Triglyceride glucose index as a marker of primary patency rate of arteriovenous fistula in diabetic hemodialysis patients.

OBJECTIVE: Arteriovenous fistula (AVF) structures are vital formations used for hemodialysis. Diabetes mellitus (DM) is a critical disease affecting the vascular system. The triglyceride glucose (TyG) index has been shown to be associated with major adverse cardiovascular events in patients with Type 2 DM. In this study, we aimed to investigate the effect of the TyG index on the primary AVF patency of diabetic patients. PATIENTS AND METHODS: Between March 2018 and March 2023, patients with DM who underwent AVF surgery in our clinic due to end-stage renal disease were retrospectively included in this study. The patients who could receive hemodialysis were determined as Group 1, and those who could not were determined as Group 2. RESULTS: A total of 189 patients were included in the study. Those who did not develop AVF primary failure were included in Group 1 [n=138, median age = 59 (22-77) years], and those who did were included in Group 2 [n=51, median age = 63 (20-81) years]. In the multivariate analysis, age >70 years (OR: 0.871, 95% CI: 0.594-0.983, p=0.039), the presence of PAD (OR: 0.582, 95% CI: 0.0.458-0.896, p=0.046), and TyG index (OR: 0.879, 95% CI: 0.591-0.916, p<0.001) were determined as independent predictors for primary AVF failure. CONCLUSIONS: This study demonstrated that the TyG index value, calculated from blood samples taken at the time of hospital admission in hemodialysis patients with diabetes mellitus (DM), is an independent predictor of primary AVF failure following AVF surgery.

Investigation of the effect of postoperative early-term high-flow oxygen use on new-onset atrial fibrillation in high-risk patient groups after isolated coronary artery bypass graft operations.

OBJECTIVE: Postoperative atrial fibrillation (PoAF) is a significant complication that may occur after coronary artery bypass graft (CABG) surgeries. High-flow nasal oxygen (HFNO) therapy has recently been used in adult patients. In this current study, we aimed to investigate the effect of early HFNO treatment after extubation on the development of postoperative atrial fibrillation, in patient groups at risk for PoAF. PATIENTS AND METHODS: Patients who underwent isolated CABG surgery in our clinic between October 2021 and January 2022 and had a preoperative HATCH score of above 2, were retrospectively included in this study. After the extubation, patients who were followed-up with HFNO were defined as Group 1, and patients who were followed-up with a standard oxygen treatment were determined as Group 2. RESULTS: Group 1 consisted of thirty-seven patients with a median age of 56 (ranging between 37 and 75) years, while Group 2 had seventy-one patients with a median age of 58 (ranging between 41 and 71) years (p=0.357). The groups were similar in terms of gender, hypertension, diabetes mellitus, hypercholesterolemia, smoking, body mass index, and ejection fraction. The need for positive inotropic support and incidence of PoAF was significantly higher in Group 2 (p=0.022, p=0.017, respectively). CONCLUSIONS: In this study, we showed that HFNO treatment can reduce the rates of PoAF in high-risk patient groups.

The role of neutrophil-lymphocyte platelet ratio in predicting in-hospital mortality after acute Type A aortic dissection operations.

OBJECTIVE: Acute Type A aortic dissection (ATAAD) is an emergency cardiovascular condition. In this current study, we aimed to investigate the prognostic importance of preoperative neutrophil-lymphocyte platelet ratio (NLPR) value in predicting in-hospital mortality, after surgical treatment of ATAAD. PATIENTS AND METHODS: Consecutive patients who underwent an emergency operation as a result of ATAAD between August 2012 and August 2021 in our hospital, were retrospectively included in this study. Patients who survived the operation and were released were recorded as Group 1 and those who died in the hospital, as Group 2. RESULTS: Mortality (in-hospital) occurred in 44 (22.5%) patients (Group 2). The median age of the 151 patients included in Group 1 and 44 patients in Group 2 were 55 (37 to 81) and 59 (33 to 72) years, respectively (p = 0.191). In multivariate analysis Model 1, malperfusion (OR: 3.764, 95% CI: 2.140-4.152, p < 0.001), total perfusion time (OR: 1.156, 95% CI: 1.040-1.469, p = 0.012), low platelet counts (OR: 0.894, 95% CI: 0.685-0.954, p = 0.035) and NLR (OR: 1.944, 95% CI: 1.230-2.390, p < 0.001) were determined as independent predictors for mortality. In Model 2, malperfusion (OR: 3.391, 95% CI: 2.426-3.965, p < 0.001) and NLPR (OR: 2.371, 95% CI: 1.892-3.519, p < 0.001) were determined as independent predictors for mortality. CONCLUSIONS: According to our study, the NLPR value obtained preoperatively can be used to predict the risk of in-hospital mortality, after ATAAD surgery.

