Adverse Drug Event Profile Associated with Anti-dementia Drugs: Analysis of a Spontaneous Reporting Database.

Adverse drug events (ADEs) rates associated with anti-dementia acetylcholinesterase inhibitors are estimated to be 5%-20% and show a wide range of symptoms. No report has examined whether there is a difference in the anti-dementia drugs' ADEs profile. This study aimed to establish whether anti-dementia drugs' ADEs profile differed. Data was based on the Japanese Adverse Drug Event Report (JADER) database. The reporting odds ratios (RORs) was used to analyze data for ADEs from April 2004-October 2021. The target drugs were donepezil, rivastigmine, galantamine, and memantine. The top ten most frequently occurring adverse events were selected. The association between the RORs and antidementia drug ADEs was evaluated, and compared the distribution rate of expression age related to ADEs and each ADEs' timing of onset due to anti-dementia drugs. The primary outcome was RORs. Secondary outcome were expression age and time-to-onset of ADE associated with anti-dementia drugs. A total of 705,294 reports were analyzed. The adverse events incidence differed. Bradycardia, loss of consciousness, falls, and syncope incidence were significantly diverse. The Kaplan-Meier curve results for the cumulative ADEs incidence showed that donepezil had the slowest onset, while galantamine, rivastigmine, and memantine had approximately the same timing of onset.

Pharmacist Interventions for Adverse Drug Reactions in Palliative Care: A Multicentre Pilot Study.

This study aimed to investigate adverse reactions to medications administered during palliative care and compare the responses of Board-Certified Pharmacists in Palliative Pharmacy (BCPPP) and non-BCPPP professionals. Methods: This multicentre prospective survey included hospital and community pharmacists who are members of the Japanese Society for Pharmaceutical Palliative Care and Sciences. Study participants included patients who experienced new drug reactions during the study period and responded to the requested survey items. The follow-up period for each eligible patient began on the day the pharmacists initiated the intervention and ended at discharge, death, or after one month of intervention. The primary endpoint was the impact of pharmacist intervention on adverse drug reactions. The pharmacists included in the study evaluated the severity of adverse drug reactions to assess the effect of their intervention using an integrated palliative care outcome scale before and after the intervention. Key findings: During the survey period, 79 adverse drug reaction intervention reports from 69 patients were obtained from 54 pharmacists (28 certified and 26 non-certified). The response rate was 1.62% (54/3,343). The management of palliative pharmacotherapy side effects by BCPPP and non-BCPPP significantly improved the patients' activities of daily living (P < 0.001). The BCPPP group intervened for significantly more patients with adverse drug reactions and overall adverse drug reactions than the non-BCPPP group (P < 0.023 and P < 0.013, respectively). Conclusion: BCPPP interventions can improve symptom management.

Association of Pharmacist-led Deprescribing Intervention with the Functional Recovery in Convalescent Setting.

So far, no studies investigated the association between pharmacist intervention and rehabilitation outcomes. The aim of study was to establish whether the pharmacist-led deprescribing intervention affects rehabilitation outcomes. This retrospective, observational, single-center, cohort study included consecutive geriatric patients (n = 448) with pharmacist-led intervention between 2017 and 2019. Participants were divided based on pharmacist-led deprescribing and non deprescribing interventions during hospitalization. Demographic data, laboratory data, the Functional Independence Measure were (FIM) analyzed between the groups. Multiple linear regression analysis was performed to analyze the relationship between pharmacist-led deprescribing and FIM total gain. The primary outcome was FIM total gain. The rate of pharmacist intervention during the study period was 92.4%. A multiple linear regression analysis of FMI-T gain, adjusting for confounding factors, revealed that the pharmacist-led deprescribing intervention was independently correlated with FMI-T gain. Particularly, the use of dyslipidemia drugs, antipsychotic drugs, hypnotics, and nonsteroidal anti-inflammatory drugs significantly decreased during hospitalization. The pharmacist-led deprescribing intervention was independently and significantly associated with FIM-T gain. The pharmacist-led deprescribing intervention improved functional recovery in a rehabilitation setting.

