Benchmarking of AlphaFold2 accuracy self-estimates as indicators of empirical model quality and ranking: a comparison with independent model quality assessment programmes.

MOTIVATION: Despite an increase in protein modelling accuracy following the development of AlphaFold2, there remains an accuracy gap between predicted and observed model quality assessment (MQA) scores. In CASP15, variations in AlphaFold2 model accuracy prediction were noticed for quaternary models of very similar observed quality. In this study, we compare plDDT and pTM to their observed counterparts the local distance difference test (lDDT) and TM-score for both tertiary and quaternary models to examine whether reliability is retained across the scoring range under normal modelling conditions and in situations where AlphaFold2 functionality is customized. We also explore plDDT and pTM ranking accuracy in comparison with the published independent MQA programmes ModFOLD9 and ModFOLDdock. RESULTS: plDDT was found to be an accurate descriptor of tertiary model quality compared to observed lDDT-Cα scores (Pearson r = 0.97), and achieved a ranking agreement true positive rate (TPR) of 0.34 with observed scores, which ModFOLD9 could not improve. However, quaternary structure accuracy was reduced (plDDT r = 0.67, pTM r = 0.70) and significant overprediction was seen with both scores for some lower quality models. Additionally, ModFOLDdock was able to improve upon AF2-Multimer model ranking compared to TM-score (TPR 0.34) and oligo-lDDT score (TPR 0.43). Finally, evidence is presented for increased variability in plDDT and pTM when using custom template recycling, which is more pronounced for quaternary structures. AVAILABILITY AND IMPLEMENTATION: The ModFOLD9 and ModFOLDdock quality assessment servers are available at https://www.reading.ac.uk/bioinf/ModFOLD/ and https://www.reading.ac.uk/bioinf/ModFOLDdock/, respectively. A docker image is available at https://hub.docker.com/r/mcguffin/multifold.

Prediction of protein structures, functions and interactions using the IntFOLD7, MultiFOLD and ModFOLDdock servers.

The IntFOLD server based at the University of Reading has been a leading method over the past decade in providing free access to accurate prediction of protein structures and functions. In a post-AlphaFold2 world, accurate models of tertiary structures are widely available for even more protein targets, so there has been a refocus in the prediction community towards the accurate modelling of protein-ligand interactions as well as modelling quaternary structure assemblies. In this paper, we describe the latest improvements to IntFOLD, which maintains its competitive structure prediction performance by including the latest deep learning methods while also integrating accurate model quality estimates and 3D models of protein-ligand interactions. Furthermore, we also introduce our two new server methods: MultiFOLD for accurately modelling both tertiary and quaternary structures, with performance which has been independently verified to outperform the standard AlphaFold2 methods, and ModFOLDdock, which provides world-leading quality estimates for quaternary structure models. The IntFOLD7, MultiFOLD and ModFOLDdock servers are available at: https://www.reading.ac.uk/bioinf/.

Estimation of model accuracy in CASP15 using the ModFOLDdock server.

In CASP15, there was a greater emphasis on multimeric modeling than in previous experiments, with assembly structures nearly doubling in number (41 up from 22) since the previous round. CASP15 also included a new estimation of model accuracy (EMA) category in recognition of the importance of objective quality assessment (QA) for quaternary structure models. ModFOLDdock is a multimeric model QA server developed by the McGuffin group at the University of Reading, which brings together a range of single-model, clustering, and deep learning methods to form a consensus of approaches. For CASP15, three variants of ModFOLDdock were developed to optimize for the different facets of the quality estimation problem. The standard ModFOLDdock variant produced predicted scores optimized for positive linear correlations with the observed scores. The ModFOLDdockR variant produced predicted scores optimized for ranking, that is, the top-ranked models have the highest accuracy. In addition, the ModFOLDdockS variant used a quasi-single model approach to score each model on an individual basis. The scores from all three variants achieved strongly positive Pearson correlation coefficients with the CASP observed scores (oligo-lDDT) in excess of 0.70, which were maintained across both homomeric and heteromeric model populations. In addition, at least one of the ModFOLDdock variants was consistently ranked in the top two methods across all three EMA categories. Specifically, for overall global fold prediction accuracy, ModFOLDdock placed second and ModFOLDdockR placed third; for overall interface quality prediction accuracy, ModFOLDdockR, ModFOLDdock, and ModFOLDdockS were placed above all other predictor methods, and ModFOLDdockR and ModFOLDdockS were placed second and third respectively for individual residue confidence scores. The ModFOLDdock server is available at: https://www.reading.ac.uk/bioinf/ModFOLDdock/. ModFOLDdock is also available as part of the MultiFOLD docker package: https://hub.docker.com/r/mcguffin/multifold.

