Mean platelet volume and vitamin D level

Cure, Medine Cumhur/0000-0001-9253-6459; cure, erkan/0000-0001-7807-135XWOS: 000332681100003PubMed: 24624344Background: Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV. Methods: This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent microparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MIN was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were divided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of 20 ng/mL, respectively. Results: the vitamin D level in Group 1 (7.7 +/- 1.9 ng/mL) was lower than that in Group 2 (15.1 +/- 1.6 ng/mL, P<0.001) and Group 3 (25.6 +/- 6.3 ng/mL, P<0.001). the MPV in Group 3 (7.5 +/- 1.0 fL) was lower than that in Group 1 (8.1 +/- 1.1 fL, P<0.001) and Group 2 (7.9 +/- 1.0 fL, P=0.009). Linear regression analysis showed that low levels of vitamin D (beta = -0.109, P = 0.019) was independently associated with increased MPV. Conclusions: There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV

Topiramate has protective effect on renal injury

Cure, Medine Cumhur/0000-0001-9253-6459; cure, erkan/0000-0001-7807-135XWOS: 000351975100010PubMed: 25773955Background: Topiramate (TPM) decreases tumor necrosis factor-alpha (TNF-alpha) and oxidative stress. We investigated protective effects of TPM on cell damage in kidney tissue during ischemia-reperfusion (I/R) damage. Methods: A total of 30 male Wistar albino rats were divided into three groups: control, I/R, and I/R plus TPM (I/R+TPM). Laparotomy without I/R injury was performed in control group. After laparotomy, cross ligation of infrarenal abdominal aorta was applied for two hours in I/R groups which was followed by two hours of reperfusion. TPM (100 mg/kg/day) was orally administrated to animals in the I/R+TPM group for seven consecutive days before I/R. Results: the I/R group's TNF-a and interleukin-1 beta (IL-1(3) levels were significantly higher (1184.2 +/- 129.1 pg/mg protein; 413.1 +/- 28.8 pg/mg protein, respectively) than those of the control (907.8 +/- 113.0 pg/mg protein, p = 0.002; 374.7 +/- 23.7 pg/mg protein, p = 0.010, respectively) and I/R+TPM groups (999.5 +/- 115.2 pg/mg protein, p < 0.001; 377.9 +/- 30.9 pg/mg protein, p = 0.007, respectively). Conclusion: TPM may partially prevent renal damage in rats. the opening of new horizons of this kind of knowledge will help understand the complex challenge in the prevention of renal I/R damage (Tab. 1, Fig. 3, Ref. 42). Text in PDF www.elis.sk.RTEU Bilimsel Arastirmalar Proje birimi (BAP)Recep Tayyip Erdogan University [2012.106.01.8]The authors would like to thank Ayhan Kanat who improved the spelling errors in this article. Source of Support: RTEU Bilimsel Arastirmalar Proje birimi (BAP), Project number: 2012.106.01.8

Reappraisal of the transthoracic echocardiographic algorithm in predicting pulmonary hypertension redefined by updated pulmonary artery mean pressure threshold

BACKGROUND: Although an adopted echocardiography algorithm based on tricuspid regurgitation jet peak velocity and suggestive findings for pulmonary hypertension has been utilized in the non-invasive prediction of pulmonary hypertension probability, the reliability of this approach for the updated hemodynamic definition of pulmonary hypertension remains to be determined. In this study, for the first time, we aimed to evaluate the tricuspid regurgitation jet peak velocity and suggestive findings in predicting the probability of pulmonary hypertension as defined by mean pulmonary arterial pressure > 20 mm Hg and > 25 mm Hg, respectively. METHODS: Our study group was comprised of the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. All echocardiographic and right heart catheterization assessments were performed in accordance with the European Society of Cardiology/European Respiratory Society 2015 Pulmonary Hypertension Guidelines. RESULTS: Although tricuspid regurgitation jet peak velocity showed a significant relation with mean pulmonary arterial pressure in both definitions, suggestive findings offered a significant contribution only in predicting mean pulmonary arterial pressure ≥ 25 mm Hg but not for mean pulmonary arterial pressure > 20 mm Hg. In predicting the mean pulmonary arterial pressure > 20 mm Hg, tricuspid regurgitation jet peak velocity and suggestive findings showed an odds ratio of 2.57 (1.59-4.14, P 3.4 m/s were associated with 70% and 84% probability of mean pulmonary arterial pressure > 20 mm Hg and 60% and 76% probability of mean pulmonary arterial pressure ≥ 25 mm Hg, respectively. CONCLUSIONS: In contrast to those in predicting the mean pulmonary arterial pressure ≥ 25 mm Hg, suggestive findings did not provide a significant contribution to the probability of mean pulmonary arterial pressure > 20 mm Hg predicted by tricuspid regurgitation jet peak velocity solely. The impact of the novel mean pulmonary arterial pressure threshold on the echocardiographic prediction of pulmonary hypertension remains to be clarified by future studies

