Systemic inflammation response index is associated MACE in patients with NSTEMI.

OBJECTIVE: Non-ST segment elevation myocardial infarction (NSTEMI) poses a significant health concern. The systemic inflammation response index (SIRI), an emerging inflammatory marker linked to conditions like stroke and cancer, has shown potential relevance. Inflammation's pivotal role in acute coronary syndromes is well-established, yet its specific association with NSTEMI and SIRI remains unexplored. This study aims to elucidate the correlation between SIRI and major adverse cardiovascular events (MACE) in patients with NSTEMI. PATIENTS AND METHODS: A cohort of 935 consecutive NSTEMI patients who underwent percutaneous intervention was recruited. MACE was defined to encompass all-cause death, malignant arrhythmia, and unplanned percutaneous coronary intervention. The systemic inflammation response index, a composite metric involving three distinct inflammatory cell counts, was computed as the product of neutrophil count and monocyte count divided by lymphocyte count. A receiver operator characteristic (ROC) curve analysis was used to define a cut-off level of SIRI to predict MACE. Then, the study population was divided into two groups according to the cut-off SIRI level in ROC curve analysis. The 12-month follow-up results of the patients were recorded retrospectively. RESULTS: The participants exhibited a mean age of 64.12. Notably, the mean SIRI level registered at 1.98 among patients experiencing MACE and 4.97 among others. Through rigorous multivariate logistic regression analysis, SIRI emerged as an independent predictor of MACE. Further analysis via ROC curve yielded a sensitivity of 68% and specificity of 76% for MACE detection, with a SIRI cut-off of 2.3. CONCLUSIONS: In the context of NSTEMI, SIRI emerges as a robust independent predictor of MACE. These findings underscore the potential utility of SIRI as a prognostic indicator for adverse cardiovascular events, enhancing our understanding of the disease's pathophysiological mechanisms and potential avenues for improved clinical management.

Association of CABG SYNTAX score with long term clinical outcomes in patients with acute myocardial infarction undergoing SVG PCI.

OBJECTIVE: The CABG SYNTAX score (CSS) has been recommended as an objective and quantitative evaluation tool for coronary anatomic complexity after CABG. We aimed at evaluating the long-term prognostic value of the CSS and its relationship with the composite criteria of all-cause death, cerebrovascular accident (CVA) and/or non-fatal myocardial infarction (MI) in patients who underwent percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). PATIENTS AND METHODS: We retrospectively evaluated 232 patients who were admitted with MI and underwent PCI of SVGs, between 2012 and 2018. The study population was divided into two groups according to the results of the median pre-PCI CSS. RESULTS: The composite criteria of all-cause death/CVA/non-fatal MI were observed in 107 patients (46.1%). The incidence of the primary endpoint was significantly higher among the patients with a high pre-PCI CSS (p < .001). Multivariable Cox regression analyses demonstrated that both pre-PCI CSS (HR = 1.678, 95% CI = 1.082-2.602, p = .021) and post-PCI CSS (HR = 1.663, 95% CI = 1.066-2.596, p = .025) were significantly associated with the primary endpoint. The Kaplan-Meier cumulative curves divided by the median of the pre-PCI CSS demonstrated that, compared with the low pre-PCI CSS group, the high-score group was associated at five years with higher composite criteria of all-cause death/CVA/non-fatal MI (low, 40.3%; high, 57.8%; p = .015). CONCLUSIONS: Pre-PCI CSS is a significant prognostic factor for the long-term clinical outcomes in patients with previous CABG who underwent PCI of SVG.

Melatonin Improves Reduced Activities of Membrane ATPases and Preserves Ultrastructure of Gray and White Matter in the Rat Brain Ischemia/Reperfusion Model.

