Characterization of PAHs bound to ambient ultrafine particles around runways at an international airport.

The impact of airport activities on air quality, is not sufficiently documented. In order to better understand the magnitude and properly assess the sources of emissions in the sector, it is necessary to establish databases with real data on those pollutants that could have the greatest impact on both health and the environment. Particulate matter (PM), especially ultrafine particles, are a research priority, not only because of its physical properties, but also because of its ability to bind highly toxic compounds such as polycyclic aromatic hydrocarbons (PAHs). Samples of PM were collected in the ambient air around the runways at Barajas International Airport (Madrid, Spain) during October, November and December 2021. Samples were gathered using three different sampling systems and analysed to determine the concentration of PAHs bound to PM. A high-volume air sampler, a Berner low-pressure impactor, and an automated off-line sampler developed in-house were used. The agreement between the samplers was statistically verified from the PM and PAH results. The highest concentration of PM measured was 31 µg m-3, while the concentration of total PAH was 3 ng m-3, both comparable to those recorded in a semi-urban area of Madrid. The PAHs showed a similar profile to the particle size distribution, with a maximum in the 0.27-0.54 µm size range, being preferentially found in the submicron size fractions, with more than 84% and around 15-20% associated to UFPs. It was found that the ratio [PAHs(m)/PM(m)] was around 10-4 in the warmer period (October), whereas it more than doubled in the colder months (November-December). It is significant the shift in the relative distribution of compounds within these two periods, with a notable increase in the 5 and 6 ring proportions in the colder period. This increase was probably due to the additional contribution of other external sources, possibly thermal and related to combustion processes, as supported by the PAH diagnostic ratios.

An investigation of the relationship between the functional status of the individuals with knee osteoarthritis and their quality of life.

Background: Knee osteoarthritis, a chronic and degenerative joint disease, is more common among the growing elderly population. With the increasing life expectancy and obesity, the significance of knee osteoarthritis for public health has become more evident. Aim: This study was carried out to investigate the relationship between the functional status of individuals with knee osteoarthritis and their quality of life. Patients and Methods: The population of the study consisted of individuals with 1-4 s level of knee osteoarthritis diagnosed over the age of 50 who attended the physical therapy and rehabilitation polyclinic at Atatürk University hospital. The study was carried out with 129 individuals with knee osteoarthritis without sample selection. The data were collected using a demographic questionnaire and The Knee Injury and Osteoarthritis Outcome Score (KOOS) and analyzed with SPSS 22.00 statistical package program using frequency, percentage, t-test, Mann-Whitney U test, Kruskal-Wallis H test, and Dunnett T3 post hoc test. Results: According to the results, the KOOS Function and Daily Life scores showing the functional status of the participants were 46.61 ± 16.17. The Function and Sports/Leisure Activities subscale scores were 29.49 ± 23.73, and the mean scores of the Quality of Life subscale were 34.15 ± 18.11. A positive significant relationship was determined between the functional status and the quality of life in the individuals. Conclusions: As the functional status of individuals improves, the quality of life increases too.

Effect of Kegel exercises on the prevention of urinary and fecal incontinence in patients with prostate cancer undergoing radiotherapy.

PURPOSE: This is a nonrandomized experimental study conducted to evaluate the effect of Kegel exercises on the prevention of urinary and fecal incontinence in prostate cancer patients undergoing radiotherapy. METHOD: The study was conducted with 30 patients in the intervention group (IG) and 30 patients in the control group (CG). Data were collected using a patient information form, CTCAE, EORTC QLQ-C30, and a follow-up form reporting weekly Kegel exercises. Before radiotherapy, the IG was provided with Kegel exercise training via visual training material; exercises were performed under the supervision of the researcher, and the exercise pamphlet was handed out. During radiotherapy, weekly follow-ups were performed by face-to-face contact or phone calls. No similar application was provided to the CG. CTCAE and EORTC QLQ-C30 were evaluated three times (baseline, 4th and 8th weeks of exercises). RESULTS: At the end of the 4th week of exercises, 1st-grade urinary incontinence (UI) developed in the IG (10%) and in the CG (13.3%). At the end of the 8th week, 2nd-grade UI (3.3%) developed in the IG and 1st-grade (10%) and 2nd-grade UI (6.7%) developed in the CG. Fecal incontinence developed in neither group. At the end of the intervention, there was a significant improvement in Role, Social function and Global Health Status in the IG compared with the 4th week scores. In addition, less Fatigue, Diarrhea, Anorexia and Constipation scores were found compared with the baseline. CONCLUSION: Kegel exercises can be recommended as an approach in the prevention of urinary incontinence and to improve quality of life.

