Airport business models and the COVID-19 pandemic: An exploration of the UK case study

The COVID-19 pandemic had been a major crisis for the air transport industry due to its global reach, duration, and continuing uncertainty. Demand for air travel fell globally by around 90% in the period immediately following the introduction of lockdown restrictions which induced significant revenue loss for the industry and led to widespread bankruptcies and job losses. Within this extremely challenging business environment, commercially operated airports have struggled. This paper investigates how airport management has been impacted by this sudden and prolonged fall in the demand for air travel. Specifically, the UK case was studied through the Business Model Canvas, with documentary evidence supplemented with 31 in-depth interviews from the Government, airports, airlines, and other aviation organisations and from a variety of stakeholder roles within airports across the country. Interviewees were asked about how airport business models responded to COVID-19 and how they were likely to change in the future as a consequence. The findings suggest that COVID-19 encouraged airports to restructure key components in their business models. Fundamentally, airports have significant fixed costs, and it has been especially challenging to run terminals and operations with little or no revenue from conventional channels. The study finds airports were introducing more flexibility into their cost base while diversifying their revenue streams into areas such as developing business parks and enhancing retail portfolios. This is leading to a restructuring of airport business models to improve resilience to future systemic shocks. Overall, 4 future airport business drivers and approaches have emerged: 1) Cost-effectiveness and minimisation, 2) Diversification of revenue streams and intensified commercial activities, 3) Enhanced digitalisation and operational efficiency, and 4) Sustainability focused approach.

Individual factors influencing public's perceptions about the importance of COVID-19 immunity certificates: a cross-sectional online questionnaire survey in the UK

BACKGROUND

Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification.

OBJECTIVE

To assess what were the main individual factors (including health beliefs about COVID-19, vaccination views, socio-demographic and lifestyle factors) influencing people's perception of the importance of using COVID-19 immunity certificates.

METHODS

Cross-sectional online survey with a nationally representative sample in the UK, conducted on the 3rd of August 2021. Responses were collected and analysed from 534 participants, aged 18 and older, residents of the UK. The primary outcome measure (dependent variable) was the participants' perceived importance of using immunity certificates, computed as an index of six items. The following individual drivers were used as the independent variables: a) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), b) personal views on vaccination, c) willingness to share immunity status with service providers, and d) variables related to respondents' lifestyle and socio-demographic characteristics.

RESULTS

Perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (β=0.2564, P<.001=0.0000) and felt safer if vaccinated (β =0.1552, P<.001=0.0000). The prospect of future economic recovery positively influenced perceived importance of immunity certificates. Respondents who were employed or self-employed (β=-0.2412, P=.0010), or experienced an increase in income after the COVID-19 pandemic (β=-0.1287, P=.0020) perceived less important the use of immunity certificates compared to those who were unemployed or had retired or those who had experienced reduction in their income during the pandemic.

CONCLUSIONS

The findings of our survey suggest that more vulnerable members in our society (unemployed or retired and those believing that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher.

CLINICALTRIAL

Electrocardiographic changes after breast reduction surgery

Macromastia is associated with symptoms related to postural changes and decreased mobility. Breast reduction surgery (BRS) is the treatment of choice for these patients. Anatomical and structural changes in body posture and habitus might cause changes in electrocardiography (ECG). In this study, we aimed to evaluate the outcome of BRS on ECG changes of the patients after surgery. Study population included 33 female patients who had undergone BRS. ECG records of every patient before procedure and 6 months after procedure were analyzed retrospectively. Patients were naïve of known cardiac diseases and the patients did not have any known arrhythmia. The mean age of the study population was 40.8 ± 9.6. Total removed breast tissue from both sides was 1493 (1052-2138) mL, as 800 (513-1093) mL removed from right side and 740 (519-1050) mL removed from left side. There were significant changes in ECG of the patients in post-operative period. Atrial conduction parameters such as, PR duration (p<.001), Pmax duration (p<.001) and P wave dispersion (p<.001) were significantly decreased post-operatively. Additionally, ventricular conduction parameters such as, TPe duration (p<.001), TPe/QT (p=.013) and TPe/QTc (p=.005) ratios were found significantly decreased in ECGs of the patients. BRS as a treatment for macromastia does not only improve posture and mobility of the patients and also have positive impact on cardiac conductions. In patients those had BRS, atrial and ventricular conductions detected by ECG recordings were improved after surgery.

Why 'one size fits all' is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey

OBJECTIVES

The present study explored public's willingness to use COVID-19 immunity certificates across six different domestic scenarios.

DESIGN

Cross-sectional online survey.

SETTING

UK representative survey conducted on 3 August 2021.

PARTICIPANTS

534 UK residents over 18 years old.

INTERVENTIONS

Participants replied to the same set of questions.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents' sociodemographic characteristics.

RESULTS

Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle.

CONCLUSIONS

The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.

