Ultrasonographically Measured Rectus Femoris Cross-sectional Area might Predict Osteosarcopenia.

AIM: We have aimed to investigate the role of ultrasonographic muscle parameters (UMP) in predicting osteosarcopenia in bedridden patients in a palliative care center. BACKGROUND: The role of ultrasound has not been evaluated in predicting osteosarcopenia. OBJECTIVE: Reduced muscle thickness (MT) and cross-sectional area (CSA) have often been observed in individuals with sarcopenia, reflecting muscle loss and atrophy. Meanwhile, the potential role of muscle ultrasound has not been evaluated in predicting osteosarcopenia. METHODS: We have conducted a prospective, observational study between January 2021 and 2022. We have recorded the demographics, comorbidities, and nutritional status by using the mini nutritional assessment-short form. We measured handgrip strength with a hand dynamometer and the muscle mass with dual X-ray absorptiometry. Sarcopenia was defined by the European Working Group on Sarcopenia in Older People 2 criteria. Osteoporosis was diagnosed according to the World Health Organization criteria. We have categorized the body phenotypes into four groups: "non-sarcopenic non-osteoporotic," "sarcopenic alone," "osteoporotic alone," and "sarcopenic osteoporotic." We have measured the subcutaneous fat thickness (SFT), MT, and CSA of the rectus femoris (RF) and biceps brachii (BB) via ultrasonography. A multivariate regression analysis was performed and area under curve (AUC) values were used to evaluate the accuracy of UMPs. RESULTS: We included 31 patients (mean age: 74.6±12.1 years, 54.8%: male). The prevalences of sarcopenia, osteoporosis, and sarcopenic osteoporosis were 71%, 48.4%, and 41.9%, respectively. Only the "sarcopenic osteoporotic" phenotype was negatively correlated with all UMPs. In the regression analysis, only the "sarcopenic osteoporotic" phenotype was independently associated with RFCSA (ß=-0.456, p= 0.024). The AUC for all patients was >0.700. CONCLUSION: RFCSA measurement might be useful in the screening for osteosarcopenia. This has been the first study investigating the relationship between UMPs and body phenotypes. Multi-center and large-scale studies are, however, needed.

Comparison of muscle and fat parameters measured by ultrasonography and dual-energy x-ray absorptiometry between older palliative care patients with and without type 2 diabetes mellitus.

BACKGROUND AND AIMS: There are limited data on the comparison of body compositions between diabetic and non-diabetic patients. We aimed to compare the muscle mass and fat parameters measured by ultrasonography (USG) and dual-energy x-ray absorptiometry (DXA) between older palliative care patients with and without type 2 diabetes mellitus (DM). METHODS: We conducted a prospective, cross-sectional study. We recorded the demographics, comorbidities, blood pressures, microvascular complications, pressure injuries, ambulation and nutritional status, and laboratory parameters. We measured the handgrip strength with a hand dynamometer and anthropometric parameters. We analyzed the subcutaneous fat thickness, muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii muscles by USG and the total and regional muscle mass and fat parameters by DXA. We performed a regression analysis to examine the independently associated factors of DM. RESULTS: We included 55 patients (mean age: 79.0 ± 8.0 years, 56.4%: female). 43.6% had type 2 DM. The patients with DM had significantly higher glucose and HbA1c levels and lower RFMT and RFCSA values than the patients without DM (p < 0.01, for all). The RFMT was independently associated with DM after adjusting age, sex, and body mass index (Odds ratio = 0.735, 95% confidence interval = 0.565-0.956, p = 0.022). CONCLUSION: Our study demonstrated that the RFMT might be associated with type 2 DM. This was the first study comparing the body compositions measured by USG and DXA between older diabetic and non-diabetic palliative patients with a wide range of laboratory evaluations. Longitudinal, multi-center studies are warranted to understand the underlying mechanisms.

COVID-19 presenting with diarrhea in a heart transplant patient.

A 55-year-old man who underwent bicaval orthotopic heart transplantation nine months earlier presented with complaints of diarrhea and oliguria. Laboratory findings showed pancytopenia and an elevated creatinine level. Cyclosporine and mycophenolate mofetil were discontinued, and the patient received only everolimus. As he was immunosuppressed and had atypical symptoms during the COVID-19 pandemic, reverse transcriptase-polymerase chain reaction testing was performed, which yielded a positive result. Treatment with hydroxychloroquine and favipiravir were initiated. Although the patient suffered from acute renal failure, his condition showed an improvement after hydration plus a five-day antiviral treatment and, then, treatment was stopped. His COVID-19 test was negative after 10 days of follow-up and treatment, and he was discharged with cyclosporin and mycophenolate mofetil.

