Multimodal ultrasonography evaluation in thyroid nodule characterization: what is the ideal algorithm?

AIMS: The aim of this study is to investigate the diagnostic performances of Ultrasonography (US), Shear-wave Elastography (SWE), and Superb Microvascular Imaging (SMI) findings in the diagnosis of malignant thyroid nodules (MTNs) and to determine the US algorithm with the best diagnostic performance. MATERIAL AND METHODS: Eighty-one nodules in 77 patients who had underwent multimodal US with biopsy results, were evaluated. Echogenicity, nodule components, contours, presence and type of calcification, and size were analyzed with US. Nodule stiffness and vascular index (VI) measurements were performed via SWE and SMI. The power of the US algorithm in predicting malignancy was evaluated. RESULTS: Hypoechogenicity, irregular contour, aspect ratio (anteroposterior (AP)/transvers diameter) >1, and >43.9 kPa were the characteristicshad significant efficacy in the diagnosis of MTNs. Sensitivity, specificity, and AUC values were respectively 100%, 48.5%, and 0.742 for hypoechogenicity; 80%, 90.1%, and 0.855 for irregular contour; 60%, 71.2%, and 0.656 for aspect ratio >1; 60%, 72.7%, and 0.671 for >43.9 kPa; and 93.3%, 90.9%, and 0.921 for the US algorithm. VI did not show significant efficacy in diagnosis. CONCLUSION: Some B-mode and SWE findings showed sufficient efficacy in differentiating benign and malign nodules on their own. However, diagnostic accuracy increased significantly when the US algorithm was applied.

Effect of Ticagrelor on Left Ventricular Function in Patients with Mildly Reduced Ejection Fraction after Acute Myocardial Infarction

Abstract Background There are limited data about the effect of new P2Y12 inhibitors on left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Objectives We aimed to investigate the effect of ticagrelor on left ventricular function, compared to clopidogrel in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after AMI. Methods In this cross-sectional, single-center study, we included 251 patients with LVEF between 40% and 50% after AMI before discharge. The patients were divided into 2 groups according to the use of ticagrelor (166 patients) and clopidogrel (85 patients). At the end of the 12-month period, LVEF changes were assessed by echocardiography. P < 0.05 was considered statistically significant. Results The mean LVEF before discharge was 46.5% ± 3.6%, and no difference was observed between the ticagrelor and clopidogrel groups (p = 0.20). At the end of the first year, the mean LVEF of the patients increased to 49.8% ± 7.6% in both groups. The use of ticagrelor (β ± SE = 2.05 ± 0.93; p = 0.029), low creatinine level (β ± SE = −10.44 ± 2.35; p < 0.001), low troponin level (β ± SE = −0.38 ± 0.14; p = 0.006), and low heart rate (β ± SE = −0.98 ± 0.33; p = 0.003) were found to be independent predictors of the increase in LVEF (β ± SE 2.05 ± 0.93; 95% confidence interval: 0.21 to 3.90; p = 0.029). Conclusion In our study, ticagrelor improved left ventricular function in 12 months follow-up compared to clopidogrel in patients with HFmrEF after AMI.

Can the greater trochanter/femoral neck signal intensity ratio on coronal T1 weighted images of the hip differentiate normal-abnormal bone mineral density?

A simple index calculated by dividing the greater trochanter signal intensity by that of the femoral neck on coronal T1-weighted magnetic resonance images of the hip may be useful as an opportunistic screening tool to differentiate normal vs. abnormal bone mineral density. PURPOSE: The aim of this study is to evaluate the efficacy of the greater trochanter/femoral neck (T/N) signal intensity (SI) ratio on T1 weighted images of the hip in differentiating patients with normal vs. abnormal bone mineral density (BMD) using hip dual-energy x-ray absorptiometry (DXA) as the reference. METHODS: Three BMD groups according to the T score of the femoral neck (i.e., normal, osteopenia, and osteoporosis) were created, and 20 patients were included for each group. The T/N ratio was calculated by dividing the greater trochanter SI by that of the femoral neck on coronal T1-weighted images. Receiver-operator characteristic (ROC) analysis was performed to determine diagnostic efficacy. RESULTS: The mean age was 59.2±9.4; there were 57 women and 3 men. The mean BMD was 0.67±0.14 g/cm2. The mean T/N ratio for the normal, osteopenia, and osteoporosis groups were 1.37 (±0.12), 1.19 (±0.10), and 1.18 (±0.13), respectively. When the osteopenia and osteoporosis groups were combined into one group, i.e., low BMD group, the mean T/N ratio was 1.18 (±0.11), and it was significantly different from that of the normal BMD group (p<0.00001). In ROC analysis, the area under curve (AUC) for the T/N ratio in the diagnosis of low BMD was 0.870. An optimal cutoff value of 1.28 was found for the differentiation of normal vs. abnormal BMD with 80% sensitivity and 80% specificity. CONCLUSIONS: The T/N ratio seems to be effective at differentiating patients with normal vs. abnormal BMD and may help triage patients for additional evaluation.

