Association between Kelch-like ECH-associated protein-1 and GRACE risk score in non-ST elevation myocardial infarction.

OBJECTIVE: In this study, we measured the levels of Kelch-like ECH-associated protein 1 (KEAP1), which has the potential antioxidant capacity, among non-ST elevation myocardial infarction (NSTEMI) patients compared with healthy controls. We also investigated the possible association between KEAP1 levels and the GRACE score, which is a universal risk score commonly used for patients with acute myocardial infarction. PATIENTS AND METHODS: As the patient group, 78 patients admitted to our center with a diagnosis of NSTEMI were included in the study. As the control group, 77 individuals found to have normal coronary arteries after coronary arteriography were included (155 patients in total). GRACE risk scores and left ventricular ejection fractions (LVEFs) were calculated, KEAP1 levels were measured, and the usual blood tests were performed. RESULTS: KEAP1 levels were significantly higher among the NSTEMI patients compared to the healthy control group (671.1 ± 120.7 vs. 262.7 ± 105.7, p < 0.001). We also found a moderate positive correlation between KEAP1 levels and GRACE risk scores among patients with NSTEMI (r = +0.521, p < 0.001). Additionally, a negative correlation between KEAP1 levels and LVEFs was detected (r = -0.264, p < 0.001). CONCLUSIONS: Elevated KEAP1 levels have the potential to be used as a risk factor for NSTEMI in terms of clinical adverse events and poor prognosis at admission.

One-year follow-up of a new posterior chamber toric phakic intraocular lens implantation for moderate-to-high myopic astigmatism.

PURPOSE: To investigate refractive and visual outcomes as well as rotational stability following implantation of Eyecryl phakic toric intraocular lens (pIOL) for moderate-to-high myopic astigmatism. METHODS: The efficacy, safety, predictability, stability, and adverse events of Eyecryl toric pIOL were evaluated in patients with spherical refraction from - 4.50 to - 18.50 diopters (D) and cylindrical refraction from - 0.50 to - 5.50 D. RESULTS: This study included 60 eyes of 31 patients. The mean manifest refraction spherical equivalent (MRSE) dropped from - 10.45 ± 2.74 D preoperatively to - 0.34 ± 0.51 D and - 0.40 ± 0.56 D at 6 and 12 months postoperatively, respectively. There was an 81% decrease in astigmatism after surgery. The safety and efficacy of indices were 1.36 ± 0.43 and 1.20 ± 0 .32. At the final follow-up, the rate of eyes within ± 1.00 D and ± 0.50 D of the desired MRSE were 85% and 68.33%, respectively. Vision-threatening complications were not observed during the follow-up. CONCLUSIONS: The implantation of pIOL was effective, safe, and predictable in patients with moderate-to-high myopic astigmatism during 1-year follow-up.

Explantation of phakic intraocular lenses: causes and outcomes.

PURPOSE: To describe reasons for explantation of anterior and posterior chamber phakic intraocular lenses (pIOLs), as well as outcomes of the surgery. METHODS: The medical files of patients who underwent pIOL explantation due to complications were reviewed. All patients were divided into three groups based on the type of explanted pIOL: anterior chamber angle-supported (AS pIOL), anterior chamber iris-fixated (IF pIOL), and posterior chamber (PC pIOL). RESULTS: Sixty-two eyes of 41 patients were evaluated. There were 26 (41.9%), 16 (25.8%), and 20 (32.2%) eyes in the AS pIOL, IF pIOL, and PC pIOL groups, respectively. The mean interval between the implantation and removal of the pIOL (i.e., survival time) was 13.6 ± 8.1 years (range 0.01-21.22 years). The mean follow-up after the explantation was 22.5 ± 4.0 months (range 11.3-28.7 months). The main causes of explantation were cataract in the PC pIOL group (60%) and chronic endothelial cell loss in the AS pIOL group (53.8%) and IF pIOL group (56.2%). Overall, the procedure most often combined with pIOL explantation was phacoemulsification and implantation of a posterior chamber IOL (40.3%), followed by keratoplasty (9.6%). Intraoperative complications were significantly more common in the AS pIOL group than the other groups (p < 0.001). CONCLUSIONS: Explantation of anterior chamber pIOLs due to severe endothelial cell loss and the proportion of keratoplasty was more common in patients with a relatively long survival time. Therefore, patients with pIOL implantation should be monitored regularly after surgery.

Deep anterior lamellar keratoplasty techniques; predescemetic versus big bubble: Anterior segment optical coherence tomography study.

