Explaining the decline in coronary heart disease mortality in Turkey between 1995 and 2008.

BACKGROUND: Coronary heart disease (CHD) mortality rates have been decreasing in Turkey since the early 1990s. Our study aimed to determine how much of the CHD mortality decrease in Turkey between 1995 and 2008 could be attributed to temporal trends in major risk factors and how much to advances in medical and surgical treatments. METHODS: The validated IMPACT CHD mortality model was used to combine and analyse data on uptake and effectiveness of CHD treatments and risk factor trends in Turkey in adults aged 35-84 years between 1995 and 2008.Data sources were identified, searched and appraised on population, mortality and major CHD risk factors for adults those aged 35-84 years. Official statistics, electronic databases, national registers, surveys and published trials were screened from 1995 onwards. RESULTS: Between 1995 and 2008, coronary heart disease mortality rates in Turkey decreased by 34% in men and 28% in women 35 years and over. This resulted in 35,720 fewer deaths in 2008.Approximately 47% of this mortality decrease was attributed to treatments in individuals (including approximately 16% to secondary prevention, 3% angina treatments, 9% to heart failure treatments, 5% to initial treatments of acute myocardial infarction, and 5% to hypertension treatments) and approximately 42% was attributable to population risk factor reductions (notably blood pressure 29%; smoking 27%; and cholesterol 1%). Adverse trends were seen for obesity and diabetes (potentially increasing mortality by approximately 11% and 14% respectively). The model explained almost 90% of the mortality fall. CONCLUSION: Reduction in major cardiovascular risk factors explained approximately 42% and improvements in medical and surgical treatments explained some 47% of the CHD mortality fall. These findings emphasize the complimentary value of primary prevention and evidence-based medical treatments in controlling coronary heart disease

Ligamentum Meniscofemorale Anterius ve Ligamentum Meniscofemorale Posterius’un varyasyonları, Meniscus Lateralis ve Femur’a tutunma yerlerinin morfometresi

ÖZETLigamentum meniscofemorale’ler (MFL) hem fonksiyonel hem de klinik açıdan önemli yapılardır. Anatomisi iyi tanımlanmış olsa da, boyutları değişkenlik göstermektedir. Bu çalışmada MFL’lerin boyutları, krus yapısı ve tutunma yerlerinin özellikleri, ligamentum cruciatum posterius (PCL) ve PCL’nin oblik lifleri ile ilişkisinin tanımlanması hedeflenmiştir. Yaşı ve ölüm nedeni kayıtlı, artrozu ve ligament hasarı olmayan taze 22 dondurulmuş kadavranın 40 dizi incelendi. Değerlendirilen 40 dizin 37’sinde (%92,5) en az bir MFL, ligamentum meniscofemorale anterius (aMFL) 20’sinde (%50) , ligamentum meniscofemorale posterius (pMFL) , 24’ünde (%60) tespit edildi. Dizlerin 7 (%17,5) tanesinde her iki ligamentin birarada olduğu gözlendi, 11 (%27,5) dizde PCL’nin oblik liflerine rastlandı. pMFL’nin ortalama uzunluğu 23,82±1,51mm ve aMFL’nin uzunluğu 21,55±0,97mm bulundu. pMFL’nin ortalama eni 3,43±0,57mm ve aMFL’nin eni 4,09±0,77mm ölçüldü. pMFL’nin ortalama krus uzunluğu, eni ve PCL ile arasındaki mesafe sırayla 11,3±1,8mm, 3,39±0,92mm, 4,19±1,59mm olarak tespit edildi. aMFL’nin krus uzunluğu ve eni sırayla 6,19±1,23mm ve 4,8±0,96mm bulundu. Bacak uzunluğu ile ligament uzunluğu karşılaştırıldığında doğru orantılı olarak artığı tespit edildi. aMFL uzunluğu ile aMFL krusunun uzunluğu arasında ters bir orantı olduğu gözlendi. Bunların dışında ligamentlerin boyutları ile ligamentlerin kruslarının boyutları arasında anlamlı bir bağlantı bulunamadı. Her iki ligamentin menisküs üzerine tek veya çift krus ile ayrı ayrı ve arada bir ayırıcı doku ile tutunduğu gözlendi.Meniscus lateralis için önemli bir fonksiyona sahip olan MFL’lerin anatomisinin iyi tanımlanması, patolojilerin doğru teşhis ve tedavisinde veya bölgenin cerrahisi açısından önemlidir. Anahtar Kelimeler: meniscofemoral ligament, menisküs, meniscus lateralis, ligament, lateral menisküs,SUMMARYTHE VARIATION and MORFOMETRIES of ANTERIOR and POSTERIOR MENISCOFEMORAL LIGAMENTSMeniscofemoral ligaments (MFL) have clinical and functional importance. Although, these ligaments are well defined, there is variance in their dimensions.The objectives of this study are to determine the dimensions of MFLs, to define the properties of the crura and their attachments, and to analyze the relations of ligamentum cruciatum posterior (PCL) and oblique bundles of the PCL. 40 knees of 22 frozen cadavers who had no ligament injury and no arthrosis were analyzed. The ages and the reasons of deaths of the cadavers were known. In 37 knees (%92,5) at least one MFL, in 20 knees (50%) anterior meniscofemoral ligament (aMFL), in 24 knees (60%) posterior meniscofemoral ligament (pMFL) were observed. Both ligaments were present in 7 specimens (%17,5). The oblique fibers of PCL was present in 11 knees (%27,5). The average length of the pMFL was 23,82±1,51mm and the aMFL was 21,55±0,97mm respectively. The mean width of the pMFL was 3,43±0,57mm and the aMFL was 4,09±0,77mm. The mean length and the width of the pMFL’s crus and the distance between pMFL and PCL were defined as 11,3±1,8mm, 3,39±0,92mm, 4,19±1,59mm respectively. The mean length and width of aMFL’s crus were found as 6,19±1,23mm and 4,8±0,96mm. The linear relationship was observed between ligament length and leg length. There was inverse relation between the length of aMLF and the width of the aMFL crus. No any other relation was found between ligaments and the dimensions of the crura. Both ligaments were seen to attach on meniscus by single crus or double crura. These crura were separated from each other by a thin layer of tissue. To understand the anatomy of MFL which has important role in the function of lateral meniscus is important to diagnose and treatment of the pathologies of the knee.Key words: meniscofemoral ligament, meniscus lateralis, ligament, meniscu

