Mechanical Behaviour of As-Manufactured and Repaired Aligned Discontinuous Basalt Fibre-Reinforced Vitrimer Composites.

The aim of this research is to investigate basalt as a natural mineral-based fibre together with a vitrimeric resin as a sustainable alternative to standard composite materials. Vitrimers combine the properties of thermoset and thermoplastic polymers, enabling the repair of specimens and hence prolonging the lifetime of the composite material. The micro-mechanical characteristics between the basalt fibres and the vitrimer resin are reported and shown to match those of a standard Skyflex K51 epoxy resin. Discontinuous (4 mm) basalt fibres were employed to produce aligned discontinuous fibre-reinforced composites (ADFRCs) using the high-performance discontinuous fibre (HiPerDiF) technology. The mechanical characteristics of the laminates were investigated through tensile testing and the fracture zones were analysed under a scanning electron microscope. By normalising the results by their respective fibre volume fraction, it was discovered that the vitrimer-basalt ADFRCs exhibited, on average, a 4% higher strength and a 25% higher stiffness compared to their basalt epoxy counterparts. The repair potential of the vitrimer ADFRC specimens was explored during low-temperature compression repair. Two approaches were tested using double-sided local- and full-patch repair. Both successfully recovered a significant amount of their prime strength. In conclusion, the potential of the sustainable vitrimer-basalt composite is shown by its competitive mechanical performance. Combining this with the manufacturing flexibility, repair potential, and recyclability of the material, the vitrimer-basalt composite seems to be a competitive alternative to standard glass epoxies.

Preoperative Immunonutrition and Postoperative Outcomes in Radical Pancreaticoduodenectomy Patients.

BACKGROUND/AIMS: This study aimed to compare the patient groups who received and did not receive immunonutrition in terms of mortality and morbidity in patients who underwent radical pancreaticoduodenectomy. MATERIALS AND METHODS: Two groups were formed from 40 patients who underwent radical pancreaticoduodenectomy in our clinic in 2021. The patients in study group were given enteral immunonutrition support for 5 days preoperatively. For this purpose, a standard enteral immunonutrition product containing arginine, omega-3 fatty acids, and RNA (dietary nucleotides) was used. Patients' data of demographical, laboratory, postoperative complications, and current clinical status were analyzed. RESULT: Mortality developed in 5 (25 %) patients in the treatment group and 4 (20 %) patients in the control group in the following months (P > .05). The estimated survival rate in the treatment group was 21.8 ± 2.8 months in the treatment group 19.1 ± 1.7 months in the control group (P > .05). The length of hospital stay was 12.89 ± 3.3 days in the treatment group, while it was 16.47 ± 6.83 days in the control group (P < .05). In the postoperative follow-ups, delayed gastric emptying symptoms developed in 3 patients in the treatment group, while the same complication was observed in 9 patients in the control group (P < .05). Surgical site infections occurred in 4 patients in the treatment group and 9 patients in the control group (P < .05). CONCLUSION: It was observed that preoperative oral immunonutrition before pancreaticoduodenectomy was effective in reducing the risk of delayed gastric emptying after surgery and the length of hospital stay.

Efficacy and safety of interleukin-1 blockers in kidney transplant recipients with familial Mediterranean fever: a propensity score-matched cohort study.

BACKGROUND: Data on use of interleukin (IL)-1 blockers in kidney transplant recipients (KTRs) with familial Mediterranean fever (FMF) are very limited. We aimed to evaluate the efficacy and safety of anakinra and canakinumab in the transplantation setting. METHODS: In this retrospective cohort study, we included KTRs who suffered from AA amyloidosis caused by FMF and treated with anakinra or canakinumab (study group, n = 36). Using propensity score matching, we selected 36 patients without FMF or amyloidosis from our database of 696 KTRs as the control group. Primary outcomes were patient and graft survival. Biopsy-confirmed graft rejection, changes in estimated glomerular filtration rate (eGFR), high-sensitivity CRP (hsCRP), erythrocyte sedimentation rate (ESR), proteinuria and number of monthly attacks were secondary outcomes. RESULTS: All KTRs with FMF began IL-1 blocker therapy with anakinra and nine (25%) were switched to canakinumab. Overall death was more frequent in the study group (19.4% vs 0%) (P = .005); however, overall graft loss was comparable between study (27.8%) and control groups (36.1%) (P = .448). Five- and 10-year graft survival rates were significantly higher in the study group (94.4% and 83.3%, respectively) than in the control group (77.8% and 63.9%, respectively) (P = .014 and P < .001, respectively). Rejections were numerically lower in study group (8.3% vs 25%), but it did not reach to statistical significance (P = .058). When compared with the pre-treatment period, with IL-1 blockers, the number of attacks per month (P < .001), and eGFR (P = .004), hsCRP (P < .001) and ESR (P = .026) levels were lower throughout the follow-up, whereas proteinuria levels were not. CONCLUSIONS: Anakinra and canakinumab are effective in KTRs suffering from FMF; however, the mortality rate may be of concern.