PURPOSE: To compare the visual and refractive outcomes and anterior segment optical coherence tomography (AS-OCT) findings of 2 different deep anterior lamellar keratoplasty (DALK) techniques in the treatment of advanced keratoconus with and without successful big bubble formation. METHODS: In this retrospective comparative case series, data from 79 consecutive eyes of 69 patients who underwent either big bubble (group 1, n: 62) or manual DALK (group 2, n: 17) were analyzed. The visual and refractive results, keratometric values and residual stromal thickness were assessed. Patients were seen at 1, 3, 6 and 12 months after the procedure and 1 month after complete suture removal. RESULTS: A big bubble was successfully obtained in 62 eyes (78.5%; group 1) and manual dissection was performed in the 17 remaining eyes (21.5%; group 2). The final best spectacle-corrected visual acuity (BSCVA) was 0.38 logMAR and 0.55 logMAR in Group 1 and 2, respectively (P<0.05). At the final visit, BSCVA≤0.30 logMAR was achieved in 80% and 60.8% of eyes in Groups 1 and 2, respectively (P<0.001). Groups 1 and 2 were comparable in terms of mean keratometry: 47.80D±2.81D (range, 41.30D to 54.2D) versus 45.90D±3.62D (range, 41.10D to 53.8 D), respectively; (P=0.56) and keratometric astigmatism: 3.81D± 2.1D (range, 1.0D to 6.20D) versus 3.56D±1.92D (range 1.2D to 6.85D), respectively; (P=0.40) at the final follow-up. The mean residual stromal thickness was 36.90±17.80µm in group 2. CONCLUSION: The presence of residual posterior corneal stroma when big bubble formation is not successfully achieved in DALK is correlated with lower postoperative visual acuity.

Lycopene has a protective effect on septic shock­induced cardiac injury in rats.

OBJECTIVE: The aim of the present study is to investigate the cardioprotective effect of lycopene, known for its antioxidant and anti-inflammatory effect, in a rat sepsis model induced by lypopolysaccharide (LPS). METHODS: The oxidative stress parameters, antioxidant parameters and cytokine levels with or without lycopene treatment in LPS­induced septic rats as well as in controls were measured in serum and tissue. Histologic examinations of the cardiac tissues were also performed. The Kruskal-Wallis and the Bonferroni-adjusted Mann-Whitney U Test was used for analysis. A p value < 0.05 was considered significant. RESULTS: The data of this study showed that lycopene pretreatment reduced the oxidative stres parametersand , proinflammatory cytokines as well as increased the antoxidant enzyme activities in both serum and cardiac tissues in LPS­induced septic rats.. Moreover, hyperaemia and haemorrhage in the epicardium, myocardium and endocardium were lower in the lycopene pretreated group as compared to the LPS alone group. CONCLUSION: These results suggest that lycopene could be beneficial for the prevention of cardiac injury caused by sepsis through reducing the cytokine levels and oxidative stress parameters (Tab. 4, Fig. 1, Ref. 35).

The effects of complicated cataract surgery on iris structure and anterior chamber angle.

PURPOSE: To evaluate iris structure in aphakic eyes scheduled for placement of a secondary intraocular lens. METHODS: Twenty-eight aphakic eyes of 28 patients who were scheduled for secondary intraocular lens implantation between January 2012 and January 2017 at Beyoglu Eye Training and Research Hospital after a complicated cataract surgery were recruited in this study. The phakic fellow eyes of the patients were defined as a control group. Iris thickness was assessed using anterior segment optical coherence tomography at 750µm (IT750) and 2000µm (IT2000) from the scleral spur. Moreover, maximum iris thickness (ITM) and anterior chamber angle parameters such as trabecular iris surface area at 500 and 750µm (TISA500, TISA750), angle opening distances at 500 and 750µm (AOD500, AOD750) and anterior chamber depth (ACD) were also evaluated. RESULTS: Mean IT750, IT2000 and ITM readings and were significantly lower in the aphakic eyes compared to the healthy eyes (P=0.04, P=0.01, P=0.01 respectively). Anterior chamber parameters (TISA500, TISA750, AOD500 and AOD750) and ACD were significantly increased in aphakic eyes following complicated cataract surgery compared to healthy fellow eyes (all P<0.001). CONCLUSIONS: Complicated cataract surgery leading to aphakia results in decreased iris thickness and increased anterior chamber depth. These findings might be helpful in the selection of the type of surgery for placement of a secondary IOL.

Long-term assessment of visual and refractive outcomes of laser in situ keratomileusis for hyperopia using the AMARIS® 750S Excimer laser.

