Faster olfactory adaptation in patients with olfactory deficits: an analysis of results from odor threshold testing.

BACKGROUND: Patients with olfactory deficits often report rapid and lasting olfactory adaptation compared to the time when they had normal olfactory function. However, this phenomenon receives little scientific attention. This retrospective study aimed to compare the patterns of olfactory adaptation in normosmic controls and patients with olfactory impairment by analyzing the trajectory of turning points in odor threshold tests based on the staircase technique. METHODS: 4120 subjects (1684 hyposmia, 1742 anosmia and 694 normosmic controls) were included in this study. Their odor threshold, odor discrimination and odor identification ability were assessed using the Sniffin’ Sticks. We analyzed the trajectory of turning points in the odor threshold test. RESULTS: Current results suggested that patients with hyposmia needed significantly more trials to reach the final threshold scores than controls and anosmic group, and controls needed more trials than anosmic group. The difference between the first turning point and final threshold scores in the anosmic group was significantly larger than in the hyposmia group and in controls. CONCLUSION: People with poor olfaction seem to adapt faster to olfactory stimuli. The trajectory of turning points in odor threshold test may serve as an indicator of olfactory adaptation and function of olfactory receptors. Olfactory adaptation may provide a new tool in the assessment of subtle olfactory loss.

The effect of olfactory training on olfactory bulb volumes in patients with idiopathic olfactory loss.

Olfactory loss impacts around 20% of the population and is associated with the reduction of pleasure from eating and drinking, sex and depression (1). Encouragingly, research findings have consistently demonstrated that olfactory training (OT) can improve olfactory function in people with olfactory loss due to various aetiologies (2). The most commonly used method for OT involves smelling four different odours (lemon, eucalyptus, rose and cloves), twice daily, for 12 weeks.

Outcomes of arteriovenous fistula for hemodialysis in octogenarian population.

Introduction Guidelines have been recommending the use of arteriovenous fistula among the hemodialysis population, but no clear conclusion has emerged with regard to the adequate access type in octogenarians. In this paper, the outcomes of arteriovenous fistula in octogenarian cohort were presented for death-censored cumulative patency rate, complications, and patients' survival rate. Methods A retrospective review of 88 consecutive arteriovenous fistula interventions in 70 octogenarian patients were performed at one referral institution between January 2010 and June 2014. The patients' records were analyzed and postoperative complications were documented. Death-censored cumulative arteriovenous fistula patency rates were calculated, and Kaplan-Meier method was used to analyze patient survival for 24 months. FINDINGS: Eighty-eight arteriovenous fistula constructions and six salvage procedures were performed in 70 octogenarians. Fifty-four (61.3%) forearm and 34 (38.7%) upper arm fistulas were created. All types of fistulas had 6-, 12-, 18-, and 24-month death-censored cumulative patency rates of 63.6%, 58.3%, 48.8%, and 41.4%, respectively. The primary failure rate was 40.9%. A total of 15 complications were documented as edema, hematoma/bleeding, infection, distal ischemia, and venous aneurysm, all of which had been treated. Patient survival rates for 12 and 24 months were 68.5% and 58.5%, respectively. DISCUSSION AND CONCLUSION: This analysis regarding arteriovenous fistula in octogenarian end-stage renal disease patients figured out equal death-censored cumulative patency compared to nonelderly, and two-year survival rate was acceptable. This study strengthens the argument that arteriovenous fistula should be the best proper choice in selected octogenarians; older age only should not be considered as an absolute contraindication for arteriovenous fistula creation in octogenarians; and patient-based approach should be applied.

Leadership and Bullying in the Forestry Organization of Turkey.

It is observed that the importance of executive-employee relationships is continuously increasing in today's professional life in addition to the importance of leadership types of managers along with the efficiency of employees as well as the sufficiency of these people in their social relations. Communication of employees with one another and with their manager, along with their social relations, is among the most important factors that sustain an organization. Bullying is a kind of psychological terror that takes place in the form of repeated attacks among workers, as well as by the manager on the employees, aiming to instill stress, job dissatisfaction, and exhaustion on the employees. It has been put forth especially by recent studies that the leadership styles of the managers are highly influential on bullying. The study was carried out with 1189 forest engineers working at 25 different Regional Directorates of Forestry in Turkey. The status of engineers subject to bullying in addition to the effects of leadership types on bullying was determined as a result of the statistical analyses carried out. The results of the study were evaluated comprehensively in comparison with other studies in the relevant literature, thus developing suggestions for preventing bullying behaviors that vary across leadership types.

