Intralesional Epidermal Growth Factor for Diabetic Foot Ulcers.

OBJECTIVE: To determine the role of the intralesional recombinant epidermal growth factor (rEGF) in the healing and prevention of extremity amputation in advanced diabetic foot ulcer patients. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Duzce State Hospital, Duzce, Turkey, between November 2018 and September 2019. METHODOLOGY: A total of 58 patients with diabetic foot ulcers that were treated at the study place were enrolled. The lesions were graded with Wagner Classification System. EGF (75 microg of Heberprot-P) vials were stored at +4°C and cold-chain requirements were followed. EGF 5 mL was dissolved with 0.09% saline solution; and 0.5-1 ml of the solution was injected into the tissues and edge of the lesions regularly. The data was evaluated at the end of two years of the treatment period. The primary objective was wound healing, formation of granulation tissue; and the secondary objective was the prevention of lower extremity amputation. RESULTS: Diabetic foot ulcers wound healing was achieved in 93.1% (n=54) of patients with the formation of granulation tissue. The complete recovery was observed in 94.1% (n=32) of the patients who had Grade III and IV lesions. Lower extremity amputation was performed in two (3.4%) subjects. The lesions of two patients required flap surgery. The most common adverse events were tremor and syncope. CONCLUSION: Recombinant epidermal growth factor is highly effective for the treatment of diabetic foot ulcers and prevention of extremity amputation. Intralesional rEGf provides efficient and safe wound healing/closure in patients with diabetic foot ulcers. Key Words: Amputation, Epidermal growth factor, Diabetic foot, Wound healing.

Diagnostic accuracy of copeptin and NT-proBNP level in predicting mortality and postoperative prognosis in coronary surgery with respect to EuroSCORE risk.

Introduction: During the last few years, many modifications in risk stratification of all cardiac surgical patients have been reported based on EuroSCORE. Aim: In this study we aimed to interpret copeptin and NT-proBNP levels in patients who had undergone coronary surgery with respect to EuroSCORE. Material and methods: We investigated the correlation between pre-operative copeptin and NT-proBNP levels with respect to mortality and post-operative complications via EuroSCORE II in the 484 enrolled patients. In terms of analyzing mortality the first 30 days were taken into account and duration of hospital stay was considered for prognosis. The statistical significance of copeptin and NT-proBNP with respect to EuroSCORE II ≥ 2 was studied. Results: The critical threshold levels of mortality for NT-proBNP was 1296 pg/ml and for copeptin was 116 pmol/l in patients whose EuroSCORE II ≥ 2. Mortality increases 9.04-fold in cases with EuroSCORE ≥ 2, 5.04-fold when NT-proBNP level is > 1296 pg/ml. A dramatic outcome was observed in copeptin levels as mortality increased 138.17-fold when copeptin was > 116 pmol/l. Conclusions: Increased levels of copeptin and NT-proBNP negatively affect mortality and complication rates in isolated cardiac surgery patients.

Results of carotid endarterectomy under regional anesthesia.

OBJECTIVE: The purpose of this study is to assess the efficacy of carotid endarterectomy (CEA) surgery under regional anesthesia and to report early mid-term results. METHODS: Data for 42 patients who underwent CEA were reviewed retrospectively between January 2013 and June 2015. Of the patients, 60% (n=25) were male and 40% (n=17) were female. The mean age was 74.03 years. Early and midterm mortality, intraoperative stroke, and complication rates were calculated by reviewing patient's data at the end of 2 years. RESULTS: The level of carotid stenosis was over 70% in 83% (n=35) of the patients. Seventeen percent (n=7) of the patients had 60% carotid stenosis. Forty patients received regional anesthesia and two patients received general anesthesia. The mean cross-clamp time was 13.08 min. The mean operation time was 53.09 min. No early post-operative deaths occurred. The midterm (24 months) mortality rate was 2% (n=1). Recurrent atheromatous plaque was found in 2% (n=1) of the patients. CONCLUSION: Our study demonstrated that CEA surgery may be safely performed under regional anesthesia will acceptable low mortality and morbidity rate.

Is Surgical Thrombo-Embolectomy in Acute Limb Ischemia Still Advantageous in Patients More Than 65 Years of Age?

