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Background: This study aimed to demonstrate that PiCCO monitoring can be early guidance for fluid monitoring and hemodynamic parameter analysis in the pediatric OLT population. Method: A single-centre, retrospective cohort study in pediatric patients who underwent OLT between September 2014 and October 2017. Results: Forty-one pediatric patients (aged 4 months to 17 years) underwent hemodynamic monitoring with PiCCO during OLT. Measurements including mean arterial pressure (MAP), central venous pressure (CVP) and cardiac index (CI) were significantly lower during the Tanhepatic phase when compared to Tbaseline and Tnewhepatic phases (p

Purpose: The aim of this study was to evaluate the effect of red blood cell transfusion and/or inotropic/vasopressor agent infusion during intraoperative and postoperative first 24-hour period on 30-day and one-year survival. Materials and Methods: In the final analysis, 133 patients who underwent radical cystectomy and urinary diversion surgery between November 2011 and January 2019 were included in this study. Perioperative anesthesia management early postoperative intensive care patient follow-ups were based on. Results: A statistically significant relationship was found between intraoperative red blood cell transfusion and one-year mortality rates. A statistically significant relationship was found between red blood cell transfusion in the intensive care unit and postoperative 30-day mortality rates. The relationship between vasopressor/inotrope agent infusion in intensive care unit and postoperative 30-day mortality was statistically significant. Conclusion: In radical cystectomy and urinary diversion, intraoperative red blood cell and/or inotrope/vasopressor drug administration, and red blood cell transfusion within first 24 postoperative hours in intensive care unit are associated with lower survival rates in both early and late periods. Future studies should focus on developing and implementing different strategies for perioperative blood management and maintenance of patient hemodynamics that may affect early and late outcomes.

Background: Many techniques, including multimodal analgesia, have been used to manage postoperative pain after laparoscopic cholecystectomy (LC). Although the number of studies using intravenous ibuprofen (IV) is still limited, ibuprofen has been shown to have a potential role in managing postoperative pain. The primary outcome of this study is to evaluate and compare the impact of IV forms of ibuprofen and acetaminophen on 24-hour postoperative opioid consumption and pain management in patients undergoing LC. The second outcome of the study is to evaluate the impact of ibuprofen and acetaminophen on opioid-related adverse events (ORAE). Materials and Methods: This study was a prospective, randomized, double-blind clinical trial. Following ethical committee approval, 70 patients aged 18 to 65, American Society of Anesthesiology (ASA) score I- II, and those scheduled for LC were enrolled in the study. Patients were randomly divided into two groups. The control group (n=35) received 800 mg IV ibuprofen (group I) in 100 mL saline during surgery, while the acetaminophen group (n=35) received 1000 mg (group A). In the postoperative period, all patients received a patient-controlled analgesia (PCA) device with tramadol. The PCA device was set to a bolus dose of 10 mg and had a lockout time of 15 minutes. A blinded pain nurse assessed postoperative analgesia at 1, 2, 4, 6, 12, and 24 hours using a numerical rating scale (NRS). The incidence of postoperative nausea and vomiting (PONV), total tramadol consumption, and the need for additional analgesics during the 24-hour postoperative period were recorded. Results: Seventy patients who underwent LC participated in this study. The use of analgesic medications was statistically lower in group I than in the other group A. NRS scores between the IV ibuprofen and acetaminophen groups were statistically similar at 1, 2, 4, 6, 12, and 24 hours postoperatively (P>0.05). 24-hour opioid consumption was statistically significantly higher in group A than in group I (P0.05). PONV rates were similar in the ibuprofen and acetaminophen groups (P>0.05). ORAEs were similar between groups. Conclusion: Ibuprofen as part of tramadol-based multimodal analgesia reduced tramadol consumption compared to acetaminophen during the first 24 hours postoperatively following elective LC surgery. The IV ibuprofen-tramadol combination appeared superior to an acetaminophen-tramadol combination. ORAEs were similar in both groups.

