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This study aims to examine the dynamic relationship between carbon dioxide (CO2) emissions, renewable energy consumption, and economic growth in Denmark, Sweden, and Chile. These countries were not randomly selected. They were chosen since they have the highest scores according to the Climate Change Performance Index (2023). In addition, Markov-switching vector autoregressive (MS-VAR) and Markov-switching Granger (MS-Granger) causality methods are applied to the annual data of the three countries over the period 1971–2021. Contrary to linear methods, MS-VAR and MS-Granger causality approaches allow us to estimate and interpret this relationship for different regimes, such as recession and expansion. These methods also provide insights into the likelihood and duration of the persistence of the current economic regime. The empirical results show that there is a two-way MS-Granger causality between renewable energy consumption and economic growth in all regimes for the three countries except for moderate and high expansion regimes for Chile. Moreover, in general, there is a two-way MS-Granger causality between economic growth and CO2 emissions in all regimes. Furthermore, the findings from the estimated models indicate that there is a two-way MS-Granger causality between renewable energy consumption and CO2 emissions in general, except for the second regime for Chile.

Functionally graded materials (FGMs) are advanced materials designed to achieve specific property gradients. The unique characteristic of these materials—variations in spatial dimensions—allows for integrating the advantages of different materials within a single component, where a combination of properties, such as mechanical strength, thermal resistance, and others, is needed. This paper utilizes finite element analysis to examine the deflection and stress responses of FGM rectangular plates with different material gradient profiles. Various boundary conditions, including clamped, simply supported, and free edges in different configurations, are considered. The plates are subjected to uniformly distributed, sinusoidally distributed, and concentrated loads. The study investigates the effects of boundary and loading conditions, along with the impact of the material gradient, on the deflections and stress responses of FGM rectangular plates. The results indicate variations in deflection and stress values for different material gradients, under varying boundary and loading conditions.

Objective: The objective of this study is to demonstrate any inner ear injury caused by drilling in mastoid surgery with prestin, outer hair cell motor protein specific to the cochlea. Methods: The patients with chronic otitis media requiring mastoidectomy (n = 21) and myringoplasty (n = 21) were included. Serum prestin level obtained from blood samples was measured before surgery and on postoperative days 0, 3, and 7 using Human Prestin (SLC26A5) ELISA Kit. All patients underwent the Pure Tone Audiometry (PTA) test before surgery and on the postoperative 7th day. The drilling time was also recorded for all patients who underwent mastoidectomy. Results: In both mastoidectomy and myringoplasty groups, the postoperative serum prestin levels increased on days 0 and 7 (pday-0 = 0.002, pday-7 = 0.001 and pday-0 = 0.005, pday-7 = 0.001, respectively). There was no significant difference in the serum prestin levels between the two groups, postoperatively. The PTA thresholds at day 7 did not change in either group. A significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. There was no correlation between the drilling time and the increase of prestin levels in the postoperative day 0, 3, and 7. Conclusion: Our results showed that mastoid drilling is not related to a significant inner ear injury. Although the myringoplasty group was not exposed to drill trauma, there was a similar increase in serum prestin levels as the mastoidectomy group. Also, a significant decline at 2000 Hz of bone conduction hearing threshold in both groups and a decline at 4000 Hz in the myringoplasty group were found. These findings suggest that suction and ossicular manipulation trauma can lead to an increase in serum prestin levels and postoperative temporary or permanent SNHL at 2000 and 4000 Hz. Level of evidence: Level-4.

Abstract Separation and identification of molecules and biomolecules such as nucleic acids, proteins, and polysaccharides from complex fluids are known to be important due to unmet needs in various applications. Generally, many different separation techniques, including chromatography, electrophoresis, and magnetophoresis, have been developed to identify the target molecules precisely. However, these techniques are expensive and time consuming. “Lab‐on‐a‐chip” systems with low cost per device, quick analysis capabilities, and minimal sample consumption seem to be ideal candidates for separating particles, cells, blood samples, and molecules. From this perspective, different microfluidic‐based techniques have been extensively developed in the past two decades to separate samples with different origins. In this review, “lab‐on‐a‐chip” methods by passive, active, and hybrid approaches for the separation of biomolecules developed in the past decade are comprehensively discussed. Due to the wide variety in the field, it will be impossible to cover every facet of the subject. Therefore, this review paper covers passive and active methods generally used for biomolecule separation. Then, an investigation of the combined sophisticated methods is highlighted. The spotlight also will be shined on the elegance of separation successes in recent years, and the remainder of the article explores how these permit the development of novel techniques.