The relationship between visceral adipose index and resistant hypertension in people living with diabetes.

OBJECTIVE: Resistant hypertension (RHT) is a more risky HT phenotype in terms of mortality and morbidity. It is more common in people living with diabetes. Studies have shown that visceral adipose index (VAI), a new obesity parameter, is associated with HT and diabetes mellitus (DM). The association of VIA with RHT has not been previously evaluated. The aim of this study is to analyze the relationship between VAI and RHT in people living with diabetes. METHODS: We have conducted a single-center, retrospective study in patients with HT and DM (n = 557). Patients were divided into RHT (n = 274) and non-RHT (n = 283) groups. Patients using 3 or more antihypertensive drugs, one of which was a diuretic drug, were defined as RHT. VAIs of the patients were calculated according to gender. RESULTS: VAI was significantly higher in the RHT group compared to the non-RHT group (4.59 ± 2.77 vs. 3.73 ± 2.31, p < 0.001). Multivariate regression analysis revealed that coronary artery disease (OR 2.099 (1.327-3.318), p = 0.002), waist circumference (OR 1.043 (1.026-1.061), p < 0.001) and VAI (OR 1.216 (1.062-1.339), p = 0.005) were independent risk factors for the development of RHT in people living with diabetes. In addition, smoking, high triglyceride levels, and low high-density lipoprotein levels were among the predictive factors for RHT in people living with diabetes. CONCLUSION: In our study, we have determined that increased VAI is an independent risk factor for RHT in people living with diabetes. VAI may have better ability to predict RHT than many other parameters.

Examination of Facial Convexity and Concavity Values With Reference to the External Acoustic Pore: A Retrospective Study.

The human skull serves as an essential material for facial reconstruction. In particular, the petrous part of the temporal bone is vital due to its compact structure, which can resist mechanical forces. The study aims to give descriptive values to estimate the face shape and produce regression formulas through the external acoustic pore as a reference point. The study was carried out on 3-dimensional computed tomography images, a total of 83 adult images (45 females and 38 males) in the Department of Radiology of Bursa Uludag University Medical Faculty. The distances between the imaginary vertical line passing through the porion and the anthropometric points revealing the facial features were measured for the soft and hard tissue. The vertical distances between the soft and hard tissue landmarks were also measured for both sexes. Measurements were performed with the Image J program, and for the statistical analysis, SPSS 25.0 was used ( P < 0.005). Linear simple regression analysis was used to produce formulas to estimate the soft tissue thickness using hard tissue. Also, discriminant function analysis was performed to determine sex in the presence of an unknown skull. The descriptive values of the variables on the axial and vertical planes and the differences between sexes are given. Also, all formulas make accurate predictions of 90% or more. The authors tried to estimate the anatomical points that roughly reveal the facial features with the regression formulas developed using anthropometric measurements. The authors think that the shape of the face, which is more specific to the individual, can be reached more clearly using mathematical models, and the authors believe that this study will set an example for future studies.

An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography.

BACKGROUND: Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. PURPOSE: To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. MATERIAL AND METHODS: In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. RESULTS: According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images (P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% (P = 0.015). CONCLUSION: The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.

The association between the CT severity index and the pulmonary artery area in COVID-19 pneumonia.

