Baseline Factors Affecting the Prognosis of Ischemic Cerebellar Stroke Patients in Turkey: A Cross-Sectional Study.

BACKGROUND: Cerebellar infarcts are encountered commonly in clinical practice; however, they are likely to be misinterpreted. They cannot be adequately evaluated on scales such as the National Institute of Health Stroke Scale (NIHSS), which can have fatal consequences. AIM: To evaluate the baseline features, prognosis, and 6-month survival in patients with cerebellar stroke. METHODS: A total of 200 patients with cerebellar ischemia were included in the study. Patients were analyzed retrospectively from 10 years of data. Both univariate and multivariate analyses were evaluated. RESULTS: Mean age was 68 years old, and men were more frequently affected. The most common symptoms were dysarthria and vertiginous sensations. Ischemic lesions were usually cortical/juxtacortical, multiple, hemispheric, and small (below 1.5 cm). The most commonly affected artery was the medial branch of the posterior inferior cerebellar artery. Cardioembolism was the more frequent etiology. Gait ataxia was associated with a more favorable prognosis and 6-month modified Rankin Scale (mRS) scores (OR: 0.15, 95% CI, P = 0.03). Older age (OR: 1.75, 95%, P = 0.02), female gender (OR: 6.72, 95%, P = 0.02), multiple (OR: 10.92, 95%, P = 0.01) and large lesions (OR: 6.56, 95% CI, P = 0.01), posterior circulation ischemic lesions extra-cerebellum (OR: 8.33, 95% CI, P = 0.01), left ventricular apical hypokinesia or AF (OR: 5.58, 95% CI, P = 0.02), and a high mRS score on admission (OR: 5.21, 95% CI, P < 0.001) was correlated with higher 6-month mRS and a lower survival rates. CONCLUSION: The study found that some baseline clinical, neurovascular imaging findings, and the mRS score on admission are useful predictors of cerebellar stroke prognosis and outcome.

Prognostic factors and survival in patients undergoing surgery for T4 nonsmall cell lung carcinoma.

BACKGROUND: Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial. METHODS: Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9). RESULTS: Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2; p = 0.01) and complete resection (R0 versus R1; p = 0.06). CONCLUSION: Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups.

Engineering care transitions: Clinician perceptions of barriers to safe medication management during transitions of patient care.

Medication safety during care transitions is a significant challenge, especially for older adults prescribed multiple medications. Using a systems approach to understand barriers to and strategies for safe medication management throughout high-risk periods of hospital-to-home transition is one important step in designing effective interventions. Framing the care transition as a collaboration between healthcare and patient "work systems," we conducted semi-structured interviews with 37 clinical team members, representing 10 different professional roles involved in providing transitional care for patients. Thematic analyses identified key strategies used by clinical team members in preparing patients to self-manage medications safely in the home environment: (1) streamlining and coordinating clinical management of medication reconciliation across care settings; (2) building patient capacity and engagement in self-management of medications; and (3) redesigning the transitional process. Our research highlights the value in aligning professionals' care transition goals with patients and caregiver(s) to better prepare them to self-manage medications upon discharge.

Minimally invasive excision of multiple cystic lymphangiomas of the mediastinum: a case report.

Mediastinal lymphangioma is one of the rarest benign mediastinal masses. We report the successful minimally invasive surgical treatment of multiple cystic lymphangiomas in a middle-aged man with a familial history of lung cancer. This case report describes cystic lymphangioma as a rare differential diagnosis for a mediastinal mass in an adult.

Very important histopathological factors in patients with resected non-small cell lung cancer: necrosis and perineural invasion.

BACKGROUND: The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied. METHODS: During a 4-year period, 152 patients operated for non-small cell lung cancer (NSCLC) at our hospital were analyzed. Mean age of patients was 55.7 +/- 10.1 years. RESULTS: Overall 5-year survival was 42.2 %. Mediastinal lymph node involvement, tumor size, incomplete resection, pneumonectomy, presence of necrosis and perineural invasion were significant prognosticators ( P = 0.03, 0.04, 0.0001, 0.046, 0.0246, < 0.0001, respectively). Multivariate analysis revealed that N status, perineural invasion, and the presence of necrosis were independent prognostic factors ( P = 0.006, P = 0.001, P = 0.001, respectively). Patients who had stage I tumor with necrosis and perineural invasion had a lower survival rate than those with stage IIIA tumor without these histopathological features ( P = 0.04). The presence of these histopathological characteristics in stage IIIA patients was a sign of a poorer prognosis ( P = 0.0001). CONCLUSIONS: Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.

Pulmonary sclerosing haemangioma mimicking hydatid cyst: a case report.

