Efficacy and safety of particle embolization in bronchial arteries of hemoptysis patients with shunts.

AIM: This study assesses the safety and efficacy of particle embolization during bronchial artery embolization (BAE) in patients with shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. METHODS: In this retrospective, single-center study, we analyzed 312 BAE procedures performed from June 2020 to April 2023. The patient cohort had shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. We meticulously collected and examined comprehensive data, including clinical characteristics, computed tomography (CT) imaging, and embolization procedural details. RESULTS: Vascular shunts were identified in 49 patients. The etiologies of hemoptysis included post-TB sequelae (42.8%), bronchiectasis (26.5%), active TB (12.2%), aspergilloma (8.1%), bacterial pneumonia (4.1%), lung cancer (4.1%), and non-tuberculous mycobacterial infection (2%). The technical success rate of the procedures was 98%, with 149 out of 152 identified vessels successfully embolized. All patients experienced cessation or significant reduction of hemoptysis within 24 hours following the procedure. The clinical success rates were 97.9% at one month, 93.9% at six months, and 89.8% at one year. No shunt-related complications were detected. CONCLUSION: BAE with particle embolization is a safe and effective treatment for hemoptysis, particularly in cases with complex shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery.

Effectiveness of Peripheral Nerve Block in Terms of Search for a Standardized Treatment Protocol in Diabetic Foot Patients Using Anticoagulants: A Double-Center Study.

BACKGROUND: Lower-extremity amputation for a diabetic foot is mainly performed under general or central neuraxial anesthesia. Ultrasound-guided peripheral nerve block (PNB) can be a good alternative, especially for patients who require continuous anticoagulation treatment and patients with additional comorbidities. We evaluated bleeding due to PNB application in patients with diabetic foot receiving antiplatelet or anticoagulant therapy. Perioperative morbidity and mortality and the need for intensive care hospitalization were analyzed. METHODS: This study included 105 patients with diabetic foot or debridement who underwent distal foot amputation or debridement between February and October 2020. Popliteal nerve block (17 mL of 5% bupivacaine and 3 mL of saline) and saphenous nerve block (5 mL of 2% lidocaine) were applied to the patients. Postoperative pain scores (at 4, 8, 12, and 24 hours) and complications due to PNB were evaluated. Intensive care admission and 1-month mortality were recorded. RESULTS: The most common diseases accompanying diabetes were hypertension and peripheral artery disease. No complications due to PNB were observed. Mean ± SD postoperative first analgesic need was determined to be 14.1 ± 4.1 hours. Except for one patient, this group was followed up without the need for postoperative intensive care. In 16 patients, bleeding occurred as leakage from the surgical area, and it was stopped with repeated pressure dressing. Mean ± SD patient satisfaction score was 8.36 ± 1.59. Perioperative mortality was not observed. CONCLUSIONS: Ultrasound-guided PNB can be an effective and safe anesthetic technique for diabetic patients undergoing distal foot amputation, especially those receiving antiplatelet or anticoagulant therapy and considered high risk.

Evaluation of the factors affecting mortality after cardiac arrest - do lactate and procalcitonin concentrations have any implications?

OBJECTIVE: Mortality and morbidity rates are very high in patients admitted to the Intensive Care Unit (ICU) after cardiac arrest. In this study, we aimed to determine the mortality rates, risk factors, and predictive factors for mortality in post-cardiac arrest patients admitted to the ICU. PATIENTS AND METHODS: Following approval from the Ethics Committee, we conducted a retrospective review of patient files for individuals over the age of 18 who received treatment for cardiac arrest in the ICU from January 2017 to June 2020. Demographic data of the patients, comorbidities, arrest location, etiology of arrest, duration of hospitalization, CPR duration, APACHE 2 scores, pH and HCO3 measurements in initial blood gases, lactate levels (1st, 6th, 12th, 24th hour), change in lactate levels (24-1), rate of lactate change, procalcitonin (PRC) levels (1st and 24th hour), change in PRC levels (24-1), rate of PRC change, and blood glucose levels were recorded. The patients were divided into two groups (survivors and non-survivors groups). RESULTS: 151 patients were included in the study. pH and HCO3 levels were lower in the non-survivors group than in the survivors group. Initial PRC levels were similar in both groups, but the 24th-hour PRC levels were higher, and the changes in PRC levels in the first 24 hours were greater in the non-survivors group. The lactate changes in the first 24 hours were higher in the non-survivors group. The receiver operating characteristic (ROC) curve showed that the HCO3 levels, 1st-, 6th-, 12th-, and 24th-hour lactate levels, and changes in lactate levels had predictability for mortality. In logistic regression analysis, we found that high 24th-hour lactate levels and changes in lactate levels were independent risk factors for mortality. CONCLUSIONS: Considering PRC and lactate levels, along with clinical examination and laboratory findings, may improve the accuracy of determining the prognosis of patients experiencing cardiac arrest.