Use of arteriovenous loop vein graft in the microsurgical free tissue transfer: A Case Report

In reconstructions after severe traumatic injuries of the lower extremity, free tissue transfers are essentially used to cover the defects and accepted as extremity saving procedures. When major vessels of the lower extremity are patent or uninjured, these vessels can be used for anastomoses in free tissue transfers, however, in some injuries, only one major vessel remains intact and concomitant endothelial damage might also be present in this vessel. In such cases, since the nourishment of the extremity is dependent on this single vessel, its use as a recipient vessel may be risky for the perfusion of the extremity. In such cases, bringing an additional and healthy recipient vessel to the field is a useful option. Loop vein grafts are normally created by vascular surgeons for dialysis patients, and reconstructive surgeons often do not have much experience in this procedure. In this study, it was aimed to give information about the decision making progress that we used during and after the operation by presenting a 32-year-old case who had been admitted with a mangled extremity severity score (MESS) score of seven and a Gustilo-Anderson Type 3C lower extremity injury after a traumatic motorcycle accident injury. It is considered to be helpful for our colleagues who have not used loop grafts in reconstructive microsurgery operations before.

Long term results from the treatment of sub-condylar region fractures of the mandible

The Sub-condylar region is a common place for mandible fractures and these fractures can be managed by open reduction and internal fixation techniques, or only inter-maxillary fixations. The aim was to reveal the effects of healing of these fractures on clinical and radiologic findings. This is a clinical study including 15 patients. All patients had unilateral sub-condylar fractures and patients who had bilateral sub-condylar fractures, intra-articular fractures, or displaced mandible fractures that were located on another subpart were excluded. Clinical assessments include occlusion, maximum mouth opening at an interincisal distance, deviation of the mandible with mouth opening, and general oral and health assessment index. Radiologic assessments include the heights of the condyles and rami + condyles, and the distances between the mandible anguli and cranial base. Statistical tests have been performed. The patients’ ages ranged between 9 and 70 years (mean:28.1±15.4). Follow-up period ranged between 6 and 74 months (mean: 28.3±27.2). 13 patients had normal occlusions. The mean maximum mouth opening was 4.3±0.69 centimeters. 11 patients had a mean mandibular deviation of 0.26±0.27 centimeters with mouth opening. Clinical effects of the fracture and healing period can be accepted as quite satisfying in both clinical and radiologic means with either treatment options including open reduction internal fixations and IMF/Arch-Bar-only techniques. Long-term results of sub-condylar region fractures are quite acceptable with a high level of quality of life.

Effects of Different Variables on Postoperative Ruptures After Flexor Tendon Repairs in Delayed Primary Period

Introduction : Flexor tendon injuries are important and surgically problematic injuries. Despite universally accepted repair techniques being used, several variables can affect the success of tendon repair. Although it is not very common, patients have to be operated again after ruptures, which increases morbidity. Material methods : 73 patients who had primary tendon repairs after flexor tendon injuries were included in the presented study. Gender, age group (pediatric and adult group), identity (native or foreigner), the repaired tendons, the zone of the tendon, the time period between the trauma and the repair surgery were noted. Results : A total of 211 flexor tendons were repaired 72 of the patients were in delayed primary repair period. Patients’ ages ranged between 2 and 61 years. The Follow-up period ranged between 6 and 9 months. 5.5% of the patients were re-operated on as a result of tendon ruptures (n=4). The median ages for rupture and non-rupture groups were 19,5 and 25, respectively (p=0.815). There was no difference amongst the pediatric and the adult groups (p=0,283). The mean time interval for repair surgery was 7,13 ±6,96 days without correlation between rupture and non-rupture groups (p=0,496). All tendon-rupture patients were males (p=0,567). 63% of the patients had multiple tendon lacerations and rupture rate was 4,3% (p=0,623). 67% of the patients had co-existing nerve injuries (n=1,00). 83% were Turkish nationals and there was no significant effect of the ethnicity on the tendon ruptures. Conclusion : Flexor tendons can safely be repaired in the delayed primary period when universally accepted surgical techniques are used.

Synthesis, molecular modeling studies, ADME prediction of arachidonic acid carbamate derivatives, and evaluation of their acetylcholinesterase activity

In this work, a series of novel anandamide units containing carbamate were designed and synthesized. All the derivatives were evaluated in vitro for their inhibitory potential against the electric eel acetylcholinesterase enzyme (AChE) and showed reversible inhibitions. The compounds 7a, 7d, 7e, and 7f are mixed inhibitors of AChE, while the compounds 7b, 7c, and 7g are uncompetitive (K_i in the range 0.93-8.86 μM). The kinetic studies revealed that compounds 7b, 7c, 7f, and 7g inhibit considerably AChE activity. Molecular docking analyses were made to evaluate the binding type and interactions of the synthesized compounds to the ligand-binding site of hAChE. It was observed that the docking results were in parallel with the in vitro results. The adsorption, distribution, metabolism, and excretion properties were computed for the compounds, and were found within the acceptable range. This study suggests the compounds 7b, 7c, 7f, and 7g identified as novel reversible AChE inhibitors may be useful lead compounds for the treatment of Alzheimer's disease.

The Impact of Duration and Force of Centrifugation on Platelet Content and Mass in the Preparation of Platelet-Rich Plasma

PURPOSE

Platelet-rich plasma (PRP) is an autologous prepared plasma enriched with platelets and obtained after a centrifugal separation and aggregation procedure. However, the optimized preparation protocol for PRP is still controversial and there are no standardized preparation protocols. The aim of this study is to show the effect of time and force of the centrifugation on the concentrations of platelets and to optimize the effective PRP preparation protocol.

METHODS

For the study, whole blood was drawn into 24 different 6-ml standard tubes containing 0.6 ml anticoagulant citrate dextrose solution-formula A. The samples were centrifuged separately at forces of 45×g, 180×g, 400×g, 725×g, 1130×g and 1630×g for 5, 10, 15 and 20 min. Every sample was analyzed, and a comparison was made between all groups.