Maternal and fetal outcomes in pregnant women with pulmonary arterial hypertension: A single-center experience and review of current literature

BACKGROUND: Although pregnancy in women with pulmonary arterial hypertension has been considered a high-risk condition, current data regarding pregnancy with pulmonary arterial hypertension are scarce. In this study, we aimed to evaluate our single-center data on maternal and fetal outcomes in pregnant women with PAH and review currently available risk-based management strategies. METHODS: Our single-center study group comprised 35 women who became pregnant after the diagnosis of pulmonary arterial hypertension or in whom pulmonary arterial hypertension was diagnosed within early post-partum period. Clinical, laboratory, echocardiographic, and hemodynamic characteristics of pregnant and non-pregnant productive women with pulmonary arterial hypertension were compared, and similar comparison was also repeated for survivors and non-survivors in pregnant patient group. RESULTS: Pregnancy was noted in 15% of the 228 females with pulmonary arterial hypertension who were of hormonally productive ages, generally well-tolerated until delivery. Elective abortion and pre-term delivery were documented in 1 (2.8%) and 12 (35.3%) pregnant women, respectively. Switching to sildenafil was the standard medication during pregnancy. Cesarian section was the preferred method of delivery in all pregnant women with pulmonary arterial hypertension and was performed without any complication. Clinic deteoriation within the first week of delivery was observed in 5 (41.6%) patients. Maternal mortality was noted in 13 (37.1%) patients and was documented to cumulate within the first month of delivery. However, any sign predicting post-partum clinical deterioration was not found. No fetal mortality was observed. CONCLUSION: Despite the development of advanced therapies, pregnancy in pulmonary arterial hypertension still carries a high mortality risk and requires multi-disciplinary expert center care with more proactive management strategies

Association Between Atherogenic Index of Plasma and Atherogenic Coefficient and in-Stent Restenosis After Drug-eluting Stent Implantation for Stable Coronary Artery Disease

Introduction:Despite improvements in stent science, in-stent restenosis (ISR) remains a major problem. This study was designed to evaluate the atherogenic index of plasma (AIP) and atherogenic coefficient (AC) levels and their predictive values in patients who developed ISR after drug-eluting stent implantation for stable coronary artery disease.Methods:One hundred ninety-nine patients with ISR and 377 without ISR were included in the study. The biochemical and hematological parameters of the patients were measured. The AIP and AC values were calculated.Results:Patients with ISR had significantly longer stent length, lower stent diameter, lower ejection fraction, and higher SYNTAX score. They also had significantly higher levels of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), total cholesterol, AIP, and AC compared to that of patients who did not develop ISR. AIP had a sensitivity of 61.3% and specificity of 72.1% for predicting ISR a cut-off value of 0.58. AC had sensitivity and specificity of 69.8% and 58.8%, respectively, for the presence of ISR a cut-off value of 3.44. LDL-C level of 111.5 mg/dL had sensitivity and specificity of 65.3% and 54% for developing ISR, respectively. Paired comparisons of area difference under the receiver operating characteristic curve showed that AIP and AC had significantly greater area compared with that of LDL-C. Stent diameter, stent length, SYNTAX score, ejection fraction, AIP, and AC were the predictors of ISR.Conclusion:AIP and AC had higher specificities compared with that of LDL-C in predicting ISR. The calculation of AIP and AC is simple and could be used easily in clinical practice

