Platelet distribution width in young patients with chronic venous insufficiency.

OBJECTIVE: Platelet distribution width (PDW) has been reported in a wide range of pathological settings. In this study, we aimed to investigate the relationship between PDW and lower extremity chronic venous insufficiency (CVI) by comparing the levels of PDW and other parameters derived from complete blood count (CBC) tests in young individuals with or without lower extremity CVI. METHODS: This prospective clinical study was conducted between January 2020 and December 2020. A total of 108 patients, 72 patients with lower extremity CVI (study group) and 36 healthy volunteers (control group) were enrolled from the Bursa Yuksek Ihtisas Education Research Hospital and the Bolu Abant Izzet Baysal University Training and Research Hospital. The age range of the participants was between 18 and 50 years old. Participants' baseline clinical features and CBC parameters including PDW, white blood cell, hemoglobin, hematocrit, mean corpuscular volume, red cell distribution width, neutrophil, lymphocyte, platelet count, mean platelet volume, plateletcrit, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were compared between the two groups. RESULTS: The groups were statistically similar in terms of baseline clinical features. The median PDW value was significantly higher for the CVI patients relative to the control group (17.6 vs 16.8; p < 0.001). In terms of other CBC parameters, there were no significant differences between the groups. According to ROC analysis, area under the curve of PDW was 0.749 (95% confidence interval: 0.653-0.846 and p < 0.001). If the value of PDW was accepted as 17, it could predict CVI with 76% sensitivity and 59% specificity, whereas a PDW value of 17.5 could predict CVI with 51% sensitivity and 81% specificity. CONCLUSION: Platelet distribution width might be a useful marker to determine an increased inflammatory response and thrombotic status in young patients with CVI.

Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological marker.

OBJECTIVE: To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA). METHODS: A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group (n = 23) and favorable outcome group (n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates. RESULTS: A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004-1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64-0.851). CONCLUSIONS: Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.

Dynamic thiol/disulphide homeostasis metrics as a risk factor for peripheral arterial disease.

OBJECTIVE: To examine dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in patients with peripheral arterial disease. METHODS: One hundred patients with lower extremity peripheral arterial disease (a study group) and 100 control subjects were included in this prospective case-control study. Participants' baseline clinical characteristics and laboratory data including some oxidant/antioxidant status parameters such as albumin, ferroxidase and myeloperoxidase, and thiol/disulphide homeostasis parameters such as native thiol, total thiol and disulphide, as well as native thiol/total thiol, disulphide/native thiol and disulphide/total thiol ratios were all recorded and then compared between the groups. RESULTS: Mean albumin and ferroxidase, and median myeloperoxidase levels were found to be significantly higher in patients with the peripheral arterial disease than in control group (p = 0.045, p = 0.000 and p = 0.000, respectively). Mean native thiol and total thiol, and median disulphide levels were found to be significantly lower in the study group as compared with the control group (p = 0.000, p = 0.000 and p = 0.037, respectively). According to the results of logistic regression analysis, systolic blood pressure, ferroxidase and myeloperoxidase levels were detected to be the independent predictors of peripheral arterial disease. CONCLUSION: Our report is the first one in the literature investigating dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in peripheral arterial disease. Dynamic thiol/disulphide homeostasis metrics may be used as a valuable risk factor of oxidative stress in patients with the peripheral arterial disease since it is readily available, easily calculated and relatively cheap.

Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups.

OBJECTIVE: The aim of this study was to contribute to the issue of "Who should we perform Doppler ultrasonography on?" and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and preoperative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke. METHOD: Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed. RESULTS: Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE. CONCLUSION: For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.

Novel Mortality Markers for Critically Ill Patients.