PURPOSE: To evaluate the long-term efficacy and safety of hyperopic laser in situ keratomileusis (LASIK) using the AMARIS® 750S (Schwind, Eye-tech-solutions, GmbH) excimer laser. METHODS: The medical records of one hundred eleven eyes of 62 patients who underwent LASIK for hyperopia using the AMARIS® 750S excimer laser were reviewed retrospectively. Patients were divided into three groups based on preoperative spherical equivalent (SE) refraction: low hyperopia (less than +2.50 diopters [D]), moderate hyperopia (+2.75D to +4.00D), and high hyperopia (over +4.00D). Uncorrected and best corrected visual acuity (BCVA), long-term stability of refraction, and complications were evaluated. RESULTS: Of the entire sample, the mean preoperative SE was +3.64D±1.22D. The mean age was 37.4±11.2 years (20-59). The mean follow-up for all eyes was 51 months. At the last visit, the mean SE was +0.85D±0.34D (SD) in the low hyperopia group, +1.09D±0.43D in the moderate hyperopia group, and +1.63D±0.47D in the high hyperopia group. (+1.15D±0.49D overall). Preoperative uncorrected visual acuity (UCVA) was 0.52±0.34 logMAR and increased to 0.18±0.15 logMAR at 4 years follow-up (P<0.01). There was no statistically significant difference between preoperative and postoperative BCVA. The UCVA was 0.30 logMAR or better in 100% of eyes in the low hyperopia group, 93.7% in the moderate hyperopia group, and 69.9% in the high hyperopia group (%89.2 overall). CONCLUSIONS: LASIK is safe and effective for correcting hyperopia in the short term; however, the efficacy of the procedure is limited in the patients with high hyperopia and longer follow-up.

Mullerian adenosarcoma of the uterine cervix in an adolescent girl.

BACKGROUND: Cervical adenosarcoma is a rare gynecological tumor which is prone to recur locally. A case of cervical adenosarcoma in a 14-year-old girl treated in order to preserve fertility. CASE: A 14-year-old girl presented with a pedunculated mass protruding from the vagina. Simple excision was performed. Histological evaluation revealed adenosarcoma. Her clinical course has been uneventful for fifteen months. SUMMARY AND CONCLUSION: Adenosarcoma is a low malignant potential tumor of the female genital tract. A simple excision may be an option for young women who need to preserve their fertility. It is mandatory to monitor regularly the cervical base of the lesion for the purpose of the high potential of the local recurrence.

A dreadful sign of aortic dissection: aortic intimo-intimal intussusception with prominent intimal flap prolapsing into the left ventricular apex.

Intimo-intimal intussusception is an unusual clinical form of aortic dissection resulting from circumferential detachment of the intima. Clinical presentation varies according to the level of detached intima in the aorta. We present a case of acute type A dissection with prominent prolapse of the circumferential detachment intimal flap into the left ventricular cavity extended to the apex.

Cardiac memory T-wave changes after ventricular tachycardia in pregnancy.

A 36-year-old pregnant woman (20 weeks) was admitted to the coronary care unit because of ventricular tachycardia (VT). 12-Lead electrocardiogram showed a monomorphic regular wide QRS tachycardia with a ventricular rate of 220 beats/min and left bundle branch block morphology. Her electrocardiogram after the termination of the tachycardia returned to baseline with the Twave inversions in V1-V6 and DII, DII, aVF. The marked T-wave inversions demonstrate cardiac memory due to the preceding abnormal ventricular activation caused by VT. Because the T-wave inversion happened after the conversion from VT to sinus rhythm, it may be explained by the cardiac memory phenomenon.

Applicability of leachates originating from solid-waste landfills for irrigation in landfill restoration projects.

Since, landfill areas are still the most widely used solid waste disposal method across the world, leachate generated from landfills should be given importance. Leachate of landfills exerts environmental risks mostly on surface and groundwater with its high pollutant content, which may cause unbearable water quality. This leads to the obligation for decontamination and remediation program to be taken into progress for the landfill area. Among a number of alternatives to cope with leachate, one is to employ the technology of phytoremediation. The main objective of this study was to determine the N accumulation ratios and the effects of landfill leachate in diluted proportions of chosen ratios (as 1/1, 1/2, 1/4, 0), on the growth and development of Cynodon dactylon, Stenotaphrum secundatum, Paspalum notatum, Pennisetum clandestinum, Mentha piperita, Rosmarinus officinalis, Nerium oleander, Pelargonium peltatum and Kochia scoparia species. In order to simulate the actual conditions of the landfill, soil covering the landfill is taken and used as medium for the trials. The study showed that S. secundatum, K. scoparia and N. oleander species had an impressive survival rate of 100%, being irrigated with pure leachate, while the others' survival rates were between 0 to 35% under the same conditions. As expected, application of leachate to the plants caused an increase in the accumulation of N, in the upper parts of all plants except P. peltatum. The highest N content increase was observed at S. Secundatum set, accumulating 3.70 times higher than its control set, whereas P. clandestinum value was 3.41 times of its control set.

Phytoremediation of landfill leachate using Pennisetum clandestinum.

