Abstract Objective: Lymphocyte-to-monocyte ratio (LMR) has been introduced as a predictor and a prognostic factor for multiple diseases. This study aimed to determine the efficiency of LMR in predicting the recurrence of spontaneous pneumothorax. Materials and methods: A total of 374 patients who had received chest tubes at the first episode of primary spontaneous pneumothorax were examined in terms of age, gender, side of the pneumothorax, status of recurrence, LMRs at the time of admittance and recurrence, and the interval until the recurrence. Results: Recurrence was diagnosed in 106 (28.3%) patients, whereas the mean time until the recurrence was 15.32 ± 5.57 months. Significantly, the recurrence rate was higher, while the time until the relapse was shorter for patients with elevated levels of LMR. Moreover, LMR counting over 1.25 demonstrated a 70.8% sensitivity and a 94.4% specificity in predicting a potential recurrence. Conclusions: Calculation of LMR at the first episode of spontaneous pneumothorax contributes to predict a potential recurrence when combined with traditional risk factors.

Resumen Objetivos: La proporción de linfocitos a monocitos (PLM) se ha introducido como un predictor y un factor pronóstico para múltiples enfermedades. Este estudio tuvo como objetivo determinar la eficiencia de LMR en la predicción de la recurrencia del neumotórax espontáneo. Materiales y métodos: Un total de 374 pacientes que habían recibido tubos de tórax en el primer episodio de neumotórax espontáneo primario fueron examinados en términos de edad, género, lado del neumotórax, estado de recurrencia, PLM al momento del ingreso y recurrencia, y el intervalo hasta la recurrencia. Resultados: Se diagnosticó recidiva en 106 (28.3%) pacientes, siendo el tiempo medio hasta la recidiva de 15.32 ± 5.57 meses. Significativamente, la tasa de recurrencia fue mayor, mientras que el tiempo hasta la recaída fue más corto para los pacientes con niveles elevados de PLM. Además, el recuento de PLM superior a 1.25 demostró una sensibilidad del 70.8 % y una especificidad del 94.4 % para predecir una posible recurrencia. Conclusión: Calcular la PLM en el primer episodio de neumotórax espontáneo predice una posible recurrencia cuando se combina con los factores de riesgo tradicionales.

The enhancement of shear flocculation of a galena suspension by ultrasound in the presence of sodium isopropyl xanthate and potassium ethyl xanthate was investigated by studying the effects of surfactant concentration on flocculation efficiency, contact angle, and zeta potential. Strong flocculation was obtained under alkaline conditions (pH > 9) and a high ultrasound power level (150 W). Although the ultrasonic treatment increased the negativity of the zeta potential of the galena particles, this did not decrease the flocculation efficiency, thereby showing that the hydrophobic interactions between the particle were stronger than the electrical double-layer repulsion resulting from xanthate adsorption. The findings indicate that the ultrasonic treatment promoted the adsorption of surfactants onto the mineral surfaces.

Abstract Background Due to their semiological similarities, psychogenic nonepileptic seizures (PNESs) can occasionally hardly be differentiated from epileptic seizures (ESs), and long-term video-electroencephalographic monitoring (VEM) is needed for the differential diagnosis. Objective To investigate the time of the first clinical event and its distribution on the days of VEM in ES and PNES patients. Methods In total, a consecutive series of 48 PNES and 51 ES patients matched for gender and age were retrospectively and consecutively evaluated. The time distribution of the seizures during the day was noted. Seizure latency was determined as the time in hours from the start of the video-electroencephalographic recording to the first clinical event. Results The seizure latency was significantly shorter in PNES patients compared to ES patients (p < 0.001). Seventy-two percent of PNES patients and 49.1% of ES patients had their first seizure in the 24 hours of video-EEG recording (p = 0.023). Recording longer than 48 hours was required for 12.5% of PNES patients and 37.3% of ES patients (p = 0.006). While ESs were almost evenly distributed throughout the day, most PNESs occurred during the evening hours (p = 0.011). Conclusion We observed that the PNESs appeared earlier than the ESs in the VEM and were concentrated during daylight hours. Although not strictly reliable, seizure latency can contribute to the differential diagnosis of ES and PNES.

