EMCAPT study: the effect of MitraClip treatment on the mitral annulus and left atrial appendage evaluation by transoesophageal echocardiography.

Introduction: Data on the change in mitral valve annulus diameter (MAD), and left atrial appendage (LAA) structure and function after transcatheter edge-to-edge repair (TEER) of the mitral valve in patients with secondary mitral regurgitation (MR) are lacking. Aim: To evaluate the change in these parameters just after the clip insertion and its relationship with prognosis in the long term. Material and methods: A total of 50 patients (age: 71.5 ±11.3 years, 70% male) with moderate-to-severe or severe MR were included in the study. Transthoracic (TTE) and transoesophageal echocardiography (TEE) were performed before and after the procedure. Prognostic data were recorded with post-procedure telephone calls and follow-up visits. Results: TEE performed during the procedure showed that LAA contraction and filling velocity significantly increased (p < 0.001 for all). Systolic pulmonary artery pressure (SPAP), MAD, and LAA landing zone dimension significantly decreased (p < 0.001 for all). There was only a significant correlation between the MAD before clip placement and the MAD change after clip placement (r = 0.6, p < 0.001). During a mean follow-up period of 10.5 ±8.9 months, no significant correlation was found between MAD change, LAA contraction and filling velocity change, and LAA landing zone dimension change and rehospitalization, stroke, mortality, and composite outcome. Conclusions: The contraction and filling velocity of LAA, SPAP, MAD, and LAA landing zone dimension changed significantly immediately after the MitraClip procedure. Although these parameters are not related to composite outcome in our study, MAD, LAA diameter, and velocity need to be compared between successful and unsuccessful procedures to predict their clinical relevance.

Three dimensional evaluation of the effect of rapid maxillary expansion on maxillary sinus volume.

AIM: To compare the maxillary sinus volume (MSV) of posterior cross bite (PCB) patients before and after rapid maxillary expansion (RME) by cone-beam computed tomography (CBCT). METHODS: A total of 24 patients' CBCT scans that underwent RME therapy for their orthodontic treatment were used. CBCTs were obtained before (T1), immediately after (T2), and 6 months after (T3) RME. MSVs were calculated by using the 3D module of Dolphin 11.0 software. Repeated measures ANOVA (RMANOVA) was used to identify the MSV differences. RESULTS: The results showed no significant differences between the right and left MSVs of the T1 group (p>.05). No significant differences were found between the right and left side MSV of the T2 group (p>.05). There were no significant differences between the right and left side MSV of the T3 group (p>.05). According to the intergroup comparisons, the RMANOVA test results revealed statistically significant right (F = 459.37, p<.001), left (F = 409.34, p<.001), and mean (F = 489.33, p<.001) MSV differences between groups. Multiple comparisons of the right, left, and mean MSV between the T1 and T2, T2 and T3, and T1 and T3 groups with Bonferroni's test revealed no significant differences between the T1 and T2 (p>.05) and T2 and T3 (p>.05) groups. However, significant differences were found in the right (p<.05), left (p<.05), and mean (p<.05) MSV between the T1 and T3 groups. The right, left, and mean MSV of the T3 group were significantly higher than those of the T1 group. CONCLUSION: No significant change was detected in the MSV immediately after RME. However, MSV was significantly increased at the end of the retention period.

Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions

Background/aim: Hypertensive patients have shown autonomic dysfunction that is closely associated with the measurements of heart rate variability (HRV) and heart rate turbulence (HRT). We aimed to show the alterations of HRV and HRT measurements in patients with both dipper and non-dipper hypertension. Materials and methods: This was a retrospective study consisting of one hundred and twenty-three participants (mean age ± SD, 55.7 ± 14.8 years; range, 18­90 years). The participants were divided into two groups: Group1: The patients with dipper hypertension, Group2: The patients with non-dipper hypertension. Two cardiologists performed HRV and HRT using 24-h electrocardiography (ECG) Holter and ambulatory blood pressure monitoring (ABPM) of patients. Results: The results indicated that patients in group 2 had higher low frequency power/high frequency power ratio (LF/HF), lower high frequency power (HF) , root mean square of standard deviation (RMSSD) values than group 1 (p = 0.007, p = 0.008, and p = 0.002, respectively). Group 2 also showed higher heart rate turbulence onset (HRTTO) and lower heart rate turbulence slope (HRTTS) values than Group 1 (p = 0.004, p = 0.001, respectively). We performed multivariate analysis and observed that HRTTS and HRTTO have statistically significant associations with the presence of dipper or non-dipper hypertension [F = 7.755, p = 0.001], LF/HF [F = 7.868, p = 0.001], and HF [F = 4.081, p = 0.020]. Conclusion: This study shows a statistically significant difference in HRT measurements between dipper and non-dipper hypertensive patients. Deteriorated autonomic circadian rhythm and autonomic functions may contribute to these results.