Effectiveness of the sternocleidomastoid muscle contraction asymmetry and filter: cervical vestibular evoked myogenic potential.

OBJECTIVE: This study aimed to determine the precautions that can be taken to increase the reliability of the vestibular evoked myogenic potentials test without being affected by the asymmetry of the sternocleidomastoid muscle and the issues that should be considered in the interpretation of vestibular evoked myogenic potential results if these precautions are not taken. METHOD: Individuals with sternocleidomastoid muscle activity of less than 30 µV in cervical vestibular evoked myogenic potential testing and an asymmetry ratio of more than 0.35 were excluded. In our study, individuals were divided into different groups according to sternocleidomastoid muscle asymetry. RESULTS: A total of 53 individuals were included in the study. Intergroup comparisons were made to determine the effect of electromyogram scaling and filter use on amplitude asymmetry ratio according to sternocleidomastoid muscle asymmetry. CONCLUSION: Keeping the sternocleidomastoid muscle asymmetry not exceeding 10 µV maximises the reliability of cervical vestibular evoked myogenic potentials. As a result of our study, it can be concluded that in clinical applications the asymmetry should not exceed 20 µV.

Organoleptic characteristics and compositional profile of meat of growing Japanese quail fed different levels of poultry byproducts compost.

The poultry industry generates a lot of waste, including dead birds, manure, and poultry litter. Poultry waste should never be disposed of improperly because it can seriously harm the environment. The waste can be recycled as a feedstock for use in poultry feed by composting the litter and deceased birds. The compositional profile and organoleptic properties of the meat of growing Japanese quail were examined over the course of a 4-week trial to ascertain the effect of adding compost to the diet. In a completely randomized design (CRD), 1200 newly hatched quail chicks (Coturnix coturnix japonica) were divided into five treatment groups (diets with 0, 2.5, 5, 7.5, and 10% compost), each consisting of 40 birds with six replicates. The addition of compost to the diet had no noticeable effects on the organoleptic qualities of appearance, color, aroma, taste, texture, juiciness, tenderness, and acceptability (P>0.05). The compositional profile characteristics for chicks given compost at any level compared to chicks fed the control diet showed no differences (P>0.05). These findings suggest that the sensory characteristics and compositional profile of growing meat quails can be maintained when fed diets including up to 10% compost.

Assessing effect of feeding poultry byproducts compost on organoleptic characteristics and compositional profile of meat of broiler chickens.

Large amounts of waste, including dead birds, manure, and poultry litter, are produced by the poultry industry. Poultry waste should be disposed of properly to avoid major pollution and health risks. Composting litter and dead birds could be an option to recycle the waste and use in poultry feed. A study was conducted to investigate the effects of feeding composted poultry waste on the organoleptic qualities and compositional profile of the meat of broiler chickens. A total of 300 day-old broiler chicks (500-Cobb) were randomly allocated to five treatment groups replicated six times with 10 birds each, under a completely randomized design (CRD). Five iso-caloric and iso-nitrogenous diets including composted poultry byproducts at concentrations of 0, 2.5, 5, 7.5, and 10% were fed ad libitum to the birds from day 0 to day 35. The sensory grading and meat composition profile of 500 Cobb broiler chickens were tested at 35 days of age. The findings showed that there were no variations in the sensory profiles of the meat from birds given various diets (P>0.05). Although the results were somewhat lower for the chicks fed compost-containing diets than for the control group, this difference was deemed to be insignificant (P>0.05). Similarly, there were no variations in the compositional profile values of the meat between meat from birds fed various diets (P>0.05). These findings imply that broiler chickens may be raised on diets containing up to 10% poultry byproduct compost without any negative impacts on the meat's sensory quality or composition. Additionally, using compost into broiler diets may help to lower the cost of feed.