RESULTS

No significant difference was observed in terms of platelet concentration, mean platelet volume or platelet mass between all groups (p > 0.05). The mean ± SD of platelet mass in baseline is 1890 ± 134 × 10³ fL/μL. The mean ± SD of platelet mass in the high centrifugal force of 1630×g was 3395 ± 564 × 10³ fL/μL, 2638 ± 425 × 10³ fL/μL, 2355 ± 449 × 10³ fL/μL and 2109 ± 41 × 10³ fL/μL over times of 5, 10, 15 and 20 min, respectively. The mean ± SD of platelet mass in the low centrifugal force of 45×g was 2002 ± 1623 × 10³ fL/μL, 2491 ± 1591 × 10³ fL/μL, 2611 ± 876 × 10³ fL/μL and 3003 ± 511 × 10³/μL over times of 5, 10, 15 and 20 min, respectively.

CONCLUSIONS

Platelets should be evaluated with platelet mass not including platelet concentrations alone, but also with mean platelet volume, which symbolizes the size of platelets while comparing platelet-rich plasma preparation protocols and kits. This could be a new starting point for comparison of PRP for all applications in the literature. All centrifugation forces and times could produce biologically reactive PRP. It may be only suggested that if high acceleration force is used, low durations should be selected, or if low acceleration force is used, long time of centrifugation should be selected.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Leucocyte- and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities

BACKGROUND

Generally, advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing teams. In this report, the use of leukocyte- and platelet-rich fibrin (L-PRF) is emphasized for complex wounds as an alternative, simple, inexpensive, time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue, including bone, tendon, and ligaments. The aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures viable.

METHODS

Between January 2016 and December 2017, 17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital, Turkey. The treatment was administered twice per week in the outpatient clinic. Depending on the size and extension of the complex wound, two to five blood samples were collected into 8.5 ml dry, glass vacuum tubes with no anticoagulant, and samples were immediately centrifuged at 1630×g for 5 min to obtain L-PRF. Complete healing was defined as the day of complete wound epithelialization.

RESULTS

The median values of the initial wound size and wound duration were 12 cm2 (interquartile range, 6 to 23 cm2) and 8 months before first admission (interquartile range, 4 to 18 months), respectively. All wounds showed significant improvements after L-PRF therapy and full closure after a median of 18 months, with an interquartile range of 11 to 34 months of L-PRF applications. There were recurrences of wounds during the first 6 months after therapy. No adverse events were observed.

CONCLUSIONS

Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable, facilitate the formation of granulation tissue and epithelization, and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.

Evaluation of Safe Systemic Immunosuppression Created with Dexamethasone in Prevention of Capsular Contracture: A Glance to Distinct Perspectives with Toll-Like Receptors

PURPOSE

The toll-like receptors (TLRs) stand at the interface of innate immune activation. We hypothesize to decrease the response of innate immunity activated by TLR4 by a safe, short-term, systemic immunosuppression.

METHODS

Two silicone block implants were placed into two dorsal subcutaneous pockets in 32 rats that were subdivided into four groups: The two study groups were the IV DEX group (single intravenous injection of dexamethasone 1 h before surgery) and the IV DEX + IP DEX group (in addition to a single intravenous injection of dexamethasone 1 h before surgery, intraperitoneal dexamethasone was administered for 10 days after surgery), and the two control groups were the untreated control group and the saline-treated control group. After 10 weeks, all animals were killed to determine capsular thickness, inflammatory cell density, presence of pseudoepitheliomatous hyperplasia, edema, necrosis, vascularization, TLR4 expression and myofibroblast proliferation.

RESULTS

No significant difference was observed in any parameter between the untreated and saline-treated control groups (p > 0.05). Capsular thickness, myofibroblast proliferation, TLR4 expression density were statistically different among study groups compared to control (p < 0.05).

CONCLUSIONS

This study demonstrates the relationship between toll-like receptors and fibrous capsule after implant surgery. Decreasing the innate immunity by a safe, short-term perioperative systemic immunosuppression resulted in decreased TLR4 expression and myofibroblast differentiation which could be a new research field in profibrotic pathophysiology underlying breast capsule formation.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A rare location for a common problem: popliteal pressure ulcer

Pressure ulcer is defined as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. The most frequent sites for pressure ulcers are the occiput, sacrum, ischial tuberosities, trochanters, lateral malleoli and posterior heels. Herein, we present a case of grade III pressure ulcer seen in popliteal region which is an unusual localisation that is rarely seen in the literature. An awareness of this unusual localisation of pressure ulcer is necessary to prevent decrease in quality of life, particularly in the wheelchair-dependent population.

Lawsonia inermis - an alternative treatment for hyperthyroidism?

AIM

The goal of our study was to determine the effects of Lawsonia inermis (L. inermis) in mice, in which hyperthyroidism had been caused by thyroid stimulant hormone (TSH).

MATERIAL AND METHOD

The first phase of the study aimed to detect the effects of L. inermis on the amount of ionized hydrogen (pH) in cells. For this aim, the effect of L. inermis on pH levels in the liver tissues of mice, in whom Escherichia coli (E. coli) had caused peritonitis, was examined. In the second phase of the study, the effect of L. inermis on the serum T4 levels in the 24th and 48th hour in mice, whose thyroid cells showed an increased activity by TSH was measured.

