Clinical and morphological evaluation of permanent first molars in Turkey.

Aim: The aim of this study was to investigate the pit and fissure morphology of the permanent first molars (PFMs) in the dentition of 7- to 12-year-old patients in Turkish children. Patients and Methods: The study was conducted on 706 patients who attended the Dokuz Eylul University Child Clinic. Examinations of the patients were carried out with dental unit light, mouth mirror, and probe by two dentists. Age, gender, plaque scores, pit and fissure morphology, caries, restorations, and missing teeth were recorded. Results: Of the 706 patients included in this study, 441 (62.5%) of them have affected PFMs. Intermediate type fissure morphology (57.5%) was seen as the most common type. A positive correlation was observed between the age and the caries experience (p = 0.000). Patients with deep pits and fissure morphology have more caries affected teeth than patients with shallow pit and fissure morphology, and the difference was statistically significant (p = 0.000). Patients with deep pits and fissure morphology have significantly more plaque accumulation on PFMs compared to the patients with shallow and intermediate fissure morphology (p = 0.000). Conclusions: Despite the limitations of the study, we can conclude that the patients with deep pit-fissure morphology are more susceptible to caries development and plaque accumulation than the patients with shallow and intermediate type pit and fissure morphology.

The prognostic value of ischemia-modified albumin in patients with sepsis.

BACKGROUND: Sepsis is a significant contributor of mortality all over the world. Emergency departments have a critical role for diagnosing a suspected sepsis in a patient, since early and proper administration of antibiotics may decrease mortality significantly. But, the unavailability of an objective and reliable diagnostic test is the major challenge of this critical issue. AIMS: The aim of this study is to evaluate the prognostic value of a novel biomarker, the ischemia-modified albumin (IMA) in patients with sepsis and septic shock in emergency department. SUBJECTS AND METHODS: This prospective, observational study included 81 patients with sepsis or septic shock and 75 controls. Sociodemographic characteristics of the patients, site of infection, IMA levels, other biomarkers (procalcitonin, pH, lactate), mortality at 24-h and 28-day were evaluated. RESULTS: The serum IMA levels in patient and control groups were 117.8 ± 85 IU/g and 115.8 ± 134.0 IU/g, respectively (P = 0.072). There was a weak but statistically significant positive correlation between IMA and lactate levels (P = 0.009). The mortality rates of patient group at 24-h and 28 days were 21% and 79%, respectively, but serum IMA levels were not found to be a prognostic marker to predict mortality. CONCLUSION: The main reason for the similarity between groups regarding IMA levels was thought to be associated with the distribution of the acute and chronic health problems other than sepsis in the control group. Emergency department physicians should not only depend on serum IMA levels for predicting the prognosis of patients with sepsis or septic shock.

Post-Synthetically Elaborated BODIPY-Based Porous Organic Polymers (POPs) for the Photochemical Detoxification of a Sulfur Mustard Simulant.

Designing new materials for the effective detoxification of chemical warfare agents (CWAs) is of current interest given the recent use of CWAs. Although halogenated boron-dipyrromethene derivatives (4,4-difluoro-4-bora-3a,4a-diaza-s-indacene or BDP or BODIPY) at the 2 and 6 positions have been extensively explored as efficient photosensitizers for generating singlet oxygen (1O2) in homogeneous media, their utilization in the design of porous organic polymers (POPs) has remained elusive due to the difficulty of controlling polymerization processes through cross-coupling synthesis pathways. Our approach to overcome these difficulties and prepare halogenated BODIPY-based porous organic polymers (X-BDP-POP where X = Br or I) represents an attractive alternative through post-synthesis modification (PSM) of the parent hydrogenated polymer. Upon synthesis of both the parent polymer, H-BDP-POP, and its post-synthetically modified derivatives, Br-BDP-POP and I-BDP-POP, the BET surface areas of all POPs have been measured and found to be 640, 430, and 400 m2·g-1, respectively. In addition, the insertion of heavy halogen atoms at the 2 and 6 positions of the BODIPY unit leads to the quenching of fluorescence (both polymer and solution-phase monomer forms) and the enhancement of phosphorescence (particularly for the iodo versions of the polymers and monomers), as a result of efficient intersystem crossing. The heterogeneous photocatalytic activities of both the parent POP and its derivatives for the detoxification of the sulfur mustard simulant, 2-chloroethyl ethyl sulfide (CEES), have been examined; the results show a significant enhancement in the generation of singlet oxygen (1O2). Both the bromination and iodination of H-BDP-POP served to shorten by 5-fold of the time needed for the selective and catalytic photo-oxidation of CEES to 2-chloroethyl ethyl sulfoxide (CEESO).