Fabrication of hydroxyapatite-based nano-gold and nano-silver-doped bioceramic bone grafts: Enhanced mechanostructure, cell viability, and nuclear abnormality properties.

In this study, nano-gold (nAu) and nano-silver (nAg) were doped at the molar ratios of Molar5-Molar30 to the Hydroxyapatite (HAp)-based bioceramic bone graft synthesized by the sol-gel method. The effects of nAu and nAg on structural, mechanical, cell viability, and nuclear abnormality of the synthesized bioceramic grafts were evaluated. The chemical and morphological properties of the bone grafts after production were examined through XRD and SEM-EDX analyses and mechanical tests. To determine the biocompatibility of the bone grafts, cell viability tests were performed using human fibroblast cells. In the cytotoxicity analyses, only HAp and HAp-nAu5 grafts did not show toxicological properties at any concentration, while HAp-nAg5 among the nAg-containing grafts gave the best results at the 200-100 µg/mL concentrations and showed significant cytotoxicity in human fibroblast cells. The other nAu-containing grafts showed toxicological properties in the concentration range of 200-50 µg/mL and nAg-containing grafts in the concentration range of 200-100 µg/mL against the negative control. The micronucleus (MN) analyses showed that the lowest total MN and L (lobbed) amounts, while the lowest total N (notched) amount, was obtained from the only HAp graft. It was found that the nAg-doped bone grafts gave higher total MN, L, and N amounts compared to the nAu-doped bone grafts. Furthermore, while the mean nuclear abnormality (NA) values of all grafts gave close results, the highest values were again obtained from the nAg-doped bone grafts.

Neuroprotective effects of Geranium Robertianum L. Aqueous extract on the cellular Parkinson's disease model.

OBJECTIVE: In recent years, botanical medicines alone or in conjunction with existing therapies have attracted considerable popularity as an alternative treatment for Parkinson's Disease (PD). For instance, Geranium robertianum L. (Geraniaceae family) has been used in folk medicine for its antioxidant and anti-inflammatory properties. However, its neuroprotective potential has not been well demonstrated. MATERIALS AND METHODS: Herein and for the first time, we have investigated the in vitro neuroprotective effects of leaf extract of G. Robertianum over a wide dose range (0-200 µg/mL) on the PD model using retinoic acid (RA)-differentiated SHSY-5Y cells and 1-methyl-4-phenylpyridinium (MPP+)-induced neurotoxicity. The neuroprotective effects were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and lactate dehydrogenase (LDH) release assays. The antioxidant activity of the extract was measured by total antioxidant status (TAS) and total oxidant status (TOS). The effect of leaf aqueous extracts on acetylcholinesterase (AChE) activity was also determined. Finally, cell death mechanisms were analyzed by flow cytometry. RESULTS: Our results showed that G. Robertianum leaf extract ameliorated cytotoxicity and oxidative damage by MPP+. Moreover, G. Robertianum extract exhibited a protective activity against MPP+ induced apoptosis. CONCLUSIONS: The current findings could lead to a promising new candidate for a possible cure of Parkinson's disease through neuroprotective mechanisms with respect to antioxidant and apoptosis inhibitory properties of G. Robertianum water extracts.

Effects of selenium supplementation on the growth performance, slaughter characteristics, and blood biochemistry of naked neck chicken.

