g corn oil (TQ), 10 µmol/kg/day CAPE dissolved in 10% ethanol (CAPE), 500 mg/kg/day toluene (T), toluene and TQ together (T + TQ), or toluene and CAPE together (T + CAPE). All rats were sacrificed on day 15. Liver samples were obtained for histological analysis. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured to evaluate liver function. Liver sections from the control I and TQ groups exhibited normal histology. Sections from the T group exhibited sinusoid dilation, hemorrhage, vacuolization and necrosis. TQ and CAPE protected against toluene induced histopathological changes. AST and ALT levels were increased significantly in T group compared to both control groups. CAPE decreased significantly the toluene induced increase in AST and ALT levels, while TQ did not. CAPE and TQ exhibited some antitoxic and hepato-protective effects on toluene induced liver damage.

Diverticular disease and posture during defecation : a prospective comparative study

BACKGROUND AND STUDY AIMS

Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation.

PATIENTS AND METHODS

This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662).

RESULTS

The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis.

CONCLUSION

Sitting during defecation seems to increase the risk of CD.

The effects of chronic smoking on lung tissue and the role of alpha lipoic acid

We investigated the effects of alpha lipoic acid (ALA) on blood and lung tissue exposed chronically to cigarette smoke (CS). Female Sprague-Dawley rats were divided into three groups. Group 1 was the control group (CON): fresh air was supplied twice daily and 0.1 ml physiological saline was given orally for 8 weeks. Group 2 was exposed to CS: 12 cigarettes were smoked daily at two sessions for 1 h and 0.1 ml saline was given orally for 8 weeks. Group 3 (CS + ALA) was exposed to 12 cigarettes daily in two sessions for 1 h and 100 mg/kg/day ALA was given orally for 8 weeks. DNA damage was assessed using comet analysis; oxidative damage was assessed using ischemia-modified albumin (IMA) from blood; and total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were measured in blood and lung tissue. Histopathological and immunohistochemical evaluation of hypoxia-inducible factor (HIF)-1α, and -2α, caspase-3, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF₂) were conducted using lung tissue. The oxidative markers, TOS, OSI and IMA, and the comet analysis score were increased and the TAS level was decreased in the blood of the CS group compared to the CON group. IMA levels in blood, and TOS and OSI levels in the lung were decreased significantly in the CS + ALA group compared to the CS group. We observed increased septal wall thickness, marked and diffuse inflammatory reaction, emphysema, and necrotic cell debris in bronchial and bronchiolar lumens in the CS group. HIF-1α, HIF-2α, caspase-3 and FGF₂ expressions were increased, while VEGF expression decreased in the lung tissues of the CS group compared to the CON group. ALA slightly ameliorated the damage caused by chronic exposure to CS in the lungs, but further investigation is needed to determine its possible protective effects at different dosages.

Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect

INTRODUCTION

Speckle tracking echocardiography (STE) for two-dimensional (2D) strain analysis is a new tool to assess myocardial function. The aim of this study was to assess right atrial (RA) function using STE in patients with an atrial septal defect (ASD) before and one month after percutaneous closure.

METHODS

We prospectively examined 32 consecutive patients (nine male, 23 female) who underwent percutaneous transcatheter closure of a secundum ASD between June 2013 and December 2015. Echocardiography was performed on admission, prior to cardiac catheterization and then one month after ASD closure. Peak global RA longitudinal strain was analyzed by 2D-STE.

RESULTS

Patients' mean age was 34.6±8.2 years. The mean diameter of the occlusive devices was 18.5±7.5 mm. Right ventricular (RV) end-diastolic diameters were significantly increased but decreased significantly after ASD closure (43±5 vs. 38±4 mm, p<0.05). Left atrial (LA) diameters (40±8 vs. 37±6 mm, p<0.05) decreased significantly after the intervention, whereas left ventricular (LV) end-diastolic diameters (45±5 vs. 46±4 mm, NS) remained unchanged. Tricuspid annular plane systolic excursion increased significantly (17.6±5.4 vs. 22.3±8.1 mm, p<0.05). After closure of the defect, a significant increase was observed in longitudinal RA strain (26.5±9.6% vs. 35.3±10.5%, p<0.001).