The effect of elbow position at the time of tourniquet inflation on clinical outcomes.

OBJECTIVE: The aim of this study was to prospectively investigate the effects of elbow position on perioperative and postoperative clinical outcomes during tourniquet inflation. PATIENTS AND METHODS: The patients were divided into two groups based on their elbow position during tourniquet inflation: patients with elbows extended group E (30 patients), patients with flexed elbows group F (30 patients). Both groups were compared in terms of perioperative bloodless surgical field, tourniquet pain, time to onset of pain, and pain in the tourniquet area on the first postoperative day, plus elbow-forearm range of motion deficit on both the perioperative and postoperative first day. RESULTS: The bloodless surgical field provided by the tourniquet was 0.46 (0-5) in Group E and 0.4 (0-4) in Group F. Perioperative tourniquet pain started in an average of 51 (33-71) minutes in 4 patients in Group E and 49 (31-74) minutes in 5 patients in Group F. Pain was present in 2 patients in both groups in the postoperative tourniquet area. When the preoperatively measured elbow flexion-extension and forearm supination-pronation deficits were compared with the perioperative values, the deficits were 1%, 2%, 1%, 1% in Group E, and 1%, 1%, 2%, 1% in Group F, respectively. When compared with the postoperative values, 1%, 3%, 1%, 1% in Group E and 1%, 2%, 1%, and 1% in Group F were observed, respectively. CONCLUSIONS: There was no statistically significant difference between the two groups, but since repositioning the elbow after the tourniquet is inflated will cause an additional shearing effect on the tissues under the cuff, we recommend inflating the tourniquet in that position in which the operation will be performed in upper extremity surgeries.

Factors affecting extubating time of postoperative patients who underwent congenital cardiac surgery: a randomized prospective study.

OBJECTIVE: Anesthesia management in pediatric cardiac surgery using health resources sparingly focuses on reducing morbidity and mortality and increasing patients' quality of life. The duration of postoperative mechanical ventilation (MV) heavily influences pediatric cardiac surgery recovery. Thus, in this study we aimed to determine factors influencing extubation times after pediatric cardiac surgery. PATIENTS AND METHODS: A total of 72 pediatric patients with an ASA score of III or above undergoing cardiac surgery were included in the study. As a result of their extubation time, the patients were divided into three groups as follows: those who were extubated immediately after surgery or in the operating room (OR) were recorded as Immediate Extubators (IE); those who were extubated within 6 to 48 hours of entering the intensive care unit were recorded as Early Extubators (EE), and those who were extubated after 48 hours or not extubated were recorded as Delayed Extubators (DE). RESULTS: A logistic regression analysis showed that anomalies and need of MV before surgery, airway difficulty, and prolonged cross-clamp (CC) time were observed as factors affecting DE. The risk of DE was significantly correlated with the presence of abnormality [Odds ratio (OR): 20.3, 95% Confident interval (CI): 2.8-142.7], with the need of MV before surgery (OR: 1,844, 95% CI: 1.8-1,790,461.9), and with the presence of airway difficulty (OR: 44.7, 95% CI: 4.4-445.0). In addition, it was determined that CC time increased the probability of DE 1.038 times per minute (95% CI: 1.004-1.072). CONCLUSIONS: Early and immediate extubation in children who underwent congenital heart surgery was successfully performed in our clinic. Early and immediate extubation in pediatric cardiac surgery can be completed safely and successfully when suitable conditions are provided.