Resumen Antecedentes Debido a sus similitudes semiológicas, las crisis no epilépticas psicógenas (CNEP) en ocasiones apenas se pueden diferenciar de las crisis epilépticas (CE), y se necesita una monitorización video-electroencefalográfica (EEG) prolongada para el diagnóstico diferencial. Objectivo Investigar el momento del primer evento clínico y su distribución en los días de monitorización video-EEG en pacientes con CE y CNEP. Métodos Se evaluó retrospectivamente a una serie consecutiva de 48 pacientes con CNEP y 51 con ES emparejados por sexo y edad. Se anotó la distribución temporal de las incautaciones durante el día. La latencia de las crisis se determinó como el tiempo en horas desde el inicio de la grabación del video-EEG hasta el primer evento clínico. Resultados La latencia de las crisis fue significativamente menor en los pacientes con CNEP en comparación con los pacientes con CE (p < 0,001). El 72% de los pacientes con CNEP y el 49,1% de los pacientes con CE tuvieron su primera crisis en las 24 horas de registro del video-EEG (p = 0,023). Se requirió un registro de más de 48 horas para el 12,5% de los pacientes con CNEP y el 37,3% de los pacientes con CE (p = 0,006). Mientras que las CE se distribuyeron casi uniformemente a lo largo del día, la mayoría de las CNEP ocurrieron durante las horas después del anochecer (p = 0,011). Conclusión Observamos que las CNEPs aparecieron antes que las CEs en la monitorización video-EEG, y se agruparon durante las horas del día. Aunque no es estrictamente confiable, la latencia de las crisis puede contribuir al diagnóstico diferencial de ES y CNEP.

Abstract: Plywood is used for insulation systems in liquid natural gas cargo ships because of its good thermal properties. However, there are only a few research investigating the mechanical properties of plywood exposed to ultra-low temperatures. This study aims to determine how plywood reacts when exposed to ultra-low temperatures, such as - 196 °C. To achieve this purpose, the present study investigated the bending strength, modulus of elasticity, and tensile-shear strength of painted and film-coated plywood under ultra-low temperatures. The mechanical properties of plywood were discovered to be significantly impacted by the ultra-low temperature as a result of this research. Moreover, not only the bending strength of the painted and film-coated plywood increased with decreasing temperature, but also the modules of elasticity of the painted and film-coated plywood increased. At decreasing temperature, the tensile shear strength of the painted and film-coated oven-dried plywood increased, but the ensile-shear strength of painted and film-coated air-dried plywood decreased. The tensile shear strength of air-dried plywood was determined to be more sensitive to the temperature change. Therefore, attention should be paid to plywood used in liquefied natural gas cargo ships with high humidity.

Abstract Selonsertib (GS-4997), a serine/threonine kinase inhibitor, targets apoptosis signal-regulating kinase 1 (ASK1) and is now in a phase III clinical trial for the treatment of non-alcoholic steatohepatitis (NASH). Inflammation is a defense against an effect that can damage the tissue or organ itself. Cytokines are the agents that play a key role in acute inflammation and one of the most important cytokine proteins, IL-1β. In this study, we investigated whether selonsertib and diclofenac sodium (positive control) could inhibit IL-1β caused by two different LPS (Salmonella enterica serotype enteritidis and Escherichia coli O111:B4) stimulated on THP-1 cell line. As a result of the WST-1 assay, the inhibitory concentration of diclofenac sodium at doses of IC50 of 32.5 μM/mL and selonsertib was calculated to be 120 μM/mL. The immunological responses of diclofenac sodium and selonsertib (IL-1β) in different LPS-stimulated THP-1 cells were assessed cytometrically: diclofenac sodium and Selonsertib were found to be effective in stimulation from E. coli. The results showed that selonsertib had a significantly anti-inflammatory effect like diclofenac sodium.

Abstract In the human gut, there is a metabolically active microbiome whose metabolic products reach various organs and are used in the physiological activities of the body. When dysbiosis of intestinal microbial homeostasis occurs, pathogenic metabolites may increase and one of them is trimethyl amine-N-oxide (TMAO). TMAO is thought to have a role in the pathogenesis of insulin resistance, diabetes, hyperlipidemia, atherosclerotic heart diseases, and cerebrovascular events. TMAO level is also associated with renal inflammation, fibrosis, acute kidney injury, diabetic kidney disease, and chronic kidney disease. In this review, the effect of TMAO on various kidney diseases is discussed.

