SUMMARY OBJECTIVE: Premature ventricular complexes are common in healthy individuals’ ambulatory monitoring. The index of cardiac-electrophysiological balance may predict malignant ventricular arrhythmias. This study investigated the relation between Premature ventricular complex burden and index of cardiac-electrophysiological balance in 24-h Holter monitoring. METHODS: A total of 257 patients who were admitted to a cardiology outpatient clinic without structural heart disease and underwent 24-h Holter monitoring were included in the study. Demographic features, laboratory parameters, and electrocardiographic and echocardiographic values of all patients were obtained from the hospital database. Patients were categorized into the following four groups according to their premature ventricular complex burden: ≤5% premature ventricular complexes as group 1, >6 and ≤10% premature ventricular complexes as group 2, >11 and ≤20% premature ventricular complexes as group 3, and >20% premature ventricular complexes as group 4. QRS, QT, and T peak to end interval were measured by resting electrocardiography. QT interval was corrected using Bazett’s formula. T peak to end interval/QT, T peak to end interval/corrected QT interval, index of cardiac-electrophysiological balance, and corrected index of cardio-electrophysiological balance ratios were calculated. RESULTS: There was no significant difference between groups regarding cardiovascular risk factors. In group 4, beta-blocker usage was significantly higher, and the serum magnesium levels were significantly lower than in other groups. There was no difference in QT duration or index of cardiac-electrophysiological balance values; however, corrected index of cardio-electrophysiological balance was significantly lower in the highest premature ventricular complex group (5.1, 5.1, 4.8, 4.7, p=0.005). In multivariate backward logistic regression analyses, it was found that lower corrected index of cardio-electrophysiological balance, lower serum magnesium levels, lower serum creatinine levels, larger left atrium size, and higher T peak to end interval were associated with higher premature ventricular complexes. CONCLUSION: Corrected index of cardio-electrophysiological balance is a novel and noninvasive marker that can predict premature ventricular complex burden in patients with structurally normal hearts.

SUMMARY OBJECTIVE: The objective of this study was to evaluate the minimum number of required cases for successful robotic retroperitoneal partial nephrectomy for an experienced surgeon in transperitoneal robotic surgery. METHODS: Our prospectively collected clinic database was evaluated retrospectively, and 50 patients who underwent robotic retroperitoneal partial nephrectomy by a single experienced surgeon from January 2019 to February 2023 were included in this study. Demographic and perioperative data and R.E.N.A.L. nephrometry scores were noted. margin, ischemia, and complication score was used to predict surgical success. Receiver operating characteristic curve analysis was used to determine how many cases were required to achieve margin, ischemia, and complication score positivity and to apply the off-clamp technique. Also, the first 25 patients were assigned to Group 1 and the second 25 patients to Group 2, and the data were compared between the groups. RESULTS: The patients’ demographic data and tumor characteristics were similar in the groups. The off-clamp technique and sutureless technique rates in Group 2 were significantly higher than that in Group 1. Margin, ischemia, and complication score positivity was observed in 60% (n=15) of Group 1 and 96% (n=24) of Group 2. At receiver operating characteristic curve analysis, the 25th and later cases were statistically significant in terms of margin, ischemia, and complication score positivity. In terms of performing surgery with the off-clamp technique, the 28th and subsequent cases were statistically significant. CONCLUSION: A total of 25 or more cases appear to be sufficient to provide optimal surgical results in robotic retroperitoneal partial nephrectomy for an experienced surgeon.

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 This study aimed to investigate the role and signaling pathways of β3-AR in myocardial ischemia/reperfusion (I/R) injury, which is one of the leading causes of death worldwide. 47 male rats were randomly divided into two main groups to evaluate infarct size and molecular parameters. Rats in both groups were randomly divided into 4 groups. Control (sham), I/R (30 min ischemia/120 min reperfusion), BRL37344 (BRL) (A) (5 µg/kg single-dose pre-treatment (preT) before I/R) and BRL (B) (5 µg/kg/day preT for 10 days before I/R). Infarct size was determined with triphenyltetrazolium chloride staining and analyzed with ImageJ program. The levels of AMPK, SIRT1, mTOR, and p70SK6 responsible for cellular energy and autophagy were evaluated by western blot. Infarct size increased in the I/R group (44.84 ± 1.47%) and reduced in the single-dose and 10-day BRL-treated groups (32.22 ± 1.57%, 29.65 ± 0.55%; respectively). AMPK and SIRT1 levels were decreased by I/R but improved in the treatment groups. While mTOR and p70S6K levels increased in the I/R group, they decreased with BRL preT. BRL preT protects the heart against I/R injury. These beneficial effects are mediated in part by activation of AMPK and SIRT1, inhibition of mTOR and p70S6K, and consequently protected autophagy.

