Uric Acid and P-Wave Dispersion in Subjects with Heart Failure

Uric acid used as a marker of cardiovascular risk, which is associated with oxidative stress and inflammation. P-wave dispersion (PWD) is an electrocardiographic measure, which shows heterogeneity of atrial depolarization. It has demonstrated that there is an association of increased PWD with atrial fibrillation. This article aimed to investigate the relationship between PWD and uric acid in subjects with heart failure (HF). This descriptive method, cross-sectional study included a total of 315 stable HF outpatients. The subjects were classified into two groups by their PWD: the normal PWD group consisted of subjects with a PWD lower than 40 ms (n = 201), and the increased PWD group consisted of subjects with a PWD higher than or equal to 40 ms (n = 114). Significantly, the results showed higher uric acid levels determined in the increased PWD group, in comparison with the normal PWD group (7.4 ± 1.6 mg/dL, vs. 6.5 ± 1.6 mg/dL p < 0.001). Univariate analyses revealed an association between uric acid, blood urea nitrogen, systolic pulmonary artery pressure, left atrial diameter, and increased PWD. In multivariate logistic regression analysis, there was an association of uric acid level (OR: 1.293; 95% CI: 1.106-1.511, p: 0.001), systolic pulmonary artery pressure (OR: 1.027; 95% CI: 1.011-1.044, p: 0.001), and left atrial diameter (OR: 1.754; 95% CI: 1.028-2.992, p: 0.039) with PWD. The receiver operating characteristics (ROC) curve analysis demonstrated that the optimal cut-off level of uric acid for predicting increased PWD was ≥ 7.1 mg/dL with a specificity of 77 percent and a sensitivity of 81 percent. Conclusion of our study results suggested that serum uric acid levels independently correlated with PWD in subjects with HF

Increased Monocyte Count is Related to the Development of Atrial Fibrillation in Subjects with Heart Failure

Determining subjects with heart failure (HF), who have a high risk of developing atrial fibrillation (AF), is crucial since it is related to an increase in morbidity and mortality. The importance of an increase in inflammatory response cannot be ignored in developing AF in subjects with HF. This study’s goal was to evaluate the relationship between the development of AF and monocyte count, the main components of the inflammatory response, in subjects with HF. Medical data of 158 subjects in total with sinus rhythm, admitted to the emergency department and hospitalized with systolic HF between January 2009 and February 2014, were analyzed prospectively. All the subjects followed up in terms of the development of AF. The subjects separated into two groups according to their rhythm at the end of the follow-up period. Group 1 included subjects who maintained sinus rhythm, while Group 2 included subjects with AF. Echocardiographic findings and laboratory data were collected. No statistically significant difference was determined between the groups concerning age, sex (p=0.056), hypertension, diabetes mellitus, and smoking status. The two groups differed significantly regarding the presence of moderate-to-severe mitral regurgitation (MR) [32 (28%) vs. 22 (51%), p=0.010] and monocyte count [560 (20-3100) vs. 800 (380-1510) μL,

Motorlu taşıtlar için egzoz sistemine uygun termoelektrik jeneratör geliştirilmesi ve deneysel incelenmesi