Comparison of anthropometric and conic beam computed tomography measurements of patients with and without difficult intubation risk according to modified mallampati score: New markers for difficult intubation.

BACKGROUND: The aim of this study was to compare the anthropometric and cone beam computed tomography (CBCT) measurements taken from risk-free and risky groups by using the modified Mallampati score (MMS). PATIENTS AND METHODS: A total of 176 volunteers between the ages of 18 and 65 in four different MMS classes were included in the study. The patients in classes MMS I and MMS II were accepted as risk-free and the patients in classes MMS III and MMS IV were accepted as risky for intubation. The Mann-Whitney U test was performed on the data to compare the anthropometric and radiological measurements taken from the risk-free and risky groups. A receiver operating characteristic (ROC) analysis was applied to the parameters that had a statistically significant difference. RESULTS: According to the analysis results, statistically significant differences were found in the neck circumference (NC), maximum interincisal distance (MID), thyromental distance (TMD) and sternomental distance (SMD) of the anthropometric measurements of men and women between the risk-free and risky groups (P < 0.05). In terms of CBCT measurements, the thickness of the tongue (TT), distance between the uvula and posterior wall of pharynx (U-Ph), distance between posterior nasal spine and nasopharynx (Snp-Nph) and length of the epiglottis (LE) were found to have statistically significant differences between the risk-free and risky groups of men and women (P < 0.05). CONCLUSION: The NC, MID, TMD and SMD anthropometric measurements and TT, U-Ph, Snp-Nph and LE radiologic measurements were found to support MMS, which is one of the most widely used bedside intubation prediction tests. In addition to the inclusion of CBCT for intubation prediction, U-Ph and Snp-Nph radiologic measurements were added as difficult intubation markers.

Anticholinergic load negatively correlates with recovery of cognitive activities of daily living for geriatric patients after stroke in the convalescent stage.

WHAT IS KNOWN AND OBJECTIVE: Anticholinergic drugs are associated with risks of falls, confusion and cognitive dysfunction. However, the effect of anticholinergic drug use on rehabilitation outcomes after a stroke is poorly documented. We therefore aimed to establish whether the anticholinergic load was associated with functional recovery among geriatric patients convalescing after stroke. METHOD: Consecutive geriatric stroke patients admitted and discharged from a convalescence rehabilitation ward between 2010 and 2016 were included in this retrospective cohort study. Anticholinergic load was assessed by the Anticholinergic Risk Scale (ARS), and functional recovery was assessed by the Functional Independence Measure (FIM). The primary outcome was cognitive FIM (FIM-C) gain, but we also assessed the interaction of other putative factors identified from univariate analysis. Multivariate analyses were performed, adjusting for confounding factors. RESULTS AND DISCUSSION: We included 418 participants (171 males, 247 females) with a median age of 78 years (interquartile range, 72-84 years). Multiple regression analysis revealed that ARS change, length of stay, and epilepsy were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the "Comprehension" and "Memory" items of the cognitive FIM gain were independently and negatively associated with anticholinergic load. WHAT IS NEW AND CONCLUSION: A causal relationship cannot be established, but increased ARS scores during hospitalization may predict limited cognitive functional improvement in geriatric patients after stroke. Alternatively, cognitive impairment may lead to increased use of anticholinergic drugs.

First report of carglumic acid in a patient with citrullinemia type 1 (argininosuccinate synthetase deficiency).

