The relationship between Salusin-α, Salusin-ß, and Klotho levels with subclinical atherosclerosis in ankylosing spondylitis.

OBJECTIVE: Subclinical atherosclerosis (SA) is often observed in ankylosing spondylitis (AS) patients; Salusin-α (Sal-α), Salusin-ß (Sal-ß), and Klotho hormones are thought to be associated with atherosclerosis. This study aims to evaluate the relationship between Sal-α, Sal-ß, and Klotho levels with SA in AS. PATIENTS AND METHODS: The study included patients older than 18 years who applied between August 1, 2019, and September 1, 2019. Patients with AS were included in the AS group, and patients without a known disease were included in the healthy group. Epicardial adipose tissue thickness (EATT) and carotid intima-media thickness (CIMT) measurements were used to assess SA. RESULTS: The study group included 38 (40.9%) patients diagnosed with AS, and the control group included 55 (59.1%) participants. CIMT and EATT levels were higher in the AS group than in the healthy group [0.37 (0.17) vs. 0.54±0.18, p<0.001; 0.44±0.11 vs. 0.54 (0.18), p=0.004, respectively]. There was no significant difference in Sal-α, Sal-ß, and Klotho levels between the AS and healthy groups (p>0.05). Furthermore, there was no observed relationship between EATT or CIMT and Klotho, Sal-α, or Sal-ß in either group (p>0.05). CONCLUSIONS: Although SA level was higher in AS patients, there was no relationship between SA and Sal-α, Sal-ß, and Klotho levels.

Can artificial intelligence predict COVID-19 mortality?

OBJECTIVE: COVID-19 infection rapidly spread across the globe and evolved into a pandemic. Artificial intelligence (AI) has been used to predict the spread of the virus and diagnose and treat the disease. In this study, we aimed to predict whether patients admitted to the intensive care unit (ICU) due to COVID-19 infection will result in mortality. PATIENTS AND METHODS: Ninety parameters were used for each 589 ICU patient. The nine parameters with the highest effect on mortality were determined. Four hundred seventy-one patients were used to train the AI with these nine parameters. AI was tested with 118 patient data. RESULTS: AI estimated mortality with 83% sensitivity, 84% specificity, 84% accuracy, and 0.81 F1 score. Therefore, the area under the curve was calculated as 0.91. The results indicate that mortality among COVID-19 patients admitted to the ICU can be predicted based on their laboratory parameters on the first day. CONCLUSIONS: These findings underscore the potential benefits of utilizing AI in managing pandemics.

Assessment of the clinical features of rheumatoid arthritis-related interstitial lung diseases: a retrospective evaluation.

OBJECTIVE: Rheumatoid Arthritis (RA) stands as the most prevalent form of inflammatory arthritis, affecting approximately 1% of the population. Among individuals diagnosed with RA, a notable proportion, ranging from 10% to 40%, also experience Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD). This coexistence of RA and ILD has been identified as a detrimental factor contributing to increased mortality rates. Furthermore, RA-ILD often exhibits an insidious nature, posing challenges in its timely detection and management. Hence, our objective was to conduct a retrospective analysis of the clinical characteristics observed in patients who underwent evaluation for RA-ILD. PATIENTS AND METHODS: A total of 87 patients who were evaluated for RA-ILD within one year were included in the study. This study was conducted retrospectively using a cross-sectional and descriptive approach to analyze the demographic and clinical data of the included patients. RESULTS: Among the 87 patients, eight were diagnosed with RA-ILD, with four being male and four being female. Of the eight patients, two had non-specific interstitial pneumonia, five had usual interstitial pneumonia, and one had nodules consistent with RA. Subpleural fibrosis increased the likelihood of RA-ILD by 6.9 times. In the group with ILD, the residual volume and total capacity were found to be lower compared to the other group. Among the eight patients diagnosed with RA-ILD, five had used methotrexate before the diagnosis. CONCLUSIONS: In order to mitigate the risk of delayed diagnosis of RA-ILD, which can lead to increased mortality and has a subtle onset, it is recommended that patients with RA who possess certain risk factors undergo regular monitoring. It is advisable for RA patients to undergo annual assessments involving carbon monoxide diffusion capacity and spirometry function tests. In cases, where deemed necessary, more advanced investigations such as high-resolution computed tomography should be conducted.

