SARS-CoV-2 specific antibody responses in healthcare workers after a third booster dose of CoronaVac or BNT162b2 vaccine.

The first SARS-CoV-2 vaccination campaign in Turkey has started in mid-January for the healthcare workers (HCWs) with the inactive virus vaccine CoronaVac (Sinovac). After four and a half months, the Turkish Ministry of Health rolled out a booster-dose vaccination campaign for HCWs and all people over 50 years old beginning in July 2021. The individuals eligible were given the choice of either CoronaVac or mRNA vaccine BNT162b2 for the third booster-dose vaccination. This study aimed to evaluate SARS-CoV-2 IgG antibody titers against the S1 subunit of the spike protein as a marker of the humoral response in 179 HCWs who received a third booster dose of either CoronaVac or BNT162b2. A total of 136 HCWs, 71 female (52.2%) and 65 male (47.8%), completed both serum collections on Days 0 and 28. The median SARS-CoV-2 IgG S Protein (SP) titer in all participants before the vaccination was 175.7 AU/ml. Of 136 HCWs, 103 (75.73%) chose BNT162b2 vaccine and 33 (24.26%) chose CoronaVac as the third booster dose. There was a significant difference between the BNT162b2 group and the CoronaVac group in terms of SARS-CoV-2 IgG SP titers (p < 0.001). The median SARS-CoV-2 IgG SP titers in BNT162b2 group (n = 103) and in CoronaVac group (n = 33) were 17619.3 AU/ml and 1153.0 AU/ml, respectively. The third booster dose with BNT162b2 and CoronaVac increased antibody titers in each participant a mean of 162-fold and 9-fold, respectively. HCWs in the BNT162b2 group reported more frequent adverse events than HCWs in the CoronaVac group (p < 0.001).

Protective effect of thymoquinone in preventing trauma-related damage: an experimental study.

BACKGROUND: Secondary injury is a potentially modifiable factor of outcome in traumatic brain injury. This study aimed to investigate thymoquinone's effects on trauma-induced neuronal damage. METHODS: Eighteen adult female Sprague-Dawley rats were assigned into three groups following ketamine and xylazine anaesthesia (n = 6): Control, Trauma, Trauma + Thymoquinone. First dose of thymoquinone was administered three hours after the trauma. RESULTS: The trauma group showed significant oedema, vascular congestion, and ischaemia. Also, caspase-3 activity and malondialdehyde content of brain tissue was significantly increased, and Na,K-ATPase activity and glutathione levels were significantly reduced. Thymoquinone significantly reduced oedema, vascular congestion, ischaemia, and caspase-3 activity compared with the trauma group. While Na,K-ATPase activity and glutathione levels was similar to the Control group, malondialdehyde content was similar to the trauma group. CONCLUSIONS: This study showed that low dose thymoquinone exhibited a neuroprotective effect following severe traumatic brain injury, if administered within three hours of injury. Similar levels of glutathione and malondialdehyde suggest no antioxidant effect. Significant reduction in oedema and ischaemia in the neuron cells and partially preserved activity of Na,K-ATPase suggest that thymoquinone protects mitochondrial functions and energy levels of the neuronal cells following severe traumatic brain injury.

The effect of dexmedetomidine on liver injury secondary to lower extremity ischemia-reperfusion in a diabetic rat model.

Introduction: In this study, we aimed to evaluate the hepatic protective effects of dexmedetomidine in the lower extremity ischemia-reperfusion model in diabetic rats biochemically and histopathologically.Methods: Rats were randomly divided into 4 equal groups (n = 6); Control (C) group, diabetic control group (DM), diabetic ischemia-reperfusion group (IR), group with diabetic IR and dexmedetomidine (DEX). In the IR and DEX groups were performed 120 min reperfusion after 120 min ischemia. In group DEX, 100 µ / kg dexmedetomidine was administered intraperitoneally 30 minutes before renal IR administration. Then, various histopathological and biochemical parameters were evaluated in liver tissue.Results: After ischemia-reperfusion, aspartate amino transaminase, alanine amino transaminase, total oxidant level, and thiobarbituric acid -reactive substances were increased, total thiol group and total antioxidant level were decreased and these parameters were found to improve in the group given dexmedetomidine. It was also observed that there was histopathological deterioration after ischemia-reperfusion and histopathological deterioration was found to be less with dexmedetomidine administration.Conclusion: The effects of lower extremity ischemia-reperfusion on hepatic tissue as distant organs were evaluated in diabetic rats, histopathologically, immunologically, biochemically, and liver damage was determined after ischemia-reperfusion, and dexmedetomidine was found to decrease liver damage.