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index.

Traditional and Additional Isokinetic Knee Strength Assessments of Athletes; Post-Operative Results of Hamstring Autograft ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries are common injuries in athletes, and, accordingly, ACL reconstruction (ACLR) is one of the most common orthopedic surgical procedures performed on athletes. This study aims to compare the 6-month post-operative isokinetic knee strength evaluations of the semitendinous/gracilis (ST/G) ACLR technique performed on healthy (HK) and ACLR knees of athletes. Materials and Methods: A retrospective cohort of 29 athletes from various sports branches who underwent ST/G ACLR technique by the same surgeon were evaluated. The isokinetic knee extension (Ex) and flexion (Flx) strength of the patients on the HK and ACLR sides were evaluated with a series consisting of three different angular velocities (60, 180, and 240°/s). In addition to the traditional evaluations of peak torque (PT) and hamstring/quadriceps (H/Q) parameters, the findings were also evaluated with additional parameters such as the joint angle at peak torque (JAPT), time to peak torque (TPT), and reciprocal delay (RD). Results: There was a significant improvement in the mean Lysholm, Tegner, and IKDC scores after surgery compared with preoperative levels (p < 0.05). As for the isokinetic PT values, there were significant differences in favor of HK in the 60°/s Flx, 180°, and 240°/s Ex phases (p < 0.05). In addition, there was a significant difference in the 60° and 180°/s Flx phases in RD (p < 0.05). In H/Q ratio, TPT, and JAPT values, no significant difference was observed between HK and ACLR at all angular velocities. Conclusions: The findings showed that the ST/G 6-month post-operative isokinetic knee strength in athletes produced high results in HK, and, when evaluated in terms of returning to sports, the H/Q ratios on the ACLR side were sufficient to make the decision to return to sports. It was found that the ACLR side was slower than the HK side in the reciprocal transitions, particularly in the Flx phase. We believe that this results from the deformation of the hamstring muscle after reconstruction of the ST/G ACLR side.

The Effect of Five Single Nucleotide Polymorphisms on Hb F Variation of ß-Thalassemia Traits and Hematologically Normal Individuals in Southeast Turkey.

ß-Thalassemia (ß-thal) is caused by deficiency of ß-globin chain synthesis and leads to the accumulation of unstable globin chain production. This results in a higher Hb F level in order to neutralize the excess α chains. In addition, γ-globin gene expression, due to genetic factors after birth, leads to increased Hb F levels in adulthood [hereditary persistence of fetal hemoglobin (Hb) (HPFH)]. In this study, the relationship between ß-thal trait and individuals with suspected HPFH and a control group was investigated in Adiyaman, Turkey. Single nucleotide polymorphism (SNP) analyses were performed in five different polymorphic regions using real-time polymerase chain reaction (qPCR) methods [rs4671393 (G>A), rs766432 (A>C), rs9402686 (G>A), rs28384513 (T>G), rs1609812 (A>G)]. No significant difference was found between the control and ß-thal group in the codominant inheritance model in the rs1609812 (A>G) polymorphism region only, while all the other polymorphic regions were found to be statistically significant. It was found that different genotype models increased Hb F levels between 1.6- and 3.06-fold in four studied polymorphic regions [rs4671393 (G>A), rs766432 (A>C), rs9402686 (G>A), rs28384513 (T>G)]. All of the polymorphic regions increased the Hb F levels from 1.86- to 24.76-fold, except rs9402686 (G>A) and rs28384513 (T>G) over dominant and rs1609812 (A>G) codominant inheritance models. The AC and AA genotypes increased Hb F levels in the B-cell CLL/lymphoma 11 A haplotype studies. It was determined that both haplotypes 2 and 4 increased Hb F levels. As a result, SNPs strongly affect the Hb F levels in both healthy individuals and ß-thal trait.

The relationship between the variations in Gγ and Aγ promotors and the Hereditary Persistence of Fetal Hemoglobin (HPFH).