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır

THE EFFECT OF SOCIO-ECONOMIC AND FINANCIAL DEVELOPMENT ON TAX GAP: A REGIONAL ANALYSIS

Vergi idaresinin vergi toplamada etkinliği ve mükelleflerin vergiye gönüllü uyumunun ölçümünde bir gösterge olarak kullanılan vergi açığı, maliye literatürüne özellikle son yıllarda girmiş, dikkat çeken bir kavram olarak yer almaktadır. Tahsil edilen toplam vergi miktarı ile tam vergi uyumu altında tahsil edilecek toplam vergi gelirleri arasındaki fark olan vergi açığı kavramını, Türkiye’de il bazında sosyoekonomik ve finansal gelişmişlik boyutuyla ampirik olarak incelemek bu çalışmanın ana amacını oluşturmaktadır. Elde edilen bulgularda sosyo-ekonomik faktörlerin finansal gelişmişlik düzeyinden daha etkili bir şekilde vergi açığının azaltılmasında etkili olduğu tespit edilmiştir.The tax gap used as an indicator in tax collection of the tax administration and the taxpayer compliance_x000D_ measurement of taxpayers is a noteworthy concept becoming to an end-use according to the financial_x000D_ literature. The main concept of taxation is to be socio-economic and financial development in some_x000D_ provinces in Turkey. In the obtained findings, it has been determined that socio-economic factors are_x000D_ more effective in reducing the tax deficit than the financial development level.The tax gap used as an indicator in tax collection of the tax administration and the taxpayer compliance measurement of taxpayers is a noteworthy concept becoming to an end-use according to the financial literature. The main concept of taxation is to be socio-economic and financial development in some provinces in Turkey. In the obtained findings, it has been determined that socio-economic factors are more effective in reducing the tax deficit than the financial development level

Outcomes of Percutaneous Balloon Mitral Valvuloplasty in Significant Mitral Stenosis with Moderate Mitral Regurgitation - Single Center Study

Objective:Rheumatic heart disease is the deposition of immune complexes which cause malfunction of the heart valves. Percutaneous mitral balloon valvuloplasty (PMBV) is an established treatment option in patients with symptomatic moderate or severe rheumatic mitral valve disease, but PMBV is not a preferred option in mitral stenosis (MS) patients with moderate mitral regurgitation (MR) due to the risk of severe MR. The aim of this study was to evaluate the safety and feasibility of PMBV in symptomatic MS patients with moderate MR by comparing the post-procedural parameters with those of MS patients with mild or no MR.Method:Among 104 patients with symptomatic MS, 10 patients with moderate MR were classified as group 2 while 94 patients who had mild or none MR were classified as group 1 in the present work. All patients underwent PMBV and pre- and post-procedural mitral valve area, MRs were recorded and cardiovascular events and complications were assessed in 30 days.Results:The only difference in both groups before and after the procedure was the severity of the MR. Cardiovascular death was not observed for both groups in 30 days. In group 1, there were 3 patients and in group 2, there was 1 patient who developed severe MR after PMBV. All patients who had post-procedural severe MR required mitral valve replacement in 30 days due to severe MR in group 1. The composite complication rate was similar between the groups.Conclusion:PMBV might be an alternative treatment option for selected patients having significant MS with moderate MR

The Relationship Between Arthroplasty Surgeons' Experience Level and Optimal Cable Tensioning in the Fixation of Extended Trochanteric Osteotomy

Introduction: In this study, our aim was to examine the relationship between the arthroplasty surgeons' experience level and their aptitude to adjust the cable tension to the value recommended by the manufacturer when asked to provide fixation with cables in artificial bones that underwent extended trochanteric osteotomy (ETO). Materials and Methods: A custom-made cable tensioning device with a microvoltmeter was used to measure the tension values in Newtons (N). An ETO was performed on 4 artificial femur bones. Surgeons at various levels of experience attending the IXth National Arthroplasty Congress were asked to fix the osteotomized fragment using 1.7-mm cables and the tensioning device. The participants' demographic and experience data were investigated and recorded. The surgeons with different level of experience repeated the tensioning test 3 times and the average of these measurements were recorded. Results: In 19 (35.2%) of the 54 participants, the force applied to the cable was found to be greater than the 490.33 N (50 kg) value recommended by the manufacturer. No statistically significant difference was determined between the surgeon's years of experience, the number of cases, and the number of cables used and the tension applied over the recommended maximum value (P = .475, P = .312, and P = .691, respectively). Conclusions: No significant relationship was found between the arthroplasty surgeon's level of experience and the adjustment of the cable with the correct tension level. For this reason, we believe that the use of tensioning devices with calibrated tension gauges by orthopedic surgeons would help in reducing the number of complications that may occur due to the cable

Regio- and stereo-chemical ring-opening reactions of the 2,3-epoxy alcohol derivative with nucleophiles: Explanation of the structures and C-2 selectivity supported by theoretical computations

