Neurocognition and social cognition in youth and young adults at ultra-high-risk for psychosis and bipolar disorder.

BACKGROUND: Schizophrenia and bipolar disorder are associated with significant deficits in neurocognition and social cognition. Unlike the studies in chronic stages of these disorders, very limited information is available regarding neurocognitive and social-cognitive impairment before the onset of bipolar disorder. Our main aim was to investigate the differences in neurocognition and social cognition between individuals at ultra-high risk for psychosis (UHR-P) and bipolar disorder (UHR-BD). METHODS: This study included 152 help-seeking individuals identified as UHR-P (n = 78) and UHR-BD (n = 74), who were compared with a healthy control group (n = 43). A comprehensive neuropsychological battery was administered to all participants. RESULTS: UHR-P was associated with widespread deficits in all neurocognitive and social-cognitive domains. Effect sizes (Cohen's d) of these deficits ranged from -0.57 to -1.34. UHR-BD was associated with significant deficits in processing speed, executive functions, sustained attention and social cognition (d = -0.48 to-0.70, p < 0.05). UHR-P performed significantly worse than UHR-BD in social cognition, processing speed, verbal memory and executive function domains (d = -0.39 to-0.64, p < 0.05). Negative symptoms were associated with impaired social cognition in the UHR-P group and verbal memory deficits in the UHR-BD group. Cognitive impairment was associated with functional impairment in both groups. CONCLUSIONS: While UHR-P is associated with more widespread cognitive impairment, deficits in processing speed, executive functions, sustained attention and social cognition might be common features of both UHR groups. In early intervention services, cognition should be considered as a target for assessment and intervention not only for individuals at high risk for psychosis but also for bipolar disorder.

Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Prospective, Randomized, Controlled Double-Blinded Comparison of Propofol and Ketofol Anesthesia.

BACKGROUND: ERCP is an endoscopic procedure for the diagnosis and treatment of biliopancreatic system diseases. An increase in intra-abdominal pressure due to the insufflation of air to the intestinal lumen may be transmitted to ICP through the course of ERCP. In this prospective, randomized, controlled double-blinded study, we aimed to assess the ICP change using ultrasonography measurement of ONSD in patients undergoing ERCP comparing the effects of propofol and ketofol anesthesia. MATERIAL/METHODS: One hundred and nine patients undergoing ERCP under propofol or ketofol anesthesia were enrolled in the study. Ultrasonography measurement of ONSD was performed before (T0) and immediately after induction of anesthesia (T1), during sphincterotomy (T2), at the end of procedure (T3), and after the patient is fully awake (T4). RESULTS: Comparison of ONSD values and ONSD alteration between groups showed no statistically significant difference (P > 0.05). Both groups showed significantly greater changes from T0 to T2 compared with values from T0 to T1, T3, and T4, respectively (P = 0,000). T0 to T3 alteration was also significantly greater than T0 to T1 and T4 change in both groups (P = 0,000). CONCLUSIONS: ERCP procedure increases intracranial pressure most prominently during sphincterotomy both under propofol or ketofol anesthesia. Further studies are needed to investigate the impact of this phenomenon on adverse clinical outcomes.

Social cognition and neurocognition in first-episode bipolar disorder and psychosis: The effect of negative and attenuated positive symptoms.

BACKGROUND: Schizophrenia and bipolar disorder are associated with neurocognitive and social-cognitive impairments. To date very few studies investigated social cognition in first-episode bipolar disorder (FEBD). Our main aim was to investigate the differences in social cognition and neurocognition between FEBD and first-episode psychosis (FEP). Another aim was to investigate neurocognitive correlates of negative symptoms and attenuated psychotic symptoms in FEBD. METHODS: This study included 55 FEBD, 64 FEP and 43 healthy controls. A comprehensive neuropsychological battery assessing social cognition, processing speed, verbal and visual memory, working memory, sustained attention, and executive functions was administered to all participants. RESULTS: Both FEBD and FEP were associated with widespread deficits in all neurocognitive domains and social cognition. Both FEP (d = -1.19) and FEBP (d = -0.88) were also impaired in social cognition. In FEP, effect sizes (Cohen's d) of neurocognitive deficits ranged from -0.71 to -1.56. FEBD was also associated with relatively milder but similar neurocognitive deficits (d = -0.61 to-1.17). FEBD group performed significantly better than FEP group in verbal and visual memory, processing speed, and executive function domains (d = -0.40 to-0.52). Negative symptoms and social functioning were associated with neuropsychological impairment in both groups. The severity of attenuated psychotic symptoms was associated with poorer verbal memory in FEBD (r = -0.39, p < 0.01). LIMITATIONS: The cross-sectional nature of the current study is the main limitation. CONCLUSIONS: Neurocognitive and social-cognitive deficits are evident in both FEBD and FEP. In FEBD, more severe memory deficits might be markers of clinical overlap and shared neurobiological vulnerability with psychotic disorders.