Bu çalışmada Türkiye’de bir devlet üniversitenin İşletme Fakültesi ve Sağlık Hizmetleri Meslek Yüksekokulunda öğrenci olan genç kadınların siber zorbalık ve siber mağduriyet düzeylerinin incelenmesi amaçlanmaktadır. Tanımlayıcı tipte olan araştırmanın çalışma grubunu bir üniversitede 15 Ekim-1 Aralık 2022 tarihleri arasında öğrenim gören 450 kız öğrenci oluşturmuştur. Araştırma verilerinin toplanmasında “Tanımlayıcı Anket Formu” ve “Üniversite Öğrencileri için Yenilenmiş Siber Zorbalık Ölçeği” kullanılmıştır. Araştırma bulgularında öğrencilerin siber mağduriyet düzeyleri, siber zorbalık düzeylerinden yüksek olarak gözlenmiştir. Siber zorbalık ölçeği ve siber mağduriyet ölçeği arasındaki ilişki anlamlı bulunmuştur. Öğrencilerin internet kullanım amacı, sosyal ağ hesabı bulunması gibi değişkenlerin siber zorbalık düzeylerini anlamlı şekilde etkilediği saptanmıştır. Öğrencilerin baba eğitim düzeyi, internet kullanım amacı, sosyal ağ hesabı bulunması gibi değişkenlerin ise siber mağduriyet düzeylerini anlamlı ölçüde etkilediği ortaya çıkmıştır.

Bu çalışmada, Batı/Hristiyan kökenli bireyler ile Doğu/Müslüman kökenli bireylerin Batılı ülkelerde gerçekleştirdikleri şiddet eylemlerinin Alman medyasındaki yansımaları incelenmiştir. Doğulu/Müslüman kişilerce yapılan 2016 Berlin Noel Panayırı ve 2017 Barselona saldırısı ile Batılı/Hristiyan kişilerce Müslüman ve göçmenlere yönelik gerçekleştirilen 2019 Christchurch ve 2020 Hanau saldırılarına ilişkin Bild, Zeit, Taz ve Süddeutsche gazetelerinin internet sitelerinde yayımladıkları haberler üzerinden, İçerik Analizi ve Eleştirel Söylem Analizi metotlarından yararlanılarak haber incelemeleri yapılmıştır. İçerik Analizinde 1300 haber değerlendirilirken, konuyla ilgili 16 haber Teun A. van Dijk Eleştirel Söylem Analizi kapsamında incelenmiştir. Elde edilen verilere göre Batılı/Hristiyan kişi ya da kişilerce Müslüman ve göçmenlere yönelik saldırılar haberleştirilirken olayın ırkçı, aşırı sağcı bir motivasyona sahip olduğu, faillerin ise suç geçmişi bulunmayan, sonradan radikal fikirlere kapılan, akıl hastası (Hanau için) olduğu bilgilerinin öne çıkarıldığı, buna karşılık Müslüman/Doğulu kişiler tarafından gerçekleştirilen şiddet eylemi haberlerinde dini kimlikleri, mülteci olarak söz konusu ülkelere geldikleri arka plan bilgisinin paylaşıldığı görülmüştür. Bu bağlamda Müslüman/Doğulu kişilerin eylemleri, genel bir İslam tehdidine işaret ederek sunulmaya çalışılmıştır. Batılı/Hristiyan kişilerin eylemleri ise marjinal, sıra dışı olarak lanse edilmek üzere çerçevelenmiştir.

Forest bathing is an approach that uses the healing effects of forests to improve people's health and prevent disease through forest walks. Although the terms forest therapy and forest bath are used in the same sense, they are different applications. While the forest therapy application is carried out in the company of a professional trained in this subject, the therapist in the forest bath is the forest itself. Considering the positive effects of forest bathing on the cardiovascular system, nervous system, endocrine system, immune system and mental health, it is thought that it can be used as an approach to protect and improve women's health. In this context, the aim of the study is to examine the physiological and psychological effects of forest bathing and forest therapy on women's health. In this study, which was revealed by literature review, the results of national and international studies on the subject were compiled. Many positive effects of forest bathing and forest therapy on the protection of human health have been reported in the literature. There are limited studies on the effects of forest therapy and forest bathing on human health, and no scientific research has been found in the field of health in our country. It is thought that these practices can be used in our country, which is rich in forests, and that scientific studies on this subject can provide benefits for women's health.

In the present work, 3D-printed wound dressings containing different amounts of Centella Asiatica extract were synthesized via dual-crosslinking method. Methacrylic anhydride modified gelatin (Gel-MA) and pectin (Pec) were chosen as the base material for dressings. A dual crosslinked network was formed with Gel-MA photo-crosslinking using Irgacure 2959 and Pectin (Pec) psychical-crosslinking using Ca++ ions. Meanwhile, the developed dual-crosslinked hydrogel dressings were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and mechanical, swelling, in vitro degradation as well as ex vivo bioadhesion tests. It has been observed that the preapred dressings provide good bioadhesion on the chicken skin. Moreover, MTT assay revealed cell viability of Gel-MA/Pec hydrogel dressings containing Centella Asiatica extract. The results presented the dressings as a promising biomaterial to be used for wound healing purposes, which should be further investigated in future.