ABSTRACT Introduction: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, “most threatened organ priority’’ was considered as clinical parameter.

ABSTRACT Objectives: Diabetic nephropathy is a microvascular complication of diabetes and the most common cause of end-stage renal failure throughout the world. Videocapillaroscopy is a simple and noninvasive method that can display capillaries in the nail bed at the micron level. A few studies have been conducted on detecting retinopathy, another important diabetic microvascular complication, with videocapillaroscopy; however, no comprehensive study has been performed on diabetic nephropathy. We aimed to determine the relationship between nephropathy and capillaroscopic changes. Subjects and methods: Capillaroscopic findings of 144 patients with type 2 diabetes and 88 healthy controls were assessed prospectively by nailfold videocapillaroscopy. Twelve capillaroscopic findings were evaluated in all subjects. Results: Patients with albuminuria had more capillary aneurysms (15.5%), more microhemorrhages (15.5%), greater tortuosity (76.3%), more neoformations (29.9%), more bizarre capillaries (49.5%) and more bushy capillaries (20.6%) than the control group. In logistic regression analysis, tortuosity was significantly correlated with albuminuria (OR: 2.451, p = 0.048). Conclusions: Our findings show that the application of nailfold videocapillaroscopy can detect microvascular abnormalities in the nail bed that occur in diabetes mellitus patients compared to healthy people. Although there was no difference in the microvascular changes among the stages of diabetic nephropathy, a relationship between tortuosity and albuminuria was identified by logistic regression analysis. Nailfold videocapillaroscopy may be a new application that can be used to screen the microvascular changes that occur in diabetes mellitus.

SUMMARY BACKGROUND: The CHA2DS2-VASc score is used to determine thromboembolic risk in cases of atrial fibrillation. The predictive value of this score in predicting coronary collateral circulation in chronic total occlusion is unknown. OBJECTIVE: The aim of this study was to investigate the relationship between the CHA2DS2-VASc score and coronary collateral circulation in patients with chronic total occlusion. METHODS: A total of 189 patients, who underwent coronary angiography and had a chronic total occlusion in at least one coronary artery, were enrolled in this study. The Rentrop scoring system was used for grouping the patients, and patients were classified as having poorly developed coronary collateral circulation (Rentrop grade 0 or 1) or well-developed coronary collateral circulation (Rentrop grade 2 or 3). RESULTS: The CHA2DS2-VASc score of the good coronary collateral circulation group was significantly lower than the other group (3.1±1.7 vs. 3.7±1.7, p=0.021). During the follow-up period, 30 (32.2%) patients in the poorly developed coronary collateral circulation group and 16 (16.7%) patients in the well-developed coronary collateral circulation group died (p=0.028). According to the multivariable Cox regression model, the CHA2DS2-VASc score [hazard ratio (HR): 1.262, p=0.009], heart rate (HR: 1.049, p=0.003), LVEF (HR: 0.975, p=0.039), mean platelet volume (HR: 1.414, p=0.028), and not taking acetylsalicylic acid during admission (HR: 0.514, p=0.042) were independently associated with a higher risk of mortality. CONCLUSIONS: The CHA2DS2-VASc score is closely related to coronary collateral development and predicts mortality in patients with chronic total occlusion.