Mechanical-Bond-Induced Exciplex Fluorescence in an Anthracene-Based Homo[2]catenane.

Collisional intermolecular interactions between excited states form short-lived dimers and complexes that lead to the emergence of excimer/exciplex emission of lower energy, a phenomenon which must be differentiated from the photoluminescence (PL) arising from the monomeric molecules. Although the utilization of noncovalent bonding interactions, leading to the generation of excimer/exciplex PL, has been investigated extensively, precise control of the aggregates and their persistence at very low concentrations remains a rare phenomenon. In the search for a fresh approach, we sought to obtain exciplex PL from permanent structures by incorporating anthracene moieties into pyridinium-containing mechanically interlocked molecules. Beyond the optical properties of the anthracene moieties, their π-extended nature enforces [π···π] stacking that can overcome the Coulombic repulsion between the pyridinium units, affording an efficient synthesis of an octacationic homo[2]catenane. Notably, upon increasing the ionic strength by adding tetrabutylammonium hexafluorophosphate, the catenane yield increases significantly as a result of the decrease in Coulombic repulsions between the pyridinium units. Although the ground-state photophysical properties of the free cyclophane and the catenane are similar and show a charge-transfer band at ∼455 nm, their PL characters are distinct, denoting different excited states. The cyclophane emits at ∼562 nm (quantum yield ϕF = 3.6%, emission lifetime τs = 3 ns in MeCN), which is characteristic of a disubstituted anthracene-pyridinium linker. By contrast, the catenane displays an exciplex PL at low concentration (10-8 M) with an emission band centered on 650 nm (ϕF = 0.5%, τs = 14 ns) in MeCN and at 675 nm in aqueous solution. Live-cell imaging performed in MIAPaCa-2 prostate cancer cells confirmed that the catenane exciplex emission can be detected at micromolar concentrations.

Integration of Enzymes and Photosensitizers in a Hierarchical Mesoporous Metal-Organic Framework for Light-Driven CO2 Reduction.

Protection of enzymes with synthetic materials is a viable strategy to stabilize, and hence to retain, the reactivity of these highly active biomolecules in non-native environments. Active synthetic supports, coupled to encapsulated enzymes, can enable efficient cascade reactions which are necessary for processes like light-driven CO2 reduction, providing a promising pathway for alternative energy generation. Herein, a semi-artificial system-containing an immobilized enzyme, formate dehydrogenase, in a light harvesting scaffold-is reported for the conversion of CO2 to formic acid using white light. The electron-mediator Cp*Rh(2,2'-bipyridyl-5,5'-dicarboxylic acid)Cl was anchored to the nodes of the metal-organic framework NU-1006 to facilitate ultrafast photo-induced electron transfer when irradiated, leading to the reduction of the coenzyme nicotinamide adenine dinucleotide at a rate of about 28 mM·h-1. Most importantly, the immobilized enzyme utilizes the reduced coenzyme to generate formic acid selectively from CO2 at a high turnover frequency of about 865 h-1 in 24 h. The outcome of this research is the demonstration of a feasible pathway for solar-driven carbon fixation.

Clinical characteristics and prognosis of cardiac tamponade patients: 5­year experience at a tertiary center.

