A new diagnostic method for woven coronary artery: optical coherence tomography.

Woven coronary artery is an extremely rare and not clearly defined congenital malformation in which the epicardial coronary artery is divided into multiple thin channels. These multiple channels merge again into a normal conduit. This anomaly is a benign condition because there is normal blood flow after the anomalous segment of the abnormal coronary artery. We describe a woven coronary artery anomaly in the left anterior descending artery (LAD) and its first diagonal (DI) branch causing myocardial infarction that was confused with coronary dissection. The definitive diagnosis was made by optical coherence tomography (OCT). Although woven coronary is a benign anomaly, it may cause myocardial infarction. We used the novel method of OCT for the definitive diagnosis and appropriate treatment of this anomaly.

Familial Takayasu arteritis in a mother and daughter. A report of two cases.

Takayasu arteritis (TA) is a chronic granulomatous panarteritis, predominantly affecting the aorta and its main branches. Infections, genetic factors as suggested by familial clustering, and autoimmunity may play a role in its pathogenesis. In this report, we describe familial TA in a mother and daughter with diverse clinical manifestations. In addition to being a familial form of vasculitis, both of our cases demonstrated amyloidosis, chronic renal disease thought to be due to ischemic nephropathy, and hypertensive nephrosclerosis.

Effects of Sixty-Minute Race-Pace Running on Cardiac Stress Biomarkers in Recreational Distance Runners.

Sudden cardiac death (SCD) in athletes is generally rare, but a serious complication of cardiovascular events during exercise. Although regular intensive physical exercise is thought to be a key to a healthy life, unsuspected pathologies might lead to SCD during or after physical activity. Cardiac dysfunction and elevated cardiac markers have been reported after prolonged exercise. We sought to clarify the cardiac marker levels and hydration status in healthy, middle-aged male subjects for 24 hours after running sixty-minute at race-pace. The participants were 47.4±1.7 years old, had peak oxygen consumption of 47.1±1.2ml/kg/min, and regularly running 70.5±6.4km/week. Blood biomarkers were performed before, immediately after, at the fourth and twenty-fourth hours after running. Compared to initial values, creatine kinase (before:161.2±22.5U/L, 24 hours after:411.9±139.7U/L, p<0.001) and CK-MB (before:4.3±0.7ng/ml, 24 hours after:10.1±3.0ng/ml, p<0.001) were significantly elevated immediately after running and remained significantly high for 24 hours. In addition, Troponin-I (before:5.0±1.1ng/l, 4 hours after:81.5±29.9ng/l, p<0.001) and NT-proBNP (before: 31.2±5.3pg/ml, immediately after: 64.4±8.5pg/ml, p<0.01) were significantly elevated immediately after running and returned to baseline levels in 24 hours. The sixty-minute running caused significant dehydration, but athletes were rehydrated at the 4th hour in their voluntary hydration behavior. As the individual data were analyzed, it was interesting to see that some of the athletes had critical biomarker levels without any cardiac symptom. Our findings indicate that race-pace sixty-minute running may induce a possible transient silent myocardial injury in apparently healthy master runners. Detailed pre-participation screening of these athletes may be necessary to reduce the risk of SCD.

Comparative evaluation of As, Se and V removal technologies for the treatment of oil refinery wastewater.

In this study, a broad range of readily deployable metal removal technologies were tested on a US refinery's wastewater to determine vanadium, arsenic and selenium removal performance. The bench-scale treatability studies were designed and performed so that test conditions could be as uniform as possible given the different mechanisms of action and engineering applications of each technology. The experimental data show that both ferric precipitation and reactive filtration were able to remove As, Se and V more efficiently from the wastewater than other tested technologies. Additionally, granular ferric hydroxide (GFH) adsorption was also effective in both V and As removal. Although the thiol-SAMMS adsorbent was developed for mercury removal, it also demonstrated appreciable selenium removal. None of the tested membrane filtration technologies showed any significant metals removal. This was attributed to the dissolved form of the metals as well as the wastewater's fouling characteristics.

ENT symptoms of mask-wearing in the coronavirus disease 2019 era.