In the present study, sixty-two samples that have 1.5% and upper level of fetal hemoglobin (HbF), were examined to investigate the relationship between HbF level and non-deletional mutations in both Gγ (G gamma) globin (HBG2) and Aγ (A gamma) globin (HBG1) genes. Four variations were observed in the promotor of Gγ gene, which are -158C/T, -309A/G, -369C/G, and -567T/G. Also, four variations were observed in the 5'-UTR (untranslated regions) and promotor of Aγ gene, which are +25G/A, -369G/C, -499T/A, and -588G/A. One -222/-225 AGCA del homozygous and six variations as heterozygous in A gamma globin gene promotor region were also observed. The results of the current study suggested that there was a significant relationship between high HbF levels and two variations (-309A/T and -369C/G) in Gγ gene promotor. Additionally, a significant relationship between two variations (+25G/A and -499T/A) in Aγ gene promotor was also observed. Furthermore, the persons who carry these variations with high levels of HbF indicated that there might be a haplotype effect between these variations.

Agreement of serum potassium measured by blood gas and biochemistry analyzer in patients with moderate to severe hyperkalemia.

PURPOSE: Several studies investigated the agreement between central laboratory biochemistry analyzers and blood gas analyzers for potassium measurements. However, data are scarce when the potassium level is moderate to severely high. We aimed to evaluate the agreement between central laboratory biochemistry analyzers and blood gas analyzer in terms of serum potassium level measurement because differences in potassium at this level translate into very different clinical actions. BASIC PROCEDURES: This was a retrospective medical record review study in which patients who presented to the emergency department and had serum potassium levels ≥6mmol/L were included. Patients who did not have simultaneous potassium measurement by blood gas analyzer were excluded. We included all patients meeting potassium criteria irrespective of their underlying disease or comorbidities. We evaluated agreement between the measurement methods with Pearson correlation, Bland-Altman plot, and Sign test. MAIN FINDINGS: A total of 118 blood sample pairs were included. The mean serum potassium level measured by biochemistry analyzer was 6.78±0.79mmol/L, whereas it was 6.16±0.86mmol/L by blood gas analyzer (P<.001, Sign test). There was a strong correlation (P<.001, r=0.864) between the 2 methods, but agreement was relatively poor. Blood gas analyzer tended to measure potassium significantly lower than measured by biochemistry analyzer. The mean difference between the methods was 0.62±0.43mmol/L. PRINCIPAL CONCLUSIONS: In patients with moderate to severe hyperkalemia, blood gas analyzer and biochemistry analyzer gives significantly different serum potassium results which may be clinically important.

Effect of p53 Arg72Pro polymorphism on the induction of micronucleus by aflatoxin B1 in in vitro in human blood lymphocytes.

Aflatoxin B1 (AFB1) is a class 1 carcinogen produced by Aspergillus flavus and Aspergillus parasiticus that can contaminate a variety of food substances, the liver being its target organ. A common p53 Arg72Pro polymorphism resulting in the substitution of an arginine amino acid by proline amino acid in the transactivating domain has been demonstrated to affect p53 function. The aim of this study is to investigate association between p53 Arg72Pro polymorphism and the frequencies of spontaneous and AFB1-induced DNA damage in peripheral blood lymphocytes from 100 healthy individuals in Turkish population. In vitro cytokinesis-blocked micronucleus (CBMN) assay was used to detect the spontaneous and AFB1-induced DNA damage whereas, genotyping of p53 Arg72Pro polymorphism was carried out by using a polymerase chain reaction restriction fragment length polymorphism assay. During 68 h incubation time, lymphocytes treated with AFB1 (1.56 µg/mL) and S9 mix for a total of 3 h (48-51 h). Treatment of the lymphocytes with AFB1 significantly increased the overall frequencies of micronucleus (MN) when compared to untreated cultures (1.23 ± 0.05 versus 0.55 ± 0.02; p <0.001). Moreover, genotype analysis revealed a statistically significant association between Pro/Pro genotype of p53 Arg72Pro polymorphism and increased frequencies of MN both spontaneous and AFB1-induced cultures when compared Arg/Arg genotype (0.69 ± 0.19 versus 0.46 ± 0.13, p < 0.001; 1.59 ± 0.65 versus 1.01 ± 0.41 p < 0.001; respectively). Our data indicate that p53 Arg72Pro polymorphism plays a significant role in human sensitivity to the genotoxic effects of AFB1. Further investigations in larger sample size and with different ethnic origins as well as including more functional single nucleotide polymorphisms might lead to the identification of novel genetic factors responsible for susceptibility to human carcinogens such as AFB1.