Adsorption mechanism of the N2 and NRR intermediates on oxygen modified MnN4-graphene layers - a single atom catalysis perspective.

In the present work the adsorption of N2 and the nitrogen reduction reaction (NRR) intermediates have been investigated on oxygen modified MnNxOy (x + y = 4, x ≠ 0)/graphene layers through periodic density functional theory calculations. Various number of oxygen atoms substitute nitrogen atoms within the MnNxOy, with their effect on the layer stability, chemical bonding and N2 adsorption being explored. As the oxygen amount increases in the porphyrin unit, Mn-O interactions weaken with reference to that of Mn-N, bonding orbitals become less populated while the antibonding orbitals between Mn-N-O atoms become partially occupied, as evidenced by the Crystal orbital Hamiltonian population (COHP) and integrated crystal orbital bond index (ICOBI) analyses. During N2 adsorption on the different layers, the substitution of two and three nitrogen atoms by oxygen leads to the longest NN molecular bond length. Two main orientations for the N2 molecules sorption have been investigated: side-on and end-on which are perpendicular and parallel to the surface normal, respectively. When the interaction of N2 with MnNO3 layer is considered, d-band center variation of the Mn with reference to the pre-adsorbed state is more obvious after side-on adsorption configuration. For the selected layers based on initial N2 adsorption energies, the adsorption energies of nitrogen reduction reaction intermediates follow a trend based on the number of oxygen atoms in the porphyrin units. Charge density difference (CDD) maps and partial density of states (PDOS) analysis reveal that the interaction of N2 with oxygen modified layers takes place through electron acception-donation mechanism between the partially occupied Mn-d orbitals and the 2p orbitals of the N2 molecule. DDEC6-derived bond orders and atomic charges support the PDOS and adsorption/formation energy trends, and further clarify the bonding strengths of the atoms in the porphyrin units, as well as the Mn-N2 interactions in the adsorbed systems.

The aggregate index of systemic inflammation may predict mortality in COVID-19 patients with chronic renal failure.

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in December 2019 and then spread globally, resulting in a pandemic. Initially, it was unknown if chronic kidney disease (CKD) contributed to the mortality caused by COVID-19. The immunosuppression associated with this disease may minimize the COVID-19-described hyper-inflammatory state or immunological dysfunction, and a high prevalence of comorbidities may lead to a poorer clinical prognosis. Patients with COVID-19 have abnormal circulating blood cells associated with inflammation. Risk stratification, diagnosis, and prognosis primarily rely on hematological features, such as white blood cells and their subpopulations, red cell distribution width, mean platelet volume, and platelet count, in addition to their combined ratios. In non-small-cell lung cancer, the aggregate index of systemic inflammation (AISI), (neutrophils x monocytes x platelets/lymphocytes) is evaluated. In light of the relevance of inflammation in mortality, the objective of this study is to determine the impact of AISI on the hospital mortality of CKD patients. PATIENTS AND METHODS: This study is an observational retrospective study. Data and test outcomes of all CKD patients, stages 3-5, hospitalized for COVID-19 and followed between April and October 2021 were analyzed. RESULTS: Patients were divided into two groups according to death (Group 1-Alive, Group 2-Died). Neutrophil count, AISI and C-reactive protein (CRP) levels were increased in Group-2 [10.3±4.6 vs. 7.65±4.22; p=0.001, 2,084.1 (364.8-2,577.5) vs. 628.9 (53.1-2,275); p=0.00 and 141.9 (20.5-318) vs. 84.75 (0.92-195); p=0.00; respectively]. Receiver operating characteristic (ROC) analysis demonstrated 621.1 as a cut-off value for AISI to predict hospital mortality with 81% sensitivity and 69.1% specificity [area under ROC curve 0.820 (95% CI: 0.733-0.907), p<.005]. Cox regression analysis was used to analyze the effect of risk variables on survival. In survival analysis, AISI and CRP were identified as important survival predictors [hazard ratio (HR): 1.001, 95% CI: 1-1.001; p=0.00 and HR: 1.009, 95% CI: 1.004-1.013; p=0.00]. CONCLUSIONS: This study demonstrated the discriminative effectiveness of AISI in predicting disease mortality in COVID-19 patients with CKD. Quantification of AISI upon admission might assist in the early detection and treatment of individuals with a bad prognosis.