CONCLUSIONS

After percutaneous transcatheter closure of a secundum ASD, there was an increase in RA longitudinal strain. 2D-STE strain analysis appears to be helpful for the assessment of RA function and of response to correction of volume overload after percutaneous transcatheter closure of a secundum ASD.

The effects of stabilization splint treatment on the volume of masseter muscle in sleep bruxism patients

OBJECTIVE

The aim of this study was to evaluate, quantitatively, the volumetric effects of stabilization splint therapy on the masseter muscle of sleep bruxism (SB) patients.

METHODS

The magnetic resonance (MR) images of 16 SB patients diagnosed by polysomnography (PSG) who used stabilization splints for four months were obtained before and after the therapy. The masseter muscle volume was calculated using Cavalieri's principle on the MR images.

RESULTS

After the splint therapy, the mean volume of the masseter muscle did not reduce significantly. The fat and/or water content of the muscles did not change either.

DISCUSSION

The stabilization splint therapy had no effect on the volume, fat and/or water content of the masseter muscle; however the discomfort was reduced in the patients. Although the effect of splint therapy is not fully understood, the non-invasive and reversible stabilization splint can be used in SB patients because of its relaxation effect on muscles.

Treatment of resistant idiopathic hiccups with pulse radio frequency on phrenic nerve and gabapentin: A case report

Hiccups affect life quality, career and family life when they become persistent. We present here a 54-year-old man who worked as a mason and a blacksmith with hiccups complaint for nearly one and a half years. In this period, he was admitted to emergency service ten times with fainting or almost fainting, cold sweating and hand stretching complaints. The patient expressed that he frequently threw up when he had hiccups and his social life was negatively affected. He reported that he was treated with baclofen, esomeprazole and hyoscine-n-butyl bromur without relief. He used escitalopram and chlorpromazine for a short time and quit because they negatively affected his sleeping. As he did not have any relief from medications, he refused any oral medical therapy including gabapentin and started to seek remedy from paramedical treatments resulted with no benefit. The patient was referred to algology department and an intervention on phrenic nerve with pulse radio frequency (8 minutes, 45 Volts, 20 milliseconds wavelength) was performed. Symptoms stopped immediately after the procedure but one week later, although the patient reported a significant decline in symptoms he still had hiccups. The patient was offered oral medical therapy again. With considerable relief from symptoms, the patient accepted oral therapy this time. Gabapentin 300 mg bid was prescribed. The symptoms were completely recovered and the patient reported no hiccups after 30 days of Gabapentin administration. Our case suggests that administration of gabapentin after pulsed radiofrequency might be effective for the treatment of persistent hiccups.

Carpal Tunnel Syndrome Surgery Anti-Adhesion Gel Is Effective?

PURPOSE OF THE STUDY The purpose of the current study is to assess the efficacy of anti-adhesion gel on the symptom severity and functional outcomes after mini incision open surgery for carpal tunnel syndrom (CTS). MATERIAL AND METHODS A total of 200 CTS patients (154 women, 46 men) were included in this study. Group I (n = 100; 78 women, 22 men) did not receive local administration of anti-adhesion gel, while anti-adhesion gel consisting of hyaluronic acid-carboxymethylcellulose (Seprafilm®, SanofiBiosurgery, Bridgewater, NJ, USA) was locally applied to patients in Group II (n = 100; 76 women, 24 men). All patients recruited in this study had received conservative treatment comprised of non-steroidal antiinflammatory drugs, steroid injection, replacement of vitamin B and stabilization with splints. Cases that did not benefit from these therapeutic options during one year were assigned as candidates for surgical treatment. RESULTS There was no significant difference between two groups in terms of mean age, gender distribution, preoperative and postoperative Boston questionnaire (BQ) scores, difference of BQ scores after the operation, and the presence of the disease on the left or right side. According to postoperative 1. Year results, there was no significant difference between two groups. CONCLUSIONS Results of the current study demonstrated that use of anti-adhesion gel during mini incision open surgery for CTS did not bring about significant advantages in terms of functional or symptomatic outcomes. Further, controlled trials on larger series are warranted to understand the beneficial effects of anti-adhesive materials during the surgical treatment of CTS. Key words: anti-adhesion gel, Boston questionnaire, carpal tunnel syndrome.