Carotenoids are hydrophobic pigments produced exclusively by plants, fungi, and specific microbes. Microalgae are well suited for the production of valuable carotenoids due to their rapid growth, efficient isoprenoid production pathway, and ability to store these compounds within their cells. The possible markets for bio-products range from feed additives in aquaculture and agriculture to pharmaceutical uses. The production of carotenoids in microalgae is affected by several environmental conditions, which can be utilized to enhance productivity. The current study focused on optimizing the extraction parameters (time, temperature, and extraction number) to maximize the yield of carotenoids. Additionally, the impact of various nitrogen sources (ammonia, nitrate, nitrite, and urea) on the production of lutein and loroxanthin in Scenedesmus obliquus was examined. To isolate the carotenoids, 0.20 g of biomass was added to 0.20 g of CaCO3 and 10.0 mL of ethanol solution containing 0.01% (w/v) pyrogallol. Subsequently, the extraction was performed using an ultrasonic bath for a duration of 10 min at a temperature of 30 °C. This was followed by a four-hour saponification process using a 10% methanolic KOH solution. The concentration of lutein and loroxanthin was measured using HPLC–DAD at 446 nm, with a flow rate of 1.0 mL/min using a Waters YMC C30 Carotenoid column (4.6 × 250 mm, 5 μm). The confirmation of carotenoids after their isolation using preparative chromatography was achieved using liquid chromatography–tandem mass spectrometry (LC–MS/MS) with an atmospheric pressure chemical ionization (APCI) probe and UV–vis spectroscopy. In summary, S. obliquus shows significant promise for the large-scale extraction of lutein and loroxanthin. The findings of this study provide strong support for the application of this technology to other species.

The Heart Goes Last is a dystopic novel set in the United States of America. The book portrays a society in which the whole system is broken, from banking to manufacturing; unemployment, homelessness, and violence have accelerated in such a way that they constitute norms rather than the exception. The story is about a young couple, Charmaine and Stan, who lost their homes and jobs and live in their cars. Their lives are now organized around their bare lives, and they are at the point where they exchange their freedom for security. Dystopias reflect the fear of the era in which they are written, and the society portrayed in the novel is a late capitalist society. Late capitalist societies are characterized by uncertainty, insecurity, and vulnerability. Late capitalist societies exploit the fears and anxieties derived from uncertainty and insecurity, and The Heart Goes Last projects this exploitation, resulting in the loss of freedom. The first part of the study gives the relationship between dystopia and social theory. In the second part, the context of the novel is given. The third part analyzes the late capitalist societies through liquid modernity thesis. Finally, the renunciation of freedom for the sake of security and The Heart Goes Last is a dystopic novel set in the United States of America. The book portrays a society in which the whole system is broken, from banking to manufacturing; unemployment, homelessness, and violence have accelerated in such a way that they constitute norms rather than the exception. The story is about a young couple, Charmaine and Stan, who lost their homes and jobs and live in their cars. Their lives are now organized around their bare lives, and they are at the point where they exchange their freedom for security. Dystopias reflect the fear of the era in which they are written, and the society portrayed in the novel is a late capitalist society. Late capitalist societies are characterized by uncertainty, insecurity, and vulnerability. Late capitalist societies exploit the fears and anxieties derived from uncertainty and insecurity, and The Heart Goes Last projects this exploitation, resulting in the loss of freedom. The first part of the study gives the relationship between dystopia and social theory. In the second part, the context of the novel is given. The third part analyzes the late capitalist societies through liquid modernity thesis. Finally, the renunciation of freedom for the sake of security and stability is analyzed. An emphasis on the contradiction between freedom and security and the cooccurrence of freedom and domination will be given. It is argued that the social structure that exploits fear triggers the need for security, which results in the loss of freedom.

Amaç: Dijital dönüşüm sürecinde dijitalleşme ve dijitalleşmenin verimlilik üzerindeki etkisinin teorik ve pratik olarak incelenmesi amaçlanmaktadır. Yöntem: 2005-2020 yıllık dönemleri kapsamında, Türkiye’de verimlilik üzerinde etkili olan dijitalleşme sürecini niteleyen değişkenlerin ortaya konması ve önem sıralamalarının gerçekleştirilmesinde yapay sinir ağ mimarisi kulanılmaktadır. Bulgular: Dijitalleşme süreci çerçevesinde hem sosyo-ekonomik ortamın oluşturulması hem de önem düzeylerinden yola çıkılarak verimlilik artışının teşvik edilmesi sonucunda kapsayıcı sürdürülebilir kalkınma potansiyeline katkı sağlanabileceği bulgusu elde edilmektedir. Özgünlük: Dijitalleşmenin etkilerine ilişkin bu ampirik çalışmanın, konuyu inceleme şekli ve yapılan detaylı ampirik analizler kapsamında farklı modelleme tekniğinin ele alınması sonucunda alanında ilk olma özelliği ile literatüre katkı sağlaması beklenmektedir.