BACKGROUND: The pulmonary artery area (PAA) is a valuable non-invasive method for the diagnosis of pulmonary hypertension. PURPOSE: To compare the change in PAA in patients with COVID-19 with the computed tomography (CT) severity index using follow-up imaging. MATERIAL AND METHODS: A total of 81 patients who were followed up and underwent CT assessment more than once at our hospital's pandemic department were evaluated retrospectively. Patients with progression were separated into three groups: progression ranging from mild-to-mild infiltration (Group A, CT severity index of 0-2); progression from mild to severe infiltration (Group B, CT severity index of 0-2 to 3-5); and progression from severe-to-severe infiltration (Group C, CT severity index of 3-5). The PAAs were calculated separately. RESULTS: The mean age was 56 ± 12 years. In terms of those patients showing progression in the CT images, the number of patients in Groups A, B, and C was 29, 40, and 12 in the right lung; 32, 45, and 4 in the left lung; 23, 45, and 13 on both lungs, respectively. There was no significant difference between the main, right, and left PAAs in Group A (P > 0.05). In Group B, there were significant increases in the areas of the main, right, and left PAAs (P < 0.05). There were also significant increases in the areas of the right and main pulmonary arteries in Group C (P < 0.05). CONCLUSION: PAAs increase as disease involvement advances in cases with COVID-19 pneumonia, which is thought to be correlated with progression.

H2FPEF Score and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is one of the most common complications associated with coronary angiography and percutaneous coronary intervention (PCI). This study evaluated the relationship between the H2FPEF (obesity (H), hypertension(H), atrial fibrillation (F), pulmonary hypertension (P), an age >60 years (E), and E/e' > 9 (F)) score which is used to diagnose heart failure with preserved ejection fraction and CIN. Patients (n = 1346) who underwent PCI for acute coronary syndrome (ACS) between December 2018 and January 2021 were retrospectively included. Contrast-induced nephropathy patients had significantly higher H2FPEF scores (4.10 ± 1.92 vs 2.28 ± 1.56, P < .001). In addition, the H2FPEF score was found to be an independent risk factor for the development of CIN (Odd Ratio 1.633 95% CI (1.473-1.811), P < .001) together with age, diabetes mellitus, systolic pulmonary arterial pressure, and left anterior descending as an infarct-related artery. According to point biserial correlation analysis, CIN and H2FPEF score have a strong correlation (rpb = .376, P < .001). The receiver operating characteristic curve showed the optimal cutoff value of the H2FPEF score to predict the development of CIN was 2.5, with 79.8% sensitivity and 64.1% specificity. In conclusion, the H2FPEF score may predict the development of CIN in patients presenting with ACS and undergoing PCI.

Could Systemic Inflammation in Healthy Individuals With Obesity Indicate Subclinical Atherosclerosis?

Obesity is one of today's pandemics. The link between obesity and inflammation is well established and contributes to atherogenesis. We aimed to determine the relationship between carotid intima-media thickness (cIMT) and inflammation in healthy obese patients (n = 289). The patients were referred to the outpatient clinic due to obesity but had no chronic diseases. Subclinical atherosclerosis was defined as present in participants with cIMT values greater than those expected according to their age group. In patients with subclinical atherosclerosis, the neutrophil-lymphocyte ratio (1.86 ± .65 vs 1.57 ± .45, P < .01), platelet-lymphocyte ratio (120.0 ± 41.2 vs 106.8 ± 30.5, P ≤ .01), and systemic immune-inflammatory index (SII) (550.0 ± 232.8 vs 430.4 ± 135.0, P ≤ .01) were found to be higher. SII was the only independent risk factor for developing subclinical atherosclerosis (odds ratio (OR): 1.995, odds ratio (95% confidence interval): 1.692-4.099), P = .004). The area under the curve (AUC) was .664 (95% CI: .605-.729, P ≤ .001), and the optimal cut-off value was 436.7 (69.3% sensitivity and 61.6% specificity). In conclusion, SII may indicate subclinical atherosclerosis in healthy obese patients, thus leading to early initiation of treatment to reduce cardiovascular morbidity and mortality.