Could subcutaneous rifampicin administration be an effective approach for reducing episiotomy infections?

OBJECTIVE: The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection and wound dehiscence in women who had vaginal delivery with episiotomy. PATIENTS AND METHODS: A prospective cross-sectional study was conducted with a total of 400 primigravida patients. In the study group, irrigation with rifampicin of the subcutaneous tissue of the episiotomy incision was applied, and in the control group, there was no irrigation. Patients were evaluated for infection at the 1st, 3rd week, and 1-month controls. The groups were compared according to episiotomy infection and wound dehiscence rates. RESULTS: The episiotomy infection rate of the whole group was 8.5%, the wound dehiscence rate was 3.75%, and the average time of occurrence of the infection was 5.35±2.21 days. The most common infection findings were local pain and purulent discharge at 4.75%. In the control group, where the infection occurred earlier, the infection and wound dehiscence rates were significantly higher [11.5% vs. 5.5%; 6.0% vs. 1.5% (p<0.05)]. Purulent discharge was the most common finding in the control group, and local pain in the study group, but no significant difference was found between the two groups in terms of findings (p<0.05). When only the patients who developed episiotomy infection were evaluated among themselves, the only significant difference was found in wound dehiscence, which was higher in the control group (p<0.05). CONCLUSIONS: Considering the high rates of episiotomy in our country, subcutaneous irrigation with rifampicin is a good option that can be kept in the foreground due to its low cost and ease of application.

Oxidative stress, apoptosis, inflammation, and proliferation modulator function of visnagin provide gonadoprotective activity in testicular ischemia-reperfusion injury.

OBJECTIVE: Visnagin (Vis) is a compound found in the flowers and seeds of the Ammi visnaga plant with promising antioxidant and anti-inflammatory properties. We aimed to investigate the dose-dependent gonadoprotective effects of visnagin in rats while considering oxidative stress, apoptosis, and inflammation-related protein expression levels. MATERIALS AND METHODS: Twenty-eight adult rats were divided into four groups of seven animals each; control, ischemia/reperfusion (I/R), I/R+30Vis, and I/R+60Vis. Animals in control received no surgical application and were sacrificed at the end of the experiment. The rats in I/R, I/R + Vis30, and I/R + Vis60 were exposed to testicular ischemia and the animals in I/R + Vis30, and I/R + Vis60 groups received either 30 or 60 mg/kg visnagin intraperitoneal. At the end of the experiment, testis tissues were used for the measurement of oxidative stress, apoptosis, and inflammation. RESULTS: Our microscopic examinations indicated that I/R resulted in testicular degenerations and morphological alterations, which were improved in visnagin-treated animals. The biochemical analyses demonstrated that oxidative stress in the I/R group increased significantly (p<0.05) compared to the control group. The immunohistochemical examinations showed that pro-apoptotic Bax and Caspase 3 expressions, and pro-inflammatory tumor necrosis factor-alpha (TNF-α) levels were significantly up-regulated (p<0.05) but proliferating nuclear antigen (PCNA) levels in I/R group was significantly (p<0.001) down-regulated compared to the control group. CONCLUSIONS: Ischemia leading to testicular torsion is a reproductive health-affecting problem, and current surgical treatment methods might be insufficient to recover the testis due to the accumulation of reactive oxygen species (ROS). Our observations indicate that visnagin is a potential co-modality along with the surgical interventions for the recovery of ischemia encountered testis, but we believe the requirement of more detailed studies to explore the underlying signaling pathways and the strength of visnagin against testicular ischemia-reperfusion injury. Graphical Abstract: https://www.europeanreview.org/wp/wp-content/uploads/GRAB.jpg.