This study examined how selenium-supplemented diets affected the performance of naked neck chickens. The birds were fed both organic and inorganic selenium at 0.30 ppm, while the control diet did not include any additional selenium. A total of 225 one-day-old naked neck chicks were randomly divided into 3 experimental groups, each of which was replicated 5 times (replicates) and contained 15 birds. This was done using a completely randomized design. The data was collected after growth, meat quality, and blood profile parameters were assessed. The findings showed that the birds fed inorganic selenium in the diet displayed increased (P < 0.05) feed intake followed by those administered organic selenium and the control diet. On the other hand, birds fed organic selenium in the diet showed enhanced body weight gain and better feed conversion ratio (P < 0.05). Similarly, organic selenium supplementation increased (P < 0.05) breast and thigh weight compared to inorganic selenium, but no other metrics, such as dressing percentage, drumstick weight, liver weight, gizzard weight, heart weight, or wing weight, significantly differed between treatments (P > 0.05). When compared to birds fed inorganic Se and control diet, the birds fed organic Se had greater (P < 0.05) blood levels of total protein and globulin. Additionally, it was discovered that organic Se-fed birds had greater (P < 0.05) blood Se concentrations than control and inorganic Se-fed birds. However, no differences between treatments were found in albumin, glucose, cholesterol, triglycerides, or uric acid (P > 0.05). In conclusion, adding Se-enriched yeast, as an organic selenium source, to diets may enhance the poor growth and slaughter characteristics of naked neck chicks without negatively affecting blood chemistry.

Rapid TAURUS for Relaxation-Based Color Magnetic Particle Imaging.

Magnetic particle imaging (MPI) is a rapidly developing medical imaging modality that exploits the non-linear response of magnetic nanoparticles (MNPs). Color MPI widens the functionality of MPI, empowering it with the capability to distinguish different MNPs and/or MNP environments. The system function approach for color MPI relies on extensive calibrations that capture the differences in the harmonic responses of the MNPs. An alternative calibration-free x-space-based method called TAURUS estimates a map of the relaxation time constant, τ , by recovering the underlying mirror symmetry in the MPI signal. However, TAURUS requires a back and forth scanning of a given region, restricting its usage to slow trajectories with constant or piecewise constant focus fields (FFs). In this work, we propose a novel technique to increase the performance of TAURUS and enable τ map estimation for rapid and multi-dimensional trajectories. The proposed technique is based on correcting the distortions on mirror symmetry induced by time-varying FFs. We demonstrate via simulations and experiments in our in-house MPI scanner that the proposed method successfully estimates high-fidelity τ maps for rapid trajectories that provide orders of magnitude reduction in scanning time (over 300 fold for simulations and over 8 fold for experiments) while preserving the calibration-free property of TAURUS.

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

BACKGROUND: Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. METHODS: A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. RESULTS: Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97 mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79 mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9 mm on the right and 24.2 mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35 mm and 4.62 mm at 2 cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2 cm below the SHP bifurcation. CONCLUSIONS: Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

Assessing growth performance, morphometric traits, meat chemical composition and cholesterol content in four phenotypes of naked neck chicken.

The present study was conducted to assess the growth performance, morphometric traits, muscle chemical composition and cholesterol content in four phenotypes of naked neck chicken (black, white-black, light brown and dark brown). A total of 320-day-old chicks, 80 from each phenotype, were randomly stratified into 20 replicates (16/replicate), according to a completely randomized design. The results showed higher final body weight, weight gain, and better FCR in both light brown and dark brown phenotypes whereas time of gains was found to be greater in dark brown phenotype. Keel length and shank circumference were greater in dark brown whereas wing spread was found to be higher in light brown phenotype. Drumstick circumference and body length did not show any significant differences (P > 0.05) across the phenotypes. Dry matter was found to be higher in white black, crude protein in black, white black and dark brown, moisture in light brown, and cholesterol content in black whereas ether extract and ash content were found to be greater in black and white black phenotypes. In conclusion, both light brown and dark brown phenotypes showed superior growth performance and morphometric traits. Similarly, from a health point of view, the dark brown and light brown phenotypes seem superior because their cholesterol content was low. Thus, it is strongly recommended that there should be a conscious effort to improve economically important traits of the light and dark brown birds to be used as dual-purpose slow growing chicken, especially in developing countries.

Coronary CT angiography for suspected acute coronary syndrome: sex-associated differences.