RESULTS

In the first phase, in mice, in whom E.coli had caused peritonitis, the pH in the liver tissue of the group that had been given L. inermis was found to be significantly alkaline (p<0.05). In the second phase, in mice, in whom TSH had caused hyperthyroidism, it was noted that serum total T4 levels were significantly lower than in the group that had been given L. inermis in the 48th hour (p<0.05).

CONCLUSION

In our study, we detected that L. inermis significantly decreased serum total T4 levels in the 48th hour in mice in whom TSH had caused hyperthyroidism. These results suggest that L. inermis can be used as an alternative treatment for the Graves' disease (Tab. 2, Fig. 1, Ref. 34).

High sensitive C-reactive protein: a new marker for urinary tract infection, VUR and renal scar

BACKGROUND

Accurate diagnosis and early treatment of urinary tract infections (UTI) are important because of its association with renal scarring (RS).

AIMS

To investigate the serum levels of fibronectin, high sensitive CRP (Hs-CRP), urinary fibronectin, and beta-2 microglobulin (beta2MG) levels in patients with UTI and relationship of these parameters with VUR (vesicoureteral reflex) and RS.

PATIENTS AND METHODS

72 patients were included in study and divided into three groups: Group I (20 patients with first UTI); Group II (16 patients with recurrent UTI with VUR); Group III (16 patients without UTI with VUR).

RESULTS

Serum and urine fibronectin levels were similar in all study groups and controls. Urinary beta2MG levels were higher in Group II (302±179 ng/ml) than in the Group I (134±90 ng/ml) (p < 0.001). Moreover, beta2MG levels were similar in Group II (302±179 ng/ml) and group III (218±147 ng/ml). By contrast, beta2MG levels were higher in Group III (218±147 ng/ml) than in the controls (64±32 ng/ml) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L), Group II (23.1±32 mg/L), and III (0.4±0.1 mg/L) than the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP levels were higher in Group II (23.1±31.9 mg/L) than in the Group I (1.8±2.7 mg/L) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L) and Group II (23.1±31.9 mg/L) than in the Group III (0.4±0.1 mg/L) (p < 0.001). Hs-CRP levels were higher in group III (0.37±0.17 mg/L) than in the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP (18.8±25 mg/L) and beta2MG levels (349.4±128.5 ng/ml) were different in UTI with RS from the controls (0.2±0.08 mg/L and 64±32 ng/ml respectively, p < 0.001). Fibronectin levels were similar in patients with and without RS.

CONCLUSIONS

Increased urinary beta2MG and Hs-CRP were observed in initial UTI and recurrent UTI with VUR. Fibronectin levels were not useful for detection of first and recurrent UTI with VUR and RS. Elevated Hs-CRP levels can help us predetermine the patients with VUR prone to proceed to clinical chronic renal failure.

Preoperative serum vascular endothelial growth factor (VEGF) in ovarian masses

PURPOSE OF THE INVESTIGATION

To determine the diagnostic value of serum vascular endothelial growth factor (VEGF) in the preoperative assessment of the nature of ovarian masses.

MATERIALS AND METHODS

A prospective cohort study was conducted from August 2001 to September 2002 on 40 premenopausal and 23 postmenopausal patients with ovarian masses. During preoperative workup, patient age, serum Ca-125 levels, serum VEGF levels, and tumor volume based on ultrasonographic examination were determined. Laparoscopic (n=23) or laparotomic (n=39) approaches were undertaken to obtain the final pathologic result. According to the final ovarian pathology, follicular cysts, corpus luteum cysts and endometriomas were grouped as non-neoplastic ovarian masses (n=40, group I). Serous or mucinous cyctadenomas, dermoid tumors and fibromas were allocated into the neoplastic benign ovarian mass group (n=10, group II). Primary malignant ovarian neoplasms were categorized into the neoplastic-malign group (n=12, group III).

RESULTS

Mean ages of cases among groups I, II and III were 39.0 +/- 2.0, 42.2 +/- 5.2 and 56.9 +/- 4.2, respectively. As age of the cases enrolled in this sudy increased, the more likely was the occurrence of neoplastic malign ovarian pathologies (p < 0.001). Among postmenopausal cases diagnosed with an ovarian mass, serum Ca-125 levels were 113.5 +/- 20 IU/ml compared to those in premenopausal cases (85.8 +/- 16.0, p = 0.05). The values for serum VEGF values among pre- and postmenopausal ovarian masses were 46.2 +/- 6.7 pg/ml and 68.2 +/- 7.9, respectively (p = 0.04). In group I, serum VEGF levels of endometriomas (56.5 +/- 1.5 pg/ml) were higher compared to those of follicular or corpus luteum cysts (30.6 +/- 2.8, p = 0.05). In contrast, tumor size appeared to be larger in non-endometriotic. non-neoplastic cysts (10.1 +/- 2.0 cm), compared to endometriomas (6.4 +/- 0.6 cm, p < 0.01). Serum VEGF levels of group III were higher than other groups (p < 0.001). With respect to the discriminating benign or malign nature of the mass, with a specific cut-off value of serum VEGF level of 68.7 pg/ml, the sensitivity, specificity, positive and negative likelihood ratios were 92.3%, 88.0%, 3.3 and 0.1, respectively. For serum Ca-125 levels, the sensitivity, specificity, positive and negative likelihood ratio with a statistically relevant cut-off value of 102 IU/ml were, 76.9%, 76.0%, 3.21 and 0.3, respectively. Area under curve (AUC) for serum VEGF and Ca-125 values were 0.938 (95% CI: 0.81-0.96) and 0.769 (95% CI: 0.64-0.86), respectively (p = 0.02). Among the postmenopausal group, AUC for serum VEGF and Ca-125 was detected as 0.902 (95% CI: 0.70-0.98) and 0.873 (95% CI: 0.66-0.91) (p = 0.14).

