Coronary artery disease mimicking Tako-tsubo cardiomyopathy: a case report

Tako-tsubo cardiomyopathy is a syndrome mostly observed in post-menopausal women, which mimics myocardial infarction with an ST elevation; and coronary angiography shows apical ballooning but a normal left anterior descending. Although coronary artery disease is considered as an exclusion criterion, for differential diagnosis of this type of cardiomyopathy, Tako-tsubo cardiomyopathy cases accompanied by coronary artery disease were also reported. In this report, we are presenting a patient who exhibits different findings than a classical Tako-tsubo cardiomyopathy case because of her young age, coexisting atherosclerotic lesion, smaller diameter of the apical systolic ballooning and absence of an increase in cardiac enzymes

Application of a Neural Network Model for Prediction of Wear Properties of Ultrahigh Molecular Weight Polyethylene Composites

In the current study, the effect of applied load, sliding speed, and type and weight percentages of reinforcements on the wear properties of ultrahigh molecular weight polyethylene (UHMWPE) was theoretically studied. The extensive experimental results were taken from literature and modeled with artificial neural network (ANN). The feed forward (FF) back-propagation (BP) neural network (NN) was used to predict the dry sliding wear behavior of UHMWPE composites. Eleven input vectors were used in the construction of the proposed NN. The carbon nanotube (CNT), carbon fiber (CF), graphene oxide (GO), and wollastonite additives are the main input parameters and the volume loss is the output parameter for the developed NN. It was observed that the sliding speed and applied load have a stronger effect on the volume loss of UHMWPE composites in comparison to other input parameters. The proper condition for achieving the desired wear behaviors of UHMWPE by tailoring the weight percentage and reinforcement particle size and composition was presented. The proposed NN model and the derived explicit form of mathematical formulation show good agreement with test results and can be used to predict the volume loss of UHMWPE composites

The ıncidence of residual neuromuscular blockade associated with single dose of ıntermediate-acting non-depolarizing neuromuscular blocking

Bu çalısmanın amacı saglıklı, eriskin hastalarda endotrakeal entübasyon için uygulanan tek doz orta etki süreli kas gevseticilerine (atrakuryum, vekuronyum ve rokuronyum) baglı erken postoperatif rezidüel nöromusküler blok (PRNB) insidansını ve buna etki eden sonra faktörleri arastırmaktır. Çalısma prospektif, gözlemsel olarak, anestezi sırasında sadece endotrakeal entübasyonu kolaylastırmak için tek doz vekuronyum, atrakuryum veya rokuronyum kullanılan ve ameliyat bittikten sonra derlenme odasına alınan hastalarda yapıldı. Derlenme odasında akselomiyograf ile nöromusküler ileti monitorize edildi ve dörtlü uyarıya yanıt (TOF) oranı ölçüldü; 0,9'un altındaki degerler “PRNB var” olarak kaydedildi. Hastalara kullanılan anestezikler ve kas gevseticisinin seçimi, antidot (neostigmin) kullanımı, ekstübasyon ve derlenme odasına alınma kararları hastayı takip eden anestezi doktoruna bırakıldı. Yas, kilo, cinsiyet, antidot kullanımı, anestezi süresi, ekstübasyondan sonra derlenme odasına alınma süreleri PRNB için risk faktörü olarak alındı, stepwise lojistik regresyon analizi yapıldı. Çalısmaya 84 hasta alındı, vekuronyum, atrakuryum, rokuronyum kullanılan hasta sayısı sırasıyla 29, 28, 27 oldu. Hastaların % 58,3'ne neostigmin yapıldı. Medyan anestezi süresi 80 dakikaydı. Derlenme odasında PRNB insidansı (TOF<0,90) % 13,1 bulundu. Regresyon analizinde cinsiyetin PRNB'u etkiledigi; kadın cinsiyetin, PRNB riskini artırdıgı bulundu (OR: 7,250, %95 CI:1,019-51,593). Diger risk faktörlerinin PRNB'a anlamlı etkisi saptanmadı. Klinik olarak ameliyat nedeni dısında ek risk faktörü tasımayan ve anestezi süresi bir saatten uzun olan hastalarda, “cinsiyet” tek doz orta etkili kas gevseticilerine baglıPRNBinsidansını etkileyebilirThe aim of this study is to investigate the incidence of postoperative residual neuromuscular blockade (PRNB) associated with single-dose intermediate-acting muscle relaxants (atracurium, vecuronium, rocuronium) administered to adult patients for endotracheal intubation during early postoperative period and subsequent factors affecting. This prospective and observational study was conducted after obtaining the permission of the local ethics committee. Adult patients who received a single dose of vecuronium, atracurium or rocuronium during general anesthesia for elective surgical procedure were included in the study. The decisions about the anesthetics and muscle relaxants used on the patients, reversal with neostigmine, extubation and transfer to the recovery room were left to be made by the anesthesiologist following the patient. The patient who was taken into the recovery room had neuromuscular monitoring using accelomyography. Train-of-four (TOF) ratios under 0.9 were recorded as “PRNB present”. Age, weight, gender, reversal, anesthesia duration, time for transfer to the recovery room after extubation were considered risk factors for PRNB, stepwise logistic regression analysis was conducted. This study included 84 patients were given vecuronium (n=29), atracurium (n=28) and rocuronium (27). Reversal was performed with neostigmine in 58.3% of the patients at the end of the operation. The median length of anesthesia was 80 minutes. PRNB incidence (TOF<0.90) in the recovery room was determined to be 13.1%. Based on the regression analysis, PRNB risk was determined to increase in a gender dependent manner in female gender (OR: 7.250, 95%, CI:1.019-51.593). The remaining factors did not have any significant effect on PRNB. In patients who do not have other risk factors in addition to the operation reason and whose anesthesia duration is longer than one hour, “gender” may affect PRNB incidence associated with single-dose intermediate-acting muscle relaxants