A new index for the prediction of in-hospital mortality in patients with acute pulmonary embolism: The modified shock index

BACKGROUND: Pulmonary embolism severity index, its simplified version, and shock index have been used for risk stratification in acute pulmonary embolism. In this study, we proposed a modification in severity index and evaluated the correlates and prognostic value of modification in severity index in this setting. METHODS: The study group comprised retrospectively evaluated 181 patients with acute pulmonary embolism. Systematic workup including pulmonary embolism severity index, its simplified version, shock index, biomarkers, and echocardiographic and multidetector computed tomography assessments was performed in all patients. Moreover, we calculated modification in severity index by multiplying original shock index (heart rate/systolic blood pressure ratio) and a third component, 1/pulse oxymetric saturation (pSat O2%) ratio. The primary endpoint was defined as all-cause mortality and hemodynamic collapse during the hospital stay. RESULTS: On the basis of initial risk stratification, ultrasound-assisted thrombolysis, systemic tissue-type plasminogen activator, and unfractionated heparin therapies were utilized in 83 (45.9%), 37 (20.4%), and 61 (33.7%) patients, respectively. The primary end-point occurred in 13 (7.2%) patients. Receiver-operating curve analysis revealed that modification in severity index had the highest area under the curve of 0.739 (0.588-0.890, P =.002) compared with shock index, pulmonary embolism severity index, or its simplified version. The modification in severity index > 0.989 predicted primary endpoint with 73% sensitivity and 54% specificity. CONCLUSIONS: The modification in severity index seems to be a simple, quick, and compre-hensive risk assessment tool for bedside evaluation at initial stratification, in monitoring the clinical benefit from therapies, and decision-making for escalation to other reperfusion strategies in patients with acute pulmonary embolism. However, the prognostic value of modification in severity index needs to be validated with further studies

A novel composed index to evaluate the right ventricle free-wall adaptation against ventricular wall stress in acute pulmonary embolism

Background: Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. Methods: Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). Results: This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P = .001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. Conclusions: Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality

Kocaeli’de evlerde, ofislerde ve okullarda iç ortam hava kalitesinin belirlenmesi