We report the case of a pulmonary sclerosing haemangioma radiologically presenting as a cystic lesion. The patient was found to have specific anti-echinococcus immunoglobulin E and therefore the preoperative diagnosis was that of pulmonary hydatid cyst. A surgical resection was performed. Although rarely encountered, pulmonary sclerosing haemangioma may show radiological and serological similarities to a pulmonary hydatid cyst. Both entities necessitate complete removal of the lesion without parenchymal resection.

Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. METHODS: In the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or 'usual care'. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include 'all cause' hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. DISCUSSION: Unlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations.

Adsorptive removal of phosphate from aqueous solutions using raw and calcinated dolomite.

This study explored the feasibility of utilizing raw and calcinated dolomite under CO2 atmosphere for phosphate removal in laboratory experiments. The experimental work emphasized the evaluation of phosphate adsorption characteristics of this adsorbent material. Studies were conducted to delineate the effect of contact time, initial phosphate concentration, temperature, pH, stirring speed, adsorbent dose and calcination temperature. Phosphate removal decreased with increasing temperature and slightly increased with increasing of pH. The observed decrease in the adsorption capacity with increase of the temperature from 20 to 40 and to 60 degrees C indicates that the low temperatures favor the phosphate removal by adsorption onto dolomite. Phosphate removal was seen to decrease with increasing calcination temperature due to the structural changes occurring in the structure and pore size distribution of dolomite samples during calcination. The experimental data obtained were applied to the Freundlich, Langmuir, BET, Halsey, Harkins-Jura, Smith and Henderson isotherm equations to test the fit of these equations to raw and calcinated dolomite samples. By considering the experimental results and adsorption models applied in this study, it can be concluded that adsorption of phosphate occurs predominantly through physical interactions, and the dolomite sample has a heteroporous structure. The large values of the constants for Henderson equation and the high value of y(m) obtained from BET equation indicate the microporous structure is more stable in raw and calcinated dolomite samples.

Production of granular activated carbon from waste Rosa canina sp. seeds and its adsorption characteristics for dye.

An activated carbon was developed from Rosa canina sp. seeds, characterized and used for the removal of methylene blue (basic dye) from aqueous solutions. Adsorption studies were carried out at 20 degrees C and various initial dye concentrations (20, 40, 60, 80, and 100 mg/L) for different times (15, 30, 60, and 120 min). The adsorption isotherm was obtained from data. The results indicate that the adsorption isotherm of methylene blue is typically S-shaped. The shape of isotherm is believed to reflect three distinct modes of adsorption. In region 1, the adsorption of methylene blue is carried out mainly by ion exchange. In region 2 by polarizations of pi-electrons established at cyclic parts of the previously adsorbed methylene blue molecules is occurred. However, it is not observed any change at the sign of the surface charge although zeta potential value is decreased with increase of amount adsorbed. In region 3, the slope of the isotherm is reduced, because adsorption now must overcome electrostatic repulsion between oncoming ions and the similarly charged solid. Adsorption in this fashion is usually complete when the surface is covered with a monolayer of methylene blue. To reveal the adsorptive characteristics of the produced active carbon, porosity and BET surface area measurements were made. Structural analysis was performed using SEM-EDS. The produced active carbon has the specific surface area of 799.2 m2 g-1 and the iodine number of 495 mg/g.

The adsorption kinetics of the cationic dye, methylene blue, onto clay.

In this study, adsorption kinetics of a cationic dye, methylene blue, onto clay from aqueous solution with respect to the initial dye concentration, temperature, pH, mixing rate and sorbent dosage were investigated. In order to understand the adsorption mechanism in detail, zeta potentials and the conductivities of clay suspensions at various pH (1-11) and cation exchange capacity (CEC) were measured. Porosity and BET surface area of clay studied were determined. The results showed that the adsorption has been reached to equilibrium in 1 h. It was found that the amount adsorbed of methylene blue increases with decreasing temperature and also with increasing both sorbent dosage and increasing initial dye concentration. Adsorption capacity decreases with increasing pH, except for the natural pH (5.6) of clay suspensions. The adsorption kinetics of methylene blue has been studied in terms of pseudo-first-order, pseudo-second-order sorption and intraparticle diffusion processes thus comparing chemical sorption and diffusion sorption processes. It was found that the pseudo-second-order mechanism is predominant and the overall rate of the dye adsorption process appears to be controlled by the more than one-step.

Pulmonary malacoplakia.

We report a case of a 76-year-old man with bilateral pulmonary and pleural nodules and type 2 diabetes mellitus. Laboratory investigations revealed no sign of immunodeficiency. Pleural, pulmonary and diaphragmatic biopsies were taken through a mini-thoracotomy. Pathology showed Michaelis-Gutmann inclusion bodies and diagnosis of malacoplakia was made. Malacoplakia masquerading as bilateral tumour masses was thought to be noteworthy especially in an immunocompetent patient.