The effect of thrombosis-related laboratory values on mortality in COVID-19 infection.

OBJECTIVE: COVID-19 may cause thrombosis in both venous and arterial systems. Familiarity with the signs and symptoms of thrombosis and its treatment is essential in treating COVID-19 infection and its complications. D-Dimer and mean platelet volume (MPV) are measurements related to the development of thrombosis. This study investigates whether MPV and D-Dimer values could be used to determine the risk of thrombosis and mortality in the COVID-19 early stages. PATIENTS AND METHODS: 424 patients who were COVID-19 positive, according to the World Health Organization (WHO) guidelines, were randomly and retrospectively included in the study. Demographic and clinical characteristics such as age, gender, and length of hospitalization were obtained from the digital records of participants. Participants were divided into living and deceased groups. The patients' biochemical, hormonal, and hematological parameters were analyzed retrospectively. RESULTS: White blood cells (WBC), neutrophils, and monocytes were significantly different in the two groups (p-value <0.001), and their values were lower in the living group than in the deceased group. MPV median values did not differ according to prognosis (p-value = 0.994). While the median value was 9.9 in the survivors, it was 10 in the deceased. Creatinine, procalcitonin, ferritin, and the number of hospitalization days in living patients were significantly lower than in patients who died (p-value <0.001). Median values of D-dimer (mg/L) differ according to prognosis (p-value <0.001). While the median value was 0.63 in the survivors, it was found as 438 in the deceased. CONCLUSIONS: Our results did not show any significant relationship between the mortality of COVID-19 patients and their MPV levels. However, a significant association between D-Dimer and mortality in COVID-19 patients was observed.

The significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19.

OBJECTIVE: This study aims at determining the significance of a novel inflammatory biomarker, presepsin, in predicting disease prognosis in patients with COVID-19. PATIENTS AND METHODS: This retrospective study was concluded at the University Hospital between April and August 2020. The study involved 88 COVID-19 patients (48 men and 40 women). The patients were categorized into two groups: the patients admitted to the COVID-19 clinic, described as the moderate COVID-19 patients (Group-1; n=44), and those admitted to the internal medicine outpatient clinic, who were the mild COVID-19 patients (Group-2; n=44). The groups were compared using inflammatory markers: presepsin, C-Reactive Protein to Albumin Ratio, Neutrophil to Lymphocyte Ratio, and procalcitonin. RESULTS: Serum presepsin levels (195.29 vs. 52.12 pg/ml) were significantly higher in the Group-1 compared to the Group-2 (p=0.001). The gender distribution and average age were similar in both groups (p > 0.05). While ferritin, lactate dehydrogenase, D-Dimer, platelet lymphocyte ratio, C-Reactive Protein to Albumin Ratio (p=0.001), erythrocyte sedimentation ratio, C-Reactive Protein and presepsin were significantly higher in the Group-1 compared to Group-2 (p<0.05), while hemoglobin and lymphocyte were significantly lower in the Group-1 than in Group-2 (p<0.05). CONCLUSIONS: Serum presepsin levels were found to be significantly higher in moderate clinical group COVID-19 patients compared to mild group. Presepsin, a new inflammatory biomarker, may be useful in predicting the prognosis and early treatment of COVID-19 infection.