AIM: The optimal diagnostic test in the work-up of suspected acute coronary syndrome (ACS) may differ between men and women. The aim of this study was to compare sex-associated differences between using a diagnostic strategy including early coronary computed tomography angiography (CCTA) and standard of care (SOC). METHODS: In total, 500 patients who presented with symptoms suggestive of ACS at the emergency department were randomised between a diagnostic strategy supplemented with early CCTA and SOC. RESULTS: Women were generally older than men (mean ± standard deviation 56 ± 10 vs 53 ± 10 years, p < 0.01) and were less often admitted to hospital (33% vs 44%, p = 0.02). Obstructive coronary artery disease on CCTA (> 50% luminal narrowing) was less frequently seen in women (14% vs 26%, p = 0.02), and ACS was diagnosed less often in women (5% vs 10%, p = 0.03). Women underwent less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS (p = 0.008). CONCLUSION: Women had a lower incidence of obstructive CAD on CCTA and were less often admitted to hospital than men. They were subjected to less outpatient testing when early CCTA was used in the emergency department evaluation of suspected ACS.

Quantification of arterial, venous, and cerebrospinal fluid flow dynamics by magnetic resonance imaging under simulated micro-gravity conditions: a prospective cohort study.

BACKGROUND: Astronauts undergoing long-duration spaceflight are exposed to numerous health risks, including Spaceflight-Associated Neuro-Ocular Syndrome (SANS), a spectrum of ophthalmic changes that can result in permanent loss of visual acuity. The etiology of SANS is not well understood but is thought to involve changes in cerebrovascular flow dynamics in response to microgravity. There is a paucity of knowledge in this area; in particular, cerebrospinal fluid (CSF) flow dynamics have not been well characterized under microgravity conditions. Our study was designed to determine the effect of simulated microgravity (head-down tilt [HDT]) on cerebrovascular flow dynamics. We hypothesized that microgravity conditions simulated by acute HDT would result in increases in CSF pulsatile flow. METHODS: In a prospective cohort study, we measured flow in major cerebral arteries, veins, and CSF spaces in fifteen healthy volunteers using phase contrast magnetic resonance (PCMR) before and during 15° HDT. RESULTS: We found a decrease in all CSF flow variables [systolic peak flow (p = 0.009), and peak-to-peak pulse amplitude (p = 0.001)]. Cerebral arterial average flow (p = 0.04), systolic peak flow (p = 0.04), and peak-to-peak pulse amplitude (p = 0.02) all also significantly decreased. We additionally found a decrease in average cerebral arterial flow (p = 0.040). Finally, a significant increase in cerebral venous cross-sectional area under HDT (p = 0.005) was also observed. CONCLUSIONS: These results collectively demonstrate that acute application of -15° HDT caused a reduction in CSF flow variables (systolic peak flow and peak-to-peak pulse amplitude) which, when coupled with a decrease in average cerebral arterial flow, systolic peak flow, and peak-to-peak pulse amplitude, is consistent with a decrease in cardiac-related pulsatile CSF flow. These results suggest that decreases in cerebral arterial inflow were the principal drivers of decreases in CSF pulsatile flow.

Apelin-13: A Promising Biomarker for Age-Related Macular Degeneration?

PURPOSE: To investigate the value of serum apelin-13 levels in patients with age-related macular degeneration (AMD). METHODS: Patients with dry-type AMD, patients with treatment-naïve neovascular-type AMD, and healthy controls were included in this study. Diagnoses were confirmed on detailed fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Central foveal thickness and subfoveal choroidal thickness were evaluated. Both serum apelin-13 and vascular endothelial growth factor (VEGF) levels were measured by a competitive enzyme-linked immunosorbent assay (ELISA) principle. RESULTS: A total of 84 subjects, i.e., 24 in the dry-type AMD group (group 1), 27 in the neovascular-type AMD group (group 2), and 33 in the control group (group 3) were included in the study. Mean best-corrected visual acuity (BCVA) was 76 ± 4.5, 48.4 ± 16.3, and 83.4 ± 3.09 ETDRS letters in group 1, 2, and 3, respectively. The level of serum VEGF was 44.11 ± 26.14, 56.53 ± 53.77, and 61.47 ± 41.62 pg/mL in groups 1, 2, and 3, respectively (p = 0.553, p = 0.286, and p = 0.896, respectively). The level of serum apelin-13 was 586.47 ± 167.56, 622.18 ± 324.52, and 379.31 ± 171.96 pg/mL in groups 1, 2, and 3, respectively (p = 0.847, p = 0.04, and p ≤ 0.001, respectively). There was a negative correlation between the level of serum apelin and visual acuity (VA) and choroidal thickness. CONCLUSION: Serum apelin-13 levels were higher in both dry-type and neovascular-type AMD patients than in controls. Further studies demonstrating the relationship of the level of serum apelin-13 and AMD are needed.

