Fuel properties and incineration behavior of poultry litter blended with sweet sorghum bagasse and pyrolysis oil

The incineration of poultry litter (PL) effectively reduces the volume of waste in line with the United Nations Sustainable Development Goal of "affordable and clean energy". However, mono-incineration is associated with considerable challenges due to the varying moisture, structural and chemical composition and low energy yield. The aim of the present work was to investigate the influence of sweet sorghum bagasse (SS) and pyrolysis oil (PO) on improving the fuel properties of PL and mitigating ash related burdens during incineration. The different biomass feedstocks were produced by combining PL with SS at 0.0% (T0), 25% (T1), 50% (T2), 75% (T3) and compared with 100% SS (T4). In order to achieve high energy potential and low ash deposition, the parallel samples were additionally mixed with 10% PO to improve the energy value. The experimental results show that increasing the proportion of SS and adding PO to the mixtures increases the volatile matter and decreases the moisture and ash content. The addition of PO also increases the carbon and hydrogen content. The use of SS and PO thus increased the values of the ignitability index and apparently also the flammability by 30.0%-49.4% compared to pure PL. SS and PO shifted the HHV of the starting material from 16.90 to 18.78 MJ kg-1. In addition, SS + PO improved the flame volume and red color intensity of the PL blends based on the image analysis method. However, the presence of SS and PO did not sufficiently improve the ash-related index values, which requires further investigation.

Investigation of heavy metal and micro-macro element speciation in biomass ash enriched sewage sludge compost

The objective of this study was to enrich the nutrient content of compost and to investigate the passivation and solubilization of plant micronutrients (Fe, Al, Cu, Ni, Zn, Na, Mn), macroelements (P, K, Mg, Ca), and heavy metals (Cr, Cd, Pb) during sewage sludge composting with nutrient-rich biomass ash additives. T0: 0%, T1: 3.5%, T2: 7.0%, and T3: 14.0% dry weight (DW), weight/weight (w/w) biomass ash was added to the sewage sludge + sawdust mixture (volume, 1:1) to obtain the final NPK content and monitored over a 45-day period. Sawdust was used as auxiliary material. The sequential extraction method was used to determine the elemental species. Cr, Cd and Pb showed higher affinity to the residual fraction and occluded in the oxide fraction, which decreased the bioavailability factor (BF) (<1% BF-Cr, 21% BF-Cd and 9% BF-Pb) compared to the control treatment (46% BF-Cr, 47% BF-Cd and 80% BF-Pb). As the amount of biomass ash increased (T1-T3), the percentages of residual Cr (Res-Cr) (10-65%), exchangeable Cd (Exc-Cd) and organically bound Cd (Org-Cd) (14% and 21%), and oxides-Pb (Oxi-Pb) (20-61%) increased. In all composts, Fe, Al, and Cu were associated with organically bound and oxides-entrapped fractions. More than 50% of total Mn and Mg were concentrated mainly in exchangeable fractions, suggesting high mobility and bioavailability (42% BF-Mn and 98% BF-Mg). Ni, Zn, and Na tended to be present in oxide-bound, organically bound, and residual fractions, while K and P were associated with exchangeable and organically bound fractions. The overall results suggest that composting sewage sludge with biomass ash may be the best strategy and technique to overcome soil application bottlenecks because it passivates heavy metals and improves the bioavailability of plant nutrients.

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

Background/Introduction

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

Purpose

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

Methods

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

Results

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

Conclusions

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

Funding Acknowledgement

Type of funding sources: None.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A techno-sustainable bio-waste management strategy for closing chickpea yield gap

