Relationship Between Urinary Angiotensinogen and Mortality in Patients with Heart Failure with Reduced Ejection Fraction.

BACKGROUND: Activation of the reninangi otens in-aldosterone system has an important role in the pathophysiology of heart failure with reduced ejection fraction. While the effects of systemic reninangi otens in-aldosterone system activation on heart failure with reduced ejection fraction are well known, the impact of the local reninangi otens in-aldosterone system on heart failure with reduced ejection fraction is not fully understood because of limited clinical research. This study aimed to investigate the effect of urinary angiotensinogen level, an accepted indicator of local reninangi otens in-aldosterone system activation, on all-cause mortality in patients with heart failure with reduced ejection fraction. METHODS: This retrospective, single-center study included 60 patients with baseline urinary angiotensinogen data and survival/mortality data at 4 years. Urinary angiotensinogen values were standardized to the urinary creatinine value measured from the same urine sample. The median urinary angio tensi nogen /urin ary creatinine value among all patients (114 µg/g) was used as a cutoff to divide the patients into 2 groups. Mortality data were obtained from the national registry systems or by telephone. RESULTS: Comparison of all-cause mortality in the 2 groups showed that 22 deaths (71%) occurred in the group with a urinary angio tensinogen/urinary creatinine ratio above the median and 10 deaths (35.5%) occurred in the group of patients with urinary angio tensinogen/urinary creatinine equal to or below the median value (P =.005). CONCLUSION: Our study suggests that urinary angiotensinogen can be used as a new biomarker in the prognosis and follow-up of heart failure patients.

Nucleated red blood cells as predictor of all-cause mortality in emergency department.

BACGROUND: Nucleated red blood cells (NRBCs) are immature erythrocytes that are not normally detected in the blood of healthy adults. The detection of these cells in peripheral blood is associated with increased mortality and poor prognosis. In this study, we aimed to investigate whether NRBCs predict for all causes of death in patients admitted to the emergency department (ED). METHOD: This study was conducted retrospectively between January 2019 and December 2019 in academic emergency department, faculty of medicine. We included all patients who died of non-traumatic causes and The control group consisted of patients discharged from the ED. NRBCs and other laboratory parameters were compared between the two groups. The primary outcome is all-cause mortality in the ED. Multivariate logistic analysis was performed. RESULTS: A total of 204 patients (119 male) were included in the study. The mean age of the patients was 66.7 ±â€¯14.6 years. NRBC value was higher in those who died (678.43 ±â€¯655.16/ µl) compared to the control group (22.55 ±â€¯57.86/ µl) (P < 0.001). According to receiver operating characteristic curve analysis (ROC) performed for the prediction all cause mortality in the ED, the best cut-off point for NRBC was >0 /µl (sensitivity 94,12%, specificity 82,35%, Area Under Curve (AUC) =0.97). In the multivariate logistic regression analysis, the NRBC was associated with all-cause mortality in the ED (odds ratio,OR = 1.020, confidence interval, CI = 1.012-1.028). CONCLUSiONS: High blood levels of nucleated red blood cells at admission to the emergency department may be associated with increased mortality.

Determination of NF-κB and RANKL levels in peripheral blood osteoclast precursor cells in chronic kidney disease patients.

PURPOSE: Chronic kidney disease (CKD) is a progressive condition characterized by irreversible loss of functional nephron mass due to variety of causes; an inevitable complication of CKD is metabolic bone disease, and this pathology is called as renal osteodystrophy (ROD). In this study, we aimed to determine the levels of serum sRANKL and intracellular NF-κB levels in peripheral blood osteoclast precursor cells in patients with stage 3 CKD. MATERIALS AND METHODS: Forty-one male patients aged 35-60 with CKD identified as stage 3 according to GFR calculated on the basis of creatinine values and 27 healthy male subjects with age ranging from 40 to 60 as control group were included in this study. Levels of biochemical parameters, vitamin D3, parathyroid hormone, bone mineral density, sRANKL and NF-κB were determined by using photometric, electrochemiluminescence, HPLC, ELISA and flow cytometric methods in control and patient groups, respectively. RESULTS: When stage 3 CKD patients were compared with controls, patients with stage 3 CKD had statistically significantly higher iPTH levels, but they had statistically significantly lower vitamin D3 levels. However, the other biochemical parameters, bone mineral density, sRANKL and NF-κB levels did not reveal any significance. CONCLUSION: In conclusion, vitamin D3 and iPTH levels seem to be important parameters for evaluating the early stages of ROD. The lack of statistically significant differences in the levels of sRANKL and NF-κB suggests that these parameters are not sufficient in the evaluation of bone metabolism in the early stages of renal failure.