The Theoretical Overview of the Selected Optimization and Prediction Models Useful in the Design of Aluminum Alloys and Aluminum Matrix Composites

The growing attention regarding aluminum alloy matrix composites within the aerospace, automotive, defense, and transportation industries make the development of new engineering materials with the improved mechanical properties. Currently, materials are selected because of their abilities to satisfy engineering demands high for strength-to-weight ratio, tensile strength, corrosion resistance, and workability. These properties make aluminum alloys and aluminum matrix composites (AMCs) an excellent option for various industrial applications. Soft computing methods such as the artificial neural network (ANN), adaptive-neuro fuzzy inference systems (ANFIS), and Taguchi with ANOVA are the most important approaches to solve the details of the mechanism and structure of materials. The optimal selection of variables has important effects on the final properties of the alloys and composites. The chapter presents original research papers from our works and taken from literature studies dealing with the theory of ANN, ANFIS, and Taguchi, and their applications in engineering design and manufacturing of aluminum alloys and AMCs. Also, the chapter identifies the strengths and limitations of the techniques. The ANFIS and ANN approaches stand out with wide properties, optimization, and prediction, and to solving the complex problems while the Taguchi experimental design technique provides the optimum results with fewer experiments

Automatic ventilator (surevent™) use for the transport of the patients who had undergone open heart surgery

Bu çalısmanın amacı açık kalp cerrahisi uygulanan hastaların yogun bakıma transportu sırasında balonvalv cihazıyla (Ambu® resüsitatör Mark III) yapılan manuel ventilasyon ile Surevent™ otomatik ventilatörle yapılan mekanik ventilasyona baglı hemodinamik ve kan gazı degisiklikleri karsılastırmaktır.Açık kalp cerrahisinden sonra entübe olarak yogun bakıma transfer edilecek 50 hasta çalısmaya alındı. Hastalar randomize edilerek transportta kullanılacak ventilasyon yöntemine göre manuel ventilasyon (Ambu® resüsitatör Mark III; Grup BV, n= 25) veya mekanik ventilasyon (Surevent™ otomatik ventilatör; Grup SV, n= 25) gruplarından birine dahil edildi. Hastalardan, yogun bakıma transporttan önce (T0), yogun bakıma transporttan hemen sonra (T1) ve yogun bakıma transporttan 20 dakikada sonra (T2) olmak üzere üç kez kan gazı ve hemodinamik verileri kaydedildi.Iki grubun da transport süresinin medyan degeri 5 dakikaydı. Gruplar arasında PaO2' de, transporttan önce fark saptanmazken, yogun bakıma transporttan sonra Grup SV'de Grup BV' den belirgin olarak yüksek bulundu (p= 0,002). Yogun bakıma transporttan sonra 20. dakikada bakılan PaO2 degerlerinde fark saptanmadı. Diger kan gazı verilerinde ve hemodinamik parametrelerde gruplar arasında önemli fark saptanmadı.Surevent™ otomatik ventilatör, açık kalp cerrahisi uygulanan hastaların transportunda kısa süreli olarak kullanılabilecegi ve manuel ventilasyonla karsılastırıldıgında aralarında anlamlı bir fark olmadıgı görüldü.To investigate whether Surevent™automatic ventilator could be safely used or not for the transport of the patients who had undergone open heart surgery to intensive care unit (ICU) and to compare this equipment with manual ventilator(Ambu® Resusitator Mark III). The study included 50 patients greater than 18 years old, that would be transported intubated to ICU after open heart surgery. The patients were randomized to two groups according to the ventilation method that would be used during the transport as, the patients that would be transported with manuel ventilation (Group BV, n= 25) or Surevent™automatic ventilator (Group SV, n= 25). Arterial blood gas testing was performed three times for each patient before the transport to the ICU (T0), after the transport to the ICU (T1), at 20 minutes after the transport to the ICU (T2). Hemodynamic variables were recorded at the same time periods. While there were no significant differences between the two groups according to PaO2 values measured during the preoperative and before the transport, the PaO2 values of group SVwas significantly greater than group BV postoperatively after the transport to the ICU (p= 0.002). PaO2 values at 20 minutes after the transport to the ICU were not different between the two groups. There were no significant differences between the two groups in the hemodynamics variables. Surevent™automatic ventilator can be used for a short period for the transport of the patients after open heart surgery and we observed no significant difference when compared with manual ventilatio

