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Objective: Our aim was to evaluate the histopathological effects of tissue adhesives on peripheral nerve regeneration after experimental sciatic nerve transection in rats and to search whether these tissue adhesives may possess a therapeutic potential in peripheral nerve injuries., Methods: This experimental study was performed using 42 female Wistar-Albino rats distributed in 6 groups subsequent to transection of right sciatic nerves. Group I underwent external circumferential neurolysis; Group II received suture repair; Group III had local polymeric hydrogel based tissue adhesive administration; Group IV received suture repair and polymeric hydrogel based tissue adhesive application together; Group V had gelatin based tissue adhesive application and Group VI had suture repair and gelatin based tissue adhesive together. After a 6-week follow-up period, biopsies were obtained from site of neural injury and groups were compared with respect to histopathological scoring based on inflammatory, degenerative, necrotic and fibrotic changes., Results: There were remarkable differences between control group and study groups with respect to inflammation (p=0.001), degeneration (p=0.002), necrosis (p=0.007), fibrosis (p<0.001) and vascularity (p=0.001). Histopathological scores were similar between study groups and the only noteworthy difference was that Group V displayed a lower score for necrosis and higher score in terms of vascularization., Conclusion: Our results imply that tissue adhesives can be useful in repair of peripheral nerve injuries by decreasing the surgical trauma and shortening the duration of intervention. Results with gelatin based tissue adhesive are especially promising since more intense vascularity was observed in tissue after application. However, trials on larger series with longer durations of follow-up are essential for reaching more reliable conclusions.

Background: Oxidative stress as a significant factor in the development of diabetes induced neuropathic pain as well as the potential for prevention of this complication. Therefore, we hypothesized that locally administrated dobutamine, a beta-adrenoreceptor agonist, or esmolol, a beta-adrenoreceptor antagonist, can modulate the oxidative stress and ameliorate the diabetes induced neuropathic pain., Methods: Effects of locally (intraplantar) treated two pharmaceutical preparations used in clinical applications, dobutamine or esmolol, were investigated by measuring thermal latencies, mechanical thresholds and several oxidative stress parameters in streptozotocin (STZ) induced diabetic rats., Results: Diabetes induced hyperalgesia and allodynia more effectively relieved by dobutamine than esmolol. Anti-hypersensitive action of dobutamine continued through the experiment. Diabetes induced oxidative damage in the paw tissues since STZ rats showed significant increased malondialdehyde (MDA), nitric oxide (NO) and decreased superoxide dismutase (SOD), catalase (CAT), myeloperoxidase (MPO) in the paw. Dobutamine, but not esmolol, restored the tissue oxidative and nitrossive stress parameters to those observed in the non-diabetic rats., Conclusions: Findings suggest that diabetes-induced oxidative stress may be partially responsible for the development of diabetic neural complications. Amelioration of oxidative stress by locally treated dobutamine can be beneficial in diabetes induced neuropathic pain., (Copyright © 2015 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

Background: This study aimed to assess myocardial performance index (MPI) and arterial elasticity indices in asymptomatic patients with beta-thalassemia major without known heart disease and to determine relationship between these indices and parameters indicating iron load of body., Methods: The study included 55 asymptomatic beta-thalassemia patients (median age: 20 years (10 - 48 years)) without known history of heart disease and 40 age- and sex-matched healthy controls. MPI and arterial elasticity indices were determined by using standard two-dimensional and Doppler echocardiography. Data were analyzed by SPSS for Windows version 20.0 (SPSS Inc., Chicago, IL, USA)., Results: Left ventricular mass index (83.917 (50.62 - 144) and 68.37 (41.9 - 113.3)) and MPI (0.464 (0.33 - 0.68) and 0.431 (0.31 - 0.51)) were significantly higher in patients with beta-thalassemia when compared to control group (P < 0.001 and P = 0.006). Aortic elasticity indices were significantly higher while aortic strain and distensibility values were significantly lower in patients with beta-thalassemia compared to controls (all P values < 0.001). Positive correlations were detected between aortic stiffness index and platelet (r = 0.235; P = 0.019) and ferritin values (r = 0.328; P = 0.008). Presence of thalassemia (β = -0.729; P = 0.041) and higher platelet value (β = 0.235; P = 0.019) were significant determinants for increased aortic stiffness in linear regression analysis., Conclusion: Arterial elasticity indices and MPI are impaired in patients with beta-thalassemia major and these parameters may be used to predict cardiovascular complications in asymptomatic patients with beta-thalassemia major.