Effects of fullerenol nanoparticles on kidney tissue in sevoflurane­treated rats.

AIM: The aim of this study is to demonstrate whether fullerenol C60 protects renal injury in sevoflurane­administered rats. METHOD: Rats (n: 24) were randomly divided into four groups: Control (Group C), Fullerenol C60 (Group F), Sevoflurane (Group S), Fullerenol C60-Sevoflurane (Group FS). Thirty minutes before the procedure, Fullerenol C60, 100 mg/kg, was administered intraperitoneally. Sevoflurane (2.3 %) was applied for 3 hours to rats in S and FS groups. Biochemical and histopathological parameters were analyzed in renal tissue samples. Kruskal-Wallis and Mann-Whitney U tests were used in statistical analyzes. RESULTS: Malondialdehyde (MDA) level and catalase (CAT) enzyme activity in Group S were significantly higher than that in all other groups. Paraoxanase (PON) enzyme activity in Group S was significantly lower than in Groups C and FS. The histopathological examination showed that vascular vacuolization and hypertrophy (VVH) and lymphocyte infiltration (LI) were significantly higher in the Group S compared to the Group C. CONCLUSION: Renal histopathology revealed that the administration of Fullerenol C60 prior to sevoflurane inhalation reduced oxidative stress and partially corrected the damage caused by anesthesia. We concluded that Fullerenol C60 has a renal protective effect in rats when administered before sevoflurane anesthesia (Tab. 2, Fig. 4, Ref. 40).

Effect of favorite music on postoperative anxiety and pain.

BACKGROUND: Music is one of the most commonly used non-pharmacological interventions to reduce anxiety. It helps patients overcome emotional and physical alienation, provides comfort and familiarity in an improved environment and offers a pleasant distraction from pain and anxiety. This study aimed to evaluate the effects of listening to preoperative favorite music on postoperative anxiety and pain. MATERIAL AND METHODS: This prospective, randomized, single-blinded, controlled trial included the American Society of Anesthesiologists (ASA) I-III patients, aged 18-70 years, undergoing elective inguinal hernia surgery. Demographic data and anxiety status were recorded. Anxiety status was measured using the Spielberger state-trait anxiety inventory form 1 (STAI-1) and state-trait anxiety inventory form 2 (STAI-2). After recording baseline heart rate, blood pressure and STAI levels, patients were randomly allocated to the music group (Group M) or control group (Group C). Patients in Group M listened to their favorite music using headphones and patients in the control group received standard care. The STAI­1 was repeated after surgery and the numeric rating scale (NRS) and patient satisfaction were measured. RESULTS: A total of 117 patients were included. Demographic data, educational status, and previous surgical history were similar between the groups. Mean preoperative STAI­1 and STAI­2 scores were similar between the groups (p > 0.05). Mean postoperative STAI­1 score was significantly lower in Group M than in Group C (39 [range 35-43] vs. 41 [range 37-43], p < 0.05). Moreover, the change in the STAI score was significantly higher in Group M compared with Group C (p < 0.05). The difference of hemodynamic measurements pre-music to post-music was significant between Group M and Group C (p = 0.001). The NRS scores remained similar between the groups. Patient satisfaction score was significantly higher in Group M (p = 0.017). CONCLUSION: Listening to patient-preferred favorite music preoperatively reduced anxiety, regulated hemodynamic parameters, and improved postoperative patient satisfaction. Reduced anxiety was not associated with reduced pain.

Expression of neutrophil elastase and myeloperoxidase mRNA in patients with newly diagnosed type 2 diabetes mellitus.

