The role of an open artificial intelligence platform in modern neurosurgical education: a preliminary study.

The use of artificial intelligence in neurosurgical education has been growing in recent times. ChatGPT, a free and easily accessible language model, has been gaining popularity as an alternative education method. It is necessary to explore the potential of this program in neurosurgery education and to evaluate its reliability. This study aimed to show the reliability of ChatGPT by asking various questions to the chat engine, how it can contribute to neurosurgery education by preparing case reports or questions, and its contributions when writing academic articles. The results of the study showed that while ChatGPT provided intriguing and interesting responses, it should not be considered a dependable source of information. The absence of citations for scientific queries raises doubts about the credibility of the answers provided. Therefore, it is not advisable to solely rely on ChatGPT as an educational resource. With further updates and more specific prompts, it may be possible to improve its accuracy. In conclusion, while ChatGPT has potential as an educational tool, its reliability needs to be further evaluated and improved before it can be widely adopted in neurosurgical education.

Protective Effect of Thymosin ß4 against Abdominal Aortic Ischemia-Reperfusion-Induced Acute Lung Injury in Rats.

Background and objectives: Ischemia-reperfusion (IR) caused by infrarenal abdominal aorta cross-clamping is an important factor in the development of ischemia-reperfusion injury in various distant organs. Materials and Methods: We investigated potential antioxidant/anti-inflammatory effects of thymosin beta 4 (Tß4) in a rat model of abdominal aortic surgery-induced IR. Tß4 (10 mg/kg, intravenous (i.v.)) was administered to rats with IR (90-min ischemia, 180-min reperfusion) at two different periods. One group received Tß4 1 h before ischemia, and the other received 15 min before the reperfusion period. Results: Results were compared to control and non-Tß4-treated rats with IR. Serum, bronchoalveolar lavage fluid and lung tissue levels of oxidant parameters were higher, while antioxidant levels were lower in the IR group compared to control. IR also increased inflammatory cytokine levels. Tß4 reverted these parameters in both Tß4-treated groups compared to the untreated IR group. Conclusions: Since there is no statistical difference between the prescribed results of both Tß4-treated groups, our study demonstrates that Tß4 reduced lung oxidative stress and inflammation following IR and prevented lung tissue injury regardless of timing of administration.

New Markers in Atherosclerosis: Thrombospondin-2 (THBS-2) and Leukocyte Cell-Derived Chemotaxin-2 (LECT-2); An Immunohistochemical Study.

BACKGROUND Current research investigating the role of THBS2 and LECT-2 in atherogenesis is very limited. Therefore, we designed this study to demonstrate the role of THBS-2 and LECT-2 in atherosclerosis at the tissue level in fresh specimens. MATERIAL AND METHODS A total of 32 patients who underwent coronary bypass surgery were enrolled. Aortic wall punch biopsies were obtained at the site of proximal aortosaphenous bypass graft anastomosis. A specimen of left internal mammarian artery (LiMA) was taken from the segment just proximal to its anastomosis. The aortic tissue is representive of the atherosclerotic tisue, and LiMA tissue is representative of the non-atherosclerotic area. The specimens were painted with CD68 for macrophage, and THBS-2 and LECT-2 antibodies for immunohistochemical staining. RESULTS Aortic THBS-2 levels were significantly lower, whereas aortic LECT-2 levels were significantly higher when compare to LiMA (14.4±9.9 (5-30) and 36.9±13.0 (5-60) p: 0.0001 and 20.3±15.0 (5-60) and 20.8±13,8 (10-30) p: 0.0001, respectively). CD68+ and monocyte level correlated significantly with AHA atherosclerosis grade (p=0.01, r=0.45 and p=0.001, r=0.56, Spearman's test). CD68+ level correlated significantly with LECT-2 levels in atherosclerotic aortic tissue (p=0.026, r=0.392, Spearman's test), whereas aortic TSBN-2 levels were not. CONCLUSIONS The present study has taken the first steps to highlight new markers in atherosclerosis by using immunohistochemical method. The study results suggest that the tissue levels of THBS2 and LECT-2 may correlate with the stage of atherosclerosis.

Circadian Rhythm of Infarct Size and Left Ventricular Function Evaluated with Tissue Doppler Echocardiography in ST Elevation Myocardial Infarction.

