Search

Background: In this systematic review, we aimed to examine the risk factors and surgical outcomes of gastrointestinal complications using the meta-analysis techniques. Methods: Studies involving patients with and without gastrointestinal complications after cardiac surgery were electronically searched using the PubMed database, Cochrane Library and Scopus database, between January 2000 and May 2022. Some studies on gastrointestinal complications examined only single gastrointestinal complication (only intestinal ischemia, only gastrointestinal bleeding or only liver failure). Studies evaluating at least three different gastrointestinal complications were included in the meta-analysis to reduce the heterogeneity. Cohort series that did not compare outcomes of patients with and without gastrointestinal complications, studies conducted in a country"s health system databases, review articles, small case series ( Results: Twenty-five studies (8 prospective and 17 retrospective) with 116,105 patients were included in the meta-analysis. The pooled incidence of gastrointestinal complications was 2.51%. Patients with gastrointestinal complications were older (mean difference [MD]=4.88 [95% confidence interval [CI]: 2.85-6.92]; p Conclusion: The development of gastrointestinal complications after cardiac surgery is more commonly seen in patients with comorbidities. In-hospital mortality after cardiac surgery is 11.8 times higher in patients with gastrointestinal complications than in patients without.

Aim: The gold standard repair of thoracoabdominal aortic aneurysm (TAAA) is still open surgery. However, few cardiovascular centers are experienced in TAAA repair. The aim of this study was to examine the methods and four-year outcomes of the open TAAA repair program initiated by a single surgical team. Material and Methods: In this retrospective cohort, patients who were operated for TAAA between August 2018 and March 2022 were collected. Patients treated with the endovascular approach were excluded. After exclusion, 19 patients were included in our analysis. As postoperative outcomes, in-hospital mortality, spinal cord deficit, major neurologic complications, need for dialysis, and visceral ischemia were collected. Results: Crawford extent II TAAA repair was performed in 10 (52.6%) patients, Crawford extent III in 5 (26.3%) patients, and Crawford extent IV in 4 (21.1%) patients. In hospital mortality occurred in 6 (31.6%) patients. The causes of mortality were perioperative myocardial infarction in 2 (10.5%) patients, visceral ischemia in 1 (5.3%) patient, multisystem organ failure in 3 (15.8%) patients. The highest mortality rate (50.0%) occurred in Crawford extent II repair. Spinal cord deficit developed in 2 (10.5%) patients. Conclusion: Thoracoabdominal aortic aneurysm surgery is associated with high mortality rates. Open thoracoabdominal aortic aneurysm repair programs in tertiary vascular centers should be supported, to improve the surgical results of thoracoabdominal aortic aneurysm repair.

In this study, we aimed to investigate the prognostic value of C-reactive protein (CRP) to albumin ratio (CAR) for predicting restenosis in superficial femoral artery (SFA) lesions and its association with subsequent clinical outcomes in patients undergoing endovascular intervention.The records of 685 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into 2 groups, based on the CAR values. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed.According to our study, patients with high CAR values had higher rates of restenosis (30.2% vs. 10.3%, P 0.05) and mortality (31.3% vs. 12.9%, P 0.05). The rate of lower extremity amputations was also significantly higher in patients with high CAR values compared to those with low CAR values (9.1% vs. 3%, P 0.05). With respect to Receiver operating characteristic ROC curves of inflammatory markers, the area under the curve (AUC) value of CAR was statistically significant (AUC: 0.659; 95% confidence interval CI: 0.611-0.706; P 0.01).Our data showed that CAR is an independent predictor of restenosis and poor clinical outcomes in patients undergoing endovascular intervention.