BACKGROUND: Cardiac tamponade (CT) is characterized by compression of the cardiac chambers due to pericardial fluid accumulation. The etiology and prognosis may vary in different regions, and thus patient series from various regions can be useful for exploring the etiological and prognostic disparities. The aim of this study was to determine the clinical characteristics of patients with imminent CT, to evaluate the diagnostic performance of biochemical, microbiologic, and pathologic laboratory analysis, and to ascertain the prognosis of CT patients. METHODS: We enrolled all patients with imminent CT who underwent percutaneous pericardiocentesis between July 2012 and December 2017 in this retrospective study. The patients were classified into three etiology groups: (a) malignancy (MRCT); (b) iatrogenic/mechanical complication of myocardial infarction (IMCT); and (c) other causes (OCT). Clinical information, laboratory findings, and survival data were recorded. RESULTS: In total, 186 pericardiocentesis procedures were performed on 153 consecutive patients with CT. The median follow-up was 137 days (range: 1-1937). The MRCT group had the highest mortality rate (79%) in 12 months, while the OCT group had the lowest rate (27%). We determined that increased age, higher serum urea levels, and malignancy-related CT were independent predictors of mortality. The mortality rates of the MRCT and IMCT groups were similar, with both of them being significantly higher than the rate of the OCT group. In all, 15 patients were diagnosed with a new malignancy via pericardial fluid cytology. CONCLUSION: Patients in the MRCT and IMCT groups had a poor prognosis. The presence of malignancy was found to be the most powerful predictor of mortality in CT patients.

Predictive value of fibrinogen-to-albumin ratio in acute coronary syndrome.

BACKGROUND: We aimed to investigate the predictive value of the fibrinogen-to-albumin ratio (FAR) regarding the development of major cardiovascular events (MACE) in patients treated with percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). METHODS: This was a prospective, observational cohort study that included 261 consecutive patients who were treated with PCI. The patients were grouped according to the occurrence of MACE during the follow-up period. RESULTS: During follow-up, MACE occurred in 68 (26%) patients. The FAR was independently predictive of MACE (HR: 1.017, 95% CI: 1.010-1.024, p < 0.001). In addition, left ventricular ejection fraction (LVEF) and a diagnosis of ST-segment elevation myocardial infarction (STEMI) were independent predictors of MACE. The area under the curve (AUC) of the multivariable model, including LVEF and diagnosis of STEMI, was 0.707 (95% CI: 0.631-0.782, p < 0.001). When the FAR was added to the multivariable model, the AUC was 0.770 (95% CI: 0.702-0.838, z = 2.820, difference p = 0.0048). CONCLUSION: The FAR could be used for the prediction of MACE in patients with ACS who have undergone PCI.

[Hepatocellular Carcinoma Cells with Downregulated ZEB2 Become Resistant to Resveratrol by Concomitant Induction of ABCG2 Expression].

In hepatocellular carcinoma (HCC), the presence of cancer stem cells (CSCs) have been linked to drug resistance, epithelial-mesenchymal transition (EMT), and cancer relapse. This study investigates the expression profile of ZEB1, ZEB2, ABCG2 in HCC-CSCs, and the role of EMT promoter ZEB2 in cells treated with resveratrol. The expression of ZEB1, ZEB2 and ABCG2 transcripts were analyzed in CD133^(+)/CD44^(+) cells isolated from the PLC/PRF/5 cell line. ZEB2-dependent ABCG2 gene expression and the effects of resveratrol on proliferation, cell cycle and apoptosis were explored in SNU398 cell clones. An inverse correlation between ZEB1/ZEB2 and ABCG2 levels were observed both in CSCs and in ZEB2-knock-down cells. The resveratrol treatment significantly decreased cell viability, while promoting cell cycle arrest in ZEB2-independent manner. Interestingly, resveratrol-treated cells with low levels of ZEB2 were resistant to apoptosis. The interplay of expression levels of ABCG2 and ZEB family EMT transcription factors may play a role in establishing CSC-like phenotype in HCC cells resistant to resveratrol.