Introduction: Although numerous risk factors for acute kidney injury (AKI) have been identified, their cumulative impact remains unclear. This study aimed to identify perioperative risk factors for early post-transplant AKI on patients and outcomes and to predict AKI using clinical variables.Material and Methods: A single-center, retrospective cohort study involving 34 pediatric patients and 31 adults who underwent LT between 2015 and 2017.Results: AKI occurred in 16 (47%) pediatric patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8, 50, and 6.3%, respectively. Renal replacement therapy (RRT) was initiated in 18.8% of pediatric LT patients. Preoperative liver enzymes and the etiology of liver failure are the most critical factors affecting AKI in pediatric LT patients. AKI occurred in 15 (48%) adult patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. The requirement for RRT was seen in 43% of adult LT patients. There were also statistical differences between the two groups regarding the number of patients with preoperative kidney dysfunction (20-80%, p=.047) and mortality rates (6-31 %, p=.047). In adult patients who developed post-LT AKI compared with those who did not develop post-LT AKI, they had significantly higher levels of serum creatinine (sCr) (1.9±1.9 mg/dL vs. 0.7±0.1 mg/dL, p=.013), were given lower amounts of crystalloids (73±32 mL/kg vs. 106±33 mL/kg, p=.018) and had lower urine output (UO) intraoperatively (11±9 mL/kg vs. 20±9 mL/kg, p=.047). There was a higher mortality rate in adult patients with post-LT AKI (89 vs. 11%, p=.003).Conclusion: The results of our study contribute to raising awareness of the potential risk factors associated with preoperative evaluation, intraoperative and postoperative close follow-up, careful anesthesia management, and early onset of post-LT AKI., Giriş: Akut böbrek hasarı (ABH) için çok sayıda risk faktörü tanımlanmış olmasına rağmen, bunların kümülatif etkileri belirsizliğini koruyor. Bu çalışmanın amacı, karaciğer transplantasyonu (KT) sonrası hastalarda ABH için perioperatif risk faktörlerini belirlemek ve bu faktörlerin sonuçlar üzerindeki erken klinik değişkenleri kullanarak ABH'yı öngörmektir.Gereç ve Yöntemler: 2015 ve 2017 yılları arasında KT uygulanan 34 pediatrik hasta ve 31 yetişkinin yer aldığı tek merkezli, retrospektif bir kohort çalışmadır.Bulgular: 16 (%47) pediatrik hastada KT sonrası ilk haftada ABH meydana geldi ve sırasıyla evre 1, evre 2 ve evre 3 ABH sıklıkları %43.8, %50 ve %6.3 idi. Pediatrik KT hastalarının %18,8'ine renal replasman tedavisi (RRT) başlandı. Pediatrik KT hastalarında preoperatif karaciğer enzimleri ve karaciğer yetmezliği etiyolojisi ABH'yi etkileyen en önemli faktörlerdir. ABH 15 (%48) yetişkin hastada KT sonrası ilk haftada meydana geldi ve sırasıyla %43, %21 ve %21'lik evre 1, evre 2 ve evre 3 AKI oluştu. Erişkin KT hastalarının %43'ünde RRT gereksinimi görüldü. Ameliyat öncesi böbrek fonksiyon bozukluğu olan hasta sayısı (%20-80, p=.047) ve mortalite oranları (%6-31, p=.047) açısından da iki grup arasında istatistiksel fark vardı. KT sonrası ABH gelişen erişkin hastalar, KT sonrası ABH gelişmeyenlerle karşılaştırıldığında, bu hastalarda anlamlı olarak daha yüksek serum kreatinin (sCr) seviyeleri vardı (1,9±1,9 mg/dL'ye karşı 0,7±0,1 mg /dL, p=.013), daha düşük miktarlarda kristalloid verilmişti (73±32 mL/kg- 106±33 mL/kg, p=.018) ve intraoperatif olarak daha düşük idrar çıkışları (UO) (11±9 mL/ kg'a karşı 20±9 mL/kg, p=.047) olduğu tespit edildi. KT sonrası ABH olan yetişkin hastalarda daha yüksek bir mortalite oranı vardı (%89'a karşı %11, p=.003).Sonuç: Çalışmamızın sonuçları, preoperatif değerlendirme, intraoperatif ve postoperatif yakın takip, dikkatli anestezi yönetimi sağlanmasının önemini vurgulamak ve KT sonrası ABH'nin erken başlaması ile ilişkili potansiyel risk faktörleri konusunda farkındalığın artmasına katkıda bulunmaktadır.