Lower extremity hypoperfusion occurs in 5.7-30% of Stanford type B aortic dissection cases. A 53-year-old male patient presented with type B aortic dissection. His left femoral pulse was not palpable. The proximal left common iliac artery was nearly occluded in computed tomography angiography. There was no extremitythreatening rest pain, but there was intermittent claudication at 100 meters. Cross femoral bypass was planned for the patient under elective conditions. After two months, the left femoral pulse was palpable, and the patient no longer had intermittent claudication. In this study, we report that lower extremity hypoperfusion, which developed after acute type B aortic dissection resolved without open and endovascular surgery.

Using the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) ratio as an index of right ventricular load adaptability, we aimed to evaluate early changes in right heart contractile function of patients with group 1 pulmonary artery hypertension (PAH) after sequential combination PAH-specific therapy.A total of 49 patients with group 1 PAH and 31 control participants were included in the study. The baseline clinical and echocardiographic data of the control and PAH group were compared. Subsequently, clinical and echocardiographic data of PAH patients before treatment and at 6 months after PAH-specific treatment were analyzed.A significant increase in the TAPSE/PASP ratio was found in patients at 6 months of PAH-specific treatment (0.25 ± 0.14; 0.33 ± 0.16, p 0.001). Right atrial pressure (8 mm Hg [5-10]; 5 mm Hg [3-8], p 0.001) and PASP (80.8 ± 30.6 mm Hg; 65.9 ± 25.7 mm Hg, p 0.001) were significantly lower after sequential combination PAH-specific therapy. Negative correlations were found between the TAPSE/PASP ratio and N‑terminal pro-B-type natriuretic peptide (r = -0.524, p 0.001), tricuspid regurgitation velocity (r = -0.749, p 0.001), right atrial area (r = -0.298, p = 0.037), and right atrial pressure (r = -0.463, p = 0.001).In patients with group 1 PAH, echocardiographic evaluation at the early stage of treatment (6 months) shows a significant improvement in the TAPSE/PASP ratio indicating right ventricular load adaptation. Comprehensive studies are needed on the routine use of the TAPSE/PASP ratio in the risk assessment of PAH patients.HINTERGRUND: Ziel der Arbeit war es, mit der Verwendung des Quotienten (TAPSE/PASP) der systolischen Exkursion der Trikuspidalringebene (TAPSE) zum pulmonalarteriellen systolischen Druck (PASP) – als Index für die rechtsventrikuläre Anpassungsfähigkeit an die Herzlast – früh auftretende Veränderungen der kontraktilen Funktion des rechten Herzens bei Betroffenen mit pulmonalarterieller Hypertonie (PAH) der Gruppe 1 nach sequenzieller PAH-spezifischer Kombinationstherapie zu beurteilen.In die vorliegende Studie wurden 49 Betroffene mit PAH der Gruppe 1 und 31 Teilnehmende als Kontrollen einbezogen. Dabei wurden die klinischen und echokardiographischen Ausgangsdaten der Kontroll- und der PAH-Gruppe verglichen. Anschließend wurden die klinischen und echokardiographischen Daten der PAH-Betroffenen vor der Behandlung und 6 Monate nach PAH-spezifischer Therapie ausgewertet.Bei PAH-Betroffenen fand sich beim Follow-up nach 6 Monaten ein signifikanter Anstieg beim TAPSE/PASP-Quotienten (0,25 ± 0,14; 0,33 ± 0,16; p 0,001). Der rechtsatriale Druck (8 mm Hg [5–10]; 5 mm Hg [3–8]; p 0,001) und PASP (80,8 ± 30,6 mm Hg; 65,9 ± 25,7 mm Hg; p 0,001) waren nach sequenzieller PAH-spezifischer Kombinationstherapie signifikant niedriger. Negative Korrelationen wurden festgestellt zwischen dem TAPSE/PASP-Quotienten und dem „N-terminal pro-B-type natriuretic peptide“ (NT-proBNP; r = −0,524; p 0,001), der trikuspidalen Regurgitationsgeschwindigkeit (r = −0,749; p 0,001), der rechtsatrialen Fläche (r = −0,298; p = 0,037) und dem rechtsatrialen Druck (r = −0,463; p = 0,001).Bei Betroffenen mit PAH der Gruppe 1 war bei der echokardiographischen Beurteilung in einem frühen Behandlungsstadium (nach 6 Monaten) eine signifikante Verbesserung des TAPSE/PASP-Quotienten festzustellen, was ein Zeichen einer rechtsventrikulären Anpassung an die Herzlast darstellt. Vergleichende Studien sind erforderlich, um den Routineeinsatz des TAPSE/PASP-Quotienten in der Risikoabschätzung von PAH-Betroffenen zu beurteilen.