Atrial electromechanical delay and p wave dispersion associated with severity of chronic obstructive pulmonary disease.

BACKGROUND: The aim of this study was to evaluate atrial electromechanical delay (AEMD) with both electrocardiography (ECG) and echocardiography in patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS: Total of 110 patients were included in this cross-sectional case-control study. P-wave dispersion (PWD) was measured on a 12-lead ECG. Atrial electromechanical intervals (PA) were measured as the time interval between the onset of the P wave on the ECG and the beginning of the late diastolic A wave. RESULTS: PWD was found to be 40.9±9.2 ms in the healthy control group, 45.6±8.2 ms in the mild COPD and 44.8±8.7 ms in the severe COPD group (p<0.05). Intra-right atrial EMD was found to be 10.7±5.8 ms in mild COPD, 11.0±7 ms in severe COPD, and it was 16.4±7.3 ms in healthy control group (p<0.001). Interatrial EMD was detected to be 29.5±9.1 ms in the control group, 24.1±9 ms in mild COPD group, and 23.9±11.1 ms in the severe COPD group (p<0.001). CONCLUSION: Both mild and severe COPD groups decreased PWD, increased tricuspid PA and significantly decreased interand right intra-AEMD times in comparison to the control group.

Evaluation of the effects of diode laser application on experimental orthodontic tooth movements in rats. Histopathological analysis.

PURPOSE: To evaluate the effect of diode laser use on experimental orthodontic tooth movements. METHODS: Thirty Rattus norvegicus albinus Wistar were divided into three equal groups (n = 10), two experimentals and one control. Applying 20 g orthodontic force were attached to the maxillary incisors of the rats in all groups. Low dose laser was applied to the surrounding tissues of the maxillary incisors of the rats in the experimental groups. Two exposure times for laser irradiation were used for seven days: t = 12 min (energy dose = 72 J) and t = 9 min (energy dose = 54 J) by a 0.1 W DEKA brand diode laser with wavelength of 980 nm. RESULTS: Osteoclastic activation increased in the 72 J group when compared to control group and decreased in comparison to the 54 J group. Osteoblastic activation was decreased in the 72 J group when compared to the control group and increased in comparison to the 54 J group. CONCLUSIONS: Applying 54 J laser energy has been found effective to accelerate the orthodontic tooth movement.

Bond Strength of Metal and Ceramic Brackets on Resin Nanoceramic Material With Different Surface Treatments.

OBJECTIVE: This study aimed to evaluate the effects of different surface conditoning methods on surface texture and shear bond strength (SBS) of brackets bonded to resin nanoceramic material. METHODS: Ceramic specimens were divided into two groups as metal brackets and ceramic brackets. In each group, the following five subgroups were conditoned with orthophosphoric acid (OPA), hydrofluoric acid (HFA), silica coating with Cojet, Nd: Yag laser, and Femtosecond (Fs) laser. Extra samples were used for scanning electron microscopy and 3D profilometer evaluation. RESULTS: All surface conditioning methods caused optimum or higher SBS. Metal brackets had higher SBS than porcelain brackets, but this difference reached statistical significance only in Fs laser group. OPA caused surface modification comparable to HFA because of polymer content of resin nanoceramic. Although Fs laser and Cojet conditioning caused optimum or higher SBS, surface damage of these methods to the resin nanoceramic specimens clearly seen on 3D profilometer. CONCLUSION: HFA and Nd: Yag laser are effective surface conditioning methods for resin nanoceramics. OPA combined with silane application caused optimum SBS and can be used as an alternative to HFA. Surface texture changes should be considered to determine surface damage while deciding the optimum surface conditioning method for ceramics other than SBS.

Endothelial and Autonomic Functions in Patients with Migraine.

OBJECTIVE: It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. DESIGN: This was a cross-sectional, randomized study. SUBJECTS AND METHODS: A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.8 ± 12.2 years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. RESULTS: Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P < 0.001, P < 0.001, and P = 0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P < 0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P < 0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P < 0.001). CONCLUSIONS: We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura.

Influence of circadian blood pressure alterations on serum SCUBE-1 and soluble CD40 ligand levels in patients with essential hypertension.