Systemic inflammation in both open-angle and angle-closure glaucoma: role of platelet-to-lymphocyte ratio.

AIM: To analyse the effect of systemic inflammatory status in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) by calculating platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). METHODS: This retrospective case-control study included 200 patients with POAG, 22 patients with PACG and 100 healthy subjects. The participants' white-blood-cell, lymphocyte, neutrophil, and platelet counts were recorded from previous blood assays. NLR and PLR were calculated manually. Results were compared among the groups. RESULTS: Both the POAG and PACG groups had higher platelet counts and PLR values than the control group (p=0.001 and p=0.001; respectively). The difference in NLR between POAG, PACG and control groups was not statistically significant (p=0.076). The POAG group had higher NLR values than the control (p=0.035). CONCLUSION: Both the POAG and the PACG groups exhibited higher platelet and PLR levels than the control. These results indicate a potential role of systemic inflammation in the pathogenesis of POAG and PACG (Tab. 4, Fig. 1, Ref. 35).

Variations of the 6th cranial nerve (nervus abducens) in the petroclival region: A microsurgical study.

The aim of this study is to present the variations of nervus abducens in localization and number as it pierces the clival dura mater. The calvaria of 16 cadaveric heads were removed by making horizontal incisions from Glabella to Inion in both sides of the head. The dura mater was dissected. Cerebrum and cerebellum were taken out by obtuse dissection. Dissections of cavernous sinus were made under the stereomicroscope and the findings were photographed. Out of 16 specimens, one of them was excluded. Fifteen heads were bilaterally analyzed. Analysis of these nerves presented four different variations. Variation types a classified CN VI as a single trunk and entering a single dural pore with 77% occurrence. Variation type b classified CN VI with two branches running in the petroclival region and entering a single dural pore with 10% occurrence. Variation type c classified CN VI as 2 trunks and entering 2 separate but close dural pores with 10% occurrence. Variation type d classified CN VI with 2 distinct trunks and 2 branches entering 2 separate but close dural pores with 3% occurrence. CN VI plays a major role in the clinic of the eye. Due to its intracranial and extracranial course, injuries to the head and to the nerve may result in malfunctioning of the lateral muscles of the eye. Therefore, the variations of branching, relations and its course were analyzed.

Resuscitation quality of rotating chest compression providers at one-minute vs. two-minute intervals: A mannequin study.

OBJECTIVE: The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ED. MATERIALS AND METHODS: Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p=0.83), mean compression depth (p=0.61), good compressions (p=0.31), the percentage of complete release (p=0.07), adequate compression depth (p=0.11) or the percentage of good rate (p=51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p<0.001). In the 2-minute group, the mean compression depth (p=0.19), good compression (p=0.92), the percentage of complete release (p=0.28), adequate compression depth (p=0.96), and the percentage of good rate (p=0.09) were not statistically significant over time. In this group, the number of compressions (248±31 vs 253±33, p=0.01) and mean compression rates (123±15 vs 126±17, p=0.01) and flow time (p=0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups. CONCLUSION: There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups.

Distinctive role of opinion leaders in the social networks of school adolescents: an investigation of e-cigarette use.

OBJECTIVES: This study examines a diverse set of social motives (e.g. peer support, peer pressure, social loneliness) for e-cigarette use, through the mediating effects of opinion leadership, among both male and female adolescents. STUDY DESIGN: Prospective cohort study. METHODS: The data were obtained from a survey conducted among 666 adolescents across 14 school classes, namely, students at three urban schools, public and private, in Lille, France. The proposed integrative model includes social motives, opinion leadership and e-cigarette use in a trilateral relationship; gender is proposed and tested as a potential moderator in a structural equation model. RESULTS: More positive peer support is negatively associated with opinion leadership and e-cigarette use. Both loneliness and susceptibility to peer influence are positively related to opinion leadership and e-cigarette use. Moreover, social support from peers and opinion leadership shape e-cigarette use differently across genders. CONCLUSIONS: Policy makers should account for the various (positive and negative) roles of peers and consider the gender of their audience when designing anti-e-cigarette policies.