OBJECTIVE: In this study, we investigated the benefits of using Fogarty balloon catheterization in the treatment of acute leg ischemia with respect to amputation, fasciotomy, and mortality in older patients. METHODS: A total of 102 patients age >65 who had a Fogarty thrombo-embolectomy for acute thromboembolic limb ischemia were investigated retrospectively. Patients were evaluated based on Rutherford IIa and IIb criteria and duration of ischemia. Duration of ischemia was divided into 3 categories (as 0 to 4, 4 to 8, and >8 hours) to evaluate the effect of ischemia period on vital parameters and mortality. Analysis with Cox regression showed that 30-day mortality was associated with older age and number of comorbidities such as amputation and fasciotomy. RESULTS: In 102 patients >65 years of age who underwent embolectomy, rates were 7.2% fasciotomy (n = 7) and 13.7% amputation (n = 14), and 10 patients died (9.8%). According to multiple regression analysis, the surgical risk increases 1074 times when each year is added to the chronological age of over  65 years. CONCLUSION: In a majority of cases, limb salvage can be obtained via simple embolectomy rather than risking intravenous iodinated contrast. Although alternatives in older patients are limited, the Fogarty catheter should be regarded as a first-line treatment because of its ease of use and low complication rate.

Comparison of Two Sternal Closure Techniques Based on Risk Factors: A Prospective, Observational Study.

BACKGROUND: Stainless steel wires are still commonly used as a sternum closure technique. However, it can cause fatal complications due to rupture and dehiscence. It was anticipated that the sternal Cable System (Pioneer Surgical Technology Inc., Marquette, MI, USA) could provide a better sternal fixation and reduce the possible complications. Materials and Method. A total of 100 patients (57 male, 43 female) at high risk of dehiscence were included in this prospective observational study. Among those with EuroSCORE value of 4 and above, patients with chronic lung disease, chronic kidney disease, diabetes mellitus, obesity, smoking, body mass index, advanced age, and resurgery were operated in two separate centers. Standard steel wires (n: 51) used for sternotomy were compared with the sternal cable (n: 49). Early and late sternal dehiscence rates were compared in the study. The relationship between risk factors causing dehiscence and both methods was assessed statistically. RESULTS: Early dehiscence rates were 6.4% in those closed with a sternal cable (n: 3) and 11.8% in those closed with a sternal wire (n: 6) (p < 0.05)). In risky patients, body mass index was the most determining parameter in terms of sternum dehiscence risk. CONCLUSION: In risky patients, we recommend the sternal cable system as a good and reliable closure technique to achieve a more stable and compact sternum.

Protein detection with potentiometric aptasensors: a comparative study between polyaniline and single-walled carbon nanotubes transducers.

A comparison study on the performance characteristics and surface characterization of two different solid-contact selective potentiometric thrombin aptasensors, one exploiting a network of single-walled carbon nanotubes (SWCNTs) and the other the polyaniline (PANI), both acting as a transducing element, is described in this work. The molecular properties of both SWCNT and PANI surfaces have been modified by covalently linking thrombin binding aptamers as biorecognition elements. The two aptasensors are compared and characterized through potentiometry and electrochemical impedance spectroscopy (EIS) based on the voltammetric response of multiply charged transition metal cations (such as hexaammineruthenium, [Ru(NH3)6](3+)) bound electrostatically to the DNA probes. The surface densities of aptamers were accurately determined by the integration of the peak for the reduction of [Ru(NH3)6](3+) to [Ru(NH3)6](2+). The differences and the similarities, as well as the transduction mechanism, are also discussed. The sensitivity is calculated as 2.97 mV/decade and 8.03 mV/decade for the PANI and SWCNTs aptasensors, respectively. These results are in accordance with the higher surface density of the aptamers in the SWCNT potentiometric sensor.

Nanostructured materials in potentiometry.