TÜBİTAK ÇAYDAG01.01.2008Bu çalışmada, Kocaeli’de farklı bölgelerde ve farklı mikroçevrelerde (ev, okul, ofis), iç ve dış ortamda yapılan örneklemeler ile aktif ve pasif örnekleme ve ölçüm teknikleri kullanılarak 2 farklı partikül fraksiyonunda (PM2.5 ve PM10) 16 ağır metal (Al, As, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, S, Si, Ti, V ve Zn), uçucu organik bileşikler (UOB’ler), SO2, NO2 ve O3 konsantrasyonları belirlenmiştir. Ayrıca, iç ortamda ölçülen konsantrasyonlarla maruziyet arasındaki ilişkiyi kurabilmek için, kişisel örnekleyiciler kullanılarak kişisel maruziyet düzeyleri de belirlenmiştir. NO2 için İç Ortam/Dış Ortam konsantrasyon oranlarının evlerde her 2 mevsimde de okullar ve ofislere nazaran yüksek bulunması evlerin iç ortamlarında NO2 kirletici kaynaklarının ofis ve okullara oranla daha baskın olduğu göstermektedir. İç Ortam/Dış Ortam oranlarının 1’in çok altında bulunması O3 ve SO2’in dış ortam kaynaklı bir kirletici olduğunu ve iç ortamlarda önemli bir kaynağının bulunmadığını göstermektedir. PM2.5 fraksiyonundaki toprak kaynaklı elementlerin iç ve dış ortam konsantrasyonlarının yüksek düzeylerde bulunması bu elementlerin iç ortamlara taşınımının yüksek olduğunu göstermektedir. PM2.5 kişisel maruziyet düzeylerinin As, S, V, Cu ve Cr gibi yanma kaynaklı elementler için iç ortam maruziyet düzeylerinden 2–6 kat daha yüksek olması ve bazı mevsimsel farklılıklar bulunmasına rağmen İç Ortam/Dış Ortam oranlarının genellikle 0.3–0.7 aralığında bulunması gözlenen yüksek kişisel maruziyet düzeylerinde dış ortamların etkisini göstermektedir. PM10 partikül fraksiyonunda belirlenen ağır metallerin büyük bir bölümü için İç Ortam/Dış Ortam oranlarının 1’den küçük bulunması dış ortam kirletici kaynaklarının iç ortam kirletici kaynaklarına daha baskın olduğunu göstermektedir. En yüksek UOB kirlilik düzeylerine örneklenen kişilerde rastlanırken bunu iç ortam ve dış ortam UOB kirlilik düzeyleri takip etmiştir. Her 2 mevsimde de toluen ev, ofis ve okullardaki UOB kirlilik düzeylerine en çok katkıda bulunan bileşik olurken onu etilbenzen, m,p-ksilen, stiren, nonan, hegzan, benzen, o-ksilen ve heptan bileşikleri takip etmektedir. Kentsel alanlarda elde edilen toplam UOB konsantrasyonlarının endüstriyel alanlarda elde edilen değerlerle uyum içinde bulunmuştur. Trafiğin belirteci olan bileşikler (BTEX, 1,2,4-trimetilbenzen) kentsel alanlarda yüksek bulunurken petrokimyanın belirteci olan hexane ve heptane bileşikleri endüstrinin yoğun olduğu alanlarda yüksek bulunmuştur. Ayrıca kentsel ve endüstriyel alanlarda elde edilen UOB konsantrasyonlarının sanayii ve trafikten uzak alanlarda elde edilen konsantrasyonlardan yüksek olması trafik ve sanayiinin tesbit edilen UOBlere olan katkısının ne kadar yüksek olduğunu göstermektedir. İç ortam, dış ortam ve kişisel maruziyet kirlilik düzeylerine etki ederek hava kalitesine olumsuz yönde katkıda bulunan kirletici kaynakların belirlenmesi amacıyla Pozitif Matris Faktörizasyonu (PMF) reseptör modelleme tekniği kullanılmıştır. PMF modellemesi, korelasyon analizi, iç ortam/dış ortam oranları, mikroçevre karakteristikleri, anketler ve zaman aktivite çizelgeleri incelenen kirleticilerin en önemli emisyon kaynaklarının endüstri, trafik ve sigara kullanımı olduğunu göstermektedir. İç ortam, dış ortam ve kişisel maruziyet düzeylerinin dünyanın diğer bölgelerinde yapılan çalışmalarda raporlanan düzeyler ile kıyaslanabilir olduğu bulunmuştur. Kişisel maruziyet konsantrasyonları kullanılarak çalışmada incelenen inorganik ve organik kirleticilerden kaynaklanan sağlık riski değerlendirmesi yapılmıştır. Ev, ofis ve okullarda örneklenen kişiler için hesaplanan “Toplam Kanser Riski” ve “Toplam Tehlike İndeksi” değerleri hem ortalama konsantrasyonlar hem de en kötü senaryo göz önüne alınarak incelendiğinde en yüksek risk altında bulunan kişilerin ev hanımları olduğu bunları öğretmenler ve ofis çalışanlarının takip ettiği söylenebilir. Değerlendirme kentsel, endüstriyel, endüstri ve trafikten uzak alanlar için yapıldığında her 3 alanda da yaşayan kişilerin birbirine yakın ve yüksek kanser riski taşıdıkları söylenebilir. Aynı değerlendirme sigara kullanan ve kullanmayan kişiler için yapıldığında sigara kullanan kişilerin kullanmayanlara nazaran yaklaşık %50 daha fazla kanser riski taşıdıkları gözlenmiştir.In this study, indoor and outdoor environment samples were taken from different regions and microenvironments (home, school, office) in Kocaeli. Through active and passive sampling and measurement techniques, 16 heavy metals (Al, As, Ca, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb, S, Si, Ti, V and Zn) at 2 different particle fractions (PM2.5 and PM10), volatile organic compounds (VOCs), and SO2, NO2 and O3 concentrations were determined. Moreover, in an effort to establish the relationship between exposure and the indoor concentrations measured, personal samplers were used to determine personal exposure levels. Indoor/outdoor concentration ratios for NO2 were higher in homes than in schools or offices in both summer and winter, which shows that sources of NO2 pollutants