Assessment of fetal cardiac functions in pregnant women with anemia: prospective, case-control study

OBJECTIVE

To compare the fetal cardiac functions between pregnant women with iron deficiency anemia (IDA) and healthy controls.

METHODS

This single-center, prospective, case-control study was conducted at a tertiary hospital. A total of 150 patients, including 50 patients with IDA and 100 healthy pregnant women at 30-34 weeks of gestation, were included in the study. Of the patients with anemia, 20 had mild anemia, 18 had moderate anemia, and 12 had severe anemia. Pulsed-wave Doppler, M-mode, and tissue Doppler imaging (TDI) were performed to evaluate fetal cardiac functions. The fetal cardiac score was calculated using the systolic, diastolic, and global hemodynamic function parameters.

RESULTS

The myocardial performance index and isovolumetric relaxation time were significantly higher in the IDA group than the control group, while isovolumetric contraction time was similar. Among the tricuspid and mitral valve diastolic parameters, the E, A, and E/A values were significantly lower in the IDA group (p<0.001). Mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) were significantly lower in the IDA group (p<0.001). The IDA group also had significantly lower values for the TDI parameters, mitral and tricuspid E', A', S', E'/A' and a significantly higher E/E' ratio (p<0.001). Upon examination of anemia subgroups, a significant decrease was observed in the tricuspid and mitral A, E, and E/A in those with severe anemia (p<0.001). M-mode Doppler analysis revealed significantly lower TAPSE and MAPSE in the patient group with severe anemia. According to the subgroup comparison of TDI findings, the patients with severe anemia had significantly lower tricuspid and mitral E', A', S' and E'/A' (p<0.001) values and a significantly higher E/E' ratio (p<0.001). The fetal cardiac score was significantly higher in the maternal IDA group compared to the control group. A significant negative correlation was found between maternal hemoglobin level and fetal cardiac score (p<0.001).

CONCLUSIONS

There may be changes in the systolic and diastolic cardiac functions of the fetuses of pregnant women with IDA. This study showed an increased E/E' ratio in the fetuses of pregnant women with IDA, suggesting a decrease in fetal heart maturation. Within the IDA group, fetal cardiac functions were more affected in those with severe anemia. This article is protected by copyright. All rights reserved.

Intraoperative ultrasound-guided ventricular cannulation in patients with normal-sized ventricles

INTRODUCTION

Many pathologies require normal-sized ventricle cannulation, which may be technically challenging even with neuronavigation guidance. This study presents a series of ventricular cannulation of normal-sized ventricles using intraoperative ultrasound (iUS) guidance and the outcomes of patients treated by this technique, for the first time.

METHODS

The study included patients who underwent ultrasound-guided ventricular cannulation of normal-sized ventricles (either ventriculoperitoneal (VP) shunting or Ommaya reservoir) between January 2020 and June 2022. All patients underwent iUS-guided ventricular cannulation from the right Kocher's point. The inclusion criteria for normal-sized ventricles were as follows: (1) Evans index <30%, and (2) widest third ventricle diameter <6mm. Medical records and pre-, intra- and post-operative imaging were retrospectively analyzed.

RESULTS

Nine of the 18 included patients underwent VP shunt placement; 6 had idiopathic intracranial hypertension (IIH), 2 had resistant cerebrospinal fluid fistula following posterior fossa surgery, and 1 had iatrogenic intracranial pressure elevation following foramen magnum decompression. Nine patients underwent Ommaya reservoir implantation, 6 of whom had breast carcinoma and leptomeningeal metastases and 3 hematologic disease and leptomeningeal infiltration. All catheter tip positions were achieved in a single attempt, and none were placed suboptimally. Mean follow-up was 10 months. One IIH patient (5.5%) had early shunt infection which necessitated shunt removal.

CONCLUSION

iUS is a simple and safe method for accurate cannulation of normal-sized ventricles. It provides an effective real-time guidance option for challenging punctures.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Effect of PET/CT standardized uptake values on complete response to treatment before definitive chemoradiotherapy in stage III non-small cell lung cancer

PURPOSE

The standard treatment for patients with stage III non-small cell lung cancer (NSCLC), unsuitable for resection and with good performance, is definitive radiotherapy with cisplatin-based chemotherapy. Our aim is to evaluate the effect of the maximum value of standardized uptake values (SUVmax) of the primary tumor in positron emission tomography-computed tomography (PET/CT) before treatment on complete response (CR) and overall survival.