Freshwater ecosystems are becoming saltier due to human activities. The effects of increased salinity can lead to cascading trophic interactions, affecting ecosystem functioning and energy transfer, through changes in community and size structure. These effects can be modulated by other environmental factors, such as nutrients. For example, communities developed under eutrophic conditions could be less sensitive to salinization due to cross-tolerance mechanisms. In this study, we used a mesocosm approach to assess the effects of a salinization gradient on the zooplankton community composition and size structure under eutrophic conditions and the cascading effects on algal communities. Our results showed that zooplankton biomass, size diversity and mean body size decreased with increased chloride concentration induced by salt addition. This change in the zooplankton community did not have cascading effects on phytoplankton. The phytoplankton biomass decreased after the chloride concentration threshold of 500 mg L-1 was reached, most likely due to direct toxic effects on the osmotic regulation and nutrient uptake processes of certain algae rather than as a response to community turnover or top-down control. Our study can help to put in place mitigation strategies for salinization and eutrophication, which often co-occur in freshwater ecosystems., This study is part of the Global Lakes Ecological Observatory Network (GLEON), Global Salt Initiative. We thank FEHM and CT-BETA for allowing us to use their research facilities. LP has received funding from the Beatriu de Pinós Postdoctoral Fellowships Programme, funded by the Secretary of Universities and Research (Government of Catalonia) and by the Horizon 2020 Programme of Research and Innovation of the European Union under the Marie Skłodowska-Curie Grant Agreement No. 801370 and by a Ramón y Cajal contract funded by the Spanish Ministry of Science and Innovation (RYC 2020-029829-I). MCA was supported by the Serra-Hunter programme funded by the Generalitat of Catalunya and by a Ramón y Cajal contract funded by the Spanish Ministry of Science and Innovation (RYC 2020-029829-I). We also thank three anonymous reviewers for their constructive comments and suggestions

Human-induced salinization caused by the use of road deicing salts, agricultural practices, mining operations, and climate change is a major threat to the biodiversity and functioning of freshwater ecosystems. Yet, it is unclear if freshwater ecosystems are protected from salinization by current water quality guidelines. Leveraging an experimental network of land-based and in-lake mesocosms across North America and Europe, we tested how salinization—indicated as elevated chloride (Cl−) concentration—will affect lake food webs and if two of the lowest Cl− thresholds found globally are sufficient to protect these food webs. Our results indicated that salinization will cause substantial zooplankton mortality at the lowest Cl− thresholds established in Canada (120 mg Cl−/L) and the United States (230 mg Cl−/L) and throughout Europe where Cl− thresholds are generally higher. For instance, at 73% of our study sites, Cl− concentrations that caused a ≥50% reduction in cladoceran abundance were at or below Cl− thresholds in Canada, in the United States, and throughout Europe. Similar trends occurred for copepod and rotifer zooplankton. The loss of zooplankton triggered a cascading effect causing an increase in phytoplankton biomass at 47% of study sites. Such changes in lake food webs could alter nutrient cycling and water clarity and trigger declines in fish production. Current Cl− thresholds across North America and Europe clearly do not adequately protect lake food webs. Water quality guidelines should be developed where they do not exist, and there is an urgent need to reassess existing guidelines to protect lake ecosystems from human-induced salinization. This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2115033119/-/DCSupplemental

Orthotopic liver transplantation (OLT) is the gold standard treatment for patients with end-stage liver disease. Understanding of the multisystem physiology of end stage liver desease (ESLD) is fundamental to the management of transplant recipient. Since OLT is a very dynamic process, a multidisciplinary approach and optimization is essential in the perioperative period. During the management anesthesiologists should focus on significant hemodynamic instability, physiology, metabolic disturbance and coagulopathy of those patients. The aim of this review was to summarize peroperative and anesthesia management in line with the guidelines.

