Association between high on-treatment platelet reactivity to clopidogrel and hepatosteatosis in patients undergoing elective stent implantation

OBJECTIVE

The present study is an investigation of the association between high on-treatment platelet reactivity to clopidogrel (HTPRC) and hepatosteatosis in patients who had elective stent implantation due to coronary artery disease.

METHODS

A total of 190 consecutive patients who underwent an elective coronary stent implantation due to coronary artery disease were prospectively enrolled in the study. Eligible patients were given a 300 mg loading dose of clopidogrel before percutaneous coronary intervention. All of the patients underwent an ultrasound assessment for fatty liver. The patients were divided into 2 groups according to the detection of HTPRC: patients with HTPRC and patients without HTPRC.

RESULTS

HTPRC was present in 54.2% (103 of 190 patients) of the total study population. The age and body mass index data were similar between the 2 groups. In all, 111 (58.6%) patients had hepatosteatosis. The HTPRC ratio was statistically higher in female patients (p=0.032). Hepatosteatosis was significantly greater in patients with HTPRC (p<0.001); 84 (81.6%) patients with HTPRC had hepatosteatosis (p=0.001). There was also a statistically significant association between the hepatosteatosis grade and HTPRC (p<0.001). The percentage of HTPRC was greater in patients with ≥grade 2 hepatosteatosis than grade 1 (p<0.001). Logistic regression analysis indicated that hepatosteatosis (odds ratio: 9.403, 95% confidence interval: 4.519-19.566; p<0.001), fasting blood glucose, and hypertension were independent predictors of HTPRC.

CONCLUSION

To the best of our knowledge, this is the first study to demonstrate a relationship between hepatosteatosis and HTPRC.

Internet use patterns and Internet addiction in children and adolescents with obesity

BACKGROUND

There are no data regarding the Internet addiction (IA) rates and patterns in youth with obesity.

OBJECTIVE

This study aimed to explore the prevalence and patterns of IA in children and adolescents with obesity. The relationship between IA and body mass index (BMI) was also investigated.

METHODS

Study includes 437 children and adolescents with age ranging from 8 to 17 years: 268 with obesity and 169 with healthy controls. The Internet addiction scale (IAS) form was administered to all participants. The obesity group also completed a personal information form including Internet usage habits and goals. Linear regression analysis was utilized to assess the contributions of Internet use habits and goals to BMI in the obesity group and IAS scores to BMI in both groups.

RESULTS

A total of 24.6% of the obese children and adolescents were diagnosed with IA according to IAS, while 11.2% of healthy peers had IA (p < 0.05). The mean IAS scores for the obesity group and the control group were 53.71 ± 25.04 and 43.42 ± 17.36, respectively (p < 0.05). The IAS scores (t = 3.105) and spending time more than 21 h week^-1 on the Internet (t = 3.262) were significantly associated with increased BMI in the obesity group (p < 0.05). Other Internet habits and goals were not associated with BMI (p > 0.05). The IAS scores (t = 8.719) were also found to be associated with increased BMI in the control group (p < 0.05).

CONCLUSIONS

The present study suggests that obese children and adolescents were found to have higher IA rates than their healthy peers, and the results indicate an association between IA and BMI.

Effect of Nonalcoholic Fatty Liver Disease on In-Hospital and Long-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction

Nonalcoholic fatty liver disease (NAFLD) is a risk factor for coronary artery disease. We investigated the effect of NAFLD grade on in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The study group consisted of 360 patients with STEMI. The patients were classified according to the grade of the NAFLD using ultrasonography. Based on this classification, all patients were divided into 4 subgroups as grade 0 (no fatty liver disease), grade 1, grade 2, and grade 3. Hierarchical logistic regression and Cox proportional regression analysis were used to establish the relation between NAFLD grade and outcomes. In-hospital mortality for grade 0, 1, 2, and 3 NAFLDs were 4.7%, 8.3%, 11.3%, and 33.9%, respectively. Three-year mortality for grade 0, 1, 2, and 3 NAFLDs were 5.6%, 7.8%, 9.5%, and 33.3%, respectively. In the multivariable hierarchical logistic regression analysis, in-hospital mortality risks were higher for patients with grade 3 NAFLD (odds ratio 4.2). In a multivariable Cox proportional regression analysis, the mortality risk was higher for patients with grade 3 NAFLD (hazard ratio 4.0). In conclusion, in patients with STEMI, the presence of NAFLD is associated with unfavorable clinical outcomes. Among these patients, grade 3 NAFLD had the highest mortality rates. The present study supports NAFLD screening in patients with STEMI.