BACKGROUND: We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI). METHODS: We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated. RESULTS: A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p=0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06:00-noon compared with period of noon-18:00 and 18:00-midnight (p=0.029 and p=0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9±7.3% versus 47.3±7.9%, p=0.018, and 7.6±1.4cm/s versus 8.2±1.6cm/s, p=0.003, respectively). CONCLUSIONS: This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06:00-noon period.

Transcatheter trans-apical closure of paravalvular mitral and aortic leaks using a new device: first in man experience.

This report describes the first use of a new paravalvular leak (PVL) device designed specifically to close paravalvular mitral and paravalvular aortic leaks. The first patient had severe paravalvular mitral leak that was closed using the transapical route with a rectangular designed PVL device that has an oval waist for self-centering and the second patient had moderate paravalvular aortic leak that was closed with a square designed device that has a round waist for self-centering. Both patients had complete closure.

Novel fibro-inflammation markers in assessing left atrial remodeling in non-valvular atrial fibrillation.

BACKGROUND: Structural remodeling is associated with the fibroinflammatory process in the atrial extracellular matrix. In the present study we aimed to investigate whether serum levels of new circulating remodeling markers differ in patients with atrial fibrillation (AF) compared to patients with sinus rhythm. MATERIAL AND METHODS: The study population included 52 patients diagnosed with non-valvular AF and 33 age-matched patients with sinus rhythm. Serum levels of Galectin-3, matrix metalloproteinase-9 (MMP-9), lipocalin-2 (Lcn2/NGAL), N-terminal propeptide of type III procollagen (PIIINP), Hs-Crp, and neutrophil-to-lymphocyte ratio (NLR) were measured. The left atrial volume (LAV) was calculated by echocardiographic method and LAV index was calculated. RESULTS: Galectin-3, MMP-9, and PIIINP levels were significantly higher in AF patients except NGAL levels (1166 pg/ml (1126-1204) and 1204 pg/ml (1166-1362) p=0.001, 104 (81-179) pg/ml and 404 (162-564) pg/ml p<0.0001, and 1101 (500-1960) pg/ml and 6710 (2370-9950) pg/ml p<0.0001, respectively). The NLR and Hs-CRP levels were also higher in AF (2.1 ± 1.0 and 2.7 ± 1.1 p=0.02 and 4.2 ± 1.9 mg/L and 6.0 ± 4.7 mg/L p=0.04, respectively). In correlation analyses, NLR showed a strongly significant correlation with LAVi, but Hs-CRP did not (p=0.007 r=0.247, Pearson test and p=0.808 r=0.025, Pearson test, respectively). Moreover, Galectin-3, MMP-9, and PIIINP had a strong positive correlation with LAVi (p=0.021 r=640, Spearman test and p=0.004 r=0.319 Pearson test, and p=0.004 r=0.325 Pearson test, respectively). CONCLUSIONS: Novel fibrosis and inflammation markers in AF are correlated with atrial remodeling. Several unexplained mechanisms of atrial remodeling remain, but the present study has taken the first step in elucidating the mechanisms involving fibrosis and inflammation markers.

Does estimated glomerular filtration rate have an effect on left ventricular function after ST-elevation myocardial infarction?

OBJECTIVES: Little is known about whether estimated glomerular filtration rates (eGFR) affect left ventricular (LV) function and gain benefit with antiremodeling treatment in patients with ST-elevation myocardial infarction (STEMI). We investigated the effect of eGFR on LV function using tissue Doppler imaging (TDI) parameters. In addition, we sought to evaluate the antiremodeling effect of standard treatment at follow-up in patients with renal insufficiency (RI) after STEMI. METHODS AND RESULTS: A retrospective analysis of 579 patients with STEMI was performed. Patients were divided into 3 groups according to eGFR (Group 1: eGFR > 90 mL/min per 1.73 m(2); Group 2: eGFR = 60-89 mL/min per 1.73 m(2); Group 3: eGFR < 60 mL/min per 1.73 m(2)). Conventional echocardiography and TDI were performed within 48-72 hours after STEMI and at 6-month follow-up. The mean left ventricular ejection fraction (LVEF) was significantly lower in Group 3 than in Group 1 (P = 0.021). The mean peak systolic velocity (Sm) was significantly lower in Group 3 than in Group 1 and Group 2 (P = 0.002 and 0.006, respectively). The estimated GFR had a linear association with Sm and LVEF (P = 0.001, r = 0.161; P = 0.005, r = 0.132, respectively). Multivariate analysis showed that an eGFR < 60 mL/min per 1.73 m(2) was an independent predictor of lower Sm and in-hospital mortality. In addition, an antiremodeling effect of standard treatment was seen in all groups at 6-month follow-up. CONCLUSIONS: Estimated glomerular filtration rate of <60 mL/min per 1.73 m(2) was associated with lower LV function after STEMI, and may gain an antiremodeling effect with standard treatment at follow-up.