Submerged macrophytes are of key importance for the structure and functioning of shallow lakes and can be decisive for maintaining them in a clear water state. The ongoing climate change affects the macrophytes through changes in temperature and precipitation, causing variations in nutrient load, water level and light availability. To investigate how these factors jointly determine macrophyte dominance and growth, we conducted a highly standardized pan-European experiment involving the installation of mesocosms in lakes. The experimental design consisted of mesotrophic and eutrophic nutrient conditions at 1 m (shallow) and 2 m (deep) depth along a latitudinal temperature gradient with average water temperatures ranging from 14.9 to 23.9°C (Sweden to Greece) and a natural drop in water levels in the warmest countries (Greece and Turkey). We determined percent plant volume inhabited (PVI) of submerged macrophytes on a monthly basis for 5 months and dry weight at the end of the experiment. Over the temperature gradient, PVI was highest in the shallow mesotrophic mesocosms followed by intermediate levels in the shallow eutrophic and deep mesotrophic mesocosms, and lowest levels in the deep eutrophic mesocosms. We identified three pathways along which water temperature likely affected PVI, exhibiting (a) a direct positive effect if light was not limiting; (b) an indirect positive effect due to an evaporation-driven water level reduction, causing a nonlinear increase in mean available light; and (c) an indirect negative effect through algal growth and, thus, high light attenuation under eutrophic conditions. We conclude that high temperatures combined with a temperature-mediated water level decrease can counterbalance the negative effects of eutrophic conditions on macrophytes by enhancing the light availability. While a water level reduction can promote macrophyte dominance, an extreme reduction will likely decrease macrophyte biomass and, consequently, their capacity to function as a carbon store and food source. Eesti Teadusagentuur, Grant/Award Number: PRG709; Türkiye Bilimsel ve Teknolojik Araştirma Kurumu (TÜBİTAK), Grant/Award Number: BIDEB 2232, 2211 and ÇAYDAĞ 110Y125; CLEAR2 (a Villum Kann Rasmussen Centre of Excellence project); AU Centre for Water Technology; EU FP-7 Theme 6 projects REFRESH (Adaptive Strategies to Mitigate the Impacts of Climate Change on European Freshwater Ecosystems), Grant/Award Number: 244121; Orta Doğu Teknik Üniversitesi BAP Programme Eesti Teadusagentuur, Grant/Award Number: PRG709; Türkiye Bilimsel ve Teknolojik Araştirma Kurumu (TÜBİTAK), Grant/Award Number: BIDEB 2232, 2211 and ÇAYDAĞ 110Y125; CLEAR2 (a Villum Kann Rasmussen Centre of Excellence project); AU Centre for Water Technology; EU FP-7 Theme 6 projects REFRESH (Adaptive Strategies to Mitigate the Impacts of Climate Change on European Freshwater Ecosystems), Grant/Award Number: 244121; Orta Doğu Teknik Üniversitesi BAP Programme

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19. On March 11, 2020, the WHO declared it a pandemic. SARS-CoV-2 indicates that it poses a significant threat to public health and global economy. The aim of the study was to determine (a) patient characteristics, (b) demographic characteristics, (c) comorbidities, diagnostic methods used, treatment, and outcomes, and (d) mortality rates of patients.This retrospective cohort study included 352 hospitalized adult patients from Baskent University Hospital in Ankara who were confirmed cases of COVID-19 between March 2020 and March 2021. SPSS v. 14.0 was used for statistical analysis.Out of 352 patients, 55 died (males: 37, females: 18), while 297 survived (males: 162, females: 135). The most common comorbidities were hypertension (HT), diabetes mellitus (DM), coronary artery disease (CAD), cancer, Vitamin D deficiency, and chronic obstructive pulmonary disease. Comorbidities associated with mortality rate were obesity (33%) (Our study shows that male gender, advanced age, and presence of comorbidities in COVID 19 patients are at higher risk for severe disease, ICU admission, and death. We emphasize that morbidity and mortality can be reduced by early and comprehensive identification of risk factors and the warning systems that will meet the ICU needs of these patients.

Kidney transplant is the best choice for treatment of patients with advanced chronic renal disease. However, small, poorly compliant, and unstable bladders can result in major problems for patients. Here, we aimed to develop and evaluate a new ileobladder model.Fifteen rats (250-300 g) and 5 pigs (~100 kg) were cared for according to institutional and published guidelines. After general anesthesia, laparotomy was done through midline incision. Ileal loops were prepared for ileobladder. After cystectomy (0.5 cm above the trigone in rats, 1 cm above the trigone in pigs), anastomoses were done between antimesenteric sides of ileal loops and bladder remnant with 6/0 Prolene suture. Three other pigs received simultaneous renal transplant.One rat died on day 1 postsurgery from multiorgan hemorrhage. Two rats survived for 5 days, 3 rats for 7 days, and 3 rats for 11 days; 6 rats were killed for pathologic evaluation after 3 months. One pig survived for 22 days and 1 for 9 days. Of the 3 pigs that received a simultaneous renal transplant, 2 pigs were alive and doing well 80 and 72 days after surgery with normal urinary discharge (1 pig was killed for pathologic evaluation after 3 days). When ileobladder was opened, complete recovery of the anastomosis line was observed. Pathologic examination of the anastomosis sites reported a normal healing process with moderate inflammation and the muscular wall of the intestine showed hypertrophia that nearly reached the size of the bladder muscularis propria.Although we had some complications because no draining procedure was used, in terms of technique, our new ileobladder model is promising for providing functional bladder volume. A larger scale series in the clinical setting is planned. This technique can be useful for small bladders and bladder physiology disorders.