A Supramolecular Approach for Modulated Photoprotection, Lysosomal Delivery, and Photodynamic Activity of a Photosensitizer.

Prompted by a knowledge of the photoprotective mechanism operating in photosystem supercomplexes and bacterial antenna complexes by pigment binding proteins, we have appealed to a boxlike synthetic receptor (ExBox·4Cl) that binds a photosensitizer, 5,15-diphenylporphyrin (DPP), to provide photoprotection by regulating light energy. The hydrophilic ExBox4+ renders DPP soluble in water and modulates the phototoxicity of DPP by trapping it in its cavity and releasing it when required. While trapping removes access to the DPP triplet state, a pH-dependent release of diprotonated DPP (DPPH22+) restores the triplet deactivation pathway, thereby activating its ability to generate reactive oxygen species. We have employed the ExBox4+-bound DPP complex (ExBox4+⊃DPP) for the safe delivery of DPP into the lysosomes of cancer cells, imaging the cells by utilizing the fluorescence of the released DPPH22+ and regulating photodynamic therapy to kill cancer cells with high efficiency.

Supramolecular Tessellations by a Rigid Naphthalene Diimide Triangle.

Tessellation of organic polygons though [π···π] and charge-transfer (CT) interactions offers a unique opportunity to construct supramolecular organic electronic materials with 2D topologies. Our approach to exploring the 3D topology of 2D tessellations of a naphthalene diimide-based molecular triangle (NDI-Δ) reveals that the 2D molecular arrangement is sensitive to the identity of the solvent and solute concentrations. Utilization of nonhalogenated solvents, combined with careful tailoring of the concentrations, results in NDI-Δ self-assembling though [π···π] interactions into 2D honeycomb triangular and hexagonal tiling patterns. Cocrystallization of NDI-Δ with tetrathiafulvalene (TTF) leads systematically to the formation of 2D tessellations as a result of superstructure-directing CT interactions. Different solvents lead to different packing arrangements. Using MeCN, CHCl3, and CH2Cl2, we identified three sets of cocrystals, namely CT-A, CT-B, and CT-C, respectively. Solvent modulation plays a critical role in controlling not only the NDI-Δ:TTF stoichiometric ratios and the molecular arrangements in the crystal superstructures, but also prevents the inclusion of TTF guests inside the cavities of NDI-Δ. Confinement of TTF inside the NDI-Δ cavities in the CT-A superstructure enhances the CT character with the observation of a broad absorption band in the NIR region. In the CT-B superstructure, the CHCl3 lattice molecules establish a set of [Cl···Cl] and [Cl···S] intermolecular interactions, leading to the formation of a hexagonal grid of solvent in which NDI-Δ forms a triangular grid. In the CT-C superstructure, three TTF molecules self-assemble, forming a supramolecular isosceles triangle TTF-Δ, which tiles in a plane alongside the NDI-Δ, producing a 3 + 3 honeycomb tiling pattern of the two different polygons. Solid-state spectroscopic investigations on CT-C revealed the existence of an absorption band at 2500 nm, which on the basis of TDDFT calculations, was attributed to the mixed-valence character between two TTF•+ radical cations and one neutral TTF molecule.

Combining Intra- and Intermolecular Charge Transfer with Polycationic Cyclophanes To Design 2D Tessellations.