Depression and socio-economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG).

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.

Comparison of hematologic toxicity between 3DCRT and IMRT planning in cervical cancer patients after concurrent chemoradiotherapy: a national multi-center study.

PURPOSE: To compare the incidence and severity of acute and chronic hematologic toxicity (HT) in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) for curative treatment of cervical cancer and to ascertain the dosimetric parameters of two techniques associated with acute and chronic HT. MATERIALS AND METHODS: A total of 127 patients with cervical cancer receiving concomitant pelvic radiotherapy (RT) and cisplatin were evaluated. Pelvic bone marrow (BM) was contoured for each patient and divided into five sub-regions: lumbosacrum (LS), ilium (IL), lower pelvis (LP), pelvis (P), and whole pelvis (WP). The volume of each BM region receiving 10, 20, 30, and 40 Gy was calculated (V10, -V20, -V30, and -V40). The lowest level of hemoglobin, leukocyte, neutrophil, and platelet counts were obtained during chemoradiotherapy and six months after RT. The nadir values were graded according to Common Terminology Criteria for Adverse Events (version 3.0). RESULTS: Grade 2 or greater acute anemia, leukopenia, neutropenia, thrombocytopenia was observed in 2%, 41.5%, 12% ,and 0% in 3DCRT group and in 27%, 53%, 24.5%, and 4.5% in IMRT group, respectively. Grade 2 or greater chronic anemia, leukopenia, neutropenia, and thrombocytopenia was observed in 11%, 10%, 6%, and 0% in 3DCRT group and in 11%, 9%, 4.5%, and 0% in IMRT group, respectively. LS-V30, 40; IL-V10, 20, 30, 40; LP-V10, 20 ,40; P-V10, 20, 30, 40, and TP-V10, 20, 30, 40 were significantly reduced with IMRT planning compared to 3DCRT planning. Logistic regression analysis of potential predictors showed that none of the dosimetric parameters were significant for predicting acute and chronic HT. CONCLUSION: The present findings showed that IMRT planning reduced irradiated BM volumes compared to 3DCRT planning. However, no difference between the two techniques was observed in terms of acute and chronic HT. Further studies are needed to confirm these results.

Optical coherence tomography in bioabsorbable stents: mechanism of vascular response and guidance of stent implantation.

Fully biodegradable L-polylactic acid stents (biodegradable vascular scaffold, BVS), the latest breakthrough in the area of coronary implants, entered clinical trials in 2005 and became commercially available in 2011. Optical coherence tomography (OCT) was used from the first implants to study the vessel wall response and the timing of the resorption process in man. Analysis of BVS with OCT has several advantages over that of metallic stents. BVS polymeric struts are transparent to the light so that scaffold integrity, apposition to the underlying wall, presence of thrombus and hyperplasia, and changes in the strut characteristics over time can be easily studied. We present a comprehensive review of the findings OCT provided when used as a research tool in serial examination up to five years for investigation of the mechanism of resorption, neointimal coverage, shrinkage and late lumen enlargement. We also report our experience with OCT in 47 lesions of various complexity as a practical means of percutaneous coronary intervention guidance during BVS implantation.

The protective effects of Ginkgo biloba extract (EGb-761) on radiation-induced dermatitis: an experimental study.