METHODS

The data of 73 stage III NSCLC patients treated with concurrent definitive chemoradiotherapy (CRT) between 2008 and 2017 and had PET/CT staging in the pretreatment period were evaluated. ROC curve analysis was performed to determine the ideal cut-off value of pretreatment SUVmax to predict CR.

RESULTS

Median age was 58 years (range 27-83 years) and 66 patients were male (90.4%). Median follow-up time was 18 months (range 3-98 months); median survival was 23 months. 1-year overall survival (OS) rate and 5-year OS rate were 72 and 19%, respectively. Median progression-free survival (PFS) was 9 months; 1-year PFS rate and 5-year PFS rate were 38 and 19%, respectively. The ideal cut-off value of pretreatment SUVmax that predicted the complete response of CRT was 12 in the ROC analysis [AUC 0.699 (0.550-0.833)/P < 0.01] with a sensitivity of 83%, and specificity of 55%. In patients with SUVmax < 12, CR rate was 60%, while, in patients with SUV ≥ 12, it was only 19% (P = 0.002). Median OS was 26 months in patients with pretreatment SUVmax < 12, and 21 months in patients with SUVmax ≥ 12 (HR = 2.93; 95% CI 17.24-28.75; P = 0.087). CR rate of the whole patient population was 26%, and it was the only factor that showed a significant benefit on survival in both univariate and multivariate analyses.

CONCLUSION

Pretreatment SUVmax of the primary tumor in PET/CT may predict CR in stage III NSCLC patients who were treated with definitive CRT. Having clinical CR is the only positive predictive factor for prolonged survival.

Comparison of conventional cytology and SurePath in split thyroid fine needle aspiration materials

OBJECTIVE

The aim of the present study was to compare the cytomorphological features and cytopathological diagnoses in thyroid aspiration materials prepared by SurePath® (SP) and conventional cytology (CC).

MATERIALS AND METHODS

Fine needle aspiration (FNA) materials from 180 thyroid nodules were divided into two groups to prepare three conventional smears and one SP slide. Twenty-nine cytomorphological features of thyroid lesions were compared in the CC and SP slides. The Kappa coefficiency was determined for each. The cytopathological diagnosis of CC and SP were compared.

RESULTS

The feature with the lowest Kappa coefficient was the haemorrhagic background, whereas nuclear molding had the highest Kappa coefficient. The rates of the atypical and suspicious cytopathological diagnostic categories were decreased, whereas the rates of benign and malignant categories were increased in SP. When the cytopathological diagnoses of CC and SP were compared with the histopathological diagnoses of the 31 thyroidectomy materials, the results were similar.

CONCLUSION

The common problems seen in CC, such as an excessive number of slides, a haemorrhagic background and air drying artefact in the SP method were not encountered. Through these advantages, the rate of the indeterminate cytopathological diagnosis was low in SP. In addition to those advantages, the increased rates of non-diagnostic cases, the difficulty in evaluating the cytomorphologic features owing to tridimensional structures and the smaller size of the cells and the presence of tridimensional structures uninterpreted microscopically were the disadvantages of SP. The present results showed that SP could be used instead of CC in thyroid cytopathology.

Position-Dependent Local Detection Efficiency in a Nanowire Superconducting Single-Photon Detector

We probe the local detection efficiency in a nanowire superconducting single-photon detector along the cross-section of the wire with a far subwavelength resolution. We experimentally find a strong variation in the local detection efficiency of the device. We demonstrate that this effect explains previously observed variations in NbN detector efficiency as a function of device geometry.

Experimental test of theories of the detection mechanism in a nanowire superconducting single photon detector

We report an experimental test of the photodetection mechanism in a nanowire superconducting single photon detector. Detector tomography allows us to explore the 0.8-8 eV energy range via multiphoton excitations. High accuracy results enable a detailed comparison of the experimental data with theories for the mechanism of photon detection. We show that the temperature dependence of the efficiency of the superconducting single photon detector is determined not by the critical current but by the current associated with vortex unbinding. We find that both quasiparticle diffusion and vortices play a role in the detection event.