BACKGROUND AND AIMS: Neutrophil elastase and myeloperoxidase enzymes protect us from infection by killing pathogens. However, exaggerated activities of these enzymes can induce tissue damage, inflammation and oxidative stress. The present study was aimed to explore the expressions of neutrophil elastase and myeloperoxidase mRNA in the peripheral blood leukocytes (PBL) in patients with newly diagnosed type 2 diabetes mellitus. METHODS: In this cross-sectional study, 104 participants including 65 normoglycemic control subjects and 39 newly diagnosed type 2 diabetes patients were recruited. Glycemic and metabolic markers were evaluated from fasting blood samples. The mRNA levels of neutrophil elastase and myeloperoxidase genes in the PBL were quantified by real-time quantitative PCR. RESULTS: Compared to control subjects, diabetes patients showed a significant down regulation of both neutrophil elastase (p = 0.039) and myeloperoxidase (p = 0.023) mRNA expressions in the PBL. The neutrophil elastase and myeloperoxidase mRNA levels showed a negative trend with fasting glucose levels but did not show any significant correlations with HbA1c, insulin level, insulin resistance or sensitivity status. CONCLUSIONS: It was concluded that type 2 diabetes mellitus is associated with a decrease in neutrophil elastase and myeloperoxidase gene expression in the PBL.

Does hypertension at initial presentation adversely affect outcomes in pediatric traumatic brain injury?

BACKGROUND: Adults with traumatic brain injury (TBI) who present hypertensive suffer worse outcomes and increased mortality compared to normotensive patients. The purpose of this study is to determine if age-adjusted hypertension on presentation is associated with worsened outcomes in pediatric TBI. METHODS: A retrospective chart review was conducted on pediatric patients with severe TBI admitted to a single system pediatric tertiary care center. The primary outcome was mortality. Secondary outcomes included length of stay, need for neurosurgical intervention, duration of mechanical ventilation, and the need for inpatient rehabilitation. RESULTS: Of 150 patients, 70% were hypertensive and 30% were normotensive on presentation. Comparing both groups, no statistically significant differences were noted in mortality (13.3% for both groups), need for neurosurgical intervention (51.4% vs 48.8%, p = 0.776), length of stay (6 vs 8 days, p = 0.732), duration of mechanical ventilation (2 vs 3 days, p = 0.912), or inpatient rehabilitation rates (48.6% vs 48.9%, p = 0.972). In comparing just the hypertensive patients, there was a trend toward increased mortality in the 95th and 99th percentile groups at 15.8% and 14.1%, versus the 90th percentile group at 6.7% but the difference was not statistically significant (p = 0.701). CONCLUSIONS: Contrary to the adult literature, pediatric patients with severe TBI and hypertension on presentation do not appear to have worsened outcomes compared to those who are normotensive. However, a trend toward increased mortality did exist at extremes of age adjusted hypertension. Larger scale studies are needed to validate these findings. STUDY TYPE: Retrospective cohort study LEVEL OF EVIDENCE: III.

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis.

AIMS: The purpose of this study was to determine (a) the ability of serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and (b) the ability of a single high baseline high-sensitivity cardiac troponin T measurement to rule in acute myocardial infarction in patients presenting to the emergency department with acute chest pain. METHODS AND RESULTS: Embase, Medline, Cochrane, Web of Science and Google scholar were searched for prospective cohort studies that evaluated parameters of diagnostic accuracy of serial high-sensitivity cardiac troponin T to rule out acute myocardial infarction and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction. The search yielded 21 studies for the systematic review, of which 14 were included in the meta-analysis, with a total of 11,929 patients and an overall prevalence of acute myocardial infarction of 13.0%. For rule-out, six studies presented the sensitivity of serial measurements <14 ng/l. This cut-off classified 60.1% of patients as rule-out and the summary sensitivity was 96.7% (95% confidence interval: 92.3-99.3). Three studies presented the sensitivity of a one-hour algorithm with a baseline high-sensitivity cardiac troponin T value<12 ng/l and delta 1 hour <3 ng/l. This algorithm classified 60.2% of patients as rule-out and the summary sensitivity was 98.9% (96.4-100). For rule-in, six studies reported the specificity of baseline high-sensitivity cardiac troponin T value>50 ng/l. The summary specificity was 94.6% (91.5-97.1). CONCLUSION: Serial high-sensitivity cardiac troponin T measurement strategies to rule out acute myocardial infarction perform well, and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction has a high specificity.