OBJECTIVE: Analysis of the otorhinolaryngological problems caused by mask-wearing in the coronavirus disease 2019 era. METHODS: A survey with 26 questions was sent by e-mail to 576 individuals. RESULTS: The most frequently worn masks were three-layer surgical ear loop masks (n = 434, 80.1 per cent), followed by N95 or filtering facepiece code 2 masks (n = 58, 10.7 per cent), and cloth masks (n = 50, 9.2 per cent). The most bothersome symptoms caused by mask-wearing were difficulty in nasal breathing (n = 227, 41.8 per cent), nasal itching and pain (n = 93, 17.2 per cent), earache (n = 88, 16.2 per cent), difficulty in expressing oneself (n = 73, 13.5 per cent), difficulty in understanding speech (n = 56, 10.3 per cent), and ear itching (n = 5, 0.9 per cent). CONCLUSION: The problems associated with mask-wearing may result in avoidance of wearing them. Thus, there is a need for new methods that will reduce the problems related to mask-wearing, to increase their use in the community.

Effect of influent nitrogen speciation on organic nitrogen occurrence in activated sludge process effluents.

The effect of influent nitrogen composition on organic nitrogen production in a sequencing batch reactor (SBR) activated sludge process was investigated. A laboratory-scale SBR was fed with three different type synthetic wastewaters with varying nitrogen compositions (phase I = nitriloacetic acid + ammonium [NH4-N], phase II = NH(4-)N, and phase III = amino acid mixture + NH(4-)N) was operated. The effluent contained approximately 1 to 2 mg N/L organic nitrogen, even though there was no organic nitrogen in influent. The effluent organic nitrogen increased to approximately 4 mg N/L when the influent composition was changed and then stabilized at <2 mg N/L. The maximum nitrifier growth rate constants (microN) were calculated as 0.91+/-0.10 to 1.14+/-0.08 day-1, 0.82 +/-0.13 day-1, and 0.89+/-0.08 day-1 at 20 degrees C for the three different influent compositions. The effluent colloidal organic nitrogen (CON) was negligible, suggesting that the effluent CON found in full-scale plants may be the result of influent-derived suspended matter.

Comparison of nifedipine and captopril in children with pulmonary hypertension due to bronchopneumonia.

This study included 40 children, who were diagnosed with pneumonia and pulmonary hypertension (from the radiographic and clinical features), was performed at Yuzuncu Yil University Faculty of Medicine, Department of Pediatrics, from September 2003 to July 2005. Patients who had pneumonia and congenital heart disease or systemic hypertension or renal and liver disease together were excluded from the study. Blood gas analysis and oxygen concentration, measured with pulse oximetry, were performed in all patients. Besides chest X-ray, electrocardiography and echocardiographic search was also carried out. Echocardiographic examination was performed by using M mode, two-dimensional echocardiography and colored Doppler sonotron Vingmed CFM 725. At echocardiographic examination, pulmonary hypertension is defined as above 35 mmHg of pulmonary artery pressure. For echocardiographic examination, patients with pulmonary hypertension were divided into two groups. Captopril (2 mg/kg/day, three doses a day) and nifedipine (0.5 mg/kg/day, three doses a day) were given to the first and the second group, respectively. Echocardiography was performed daily until normal pulmonary artery pressure was achieved. At the beginning of the treatment, the patients were treated with double antibiotics and antibiotic change was carried out in needed cases at the follow up. Digoxin was administered to the cases of respiratory infection with heart failure.

Nitrogen speciation in wastewater treatment plant influents and effluents-the US and Polish case studies.

The fate of N species, particularly dissolved organic nitrogen (DON), through process trains of a wastewater treatment plant (WWTP) was investigated. In this study, three fully nitrifying plants in Illinois, USA and biological nutrient removal (BNR) plants in northern Poland were sampled for N characterization in the primary and secondary effluents as a function of the particle size distribution. The correlations between dissolved organic carbon (DOC) and dissolved organic nitrogen (DON) concentrations were examined. The key findings are that DON becomes significant portion (about 20%) of the effluent N, reaching up to 50% of effluent total N in one of the Polish plants. The DON constituted 56-95% of total ON (TON) in the secondary effluents, whereas in the Polish plants the DON contribution was substantially lower (19-62%) and in one case (Gdansk WWTP) colloidal ON was the dominating fraction (62% of TON). The DOC to DON ratio in the US plants is significantly lower than that in the receiving waters indicating potential for deterioration of receiving water quality. In Polish plants, the influent and effluent C:N ratios are similar, but not in the US plants.

Nutrient removal process selection for planning and design of large wastewater treatment plant upgrade needs.