Eyes are one of the main critical organs of the body that provide our brain with the most information about the surrounding environment. Disturbance in the activity of this informational organ, resulting from different ocular diseases, could affect the quality of life, so finding appropriate methods for treating ocular disease has attracted lots of attention. This is especially due to the ineffectiveness of the conventional therapeutic method to deliver drugs into the interior parts of the eye, and the also presence of barriers such as tear film, blood-ocular, and blood-retina barriers. Recently, some novel techniques, such as different types of contact lenses, micro and nanoneedles and in situ gels, have been introduced which can overcome the previously mentioned barriers. These novel techniques could enhance the bioavailability of therapeutic components inside the eyes, deliver them to the posterior side of the eyes, release them in a controlled manner, and reduce the side effects of previous methods (such as eye drops). Accordingly, this review paper aims to summarize some of the evidence on the effectiveness of these new techniques for treating ocular disease, their preclinical and clinical progression, current limitations, and future perspectives.

Microalgae produce a variety of high-value chemicals including carotenoids. Fucoxanthin is also a carotenoid that has many physiological functions and biological properties. For this reason, the cost-effective production of fucoxanthin at an industrial scale has gained significant attention. In the proposed study, fucoxanthin production was aimed to be increased by altering the culture conditions of N. shiloi. The effect of light intensity aeration rate, different nitrogen sources, and oxidative stress on the biomass and fucoxanthin productivity have been discussed. Based on these results, the fucoxanthin increased to 97.45 ± 2.64 mg/g by adjusting the light intensity to 50 µmol/m2s, and aeration rate at 5 L/min using oxidative stress through the addition of 0.1 mM H2O2 and 0.1 mM NaOCl to the culture medium. Fucoxanthin was then purified with preparative HPLC using C30 carotenoid column (10 mm × 250 mm, 5 μm). After the purification procedure, Liquid chromatography tandem mass spectrometry (LC–MS/MS) and UV-vis spectroscopy were employed for the confirmation of fucoxanthin. This study presented a protocol for obtaining and purifying considerable amounts of biomass and fucoxanthin from diatom by manipulating culture conditions. With the developed methodology, N. shiloi could be evaluated as a promising source of fucoxanthin at the industrial scale for food, feed, cosmetic, and pharmaceutical industries.

AbstractBackground/Aims:Metabolic syndrome (MS) is linked to type of type 2 diabetes mellitus associated with high glucose level and insulin resistance. Thioredoxin-1 (TRX-1) is localized in the cytoplasm and the mitochondria and controls cellular reactive oxygen species. The purpose of this study is to examine the relation between MS and oxidative stress, and effect of quercetin on oxidative stress via TRX-1 in liver of MS rats. Methods: Male wistar rats (200-250g in weight) were used. They were divided three groups. Control group, MS group receiving (935 mM sucrose in drinking water) and quercetin treated (15 mg/kg/day, administered by gavage) MS group. Protein level of TRX-1 was determined by Western blot.Results:Aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), levels increased in MS group as compared with the Con group. Total-antioxidant-status (TAS), superoxide-dismutase (SOD), and glutathione-peroxidase (GSH-Px) levels decreased in MS group when compared to Con group. Total-oxidant-status (TOS) levels increased in MS group as compared with the Con group. Triglycerides, total-cholesterol and LDL-cholesterol increased in MS group when compared with the Con group. TRX-1 level decreased in MS group and TRX-1 activity was lower in MS group than Con group. Conclusions: Treatment of quercetin decreased AST, ALT, LDH, and TOS levels while it increased GSH-Px, SOD, and TAS levels. Also, lipid profile changed with quercetin. In conclusion, treatment of quercetin significantly increased TRX-1 level and activity of TRX-1 in MS group. These data suggest that elevated oxidative stress in liver of MS may be reduced by quercetin.

Cochlear implantation (CI) is now widely used to provide auditory rehabilitation to individuals having severe to profound sensorineural hearing loss (SNHL). However, CI can lead to electrode insertion trauma (EIT) that can cause damage to sensory cells in the inner ear resulting in loss of residual hearing. Even with soft surgical techniques where there is minimal macroscopic damage, we can still observe the generation of molecular events that may initiate programmed cell death via various mechanisms such as oxidative stress, the release of pro-inflammatory cytokines, and activation of the caspase pathway. In addition, individuals with CI may be exposed to noise trauma (NT) due to occupation and leisure activities that may affect their hearing ability. Recently, there has been an increased interest in the auditory community to determine the efficacy of drug-eluting electrodes for the protection of residual hearing. The objective of this study is to determine the effect of NT on implanted cochlea as well as the otoprotective efficacy of dexamethasone eluting electrode to implanted cochlea exposed to NT in a guinea pig model of CI. Animals were divided into five groups: EIT with dexamethasone eluting electrode exposed to NT; EIT exposed to NT; NT only; EIT only and naïve animals (control group). The hearing thresholds were determined by auditory brainstem recordings (ABRs). The cochlea was harvested and analyzed for transcript levels of inflammation, apoptosis and fibrosis genes. We observed that threshold shifts were significantly higher in EIT, NT or EIT + NT groups compared to naive animals at all the tested frequencies. The dexamethasone eluting electrode led to a significant decrease in hearing threshold shifts in implanted animals exposed to NT. Proapoptotic tumor necrosis factor-α [TNF-α, TNF-α receptor 1a (TNFαR1a)] and pro-fibrotic transforming growth factor β1 (TGFβ) genes were more than two-fold up-regulated following EIT and EIT + NT compared to the control group. The use of dexamethasone releasing electrode significantly decreased the transcript levels of pro-apoptotic and pro-fibrotic genes. The dexamethasone releasing electrode has shown promising results for hearing protection in implanted animals exposed to NT. The results of this study suggest that dexamethasone releasing electrode holds great potential in developing effective treatment modalities for NT in the implanted cochlea.