Evaluation of the relationship between trochlear and patellar morphology and patellar chondromalacia with magnetic resonance imaging.

It was aimed to investigate the relationship between magnetic resonance imaging (MRI) measurements of trochlear and patellar morphology and grade 3-4 patellar chondromalacia. Grade 3-4 patellar chondromalacia group, and an age- and sex-matched control group with normal patellar joint cartilage were comprised. For trochlear morphology evaluation in MRI; sulcus angle, trochlear angle, lateral trochlear inclination angle and medial trochlear inclination angle were measured. For patellar morphology evaluation; patella trochlear ratio, insall-salvati ratio, modified Insall- Salvati ratio and Blackburne-Peel ratio were measured. Obtained measurements were statistically analyzed according to demographic characteristics. One hundred and twenty-five patients with chondromalacia and 125 controls participated. The sulcus angle and the trochlear angle were significantly higher in the patellar chondromalacia group (p<0.05). The lateral trochlear inclination angle was significantly less in the patellar chondromalacia group (p=0.011). There was no significant difference between the groups in terms of medial trochlear inclination angle (p=0.520). There was no significant difference between the groups in terms of patella-trochlear ratio (p=0.617). Insall-Salvati ratio was significantly higher in the patellar chondromalacia group (p=0.003). Modified Insall-Salvati ratio was significantly lower in the patellar chondromalacia group (p=0.001). The rate of Blackburne-Peel was significantly higher in the patellar chondromalacia group (p=0.004). Measurements of sulcus angle, trochlear angle, lateral trochlear inclination angle, Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel ratio have diagnostic value for grade 3-4 chondromalacia.

Short-term clinical and hormonal effects of a deslorelin implant on late-prepubertal bitches - Based on flare-up signs.

Gonadotropin-releasing hormone (GnRH) agonists offer an alternative to surgical sterilization in prepubertal dogs, preserving ovarian and uterine functions. However, the clinical and hormonal effects of GnRH agonist application during the late-prepubertal stage remain insufficiently understood. This study aimed to investigate the clinical effect (flare-up) and hormonal changes, specifically serum progesterone (P4) and estradiol (E2) levels, in bitches treated with 4.7 mg deslorelin acetate (DA) implants (Suprelorin®, Virbac, F) during the late prepubertal period. Sixteen clinically healthy kangal cross-breed bitches, aged 7-8 months, with a mean body weight of 20.5 ± 0.8 kg, were implanted with DA. Estrus signs were monitored daily, and blood and vaginal cytological samples were collected every other day for four weeks. Cytological changes were analyzed for overall and superficial cell index. Six out of sixteen DA-treated bitches (EST group; n = 6) exhibited clinical proestrus 8.6 ± 0.6 days after implant insertion. The mean serum concentrations of P4 and E2 at the onset of estrus were 1.38 ± 0.32 ng/ml and 37.38 ± 10.07 pg/ml, respectively. Notably, all non-estrus (N-EST group; n = 10) bitches demonstrated an increase in superficial cell index, in addition to expected cytological changes observed in the EST group. On the 18th day post-implantation, the EST group exhibited a significantly higher number of superficial cells compared to the N-EST group (p < 0.001). DA implantation resulted in cytological profile alterations accompanied by a slight increase in estrogen concentrations in all dogs. However, the flare-up response exhibited significant variability, differing from that observed in adult dogs. This study highlights the importance of meticulous timing and breed-specific considerations when utilizing DA for puberty manipulation in late-prepubertal bitches. The observed cytological and hormonal changes in response to DA implants provide valuable insights, but the variability in flare-up responses warrants further investigation.

Antioxidant and anti-inflammatory potential of crocin on the doxorubicin mediated hepatotoxicity in Wistar rats.