A New Inflammatory Prognostic Index, Based on C-reactive Protein, the Neutrophil to Lymphocyte Ratio and Serum Albumin is Useful for Predicting Prognosis in Non-Small Cell Lung Cancer Cases

Purpose: We aimed to establish an inflammatory prognostic index (IPI) in early and advanced non-small cell lung cancer (NSCLC) patients based on hematologic and biochemical parameters and to analyze its predictive value for NSCLC survival. Materials and Methods: A retrospective review of 685 patients with early and advanced NSCLC diagnosed between 2009 and 2014 was conducted with collection of clinical, and laboratory data. The IPI was calculated as C-reactive protein × NLR (neutrophil/ lymphocyte ratio)/serum albumin. Univariate and multivariate analyses were performed to assess the prognostic value of relevant factors. Results: The optimal cut-off value of IPI for overall survival (OS) stratification was determined to be 15. Totals of 334 (48.8%) and 351 (51.2%) patients were assigned to high and low IPI groups, respectively. Compared with low IPI, high IPI was associated with older age, greater tumor size, high lymph node involvement, distant metastases, advanced stage and poor performance status. Median OS was worse in the high IPI group (low vs high, 8.0 vs 34.0 months; HR, 3.5; p<0.001). Progression free survival values of the patients who had high vs low IPI were determined 6 months (95% CI:5.3-6.6) and 14 months (95% CI:12.1-15.8), respectively (HR; 2.4, P<0.001). On multivariate analysis, stage, performance status, lactate dehydrogenase and IPI were independent prognostic factors for OS. Subgroup analysis showed IPI was generally a significant prognostic factor in all clinical variables. Conclusion: The described IPI may be an inexpensive, easily accessible and independent prognostic index for NSCLC patients, useful for clinical practice.

miR-181b-5p, miR-195-5p and miR-301a-3p are related with treatment resistance in schizophrenia

The aim of the study was to determine the differences between expression levels of certain miRNAs, as their association with schizophrenia has been well presented in the literature, and to investigate their relation to treatment resistance in schizophrenic patients. Three groups were formed: 1) treatment-resistant group, 2) treatment responsive group and 3) healthy control group. Expression levels of miRNAs from peripheric blood samples were determined by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). We investigated the roles of 29 schizophrenia-related miRNAs in schizophrenia treatment and their potentials to be considered as indicators. Among these miRNAs, only miR-181b-5p, miR-195-5p and miR-301a-3p expressions were found to be significantly different between the treatment-resistant group and the group responding well to the treatment. miRNAs may cause resistance by silencing the receptor genes of the drugs used for schizophrenia treatment. miR-181b-5p, miR-195-5p and miR-301a-3p may be candidate indicators that can be used to reveal resistance against schizophrenia treatment.

The impact of methotrexate on lung inflammatory and apoptotic pathway biomarkers-The role of gallic acid

BACKGROUNDS

The aim of this study was to investigate the effects of methotrexate (MTX) on the lung via inflammatory and apoptotic pathway biomarkers and the role of gallic acid (GA).

METHODS

In this study, twenty four male Wistar-Albino rats weighing 300-350g were divided into 3 groups as follows; Control group (0.1ml/oral saline, for 7 days+2nd day i.p.). MTX group (20mg/kg, single dose, on 2nd day). MTX+GA group (15mg/kg, orally, for 7 days). Comet analysis, oxidant-antioxidant status, IMA were conducted. Histopathological analyses were evaluated.

RESULTS

Comet assay on the blood, TOS and OSI values in the lung were increased in the group II compared with the control group (p<0.05). GA significantly reduced the comet score and IMA levels in the blood, TOS and OSI values in the lung tissue in group III compared with group II (p<0.05). Immunohistochemically PGE₂, TNF-α, CRP, serum SAA, Caspase 3 and Caspase 9 expressions significantly increased in group II compared with the control group (p<0.001) and GA treatment ameliorated these parameters significantly in group III compared with group II (p<0.001).

CONCLUSIONS

MTX caused oxidative stress and DNA damage in the blood tissue and caused oxidative damage, inflammation and apoptosis in the lung tissue.