AIM: Inflammatory markers, such as the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), derived from a complete blood count have recently attracted attention as potential markers of morbidity and mortality in various diseases. The aim of the present study was to assess the usefulness of the NLR and PLR as markers of hospital stay and mortality of patients in intensive care units (ICUs). METHODS: Patients treated in the ICU of our institution between October 2016 and August 2017 were enrolled in the study. After obtaining approval from the institutional committee, patient data were sourced from the institution's computerized database and retrospectively analyzed. The patients were assigned to 2 groups according to the outcomes: survivors and deceased. RESULTS: The NLR of survivors and deceased patients was 2.06 (1.18-21.68) and 10.42 (2.85-48.2), respectively. The NLR was significantly elevated in deceased patients as compared with that of survivors (P < .001). Similarly, the median PLR of patients in the deceased group (268.9 [150-3000]) was significantly higher than that of patients in the survivor group (55.7 [11.8-152.5]). The difference in the PLR between groups was significant (P < .001). CONCLUSION: Both the NLR and PLR, as well as C-reactive protein, predicted mortality in this critically ill population. The PLR and NLR are easy-to-measure, inexpensive markers. Physicians should be aware of elevations in PLR and NLR in patient care in ICUs.

Complete blood count parameters in peripheral arterial disease.

Objective: To determine whether complete blood count parameters could be used as the biomarkers of inflammation in patients with in peripheral arterial disease. Methods: Seventy-five patients with peripheral arterial disease (study group) and 75 healthy subjects (control group) were included in this retrospective study. Their baseline clinical characteristics and laboratory data were recorded and compared. Data were compared using univariate tests including independent samples t-test, Mann-Whitney U-test and chi-square test. Moreover, multivariate logistic regression analysis was also conducted to determine independent predictors of peripheral arterial disease. Results: The groups were statistically similar with regards to baseline clinical and demographic features. The values of C-reactive protein, white blood cell and neutrophil-to-lymphocyte ratio values were found to be statistically significantly higher in study group versus control group, but none of them were considered as an independent predictor of peripheral arterial disease according to multivariate logistic regression analysis. Only mean platelet volume was demonstrated to be a statistically significant predictor of peripheral arterial disease. Conclusion: Our study deduced that mean platelet volume was an independent predictor of peripheral arterial disease, and could be used as a marker of inflammation in patients with peripheral arterial disease.

Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary Artery Bypass Surgery.

BACKGROUND: The current study analyzed and compared early-term outcomes of off-pump versus on-pump beating heart coronary artery bypass surgery. METHODS: From January 2011 to January 2018, a total of 736 patients underwent isolated first-time elective beating-heart coronary artery bypass surgery without the use of aortic cross-clamping and cardioplegic arrest at our institution, and they were included in this study. Data of patients were collected and retrospectively analyzed. Patients were divided into two groups according to the use of cardiopulmonary bypass during the operation, as off-pump group (n = 399) and on-pump beating-heart group (n = 337). Both groups were compared with each other in terms of preoperative, intraoperative, and postoperative data. RESULTS: Groups were statistically similar with regard to baseline clinical characteristics and demographics. When compared with off-pump group, on-pump beating-heart group had a greater number of distal bypass, longer length of hospital stay, and lower postoperative hematocrit level, and received more blood product transfusion. No statistically significant differences were detected between the groups with respect to mortality and postoperative complications except for atrial fibrillation. Atrial fibrillation was significantly frequent in on-pump beating-heart group. CONCLUSION: Our study suggested that off-pump and on-pump beating-heart coronary artery bypass procedures had similar early mortality and major complication rates except for atrial fibrillation. However, it seemed that off-pump procedure was superior to on-pump beating-heart procedure with regard to length of hospital stay, blood product transfusion, and atrial fibrillation development. Further prospective randomized studies with larger patient series are needed to support our research and attain more accurate data.

Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions.