A protocol to select nutrient removal technologies that can achieve low nutrient effluents (total nitrogen (TN) < 5 mg/L and total phosphorus (TP) < 0.5 mg/L) was developed for different wastewater treatment plant (WWTP) sizes based on the research conducted during a Water Environment Research Foundation funded project. The adaptable protocol includes technology and cost assessment of feasible (pre-screened) nutrient removal technologies that are being successfully implemented at full scale. The information collected from the full scale nutrient removal plants to develop this protocol includes design, operational, performance, and cost data through a direct survey of plants, and published data. The protocol includes a "technology threshold" approach consisting of Tier I (TN < 5.0 mg/L; TP < 0.5 mg/L) and Tier II (TN < 3.0 mg/L; TP < 0.1 mg/L) effluent nutrient levels for different plant sizes. A very large WWTP (1,250,000 m(3)/day flow) in Chicago, Illinois, USA adapted this protocol for master planning and design of future nutrient removal facilities based on plant and site specific criteria.

[Surgery of cardiac hydatid cysts. Experience of 39 years]. / Chirurgie des kystes hydatiques cardiaques. Trente-neuf ans d'expérience.

In some countries, Hydatidosis is a common public health problem but cardiac hydatid cysts are rarely observed. The evaluations of operative results and follow up of cardiac hydatid cases. Twenty-five consecutive unselected patients suffering from cardiac hydatidosis and operated on between 1967 and 2006 in Siyami Ersek Cardiothoracic and Vascular Surgery Center were retrospectively analyzed. In 10 of these patients the hydatid cyst was intracardiac, while in 13 patients cysts were extracavitary but located into the pericardium. In 2 patients the hydatid cyst was both intra and extracavitary. Mean age of the patients was 31+/-9.2. The female/male ratio was 17/8. The 12 patients with intracavitary and 2 patients wit extracavitary hydatid cysts were operated on with the aid of extracorporeal circulation. One patient died postoperatively. In one patient recurrence of the hydatidosis was observed. The majority of cases in previous publications were located in the left side of the heart. In our series, most were located in the right heart. In such cases clamping the pulmonary artery is mandatory to prevent pulmonary migration. Careful resection is important for prevention of recurrence.

Low effluent nutrient technologies for wastewater treatment.

The USEPA (2001) water quality nutrient criteria will have a significant impact on water pollution control industry due to stringent N and P requirements. This paper presents an update of findings on successful total N (TN) and total P (TP) technologies being implemented at existing wastewater treatment plants (WWTP) to achieve low TN and TP effluents and some key challenges in achieving lower levels. Plants consistently achieving <5 mg TN/L and < 0.5 mg TP/L were identified from a worldwide literature search and plant data collection. Technology gaps and research needs to improve successful technologies to achieve very low TN and TP effluents are summarised in this paper. The dissolved and colloidal organic N have been identified as major challenges in achieving very low levels of TN. Technical and economic challenges to achieve very low TP effluents include alkalinity deficiency, high chemical usage, high sludge production and lack of sufficient influent BOD for biological P uptake.

Effects of Nigella sativa on apoptosis and GABAA receptor density in cerebral cortical and hippocampal neurons in pentylenetetrazol induced kindling in rats.

We investigated the effects of Nigella sativa on apoptosis and gamma-aminobutyric acid (GABAA) receptor density in cerebral cortical and hippocampal neurons in a pentylenetetrazol (PTZ)-induced kindling model in rats. The PTZ kindling model was produced by injecting PTZ in subconvulsive doses to rats on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22 and 24 of the study into animals of PTZ treated (PTZ) and PTZ + N. sativa treated (PTZ + NS) groups. Clonic and tonic seizures were induced by injecting a convulsive dose of PTZ on day 26 of the study. Rats in the PTZ + NS group were treated also with a 10 mg/kg methanolic extract of N. sativa 2 h before each PTZ injection. Rats in the control group were treated with 4 ml/kg saline. The number of neurons that expressed GABAA receptors in the hippocampus and cerebral cortex of rats in the PTZ and PTZ + NS groups increased significantly. There was no significant difference in the number of GABAA receptors between the PTZ and PTZ + NS groups. GABAA receptor density of the neurons in the cerebral cortex, but not hippocampus, was increased in PTZ group compared to controls. We observed a significant increase in the number of apoptotic neurons in the cerebral cortex of rats of both the PTZ and PTZ + NS groups compared to controls. We observed a significant decrease in the number of the apoptotic neurons in the cerebral cortex of rats in the PTZ + NS group compared to the PTZ group. N. sativa treatment ameliorated the PTZ induced neurodegeneration in the cerebral cortex as reflected by neuronal apoptosis and neuronal GABAA receptor frequency.