Introduction: Slow coronary flow (SCF) is a well-known angiographic finding; however, the pathophysiology of SCF remains only partially understood. In this study, we have examined the risk factors of slow coronary flow., Methods: Seventy patients with angiographically proven SCF were studied along with 60 control participants. Patients were divided into 2 groups based on the angiographic findings as with or without SCF. In both groups, clinical information was collected and laboratory parameters were measured and compared., Results: Patients with SCF had higher serum uric acid, creatinine and hemoglobin levels. They also more commonly had a history of smoking. On the other hand, C-reactive protein and hematologic parameters such as mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte (N/L) ratio did not differ significantly between the two groups. In the logistic regression analysis, only uric acid (odds ratio [OR]=1.583, 95% confidence interval [CI]=1.011-2.349, P=0.034) was found as an independent correlate of SCF., Conclusions: This study demonstrates that serum uric acid level is significantly correlated with SCF and may play a role in the development of the condition. These findings provide impetus for additional studies to confirm these results and treatment of SCF.

We aimed to investigate whether or not cardiotrophin-1 (CT-1) can be used as a predictor of sinus rhythm constancy in patients with atrial fibrillation (AF) converted to sinus rhythm. Thirty two patients with AF (48-78 years), without any structural heart disease were enrolled for the study. The control group consisted of 32, age and gender matched healthy persons. Measurements of CT-1 were made after transthoracic and transesophageal echocardiography prior to cardioversion (CV). Relapses of AF were investigated by monthly electrocardiograms (ECGs) and ambulatory ECGs at 1st, 3rd, and 6th month. At the end of 6th month, measurements of CT-1 were repeated. At the beginning patients with AF had increased CT-1 levels when compared to controls (0.94 ± 0.32 pg/mL vs. 0.30 ± 0.12 pg/mL, [p < 0.001]). At the end of follow-up of the 32 patients, 17 (53%) had AF relapse. Age, initial duration of AF, left ventricle diameters, ejection fraction, left atrium appendix flow rates were similar among patients with and without AF relapse. However, basal left atrium diameter (4.24 ± 0.14 cm vs. 4.04 ± 0.22 cm, p = 0.005), pulmonary artery pressure (32.82 ± 5 vs. 28.60 ± 6.23 mmHg, p = 0.004) and CT-1 values (1.08 ± 0.37 vs. 0.82 ± 0.16 pg/mL, p = 0.02) were significantly increased in patients with AF relapse. Furthermore, patients with relapsed AF had higher CT-1 levels at 6th month when compared to those in sinus rhythm (1.00 ± 0.40 vs. 0.71 ± 0.23 pg/mL). We conclude that post-CV, AF relapses are more frequent among patients with increased baseline CT-1 levels, and CT-1 may be a potential predictor of AF relapse.

