Shallow foundation analysis by smoothed particle hydrodynamics method

This paper illustrates the use of Smoothed Particle Hydrodynamics (SPH) technique to compute the bearingcapacity of shallow foundations and establish their failure mechanism. SPH is a numerical method based on aLagrangian formulation to solve partial differential equations by discretizing the computational domain with a setof particles that have field variables such as mass, and density. SPH is a meshless method and is not affected bythe particles’ arbitrariness due to its adaptive nature, and it can naturally handle problems that are caused by largedeformations. Non-associated Drucker-Prager model is implemented into the model to simulate the soil behavior.The computed values are then compared with PLAXIS 2D finite element results. Agreements of the results ofthese two methods show that SPH is potentially a promising method for geotechnical problems experiencing largedeformations and mesh distortions

Determinants of coronary angiography in Non-ST-elevation myocardial infarction with low ejection fraction

Objective: To investigate the clinical and demographic factors affecting the selection of angiography in patients with severe left ventricular systolic dysfunction (SLVSD, ejection fraction lower than 30%) developing non-ST-segment elevation (NSTEMI). Study Design: Descriptive study. Place and Duration of Study: This study was conducted at the Department of Cardiology, School of Medicine, Izmir Katip Celebi University, Izmir, Turkey, between March 2018 and March 2021. Methodology: Patients with SLVSD (Ejection fraction = 2 [Odds ratio (OR) :33.85, 95% Confidence Interval (CI): 5.03-227.405 p= 65 years (OR: 7.124, 95% CI: 1.33-38.12, p=0.02), and PCI history (OR: 0.132, 95% CI: 0.02-0.84, p=0.032) were associated factors with the decision of only medical treatments instead of angiography. Conclusion: Demographic factors such as age and education level and clinical factors such as decompensation, PCI history, and anaemia significantly affect the decision of angiography in the patients with SLVSD and NSTEMI

Arrhythmogenic right ventricular dysplasia with apical thrombus atypical presentation of cardiomyopaties

Aritmojenik sağ ventrikül displazisi (ARVD) na-dir görülen bir kardiyomiyopatidir. ARVD ço-ğunlukla genç yaşlarda tanı alır ve kendisini ventriküler aritmiler, çarpıntı, baş dönmesi, kalp yetmezliği ve hatta ani kardiyak ölüm ile gösterebilir. Görüntüleme yöntemleri ile sağ ventrikül (SV) dilatasyonu ve apikal anevrizma tipik bulgusudur. Fakat ARVD olgularında int-raventriküler trombüs çok nadir görülmektedir. 19 yaşında erkek hasta, hastanemize çarpıntı ve bayılma şikâyetleri ile başvurdu. Elektrokar-diyografisinde ön yüz derivasyonlarda T nega-tifliği bulunmakta idi. Ekokardiyografide sağ ventrikül dilate ve SV apeksinde anevrizmatik oluşum içinde trombüs görüldü (Fig-1). Kardi-yak manyetik rezonans incelemede sağ vent-rikül genişlemesini, yağ infiltrasyonunu, fibro-tik dokuları, SV duvar hareket bozukluğunu ve trombüslü apikal anevrizma doğrulandı. Anti-koagulan tedaviyle üç ay sonra trombüsün rezole olduğu gözlendi ve ICD implante edildi. ARVD tanısında elektrokardiyografik, aritmik, histolojik ve ailesel özelliklerin yanında görün-tüleme yöntemleri de büyük önem taşımak-tadır. Sağ ventrikül dilatasyonu ve apikal anev-rizması tanı sürecinde önemli kriterler olmakla birlikte bu gibi bulgular saptandığında trom-büs varlığı da dikkatlice değerlendirilmelidArrhythmogenic right ventricular dysplasia (ARVD) is a rare form of cardiomyopathy. It commonly presents in young adults with ventricular tachycardia or sudden death. Right ventricular (RV) dilatation and apical aneurysm are the typical findings in imaging methods. However intraventricular thrombus is rarely seen in ARVD cases. A 19 year old male was admitted to hospital with palpitation and syncope. T wave inversion was detected on anterior surface electrocardiogram. Transthoracic echocardiography revealed dilated RV and apical aneurysm in which thrombus located (Fig-1). Cardiac magnetic rezonans imaging comfirmed RV enlargement, fatty infiltration, fibrosis, wall motion abnormalities and apical aneursym with thrombus. Anticoagulation theraphy commenced to the patient. After three months later trombus resoluted and ICD was implanted. Imaging methods have a great importance in the diagnosis of ARVD besides electrocardiographic, arrhythmic, histological and familial characteristics. While right ventricular dilatation and apical aneurysm are important criteria for the diagnosis process, the presence of thrombus should be evaluated carefully

Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion

Introduction: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3 ± 15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p= 0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR= 3.447; 95% CI= 1.266, 9.386; p= 0.015), and receiving antithrombotic therapy (OR= 2.306; 95% CI= 1.078, 4.932; p= 0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality

Evaluation of Trastuzumab-induced early cardiac dysfunction using two-dimensional Strain Echocardiography

Abstract Aim: Trastuzumab, a chemotherapeutic agent used in the treatment of breast cancer. has been shown to induce subclinical left ventricular (LV) dysfunction during a three to six month period as evidenced by strain echocardiographic examination without any change occurring in the ejection fraction of LV. The present study evaluated the presence of subclinical LV dysfunction using strain echocardiography 1 day and 7 days after the initiation of trastuzumab therapy. Material and methods: The patients with breast cancer receiving adjuvant trastuzumab therapy underwent 2-dimensional, tissue Doppler, and strain echocardiographic examination at baseline and 1 day and 7 days after therapy. LV global longitudinal strain (GLS), global circumferential strain (GCS) values, and other echocardiographic parameters were calculated. Results: A total of 40 females, mean age 50±10 years, were evaluated. Of these patients, 97% received anthracycline and 73% received radiotherapy before the initiation of trastuzumab therapy. No change was observed in any of the echocardiographic parameters 1 day after the initiation of trastuzumab therapy (p>0.05). The LV ejection fraction, tissue Doppler parameters, and GCS values did not show any changes 7 days after the initiation of therapy, whereas significant decreases were observed in GLS value (19.2±4.0% vs. 17.2±3.4, p=0.001) and systolic annular velocity of the lateral LV wall (S' velocity) (10.5±3.2 vs. 8.6±2.2, p=0.002). Conclusion: Trastuzumab therapy is associated with subclinical LV dysfunction as early as 7 days after initiation of the therapy as evidenced by the decreases in GLS value of LV and systolic annular velocity of the lateral LV wall

Secondary prevention of coronary heart disease in elderly population of Turkey: A subgroup analysis of ELDERTURK study

Background: Secondary prevention plays an important role after acute coronary event due to high risk of adverse events in elderly. In present study we aimed to evaluate the lifestyle, management of risk factors and medical treatment for secondary protection in elderly patients with known coronary heart disease (CHD). Methods: ELDERTURK is a non-interventional, multi-centered, observational study, which included total of 5694 elderly patients ( > 65 years) from 50 centers in Turkey. In this study elderly patients from the ELDERTURK population with known CHD were evaluated for cardiovascular risk factors, comor- bidities and medication usage. Results: A total of 2976 (52.3% of study) out of 5694 patients included in the ELDERTURK study were evaluated. All had known CHD with a mean age of 73.4 ± 6.2 years and 60.3% were male. 13.0% of patients were smokers, 42.4% were overweight and 21.1% were obese. Only 23.6% of patients reported to do regular exercise, 73.4% had history of hypertension, 47.4% had dyslipidemia and 33.9% had diabetes mellitus. The rate of patients with systolic blood pressure > 140 mmHg were 31.1% and only 13.9% of patients had a recommended ≤ 70 mg/dL level of low-density lipoprotein cholesterol. Anti- platelet, statin, beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage was limited to 27.3%. Conclusions: The ELDERTURK study shows that many patients with CHD have a high prevalence of modifiable risk factors and unhealthy lifestyle. Apart from this, many patients are not receiving thera- peutic intervention and as a consequence most were not achieving the recommended goals.   

Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

An impaired heart rate recovery (HRR) has been associated with increased risk of cardiovascular events, cardiovascular, and all‐cause mortality. However, the diagnostic ability of HRR for the presence and severity of coronary artery disease (CAD) has not been clearly elucidated. Our aim was to investigate the relationship between HRR and the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score in patients with stable CAD (SCAD). A total of 406 patients with an abnormal treadmill exercise test and ≥50% coronary stenosis on coronary angiography were included. The HRR was calculated by subtracting the HR in the first minute of the recovery period from the maximum HR during exercise. The SYNTAX score ≥23 was accepted as high. Correlation of HRR with SYNTAX score and independent predictors of high SYNTAX score were determined. A high SYNTAX score was present in 172 (42%) patients. Mean HRR was lower in patients with a high SYNTAX score (9.8 ± 4.5 vs. 21.3 ± 9, p < 0.001). The SYNTAX score was negatively correlated with HRR (r: -0.580, p < 0.001). In multivariate logistic regression analysis, peripheral arterial disease (OR: 13.3; 95% CI: 3.120–34.520; p < 0.001), decreased HRR (OR: 0.780; 95% CI: 0.674–0.902; p = 0.001), peak systolic blood pressure (OR: 1.054; 95% CI: 1.023–1.087; p = 0.001), and peak HR (OR: 0.950; 95% CI: 0.923–0.977; p < 0.001) were found to be independent predictors of a high SYNTAX score. Our results showed that HRR is significantly correlated with the SYNTAX score, and a decreased HRR is an independent predictor of a high SYNTAX score in patients with SCAD

Açık deniz petrol platform temellerinin killi zeminlere penetrasyonunun 3 boyutlu sonlu elemanlar modeli.

The penetration of the foundation for “jack-up rig” type offshore oil platform (spudcan) into a uniform clayey seabed is studied with three dimensional finite element modeling (Abaqus 6.14) using Coupled Eulerian Lagrangian method. Although there exists some analytical methods (InSafeJIP etc.) for the calculation of the spudcan bearing capacity, they frequently underestimate or overestimate the bearing capacity due to simplifications involved. For the spudcan geometry and soil properties used in this study, based on the 3D FEM analyses, the required penetration depth for a target bearing capacity of spudcans can be reduced by 2 to 4 m. Rate of increase of the bearing capacity with depth is larger in 3D FEM analyses as compared to InSafeJIP method, which may also result in significant savings, however this finding is limited for the spudcan geometry and soil properties used in this study. A systematic parametric study is conducted for the variables that affect the spudcan penetration resistance. These parameters were spudcan diameter (7.5 to 15 m), spudcan cone angle (90 to 150 degrees), roughness of spudcan surface (roughness coefficient of 0 to 1.0), undrained shear strength of clay (20 to 80 kPa), spudcan penetration depths (3 to 20 m), and the spacing between two adjacent spudcans (spacing/diameter ratio of 1.5 to 3.0). Based on these results, spudcan size, cone tip angle etc. can be selected, for each case, to provide required penetration resistance and/or to reduce the required penetration depth. Understanding the relations between the factors and penetration resistance based on this study, may provide a significant step in enhancing the safe and economical design and successful penetration operation of spudcans. However, it should not be forgotten that, the key is to have extensive and correct information and interpretation about the subsoil profile and material properties.M.S. - Master of Scienc

Czy wskaźnik powrotu rytmu zatokowego serca jest czynnikiem predykcyjnym omdlenia kardiodepresyjnego?