In this paper, copula approach was applied to determine the dependence structure the two indices (PPI and CPI). Ali ? Mikhail ? Haq, Clayton, Frank and Gumbel ? Hougaard from Archimedean family were used. As a result it was found that the Gumbel ? Hougaard?s family with parameter was the best fitted family which models the dependence structure between the two indices.

The purpose of this study is to modelling the relationship among CO2 emission per capita, renewable energy consumption per capita and gross domestic product per capita. In this context, the multivariate version of univariate Markov regime change model (MS-VAR) which is developed by Hamilton (1989) and is used prevalently in econometric applications, is performed for Turkey. Markov regime model is a non-linear model approach for changes that it is not known when they occured and it is used to predict the results in stochastic way. Moreover, these models are widely used because they also enable the dating of economic networks. This study the relationship among CO2 emission, renewable energy consumption and gross domestic product were analyzed by the use of MS-VAR model.

Yellow water is a segregated domestic wastewater stream resulting from Ecological Sanitation (ECOSAN). It is mainly source separated human urine which is rich in nutrients. The potential contribution of yellow water as fertilizer to food security is considerable. The use of this potential however is related to the acceptance of the consumers towards urine based fertilizers (UBF). This work aims to assess acceptance of consumers towards UBF and urine diverting toilets (UDT) for separation of urine, through questionnaires with 444 participants from Egypt, Iraq and Turkey with different age groups, genders, educational backgrounds and occupations. The overall acceptance for UDTs and UBF was 62% and 56%, respectively. All-in-all, public opinion regarding the use of UDT/UBF is promising.

Background: Contrast induced nephropathy (CIN) is one of the feared complications of contrast medium-using procedures. Present study was conducted in order to evaluate the value of systemic inflammatory-response index (SIRI) for development of CIN among patients who underwent primary percutaneous intervention., Methods: Six hundred seventy-six patients with the diagnosis of ST elevation myocardial infarction were included. The patients were divided into two groups according to the presence of CIN. Patients without ( n  = 530) and with ( n  = 146) CIN constituted group 0 and group 1, respectively. Clinical and biochemical features of the patients were recorded. Calculation of SIRI was made for each patient., Result: CIN patients were older, had higher prevalence of hyperlipidaemia, higher values of pre- and post-procedural creatinine levels, neutrophil and monocyte counts, neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) and SIRI. They had lower values of left ventricular ejection fraction (LVEF), haemoglobin and high-density lipoprotein-cholesterol levels. SIRI had the highest area under the curve (AUC) for prediction of CIN. Pairwise analyses of the AUC's demonstrated that SIRI had statistically significantly higher AUC compared to NLR and MLR. Multivariate logistic regression analysis showed that besides from LVEF and pre-procedural creatinine, NLR and SIRI were the independent predictors of CIN. SIRI had a higher odds ratio compared to NLR., Conclusion: SIRI had greater diagnostic power than NLR and MLR and it can easily be used by physicians for the identification of high-risk patients for the occurrence of CIN.

Coronary artery disease (CAD) is uncommon in young adult patients. However, these patients have different risk factor profiles and high-risk coronary plaques are more common. The aim of this study was to examine the relations between the coronary plaque burden, plaque composition, serum non-high-density lipoprotein cholesterol (non-HDL-C) levels, and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio in young adults. We analyzed a total of 551 patients under age 45 who had undergone coronary computed tomography angiography (CCTA). Coronary plaque characteristics were analyzed using CCTA. Multivariate linear regression analysis was used to assess the predictors of non-calcified plaque (NCB) and calcified plaque (CB) burdens. Serum non-HDL-C levels and TG/HDL-C ratio were higher in the coronary atherosclerosis patient group. Serum non-HDL-C levels and the TG/HDL-C ratio were higher in the obstructive CAD patient group. The plaque burden was positively correlated with non-HDL-C (r = 0.30; p < 0.001), and TG/HDL-C ratio (r = 0.18; p < 0.001).  NCB was positively correlated with age, gender, smoking status, fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, serum triglycerides, hbA1c, non-HDL-C, and TG/HDL-C ratio. Non-HDL-C (β coefficient = 0.13; p = 0.023) and TG/HDL-C ratio (β = 0.10;  p = 0.042) were independent predictors of NCB. Serum non-HDL-C levels and TG/HDL-C were significantly associated with the presence and burden of coronary plaques. Serum non-HDL-C and TG/HDL-C ratios were independently associated with NCB, suggesting their use as easy-to-compute markers for identifying high-risk groups in young adults.

