Late perforation of anterior mitral leaflet after surgical resection of the subaortic membrane

AbstractA 54-year-old woman who underwent surgical resection of the subaortic membrane 10 years earlier presented with new onset dyspnea. Cardiovascular examination revealed 3–4/6 pansystolic murmur at the apex. She was found to have severe mitral regurgitation (MR) with transthoracic echocardiography; 2D and real-time-3D transesophageal echocardiography demonstrated severe MR through anterior mitral leaflet perforation with precise localization. The patient was treated with surgery in which the perforated segment was closed by direct suture technique and discharged on postoperative 5th day.<Learning objective: Late anterior mitral leaflet perforation after surgical or interventional procedures has rarely been reported. We present this case to emphasize the role of traumatic injury to weak endothelial surfaces such as a valve leaflet in the development of late leaflet perforation after surgical or interventional procedures.

The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index

Background: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 &#177; 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 &#177; 0.11, 0.61 &#177; 0.10, p = 0,005 vs 0.51 &#177; 0.09, 0.59 &#177; 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 &#177; 0.14, 0.50 &#177; 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

ÖĞRENME YÖNTEMLERİNİN FUTBOLA UYGULANMASI ÜZERİNE BİR DENEME

ÖĞRENME YÖNTEMLERİNİN FUTBOLA UYGULANMASI ÜZERİNE BİR DENEM

Organic chemical characterization of size segregated particulate matter samples collected from a thermal power plant area

Kutahya city, a thermal power plant (TPPs) affected region of Turkey, has serious air quality problems like similar industrial regions of the world due to the emissions from three closely-located coal-fired TPPs, residential coal combustion along with the contribution of several industrial stacks. The organic chemical speciation of ambient size-segregated particulate matter (PM) was investigated during two seasons at two sites with different pollution characteristics (urban and rural). The ambient PM was collected using a high volume cascade impactor, with 6 stages: PM>10.2, PM10.2-4.2, PM4.2-2.1, PM2.1-1.3, PM1.3-0.69 and PM<0.69. Collected PM samples were extracted with organic solvents and the organic composition (Polycyclic aromatic hydrocarbons (PAHs), n-alkanes and carboxylic acids) was determined by GC-MS. Sources of the organic species were assessed using molecular PAH diagnostic ratios, carbon preference index and wax percentages. More than 70% of the PM-bound PAHs were quantified in submicron particles. Similarly, 34-42% of n-alkanes and approximately 30% of the carboxylic acids were found on the smallest particles. The main sources of the PM-bound organic species were considered as the anthropogenic emissions such as coal and biomass combustion and also vehicular emissions rather than the biogenic sources. Considerably high cancer risk levels were obtained through inhalation of PAHs. Seasonal variations and size distributions of the carboxylic acids and levoglucosan were also evaluated. Polar organic compound concentrations were higher in the summer period at both locations probably due to the higher sunlight intensity and temperature favoring their photochemical formation. (C) 2020 Elsevier Ltd. All rights reserved

Investigation of spatial and temporal variation of particulate matter in vitro genotoxicity and cytotoxicity in relation to the elemental composition

Even though the outdoor air pollution and its major component Particulate Matter (PM) are recently classified as human carcinogen, attempts to elucidate the underlying mechanisms of PM toxicity are still crucial and continuing with in vitro approaches in various environmental circumstances. Present study investigated the genotoxicity (Comet assay) and the cytotoxicity (lactate dehydrogenase (LDH) leakage and the water-soluble tetrazolium (WST-1) assays) of 30 daily PM2.5 samples collected in the Kutahya province, to address their daily variability in effects with season (i.e. winter versus summer) and location (i.e. rural versus urban) using A549 human lung cancer epithelial cell line, as well as in relation to their chemical composition, specifically trace elements, organic carbon (OC) and elemental carbon (EC). The genotoxicity, measured by the percentage tail intensity (TI), of the daily PM2.5 samples at the traffic dense urban station was higher than that of the rural site for 80% of the parallel days. The genotoxicity was significant in the winter at the urban and in the summer at the rural site. Cytotoxicity was the highest for the winter urban samples. The PM2.5 mass, OC, and EC concentrations were not correlated to DNA damage, while there were correlations with Mn, Fe, Cu and Ba at the rural PM2.5 samples, and Mn, Co and Ni at the urban samples, respectively. The present study is confirming that the complex composition of PM2.5 originating from spatial and temporal changes can cause differences in the health effects

A New Approach for Site Selection of Air Quality Monitoring Stations: Multi-Criteria Decision-Making

The main objective of this study was to choose appropriate locations for two air quality monitoring stations in an urban area in Turkey by using specific decision-making techniques. For this purpose, five different potential locations for an urban station and seven different potential locations for a rural station were evaluated according to two Multi Criteria Decision Making techniques (MCDM): Analytic Hierarchy Process (AHP) and Elimination Et Choix Traduisant la Realite III (ELECTRE III). The main inputs of these methods were the air quality levels and associated pollution hot spots estimated by an air quality dispersion model (AERMOD), and the rankings determined according to the views of experts and local authorities regarding the selection criteria. The prioritization and ranking of the alternatives were determined and compared for both methods. The results of the two methods validated each other since the same locations were determined as the best alternatives by both methods. In this study, AHP and ELECTRE III, which are two well-known MCDM techniques, were used for the first time for the selection of the optimal air quality monitoring stations using seven criteria (pollution levels, security, availability of electricity, collaborations, staff support, easy access, distance)

Elemental characterization of general aviation aircraft emissions using moss bags

In light of growing concern and insufficient knowledge on the negative impact of aircraft emissions on environmental health, this study strives to investigate the air burden of major and trace elements caused by general aviation, piston-engine, and turboprop aircraft, within the vicinity of Eskisehir Hasan Polatkan Airport (Eskisehir, Turkey). The levels of 57 elements were investigated, based on moss bag biomonitoring using Sphagnum sp., along with chemical analyses of lubrication oil and aviation gasoline fuel used in the aircraft's operations. Five sampling sites were selected within the vicinity of the airport area to capture spatial changes in the concentration of airborne elements. The study demonstrates that moss bag biomonitoring is a useful tool in the identification of differences in the air burden by major and trace elements that have concentrated downwind of the aircraft emission sources. Moreover, pollutant enrichment in the Sphagnum moss bags and elemental characterization of oil/fuel are in agreement suggesting that Pb, followed by Cd, Cu, Mo, Cr, Ni, Fe, Si, Zn, Na, P, Ca, Mg, and Al are dominant elements that shaped the general aviation aircraft emissions