Bringing Packed Red Blood Cells to the Point of Combat Injury: Are We There Yet?

INTRODUCTION: Hemorrhage is the leading cause of injury related pre-hospital mortality. We investigated worst case scenarios and possible requirements of Turkish Military. As we plan to use blood resources during casualty transport, the impact of transport related mechanical stress on PRBC (packed red blood cell) were analyzed. MATERIAL AND METHODS: The in vitro experiment was performed in the environmental test laboratories of ASELSAN(R). Operational vibrations of potential casualty transport mediums such as Sikorsky Helicopters, Kirpi(R) Armoured Vehicle and NATO vibration standardsoftware MIL-STD-810G were recorded. The most powerful mechanical stress, which was created by the NATO standard, was applied to 15 units of fresh (7 day) PRBC in a blood cooler box. The vibrations were simulated by TDS v895 Medium-Force Shaker Device. On site blood samples were analyzed at 0, 6th and 24th hours for biochemical and biomechanical analyses. RESULTS: The mean age of fresh and old PRBCs was 4.9 (SD +/- 2.2) and 32.8 (SD +/- 11.8) days, respectively. Six-hour mechanical damage of fresh PRBC was demonstrated by increased erythrocyte fragmentation rates (p=0.015), hemolysis rates (p=0.003), supernatant potassium levels (p=0.003) and decreased hematocrit levels (p=0.015). Old PRBC hemolysis rates (p=0.015), supernatant potassium levels (p=0.015), supernatant Hb (p=0.015) were increased and Htc levels were decreased (p=0.015) within 6 hours. Two (%13) units of fresh and none of the old PRBC were eligible for transfusion after 6 hours of mechanical stress. CONCLUSION: When the austere combat environment was simulated for 24 hours, fresh and old PRBC hemolysis rates were above the quality criteria. Currently, a technology to overcome this mechanical damage does not seem to exist. In the light of the above data, a new national project is being performed

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted kappa values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders

Being Digital Citizen

AbstractDigital citizenship can be defined as “the norms of appropriate, responsible behavior with regard to technology use” (Ribble & Bailey, 2007). Based on this definition, this study is aimed to determine whose students are digital citizens and whose are not. Within the scope of this research, face-to-face learning students and blended learning students were compared with of the fact that being digital citizen. In order to make this comparison, Digital Citizenship Survey was used

Statistical optimization of cell disruption techniques for releasing intracellular X-prolyl dipeptidyl aminopeptidase from Lactococcus lactis spp. lactis

WOS: 000366238000017PubMed ID: 26584994X-prolyl dipeptidyl aminopeptidase (PepX) is an intracellular enzyme from the Gram-positive bacterium Lactococcus lactis spp. lactis NRRL B-1821, and it has commercial importance. The objective of this study was to compare the effects of several cell disruption methods on the activity of PepX. Statistical optimization methods were performed for two cavitation methods, hydrodynamic (high-pressure homogenization) and acoustic (sonication), to determine the more appropriate disruption method. Two level factorial design (2FI), with the parameters of number of cycles and pressure, and Box-Behnken design (BBD), with the parameters of cycle, sonication time, and power, were used for the optimization of the high-pressure homogenization and sonication methods, respectively. In addition, disruption methods, consisting of lysozyme, bead milling, heat treatment, freeze-thawing, liquid nitrogen, ethylenediaminetetraacetic acid (EDTA), Triton-X, sodium dodecyl sulfate (SOS), chloroform, and antibiotics, were performed and compared with the high-pressure homogenization and sonication methods. The optimized values of high-pressure homogenization were one cycle at 130 MPa providing activity of 114.47 mU ml(-1), while sonication afforded an activity of 145.09 mU ml(-1) at 28 min with 91% power and three cycles. In conclusion, sonication was the more effective disruption method, and its optimal operation parameters were manifested for the release of intracellular enzyme from a L. lactis spp. lactis strain, which is a Gram-positive bacterium. (C) 2015 Elsevier B.V. All rights reserved.Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [113Z841]This work was supported by a Research Grant from the Scientific and Technological Research Council of Turkey (TUBITAK), project no. 113Z841. We thank Gaye Ongen for her contributions

The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery

WOS: 000256807300006PubMed ID: 18524727Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent's usage to maintain,sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13 +/- 11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 IN) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests. Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1 % patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9 +/- 2.7 days). Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population