Background: The relation between body mass index (BMI) and coronary artery disease (CAD) extension remains controversial. A new score was developed to estimate body fat percentage (BFP) known as Relative Fat Mass (RFM) Index. This study aimed to evaluate the value of RFM Index in predicting the severity of the CAD, compared with other anthropometric measurements., Methods: A total of 325 patients with chronic CAD were investigated. RFM, BFP, BMI and other anthropometric characteristics of patients were measured before angiography. CAD severity was determined by SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial (SYNTAX) Score. The association between SYNTAX Score and variables was evaluated using linear regression models. In order to compare the model performance, R-squared (R 2 ), Akaike's information criterion, Bayesian information criterion and root mean square error were used., Results: Univariate linear regression outcome variable, SYNTAX was used to determine whether there was any relationship between variables. Independent variables were included in the multivariable linear logistic regression models. The analysis showed that in model 1, RFM (β coefficient: 2.31 (0.90 to 3.71), p=0.001)), diabetes mellitus (β coefficient: 3.72 (1.67 to 3.76), p=0.004)), haemoglobin (β coefficient: -2.12 (-3.70 to -0.53), p=0.03) and age (β coefficient: 1.83 (0.29 to 3.37), p=0.02)) were statistically significant. The adjusted R 2 values in model 1 were higher than model 2 (BFP) and model 3 (BMI) (0.155, 0.137 and 0.130, respectively), and χ 2 values of RFM were higher than BFP and BMI (10.5, 3.4 and 1.0, respectively)., Conclusion: RFM Index is a more reliable and compatible marker of obesity in showing the severity of CAD compared to BMI., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Contrast-induced acute kidney injury (CI-AKI) can occur after coronary interventions despite protective measures. We evaluated the effect of urinary system contrast blush grading for predicting post-procedure CI-AKI in 486 patients with chronic coronary artery disease. Patient characteristics and blood samples were collected. Urinary system contrast blush grade was recorded during the coronary angiography and interventions. Post-procedure third to fourth day blood samples were collected for diagnosis of CI-AKI. The median age of the patients was 61 years (53-70, interquartile range), and 194 (39.9%) participants were female. Contrast-induced acute kidney injury occurred in 78 (16%) patients. By comparing full and reduced models with the likelihood ratio test, it was observed that in the reduced model, factors such as age, diabetes mellitus, body weight-adapted contrast media (CM), hemoglobin, and urinary system blush were associated with CI-AKI presence. The probability of CI-AKI presence increased slightly from grade 0 to 1 blush, but it increased sharply grade from 1 to 2 blush. According to our results, an increase in body weight-adapted CM and urinary blush grading were the main predictors of CI-AKI. These findings suggest that when body weight-adapted CM ratio exceeds 3.5 mL/kg and urinary contrast blush reaches grade 2, the patients should be followed up more carefully for the development of CI-AKI.

Background: Malnutrition reflects the general condition of a patient including physical condition, protein turnover, and immune competence. Contrast-induced acute kidney injury (CI-AKI) is a disorder that adversely affects the prognosis of older adults. In our study, we aimed to show the relationship between CI-AKI and malnutrition status in elderly patients over 65 years of age with chronic coronary artery disease (CAD)., Methods: Study enrolled 360 consecutive patients with coronary angiography performed because of chronic coronary artery disease. Patients pre-procedural and post-procedural blood samples were taken and prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and geriatric nutritional risk index (GNRI) malnutrition scores were calculated., Results: The median age of the patients included in the study was 69 (67-72, IQR) and CI-AKI was seen in 91 (25.2%) patients. Univariate regression analysis showed that age, diabetes mellitus, baseline creatinine, body weight-adapted contrast agent, haemoglobin, left ventricular ejection fraction, CONUT score, PNI score, and GNRI score were independent predictors of CI-AKI. In model 1, increase in CONUT score (2 to 5) (OR: 3.21 (2.11-4.88), in model 2, increase in PNI score (37.4 to 45) (OR: 0.34, (0.24-0.49)), and in model 3, increase in GNRI score (89.5 to 103.8) (OR: 0.55, (0.38-0.81)) were independently associated with the presence of CI-AKI. PNI showed better results than other models in discriminating the predictable capability for CI-AKI., Conclusion: Malnutrition assessment of elderly patients before performing diagnostic or interventional coronary procedures could help clinicians to identify patients with elevated risk for CI-AKI., (© 2021 John Wiley & Sons Ltd.)

Objectives: Several studies demonstrate the relationship between coronary artery disease and inflammatory parameters. Nevertheless, there is paucity of data regarding the role of high sensitivity (hs)-C-reactive protein (CRP) to albumin ratio (CAR) in patients with ischemia on gated single photon emission tomography (SPECT) myocardial perfusion imaging (MPI). This study was aimed at demonstrating the relationship between CAR and the occurrence of ischemia on gated SPECT MPI., Methods: We retrospectively evaluated 2.048 referred patients for gated SPECT MPI from a cardiology outpatient clinic between October 2017 and June 2019. After applying exclusion criteria and measuring serum CRP and albumin levels, we included 126 patients in the study. We then classified subjects into different groups according to the absence or presence of ischemia on gated SPECT MPI., Results: According to laboratory findings, hs-CRP and CAR were significantly higher in the ischemia group, while the serum albumin was significantly lower in ischemia group (p<0.05 for each). The independent predictors of presence of ischemia in multivariate analysis were hypertension and CAR (CAR; odds ratio: 5.720, 95% confidence interval: 2.697-12.133, p<0.001). The optimal value of CAR for presence of ischemia was 0.96 with 76% sensitivity and 71% specificity., Conclusion: We found CAR values as a predictor for ischemia before MPI.

