Characterization of TEMPO-Oxidized Cellulose Nanofiber From Biowaste and Its Influence on Molecular Behavior of Fluorescent Rhodamine B Dye in Aqueous Suspensions.

Cellulose nanofiber (CNFs) obtained through TEMPO oxidation was structurally characterized using FT-IR (Fourier Transformed Infrared) and SEM (Scanning Electron Microscopy) spectroscopy. The molecular aggregation and spectroscopic properties of Rhodamine B (Rh-B) in CNFs suspension were investigated using molecular absorption and steady-state fluorescence spectroscopy techniques. The interaction between CNFs particles in the aqueous suspension and the cationic dye compound was examined in comparison to its behavior in deionized water. This interaction led to significant changes in the spectral features of Rh-B, resulting in an increase in the presence of H-dimer and H-aggregate in CNFs suspension. The H-type aggregates of Rh-B in CNFs suspensions were defined by the observation of a blue-shifted absorption band compared to that of the monomer. Even at diluted dye concentrations, the formation of Rh-B's H-aggregate was observed in CNFs suspension. The pronounced aggregation in suspensions originated from the strong interaction between negatively charged carboxylate ions and the dye. The aggregation behavior was discussed with deconvoluted absorption spectra. Fluorescence spectroscopy studies revealed a significant reduction in the fluorescence intensity of the dye in CNFs suspension due to H-aggregates. Furthermore, the presence of H-aggregates in the suspensions caused a decrease in the quantum yield of Rh-B compared to that in deionized water.

Growth performance, carcass, and meat quality traits in broiler chickens reared on plastic-grid flooring, wood shavings, and zeolite-supplemented wood shavings.

This study aimed to assess the growth performance, carcass characteristics, and meat quality traits of broiler chickens raised on plastic-grid floors, traditional wood shavings, and wood shavings enriched with zeolite. The experimental design included the allocation of 504-day-old chicks to three different bedding materials, namely wood shavings, plastic-grid floors, and zeolite litter, each with four replications (42 birds per replicate). The chicks were individually weighed at birth and grouped according to their average body weights. An experiment involving 504 chicks was conducted, with each replicate consisting of 42 male chicks of similar body weight. At the end of the experiment, a total of 120 chickens were slaughtered with 10 chickens selected from each replicate for processing carcass and meat quality traits. The effects of different bedding materials on mortality (P = 0.812), body weight (P = 0.565), and body weight gain (P = 0.569) were not significant. The ANOVA test was conducted to compare the main effects of performance, carcass, and meat quality characteristics. The feed intake was significantly affected in the 2nd, and 3rd weeks (P = 0.001; 0.023); in addition, the feed conversion ratio was significant in the 2nd, 4th, and overall period (P = 0.003; P = 0.026; P = 0.038) by the bedding materials. The breast yield (P = 0.001), thigh yield (P = 0.028), and wing yield (P = 0.023) were significant. The type of bedding material used in broiler production significantly influenced the pH24 (P = 0.030), L* (P = 0.037), a* (P = 0.000), and CL (P = 0.028). It was concluded that both a plastic-grid floor and zeolite supplementation to wood shaving litter did not significantly affect overall growth performance in broiler chickens. However, the plastic-grid floor showed superior effects on breast meat yield and quality characteristics, particularly reducing cooking loss, when compared to zeolite supplementation in wood shaving litter. The plastic-grid floor led to a slight increase in the feed conversion ratio. Consequently, adopting a plastic grid floor emerges as a viable alternative to traditional wood shavings in broiler farming.

The importance of skin prick test in differentiating cat sensitivities and allergies in children.