Sustainable development goals imply environmentally sound management of all wastes to minimize the waste generation through prevention, reduction, recycling, and reuse. In particular, the poultry industry produces nutrient-rich waste that requires proper management.Additionally, the recycling of bio-wastes in agricultural lands is still a key technology for the sustainable use of nutrients as a renewable fertilizer. Currently, there are very few studies on the utilization of agro-industrial bio-wastes, such as poultry abattoir sludge (PAS), for crop cultivation in soils containing low organic matter and high pH. In this context, it is necessary to make a more particular assessment of poultry industry-oriented and locally available nutrient-rich organic wastes for nodulation, physiological adaptation, and crop yield. Considering the scarcity of the literature in this field, the present study aimed to fulfill the apparent gap by focusing on the applicability of recycled PAS to low fertility soil in the growth of chickpea selected as a model legume, thereby contributing to the development of an agricultural and sustainable industrial management strategy for the relevant sectors. In this study, leaf chlorophyll content and nodule color were also investigated by the image analysis methodology to describe the effects of bio-waste on closing chickpea yield gap in a marginal land with high soil pH and low organic matter. Two-year consecutive field experiments were carried out to explore the effect of the PAS with the application rates of 25 kg N ha^-1 (T₂), 50 kg N ha^-1 (T₃), and 100 kg N ha^-1 (T₄) along with unamended (T₀) and fertilized control (T₁). The results indicated that the PAS treatments significantly differed in chlorophyll content, nodulation parameters, and biomass and grain yields. The chlorophyll content was correlated (r = 0.910) with the red color value (RGB color model) of nodule image analysis in the response to bio-waste. Based on the two-year average, it was concluded that chickpea yield could be increased 45% by amending with the PAS (T₃). The present study clearly demonstrated that the image analysis could be a useful digital tool for the evaluation of chlorophyll content, nitrogen fixation efficiency, and forecasting biomass and grain yields of chickpea. The results also confirmed that the PAS application to low fertility soil could prominently contribute to establish sustainable waste management and crop production alternatives for closing chickpea yield gap.

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

Background

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

Aims

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

Materials and Methods

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

Results

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

Conclusion

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

Mitigation of soil loss from turfgrass cultivation by utilizing poultry abattoir sludge compost and biochar on low-organic matter soil

Commercial turfgrass cultivation is one of the main ornamental industries world-wide; however, successive turfgrass sod cutting from the same site removes surface soil, leading to a decline in soil organic matter, impairment of soil fertility and degradation of environment. The present study was aimed to investigate the applicability of poultry abattoir sludge compost (PASC) and biochar (BC) on the establishment of turfgrass by evaluating plant growth performance and mitigation of soil loss by organic waste amendments. The experimental study was designed on the soil which had originally low-organic matter content and previously used as a turfgrass sod harvested site in a sandy loam soil. Incorporation of PASC to soil improved the physicochemical properties in terms of bulk density (BD), water holding capacity (WHC), cation exchange capacity (CEC), pH, total nitrogen, total organic carbon (TOC), and organic matter (OM) by 37 (±2)%, 45 (±3)%, 55 (±3)%, 21 (±2)%, 48 (±2)%, 90 (±10)%, and 96 (±4)%, respectively. PASC-amended treatments enhanced the turfgrass growth rate more than the BC due to its increased nutrient availability. Incorporation of 100 Mg ha^-1 (mega gram per hectare) PASC in surface soil with or without BC decreased the mineral soil removal rate by half of the respective soil (control) treatments. The results of the present study confirmed the utilization of PASC and BC as promising agro-industrial-based fertilizers in turfgrass sod production for sustainable soil and nutrient management.

Development of nutrient-rich growing media with hazelnut husk and municipal sewage sludge

The aim of the present study was to develop structurally stable, nutrient-rich and environmentally safe growing media by combining waste material: crop residue hazelnut husk (HH) and municipal sewage sludge. In order to achieve this goal, lignocellulosic HH residue was mixed with nutrient-rich sewage sludge (S) in various proportions: HH 100%; HH + S1 87.5% : 12.5%; HH + S2 75% : 2 5%; HH + S3 50% : 5 0%. Following composting, the key physical, chemical and microbiological properties of the growing media were characterized for long-term ornamental nursery crops. The addition of S to the mixture had both significant detrimental and remedial effects on physical properties such as reduced total porosity and water-holding capacity, whilst improved the air capacity, wettability and shrinkage. S content of growing media significantly enriched the plant nutrients, especially the most desired soluble and organic nitrogen fractions and micro nutrients. Germination tests and microbiological analysis confirmed the products as environmentally safe ornamental growing media. We conclude that composting of HH with S is a viable alternative for the development of nutrient-rich growing media and recycling of such waste in the ornamental industry could be a beneficial method in order to sustain waste management and crop production.