Chylomediastinum following tracheal surgery.

Chylomediastinum is a rare but serious complication following thoracic procedures. A 70-year-old woman underwent tracheal resection through median sternotomy. Sternal dehiscence and chylous drainage appeared on the second postoperative week. Oral intake was stopped and total parenteral nutrition was started. Drainage stopped after two weeks. The region was ligated with a purse string suture during revision of sternotomy. A minimal lymph leakage was determined on control Tc-99 lymphoscintigraphy, which indicated injury of the thoracic duct. The patient has been problem-free for 9 months.

Elective pneumonectomy for non-small cell lung cancer: factors affecting early operative mortality and morbidity.

BACKGROUND: The aim of this study was to investigate the factors influencing the morbidity and mortality of the non-small cell lung cancer (NSCLC) cases where pneumonectomy was performed. MATERIAL & METHODS: All 101 patients who had underwent a pneumonectomy for NSCLC between 1994-2001 in our hospital were included in the retrospective study. There were 97 males and 4 females with a mean age of 56+/-9.6. Factors affecting morbidity and mortality were analysed by univariate and multivariate analysis. RESULTS: The morbidity rate was 53% and the mortality rate was 9%. Morbidity was related to cardiopulmonary complications in 40% of the cases. The risk factors for cardiopulmonary morbidity with univariate analysis were age > 60 years (p = 0.004), FEV1 < 2 lt (p = 0.016), early bronchopleural fistula (p = 0.0001), tumour size > 4 cm (p = 0.033), vital capacity < 3.7 lt (p = 0.016), forced vital capacity < 3.5 lt (p = 0.033).. With multivariate analysis the risk factors cardiopulmonary morbidity were age (60 >) (p = 0.012) and tumour size > 4 cm (p = 0.043). The risk factors mortality with univariate analysis were right pneumonectomy (p = 0.025), respiratory morbidity (p = 0.0001), cardiac morbidity (p = 0.002), cell type (Epidermoid CA) (0.047), tumour size > 6 cm (p = 0.036), fluid infusion (p = 0.009), forced vital capacity < 78% (p = 0.039), forced expiratory volume in 1 second < 75% (p = 0.039), PO2 (p = 0.037), PCO2 > 42 mmHg (p = 0.023). CONCLUSION: Among the pneumonectomies performed for NSCLC, the causes of postoperative morbidity were multifactorial, however, multivariate analysis did not show any significant factor affecting the mortality, related to this procedure.

Moisture adsorption properties and adsorption isosteric heat of dehydrated slices of Pastirma (Turkish dry meat product).

Moisture sorption characteristics of dehydrated pastirma were investigated at 15°C, 20°C and 30°C over a water activity (a(w)) range of 0.2-0.9. Sigmoidal (type-II) adsorption isotherms were observed for pastirma. The experimental sorption data obtained were applied to the Halsey, Harkins-Jura, Smith, BET, Henderson, Freundlich and GAB isotherm equations to test fitness of these equations to pastirma. The order of the best fit of sorption data obtained for pastirma at 15°C, 20°C and 30°C in all the range of a(w) studied (0.2-0.9) was Harkins-Jura>Halsey>BET>Smith>Freundlich>GAB>Henderson, respectively. In the range a(w) 0.2-0.55, BET model has a better fit than in the range a(w) 0.2-0.9. Isosteric heats of adsorption were evaluated by applying the Clausius-Clapeyron equation to experimental isotherms and decreased with increasing moisture content.

The coincidence of mediastinal tuberculosis lymphadenitis in lung cancer patients.

Mediastinal lymph node enlargement in operable non-small cell lung cancer is of clinical importance since it indicates the high possibility of nodal metastasis. The coincidence of tuberculosis and lung cancer is detected by the mediastinal lymph node staging of lung cancer patients. In our study, we retrospectively re-evaluated the records of patients who had been hospitalized with the diagnosis of lung cancer for the past 10 years. The mean age was 58 +/- 10 years (ranging from 39 to 72). A tuberculous lymphadenitis was detected in 16 of the 315 (5.1%) patients in one and/or multiple stations by either mediastinoscopy or thoracotomy. Inferior paratracheal lymph nodes (4R-4L) were the most frequently affected. None of the patients had a history of primary tuberculosis infection. The cell type was squamous cell carcinoma in ten patients (62.5%) and adenocarcinoma in six patients (37.5%). The tumour was located in the right lung in nine patients (56.2%). The most frequently involved site was the right upper lobe (n = 13, 81.2%). N2 disease was detected in six patients (37.5%). Our study showed that 5.1% of lung patients had tuberculous lymphadenitis coincidentally. The diagnosis and treatment of this latent disease could be considered as important, especially in lung cancer patients who would potentially receive radiotherapy or chemotherapy which alters the immune system. However, the real value of this finding needs further study.