Potentiometry is a very simple electrochemical technique with extraordinary analytical capabilities. It is also well known that nanostructured materials display properties which they do not show in the bulk phase. The combination of the two fields of potentiometry and nanomaterials is therefore a promising area of research and development. In this report, we explain the fundamentals of potentiometric devices that incorporate nanostructured materials and we highlight the advantages and drawbacks of combining nanomaterials and potentiometry. The paper provides an overview of the role of nanostructured materials in the two commonest potentiometric sensors: field-effect transistors and ion-selective electrodes. Additionally, we provide a few recent examples of new potentiometric sensors that are based on receptors immobilized directly onto the nanostructured material surface. Moreover, we summarize the use of potentiometry to analyze processes involving nanostructured materials and the prospects that the use of nanopores offer to potentiometry. Finally, we discuss several difficulties that currently hinder developments in the field and some future trends that will extend potentiometry into new analytical areas such as biology and medicine.

Solid-contact potentiometric aptasensor based on aptamer functionalized carbon nanotubes for the direct determination of proteins.

A facile, solid-contact selective potentiometric aptasensor exploiting a network of single-walled carbon nanotubes (SWCNT) acting as a transducing element is described in this work. The molecular properties of the SWCNT surface have been modified by covalently linking aptamers as biorecognition elements to the carboxylic groups of the SWCNT walls. As a model system to demonstrate the generic application of the approach, a 15-mer thrombin aptamer interacts with thrombin and the affinity interaction gives rise to a direct potentiometric signal that can be easily recorded within 15 s. The dynamic linear range, with a sensitivity of 8.0 mV/log a(Thr) corresponds to the 10(-7)-10(-6) M range of thrombin concentrations, with a limit of detection of 80 nM. The aptasensor displays selectivity against elastase and bovine serum albumin and is easily regenerated by immersion in 2 M NaCl. The aptasensor demonstrates the capacity of direct detection of the recognition event avoiding the use of labels, mediators, or the addition of further reagents or analyte accumulation.

[Comparison of the ability to fertilize females by Hyalomma anatolicum anatolicum males irradiated with gamma radiation from caesium 137 with non-irradiated males]. / Caesium-137 Kaynakli Gamma Radyasyonla Isinlanmis Hyalomma anatolicum anatolicum Erkeklerinin Bir Arada Bulunduklari Isinlanmamis Erkekler ile Disileri Dölleme Yetilerinin Karsilastirilmasi.

In this study, Hyalomma anatolicum anatolicum male ticks were subjected to gamma radiation with a dose of 10 Gy emitted by a gamma-ray source of Caesium 137. Female ticks were divided into 3 groups and placed in rabbit ears to feed. In the first group, the females fed with normal and irradiated males, in the second group females fed only with irradiated males and in last group females fed with normal males. Biological parameters such as the feeding period, weights, period of time from dropping until egg-laying began, the number of eggs and the number of larva hatching from eggs were recorded. With the results of statistical analysis it was found that the average egg laying period of females in the second group was clearly less (22.77 days) than other groups and the difference between these groups was statistically important (P < 0.05). After evaluation of numbers of larva, also there was a statistically important difference between the groups and the average number of larva was clearly higher (2519.30) in third group than other groups. In conclusion, in this study it was found that irradiated males could not compete with normal males in mating with females and because of this they couldn't affect the feeding and reproductivity of females.

[The importance of gamma irradiations with caesium-137 for Hyalomma anatolicum anatolicum (Metastigmata, Ixodidae) control]. / Hyalomma anatolicum anatolicum (Metastigmata, Ixodidae) mücadelesinde Caesium-137 kaynakli gamma radyasyon uygulamalarinin önemi.

In this study, male ticks belonging to the Hyalomma anatolicum anatolicum species were subjected to gamma radiation doses of 5, 10, 15, 20 and 50 Gy, emitted by a gamma-ray source of Caesium 137. In females that fed with these male ticks, proportional to the increase in radiation dose, the period of feeding was found to shorten. A decrease was demonstrated in the number of engorged female ticks, engorgement weights, number of laying ticks and number of eggs. The hatching period of larvae from eggs was found to increase despite the decrease in the number of hatched larvae. Moreover no larvae were observed to hatch from any of the eggs of female ticks treated with a radiation dose of 50 Gy. Similarly, proportional to the applied dose of radiation, rates of viability and activity were observed to decrease in male ticks. In conclusion, taking into consideration the feeding periods and fertility rates of female ticks as indicators of male activity, this study has demonstrated that in combating with H. anatolicum anatolicum, radiation may be successful and a radiation dose of 10 Gy is most favorable.