The Role of Oxidative Stress and Inflammatory Mediators in Benign Paroxysmal Positional Vertigo.

OBJECTIVE: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. It can be defined as transient vertigo induced by rapid changes in head position associated with a characteristic paroxysmal positional nystagmus. The aim of this study was to search for the possible role of oxidative stress and inflammatory mediators in the pathogenesis of BPPV. MATERIALS AND METHODS: Total antioxidant status as well as paraoxonase, tumor necrosis factor alpha, interleukin (IL) 6, and IL-1ß levels were evaluated in peripheral venous serum samples of 30 BPPV and 30 control patients. RESULTS: Total antioxidant status levels were lower in the BPPV group than in the control group (p=0.008). After Epley's repositioning maneuver in the vertigo group, there was a statistically significant decline in IL-1ß levels at the first and third month visits (p=0.014 for first month and p=0.013 for third month). CONCLUSION: Our findings suggested that IL-1ß and oxidative stress contributed to the pathogenesis of BPPV.

Association between teething and independent walking in healthy children.

Developing teeth provide a reliable indication of maturation and biological age. The objective of this study was to establish whether there is any association between the time of emergence of the first primary tooth and the time when independent walking occurs. A cross-sectional study was conducted with a sample of 206 healthy children (95 girls and 111 boys) aged 12 to 60 (mean: 29.79±0.66) months who were able to walk independently. The study was conducted using a questionnaire that was filled out by the parents. The first primary tooth emerged at 6.86±0.14 (min: 3-max: 13) months; the mean independent walking time was 12.58±2.15 (min: 8.50-max: 24.00) months. There was no correlation between the first teething and independent walking times (r=0.045, p=0.523). Factors such as breastfeeding status, intake of vitamins, walker usage and body mass index were found not to affect the time of either emergence of the first deciduous tooth or independent walking. To the best of our knowledge, this is the first paper in literature to have researched the relationship between the time of emergence of the first deciduous tooth and that of independent walking. It should be explained to parents that there is no relationship between the two in order to resolve anxiety when their child acquires a tooth but does not walk, or vice versa.

Dermatoglyphic features in patients with multiple sclerosis.

OBJECTIVE: To examine dermatoglyphic features to clarify implicated genetic predisposition in the etiology of multiple sclerosis (MS). METHODS: The study was conducted between January and December 2013 in the Departments of Anatomy, and Neurology, Cumhuriyet University School of Medicine, Sivas, Turkey. The dermatoglyphic data of 61 patients, and a control group consisting of 62 healthy adults obtained with a digital scanner were transferred to a computer environment. The ImageJ program was used, and atd, dat, adt angles, a-b ridge count, sample types of all fingers, and ridge counts were calculated. RESULTS: In both hands of the patients with MS, the a-b ridge count and ridge counts in all fingers increased, and the differences in these values were statistically significant. There was also a statistically significant increase in the dat angle in both hands of the MS patients. On the contrary, there was no statistically significant difference between the groups in terms of dermal ridge samples, and the most frequent sample in both groups was the ulnar loop. CONCLUSION: Aberrations in the distribution of dermatoglyphic samples support the genetic predisposition in MS etiology. Multiple sclerosis susceptible individuals may be determined by analyzing dermatoglyphic samples.

Evaluation of the vertebral artery by 3D digital subtraction angiography / Evaluación de la arteria vertebral mediante angiografía por sustracción digital 3D

The objective of the present study is to determine origin, entry level to the transverse foramen and diameter according to sex and side through 3D angiographic images of seventy-nine vertebral arteries obtained using DSA imaging method. During radiological evaluation, axial, coronal and sagittal images of the artery were used. Data of our study was uploaded to SPSS 14.0 program and significance test and Mann Whitney-U test of the difference between two means were used to evaluate the data. While 76 of the vertebral arteries (96.2%) were originating from the subclavian artery, 3 of them (3.8%) were directly originating from aortic arch. In 67 of 76 the vertebral arteries originating from the subclavian artery were entering through C6, 6 through C7, 2 through C5 and one through C4 transverse foramen. It was seen that one of 3 the vertebral artery originating from aortic arch was entering through C6, one through C7 and the other through C4 transverse foramen. While the mean diameter of the vertebral artery was 3.88±0.71 mm at the right side (3.99 mm in men, 3.66 mm in women), the mean diameter at the left side was 4.15±1.05 mm (4.23 mm in men, 4.06 mm in women).