Extraction of low-dimensional features for single-channel common lung sound classification.

In this study, feature extraction methods used in the classification of single-channel lung sounds obtained by automatic identification of respiratory cycles were examined in detail in order to extract distinctive features at the lowest size. In this way, it will be possible to design a system for the detection of lung diseases, completely autonomously. In the study, automatic separation and classification of 400 respiratory cycles were performed from the single-channel common lung sounds obtained from 94 people. Leave one out cross validation (LOOCV) was used for the calibration and validation of the classification model. The Mel frequency cepstrum coefficients (MFCC), time domain features, frequency domain features, and linear predictive coding (LPC) were used for classification. The performance of the features was tested using linear discriminant analysis (LDA), k-nearest neighbors (k-NN), support vector machines (SVM), and naive Bayes (NB) classification algorithms. The success of combinations of features was explored and enhanced using the sequential forward selection (SFS). As a result, the best accuracy (90.14% in the training set and 90.63% in the test set) was acquired using the k-NN for the triple combination, which included the standard deviation of LPC and the standard deviation and the mean of MFCC.

Investigation of the effects of preoperative nutritional status scores on renal injury after cardiac surgery in elderly patients.

OBJECTIVE: Acute kidney injury (AKI) is a common complication after cardiac operations accompanied by cardiopulmonary bypass (CPB). Nutritional status is an important parameter that reflects the general health status of patients, and its prognostic importance has been shown in numerous diseases. For this reason, various scoring systems are used to show nutritional status, the most known of which are the controlling nutritional status (CONUT) score and the geriatric nutritional risk index (GNRI). In this current study, we aimed to investigate the prognostic values of the CONUT score and GNRI in predicting AKI after cardiac surgery. PATIENTS AND METHODS: Patients over sixty-five years of age who underwent cardiac surgery with CPB in our clinic between March 2019 and January 2021, were consecutively included in the study. The patients who did not develop AKI in the postoperative period were recorded as Group 1, whereas the patients who did develop were defined as Group 2. RESULTS: Postoperative AKI occurred in 126 (28.7%) patients (Group 2). The median age of the 313 patients included in Group 1 and 126 patients in Group 2 was 69 (67 to 81) and 71 (66 to 85) years, respectively (p = 0.033). The two groups were similar in terms of gender, body mass index, hypertension, smoking, and left ventricular ejection fraction rates. In Group 2, albumin and GNRI values were significantly lower (p = 0.019 and p < 0.001, respectively), whereas the CONUT score was significantly higher (p < 0.001). CONCLUSIONS: We showed the CONUT score and GNRI values calculated in the preoperative period in patients over 65 years of age as independent predictors of the development of AKI, after cardiac surgery.

Os subtibiale: Mimicking medial malleolar fracture.

There are numerous sesamoids and accessory ossicles around the foot which can easily be misdiagnosed as fractures. Os subtibiale is a very rare normal variant of the medial malleolus which is usually diagnosed incidentally in routine ankle radiographs. In this report, we present a case series of 3 patients with os subtibiale who were admitted to the emergency department with ankle sprains and misdiagnosed as medial malleolar fractures. We would like to raise awareness to the very rare and usually asymptomatic os subtibiale as a diagnostic pitfall.

Investigation of venous drainage patterns of rabbit peripheral nerves.

In this study, the venous drainage patterns of white New Zealand rabbits' peripheral nerves were examined in an effort to provide an animal model for studies focusing on the venous drainage of the healing nerves. Extremities of rabbits sacrificed via intraarterial lead oxide-gelatin solution, and thus had their peripheral bloods pushed out of the arteries and into the veins were dissected for the venous drainage of radial, median, ulnar, femoral, sciatic, tibial and fibular nerves. The observations revealed that white New Zealand rabbit was a feasible model due to its consistent venous anatomy draining the major nerves and accessibility and workability of them. Of those dissected, the most suitable set of nerves suitable for such studies seem to be the Median nerve of the anterior extremity, and Sciatic nerve of the posterior extremity (Fig. 12, Ref. 16). Text in PDF www.elis.sk. Text in PDF www.elis.sk.