The impact of admission red cell distribution width on long-term cardiovascular events after primary percutaneous intervention: A four-year prospective study

Background: Red cell distribution width (RDW) is an indicator of erythrocyte in different size, and its prognostic value has been demonstrated in numerous cardiac and non-cardiac diseases. The purpose of this study was to evaluate the predictive value of RDW on the long- -term cardiovascular events in patients undergoing primary percutaneous coronary intervention (PCI). Methods: Ninety-six consecutive patients (mean age 60.6 ± 12.5 years, 77.1% male) with ST-segment elevation myocardial infarction (STEMI), who were treated with primary PCI, were analyzed prospectively. Baseline RDW and high sensitive C-reactive protein (hs-CRP) were measured. The patients were followed up for major adverse cardiac events (MACE) for up to 48 months after discharge. Results: There were 30 patients with long-term MACE (Group 1) and 66 patients without long-term MACE (Group 2). Age, admission RDW, hs-CRP and creatine kinase-MB levels, heart rate after PCI, previously used angiotensin converting enzyme inhibitor, left anterior descending artery lesion, and electrocardiographic no-reflow were higher in Group 1. Admission hemoglobin levels were lower in Group 1. An RDW level ≥ 13.85% measured on admission had 80% sensitivity and 64% specificity in predicting long-term MACE on receiver-operating characteristic curve analysis. In multivariate analyses, only admission RDW (HR 5.26, &lt; 95% CI 1.71–16.10; p = 0.004) was an independent predictor of long-term MACE. Conclusions: A high baseline RDW value in patients with STEMI undergoing primary PCI is independently associated with increased risk for long term MACE

Is routine echocardiography necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia?

Background: The aim of this study was to investigate whether pericardial effusion (PE) detected by transthoracic echocardiography (TTE) was clinically significant and whether routine echocardiography was necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). Methods: A total of 202 patients with AVNRT were included in the study from three centers. The patients received basic electrophysiology-guided therapy, followed by radiofrequency ablation (RFA). All patients underwent TTE before and after RFA therapy. Results: The mean age of the study population was 46.2 &#177; 17.9 and 30.7% of the patients were male. Of these patients, six (3%) had postoperative PE, as detected by TTE. However, none of them had cardiac tamponade (CT). Four patients had minimal PE, while two had mild PE. Repeated TTE at one to three months showed resolved PE. No significant difference was seen among the patients with and/or without PE in terms of age, gender, the number of RFA applications, or RFA duration; however, significantly prolonged duration of fluoroscopy exposure was observed in the patients with PE. Conclusions: PE was detected in 3% of the patients by TTE and associated with prolonged duration of fluoroscopy exposure. However, no patients with moderate or large PE or cardiac tamponade were found in the study. In conclusion, we suggest that TTE should only be performed in the presence of clinical indications following ablation of AVNRT

Increased mean platelet volume associated with extent of slow coronary flow

Background: Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices. Methods: In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF. Results: Among the 147 patients (mean age 52.7 &#177; 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 &#177; 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15&#8211;10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99&#8211;12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43&#8211;8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22&#8211;2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43&#8211;4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05&#8211;4.33, p = 0.03) was identified as an independent correlate of extent of SCF. Conclusions: Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 &#177; 8.2 vs 11.4 &#177; &#177; 7.9 and 15.2 &#177; 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 &#177; 3.7 vs 11.1 &#177; 7.2 and 14.1 &#177; 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1&#8211;19, p = 0.014) and CAVI (95% CI 15&#8211;29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. Conclusions: We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research