BACKGROUND: The incidence of cat allergies in children has increased over the years. Children with cat allergies have mostly reported respiratory symptoms. The skin prick test (SPT) is the most preferred method to demonstrate sensitization to allergens. However, not all children who develop cat sensitization due to environmental exposure become allergic to cats. In our study, we aimed to determine the frequency of sensitization to cat and cat allergy, cat-related symptoms, and the cut-off value for the SPT that may indicate cat allergy. METHODS: Patients aged 2-18 years, who applied to the Health Sciences University Izmir Dr Behçet Uz Pediatrics and Surgery Training and Research Hospital and Balikesir University Application and Research Hospital Pediatric Allergy outpatient clinics between January 01, 2019 and December 31, 2020, were included in the study. Patients who underwent SPT and found to be sensitized to cat allergen, were evaluated retrospectively. Clinical and laboratory findings of the patients were recorded. Receiver operating characteristics (ROC) analysis was performed to determine the cut-off value for the SPT. RESULTS: Sensitization to cat was detected in 140 (4%) out of 3499 patients who underwent SPT. The median age of the patients was 12 years (min-max: 5-18) and 67.1% were male. Eighty-eight (62.9%) patients were symptomatic upon contact with cats, predominantly with nasal symptoms. These patients had significantly larger cat SPT wheal size than asymptomatic patients. The cut-off value was determined as 5.5 mm with a sensitivity of 72.7% and a specificity of 61.5% (95% CI, 60.5%-78.4%). Symptoms resolved in about half of our patients by reducing contact with cats. DISCUSSION: The present study is the first to report the frequency and clinical findings of cat sensitizations and allergies in Turkish children. For effective treatment, cat allergy must be diagnosed. In this regard, the use of a practical, readily accessible 5.5 mm cut-off point on the SPT may be helpful.

HER2-low breast cancer could be associated with an increased risk of brain metastasis.

PURPOSE: The HER2-low breast cancer is a newly recognized entity with the clinical characteristics is yet to be defined. We hypothesized that HER2-low breast cancer could lead to an increased rate of brain metastases in patients with localized breast cancer. We tested this hypothesis in a large cohort of breast cancer patients with long follow-up. METHODS: We included 2686 adult breast cancer patients followed up in Hacettepe University Cancer Center. Patients with 1 + positive HER2 expression and 2 + HER2 expression with a negative FISH were categorized as HER2-low disease. We evaluated the brain metastasis risk with binary logistic regression analyses and reported odds ratios (OR) with 95% confidence intervals (CI). RESULTS: During a median 95.4 (IQR 72.6-123.1) month follow-up, 184 patients developed brain metastasis (6.9%). The brain metastases were developed in 5.1% of the patients with HER2-negative disease, 8.5% of the patients with HER2-low disease, and 10.1% of the patients with HER2-positive disease. A multivariable binary logistic regression model demonstrated an increased risk of brain metastasis in patients with HER2-low disease (OR: 1.611, 95% CI 1.055-2.460, p = 0.027) and in HER2-positive patients (OR: 1.837, 95% CI 1.308-2.580, p < 0.001). Additionally, HR + -HER2-low disease was associated with a decreased DFS compared to HR + -HER2-negative disease (p = 0.008). CONCLUSION: In this study, we observed an increased risk of brain metastasis in localized breast cancer patients with HER2-low disease. We think that a high level of vigilance and a low threshold for brain imaging could benefit HER2-low breast cancer patients similar to the patients with HER-positive disease.

The role of hemogram parameters and C-reactive protein in predicting mortality in COVID-19 infection.

AIM: This study aimed to investigate hemogram parameters and C-reactive protein (CRP) that can be used in clinical practice to predict mortality in hospitalized patients with a diagnosis of COVID-19. METHODS: This cohort study was conducted at University Hospital, which is a designated hospital for COVID-19 patients. Adult patients who were admitted to our hospital emergency department with suspected COVID-19 and who were hospitalized in our institution with a COVID-19 diagnosis were analysed. RESULTS: There were 148 patients hospitalized with COVID-19. All-cause mortality of follow-up was 12.8%. There were statistically significant results between the two groups (survivors and nonsurvivors), which were classified based on hospital mortality rates, in terms of the lymphocyte to C-reactive protein ratio (LCRP), systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), CRP concentration and comorbid disease. In a receiver operating characteristic (ROC), curve analysis, LCRP, NLR, PLR and SII area under the curve (AUC) for in-hospital mortality were 0.817, 0.816, 0.733 and 0.742, respectively. Based on an LCRP value of 1 for in-hospital mortality, the sensitivity and specificity rates were 100% and 86.8%, respectively. Based on the average SII of 2699 for in-hospital mortality, the sensitivity, specificity and accuracy rates were 68.4%, 77.5% and 76.3%, respectively. A total of 19 patients died during hospitalization. All of these patients had an LCRP level ≤ 1; 14 had an NLR level ≤ 10.8; 13 had an SII ≥ 2699 (Fisher's exact test, P = .000). Independent predictors of in-hospital mortality rates were LCRP < 1, PLR, SII ≥ 2699, white blood cell count, CRP, age, comorbidities, and ICU stay. CONCLUSIONS: We concluded that inflammatory parameters, such as LRCP, SII and NLR, were associated with disease severity and could be used as potentially important risk factors for COVID-19 progression.