Doxorubicin (DXR) is widely used in cancer treatment. However, it has not yet been possible to prevent the side effects of DXR. The aim of this study was to investigate the hepatoprotective effect of crocin against DXR used in cancer treatment. For this reason; forty Wistar rats (male-250-300 g) were allocated into four groups (n = 10/group): Control, Crocin, DXR and DXR+Crocin. Control and Crocin groups were administered saline and crocin (40 mg/kg, i.p) for 15 days, respectively. DXR group, cumulative dose 12 mg/kg DXR, was administered for 12 days via 48 h intervals in six injections (2 mg/kg each, i.p). DXR+Crocin group, crocin (40 mg/kg-i.p) was administered for 15 days, and DXR was given as in the DXR group. The results revealed that serum liver markers (alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) increased significantly after DXR administration but recovered after crocin therapy. In addition, lipid peroxidation (MDA), and inflammatory cytokine (TNF-α) increased after DXR application and the antioxidative defense system (GSH, SOD, CAT) significantly decreased and re-achieved by crocin treatment. Our results conclude that crocin treatment was related to ameliorated hepatocellular architecture and reduced hepatic oxidative stress and inflammation in rats with DXR-induced hepatotoxicity.

8-Hydroxy-2-deoxyguanosine, a product of oxidative DNA degradation, is increased in the amniotic fluid of preterm births.

OBJECTIVE: 8-Hydroxy-2-deoxyguanosine (8-OH-2dG) is a measurable biomarker of oxidative DNA damage. This study was designed to determine amniotic fluid 8-OH-2dG levels in healthy full-term pregnant women and preterm pregnant women. To reveal the effect of reactive oxygen species on 8-OH-2dG levels, amniotic fluid total oxidant capacity (TOS), total antioxidant capacity (TAC) and oxidative stress index (OSI) were also measured. PATIENTS AND METHODS: A total of 60 patients, 35 patients with full-term pregnancy and 25 patients with preterm pregnancy, participated in the study. Labor occurring before 37 weeks of gestation was considered as spontaneous preterm birth. Amniotic fluid samples were collected from full-term patients during cesarean section or normal vaginal delivery. 8-OH-2dG concentrations in amniotic fluid samples were measured quantitatively by Enzyme-Linked Immunosorbent Assay (ELISA). Amniotic fluid total antioxidant capacity (TAC) and total oxidant capacity (TOC) was determined in amniotic samples. RESULTS: The amniotic fluid 8-OH-2dG levels of the preterm group were significantly higher than the full-term group (60.8±7.02 ng/mL vs. 33.6±4.11 ng/mL, p<0.01). Similarly, TOC levels of the preterm group were significantly higher than the full-term group (89.7±4.80 µmol/L vs. 54.3±6.60 µmol, p<0.02). TAC was significantly higher in the full-term group compared to the preterm group (1.87±0.10 mmol/L vs. 0.97±0.44 mmol/L, p<0.01). The OSI values of the preterm group were significantly higher than the full-term group. A negative and significant correlation was found between gestational age and amniotic fluid 8-OH-2dG levels in the full-term pregnancy group (r=-0.78, p<0.01). A negative and significant correlation was observed between TAC and amniotic fluid 8-OH-2dG levels in the full-term group (r=-0.60, p<0.02). A positive and significant correlation was also detected between TOC, OSI and amniotic fluid 8-OH-2dG levels in the full-term group. There was a negative but insignificant correlation between fetal weight and amniotic fluid 8-OH-2dG levels. The correlation analysis results of the preterm pregnancy group were similar to the full-term group. CONCLUSIONS: Increased reactive oxygen derivatives in preterm birth increase amniotic fluid levels of DNA degradation product 8-OH2dG and may lead to premature rupture of fetal membranes. This is the first clinical study investigating 8-OH-2dG levels in amniotic fluid of preterm birth.

Hydrosalpingeal fluid leads to subfertility via endometrial TNF-α and IL-7 and NF-κB signaling pathways.