Emergency surgery for massive haemoptysis.

BACKGROUND: Massive haemoptysis (600 ml in 24 hours) results in considerable mortality and deserves appropriate management. Since it is life threatening, lung resection remains the surgical treatment of choice in unrelenting haemoptysis. MATERIAL AND METHODS: We retrospectively reviewed all patients (n = 29) who were referred to our clinic between January 1994 to September 2001 with massive haemoptysis (> 600 ml/24 h). All patients had uncontrollable haemorrhage and/or failure of conservative treatment. After initial resuscitation, assuring adequate airway and providing adequate intravenous access, emergency thoracotomy was performed in all patients following rigid bronchoscopy (n = 27) in order to localize the bleeding. RESULTS: The most common underlying cause of the massive haemoptysis was pulmonary tuberculosis (n = 10) followed by emphysema in 4, lung cancer in 3, collagenous vascular disease in 2 and aspergilloma in one patient. Seventeen lobectomies (58.6%), 5 pneumonectomies (17.2%), 3 segmentectomies and 3 bilobectomies were done whereas physiological lung exclusion was performed in one patient. Haemoptysis could be controlled in all patients. Rate of operative morbidity and hospital mortality were 27.5% and 11.5% respectively. We recorded one patient with recurrent haemoptysis who was treated by completion pneumonectomy. CONCLUSION: Despite the debate over definition of massive haemoptysis and indication for surgery in these patients, emergency pulmonary resection provides an effective treatment with acceptable morbidity and mortality in patients with massive haemoptysis.

Testing the Electronic Personal Health Record Acceptance Model by Nurses for Managing Their Own Health: A Cross-sectional Survey.

BACKGROUND: To our knowledge, no evidence is available on health care professionals' use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses' personal use of ePHRs using a modified technology acceptance model. OBJECTIVES: To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses' own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers' use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use. METHODS: A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect. RESULTS: Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses' own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses. CONCLUSIONS: Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their individual patients.

The removal of Cu(II) from aqueous solutions by Ulothrix zonata.

In this work, adsorption of copper(II) ions on alga has been studied by using batch adsorption techniques. The equilibrium biosorption level was determined as a function of contact time at several initial metal ion concentrations. The effect of adsorbent concentration on the amount adsorbed was also investigated. The experimental adsorption data were fitted to the Langmuir adsorption model. The free energy change (deltaG0) for the adsorption process was found to be -12.60 kJ/mol. The results indicated that the biomass of Ulothrix zonata is a suitable biosorbent for both the removal and recovery of heavy metals from wastewater.

Kinetic modeling of liquid-phase adsorption of phosphate on dolomite.

The adsorption of phosphate from aqueous solution on dolomite was investigated at 20 and 40 degrees C in terms of pseudo-second-order mechanism for chemical adsorption as well as an intraparticle diffusion mechanism process. Adsorption was changed with increased contact time, initial phosphate concentration, temperature, solution pH. A pseudo-second-order model and intraparticle diffusion model have been developed to predict the rate constants of adsorption and equilibrium capacities. The activation energy of adsorption can be evaluated using the pseudo-second-order rate constants. The adsorption of phosphate onto dolomite are an exothermically activated process. A relatively low activation energy and a model highly fitting to intraparticle diffusion suggest that the adsorption of phosphate by dolomite may involve not only physical but also chemisorption. This was likely due to its combined control of chemisorption and intraparticle diffusion. However, for phosphate/dolomite system chemical reaction is important and significant in the rate-controlling step, and for the adsorption of phosphate onto dolomite the pseudo-second-order chemical reaction kinetics provides the best correlation of the experimental data.

Determination of adsorptive properties of clay/water system: methylene blue sorption.

In this study, adsorption of methylene blue onto clay was investigated. The effect of adsorption time and temperature on the adsorption process was studied. To reveal the adsorptive characteristics of the clay studied, porosity and BET surface area measurements were made. It was observed that the adsorption capacity decreases with increasing temperature, and adsorption equilibrium was attained within 1 h. It was found that the data fit well to Langmuir, Halsey, Henderson, and Harkins-Jura models but experimental data deviate significantly from BET and Freundlich models at especially high concentrations. Furthermore, isosteric adsorption enthalpy and entropy are calculated as -7.99 kJ mol(-1) and 25.41 JK(-1)mol(-1), respectively.