Abstract Aim: We present our subclavian artery revascularization experiences in the patients with thoracic aortic aneurysm who underwent hybrid repair. Materail and Methods: Between May 2015-December 2018,4 patients underwent TEVAR procedure following axilloaxillary bypass grafting.The mean age of the patients was 72.5 ± 3.01 years.One patient was female and 3 patients were male.Patients had thoracic aortic aneurysms including the left subclavian artery or aberrant right subclavian artery. Results: All patients underwent endovascular stent graft repair following axilloaxillary bypass grafting in the same day.Mortality did not occur in the perioperative period.One patient had graft infection at 8th month of the operation and the graft was removed.He was lost due to pneumonia following the operation.The control computed tomographies of the other 3 patients revealed patent grafts together with successful endovascular interventions and they have been following uneventfully a mean of 27±6.2 months (range:24-32,median:29). Conclusion: The risk of stroke,spinal cord ischemia, and upper extremity ischemia are found higher in the patients who underwent coverage of the left subclavian artery without revascularization.The axilloaxillary bypass grafting may be performed in the patients with high risk to prevent carotid artery manipulation and clamping during carotid-subclavian bypass with long term promising patency rates.

Resumen Objetivo: Presentamos nuestras experiencias de revascularización de la arteria subclavia en los pacientes con aneurisma de aorta torácica sometidos a reparación híbrida. Material y métodos: entre mayo de 2015 y diciembre de 2018, 4 pacientes fueron sometidos a TEVAR después de un injerto de derivación axiloaxilar. La edad media de los pacientes fue 72,5 ± 3,01 años. Un paciente era mujer y 3 pacientes eran varones. Los pacientes tenían aneurismas de la aorta torácica incluyendo el arteria subclavia izquierda o arteria subclavia derecha aberrante. Resultados: Todos los pacientes fueron sometidos a reparación endovascular con endoprótesis vascular en el mismo día después de un bypass axiloaxilar, no hubo mortalidad en el perioperatorio, un paciente presentó infección del injerto a los 8 meses de la operación y se retiró el injerto, se perdió por neumonía Las tomografías computarizadas de control de los otros 3 pacientes revelaron injertos permeables junto con intervenciones endovasculares exitosas y han estado siguiendo sin incidentes una media de 27 ± 6,2 meses (rango: 24-32, mediana: 29). Conclusión: El riesgo de ictus, isquemia medular e isquemia de la extremidad superior es mayor en los pacientes sometidos a cobertura de la arteria subclavia izquierda sin revascularización; en los pacientes con alto riesgo se puede realizar un bypass axiloaxilar para prevenir la manipulación de la arteria carótida. y pinzamiento durante la derivación carótido-subclavia con tasas de permeabilidad prometedoras a largo plazo.

Abstract Although various methods have been used in the treatment of bovine cutaneous papillomatosis (BCP), no definite treatment has yet been established. There are no studies regarding the efficacy of azithromycin (AZ) and of any combination of trypsin, chymotrypsin, and papain proteolytic enzymes (PEC) in the treatment of BCP. The objective of this study was to investigate the efficacy of AZ and PEC in the treatment of BCP. A total of 24 female Holstein cattle of 6-17 months of age with spontaneous BCP were used for this study. In addition to the clinical findings, the diagnosis was confirmed with histo-pathological examinations. The animals were divided at random into three groups (n = 8). The AZ group received 10 mg/kg/day PO for 10 days. In the PEC group, an injectable suspension of proteolytic enzymes was applied IM at 0.4 mL/10 kg dose, 3 times with 8-10 days interval and the spray was used topically once a day for 10 days. The control group (CO) was not treated. The mean in papilloma warts decreased 92.4 % in the AZ group, 83.38 % in the PEC group, and 59.48 % in the CO. There were statistically significant differences in warts presence decreases between the three groups (P < 0.05). Both AZ and PEC were considered successful for the BCP treatment. However, AZ was found more effective than PEC.

SUMMARY: Anthropometric data, which is highly correlated with health and high level of physical capacity, is very important for police officer. The aim of this study was to examine the anthropometric data of police college students and compare in terms of gender. Fifty-two police college students (32 females and 20 males) participated in the present study. Index calculations were made by applying anthropometric test measurements to all participants. The data included anthropometric (length measurements, width measurements, circumference measurement) and index [Body Mass Index (BMI), Cormic Index (C-Index), Body Adiposity Index (BAI), Ponderal Index (PI), Conicity Index (Con-Index) Waist-to-Height Ratio (WHtR)] parameters. The Independent Sample T-Test was used to analyze the difference in groups. A statistically significant difference was found in all parameters except leg length in length measurements (p<0.05). The mean of all width measurements except shoulder width of females was higher than that of male participants. Differences were obtained in all variables except hand and hip-width (p<0.05). In circumference measurements, there was a difference between the groups in the measurement values of the relaxed arm, maximum arm, wrist, shoulder, chest, and hip circumferences (p<0.05). The BAI, PI, WHtR, and Con-Index values were significantly different between groups (p<0.05). In conclusion, the length, width, circumference, and kinanthropometric indexes of male and female police candidates differ. Although male have higher mean values in length and circumference measurements, female have a higher mean for width measurements. Females have higher mean values in general in terms of index values and they are inincreased risk group in terms of WHtR index. It can be recommended for all participants, especially females, to participate in regular physical activity after they start working.