OBJECTIVE: To determine the concentrations of the nuclear factor kappa B (NF-κB), tumor necrosis factor-alpha (TNF-α) and interleukin-7 (IL-7) in midluteal phase endometrial samples of infertile patients diagnosed with uni or bilateral hydrosalpinx (HX). PATIENTS AND METHODS: A total of 24 patients who decided to undergo laparoscopic salpingectomy were included in the study. Salpingectomy indications consisted of patients with a diagnosis of hydrosalpinx (n=12) or ectopic pregnancy (n=12). Twelve healthy patients who underwent Pomeroy-type tubal ligation were considered as the second and healthy control group. The diagnosis of hydrosalpinges was made by transvaginal 2D ultrasonography or HSG. All patients in the hydrosalpinges or ectopic pregnancy group underwent laparoscopic salpingectomy. Just before salpingectomy, endometrial samples were obtained from all patients by Pipelle cannula. Endometrial sampling was performed 7-9 days after the LH surge in the control group. IL-7, NF-κB and TNF-α concentrations were measured by ELISA method in the endometrial samples of all three groups. RESULTS: The endometrial IL-7 concentration before salpingectomy of the patients in the hydrosalpinx group was 44.6±6.65 ng/mg wet-tissue. The IL-7 levels of the HX group were significantly higher than those of the patients in the ectopic pregnancy group (19.3±3.06 ng/mg wet tissue versus 44.6±6.65 ng/mg wet tissue, p<0.04). Similarly, IL-7 levels of the HX group were significantly higher than those of the tubal ligation group (6.08±1.48 ng/mg wet tissue versus 44.6±6.65 ng/mg wet tissue, p<0.03). The endometrial TNF-α concentration of the patients in the hydrosalpinx group was 33.20±5.40 ng/mg wet-tissue. The TNF-α value detected in the hydrosalpinx group was significantly higher than both the TNF-α value in the ectopic pregnancy group (11.8±1.07 ng/mg wet-tissue vs. 33.20±5.40 ng/mg wet-tissue, p<0.01) and the TNF-α value in the tubal ligation group (5.30±1.22 ng/mg wet-tissue vs. 33.20±5.40 ng/mg wet-tissue, p<0.01). The pre-salpingectomy endometrial NF-κB concentration of the patients in the hydrosalpinx group was 6.38±1.40 ng/mg wet-tissue. This value is higher than endometrial NF-κB levels in the ectopic pregnancy group (3.67±0.41 ng/mg wet-tissue vs. 6.38±1.40 ng/mg wet-tissue, p<0.02) and NF-κB levels in the tubal ligation group (1.07±0.38 ng/mg wet-tissue vs. 6.38±1.40 ng/mg wet-tissue, p<0.01). CONCLUSIONS: The presence of hydrosalpinx prevents successful implantation by increasing the levels of endometrial proinflammatory cytokines TNF-α, IL-7 and NF-κB.

Prognostic importance of nutritional assessment in patients with acute ischemic stroke undergoing endovascular thrombectomy.

OBJECTIVE: The prevalence of malnutrition in patients with acute ischemic stroke (AIS) can range from 8% to 34%. It has been shown that prognostic nutritional index (PNI) and control nutritional status (CONUT) scores can provide an opportunity to make prognostic predictions in some disease groups. Previous studies have shown a close relationship between malnutrition scores and stroke prognosis. We evaluated the effect of nutritional scores on in-hospital and long-term mortality in AIS patients undergoing endovascular therapy (EVT). PATIENTS AND METHODS: 219 patients who underwent EVT for the AIS were included in this retrospective design and cross-sectional study. The primary endpoint of the study was accepted as all-cause death including in-hospital death, 1-year death, and 3-years death. RESULTS: A total of 57 patients died in the hospital. In-hospital mortality rate was higher in the high CONUT group [36 (49.3%), 10 (13.7%), 11 (15.1%), p<0.001]. A total of 78 patients died within one year, and 1-year mortality was higher in the high CONUT group [43 (58.9%), 21 (28.8), 14 (19.2), p<0.001]. At the end of the 3-year follow-up, 90 patients had died, and the 3-year mortality rate was significantly higher in groups with a high CONUT score than in those with a low CONUT score (p<0.001). CONCLUSIONS: A higher CONUT score, calculated easily by simple scoring with parameters studied from peripheral blood before the EVT procedure, is an independent predictor of in-hospital, 1-year, and 3-years all-cause mortality.

A novel predictor in patients undergoing heart valve surgery: systemic inflammation response index: a single center cross-sectional study.