Ischemia/reperfusion (I/R) is among the most frequent neurological problems and early intervention to limit the damage is crucial in decreasing mortality and morbidity. Based on reports regarding beneficial effects of melatonin, we investigated its impact on Na+-K+/Mg2+ ATPase and Ca2+/Mg2+ ATPase activities and ultrastructure of gray and white matter in the rat forebrain I/R model. Adult Wistar-albino rats (n = 78), were randomized into control, ischemia (I), ischemia/reperfusion (I/R), low (I/R + melatonin 400 µg/kg), moderate (I/R + melatonin 1200 µg/kg), and high (I/R + melatonin 2400 µg/kg) dose melatonin. Two-vessel occlusion combined with hypotension (15 min) induced ischemia and reperfusion (75 min) achieved by blood reinfusion were performed. Activities of the membrane-bound enzyme, brain malondialdehyde levels, and brain matter ultrastructure were examined in frontoparietal cortices. Melatonin lowered production of malondialdehyde in a dose-dependently. The enzyme activities attenuated under I and I/R, improved with melatonin treatment. I and I/R severely disturbed gray and white matter morphology. Melatonin, in all applied doses, decreased ultrastructural damages in both gray and white matter. Favorable effects of melatonin can be attributed to its antioxidant properties suggesting that it could be a promising neuroprotective agent against I/R injury being effective both for gray and white matter due to favorable biological properties.

Internal Carotid Artery Agenesis with an Intercavernous Anastomosis: A Rare Case.

BACKGROUND: Agenesis of the internal carotid artery (ICA) is a rare vascular anomaly that was first observed postmortem. Various anastomoses supply the distal vessels at the site of agenesis. Of these anastomoses, an intercavernous anastomosis is very rare. This paper presents a patient with ischemic stroke in whom we discovered left ICA agenesis and an ipsilateral intercavernous anastomosis. CASE: A 58-year-old man with a history of myocardial infarction and diabetes mellitus presented with sudden-onset difficulty in speaking, numbness on the left side of the face, and weakness of the left arm and leg. Neurological examination revealed dysarthria, left facial paralysis, left hemiparesis, and bilateral absence of the plantar reflexes. Diffusion-weighted magnetic resonance imaging showed a right middle cerebral artery (MCA) infarction. On cranial and cervical magnetic resonance angiography, the left ICA could not be seen distal to the bifurcation; the left MCA was supplied through an intercavernous anastomosis between the right ICA and the left ICA. Cranial computed tomography (CT) revealed the absence of the left carotid canal. Digital subtraction angiography led to a diagnosis of left ICA agenesis with an intercavernous anastomosis. The patient was discharged on acetylsalicylic acid and warfarin. CONCLUSION: ICA agenesis with an intercavernous anastomosis is a rare vascular anomaly that should be differentiated from secondary causes of ICA stenosis and occlusions by showing agenesis of the carotid canal on cranial CT.

Is there any association between irritable bowel syndrome subgroups and autonomous dysfunction.

OBJECTIVE: Irritable bowel syndrome (IBS) is a common functional intestinal disorder. Although there are marked improvements in the conceptualization of IBS pathophysiology in brain-intestinal interaction disorder, there is no definite consensus in the role of autonomic dysfunction (AD) in disease development and symptom progression. The aim of this study was to evaluate autonomous dysfunction in IBS subgroups. PATIENTS AND METHODS: A total of 50 patients and 49 healthy controls were included. IBS subgroup types and demographic characteristics of patients were recorded. AD investigations were made up of parasympathetic and sympathetic tests. RESULTS: There was no statistically significant difference was determined between the groups in accordance to demographic characteristics such as age, gender, BMI and resting heart rate (p > 0.05). Three parasympathetic and one sympathetic autonomic neuropathy tests were found significantly different (respectively p < 0.001, p = 0.001, p = 0.016, p < 0.001, p = 0.375). There were significant decreases in parasympathetic tests in IBS-C patients; however, in the control group, there were significant decreases in sympathetic tests when compared with IBS-D patients (p < 0.001). The severity of AD in IBS-C subgroup was more pronounced than the IBS-D subgroup. No correlation was determined between dysautonomia and disease duration (p > 0.05). CONCLUSIONS: AD may have a role in IBS pathophysiology. Deterioration of the autonomous system not only affects the gastrointestinal system but also other systems including the cardiovascular system. Patients may also be susceptible to more diverse problems.