Comparison of Pulse Rate Variability and Heart Rate Variability for Hypoglycemia Syndrome.

BACKGROUND: Heart rate variability (HRV) is a signal obtained from RR intervals of electrocardiography (ECG) signals to evaluate the balance between the sympathetic nervous system and the parasympathetic nervous system; not only HRV but also pulse rate variability (PRV) extracted from finger pulse plethysmography (PPG) can reflect irregularities that may occur in heart rate and control procedures. OBJECTIVES: The purpose of this study is to compare the HRV and PRV during hypoglycemia in order to evaluate the features that computed from PRV that can be used in detection of hypoglycemia. METHODS: To this end, PRV and HRV of 10 patients who required testing with insulin-induced hypoglycemia (IIHT) in Clinics of Endocrinology and Metabolism Diseases of Bezm-i Alem University (Istanbul, Turkey), were obtained. The recordings were done at three stages: prior to IIHT, during the IIHT, and after the IIHT. We used Bland-Altman analysis for comparing the parameters and to evaluate the correlation between HRV and PRV if exists. RESULTS: Significant correlation (r > 0.90, p < 0.05) and close agreement were found between HRV and PRV for mean intervals, the root-mean square of the difference of successive intervals, standard deviation of successive intervals and the ratio of the low-to-high frequency power. CONCLUSIONS: In conclusion, all the features computed from PRV and HRV have close agreement and correlation according to Bland-Altman analyses' results and features computed from PRV can be used in detection of hypoglycemia.

Spatiotemporal changes of land use patterns in high mountain areas of Northeast Turkey: a case study in Maçka.

High mountain forests (HMFs) have an important significance in forest ecosystems, but the benefits from such ecosystems have been compromised in recent years. In Turkey, HMFs constitute significant portions of Turkish forests because they cover 4% of Turkey; 15% of all Turkish forest areas are HMFs. The Eastern Black Sea region has a particular importance for HMFs due to its biological diversity and the rich presence of endemic species. This study analyzes the changes in spatial and temporal patterns of forest cover in HMF from 1973 to 2008 in the town of Maçka, which is located at the center of the Eastern Black Sea region of Turkey. The spatial and temporal change patterns of land use are quantified by interpreting spatial data. Remote sensing (RS), geographical information system (GIS), and a spatial pattern analysis program for categorical maps (FRAGSTATS) have been used for data collection, analysis, and presentation. The results showed that the HMF areas had biphasic growth from 1973 to 2008. Despite a net increase of 200.6 ha in forested areas between 1984 and 2008, there was an overall decrease from 1973 to 2008. The annual percentage of forestation for the forest areas within the study period was 0.04% in Maçka. The amount of aggregated forest area fragments rose from 388 in 1973 to 711 in 2008. The increase in the HMF of Maçka can be explained to some extent by the change in the demographic structure of Maçka and its plateaus, which contributed to changes in the daily life of the population of Maçka and its villages, such as changes in annual incomes, their lifestyles, decrease in transhumance and stockbreeding, decrease in the time of dwelling on the plateaus, and changes in the traditional architectural style.

Five Years' Evaluation of the BD ProbeTec System for the Direct Molecular Detection of Mycobacterium tuberculosis Complex in Respiratory and Nonrespiratory Clinical Samples.

In this study, Mycobacterium tuberculosis complex was detected by BD ProbeTec ET system in 4716 respiratory and 167 nonrespiratory samples [mostly (98%) smear negative). Sensitivity, specificity, positive and negative predictive values were 81.8%, 98.3, 85.1 and 97.9 for respiratory and 100%, 96.2, 64.7 and 100, for nonrespiratory samples, respectively. Among 149 (3.1%) ProbeTec DTB positive and culture negative samples, 72 (65 respiratory and seven nonrespiratory) (48.3%) were recovered from the patients who were evaluated as having TB infection. The system has been found as useful in early diagnosis of tuberculosis infection in association with the clinical, radiological and histopathological findings.