WHAT IS KNOWN AND OBJECTIVE: Carglumic acid is a structural analogue of human N-acetylglutamate, which has become an alternative therapeutic option for hyperammonaemia in organic acidaemias such as isovaleric acidaemia, methylmalonic acidaemia and propionic acidaemia, and it has been suggested in other urea cycle disorders such as ornithine transcarbamylase deficiency and carbamoyl phosphate synthetase 1 deficiency. CASE DESCRIPTION: A male newborn was diagnosed with citrullinemia after serum amino acid analyses revealed markedly elevated citrulline concentration together with homozygous p.Gly390Arg mutation in ASS1 gene. The ammonia concentration decreased and blood gas analysis normalized after peritoneal dialysis was performed for three days. Also, sodium benzoate, L-arginine and parenteral nutrition with glucose and lipid therapy were initiated. Until 1 year of age, low adherence to sodium benzoate therapy due to unpleasant taste caused hyperammonaemic episodes and obligated us to initiate carglumic acid (100 mg/kg/day) therapy. During treatment with carglumic acid, the median ammonia level was 45.6 µmol/L. The patient's treatment was switched from carglumic acid to sodium phenylbutyrate when he was 4.5 years old. Currently, the patient is 6.5 years old and remains under follow-up with sodium phenylbutyrate, L-arginine and protein-restricted diet. Plasma ornithine level was found to be significantly lower during the carglumic acid treatment compared to other treatments (P=.039). Also, glutamic acid was found to be higher during the sodium benzoate treatment period compared to other treatment periods (P=.024). WHAT IS NEW AND CONCLUSION: To the best of our knowledge, this is the first report describing the long-term use of carglumic acid in a patient with argininosuccinate synthetase deficiency.

Assessment of oral anticoagulation control at pharmacist-managed clinics: A retrospective cohort study.

In chronic kidney disease (CKD) patients, the ratio of warfarin enantiomers is changed and becomes unstable due to a reduction of cytochrome P450 (CYP) 2C9 activity of, which contributes to the development of hemorrhagic complications. The aim of this study was to investigate the influence of interventions by clinical pharmacists in addition to guidance by physicians on time in therapeutic range (TTR) control of warfarin therapy for CKD patients with non-valvular atrial fibrillation (NVAF). This retrospective cohort study included NVAF patients with CKD admitted and discharged from a cardiovascular internal medicine ward between March 2011 and July 2013 in Yokosuka Kyousai Hospital. Participants were classified into two groups according to the instructions by clinical pharmacists and physicians (intervention group) and by physicians only (usual care group). The primary outcome was TTR. Secondary outcomes were major bleeding and minor bleeding. In total, 39 participants (28 males, 11 females; mean age: 72.1 years) were classified into the intervention (n = 16) and usual care (n = 23) groups. TTR in the intervention group was significantly higher than in the usual care group. Major bleeding and minor bleeding were not significantly different between the two groups. The intervention of clinical pharmacists with anticoagulation therapy can lead to a proper use of warfarin prescribed by physicians.

The association between the increase in pulse pressure and renal function in chronic kidney disease patients with dyslipidemia.

In recent years, an association between chronic kidney disease (CKD) and arteriosclerosis has been identified. Pulse pressure (PP) is used as an index of arteriosclerosis. However, there have been few studies of the relationship between PP and renal dysfunction in patients with CKD. Therefore, we examined the association of increased PP on renal function in patients with CKD and dyslipidemia. This study included 104 patients with CKD who were diagnosed with dyslipidemia and commenced on drug treatment. In the present study, patients with PP ≥65 mmHg were included in the High PP group, and patients with PP <65 mmHg were included in the Low PP group. We compared the High PP group with the Low PP group about background patient characteristics, laboratory data and antihypertensive medications and type. Mutiple logistic regression analysis identified estimated glomerular filtration rate (eGFR) as a significant predictor of PP ≥65 mmHg. In addition, values of BUN, Ccr, and eGFR baseline and 12 months later were compared. In the High PP group, compared with baseline, BUN increased significantly and Ccr and eGFR decreased significantly after 12 months later. We consider that PP may be an auxiliary indicator of generalized arterial sclerosis and renal function.

Effects of antidiabetes drugs on functional independence measure on a subacute rehabilitation ward for stroke patients.