The Relationship between Angiotensin-II Type 1 Receptor Gene Polymorphism and Repolarization Parameters after a First Anterior Acute Myocardial Infarction

Background and Objectives

Genetic influence on T-wave peak to End (Tpe) time in patients with a first anterior acute myocardial infarction (AMI) is uncertain. A polymorphism in the angiotensin-II type 1 receptor (AT1R) gene was discovered recently. The polymorphism consists of an A or C variant, given three different possible genotypes: AA, AC, CC. The purpose of this study was to determine the effects of polymorphism of the AT1R gene polymorphism on Tpe after a first anterior AMI.

Subjects and Methods

The subjects were 142 patients (110 men, 32 women, 58±13 years) with a first anterior AMI; ten patients were excluded from this study. Based on the polymorphism of the AT1R gene, they were classified into two groups: Group 1 (AA genotype) of 91 patients and group 2 (AC and CC genotype) of 41 patients. A 12-lead resting ECG was recorded at admission to the coronary care unit in patients with anterior AMI and were manually measured with a ruler. QTc, QTd, QTcd, Tpe, Tpe/QT parameters were measured.

Results

There was no significant difference in the baseline characteristics of patients (p>0.05). We found significant reduction in QTc, QTd, QTcd, Tpe, Tpe/QT indices Group 1 (AA genotype) (mean 66±28 ms) than group 2 (AC and CC genotype) (mean 95±34 ms) (p<0.05).

Conclusion

In patients with a first anterior AMI, AT1R gene polymorphisms may influence on repolarization parameters. Although further studies are required.

Brain-Derived Neurotrophic Factor Gene Val66Met Polymorphism Is a Risk Factor for Attention-Deficit Hyperactivity Disorder in a Turkish Sample

OBJECTIVE

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that negatively affects different areas of life. We aimed to evaluate the associations between the Val66Met polymorphism of brain-derived neurotrophic factor (BDNF) and ADHD and to assess the effect of the BDNF polymorphism on the neurocognitive profile and clinical symptomatology in ADHD.

METHODS

Two hundred one ADHD cases and 99 typically developing subjects (TD) between the ages of 8 and 15 years were involved in the study. All subjects were evaluated using a complete neuropsychological battery, Child Behavior Checklist, the Teacher's Report Form (TRF) and the DSM-IV Disruptive Behavior Disorders Rating Scale-teacher and parent forms.

RESULTS

The GG genotype was significantly more frequent in the patients with ADHD than in the TD controls, and the GG genotype was also significantly more frequent in the ADHD-combined (ADHD-C) subtype patients than in the TDs. However, there were no significant associations of the BDNF polymorphism with the ADHD subtypes or neurocognitive profiles of the patients. The teacher-assessed hyperactivity and inattention symptom count and the total score were higher, and the appropriately behaving subtest score of the TRF was lower in the GG genotypes than in the GA and AA (i.e., the A-containing) genotypes.

CONCLUSION

We found a positive association between the BDNF gene Val66Met polymorphism and ADHD, and this association was observed specifically in the ADHD-C subtype and not the ADHD-predominantly inattentive subtype. Our findings support that the Val66Met polymorphism of BDNF gene might be involved in the pathogenesis of ADHD. Furthermore Val66Met polymorphism of BDNF gene may be more closely associated with hyperactivity rather than inattention.

The Effect of Single Dose Methylphenidate on Neurometabolites according to COMT Gene Val158Met Polymorphism in the Patient with Attention Deficit Hyperactivity Disorder: A Study Using Magnetic Resonance Spectroscopy

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Thus, the present study aimed to determine the effects of a single dose of methylphenidate (Mph) on neurometabolite levels according to polymorphisms of the catechol-O-methyltransferase (COMT) gene.

METHODS

This study evaluated the neurometabolite levels including N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) of ADHD patients, before and after treatment with Mph (10 mg) according to the presence of COMT polymorphisms. The spectra were obtained from the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), cerebellum, and striatum.