Landfills are still the most widely used solid waste disposal method used across the world. Leachate generated from landfill areas exerts environmental risks mostly on surface and groundwater, with its high pollutant content, most notably metals, which cause an unbearable lower water quality. During dumping or after the capacity of the landfill has been reached, a decontamination and remediation program should be taken for the area. This study was conducted to assess the capacity and efficiency of Pennisetum clandestinum, a prostrate perennial plant, to accumulate chromium (Cr), copper (Cu), iron (Fe), nickel (Ni), zinc (Zn) and lead (Pb). Leachate, taken from the Sofulu Landfill Site, was given to Pennisetum clandestinum for 180 days, in 3 dilution sets as 1/1, 1/2 and 1/4, in batch configuration. An additional control set was also installed for comparison. Results showed that, even though the metal content of soil had risen, plants accumulated 2 to 8.5 times higher concentrations than the control set. It is important to see, the plant showed almost no stress symptoms even if the set was fed by pure leachate. Pennisetum clandestinum was observed to accumulate metals mostly in the upper bodies, excluding Fe and Cu. 76% of accumulated Cr, 85% of Ni, 66% of Zn and 100% of Pb was observed to accumulate in above-ground parts, where only 20% of Cu and 4% of Fe was accumulated. Due to the high pollution tolerance of Pennisetum clandestinum, makes this plant suitable for decontamination and remediation of landfill sites.

The serial changes in plasma homocysteine levels and it's relationship with acute phase reactants in early postmyocardial infarction period.

OBJECTIVE: We aimed to study the change in the plasma homocysteine concentration in the early stage of acute myocardial infarction and its relationship with the acute phase reactants. METHODS: We included into the study 33 patients who were admitted to the hospital with acute myocardial infarction within the first three hours after the onset of symptoms. The plasma samples were obtained on admission (within 3 hours onset of symptom) and at 6, 12, 24 hours and 2, 4, 7, 30 and 90th day after admission. RESULTS: The serial homocysteine measurements were as following: 11.87+/-0.71 micromol/L, 11.89+/-0.62 micromol/L, 11.37+/-0.83 micromol/L, 10.96+/-0.93 micromol/L, 11.37+/-0.89 micromol/L, 11.24+/-0.66 micromol/L, 13.09+/-0.64 micromol/L, 12.85+/-0.71 micromol/L, and 12.19+/-0.91 micromol/L, respectively (p=0.05). Statistically significant difference was found only between the hour 24 and the day 7 (p=0.04). However, there was no statistically significant difference between the admission level and none of the other time points. No correlation was identified between acute phase reactants and lipid parameters that were measured serially at the same time periods and homocysteine levels. CONCLUSION: Although homocysteine plasma values obtained during the sixth and twelfth hours of acute myocardial infarction provide reliable results as a risk markers, timing of blood sampling during the myocardial infarction does not have significant role since plasma values of homocysteine did not affect acute phase reactants.

[The relation of coronary artery disease with Doppler flow velocity and resistance index in cases without significant carotid artery stenosis]. / Anlamli karotid arter darligi olmayan olgularda Doppler akim hizlari ve rezistans indekslerinin koroner arter hastaligi ile iliskisi.

OBJECTIVE: Atherosclerosis causes functional vasomotor changes as well as well as atheromatous carotid plaques and luminal stenosis resulting in mechanical effect. The relation between functional vasomotor changes in carotid arteries and extent of coronary artery disease is unknown. In our study, the probable relationship between carotid arterial flow velocities and resistance indexes (RI) with the extent of coronary artery disease (CAD) in patients who do not have significant carotid luminal stenosis was evaluated. METHODS: One hundred and fourteen patients (74 males, mean age 53+/-10 years, range 33-72 years) were studied. All patients underwent color Doppler sonography before coronary angiography. Peak systolic flow velocity, end-diastolic flow velocity and resistance index (RI) of right and left common carotid and internal carotid and internal carotid arteries were measured by color Doppler sonographic technique. Doppler parameters were correlated with the extent of CAD and left ventricular ejection fraction. RESULTS: Patients were classified on the basis of presence of significant CAD and the number of affected coronary arteries. Thirty-three patients did not have (normal group) and 81 patients had significant coronary arterial stenosis (22 patients with one-vessel disease, 27, with two-vessel disease and 32 patients with three-vessel disease). Flow velocities were the highest in normal group but the lowest in CAD patients, especially when 3 coronary arteries were affected. Correlation analysis demonstrated negative relationship of age, ejection fraction and number of affected coronary arteries with end-diastolic flow velocity, but positive and significant correlation with RI value. CONCLUSION: Our study is the first on this object. The results suggest that presence and extent of CAD changes flow velocities and RI values of common and internal carotid arteries. However, further investigations are required before these parameters can be applied as diagnostic criteria.