RESUMEN: Los datos antropométricos que están fuertemente correlacionados con la salud y el alto nivel de capacidad física, son muy importantes para el oficial de policía. El objetivo de este estudio fue examinar los datos antropométricos de estudiantes universitarios de policía y compararlos en relación al género. En el estudio participaron 52 estudiantes universitarios de policía (32 mujeres y 20 hombres). Los cálculos de los índices a los participantes se realizaron aplicando mediciones de pruebas antropométricas. Los datos antropométricos incluyeron (medidas de longitud, ancho y circunferencia) además de índice [Índice de masa corporal (IMC), Índice córmico (Índice C), Índice de adiposidad corporal (IAC), Índice ponderal (IP), Índice de conicidad (Con-Índice) y Relación cintura-altura (WHtR)]. Se utilizó la prueba T para muestras independientes para analizar la diferencia entre los grupos. Se encontró una diferencia estadísticamente significativa en todos los parámetros excepto en la longitud de las piernas (p<0,05). La media de todas las medidas de ancho excepto el ancho de los hombros de las mujeres fue mayor que la de los hombres. Se obtuvieron diferencias en todas las variables excepto en el ancho de manos y caderas (p<0,05). En las medidas de circunferencia, hubo diferencia entre los grupos en el brazo relajado, brazo máximo, muñeca, hombro, pecho y cadera (p<0,05). Los valores de BAI, IPI, WHtR y Con-Index fueron significativamente diferentes entre los grupos (p<0,05). En conclusión, los índices de largo, ancho, circunferencia y cineantropométricos de los candidatos a policías difieren entre hombres y mujeres. Aunque los hombres tienen valores medios más altos en las medidas de longitud y circunferencia, las mujeres tienen una media más alta en las medidas de ancho. Las mujeres tienen valores medios más altos en general, en términos de valores de índice, y se encuentran en un grupo de mayor riesgo en términos de índice WHtR. Se puede recomendar a todos los candidatos y candidatas a policía, especialmente a las mujeres, que participen en actividades físicas regularmente después de comenzar a trabajar.

RESUMO Introdução Neste estudo, investigamos o efeito do ácido tranexâmico (TXA) sobre a consolidação de fraturas em um modelo animal estabelecido, quando é usado para estancar o sangramento em cirurgias de trauma ortopédico. Materiais e Métodos Trata-se de estudo de laboratório randomizado e controlado. Dezoito ratos Sprague-Dawley foram atribuídos randomicamente em três grupos, que receberam TXA por via intravenosa (Grupo 1), TXA tópico (Grupo 2) ou isotônico por via intravenosa e tópico na mesma quantidade como grupo controle (Grupo 3). Primeiro, foi inserido um fio de Kirschner por via retrógrada no canal intramedular femoral. Em seguida, o fêmur dos animais foi fraturado na região média do corpo do fêmur com guilhotina romba. Depois de quatro semanas, os ratos foram sacrificados e os fêmures foram retirados. O volume do osso cortical, o volume do calo e a densidade mineral óssea foram calculados por meio de tomografia computadorizada e foram realizados testes de torção. Os grupos foram comparados de acordo com o torque máximo até a falha e a rigidez do calo. Resultados Não houve diferença estatística no torque até a falha e rigidez entre os três grupos nem diferenças entre os grupos quanto ao volume médio total do osso, volume e densidade do calo e percentual de volume ósseo. Conclusões Uma dose única de TXA tópico ou intravenoso não tem efeito negativo sobre a consolidação da fratura quando usada em cirurgia de fratura traumática de fêmur em modelo animal. Nível de evidência II; Estudo experimental controlado randomizado.