Epicardial fat thickness in patients with psoriasis vulgaris.

OBJECTIVES: Psoriasis vulgaris is one of the most common skin disorders. Patients with psoriasis carry an excessive risk of coronary artery disease. Visceral adipose tissue around the heart affects the heart and coronaries by secreting proatherogenic mediators. It can be evaluated easily by measurement of epicardial fat thickness (EFT). The aim of this study was to investigate EFT in patients with psoriasis vulgaris. STUDY DESIGN: One hundred and fifteen adult patients (62 male; mean age 33.6±6.0 years) with psoriasis vulgaris (Group 1) and 60 age- and sex-matched healthy individuals (28 male; mean age, 32.5±8.3 years) (Group 2) were included in this study. EFT was obtained by transthoracic echocardiography. Disease-specific characteristics of the patients were recorded. Serum glucose, lipid profile and high-sensitive C-reactive protein (hs-CRP) levels were measured. RESULTS: EFT and hs-CRP were significantly higher in Group 1 than in Group 2 (5.7±1.2 vs. 4.1±1.0 mm, p<0.001 and 0.52±0.45 mg/dl vs. 0.19±0.17 mg/dl, p<0.001, respectively). The psoriasis disease activity score and hs-CRP were found to be independent predictors of EFT in patients with psoriasis vulgaris (ß=0.21, t=2.67, p=0.01 and ß=0.62, t=7.72, p=0.001, respectively). CONCLUSION: Our findings indicate that EFT was significantly higher in patients with psoriasis vulgaris compared with the controls. It was more prominent in patients with severe disease.

Comparison of three supraglottic airway devices for blind tracheal intubation by novice practitioners: A randomized manikin study.

OBJECTIVES: Supraglottic airway (SGA) devices are good alternatives for failed intubations or difficult airways. The aim of our study was to compare the success of intubation with SGA devices such as LMA Fastrach® (LMA Fastrach), Ambu Aura-i® (Aura-i), and Cookgas Air-Q® (Air-Q) in an airway manikin by novice practitioners. METHODS: This study was conducted in a randomized crossover design using a manikin model. Following training on the equipment used, 36 6th-year medical students were randomized into six groups. Participants performed three stages of intubation as follows: the first stage (1S) as SGA insertion, the second stage (2S) as intubation through the SGA, and the third stage (3S) as the removal of the SGA over the intubation tube. The primary outcomes were intubation success and duration. RESULTS: The successful intubation rate (Stage 1S + 2S + 3S) was 100% for LMA Fastrach and Air-Q and 83.3% for Aura-i (P = 0.002). The median time to intubation was 54.4 s, 55.8 s, and 58.7 s for LMA Fastrach, Aura-i, and Air-Q, respectively (P = 0.794). CONCLUSION: Our study shows that novice practitioners can proficiently utilize LMA Fastrach, Air-Q, and Aura-i as SGAs in airway management. LMA Fastrach and Air-Q are more successful for endotracheal intubation than Aura-i. While the successful intubation time with SGA is similar for all three devices, the successful SGA insertion time is shorter with LMA Fastrach and Aura-i compared to Air-Q. Practitioners preferred LMA Fastrach and Air-Q more than Aura-i.

The Role of Glycogen Synthase Kinase-3ß in the Zinc-Mediated Neuroprotective Effect of Metformin in Rats with Glutamate Neurotoxicity.