SUMMARY BACKGROUND: Percutaneous mitral balloon valvuloplasty and mitral valve replacement have been the treatment options for mitral stenosis for several years, however, studies that compare these two modalities are very rare in the literature. ObjectIve: In this article, we aim to investigate the comparison of clinical results of percutaneous mitral balloon valvuloplasty and mitral valve replacement. Methods: 527 patients with rheumatic mitral stenosis, treated with percutaneous mitral balloon valvuloplasty or mitral valve replacement (276 patients with percutaneous mitral balloon valvuloplasty and 251 patients with mitral valve replacement) from 1991 to 2012 were evaluated. The demographic characteristics, clinical, echocardiographic and catheterization data of patients were evaluated retrospectively. The results of early and late clinical follow-up of patients after percutaneous mitral balloon valvuloplasty and mitral valve replacement were also evaluated. Results: The mean follow-up time of the percutaneous mitral balloon valvuloplasty group was 4.7 years and, for the mitral valve replacement-group, it was 5.45 years. The hospital stay of the percutaneous mitral balloon valvuloplasty group was shorter than that of the mitral valve replacement group (2.02 days vs 10.62 days, p

Objectives C-reactive protein to albumin ratio (CAR) and prognostic nutritional index (PNI) are novel parameters with proven prognostic importance in the postoperative outcomes of coronary and peripheral vascular diseases. In this study, we aimed to evaluate the ability of CAR and PNI to predict major cardiac and cerebrovascular events (MACCE) during the postoperative period of Carotid artery endarterectomy (CEA). Methods A total of 505 carotid endarterectomy patients were retrospectively evaluated. Of 505 patients, 23 patients who died and who experienced myocardial infarction or major neurologic complication in the first 30 days after the operation were included in MACCE group (Group 1). The remaining 482 patients were included in Group 2. Receiver operating characteristics (ROC) curve analysis was used to evaluate preoperative serum albumin value, lymphocytes count, PNI, and CAR to predict the MACCE. The DeLong test was used to compare the area below the curve (AUC) with each of these parameters. Results CAR (2.48 ± 1.82 and 1.64 ± 1.37) and CRP (9.98 ± 7.42 and 6.81 ± 5.70) values are statistically higher in Group 1 than in Group 2. PNI (41.59 ± 3.11 and 43.54 ± 4.20) and albumin (40.43 ± 3.15 and 42.35 ± 4.15) values were significantly lower in Group 1 than in Group 2. The accuracy of albumin (AUC: 0.669) in the prediction of MACCE was found to be the highest among CAR (AUC: 0.631), PNI (AUC:0.667), and CRP (AUC:0.631). Conclusion Preoperative nutritional and inflammatory status is significantly associated with post-operative outcomes. PNI and CAR can be used for preoperative evaluation, as CEA is recommended for patients who have low possibility of having postoperative major adverse events.