ABSTRACT Introduction In this study we investigated the effect of tranexamic acid (TXA) on fracture healing in an established animal model, when used to stop bleeding in orthopedic trauma surgery. Materials and Methods This study was a randomized, controlled, laboratory study. Eighteen Sprague-Dawley rats were randomly assigned to three groups, either receiving TXA intravenously (Group 1), TXA topically (Group 2), or isotonic TXA intravenously and TXA topically in the same amounts for the control group (Group 3). First, a Kirschner wire was inserted retrogradely into the femoral intramedullary canal. Then the femurs were fractured at the midshaft region with blunt guillotine. After 4 weeks, the rats were sacrified and the femurs harvested. Cortical bone volume, callus volume, and bone mineral density were calculated using computer tomography scans. Torsion tests were performed. Groups were compared by maximum torque to failure and callus stiffness. Results There were no statistical differences in torque to failure and stiffness between the 3 groups. There were no differences in mean total bone volume, callus volume, percent bone volume, or callus density between the groups. Conclusions A single dose of topical or intravenous TXA has no negative effect on fracture healing when used in traumatic femur fracture surgery in an animal model. Evidence level II; Randomized controlled experimental study.

Abstract The aim of this study was to determine antimicrobial activities of Alchemilla mollis, Alchemilla persica as well as ellagic acid and miquelianin against Staphylococcus aureus, Enterococcus faecalis, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans by using microbroth dilution method and anti-inflammatory activity by using human red blood cell (HRBC) membrane stabilization method. Microbroth dilution method was used to determine the antimicrobial activities. Extracts possessed activity having MIC values of 2.5-5-10mg/ mL, compounds possessed activity having MIC values of 1.25-2.5-4-5mg/mL. A.mollis aerial parts displayed the highest anti-inflammatory activity (IC50=1.22±0.07mg/mL). Ellagic acid and miquelianin were also determined as anti-inflammatory agents with 0.57±0.01mg/mL and 1.23±0.02mg/mL IC50 values, respectively. Total phenolic content and tannin content of the A.mollis and A.persica were determined as 357.00±75.80mg, 282.50±28.70mg PGE/g plant material and 18.02%, 18.63% respectively according to the method described by European Pharmacopoeia. Ellagic acid, miquelianin and catechin were analyzed by HPLC. The highest catechin content was detected in A.persica roots (6.69±0.05g/100g plant material). A.mollis aerial parts contain higher miquelianin (0.39±0.02g/plant material) and ellagic acid (1.56±0.01g/ plant material) than A.persica.

Resumo Fundamento A inflamação desempenha um papel fundamental no início e na progressão da doença arterial coronariana (DAC). O Índice Imune-inflamação Sistêmico (SII) é um novo parâmetro inflamatório que demonstrou estar associado à DAC. Objetivos Este estudo teve como objetivo investigar a relação entre o SII e a circulação colateral coronariana (CCC) em pacientes com DAC estável e oclusão crônica total (OTC). Métodos Os pacientes foram divididos em dois grupos, com CCC deficiente e CCC boa, de acordo com a Classificação Rentrop. Noventa e quatro pacientes apresentavam CCC deficiente e 81 pacientes CCC boa. Os parâmetros de inflamação foram calculados a partir dos resultados laboratoriais. O nível de significância estatística aplicado foi de 0,05. Resultados Alto nível de SII (OR: 1,003, IC 95%: 1,001-1,004, p<0,001), ausência de OTC na ACD (artéria coronária direita) (OR: 0,204, IC 95%: 0,096-0,436, p<0,001) e baixo escore de Gensini (OR: 0,980, IC 95%: 0,962-0,998, p=0,028) foram significantemente associados com CCC deficiente. O valor de corte do SII foi de 679,96 para o maior poder preditivo de CCC deficiente, com sensibilidade de 74,5% e especificidade de 43,2%. As taxas de mortalidade foram semelhantes entre os dois grupos durante um seguimento médio de 21,5±10,8 meses (p=0,107). Conclusões Alto nível de SII, ausência de OTC na artéria coronária direita e baixo escore de Gensini foram significantemente relacionados à CCC deficiente. O uso rápido e custo-efetivo de novos marcadores inflamatórios na prática clínica orienta o prognóstico da DAC.