Remifentanil versus propofol sedation for peribulbar anesthesia.

The short onset and offset of remifentanil may allow for accurate dosing of sedative effect with few side-effects and rapid recovery. In this study, remifentanil is compared with propofol for sedation intraocular pressure hemodynamics and oxygen saturation, in patients undergoing cataract surgery with peribulbar block. After ethical committee approval, fifty patients scheduled for one eye cataract surgery were enrolled into the prospective study. Remifentanil infusion was initialized at a rate of 0.04 microg/kg/min, 10 min before peribulbar anesthesia in Remifentanil group (Group R). In Propofol Group (Group P), propofol infusion of 2 mg/kg/h was reduced to 1mg/kg/h. Intraocular pressures of the contralateral eye were measured before and after peribulbar anesthesia and at the end of the operation. Sedation scores (1-5), hemodynamic parameters and saturation were assessed at 5 minute intervals. Heart rate, intraocular pressure, saturation and sedation scores were similar between groups. Intraocular pressures decreased within time in both groups. There were significant changes in mean blood pressure after 5th min between groups (P < 0.05). The infusion of remifentanil or propofol for sedation provided adequate sedation, hemodynamic stability without increasing intraocular pressure during surgery in patients undergoing cataract surgery with peribulbar anesthesia.

Serum uric acid level predicts new-onset atrial fibrillation after coronary artery bypass graft operation.

OBJECTIVE: To investigate the association between serum uric acid levels and the risk of incident atrial fibrillation in patients after coronary artery bypass graft (cABG) operation. PATIENTS AND METHODS: A total of 174 patients undergoing nonemergency coronary artery bypass graft operation were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We prospectively analyzed 174 patients (mean age: 59.8 years; 109 male and 65 female). The serum uric acid level was determined preoperatively. RESULTS: After a coronary artery bypass graft operation operation, 35 (20%) patients developed atrial fibrillation. Preoperative uric acid levels were significantly higher in patients who developed atrial fibrillation than in those who did not (7.8 ± 1.1 vs 5 ± 0.9). Using a cutpoint of 6.55, the preoperative level correlated with the appearance of atrial fibrillation with a sensitivity of 91.4% and specificity of 84.2%. CONCLUSIONS: Serum uric acid level can increase the sensitivity and specificity in predicting atrial fibrillation in patients after CABG operation.

Phenotypic variability of triphalangeal thumb-polysyndactyly syndrome linked to chromosome 7q36.

Triphalangeal thumb-polysyndactyly (TPT-PS) is an isolated limb malformation consisting of pre- and postaxial polysyndactyly of hands and feet. The only family reported so far is of Dutch origin, and the genetic mapping study localized the TPT-PS locus at chromosome region 7q36 where the isolated triphalangeal thumb (TPT) anomaly has also been mapped. It was suggested that TPT-PS is a phenotypic variation of isolated TPT, and the same ancestral mutation may produce both phenotypes. Here we report on the second family with this malformation from the Turkish population. The characteristic findings in this family are triphalangeal thumb, webbing between 3rd, 4th, and 5th fingers associated with bony synostosis in the distal phalanges of the same fingers, and pre- and postaxial polysyndactyly of feet. Some individuals show a more severe phenotype with a complete syndactyly of all fingers giving a "cup-like" appearance to the hands. Genetic linkage study with DNA markers D7S1823, D7S550, D7S559, and D7S2423 demonstrated that this family is also linked to chromosome band 7q36. Identification of a second family from a distinct ethnic background suggests that TPT-PS and isolated TPT are not caused by the same ancestral mutation as it was originally anticipated.

Cardiac hydatid cysts with intracavitary expansion.