Metformin has been suggested to have protective effects on the central nervous system, but the mechanism is unknown. The similarity between the effects of metformin and the inhibition of glycogen synthase kinase (GSK)-3ß suggests that metformin may inhibit GSK-3ß. In addition, zinc is an important element that inhibits GSK-3ß by phosphorylation. In this study, we investigated whether the effects of metformin on neuroprotection and neuronal survival were mediated by zinc-dependent inhibition of GSK-3ß in rats with glutamate-induced neurotoxicity. Forty adult male rats were divided into 5 groups: control, glutamate, metformin + glutamate, zinc deficiency + glutamate, and zinc deficiency + metformin + glutamate. Zinc deficiency was induced with a zinc-poor pellet. Metformin was orally administered for 35 days. D-glutamic acid was intraperitoneally administered on the 35th day. On the 38th day, neurodegeneration was examined histopathologically, and the effects on neuronal protection and survival were evaluated via intracellular S-100ß immunohistochemical staining. The findings were examined in relation to nonphosphorylated (active) GSK-3ß levels and oxidative stress parameters in brain tissue and blood. Neurodegeneration was increased (p < 0.05) in rats fed a zinc-deficient diet. Active GSK-3ß levels were increased in groups with neurodegeneration (p < 0.01). Decreased neurodegeneration, increased neuronal survival (p < 0.01), decreased active GSK-3ß (p < 0.01) levels and oxidative stress parameters, and increased antioxidant parameters were observed in groups treated with metformin (p < 0.01). Metformin had fewer protective effects on rats fed a zinc-deficient diet. Metformin may exert neuroprotective effects and increase S-100ß-mediated neuronal survival by zinc-dependent inhibition of GSK-3ß during glutamate neurotoxicity.

Is postdilatation with a noncompliant balloon necessary after coronary stent deployment during primary angioplasty?

BACKGROUND: Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs). METHODS: A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physician's discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG). RESULTS: PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (P>0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (ß=0.52, P=0.01, and ß=-0.47, P=0.02; respectively). CONCLUSION: Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.

Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting.

INTRODUCTION: Red cell distribution width (RDW) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of RDW in prediction of new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). We aimed to investigate the relation between the RDW and postoperative AF in patients undergoing CABG. METHODS: A total of 132 patients undergoing nonemergency CABG were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We retrospectively analyzed 132 consecutive patients (mean age, 60.55 ± 9.5 years; 99 male and 33 female). The RDW level was determined preoperatively and on postoperative Day 1. RESULTS: Preoperative RDW levels were significantly higher in patients who developed AF than in those who did not (13.9 ± 1.4 vs. 13.3 ± 1.2, p = 0.03). There was not any correlation between postoperative RDW levels and AF. Using a cutpoint of 13.45, the preoperative level correlated with the incidence of AF with a sensitivity of 61% and specificity of 60%. CONCLUSION: Preoperative RDW level predicts new-onset AF after CABG in patients without histories of AF.

Short-term effect of percutaneous recanalization of chronic total occlusions on QT dispersion and heart rate variability parameters.

BACKGROUND: QT dispersion (QTd), which is a measure of inhomogeneity of myocardial repolarization, increases following impaired myocardial perfusion. Its prolongation may provide a suitable substrate for life-threatening ventricular arrhythmias. We investigated the changes in QTd and heart rate variability (HRV) parameters after successful coronary artery revascularization in a patient with chronic total occlusions (CTO). MATERIAL/METHODS: This study included 139 successfully revascularized CTO patients (118 men, 21 women, mean age 58.3±9.6 years). QTd was measured from a 12-lead electrocardiogram and was defined as the difference between maximum and minimum QT interval. HRV analyses of all subjects were obtained. Frequency domain (LF: HF) and time domain (SDNN, pNN50, and rMSSD) parameters were analyzed. QT intervals were also corrected for heart rate using Bazett's formula, and the corrected QT interval dispersion (QTcd) was then calculated. All measurements were made before and after percutaneous coronary intervention (PCI). RESULTS: Both QTd and QTcd showed significant improvement following successful revascularization of CTO (55.83±14.79 to 38.87±11.69; p<0.001 and 61.02±16.28 to 42.92±13.41; p<0.001). The revascularization of LAD (n=38), Cx (n=28) and RCA (n=73) resulted in decrease in HRV indices, including SDDN, rMSSD, and pNN50, but none of the variables reached statistical significance. CONCLUSIONS: Successful revascularization of CTO may result in improvement in regional heterogeneity of myocardial repolarization, evidenced as decreased QTcd after the PCI. The revascularization in CTO lesions does not seem to have a significant impact on HRV.

Ambulatory blood pressure monitoring can unmask hypertension in patients with psoriasis vulgaris.

BACKGROUND: Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. MATERIAL AND METHODS: On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. RESULTS: The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p<0.01). Predictors of MH in patients with psoriasis vulgaris were detected as male sex, smoking, obesity-related anthropometric measures, and disease activity. Male sex, waist circumference, and diffuse psoriatic involvement were detected as independent predictors of MH. CONCLUSIONS: MH is prevalent in patients with psoriasis vulgaris. Assessment with ABPM and close follow-up for development of hypertension is reasonable.