The ring-opening reactions of (1aS,2S,6bR)-5-ethyl-2-hydroxyhexahydro-4H-oxireno[2,3-e]isoindole-4,6(5H)-dione were investigated under very mild and nonchelated conditions. C-2 selective ring-opening products were obtained with nucleophilic additions such as Cl-, Br- and N-3(-). The exact configuration of (3aS,4R,5R,6S,7aS)-5-chloro-2-ethyl-4,6-dihydroxyhexahydro-1H-isoindole-1,3(2H)-dione was determined by X-Ray diffraction analysis which was obtained from the reaction of epoxy alcohol with HCl . On the other hand, theoretical computations were carried out to explain the regioselectivity in the ring opening reaction of epoxy alcohols. The results showed that the ring-opening reaction of both epoxy alcohols proceeds in a kinetically controlled manner and regioselectivity occurs depending on the transition state. (c) 2022 Published by Elsevier B.V

The association of left atrial mechanics with left ventricular morphology in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance study

Purpose: Hypertrophic cardiomyopathy (HCM) is related with structural and pathologic changes in the left atrium (LA) and left ventricle (LV). The aim of this study was to explore the association between LA mechanics and LV charac-teristics in patients with HCM using cardiac magnetic resonance feature tracking (CMR-FT). Material and methods: A total of 76 patients with HCM and 26 healthy controls were included in the study. The pa-rameters including the extent of LV late gadolinium enhancement (LGE-%) and the LV early diastolic longitudinal strain rate (edLSR) were assessed for LV. LA conduit, booster, and reservoir functions were assessed by LA fractional volumes and strain analyses using CMR-FT. HCM patients were classified as HCM patients without LGE, with mild LGE-% (0% = 10%), and prominent LGE-% (10% < LGE-%).Results: HCM patients had worse LA functions compared with the controls (p < 0.05). The majority of LA functional indices were more impaired in HCM patients with regard to LGE. LA volumes were higher in HCM patients with prominent LGE-% compared with HCM patients with mild LGE-% (p < 0.05). However, only a minority of LA functional parameters differed between the 2 groups. LA strain parameters showed weak to modest correlations with LV LGE-% and LV edLSR.Conclusions: LV characteristics, to some extent, influence LA mechanics, but they might not be the only factor induc-ing LA dysfunction in patients with HCM

Association Between Bifurcation Angle and Coronary No-reflow Following Primary Percutaneous Coronary Intervention in Patients

Objective:Percutaneous coronary intervention (PCI) has become the treatment method for patients presenting with ST elevation myocardial infarction (STEMI). One of the well-known complications of PCI is no-reflow. Studies demonstrated a relationship between endothelial dysfunction and disturbed vascular flow due to angulation of vascular tree. Although the relationship between hemodynamic alterations and coronary angulation is evident, there is a lack of detailed analysis in terms of hemodynamic changes between vascular geometry and coronary no-reflow. We aimed to elucidate the relationship between vascular geometry and coronary no-reflow.Method:We reviewed PCI database of our hospital and enrolled a total of 120 patients with STEMI, who developed no-reflow following PCI, and sex and age matched 80 patients with normal flow. For each group, demographic and clinical characteristics, laboratory values and two dimensional quantitative coronary angiography measurements were evaluated.Results:Patients with no-reflow had a higher prevalence of hypertension and diabetes mellitus. In addition, serum C-reactive protein levels were higher in patients with no-reflow compared to patients with normal flow (p<0.001). On the other hand, serum hemoglobin levels were significantly lower in patients with no-reflow compared to patients with normal flow (p<0.001). With respect to 3 dimensional coronary measurements, calculated bifurcation angle of left anterior descending artery (LAD) and circumflex artery (CX) was significantly wider in the no-reflow group than in the control group [110.9° (21.8°) vs. 85.9° (15.8°), p<0.001].Conclusion:Our data showed that a strong association existed between bifurcation angle of LAD-CX and no-reflow phenomenon in STEMI patients who underwent PCI

Examınatıon of the effects of phase I complex decongestıve physıotherapy on balance and gaıt ın lower extremıty lymphedema