Frequency and types of headaches in patients with metabolic syndrome.

BACKGROUND AND PURPOSE: Metabolic Syndrome (MetS) and headaches are common public health problems in whole world. The relationship between headaches and the MetS isn't understood clearly. Purpose - The aim of this study is to determine the prevalence and types of headaches, and evaluate the relationship between headache characteristics and clinical and laboratory parameters analyzed in patients diagnosed with MetS. METHODS: Of the patients diagnosed with MetS in Endocrinology outpatient clinics between July 2011 and July 2012, 202 patients were included in the study. Hemoglobin, fasting blood glucose (FBG), total cholesterol, triglyceride, HDL and LDL cholesterol, thyroid function tests and HbA1c values of all patients were recorded. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all patients. The headache severity was assessed by Visual Analog Scale (VAS). RESULTS: The prevalence of headache in patients with MetS was found to be 61.4%. The incidence of headache was higher in female patients (F: 86.4%, M: 13.6%). The distribution of the subtypes of headaches was as follows: Episodic Tension-Type Headaches (ETTH) 24.8%, Episodic Migraine 14.4%, Chronic Tension-Type Headaches (CTTH) 11.3%, Episodic Tension-Type Headaches (ETTH) and Episodic Migraine 7.9%, and other types of headaches (Cervicogenic Headache and Cluster Headache) 3%. No statistically significant relationship was found between headache and non-headache groups in terms of body mass index, waist circumference, and the laboratory parameters (p>0.05). The mean BDI and BAI scores were higher in the headache group (p<0.001 and p<0.001). No significant difference was found between the mean MIDAS scores in the subtypes of headaches (p=0.35). In the headache group, there was a significant relationship only between triglyceride levels and attack frequency, duration and severity. CONCLUSION: Prevalence of headache in patients with MetS was 61.4%. The incidence of subtypes of headaches was similar to those in the general population. A relationship was found between triglyceride levels and attack frequency and severity. The result may be important to draw attention to the evaluation of triglyceride levels for reducing the frequency and severity of attacks in patients with headaches.

Effect of HOTAIR rs920778 polymorphism on breast cancer susceptibility and clinicopathologic features in a Turkish population.

Overexpression of Hox transcript antisense intergenic RNA (HOTAIR), a long non-coding RNA (lncRNA), is associated with cancer cell proliferation, invasion, progression, and metastasis as well as poor survival in a variety of human cancers including breast cancer (BC). A common functional single nucleotide polymorphism (SNP) rs920778 (T → C) in the intronic enhancer of the HOTAIR has been reported to influence HOTAIR expression and cancer predisposition, but the association of HOTAIR rs920778 polymorphism with BC susceptibility and clinicopathological features has yet to be investigated. We genotyped HOTAIR rs920778 polymorphism in 245 Turkish women including 123 BC patients and 122 age-matched healthy controls by a real-time polymerase chain reaction (PCR) with the TaqMan assay. We found that the CC genotype of HOTAIR rs920778 polymorphism significantly increased the risk of BC in both codominant (odds ratio (OR) = 2.12, 95 % confidence interval (CI) 1.00-4.51, P = 0.05) and recessive (OR = 2.40, 95 % CI 1.22-4.73, P = 0.01) inheritance genetic models. Our research also indicated an association between the CC genotype of HOTAIR rs920778 polymorphism and clinicopathologic features of tumor, including advanced tumor-node-metastasis (TNM) stage, larger tumor size, distant metastasis, and poor histological grade (P < 0.05). Because our findings suggest for the first time that the CC genotype of HOTAIR rs920778 polymorphism might play important roles in genetic susceptibility to BC development and aggressiveness in a Turkish population, further independent studies are required to validate our findings in a larger series, as well as in patients of different populations.

[Levels of awareness of occupational and general cardiovascular risk factors among metal industry employees]. / Metal sektörü çalisanlarinin mesleki ve genel kardiyovasküler risk faktörleri bilgi düzeyleri.