Evaluation of electrocardiographic ventricular repolarization variables in patients with newly diagnosed COVID-19.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a newly recognized infectious disease that has spread rapidly. COVID-19 has been associated with a number of cardiovascular complications, including arrhythmias. The mechanism of ventricular arrhythmias in patients with COVID-19 is uncertain. The aim of the present study was to evaluate the ventricular repolarization by using the Tp-e interval, QT dispersion, Tp-e/QT ratio, and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with newly diagnosed COVID-19. In addition, the relationship between the repolarization parameters and the CRP (C-reactive protein) was investigated. METHODS: 75 newly diagnosed COVID-19 patients, 75 age and sex matched healthy subjects were included in the study between 20th March 2020 and 10th April 2020. The risk of ventricular arrhythmias was evaluated by calculating the electrocardiographic Tp-e and QT interval, Tp-e dispersion, corrected QT(QTc), QT dispersion (QTd), corrected QTd, Tp-e/QT and Tp-e/QTc ratios. CRP values were also measured in patients with newly diagnosed COVID-19. RESULTS: Tp-e interval (80.7 ±â€¯4.6 vs. 70.9 ±â€¯4.8; p < .001), Tp-e / QT ratio (0.21 ±â€¯0.01 vs. 0.19 ±â€¯0.01; p < .001) and Tp-e/QTc ratio (0.19 ±â€¯0.01 vs.0.17 ±â€¯0.01; p < .001) were significantly higher in patients with newly diagnosed COVID-19 than the control group. There was a significant positive correlation between Tp-e interval, Tp-e/QTc ratio and CRP in patients with newly diagnosed COVID-19 (rs = 0.332, p = .005, rs = 0.397, p < .001 consecutively). During their treatment with hydroxychloroquine (HCQ), azithromycin and favipiravir, ventricular tachycardia episodes were observed in in two COVID-19 patients during their hospitalization in the intensive care unit. CONCLUSION: Our study showed for the first time in literature that the Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio, which are evaluated electrocardiographically in patients with newly diagnosed COVID-19, were prolonged compared with normal healthy individuals. A positive correlation was determined between repolarization parameters and CRP. We believe that pre-treatment evaluation of repolarization parameters in newly diagnosed COVID-19 would be beneficial for predicting ventricular arrhythmia risk.

Dysmetabolic markers predict outcomes in autosomal dominant polycystic kidney disease.

BACKGROUND: Overweight and obesity were recently associated with a poor prognosis in patients with autosomal dominant polycystic kidney disease (ADPKD). Whether the metabolic consequences of obesity as defined by the metabolic syndrome (MS) are also linked with disease progression remains untested. METHODS: Eligible ADPKD patients with different stages of CKD (n = 105) and 105 non-diabetic controls matched for CKD stage were enrolled in the study. Groups were evaluated at baseline for presence of MS, blood markers of metabolism, homeostasis model assessment of insulin resistance (HOMA-IR) score, and biochemical markers of inflammation (hs-CRP, IL-1ß, IL-6, TNF-α and PON-1). MS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Patients were followed for 12 months and progression defined as a decrease in baseline eGFR > 10%. RESULTS: MS and hypertension were more prevalent amongst ADPKD patients than in the control group. Meanwhile, markers of inflammation such as hs-CRP (3.63 [3.45-5.17] vs. 4.2 [3.45-8.99] mg/dL; p = 0.014), IL-6 (21.65 [14.1-27.49] vs. 24.9 [16.23-39.4] pg/mL; p = 0.004) and IL-1ß (21.33 [15.8-26.4] vs. 26.78 [18.22-35] pg/mL; p < 0.001) levels were all more elevated in ADPKD patients than in non-diabetic CKD subjects. In multivariate analysis having a truncating PKD1 mutation predicted (OR 1.25 [1.09-1.43]; p = 0.002) fulfilling the MS criteria. Finally, ADPKD patients fulfilling MS criteria had a significantly more rapid progression during 12 months of follow-up than did those that did not (OR 3.28 [1.09-9.87]; p = 0.035). CONCLUSIONS: Our data supports the notion that dysmetabolisms part of the ADPKD phenotype and associated with a poor outcome, especially in patients with a truncating PKD1 mutation.