Frequency of eosinophilic esophagitis in patients with esophageal symptoms: a single-center Turkish experience.

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized with symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. There has been a dramatic increase in the diagnosis of this disease in recent years. The primary objective of this study was to determine the frequency of EoE in adult patients who were evaluated by gastroenterologists in our clinic with esophageal symptoms. Between November 2010 and May 2011, 311 adult patients who were evaluated in our clinic with esophageal symptoms were enrolled prospectively. All patients underwent endoscopy and had biopsies taken. Gastroesophageal reflux disease was excluded by either proton pump inhibitory treatment or 24-hour ambulatory pH monitorization. The diagnosis was confirmed by one independent pathologist. Frequency of EoE in patients with esophageal symptoms was 2.6% (n = 8; four men and four women). Mean age at diagnosis was 40.2 ± 8 years. Heartburn was the predominant symptom in patients (75% of the patients), and 87.5% (n = 7) of patients had more than one symptom at diagnosis. Nearly 38% of the patients (n = 3) had a history of allergic disease. Endoscopic findings were as follows: transient/fixed esophageal rings (25%), white exudates (25%), and normal appearance (50%). Median number of circulating eosinophils was 208 (93-659)/mm(3) . Median number of intraepithelial eosinophils in proximal-middle 1/3 part and distal 1/3 part of esophagus were 0 (0-50)/hpf and 37 (16-50)/hpf, respectively. In conclusion, EoE is not rare in Turkey, and it should be considered in the differential diagnosis of patients with esophageal symptoms.

Evaluation of parenchymal neuro-behçet disease by using susceptibility-weighted imaging.

BACKGROUND AND PURPOSE: Neurologic involvement in Behçet disease, also known as NBD, is one of the most devastating manifestations of the disease. The precise pathologic mechanism of parenchymal NBD lesions has not been established. We evaluated lesion characteristics and probable venous hemorrhage in parenchymal NBD by using SWI, and we compared the imaging results with conventional MR imaging sequences. MATERIALS AND METHODS: We performed cranial MR imaging by using a 1.5T scanner in 23 patients with a definitive diagnosis of parenchymal NBD. We compared the proportion of lesion detection and the performance of hemorrhagic detection with the T2 FSE, T2*GE, and SWI magnitude, and SWI mIP by using the χ(2) test. RESULTS: The proportion of lesion detection with both SWI magnitude and SWI MinMIP was significantly larger than that with T2*GE. The proportions of lesion detection among all other pairs of methods were not significantly different according to the corresponding P value (χ(2) = 17.4929, df = 3, P = .0006). Proportions of hypointense hemorrhagic lesions with T2 FSE and T2*GE were not significantly different, and likewise for the proportions of hypointense hemorrhagic lesions with SWI magnitude and SWI mIP. In contrast, the proportions of hypointense hemorrhagic lesions with SWI magnitude and SWI mIP were significantly larger than that with T2 FSE and T2*GE (χ(2) = 108.5396, df = 3, P < .0001). CONCLUSIONS: Most of the lesions in parenchymal NBD were found to be hemorrhagic with SWI, supporting the proposed venous theory in pathology. In addition, compared with T2 FSE and T2*GE sequences, SWI was more successful in the determination of widespread involvement of the disease, particularly in nonchronic cases.

Long-term results of hepatitis B immunoglobulin and lamuvidine for hepatitis B prophylaxis after liver transplantation.