Ocular injuries among oral and maxillofacial surgeons: Have high risk or not? An overview of a two-centered experience.

BACKGROUND: Oral and maxillofacial surgeons are occupationally exposed to ocular injuries via bodily fluid (ie, blood or saliva), which can carry substantial latent risks, both bacterial and viral. The aim of this study was to determine the prevalence of ocular injury and infection among oral and maxillofacial surgeons during outpatient procedures. METHODS: Data were collected from a consecutive series of 500 surgeries conducted by 26 resident surgeons via a questionnaire. Responses were categorized into two groups: Group I did not indicate an eye injury, and Group II did indicate an eye injury. RESULTS: Of 500 procedures, 161 resulted in ocular injuries, a rate of 32.2 injuries per 100 person-procedures. Educated participants experienced eye injuries at a significantly higher rate than those who were uneducated (23.33% vs. 15.11%; P=0.022). Those not using eye protection experienced eye injuries at a significantly higher rate than those using eye protection (23.32% vs. 2.33%; P<0.001). Of all eye injuries, 14.28% required medical management. Incidents were reported at a rate of 10.56%, higher in those with multiple injuries. CONCLUSION: These findings demonstrate major inadequacies and breaches of the present eye/face protection protocols. Because the number of clinical studies on ocular injuries during oral and maxillofacial surgerical procedures is limited in the literature, each additional study can be important for promoting awareness among professionals, so that serious morbidity can be prevented.

Vitamin D Deficiency Is a Predictor of Mortality in Elderly with Chronic Heart Failure.

Context: The prevalence of both heart failure and vitamin D deficiency increases with age and is associated with poor outcome in the elderly. Objectives: We aimed to investigate the relationship between all-cause mortality and vitamin D deficiency in elderly patients with chronic heart failure. Design: It is a retrospective, observational cross-sectional study. Median follow-up time was 497 days. Subjects and Methods: 302 patients aged ≥65 years heart failure patients was categorized into tertiles based on the 25-hydroxy-vitamin D levels. Clinical and laboratory parameters were evaluated according to tertiles. Hospitalization rates and overall survival were compared between tertiles. Independent predictors of all cause mortality were defined. Results: Patients with low vitamin D tertile were mostly women (p=0.001), and had a worse NYHA functional class (p=0.005). During follow-up, deaths were more frequent in the first tertile (p = 0.001). All-cause mortality increased significantly with decreasing vitamin D tertiles (from third tertile 7.9%, to 11.9%, to 26%; log rank test p=0.003). No significant difference was observed at the composite endpoint of mortality or HF hospitalizations (P=0.451). Multivariate analysis supported that low vitamin D concentration was an independent predictor of all causes of mortality (HR 0.93; 95% CI 0.89-0.97; p=0.004). Conclusions: Low vitamin D levels were independent predictors of all-cause mortality in the elderly population with chronic heart failure.

Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children.

INTRODUCTION: Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures. MATERIAL AND METHOD: We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-LocTM, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion. RESULTS: The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110 min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p = 0.001 and p = 0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p = 0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months. CONCLUSION: In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.

Electroflotation of oily wastewater using stainless steel sponge electrodes.

In this study, emulsified oil removals have been studied electrochemically by using stainless steel sponge electrode beds. A first-order electroflotation model was developed and the model estimation were consistent with the experimental results. It was found out that the mean electroflotation rate constant was mainly a function of the voltage applied to the electrode beds. In addition, the properties of intermediate materials (electrical conductivity) placed between the anode and cathode electrode beds strongly affected removal yields. For the initial concentration of 57,150 mg/L, the chemical oxygen demand (COD) removal was obtained as 85% under the conditions of voltage gradient 15 V. The experiments were also performed by varying the electrode bed lengths. Even though higher oil yields were obtained at 27 cm bed length, similar oil yields were also obtained at 18 cm bed length, especially after 60 min, with less energy consumption. Therefore, the optimum electrode bed length was concluded to be 18 cm.