CONCLUSION

Serum VEGF has the potential to be considered as a tumor marker with a good diagnostic relevance in differentiating the nature of ovarian masses.

Early blunted cortisol response to insulin induced hypoglycaemia in familial Mediterranian fever

OBJECTIVE

To study cortisol, adrenocorticotropic hormone and C-reactive protein responses to specific stimuli in familial Mediterranean fever (FMF).

METHODS

For the purpose of measuring cortisol, ACTH, and CRP responses to insulin induced hypoglycaemia during attack-free periods, 14 FMF patients, 11 patients with ankylosing spondylitis or Behçet's disease as disease controls (DC), and a further 10 healthy control subjects (HC) were involved in this study. None of the subjects had ever received corticosteroids before this study. Cortisol and ACTH levels were measured by chemiluminescence enzyme immunoassay.

RESULTS

No attack was observed among FMF patients during the test. No significant difference in the mean cortisol values after insulin induced hypoglycaemia was observed between the groups involved at any stage of the test. The integral cortisol response to hypoglycaemia expressed as the AUC (0-90 min) was found not to differ among the study groups (1827 +/- 115.6 in FMF; 2196 +/- 205.4 in DC, p = 0.12; 1771 +/- 98.4 in HC, p = 0.9). The delta response of cortisol to insulin induced hypoglycaemia wasfound to be statistically lower (-4 +/- 0.8 mg/dl vs. -1.9 +/- 0.7 microg/dl; p<0.03) only for the 0 to 30 min interval in patients with FMF compared to HC respectively. Similar results, though of no statistical significance, were also found for the 0 to 45 min interval (1.17 +/- 2.2 microg/dl in FMF patients vs. 3.3 +/- 2 microg/dl in HC; p = 0.6). The mean basal CRP level of patients with FMF was remarkably higher than that in HC. Although the mean CRP level at 90 min for FMF cases with cortisol levels under 12 microg/dl at 30 min was found to be higher than those with cortisol levels over 12 microg/dl at 30 min, no significant difference was observed.

CONCLUSION

An early blunted cortisol response observed in a stressful situation in FMF patients may well account for the curious relationship between stress and an inflammatory reaction and/or attack. Furthermore, the fact that the CRP level was relatively higher in FMF patients with lower cortisol levels might also highlight the importance of endogen cortisol in the inflammatory feature of this disease.

Protective effect of fucoidin (a neutrophil rolling inhibitor) on ischemia reperfusion injury: experimental study in rat epigastric island flaps

The objective of this study was to examine whether a decrease in neutrophil-mediated tissue injury using Fucoidin, a nontoxic neutrophil rolling inhibitor, would improve flap survival in an island flap model after ischemia-reperfusion. Myeloperoxidase activity (an indirect index of tissue neutrophil count) and malondialdehyde (an indicator of lipid peroxidation), the degree of neutrophil infiltration by direct counting, and macroscopic flap survival were assessed in the flap after arterial ischemia-reperfusion. Epigastric island skin flaps were elevated in 56 rats. The first group of 21 rats was subjected to 6 hours of arterial ischemia. The second group of 21 rats was subjected to 10 hours of arterial ischemia, and the rest of the rats were used as nonischemic controls (sham flaps). For inhibiting neutrophil rolling, a nontoxic polysaccharide agent-Fucoidin-was used. Each ischemic group was divided further into three subgroups: Subgroup I (control rats) received saline, subgroup II received 10 mg per kilogram Fucoidin, and subgroup III received 25 mg per kilogram Fucoidin before reperfusion. The results were evaluated as tissue neutrophil counts, tissue malondialdehyde content, tissue myeloperoxidase activity, and flap survival. Neutrophil counts and tissue myeloperoxidase activity were decreased significantly (p <0.001) in subgroup III, but lipid peroxidation by means of tissue malondialdehyde content was not affected by Fucoidin administration. The authors conclude that administration of Fucoidin before reperfusion can limit tissue injury apparently by inhibiting neutrophil rolling in a dose-dependent manner.

Soluble interleukin-2 receptor and interleukin-8 plasma levels during and after cardiopulmonary bypass: correlations with creatine kinase and creatine kinase MB