Platelet-hemoglobin ratio predicts amputation in patients with below-knee peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) causes significant morbidity today. Atherosclerosis is evident in the pathophysiological process in most patients, so PAD has similar risk factors as coronary artery disease. Platelet-Hemoglobin ratio (PHR) has been proven to predict mortality in atherosclerotic heart disease. We aimed to determine the relationship between PHR and below-knee amputation. METHODS: The study is a single-center retrospective study. Platelet count/hemoglobin amount formula was used for PHR. Only PAD patients with below-knee critical extremity ischemia and unsuitable for revascularization were included in the study. RESULTS: 235 patients were included in the study retrospectively. The mean age was 65.7 ± 9.9 years and 175(74.5%) of them were male. In the amputated group, white blood cell, neutrophil, platelet, creatinine, glucose, and PHR were higher (p = .031, p = .045, p = .011, p = .048 p = .018, p = .004, respectively). Only hemoglobin values were lower (p = .003). Multivariable regression analysis showed; age, albumin and PHR were determined as independent risk factors for amputation (Age; OR (95%CI): (1.094(1.040-1.152), p = .001) (Albumin; OR (95% CI): 1.950(1.623-1.799), p = .001) (PHR; OR (95% CI): 1.872(1.246-2.812), p = .003). Receiver operating characteristics analysis performed to determine the optimal cut-off value of PHR for amputation, the optimal value was found 2.08 (65.8% sensitivity, 67.5% specificity, p < .001). CONCLUSIONS: PHR was a good predictor for BKA. Using the PHR, it may be possible to identify high-risk patients for amputation.

Novel marker for predicting the severity and prognosis of acute pulmonary embolism: platelet-to-hemoglobin ratio.

Background: We investigated the ability of the platelet-to-hemoglobin ratio (PHR) to predict mortality and disease severity in patients with acute pulmonary embolism (APE). Materials & methods: The severity of APE was classified as massive (high risk), submassive (intermediate risk) or nonmassive (low risk). PHR is defined as platelet count/hemoglobin count. Results: PHR was significantly higher in patients with massive APE, and this elevation showed a gradual increase from the nonmassive group to the massive group (p < 0.001). In-hospital and 1-month mortality were higher in patients with high PHR values. PHR was an independent risk factor for the development of massive APE (odds ratio: 1.014; 95% CI: 1.011-1.017; p = 0.009). Conclusion: PHR values predicted massive APE and were an independent predictor of mortality in APE.

Acute pulmonary embolism is an important cause of death and disability. It is essential to diagnose this disease early, determine its severity and give appropriate treatments. Our study was carried out to investigate whether it is possible to determine the severity of this disease and reveal how it might progress by using the platelet-to-hemoglobin ratio, which is a simple blood measurement and can be found in any health institution.

The impact of midazolam used in cataract surgery sedation on frontal QRS-T angle.

WHAT IS KNOWN AND OBJECTIVE: Midazolam is one of the most commonly used drugs in procedures requiring sedoanalgesia. It affects the myocardium's ventricular depolarization and repolarization. Previous studies examining the arrhythmogenic effects of midazolam yielded conclusive results. These studies are based on QT and Tp -e distances. The frontal QRS-T angle (f-[QRS-T]a) is a new electro cardiac parameter that shows the heterogeneity of ventricular electrical activity. This study aims to examine the effect of midazolam on f-(QRS- T)a and other depolarization-repolarization parameters in patients who have had cataract surgery. METHODS: The study included 177 patients administered midazolam as a sedoanalgesia during cataract surgery. The sedative effect was evaluated 2-3 minutes after a 0.05 mg/kg dose of midazolam was given. Sedation was assessed again by giving 0.5 mg every 2-3 minutes until the desired level of sedation was achieved. 12-lead electrocardiogram (ECG) recordings of all patients were taken just before and immediately after surgery. ECGs were used to calculate the QT interval, QTc interval, Tp -e interval, Tp -e/QT, Tp -e/ QTc ratios and f-(QRS-T)a. RESULTS AND DISCUSSION: After cataract surgery, f-(QRS-T)a was unchanged compared to presurgery (29.14 ± 4.52 vs. 29.18 ± 5.39, p = 0.852). In addition, no significant change in QT(351.32 ± 21.98 vs. 351.94 ± 22.44, p = 0.091), QTc (384.05 ± 24.52 vs. 385.19 ± 26.12, p = 0.819), Tp -e interval (93.12 ± 9.60 vs. 94.44 ± 8.82, p = 0.179) and Tp -e/QT (0.27 ± 0.02 vs. 0.28 ± 0.03, p = 0.664), Tp -e/ QTc ratios (0.28 ± 0.02 vs. 0.29 ± 0.03, p = 0.655) was observed after surgery when compared to presurgery values. Significant ventricular and supraventricular arrhythmias were not observed in any patient during the operation. WHAT IS NEW AND CONCLUSION: Midazolam did not affect f -(QRS-T) with classical repolarization parameters in patients who underwent cataract surgery, according to this study. Midazolam has been found to be safe for the heart in sedoanalgesia. These results show that sedation with midazolam can be performed without electrocardiogram monitoring.