Polycystic ovary syndrome is associated with P-wave prolongation and increased P-wave dispersion.

BACKGROUND: The polycystic ovary syndrome (PCOS) is associated with various cardiac manifestations including cardiac arrhythmias. P-wave dispersion (Pdis) is an appealing marker for predicting the risk of developing atrial arrhythmias. The purpose of this study was to evaluate P-wave durations and Pdis in patients with PCOS. METHODS: Forty adult patients with PCOS and 46 age- and sex-matched healthy individuals were included in this study. P-wave maximum duration (Pmax) and P-wave minimum duration (Pmin) were calculated on the 12-lead electrocardiogram, and the difference between the Pmax and the Pmin was defined as Pdis. All individuals also underwent transthoracic echocardiographic evaluation. RESULTS: Pmax and Pdis were significantly higher in patients with PCOS compared with controls (p = 0.007, p < 0.001, respectively). There was no difference in Pmin duration between both the groups (p = 0.2). Waist-to-hip ratio, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were higher in the PCOS group. Early mitral inflow deceleration time (DT) (p < 0.001) and isovolumetric relaxation time (p = 0.003) were longer in PCOS group. Waist-to-hip ratio, DT, E/A ratio and diastolic blood pressure correlated with Pdis. CONCLUSIONS: Patients with PCOS have prolonged Pmax and Pdis. The increase in those parameters may be an indicator for identification of patients at increased risk of atrial fibrillation.

The relationship between coronary sinus and impaired right ventricular myocardial performance index in mitral stenosis.

OBJECTIVES: We aimed to investigate whether coronary sinus (CS) dilatation develops in patients with mitral stenosis (MS) and to demonstrate its relationship with the global myocardial performance of the right ventricle (RV). METHODS: We enrolled 34 patients with MS who underwent echocardiography after exhibiting typical symptoms (31 female; mean age 41 ± 12 years) and 20 age- and sex-matched controls without MS who underwent echocardiography (16 female; mean age 38 ± 13 years). The RV myocardial performance index (MPI) was detected using tissue Doppler echocardiography (TDE), and maximum CS diameter was measured from the posterior atrioventricular groove in the apical four-chamber view during the ventricular systole. RESULTS: The RV MPI was significantly higher in the MS group compared to the control group (0.60 ± 0.11 vs. 0.41 ± 0.08, P < 0.001). Moreover, the maximum CS dimension was higher in the MS group compared to the control group (8.5 ± 1.1 mm vs. 6.5 ± 1.4 mm, P < 0.001). The maximum CS dilatation was positively correlated with the RV MPI (r = 0.691; P < 0.001). CONCLUSION: The RV MPI, which represents both systolic and diastolic functions, is increased in patients with MS and correlates with CS dilatation.

The effect of smoking on myocardial performance index in middle-aged males after first acute myocardial infarction.

BACKGROUND: Cigarette smoking is associated with increased rates of coronary artery disease and acute myocardial infarction (MI). Paradoxically, smokers had lower mortality after MI. The purpose of this study was to evaluate the effect of chronic smoking on myocardial performance index (MPI) in middle-aged men after an acute MI. MATERIAL AND METHODS: A total of 429 patients (325 smokers vs. 104 nonsmokers) presenting with acute ST elevation MI were enrolled in this study. Thrombolysis in myocardial infarction (TIMI) flow of the infarct related artery was measured before and after the primary percutaneous coronary intervention (PCI), and Gensini score was also calculated. Conventional echocardiography and tissue Doppler echocardiography (TDI) were performed within 48-72 hours after onset of chest pain. Peak early (Em) and late (Am) diastolic velocities, peak systolic (Sm) mitral annular velocities and time intervals were recorded with TDI. The MPI, ratio of Em/Am, and E/Em were calculated. RESULTS: Baseline demographic and angiographic characteristics such as Gensini score, pre and, post PCI TIMI flow were similar in 2 groups. In contrast, LV MPI was preserved among smokers (0.59 ± 0.15 vs. 0.66 ± 0.14, P = 0.01), and Em/Am values were also higher in smokers (0.84 ± 0.28 vs. 0.75 ± 0.31, P = 0.01). Independent predictors of impaired MPI (≥0.60) were determined as nonsmoking status (odds ratio 2.940, 95% CI 0.98-5.83, P = 0.05), left anterior descending artery stenosis (odds ratio 3.196, 95% CI 1.73-5.91 P = 0.001), and, age (odds ratio 1.12, 95% CI 1.03-1.22, P = 0.01). CONCLUSIONS: Despite similar demographic and angiographic characteristics, smoker males had a paradoxically better MPI after acute MI.