In this study, soluble receptor of interleukin-2, interleukin-8, creatine kinase, and creatine kinase MB isoenzyme levels were determined serially before, during, and after cardiopulmonary bypass in blood samples of 24 patients. Interleukin-2 receptor levels were 683+/-80 U/ml in the preoperative period and 640+/-60 U/ml during hypothermia. Subsequently, these levels increased significantly at the end of the procedure (791+/-70 U/ml, P<0.01), remaining elevated 1 h after (882+/-92 U/ml, P<0.001) and reaching peak values 24 h postoperatively (1,752+/-200 U/ml, P<0.001). Preoperative plasma values of interleukin-8 were 230+/-43 pg/ml. Interleukin-8 concentrations were 185+/-25 pg/ml during hypothermia. The peak interleukin-8 levels were observed at the end of cardiopulmonary bypass (754+/-94 pg/ml, P<0.001) and tended to decrease 1 h after the procedure (643+/-76 pg/ml, P<0.001), declining to preoperative values, 24 h postoperatively (273+/-41 pg/ml). Interleukin-2 receptor levels correlated well with creatine kinase levels during the procedure. Furthermore, creatine kinase MB levels were correlated with interleukin-2 receptor values only at the end and 1 h after completion of cardiopulmonary bypass. We concluded that interleukin-8 and Interleukin-2 receptor levels are elevated after cardiopulmonary bypass and may contribute to myocardial injury as reflected by increased levels of creatine kinase and creatine kinase MB and correlations between interleukin-2 receptor and both creatine kinase and creatine kinase MB levels.

Fluticasone propionate and budesonide do not influence bone metabolism in the long term treatment of asthma

BACKGROUND

Inhaled corticosteroids (ICS) are recommended in the treatment of asthmatic patients. They have been said to be efficacious in the treatment of asthma in respect to cortisol and bone metabolism.

METHODS

The effects of the two inhaled corticosteroid, budesonide (BUD) and fluticasone propionate (FP) on bone metabolism, morning cortisol and their effects on the clinical parameters (FEV1, diurnal variation of peak expiratory flow rate = PEFR and log PC20) were examined in a group of 16 asthmatic patients. Eight patients used 800 micrograms/daily BUD and 8,400 micrograms/daily FP during 6 months period.

RESULTS

Both BUD and FP improved clinical parameters as determined by FEV1 (p < 0.05) and PEFR (p < 0.01). There was no difference in respect to log PC20 values in either group (p > 0.05). Both treatments didn't change morning cortisol (p < 0.05). Both FP and BUD didn't change any indices of bone formation as determined by serum alkaline phosphatase, bone alkaline phosphatase, osteocalcin and carboxyterminal propeptide of type 1 procollagen and bone resorption as determined by urinary calcium and deoxypyridinoline (p > 0.05). In addition there was no significant effect on calcium and phosphate metabolism (serum calcium, phosphate and parathyroid hormone).

CONCLUSION

As a result, having no adverse effect on bone metabolism and adrenal function, in the regard to clinical efficacy, FP is as effective as the double dose of BUD on PEFR and FEV1.

Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions

The aim of this study was to evaluate the individual and combined diagnostic utility of six tumor markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), cytokeratin fragment 19 (CYFRA 21-1), neuron-specific enolase (NSE) and total sialic acid (TSA) were assayed in 74 patients with pleural effusions (44 malignant and 30 benign). All tumor markers except TSA and NSE were increased in both serum and pleural fluid of patients with malignant diseases. Using the cut-off values 3 ng/ml, 14 U/ml, 5 U/ml, 8 ng/ml and 70 mg/dl for pleural fluid CEA, CA 15-3, CA 19-9, CYFRA 21-1 and TSA, respectively, the sensitivity (%) and specificity (%) of these tumor markers were as follows: CEA; 52/77, CA 15-3; 80/93, CA 19-9; 36/83, CYFRA 21-1; 91/90, TSA; 80/67, for differentiating malignant effusions from benign. When CA 15-3 and CYFRA 21-1 combined, the sensitivity and specificity were increased (100 and 83%, respectively). Classifying the malignant effusions as bronchial carcinoma and malignant pleural mesothelioma, CEA was shown to have the highest sensitivity and specificity (88 and 90%, respectively) while the combination of CEA with other tumor markers increased sensitivity but decreased specificity. According to our results, tumor markers are not suitable for the differential diagnosis of malignancy.

Octreotide prevents postoperative adhesion formation by suppressing peritoneal myeloperoxidase activity

BACKGROUND/AIMS

Despite a great deal of effort to prevent the adhesion formation, an ideal therapy or drug remains to be identified. The aim of this study was to investigate the effect of octreotide on adhesion prevention and neutrophil infiltration.

METHODOLOGY

Fourteen female Sprague-Dawley rats were subjected to a standard intraabdominal adhesion model operation. Octreotide group (n = 7) rats were administered 20 micrograms/kg octreotide intramuscular while control group (n = 7) rats were given no treatment. On the 10th day the rats were decapitated and the degrees of adhesions were recorded and the plasma, peritoneal fluid, peritoneal tissue myeloperoxidase levels were determined.

RESULTS

Intraabdominal adhesions and peritoneal tissue myeloperoxidase levels were significantly reduced in the octreotide group as compared to saline treated adhesion group.

CONCLUSIONS

We concluded that octreotide reduces the intraabdominal adhesions. This adhesion-preventive effect may be due to the inhibition of neutrophil infiltration.

Octreotide inhibits myeloperoxidase activity in rat uterus

OBJECTIVE

Several studies have demonstrated that synthetic somatostatin-analog octreotide could affect the functions of the hypothalamus, anterior pituitary gland and ovary. To date, very few studies on the effect of octreotide on uterine function have been reported. We investigated the effects of octreotide on neutrophil functions in rat uterus.