The Assessment of a Drama Therapy Process for Patients with Severe Psychiatric Patients

Introduction

Drama therapy is a useful therapy method for improving the life quality of psychiatric patients. Drama therapy is a rehearsal of everyday life. In this therapy method, clients actively join the creative process in order to better understand their life experiences.

Objectives

Drama therapy may improve patients’ ego functions, psycho-social and self-expression abilities, problem-solving skills, real-life adaptations and contribute to patient's psychiatric treatment.

Aim

The main aims were to examine the curative effects of drama group therapy and the effects of drama therapy on functionality in psychiatric patients.

Method

The study was performed at the Istanbul University Faculty of Medicine. Patients were referred from the Psychiatry Polyclinic of this university to Art Therapy and Rehabilitation Program. Drama therapy is an applied drama-based art group therapy. The 10 subjects in our study, ranged from 20 to 50 years old. This therapy group gathered once a week for a ninety minute session. Subjects continued their medical care and received psychotherapy throughout the 24-week study. The therapy plan included an introduction, a warm-up session, a drama therapy work and a sharing session. Patients were assessed in pre and post-treatment with Global Assessment of Functioning and Wilcoxon Signed Ranks Test was used for statistical analysis. Yalom's Group Curative Factors Scale was applied.

Result

There was a significant decrease in loss of functioning (P < .05). In Group Curative Factors, the means of hope, identification, group cohesion and altruism were determined high.

Conclusion

Our study demonstrates that drama therapy has positive effects on patients with severe psychiatric patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Pulsatile Mass Sensation with Intense Abdominal Pain; Atypical Presentation of the Nutcracker Syndrome

Background

Patients with Nutcracker syndrome generally present with nonspecific abdominal pain, with the left renal vein (LRV) lodged between the aorta and the superior mesenteric artery. In rare cases this can result in atypical gastrointestinal symptoms, making the diagnosis of Nutcracker syndrome challenging.

Case Report

A 28-year-old female patient presented with complaints of severe abdominal pain and palpable pulsatile abdominal mass located in the left epigastric area. Computed tomography angiography revealed that the LRV was lodged in the aortomesenteric region with a dilated left ovarian vein and pelvic varicose veins. The upper gastrointestinal endoscopy and colonoscopy were normal. The patient was diagnosed as Nutcracker syndrome and discharged to be treated with analgesics.

Conclusions

Nutcracker syndrome can be seen with atypical gastrointestinal and vascular symptoms. Computed tomography angiography is a reliable and robust technique to prove the diagnosis of nutcracker syndrome.

Diagonal earlobe crease associated with increased epicardial adipose tissue and carotid intima media thickness in subjects free of clinical cardiovascular disease

OBJECTIVE

Atherosclerotic coronary artery disease is a leading cause of death, worldwide. Diagonal earlobe crease (DELC) has been suggested as a simple, noninvasive marker of cardiovascular disease. Although epicardial adipose tissue (EAT) thickness and carotid intima media thickness (CIMT) are closely related to atherosclerosis, the relation between EAT, CIMT, and DELC had yet to be studied. The present objective was to analyze this association.

METHODS

Subjects were apparently healthy individuals referred to the cardiology outpatient clinic. A total of 65 subjects with DELC and 65 age- and sex-matched controls without DELC were enrolled. EAT thickness and CIMT were measured and analyzed.