Tracking Topological and Electronic Effects on the Folding and Stability of Guanine-Deficient RNA G-Quadruplexes, Engineered with a New Computational Tool for De Novo Quadruplex Folding.

The initial aim of this work was to elucidate the mutual influence of different single-stranded segments (loops and caps) on the thermodynamic stability of RNA G-quadruplexes. To this end, we used a new NAB-GQ-builder software program, to construct dozens of two-tetrad G-quadruplex topologies, based on a designed library of sequences. Then, to probe the sequence-morphology-stability relationships of the designed topologies, we performed molecular dynamics simulations. Their results provide guidance for the design of G-quadruplexes with balanced structures, and in turn programmable physicochemical properties for applications as biomaterials. Moreover, by comparative examinations of the single-stranded segments of three oncogene promoter G-quadruplexes, we assess their druggability potential for future therapeutic strategies. Finally, on the basis of a thorough analysis at the quantum mechanical level of theory on a series of guanine assemblies, we demonstrate how a valence tautomerism, triggered by a coordination of cations, initiates the process of G-quadruplex folding, and we propose a sequential folding mechanism, otherwise dictated by the cancellation of the dipole moments on guanines.

Dipyridamole does not have any additive effect on the prevention of COVID-19 coagulopathy.

OBJECTIVE: Severe acute respiratory syndrome (SARS) coronavirus 2 (SaRS-Cov-2) associated respiratory disease (COVID-19), announced as a pandemic, is a multisystem syndrome. SARS-CoV-2 directly infects and damages vascular endothelial cells, which leads to microvascular dysfunction and promotes a procoagulant state. Dipyridamole (DP) acts as a reversible phosphodiesterase inhibitor and is used mainly as an antiplatelet agent. It is hypothetised that it has possible activities in COVID-19. DESIGN AND METHODOLOGY: We report our retrospective, real-world results of DP added to low-molecular weight heparin (LMWH) in the treatment of 462 clinically diagnosed and hospitalized COVID-19 patients. We compared anticoagulation with and without DP addition with no administration of anticoagulation in the same time frame. The primary outcome was proven or highly suspected coagulopathy within 30 days of hospitalization. RESULTS: Definitive coagulopathy has been diagnosed in 3 (3.5%) of 85 LMWH administered patients and 7 (2.13%) of 328 DP + LMWH received patients (P=0.456). Five cases with definitive coagulopathy were not initiated any anticoagulation at the time of the event. The multivariate analysis showed that DP addition to the anticoagulant approach did not have any impact on the risk of demonstrated coagulopathy and highly-suspected coagulopathy. CONCLUSION: We think that our clinical experience is valuable in showing the real-life results of DP + LMWH treatment in COVID-19. This approach did not affect the coagulopathy rate. Our data did also not document an additive effect of DP in the COVID-19 outcome. Prospective controlled trials would give more convincing results regarding the role of DP in COVID-19 endothelial dysfunction and clinical outcome.

Estimated probabilities of positive, vs. negative, events show separable correlations with COVID-19 preventive behaviours.

Research has associated optimism with better health-protective behaviours, but few studies have measured optimism or pessimism directly, by asking participants to estimate probabilities of events. We used these probability estimates to examine how optimism and/or pessimism relate to protecting oneself from COVID-19. When COVID-19 first reached Turkey, we asked a snowball sample of 494 Istanbul adults how much they engaged in various COVID-protective behaviours. They also estimated the probabilities of their catching COVID-19, and of other positive and negative events happening to them. Estimated probability of general positive events (optimism) correlated positively with officially-recommended helpful behaviours (e.g. wearing masks), but not with less-helpful behaviours (e.g. sharing 'alternative' COVID-related information online). Estimated probabilities of general negative events (pessimism), or of catching COVID, did not correlate significantly with helpful COVID-related behaviours; but they did correlate with psychopathological symptoms, as did less-helpful COVID-related behaviours. This shows important nuances can be revealed by measuring optimism and pessimism, as separate variables, using probability estimates.

Surgical myotomy and anterior fundoplication for achalasia disease. Short-term outcomes.