METHODS

Twenty Sprague-Dawley rats were subjected to a standardized uterine horn excision. To evaluate the effect of octreotide, the rats were assigned randomly to treatment (octreotide 20 microgr/kg, SC) and control groups. After two weeks relaparotomy was performed and contralateral uterine horns were excised in the same standardized manner. The excised segment was washed in cold saline solution and was frozen in liquid nitrogen immediately and homogenized. Myeloperoxidase (MPO) and elastase concentrations were determined in homogenates of uterine horns. The data were analyzed by Mann-Whitney U test.

RESULTS

In octreotide-treated rats the MPO activity was significantly reduced after 14 days (14.79+/-2.08 versus 6.62+/-1.72 U/mg protein; p=0.012). There was also a significant difference in mean MPO levels between the two groups at the end of the experiment (6.62+/- 1.72 versus 18.56+/-2.49 U/mg protein; p=0.001). The octreotide administration did not affect elastase levels significantly. No differences were found in mean elastase levels in both groups after the treatment.

CONCLUSION

This study demonstrates that octreotide has a significant effect on the neutrophil function in terms of MPO activity in rat uterus. Further studies are needed to clarify the clinical relevance of the inhibitory effect of octreotide in the uterus and the possibility of its applications.

Coronary risk factors in Turkish schoolchildren: randomized cross-sectional study

BACKGROUND

There is a strong association between the extent of atherosclerotic lesions in aorta and coronary arteries and antemortem risk factors in children and young adults. Cardiovascular diseases are the most common cause of death in adults in Turkey. However, the data about the extent of coronary risk factors in Turkish children is very limited. The aim of this cross-sectional study was to investigate the prevalence of coronary risk factors in Turkish schoolchildren living in Eskişehir, Turkey.

METHODS

A randomly selected population of 4026 schoolchildren, aged between 7 and 18 years, residing in urban and rural parts of Eskişehir were evaluated for coronary risk factors, using previously predicted risk threshold values.

RESULTS

Hypertension was found in 4.8% of the girls and 3.8% of the boys, 14.9% of the girls and 10.8% of the boys had abnormal lipid values, 18.2% of the girls and 26.4% of the boys had elevated total body fat percentages, 20.7% of the girls and 14.5% of the boys had physical inactivity and 3.8% of the girls and 11.4% of the boys were regular smokers. Urban children had higher rates of hypercholesterolemia; however, rural children had higher rates of physical inactivity. When the modifiable risk factors were considered, excluding family history, 47.7% of the children had at least one risk factor and 11.7% of them exhibited two or more risk factors.

CONCLUSIONS

Turkish schoolchildren living in Eskişehir had considerably high levels of coronary risk factors. The interventional measures established in childhood, during which the lifestyle and habits responsible for coronary heart diseases are acquired, will be very effective for preventing and modifying the risk factors predisposing children to coronary heart disease.

Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting

BACKGROUND

The aim of the present study was to evaluate potential myocardial protection by trimetazidine by measurement of the cardiac marker protein troponin T (TnT) during coronary bypass operations.

METHODS

We conducted a double-blind, placebo-controlled study on 30 randomized patients who had aorta-coronary artery bypass operations. The TMZ group was composed of 15 patients and the placebo group of 15 patients in New York Heart Association class III or IV. Pretreatment was started 3 weeks preoperatively with trimetazidine (60 mg orally per day) or the placebo. In the trimetazidine TMZ group, there were 2 women and 13 men with a mean age of 57.1+/-2.2 years and mean cross-clamp time of 44+/-1.8 minutes. In the placebo group, there were 5 women and 10 men with a mean age of 58.4+/-1.2 years and a mean cross-clamp time of 42+/-2.4 minutes. Serial blood samples were collected before and after the operation, and serum concentrations of cardiac TnT were measured.

RESULTS

The preoperative serum concentration of TnT was 0 to 0.39 ng/mL in all patients. The mean TnT levels were measured 5 minutes after completion of cardiopulmonary bypass (1.5+/-0.3 ng/mL) and 12 (1.4+/-0.1 ng/mL), 24 (0.9+/-0.1 ng/mL), and 48 hours postoperatively (0.1+/-0.1 ng/mL) in the trimetazidine group. Troponin T levels in the placebo group measured at the same time periods were 4.4+/-0.4, 4.8+/-0.7, 2.8+/-0.4, and 0.7+/-0.1 ng/mL. In the trimetazidine group, TnT levels were significantly less than those of the placebo group (p < 0.001). The levels of TnT were tested by creatine kinase-MB levels of both groups. Mean cardiac index was evaluated in all patients preoperatively and postoperatively. There was no significant difference in perioperative hemodynamics (blood pressure and cardiac index) between groups.

CONCLUSIONS

These results obtained by measurement of cardiac TnT suggested that pretreatment with trimetazidine reduces ischemic-reperfusion damage during coronary bypass operations but did not affect postoperative hemodynamics.

Clinical, biochemical and histochemical assessment of pretreatment with glucose-insulin-potassium for patients undergoing mitral valve replacement in the third and fourth functional groups of the New York Heart Association

In this study, the potentially beneficial effects of preoperative treatment with glucose, insulin and potassium in a randomized series of 30 consecutive patients undergoing mitral valve replacement, who were in the third and fourth functional groups of the New York Heart Association scale, were investigated. Fifteen patients received glucose, insulin and potassium, and 15 patients received the same volume of normal saline. The characteristics of the groups did not differ. Papillary muscle-biopsy samples were obtained at the time of surgery and analysed for glycogen, both biochemically and histochemically. The clinical course of all patients was monitored closely during the first 24 hours after surgery. The patients receiving glucose, insulin and potassium had higher glycogen levels (43 +/- 13.54 micromol/g) (P < 0.001). In addition, they required less inotropic pharmacological support (scored by the Gradinac method), had fewer ventricular arrhythmias and exhibited improved haemodynamic indices: cardiac output increased (P < 0.025 to P < 0.005), while systemic vascular resistance decreased (P < 0.001). Pretreatment with glucose, insulin and potassium did not, however, affect the patients' postoperative wedge pressure and mortality. The results of this study suggest that glucose, insulin and potassium pretreatment may be beneficial in unfit patients undergoing mitral valve replacement.