Tuberculosis-associated pericardial disorders are an excessively rare manifestation of extrapulmonary tuberculosis. The patients may present with constrictive pericarditis or pericardial fluid accumulation leading to cardiac tamponade. This paper reports a case of tuberculosis-associated pericardial effusion with dense fibrinous material not causing tamponade in a foreigner presenting with nonspecific symptoms. It also provides a discussion about the diagnostic and therapeutic methods as well as interesting echocardiographic images of the patient.

Aim: We investigated the association between platelet indices and the severity of coronary artery disease (CAD) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI)., Methods: A total of 484 consecutive patients who were routinely referred to coronary angiography for STEMI and 81 age- and gender-matched patients with normal coronary arteries were included in the present study. We analyzed the relation between the platelet distribution width (PDW) and the angiographic severity of CAD. The SYNTAX score was used for assessing the severity of coronary atherosclerosis., Results: The mean platelet volume (MPV), the plateletcrit (PCT) and the neutrophil levels were significantly higher in the STEMI group than in the control group. Patients with an elevated SYNTAX score (>32) had higher PDW values. The levels of plateletcrit and the estimated glomerular filtration rate (eGFR) were lower in the high SYNTAX score group compared to the moderate-to-low SYNTAX score group. The PDW was positively correlated with age (r = 0.128, p=0.004) and SYNTAX score (r = 0.209, p<0.001). There was a mild, significant inverse association between the PDW level and the eGFR (r = -0.101, p=0.049), the mean platelet volume (MPV) (r = -290, p<0.001) and the PCT (r = -345, p<001). Using multivariate logistic regression analysis, we found that age (OR = 1.046, 95% CI 1.013-1.079, p=0.005), diabetes (OR = 4.779, 95% CI 2.339-9.767, p<0.001) and PDW (OR = 1.229, 95% CI 1.072-1409, p=0.003) were independent correlates of high SYNTAX score., Conclusion: Platelet distribution width, an inexpensive and easily measurable laboratory variable, is independently associated with high SYNTAX score., (© The Author(s) 2015.)

We investigated the association between the preoperative logistic clinical syntax score (log CSS), saphenous vein graft (SVG) patency, and major adverse cardiac and cerebrovascular events (MACCEs) after coronary artery bypass surgery (CABG). Of 1875 patients undergoing isolated CABG between 2009 and 2011, 267 patients, who later underwent coronary angiography, were included in the study. The primary end point was at least 1 graft occlusion on the follow-up coronary angiogram. The secondary end point was a composite of MACCE. In multivariate analysis, log CSS was found as a strong predictor of SVG failure (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.46-0.94, P = .02; and OR: 2.21, 95% CI: 1.02-4.75, P = .04, respectively): log CSS was also associated with MACCE (P = .001 and P < .001, respectively). The addition of clinical parameters to the anatomical SYNTAX score, termed as "log CSS", augmented the accuracy and reliability of the prediction of SVG failure and MACCE in patients undergoing CABG., (© The Author(s) 2014.)

We hypothesized that contrast media volume-estimated glomerular filtration rate (CV-e-GFR) ratio may be a predictor of contrast media-induced acute kidney injury (CI-AKI). We investigated the associations between CV-e-GFR ratio and CI-AKI in 597 patients undergoing primary percutaneous coronary intervention (pPCI). An absolute ≥0.3 mg/dL increase in serum creatinine compared with baseline levels within 48 hours after the procedure was considered as CI-AKI; 78 (13.1%) of the 597 patients experienced CI-AKI. The amount of contrast during procedure was higher in the CI-AKI group than in those without CI-AKI (153 vs 135 mL, P = .003). The CV-e-GFR ratio was significantly higher in patients with CI-AKI than without (2.3 vs 1.5, P < .001). In multivariate analysis, independent predictors of CI-AKI were low left ventricular ejection fraction (P = .018, odds ratio [OR] = 0.966), e-GFR <60 mL/min (P = .012, OR = 2.558), and CV-e-GFR >2 (P < .001, OR = 5.917). In conclusion, CV-e-GFR ratio is significantly associated with CI-AKI after pPCI., (© The Author(s) 2014.)