Bu çalışma, PAÜ Bilimsel Araştırma Projeleri Koordinasyon Birimi tarafından desteklenmiştir (Proje No: 2015SBE006).Bu çalışmanın amacı alt ekstremite lenfödeminde Faz I Kompleks Dekonjestif Fizyoterapinin (KDF) denge ve yürüyüş üzerine etkilerini incelemektir. Çalışmaya 18-70 yaş aralığında, unilateral alt ekstremite lenfödemi olan 16 katılımcı dahil edilmiştir. Ödem, çevre ölçümü ve Frustum yöntemi ile; eklem hareket açıklığı gonyometre ile; kas kuvveti, manuel kas testi ve bir maksimum tekrar yöntemi ile; statik denge Tek Ayak Üzerinde Durma Testi, dinamik denge Fonksiyonel Uzanma Testi, Lateral Uzanma Testi ve 30 sn Saniyede Sandalyede Otur – Kalk Testi ile; fiziksel performans Yarı Çömelme Testi ve Zamanlı Merdiven İnip Çıkma Testi ile; aerobik kapasite Altı Dakika Yürüme Testi ve yürüyüş LEGSys™ yürüme analiz cihazı ile değerlendirilmiştir. Değerlendirmeler tedavi öncesi ve tedavi sonrası olmak üzere 2 kez yapılmıştır. Tedavi olarak katılımcılara manuel lenfatik drenaj, kompresyon bandajı, dekonjestif egzersizler ve cilt bakımından oluşan Faz I Kompleks Dekonjestif Fizyoterapi programı 4 hafta boyunca, haftada 5 gün toplam 20 seans uygulanmıştır. Katılıcımların yaş ortalaması 50 ± 17,91 yıl olup 11’i kadın (%68,8), 5’i (%31,2) erkektir. Tedavi sonrası ödem, kalça ve diz eklemi eklem hareket açıklığı, quadriceps ve hamstring kas kuvveti, dinamik denge, fiziksel performans, altı dakika yürüme mesafesi, kadans, yürüyüş hızı, çift adım hızı, çift adım zamanı ve adım sayısında istatistiksel olarak anlamlı fark bulunmuştur (p<0.05). Bu çalışmanın sonucuna göre alt ekstremite lenfödeminde Faz I KDF programının ödem, eklem hareket açıklığı, fiziksel performans, aerobik kapasite, dinamik denge ve yürüyüşün hız ile ilişkili parametreleri üzerinde olumlu etkileri vardır.The purpose of this study is investigate the effects of Phase I Complex Decongestive Physiotherapy (CDP) programme on balance and gait in lower extremity lymphedema. Sixteen participants with unilateral lower extremity lymphedema, between 18-70 years old, were included in study. Edema evaluated with circumferential measurement and Frustum formula; range of motion evaluated with goniometer; muscle strength evaluated with manual muscle testing and One Repetition Maximum Test; static balance evaluated with Single Leg Stance Test, dynamic balance evaluated with Functional Reach Test, Lateral Reach Test and 30 s Chair Stand Test; physical performance evaluated with Half Squat Test and Timed Up & Down Stairs Test; aerobic capacity evaluated with Six Minute Walking Test and gait evaluated with LEGSys™ gait analysis system. Assessments were performed 2 times before and after the treatment. Phase I Complex Decongestive Physiotherapy programme, which is composed of manual lymphatic drainage, compression bandage, decongestive exercises and skin care, was applied to participants during 4 week, 5 days per week, totally 20 sessions. The mean age of participants were 50 ± 17,91 years and 11 (68,8%) were female and 5 (31,2%) were male. After treatment statistically significant difference were founded in oedema, hip and knee joints range of motion, quadriceps and hamstring muscle strength, dynamic balance, physical performance, six minute walking distance, cadence, gait speed, stride velocity, stride time and step number (p<0,05). According to the findings in this study there are positive effects of Phase I Complex Decongestive Physiotherapy programme on oedema, range of motion, physical performance, aerobic capacity, dynamic balance and speed-related parameters of the gait