BACKGROUND: Olfactory and taste sensations have a high impact on the quality of life. Impaired olfactory and taste functions may have a negative effect on physical and mental well-being, personal hygiene, and nutritional satisfaction, leading to the occurrence of depressive symptoms and impaired quality of life. Therefore, the recovery period of patients with disturbed olfactory and taste functions may be prolonged, and return to active life may be delayed. We designed this study to determine whether on-pump and off-pump coronary artery bypass grafting (CABG) surgeries have any effects on olfactory and taste functions and compare these functions between the surgical groups. METHODS: A total of 60 patients, who underwent elective isolated first-time CABG, were included in this study. Patients were divided into two groups as Off-Pump and On-Pump CABG groups with 30 patients in each group. In addition to patients' primary clinical and laboratory data, olfactory and taste functions were evaluated pre- and postoperatively in both groups separately, and then these functions were compared between the groups. Olfactory functions were evaluated by the Brief Smell Identification Test, while taste functions by the Burghart Taste test. RESULTS: Olfactory functions significantly were disrupted in the postoperative period in patients undergoing on-pump CABG (P value < .05), while these functions significantly were not affected in patients undergoing off-pump CABG (P value > .05). During the preoperative period, advanced age and smoking were detected to be independent predictors of impaired olfactory function for the study population. During the postoperative period, smoking, amount of postoperative bleeding and serum low-density lipoprotein (LDL) level were found to be independent predictors of impaired olfactory function for just the On-Pump CABG Group. In both groups, no significant deterioration in taste functions occurred during the postoperative period (P value > .05). CONCLUSION: Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests.

Predictors of Postoperative Atrial Fibrillation after Beating-Heart Coronary Artery Bypass Surgery: Is Cardiopulmonary Bypass a Risk Factor?

BACKGROUND: To determine the risk factors and postoperative outcomes of new-onset atrial fibrillation (AF) following beating-heart coronary artery bypass grafting (CABG) surgery. METHODS: A total of 458 patients who underwent beating-heart CABG without the use of aortic cross clamping and cardioplegic arrest between January 2011 and January 2015 were included in the study, and they were divided into two groups according to the development of new-onset AF as the AF group (n = 143) and non-AF group (n = 315). Both groups were compared in terms of preoperative clinical features and perioperative data, and the risk factors and postoperative outcomes of AF following beating-heart CABG were determined. RESULTS: The incidence of postoperative AF was 31.2%. Patients in the AF group were significantly older (68.08 ± 7.76 vs. 61.76 ± 9.83 years, p ≤ 0.001) and had significantly higher use of cardiopulmonary bypass during surgery (69.2% vs. 43.2%, p ≤ 0.001) than the patients in the non-AF group. The patients with AF also had statistically significantly longer lengths of intensive care unit and hospital stay than those without AF (43.79 ± 32.39 vs. 30.49 ± 33.31 hours, p ≤ 0.001, and 8.20 ± 4.37 vs. 5.77 ± 2.16 days, p ≤ 0.001, respectively). CONCLUSIONS: Our study revealed that age and the use of cardiopulmonary bypass during surgery were independent predictors of AF following beating-heart CABG. In addition, postoperative AF was associated with prolonged intensive care unit and hospital stay. Further prospective randomized studies with larger patient series are required to support our research and attain more accurate data.

An Overview and Update of Femorofemoral Crossover Bypass Surgery as an Extra-Anatomic Bypass Procedure.

Femorofemoral crossover bypass is a surgical arterial revascularization modality which is commonly performed for unilateral aortoiliac occlusive disease. It is primarily applied to patients with intermittent claudication or critical limb ischemia in whom underlying anatomic constraints rule out endovascular means of restoring in-line flow and those who do not qualify for anatomic reconstruction due to the comorbid conditions that preclude a more invasive open surgical approach. This surgical procedure may be also used as a complementary component of endovascular repair of abdominal aortic aneurysms when one aortoiliac arterial system is occluded to ensure exclusion of the aortic aneurysm. This review represents the current status of femorofemoral crossover bypass surgery as an extra-anatomic bypass procedure.

A comparison of early clinical outcomes of off-pump and on-pump coronary artery bypass grafting surgery in elderly patients.