Study Design: Oxidative/nitrosative stress in vertebral endplates of patients with low back pain and Modic changes (MCs) (types I, II, and III) endplate changes on magnetic resonance imaging., Objective: The aim of this study was to assess the levels of oxidative/nitrosative stress biomarkers in patients with MCs., Summary of Background Data: Degenerated discs and endplate abnormalities is postulated as a possible source of low back pain. Oxidative/nitrosative stress plays an important the role in various human diseases. However, the presence of oxidative/nitrosative stress has not been studied in patients with low back pain and endplate changes on magnetic resonance imaging., Methods: Patients with MCI, II, and III (n = 32) and age- and sex-matched controls subjects (n = 15) were enrolled in this study. Also, 3-nitrotyrosine (3-NT) and nitric oxide levels as nitrosative stress biomarkers were measured with enzyme-linked immunosorbent assay. Also, the activities of catalase (CAT) and superoxide dismutase (SOD), and the levels of malondialdehyde (MDA) as oxidative stress biomarkers were determined on spectrophotometer., Results: Oxidative/nitrosative stress was confirmed by the significant elevation in nitric oxide, 3-NT, MDA and decreased of CAT and SOD activities in MCI compared with other MCs and the control group (P < 0.05). The highest CAT and SOD activities were found in patients with MCII compared with the other MCs and the control group. However, the levels of nitric oxide, 3-NT, and MDA showed moderate increase in this group (P < 0.05). In addition, the levels of nitrosative stress biomarkers in patients with MCIII were approximated to the control values (P > 0.05). However, the levels of oxidative stress biomarkers in patients with MCIII were slightly higher than that of the control group (P < 0.05)., Conclusion: Our findings indicated that oxidative/nitrosative stress in patients with MCI may be aggravated as a result of oxidant/antioxidant imbalance and it may cause formation of the lesion in these patients. However, the increased antioxidant activities and MDA, 3-NT levels in patients with MCII and MCIII may be an adaptative response to against oxidative/nitrosative stress., Level of Evidence: 4.

Purpose: Clinical chronic neuropathic pain is often resistant to currently used pharmacotherapeutic applications. A number studies have shown that pulsed magnetic field (PMF) application may ameliorate the pain associated with damages, surgeries or diseases. However, possible potential mechanisms of PMF treatments have not been well documented. This study aimed to assess the therapeutic effects of PMF treatment on a Chronic Constriction Injury model (CCI) which mimics clinical chronic neuropathic pain symptoms., Materials and Methods: Effects of PMF treatments or sham PMF (SPMF) were investigated by measuring the latencies, thresholds and cytokine levels (interleukin [IL]-1 beta, IL-6 and IL-10) of sciatic nerve in CCI or sham surgery rats. PMF was treated on CCI rats before (a day after surgery, PMF-AD) and after (a week after surgery, PMF-AW) the development of pain signs., Results: Rats exhibited hyperalgesia and allodynia within one week following surgery, and lasted through the experiment. PMF treatments, but not SPMF, significantly enhanced the latency and threshold. Both anti-hyperalgesic and anti-allodynic actions of PMF-AD were greater than those of PMF-AW treatment. Similarly, PMF-AD had more pronounced effects on the level of pro- and anti-inflammatory cytokines than did PMF-AW., Conclusions: The present findings may suggest that PMF treatment may reverse the CCI-induced changes in neuropathic pain behaviors by decreasing the production of pro-inflammatory cytokines and increasing the anti-inflammatory cytokine production at the site of injury.

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.

Introduction: The aims of this study were to determine the severity of cognitive impairment with Brief Repeatable Battery Neuropsychology (BRB-N) and to show the benefits of cognitive rehabilitation programs to develop coping strategies for the retardation of cognitive losses in relapsing remitting multiple sclerosis (RRMS) patients., Methods: The cognitive screening with BRB-N was performed in RRMS patients who had applied to the MS outpatient clinic of Bakırköy Psychiatric and Neurological Diseases Hospital, had an Expanded Disability Status Scale (EDSS) score between 1.0 and 5.5, and had no other cognitive disease or used drugs that effected the cognitive status. Thirty two patients with cognitive impairment underwent consecutive computer-assisted cognitive rehabilitation program once a week for 8 weeks conducted by psychologists. The effects of the program were evaluated with the tests repeated every 4 weeks., Results: The mean age of the patients was 36.09±7.19 years. Their initial and control test scores were found to be paced auditory serial addition test (PASAT) 29.21±17.97; 42.43±15.43, Selective Reminding Test-Total Learning (SRT-TL) 8.03±2.36; 10.09±1.77, Selective Reminding Test-Long-term Memory (SRT-DR) 6.72±2.74; 9±2.29, Spatial Recall Test-Total Learning (SPART-TL) 4.72±2.02; 4.22±1.74, Spatial Recall Test-Long-term Memory (SPART-DR) 5.94±2.54; 5.16±2.23, Symbol Digit Modalities Test (SDMT) 40.44±17.04; 46.47±17.94, Word Fluency Test (WLG) 32.88±9.87; 40.44±9.95 respectively. There was no significant statistical difference between Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) and SPART values of preface, 1 st control and 2 nd control (p>0.05). There was significant statistical difference between PASAT, WLG, SDMT, SRT-TL, SRT-DR values of Preface, 1 st control, and 2 nd control (p=0.0001)., Conclusion: It was determined that on distinctive improvement on sustaining attention, working memory and information processing speed, and verbal fluency and verbal learning with cognitive rehabilitation, no changes were observed on visuospatial learning. This approach is hopeful and further comprehensive studies are needed., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