BACKGROUND: Hydatid cyst disease is a significant health problem for undeveloped and developing countries. Although cardiac involvement is rare, early diagnosis and treatment of this situation is important. METHODS: To investigate the long-term outcome of patients who underwent operation for cardiac hydatid cysts with intracavitary expansion, we reviewed 8 patients who had cardiac hydatidosis and who underwent operation in our institution between January 1988 and November 1999. All patients presented with intracavitary protrusion of the cysts. Seven patients were women. The mean age was 33 +/- 14.3 years with a range of 17 to 55 years. The cysts were located on the right ventricular outflow tract (2 patients), right midventricular part of the muscular septum, left atrial free wall and apical portions of the right (2), or left (2 patients) ventricle. Standard cardiopulmonary bypass and crystalloid antegrade cardioplegia with aortic cross-clamping were used in all patients. In one, with right ventricular hydatid cyst, we used cardiopulmonary bypass with femoral cannulation and total circulatory arrest at less than 18 degrees C systemic hypothermia. This patient, who was arrested because of pulmonary emboli could not be weaned from cardiopulmonary bypass and died. RESULTS: The cystic cavity was cleaned and closed with multiple pursestring sutures in 4 patients. In 2, cardiac and cystic cavities were united by partially resecting part of the cyst facing the cavity. In another patient, a left ventricular patch plasty was performed after removal of the cystic material in the left ventricle. Mebendazole was used postoperatively in all patients. Except for 1 patient who died, all were discharged without postoperative complications. The mean follow-up was 7.5 +/- 5 years. There was no late cardiac mortality or recurrence. CONCLUSIONS: Cardiac hydatid cysts with intracavitary expansion should be treated surgically without delay. Gentle handling of the heart during cardiopulmonary bypass minimizes operative risk. All patients should be investigated for systemic cysts.

The role of intraoperative antibiotic irrigation and postoperative antibiotic therapy for contaminated implantable prosthesis: in a rat model in vivo.

The aim of this study was to determine the usefulness of intraoperative antibiotic irrigation solution and long-term effective antibiotic therapy for the infected prostheses. Forty-five male Wistar albino rats were divided into three equal groups and a small piece of silicone prosthesis contaminated with Staphylococcus epidermidis was implanted into the scrotum. In the first group, the silicone pieces were irrigated with an antibiotic solution intraoperatively and antibiotic therapy was applied for 20 days postoperatively. The second group underwent only antibiotic therapy. In the third group (control) neither intraoperative irrigation nor postoperative antibiotic therapy was applied. Postoperative clinical infection was determined as follow-up. All implants were extracted 20 days after the implantation and cultured to observe the bacterial growth. In the first group, in 13 rats the cultures were negative and in two rats, the cultures revealed positive bacterial growth. In the second group, in four rats the cultures were negative, in five rats the cultures were positive and six rats revealed infectious findings. In the third group, 13 rats revealed infectious findings, and in the remaining two rats the cultures were positive. The differences between three groups are statistically significant (P < 0.05). We conclude that intraoperative antibiotic irrigation and postoperative antibiotic therapy are highly beneficial in the infected prosthesis surgery.

Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis.

Mitral valve replacement with preserving all chordae tendineae in patients with mitral regurgitation has been proved to be beneficial for left ventricular performance in the postoperative period. To evaluate the effectiveness of this technique in patients with mitral stenosis a comparison of the hemodynamic and echocardiographic data between patients having operation with this technique (Group P, n = 15, mean age = 37.5 +/- 12 years), and those having operation with the conventional method of mitral valve replacement (Group C, n = 15, mean age = 39 +/- 10.4 years) was made. The study population was limited to patients who had no clinical evidence of coronary artery disease and if over 40 years of age had normal coronary artery anatomy on coronary arteriography; patients with no evidence of aortic stenosis and/or regurgitation; and patients who had pure mitral stenosis or mitral stenosis with slight regurgitation (Grade 2 or less) with a mean gradient across the mitral valve greater than 10 mmHg. Hemodynamic parameters improved in both groups after the operation. However, echocardiographic measurements obtained six months postoperatively revealed a significant decrease in left ventricular ejection fraction in Group C (61.33 +/- 9.29% preoperatively versus 53.2 +/- 10.3% postoperatively; p < 0.05). The difference between left ventricular ejection fraction diminution of the two groups was statistically significant (-0.71 +/- 6.28% in Group P versus -8.07 +/- 13.35% in Group C; p < 0.01). Left ventricular end systolic and end diastolic dimensions decreased in patients with preserved valves and increased in patients operated on with conventional method without reaching a statistical significance. Sizes of prosthetic valves inserted were in the same range and no significant differences were found in preoperative and postoperative comparison of the two groups in respect to effective mitral orifice area and transvalvular gradient. There were no evidence of prosthetic valve dysfunction and paravalvular leakage and no operative or late deaths. It is concluded that if it is suitable, mitral valve replacement with preservation of chordae tendineae is expected to have a beneficial effect on postoperative left ventricular performance in patients with mitral stenosis.