In-Hospital and Long-Term outcomes after Open-Heart Surgery in Turkish Octogenarians: a Single-Center Study.

OBJECTIVE: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. METHODS: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. RESULTS: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). CONCLUSION: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse inhospital outcomes and long-term follow-up results.

In-hospital and long-term outcomes after open-heart surgery in turkish octogenarians: a single-center study

Abstract Objective: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. Methods: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. Results: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). Conclusion: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse in-hospital outcomes and long-term follow-up results.

Clinical Effects of Pleurotomy on Postoperative Outcomes of Patients Undergoing On-Pump Coronary Artery Bypass Grafting with Skeletonized Left Internal Thoracic Artery.

PURPOSE: To evaluate the clinical impact of pleurotomy during skeletonized internal thoracic artery (ITA) harvesting in patients undergoing on-pump coronary artery bypass grafting (CABG). METHODS: Consecutive patients (n = 758) who underwent CABG with skeletonized ITA were divided into 2 groups according to pleural integrity: open pleura (OP) and closed pleura (CP). Propensity score matching was performed after retrospective data extraction. The measured outcomes were postoperative pulmonary and hemorrhagic complications, 30-day mortality, and duration of hospital stay. RESULTS: Among 236 propensity score-matched pairs, there was no statistically significant difference between the 2 groups in terms of first 30-day mortality (OP, n = 7 [3%]; CP, n = 5 [2.5%]), blood product use (OP, 0.90 ± 0.71; CP, 0.74 ± 0.7), or median duration of hospital stay. The incidence of postoperative pleural effusion, thoracentesis, prolonged mechanical ventilation, respiratory failure, excessive drainage, cardiac tamponade, and reexploration and the number of patients requiring transfusion were similar in both groups. CONCLUSION: The clinical effect of pleural protection or pleurotomy on postoperative outcomes is limited in patients undergoing on-pump CABG with skeletonized ITA.

Transition from Conventional Technique to Less Invasive Approach in Left Ventricular Assist Device Implantations.

Surgical treatments for heart failure patients are being increasingly performed every year. While experiences in this field are increasing, transition to alternative surgical approaches to minimize incisions is gaining popularity. However, there are clinics that still avoid performing these techniques. In the current study, we aim to present our experiences in transitioning to a minimally invasive technique by comparing two groups. One group was operated with a minimally invasive technique that has been performed in the learning curve period, while the second was operated with a familiar and standard technique. One hundred twenty patients who were implanted with left ventricular assist devices (LVADs) from April 2015 to January 2019 were retrospectively analyzed. The first 30 LVAD-implanted patients via less invasive approach (since April 2017) were included in group 1, and the last 30 isolated LVAD implanted patients via standard full sternotomy were included in group 2. Early clinical outcomes were compared between these two groups. There were no significant differences between two groups in terms of demographic features and preoperative statuses. Group 1 had significantly lesser mortality rates, cardiopulmonary bypass times, drainages, and blood products. Hospital stays had no significant difference between the groups, while extubation times and ICU stays were significantly lesser in group 1. Left ventricular assist device implantation through thoracotomy and ministernotomy is as feasible as that done through the conventional full sternotomy technique. In this group of patients with a high risk of bleeding, besides providing less hemorrhage, we believe that the surgical procedure was not more difficult than the conventional method.

Seasonal variations of digestive enzymes in sea cucumbers (Holothuria tubulosa, G. 1788) under culture conditions.

Sea cucumber, Holothuria tubulosa (Gmelin, 1788), is an economically valuable species due to its rich nutrients content that being exported in Turkey. However, culture of this species is difficult due to a lack of knowledge. The main objective of this study is to investigate seasonal activities of main digestive enzymes (protease, lipase, and amylase) for nutritional requirements. In this sense, sea cucumbers were stocked in the glass aquarium and sediment was 10 cm. It was replaced monthly and enriched (1% of the living individual weight) by dried Sargassum sp. Total protease and amylase enzymes have shown higher activity compared to lipase. All three enzyme activities were maximum in the summer and minimum in the winter. In summer, the highest measured total protease, amylase, and lipase activity values were 6.45 ± 0.66, 6.77 ± 0.72, and 2.78 ± 0.32 U/mg per protein, respectively. In winter, the lowest total protease, amylase, and lipase activity values were measured as 2.03 ± 0.16, 1.14 ± 0.14, and 0.12 ± 0.01 U/mg per protein, respectively. As a conclusion of the study, seasonal expression of the main digestive enzymes was strictly dependent on water temperatures and food abundance and also it was ideal to feed this species with food containing high protein and carbohydrate under appropriate temperatures for commercial culture.