BACKGROUND: The reply of question of "which coronary artery bypass grafting (CABG) technique is superior in elderly patients, off-pump or on-pump CABG surgery?" is controversial. We aimed to compare the early clinical outcomes in elderly patients undergoing off-pump and on-pump CABG. METHODS: From January 2009 to January 2015, 344 elderly patients (aged 70 or older) underwent off-pump (n = 137) or on-pump (n = 207) CABG. Patients' medical records were retrospectively reviewed, and their baseline preoperative characteristics, operative data and postoperative outcomes were analyzed, thereby a comparison of early outcomes between off-pump and on-pump patients was performed. RESULTS: Mean age of patients was 74.4 ± 3.8 years. Both groups were statistically similar in terms of baseline preoperative characteristics. Number of distal bypass was significantly lower in off-pump group than in on-pump group. Postoperative length of intensive care unit and hospital stay were similar between two groups. Amounts of transfused blood products were significantly lower in off-pump CABG group. There were no significant differences in terms of postoperative complications and mortality between two groups. CONCLUSIONS: Our results did not reveal a significant benefit of either surgical technique with respect to early-term clinical outcomes in elderly CABG patients. Further investigations are needed to determine whether off-pump CABG is superior than on-pump CABG in elderly patients.

Management of lymphoedema.

Lymphoedema is a common and progressive disease which causes deterioration of the quality of life of patients. It is divided into two groups: primary and secondary lymphoedema. Nowadays, the majority of patients with lymphoedema are associated with a malignancy or its treatment modalities, such as cancer surgery and radiation therapy. Accurate diagnosis and effective treatment are crucial for alleviating the symptoms, preventing progression and reducing the potential risks of lymphoedema. This report provides an overview of the management of lymphoedema.

Multi-inflammatory index as a novel predictor of new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

BACKGROUND: To our knowledge, a possible predictive relationship of the multi-inflammatory index (MII) with new-onset atrial fibrillation (AF) after off-pump coronary artery bypass grafting (CABG) has not yet been studied in the literature. AIMS: We aimed to investigate whether the MII is a novel group of hematological markers for predicting postoperative new-onset AF in patients undergoing off-pump CABG. METHODS: A total of 427 patients undergoing isolated off-pump CABG between October 2021 and December 2023 were enrolled in this retrospective observational cohort study and allocated to two groups: the AF group (n = 108) and the non-AF group (n = 319). The groups were compared in terms of baseline clinical patient characteristics, laboratory parameters, and operative and postoperative data. RESULTS: The median values of age, length of hospital stay, platelet and neutrophil count, C-reactive protein level, systemic immune-inflammation index, MII-1, MII-2, and MII-3 were significantly greater in the AF group compared to the non-AF group in univariate analyses. In multiple explanatory variable logistic regression analysis, MII-1, MII-2, and MII-3 were determined to be significant hematological variables, and thereby these indices were considered the independent predictors of postoperative new-onset AF. Receiver operating characteristic curve analyses showed that to predict postoperative new-onset AF, MII-1 of 22.47 constituted the cut-off value with 62.0% sensitivity and 57.0% specificity, MII-2 of 141.77 constituted the cut-off value with 43.5% sensitivity and 76.8% specificity, and MII-3 of 5669 constituted the cut-off value with 63.8% sensitivity and 58.3% specificity. CONCLUSION: This study demonstrated for the first time that all MIIs predicted new-onset AF after off-pump CABG.

Evaluation of the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency.

OBJECTIVE: There is no study in the literature evaluating the dynamic thiol/disulfide homeostasis in patients with chronic venous insufficiency. Thus, we designed this study to evaluate the dynamic thiol/disulfide homeostasis as a novel indicator of oxidative stress in patients with chronic venous insufficiency. METHODS: This was a prospective case-control study performed at the department of cardiovascular surgery of a tertiary referral hospital in Turkey. A total of 80 (CEAP C3-C6) patients with lower extremity chronic venous insufficiency (as the study group) and 80 healthy subjects (as the control group) were enrolled to the study. The participants' basic demographic and clinical characteristics as well as serum levels of some laboratory parameters including albumin, ferroxidase, myeloperoxidase, native thiol, total thiol, disulphide, native thiol/total thiol, disulphide/native thiol, and disulphide/total thiol were determined, and then compared between the groups. RESULTS: In terms of basic demographic and clinical characteristics, both groups were statistically similar, and there were no significant differences between the groups. When the laboratory parameters were considered, serum ferroxidase and myeloperoxidase levels were detected to be significantly higher, whereas albumin, native thiol, total thiol, and disulphide levels were detected to be significantly lower in the study group than in the control group. CONCLUSIONS: Dynamic thiol/disulphide homeostasis could be considered as an indicator reflecting the oxidative stress status in patients with chronic venous insufficiency.