The effect of swimming training on adrenomedullin levels, oxidative stress variables, and gastrocnemius muscle contractile properties in hypertensive rats.

Introduction/Aim: Regular exercise may have beneficial effects on high blood-pressure, as shown in different types of experimental hypertension models in rats. The present study aims to investigate the effects of 6-week swimming training on blood pressure, oxidative stress variables of selected tissues, serum adrenomedullin (ADM) levels, and in situ muscle contraction in rats with hypertension induced by Nω-nitro-L-arginine methyl ester hydrochloride (L-NAME), an inhibitor of endothelial nitric oxide synthases (eNOs). Materials and Methods: Twenty-six male Sprague Dawley, 8 weeks of age, rats were randomly divided into four groups: (I) normotensive (C), (II) normotensive + exercise (E), (III) hypertensive (L), and (IV) hypertensive + exercise (LE). Hypertension was induced by the oral administration of L-NAME (60 mg/kg) for 6 weeks. Exercise was performed 5 times (1-h each) per week for 6 weeks. At the end of the experiment, blood and tissue samples (the gastrocnemius muscle, heart, kidney, and thoracic aorta) were collected following contractile properties of the gastrocnemius muscle in situ weredetermined. In the collected tissues, oxidative stress (e.g., lipid oxidation and antioxidant enzyme activity) and serum ADM levels were measured. 6-week L-NAME administration per se (Group L) led to a significant increase in systolic and diastolic blood pressure compared to other groups.  Results: Importantly, 6-week exercise caused a protective effect of high blood pressure in the rats received L-NAME (Group LE). The level of ADM was lower in the rats received L-NAME than that of the control group. L-NAME increased lipid peroxidation in the thoracic aorta and decreased superoxide dismutase in the heart, kidney and muscle, and decreased catalase and glutathione in the heart. However, the exercise intervention did not have protective effect on the L-NAME-mediated oxidative damage in the collected tissues.  Conclusion: In conclusion, 6-week exercise intervention rescued rats from high blood pressure, but did not have ameliorative effect on the decreased ADM levels.

The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results.

PURPOSE: Major salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors. MATERIALS AND METHODS: We retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013-December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis. RESULTS: The number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14-86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628). CONCLUSIONS: FNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.

Effect of humate supplementation to feed and/or litter on performance, intestinal viscosity, litter quality, and occurrence of footpad dermatitis in broilers fed barley-based diets.

We investigated the effect of in-feed and/or in-litter supplemental humate against footpad dermatitis (FPD) in broilers fed diets based on barley. Three hundred and sixty 1-day-old Ross 308 broiler chickens were randomly distributed to 24 floor pens (4 treatments, each consisting of 6 replicate pens; 15 chickens per pen) as a completely randomized design with 2 × 2 factorial arrangement of two levels of supplemental humate in feed (0 and 1 g/kg feed) and litter (0 and 5 g/kg litter). Growth performance, intestinal viscosity, litter quality, and incidence and severity of FPD in broilers were measured. In addition, malondialdehyde (MDA) and superoxide dismutase (SOD) levels were determined in blood and footpad tissues of broilers with different FPD scores. The results revealed that there was no interaction between humate supplementation to feed and litter. Neither dietary nor litter supplementation of humate had a significant effect on growth performance, intestinal viscosity, litter quality, and occurrence of FPD. And also, MDA and SOD levels in serum and footpad tissue did not affect by either dietary or litter supplementation of humate. The presence of FPD (score 1) had no effect on MDA and SOD levels in serum, however, increased the MDA and SOD levels (P < 0.001, P = 0.001, respectively) in footpad tissue of broilers. The intestinal viscosity did not differ between FPD scores 0 and 1. In conclusion, findings of this experiment suggest that humate supplementation to feed and litter did not alleviate FPD development in broilers fed diets based on barley. In addition, the presence of FPD lesions increases the MDA and SOD levels in the footpad tissues.

Video-assisted thoracoscopic surgery for the treatment of pericardial hydatid cyst.