Preoperative platelettolymphocyte ratio as a prognostic factor in geriatric patients with proximal femoral fractures.

INTRODUCTION: The aim of this study was to investigate whether the platelet to lymphocyte ratio is a prognostic factor in geriatric patients who underwent surgery for proximal femoral fractures. MATERIALS AND METHODS: Clinical and laboratory data of 288 patients who underwent surgery for proximal femoral fracture were analysed. The patients were divided into six groups on the basis of sex (male and female) and survival duration after the operation (death within the first 6 months, death between the 6 and 12 months, survival for more than 12 months). Pre-operative platelet/lymphocyte ratios of these groups were compared. RESULTS: Of 288 patients, 187 were female and 101 were male. There was no significant difference between the groups with regard to age (p = 0.123 female groups) (p = 0.207 male groups). Although the preoperative platelet to lymphocyte ratio was higher in patients who died within 12 months than in those who survived beyond that, this platelet/lymphocyte ratio was statistically significant in females who died in the first 6 months (p = 0.038). CONCLUSION: A high preoperative platelet to lymphocyte ratio may be associated with high risk of mortality in patients who were operated for proximal femoral fracture.

Investigation of genotoxic effects of doripenem using cytogenetic and molecular methods.

The main aim of this study was to investigate the genotoxic effects of doripenem (DRP) using both cytogenetic and molecular test systems. Although there have been some studies reporting the effects of DRP, none of them has shown the genotoxic effects of DRP. In order to achieve the main aim of the study, the human peripheral lymphocytes were treated with 100 µg/ml, 200 µg/ml, and 400 µg/ml concentrations of DRP for 24 and 48 hours, and the chromosome aberration (CA) and micronucleus (MN) methods were used as the cytogenetic tests and RAPD-PCR method was used as the molecular test to determine the genotoxic effects of DRP. DRP did not induce the chromosome aberrations and micronucleus frequencies at all concentrations and at all treatment periods. So, it was concluded that DRP did not show any cytotoxic effect. However, DRP increased the number of polymorphic bands and decreased the ratio of genomic template stability, especially at the 48-hour treatment period. In this study, according to the obtained results, it was determined that DRP failed to show any genotoxic risk at the therapeutic doses. This result also indicates that DRP could be a reliable antibiotics according to its rapid metabolism.

Alterations on high HbF levels may be associated with KLF1 gene mutations.

The KLF1 gene synthesizes a transcription factor in the zinc finger structure that regulates the transcription of ß-, γ-globin, and Foxm1 genes. This factor plays an important role in the erythropoiesis mechanism by modifying the chromatin structure and is involved in the regulation of transcription in the opening of the ß-globin gene. ß-globin gene expression could be disrupted by a mutation, which may be a possible cause of a disruption in regulation of the promotor of the ß-globin gene where the KLF1 transcription factor binds. This can lead to an inherited high fetal hemoglobin (HbF) ratio in people. Therefore, the main aim of this study was to determine the effects of KLF1 mutations on these high levels of HbF. In this study, in order to determine the relationship between the KLF1 mutations and the high HbF levels three exons along with the 5'-UTR and 3'-UTR regions of the KLF1 gene were sequenced of 53 volunteers. In this study, 3 variations in the non-coding regions of the KLF1 gene were not associated with a high level of HbF. Five variations were detected in the second exon of KLF1 gene. One of these is a frame shift that occurs when GG bases are inserted between the 59-60 codons, and the other four variations occur as a base substitution variations.  No correlation was found between high HbF levels and neutral variants. Only polar-nonpolar amino acid changes were found at two points. At one of them, a significant drop in the high HbF levels was observed, while the other was observed to be high near to the critical limit. These findings suggested that variations in function of the KLF1 gene can alter the HbF levels.

The analysis of lncRNA HOTAIR rs12826786 C>T polymorphism and gastric cancer susceptibility in a Turkish population: lack of any association in a hospital-based case-control study.