Plasma Calcium Level and C-Reactive Protein Albumin Ratio Affect Severe Bleeding After Coronary Artery Bypass Grafting.

OBJECTIVE: In this study, we aimed to determine whether plasma calcium level and C-reactive protein albumin ratio (CAR) as well as other demographic and hematological markers are related in predicting severe bleeding after coronary artery bypass grafting (CABG). METHODS: A total of 227 adult patients who underwent CABG at our hospital between December 2021 and June 2022 were prospectively studied. Total amount of chest tube drainage was evaluated within the first 24 hours postoperatively or until the patient was re-explored for bleeding. The patients were divided into two groups - Group 1, patients with low amount of bleeding (n=174), and Group 2, patients with severe bleeding (n=53). Univariate and multivariate regression analyzes were performed to determine independent parameters related to severe bleeding within the first 24 hours after surgery. RESULTS: When the groups were compared in terms of demographic, clinical, and preoperative blood parameters; cardiopulmonary bypass time and serum C-reactive protein (CRP) levels were found to be significantly higher in Group 2 compared to the low bleeding group. In addition, lymphocytes, hemoglobin, calcium, albumin, and CAR were found to be significantly lower in Group 2. In multivariate analysis, calcium, albumin, CRP, and CAR were found to be independent predictors of significant association with excessive bleeding. A cut-off value of 8.7 (94.3% sensitivity and 94.8% specificity) for calcium and 0.155 (75.4% sensitivity and 80.4% specificity) for CAR predicted excessive bleeding. CONCLUSION: Plasma calcium level, CRP, albumin, and CAR can be used to predict severe bleeding after CABG.

Systemic immune-inflammation index as a novel predictor of atrial fibrillation after off-pump coronary artery bypass grafting.

OBJECTIVE: This study aims to examine the predictive role of systemic immune-inflammation index on postoperative new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. METHODS: A total of 722 patients undergoing elective off-pump coronary artery bypass grafting between January 2017 and September 2021 were included in this study and divided into two groups as the atrial fibrillation group (n=172) and the non-atrial fibrillation group (n=550). Both groups were compared in terms of patients' baseline clinical features, operative and postoperative variables, and preoperative hematological indices derived from the complete blood count analysis. Multivariate logistic regression and receiver-operating characteristic curve analyses were performed to detect the independent predictors of postoperative new-onset atrial fibrillation. RESULTS: The median age and length of hospital stay in the atrial fibrillation group were significantly higher than those in the non-atrial fibrillation group. The median values of white blood cell, platelet, neutrophil, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and systemic immune-inflammation in the atrial fibrillation group were significantly greater than in those in the non- atrial fibrillation group. Logistic regression analysis demonstrated that age, platelet, platelet/lymphocyte ratio, and systemic immune-inflammation were independent predictors of postoperative new-onset atrial fibrillation. receiver-operating characteristic curve analysis revealed that systemic immune-inflammation of 706.7×103/mm3 constituted cut-off value to predict the occurrence of new-onset atrial fibrillation with 86.6% sensitivity and 29.3% specificity. CONCLUSION: Our study revealed for the first time that systemic immune-inflammation predicted new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

Does pulmonary hypertension affect early-term outcomes of off-pump coronary artery bypass surgery?