OBJECTIVE: Inflammation plays a pivotal role in heart valve disease (HVD). This study aimed at evaluating the prognostic value of systemic inflammation response index (SIRI) after valve replacement surgery. SUBJECTS AND METHODS: The study enrolled 90 patients who underwent valve replacement surgery. SIRI was calculated using laboratory data on admission. Receiver operating characteristic (ROC) analysis was used to calculate the optimal cutoff values of SIRI for predicting mortality. Univariable and multivariable COX analysis was used to assess the relationship of SIRI with clinical outcomes. RESULTS: 5-year mortality rate was higher in SIRI ≥1.55 group than SIRI <1.55 group [16 (38.1%) vs. 9 (18.8%)]. In receiver operating characteristic analysis, the optimal cutoff values for SIRI were 1.55 (area under the curve 0.654, p: 0.025). Univariable analysis revealed that SIRI [OR: 1.41, 95%CI (1.13-1.75), p<0.001] was an independent predictor of 5-years mortality. Multivariable analysis revealed that glomerular filtration rate (GFR) [OR: 0.98, 95%CI (0.97-0.99)] was an independent predictor of 5-years mortality. CONCLUSIONS: Although SIRI is a preferable parameter for the detection of long-term mortality, it failed to predict in-hospital and 1-year mortality. Larger multi-center studies are needed to investigate effect of SIRI on prognosis.

Disrupted redox balance in utero-placenteal junction may be the main culprit in the occurrence of abruptio placenta.

OBJECTIVE: To determine the oxidant/antioxidant balance and proinflammatory status in amniotic fluids collected during cesarean section of patients diagnosed with abruptio placenta. PATIENTS AND METHODS: Twenty-five patients diagnosed with ablatio placenta with intact membranes who went to emergency cesarean section were included in the study. A diagnosis of AP was made in those who had at least one of the following criteria or, in suspicious cases, two findings. (i) Antepartum hemorrhage starting after 20 weeks of gestation, (ii) presence of retroplacental hematoma on ultrasonography, (iii) severe fetal distress or death, (iv) localized or diffuse uterine tenderness or pain. The control group consisted of 25 patients who presented for delivery, who were not diagnosed with AP, and whose membranes were intact. NF-κB, total oxidant capacity (TOC), total antioxidant capacity (TAC), and oxidative stress index (TOC/TAC=OSI) levels were measured in amniotic fluids collected during cesarean section from both groups. RESULTS: Amniotic fluid TAS values of the AP group were significantly lower than the healthy controls (1.14±0.33 vs. 9.05.±3.40, p<0.01). Amniotic fluid TOS values were significantly increased in the AP group (36.1±8.10 vs. 11.4±2.77, p<0.02). OSI values were significantly higher in the AP group (31.6±9.03 vs. 1.26±0.02, p<0.01). Amniotic fluid NF-κB expression of the AP group was approximately 5 times higher than the control group (10.4±2.56 ng/mL vs. 1.86±0.30 ng/mL, p<0.01). High blood pressure and smoking history were significantly higher in the AP group. Gestational age and fetal birth weight of the AP group were lower than the control group. CONCLUSIONS: Since the increase in amniotic fluid oxidant capacity and proinflammatory cytokine synthesis cannot be neutralized by the antioxidant system, hypoxic cell damage may lead to premature separation of the placenta.

Outcomes of transcorneal electrical stimulation therapy in the early stages of retinitis pigmentosa.

BACKGROUND: To investigate the effect of transcorneal electrical stimulation (TES) therapy in patients with retinitis pigmentosa (RP). METHODS: We performed TES therapy in 21 patients with RP in 12 sessions with 1-week intervals. The following parameters obtained before and after the TES therapy were compared statistically; the best corrected visual acuity (BCVA, logMAR), Ishihara color vision level, multifocal electroretinography (mf-ERG) response, automated visual field (VF) outcome, and the 25-item low vision quality-of-life (LVQOL) questionnaire points. RESULTS: The mean age of patients (6 females; 15 males) was 31.67 ± 9.80 years (20-50 years). While increases in BCVA level, color vision level, mf-ERG response in p1 amplitude of ring 1, and LVQOL questionnaire points were statistically significant, changes in VF test and other mf-ERG responses were not. Twenty of the patients (95.24%) stated that they were satisfied with the TES therapy. No considerable side effect was observed in any patient due to the therapy. DISCUSSION: The TES therapy may be an effective and safe treatment modality in slowing the RP progression, especially in the early stages of the disease. Longer-term follow-ups in larger patient populations are warranted.