Ten-year follow-up of a cemented tapered stem.

INTRODUCTION: This stem was cleared by the FDA in 2002 and has been implanted in cementless and cemented versions. Despite its long history, there are no long-term clinical  results available for the cemented version of this implant. The aim of this study was to provide such data. It was hypothesized that this implant delivers clinical success comparable to other tapered cemented stems. MATERIALS AND METHODS: A total of 113 hip replacements were performed in 106 patients between October 2007 and December 2009 using the cemented version of this stem. The mean age of the patients at operation was 74.8 years (range 50-91 years). The mean follow-up was 8.9 years with only two patients lost to follow-up. Implant survival was determined using the Kaplan-Meier analysis. RESULTS: Stem survival with revision for any reason as the endpoint was 96.4% after 10 years. Survival for stem aseptic loosening was 100%. There were no cases of osteolysis. Clinical outcomes, as shown by Harris Hip Scores, were in line with previous investigations and the rate of adverse events was very low. CONCLUSIONS: This is a modern cemented stem with an excellent survival rate and satisfactory functional outcomes. In this cohort, there were no failures related to the stem through the first decade.

Vasopressin-related copeptin is a novel predictor of early endothelial dysfunction in patients with adult polycystic kidney disease.

BACKGROUND: In this study, we examined the relative usefulness of serum copeptin levels as a surrogate marker of vasopressin (AVP) in adult polycystic kidney disease (ADPKD) by correlating it with baseline and longitudinal changes in markers of both renal function and common CVD manifestations (hypertensive vascular disease, atherosclerosis and endothelial dysfunction) that accompany the progression of this disease. METHODS: We studied a cohort of young and otherwise healthy ADPKD patients (n = 235) and measured cardiovascular function using flow-mediation dilatation (FMD), carotid intima media thickness (cIMT) and pulse wave velocity (PWV), as well as serum copeptin (commercial ELISA, a stable marker of AVP activity). The same analyses were carried out at baseline and after 3 years of follow-up. RESULTS: At baseline, median eGFR was 69 mL/min./1.73 m2, mean FMD 6.9 ± 0.9%, cIMT 0.7 ± 0.1 mm, and PWV 8.1 ± 1.2 m/s. At follow-up, equivalent values were 65 (44-75) mL/min./1.73 m2, 5.8 ± 0.9%, 0.8 ± 0.1 mm. and 8.2 ± 1.3 m/s. with all changes statistically significant. Plasma copeptin also rose from 0.62 ± 0.12 to 0.94 ± 0.19 ng/mL and this change correlated with ΔeGFR (-0.33, p < 0.001), ΔFMD (0.599, p < 0.001), ΔcIMT (0.562, p < 0.001) and ΔPWV (0.27, p < 0.001) also after linear regression modeling to correct for confounders. Finally, ROC analysis was done for a high baseline copeptin with ΔeGFR [cut-off:≤59], ΔFMD [cut-off: ≤7.08], ΔcIMT [cut-off:>0.76], and ΔPWV [cut-off:≤7.80]. CONCLUSIONS: Vascular dysfunction as reflected by FMD and cIMT, but not PWV or an altered cardiac geometry, precede most other signs of disease in ADPKD but is predicted by elevated levels of the circulating AVP-marker copeptin.

Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery.