Resumo No intestino humano, existe um microbioma metabolicamente ativo cujos produtos metabólicos alcançam diversos órgãos e são utilizados nas atividades fisiológicas do corpo. Quando ocorre disbiose da homeostase microbiana intestinal, os metabólitos patogênicos podem aumentar, e um deles é o N-óxido de trimetilamina (TMAO). Acredita-se que o TMAO tenha um papel na patogênese da resistência à insulina, diabetes, hiperlipidemia, doenças cardíacas ateroscleróticas e eventos cerebrovasculares. O nível de TMAO também está associado à inflamação renal, fibrose, lesão renal aguda, doença renal diabética e doença renal crônica. Nesta revisão, discute-se o efeito do TMAO em diversas doenças renais.

Abstract Background The underlying pathology of isolated coronary artery ectasia (CE) has not been fully elucidated. Objective We aimed to examine the relationship between the systemic immune inflammation index (Sıı), which corresponds to the multiplying of the neutrophil-to-lymphocyte ratio (NLR) and the platelet counts, and isolated CE. Method The retrospective study population included 200 patients with isolated CE, 200 consecutive with obstructive coronary artery disease, and 200 consecutive with a normal coronary artery angiogram. A 2-sided p-value of <0.05 was considered significant. Results Sıı, NLR, platelet-to-lymphocyte ratio (PLR), and monocyte-to-high density lipoprotein cholesterol ratio (MHR) were significantly higher in the CE group compared with the other groups (all p<0.001). In multivariate analysis, Sıı (p<0.001, OR = 1.005, 95% CI =1.004-1.005) was found to be an independent predictor of isolated CE. In Receiver Operating Characteristic curve analysis, Sıı had a higher Area Under the Curve than NLR, PLR, and MHR. Sıı value of >517.35 has 79% sensitivity, 76% specificity for the prediction of the CE [AUC: 0.832, (p<0.001)]. Sıı had a significant correlation with the number of ectatic coronary arteries and Markis classification (r:0.214 p=0.002; r:-0.195, p=0.006, respectively). Conclusion To the best of our knowledge, this is the first study that Sıı was significantly associated with isolated CE presence and anatomical severity.

Resumo Fundamento A patologia subjacente da ectasia da artéria coronária (EC) isolada não foi totalmente elucidada. Objetivo Nosso objetivo foi examinar a relação entre o índice de inflamação imune sistêmica (Sıı), que corresponde à multiplicação da razão neutrófilos-linfócitos (RNL) e as contagens de plaquetas, e EC isolada. Método A população do estudo retrospectivo incluiu 200 pacientes com EC isolada, 200 consecutivos com doença arterial coronariana obstrutiva e 200 consecutivos com angiografia coronária normal. Um valor de p bicaudal <0,05 foi considerado significativo. Resultados Sıı, RNL, razão plaqueta-linfócito (RPL) e razão monócito-colesterol de lipoproteína de alta densidade (MHR) foram significativamente maiores no grupo EC em comparação com os outros grupos (todos p<0,001). Na análise multivariada, Sıı (p<0,001, OR = 1,005, IC 95% =1,004-1,005) foi considerado um preditor independente de EC isolada. Na análise da curva Receiver Operating Characteristic (ROC), Sıı teve uma área sob a curva maior em comparação com RNL, RPL e MHR. O valor de Sıı >517,35 tem 79% de sensibilidade, 76% de especificidade para a predição do EC [AUC: 0,832, (p<0,001)]. Sıı teve correlação significativa com o número de artérias coronárias ectásicas e classificação de Markis (r: 0,214 p=0,002; r:-0,195, p=0,006, respectivamente). Conclusão Até onde sabemos, este é o primeiro estudo em que Sıı foi significativamente associado à presença isolada de EC e gravidade anatômica.

SUMMARY OBJECTIVE: This prospective randomized study was conducted at Ataturk University Medical Faculty Hospital, Department of Anesthesia and Reanimation, from June 2022 to May 2023. The aim of this study was to compare the effectiveness of ultrasound-guided erector spinae plane block, quadratus lumborum block, and intrathecal morphine to decrease postoperative pain after cesarean section. METHODS: Sixty-term pregnant women who were scheduled for elective cesarean sections with spinal anesthesia were included. Patients were randomly divided into three groups (n=20 for each group): Group 1: Patients were administered intrathecal morphine during spinal anesthesia; Group 2: Patients performed bilateral erector spinae plane block postoperatively; and Group 3: Patients performed bilateral quadratus lumborum block postoperatively. In the postpartum care unit, patients received intravenous Patient-Controlled Analgesia. The Patient-Controlled Analgesia devices were set to administer an intravenous bolus of 25 μg fentanyl, with a lockout interval of 10 min. Opioid consumption and maximum pain score in the 24 postoperative hours were recorded. RESULTS: Patients in Group 1 had a longer time to first analgesic requirement compared to Group 2 (p=0.017). Opioid consumption and resting and moving visual analog score scores in the first 24 h postoperatively were similar between groups. CONCLUSION: All three methods, including intrathecal morphine, erector spinae plane block, and quadratus lumborum block, are efficacious and comparable in providing postoperative analgesia after cesarean under spinal anesthesia.