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effects of elemental sulphur on heavy metal uptake by plants growing on municipal sewage sludge

In this study experiment was carried out to determine the phytoextraction potential of six plant species (Conium maculatum, Brassica oleraceae var. oleraceae, Brassica juncea, Datura stramonium, Pelargonium hortorum and Conyza canadensis) grown in a sewage sludge medium amended with metal uptake promoters. The solubility of Cu, Cd and Pb was significantly increased with the application of elemental S due to decrease of pH. Faecal coliform number was markedly decreased by addition of elemental sulphur. The extraction of Cu, Cr and Pb from sewage sludge by using B. juncea plant was observed as 65%, 65% and 54% respectively that is statistically similar to EDTA as sulphur. The bioaccumulation factors were found higher (>1) in the plants tested for Cu and Pb like B. juncea. Translocation index (TI) calculated values for Cd and Pb were greater than one (>1) in both C. maculatum and B. oleraceae var. oleraceae. The results cleared that the amendment of sludge with elemental sulphur showed potential to solubilize heavy metals in phytoremediation as much as EDTA.

Bone mineralization defects after treatment of acute lymphoblastic leukemia ın children

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Comparison of composted biosolid substrate for containerized turfgrass production

Composts produced from composting municipal sewage sludge with bulking agent, namely hazelnut husk (HH), pine litter (PL), corn straw (CS) and sawdust (SW), were seeded with turfgrass mix and cultivated in a container to compare the suitability of composted substrates to produce turfgrass in greenhouse conditions. The performance of substrate was determined by both substrate properties compared to standard peat and by measuring plant growth parameters on each substrate during turfgrass sod establishment. In general, the physico-chemical properties of all substrates were satisfactory for container substrates, but HH and PL substrates performed better in plant growth parameters than in SW and CS composts. The comprehensive growth index values obtained for plants growing in peat, HH and PL were 0.94, 0.87 and 0.84, respectively, which were higher than those in the CS and SW. Plant growth showed linear above-ground dry matter accumulation in all substrates, but was slower in SW and CS. HH and PL substrates appeared to be suitable for containerized sod production for natural soil and peat substitution. Biosolid proved to be an efficient component as a nutrient source ingredient of composted substrates for turfgrass.

Mining wastewater management and its effects on groundwater and ecosystems

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

Effect of solarization on the removal of indicator microorganisms from municipal sewage sludge

The effect of solarization on bacterial inactivation in sewage sludge was studied using thermotolerant coliforms, enterococci and Escherichia coli (E. coli) as the indicator organisms. Solarization significantly increased the sludge temperature. The maximum temperatures were achieved at the beginning of the second week, reaching 65, 58, 55 and 50 degrees C at depths of 0-10, 10-20, 20-30 and 30-40 cm, respectively. E. coli was found to be the most sensitive microorganism and was reduced to undetectable levels after 9 d at all monitored sludge depths. Thermotolerant coliforms were rapidly inactivated but were not reduced to below the detection limit. The inactivation curves of enterococci showed both shoulders and tailing, indicating a larger heat resistant fraction than with E. coli and the thermotolerant coliforms. Overall, the results suggest that the temperature regime produced by solarization was sufficient to reduce bacterial indicators to an acceptable level, meeting the pathogen regulation limit, in two weeks.

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

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

Adjunctive use of mitomycin C in endoscopic revision dacryocystorhinostomy

OBJECTIVES

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

METHODOLOGY

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

RESULTS

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

CONCLUSIONS

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

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

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

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Critical appraisal of respirometric methods for metal inhibition on activated sludge

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

The effects of experimental hyperthyroidism on hemorheology and plasma fibrinogen concentration

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

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Mapping the mesoscale interface structure in polycrystalline materials

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

Effects of excessive copper intake on hematological and hemorheological parameters

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

Laparoscopic renal biopsy in bilateral pelvic kidney with chronic glomerulonephritis

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

Plasmapheresis: an effective therapy for refractory hyperthyroidism in the elderly

Hyperthyroidism in the elderly often presents diagnostic challenges. Elderly patients rarely present with classical signs and symptoms of hyperthyroidism. More commonly, their presentation is ayical which leads to a delay in making a diagnosis. Such delays can sometimes decrease the functional capacity of the affected patient and reduce their chance for recovery. Herein we report a 66-year-old woman whose diagnosis of hyperthyroidism was delayed. Standard therapies were ineffective. Plasmapheresis was performed to control the manifestations of the hyperthyroid state, resulting in improvement in the patient's condition.