PURPOSE: We hypothesized that cooling hyperbaric bupivacaine from 23 to 5 °C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications. METHODS: A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8 ml of 0.5 % hyperbaric bupivacaine intrathecally at either 5 °C (group I, n = 50) or at 23 °C (group II, n = 50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15 min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30 min. The levels of sensory and motor block on the operative side were evaluated until complete resolution. RESULTS: The rate of unilateral spinal anesthesia at 15 and 30 min was significantly higher in group I (p = 0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p = 0.014 and 0.037, respectively). The density and viscosity of the solution at 5 °C was significantly higher than at 23 °C (p < 0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6 min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3 min) and motor block recovery was shorter (157.6 vs 193.4 min) (p < 0.0001). CONCLUSIONS: Cooling of hyperbaric bupivacaine to 5 °C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.

Molecular characterisation and control of Acinetobacter baumannii isolates resistant to multi-drugs emerging in inter-intensive care units.

BACKGROUND: A nosocomial outbreak of Acinetobacter baumannii (AB) infections occurred among intensive care units (ICU) (surgery, medical, cardiovascular surgery, coronary unit) of Recep Tayyip Erdogan University Medical School (Rize, Turkey) between January 2011 and May 2012. The identification of isolates and clonal relation among them were investigated by molecular techniques. METHODS: A total of 109 AB isolates were obtained from 64 clinical materials from 54 ICU patients and 3 from the hands of healthcare workers (HCWs) of 42 environmental samples. The isolates were identified by 16S rDNA sequencing and OXA- specific PCR. The clonal relation between isolates was investigated by PFGE methods using ApaI restriction enzyme. RESULTS: All isolates were determined as AB by 16S rDNA sequencing and OXA-spesific PCR. While the blaOXA-51-like gene was amplified in all isolates, the blaOXA-23-like gene was amplified from 103 isolates. The PFGE pattern generated 9 pulsotypes and showed that the isolates from patients, HCWs, and the environment were genetically related. In 7 of these pulsotypes, there were 107 strains (98%) showing similar PFGE profiles that cannot be distinguished from each other, ranging from 2 to 53. The remaining 2 pulsotypes were comprised of strains closely associated with the main cluster. Two major groups were discovered with similarity coefficient of 85% and above. The first group consisted of 97 strains that are similar to each other at 92.7% rate, and the second group consisted of 12 strains that are 100% identical. CONCLUSIONS: The common utilization of the blood gas device among ICU was the reason for the contamination. AB strains can remain stable for a long period of time, although due to the disinfection procedures applied in hospitals, there is a small chance that the same clone might reappear and cause another epidemic. For that reason, the resistance profiles of the strains must be continuously followed with amplification-based methods, and these methods should be used to support the PFGE method in the short term.

Atrial fibrillation presented with syncope in a jet pilot during daily briefing on squadron.

INTRODUCTION: Syncope may be the initial clinical presentation of atrial fibrillation (AF) and has a great potential for incapacitation during flight. Herein is presented the case of a jet pilot who had paroxysmal palpitations accompanied with presyncope which progressed to syncope and was found to be associated with AF. CASE REPORT: A 23-yr-old male jet pilot had a sudden syncope at the fifth minute of his presentation during the daily flight briefing. After he regained consciousness, he was transferred to the intensive care unit of the military hospital. His medical history revealed two episodes of syncope which resulted in spontaneous recovery and were not reported to the flight surgeon. He had no abnormal findings on his physical examination except heart rate, which was irregular and 110 bpm with a rapid ventricular response. His diagnosis was AF. Laboratory tests, including thyroid hormones, CBC, transthoracic echocardiography, ultrasonography of the abdomen, chest X-rays, and also a tilt table test, were normal. He had completely normal findings on 24-h ECG Holter monitoring except rare ventricular extrasystoles and had a negative treadmill stress test. AF spontaneously converted to sinus rhythm during the follow-up in the intensive care unit. He was temporarily grounded and returned to flying duties after a 3-mo follow-up period without any recurrent arrhythmia. DISCUSSION: Syncope has various mechanisms and etiologies, and also a benign prognosis on the ground. However, not only vasovagal syncope, but also AF may be among the frequent causes of syncope in aviators and pilots, as was the case in the current study.

A data-driven computational methodology towards a pre-hospital Acute Ischaemic Stroke screening tool using haemodynamics waveforms.