Abstract Background Inflammation plays a key role in the initiation and progression of coronary artery disease (CAD). The systemic immune-inflammation index (SII) is a novel inflammatory parameter that has been shown to be associated with CAD. Objective This study aimed to investigate the relationship between SII and coronary collateral circulation (CCC) in patients with stable CAD and chronic total occlusion (CTO). Methods The patients were divided into two groups, with poor CCC and good CCC, according to the Rentrop Classification. Ninety-four patients had poor CCC, and 81 patients had good CCC. Inflammation parameters were calculated from the laboratory results. The statistical significance level applied was 0.05. Results High SII level (OR: 1.003, 95% CI: 1.001-1.004, p<0,001), absence of CTO in RCA (OR: 0.204, 95% CI: 0.096-0.436, p<0,001) and low Gensini score (OR: 0.980, 95% CI: 0.962-0.998, p=0,028) were significantly associated with poor CCC. The cutoff value of SII was 679.96 for the highest predictive power of poor CCC, with a sensitivity of 74.5% and specificity of 43.2%. Mortality rates were similar between the two groups during a mean follow-up of 21.5±10.8 months (p=0.107). Conclusions High SII level, the absence of CTO in the right coronary artery, and low Gensini score were significantly related to poor CCC. The rapid and cost-effective use of new inflammatory markers in clinical practice guides the prognosis of CAD.

SUMMARY: N-Acetylcysteine (NAC) is used for contrast induced acut kidney injury (CI-AKI) prophylaxis because of its antioxidant effects. Paricalcitol, which has reno-protective effects, is likely to provide a more effective prophylaxis when added to NAC treatment. The study was designed based on this hypothesis. The study was organised to include 4 groups each consisting of 7 rats. Group 1 was the control group, and Group 2 included rats with CI-AKI. Rats in Group 3 were administered NAC at a dose of 100 mg/kg via oral gavage once a day for 5 days. Rats in group 4 were administered paricalcitol at a dose of 0.4 mcg/kg once a day for 5 days in addition to NAC. CI-AKI was induced after the treatments in both groups. The study was terminated on the sixth day. Samples were collected from the rats’ sera and kidney tissues to study oxidant and antioxidant parameters; kidney function tests were also studied. There were significant differences between the contrast nephropathy group (Group 2) and NAC and NAC+paricalcitol groups with respect to serum urea and creatinine levels. When the same groups were compared regarding oxidant (TOS-MDA) and antioxidant (TAC-Paraoxonase) parameters, we observed that the oxidant parameters increased in serum and kidney tissue samples with NAC use, and that effect was strengthened by the addition of paricalcitol to NAC treatment. However, despite increased antioxidant effectiveness, we observed no decrease in urea and creatinine levels when paricalcitol was added for CI-AKI in rats. There was no significant difference between Group 3 and Group 4. Paricalcitol provides a more potent antioxidant effect in both serum and kidney tissue samples when added to NAC treatment in rats with CI-AKI. Despite increased antioxidant parameters, however, paricalcitol does not provide a significant decrease in urea and creatinine levels.

RESUMEN: Debido a sus efectos atioxidantes la N- acetilcisteína (NAC) se usa para la profilaxis de la lesión renal aguda inducida por contraste (CI-AKI). Es probable que el paricalcitol, que tiene efectos renoprotectores, proporcione una profilaxis más eficaz cuando se agrega al tratamiento con NAC. En base a esta hipótesis el estudio fue diseñado para incluir cuatro grupos cada uno compuesto por siete ratas. El grupo 1 fue el grupo control y el grupo 2 incluyó ratas con CI-AKI. A las ratas del Grupo 3 se les administró NAC con una dosis de 100 mg/kg por sonda oral una vez al día, durante 5 días. A las ratas del grupo 4 se les administró paricalcitol a una dosis de 0,4 mcg/kg una vez al día durante 5 días, además de NAC. Se indujo CI-AKI después de los tratamientos en ambos grupos. El estudio finalizó el sexto día. Se recolectaron muestras de suero y tejidos renales de ratas para estudiar los parámetros oxidantes y antioxidantes; También se estudiaron las pruebas de función renal. Hubo diferencias significativas entre el grupo de nefropatía por contraste (Grupo 2) y los grupos NAC y NAC+paricalcitol con respecto a los niveles séricos de urea y creatinina. Cuando se compararon los mismos grupos con respecto a los parámetros oxidantes (TOS-MDA) y antioxidantes (TAC-Paraoxonase), observamos que los parámetros oxidantes aumentaron en muestras de suero y tejido renal con el uso de NAC, y ese efecto se vio reforzado por la adición de paricalcitol a tratamiento NAC. Sin embargo, a pesar de una mayor eficacia antioxidante, no observamos una disminución en los niveles de urea y creatinina cuando se agregó paricalcitol para CI-AKI en ratas. No hubo diferencias significativas entre el Grupo 3 y el Grupo 4. El paricalcitol proporciona un efecto antioxidante más potente tanto en muestras de suero como de tejido renal cuando se agrega al tratamiento con NAC en ratas con CI-AKI. Sin embargo, a pesar del aumento de los parámetros antioxidantes, el paricalcitol no proporciona una disminución sig- nificativa en los niveles de urea y creatinina.