The relationship between long-term statin usage and myocardial injury related to percutaneous coronary interventions evaluated by high-sensitivity troponins.

OBJECTIVE: Myocardial injury related to percutaneous coronary interventions (PCI) might adversely affect the prognosis of patients with coronary artery disease. Our study aimed to investigate the effects of long-term statin usage on myocardial injury related to elective PCI. METHODS: In our study, total 102 patients were included and evaluated in 3 groups based on the statin usage before PCI, "potent statin" group (n=26), "weak statin" group (n=23), and "statin free" group (n=53). The occurrence of the procedural complications was identified (n=31). The myocardial injury was determined by serial high-sensitivity troponin T (hsTnT) testing at 0th, 2nd, 4th, and 12th hour of the procedure. RESULTS: The increase in hsTnT values in the 2nd and 4th hour was significantly lower in the potent statin group than in the other 2 groups (p=0.008 and p=0.009, respectively). In patients with procedural complications, the increase in hsTnT levels at the 2nd, 4th, and 12th hour were also lower in the potent statin group (p=0.032, p=0.019, and p=0.006, respectively). Also, in patients with procedural complications, hsTnT levels exceeding the myocardial infarction limit at the 4th and 12th hour were lower in the potent statin group (p=0.039 and p=0.006, respectively). CONCLUSION: These results show that elective PCI related myocardial injury was less frequent in patients who were using high-dose statins. This result was more pronounced in patients who developed complications during the procedure.

Right- Versus Left-Sided Approach for Transhepatic Tunneled Catheter Placement: Is There a Difference?

OBJECTIVE: We aimed to compare the technical difficulties, complications, long-term efficacy, and risks between right- and left-sided approach transhepatic tunneled catheterization. METHODS: We retrospectively evaluated transhepatic tunneled catheter placement cases in our institution between May 2012 and November 2019. Demographic and procedural parameters were recorded. Statistical tests were used to compare the complication rates of right- and left-sided approach. Furthermore, Cox regression analyses were used to investigate the relationship between functional catheter days and included parameters. RESULTS: A total of 83 procedures were performed in 46 patients, with a female to male ratio of 1.88 and a mean age of 55.5 ± 18.2 years. Indication for catheter placement was chronic renal insufficiency and loss of central venous access through traditional routes in all cases. Median functional catheter durations were 28 days (1-382) and 55.5 days (1-780) for right-sided and left-sided access, respectively. Complication rates were similar for both sides. There was no difference between primary and revision procedures in terms of safety and efficacy outcomes. In univariate Cox regression analysis, gender was the only variable which was found to be statistically significant (HR = 2.014 (1.004-4.038)) for functional catheter days. In multivariate Cox regression model, gender and access side were included which failed to reach statistical significance. CONCLUSIONS: In our study, both right- and left-sided approaches provided similar safety and efficacy outcomes, suggesting that both techniques can be employed based on physician's preference.

An association between femoral trochlear morphology and non-contact anterior cruciate ligament total rupture: a retrospective MRI study.

INTRODUCTION: The present study aims to investigate the association of the femoral trochlear morphology with the risk of ACL injury and whether this can be considered an additional risk factor in this clinical table. MATERIALS AND METHODS: This is a retrospective case-control study with 93 patients, 41 patients with ACL total rupture (ACL-TR), and 52 patients without ACL injury who underwent knee magnetic resonance imaging (MRI) between January 2013 and January 2016. The femoral trochlear morphology was evaluated at the proximal and distal levels from the axial knee MRI. The morphological features of the trochlea using sulcus angle, sulcus depth, condylar heights, trochlear sulcus height, percentage of condyles and trochlear sulcus height to transepicondylar width, and lateral and medial trochlear inclination were evaluated. The notch width index was measured on the coronal MR images for notch stenos. RESULTS: ACL-TR group had a significantly higher sulcus angle (p = 0.00-0.001) and lower sulcus depth (p = 0.00-0.002) than the control group at both levels. Femoral trochlea had morphometric differences between genders. NWI was lower in the ACL-TR group than the control group (control 0.273; ACL-TR 0.247), and there was a statistically significant difference (p = 0.00). CONCLUSION: This study was shown that the difference in morphology between the trochlear sulcus of patients with normal and ACL injuries should be taken into account in order to increase awareness of ACL injuries. We observed that mild trochlear dysplasia may cause intercondylar notch stenosis rather than changing the localization of the patella. Studies are needed regarding the effect of trochlear dysplasia on ACL.