BACKGROUND AND OBJECTIVE: Acute Ischaemic Stroke (AIS), a significant global health concern, results from occlusions in cerebral arteries, causing irreversible brain damage. Different type of treatments exist depending on the size and location of the occlusion. Challenges persist in achieving faster diagnosis and treatment, which needs to happen in the first hours after the onset of symptoms to maximize the chances of patient recovery. The current diagnostic pipeline, i.e. "drip and ship", involves diagnostic via advanced imaging tools, only available in large clinical facilities, which poses important delays. This study investigates the feasibility of developing a machine learning model to diagnose and locate occluding blood clots from velocity waveforms, which can be easily be obtained with portable devices such as Doppler Ultrasound. The goal is to explore this approach as a cost-effective and time-efficient alternative to advanced imaging techniques typically available only in large hospitals. METHODS: Simulated haemodynamic data is used to conduct blood flow simulations representing healthy and different AIS scenarios using a population-based database. A Machine Learning classification model is trained to solve the inverse problem, this is, detect and locate a potentially occluding thrombus from measured waveforms. The classification process involves two steps. First, the region where the thrombus is located is classified into nine groups, including healthy, left or right large vessel occlusion, left or right anterior cerebral artery, and left or right posterior cerebral artery. In a second step, the bifurcation generation of the thrombus location is classified as small, medium, or large vessel occlusion. RESULTS: The proposed methodology is evaluated for data without noise, achieving a true prediction rate exceeding 95% for both classification steps mentioned above. The inclusion of up to 20% noise reduces the true prediction rate to 80% for region detection and 70% for bifurcation generation detection. CONCLUSIONS: This study demonstrates the potential effectiveness and efficiency of using haemodynamic data and machine learning to detect and locate occluding thrombi in AIS patients. Although the geometric and topological data used in this study are idealized, the results suggest that this approach could be applicable in real-world situations with appropriate adjustments. Source code is available in https://github.com/ahmetsenemse/Acute-Ischaemic-Stroke-screening-tool-.

Bone and Parathyroid Scintigraphy Findings in Sagliker Syndrome.

Sagliker syndrome (SS) is a rare, exaggerated form of chronic kidney disease (CKD)-mineral and bone disorder resulting from untreated secondary hyperparathyroidism due to CKD. Herein, we describe a 34-year-old male patient whose Tc-99m-methylene diphosphonate bone scintigraphy and Tc-99m-sestamibi parathyroid scintigraphy revealed hints of SS and exhibited its defining characteristics.

The effects of dexmedetomidine on trauma-induced secondary injury in rat brain.

BACKGROUND: The objective of this study was to investigate the effect of dexmedetomidine (Dex), a sedative drug with little or no depressant effect on respiratory centers, on secondary injury in rat brain tissue by means of the Na+/K+ ATPase enzyme, which maintains the cell membrane ion gradient; malondialdehyde, an indicator of membrane lipid peroxidation; glutathione, an indicator of antioxidant capacity; and histopathological analyses. METHODS: Eighteen rats were randomized into three groups: the trauma group received anesthesia, followed by head trauma with a Mild Traumatic Brain Injury Apparatus; the Trauma+Dex group received an additional treatment of 100 µg/kg intraperitoneal dexmedetomidine daily for three days; the Control group received anesthesia only. RESULTS: The highest MDA levels compared to the Control group were found in the Trauma group. Mean levels in the Trauma+Dex group were lower, albeit still significantly high compared to the Control group. Glutathione levels were similar in all groups. Na/K-ATPase levels were significantly lower in the Trauma group compared to both the Control group and the Trauma+Dex group. Histopathologic findings of tissue degeneration including edema, vascular congestion and neuronal injury, and cleaved caspase-3 levels were lower in the Trauma+Dex group compared with the Trauma group. CONCLUSIONS: Dexmedetomidine administered during the early stage of traumatic brain injury may inhibit caspase-3 cleavageHowever, the mechanism does not seem to be related to the improvement of MDA or GSH levels.

Prediction of osteoporotic degradation of tibia human bone at trabecular scale.