Introduction: We would like to present video-assisted thoracoscopic surgery for the treatment of pericardial hydatid cyst.Patient and Method: Thirty two-year-old female patient was referred for evaluation of a left mediastinal mass. Magnetic resonance image, computed tomography and transesophageal echocardiography confirmed a well circumscribed mass with compatible hydatid cyst at the left pericardial wall end of the differantial diagnosis. Our surgical plan entailed the endoscopic resection of pericardial hydatid cyst. We did not adopt a more precise strategy such as open procedure. We managed removal of the hydatid cyst by using video assisted thoracoscopic surgery.Results: The patient has been doing well for 4 years now after her surgery.Conclusion: We think that endoscopic approach is an effective treatment modality for pericardial hydatid cyst.

Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia: A Real-World Multicenter, Retrospective, Mirror-Image Study.

PURPOSE: The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data. METHODS: This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded. RESULTS: Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less. CONCLUSIONS: Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.

High-sensitivity C-reactive protein and high mobility group box-1 levels in Parkinson's disease.

Various immunologic and inflammatory factors are contributed to pathogenesis of Parkinson's disease (PD). High mobility group box-1 (HMGB1) is a protein that plays certain roles in inflammation, DNA repair, transcription, somatic recombination, cell differentiation, cell migration, neuronal development, and neurodegeneration. The aim of the present study was to evaluate the serum levels of HMGB1 and high-sensitivity C-reactive protein (hs-CRP) among patients with Parkinson's disease and healthy controls. This study includes 30 patients with PD and 30 healthy controls, matched sex, age, body mass index, and smoking status. HMGB1 and hs-CRP serum levels were compared between the groups. The diagnostic performance of HMGB1 and hs-CRP was evaluated with receiver operating characteristic (ROC) curve analysis. HMGB1 levels were significantly higher in PD patients than in controls. Hs-CRP levels were significantly higher in PD patients than in controls There was a moderate correlation between hs-CRP and HMGB1 levels in the patient group. The cut-off value of HMGB1 level for the prediction of PD was determined as 32.8 ng/mL with 80% sensitivity and 60% specificity (p = 0.006). The cut-off value of hs-CRP level for the prediction of PD was determined as 0.63 mg/L with 66.7% sensitivity and 77.7% specificity (p = 0.007). This study demonstrates for the first time the association between HMGB1, hs-CRP, and PD. We found that HMGB1 and hs-CRP levels to be significantly higher in the PD patients than in the normal controls. As a result of the ROC curve analysis, HMGB1 and hs-CRP levels may be fair markers in the diagnosis of PD.

Evaluation of CSF flow metrics in patients with communicating hydrocephalus and idiopathic intracranial hypertension.

PURPOSE: To search for CSF dynamics of idiopathic intracranial hypertension (IIH) and communicating hydrocephalus and any correlation between MRI findings, CSF metrics and CSF opening pressure in IIH. MATERIALS AND METHODS: Healthy subjects (30) and subjects with IIH (29) and high-pressure communicating hydrocephalus (43) were enrolled. Nonparametric Kruskal-Wallis test (p = 0.05) was used to compare three groups, Mann-Whitney U test with Bonferroni correction to compare two groups (p = 0.016). Correlation of MRI findings of IIH with CSF metrics and CSF opening pressure was analyzed by Spearman's Rank correlation coefficient (p = 0.05). RESULTS: In IIH, no correlation between MRI findings and aqueductal stroke volume (ASV) but statistically significantly CSF opening pressure in the presence of transverse sinus compression was noted. Comparing with healthy subjects, ASV was nonsignificantly lower and standardized diastolic and sum and difference of systolic and diastolic flow durations were statistically significantly lower. Comparing with hydrocephalus, the width of prepontine cistern (PPC)/the width of aqueductus sylvii (AS) was significantly higher and other CSF metrics with standardized systolic and sum of systolic and diastolic flow durations were significantly lower. In hydrocephalus, ASV and peak velocities were significantly higher. Compared with normal group, PPC/AS and reverse/forward flow duration were significantly lower and other CSF metrics were significantly higher. CONCLUSION: In hydrocephalus, significant increase in ASV and peak velocities were noted. In IIH, CSF opening pressure was statistically significantly high in the presence of transverse sinus compression and standardized diastolic flow durations were statistically significantly short that are probably effects of increased impedance of CSF flow against increased intracranial pressure and unchanged or even decreased intraventricular CSF volume.