El objetivo fue determinar el origen, nivel de entrada y diámetro del foramen transverso, en función del sexo y lado sobre 79 arterias vertebrales a través de imágenes angiográficas 3D utilizando el método de formación de imágenes DSA. Durante la evaluación radiológica, se utilizaron imágenes axiales, coronales y sagitales de la arteria. Los datos se procesaron en el programa SPSS 14.0 con las pruebas U de Mann Whitney y de significancia para evaluar la diferencia entre los datos. Mientras que 76 de las arterias vertebrales (96,2%) se originaron de la arteria subclavia, 3 de ellas (3,8%) lo hicieron directamente desde el arco aórtico. En 67 de 76 arterias vertebrales, se observó el origin en la arteria subclavia a través de C6; 6 a través de C7, 2 a través de C5 y una a través del foramen transverso en C4. El diámetro medio de la arteria vertebral fue 3,88±0,71 mm en el lado derecho (3,99 mm en hombres y 3,66 mm en mujeres) y en el lado izquierdo fue 4,15±1,05 mm (4,23 mm en hombres y 4,06 mm en hombres).

Determination of lateral ventricle and brain volume in children with stereological method using MRI / Determinación del volumen del ventrículo lateral y del cerebro en niños utilizando el método estereológico mediante RNM

Although brain development is most active during the intrauterina period of life, the processes of myelination and arborization affect the structure of the brain throughout childhood and adolescence. Brain development is also very active in the early years of a child's life, and continues to be so for approximately 15 years after gestation. Volumetric changes in the brain are effected by sex. Understanding the variability of human brain volume during development is important for the interpretation of childhood neuroimaging studies. Hence the aim of this study is to determine the effects of sex difference on brain volume (BV), lateral ventricle volume (LV) and the ratio of brain volume and lateral ventricle volumes as a percentage (RLBV%) of 90 healthy children between the ages of 6-17 according to their sex with MRI. These children were divided into three age groups of 6-9, 10-13 and 14-17 also BV, LV were calculated using the Cavalieri principle, which is classified as a stereological method and than RLBV% were calculated. Results: The BV of age group 6-9 was significantly smaller than the other two age groups (P < 0.05). General average BV of the age group 10-13 was higher than the other two age groups but this difference is insignificant. When the groups were compared according to sex, there was no important difference between girls and boys (P > 0.05). General average LV of the age group 6-9 was higher than the other two age groups but this difference insignificant. Moreover there was no sex difference. This study was presented that BV was continued to increase until the ages 10-13 for both of the genders. While LV was increased until the ages 10-13 for boys, it was had a negative relationship with changes of BV for girls.

Aunque el desarrollo del cerebro es más activo durante el período de la vida intrauterina, los procesos de mielinización y arborización afectan a la estructura del cerebro durante la infancia y la adolescencia. El desarrollo del cerebro es activo en los primeros años de la vida, y sigue siendo así durante unos 15 años después de la gestación. Cambios volumétricos en el cerebro son afectados según el sexo. La comprensión de la variabilidad del volumen del cerebro humano durante el desarrollo es importante para la interpretación de los estudios de neuroimagen en la infancia. Por lo tanto, el objetivo de este estudio fue determinar, a través de resonancia nuclear magnética, los efectos de las diferencias de sexo en el volumen cerebral (VC), en el volumen del ventrículo lateral (VL) y la relación porcentual de los volúmenes del cerebro y del ventrículo lateral (% VLVC) de 90 niños sanos entre 6-17 años de edad, en ambos sexos. Los niños fueron divididos en tres grupos de edad: 6-9, 10-13 y 14-17. El VC y el VL se calcularon utilizando el principio de Cavalieri, además de la relación porcentual RLBV. El VC del grupo 6-9 años fue significativamente menor que el de los otros dos grupos (p <0,05). El promedio del BC del grupo 10-13 años fue superior a los otros dos grupos de edad, pero esta diferencia fue mínima. Cuando se compararon los grupos en cuanto al sexo, no hubo diferencia entre niños y niñas (P> 0,05). El promedio general del grupo VL de 6-9 años fue mayor que los otros dos, sin diferencia significativa entre ambos sexos. El VC siguió aumentando hasta los 10-13 años en ambos sexos. Mientras LV aumentó hasta los 10-13 años de edad en los niños, se observó en las niñas una relación negativa con cambios de BV.