It has been reported that the improvement of activities of daily living (ADL) by rehabilitation affects glycemic control. However, there are no reports about antidiabetes drugs as factors affecting the outcomes of rehabilitation. Therefore, we investigated the effects of antidiabetes drugs on functional independence measure (FIM) [total (T), motor (M), and cognition (C) items] in stroke patients with diabetes who were discharged from the subacute rehabilitation ward. We chose the frequently used antidiabetes drugs [sulfonylurea (SU), dipeptidyl peptidase-IV inhibitors (DPP-IVIs), and α-glycosidase inhibitors (α-GIs)] as the basis for categorizing the patients. We compared the patients' background features and laboratory data among the three groups. As a result, when SU was used in stroke patients with diabetes, it is difficult to obtain significant FIM-M gain, FIM-C gain, FIM-M efficiency, and FIM-C efficiency compared with of-GIs. As a reason for this, we hypothesize the possibility of the involvement of insulin resistance. Therefore, we consider that insulin resistance should be determined early and that it is important to reduce insulin resistance comprehensively by involving experts.

Analysis of factors affecting time in therapeutic range control after warfarin administration.

The protective efficacy of warfarin for cardiogenic cerebral embolism has been established. However, warfarin is generally administered to only approximately 35% of the atrial fibrillation patients who required warfarin therapy. It has been reported that international normalized ratio (INR) control was carried out appropriately in < 50% of such patients. Therefore, from the viewpoint of prevention of the onset and recurrence of embolism, the maintenance of a stable anticoagulant level is necessary. In warfarin therapy, in addition to INR control, time in therapeutic range (TTR) also markedly affects the efficacy of warfarin therapy. Therefore, we classified patients into two groups on the basis of the cutoff TTR ≥ 65% at which the inhibitory effect of warfarin on stroke has been observed. We aimed to examine the association between INR and TTR with the correction of the therapeutic efficacy of warfarin by analyzing the factors leading to poor TTR control. The most valuable finding of this study is that marked fluctuations of brain natriuretic peptide levels in patients with complication of heart failure was a risk factor for poor TTR control. Identification of the factors leading to the poor TTR control is useful for making the decision to switch to other anticoagulants, such as dabigatran or apixaban, or to continue warfarin by correcting risk factors in atrial fibrillation patients receiving long-term warfarin therapy.

Analysis of factors for poor activated partial thromboplastin time control after dabigatran administration.

In this study, we compared patients whose activated partial thromboplastin time (APTT) was prolonged excessively with those whose APTT was controlled within the normal range after dabigatran administration. We analyzed the factors for the APTT prolongation. We divided the patients into two groups: those whose APTTs prolonged to more than 65 s and those whose APTTs were less than 65 s after dabigatran administration. There were 130 patients from March 2011 to July 2013, and we analyzed the background features and laboratory data of these patients. Results showed that there were no significant differences in the patients' background and laboratory data except for the high-density lipoprotein cholesterol (HDL-C) level. However, details of the relationship between the APTT prolongation and the HDL-C level are currently unknown. We hypothesize that the reason for the APTT prolongation is the variability in such parameters as the time of blood drawing, internal time of dabigatran, individual variability, and blood concentration. Therefore, we consider that these parameters need to be carefully evaluated even if APTT does not show prolongation.

The postoperative analgesic efficacy of intraperitoneal bupivacaine compared with levobupivacaine in laparoscopic cholecystectomy.

