The relationship between functional capacity and ultrasonic tissue characterization in patients with idiopathic dilated cardiomyopathy

Background: Ultrasonic tissue characterization (UTC) has been widely used to investigate left ventricular (LV) dysfunction in various cardiac disorders. The aim of this study was to investigate the correlation between functional capacity and UTC in patients with idiopathic dilated cardiomyopathy (IDCM).Methods and Results: Treadmill test according to modified-Bruce protocol was performed in 48 patients with IDCM to assess their functional capacity. Baseline clinical and echocardiographic variables were obtained and UTC was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: [(MGLdiastole − MGLsystole) ÷ MGLdiastole] × 100.PW and septum CV indices were correlated with exercise duration (r = 0.63, p = 0.001 and r = 0.67, p = 0.0001, respectively) and “MET” level (r = 0.80, p = 0.0001 and r = 0.83,p = 0.0001, respectively). The ROC curve analysis revealed that the PW CV index was a strong indicator of good exercise capacity (> 8 METs) with an AUC of 0.97 (95% CI0.90–1.0), as the interventricular septum (IVS) CV index (AUC = 0.97, 95% CI 0.89–1.0). Sensitivity, specificity, positive predictive value, and negative predictive value to identify good exercise capacity for IVS CV index were 90%, 88%, 82%, and 94%, respectively and for the PW CV index, 90%, 88%, 82%, and 94%, respectively.Conclusions: In this particular study, we found out that in patients with severe LV dysfunction good exercise capacity was related to septum and PW CV indices measured by UTC, and these indices may be used as an indirect prognostic marker in heart failure

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score

Background: Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions.Aims: We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI.Methods: A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine >2 mg/dl).Results: Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20–1.58). The ACEF score was found to be an independent predictor of AKI (P <0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI.Conclusions: Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI

Versatility of the Reverse Dorsoulnar Fasciocutaneous Flap in Coverage of Hand Defects: Clinical Experience With 36 Cases

WOS: 000269414600025PubMed ID: 19576702Purpose Local flap reconstruction is often required for soft tissue defects of the hand. The optimal reconstruction method should provide thin, supple, well-vascularized tissue with minimal donor-site morbidity. Short operating time and a sizable pedicle for microsurgical anastomosis are helpful. In this study, outcomes of hand defects after reconstruction with a reverse dorsoulnar flap were retrospectively analyzed. Methods Between 2001 and 2008, 36 patients were evaluated (28 men, 8 women). Twenty-seven pedicle flaps and 9 free flaps were used. Nineteen patients had flexion contractures in their palms and fingers after burn injuries, 14 patients had traumatic soft tissue loss, and 3 patients had defects after tumor exicision. In 26 cases the defects were on the palm site, and in 10 cases the defects were on the dorsum of the hand. Mean follow-up was 12 months. Results The success rate was 100%, with satisfactory cosmetic results. Functional recovery of the hands showed good results as well as acceptable donor healing without complication. Conclusions The dorsoulnar flap as either pedicle or free flap provides good and reliable skin cover for substantial soft tissue defects on the palm, dorsum of the hand, and the fingers. (J Hand Surg 2009;34A:1327-1333. (C) 2009 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.

The use of scalp as a donor site for pediatric burn patients to obtain split thickness skin graft

Amaç: Pediatrik yanıklı hastaların tedavisinde kısmi kalınlıkta deri grefti (KKDG) yaygın olarak uygulanmaktadır. KKDG, sıklıkla uyluk ve kalça bölgesinden alınmaktadır. Bu hastalarda, uzun iyileşme periyodu ve kalıcı iz oluşumu gibi önemli morbiditelerle karşılaşılmaktadır. Gereç ve Yöntem: Ocak 2002 ile Aralık 2008 yılları arasında saçlı derinin KKDG donör alanı olarak kullanıldığı 86 pediatrik yanıklı hasta geriye dönük olarak değerlendirildi. Bulgular: Saçlı derinin iyileşme zamanının konvansiyonel KKGD donör alanlarından daha hızlı olduğu saptandı. Ayrıca, bu tekniğin operasyon sonrası ortaya çı- kan rahatsızlıkları azaltmak, tekrarlayan greft alımına olanak sağlamak ve görünen izi saklamak gibi önemli avantajları mevcuttu. Sonuç:Bu çalışmada, skalp donör alanının pediatrik yanıklı hastalarda düşük morbiditeye sahip güvenli bir alan olduğu düşünüldü.Aim: To treat the pediatric burn patients, split thickness skin grafting (STSG) is used widespreadly. STSG is frequently taken from the thigh or buttock. Some serious donor site morbidities such as long healing period and permanent scars are seen in these patients. Materials and Method: We retrospectively analyzed 86 pediatric burn patients in wich scalp was used as a donor-site of STSG between January 2002 and November 2008. Results: We determined that the healing time of the scalp is more rapid than conventional STSG donor site. Furthermore, this technique had important advantages such as to minimize postoperative discomforts, to allow repetitive graft harvesting and to camouflage visible scar. Conclusion: In our study, we revealed that scalp donor sites were dependable areas with low morbidity in pediatric burn patients

Experimental investigation of the effects of infrared heating mechanism on the mechanical properties of autoclave cured CFRPs

Adamant Composites Ltd.; Hellenic Aerospace Industry S.A; JEC Group; Materials Today; Photron; Shimadzu Europa GmbH18th European Conference on Composite Materials, ECCM 2018 -- 24 June 2018 through 28 June 2018 -- 155810Autoclave curing method is widely used in manufacturing of aerospace and automotive grade carbon fiber reinforced plastic (CFRP) components. However, both the autoclave operating costs and long curing times yield high component costs and limit the mass production ability. These limitations make researchers to canalize their efforts to cost effective solutions without sacrificing the product quality. These cost effective solutions can be classified into two main groups: reducing the curing times and enhancing the efficiency of the process. In this study, effects of heating mechanism on the curing and mechanical properties of autoclave cured CFRPs were investigated. Infrared and conventional resistance heating were considered and compared. For this purpose, an infrared curing oven was constructed to simulate the autoclave cure cycle without pressure. Infrared heating is a cost effective mechanism than conventional resistance heating because it just heats the material instead of whole autoclave chamber. 75 mm x 250 mm x 3 mm CFRP plates were fabricated in this infrared oven. They were cut into 3 pieces for tensile testing. Results were compared with the ones manufactured by conventional autoclave oven at the same cure cycle. A correlation of the results of the mechanical properties and curing behaviors of the products was obtained. Results showed that infrared can be used for curing of CFRPs instead of resistance heating, especially in plain geometries. But for complex shapes, a homogen heating pattern should be provided by adjusting the location of infrared heaters with regard to the product geometry. In the light of these findings, it can be deduced that hybrid autoclave ovens can be developed which are using both infrared heating and resistance heating so as to enhance the efficiency of the process in composite plate manufacturing. © CCM 2020 - 18th European Conference on Composite Materials. All rights reserved

Our Approach to Toxic Epidermal Necrolysis and Review of Current Treatment Alternatives

Toxic epidermal necrolysis (TEN) is a clinical entity which has a 30 to 40 % mortality rate, with necrolysis affecting the entire epidermis. Antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants are offender drugs in TEN etiology. A standard treatment protocol with proven efficacy is still lacking. In this study, current treatment practice and our treatment strategy for TEN is discussed and eight patients treated in our clinic between the years 2001 and 2008 are reviewed