Comparison of trace element levels after cardiopulmonary bypass between cyanotic and acyanotic patients.

Trace elements are essential micronutrients for the human body. In this study, we evaluated the alterations in copper, chromium, manganese, selenium, magnesium, zinc, iron, arsenic, boron, and silicon levels in children with cyanotic and acyanotic CHD who underwent cardiac surgery with cardiopulmonary bypass. Participants were divided into the following three groups: patients acyanotic CHDs (n=34), patients with cyanotic CHDs (n=30), and healthy controls (n=30). Blood samples were collected before the surgery and 1 hour after the sternum was closed. Serum trace elements were determined by Inductively Coupled Plasma Optical Emission Spectrometer-ICAP 6000. The baseline serum arsenic, manganese, and zinc levels of both patient groups were lower compared with controls, but there was no significant difference between baseline serum trace element levels of cyanotic and acyanotic patients. In both the patient groups, there was a significant decrease in postoperative serum arsenic, boron, copper, and zinc levels, and a significant increase in postoperative serum iron and magnesium levels. Silicon levels increased in cyanotic patients. Alterations in trace element levels were in the same direction in cyanotic and acyanotic patients. Copper, zinc, and manganase replacement may be needed after on-pump cardiac surgery.

The Effects of Lipopolysaccharide on the Disrupted Blood-Brain Barrier in a Rat Model of Preeclampsia.

BACKGROUND: Preeclampsia is a disorder characterized by high blood pressure and often proteinuria during pregnancy. It is known that a subseptic dose of bacterial lipopolysaccharide (LPS) induces production of proinflammatory cytokines, and possibly increasing the risk for developing preeclampsia. We investigated the effects of LPS on the blood-brain barrier (BBB) integrity in pregnant rats with N(omega)-nitro-l-arginine methyl ester (L-NAME) induced preeclampsia. METHODS: Starting from the 10th day of gestation, pregnant rats were given L-NAME for 10 days to produce hypertension and proteinuria. Animals were then treated with a single injection of LPS on the 19th day of pregnancy. Arterial blood pressure and proteinuria were measured on the day of the experiment, which was 24 hours after the LPS injection. The BBB integrity was assessed by using Evans blue (EB) and horseradish peroxidase (HRP) tracers. RESULTS: Proteinuria was observed in varying degrees, and the arterial blood pressure increased in L-NAME-treated pregnant rats (P < .01). The overall brain EB content did not increase in these preeclamptic rats when compared to pregnant animals, and LPS treatment also did not change EB content. Ultrastructurally, frequent vesicles containing HRP reaction products were observed in the capillary endothelial cells in the cerebral cortex and hippocampus of pregnant rats treated with L-NAME (P < .01). However, LPS did not change the amounts of HRP that mainly accumulated in brain capillary endothelial cells of these animals. CONCLUSION: Our results suggest that, in this experimental setting, LPS does not change the severity of BBB disruption observed in preeclamptic animals.

Customary practices, domestic violence, and psychosomatic pain among adolescent mothers in Turkey.

BACKGROUND: Adolescent motherhood is present in many societies worldwide, including Turkey. AIMS: We aimed to determine the demographical and cultural characteristics of adolescent mothers, lifetime domestic violence and history of miscarriage, and whether they suffer from any kind of medically unexplained (psychosomatic) pain in a study in south-eastern Turkey. METHODS: We included 501 mothers in this case-control study. The study group comprised 228 mothers who gave their first deliveries at or before 19 years of age, and the control group consisted of 273 mothers who first delivered after 19 years of age. The case-control study was conducted between February and April 2013 in Diyarbakir, Turkey. RESULTS: Adolescent mothers marry more frequently with their relatives. They have a higher prevalence of culture-bound customary applications such as bride price. They are less likely to be asked for their consent to marry and tend to have more children. They are more frequently victims of domestic violence and more often report medically unexplained psychosomatic pain. CONCLUSIONS: Adolescent motherhood is still a public health problem that seems to be related to certain culture-bound customary practices, continuing domestic violence across generations, increased number of children, and more prevalent psychosomatic pain.

WONOEP appraisal: Development of epilepsy biomarkers-What we can learn from our patients?