RESULTS

The NAA levels of the val/val and val genotype carriers (val/val and val/met genotypes) increased in the DLPFC and ACC, respectively, following Mph treatment. The NAA/Cr ratio was lower in the DLPFC of val carriers than in the met/met genotype carriers prior to Mph administration. The Cho levels of the val/met genotype and val carriers increased in the striatum following Mph treatment. Following Mph treatment, the Cr levels of the met/met genotype carriers were higher than those of the val/met genotype and val carriers. Additionally, after Mph treatment, there was a significant increase in Cr levels in the DLPFC of the met/met genotype carriers but a significant decrease in such levels in the striatum of val/val genotype carriers.

CONCLUSION

These findings suggest that polymorphisms of the COMT gene can account for individual differences in neurochemical responses to Mph among ADHD patients. Therefore, further studies are needed to fully characterize the effects of the Val158met polymorphism of the COMT gene on treatment outcomes in patients with ADHD.

The Effect of the iNOS Inhibitor S-Methylisothiourea and Hyperbaric Oxygen Treatment on Radiation Colitis in Rats

INTRODUCTION

External radiotherapy is one of the main treatment modalities for a variety of malignancies. However, the lower gastrointestinal tract is sensitive to the ionizing radiation. Hyperbaric oxygen treatment (HOT) has been suggested as a viable treatment for refractory radiation colitis, but the effect of S-Methylisothiourea (SMT) in the radiation colitis have not reported. To investigate the effect of SMT, HOT and the combination of both in an acute radiation-induced enterocolitis model.

METHODS

Sixty Sprague-Dawley rats were divided randomly into five equal groups. A single dose of gamma irradiation (25 Gy) was administered through the colorectal region to anesthetized rats. In the control group, we applied 2 ml of saline solution intraperitoneally for five days. In the HOT group, 100-per-cent oxygen at 2.5 atm pressure was applied for five days. In the SMT group, 10 mg/kg/day of SMT was applied intraperitoneally for five days. In the HOT+SMT group, HOT and SMT were both applied in the same dosages as in the preceding two groups. At the end of five days, the rats were sacrificed and colon samples were collected for histological grading. Blood samples were collected to test for : tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), IL-1β, transforming growth factor-β (TGF-β) and intercellular adhesion molecule-1 (ICAM-1) mRNA.

RESULTS

The TNF-α, IL-1β, IL-10 and TGF-β levels were reduced by SMT, HOT and HOT+SMT applications (p < 0.05). However ICAM-1 mRNA levels were not significantly lower (p:0.19). The microscopic scores differed significantly between the SMT, HOT and HOT+SMT groups and the control group. There was significant improvement histologically, especially in the HOT+SMT group. When we compared the weight of the rats before and after the study, weight loss was significantly lower in the SMT, HOT and HOT+SMT groups compared with the control group (p < 0.05).

CONCLUSION

HOT and SMT together were significantly more effective in preventing weight loss and in reducing inflammation and the severity of colitis histology when compared with HOT and SMT separately.

The impact of synapsin III gene on the neurometabolite level alterations after single-dose methylphenidate in attention-deficit hyperactivity disorder patients

OBJECTIVE

To investigate the neurometabolite level changes according to synapsin III gene rs133945G>A and rs133946C>G polymorphisms by using magnetic resonance spectroscopy (MRS) in patients with attention-deficit hyperactivity disorder (ADHD).

METHODS

Fifty-seven adults diagnosed with ADHD were recruited for the study. The participants were examined by single-voxel (1)H MRS when medication naïve and 30 minutes after oral administration of 10 mg methylphenidate (Mph). Those who had been on a stimulant discontinued the medication 48 hours before MRS imaging. Spectra were taken from the anterior cingulate cortex, dorsolateral prefrontal cortex, striatum, and cerebellum, and N-acetylaspartate (NAA), choline, and creatine levels were examined. For genotyping of the synapsin III gene polymorphisms, DNA was isolated from peripheral blood leukocytes. The effects of age, sex, and ADHD subtypes were controlled in the analyses.

RESULTS

After a single dose of Mph, choline levels increased significantly in the striatum of rs133945G>A polymorphism-GG genotypes (P=0.020) and NAA levels rose in the anterior cingulate cortex of rs133946C>G polymorphism-CG genotypes (P=0.014). Both rs133945G>A and rs133946C>G polymorphisms were found to statistically significantly affect the alteration of NAA levels in response to Mph in dorsolateral prefrontal cortex with two-way repeated measure of analysis of variance. Post hoc comparisons revealed a significant difference between CG and GG genotypes of rs133946C>G polymorphisms after Bonferroni adjustment (P=0.016).