Accumulation of heavy metals in water, sediments and wetland plants of kizilirmak delta (samsun, Turkey).

In this study, concentrations of heavy metals (Fe, Mn, Ni, Co, Zn, Cu, and Pb) were measured in water bodies including streams, bottom sediments and various wetland plants of Kizilirmak Delta. Kizilirmak Delta is one of the largest and the most important natural wetlands in Turkey and has been protected by Ramsar convention since 1993. The heavy metal concentrations in water were found lower than that of national standards for protected lakes and reserves. In bottom sediments and wetland plants, however, the accumulated amounts of different heavy metals varied in the following order: Fe>Mn>Zn>Ni>Co>Cu>Pb, and Fe>Mn>Zn>Ni>Co respectively. Heavy metal uptake of Hydrocharis morsus-ranae and Myriophyllum verticillatum plants among others were found far above the toxic levels and they might be used as bio-indicators and heavy metal accumulators in polluted natural areas.

Reconstruction of hand injuries with multiple metacarpal defects using free fibular osteoseptocutaneous flap.

Hand injuries with multiple metacarpal involvements often include midpalmar muscle, extensor tendon, and skin defects. Reconstruction method is decided according to the type and amount of structures to be restored. Bone reconstruction and resurfacing of the skin is regarded as priority, and restoration of tendon function and joint mobility can be left for further procedures. An ideal flap for such defects should provide bone for multiple metacarpal defects and a large enough skin paddle. Such flaps are few, and one of the most suitable of them all is the free fibular osteoseptocutaneous flap (free FOSCF). In this report, our experience with the use of free FOSCF for reconstruction of the mutilating hand injury in five patients with extensive skin integument and metacarpal involvement has been presented. Total lengths of fibular flaps were averagely 11 cm in length and were divided into averagely 2.4 segments. Average dimensions of the skin paddles were 7.75 × 8.75 cm. Although the nature of the devastating traumas limited the ultimate functional recovery; wound closure, stability, and various degrees of mobility were restored in all patients. In our experience, reconstruction with free FOSCF proved to be an effective tool in mutilating hand injuries with metacarpal involvement.

Finger pulp reconstruction with free dorsoulnar artery perforator (DUAP) flap.

Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complications by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible.

Contribution of a locking cross-stitch to a modified kessler core suture: a new technique.

We compared the gap-producing forces, ultimate tensile strength, and slip resistance of a new core suture technique and that of a modified Kessler suture in freshly harvested chicken tendons. Biomechanical trials were carried out using a tensile-strength testing machine. Our technique proved superior to the modified Kessler suture with respect to its ultimate tensile strength and slip resistance.

End-to-end microvascular anastomosis in the rat carotid artery using continuous horizontal mattress sutures.

This paper reports a continuous horizontal mattress suture technique with advantages such as decreased time for anastomosis, minimized anastomotic leakage, eversion around the vessel edges, and other advantages which the continuous anastomosis technique has. This technique was compared with the classical interrupted and classical continuous suture techniques on a total of 59 Sprague-Dawley rat common carotid arteries: Group 1 (n = 19), interrupted suture technique; Group 2 (n = 20), standard continuous technique, and Group 3 (n = 20), continuous horizontal mattress technique. Early (30 min) and late (21 days) patency rates, anastomosis time, leakage on clamp release, oozing duration, additional sutures needed, and total number of sutures placed were statistically compared between groups. Specimens were taken at the 21st day randomly, and light microscopy (LM), scanning electron microscopy (SEM), and angiographic studies were performed. Results revealed that the continuous mattress suture technique has the advantages of providing a water-tight anastomosis with less suture materials in a shorter time, and minimal intraluminal suture material which can incite thrombosis. On the other hand, a tendency to anastomotic stricture was found to be the sole disadvantage of this technique.

Relationship among placental cadmium, lead, zinc, and copper levels in smoking pregnant women.