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.

Objectives: This study aims to investigate any impact of nasal septal deviations on cardiac arrhythmias and heart rates by performing 24-hour rhythm Holter analysis before and after septoplasty accompanied by Nasal Obstruction Symptom Evaluation (NOSE) scale., Patients and Methods: The study included 21 male patients (mean age 33 years; range 18 to 55 years) who underwent septoplasty between September 2013 and August 2014. Patients were performed 24-hour rhythm Holter electrocardiography analysis preoperatively and at postoperative third month. Supraventricular and ventricular extrasystoles were recorded pre- and postoperatively. Operation efficiency was measured with NOSE scale., Results: Of the 21 patients, ventricular and supraventricular extrasystoles were observed in seven patients (33%) in the preoperative period. Mean age of patients with arrhythmia (mean age 51 years; range 18 to 55 years) was statistically significant higher compared to patients without arrhythmia (mean age 30 years; range 23 to 55 years) (p=0.012). Extrasystoles decreased in seven patients in the postoperative period. Average, minimum, and maximum heart rates did not change statistically significant in the postoperative period., Conclusion: The fact that septoplasty decreased arrhythmias indicates that nasal septum deviations may be associated with cardiac arrhythmias. Septoplasty had no effect on heart rates. Performing septoplasty in the early period may prevent future cardiac complications in indicated patients.

Giant hiatal hernias, generally seen at advanced ages, can rarely cause cardiac symptoms such as dyspnea and chest pain. Here, we aimed to present a case with a large hiatal hernia that largely protruded to intrathoracic cavity and caused dyspnea, particularly at postprandial period, by compressing the left atrium and right pulmonary vein. We considered presenting this case as large hiatal hernia is a rare, intra-abdominal cause of dyspnea.

Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive condition with the right ventricular myocardium being replaced by fibrofatty tissue. It is a hereditary disorder mostly caused by desmosome gene mutations. The prevalence of arrhythmogenic right ventricular cardiomyopathy is about 1/1000-5000. Clinical presentation is usually related to ventricular tachycardias, syncope, presyncope or ventricular fibrillation leading to cardiac arrest, mostly in young people and athletes. We report a case of a 17-year-old boy from Turkey, who was referred to our cardiology department for an ECG, required of him prior to joining a football team., (2014 BMJ Publishing Group Ltd.)

We evaluated the association between estimated glomerular filtration rate (eGFR) and slow coronary flow (SCF) in patients with normal to mildly impaired renal function; 211 patients with angiographically proven SCF and 219 controls were studied. Patients were categorized based on the angiographic findings as with or without SCF. We used the Modification of Diet in Renal Disease equation to calculate eGFR. The frequency of mildly decreased eGFR, serum uric acid levels, and eGFR was higher in the SCF group. Patients with mildly impaired renal function had higher thrombolysis in myocardial infarction frame counts in 3 major coronary arteries. In logistic regression analysis, uric acid (odds ratio [OR] = 1.323, 95% confidence interval [CI] = 1.109-1.572, P = .002) and eGFR (OR = 0.972, 95% CI = 0.957-0.987, P < .001) were independent correlates of SCF. In conclusion, eGFR was significantly correlated with SCF in patients with normal to mildly impaired renal function., (© The Author(s) 2014.)