OBJECTIVE: Current medications for patients with epilepsy work in only two of three patients. For those medications that do work, they only suppress seizures. They treat the symptoms, but do not modify the underlying disease, forcing patients to take these drugs with significant side effects, often for the rest of their lives. A major limitation in our ability to advance new therapeutics that permanently prevent, reduce the frequency of, or cure epilepsy comes from a lack of understanding of the disease coupled with a lack of reliable biomarkers that can predict who has or who will get epilepsy. METHODS: The main goal of this report is to present a number of approaches for identifying reliable biomarkers from observing patients with brain disorders that have a high probability of producing epilepsy. RESULTS: A given biomarker, or more likely a profile of biomarkers, will have both a quantity and a time course during epileptogenesis that can be used to predict who will get the disease, to confirm epilepsy as a diagnosis, to identify coexisting pathologies, and to monitor the course of treatments. SIGNIFICANCE: Additional studies in patients and animal models could identify common and clinically valuable biomarkers to successfully translate animal studies into new and effective clinical trials.

Changes in electroencephalographic characteristics and blood-brain barrier permeability in WAG/Rij rats with cortical dysplasia.

PURPOSE: This study investigated the effects of cortical dysplasia (CD) on electrophysiology and blood-brain barrier (BBB) permeability in WAG/Rij rats with genetic absence epilepsy. METHODS: Pregnant WAG/Rij rats were exposed to 145cGy of gamma-irradiation on embryonic day 17 to induce CD. An electroencephalogram was recorded from cortices subdurally in the offspring of the pregnant animals. Horseradish peroxidase (HRP) was used as determinant of BBB permeability. RESULTS: A massive tissue loss in the cerebral cortex was seen in WAG/Rij rats with CD (p<0.05). There was a significant decrease in the number and duration of spike-and-wave discharges (SWDs) and an increase in the frequency of SWDs in the WAG/Rij rats with CD when compared with the properties of SWDs in intact WAG/Rij rats (p<0.01). Ultrastructurally, the accumulation of HRP reaction products in the cerebral cortex and thalamus of WAG/Rij rats was significantly higher than that of control values (p<0.01). The accumulation of HRP reaction products in the cerebral cortex and thalamus regions of WAG/Rij rats with CD increased and was higher than that of the control and WAG/Rij animals (p<0.01). CONCLUSION: In our study, we showed that number and duration of SWDs decreased and SWD frequency increased in WAG/Rij rats with CD, suggesting a shift in seizure pattern. The association of these alterations with significant loss of cortical thickness and increased BBB permeability to HRP tracer may represent a causal relation of the EEG abnormalities with cerebral structural changes in these animals.

Hyperbaric oxygen therapy for five days increases blood-brain barrier permeability.

This study aimed to explore the effects of hyperbaric oxygen (HBO2) on blood-brain barrier (BBB) integrity in rats, when administered for one (at 2.5 ATA, 3 HBO2 sessions a day) and five days (at 2.5 ATA, 3 HBO2 sessions a day for the first two days, and twice a day for the last three days). Horseradish peroxidase (HRP) was used to evaluate the BBB permeability. Superoxide dismutase (SOD) activity, glutathione (GSH) and malondialdehyde (MDA) levels were measured in the cerebral cortex and hippocampus regions. Frequent vesicles containing HRP reaction products were observed in capillary endothelial cells in the cerebral cortex and hippocampus of rats subjected to HBO2. The accumulation of HRP reaction products in these brain regions was significantly higher than that of control animals (P ⟨ 0.01). In animals that received HBO2, MDA levels (P ⟨ 0.01 for five days) and GSH (p ⟨ 0.05 for one day, and P ⟨ 0.01 for five days) were decreased in the cerebral cortex, whereas SOD activities slightly increased in this region. In animals that received HBO2 significant decreases in MDA (P ⟨ 0.05 for one day; P ⟨ 0.01 for five days) and GSH (P ⟨ 0.05 for five days) levels were observed in the hippocampus region, but SOD activities decreased in this region. We showed that HBO2 administered with the doses described above impaired BBB integrity in otherwise healthy rats. Therefore, we suggest that the results of this study should be taken into consideration when patients are exposed to HBO2 with the same doses.

Cost-effectiveness analysis of left atrial appendage occlusion compared with pharmacological strategies for stroke prevention in atrial fibrillation.

BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF. METHODS: A Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One-way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty. RESULTS: LAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115, $2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24 % of 10,000 simulations using a threshold of US$50,000/QALY. CONCLUSIONS: Transcatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies. The transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management.