Prevalence of hepatic pseudolesions around the falciform ligament in a paediatric population

This study investigated the prevalence and features of hepatic pseudolesions around the falciform ligament in 320 children undergoing contrast-enhanced abdominal multidetector computed tomography. Aberrant venous drainage was investigated using thin-section computed tomography images. Pseudolesions around the falciform ligament were detected in 63 patients (20%). The longest diameter was in the craniocaudal direction in 41 (65%) patients (lesions). An inferior vein of Sappey supplying the pseudolesions was seen in 11 patients (17%). Thirteen patients of the 63 patients (21%) with pseudolesions who had a history of extrahepatic malignancy were also examined by ultrasound; in two of the 13 patients the lesions were isoechoic and, in the remainding 11 patients, they were hyperechoic. It was concluded that hepatic pseudolesions around the falciform ligament occur frequently in the paediatric population on CT images. Detection of the longest diameter in the craniocaudal direction and the presence of an inferior vein of Sappey and fatty infiltration should be sufficient to exclude true lesions and make further evaluations unnecessary.

Vagus nerve stimulation suppresses generalized seizure activity and seizure-triggered postictal cardiac rhythm changes in rats

In the present study, we investigated the effects of vagus nerve stimulation (VNS), a proposed treatment for patients with intractable epilepsy, on cardiac rhythm following seizures induced by pentylenetetrazole (PTZ) in Wistar rats. After a baseline recording of electroencephalogram (EEG), electrocardiogram (ECG) and blood pressure (BP), rats in the first group received a single convulsive dose of PTZ (70 mg/kg) (Group 1). In the other two groups, the Wistar rats were implanted with a cuff electrode on the left cervical vagus nerve. One day after surgery, rats in the second group were treated with VNS (Group 2), whereas rats in the third group were connected to the stimulator but did not receive VNS (Group 3). Ten minutes after VNS onset, 70 mg/kg dose of PTZ was injected. EEG, ECG and BP were continuously recorded during post-injection period. Seizure severity was scored behaviorally. Then, baseline, ictal and postictal periods were analyzed for cardiac rhythms, seizure severity and blood pressure variability. PTZ treatment induced tonic-clonic seizure activity in all animals of Group 1 and Group 3. In these groups a marked increase of mean arterial blood pressure (MABP) but a significant decrease in heart rate and PP interval fluctuations was observed at postictal period. However, in the VNS-treated group the seizure scores and cardiac parameter returned to the baseline level. Present results emphasize that VNS effectively reduces seizure severity and suppress the seizure-induced cardiac rhythm changes.

Changes in blood-brain barrier permeability during hot water-induced seizures in rats

Hot water epilepsy (HWE) was induced in freely moving Wistar rats by applying hot water jets over the head region. The status of the blood-brain barrier (BBB) during the seizures and during hot water-induced hyperthermia without seizures was examined using Evans blue dye. In order to investigate the contribution of concomitant factors to this process, synchronized body temperature and blood pressure recordings were also made. Tonic-clonic seizure activity was observed within an average of 3.9 min (SE= 0.6 min) in the rats exposed to the hot water jets; this treatment induced BBB opening in the cortical and deep brain areas. Body temperature and blood pressure increased from 36.5 degrees +/- 0.3 degrees C to 40.0 degrees+/- 0.2 degrees C, and from 91+/- 3 mmHg to 153+/- 4 mmHg, respectively. In the group of animals exposed to hot water application without inducing seizures, there were significant increases both in blood pressure and body temperature; however, the extravasation of Evans blue was not pronounced in the brains. Hot water-induced seizures, increased cerebrovascular permeability. Although high blood pressure and hyperthermia contribute to this permeability, the seizure activity is the major factor in this change.

Changes in the blood-brain barrier permeability and in the brain tissue trace element concentrations after single and repeated pentylenetetrazole-induced seizures in rats

The behaviour of brain capillary endothelium to the passage of macromolecules in single and repeated seizures conditions and its relationship to the brain trace element concentrations are the main subject of this study. For this purpose, animals were treated with either single or repeated doses of pentylenetetrazole (PTZ). As a marker of blood-brain barrier (B-BB) permeability changes, Evans Blue (EB) dye was used. Seizure activity was observed and seizure patterns and convulsion times were recorded. PTZ treatment induced generalised tonic-clonic seizure in all animals, but seizures were found to be lasting longer in single seizure group than repeated seizures group. Seizures induced by single dose PTZ treatment resulted in bilateral EB leakage in the preoptic area, caudate nucleus, putamen, thalamus, hypothalamus, midbrain, and the superior colliculus. However, repeated PTZ-induced seizures led to EB leakage in the brains of only few number of rats, and it was confined to hypothalamus, caudate nucleus, cerebellum, thalamus, and pons. On the other hand, while the levels of copper (Cu) and iron (Fe) in brain tissue were found to be decreased significantly in the repeated seizures group when compared with the other groups, the levels of zinc (Zn) did not show any differences between groups. These results indicate that the regional B-BB opening markedly differs between single and repeated PTZ-induced seizures group and this difference may be due to PTZ tolerance and changes in cerebral endothelial structure.