A series of donor-acceptor (D-A) naphthalene-viologen-based cyclophanes of different shapes, sizes, and symmetries have been synthesized and characterized. Solution optical studies on these cyclophanes reveal the existence of photoinduced intramolecular charge transfer (CT) at 465 nm from naphthalene (D) to viologen (A) units, resulting in a conformational change in the viologen units and the emergence of an emission at 540 nm. The D-A cyclophanes with box-like and hexagon-like shapes offer an opportunity to control the arrangement within 2D layers where D-A interactions direct the superstructures. While a box-like 2,6-disubstituted naphthalene-based tetracationic cyclophane does not form square tiling patterns, a truncated hexagon-like congener self-assembles to form a hexagonal superstructure which, in turn, adopts a hexagonal tiling pattern. Tessellation of the more rigid and highly symmetrical 2,7-disubstituted naphthalene-based cyclophanes leads to the formation of 2D square and honeycomb tiling patterns with the box-like and hexagon-like cyclophanes, respectively. Co-crystallization of the box-like cyclophanes with tetrathiafulvalene (TTF) results in the formation of D-A CT interactions between TTF and viologen units, leading to tubular superstructures. Co-crystallization of the hexagon-like cyclophane with TTF generates well-ordered and uniform tubular superstructures in which the TTF-viologen CT interactions and naphthalene-naphthalene [π···π] interactions propagate with 2D topology. In the solid state, the TTF-cyclophane co-crystals are paramagnetic and display dual intra- and intermolecular CT behavior at ∼470 and ∼1000 nm, respectively, offering multi-responsive materials with potential pathways for electron transport.

The effect of bilirubin on long-term mortality in patients with chronic total coronary occlusion.

AIM: We intended to investigate the association of bilirubin with total mortality in patients with chronic total coronary occlusion (CTO). METHODS: We included 172 patients who underwent coronary angiography due to stable angina pectoris and had CTO. We checked the viability of patients after 9 years of follow-up. RESULTS: Direct bilirubin levels were significantly lower in the non-viable group. We revealed age (OR = 1.045, 95% C.I: 1.009‒1.083; p = 0.015) and direct bilirubin concentrations (OR = 0.029, 95% C.I: 0.002‒0.435; p = 0.029) as independent predictors of mortality. Direct bilirubin value of > 0.2 mg/dL was associated with decreased mortality with a sensitivity of 85 %, and a specificity of 46 %. CONCLUSION: Serum direct bilirubin concentrations independently predict total mortality in patients with chronic total occlusion over 9 years of follow-up (Tab. 1, Fig. 2, Ref. 23).

Hepatitis C infection and other drug-related harms among inpatients who injected drugs in Turkey.

Hepatitis C virus (HCV) is easily spread among those who share drug injection equipment. Due to the ease of contraction and growing prevalence of HCV in Eastern Europe, the aims of this study focused on describing risky injection practices as well as the prevalence of HCV, HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) who were admitted to public and private drug treatment centres in Turkey from 2012 to 2013. Other aims included identifying correlates of needle sharing and HCV infection. Of the 4694 inpatients who ever injected drugs and the 3914 who injected in the past 30 days, nearly all (98%) reported heroin as their drug of choice, the vast majority reported ever sharing a needle (73.4% and 79.3%), and the mean age at first injection was 23 years. Of current PWID, 51.9% were HCV-positive, 5.9% were HBV-positive and only 0.34% of lifetime PWID were HIV-positive. Predictors of increased needle sharing include younger age, being unemployed, having lesser education and reporting heroin as a drug of choice. Significant predictors of HCV infection included being 40 years or older, receiving treatment in the Mediterranean region of Turkey, reporting heroin as a primary substance, a longer duration of drug use and sharing needles. With this information, it is essential to improve access to clean injection equipment in Turkey, to focus on improving education on clean injection practices and to enhance efforts in testing and treating HCV-positive PWID.

Immunohistochemical investigation of P16, P53 and Ki-67's prognostic values in diffuse large B-Cell lymphomas.