BACKGROUND: Irradiation of the skin induces production of free radicals, resulting in oxidative stress. EGb-761, an extract from the leaves of the Ginkgo biloba tree, has been reported to be an effective exogenous antioxidant based on its free-radical scavenger properties. AIM: To investigate the protective effect of G. biloba extract (EGb-761) on radiation-induced dermatitis in rats. METHODS: Forty male Wistar rats were divided equally into four groups: group 1 received sham radiotherapy (RT) without EGb-761, group 2 received sham RT with EGb-761, group 3 received RT without EGb-761, and group 4 received RT with EGb-761. Levels of malondialdehyde (MDA), nitric oxide (NOx) and glutathione (GSH) were measured. Dermatitis was assessed with a semiquantitative dermatitis item score. The intensity of staining and diffusion of expression for proliferating cellular nuclear antigen (PCNA) and transforming growth factor (TGF)-ß3 were also evaluated. RESULTS: The enhanced oxidative stress seen after RT was markedly diminished when EGb-761 was administered with RT; significantly lower mean MDA (P < 0.005) and higher mean GSH (P < 0.001) levels were seen in group 4 compared with group 3. Although there was a decrease in NOx levels, this was not significant. All (100%) of the animals in group 3 developed dermatitis, whereas only 13% of the animals in group 4 did so (P < 0.0001). There was a significant difference between group 1 and group 3 in PCNA and TGF-ß3 staining (P < 0.05), whereas no difference was seen between groups 3 and 4; however, the intensity of staining and diffusion of expression were lower in group 4 than in group 3. CONCLUSIONS: Prophylactic administration of EGb-761 seems to have a protective effect against radiation-induced dermatitis.

Management of chylothorax with octreotide after congenital heart surgery.

OBJECTIVE: Chylothorax is a rare complication of congenital cardiac surgery that can seriously impair the postoperative course unless treated properly. We present our treatment protocol and results with octreotide, a somatostatin analogue, in cases of chylothorax following congenital heart surgery. MATERIAL AND METHODS: Between March 2006 and December 2009, 12 patients were treated for chylothorax following congenital cardiac surgery. Patients consisted of five females and seven males, with a mean age of 16.6 months (7 days - 36 months). Octreotide was administrated as a continuous intravenous infusion with a dosage of 4-10 µg/kg/h. RESULTS: Chylothorax was successfully resolved in an average of 10.3 days (7-14 days) with octreotide infusion and a strict oral diet containing medium-chain triglycerides. At a mean follow-up of 9.4 months (1-35), all patients are doing well, without any recurrence of chylothorax. CONCLUSION: Octreotide, a long-acting somatostatin analog, is an effective and safe agent for the treatment of postoperative chylothorax and warrants further investigation in a larger series with a greater number of patients.

Factors affecting morbidity and mortality in flail chest: comparison of anterior and lateral location.

OBJECTIVE: Flail chest is most often accompanied by significant underlying pulmonary parenchymal injuries and may constitute a life-threatening thoracic injury. In this study we evaluated the treatment modalities for flail chest depending on the effect of trauma localization on mortality and morbidity. METHODS: Between 2003 and 2008, 23 patients (20 males/3 females) were treated for flail chest. Location of the trauma in the chest wall, mechanical ventilation support, prognosis and injury severity score (ISS) were recorded for all patients. Mechanical ventilation support was given in 14 patients (60.8 %), and 12 of these 14 patients required subsequent tracheostomy. Internal fixation was used in 3 patients. RESULTS: The major cause of flail chest was a car crash in 18 of 23 patients (76 %). Median ISS was 62.8 for all patients. The patients with flail chest who had bilateral costochondral separation (anterior chest location) (group I, n = 10) had a significantly higher ISS than those with single-side posterolateral flail chest (group II, n = 13; ISS: 70/55; P = 0.02). The need for mechanical ventilation support was also higher in the group with bilateral costochondral separation. Morbidity was higher in group I than in group II ( P = 0.198), and mortality was also significantly higher in group I ( P = 0.08). Patients with a cranial trauma and flail chest had a higher mortality (19 %) than patients with only flail chest (no mortality). The mean ISS was 75 for patients with cranial trauma and flail chest and 55.7 ( P = 0.001) for patients with only flail chest. Sepsis and subarachnoid bleeding were the major causes of mortality. The mean ISS was 54.5 for patients under the age of 55 (n = 14) whereas it was 69.4 in those aged 55 and over (n = 9; P = 0.034). Mortality in the older group was also higher (33 % versus 7 %; P = 0.02). CONCLUSION: Early intubation and mechanical ventilation is of paramount importance in patients with flail chest. However, prolonged mechanical ventilation is associated with a poor outcome. Tracheotomy and frequent flexible bronchoscopy are an effective pulmonary toilet. Advanced age was a major risk factor for flail chest trauma mortality, together with the severity of the injury. When cranial trauma was accompanied by flail chest, mortality and morbidity rates increased. Bilateral costochondral separation also increased the risk of morbidity and the need for mechanical ventilation in patients with flail chest.