PURPOSE: Recurrence of hepatitis B virus after a liver transplantation (OLT) is a risk factor affecting graft and patient survivals. Short-term hepatitis B virus reactivation rates after OLT range between 3% and 15%. Using combination prophylaxis, the outcomes of OLT among patients with liver disease related to hepatitis B virus have improved to levels comparable to those whose disease is not related to hepatitis B virus. MATERIALS AND METHODS: Since September 2001, we performed 288 OLT in 282 patients including 74 who had liver failure related to hepatitis B virus among whom 58 were followed for >12 months and analyzed retrospectively. Our protocol included lamivudine (100 mg orally per day beginning the day after surgery) and hepatitis B immunoglobulin (10,000 IU IV during the anhepatic phase, 2000 IU/d IV during the first week after surgery, 2000 IU IV/month from postoperative months 1 to 12). Using our protocol, the anti-hepatitis B surface antibodies (HBsAb) serum titer was maintained up to 100 IU/mL. The female:male ratio was 11:47. The mean age of patients was 43±12.8 years. RESULTS: Five patients died of causes unrelated to hepatitis B virus. At the time of death, their hepatitis B surface antigens were negative, and serum titers of anti-HBsAb were 45, 35.3, 56.4, 79.6, and 123 IU/mL. Mean follow-up was 46.5±18.9 months (range, 12-79). The hepatitis B surface antigen became positive in 4 patients; the remaining 49 had no evidence of hepatitis B surface antigen. In 18 patients, serum titer of anti-hepatitis B surface antigen was 0; in the remaining 31 patients, it was 69.2±133 IU/mL. CONCLUSION: Our combination protocol with hepatitis B immunoglobulin and lamivudine is a safe, cost-saving, and effective treatment for hepatitis B virus prophylaxis after liver transplantation.

Cerebral microhemorrhages detected by susceptibility-weighted imaging in amateur boxers.

BACKGROUND AND PURPOSE: SWI is a new technique for evaluating diffuse axonal injury associated with punctate hemorrhages. The aim of our study was to determine the prevalence of cerebral microhemorrhages in amateur boxers compared with nonboxers by using SWI and to evaluate the sensitivity of SWI compared with T2 FSE and T2*GE sequences. MATERIALS AND METHODS: We performed cranial MR imaging with a 1.5T scanner in 21 amateur boxers and 21 control subjects. The study protocol included conventional MR images, T2 FSE, T2*GE, and SWI sequences. The proportions of boxers and controls having CSP, DPVS, cerebral atrophy, cerebellar atrophy, ventricular dilation, PSWMD, and microhemorrhages were computed and were compared by using the χ(2) test of proportions. The relationship between microhemorrhages and boxing-related covariates was assessed by using the Wilcoxon rank sum test. The association between the categories was tested by using the Fisher exact test. RESULTS: Using SWI, microhemorrhages were found in 2 (9.52%) of 21 boxers. The microhemorrhages were not visible on T2 FSE or T2*GE images. The proportion of subjects with microhemorrhages did not differ significantly between the boxers and control subjects (χ(2) = 0.525, df = 1, P = .4688). The prevalence of CSP and DPVS was significantly higher in the boxers than in the control subjects. CONCLUSIONS: More microhemorrhages were detected in amateur boxers than in controls, but this difference was not statistically significant.

Intrathecal gadolinium-enhanced MR cisternography in the evaluation of CSF leakage.

BACKGROUND AND PURPOSE: Radiologic identification of the location of the CSF leakage is important for proper surgical planning and increases the chance of dural repair. This article describes our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. MATERIALS AND METHODS: A total of 85 consecutive patients with suspected CSF fistulas who presented with persistent or intermittent rhinorrhea or otorrhea lasting for more than 1 month between 2003 and 2007 were included in this study. RESULTS: We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into >1 paranasal sinus. CONCLUSIONS: MR cisternography after the intrathecal administration of gadopentate dimeglumine represents an effective and minimally invasive method for evaluating suspected CSF fistulas along the skull base. It provides multiplanar capabilities without risk of radiation exposure and is an excellent approach to depict the anatomy of CSF spaces and CSF fistulas.