Previous studies on Cd-exposed pregnant animals have reported a Cd-Zn interaction that result in increased placental Cd levels and decreased placental Zn transport. In this study, placental Cd, Pb, Cu, and Zn status in pregnant women exposed to Cd and Pb through cigarette smoke was investigated. Placental tissues obtained from 30 nonsmokers (controls), 70 passive smokers, and 90 smokers were analyzed for Cu and Zn levels using an atomic absorption spectrophotometer and for Pb and Cd levels using an EG&G PARC Model 303A hanging mercury drop electrode. The result showed that whereas the placental Cd and Pb levels in smokers were higher that those of nonsmokers, Cu and zinc levels were lower in nonsmokers. These results imply that smoking during pregnancy could be harmful for both the mother and the fetus.

Maternal and fetal plasma adenosine deaminase, xanthine oxidase and malondialdehyde levels in pre-eclampsia.

The aim of this study was to evaluate maternal-fetal plasma adenosine deaminase, xanthine oxidase (ADA, XO) activity and malondialdehyde (MDA) levels and the relationship between them in pre-eclampsia. Maternal and umbilical cord whole blood samples were taken from 29 pre-eclamptic and 33 normal pregnants. The plasma ADA, XO activities as well as MDA levels were assayed by spectrophotometric methods. MDA levels and ADA, XO activities were found to be higher in maternal and fetal plasma in pre-eclamptics than in normal pregnancy. The differences were statistically significant between groups (p < 0.05). Increased maternal-fetal plasma XO and ADA activities, as a marker of immunological disorder, may be related to the pathogenesis of pre-eclampsia. In addition, increased MDA levels may be a reflection of increased oxidative stress in pre-eclamptics and their fetuses.

Plasma D-lactic acid level: a useful marker to distinguish perforated from acute simple appendicitis.

Early diagnosis of perforated appendicitis is important for reducing morbidity rates. The aim of this study was to determine the value and utility of plasma D-lactic acid levels in identifying the type of appendicitis. In this clinical study, plasma D-lactic acid levels were assessed in 44 consecutive paediatric patients (23 with acute appendicitis, 21 with perforated appendicitis) before laparotomy. D-lactic acid levels were determined by an enzymatic spectrophotometric technique using a D-lactic acid dehydrogenase kit. Patients with perforated appendicitis had higher D-lactic acid levels (3.970 +/- 0.687 mg/dL) than patients in the control group (0.478 +/- 0.149 mg/dL) and patients with acute appendicitis (1.409 +/- 0.324 mg/dL; p < 0.05). For a plasma D-lactic acid level greater than 2.5 mg/dL, the sensitivity and specificity of the D-lactic acid assay were 96% and 87%, respectively. The positive predictive value was 87%, the negative predictive value was 96%, and the diagnostic value was 91%. These results suggest that the measurement of plasma D-lactic acid levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute non-perforated appendicitis in children.

[Comparison of the antioxidant enzyme levels with the degree of dysfunction in patients with myocardial dysfunction]. / Miyokard Disfonksiyonu Olan Hastalarda Disfonksiyonun Derecesi ile Antioksidan Enzim Düzeylerinin Karsilastirilmasi.

OBJECTIVE: Myocardial dysfunction in patients with cardiomyopathy is proposed to occur due to membrane changes caused by oxidative stress. In our study we evaluate whether there is any relation between the degree of myocardial dysfunction and antioxidant enzymes. METHODS: We studied superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase (CAT) enzyme activities from blood samples of 60 patients (30 patients had ejection fraction (EF) < %35 and 30 patients had EF= %35-50) who have myocardial dysfunction according to clinical findings and two-dimensional echocardiography, and 20 healthy volunteers. RESULTS: We found erythrocyte SOD enzyme activities of patients with EF < %35 (group 3) were significantly lower than in control subjects (group 1) (p=0.01). However in group 2 patients (EF= %35-50), erythrocyte SOD activities were found to be lower than in control subjects but this difference was not significant. Erythrocyte CAT and GSHPx enzyme activities of group 3 were also significantly lower than in control group (p=0.04 and p=0.02 respectively). CONCLUSION: In conclusion, reactive oxygen species play a significant role in the initiation and the progression of congestive heart failure. Increased free radicals levels may cause myocardial muscle dysfunction.