BACKGROUND: The aim of this randomized controlled study was to compare the postoperative analgesic efficacy of intraperitoneal bupivacaine versus levobupivacaine in patients undergoing laparoscopic cholecystectomy. METHODS: We randomly divided 90 patients undergoing elective laparoscopic cholecystectomy into 3 groups. A dose of 0.125% bupivacaine (Group B) 80 ml or 0.125% levobupivacaine (Group L) 80 ml or 0.09% NaCl (Group P) 80 ml was instilled intraperitoneally at the end of the procedure, before removal of the trocars. All patients had a standard anesthetic. Tramadol was administered intravenously via a patient controlled analgesia pump as a rescue analgesic in all patients. Postoperative pain scores were assessed at 30 minutes, 1, 2, 4, 6, 12 and 24 hours after surgery by using a visual analog scale. The primary end point of this study was to compare tramadol consumption of the three groups at the postoperative 24 h. Total tramadol consumption, first analgesic requirement time and adverse effects were recorded. RESULTS: Group B experienced significantly less pain (P < 0.01) than the placebo group at 6 h, 12 h and 24 h postoperatively during rest. Group L registered significantly lower visual analog scale scores (p < 0.01) than the placebo group at 12 h during rest. During movement, visual analog scale pain scores were lower in group B than Group P (P < 0.01). Additionally, total tramadol consumption was significantly lower in Group B than the other groups. First analgesic requirement time was shorter in the placebo group compared with group B and group L (P < 0.05). There was no significant difference between the groups with respect to right shoulder pain, total nausea and vomiting. CONCLUSION: Intraperitoneal instillation of bupivacaine 0.125% 80 ml (100 mg) is more effective than levobupivacaine 0.125% 80 ml (100 mg) in reducing the postoperative pain after laparoscopic cholecystectomy.

The effects of montelukast against amikacin-induced acute renal damage.

BACKGROUND AND OBJECTIVES: The therapeutic and protective effects of montelukast against amikacin-induced acute renal damage were investigated. MATERIAL AND METHODS: 35 Wistar albino female rats were divided into 5 groups as follows: Group I: Control; Group II: Control+montelukast; Group III: Amikacin; Group IV: Amikacin+montelukast; Group V: Montelukast+amikacin. At the end of the experiment, the kidney tissues and the blood of rats were collected. Malondialdehyde (MDA), myeloperoxidase (MPO), and reduced glutathione (GSH) levels were determined from kidney tissues. Blood urea nitrogen (BUN), creatinine (Cr), TNF-alpha, and IL-1beta levels were assessed in the serum. In addition the kidney tissues were examined histologically. RESULTS AND DISCUSSION: The MDA, MPO, BUN, and Cr levels of group III significantly increased when compared to groups I and II. These parameters of group IV decreased when compared to group III. In addition, GSH levels significantly increased when compared to the first three groups. MDA, BUN and Cr levels of group V did not reach significant level in comparison with the control group. The most significant histological damage was observed in the group III followed by the groups IV and V. Immunohistochemically, group III showed a significantly increased apoptotic staining. In group IV, it was observed that montelukast treatment reduced the expression of apoptotic cells. CONCLUSIONS: Montelukast treatment after amikacin injection could reduce the amikacin-induced kidney damage.

Rose oil inhalation protects against formaldehyde-induced testicular damage in rats.

In this experimental study, harmful effects of formaldehyde (FA) inhalation on sperm concentration, sperm quality, serum testosterone levels and the rat testes were investigated. In addition, the possible protective effects of rose oil against to these harmful effects were evaluated. For this purpose, 21 albino-Wistar rats were used. The rats in Group I were used as control group. When the rats of Group II were exposed FA (10 ppm/1 h) for 35 days, the rats of Group III inhalated rose oil (1 ml/1 h) after FA. The epididymal tissues were taken for sperm analysing and the testes were removed for histological examination. In addition, testosterone levels were determined from the blood samples. Although the testosterone levels, the epididymal sperm concentration, and the progressive sperm motility significantly decreased, the abnormal sperm rate significantly increased in the Group II when compared to Group I. In the Group III, these damages were seen less. When the rats in the Group II compared with the control group, there were serious histological damages. In the Group III, it was determined that the histological changes were less than group II. It can be expressed that serious damages occurred via formaldehyde exposure in male reproductive system and that the rose oil had protective effects against these damages.

The use of hyoid bone dimensions in age and sex estimation in a Turkish population: a cone-beam computed tomography study.