Stanford type A aortic dissection (TAAD) is the most common and fatal type of dissection. An easier-to-use risk stratification may help eliminate bias in patients at high risk of dissection. The age, serum creatinine, and ejection fraction (ACEF) score is a simple risk model developed to predict the mortality risk of elective coronary artery bypass graft surgery. This study aimed to evaluate the relationship between preoperative ACEF score and operative mortality in patients with TAAD undergoing emergency surgery.In this retrospective cohort study, 113 patients diagnosed with TAAD between January 2017 and September 2021 were evaluated. The primary endpoint was operative mortality. Receiver operating characteristic analysis was performed for the ACEF score, ACEF II score, and European System for Cardiac Operative Risk Evaluation II. Univariate and multivariate analyses of operative mortality were performed using the logistic regression model.Operative mortality occurred in 23 (20.4%) patients. The cutoff ACEF score was calculated as 1.1 for predicting operative mortality (area under the curve = 0.712,The ACEF score can be used as a useful and relatively simple tool for risk stratification before TAAD surgery. However, the ACEF score is only indicated for risk assessment and should not affect treatment.

Objectives Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement. Methods We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality. Results During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p Conclusions Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.

Recent trends in reducing the ecological footprint of the construction industry have increased the attention surrounding the use of alternative binding systems. Among the most promising are geopolymer binders, which were found to have the capability to substantially reduce the environmental impact of Portland cement use. However, even the use of this alternative binding system is known to be heavily dependent on the use of industrial byproducts, such as precursors and an alkaline source, produced through an energy intensive process. To address this and provide a greener route for this binding system, this study adopts the use of natural kaolin and raw ceramic powder as the main precursors. The activation process is performed by using solid potassium hydroxide in conjunction with sodium and magnesium sulfate, which are naturally available, to produce geopolymers. To assess the resulting geopolymer samples, 28 mixes are produced and a series of physico-mechanical and microstructural analyses is conducted. The results show that the use of ceramic powder can improve the physico-mechanical properties by reducing porosity. This, however, requires a relatively higher alkalinity for activation and strength development. These findings are further confirmed with the XRD and FTIR results. Nonetheless, the use of ceramic powder with sodium and magnesium sulfate is found to result in a more coherent and homogenous microstructure, compared to the geopolymers produced with potassium hydroxide and kaolin. The findings of this study point to the suitability of using sodium and magnesium sulfate for the cleaner production of kaolin and ceramic powder-based geopolymers.

In this digital era, many industries have widely adopted the Internet of Things (IoT), yet its implementation in the construction industry is relatively limited. Integration of Construction 4.0 drivers, such as business information modeling (BIM), procurement, construction safety, and structural health monitoring (SHM), with IoT devices, provides an effective framework for applications to enhance construction and operational efficiencies. IoT and Construction 4.0 driver integration research, however, is still in its infancy. It is necessary to understand the present state of IoT adoption in the Construction 4.0 context. This paper presented a comprehensive review to identify the IoT adoption status in the Construction 4.0 areas. Furthermore, this work highlighted the potential roadblocks to IoT’s seamless adoption that are unique to the areas of Construction 4.0 in developing countries. Altogether, 257 research articles were reviewed to present the current state of IoT adoption in developed and developing countries, as well as the topmost barriers encountered in integrating IoT with the key Construction 4.0 drivers. This study aimed to provide a reference for construction managers to observe challenges, professionals to explore the hybridization possibilities of IoT in the context of Construction 4.0, and laymen to understand the high-level scientific research that underpins IoT in the construction industry.

Significant research investigations on the characteristics of unexplored clay deposits are being conducted in light of the growing need for clay in the ceramic industry and the variable chemistry of clays. Parallel to this, the generation of waste materials like fly ash, ferrochrome slag, and silica fume is also increasing, responsible for environmental degradation. This paper aims to study the mineralogical properties of pure clays (one specimen from Siberia and five specimens from different locations in Turkey), and the effect of mentioned waste materials on the index properties of clays obtained. This study is divided into two phases, wherein in the first phase, the pure clay specimens are analyzed against mineralogical properties (i.e., chemical composition, thermal analysis, and particle size distribution). While in the second phase, index properties of pure clay specimens and clay specimens modified with 0–50% fly ash, ferrochrome slag, and silica fume are analyzed. The results reveal that the clay specimens from Turkey (USCS classification: CL) are fit for the ceramic industry and bricks production, and incorporation of waste materials can further improve their index properties. It is also observed that incorporation of 10–30% fly ash and ferrochrome slag have higher efficiency in reducing the plasticity index of clays studied as compared to the addition of silica fume.