Effects of adenosine administration on spike-wave discharge frequency in genetically epileptic rats

1. In the present study, the effects of the administration of adenosine on absence seizures were investigated in the Wistar Albino Glaxo/Rijswijk (WAG/Rij) strain of rats, which are an adequate model for human absence epilepsy. 2. After baseline electroencephalogram (EEG) recording, adenosine was injected intraperitoneally (i.p.) at doses of 6, 30 and 120 mg/kg and EEG recordings were continued for 1 h postinjection. In addition, to enable evaluation of the contribution of peripheral factors to the occurrence of spike-wave discharges (SWD) after adenosine injection, arterial blood pressure and rectal temperature were also recorded. 3. Injection of adenosine induced a dose-dependent increase in the appearance of SWD. The number and total duration of SWD were found to be significantly increased after 30 and 120 mg/kg adenosine (P < 0.05). Adenosine also induced a fall in both blood pressure and body temperature in all experimental groups. 4. These results show that peripheral administration of adenosine promotes absence seizures. It is likely that the lowering of blood pressure and body temperature and the activation of sensory afferents after adenosine injection may contribute to the facilitation of SWD observed in the present study.

Group psychotherapy with female-to-male transsexuals in Turkey

The change in Turkish law to allow local sex reassignment surgery was passed in May 1988. By law, a candidate for such surgery must obtain a medical certificate attesting that the operation is necessary. However, the law does not specify conditions for granting such a certificate, so any physician can give a certificate based on his own criteria. Sex reassignment surgery can therefore be performed without preoperative psychiatric evaluation and preparation. This is a report of 40 female-to-male transsexuals. They had completed psychiatric assessment and participated in group therapy. These meetings provided a valuable setting for getting to know transsexuals and their families. Participants' long, regular attendance and low dropout rate demonstrate high group cohesion. The aim of the study is to report characteristics of a group of transsexuals living in a different cultural setting from other studies of this patient population in order to identify problems of Turkish transsexuals and advocate changes in current Turkish laws for sex reassignment.

Increased adenoid mast cells in patients with otitis media with effusion

OBJECTIVE

Previous studies have been suggested the possible role of adenoid mast cells in the pathogenesis of otitis media with effusion (OME). The aim of the present study was to evaluate the possible relationship of adenoid mast cells and hearing loss in patients with chronic OME.

METHODS

Twenty patients with combined chronic OME and chronic adenoiditis (OME-A) and 20 patients with isolated chronic adenoiditis were studied. Hearing thresholds were determined by pure tone audiometry in both groups. All subjects underwent adenoidectomy and adenoid mast cells were counted in each specimen. Number of adenoid mast cells were determined in both groups. Possible relationship of adenoid mast cells and hearing thresholds in OME-A patients was evaluated by comparing the hearing thresholds of OME-A patients with mast cell count above the mean of OME-A group and hearing thresholds of OME-A patients with mast cell count below the mean of OME-A group.

RESULTS

All isolated chronic adenoiditis patients had normal hearing thresholds. OME-A patients had hearing thresholds ranging from 12-52 dB. The number of adenoid mast cells in OME-A group (median: 80) was significantly greater than isolated chronic adenoiditis group (median: 38) (P < 0.05). OME-A patients with adenoid mast cell count above the mean of OME-A group had significantly higher hearing thresholds compared to OME-A patients with mast cell count below the mean of OME-A group (P < 0.05).

CONCLUSIONS

Patients with OME-A have greater number of adenoid mast cells than patients with isolated chronic adenoiditis. OME-A patients with adenoid mast cell count above the mean of the OME-A group had higher hearing thresholds than OME-A patients with adenoid mast cell count below the mean of the OME-A group. Increased number of adenoid mast cells may contribute to the pathogenesis of higher hearing thresholds in some OME-A patients.