BACKGROUND: The aim of the study was to determine sex and age from hyoid bone morphology on cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The study sample comprised 130 CBCT images. Eight different measurements were performed for each hyoid bone. Fusion conditions were assigned to each side of the hyoid bone separately as; unfused, partially fused, and totally fused. RESULTS: The hyoid length, width of the left proximal end and stature variables showed sexual dimorphism in all hyoid fusion types (p < 0.05). In young adult age group, a significant difference was found between sex and fusion types (p = 0.025). The body length (81.35%) and stature measurements (76.25%) contributed most significantly to sex estimation. CONCLUSIONS: Patient's CBCT scans which enable reproducible and reliable measurements for bone tissues can be used for forensic procedures. Hyoid bone measurements with CBCT are useful methodology for age and sex estimation in forensic sciences with high predictive accuracy.

The effect of lavender oil on serum testosterone levels and epididymal sperm characteristics of formaldehyde treated male rats.

BACKGROUND AND OBJECTIVES: In this study, the harmful effects of formaldehyde (FA) on serum testosterone levels and epididymal sperm characteristics were investigated. In addition, possible protective effect of lavender oil was evaluated. MATERIALS AND METHODS: For this purpose, 21 adult male Wistar-Albino rats were used. The rats of group I was used as control group. The rats of group II were exposed FA (10 ppm/1 hour) for 35 days. The rats of group III inhaleted lavender oil (1 ml/1 hour) with FA. RESULTS: While the testosterone levels, the epididymal sperm concentration and the progressive sperm motility were significantly decreased, the abnormal sperm rate was significantly increased in FA treated group when compared to control group. However, in group III, the epididymal sperm concentration and the progressive sperm motility were significantly increased, the abnormal sperm rate was significantly decreased in comparison with the FA treated group. CONCLUSION: It can be expressed that serious damages occured via formaldehyde exposure in reproductive system and that the lavender oil had protective effects against these damages.

Anticholinergic Load and Nutritional Status in Older Individuals.

OBJECTIVES: The association between anticholinergic load-based Anticholinergic Risk Scale scores and nutritional status is unclear in Japanese patients. The aim of this study was to establish whether anticholinergic load affects the nutritional status of geriatric patients in convalescent stages. DESIGN: Retrospective longitudinal cohort study. SETTING: Convalescent rehabilitation wards. PARTICIPANTS: Of the 1490 patients aged ≥65 years who were discharged from convalescent rehabilitation wards between July 2010 and October 2018, 908 patients met the eligibility criteria. They were categorized according to the presence or absence of increased anticholinergic load from admission to discharge. MEASUREMENTS: Demographic data, laboratory data, the Functional Independence Measure were analyzed between the groups. The primary outcome was Geriatric Nutritional Risk Index (GNRI) at discharge. Multiple linear regression analysis was performed to analyze the relationship between anticholinergic load and GNRI at discharge. RESULTS: Multiple linear regression analysis after adjusting for confounding factors revealed that anticholinergic load was independently and negatively correlated with GNRI at discharge. Particularly, the use of chlorpromazine, hydroxyzine, haloperidol, metoclopramide, risperidone, etc. increased significantly from admission to discharge. CONCLUSION: Increased anticholinergic load during hospitalization may be a predictor of nutritional status in geriatric patients.

The effects of maternal presence during anesthesia induction on the mother's anxiety and changes in children's behavior.

This study aimed to evaluate whether maternal presence during induction has additional beneficial effects on a mother's anxiety or changes in the child's behavior when an information booklet was given to all mothers and premedication was given to all patients. One hundred children, aged 2-10 years, scheduled for ambulatory surgery were randomly assigned to a mother-present (Group M) or mother-absent group (Group C) after premedication with intranasal midazolam. All mothers were informed about general anesthesia with a detailed information booklet. Preoperatively (pre) and one week after the operation (post), maternal anxiety was assessed using State-Trait Anxiety Inventory (STAI), and Posthospitalization Behavior Questionnaire (PHBQ) was used to measure changes in children's behavior. Anesthesia was induced using sevoflurane-oxygen-nitrous oxide inhalation. The anesthesiologist graded the level of the children's stress at anesthesia induction with a four-point scale. There were no differences between the two groups regarding demographics, anxiety levels of the mothers and postoperative behavioral changes and stress scores of the children (p>0.05 between the groups *p<0.005 within groups). In summary, maternal presence during induction in addition to premedication for children and information booklets for mothers had no additive effects in terms of reducing the mother's or the child's anxiety or postoperative behavioral changes.