CONCLUSION

Synapsin III gene polymorphisms may be affecting the changes in neurometabolite levels in response to Mph in adult ADHD patients. Future studies are needed to confirm our findings.

White matter alterations related to attention-deficit hyperactivity disorder and COMT val(158)met polymorphism: children with valine homozygote attention-deficit hyperactivity disorder have altered white matter connectivity in the right cingulum (cingulate gyrus)

INTRODUCTION

In this article, the COMT gene val(158)met polymorphism and attention-deficit hyperactivity disorder (ADHD)-related differences in diffusion-tensor-imaging-measured white matter (WM) structure in children with ADHD and controls were investigated.

PATIENTS AND METHODS

A total of 71 children diagnosed with ADHD and 24 controls aged 8-15 years were recruited. Using diffusion tensor imaging, COMT polymorphism and ADHD-related WM alterations were investigated, and any interaction effect between the COMT polymorphism and ADHD was also examined. The effects of age, sex, and estimated total IQ were controlled by multivariate analysis of covariance (MANCOVA).

RESULTS

First, an interaction between the COMT val(158)met polymorphism and ADHD in the right (R) cingulum (cingulate gyrus) (CGC) was found. According to this, valine (val) homozygote ADHD-diagnosed children had significantly lower fractional anisotropy (FA) and higher radial diffusivity (RD) in the R-CGC than ADHD-diagnosed methionine (met) carriers, and val homozygote controls had higher FA and lower RD in the R-CGC than val homozygote ADHD patients. Second, met carriers had higher FA and axial diffusivity in the left (L)-uncinate fasciculus and lower RD in the L-posterior corona radiata and L-posterior thalamic radiation (include optic radiation) than the val homozygotes, independent of ADHD diagnosis. Third, children with ADHD had lower FA in the L-CGC and R-retrolenticular part of the internal capsule than the controls, independent of the COMT polymorphism.

CONCLUSION

Significant differences reported here may be evidence that the COMT gene val(158)met polymorphism variants, as well as ADHD, could affect brain development. ADHD and the COMT polymorphism might be interactively affecting WM development in the R-CGC to alter the WM connectivity in children with val homozygote ADHD.

The diagnostic significance of signal peptide-complement C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein-1 levels in pulmonary embolism

BACKGROUND:

Pulmonary embolism (PE) is a common and potentially life-threatening disorder. Patients with PE often have nonspecific symptoms, and the diagnosis is often delayed.

AIM:

The aim of our study was to investigate the role of signal peptide-complement C1r/C1s, Uegf, and Bmp1-epidermal growth factor domain-containing protein 1 (SCUBE1) used in the diagnosis of PE.

METHODS:

The study was designed prospectively. A total of 57 patients who were admitted to emergency service with clinically suspected PE were included in the study. The patients diagnosed with PE were defined as PE group (n = 32), and the patients with undetectable embolism on computerized tomographic pulmonary angiography were defined as non-PE group (n = 25). Twenty-five age- and sex-matched healthy cases were chosen for the study. Routine biochemical analysis, complete blood count, D-dimer, SCUBE1, and arterial blood gas analysis were performed early after admission.

RESULTS:

Mean SCUBE1 levels were higher in the PE group (0.90 ng/mL) than in the non-PE (0.38 ng/mL) and control groups (0.47 ng/mL) (P < 0.01). A cutoff point of 0.49 ng/mL for SCUBE1 indicated 100% sensitivity and 64% specificity in patients with PE. Mean D-dimer levels were not different between PE and non-PE groups (P = 0.591). A multivariable logistic regression analysis (with dichotomous PE groups as the response variable; age, gender, chest pain, syncope, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, D-dimer, neutrophil-lymphocytes ratio, and SCUBE1 variables as predictors) showed that the significant and independent predictors of PE diagnosis were SCUBE1 and chest pain.

CONCLUSION:

This study suggests that serum SCUBE1 measurement might be used as a diagnostic biomarker in PE.