Subclinical Left Ventricular Dysfunction in Asymptomatic Severe Aortic Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging Study

WOS: 000275757300008PubMed ID: 20486957Objectives: Our aim was to evaluate subclinical left ventricular (LV) dysfunction, by two novel echocardiographic techniques, velocity vector imaging (VVI)-derived strain imaging and tissue Doppler imaging (TDI), in patients with asymptomatic, severe aortic regurgitation (AR). Methods: Forty patients with severe AR with normal ejection fraction and 30 controls were included to the study. All patients underwent a standard echocardiography extended with TDI and VVI analyses. To evaluate the LV longitudinal and circumferential deformation, segmental systolic peak strain and strain rate (SRs) data were acquired from parasternal short axis, apical four-chamber, two-chamber, and long axis views, and additionally LV myocardial velocities, isovolumic myocardial acceleration (IVA), peak systolic velocity (Sa) and peak myocardial velocity during isovolumic contraction (IVV) assessed by TDI. Results: IVA was the only TDI-derived parameter which was significantly impaired in AR patients (P = 0.0001). Both longitudinal and circumferential strain and SRs of the LV were significantly decreased in patients with severe AR (P = 0.0001). Longitudinal and circumferential strain/SRs and TDI-derived LV IVA were inversely correlated with LV end-diastolic diameter (P = 0.0001) and end-systolic diameter (P = 0.0001). TDI-derived IVA was also very well correlated with longitudinal deformation parameters (P = 0.0001). Conclusions: VVI- derived strain imaging and TDI-derived IVA may be used as adjunctive, reliable, noninvasive parameters for evaluating subclinical ventricular dysfunction in patients with chronic, severe AR. This may help to identify patients for closer follow-up and to determine the need for surgery before developing irreversible, severe heart failure. (Echocardiography 2010;27:260-268)

Evaluation of Right Ventricular Systolic and Diastolic Function in Patients with Newly Diagnosed Obstructive Sleep Apnea Syndrome without Hypertension

WOS: 000263747400006PubMed ID: 19151552Objectives: We investigated right ventricular (RV) structural and functional cardiac alterations in obstructive sleep apnea (OSA) independent of systemic hypertension and their correlation to the severity of OSA. Methods: Forty-one moderate-to-severe OSA but otherwise healthy patients and 30 body mass index-matched control subjects were included. All subjects underwent 24-hour ambulatory blood pressure monitoring, standard and tissue Doppler imaging of the RV. Results: The OSA group had increased RV wall thickness, impaired right ventricular outflow tract fractional shortening (RVOT fs), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI) and RV myocardial acceleration during isovolumic contraction (IVA) (p < 0.001). Apnea hypopnea index (AHI) and mean pulmonary artery (PA) pressure were correlated with all these indices (p < 0.01 for all). RV free wall thickness (p < 0.001) and IVA (p = 0.006) remained significant predictors of AHI after adjusting for age, body mass index, mean PA pressure, RVOT fs, TAPSE and MPI in a multiple stepwise linear regression model. Conclusions: OSA is associated with impaired RV function despite normal systemic blood pressures. The level of RV dysfunction has a direct relationship with the severity of OSA. RV free wall thickness and IVA are independent predictors of AHI in uncomplicated OSA patients. Copyright (C) 2009 S. Karger AG, Base

Left Ventricular Pseudoaneurysm Complicating Inferior Myocardial Infarction: A Case Report

Acquired pseudoaneurysm of the left ventricle is a very rare disorder and mostly occurs after large transmural myocardial infarction (MI) with peak creatine phosphokinase-MB levels greater than 150 IU/mL. Patients developing left ventricular (LV) pseudoaneurysm usually present with angina or heart failure symptoms. Although different imaging modalities exist, coronary angiography is the gold standard for diagnosis. Surgery is the treatment of choice for LV pseudoaneurysms detected in the first months after MI. Here we report the case of a 74-year-old woman who presented with a relatively small inferior MI due to right coronary artery occlusion and complicated by LV pseudoaneurysm

Evaluation of Graft Patency After Coronary Artery Bypass Grafting by Using Stress Echocardiography Combined With Strain Imaging

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEYWOS: 000329858400113…Turkish Soc Cardio