Factor XI deficiency is an extremely rare disease presenting no clinical symptoms, unless there is an inducing reason such as trauma or surgery. Normally, factor levels are in the range of 70–150 U dL-1 in healthy subjects. Although no clinical symptoms are seen, only high levels of aPTT can be found. Once a prolongation is detected in aPTT, factor XI deficiency should be suspected and factor levels should be analysed. With careful preoperative preparations in factor-deficient people, preoperative and postoperative complications can be decreased. In this case report, management of anaesthesia during total hip arthroplasty of a patient with factor XI deficiency is presented.

Our objective was to evaluate the incidence of renal replacement therapy after orthotopic liver transplant and to evaluate and analyze patient outcomes.We performed a retrospective analysis of 177 consecutive patients at a tertiary care unit who underwent orthotopic liver transplant between January 2010 and June 2016. Patients who were admitted to the intensive care unit after orthotopic liver transplant and who required renal replacement therapy were included.A total of 177 (79 adult, 98 pediatric) orthotopic liver transplants were performed during the study period. Of these, 35 patients (19%) required renal replacement therapy during the early posttransplantation period. After excluding 5 patients with previous chronic renal failure, 30 patients (17%; 20 adult [25% ], 10 pediatric [10% ]) with acute kidney injury required renal replacement therapy. The mean patient age was 31.1 ± 20.0 years, with a mean Model for End-stage Liver Disease score of 16.7 ± 12.3. Of the patients with acute kidney injury who underwent renal replacement therapy, in-hospital mortality was 23.3% (7 of 30 patients), and 40% remained on dialysis. No significant difference was seen in mortality between early versus delayed initiation of renal replacement therapy in patients with stage 3 acute kidney injury (P = .17).Of liver transplant recipients who present with acute kidney injury, 19% require renal replacement therapy, and in-hospital mortality is 20% in the early postoperative period.

To analyze how graft-weight-to-bodyweight ratio in pediatric liver transplant affects intraoperative and early postoperative hemodynamic and metabolic parameters.We reviewed data from 130 children who underwent liver transplant between 2005 and 2015. Recipients were divided into 2 groups: those with a graft weight to body weight ratio4% (large for size) and those with a ratio ≤ 4% (normal for size). Data included demographics, preoperative laboratory findings, intraoperative metabolic and hemodynamic parameters, and intensive care follow-up parameters.Patients in the large-graft-for-size group (4%) received more colloid solution (57.7 ± 20.1 mL/kg vs 45.1 ± 21.9 mL/kg; P = .08) and higher doses of furosemide (0.7 ± 0.6 mg/kg vs 0.4 ± 0.7 mg/kg; P = .018). They had lower mean pH (7.1 ± 0.1 vs 7.2 ± 0.1; P = .004) and PO2 (115.4 ± 44.6 mm Hg vs 147.6 ± 49.3 mm Hg; P = .004) values, higher blood glucose values (352.8 ± 96.9 mg/dL vs 262.8 ± 88.2 mg/dL; P.001), and lower mean body temperature (34.8 ± 0.7°C vs 35.2 ± 0.6°C; P = .016) during the neohepatic phase. They received more blood transfusions during both the anhepatic (30.3 ± 24.3 mL/kg vs 18.8 ± 21.8 mL/kg; P = .013) and neohepatic (17.7 ± 20.4 mL/kg vs 10.3 ± 15.5 mL/kg; P = .031) phases and more fresh frozen plasma (13.6 ± 17.6 mL/kg vs 6.2 ± 10.2 mL/kg; P = .012) during the neohepatic phase. They also were more likely to be hypotensive (P.05) and to receive norepinephrine infusion more often (44% vs 22%; P.05) intraoperatively. More patients in this group were mechanically ventilated in the intensive care unit (56% vs 31%; P = .035). There were no significant differences between the groups in postoperative acute renal dysfunction, graft rejection or loss, infections, length of intensive care stay, and mortality (P.05).High graft weight-to-body-weight ratio is associated with adverse metabolic and hemodynamic changes during the intraoperative and early postoperative periods. These results emphasize the importance of using an appropriately sized graft in liver transplant.