Background and Aim: We investigated the utility of the preprocedural red cell distribution width (RDW) for predicting contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent a primary percutaneous coronary intervention., Materials and Methods: A total of 630 consecutive patients who were routinely referred to coronary angiography for STEMI were included in the present study., Results: CI-AKI was observed in 79 patients (12.5%). The RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the mean platelet volume were significantly higher in the CI-AKI group than in the non-CI-AKI group (P<0.001, P=032, P=0.025, and P=0.039, respectively). Serum total bilirubin and direct bilirubin levels were not different among the study groups. Using multivariate logistic regression analysis, we found that left ventricular ejection fraction [odds ratio (OR)=0.972, 95% confidence interval (CI) 0.945-0.998, P=0.033], estimated glomerular filtration rate (OR=0.970, 95% CI 0.959-0.981, P<0.001), contrast volume (OR=1.007, 95% CI 1.002-1.012, P=0.009), and RDW (OR=1.406, 95% CI 1.120-1.792, P=0.005) were independent predictors of CI-AKI., Conclusion: Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is associated independently with the development of CI-AKI. Our data suggest that RDW may be a useful marker in CI-AKI risk stratification.

Objective: The total burden of subclinical coronary atherosclerosis is significant in young adults. Serum lipoprotein-associated phospholipase A2 (Lp-PLA2) is an established predictor of morbidity and mortality because of cardiovascular disease. The aim of the present investigation was to evaluate the relationship between subclinical coronary atherosclerosis and serum Lp-PLA2 concentrations in a population of young adults., Patients and Methods: A total of 261 individuals younger than 45 years of age who had undergone coronary computed tomography angiography were evaluated. The study group included 101 patients in whom coronary computed tomography angiography detected subclinical coronary atherosclerosis; the control group included 160 sex-matched and age-matched healthy control patients., Results: Serum Lp-PLA2 levels were increased significantly in the study group patients compared with the control patients (15.42±11.88 vs. 8.06±4.32 ng/ml, P<0.001). Furthermore, a positive correlation was identified between the Lp-PLA2 levels and the total number of plaques and diseased arteries (r=0.495, P<0.001, and r=0.621, P<0.001, respectively). The presence of mixed plaque composition was also correlated with the Lp-PLA2 levels (r=0.657, P<0.001). Multivariate regression analysis identified four independently significant predictors of subclinical coronary atherosclerosis: high-sensitivity C-reactive protein levels, tobacco use, uric acid levels, and serum Lp-PLA2 levels., Conclusion: The presence of subclinical coronary atherosclerosis is associated independently with Lp-PLA2, and it has potential utility as a novel indicator of cardiovascular disease risk in the young adult population.

Background: Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality due to cardiovascular disease. The objective of the present study is to evaluate the relationship between coronary artery disease (CAD) and serum concentrations of FGF-23 and fetuin-A., Methods: A total of 383 subjects who underwent coronary computed tomography angiography (CCTA) were included in the study. CCTA detected CAD in 208 patients; the rest of the patients had no detectable CAD., Results: Serum FGF-23 and fetuin-A levels were significantly increased in CAD patients compared to non-CAD patients (26.6±21.1pg/mL vs. 17.9±16.1pg/mL, p=0.001 and 826±350mg/L vs. 595±300mg/L, p<0.001, respectively). Serum FGF-23, fetuin-A, low-density lipoprotein (LDL)-cholesterol, and uric acid values were elevated in non-diabetic patients with CAD when compared to those without CAD. FGF-23, and fetuin-A were not significantly different in diabetic patients with CAD when compared to those without CAD. Using multivariate logistic regression analysis, we found that age, hypertension, LDL-Cholesterol, high-density lipoprotein (HDL)-Cholesterol, hs-CRP, uric acid, FGF-23 and fetuin-A levels were independently associated with the presence of CAD., Conclusion: FGF-23 and fetuin-A were positively correlated with coronary atherosclerosis Similar trends were seen among diabetic patients, but this did not reach statistical significance. FGF-23 and fetuin-A could be used as novel risk markers of cardiovascular disease., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The total burden of subclinical coronary artery disease (CAD) is significant among young adults. Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality because of cardiovascular disease. The objective of the study was to evaluate the relationship between subclinical CAD and serum FGF-23 and fetuin-A concentrations among a population of young adults., Methods: A total of 241 subjects younger than 45 years who had undergone coronary computed tomographic angiography (CCTA) were included in the study. In 117 patients, the CCTA detected subclinical CAD; the rest of the patients had no CAD detected on CCTA., Results: Serum FGF-23 and fetuin-A levels were significantly increased in the CAD patients as compared with the non-CAD patients (26.7 [interquartile range, 22.4-31.9] vs 15.7 [interquartile range, 13.2-18.1] pg/mL and 904.7 [interquartile range, 695.5-1021.6] vs 469.6 [331.4-660.5] mg/L, respectively; P < 0.001 for both). Furthermore, a positive correlation was identified between FGF-23 and fetuin-A levels and the total number of plaques (r = 0.21 and r = 0.28, respectively; P < 0.001 for both). In multivariate logistic regression analysis, age, smoking status, uric acid, FGF-23, and fetuin-A levels were found to be independently associated with the presence of CAD., Conclusions: The presence of subclinical CAD is independently associated with FGF-23 and fetuin-A and could be used as novel risk markers of cardiovascular disease in the asymptomatic young adult population.