AIM: The aim of this study is to determine the immunohistochemical properties of Ki-67, P53 expression and loss of P16, and to assess their relationship with both clinical parameters and patient survival in DLBCL. METHOD: Forty patients, diagnosed at the Pathology Department of our institute with nodal DLBCL were selected as the study group. The relationship between P16, P53, Ki-67 expressions and clinical and laboratory parameters like age, gender, performance status, Eastern Cooperative Oncology Group (ECOG), clinical stage, presence of B-symptoms, bone marrow involvement, International Prognostic Index (IPI) score, lactate dehydrogenase (LDH) level, extranodal extension, relapse, C-reactive protein (CRP), sedimentation, number of leukocytes in patients and patient survival were then statistically evaluated. RESULTS: Our results display no statistically significant correlation between P53 expression and loss of P16, Ki-67 proliferation index and clinical parameters and overall survival (p > 0.05). The only statistically significant relationship was between loss of P16 and stage (p 0.05). CONCLUSION: According to the results of our study, the loss of P16, P53 gene expression and Ki-67 proliferation index have no effect on life expectancy of patients with DLBCL (Tab. 2, Fig. 2, Ref. 29).

Association of monocyte/HDL-C ratio with SYNTAX scores in patients with stable coronary artery disease.

PURPOSE: The aim of this study was to investigate the relationship between monocyte count/high density lipoprotein cholesterol (HDL-C) ratio (MHR) and the severity of coronary atherosclerosis, as assessed by the SYNTAX score (SXscore), in patients with stable coronary artery disease (CAD) undergoing coronary angiography. MATERIALS AND METHODS: A total of 428 patients were included in the study between March 2012 and February 2015. The SXscore was determined with baseline coronary angiography. An SXscore ≥ 23 was regarded as severe CAD by definition, and the patients were divided into two groups: those with low SXscores (< 23) and those with high SXscores (≥ 23). RESULTS: MHR and C-reactive protein (CRP) were significantly higher in patients with high SXscores (p < 0.001 and p < 0.001, respectively). Left ventricular ejection fraction (LVEF) was lower in the group with high MHR and high SXscores. The cutoff value of MHR that predicted a high SXscore was 24, with a sensitivity of 66 % and a specificity of 65.1 %. CONCLUSION: To the best of our knowledge, this is the first study in the literature showing that MHR is significantly associated with SXscores. Our results suggest that MHR can be used as a prognostic marker in patients with stable CAD, since it is an easily available and inexpensive test.

Coronary slow flow phenomenon: Not only low in flow rate but also in myocardial energy expenditure.

BACKGROUND AND AIM: Coronary slow flow phenomenon (CSFP) is a miscellaneous clinical entity leading to angina-like symptoms, and electrocardiographic and scintigraphic evidence of ischemia. The impact of this syndrome on myocardial performance has not been comprehensively evaluated. In this study, we sought to evaluate the myocardial energy expenditure (MEE) in patients with CSFP and its relationship with exercise capacity. METHODS AND RESULTS: A total of 64 patients (64.1% male, mean age 53.2 ± 10.3 years) with CSFP and 64 patients (60.9% male, mean age 52.2 ± 10.9 years) with normal coronary artery as control group were included. MEE was calculated by a validated formula that uses transthoracic echocardiography (TTE) parameters, including left ventricular circumferential end-systolic stress, stroke volume, and ejection time CSFP patients had significantly lower MEE (0.79 cal/systole ± 0.15 vs. 0.91 cal/systole ± 0.09, p < 0.001). In correlation analysis, MEE had a significant negative correlation with mean corrected TIMI frame count (mTFC) (ß = -0.523; p < 0.001) and positive correlations with metabolic equivalents (METs) (ß = 0.560; p < 0.001), rate pressure product (ß = 0.649; p < 0.001), and exercise duration (ß = 0.408; p < 0.001). At multivariate analysis, MEE was demonstrated as an independent predictor of CSFP (OR 1.863, CI 95% 1.485-2.338 p < 0.001). CONCLUSION: Myocardial energy consumption, as a calculation obtained from TTE parameters, was reduced in patients with CSFP, and it had a significant relationship with exercise capacity. Considering its significant correlation with exercise capacity, myocardial energy consumption seemed to use evaluation of myocardial performance and functional status in another cardiovascular disease.

Androgenetic alopecia is associated with increased arterial stiffness in asymptomatic young adults.