RESULTS

Epicardial adipose tissue thickness was significantly higher in the DELC group (0.57±0.12 vs. 0.35±0.05; p<0.0001). CIMT was also significantly higher in DELC group (0.85±0.16 vs. 0.60±0.15; p<0.0001). Correlation analysis showed that CIMT was significantly correlated with EAT thickness (r: 0.594; p<0.0001). Linear regression analysis showed that presence of DELC was independently associated with CIMT and EAT thickness.

CONCLUSION

A significant and independent association between the presence of DELC and increased CIMT and EAT thickness was presently determined, for the first time, in subjects free of clinical cardiovascular disease.

An evaluation of the difficulties and attitudes mental health professionals experience with people with personality disorders

INTRODUCTION

Working with people with a personality disorder (PD) can arouse strong feelings, and cause difficulties as well as different attitudes among mental health workers (MHWs). While attitudes towards people with PD and the difficulties experienced by MHWs have been previously investigated, the reciprocal relationship between the two has not been thoroughly investigated.

AIM/QUESTION

This study aims to investigate (1) affective reactions of MHWs to people with personality disorders, (2) the difficulties that MHWs experience while working with these patients, (3) their attitudes towards these patients, and (4) the interaction between these variables.

METHOD

The data for this study were collected through a Personal Information Questionnaire, the Difficulty of Working with Personality Disorders Scale and the Attitudes towards Patients with Personality Disorders Scale from 332 MHWs from several mental health clinics in Turkey, all of whom were experienced in working with people with PD.

RESULTS

The results indicate that the participants described 'difficulty in forming a relationship, understanding the client, and establishing cooperation' among the primary reasons of difficulties. This study also shows that there is a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing borders against people with PD.

DISCUSSION

The findings of this study imply that the level of education, expertise, psychotherapy treatment and clinical supervision of MHWs all affect perceived difficulties and attitudes towards people with PD. It is also noted that among nurses, a higher level of education results in reduced experience of difficulties while working with patients with PD.

IMPLICATION FOR PRACTICE

The results foreground the need for specific skills to be developed in MHWs through theoretical training, case-focused supervision and receiving personal psychotherapy for MHWs.

Xanthelasma Is Associated with an Increased Amount of Epicardial Adipose Tissue

OBJECTIVE

In the present study, we aimed to compare the amount of epicardial adipose tissue in subjects with and without xanthelasma.

SUBJECTS AND METHODS

Fifty-two subjects with xanthelasma and 52 age- and gender-matched control subjects were enrolled in this study. Epicardial adipose tissue was assessed by measuring epicardial fat thickness (EFT) with echocardiography. Participants were dichotomized according to median EFT, which was 4 mm. The group with EFT >4 mm was defined as the supramedian group. Body mass index (BMI) was calculated by weight (kilograms) divided by height (meters) squared. Conditional logistic regression analysis was performed to find independent factors associated with supramedian EFT (>4 mm).

RESULTS

Subjects with xanthelasma had higher BMI (31.2 ± 5.6 vs. 28.6 ± 5.7, p = 0.01) and higher levels of total cholesterol (216 ± 54 vs. 181 ± 42 mg/dl, p < 0.001), LDL cholesterol (142 ± 45 vs. 115 ± 36 mg/dl, p = 0.003) and triglycerides (median, 154 vs. 101 mg/dl, p = 0.01) than control subjects. EFT was significantly higher in subjects with xanthelasma than in controls (5.04 ± 2.02 vs. 3.81 ± 2.03 mm, p = 0.002). In the conditional logistic regression analysis, the presence of xanthelasma (OR, 3.55; 95% CI, 1.43-8.78, p = 0.006) and lower HDL cholesterol level (OR, 0.96; 95% CI, 0.92-0.99, p = 0.023) were independently associated with supramedian EFT.

CONCLUSION

The amount of epicardial adipose tissue found in subjects with xanthelasma was higher than in subjects without xanthelasma. In addition, the presence of xanthelasma was independently associated with supramedian EFT.