BACKGROUND: Dipper and non-dipper hypertension are different clinical forms of essential hypertension. In this study, the effect of circadian blood pressure changes on serum SCUBE-1 and soluble CD40 ligand (sCD40L) levels was investigated in patients with hypertension. METHODS: A total of 100 participants aged 23-89 years were included in the study. Patients with essential hypertension were followed up by ambulatory blood pressure measurement. RESULTS: Serum SCUBE1 levels were significantly higher in the non-dipper group than in the normal group (P < 0.001). Dipper and non-dipper patients had significantly higher serum sCD40L levels when compared to the normal group (P = 0.048 and P = 0.035, respectively). We also found a positive correlation between SCUBE1, sCD40L levels and 24-hour mean systolic blood pressure levels (r: 0.232, p: 0.034 and r: 0.241, p: 0.027, respectively). CONCLUSION: Serum SCUBE1 and sCD40L levels were higher in hypertensive patients than normal participants. Serum SCUBE1 levels were higher in patients with non-dipper compared to other participants.

The Effects of Nocturnal Blood Pressure Paterns and Autonomic Alterations on Erectile Functions in Patients with Hypertension.

PURPOSE: Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction. MATERIALS AND METHODS: This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring. RESULTS: In our study non-dipper hypertensives had statistically more erectile dysfunction (P=0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P= .003)(Daytime Systolic/Nighttime Diastolic Blood Pressure= 0.8 ± 0.07 / 3.90 ± 1.5, respectively). LF/HF daytime/ nighttime in holter reflecting sympathetic overactivity (P< .001). CONCLUSION: Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.

Serum pentraxin-3 levels and flow-mediated dilation in dipper and non-dipper hypertension.

BACKGROUND: Endothelial dysfunction is one of the main pathological processes of hypertension. The association of serum pentraxin-3 (PTX3) levels and endothelial dysfunction becomes a more interesting scientific research issue due to high potential of PTX3 as a diagnostic and prognostic biomarker. We aimed to investigate the relationship between serum PTX3 levels and flow-mediated dilation results in patients with dipper and non-dipper hypertension. METHODS: This study included 90 hypertensive patients were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 38 patients with a dipper pattern and 52 patients with non-dipper pattern. Noninvasive evaluation of the endothelial functions was performed using flow-mediated dilation (FMD) method. RESULTS: Serum pentraxin-3 levels were higher in patients with non-dipper HT compared to dipper hypertension (P = 0.028). In addition, we found negative correlation between serum PTX3 and FMD basal/FMD hyperemia ratio (r = -0.297, P = 0.05 for FMD basal/FMD hyperemia ratio, respectively). CONCLUSIONS: Serum PTX3 levels are closely related with the measures of indirect noninvasive evaluation methods (FMD) in both DH and NDH patients.

The comparison of the relationships about the presence of branch retinal vein occlusion and endothelial functions between diabetic and non-diabetic patients.

OBJECTIVES: The aim of this study was to investigate the endothelial functions in both patients with diabetics and non-diabetics with branch retinal vein occlusion by using pulse wave analysis and flow-mediated dilatation methods. PATIENTS AND METHODS: This cross-sectional study included a total of 136 participants (47 diabetic patients with branch retinal vein occlusion, 43 non-diabetic patients with branch retinal vein occlusion, and 46 otherwise healthy subjects). Evaluation of endothelial functions was performed by flow-mediated dilatation and pulse wave analysis methods. Stiffness index, reflection index (RI), and pulse propagation time were calculated. RESULTS: The mean stiffness index and RI were significantly higher in the diabetic branch retinal vein occlusion group compared with the non-diabetic branch retinal vein occlusion and the healthy controls (for stiffness index: 11.5 ± 2.8 vs. 10.1 ± 2.5 and 8.3 ± 2.0, P < 0.001; and for RI: 75.1 ± 11.7 vs. 65.4 ± 8.4 and 60.2 ± 18.8, P < 0.001, respectively), whereas the pulse propagation time was significantly lower in the diabetic group (156.4 ± 32.3 vs. 174.4 ± 46.5 and 205.0 ± 58.5, P < 0.001, respectively). There was a significant negative correlation between visual acuity and stiffness index (r = -0.512, P < 0.001). Besides, there was also a significant positive correlation between visual acuity and pulse propagation time (r = 0.398, P < 0.001). CONCLUSION: This study demonstrated that the stiffness index and RI values were higher in patients with branch retinal vein occlusion compared to the healthy subjects.

Combined Use of Retraction and Torque Arch with Mini-Screws: A Cephalometric Study.