Bu çalışmada, Yalova ili Çiftlikköy ilçesi gençlik caddesindeki 4 şeritli 20,00 m genişliğindeki yolun 0,65.km’sinde meydana gelen heyelanın stabilite problemi iki farklı sonlu elemanlar programında incelenmiştir.Modellemeler sırasında arazideki doğal numunelerden elde edilen fiziksel ve mekanik özellikler kullanılmıştır.Slide programı ile gerçekleştirilen stabilite analizlerinde statik ve dinamik yük etkimesi durumunda şevin kaymadairesi, güvenlik sayısı ve kayma potansiyeli incelenmiştir. Güvenlik sayısının 0,80 mertebelerine düşmesihalinde mevcut göçme davranışı meydana gelmiştir. Ayrıca Plaxis programında kazıklara gelen eksenel kuvvet,kesme kuvveti, eğilme momenti ve yer değiştirme değerleri hesaplanmıştır. Çap sabit tutularak 6,00; 8,00; 10,00;12,00 ve 14,00 m uzunluğunda kazık uygulaması ile gerçekleştirilen çözüm önerilerine göre kazıklardaki içselkuvvetler ve yer değiştirme değerleri göz önüne alındığında 8,00 m uzunluğunda bitişik nizam tek sıra 60,00cm’lik fore kazık seçilmiştir. Böylece, yolun güvenli biçimde servise açılabilmesi amacı ile kazıklı duvar önlemialınarak 4,90 seviyesine yükseltilen güvenlik sayısı ve yaklaşık 65,00 mm’lik kazık tepe deplasmanı ile şevinstabilite problemi çözülmüştür., In this study, the stability problem of the landslideoccurred at 0.65th km of road that has a 20.00 m width and 4 lanes, which islocated at Ciftlikkoy district of Yalova province, was investigated with twodifferent finite element software. Physical and mechanical properties obtainedfrom the in-situ samples were used during the modelling processes. The circleof failure, factor of safety and failure possibilities of slope were observedin the case of external static and dynamic load conditions within the stabilityanalysis performed by Slide program. In the event that the factor of safetyvalue reached the level around 0.80, the current failure behavior was occurred.Besides, axial force, shear force, bending moment and deformation values ofpiles were calculated by Plaxis. An adjacent bored pile application formed asingle row has a 60.00 cm in diameter and 8.00 m in length was chosen with respectto the internal force and displacement results of 6.00, 8.00, 10.00, 12.00 and14.00 m pile lengths as well as constant diameter. Therefore, the stabilityproblem of slope was solved by the precaution of piled wall In this study, the stability problem of the landslideoccurred at 0.65th km of road that has a 20.00 m width and 4 lanes, which islocated at Ciftlikkoy district of Yalova province, was investigated with twodifferent finite element software. Physical and mechanical properties obtainedfrom the in-situ samples were used during the modelling processes. The circleof failure, factor of safety and failure possibilities of slope were observedin the case of external static and dynamic load conditions within the stabilityanalysis performed by Slide program. In the event that the factor of safetyvalue reached the level around 0.80, the current failure behavior was occurred.Besides, axial force, shear force, bending moment and deformation values ofpiles were calculated by Plaxis. An adjacent bored pile application formed asingle row has a 60.00 cm in diameter and 8.00 m in length was chosen with respectto the internal force and displacement results of 6.00, 8.00, 10.00, 12.00 and14.00 m pile lengths as well as constant diameter. Therefore, the stabilityproblem of slope was solved by the precaution of piled wall that put into service the road safely within 4.90factor of safety and 65.00 mm top displacement of pile.