A theoretical numerical model is proposed to predict patient dependent osteoporotic bone degradation. The model parameters are identified through a particle swarm optimization algorithm and based on individual patient high resolution peripherical quantitative computer tomography (HRpQCT) scan data. The degradation model is based on cellular activity initiated by the elastic strain energy developed in the bone microstructure through patient's body weight. The macro (organ scale) and meso (trabecular scale) scale analyses are carried out and predicted bone volume fraction and microstructure evolution are compared with in-vivo experimental bone degradation for four elderly women over a period of 10 years. A significant correlation (r > 0.9) is observed between the model predictions and in-vivo experiments in all cases with an average deviation error of 1.46%. The model can easily be extended to other patients and provide good predictions for different population categories such as ethnicity, gender, age, etc.

18F-FDG PET/CT Findings Overlapping Lymphoma in a Patient with Systemic Juvenile Idiopathic Arthritis.

Systemic juvenile idiopathic arthritis (sJIA) is an important autoinflammatory disease whose first symptom is usually fever, and life-threatening conditions such as macrophage activation syndrome can develop when diagnosis and treatment is delayed. sJIA is an exclusion diagnosis, and there is no specific test that distinguishes it from other febrile diseases. We report the positron emission tomography/computed tomography (PET/CT) findings of sJIA in a 12-year-old girl who presented with fever, rash, and arthralgia. 18F-fluorodeoxyglucose (FDG) uptake was observed in the spleen, bone marrow, and lymph nodes in 18F-FDG PET/CT performed to investigate the etiology of fever of unknown origin. The result of excisional biopsy performed with the suspicion of lymphoma from the left cervical lymph node with intense 18F-FDG uptake was reported as reactive hyperplasia. PET/CT is an alternative diagnostic method for patients with fever of unknown origin. In this case report, we emphasize that in patients with sJIA, there may be intense fluorodeoxyglucose-avid lymph nodes that may lead to the consideration of lymphoproliferative disease, and PET/CT findings along with spleen and bone marrow involvement may overlap with lymphoma.

Neuroprotective effects of Vaccinium myrtillus on damage-related brain injury.

Traumatic brain injury may trigger the secondary brain injury, which has the potential to be reversible and thus preventable. Anthocyanins are phylotherapeutic plants, which are reported to exhibit anti-inflammatory properties. This study aimed to evaluate the therapeutic efficiency of an anthocyanin, namely Vaccinium myrtillus, to alleviate secondary brain injury and identify possible mechanism of actions. It is hypothesized that lipid peroxidation and Na+ -K+ -ATPase activity may be involved in neuronal ischemia. Thus, brain tissue Malondialdehyde content, Na+ -K+ -ATPase content, and cleaved caspase-3 content was investigated following moderate head trauma in a rat model. Twenty-four Sprague-Dawley male rats were allocated into four groups: Control, Trauma, Solvent-Control, and Treatment. Trauma and Solvent-Control groups showed more prominent brain edema, neuronal ischemia, vascular congestion, increase in brain tissue Malondialdehyde and cleaved caspase-3 levels, and decreased Na+-K+-ATPase activity compared to the Control group. Although the Treatment group had comparable histological signs to the Trauma and Solvent-Control groups, Malondialdehyde level and Na+-K+-ATPase activity was similar to Control group, and cleaved caspase-3 levels were lower compared to Trauma and Solvent-Control groups. We conclude that anthocyanin extracts may alleviate secondary brain injury via anti-oxidative and anti-apoptotic mechanisms.

Atrial fibrillation in two jet pilots during aircrew periodical medical examination.

BACKGROUND: Atrial fibrillation (AF) unfavorably affects cardiac output and may cause acute incapacitation in flight due to loss of the atrial systole, which mainly contributes to the diastolic filling of the ventricles. Although it is the most common type of arrhythmia, it is rare in pilots and not compatible with aviation. CASE REPORTS: We present two AF cases incidentally detected in two jet pilots. The first case was a 39-yr-old male jet pilot with a lone AF. Since there was no structural abnormality or thrombus in the left atrial appendage on transesophageal echocardiography (TEE), the patient was converted to sinus rhythm via direct current cardioversion (DCC). The pilot returned to flying duties after a follow-up period without any recurrent arrhythmia. The second case was a 23-yr-old male jet pilot who had suffered six attacks of paroxysmal AF. Conversion to sinus rhythm was provided by DCC at once and the second via pharmacological cardioversion. Also, spontaneous conversion to sinus was observed during two attacks of AF during the follow-up period. There were no abnormalities on physical examination, echocardiography, and laboratory tests. Although the cardiac ablation procedure was applied, the patient couldn't be treated successfully. Thereafter the pilot was treated with sotalol and warfarin and was permanently disqualified from flying duties. DISCUSSION: Arrhythmia is among the frequent causes for aviators to be disqualified from flying duties. AF particularly should not be overlooked due to its potential for sudden incapacitation during flight via acute hypotension or thromboembolic events.