Effect of estimated glomerular filtration rate on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention.

BACKGROUNDS: Little is known about the effect of the estimated glomerular filtration rate (eGFR) on the periprocedural myocardial infarction (PMI). The aim of this study was to determine an eGFR value that is related with PMI development in patients with stable angina undergoing elective percutaneous coronary intervention (PCI). METHOD: A retrospective analysis was conducted of 257 consecutive PCI patients with stable angina pectoris. The patients were divided into three groups according to eGFR: Group 1: eGFR > 90 mL/min/1.73 m(2), Group 2: eGFR = 60-89 mL/min/1.73 m(2), and Group 3: eGFR = 30-59 mL/min/1.73 m(2). Cardiac biomarkers were measured before, at 8, and at 24 h after the procedure. RESULTS: Periprocedural myocardial infarction occurred in 19% of the study patients. The frequency of PMI was 13.8% in group 1, 15.2% in group 2, and 35% in group 3 (p = 0.002). There was an inverse relationship with increasing cardiac biomarkers and decreasing eGFR values. Multiple regression analysis showed that an eGFR value between 30 and 59 mL/min/1.73 m(2) was an independent variable that significantly affected PMI development after PCI. CONCLUSIONS: An estimated glomerular filtration rate between 30 and 59 mL/min/1.73 m(2) is a predictor of developing PMI after elective PCI in patients with stable angina pectoris.

Adult cyanotic congenital heart disease: an unusual cause of stroke.

A 33-year-old male patient with uncorrected tetralogy of Fallot was hospitalised for multiple peripheral arterial emboli. Bilateral above-knee amputation had been done after unsuccessful femoral embolectomy. A large thrombus was detected in the apical portion of the left ventricle which was the source of the embolus.The patient complained of mild frontal headache and progressive right-sided weakness shortly after an echocardiographic examination. A computed tomography (CT) scan revealed a left middle cerebral artery territory infarct. Patients with grown-up cyanotic congenital heart disease are at increased risk of thromboembolic cerebrovascular events. This report highlights the necessity for physicians to be alert for uncommon causes of acute stroke.

Deep phenotyping of miRNAs in exercise-induced cardiac hypertrophy and fibrosis.

Cardiac hypertrophy (CH) is an adaptational enlargement of the myocardium, in exposure to altered stress conditions or in case of injury which can lead to heart failure and death. MicroRNAs (miRNAs) are noncoding RNAs that play a significant role in modulating gene expression. Here, we aimed to identify new miRNAs effective in an experimental CH model and to find an epigenetic biomarker that could demonstrate therapeutic targets responsible for the pathology of heart tissue and serum. In this study, Sprague-Dawley male rats were divided into the training group (TG, n=9) and the control group (CG, n=6). Systolic and diastolic dimensions of the left ventricle and myocardial wall thickness were measured by echocardiography to assess CH. After the exercise program of the rats, miRNA expression measurements and histological analyses were performed. The 25,000 genes in the rat genome were searched using microarray analysis. A total of 128 miRNAs were selected according to the fold change rates, and nine miRNAs were validated for expression analysis. The terminal deoxynucleotidyl transferase dUTP nick (TUNEL) method was used to detect apoptotic cells. Cell proliferation was evaluated by the proliferative cell nuclear antigen (PCNA) method. Necrosis, bleeding, and intercellular edema were detected in TG. The mean histopathological score was higher in TG (p=0.03). There were rarely positive cells for apoptosis of both groups in cardiomyocytes. In the receiver characteristic curve analysis (ROC), the heart tissue rno-miR-290 had an area under the curve (AUC) of 0.920 with 100% sensitivity and 89.90% specificity (p=0.045), rno-miR-194-5p had AUC of 0.940 with 83.33% sensitivity and 100% specificity (p=0.003), and the serum rno-miR-132-3p AUC was 0.880 with 66.67% sensitivity and 100% specificity (p=0.004) in TG. miR-194-5p was used as a therapeutic target for remodeling the cardiac process. While miR-290 contributes to CH as a negative regulator, miR-132 in serum is effective in the pathological and physiological cardiac remodeling process and is a candidate biomarker.