Red blood cell distribution width is associated with early failure of arteriovenous fistula for haemodialysis access.

This study aimed to investigate the predictive value of red blood cell distribution width (RDW) for early failure of arteriovenous fistula (AVF) for haemodialysis access. The hospital records of those patients who underwent primary AVF creation procedures for haemodialysis between December 2010 and September 2013 were included for retrospective analysis. Of 313 patients, 195 (62%) were male and 118 (38%) were female. Mean age was 60 (range 17-90) years. Of the 313 AVF procedures performed, 229 (73%) were created at forearm (radial artery-cephalic vein), and 84 (27%) were created upperarm (antecubital, brachiocephalic, or brachiobasilic procedures). Early AVF failure was found in 61 (19%) patients. According to chi-square test, the incidence of early AVF failure was higher in patients with heart failure and peripheral artery disease (P < 0.001). According to Mann-Whitney U test, the RDW (P = 0.001) and C-reactive protein (P = 0.024) values were higher in patients with early AVF. Our data showed that preoperative RDW is a reliable parameter that can be useful in predicting the early failure of AVF.

Serum hepcidin and growth differentiation factor-15 (GDF-15) levels in polycythemia vera and essential thrombocythemia.

OBJECTIVES: Hepcidin plays a regulatory role in systemic iron homeostasis. GDF-15 has been found to be expressed from matured erythroblasts and very high levels of GDF-15 suppresses hepcidin secretion. In this study, we evaluated hepcidin and GDF-15 levels in polycythemia vera (PV) and essential thrombocythemia (ET). METHODS: The study included 29 patients and 21 healthy controls. The patient group included 13 patients with ET and 16 patients with PV. Serum hepcidin and GDF-15 levels were measured at the time of diagnosis, before the initiation of any therapy. RESULTS: Hepcidin levels did not differ significantly in patients with chronic myeloproliferative disease (CMPD) and healthy controls. However, GDF-15 levels were significantly increased in patients with CMPD (P = 0.038). No difference could be found between patients with PV and ET in terms of hepcidin and GDF-15 levels. Patients with JAK2-V617F mutation had increased GDF-15 levels when compared with patients without this mutation (P: 0.006). CONCLUSIONS: The levels of GDF-15 were higher in CMPD, which are characterized by increased erythropoiesis, and this effect was more pronounced particularly in individuals with JAK2-V617F mutation. Hepcidin levels were not suppressed despite the increased erythroid activity and GDF-15 levels may be protective against the clinical complications of the disease such as thrombosis. This study revealed that, hepcidin levels were not suppressed despite increased erythroid activity and high GDF-15 levels in CMPD. We hypothesized that, this may be an attempt to prevent further amplification of erythropoietic activity by reducing iron utilization.

Systemic propolis stimulates new bone formation at the expanded suture: a histomorphometric study.

OBJECTIVE: To investigate the effects of systemically given propolis on the expanded premaxillary suture in a rat study model. MATERIALS AND METHODS: The 24 rats were randomly divided into three groups-only expansion (OE), expansion plus propolis (PRO), and nonexpansion (control) groups. After the 5-day expansion period was completed, the OE and PRO groups underwent 12 days of mechanical retention. At the end of this period, the animals were euthanatized and their pre-maxillae were dissected and fixed. Histomorphometric examination was performed to determine the number of osteoclasts, osteoblasts, and capillaries as well as the intensity of inflammatory cells and amount of new bone formation. RESULTS: Statistical analysis showed that the intensities of inflammatory cells, number of osteoblasts, and amount of new bone formation were greater in the PRO group than in the other groups. The PRO group also had more osteoclasts and new capillaries. CONCLUSION: Systemic use of propolis may hasten new bone formation at the expanded suture in rats.

The operative management of a displaced atrial septal occluder.

We present a case of a displaced atrial septal defect (ASD) occluder in the left ventricle. We successfully adapted a strategy to remove the device through a single right atrial incision which permitted retrieval of the occluder and the closure of the ASD.

Coronary-coronary bypass grafting to reduce the risk of aortic atheroembolism.