Abstract Introduction: total kidney volume (TKV) increases in patients with autosomal dominant polycystic kidney disease (ADPKD), which perturbs anthropometric measurements. Objectives: the primary objectives were to investigate the accuracy of waist circumference (WC) and waist-to-hip ratio (WHR) for determining abdominal obesity in patients with ADPKD by comparison with magnetic resonance images. The secondary objectives were to investigate the associations of energy/macronutrient intake with WC and WHR. Methods: sixty patients with ADPKD were recruited from a nephrology outpatient clinic in this cross-sectional study. Main outcome measures were: TKV, total subcutaneous fat (TSF), total intraperitoneal fat (TIF), WC, WHR, body mass index (BMI), skinfold thickness (SFT), and energy/macronutrient intake. Results: mean age was 48.6 ± 11.3 years, 38 of 60 were women, median TKV was 1486 (IQR, 981-2847) mL. The patients classed as obese by the BMI had higher WC, TSF, TIF, and SFT than did non-obese; however, WHR was similar in obese and non-obese men. In the all-patients group, the WHR of obese and non-obese patients were also similar. TKV was positively correlated with WC and WHR in women, but not in men. In the multivariate analysis, TKV was an independent factor affecting WC and WHR in women. Dietary fat intake was similar in groups with and without abdominal obesity according to WC and WHR. Conclusions: in women with ADPKD, WC and WHR may not be accurate anthropometric measurements for evaluation of abdominal obesity; however, they may be associated with TKV.

Resumen Introducción: el volumen total del riñón (TKV) crece en los pacientes con enfermedad poliquística autosómica dominante del riñón (ADPKD), la cual perturba las mediciones antropométricas. Objetivos: los principales objetivos eran investigar la precisión de la circunferencia de la cintura (WC) y del cociente cintura-cadera (WHR) para determinar la obesidad abdominal en pacientes con ADPKD en comparación con imágenes de resonancia magnética. Los objetivos secundarios eran investigar las asociaciones entre consumo de energia/macronutrientes y WC y WHR. Métodos: sesenta pacientes con ADPKD fueron reclutados por una clínica ambulatoria de nefrología en este estudio transversal. Las medidas resultantes principales fueron: TKV, grasa subcutánea total (TSF), grasa intraperitoneal total (TIF), WC, WHR, índice de masa corporal (BMI), espesor del pliegue cutáneo (SFT) y consumo de energía/macronutrientes. Resultados: la edad media era de 48,6 ± 11,3 años, 38 de 60 eran mujeres, la media de TKV era 1486 (IQR: 981-2847) mL. Los pacientes clasificados como obesos por el BMI tenían niveles más altos de WC, TSF, TIF and SFT que los no obesos; sin embargo, el WHR era similar en los hombres obesos y no obesos. En el grupo de todos los pacientes, el WHR de obesos y no obesos era también similar. El TKV se correlacionó positivamente con la WC y el WHR en las mujeres pero no en los hombres. En el análisis multivariado, el TKV era un factor independiente que afectaba a la WC y el WHR en las mujeres. La ingesta de grasas en la dieta era similar en los grupos con y sin obesidad abdominal de acuerdo con la WC y el WHR. Conclusiones: en las mujeres con ADPKD, la WC y el WHR quizá no son las medidas antropométricas más apropiadas para evaluar la obesidad abdominal; sin embargo, quizá esté relacionada con el TKV.

Abstract Background In daily practice, atopic patients and those who have other drug allergies are referred to allergy clinics for evaluation of possible general anesthetic allergy despite the fact that it is not recommended in recent guidelines. Objective The aim of this prospective study is to determine the negative predictive value of skin tests for common general anesthetic drugs prior to general anesthesia in atopic patients and in patients who had drug allergies by including the data of those who had previously tolerated or reacted to general anesthesia. Methods A database program was constituted to collect the preoperative skin test data of patients referred to our clinic between 2013 and 2018. Demographic and clinical history, medications implemented during perioperative period, reactions, and results of skin tests performed with anesthetic drugs and latex were evaluated. Results Four hundred fifty-nine out of the total 1167 patients referred fulfilled the inclusion criteria for further evaluation. Nearly 75% of the patients were female and mean age was 46.3 ± 14.3 years. History of hypersensitivity reactions (HRs) due to NSAIDs and/or antibiotics, radiocontrast agents, local anesthetics, and food were present in the 53.1%, 4.1%, 1.5%, and 2.0%, respectively. The negative predictive values of skin tests for general anesthetics were in the range of 80-100%. Only 4 patients (0,87%) experienced HRs during operation. Conclusion These real-life data reveal high rates of negative predictive value of skin tests with general anesthetic drugs and a low reaction rate in atopic patients and in patients with allergy to other drugs.