Summary Objective Cardiac resynchronisation therapy has been shown to be an effective treatment to improve functional status and prolong survival of patients in advanced chronic heart failure. This study assessed the surgical outcomes of left anterior mini-thoracotomy for the implantation of left ventricular epicardial pacing leads in cardiac resynchronisation therapy. Methods Our study consisted of 30 consecutive patients who underwent cardiac resynchronisation therapy with a left thoracotomy between November 2010 and April 2012 in our clinic. Postoperative follow up included the assessment of New York Heart Association (NYHA) functional class, electrocardiography and echocardiography. Results There were 22 male and eight female patients with a mean age of 68 ± 5.04 years. All patients were in NYHA class III or IV. Pre-procedure mean left ventricular ejection fraction was 28.1 ± 4.5% and post-procedural ejection fraction improved to 31.7 ± 5.1%. The pre-operative QRS duration changed from 171.7 ± 10.8 to 156.2 ± 4.4 ms after the operation. Also there was a significant reduction in left ventricular end-diastolic dimension from 6.98 ± 0.8 to 6.72 ± 0.8 mm (p < 0 .05), but no change in left ventricular end-systolic dimension and severity of mitral regurgitation. All patients had successful surgical left ventricular lead placement. There was no procedure-related mortality. The mean follow-up time was 40.4 months. Conclusion Surgical epicardial left ventricular lead placement procedure is a safe and effective technique in patients with a failed percutaneous attempt.

Introduction: Various surgical procedures for minimally invasive cardiac surgery have been described in recent decades as alternatives to median sternotomy. Cardiopulmonary bypass via femoral arterial and venous cannulation is the foundation of these procedures. In this study, we evaluated the mid-term outcomes of femoral cannulation performed with U-suture technique in patients undergoing robotic heart surgery. Methods: A total of 216 patients underwent robotic-assisted cardiac surgery between January 2013 and April 2017. Cardiopulmonary bypass was performed via femoral artery, jugular, and femoral vein cannulation, and a Chitwood clamp was used for aortic occlusion. A total of 192 patients attended the outpatient follow-up, and femoral arterial and venous flow pattern was examined using Doppler ultrasound (DUS) in 145 patients. Results: Hospital mortality occured in 4 of the 216 (1.85%) cases, but there was no late mortality in this patient group. Postoperatively, seroma (n=9, 4.69%) and cannulation site infection (n=3, 1.56%) were managed with outpatient treatment. DUS in 145 patients revealed triphasic flow pattern in the common femoral arteries in all patients except for 2 (1.38%). These patients were determined to have asymptomatic arterial stenosis. Chronic recanalized thrombus in the common femoral vein was also detected in 2 (1.38%) patients. Conclusion: Femoral artery cannulation with the U-suture technique can be successfully performed in robotic-assisted cardiac surgery, with good mid-term results.

Background: Minimally invasive bypass grafting surgery has entered the clincal routine in several centers around the world, with an increasing popularity in the last decade. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal left anterior descending artery (LAD) lesions. Methods: Between January 2004 and December 2011, patients with proximal LAD lesions, who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery, were included in the study. In Group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy were applied to 35 patients and in Group 2, robotically assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative, and postoperative data were collected retrospectively.Results: The mean follow-up time of the conventional bypass group was 5.7 ± 1.7 years, whereas this ratio was 7.3 ±1.3 in the robotic group. There was no postoperative transient ischemic attack (TIA), wound infection, mortality, or need for intra-aortic balloon pump (IABP) in any of the patients. In the conventional bypass group, blood transfusion and ventilation time were significantly higher (P < .05) than in the robotic group. The intensive care unit (ICU) stay and hospital stay were remarkably shorter in the robotic group (P < .01). The postoperative pneumonia rate was significantly higher (20%) in the conventional bypass group (P < .01). Postoperative day 1 pain score was higher in the robotic group (P < .05), however, postoperative day 3 pain score in the conventional bypass group was higher (P < .05). Graft patency rate was 88.6% in the conventional bypass group whereas this ratio was 91.4% in the robotic bypass group, which was not clinically significant (P > .05).Conclusion: In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