Coronary-coronary bypass grafting refers to making anastomoses between two segments of the same coronary artery or between different coronary arteries, and provides less "touch" to the aorta, which is important for the patients with severely atherosclerotic ascending aorta. In this report we represent a case of a patient with extensive atherosclerotic aorta, in whom a saphenous vein graft was placed between the acute marginal and the posterior-descending branches of the right coronary artery during an off-pump coronary artery bypass grafting surgery.

Myocardial injury during off-pump surgery. The effect of intraoperative risk factors.

OBJECTIVE: To achieve better outcomes, the degree of myocardial injury due to off-pump coronary artery bypass surgery (OPCAB) must be reduced. We studied the factors that render patients scheduled for OPCAB vulnerable to myocardial injury, using troponin T (cTnT) as a marker of myocardial injury. METHODS: We prospectively investigated 123 patients being operated by a group of surgeons with off-pump technique between January 2001 and June 2006 in Siyami Ersek Thoracic and Cardiovascular Surgery Center. Myocardial injury occurring during surgery was assessed by post-operative cTnT measurement. Then, the relation between intraoperative factors and postoperative cTnT release were statistically evaluated. RESULTS: Blood samples for cTnT measurement were taken from all patients before operation, immediately after arrival at the intensive care unit, then at 6, 12, and 24 hours after distal revascularization. When regarding the intraoperative risk factors, we found that the heart rate, blood pressure and anastomosis time are the main determinant of myocardial cell injury occurring during OPCAB surgery. CONCLUSION: Although aortic cross-clamp and cardioplegic arrest were not used in off-pump myocardial revascularization, the ischemic myocardial cell destruction was also inevitable in off-pump technique. Therefore, management of heart rate and myocardial contractility was desirable not only for precise anastomosis but also for myocardial protection during OPCAB surgery.

An outbreak of endophthalmitis after extracapsular cataract surgery probably caused by endotoxin contaminated distilled water used to dissolve acetylcholine.

AIM: To study possible causes of an outbreak of severe endophthalmitis after planned extracapsular cataract surgery in Medan, Indonesia. METHODS: In a 3 week period in November 2001, 17 of 43 patients developed signs of endophthalmitis after planned extracapsular cataract surgery. A search for possible causes was undertaken 4 months later. RESULTS: In autoclaved stored distilled water used to dissolve acetylcholine (used in 16 of 17 patients with endophthalmitis) a high amount of endotoxin was detected in a human blood essay, as well as a small number of non-typeable Pseudomonas spp. CONCLUSIONS: These findings suggest that distilled water used as solvent for acetylcholine was responsible for this outbreak of endophthalmitis. As a consequence, we now rely on solvents that are regularly checked for impurities such as an intravenous infusion fluid, rather than on vials with distilled water that is presumed to be sterile and kept for some time.

Enhanced iodide transport after transfer of the human sodium iodide symporter gene is associated with lack of retention and low absorbed dose.

Transfer of the sodium iodide symporter (hNIS) has been proposed as a new principle of cancer gene therapy. Using clinically relevant doses of (131)I for the treatment of NIS-expressing prostate carcinoma cells, we investigated the kinetics and the absorbed doses obtained in these tumors. hNIS-expressing cell lines accumulated up to 200 times more iodide when compared to wild-type cells. However, a rapid efflux of the radioactivity (80%) occurred during the first 20 min after replacement of the medium. In rats, the hNIS-expressing tumors accumulated up to 20 times more iodide when compared to contralateral transplanted wild-type tumors. After 24 h and doses of 550, 1200 or 2400 MBq/m(2) hNIS-expressing tumors lost 89, 89 and 91% of the initial activity, respectively. Dosimetric calculations showed that 1200 MBq/m(2) resulted in 3+/-0.5 Gy (wild-type tumor 0.15+/-0.1 Gy) and 2400 MBq/m(2) resulted in 3.1+/-0.9 Gy (wild-type tumor 0.26+/-0.02 Gy). Although transduction of the hNIS gene induces iodide transport in rat prostate adenocarcinoma a rapid efflux occurs, which leads to a low absorbed dose in genetically modified tumors. With regard to a therapeutic application additional conditions need to be defined leading to iodide trapping.