Global longitudinal strain score predicts all cause death in patients with chronic total occlusion with preserved ejection fraction.

OBJECTIVE: Change in LVEF is one of the most important indicators of prognosis in CTO cases. Studies in patients with CTO have shown improvement in LVEF approximately at 3 and 6 months after successful PCI. It has been shown that LV global longitudinal strain (GLS) starts to improve even 1 day after CTO-PCI. We aimed at investigating the effect of subclinical echocardiographic involvement on all-cause mortality in the group with CTO and preserved ejection fraction by evaluating the LV GLS score. PATIENTS AND METHODS: Patients with LVEF ≥ 50% were considered to have preserved ejection fraction and were included in the study. The endpoint of the study was all-cause death. For this retrospective study, 1,171 patients with coronary angiography who had had CTO in any of their vessels were screened. RESULTS: A total of 86 consecutive patients were reviewed in the study. The optimum GLS score cut-off value (≥ 14.18) for predicting mortality was determined using receiver operating characteristic (ROC) curve analysis (AUC: 0.897, sensitivity 87.5%, specificity 81.5% p<0.001). At a mean follow-up of 49 months, a significant difference was found between the two groups in all-cause mortality determined by the GLS score [2 (3.4%) vs. 14 (51.9%), p<0.001]. A significant difference in mortality was observed between the group with a low GLS score and the group with a high GLS score, according to Kaplan-Meier analysis. The effect of GLS score in predicting all-cause mortality was demonstrated in multivariate cox regression analysis (Low GLS score; OR: 6.36 95%CI (1.039-39.013), p=0.045). Cox regression multivariate analysis and the effect of GLS score in predicting mortality were observed [Low GLS score; OR: 6.368 95%CI (1.039-39.013), p=0.045]. CONCLUSIONS: As a predictor, GLS may be a valuable marker of cardiac subclinical dysfunction for all caused mortality in CTO patients.

Predictive value of lymphocyte to monocyte ratio for cardiac syndrome X.

OBJECTIVE: Cardiac syndrome X (CSX) is typically described with ischemia in stress tests in addition to angina-like chest pain and without stenosis in coronary angiography. We aimed at determining the relationship between LMR and CSX. PATIENTS AND METHODS: We retrospectively collected patients with CSX between January 2016 and December 2019. Patients with typical angina-like chest pain, normal 12-lead electrocardiography at rest, a positive response to the exercise test (> 0.1 mV ST-segment depression at 80 ms after the J point in two or more contiguous leads) or ischemia on myocardial perfusion scintigraphy and normal coronary angiography were included in the study as CSX patients. RESULTS: This study consisted of 116 patients with CSX and 153 control groups. The mean age of the patients with CSX was 52.7±9.7 years, and the mean age of the control group was 53.7±10.6 years (p= 0.416). The patients with CSX were more likely to have higher monocyte counts and LMR. According to the Pearson correlation test, the CRP value negatively correlated with the LMR. In multivariate logistic regression analysis, LMR remained a significant predictor of CSX. In ROC analysis, LMR < 4.1 had 64% sensitivity and 50% specificity (ROC area under curve: 0.587, 95% CI: 0.519-0.655, p=0.015) in accurately predicting a CSX diagnosis. CONCLUSIONS: We showed that lower LMR levels were associated with the presence of CSX.

Hematuria frequency and association with abnormal urological findings in medical check-up patients.

