Systemic immune-inflammation index: A novel marker for predicting response to cardiac resynchronization therapy in patients with heart failure

Aim: To investigate the utility of systemic immune-inflammation index (SII) in predicting response to cardiac resynchronization therapy (CRT) among patients with heart failure (HF). Method: A total of 78 patients with HF who underwent CRT device implantation were included in this 6-month follow up study. Data on laboratory findings including complete blood count, blood biochemistry and SII as well as the transthoracic echocardiography findings were recorded at baseline prior to CRT device implantation and 6 months after CRT. Results: The criteria for response to CRT including improvements in New York Heart Association (NYHA), left ventricular end-systolic volume (LVESV) (decreased by ≥15%) and ejection fraction (EF) (increased by≥10%) were met by 73.1%, 65.4% and 69.2% of patients, respectively. In patients with decreased vs. increased SII values during 6-month therapy, the likelihood of meeting LVESV (84.3 vs. 15.7%, p<0.001), EF (81.5 vs. 18.5%, p<0.001) and NYHA (77.2 vs. 22.8%, p<0.001) response criteria for successful CRT were significantly higher. Multivariate analysis revealed that decrease in SII (OR 0.982, 95% CI: 0.970 to 0.995, p=0.006) and TAPSE (OR 0.602, 95% CI. 0.396 to 0.916, p=0.018) during treatment as the only significant determinants of presence of response to CRT in heart failure (HF) patients. Conclusions: Our findings seem to indicate the favorable utility of SII, as a non-invasive readily available marker, in predicting response to CRT and thus enabling a beneficial reverse remodeling process via timely implementation of advanced treatments in HF patients

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Effect of Salt Crystallization on Microfracture Properties of the Basalts Used in Diyarbakir City Walls, Turkey

The Diyarbakır City Walls, which were recently added to UNESCO’s World Heritage List, are among the most impressive surviving structures from ancient times. Basalt is the principal construction material employed in the City Walls. Like many other historical structures, the Diyarbakır City Walls are also suffering from stone deterioration. It is known that weathering is strongly related to the type, amount, dimension, orientation and density of cracks. The extending of cracks, for instance, increases stone's surface area and consequently leads to physical, chemical and biological weathering. This makes it important to conduct microfracture studies of rock materials. In this study, it is aimed to understand how salt crystallization affects the microfractures properties of the basalts used in Diyarbakır City Walls. The studies confirmed that olivine and pyroxene are the most vulnerable minerals with the highest number of microcracks

Freeze thaw resistance of Diyarbakır City Walls

The Diyarbakir Citadel and City walls are appreciated as a masterpiece structural design of human history. Hence, UNESCO World Heritage Committee added the structure into the World Heritage List. It is considered to be a result of different cultures combined from different historical periods. The structure is shaped from the basalts of Karacadag Volcanic Complex. Based on the field surveys two types of basalts used in the Diyarbakir City Walls were identified. These are classified as massive and vesicular basalts. The City Walls reveal some signs of weathering. The freeze-thaw activity plays an important role on the deterioration of the basalt. Therefore, freeze-thaw test is carried out to assess the freeze-thaw resistance of the fresh basalts. Moreover, some physico-mechanical properties such as water absorption, weight loss, effective porosity, dry unit weight, saturation coefficient, uniaxial compressive strength (UCS) and sonic velocity of both massive and vesicular basalts are recorded at different test cycles. The cyclic test results demonstrate that the basalts are adversely affected by the freeze-thaw test

Material Properties of Basalt used in the Diyarbakır City Walls

The Diyarbakır City Walls is a significant historical and cultural example of common human design. It was constructed by using natural stones. Although the City Walls were subjected to numerous past interventions and scientific studies, studies on long-term activity of stone material and its deterioration mechanisms have yet to be launched. The Diyarbakır City Walls reveal some forms of weathering, including cracks, detachments, material losses, discoloration, and deposits. Such weathering forms are affecting the durability of the material used in the Diyarbakır City Walls

Durability assessment of the basalts used in the Diyarbakr City Walls, Turkey

The Diyarbakr City Walls (DCW), which were recently added to UNESCO's World Heritage List, are among the largest and one of the most impressive monuments from ancient times. The history of the DCW stretches back more than 4000 years, therefore making the extant City Walls a combination and reflection of influences of the various civilizations that settled in the region. Basalts having such different textural properties as massive and vesicular were employed as the principal material in the construction of the DCW. Like many other historical structures, the DCW are suffering from stone deterioration. A large variety of weathering forms can be observed on the basalts used in different sections of the DCW. The behavior of the basalt under different cyclic environmental conditions is not known. In this study, deterioration mechanisms of the basalts were investigated with field and laboratory studies. It is found that iddingsite is a common weathering product developed through the crystal boundaries of olivine. Accelerated weathering tests show that salt crystallization is the most effective deterioration mechanism. The field and laboratory studies indicate that both massive and vesicular basalts are durable; however, the massive basalts are more durable than the vesicular ones. It is also observed that although chemical processes slightly trigger the deterioration mechanisms of the rocks, most of the weathering forms on the DCW are controlled by the physical factors affecting the parameters of the basalts such as porosity, water absorption and uniaxial compressive strength

The impact of cyclic loads on physicomechanical properties of the massive and vesicular basalts

Stone monuments are the most visible and essential structures of our cultural heritage; however, many of the historical structures around the world are now suffering from stone deterioration. Diyarbakır City Walls, which were acknowledged the status of World Heritage Site by UNESCO, are among the most extensive surviving structures from ancient times. The City Walls have also some deterioration related problems. Basalts having such different textural properties as massive and vesicular were employed as the principal material in the construction of the Diyarbakır City Walls. Weathering is strongly related to the climatic and environmental conditions of the site. In order to evaluate the physical deterioration, environmental conditions were artificially simulated in accelerated weathering tests such as wetting-drying, freezing-thawing, and salt crystallization. For this purpose, 180 massive and vesicular basalt samples were prepared. The effects of these tests were evaluated by visual examination, weight loss, effective porosity, dry and saturated unit weights, water absorptions under atmospheric and vacuum pressure, sonic velocity and uniaxial compressive strength. It is found that the salt crystallization is the most effective accelerated weathering test deteriorating the basalt samples most aggressively

Effect of Weathering Tests on Microfracture Properties of the Massive and Vesicular Basalts

Petrographic investigations not only provide knowledge on the mineralogical state and provenance of rock materials, they also can be used as a strong tool for evaluating its weathering potential and durability. It is known that the type, amount, dimension, orientation and density of cracks have a great influence on the weathering of the stone material. The chemical agents, for instance, that cause weathering in rock materials, use cracks to penetrate their depths. This study aims to understand how accelerated weathering tests (wetting-drying; freezing-thawing and salt crystallization) affect the behavior of the microfractures. To conduct microfracture studies, a total of nine massive and vesicular basalt samples were questioned. Thin and polished sections were prepared and investigated using optical microscopy and back-scattered views obtained from the Electron Probe Microanalyser (EPMA). Through the investigation, type, amount, orientation and density of the microfractures were examined. Overall results of this examination suggest that aging tests have different impacts on the microfracture properties of the basalts. It can be easily stated that the pore pressure, especially after the freezing-thawing cycles and salt crystallization, triggers microfracture development. Additionally, this study indicated that the crystal boundaries of olivine and pyroxene are the weakest zones for the microcrack formations