Background: Accumulating evidence suggests that inflammatory mechanisms play a central role in the development, progression and outcome of atherosclerosis. Recent evidence suggests that statins improve anti-inflammatory, anti-thrombotic and endothelial functions, along with their lipid-decreasing effects. We examined the effect of statins on endothelial function using biochemical markers of endothelial dysfunction and brachial artery flow-mediated dilatation (FMD)., Methods: Thirty male patients presenting with acute coronary syndrome (ACS) and 26 age-matched healthy control subjects aged 40 - 60 years who were not on any medication were enrolled in the study. The patient group was started on atorvastatin (40 mg/day) without consideration of their low-density lipoprotein (LDL)-cholesterol levels. Endothelin, sICAM and E-selectin from stored serum samples were measured using commercially available enzyme-linked immunosorbant assays (ELISAs). Endothelial function was assessed using brachial artery FMD., Results: Prior to statin treatment, E-selectin, sICAM and endothelin levels, endothelial dysfunction markers, were 99.74 ± 34.67 ng/mL, 568.8 ± 149.0 ng/mL and 0.62 ± 0.33 fmol/mL, respectively in the patient group. E-selectin and sICAM levels were significantly higher in the patients than in the control subjects (P < 0.001); however, endothelin levels were not significantly different between groups. Statin treatment significantly reduced E-selectin and sICAM levels (P < 0.001); however, the decrease in endothelin levels was not statistically significant. %FMD values were significantly increased after statin treatment (P = 0.005), and levels of C-reactive protein (CRP), an inflammation marker, were significantly reduced., Conclusion: Our results indicate that statins play an important role in treatment endothelial dysfunction by reducing adhesion of inflammatory cells.

Background: Health professionals and their medical equipment have long been known to act as vectors of infectious diseases. The aim of the present study was to evaluate the role of pens used by nursing students working in clinics in relation to transmission of bacteria., Materials and Methods: The study was conducted in Sakarya University School of Health Sciences in March 2012, with the voluntary participation of 40 third-grade nursing students during their clinical practice. In total, 40 writing items were surveyed., Results: Twenty-two (55%) of the students were doing their clinical practice at pediatrics department and 18 (45%) were at obstetrics and gynecology department. All the samples consisted of pens and bacterial contamination was observed in 5 (12.5%) of them. The microorganisms identified were: 1 (2.5%) sample was Staphylococcus hominis, 2 (5%) were Staphylococcus epidermidis, 1 (2.5%) was Staphylococcus haemolyticus, and 1 (2.5%) was Staphylococcus warneri., Conclusion: This study highlights the risks of nosocomial infections, especially in pediatric units, if not enough attention is paid to the cleanliness of the pens used in the clinics.

Background: To explore Turkish parents' practices in childhood fever management., Methods: A cross-sectional study with 205 randomly selected Turkish parents of febrile children 6-months to 5-years from the paediatric hospital and two family health centres in Sakarya, Turkey in 2009. Data explored general fever management practices on the 8-item Parents' Fever Management Scale - Turkish version (5-point Liket scale; 1=never to 5=always) and socio-demographics., Results: Parents wanted to know their child's temperature (61.5%), took temperatures (60%), slept in the same room (58.5%) and sought medical advice (53.7%). Non-evidence-based-practices included over-the-counter medications (42.4%); waking children during the night for fever reducing medication (33.2%). Evidence-based-practice ensured febrile children had plenty to drink (30.2%) and febrile children were checked during the night (59%)., Conclusions: Parents' reports indicate high levels of concern about fever, overuse of over-the-counter medications and health services. Practices increase parents' burden of care, are disruptive of family life and lead to parental fatigue. The study confirms the appropriateness and applicability of the fever management instrument, a simple tool to incorporate into assessment of febrile children, in identifying Turkish parents' fever management practice., (Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.)

Retrograde coronary aortic dissection is a rare but dangerous complication of coronary angioplasty. Mostly seen in right coronary artery procedures, especially in chronic total oclussion lesions, and rarely seen in left side procedures. This is a case report of an aortic dissection complicated by coronary angioplasty of the left circumflex artery. Immediate stenting of the left main coronary artery successfully sealed the entry point of dissection and stabilized the patient.