We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures.We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Başkent University Hospital.The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33). The median time between transplant and nontransplant surgery was 1231 days. The most frequent types of nontransplant surgery were abdominal (22%), orthopedic (16%), and urologic (13%). Seventy patients had an American Society of Anesthesiologists status of 2 (49%); the status was 3 in 71 patients (49%) and 4 in 3 patients (2%). Of the 144 procedures, 23 were emergent (16%) and 48% were abdominal. General anesthesia was used in 69%, regional anesthesia in 19%, and sedoanalgesia in 11%. Twenty-five patients required intraoperative blood-product transfusion (17%). Intraoperative hemodynamic instability developed in 17% of patients, and hypoxemia developed in 2%. Eleven patients remained intubated at the end of surgery (8%). Of the 144 procedures, 19 (13%) required transfer to the intensive care unit, 108 (75%) transferred to the ward, and the remaining 17 (12%) were discharged on the same day. Eight patients developed respiratory failure (6%), 7 had renal dysfunction (5%), 4 had coagulation abnormalities (3%), and 10 had infectious complications (7%) in the early postoperative period. The median hospital stay was 4 days, and 5 patients (4%) developed rejection during hospitalization. Five patients died of respiratory or infectious complications (4%).Most liver-graft recipients who undergo nontransplant surgery are given general anesthesia, transferred to the ward after the procedure, and discharged without major complications. We suggest that orthotopic liver transplant recipients may undergo nontransplant surgery without any postoperative graft dysfunction.

1. Body size is a key trait of an organism which determines the dynamics of predator-prey interactions. Most empirical studies on the individual size distribution of the aquatic community have focused on the variations in body size of a single trophic level as a response to certain environmental variables or biotic factors. Few studies, however, have evaluated how individual size structure is altered simultaneously across interacting trophic levels and locations. Such comparative examinations of the size distribution in predator and prey communities may bring insight into the strength of the interactions between adjacent trophic levels.2. We assessed the potential predation effect of size-structured predators (i.e. predation by individuals of different sizes) on prey size structure using data from 30 shallow Turkish lakes spanning over five latitudinal degrees. We correlated size diversity and size evenness of predator and prey assemblages across the planktonic food web after accounting for the confounding effects of temperature and resource availability which may also affect size structure. We expected to find a negative relationship between size diversity of predators and prey due to the enhanced strength of top-down control with increasing predator size diversity. We also hypothesised that competitive interactions for resources in less productive systems would promote a higher size diversity. We further expected a shift towards reduced size diversity and evenness at high temperatures.3. In contrast to our hypothesis, we found a positive correlation between size structures of two interacting trophic levels of the planktonic food web; thus, highly size-diverse fish assemblages were associated with highly size-diverse zooplankton assemblages. The size evenness of fish and phytoplankton assemblages was negatively and positively related to temperature, respectively. Phytoplankton size diversity was only weakly predicted by the resource availability.4. Our results suggest that size structure within a trophic group may be controlled by the size structure at adjacent trophic levels, as well as by temperature and resource availability. The positive relationship between the size diversity of fish and zooplankton suggests that higher diversity of the resources drives a higher size diversity of consumers or vice versa, and these effects are beyond those mediated by taxonomic diversity. In contrast, the size diversity and size evenness of phytoplankton are mainly influenced by physical factors in this region and perhaps in warm shallow lakes in general.

Primary hyperoxaluria type 1 is an autosomal recessive disorder that is responsible for the overproduction of oxalate and has an incidence of 1 in 120 000 live births. Indications for combined liver and kidney transplant are still debated. However, combined liver and kidney transplant is preferred in various conditions, including primary hyperoxaluria, liver-based metabolic abnormalities affecting the kidney, and structural diseases affecting both the liver and the kidney, such as congenital hepatic fibrosis and polycystic kidney disease. When compared with sequential liver and kidney transplant, the rejection rate of both liver and kidney allografts was reported to be lower than with combined liver and kidney transplant. With proper anesthesia management, the probable increased complications with combined liver and kidney transplant can be prevented. In this report, we present the anesthesia care of a 22-year-old patient with primary hyperoxaluria type 1 who had deceased-donor combined liver and kidney transplant.