in indoor environments of homes are more dominant than those found in offices or schools. The indoor/outdoor ratios were far below 1, indicating that O3 and SO2 are pollutants originating from outdoor environments and that they do not have significant sources in indoor environments. The presence of high levels of indoor and outdoor concentrations of crustal elements at PM2.5 fractions indicates that these elements are transported into indoor environments at high levels. PM2.5 personal exposure levels were 2–6 times higher than indoor levels for combustion-related elements such as As, S, V, Cu and Cr, and although there were some seasonal differences, the indoor/outdoor environment ratios generally ranged between 0.3–0.7 and indicated the effect of outdoor environments on the observed high personal exposure levels. The indoor/outdoor ratios for a major portion of the determined heavy metals at PM10 particle fractions were smaller than 1, showing that outdoor pollutants are more dominant than indoor pollutants. The highest VOC pollution levels were encountered in individuals in the sample, and this was followed by VOC pollution levels in indoor and outdoor environments. In both seasons, toluene levels were the highest pollutants for homes, offices and schools, followed by ethylbenzene, m/p-xylene, styrene, nonane, hexane, benzene, o-xylene and heptane. Total VOC concentrations obtained from urban areas were consistent with values obtained from industrial areas. Components that are indicators of traffic (BTEX, 1,2,4-trimethylbenzene) were measured at high levels in urban areas, while hexane and heptane components, which are indicators of petrochemistry, were recorded at high levels in high- industry areas. Moreover, VOC concentrations obtained from urban and industrial areas were higher than concentrations found in areas far from industry and traffic, which demonstrates the high contribution of traffic and industry to measured VOCs. This study investigated the summer and winter concentrations of selected pollutants and the relationship between indoor and outdoor environments. In order to determine pollutant sources that negatively contribute to air quality by affecting the degree of indoor, outdoor and personal exposures, the Positive Matrix Factorization (PMF) receptor modeling technique was used, which is a multivariate statistical analysis method. PMF, correlation analyses, indoor/outdoor ratios, microenvironment characteristics, responses to questionnaires, and time activity information suggested that industry, traffic and smoking represent the main emission sources of pollutants investigated. Indoor, outdoor and personal exposure concentration values were compared to values measured in different parts of the world, thereby evaluating consistency with the observed pollution level. Based on personal exposure concentrations, an assessment was conducted concerning the health risks associated with the inorganic and organic pollutants investigated in this study. When the calculated values for “Total Health Risk” and “Total Hazard Index” for people sampled in homes, offices and schools were examined by considering both the average concentrations and the worst scenarios, it was revealed that housewives are at the highest risk, followed by teachers and office workers. An examination of urban, industrial and far from urban, industrial and traffic areas revealed that people living in all of these three areas are subjected to high cancer risks, which are at similar levels. When the same evaluation was carried out for smokers and non-smokers, it was observed that smokers have a 50% higher risk of cancer compared to non-smokers

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Search for heavy resonances decaying to two Higgs bosons in final states containing four b quarks

A search is presented for narrow heavy resonances X decaying into pairs of Higgs bosons (H) in proton-proton collisions collected by the CMS experiment at the LHC at root s = 8 TeV. The data correspond to an integrated luminosity of 19.7 fb(-1). The search considers HH resonances with masses between 1 and 3 TeV, having final states of two b quark pairs. Each Higgs boson is produced with large momentum, and the hadronization products of the pair of b quarks can usually be reconstructed as single large jets. The background from multijet and t (t) over bar events is significantly reduced by applying requirements related to the flavor of the jet, its mass, and its substructure. The signal would be identified as a peak on top of the dijet invariant mass spectrum of the remaining background events. No evidence is observed for such a signal. Upper limits obtained at 95 confidence level for the product of the production cross section and branching fraction sigma(gg -> X) B(X -> HH -> b (b) over barb (b) over bar) range from 10 to 1.5 fb for the mass of X from 1.15 to 2.0 TeV, significantly extending previous searches. For a warped extra dimension theory with amass scale Lambda(R) = 1 TeV, the data exclude radion scalar masses between 1.15 and 1.55 TeV