Clinical efficacy of leukofiltration on cardiopulmonary bypass related inflammatory response: Fact or Foe?

OBJECTIVE: The powerful precept of preoperative risk assessment has been applied to compare the efficacy of leukofiltration techniques for high-risk cohorts with the documentation of broad indicators of systemic inflammation. METHODS: Forty high risk patients were prospectively assigned to four perfusion protocols; the first group (n=10): Polyethyleneoxide (PEO) based heparin bonded extracorporeal circuits (ECC) + Continuous Leukocyte filtration; the second group (n=10): uncoated ECC + leukofiltration; the third group (n=10): PEO based heparin bonded ECC without leukofiltration; and control (n=10). Blood samples were obtained at the following intervals: Baseline (T1), on cardiopulmonary bypass (CPB) (T2), Cross clamp (T3), off CPB (T4), Intensive care unit-24 h (ICU24) (T5), ICU48 (T6). RESULTS: Tumor Necrosis Factor-alpha levels were significantly lower in Group 1 at T3, T4 (p<0.05) vs. control. Procalcitonin levels were significantly lower in Group 1 at T5, T6 (p<0.05) vs. control. Creatinine kinase-MB levels in coronary sinus blood demonstrated well preserved myocardium in filtered+coated (Group 1) and coated groups (Group 3) (p<0.05). Matrix metallopeptidase- 9 and D-Dimer levels in filtered+coated group were significantly lower at T5 and T6 vs. control (p<0.05). CONCLUSION: Leukocyte filtration on coated surfaces alleviated systemic inflammatory response with a better clinical outcome in high risk patients.

Bilateral trapped lung with concomitant Wermer's syndrome and cutis laxa.

We report a rare occurrence of trapped lung associated with Wermer's syndrome and cutis laxa. A 25-year-old man with bilateral trapped lung presented with respiratory distress. Additional investigation revealed adenoma of the parathyroid and hypophysis, a neuroendocrine abdominal tumor, and cutis laxa. Successful treatment of the respiratory symptoms was achieved through a median sternotomy with bilateral decortication, and excision of the bilateral fibrous pleural bands and bullae on the right upper lobe. Octreotide therapy was initiated and a percutaneous ultrasound-guided alcohol injection to the parathyroid adenoma was done. The patient has gynecomastia, acromegaly, and kyphoscoliosis. The patient remains well at 19 months after treatment.

Unusual manifestation of bronchiolitis obliterans organizing pneumonia.

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon fibrotic lung disease characterized by involvement of the small conducting airways. BOOP has a wide spectrum of radiologic and clinical features. Usually, it appears radiologically as multiple alveolar patchy areas of consolidation. However, different presentations have also been described. We report two cases of solitary masses of the lung that preoperatively presented as malignant lesions but were subsequently diagnosed as bronchiolitis obliterans organizing pneumonia. One of the cases of BOOP was probably secondary to suppuration of a hydatid cyst. Complicated hydatid cyst may give rise to various clinical manifestations and may present radiologically as a solid lung mass. The radiologic findings of pulmonary ruptured or complicated hydatid cyst may resemble primary lung tumor. Open surgery can be required for not only for diagnosis but also for treatment of solitary BOOP. A review of the literature is also presented.

Descending necrotizing mediastinitis: treatment of a delayed case.

Descending necrotizing mediastinitis (DNM) is a severe and rare infection that can spread to the mediastinum through the anatomic cervical spaces, secondary to cervical or odontogenical infections. Delay of diagnosis and insufficient drainage always result in high mortality. We present a case of DNM with bilaterally pulmonary infiltration in a 45-year old woman. The cause of DNM was postextraction odontogenic abscess and delay of diagnosis which resulted in sepsis. Surgical treatment was performed as soon as possible in following sequence: cervical mediastinotomy, right thoracotomy, and pleural and mediastinal irrigation with saline. Although the diagnosis was delayed, invasive surgical interventions allowed successful eradication of the injection.

Sunflower seed mimicking complicated hydatid cyst.

We present a case of a foreign body in lung parenchyma, found incidentally during surgery in an adult woman. The clinical and radiological findings were consistent with a pulmonary hydatid cyst. Owing to the similar clinical and radiological appearances, a thoracotomy was required for the correct diagnosis of a sunflower seed mimicking hydatid disease.