Performance of neutrophil to lymphocyte ratio for the prediction of long-term morbidity and mortality in coronary slow flow phenomenon patients presented with non-ST segment elevation acute coronary syndrome

Introduction: In this study, we aimed to determine if neutrophil to lymphocyte ratio could predict long term morbidity and mortality in patients who hospitalized for non-ST segment elevation acute coronary syndrome (NSTE-ACS) and had coronary slow flow on coronary angiography. Methods: In this observational study, 111 patients who presented with NSTE-ACS and diagnosed with coronary slow flow phenomenon on angiographic examination were included. Neutrophil to lymphocyte ratio (NLR) calculated as the ratio of the number of neutrophils to the number of lymphocytes. Patients classified into three groups according to NLR values. The term coronary slow flow phenomenon was depicted by calculating Thrombolysis in Myocardial Infarction frame count.Patients were followed up and the occurrence of recurrent angina, recurrent myocardial infarction, and long-term mortality was determined using medical records, phone calls, or face-to-face interviews. P values <0.05 considered to indicate statistical significance. Results: Recurrent angina and myocardial infarction occurred more frequently in the highest NLR tertile compared with middle and lowest NLR tertiles. High NLR group (NLR≥ 3.88 n=38) was significantly associated with younger age and smoking status. WBC, troponin I and CRP levels increased as the NLR tertile increased. Recurrent myocardial infarction and angina showed strong relationship with increasing NLR values. In multivariate regression analyses smoking and high NLR levels were independent predictors of recurrent myocardial infarction (HR:4.64 95%CI 0.95-22.52 P=0.04, HR: 1.48 95%CI 1.16-1.90 P<0.01 respectively) in the long term follow up. Conclusion: Our study demonstrated that high NLR values can be a valuable prognostic tool in the long term follow up of patients who presented with NSTE-ACS and diagnosed with slow flow phenomenon on coronary angiography

Life Cycle Assessment and Cumulative Energy Demand Analyses of a Photovoltaic/Thermal System with MWCNT/Water and GNP/Water Nanofluids

The global climate crisis has led society toward cleaner energy sources. Another reason is the limited reserves of fossil energy resources. Efforts to increase the efficiency of photovoltaic modules (PVs) have gained momentum. The high temperature is the biggest factor causing a decrease in the efficiency of PVs. In this study, a commercial PV was cooled with distilled water, a multiwalled carbon nanotubes (MWCNT)/water mixture, and a graphene nanoplatelets (GNP)/water mixture. The environmental impact of electricity, total energetic efficiency, energy payback time, energy return on investment, and embodied energy of the PV/thermal (PV/T) system were compared using life cycle assessment and cumulative energy demand. The electrical efficiency of the PV/T changed between 13.5% and 14.4%. The total efficiency of PV/T changed between 39.5% and 45.7%. The energy returns on investment were 1.76, 1.80, and 1.85 for PV/T-distilled water, the PV/T-MWCNT/water mixture, and the PV/T-GNP/water mixture, respectively. Moreover, the embodied energy evaluation values were 3975.88 MJ for PV/T-distilled water, 4081.06 MJ for the PV/T-MWCNT/water mixture, and 4077.86 MJ for the PV/T-GNP/water mixture. The main objective of this research was to study the energy and environmental performances of PVs cooled with different nanofluids and draw general conclusions about the applicability of these systems

Paralytic strabismus in turkish children examined at three tertiary care services: A retrospective cohort study

Purpose: To assess the etiology and distribution of pediatric ocular motor nerve palsy manifesting as paralytic strabismus. Methods: The authors retrospectively examined the medical files of patients younger than 18 years who were suspected to have strabismus between January 1999 and June 2012 in three Turkish clinics and followed up for at least 6 months. Patients with paralytic strabismus were stratified according to age, sex, affected cranial nerve, and etiology (congenital, traumatic, neoplastic, post-viral, vascular, undetermined, or other), and compared the proportions between groups. Results: Paralytic strabismus was observed in 33 of 1,263 patients (2.6%), with a mean age of 5.9 ± 4.4 years (range: 6 months to 16 years). Seventeen patients (51.5%) were boys and 16 (48.5%) were girls. Twelve patients (36.4%) had congenital paralytic strabismus, and 21 patients (63.6%) had acquired strabismus. The most prevalent cause of acquired paralytic strabismus was trauma in 11 patients (52.4%), undetermined in 6 patients (28.6%), post-viral cranial nerve paralysis in 3 patients (14.3%), and a history of hydrocephalus in 1 patient (9.1%). The fourth cranial nerve was the most frequently affected (45.5% [15 of 33]), followed by the sixth (39.4% [13 of 33]) and the third (15.2% [5 of 33]). Conclusions: Evaluating the incidence and etiology of paralytic strabismus in children in a clinical setting may improve disease management and reduce unnecessary invasive examinations. This study will assist clinicians in understanding the clinic-based distribution of pediatric paralytic strabismus. Copyright © SLACK Incorporated