OBJECTIVE: Our objective was to investigate and quantify the treatment of micro-implant-aided retraction and torque (R&T) arch on dentofacial structures. METHODS: Twelve patients (mean age 21.2 years) who required orthodontic camouflage treatment were included in the study. Following the canine distalization, mini-screws were placed between maxillary first molars and second premolars, and R&T arch was applied for the retraction of incisors. The vertical retraction arms of the arch were adjusted between the apex of the lateral incisor and the alveolar bone so that the retraction force passed through the center of resistance of four incisors and forced the incisors to bodily retraction. Closed coil-springs applying 150 gr of force were used to retract the incisors. The retraction period lasted for 217±34 days. RESULTS: SNA and NV-A decreased (p<0.05), indicating alveolar bone remodeling around Point A. The reduction in the SNA caused a statistically significant decrease in the ANB (p<0.01). SN/1, NA/1, NA-1, and overjet decreased significantly (p<0.01), depending on the retrusion of the incisors. The distances from the apex and incisal point of the central incisor to the SV reference plane also decreased significantly (p<0.01), revealing a nearly parallel movement of the incisors. Anchorage loss of the molars and decrease in nasolabial angle were not significant (p>0.05). CONCLUSION: A combined use of R&T arch with mini-screws is an effective method to retract the incisors without anchorage loss. The type of movement is nearly parallel.

The effects of treatment with atorvastatin versus rosuvastatin on endothelial dysfunction in patients with hyperlipidaemia.

INTRODUCTION: Statins can reduce cardiovascular events and improve endothelial function. However, differences in the effect of statins on endothelial dysfunction have not been researched sufficiently. Here, we aimed to compare the effects of atorvastatin versus rosuvastatin on endothelial function via flow-mediated and endothelial-independent dilation. METHODS: Hyperlipidaemic subjects on treatment with statins for one year (either 20 mg/day atorvastatin or 10 mg/day rosuvastatin) were enrolled in the study. In accordance with the literature, flow-mediated dilation (FMD) and nitrate-mediated endothelium-independent dilation (EID) were measured by ultrasonography on the right brachial artery of each subject. Baseline and final measurements were compared in each group and between the groups. RESULTS: One hundred and four subjects (50 atorvastatin and 54 rosuvastatin users) were enrolled in the study. Fifty-eight subjects were female. The groups were statistically similar in terms of age and body mass index, and haemoglobin, creatinine, total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein cholesterol levels. In each group, the mean final FMD and EID values were higher compared to their respective baseline values, but the mean changes in FMD and EID were statistically similar in both groups (p = 0.958 for FMD and 0.827 for EID). There was no statistically significant difference between the atorvastatin and rosuvastatin groups in terms of final FMD and EID values (p = 0.122 and 0.115, respectively). CONCLUSIONS: This study demonstrated that both one-year atorvastatin and rosuvastatin treatments significantly improved endothelial function, when assessed with FMD and EID and measured by ultrasonography. However, the amount of improvement in endothelial dysfunction was similar in the two treatments.

Cu2+-attached pumice particles embedded composite cryogels for protein purification.

In this study, chromatographic performance of Cu2+-attached pumice particles embedded to monolithic cryogels (Cu2+-APPsEMC) for human serum albumin (HSA) was investigated. Monolithic composite cryogels were prepared by means of polymerization of gel-forming precursors at sub-zero temperatures. The chemical composition of pumice and surface of composite cryogels were determined by X-ray fluorescence spectrometer and scanning electron microscopy, respectively. The highest adsorption capacity (549.5 mg/g pumice) of cryogels was achieved at phosphate buffer of pH 8.0 with initial HSA solution of 3 mg/ml. SDS-PAGE analysis was performed for the samples studied on human serum to determine HSA adsorption/desorption performance of cryogel qualitatively.

The association of paraoxonase 1 gene L55M polymorphism with the extent and severity of coronary artery disease in the Turkish population and its dependence on gender.

OBJECTIVE: Coronary artery disease (CAD) is a common, complex, and progressive disorder characterized by the accumulation of lipids and fibrous elements in the arteries. It is one of the leading causes of death in industrialized nations. Oxidative modification of low-density lipoprotein (LDL) in the arterial wall plays an important role in the initiation and progression of atherosclerosis. Paraoxonase1 (PON1) is involved in lipid metabolism and is believed to protect LDL oxidation. In our study, we aimed to clarify the relationship between PON1 gene L55M polymorphism and the extent and severity of CAD. METHODS: In total, 114 patients (54 males, mean age: 56.7 ± 12.0 years; 60 females, mean age: 55.7 ± 13.2 years) with stable angina or angina equivalent symptoms were enrolled in this prospective study. Cardiological evaluation was performed with electrocardiogram and transthoracic echocardiogram. The presence of hypertension, dyslipidemia, diabetes, and smoking status were ascertained. The patients were grouped according to their Gensini scores and gender. Genetic analysis of the PON1 gene L55M polymorphism was performed by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: We determined that the LL genotype was more prevalent in patients with Gensini score higher than or equal to 20 (p=0.026) and that this correlated with severe atherosclerotic coronary artery lesions in both gender groups, reaching a statistical significance in the female subjects (p=0.038). CONCLUSION: It was thought that the PON1 gene L55M polymorphism plays a significant role in CAD progression, especially in females.