OBJECTIVE: This study aimed to investigate the effect of preoperative pulmonary hypertension (PHT) on postoperative early mortality and morbidity in patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: A total of 1107 patients undergoing elective first-time off-pump CABG between January 2011 and April 2022 were included in this retrospective observational cohort study. The patients were categorized into two groups according to their preoperative systolic pulmonary artery pressure (SPAP) values. The PHT group (n=104) consisted of patients with a SPAP value >30 mmHg, while the non-PHT group (n=1003) consisted of patients with a SPAP value ≤30 mmHg. Patients' preoperative demographics and clinical features, operative data, and postoperative outcomes were recorded and then compared between the groups. RESULTS: In the PHT group, the median age was significantly higher (66 vs. 63 years, p=0.001) and the median left ventricular ejection fraction level was significantly lower (45 vs. 50%, p=0.045) as compared to the non-PHT group. Additionally, the PHT group included a significantly greater percentage of patients with chronic obstructive pulmonary disease (22.1 vs. 7.4%, p=0.019). As perioperative early-term outcomes, complications, and mortality were considered, the groups were statistically similar, and there were no significant differences between the groups, except for the development of atrial fibrillation. CONCLUSION: For the first time in the literature, this study revealed that mild PHT (mean SPAP=38.9±8.7 mmHg) did not significantly affect early-term outcomes of off-pump CABG.

Association between vitamin D levels and lower-extremity deep vein thrombosis: a case-control study.

BACKGROUND: Vitamin D has relationships with pathogenesis and inflammation pathways in many diseases. Its deficiency may make clinicians think not only of supplementation but also of presence of other diseases. OBJECTIVE: To investigate the relationship between vitamin D levels and deep vein thrombosis (DVT), given that reduced levels are related to increased risk of cardiovascular diseases. DESIGN AND SETTING: Case-control study conducted in the cardiovascular surgery and family medicine departments of a hospital in Turkey. METHODS: A total of 280 participants were included: 140 each in the DVT and control groups. Basic clinical characteristics, comorbidities and serum 25-hydroxyvitamin D (25(OH)D) levels were recorded and then compared between the groups. Serum 25(OH)D levels were also evaluated separately in three subgroups (sufficient, insufficient and deficient). RESULTS: Serum 25(OH)D levels were significantly lower in the DVT group than in the controls (P < 0.001). Females in the DVT group had lower 25(OH)D levels than those in the control group (P = 0.002). Nonetheless, the median 25(OH)D level (16.41 ng/ml) of the control group was still below the reference value. Logistic regression analysis showed that 25(OH)D was a significant predictor of DVT. Weight, height and body mass index, which all presented interaction, were significant in the logistic regression analysis but not in individual analyses. CONCLUSION: The serum vitamin D levels of DVT patients were lower than those of controls. If the results obtained from our study are supported by further large-scale randomized controlled trials, vitamin D replacement may be brought into the agenda for protection against DVT.

Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting.

OBJECTIVE: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG). METHODS: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint. RESULTS: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE. CONCLUSION: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

Effects of Lidocaine Oropharyngeal Spray Applied Before Endotracheal Intubation on QT Dispersion in Patients Undergoing Coronary Artery Bypass Grafting: A Prospective Randomized Controlled Study.

OBJECTIVE: To investigate the effects of lidocaine oropharyngeal spray applied before endotracheal intubation on hemodynamic responses and electrocardiographic parameters in patients undergoing coronary artery bypass grafting. METHODS: A total of 60 patients who underwent coronary artery bypass grafting surgery were included in this prospective randomized controlled study. Patients were randomly divided into two groups, the topical lidocaine group (administration of 10% lidocaine oropharyngeal spray, five minutes before laryngoscopy and endotracheal intubation) and the control group. Both groups were compared with each other in terms of main hemodynamic parameters including mean arterial pressure and heart rate, as well as P and QT wave dispersion durations, before and after endotracheal intubation. RESULTS: The groups were similar in terms of age, gender, and other demographics and basic clinical characteristics. There was a statistically significant difference between the groups in terms of QT dispersion durations after laryngoscopy and endotracheal intubation. The increase in QT dispersion duration was not statistically significant in the topical lidocaine group, whereas the increase in QT dispersion duration was statistically significant in the control group. When the groups were compared in terms of P wave dispersion durations, there were significant decreases in both groups, but there was no significant difference between the groups. CONCLUSION: Our study revealed that the topical lidocaine administration before endotracheal intubation prevented increase of QT dispersion duration in patients undergoing coronary artery bypass grafting. TRIAL REGISTRATION: NCT03304431.