Evaluating the Anatomical Traits of Lip on Three-Dimensional Computed Tomography Images.

BACKGROUND: Lips and mouth are the most recognizable parts of the lower face. The morphometry of the facial organs is important for the balance of the face. Besides congenital anomalies occur on the lips, some kinds of deformities might be seen because of trauma or carcinoma. In this respect, lips are in the study of plastic surgery, maxillofacial surgery and orthodontics. Lip morphology also takes an important role in forensic facial reconstruction (facial approximation). MATERIALS AND METHODS: Twenty parameters on the soft tissue and 12 parameters on the hard tissue were measured on three dimensional (3D) computed tomography (CT) images belonging 50 individuals (25 female, mean age 35.40 ±â€Š9.97; 25 male, mean age 34.32 ±â€Š11.06). RESULTS: Statistical significance was observed on 4 parameters measured at soft tissue and 6 parameters measured in hard tissue. Statistical significance was not seen between the measurements taken bilaterally. Fourteen equations were developed in order to estimate the lip morphometry using the morphometric traits of hard tissue. CONCLUSION: We hope that the results of current study will be useful at surgery and forensic sciences.

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate.

BACKGROUND: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease. METHODS: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility. RESULTS: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT. CONCLUSIONS: Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions.

Bronchial Carcinoid Tumors with Massive Osseous Metaplasia: A Case Report and Review of the Literature.

Bronchial carcinoid tumors are primary lung neoplasms thought to originate from neuroendocrine cells, i.e. Kulchitsky cells, in the bronchial mucosa, although the type of cellular origin has not been clearly understood. A 61-year-old male patient underwent surgery and microscopic examination of the specimen revealed an anastomosing trabecular bony structure among the nests of tumor cells with round nucleus, granular chromatin, and large eosinophilic cytoplasm. Our case has been deemed worthy of being presented as bronchial carcinoid tumor with exaggerated osseous metaplasia.

Association of Mediterranean diet and anthropometric measures with quality of life in coronary artery disease patients.

INTRODUCTION: Introduction: the Mediterranean diet (MD) and ideal body weight are associated with a reduction in the risk of chronic diseases, but their association with health-related quality of life (HRQL) is not clear. Objective: the aim of this study was to assess the association between adherence to MD and the HRQL and anthropometric measurements in coronary artery disease patients. Methods: this cross-sectional study was carried out in 55 women and 84 men who were diagnosed with coronary artery disease by a physician. Anthropometric indices were measured, MD adherence was evaluated with a 14-item questionnaire and the 36-Item Short Form Health Survey (SF-36) was used for HRQL. Results: mean age in males was 63.0 ± 9.7 years and mean age in females was 63.1 ± 10.1 years. Prevalence of overweight and obesity was 53.5% and 40.5%, respectively, in men and 14.5% and 83.6%, respectively, in women. Adherence to the MD was assessed and the median values were found statistically higher in male patients (p < 0.05). A significant positive correlation was found between MD and all physical component summary (PCS, its subscale) and most mental component summary (MCS) (except emotional role, social health subscale) (p < 0.05). Inverse significant associations were found between BMI, waist circumference, waist/height ratio, percent of body fat and both PCS and MCS (including most subscales). Conclusion: adoption of healthy dietary habits (adherence to the Mediterranean diet) by the participants and optimal anthropometric measurements may be considered as a possible contributor to HRQL.