Objective: The prevalence of chronic heart failure (CHF) in the elderly population is growing. Identification of risk factors in patients with CHF is important. Recent studies suggest that red cell distribution width (RDW) has prognostic significance in these patients. We aimed to evaluate the relationship of RDW with clinical and laboratory parameters in patients with young and elderly CHF patients., Methods: We evaluated patients with CHF with an ejection fraction (EF) of <50% in this observational cross-sectional study. Exclusion criteria were decompensated CHF, malignancy and end-stage renal disease. Clinical information, functional capacity (FC), hemoglobin, RDW, EF, and pro-B type natriuretic peptide (proBNP) were recorded. The younger and elderly groups were compared and correlation of RDW with clinical and laboratory parameters were analyzed in each group. Ordinal regression analysis was performed to determine independent correlates of increased FC., Results: Seventy young and 47 elderly cases were enrolled. The groups were similar regarding EF, proBNP and FC. RDW showed stronger correlation with FC in the young group (r=0.627, p<0.001) compared to the elderly group (r=0.332, p=0.023). In the younger group, there was a negative correlation between RDW and EF (r=-0.278, p=0.021) and a positive correlation between RDW and proBNP (r=0.487, p<0.001). RDW (OR=16.36, 95% CI 0.33-0.96, p<0.001), EF [OR=7.75, 95% CI (-0.16)-(-0.03), p=0.005] and usage of RAS inhibitors (OR=6.7, 95% CI 0.57-3.36, p=0.007) were independent predictors of increased FC., Conclusion: We found a stronger correlation between RDW and EF, proBNP and FC in the younger patients compared the elderly group. RDW is a simple, inexpensive and easily accessible parameter that may be considered risk predictor especially in younger patients with CHF.

The aim of this study was to investigate the effect of end-stage renal disease (ESRD) and diabetes mellitus (DM) on the number of stem cells in the peripheral blood. Sixty-two patients diagnosed with ESRD who had not received dialysis previously, 25 patients with a diagnosis of DM without nephropathy, and 21 healthy volunteers were included in the study. The group diagnosed with ESRD was divided into two groups. The first group (DM-CRD) consisted of 28 patients with DM who had developed chronic renal disease (CRD). The second group (NON-DM-CRD) consisted of 34 patients without DM who had CRD by etiology. The routine complete blood count, renal function, and number of CD34+ cells were determined for all of those involved in the study. The microalbumin/creatinine levels were measured, and glomerular filtration rates were calculated in all patients. The number of CD34+ cells was found to be significantly lower in the DM control group and DM-CRD group compared with the healthy group. No statistically significant difference was found between the NON-DM-CRD and the healthy control group. There was a moderate negative correlation between the ratio of microalbumin/creatinine and the number of CD34+ cells. A significant reduction in the number of CD34+ cells was shown in subjects with DM and ESRD caused by diabetic nephropathy.

Objective: To identify university students' hygiene behaviour using a hygiene behaviour inventory in a Turkish sample., Methods: The cross-sectional study was conducted with 353 randomly selected university students aged 17-24 years in Kocaeli, Turkey. Data were collected in December 2009 using a socio-demographic form and the Turkish version of the Hygiene Behaviour Inventory-23. SPSS 15 was used for statistical analysis., Results: The mean score was 3.08 +/- 0.94; ranging from 1.91 +/- 0.85 to 3.77 +/- 0.52. Of the students, 290 (82.2%) always washed their hands when soap was available; 266 (75.4%) had cleaned their toilets three times or more in the preceding month; 260 (73.7%) always washed their hands after touching a pet or some animal; 260 (73.7%) always washed their hand before preparing food; 256 (72.5%) always washed fruits and vegetables before eating them; 227 (64.3%) always covered the seat with paper while using a public toilet; 244 (69.1%) had always cleaned their bathroom at home three times or more in the preceding month; and 183 (51.8%) of the students always washed their hands before eating food with their hands., Conclusions: Community-based awareness and education plans must initiated to improve regular hygiene practices at the level of university students in Turkey.