Background: Cardioinhibitory syncope is related with excessive bradycardia or asystole due to parasympathetic response. Aim: We investigated whether patients with cardioinhibitory syncope have higher heart rate recovery index (HRRi) considered as a parasympathetic system activation in exercise stress testing (EST) than in those with other neurogenic syncope forms. Methods: A total of 262 patients who had neurogenic syncope documented by head-up tilt test (HUTT) and 199 healthy control individuals were examined. A maximal EST was applied to all patients after the HUTT. The HRRi was obtained by subtracting the heart rate that was measured at the first (HRRi-1), second (HRRi-2), and third minute (HRRi-3) of the recovery period from the maximal heart rate that was measured during the test. Results: Eighty patients had cardioinhibitory syncope, 118 patients had vasodepressor syncope, and 64 patients had mixed-type syncope. The HRRi-1 was higher in patients with syncope (43.3 ± 7.7) compared to the control group (34.5 ± 4.8; p &lt; 0.001). Post hoc analysis showed that among the syncope groups, there was no difference between patients with vasodepressor syncope (42.2 ± 7.6) and those with mixed type syncope (40.7 ± 4.1) in terms of HRRi-1 (p = 0.420). However, patients with cardioinhibitory syncope (47 ± 8.7) had a higher HRRi-1 than vasodepressor and mixed-type syncope groups (p &lt; 0.05). The threshold value of the HRRi-1, which can be used for the prediction of cardioinhibitory syncope development, was determined to be 41 with 75% sensitivity and 72% specificity. Conclusions: The HRRi-1 was higher in patients with cardioinhibitory syncope compared to the controls. The HRRi-1 has the predictive feature of differentiating cardioinhibitory syncope from other syncope types.Wstęp: Omdlenia kardiodepresyjne wiążą się z silną bradykardią lub asystolią wynikającą z reakcji układu przywspółczulnego. Cel: Autorzy zbadali, czy u chorych, u których występowały omdlenia kardiodepresyjne, uzyskane w badaniu wysiłkowym (EST) wartości wskaźnika powrotu rytmu zatokowego (HRRi), uważanego za wskaźnik aktywacji układu przywspółczulnego, są wyższe niż u osób z innymi typami omdleń neurogennych. Metody: Do badania włączono 262 chorych z udokumentowanym omdleniem neurogennym w teście pochyleniowym (HUTT) i 199 zdrowych osób z grupy kontrolnej. Po teście HUTT u wszystkich uczestników wykonano próbę wysiłkową. Wartość wskaźnika HRRi obliczono przez odjęcie częstotliwości rytmu serca zmierzonej w pierwszej (HRRi-1), drugiej (HRRi-2) i trzeciej minucie (HRRi-3) po zakończeniu ćwiczeń od maksymalnej częstotliwości rytmu serca w trakcie testu. Wyniki: U 80 chorych wystąpiło omdlenie kardiodepresyjne, u 118 — wazodepresyjne, a u 64 chorych — omdlenie typu mieszanego. Wskaźnik HRRi-1 był wyższy u chorych, u których występowały omdlenia (43,3 ± 7,7), w porównaniu z grupą kontrolną (34,5 ± 4,8; p < 0,001). W analizie post hoc przeprowadzonej wśród osób z omdleniami nie stwierdzono różnicy między chorymi z omdleniami typu wazodepresyjnego (42,2 ± 7,6) a chorymi z omdleniami typu mieszanego (40,7 ± 4,1) pod względem wartości HRRi-1 (p = 0,420). Jednak u pacjentów z omdleniami typu kardiodepresyjnego (47 ± 8,7) wartość wskaźnika HRRi-1 była wyższa niż w grupach z omdleniami typu wazodepresyjnego i mieszanego (p < 0,05). Ustalono, że wartość progowa wskaźnika HRRi-1, którą można stosować w predykcji omdleń kardiodepresyjnych, wynosi 41, przy czułości 75% i swoistości 72%. Wnioski: Wskaźnik HRRi-1 był wyższy u chorych z omdleniami kardiodepresyjnymi niż w grupie kontrolnej. Wskaźnik HRRi-1 może być stosowany jako czynnik predykcyjny w różnicowaniu między omdleniami kardiodepresyjnymi a omdleniami innego typu