A Rare Case of Pulmonary Alveolar Microlithiasis with Diffuse Lung Uptake on Bone Scintigraphy.

Pulmonary alveolar microlithiasis is a rare disease characterized by accumulating intraalveolar small calcium phosphate stones. The disease is slow and does not show any signs in the early stages, but the shortness of breath, cough, and right heart failure may develop as it progresses. Methylene diphosphonate used in bone scintigraphy shows high uptake of calcium deposits in the alveoli and causes diffuse increased radiopharmaceutical uptake in the lungs.

Biomechanical analysis of odontoid and transverse atlantal ligament in humans with ponticulus posticus variation under different loading conditions: Finite element study.

PURPOSE: Ponticulus posticus (PP) is a variation of the bone bridge that appears in the first cervical vertebra and through which the vertebral artery passes. Odontoid fractures are common spinal bone fractures in older people. This study aims to investigate the effect of neck movements on the odontoid and transverse atlantal ligament (TAL) of people with PP variation from a biomechanical view. METHOD: C1, C2, and C3 vertebrae of the occipital bone were analyzed using the finite element method (FEM). In this study, solid models were created with the help of normal (N), incomplete (IC), and asymmetric complete (AC) PP tomography images. The necessary elements for the models were assigned, and the material properties were defined for the elements. As boundary conditions, models were fixed from the C3 vertebra, and 74 N loading was applied from the occipital bone. Stress and deformation values in the odontoid and transverse atlantal ligament were obtained by applying 1.8 Nm moment in flexion, extension, bending, and axial rotation directions. RESULTS: The stress and deformation values of all three models in odontoid and TAL were obtained, and numerical results were evaluated. In all models, stress and deformation values were obtained in decreasing order in rotation, bending, extension, and flexion movements. The highest stress and strain values were obtained in AC and the lowest values were obtained in N. In all movements of the three models, the stress and deformation values obtained in the TAL were lower than in the odontoid. CONCLUSION: The greatest stresses and deformations obtained in spines (AC) with PP were found in the odontoid. This may help explain the pathogenesis of odontoid fractures in older people. First, this study explains the mechanism of the formation of neck trauma in people with PP and the need for a more careful evaluation of the direction of impact. Secondly, the study reveals that the rotational motion of the neck independent of PP has more negative effects on the odontoid.

Association of Mild Hyperbilirubinemia with Decreased ECG-Based Ventricular Repolarization Parameters in Young Men.

OBJECTIVE: Hyperbilirubinemia is associated with protection against various oxidative stress-mediated diseases. We aimed to investigate the association between bilirubin and novel electrocardiography (ECG)-based ventricular repolarization parameters. METHODS: We enrolled 201 healthy men with mild hyperbilirubinemia (group 1) and 219 healthy men with normal bilirubin levels (group 2). The Tpeak-Tend (Tp-e) interval (defined as the interval from the peak of the T wave to the end of the T wave), corrected (c) Tp-e interval, QT interval, cQT interval, and Tp-e interval/QT interval ratio were measured from leads V5 and V6 with 20 mm/mV amplitude and 50 mm/second rate. RESULTS: The Tp-e interval, cTp-e interval, and Tp-e interval/QT interval ratio were significantly lower in group 1 compared with group 2. The cTp-e interval showed a significant negative correlation with total bilirubin, conjugated bilirubin, and unconjugated bilirubin. The cTp-e interval (odds ratio [OR], 0.900; P =.002) and Tp-e interval/QT interval ratio (OR, 0.922; P =.04) were significantly associated with mild hyperbilirubinemia. CONCLUSION: We showed the association of mild hyperbilirubinemia with decreased novel ECG-based ventricular repolarization parameters.