The relationship between total calvarial thickness and diploe in the elderly / Relación entre el espesor total de la calvaria y diploe en ancianos

The aim of this study is the classification of the thickness of diploe, lamina externa, lamina interna and total calvarial thickness at different points of cranium in elderly men and women. In the radiology archive, measurements were made at different points in cranial MR images of 220 (110 females, 110 males) patients, the average ages of whom were 73.23 ± 8.40 (age range: 61-90) and who had no disorder of the bones. Diploe thickness, lamina externa, lamina interna and total calvarial thickness were measured in eight points of the calvaria. Midfrontal point, back and front bregma, lambda, opisthocranion and euryonpoints were used in the measurement. The data was loaded to SPSS 16.0 program. T-test, Mann-Whitney U, Pearson correlation coefficient and Kruskal Wallis variance analysis were used in the statistical assessment. Results with a p value smaller than 0.05 were accepted as significant. There was statistically significant difference in total cranial thickness between males and females in the right euryon point only. Average total calvarial thickness at right euryon point was higher in females (6.20 ± 0.78 mm) than in males (5.96 ± 0.68 mm) (p= 0.02). Average diploe thickness was higher in female than male except for point of bregma back (p<0.05). There was positive linear correlation between diploe thickness and age except for opisthocranion, right euryon and 1cm inferior to lambda. These results related to diploe thickness and cranium thickness may be leading in the determination of sex and age; surgical interventions to the cranium and bone graft choice and may increase the reliability of the operation.

El objetivo de este estudio fue clasificar el espesor del diploe, láminas externa e interna y el espesor craneal total en diferentes puntos del cráneo en hombres y mujeres ancianos. Desde el archivo de radiología se obtuvieron imágenes de RM craneales de 220 pacientes (110 mujeres y 110 varones), cuya edad media fue de 73,23±8,4 años (rango: 61 a 90 años), quienes no tenían ningún trastorno óseo. Se realizaron mediciones de espesor del diploe, láminas externa e interna, y el grosor de la bóveda craneal. Se utilizaron ocho puntos de la bóveda craneal en la medición: mediano frontal, bregma anterior y posterior, lambda superior e inferior, opistocranion y euryon derecho e izquierdo. Los datos fueron analizados mediante el programa SPSS 16.0. Para la evaluación estadística se utilizaron en las pruebas T-test, Mann-Whitney U, coeficiente de correlación de Pearson y Kruskal Wallis de análisis de varianza. Los resultados con un valor de p inferior a 0,05 se aceptaron como significativo. Sólo hubo diferencias estadísticamente significativas en el espesor total del cráneo entre hombres y mujeres en el punto euryon derecho. El promedio de espesor total de la bóveda craneal en el punto euryon derecho fue mayor en mujeres (6,20±0,78 mm) que hombres (5,96±0,68 mm) (p=0,02). El promedio de espesor del diploe fue mayor en mujeres que hombres, excepto para el punto de bregma posterior (p<0,05). Hubo una correlación lineal positiva entre el grosor diploe y edad, excepto para opistocranion, euryon derecho y 1 cm inferior a lambda. Estos resultados relacionados con el espesor del diploe y espesor craneal pueden ser relevantes para la determinación de sexo y edad; intervenciones quirúrgicas en el cráneo y la elección de injertos óseos, y puede aumentar la exactitud de la operación.

Magnetic resonance imaging mesencephalic tectum dimensions according to age and gender.

OBJECTIVE: To analyze and classify normal MRI tectum length and colliculus dimensions according to age and gender. METHODS: Tectum length and colliculus diameters were measured on the T1 midsagittal and axial cranial MR images in the radiology archive of 532 (344 women, 188 men) patients aged 37.36+/-21.49 (range: 4-91) years old on average, and with no disorders affecting the mesencephalic tectum. All 532 patients underwent clinical MR imaging of the cranium at the MRI Unit of Sivas Numune Hospital and Sivas Cumhuriyet University Hospital, Sivas, Turkey between February and December 2011. RESULTS: Although there was a positive linear correlation between tectum length and age, there was a negative correlation between the anteroposterior diameter of the colliculus superior and colliculus inferior and age (p<0.01). While tectum length (M3) increases with age, the anteroposterior diameter of the colliculus superior and inferior (M1 and M2) decreased (p<0.01). The colliculi were larger, and the tectum was longer in men. Although there was no difference in size between right and left superior colliculi, the left colliculus inferior was larger than the right one. CONCLUSION: In addition to the fact that normal mesencephalic tectum dimensions provide information on the brain development of individuals, they may also be beneficial for the detection and treatment of related pathologies.