Appraisal of self, social environment, and state authority as a possible mediator of posttraumatic stress disorder in tortured political activists

This study examined appraisal of self and others, as measured by semantic differential ratings of Police, State, Society, Family, Friend, Myself as a Man/Woman, and Myself as a Political Person, in 55 tortured political activists in Turkey, 55 nontortured political activists, and 55 nontortured, politically noninvolved controls. There were no remarkable differences between tortured and nontortured political activists; both groups differed from controls in having a more negative appraisal of the police and the state and stronger perceptions of danger, mistrust, and injustice in relation to state authority. Lack of beliefs concerning a "benevolent state" may have protected the survivors from the traumatic effects of state-perpetrated torture. Further research into the possible protective role of belief systems in posttraumatic stress disorder is needed.

Factors related to long-term traumatic stress responses in survivors of torture in Turkey

OBJECTIVE

To examine factors related to long-term psychological functioning in political ex-prisoners who had been subjected to systematic torture.

DESIGN

The psychological status of 55 tortured political activists, 55 nontortured political activists, and 55 subjects with no history of torture or political activism was assessed using Structured Clinical Interview for DSM-III for psychiatric assessment, Semi-structured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD). Correlational and multiple regression analyses were used to assess the independent effects of precaptivity, captivity, and postcaptivity variables as predictors of long-term psychological status among the torture survivors.

SETTING

Istanbul, Turkey.

MAIN OUTCOME MEASURES

Number of lifetime and current PTSD symptoms, and scores on the Beck Depression Inventory, Hamilton Depression Rating, Hamilton Anxiety Scale, and State-Trait Anxiety Inventory.

RESULTS

Effect of captivity experience on various life areas (eg, family and social, economic, and employment status) and other postcaptivity psychosocial stressors were associated with PTSD symptoms, anxiety, and depression. Perceived severity of torture was related to PTSD symptoms but not to anxiety or depression. Lack of social support predicted anxiety and depression but not PTSD. Family history of psychiatric illness correlated with higher scores on most measures. Impact of captivity experience on family was the strongest predictor of PTSD symptoms.

CONCLUSIONS

These findings point to three types of stressors related to different aspects of psychopathology in survivors of torture: perceived severity of torture, secondary effects of captivity experience on various life areas, and general psychosocial stressors following captivity. Different interventions may be needed for three components of survivors' traumatic experience: cognitive and behavioral strategies for treatment of PTSD symptoms, marital or family strategies for minimizing the impact of the trauma on the family, and strategies for enhancing social support to minimize postcaptivity depression and anxiety.

Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey

OBJECTIVE

The aim of the study was to investigate the long-term effects of torture in a group of former political prisoners.

METHOD

The study was carried out in Istanbul, Turkey, where 55 Turkish political activists who had been tortured were compared with a closely matched group of 55 activists who had not been tortured. The Structured Clinical Interview for DSM-III-R, the Semistructured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD) were used. The tortured and the nontortured activists were similar in age, sex, marital and socioeconomic status, political ideology, political involvement, stressful life events other than torture, and other features.

RESULTS

The torture survivors reported an average of 291 exposures to a mean of 23 forms of torture. The mean length of their imprisonment was 47 months. The survivors of torture had significantly more symptoms of PTSD and anxiety/depression than the nontortured comparison subjects, although their PTSD symptoms were only moderately severe and their general mood was normal. Despite the severity of their torture experiences, the survivors had only a moderate level of psychopathology.

CONCLUSIONS

The results suggest that torture has long-term psychological effects independent of those related to uprooting, refugee status, and other traumatic life events in a politically repressive environment. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.

Noradrenergic and serotoninergic depression?

The aim of this study was to test the hypothesis of noradrenergic and serotoninergic depressive subtypes. For this purpose, the correlation between three variables was investigated: urinary 3-methoxy-4-hydroxyphenylglycol (MHPG), dexamethasone suppression test (DST), and clinical response profiles to clomipramine and maprotiline, the effects of which are relatively selective on the uptake of noradrenaline (NA) and 5-hydroxytryptamine (5HT). Our results showed no correlation between these measures. Therefore, the hypothesis of two subtypes of depression was not supported. The only significant finding in this study was the obvious decrease in MHPG excretion during the antidepressant treatment in the group with high pretreatment MHPG.