The effect of Ginkgo biloba on the activity of catalase and lipid peroxidation in experimental strangulation ileus

This study was designed to assess the therapeutic effect of Ginkgo biloba extract (EGb 761) in experimental strangulation ileus. Rats were divided into control (n = 7), placebo (n = 11), and EGb-treated (n = 11) groups. No surgical procedure was carried out on the control group. Strangulation ileus was produced in the placebo and EGb groups for 2.5 h. At the end of this period, 100 mg/kg EGb in 1 ml of saline was injected intraperitoneally to the EGb-treated group. In the placebo group, animals received an equivalent amount of saline intraperitoneally; 24 h later, repeat laparotomies were performed to take blood and intestinal tissue samples. The EGb treatment decreased tissue malondialdehyde levels and increased catalase activities compared with the placebo group (P < 0.05 for both). Serum creatine kinase and phosphorus levels were also determined in all groups. In the placebo group these were significantly higher than in the control group (P < 0.01 and P < 0.05, respectively). In the EGb group these were not different from controls and the increase in creatine kinase activity in the EGb group was not as high as in the placebo group (P < 0.05). Our results suggest that EGb could be preventive against the effects of strangulation ileus in a rat model.

Comparative analysis of biochemical parameters for differentiation of pleural exudates from transudates Light's criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatine kinase, and uric acid

The differentiation of pleural effusions as being either transudate or exudate is the first step in the diagnosis of pleural effusions. The aim of this study was to compare the efficiency of the various biochemical parameters to the traditional criteria of Light et al., for differentiating exudates from transudates. Ninety-three pleural fluid and sera specimens were obtained and classified as transudates or exudates on the basis of their diagnosis. Of the 93 pleural fluids, 21 were transudates, 72 were exudates. The efficiencies of different parameters for detection of exudates were as follows: The criteria of Light 96%; effusion cholesterol concentration 77%; serum-fluid albumin gradient 67%, pleural/serum alkaline phosphatase ratio 83%; effusion creatine kinase levels 91%; pleural/serum creatine kinase ratio 83%, and effusion uric acid 71%. Pleural/serum uric acid ratio was insignificant for the purpose of this study.

Beneficial effects of allopurinol on glutathione levels and glutathione peroxidase activity in rat ischaemic acute renal failure

The protective effect of allopurinol, an inhibitor of the enzyme, xanthine oxidase, against the renal ischaemia-reperfusion of the rat was investigated. Rats were subjected to renal ischaemia by clamping of the left renal artery and vein for 45 min, and were then reperfused for 24 h; these animals were randomized to receive either saline (n = 10) or allopurinol (n = 10) at a dose of 50 mg/kg bolus intraperitoneally 5 min before reperfusion. The control group comprised seven healthy rats not exposed to ischaemia or reperfusion. The blood urea nitrogen and plasma creatinine levels were increased in the allopurinol group, but the increase was less than that in the placebo group, compared with the controls. The kidney glutathione level was significantly reduced in the placebo group but not in the allopurinol group compared with the controls. The glutathione peroxidase activity in the kidney tissues was reduced more than two-fold in the placebo group compared with the controls, but the reduction in glutathione peroxidase was considerably less in the allopurinol group. Renal tissue lactate dehydrogenase, aspartate amino-transferase, gamma-glutamyl transferase and alkaline phosphatase activities were reduced almost two-fold in the placebo group, but allopurinol treatment maintained these enzyme activities close to the control activities. These results provide evidence that allopurinol treatment may have beneficial effects on antioxidant defences against ischaemia-reperfusion injury of rat kidneys.

Osteocalcin metabolism in late fetal life: fetal and maternal osteocalcin levels

To clarify the osteocalcin metabolism in the fetus, we determined venous osteocalcin levels of 13 women and umbilical arterial and venous osteocalcin levels of their newborns at delivery. Calcium, phosphorus and alkaline phosphatase levels were also established. Umbilical arterial and venous blood calcium and phosphorus levels were significantly higher than maternal venous blood values (P < 0.001 for all). Umbilical arterial calcium was 2.46 +/- 0.02 mmol/l, phosphorus 1.48 +/- 0.04 mmol/l, umbilical venous calcium 2.50 +/- 0.03 mmol/l, phosphorus 1.45 +/- 0.04 mmol/l, maternal calcium 2.16 +/- 0.03 mmol/l, phosphorus 0.98 +/- 0.04 mmol/l. Both umbilical venous (5.85 +/- 0.66 nmol/l) and arterial (3.49 +/- 0.51 nmol/l) osteocalcin levels were significantly higher than maternal values (1.42 +/- 0.15 nmol/l). The high umbilical venous osteocalcin levels may be due to increased osteocalcin degradation in fetus or placental osteocalcin synthesis.