Serum amyloid a and lipoprotein associated phospholipase a levels in patients with malign melanoma: Correlations2 with clinical assessment and stage [Malign melanomlu hastalarda serum amiloid a ve lipoprotein İlişkili fosfolipaz a düzeyleri: Klinik değerlendirme ve evre2 ile korelasyon]

Objective: The lack of validated, sensitive, and specific biomarkers for early diagnosis and follow-up of patients with malign melanoma (MM) is a major problem today. In this study, we aimed to investigate the correlations of two inflammatory biomarkers-serum amyloid A (SAA) and lipoprotein associated phospholipase A2 (Lp-PLA2)-in clinical follow-up and staging of MM. Methods: Lactate dehydrogenase (LDH) and C-reactive protein (CRP) (Routine), SAA and S100B (ELISA), and Lp-PLA2 (PLAC® Test) activity levels were examined in histologically and clinically confirmed MM patients (n=131) and in healthy controls (n=27). Results: Sedimentation rate and LDH, CRP, S100B, SAA, Lp-PLA2 activities were found to be significantly higher in MM patients compared to control group (p<0.05). SAA showed the strongest correlation with disease stage (Spearman’s correlation coefficient=0.622, p=0.000). Receiver operating characteristic analysis revealed that SAA exhibited the largest area under the curve=0.984, p=0.000, highest sensitivity (95%) and specificity (93%). Pearson’s test indicated a weak positive correlation between SAA levels and Lp-PLA2 activity (r=0.311, p=0.000). Conclusion: This is the first study to evaluate the activity of inflammatory biomarker Lp-PLA2 in melanoma patients. Both SAA and Lp-PLA2 were in highest levels in stage 4 patients, and they are thought to be candidate biomarkers to be used in detecting tumor progression. According to our results, SAA is the biomarker which correlates best with disease stage in MM. © 2018 by Turkish Society of Dermatology.Tip-076This work was funded by a fund from Ege University Research Project Fund (Tip-076). -