BACKGROUND: The HOX transcript antisense intergenic RNA (HOTAIR), a well-known long noncoding RNA (lncRNA), has been widely identified to participate in pathogenesis of multiple cancers. An aberrant up-regulation and biological functions have been observed in gastric cancer (GC). A common single nucleotide polymorphism (SNP) (rs12826786 C>T) at the HOTAIR has been reported to influence HOTAIR expression, but its association with GC has yet to be investigated in Turkish population. AIM: The aim of the present study was to investigate whether HOTAIR rs12826786 C>T polymorphism could be involved in the risk of GC susceptibility in Turkish population. METHODS: We genotyped HOTAIR rs12826786 C>T polymorphism in 312 Turkish individuals including 105 GC patients and 207 healthy controls matched on age and gender by a Real-Time Polymerase Chain Reaction (PCR) with the TaqMan assay. RESULTS: No statistically significant differences were found in the allele or genotype distributions of the HOTAIR rs12826786 C>T polymorphism among GC and healthy control subjects (P > 0.05). CONCLUSIONS: Our results demonstrate that the HOTAIR rs12826786 C>T polymorphism has not been in any major role in genetic susceptibility to gastric carcinogenesis, at least in the population studied here. Independent studies are needed to validate our findings in a larger series, as well as in patients of different ethnic origins.

Demonstrating the steady performance of iron oxide composites over 2000 cycles at fast charge-rates for Li-ion batteries.

The feasibility of using iron oxides as negative electrode materials for safe high-power Li-ion batteries is demonstrated by the carbon-coated FeOx/CNT composite synthesized by controlled pyrolysis of ferrocene, which delivered a specific capacity retention of 84% (445 mA h g(-1)) after 2000 cycles at 2000 mA g(-1) (4C).

Retrospective evaluation of patients at follow-up with acute poisoning in Intensive Care Unit.

OBJECTIVE: Poisonings are among the major causes of emergency visits and intensive care hospitalizations. The aim of our study is to evaluate intoxicated patients at follow-up and treated in the Intensive Care Unit (ICU) in terms of demographic characteristics, type of poisonings and results of treatment. MATERIALS AND METHODS: Patients at follow-up aged 17 or older admitted with intoxication to the ICU between January 1, 2009 and December 31, 2011 were included in the study. Age, gender, presenting symptoms, duration of hospitalization, type of poisoning, the way of poisoning, medical history, seasons, hospitalization costs, treatment and prognosis of the patients were analyzed. RESULTS: Totally, 153 (8.9%) out of 1375 follow-up patients in the ICU had acute intoxication. The mean age of intoxicated patients was 29.4 ± 11, 68% of them were female, 78.4% of them were under 35 years old, and intoxication was most common in the 17-25 age group. 114 of them (94.1%) were suicidal. The most common cause of poisoning was drug-poisoning by 88.2%, and most common presenting symptoms were nausea and vomiting by 71.2%. Mean length of stay was 2.4 ± 1.6 days, and the average cost of hospitalization was 761 ± 884 Turkish Liras or 271 ± 315 USD. 5 patients (3.3%) were intubated because of respiratory failure. There was no mortal case. CONCLUSION: Suicide attempts are prominent in acute poisoning, and the young female population is at higher risk. It was found that drugs, particularly antidepressants and antipsychotic agents were the most common cause of poisoning. The high cost of treatment of acute intoxication cases is a major cause of economic burden. Clinicians should be more careful when prescribing such drugs.

Is there a difference in mad honey poisoning between geriatric and non-geriatric patient groups?