Role of Laryngopharyngeal Reflux in the Pathogenesis of Otitis Media with Effusion.

OBJECTIVE: To determine whether there is an association between otitis media with effusion and laryngopharyngeal reflux in children. MATERIALS AND METHODS: This study included 31 children with otitis media with effusion. The pepsinogen level in the middle ear fluid of all patients was measured by sandwich enzyme-linked immunosorbent assay. Each patient's middle ear fluid was investigated for Helicobacter pylori (H. pylori) using the Campylobacter-like organism (CLO) test. The middle ear pepsinogen levels were compared with those in the serum. The correlation between pepsinogen levels and H. pylori positivity in the middle ear fluid was investigated. RESULTS: The mean middle ear pepsinogen level (211.69 ng/mL) was significantly higher than that in the serum (24.18 ng/mL) in patients with otitis media with effusion. The middle ear aspirates of six patients (19%) were positive for H. pylori, and the correlation between H. pylori positivity and increased pepsinogen levels in the middle ear fluid was statistically significant in patients with otitis media with effusion. CONCLUSION: We detected higher pepsinogen levels and H. pylori positivity rates in the middle ear fluid than in the serum of patients with otitis media with effusion. These results support the role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion.

Effect of Septorhinoplasty on Olfactory Function: Assessment Using the Brief Smell Identification Test.

OBJECTIVE: Septorhinoplasty (SRP), one of the most commonly performed rhinologic surgery procedures, can affect olfactory function; however, the findings of studies investigating smell following SRP are controversial. We used a culturally adapted modified Brief Smell Identification Test (B-SIT) to investigate the long- and short-term effects of SRP on olfactory function. METHODS: We enrolled 59 patients admitted to the Ear-Nose-Throat Clinic, who were complaining of external nasal deformity and nasal obstruction. Functional SRP was performed on all cases. The B-SIT was administered prior to surgery and at 4 and 12 weeks post-surgery. The smell identification score (SIS) reflected the number of correct answers. In addition, we investigated the effects of gender and smoking on olfactory function and whether the SRP procedure changed these associations. RESULTS: The mean preoperative, 4-week, and 12-week postoperative SISs were 10.15±1.30, 10.21±1.52, and 10.92±0.95, respectively. The difference between the preoperative and 4-week postoperative SISs was not statistically significant; however, the 12-week postoperative score was significantly different from the preoperative and 4-week postoperative scores. Furthermore, the repeated measures analysis according to gender and smoking habit revealed a significant difference between the 4-and 12-week postoperative SISs. One patient developed postoperative anosmia; however, the patient recovered in the 12-week postoperative period. CONCLUSION: SRP surgery is a safe procedure in terms of olfactory function. In addition, olfactory function may increase following surgery as a result of improved nasal airflow.

Examination of extremely low frequency electromagnetic fields on orthodontic tooth movement in rats.

The purpose of this study was to evaluate whether 50 Hz extremely low frequency electromagnetic fields (ELF-EMFs) affect the amount of orthodontic tooth movement in rats. The experiments were performed on 18 male Sprague-Dawley rats. The rats were randomly divided into three groups (n = 6): cage-control (Cg-Cnt) group (n = 6); sinusoidal electromagnetic field (SEMF) group (n = 6); and pulsed electromagnetic field (PEMF) group (n = 6). In SEMF and PEMF groups, rats were subjected to 1.5 mT EMF exposure eight hours per day for eight days. In order to obtain tooth movement, holes were drilled on the right and left maxillary central incisors of the rats at a distance 1.5-2 mm away from the gingiva and 20 g of orthodontic forces were applied to the teeth. Generated linear model for repeated measures and Bonferroni tests were used to evaluate the differences between the groups. Interactions among groups by days were found by using Pillai's trace multivariate test. The results showed that significant differences were present among the groups (F = 5.035; p = 0.03) according to the extent of tooth movement. Significant differences between the amount of tooth movements were determined especially after the fifth day and the following days six, seven and eight (p < 0.001). Within the limitations, according to the results of the present study, the application of ELF-EMF accelerated the orthodontic tooth movement in rats.