OBJECTIVE Acute kidney injury (AKI) is common following cardiopulmonary bypass (CPB). The aim of this study is to determine the accuracy of urinary neutrophil gelatinase-associated lipocalin (NGAL) levels following cardiac surgery to establish the severity of renal impairment as compared to serum creatinine levels. METHODS A total number of 28 patients undergoing elective cardiopulmonary bypass were included. Diagnostic criteria of AKI was established in case of a percentage increase in serum creatinine concentration of >50%. Serum creatinine levels were recorded in the preoperative period before induction and in the postoperative period at 24, 48, and 72 hours. Urinary NGAL measurement was performed before induction and in the 4(th) postoperative hour. The duration of CPB surgery, hospital stay, and cross-clamp time were recorded. RESULTS Based on AKI criteria, subjects were grouped as AKI (n=11) and no AKI (n=19). Postoperative urinary NGAL levels were significantly higher in the group with AKI (11.8 ng mL(-1) vs. 104.0 ng mL(-1), p=0.003). In the AKI group, CPB time bypass (111.9 min vs. 82.7 min) and cross-clamp time (76.9 min vs. 59.1 min) were significantly higher. A cut-off of 25.5 ng mL(-1) yielded a sensitivity of 81.82% and a specificity of 94.12% at the postoperative 4(th) hour with an AUC of 0.947 for predication of AKI. CONCLUSION Urine NGAL rose significantly much earlier as compared to serum creatinine levels in the early postoperative period. Although larger case series are needed, we are of the opinion that urinary NGAL measurements may be used as an early clinical marker of AKI following CPB.

Background Median sternotomy provides excellent access to all mediastinal structures in patients undergoing conventional cardiovascular surgery. Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences. In this regard, considerable effort has been paid to develop techniques aiming to improve sternal healing and to enhance postoperative recovery after conventional cardiac surgery. Among these, kryptonite bone cement, a biocompatible polymer with improved mechanical properties when combined with a standard wire cerclage, represents a promising novel approach that may help prevent sternal dehiscence. In this study, the effects of this particular type of bone cement on sternal healing, postoperative pain, and quality of life have been evaluated. Methods Kryptonite bone cement enhanced sternal closure was employed in a total of 100 patients undergoing conventional cardiac surgery between November 2009 and June 2012. Of these patients, 50 expressed their willingness to participate in this study. Each participant underwent a computerized tomography imaging for the radiological assessment of sternal healing. Pain and life quality of these patients have been evaluated by Wong-Baker faces pain scale and SF-36 health survey questionnaire, respectively. Results Mean duration of follow-up was 20.14 ± 7.36 months (range: 10–32). Mean age and body mass index were 71.32 ± 7.23 years (range: 55–85) and 28.34 ± 2.62 (21–34) kg/m2, respectively. Elderly patients (≥70), females and those with chronic obstructive pulmonary disease (COPD) comprised 64%, 26% and 40% of the study population, respectively. No patients had findings suggestive of dehiscence on CT images. No patients reported severe pain (i.e. all patients had a Wong-Baker faces pain scale score

Ülkelerin gelişmesinde enerji kaynaklarının rolü büyüktür. Bu tezde fosil kaynaklı bir enerji hammaddesi olan kömürün, 1970'li yıllardan günümüze değin gelişimi incelenmiştir. Ülke kömür talebinin rasyonel ve etkin bir biçimde sağlanması için ekonomik ve teknik değerlendirmeler yapılmıştır. In the development of countries, the role of energy sources is of great importance. As an energy material, the progress of coal from 1970's up today is examined in this thesis. To meet the Turkish coal demand in a rational and eficent way, economical and technical evaluation has been performed. 113