Conformational, electronic, and spectroscopic characterization of isophthalic acid (monomer and dimer structures) experimentally and by DFT.

Isophthalic acid (C6H4(CO2H)2) is a noteworthy organic compound widely used in coating and synthesis of resins and the production of commercially important polymers such as drink plastic bottles. The effects of isophthalic acid (IPA) on human health, toxicology, and biodegradability are the main focus of many researchers. Because structural and spectroscopic investigation of molecules provides a deep understanding of interactional behaviors of compounds, this study stands for exploring those features. Therefore, the spectroscopic, structural, electronic, and thermodynamical properties of IPA were thoroughly studied in this work experimentally using UV-Vis, (1)H and (13)C NMR, FT-IR, FT-Raman and theoretically via DFT and TD-DFT calculations. The UV-Vis absorption spectrum in water was taken in the region 200-400nm. The NMR chemical shifts ((1)H and (13)C) were recorded in DMSO solution. The infrared and Raman spectra of the solid IPA were recorded in the range of 4000-400cm(-1) and 3500-50cm(-1), respectively. DFT and TD-DFT calculations were performed at the level of B3LYP/6-311++G(d,p) in determination of geometrical structure, electronic structure analysis and normal mode. The (13)C and (1)H nuclear magnetic resonance (NMR) spectra were estimated by using the gauge-invariant atomic orbital (GIAO) method. The scaled quantum mechanics (SQM) method was used to determine the total energy distribution (TED) to assign the vibrational modes accurately. Weak interactions such as hydrogen bonding and Van der Walls were analyzed via reduced density gradient (RDG) analysis in monomeric and dimeric forms. Furthermore, the excitation energies, density of state (DOS) diagram, thermodynamical properties, molecular electro-static potential (MEP), and nonlinear optical (NLO) properties were obtained.

Corona mortis: in vivo anatomical knowledge and the risk of injury in totally extraperitoneal inguinal hernia repair.

PURPOSE: Corona mortis (CMOR) is the arterial and/or venous vascular communication(s) between the obturator and external iliac vessels. Totally extraperitoneal (TEP) inguinal hernioplasty can be associated with vascular complications especially during the fixation of the mesh. Theoretically, CMOR is an important nominee. But, the data in literature are insufficient about CMOR injury. Additionally, most of the studies about CMOR have been usually performed on cadavers. We aimed to reveal the preperitoneal vascular anatomy of inguinal area and provide in vivo knowledge about CMOR. The risk of arterial injury was also evaluated. MATERIALS: The data of preperitoneal vascular anatomy of 321 patients who underwent TEP procedure between January 2005 and July 2014 were retrospectively evaluated. RESULTS: Mean age was 46 ± 8.9 years, 53 females vs 268 males. 391 hemipelvises were evaluated. Two types of arterial structure were identified; (1) an aberrant obturator artery forming an anastomosis with branches of ordinary obturator artery; (2) a pubic branch of inferior epigastric artery. The incidence of arterial CMOR was 28.4 % and of any arterial structure was 45.0 %. An arterial CMOR was considered as thick (≥2 mm) or thin (<2 mm). Injury of arterial CMOR during tack stapling on Cooper's ligament was seen in six cases (1.5 %). All of them were thin (<2 mm) in structure. Venous CMOR was visible only under low pressure in work space. CONCLUSION: During TEP hernia repair, CMOR and/or pubic branch of inferior epigastric artery can be damaged. To prevent this complication, tacks should be stapled to Cooper's ligament close to symphysis pubis and dissection should be careful on the posterior surface of superior pubic ramus. Small caliber (<2 mm) arterial CMOR is more prone to be injured during TEP procedure. To explore venous structures properly, pressure in workspace should be kept as low as possible.