Salvage pulmonary thromboembolectomy for massive pulmonary embolism in a child presented with syncope and subsequent cardiac arrest.

Pulmonary embolism is frequently under-recognised in children and, therefore, a high index of suspicion should be exerted on patients with exertional dyspnoea, presyncope/syncope and unexplained cardiopulmonary arrest. We discuss a 10-year-old previously healthy girl who presented with syncope and subsequent cardiac arrest related to massive pulmonary embolism and was salvaged successfully by emergent pulmonary embolectomy.

The publication rate of oral presentations presented in national congresses of Turkish Society of Cardiovascular Surgery.

BACKGROUND: This study aims to investigate the literature contribution of oral presentations presented in the largest national congresses of the Turkish Society of Cardiovascular Surgery. METHODS: A total of 675 orally presented abstracts during biannually organized 12th, 13th, and 14th congresses were reviewed using the PubMed and Google Scholar databases in May 2018. Abstracts were searched for institutions where they were submitted, publication status in scientific journals, type of peer-reviewed journal, and publication year. RESULTS: Of a total of 675 oral presentations, 69.1% were clinical studies, 18.8% were case reports, and 12.1% were experimental researches. Of all accepted abstracts, 47.3% were from university hospitals, 36.1% were from training and research hospitals, and 16.6% were from other multi-center institutions. A total of 279 (41.3%) abstracts were published in a scientific journal. There was a significant difference among the institutions in terms of the rate of publication (p=0.04), and the university hospitals had the highest rate. The mean time from presentation to publication in a scientific journal was 16.7±9.1 (range, 4 to 60) months. CONCLUSION: The rate of published abstracts from the last three congresses of the Turkish Society of Cardiovascular Surgery is higher compared to the literature results reporting national congresses of other specialties, but is lower than the international congresses. We believe that this ratio should be increased to reach the same level as international reports and the methods to encourage researchers to publish should be developed.

Effect of ejection fraction on left ventricular remodeling in aortic insufficiency.

BACKGROUND: Due to ventricular compensatory mechanisms, patients with severe aortic regurgitation are generally asymptomatic. Severe left ventricular dysfunction develops annually in 20% of non-operated cases, and the prognosis in those cases is poor. Although surgery is recommend in patients with left ventricular dysfunction, surgeons are wary. We investigated the changes in ventricular and effort capacity after surgery in patients with normal and abnormal left ventricular function. METHODS: We retrospectively examined the data of patients with aortic regurgitation who underwent aortic valve replacement in our clinic between 1993 and 2013. Those who had previous cardiac surgery, chemotherapy, radiotherapy, renal dysfunction, diabetes mellitus, or preoperative arrhythmias were excluded. The 113 patients were divided into 2 groups according to ejection fraction. RESULTS: In patients with ejection fraction <50%, interventricular septal thickness, posterior wall thickness, and left ventricular mass were significantly greater than in the ejection fraction ≥50% group (p < 0.01). No significant differences in intensive care unit stay and hospitalization were determined. No mortality was observed. Ejection fraction and effort capacity increased significantly after aortic valve replacement in both groups, and interventricular septal thickness, posterior wall thickness, and left ventricular mass decreased in both groups. CONCLUSIONS: Significant left ventricular functional improvements can be achieved after aortic valve replacement in patients with severe aortic regurgitation who develop left ventricular dysfunction. Despite the reported higher surgical mortality in this patient group, surgical treatment offers a survival benefit. We recommend surgical treatment in patients with severe aortic regurgitation who develop left ventricular dysfunction.

The effect of sea cucumber Holothuria tubulosa (G., 1788) on nutrient and sediment of Aegean Sea shores.

The effects of sea cucumber, Holothuria tubulosa, on sediment of hypereutrophic conditions were investigated. Research was designed as two groups with 3 replicates. And data determined from sea cucumber groups were compared to that of the control. Water samples and sediment samples were analyzed three times in a week with respect to nitrogenous materials and organic carbon. The differences between the initial and final concentrations of % C, ammonium, nitrate and nitrite were significant (p < 0.05) at the end of the 84 days of experiment. The data from the present study showed that sea cucumber played an important role in the refreshing of sea water. Therefore, it can be suggested that sea cucumbers might be successfully used for the improvement of coastal regions especially in the areas with fish farming.