Anatomy of the azygos vein examined by computerized tomography imaging.

OBJECTIVE: To examine the anatomy of the azygos vein AV using different parameters. Therefore, the diameter of the AV at its opening into the superior vena cava, the opening level of the AV into the superior vena cava, and the position of the AV, with respect to the vertebral column and carina, were examined by CT. METHODS: Chest CTs of 103 cases (42 female and 61 male) were reviewed at the Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey between July 2004 and February 2005. The CT examinations were performed with a Philips AU E1 spiral CT (Rotterdam, Netherlands) with the following parameters: 120 Hv; 200 mAs; slice thickness: 7 mm; pitch: 1; reconstruction index: 7 mm. The results were statistically analyzed. RESULTS: The diameter of the AV at the opening into the superior vena cava ranged between 4.3 mm and 16 mm. The AV was in the midline in 41 cases. The arching and opening level of the AV was at the fifth thoracic vertebra in most cases. The opening level was most often at the same level as the carina. Hemiazygos veins were detected in 90 patients. CONCLUSION: The parameters measured in this study may be useful in surgical procedures of the mediastinum and during the interpretation of chest radiographs.

Activation of solgel titanium nanofilm by UV illumination for NOM removal.

The control of natural organic matter (NOM) in drinking water treatment plants is required in order to control (i) the formation of potentially harmful disinfection byproducts (DBPs), (ii) the regrowth of bacteria and (iii) pipe corrosion in the distribution system. Photocatalysis is a promising advanced oxidation technology due to its ability to mineralise chlorinated byproduct precursors such as humic acids (HAs) to carbon dioxide and water. In this study, the efficiency of HAs and NOM removal in terms of UV absorbance at 254 nm (UV254) was tested by means of a new photocatalytic reactor made of stacked polymethylmethacrylate (PMMA) rings coated by TiO2 nanofilm. Three different sets of rings were coated with TiO2 gel one, two and three times respectively to optimise the coating thickness according to UV254 removal efficiency. The titania sol was immobilised on the substrate by a low temperature procedure and after 8 months the reactors were reactivated by means of UV radiation before the experiments. The photocatalytic removal efficiency of humic acid in terms of UV254 was significantly higher after 1 hour for the reactor employed with high thickness TiO2 nanofilm (around 20%) compared to middle and low thickness reactors (6 and 1.4%, respectively). However, during the same reaction time only 10% of UV254 was removed with high thickness TiO2 nanofilm using raw surface water, probably owing to ionic species naturally occurring in the raw water sample. Finally, the activation of the TiO2 nanofilm may be effectively accomplished by means of UV radiation where calcination cannot be applied (e.g. thermally sensitive substrates).

The role of early colonoscopy in CMV colitis of transplant recipients.

Cytomegalovirus (CMV)-associated diseases remain a major problem in transplant recipients. Early diagnosis is critical. Presentation of early CMV colitis can be mild and nonspecific in transplant recipients. Although serology is helpful in the diagnosis, sometimes it is inadequate. Because the endoscopic features of CMV colitis are specific, colonoscopy facilitates the histopathologic examination. We present the clinical properties and advantages of early colonoscopy in transplant recipients with CMV colitis. The study group included seven patients (six men, one woman of mean age, 36.7 years (range, 22 to 64 years) whose mean transplant duration was 12.3 months (range, 1 to 72 months). Six of the seven patients experienced an acute graft rejection treated with high doses of steroids; one patient had a herpes simplex virus infection. All patients were on steroid treatment with a various combinations of immunosuppressive agents, including cyclosporine, mycophenolate mofetil, and tacrolimus. All patients presented with mild diarrhea without any blood or mucous discharge. Four patients had fever exceeding 38 degrees C; two had abdominal pain. Stool examinations revealed normal findings in six patients, while one patient had white blood cells and amoebic cysts. Serum CMV IgM and CMV pp65 antigenemia were negative in five of seven patients and two had positive results. All patients showed typical colonoscopic and histopathologic findings compatible with CMV colitis. Standard ganciclovir treatment was successful in all patients. Early and rapid colonoscopy is beneficial for the early diagnosis and management of CMV colitis in transplant recipients.