OBJECTIVE: Long-term exposure to physical, chemical, ergonomic and psychosocial environmental factors may lead to occupational cardiovascular disease in metal industry employees. This study aimed to determine levels of knowledge levels regarding occupational and cardiovascular risk factors among metal industry employees. METHODS: The study was conducted between 2nd and 6th June 2014 with the participation of 82 employees. All were working in a medium-sized workplace in the metal industry. Data were collected by means of a questionnaire, which included socio-demographic characteristics and occupational cardiovascular risk factors, and a scale developed by Arikan et al. to measure awareness levels of risk factors for cardiovascular diseases (CARRF-KL). RESULTS: The mean age of employees was 39.97±8.44. Of the participants, 58.5% stated that they had knowledge on cardiac disease risk factors. The mean CARRF-KL score was found to be 18.65±4.04. The percentage of employees stating that they had no knowledge on the occupational risks for such diseases was 79.3%, while 19.5% stated that job stress caused cardiac diseases. One individual (1.2%) stated that one of the chemical solvents used in the working environment was a risk factor. CONCLUSION: Although awareness among metal industry employees of cardiovascular risk factors was above average, it was determined that they do not have adequate information on occupational risk factors. Prolonged and unprotected levels exposure to environmental factors constitute a risk for cardiovascular disease. This information is important for the development of preventive cardiology.

Prevalence of ß-thalassemia trait and abnormal hemoglobins in Sanliurfa Province in southeast Turkey.

Thalassemia is one of the most common hereditary disorders in Turkey, especially in the Mediterranean region of the country. The purpose of this study was to determine the frequency of the ß-thalassemia (ß-thal) trait and abnormal hemoglobins (Hbs) in couples who applied for premarital screening in Sanliurfa Province, in the southeastern region of Turkey, a province with the first reported incidence of ß-thal and abnormal Hbs. In the present study, in order to detect the prevalence of the ß-thal trait and abnormal Hbs in Sanliurfa Province, Turkey, a total of 37,962 couples who applied for premarital screening were analyzed. From January 2011 through March 2014, red blood cell (RBC) counts and Hb fractionation were carried out by a cell counter and high performance liquid chromatography (HPLC), respectively. The prevalence of ß-thal with high Hb A2 (>3.5%) values was found at rates of 2.44% (n = 1853) in Sanliurfa Province. Additionally, the abnormal Hb rate was 1.57% (1193/75,924), and Hb S (HBB: c.20T > A), Hb C (HBB: c.19G > A) and Hb D-Punjab (HBB: c.364G > C) were reported as 0.50, 0.38 and 0.69, respectively. This study is the first to establish the frequency of ß-thal and abnormal Hbs in Sanliurfa Province, which has the highest birth frequency. We report that the frequency of the ß-thal trait is at a high-risk level compared to other cities in Turkey. Due to the high risk of ß-thal in Sanliurfa Province, a premarital screening program would be of great value in informing parents about offspring with ß-thal.

The minimum effective concentration (MEC90) of bupivacaine for an ultrasound-guided suprainguinal fascia iliaca compartment block for analgesia in knee surgery: a dose-finding study.

BACKGROUND: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. METHODS: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward). The SFICB was performed as a postsurgical intervention after spinal anesthesia. Seventy patients were allocated using the biased-coin design up-and-down sequential method. The ultrasound-guided SFICB was performed using different bupivacaine concentrations, and standard multimodal analgesia was administered to all patients. Block success was defined as the absence of pain or presence of only tactile sensation during the pinprick test conducted on the anterior and lateral regions of the mid-thigh six hours postoperatively. RESULTS: According to isotonic regression and bootstrap CIs, the MEC90 value of bupivacaine for a successful SFICB was 0.123% (95% CI [0.098, 0.191]) and the MEC95 value was 0.188% (95% CI [0.113, 0.223]). CONCLUSIONS: Our study showed that the MEC90 and MEC95 values for bupivacaine administered via an SFICB for analgesia were 0.123% and 0.188%, respectively. One advantage of using lower concentrations of bupivacaine is the associated reduction in quadriceps weakness.

Prevalence of ß-thalassemia trait and abnormal hemoglobin in premarital screening in the province of Izmir, Turkey.