Experimental Investigation of a Concentrating Bifacial Photovoltaic/Thermal Heat Pump System with a Triangular Trough

The heat absorbed by the heat transfer fluid for cooling a concentrated photovoltaic thermal (CPVT) solar collector can be used for purposes such as residential heating and cooking. Because of the combined production of heat and power, these systems are proposed for individual or commercial use in rural areas. In this study, a hybrid system was proposed to increase the electrical efficiency of the system. Experiments were conducted in winter conditions. Two operational modes were compared, namely a CPVT system with HP (HP-CPVT) and without HP (CPVT). The evaporator of the heat pump was settled inside the triangular trough receiver. The effects of cooling the PV system with a heat pump in the bifacial CPVT system on the electrical and thermal energy efficiencies were investigated. The electricity and thermal energy efficiencies of the CPVT system were calculated as 12.54% and 38.37% in the HP-CPVT system, respectively, and 10.05% and 81.97% in the CPVT system, respectively. The electrical exergy efficiencies of the CPVT system with and without HP were 14.65% and 10.73%, respectively. The thermal exergy efficiencies of the CPVT system with and without HP were 82.47% and 85.63%, respectively. The thermal heat obtained from the HP-CPVT system can be used for heating needs. Thus, the bifacial HP-CPVT system was an example of the micro-CHP system

Performance Assessment of a Novel Solar and Biomass-Based Multi-Generation System Equipped with Nanofluid-Based Compound Parabolic Collectors

The current paper proposes a novel multi-generation system, integrated with compound parabolic collectors and a biomass combustor. In addition to analyzing the comprehensive system in a steady state, the feasibility of using nanofluids as heat transfer fluids in the solar cycle and their effect on the overall performance of the system was studied. The multi-generation system is generally designed for generating electricity, cooling, freshwater, drying, hot water, and hydrogen, with the help of six subsystems. These include a double stage refrigeration system, an organic Rankine cycle, a steam Rankine cycle, a dryer, a proton exchange membrane electrolyzer, and a multistage flash distillation system. Two types of nanoparticles (graphene, silver), which have various high-quality properties when used within ethylene glycol, were chosen as absorbing fluids in the solar cycle. The performance parameters of the base case thermodynamic analysis and some of the variable parameters were calculated, and their effect on system performance was determined. According to the results, a spike in solar irradiation, ambient temperature, output temperature of biomass combustor and nanofluids’ concentration positively affected the overall system performance. The results also clearly showed an improvement in system performance when using nanofluids as working fluids in solar collectors

Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism

While derangements in glucose metabolism in patients with primary hyperparathyroidism are well-defined, this issue is not investigated in patients with normocalcemic primary hyperparathyroidism (NPHPT). The aim of this study was to investigate the presence of insulin resistance in patients with NPHPT. Eighteen patients with NPHPT (two males and 16 females) and 18 healthy volunteers were enrolled into the study. Secondary causes of parathyroid hormone elevations were excluded in all patients. Blood samples were obtained for the measurement of serum calcium, phosphate, alkaline phosphatase (ALP), albumin, creatinine, glucose, and serum lipid levels. Glucose and insulin responses to oral glucose tolerance test (OGTT) were obtained. Homeostasis model assessment (HOMA-IR) was also used as an indice of insulin resistance. Patients and control subjects had similar age, body mass index, and sex distribution. Although within normal limits, serum calcium and ALP levels were higher in patients than in the control subjects. None of the patients and the control subjects had diabetes mellitus, while eight patients and six control subjects had impaired glucose tolerance. Insulin responses to OGTT and HOMA-IR were not significantly different among the patient and control subjects. In addition, both groups have similar serum lipid levels. Patients with NPHPT do not exhibit insulin resistance and glucose intolerance. Since so little is known about this form of disease, subjects should be monitored regularly for the metabolic aspects of the disease as well as the progression of their disease

Comparison of Electrochemiluminescence and Enzyme Immunoassay Methods for the Measurement of Salivary Cortisol

Purpose: The aim of the study was to compare electrochemiluminescence (ECL) and enzyme immunoassay (EI) methods for the measurement of salivary cortisol (SC). Material and Method: SC levels in 20 healthy subjects were measured by two different methods (EI and ECL). Results: The results obtained from EI and ECL methods were found to be significantly correlated. Discussion: Measuring SC by ECL method is faster and easier than EI in routine practice. Therefore, SC measured by ECL rather than EI may be used as a marker of hypothalamic-pituitary-adrenal (HPA) axis function