Advanced oxidation of commercial textile biocides in aqueous solution: effects on acute toxicity and biomass inhibition.

In the present study, the decomposition of two biocides used in the textile finishing process with Advanced Oxidation Processes (AOPs) has been studied. Different AOPs, i.e O3/OH-, TiO2/UV-A and Fe2+/H2O2 have been used representing mutually combined components of the chemically and photochemically driven advanced oxidation systems. The course of reaction was examined by changes in chemical oxygen demand (COD), total organic carbon (TOC) and acute toxicity towards the water flea Daphnia magna (assessed in terms of the effective dilution ratio LD50). Particular attention has been paid to determine the inhibitory effect of raw and ozonated biocides on biological activated sludge consortium at concentrations typically encountered in textile finishing effluents. Significant oxidation and mineralization of both biocides could be achieved employing ozonation at pH = 11.5 and heterogeneous photocatalysis (TiO2/UV-A) at pH = 5.0, whereas Fenton's reagent appeared to be less effective in COD and acute toxicity abatement.

Light and scanning electron microscopic examination of late changes in hair with hereditary trichodysplasia (Marie Unna hypotrichosis).

OBJECTIVE: Our aim was to investigate the microscopic surface structural alteration in hair with hereditary trichodysplasia. This article presents the results of light and scanning electron microscopy (SEM) examination of cases having hereditary trichodysplasia. METHODS: The biopsy specimens were obtained from 2 girls of ages 3 and 5-years, Department of Pediatrics, Faculty of Medicine, Hacettepe University in 2001. A large number of hair specimens were obtained from these 2 cases having hereditary trichodysplasia. Routine light microscopic and SEM procedure was performed on the tissue specimen, and then they were examined by light microscopy and SEM. RESULTS: Hair specimens taken from both patients had great similarities. Our results reveal that the atypical looking hair were flattened, twisted and partly scattered at the end. Moreover, these hairs had sheath structures with abnormal proliferation and these structures were damaged, the cuticles had fractures and were degenerative. CONCLUSION: There is only a small number of SEM studies in literature reporting the ultrastructural changes of hereditary trichodysplasia. Scanning electron microscopy is a 3 dimensional examination technique revealing easily comparable images and it is indispensable for diagnosis in various tissues which permit considerable magnification. As it is used in the hereditary trichodysplasia syndrome its routine usage in many dermatologic and hair diseases will result in valuable contributions to scientific literature.

An innovative photocatalytic technology in the treatment of river water containing humic substances.

This study addresses the application of a photoelectrocatalytic (PEC) system with separated hole and electron reactions to treat humic acid (HA) from river water. A TiO2 electrode, coated by the sol-gel method, is used for that purpose. The degradation of humic acid in the river water was followed with respect to time using parameters of UV254, color and total organic carbon (TOC). For comparison purposes the photocatalytic (PC) removal of HA was also studied on the same photoanode. The obtained results showed that the PEC system was much more effective than the PC method. The effect of other important reaction variables, such as external potential, oxygen and UV intensity on HA degradation were also investigated. For all the external applied potential conditions and UV intensity range over 90% removal of UV254 and color were obtained with the PEC system while TOC removal was between 58-80%.

Tuberous sclerosis: ultrasound, CT and MRI features of two cases with multiple organ involvement.

The cases of two patients with tuberous sclerosis with multiple sites of involvement are presented. Both patients had characteristic cerebral lesions of tuberous sclerosis associated with bilateral renal angiomyolipomas and hepatic hamartomas. Additionally there were diffuse pulmonary cystic changes in one patient and cardiac rhabdomyoma in the other.