BACKGROUND/AIMS: Thalassemia is one of the most common hereditary disorders in Turkey. The aim of our study was to determine the prevalence of the ß-thalassemia trait and abnormal hemoglobin in couples who applied for premarital screening in the third largest Turkish province of Izmir in the Aegean region. METHODS: From January 2011 to March 2012, we tested 19,277 couples at the Karsiyaka Public Health Laboratory, Thalassemia Unit for the ß-thalassemia trait and abnormal hemoglobin using a high-performance liquid chromatograph, a hematology analyzer. RESULTS: The ß-thalassemia trait with increased HbA2 (>3.5%) and abnormal hemoglobin was found in 4.96% (1912/38,554) and 0.53% (206/38,554) people, respectively. Of abnormal hemoglobin findings, HbS was determined in 128 people (0.33%), HbD in 50 (0.13%), HbE in 24 (0.06%), and HbC in four (0.01%). Furthermore, in 20 of the 19,277 couples (0.05%), both partners had the ß-thalassemia trait and were referred to counseling. CONCLUSION: The prevalence of the ß-thalassemia trait in the province of Izmir is high compared with other cities of Turkey. Izmir is a high-risk province for ß-thalassemia and sickle-cell anemia. Therefore, premarital screening is essential to prevent new hereditary hemoglobinopaties.

Prognostic Significance of High-Sensitivity Troponin T in Nonischemic Heart Failure with Reduced Ejection Fraction.

OBJECTIVE: Cardiac biomarkers can help diagnose and predict heart failure prognosis. High-sensitivity troponin T has frequently been investigated in ischemic heart failure studies. However, the relation between high-sensitivity troponin T and mortality in nonischemic heart failure and its level indicating poor prognosis remain unclear. This study aimed to show whether high-sensitivity troponin T is a predictor of all-cause mortality and the cut-off value for high-sensitivity troponin T in patients with nonischemic heart failure with reduced ejection fraction. METHODS: We included 249 nonischemic heart failure patients with left ventricular ejection fraction ≤ 40%, age ≥ 18 years, and high-sensitivity troponin T level known. RESULTS: Of the patients, 59.8% were male, 73.5% were New York Heart Association I or II, and the median age was 64. High-sensitivity troponin T value of the patients was 18 ng/L [inter-quartile range, 10-34]. The cut-off value of high-sensitivity troponin T for all-cause mortality was 21.5 ng/L, with 72.6% sensitivity and 69.9% specificity (area under the curve: 0.760, 95% CI: 0.692-0.828, P < 0.001). Patients were compared according to the 21.5 ng/L high-sensitivity troponin T cut-off value. At 30-month follow-up, all-cause mortality was 29.3%. According to the Kaplan-Meier analysis, the mortality rate was 14% in the high-sensitivity troponin T < 21.5 ng/L group, while the mortality rate was 50% in the high-sensitivity troponin T ≥ 21.5 ng/L group (P < 0.001, log-rank test). Baseline high-sensitivity troponin T was inde-pendently associated with all-cause mortality in nonischemic heart failure with reduced ejection fraction when adjusted for estimated glomerular filtration rate, hemoglobin, N-terminal pro-brain natriuretic peptide, body mass index, and left atrial diameter (hazard ratio: 1.012, 95% confidence interval: 1.003-1.020, P = 0.005). CONCLUSION: The high-sensitivity troponin T cut-off value was 21.5 ng/L to predict a worse prognosis in nonischemic heart failure with reduced ejection fraction. There was an independent association between high-sensitivity troponin T and all-cause mortality.

Evaluation of Psoas Muscle Atrophy and the Degree of Fat Infiltration After Unilateral Hip Arthroplasty.

OBJECTIVE: Atrophy of the muscles around the hip and thigh has been reported in patients with hip osteoarthritis (OA). Total hip arthroplasty (THA) reduces pain and improves quality of life and activity levels. Muscle strength of the hip and thigh also improves after THA. This study aimed to determine whether there is significant psoas muscle atrophy and to evaluate the degree of fat infiltration after unilateral hip arthroplasty. SUBJECT AND METHODS: Patients who underwent unilateral total hip arthroplasty for primary hip osteoarthritis and who had lumbar vertebra magnetic resonance imaging (MRI) for any reason in the one-year preoperative and postoperative period were evaluated retrospectively. The degree of fat infiltration was also graded visually based on a modified Goutallier rating system. RESULTS: The study was conducted with a total of 58 patients aged between 38 and 75, including 15 males and 43 females. Compared to the preoperative psoas muscle area values on the operated sides of the patients participating in the study, the decrease in the postoperative psoas muscle area was found to be statistically significant (p:0.000; p<0.05). Furthermore, the decrease in psoas muscle area on the non-operated side of the patients was also statistically significant (p:0.000; p<0.05). There was also a positive correlation between preoperative and postoperative psoas muscle areas (p:0.000; p<0.05). CONCLUSION: Early identification of psoas muscle mass reduction may allow for a more proactive psoas strength improvement program to improve post-operative function and mobility.