INTRODUCCIÓN: Introducción: la dieta mediterránea (DM) y el peso corporal ideal se asocian con una reducción en el riesgo de enfermedades crónicas, pero su asociación con la calidad de vida relacionada con la salud (CVRS) no está clara. Objetivo: el objetivo de este estudio fue evaluar la asociación entre la adherencia a la DM y la CVRS y las mediciones antropométricas en pacientes con enfermedad arterial coronaria. Métodos: este estudio transversal se llevó a cabo en 55 mujeres y 84 hombres que fueron diagnosticados con enfermedad de las arterias coronarias por un médico. Se midieron los índices antropométricos, se evaluó la adherencia a la DM con un cuestionario de 14 ítems y se utilizó el cuestionario de salud SF-36 para la CVRS. Resultados: la edad media de los hombres fue de 63,0 ± 9,7 y la edad media de las mujeres fue de 63,1 ± 10,1. La prevalencia de sobrepeso y obesidad fue del 53,5% y 40,5%, respectivamente, en hombres y del 14,5% y 83,6%, respectivamente, en mujeres. Se evaluó la adherencia a la DM y los valores de la mediana fueron estadísticamente más altos en los pacientes varones (p < 0,05). Se encontró una correlación positiva significativa (p < 0,05) entre la DM y el resumen general del componente físico (PCS, subescala) y la mayor parte del resumen del componente mental (MCS), excepto el subpeso emocional y la subescala de salud social. Hubo una correlación negativa entre el IMC, la circunferencia de la cintura, la relación cintura/estatura, el porcentaje de grasa corporal y PCS y MCS (incluida la mayoría de las subescalas). Conclusión: la adopción de hábitos alimentarios saludables (adherencia a la dieta mediterránea) por parte de los participantes y las mediciones antropométricas óptimas pueden considerarse como un posible contribuyente a la CVRS.

Association of Mediterranean diet and anthropometric measures with quality of life in coronary artery disease patients / Asociación de la dieta mediterránea y las medidas antropométricas con la calidad de vida en pacientes con enfermedad arterial coronaria

Introduction: the Mediterranean diet (MD) and ideal body weight are associated with a reduction in the risk of chronic diseases, but their association with health-related quality of life (HRQL) is not clear. Objective: the aim of this study was to assess the association between adherence to MD and the HRQL and anthropometric measurements in coronary artery disease patients. Methods: this cross-sectional study was carried out in 55 women and 84 men who were diagnosed with coronary artery disease by a physician. Anthropometric indices were measured, MD adherence was evaluated with a 14-item questionnaire and the 36-Item Short Form Health Survey (SF-36) was used for HRQL. Results: mean age in males was 63.0 ± 9.7 years and mean age in females was 63.1 ± 10.1 years. Prevalence of overweight and obesity was 53.5% and 40.5%, respectively, in men and 14.5% and 83.6%, respectively, in women. Adherence to the MD was assessed and the median values were found statistically higher in male patients (p < 0.05). A significant positive correlation was found between MD and all physical component summary (PCS, its subscale) and most mental component summary (MCS) (except emotional role, social health subscale) (p < 0.05). Inverse significant associations were found between BMI, waist circumference, waist/height ratio, percent of body fat and both PCS and MCS (including most subscales). Conclusion: adoption of healthy dietary habits (adherence to the Mediterranean diet) by the participants and optimal anthropometric measurements may be considered as a possible contributor to HRQL

Introducción: la dieta mediterránea (DM) y el peso corporal ideal se asocian con una reducción en el riesgo de enfermedades crónicas, pero su asociación con la calidad de vida relacionada con la salud (CVRS) no está clara. Objetivo: el objetivo de este estudio fue evaluar la asociación entre la adherencia a la DM y la CVRS y las mediciones antropométricas en pacientes con enfermedad arterial coronaria. Métodos: este estudio transversal se llevó a cabo en 55 mujeres y 84 hombres que fueron diagnosticados con enfermedad de las arterias coronarias por un médico. Se midieron los índices antropométricos, se evaluó la adherencia a la DM con un cuestionario de 14 ítems y se utilizó el cuestionario de salud SF-36 para la CVRS. Resultados: la edad media de los hombres fue de 63,0 ± 9,7 y la edad media de las mujeres fue de 63,1 ± 10,1. La prevalencia de sobrepeso y obesidad fue del 53,5% y 40,5%, respectivamente, en hombres y del 14,5% y 83,6%, respectivamente, en mujeres. Se evaluó la adherencia a la DM y los valores de la mediana fueron estadísticamente más altos en los pacientes varones (p < 0,05). Se encontró una correlación positiva significativa (p < 0,05) entre la DM y el resumen general del componente físico (PCS, subescala) y la mayor parte del resumen del componente mental (MCS), excepto el subpeso emocional y la subescala de salud social. Hubo una correlación negativa entre el IMC, la circunferencia de la cintura, la relación cintura/estatura, el porcentaje de grasa corporal y PCS y MCS (incluida la mayoría de las subescalas). Conclusión: la adopción de hábitos alimentarios saludables (adherencia a la dieta mediterránea) por parte de los participantes y las mediciones antropométricas óptimas pueden considerarse como un posible contribuyente a la CVRS