Objective: The purpose of this study was to assess the utility of diffusion-weighted and quantitative chemical-shift magnetic resonance imaging in the differentiation of adrenal adenomas and metastases., Methods: One hundred eight patients (45 men and 63 women; mean age, 57 years) with 126 adrenal masses were prospectively evaluated by magnetic resonance imaging in this study. Signal intensity and apparent diffusion coefficient (ADC) measurements were performed on axial in- and opposed-phase T1-weighted gradient-echo images and on diffusion-weighted images, respectively. Adrenal signal intensity index (ASII), adrenal-to-spleen chemical-shift ratio (ASR), and ADC values were assessed separately. The threshold values of more than 16.5% for ASII and less than 0.71 for ASR were regarded as highly suggestive of adenoma diagnosis. We also investigated whether a cutoff value for ADC could be found in distinguishing adenomas from metastases. Final diagnoses of adrenal lesions were based on follow-up imaging, histopathologic proof, and adrenal washout study. Apparent diffusion coefficient values of adenomas and metastases were compared by using the Student t test, and ASII and ASR values of the lesions were compared by using the Mann-Whitney U test, and a P < 0.05 was accepted as statistically significant. Receiver operating characteristic curve analysis and sensitivity, specificity, positive and negative predictive values, and overall accuracies were calculated., Results: Final analysis yielded 96 adenomas and 30 metastases. With the commonly used 16.5% threshold value for ASII, we obtained a 94.8% sensitivity, 93.3% specificity, 84.8% positive predictive value, and 97.8% negative predictive value. The overall accuracy was found as 94.4%. When we applied a 0.71 threshold value for ASR, it yielded a 91.7% sensitivity, 100% specificity, 78.9% positive predictive value, and a 100% negative predictive value. The overall accuracy was 93.6%. The mean ADC values were found to be 1.35 ± 0.19 × 10⁻³ mm²/s and 1.32 ± 0.34 × 10⁻³ mm²/s for adenomas and metastases, respectively. The difference between the groups with these ADC values was not statistically significant (P = 0.673). The receiver operating characteristic analysis could not determine a clear cutoff value for the differentiation of adenomas from metastases., Conclusions: We can advocate that a chemical-shift magnetic resonance imaging using quantitative parameters (ie, ASII and ASR formulas) has an important role in the distinction of adenomas from metastases. These 2 techniques seem to provide close sensitivity, specificity, and accuracy levels. But diffusion-weighted imaging using quantitative ADC measurements is not of value in this differential diagnosis because of the substantial overlapping of ADC values between adenomas and metastases.

Background: Sleep problems among university students are common; however, the contributing factors to poor sleep experiences are still unclear. The purpose of this study is to examine the contributing factors to poor sleep experiences in university students., Materials and Methods: The study was cross-sectional, and the students completed self-report, anonymous questionnaires provided during an in-class survey. This is a single center study. A descriptive survey was conducted randomly on 256 university students in Turkey. The instruments for data collection consisted of the demographic data, and the contributing factors to poor sleep., Results: The most frequent self-reported cause to poor sleep experiences in according to the university students were exposure psychological problems (67.2%), stress (64.8%), exposure to tobacco smoke in the sleeping room (63,7%), pain (62,9%), having family problems (62,5%), being patient (55,1%), air quality of the room (55,1%), strenuous physical activity (53,9%), fatigue (53,5%), sadness (53,1%), noise that caused by other people in the room (52.0%), room scents (sweat, perfume, humidity, naphthalene, etc.) (53.1%), depression (51, 6 %), anxiety, and tension (51, 1%)., Conclusion: Students should be encouraged to solve psychological problems, to suitable stress-relieving measures, to follow sleep hygiene practice and adequate time management for academic and social activities.