ABSTRACT Background: Steroids are the mainstream drugs of immu- nosuppressive regimen in renal transplantation. They are successfully used on induction, maintenance and rejection treatment. Due to complications caused by steroids, treatments are switched to immunosuppressive agents. Graft dysfunction risk caused by reduced total immunosuppression disturbs clinicians very often. We documented the differences among patients by means of clinical presentation and PRA/DSA levels between patients who are using steroids and patients that were prescribed for steroid-free regimen. Methods: 82 individuals who did not use steroid and 52 patients on steroid treatment were included with similar rates of age, sex, primary renal disease, dialysis type, posttransplant follow-up duration and donor type. Pre and posttransplant PRA, DSA levels, posttransplant and current graft function and comorbidities were evaluated. Results: Individuals who do not use steroids were found to have a lower posttransplant creatinine level and glomerular filtration rate (GFR) compared to steroid users. Posttransplant and current spot urinary protein/creatinine rates were also lower in the steroid-free group. However DM, BKVN and induction therapy rates were higher in the steroid-free group. PRA and DSA levels were similar in both groups. On the other hand, posttransplant PRA-I levels were significantly higher in those with less steroid use time. Conclusions: Although steroid free regimens usually worry the clinicians, they can be preferred in patients with low immunological risk for rejection to avoid its side effects such as uncontrolled diabetes, obesity, musculoskeletal problems and cataracts.

RESUMEN Antecedentes: Los esteroides son los principales fármacos del régimen inmunosupresor en el trasplante renal. Se utilizan con éxito en tratamientos de inducción, mantenimiento y rechazo. Debido a las complicaciones causadas por los esteroides, los tratamientos se cambian a agentes inmunosupresores. El riesgo de disfunción del injerto causado por la reducción de la inmunosupresión total perturba a los médicos con mucha frecuencia. Documentamos la diferencia entre los pacientes por medio de la presentación clínica y los niveles de PRA/DSA en aquellos que utilizan esteroides y a los que se les prescribió un regimen sin esteroides. Material y métodos: Se incluyeron 82 individuos que no usaban esteroides y 52 pacientes en tratamiento con esteroides con tasas similares de edad, sexo, enfermedad renal primaria, tipo de diálisis, duración del seguimiento postrasplante y tipo de donante. Se evaluaron la ARP pre y postrasplante, los niveles de DSA, la función y comorbilidades postrasplante y actual del injerto. Resultados: Se encontró que las personas que no usan esteroides tienen un nivel de creatinina postrasplante y una tasa de filtración glomerular (TFG) más bajas en comparación con los usuarios de esteroides. Las tasas de proteína/creatinina urinarias postrasplante y puntuales actuales también fueron más bajas en el grupo sin esteroides. Sin embargo, las tasas de DM, BKVN y terapia de inducción fueron más altas en el grupo sin esteroides. Los niveles de PRA y DSA fueron similares en ambos grupos. Por otro lado, los niveles de PRA-I postrasplante fueron significativamente más altos en aquellos con menos tiempo de uso de esteroides. Conclusiones: Aunque los regimenes libres de esteroides suelen preocupar a los clínicos, pueden ser preferidos en pacientes con bajo riesgo inmunológico de rechazo para evitar sus efectos secundarios, como diabetes no controlada, obesidad, problemas musculoesqueléticos y cataratas.