Frontal lobe morphometry with MRI in a normal age group of 6-17 year-olds.

BACKGROUND: Morphometric data of the frontal lobe are important for surgical planning of lesions in the frontal lobe and its surroundings. Magnetic resonance imaging (MRI) techniques provide suitable data for this purpose. OBJECTIVES: In our study, the morphometric data of mid-sagittal MRI of the frontal lobe in certain age and gender groups of children have been presented. PATIENTS AND METHODS: In a normal age group of 6-17-year-old participants, the length of the line passing through predetermined different points, including the frontal pole (FP), commissura anterior (AC), commissura posterior (PC), the outermost point of corpus callosum genu (AGCC), the innermost point of corpus callosum genu (IGCC), tuberculum sella (TS), AGCC and IGCC points parallel to AC-PC line and the point such line crosses at the frontal lobe surface (FCS) were measured in three age groups (6-9, 10-13 and 14-17 years) for each gender. RESULTS: The frontal lobe morphometric data were higher in males than females. Frontal lobe measurements peak at the age group of 10-13 in the male and at the age group of 6-13 in the female. In boys, the length of FP-AC increases 4.1% in the 10-13 age group compared with the 6-9-year-old group, while this increase is 2.3% in girls. CONCLUSION: Differences in age and gender groups were determined. While the length of AGCC-IGCC increases 10.4% in adults, in children aged 6-17, the length of AC-PC is 11.5% greater than adults. These data will contribute to the preliminary assessment for developing a surgical plan in fine interventions in the frontal lobe and its surroundings in children.

Diploe thickness and cranial dimensions in males and females in mid-Anatolian population: an MRI study.

BACKGROUND: The objective of this study is the classification of the thickness of diploe and dimensions of cranium at different points of cranium in men and women according to age groups. MATERIAL AND METHOD: In the radiology archive, measurements were made at different points in magnetic resonance (MR) images of 305 (188 females and 117 males) patients, the average ages of whom were 40.98±20.44 (age range: 4-90) and who had no disorder of the bones. To determine diploe thickness, midfrontal, back and front bregma, lambda, opisthocranion and euryon points were used in the measurement. As for the determination of cranial volume, distances between glabella-opisthocranion, basion-vertex, basion-opisthion, euryon-euryon, nasion-basion, nasion-bregma, bregma-lambda and lambda-opisthocranion were measured. The data were loaded to Statistical Package for the Social Sciences (SPSS) 16.0 program. T-test, Mann-Whitney U, Pearson correlation coefficient and Kruskal-Wallis variance analysis were used in the statistical assessment. Results with a p value smaller than 0.05 were accepted as significant. RESULTS: There was a statistically significant positive correlation between age and diploe thickness in all measurement points. The diploe thickness was also increased with age (p<0.05). In all points, average diploe thickness was higher in age 61 and over than the other groups (p<0.001). At the same time, diploe thickness in parietal bones was lower than frontal and occipital bones in both sexes. According to craniometric results cranium in males was bigger (p<0.001). While the distance between glabella-opisthocranion increased in both sexes aged 61 and over, basion-vertex height decreased in women in the same group (p<0.05). Interestingly, there was no meaningful statistical difference among age groups in terms of maximum cranial width (p>0.05). Foramen magnum length decreased related to age in both men and women (p<0.001). CONCLUSION: These results related to diploe thickness and cranium dimension may be leading in the determination of sex and age; surgical interventions to the cranium and bone graft choice may increase the reliability of the operation.

A rare variation of the right middle suprarenal artery.

According to general knowledge, the suprarenal gland is supplied by three sources: the phrenic artery, the abdominal aorta and the renal artery. Since the gland lacks a hilus, and particularly because of its clinical importance, anatomical arterial sources and branching is still not uniform and it needs to be determined by detail. In this study, the right middle suprarenal artery arising from the right renal artery was observed on the right side of a 45-year-old male cadaver.

A cadaver with azygos lobe and its clinical significance.

Although an azygos lobe is a rare anomaly of the lung, its radiological appearance has been well defined. Clinically, the azygos lobe has been accepted as a normal variation that can simulate various diseases. However, on chest roentgenograms, this anomaly may appear to be present if there are any other pathological conditions. So, the detection of this anomaly and clarification of its precise anatomical features are important not only to differentiate this anomaly from other pathological conditions, but also to alert the surgeon to potential problems during surgery. In the present study, an azygos lobe was observed on the right lung of a 56-year-old male cadaver. Because of the clinical importance and rare occurrence, this anomaly was compared and discussed with other related articles.