Is there any effect of oocyte count retrieved in the OPU procedure on pregnancy outcomes?

We aimed to investigate whether the number of oocytes retrieved during ovum pick-up has any effect on pregnancy outcomes when using the gonadotropin-releasing hormone or GnRH long agonist or antagonist protocols. A retrospective study was conducted between 2012 and 2014. The patients were grouped according to the number of oocytes retrieved at ovum pick-up; < 10 oocytes (Group 1), 10-14 oocytes (Group 2) and ≥ 15 oocytes (Group 3). Biochemical pregnancy rates were compared among the three groups. Statistical analysis was performed using one-way ANOVA test for continuous variables and chi-square test for categorical variables. In total, 825 treatment cycles were included in the study. Groups 1, 2 and 3 consisted of 514, 206 and 105 patients, respectively. There was no difference among the three groups regarding biochemical pregnancy rates (22.8%, 28.6% and 28.6%; p = 0.166, respectively). The results of our study suggest that the number of eggs retrieved has no effect on pregnancy outcome in assisted reproductive technology treatment.

The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients

BACKGROUND

Proliferative scars are benign fibrotic proliferations which demonstrate abnormal wound healing in response to skin injuries. As postulated in the "response to injury hypothesis", atherosclerosis is also triggered by an endothelial injury. Keloid and atherosclerotic processes have many pathophysiological and cytological features in common.

AIMS

In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing abnormality.

STUDY DESIGN

Cross-sectional study.

METHODS

Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the median sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ultrasonograhic examination.

RESULTS

There is no signicant difference according to the demographic data, biochemical parameters, clinical parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodila-tory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001).

CONCLUSION

This study showed that endothalial dysfunction, which is strongly correlated with atherosclerosis, was more prominent in patients with proliferative scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality.

Neuroimaging and clinical characterization of Sotos syndrome

Sotos syndrome is a well-known overgrowth syndrome characterized by excessive growth during childhood, macrocephaly, distinctive facial appearance and learning disability. This disorder is caused by mutations or deletions in NSD1 gene. The aim of this study is to examine the relationship between the neuroimaging and clinical features of children with Sotos syndrome. Six Turkish children with Sotos syndrome were followed up about 3-7 years. The diagnosis was confirmed with molecular genetic analysis. We identified the pathogenic NSD1 mutation including three novel in all patients. All the patients had a characteristic facial gestalt of Sotos syndrome consisting of triangular face with prominent forehead, frontoparietal sparseness of hair and small nose. However, the degree of psychomotor and intellectual development was variable. Severe learning defect and speech delay were remarkable in two patients. The neuroimaging analysis showed abnormalities in four of six patients including bilateral large ventricles, thinning of the corpus callosum and persistent cavum septum pellucidum et vergae. Typical craniofacial appearance is the primary finding for the diagnosis of the disease even in the infantile period. However, the degree of psychomotor and intellectual development is very variable and does not correlate with the neuroimaging findings.

A novel method for pulmonary embolism detection in CTA images

In this paper, we propose a new computer-aided detection (CAD) - based method to detect pulmonary embolism (PE) in computed tomography angiography images (CTAI). Since lung vessel segmentation is the main objective to provide high sensitivity in PE detection, this method performs accurate lung vessel segmentation. To concatenate clogged vessels due to PEs, the starting region of PEs and some reference points (RPs) are determined. These RPs are detected according to the fixed anatomical structures. After lung vessel tree is segmented, the region, intensity, and size of PEs are used to distinguish them. We used the data sets that have heart disease or abnormal tissues because of lung disease except PE in this work. According to the results, 428 of 450 PEs, labeled by the radiologists from 33 patients, have been detected. The sensitivity of the developed system is 95.1% at 14.4 false positive per data set (FP/ds). With this performance, the proposed CAD system is found quite useful to use as a second reader by the radiologists.