OBJECTIVE: This study aims to investigate the demographic, toxicological characteristics of the mad honey intoxication at ages 65 and above, to analyze the electrocardiographic parameters, and to compare with the mad honey intoxication at ages below 65 years. PATIENTS AND METHODS: Eighty-two patients, who had been treated and followed-up between June 2013 and November 2014 in the Emergency Service of the Findikli State Hospital, Turkey, due to diagnosis of mad honey intoxication, were included in our observational study. Age, gender, toxicological characteristics, laboratory parameters, heart rates, systolic and diastolic blood pressures, laboratory analyses and electrocardiographic data of the patients were recorded and analyzed. Patients with known coronary artery disease, chronic renal failure, arrhythmias, valvular heart disease, history of thyroid disease and electrolyte imbalance were not included in the study. RESULTS: Eighty-two (80.5% was male and the mean age was 53 ± 15 years) patients followed-up due to mad honey intoxication were included in our study. There were 64 (78%) patients aged below 65 years, and 18 (22%) patients aged 65 and above. The mean heart rate was 45 ± 7 beats/min, systolic blood pressure was 83 ± 12 mmHg and diastolic blood pressure was 52 ± 9 mmHg on admission. The onset of symptoms of the patients was found as 0.84 hours on average after mad honey consumption, the average amount of honey consumed was 3.7 ± 1.1 tablespoons, and the mean recovery time of the symptoms was found to be 1.04 hours. The most common presenting symptoms were nausea-vomiting in 82 (100%) patients and dizziness in 73 (89%) patients. Patients were found to consume mad honey mostly for achieving a remission in gastrointestinal complaints (n=18, 22%), and for utilizing its blood pressure lowering properties (n=11, 13.4%), in addition to the dietary consumption. Looking at the heart rates of the patients on admission to the emergency service, 65 (79.3%) patients had normal sinus rhythm/sinus bradycardia, 12 (14.6%) patients had a 1st degree atrioventricular block, 3 (3.7%) patients had nodal rhythm, 1 (1.2%) patient had atrial fibrillation and 1 (1.2%) patient had preexcitation. There were no significant pathological findings in the routine laboratory examinations of patients. It was found that all patients achieved normal sinus rhythm and normal blood pressure values after medical treatment, and were discharged approximately 5.65 hours after observation and follow-up. In our study, prolonged intensive-care need, pacemaker need and mortality caused by mad honey intoxication were not found. In the comparison of data of all patients above and below 65 years of age, there was a statistically significant finding that the geriatric patients consume mad honey mostly for hypotensive purposes and gastrointestinal complaints; in addition, the symptoms were starting early and the recovery period was longer in geriatric patients. CONCLUSIONS: The mad honey poisoning should be considered in previously healthy patients with unexplained symptoms of bradycardia, hypotension, and atrioventricular block. Therefore, diet history should carefully be obtained from the patients admitted with bradycardia and hypotension. And, in addition to the primary cardiac, neurological and metabolic disorders, mad honey intoxication should also be considered in the differential diagnosis. In geriatric patients admitted due to mad honey intoxication, the mad honey is usually consumed to reduce blood pressure and resolve gastrointestinal problems; and, their symptoms begin early, and last longer after mad honey consumption. In terms of other parameters, the geriatric age group has similar characteristics to non-geriatric age group.

Visualizing nanoscale 3D compositional fluctuation of lithium in advanced lithium-ion battery cathodes.

The distribution of cations in Li-ion battery cathodes as a function of cycling is a pivotal characteristic of battery performance. The transition metal cation distribution has been shown to affect cathode performance; however, Li is notoriously challenging to characterize with typical imaging techniques. Here laser-assisted atom probe tomography (APT) is used to map the three-dimensional distribution of Li at a sub-nanometre spatial resolution and correlate it with the distribution of the transition metal cations (M) and the oxygen. As-fabricated layered Li1.2Ni0.2Mn0.6O2 is shown to have Li-rich Li2MO3 phase regions and Li-depleted Li(Ni0.5Mn0.5)O2 regions. Cycled material has an overall loss of Li in addition to Ni-, Mn- and Li-rich regions. Spinel LiNi0.5Mn1.5O4 is shown to have a uniform distribution of all cations. APT results were compared to energy dispersive spectroscopy mapping with a scanning transmission electron microscope to confirm the transition metal cation distribution.