Aims and Background: Hematuria is one of the most common findings in urology. The management of hematuria detected in routine medical check-ups is also important in this respect. The aim of this study was to determine the frequency of hematuria in patients undergoing medical check-ups and evaluate its association with abnormal urological findings in laboratory tests and imaging. Patients and Methods: Asymptomatic patients who presented to the check-up clinic between January 1 and December 31, 2020, were included. All patients underwent a complete laboratory workup and total abdominal ultrasound (TAUS). The distribution of hematuria by sex and age and the relationship between hematuria and abnormal urological findings in the laboratory tests and TAUS were calculated. Results: The mean age of the 2,077 check-up patients was 45.8 ± 12.8 years. The female to male ratio was 1.07:1, and there was no significant difference in age between the sexes (P = 0.655). Microscopic hematuria was detected in 15.9% of the patients. The frequency of hematuria was 10.8% in men and 20.7% in women (P < 0.001). Men with hematuria were significantly older than men without hematuria (P = 0.033), whereas hematuria was not associated with age in women (P = 0.521). When its relationship between abnormal urological findings was evaluated, hematuria had a sensitivity of 21.70% (95% confidence interval [CI]: 18.84, 24.86) and a specificity of 87.11% (95% CI: 85.23, 88.79). Conclusion: The frequency of hematuria in check-up patients was remarkable, at 15.9%. Hematuria in women is more common and unrelated to age, unlike in men. Hematuria had a high specificity but low sensitivity for urological abnormal findings.

A novel intermediate coronary artery stenosis severity method: Fluoroscopy-Assisted Measurement of Coronary Volume Ratio (The FLAME FFR Trial).

OBJECTIVE: The fluoroscopy-assisted coronary volume measurement (FLASH) algorithm, based on contrast passage time and vessel size, is a simple and non-invasive method of assessing coronary blood volume. The present study evaluated the diagnostic performance of FLASH flow ratio-derived fractional flow reserve (FFRFLAME) compared to wire-based FFR (FFRWB). PATIENTS AND METHODS: FFRFLAME was defined as the ratio of FLASH at baseline to maximal hyperemia. Forty-eight patients with one intermediate coronary lesion (30-70% by angiographic visual estimation) were enrolled in this cross-sectional study. FFRFLAME and FFRWB measurements were collected in each patient. Intravenous administration of adenosine was used to achieve maximal hyperemia. The Pearson correlation coefficient and receiver operating characteristic analysis were performed to determine the predictive accuracy of FFRFLAME. RESULTS: The average age of the patients was 58 years, and 43% (21 of 48) were female. The predominant vessel assessed was the left anterior descending artery system (87.5%). The mean FFRWB was 0.91 ± 0.05 at baseline and 0.83 ± 0.07 at the hyperaemic level, with 27% (13 of 48) of patients having an FFRWB of ≤0.80. For each patient, the mean FFRFLAME was 0.668 ± 0.17. The mean FFRFLAME was 0.85 ± 0.16 for patients having an FFRWB of ≤0.80. A strong relationship existed between FFRFLAME and FFRWB (Pearson's r = - 0.765 p<0.001). The optimal cutoff value of the functional significance of coronary artery stenosis for FFRFLAME was determined to be > 0.84 (AUC: 0.899, 84% sensitivity and 97% specificity) when the FFRWB cutoff value for significant lesions was ≤ 0.80. CONCLUSIONS: FFRFLAME, applied to coronary angiography without the need for an invasive pressure wire, can be a beneficial index for appropriate lesion selection in coronary artery diseases.

Non-functional recurrent pituitary adenoma with intracranial metastasis-Pituitary carcinoma: A case report and review of the literature.

INTRODUCTION: Pituitary carcinomas are rare, with only a few case reports to date. We present a null cell type non-functioning pituitary carcinoma (NFPC) with intracranial metastases and a review of the literature. CASE REPORT: A 56-year-old male with a history of an aggressive pituitary adenoma was admitted. Initial MRI highlighted a large intracranial mass with leptomeningeal involvement, simulating meningioma. Based on his previous pathology report of the sellar mass, a diagnosis of null cell type non-functioning pituitary carcinoma has been made. CONCLUSIONS: An aggressive recurrent pituitary tumor with suprasellar and/or cavernous sinus invasion is the main characteristics of the NFPC. Single or multiple enhancing dural-based mass(es) mimicking meningioma is the most common MRI finding. The proof of malignancy is the same histopathological features of the recurrent aggressive pituitary tumor in the metastases. The histology alone is not distinctive in terms of malignancy. Most patients require a combined surgery, radiotherapy and chemotherapy.