BACKGROUND: Association of androgenetic alopecia (AGA) with increased incidence of hypertension, a strong risk factor for coronary artery disease, has been suggested. However, there are no data on arterial stiffness measures of asymptomatic young adults with AGA. OBJECTIVE: In this study, we aimed to investigate the association of the AGA with arterial stiffness assessed by cardio-ankle vascular index (CAVI), in asymptomatic young men. METHODS: A total of 162 asymptomatic men aged between 18 and 45 years were consecutively enrolled to the study. Subjects were considered to have AGA if they have ≥3 grade vertex alopecia according to Hamilton-Norwood scale. Arterial stiffness was assessed by CAVI and defined as abnormal if CAVI is ≥8. RESULTS: Frequency of abnormal CAVI was higher in patients with AGA (29.3% vs. 10.0%, P = 0.003). Subjects with AGA had higher mean CAVI than subjects without AGA (7.56 ± 0.93 vs. 7.15 ± 0.79, P = 0.004). Binary logistic regression analysis demonstrated that presence of AGA (OR, 5.6; 95% CI, 1.7-20.0, P = 0.006), age (OR, 1.1; 95% CI, 1.0-1.2, P = 0.03) and diastolic blood pressure (OR, 1.1; 95% CI, 1.0-1.3, P = 0.005) were independently associated with abnormal CAVI. CONCLUSION: We concluded that, AGA might be an indicator of arterial stiffness in asymptomatic young adults.

Terminal QRS distortion and severity of coronary artery disease in ST-elevation myocardial infarction.

BACKGROUND: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS complex on electrocardiograms (ECGs) of patients with ST-segment elevation myocardial infarction (STEMI). Although the association between G3I and short- and long-term cardiovascular events is well established, its mechanism is unclear. We assessed the association between G3I on the admission ECG and SYNTAX score (SS) in patients with STEMI undergoing primary percutaneous coronary intervention. PATIENTS AND METHODS: The study population consisted of 312 patients with STEMI. Baseline ECGs of the patients were analyzed for grade of ischemia; the online latest updated version (2.11) of the SS calculator was used to determine the SS (http://www.syntaxscore.com). Patients were divided into two groups according to their grade of ischemia: grade 2 ischemia (G2I) or G3I. Also, patients were classified according to their SS as SS < 22 (low) or SS ≥ 22 (high). RESULTS: There were 211 patients in the low SS group and 101 patients in the high SS group. G3I was present in 31.1 % (n = 97) of the study population. SS was significantly higher in patients with G3I than in patients with G2I (20.1 ± 8.8 vs. 13.7 ± 7.1, p < 0.001). G3I was significantly higher in patients with high SS (50.5 % vs. 21.8 %, p < 0.001). Multivariate logistic regression analysis revealed that G3I (p < 0.001), diabetes (p = 0.013), age (p = 0.016), and anterior MI (p = 0.011), were independent predictors of high SS. CONCLUSION: In conclusion, G3I was independently related to high SS. We suggest that elevated SS in patients with G3I may explain the relationship between G3I and the poor outcome observed in these patients. Furthermore, the prediction of high SS by means of G3I in patients with STEMI may help determine the most appropriate revascularization method and prevent procedure failure.

Management and outcomes of coronary artery perforations during percutaneous treatment of acute coronary syndromes.

BACKGROUND: Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS. METHODS: The results of 25 patients with CAP were retrospectively analyzed. RESULTS: Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients. CONCLUSION: The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

Synthesis of metalated pseudorotaxane polymers with full control over the average linear density of threaded macrocycles.

Here we report the synthesis of metalated main-chain polypseudorotaxanes via ring-opening olefin metathesis copolymerization of macrocycles and metalated [2]catenanes. By varying the feed ratio of the macrocycle and the [2]catenate comonomers, we prepared metalated pseudorotaxane polymers with selected, predictable average linear densities of threaded macrocycles that ranged from 0% to 100%, thus allowing, for the first time, both full and fine control over this key parameter.