AIM: Achalasia is a well-known disease among esophageal motility disorders, and all treatments for this disease are aimed at relaxing the lower esophageal sphincter (LES). Recently, endoscopic and surgical myotomy techniques are used more frequently because they give better results than other conservative techniques. In this study, we aimed to present the early results of surgical myotomy and anterior fundoplication techniques in the treatment of achalasia-related dysphagia. METHODS: Our study enrolled patients who operated with laparoscopic myotomy and anterior fundoplication for achalasia between 2014 and 2019. Patients' demographic and clinical properties, operative details, and postoperative shortterm outcomes were retrospectively analyzed. RESULTS: A total of 25 patients (11 women, 14 men) were enrolled. The mean age was 40.72±13.6 (range 18-66) years. The mean LES pressure was 26.6±11.2 (range 16-50) mmHg. The mean esophageal myotomy length was 7.83±1.88 (range 7-12 cm). Esophagus perforation developed in one patient during myotomy. The mean time to start oral feeding was 2.56±0.76 (range 2-4) days, and the mean length of hospital stay was 4.96±1.17 (range 3-8) days. During the follow-up, symptom regression was observed in 92 % of patients at the end of a 1-year. CONCLUSION: According to our results and available literature, myotomy with Dor fundoplication is an effective technique that can be used to treat achalasia disease. KEY WORDS: Achalasia, Dor fundoplication, Heller myotomy.

Intraabdominal Schwannomas Single-center experience.

OBJECTIVE: Intraabdominal schwannomas are rare benign tumors. In this study, we aimed to present our clinical experience in patients with intrabdominally located Schwannoma. MATERIAL-METHOD: Patients who received the diagnosis of intrabdominal schwannoma between 2011-2019 were retrospectively examined. Demographic and clinical characteristics, treatment methods, short- and long-term results and immunohistochemical characteristics of the patients were analyzed. RESULTS: A total of 7 patients were included in the study. Four patients were female and three were male. The mean age was 51.5 (31-63) years. The most common clinical presentation was abdominal pain (57.1%). Tumor location was stomach (n=2), pelvic region (n=2), rectum (n=1), retropancreas (n=1), and left juxtadrenal space (n=1). Postoperative wound infection developed in one patient and pancreatic fistula complication was seen in one patient. Re-admissions to the hospital were due to anemia and pleural effusion in two patients. The mean tumor diameter was 6 cm (0.3-13 cm). All patients were S 100 strongly positive Mitoses / 50 HPFs (high power field), <2 Ki67 <3%. The mean follow- up period was 60 months. Currently, 5 patients are being followed without disease, 1 patient survives despite recurrence and 1 patient has died due to non-cancer reasons. CONCLUSION: Intrabdominal schwannomas are rare tumors which most commonly exhibit gastrointestinal involvement. Since these tumors are mostly benign, the long-term prognosis of patients is good. Schwannoma should be kept in mind in the differential diagnosis of intrabdominal masses. Radical resections with high morbidity and mortality should be avoided if preoperative diagnosis is made. KEY WORDS: Abdominal tumor, Mesenchymal tumor, Nerve sheath tumor, Schwannoma.

Initial complete blood count score and predicting disease progression in COVID-19 patients.

INTRODUCTION: Coronavirus has caused a pandemic since it was first detected in Wuhan in December 2019. The mortality rate is high in moderate and severe cases. Our study aimed to screen the CBC parameters as a useful predictive factor for COVID-19 resulting in critical illness. METHODS: A total of 285 patients with positive PCR results were analyzed. The median age was 55 (24-90), and 64.2% of patients were male. Sixty-eight percent of cases were hospitalized with moderate, 32% with severe disease at initial admission. RESULTS: We found that lymphocyte count <620/mcl, neutrophil-to-lymphocyte ratio (NLR) >6, and platelet to lymphocyte ratio (PLR) >350 were predictive of the outcome. We scored our cohort 0-3 for these three parameters. Patients with a score of 2-3 were more likely to have progressive disease, anti-cytokine treatment, intensive care admission, intubation, and death, compared to patients with a score of 0-1. Additionally, they tended to be hospitalized for longer (median 11.5 days, mean 15.6), compared to those with a score 0 or 1 (median 9 days, mean 11.3). Twenty-eight of 38 cases with scores of 2-3 were discharged (73.6%), whereas the rate was 89% for patients with a score of 0-1 (P=0.009). CONCLUSION: Based on the absolute lymphocyte count (<620/mcl, NLR >6, PLR >350), our three-parameter score was able to predict disease progression, and the likelihood of anti-cytokine treatment, intubation, and death. We think that COVID-19 patients presenting with moderate to severe pneumonia, and having scores of 2 or 3 on our scale, should be closely monitored and robustly supported.