Reasons for chronic liver and kidney failure may vary; sometimes more than 1 family member may be affected, and may require a transplant. The aim of this study was to examine the similarities or differences between the perioperative characteristics of siblings undergoing liver or kidney transplant.The medical records of 6 pairs of siblings who underwent liver transplant and 4 pairs of siblings who underwent kidney transplant at Baskent University Hospital between 1989 and 2014 were retrospectively analyzed. Collected data included demographic features; comorbidities; reasons for liver and kidney failure; perioperative laboratory values; intraoperative hemodynamic parameters; use and volume of crystalloids, colloids, blood products, cell saver system, and albumin; duration of anesthesia; urine output; and postoperative follow-up data.The mean age of the 6 sibling pairs who underwent liver transplant was 16.3 ± 12.2 years. All 12 patients had Child-Pugh grade B cirrhosis, with mean disease duration of 7.8 ± 3.9 years. There were no significant differences between siblings with respect to intraoperative blood product transfusion, crystalloid and colloid fluid replacements, hypotension frequency, blood gas analyses, urinary output, duration of anhepatic phase, inotropic agent administration, postoperative laboratory values, need for mechanical ventilation and vasopressors, occurrence of acute renal failure and infections, and duration intensive care unit stay (P.05). The mean age of the 4 sibling pairs who underwent kidney transplant was 21.3 ± 6.4 years, with mean duration of renal insufficiency of 2.2 ± 1.6 years. There were no significant differences between siblings with respect to intraoperative crystalloid and colloid fluid administration, duration of anesthesia, intraoperative mannitol and furosemide administration, and postoperative laboratory values (P.05).In conclusion, the 6 sibling pairs who underwent liver transplant and 4 sibling pairs who underwent kidney transplant in our cohort had similar perioperative characteristics.

Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients.Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen.The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to 8 patients [25.8%]; P = .004]).Percutaneous dilational tracheotomy with bronchoscopic guidance is an efficacious and safe technique for maintaining airways in solidorgan transplant recipients who require prolonged mechanical ventilation, resulting in possible improvements in ventilatory mechanics and patient comfort.

Central venous catheters are used for delivering medications and parenteral nutrition, measuring hemodynamic variations, and providing long-term intravenous access. In our clinic, during liver transection using a living-liver donor, peripherally inserted central venous catheters are generally preferred because they involve a less invasive technique with a lower risk of complications. In this report, we present the case of a 36-year-old male liver donor into whom we peripherally inserted a central venous catheter from his left basilic vein. After transecting the hepatic vein, the surgeon found foreign material inside the venous lumen, which turned out to be the distal segment of the catheter.

AMAÇ: Eritrosit dağılım genişliği (EDG) değeri tam kan sayımının bir parçası olup dolaşımdaki kırmızı kan hücrelerinin dağılımının değişkenliğinin kantitatif bir ölçümüdür. EDG düzeyinin yüksek olması birçok hastalıkta mortalite ile ilişkili olduğu gösterilmiştir. Bu çalışmada yoğun bakımda toplum kökenli intrabdominal sepsis nedeni ile takip ve tedavi edilen hastaların EDG değerleri ile hastane mortalitesi arasındaki ilişki araştırıldı. GEREÇ VE YÖNTEM: 2010 Ocak-2013 Mart tarihleri arasında toplum kökenli karıniçi sepsis nedeni ile yoğun bakıma yatan hastaların demografik özellikleri, ek hastalıkları, laboratuvar verileri ve APACHE-II skorları geriye dönük olarak değerlendirildi. BULGULAR: Çalışmaya 55'i erkek, 48'i kadın olmak üzere toplam 103 hasta alındı. Hastaların yaş ortalaması 64.4±14 (SS), mortalite oranı ise %50.5 idi. Mortalite olan hastaların yoğun bakıma yatış anındaki ortalama EDG (EDG1) değeri ve APACHE-II skorları mortalite olmayan hastalardan daha yüksek idi. Lojistik regresyon analizinde sadece APACHE-II skoru ve EDG1 değerlerinin istatistiksel olarak mortaliteyi etkilediği saptandı. ROC analizinde eğri altında kalan alan EDG1 için 0.867 (Güven aralığı: 0.791-0.942) olarak, APACHE-II için ise 0.943 (Güven aralığı: %95, 0.902-0.984) olarak saptandı. TARTIŞMA: Bu çalışmada artmış EDG değerlerinin toplum kökenli karıniçi sepsisli yoğun bakım hastalarında mortalite ile ilişkili olduğu saptanmıştır. BACKGROUND: Red cell distribution width (RDW) is a part of the complete blood count (CBC) panel reflecting quantitative measure of variability in the size of circulating red blood cells. It has been known that higher RDW is associated with increased mortality in several diseases. The aim of this study was to investigate the association between RDW and hospital mortality in intensive care unit (ICU) patients with community-acquired intra-abdominal sepsis (C-IAS).METHODS: A retrospective analysis of the patients with C-IAS was performed between January 1, 2010 and March 31, 2013. Patients' demographics, co-morbidities, laboratory measures including RDW on admission to the ICU, and Acute Physiologic and Chronic Health Evaluation II (APACHE II) score were analyzed.RESULTS: A total of one hundred and three patients with C-IAS were included into the study with a mean age of 64±14 years. Overall mortality was 50.5%. RDW day 1 (RDW1) values and APACHE II scores were significantly higher in non-survivors than in survivors. In multivariate analysis, only RDW1 and APACHE II predicted mortality. The area under the receiver operating curves (AUC) of RDW1 and APACHE II were 0.867 (95% CI, 0.791-0.942) and 0.943 (95% CI, 0.902-0.984), respectively.CONCLUSION: This study suggests that increased RDW is associated with mortality in ICU patients with C-IAS