Abstract Objective Ischemia/reperfusion (I/R) may cause irreversible damage to tissues and organs. We evaluated the effects of dexketoprofen on a renal I/R model in rats. Methods The study included 30 male rats. Control group received 1 mL of saline. Dexketoprofen group received 1 mL (25 mg) of dexketoprofen intraperitoneally. After 60 minutes renal ischemia, 23 hours reperfusion was applied. In Sham group, laparotomy was performed with a medial line incision without any additional procedure. Changes in the plasma malondialdehyde (MDA), renal tissue MDA, plasma glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), BUN, creatinine and albumin levels, and histopathological changes were evaluated. Results CAT values were significantly lower in Control as compared with the Sham group. Plasma levels of MDA in the Control group were significantly higher than in the Dexketoprofen group. BUN and creatinine values were significantly higher in the Dexketoprofen group. The severity of tissue injury in the Dexketoprofen group was significantly higher than in Control and Sham groups Conclusion Although dexketoprofen reduces the I/R-induced systemic inflammation, it increases renal tissue damage.

Abstract Background: This study aimed to measure the levels of anxiety and burnout among healthcare workers, including attending physicians, residents, and nurses in intensive care units during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This is a cross-sectional survey analysis of healthcare workers in our institution. Data were collected on demographic variables, COVID-19 symptoms and test, disease status, anxiety level (assessed by the Beck Anxiety Inventory), and burnout level (measured by the Maslach Burnout Inventory). Subscales of the burnout inventory were evaluated separately. Results: A total of 104 participants completed the survey. Attending physicians, residents, and nurses constituted 25%, 33.7%, and 41.3% of the cohort, respectively. In comparison to untested participants, those tested for COVID-19 had a lower mean age (p = 0.02), higher emotional exhaustion and depersonalization scores (p = 0.001, 0.004, respectively), and lower personal accomplishment scores (p = 0.004). Furthermore, moderate to severe anxiety was observed more frequently in tested participants than untested ones (p = 0.022). Moderate or severe anxiety was seen in 23.1% of the attending physicians, 54.3% of the residents, and 48.8% of the nurses (p = 0.038). Emotional exhaustion, personal accomplishment, and depersonalization scores differed depending on the position of the healthcare workers (p = 0.034, 0.001, 0.004, respectively). Conclusion: This study revealed higher levels of anxiety and burnout in younger healthcare workers and those tested for COVID-19, which mainly included residents and nurses. The reasons for these observations should be further investigated to protect their mental health.

Abstract Background: We evaluated the effect of early awake prone position administration on oxygenation and intubation requirements and short-term mortality in patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) pneumonia. Methods: This is an observational-cohort study. Patients receiving mask oxygen therapy in our intensive care units because of acute respiratory failure due to COVID-19 pneumonia were included. The Awake Prone Position (APP) group consisted of patients who were applied awake prone position, whereas non-APP group consisted of patients who were not applied awake prone position. PaCO2, PaO2, pH, SpO2 values and PaO2/FiO2 ratios were recorded at the beginning and 24th hour. Demographic data, comorbidities, intubation requirements, ventilator-free days, length of intensive care unit stay and short-term mortality of the patients were recorded. Results: The data of total 225 patients were examined, and 48 patients who met our study criteria were included. At the 24th hour, the median SpO2 value of the APP group was 95%, the median PaO2 value was 82 mmHg, whereas the SpO2 value of the non-APP group was 90% and the PaO2 value was 66 mmHg. (p = 0.001, p = 0.002). There was no statistically significant difference between the groups in length of intensive care unit stay and ventilator-free days, but short-term mortality and intubation requirements was lower in the APP group (p = 0.020, p = 0.001) Conclusion: Awake prone position application in patients receiving non-rebreather mask oxygen therapy for respiratory failure due to COVID-19 pneumonia improves oxygenation and decreases the intubation requirements and mortality.