Background: Endothelial dysfunction (ED) is a key event in the development of atherosclerotic cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Association of hyperuricemia with CVD has been previously reported in the nonuremic population. In this prospective study, we aimed to evaluate the effects of treatment of hyperuricemia with allopurinol on ED and changes in the serum reactive oxygen species in patients with CKD., Methods: In this study, 19 (13 male) hyperuricemic (UA > 7 mg/dl) nondiabetic CKD patients without any comorbidity, aged < 60 years with creatinine clearance (CrCl) between 20 and 60 ml/min were evaluated. Endothelial functions were assessed by ischemia-induced forearm vasodilatation method (EDD). Oxidative stress was evaluated by measuring the serum oxidized LDL (ox-LDL), advanced oxidation protein products (AOPP) and nitrotyrosine (NT) levels. After measuring all these tests at baseline, allopurinol therapy was commenced for 8 weeks. After 8 weeks of allopurinol treatment, all measurements were repeated. Then, allopurinol treatment was ceased and same measurements were also repeated 8 weeks after ceasing of the treatment., Results: Serum creatinine, total cholesterol, albumin, hs-CRP, CrCl and proteinuria levels of the patients were similar among three study periods. After allopurinol therapy, the mean serum UA and NT levels significantly reduced as compared to baseline. At the 8th week after cessation of allopurinol treatment, serum UA levels were significantly increased. After allopurinol therapy, EDD value increased from 5.42 ± 8.3% at baseline to 11.37 ± 9% (p < 0.001). At the 8th week after ceasing allopurinol treatment, EDD returned to baseline values (5.96 ± 8%, p < 0.001)., Conclusion: Treatment of hyperuricemia with allopurinol improve ED in patients with CKD. However, mechanism responsible for this beneficial effect seems to be apart from antioxidant effects of allopurinol.

Background: Hereditary angioedema is associated either with a deficiency in the amount or in the function of the C1 inhibitor (C1 INH)., Objective: In this study the endothelial function of HAE patients was investigated to evaluate the impact of hereditary C1-INH deficiency on atherosclerosis, which has not yet been established before., Methods: A total of 26 patients (14 female, 12 male. Mean age: 38±13) diagnosed with HAE and 30 healthy controls were enrolled in the study. Measurement of coronary flow reserve (CFR) in the left anterior descending coronary artery was performed using transthoracic doppler harmonic echocardiography at baseline and following dipyridamol infusion. The intima-media thickness (IMT) in the carotid artery was measured using an echocardiographic system equipped with 10 MHz linear transducer (Vingmed System Five)., Results: The mean CFR value for the HAE patient group was significantly lower than that of the control group (p<0.001). The mean IMT was not found to be significantly different between the two groups, although it was slightly higher in the HAE patient group. No correlation was found between the CFR and the disease severity scores, nor was it shown between the CFR values and the duration of danazol treatment., Conclusion: Our results indicate that there is a microvascular endothelial dysfunction in HAE patients. Although carotid intima media thickness of these patients was not significantly increased, the presence of microvascular endothelial dysfunction might be regarded as an early indicator of a premature atherosclerosis., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: The objective of this study was to determine if a structured workshop on knowledge and management of pressure ulcers (PrUs) for nurses led to an improvement of knowledge in the participants., Methods: Nurses attended an interactive lecture-based workshop on knowledge and management of PrUs. After the participants were invited into the study, they were asked to take a test consisting of multiple-choice questions (MCQs) about the subjects covered in the presentation. The MCQ test was repeated after the teaching session to determine the participants' knowledge and practical skills., Results: Twenty-eight nurses participated in the workshop. The MCQ test consisted of 21 questions. When the scores of the control test were compared with the scores after teaching, a substantial and statistically significant development was observed (mean, 11.1 [SD, 2.1], and mean, 14.6 [SD, 0.9] on 21 items, before and after teaching, respectively, P < .001)., Conclusion: A lecture-based workshop on knowledge and management of PrUs helps improve nurses' knowledge and allows them to overcome training deficiencies.

Where pulmonary veins drain and their relationship with an atrial septal defect (ASD) are important. A sinus venosus (high venosum) type of defect is the most common pathology accompanying partial anomalous pulmonary venous connection. Typically, the right superior pulmonary vein and occasionally the middle pulmonary vein drain into the junction of the superior vena cava (SVC) and the right atrium (RA), and a sinus venosus type of ASD usually accompanies these anomalies. In this report, we assess a very rare pathology in which 3 right pulmonary veins (superior, middle, and inferior) drain into the SVC-RA junction with respect to diagnostic methods and in the light of 2 cases involving patients in 2 different age groups.