Patellar Tendon Reconstruction Using Peroneus Longus Tendon Autograft Following Revision Knee Arthroplasty: A Case Report.

Patellar tendon rupture is a rare but serious complication resulting in loss of knee extension that may develop during and after total knee arthroplasty and negatively affects the patient's quality of life. There are a number of surgical options available, from primary repair to reconstruction. Peroneus longus tendon autograft has begun to be used for knee extensor mechanism repair in recent years. In this case report, we aimed to present the case of a patient with traumatic patellar tendon rupture after revision knee arthroplasty. In conclusion, patellar tendon reconstruction using peroneus longus tendon autograft can be considered a successful method in selected patients following knee arthroplasty. It allows early rehabilitation via stable graft fixation and provides good clinical and functional outcomes in the late period.

Effect of Bendopnea on Achievement Medical Treatment Target Doses in Heart Failure.

BACKGROUND: The newly described bendopnea in heart failure (HF) is associated with increased cardiac filling pressures. The aim of the study was to show the effect of bendopnea follow-up on reaching optimal medical treatment doses in HF. METHODS: A total of 413 patients were screened, and we included 203 patients with HF who were previously evaluated for bendopnea. Demographic data, presence or absence of bendopnea, medical history, laboratory findings, and medical treatments were evaluated. Optimal medical therapy target doses at baseline and 3rd month were compared in groups with and without bendopnea. RESULTS: On admission, 64 patients (31.5%) had bendopnea. The rate of patients with bendopnea decreased in the 3rd month (n=42, 20.7%). The proportion of patients who used at least 50% of the recommended medical treatment dose on admission and in the 3rd month was compared; angiotensin-converting enzyme inhibitor /angiotensin receptor blockers use increased from 40.6% to 71.9% in those with bendopnea (P=0.013), from 56.1% to 81.3% in those without bendopnea (P<0.001) and beta-blockers use increased from 28.2% to 60.9% in those with bendopnea (P=0.042), from 31.6% to 69.8% in those without bendopnea (P<0.001). However, aldosterone antagonists use decreased from 70.3% to 67.2% in those with bendopnea (P=0.961), from 68.4 % to 64.1% in those without bendopnea (P=0.334). Bendopnea was independently effective in achieving ACE-I/ARB target doses (OR: 0.359, CI 95%: 0.151-0.854, P=0.020). CONCLUSION: Bendopnea follow-up in HF patients can provide a significant improvement in reaching the recommended treatment target doses.

The Relationship between Lower Extremity Functional Performance and Balance after Anterior Cruciate Ligament Reconstruction: Results of Patients Treated with the Modified All-Inside Technique.

BACKGROUND AND OBJECTIVES: Anterior cruciate ligament (ACL) ruptures are common injuries, and ACL reconstruction (ACLR) is among the most common surgical procedures in sports surgery. Our research aims to compare the 6-month post-operative results of the modified all-inside (MAI) ACLR technique, single leg hop tests (SLHT), and Y balance tests applied in different directions on the operated and non-operated sides. MATERIALS AND METHODS: A retrospective cohort of 22 male recreational athletes who underwent MAI ACLR techniques performed by the same surgeon were evaluated. The functional knee strengths of the participants on the operated and non-operated sides were evaluated with five different tests of SLHTs: single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) with hop for distance (MRH). Their dynamic balance was evaluated with the Y balance Test. RESULTS: Compared to pre-operative levels, there was a significant improvement in the mean Lysholm, Tegner, and IKDC scores during the post-operative period (p < 0.05). There was a difference between SH, THD, CHD, MSTH, and MRH on the operated and non-operative sides (p < 0.05). There was no difference between Y balance scores on the operated and non-operative sides, and there were no differences between LSI scores resulting from SLHTs (p > 0.05). There were no significant relationships between YBT (composite scores) and SH, TH, CH, MSTH, and MRH distances in the healthy leg (p > 0.05), but a significant correlation with only CH in the ACL leg (p < 0.05). CONCLUSIONS: Our research shows that sixth-month post-operative SLHT findings were lower on the ACL side compared to the healthy side in patients tested with the MAI ACLR technique. However, when these scores are evaluated in terms of balance, it can be seen that both sides reveal similar findings. The similarity of LSIs in SLHTs applied in different directions, and balance scores of ACL and healthy sides revealed that the MAI technique is also an ACLR technique that can be used in athletes from a functional point of view.