Background Red cell distribution width (RDW) is a part of the complete blood count (CBC) panel reflecting quantitative measure of variability in the size of circulating red blood cells. It has been known that higher RDW is associated with increased mortality in several diseases. The aim of this study was to investigate the association between RDW and hospital mortality in intensive care unit (ICU) patients with community-acquired intra-abdominal sepsis (C-IAS). Methods A retrospective analysis of the patients with C-IAS was performed between January 1, 2010 and March 31, 2013. Patients' demographics, co-morbidities, laboratory measures including RDW on admission to the ICU, and Acute Physiologic and Chronic Health Evaluation II (APACHE II) score were analyzed. Results A total of one hundred and three patients with C-IAS were included into the study with a mean age of 64±14 years. Overall mortality was 50.5%. RDW day 1 (RDW1) values and APACHE II scores were significantly higher in non-survivors than in survivors. In multivariate analysis, only RDW1 and APACHE II predicted mortality. The area under the receiver operating curves (AUC) of RDW1 and APACHE II were 0.867 (95% CI, 0.791-0.942) and 0.943 (95% CI, 0.902-0.984), respectively. Conclusion This study suggests that increased RDW is associated with mortality in ICU patients with C-IAS.

Effects of fish predation on consumers tend to be particularly strong in oligotrophic Arctic and sub-Arctic lakes. However, it remains unclear whether the fish influence the trophic structure and dynamics of naturally eutrophic lakes in these cold environments with simple food web structures. To study this, we conducted a 3-month in situ-controlled experiment in sub-Arctic Lake Mývatn, Iceland. We used the planktivorous fish three-spined sticklebacks (Gasterosteus aculeatus) as the main top predator. The cladocerans Eurycercus lamellatus and Acroperus harpae were significantly associated with fishless enclosures, whereas the rotifers Polyarthra sp. and Filinia terminalis were significantly associated with the fish enclosures. Fish predation led to a significant increase in phytoplankton biomass and a reduction in the zooplankton:phytoplankton biomass ratio, the mean zooplankton length and cladoceran mean biomass. Fish effects might have been stronger if a bloom of Anabaena in August had not overridden potential cascading effects. We argue that both top-down and bottom-up forces are important for structuring the communities in the lake. Our results suggest that Arctic and sub-Arctic lakes may undergo important changes in trophic dynamics if they get warmer and more nutrient rich as expected with the global climate change. © 2016, Springer International Publishing Switzerland. We would like to thank Arnie Einarsson for his constant advice and assistance during fieldwork and for providing useful comments on this manuscript. We also want to thank the M??vatn Research Station (Iceland) for providing us with workspace and facilities to conduct this study. We would like to thank Elisabeth Badosa, Sergi Carrasco, Mariona Munn??, Gisela Sol?? and Beatriz Tintor?? for their hard work in the field and the laboratory. This project was supported by the Carlsberg Foundation (Project 2013_01_0535) and the MARS project (Managing Aquatic ecosystems and water Resources under multiple Stress) funded under the 7th EU Framework Programme, Theme 6 (Environment including Climate Change), Contract No.: 603378 (http://www.mars-project.eu ). MC was supported by the People Program (Marie Curie Actions) of the Seventh Framework Program of the European Union (FP7/2007???2013) under grant agreement no. 600388 of REA (TECNIOspring Program) and the Agency for Competitiveness and Business of the Government of Catalonia, ACCI??. SB was supported by the Marie Curie Intra European Fellowship no. 330249 (CLIMBING) and by the project DFG, Me 1686/7-1. XQ's contribution was supported by grants from the Spanish "Ministerio de Ciencia e Innovaci??n" (CGL2011-23907) and the Generalitat de Catalunya (Ref. 2014 SGR 484).We thank Anne Mette Poulsen for valuable editorial comments.