Effects of spectral shifting in an inertial confinement fusion system

The main objective is to study the effects of spectral shifting in an inertial confinement system for kT/shot energy regime on the breeding performance for tritium and for high quality fissile fuel. A protective liquid droplet jet zone of 2 m thickness is used as coolant, energy carrier, and breeder. Flibe as the main constituent is mixed with increased mole-fractions of heavy metal salt (ThF4 or UF4) starting by 2 moles% up to 12 moles%. Spectrum softening within the inertial confinement system reduces the tritium production ratio (TBR) in the protective coolant to a lower level than unity. However, additional tritium production in the 6Li2DT zone of the system increases TBR to values above unity and allows a continuous operation of the power plant with a self-sustained fusion fuel supply. By modest fusion fuel burn efficiencies (40 to 60 %) and with a few mol.% of heavy metal salt in the coolant in form of ThF4 or % UF4, a satisfactory TBR of > 1.05 can be realized. In addition to that, excess fissile fuel of extremely high isotopic purity with a rate of ∼ 1000 kg/year of 233U or 239Pu can be produced. Radiation damage through atomic displacements and helium gas production after a plant operation period of 30 years is very low, namely dpa < 1 and He < 2 ppm, respectively.

Performance analysis of 233U for fixed bed nuclear reactors

Criticality and burn up behavior of the Fixed Bed Nuclear Reactor (FBNR) are investigated for the mixed fuel 233UO2/ThO2 as an alternative to low enriched 235UO2 fuel. CERMET fuel with a zirconium matrix and cladding has been used throughout the study. The main results of the study can be summarized as follows: Reactor criticality is already achieved by ∼2% 233UO2 with the mixed 233UO2/ThO2 fuel. At higher 233U fractions, reactor criticality rises rapidly and exceeds keff > 1.5 already by 9% 233UO2. With 100% 233UO2, start up criticality can reach keff = 2.0975. Time dependent reactor criticality keff and fuel burn up have been investigated for two different mixed fuel 233UO2/ThO2 compositions, namely: 4% 233UO2 + 96% ThO2 for a reactor power of 40 MWel (120 MWth) and 9% 233UO2 + 91% ThO2 for a reactor power of 70 MWel (210 MWth). Sufficient reactor criticality (keff > 1.06) for continuous operation without fuel change can be sustained during ∼5 and 12 years with 4% and 9% 233UO2 fractions in the mixed fuel, leading to burn ups of ∼36000 and >105000MWD/t, respectively. Thorium based fuel produces no prolific uranium. Plutonium production remains negligible.

CANDU reactors with reactor grade plutonium/thorium carbide fuel

Reactor grade (RG) plutonium, accumulated as nuclear waste of commercial reactors can be re-utilized in CANDU reactors. TRISO type fuel can withstand very high fuel burn ups. On the other hand, carbide fuel would have higher neutronic and thermal performance than oxide fuel. In the present work, RG-PuC/ThC TRISO fuels particles are imbedded body-centered cubic (BCC) in a graphite matrix with a volume fraction of 60%. The fuel compacts conform to the dimensions of sintered CANDU fuel compacts are inserted in 37 zircolay rods to build the fuel zone of a bundle. Investigations have been conducted on a conventional CANDU reactor based on GENTILLYII design with 380 fuel bundles in the core. Three mixed fuel composition have been selected for numerical calculation; (1) 10% RG-PuC + 90% ThC; (2) 30% RG-PuC + 70% ThC; (3) 50% RG-PuC + 50% ThC. Initial reactor criticality values for the modes (1), (2) and (3) are calculated as k∞,0 = 1.4848, 1.5756 and 1.627, respectively. Corresponding operation lifetimes are ∼2.7, 8.4, and 15 years and with burn ups of ∼72000, 222000 and 366000 MW.d/tonne, respectively. Higher initial plutonium charge leads to higher burn ups and longer operation periods. In the course of reactor operation, most of the plutonium will be incinerated. At the end of life, remnants of plutonium isotopes would survive; and few amounts of uranium, americium and curium isotopes would be produced.