ABSTRACT Introduction: The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in-hospital complications as well as mortality of patients undergoing Evolut™ R valve implantation. Methods: A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium-3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortality. Patients were divided into two groups, AA ≤ 48° and AA > 48°, based on the mean AA measurement (48.3±8.8) on multislice computer tomography. Results: Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis. Conclusion: This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted. Introduction (AA inhospital Evolut implantation Methods 26 transfemoralapproach transfemoral approach selfexpandable self expandable 201 2022 endpoints success Consortium3. Consortium3 Consortium 3. 3 Consortium-3 leak newonset onset stroke groups 48 48.3±8.8 48388 8 (48.3±8.8 Results Pvalue P value 02 0 2 0. odds OR [OR] 173 1 73 1.73 95 CI [CI] 0.893.38, 089338 0.89 3.38, 89 38 0.89-3.38 P=0.104, P0104 P=0.104 , 104 P=0.104) (OR 04 1.04 0.991.10, 099110 0.99 1.10, 99 10 0.99-1.10 P=0.099, P0099 P=0.099 099 P=0.099) 166 66 1.66 0.823.33, 082333 0.82 3.33, 82 33 0.82-3.33 P=0.155, P0155 P=0.155 155 P=0.155) 182 1.82 0.923.61, 092361 0.92 3.61, 92 61 0.92-3.61 P=0.084, P0084 P=0.084 084 P=0.084) 057 57 0.57 0.271.21, 027121 0.27 1.21, 27 21 0.27-1.21 P=0.145 P0145 145 Conclusion implanted 20 202 Consortium- 4 48.3±8. 4838 (48.3±8. [OR 17 7 1.7 9 [CI 893 0.893.38 08933 089 0.8 338 3.38 0.89-3.3 P010 P=0.10 1.0 991 0.991.10 09911 0.9 110 1.10 0.99-1.1 P009 P=0.09 09 16 6 1.6 823 0.823.33 08233 082 333 3.33 0.82-3.3 P015 P=0.15 15 18 1.8 923 0.923.61 09236 092 361 3.61 0.92-3.6 P008 P=0.08 08 05 5 0.5 271 0.271.21 02712 027 121 1.21 0.27-1.2 P=0.14 P014 14 48.3±8 483 (48.3±8 1. 0.893.3 0893 3.3 0.89-3. P01 P=0.1 0.991.1 0991 11 1.1 0.99-1. P00 P=0.0 0.823.3 0823 0.82-3. 0.923.6 0923 36 3.6 0.92-3. 0.271.2 0271 12 1.2 0.27-1. 48.3± (48.3± 0.893. 0.89-3 P0 P=0. 0.991. 0.99-1 0.823. 0.82-3 0.923. 0.92-3 0.271. 0.27-1 48.3 (48.3 0.893 0.89- P=0 0.991 0.99- 0.823 0.82- 0.923 0.92- 0.271 0.27- 48. (48. P= (48 (4 (

Abstract Background: The association of soluble suppression of tumorigenesis-2 (sST2) levels with prognosis in pulmonary embolism (PE) is unknown. Objective: This study aimed to investigate the relationship between sST2 levels in patients with acute PE and 6-month mortality and recurrent hospitalizations. Methods: This prospective study included 100 patients with acute PE. Patients were classified into two groups according to 6-month mortality and the presence of recurrent Cardiovascular-Related hospitalizations. Two groups were compared. A p-value of 0.05 was considered statistically significant. Results: Soluble ST2 levels were significantly higher in the group with mortality and recurrent hospitalizations. (138.6 ng/mL (56.7-236.8) vs. 38 ng/mL (26.3-75.4); p<0.001) The best cut-off threshold for sST2 levels in the prediction of a composite outcome of 6-month mortality and/or recurrent Cardiovascular-Related hospitalization was found to be >89.9 with a specificity of 90.6% and a sensitivity of 65.2%, according to the receiver operating characteristic curve (area under the curve = 0.798; 95% CI, 0.705–0.891; p <0.0001). After adjusting for confounding factors that were either statistically significant in the univariate analysis or for the variables correlated with the sST2 levels, sST2 level (OR = 1.019, 95% CI: 1.009-1.028, p 0.001) and C-reactive protein (CRP ) (OR = 1.010, 95% CI: 1.001-1.021, p = 0.046) continued to be significant predictors of 6-month mortality and/or recurrent Cardiovascular-Related hospitalization in the multiple logistic regression model via backward stepwise method. Conclusion: Soluble ST2 level seems to be a biomarker to predict 6-month mortality and/or recurrent Cardiovascular-Related hospitalization in patients with acute PE. Background tumorigenesis2 tumorigenesis 2 tumorigenesis- sST (sST2 (PE unknown Objective 6month month 6 hospitalizations Methods 10 CardiovascularRelated Cardiovascular Related compared pvalue value 005 0 05 0.0 Results ST 138.6 1386 138 (138. ngmL ng mL 56.7236.8 5672368 56.7 236.8 56 7 236 8 (56.7-236.8 vs 3 26.375.4 263754 26.3 75.4 26 75 4 (26.3-75.4) p<0.001 p0001 001 cutoff cut off andor 899 89 9 >89. 906 90 90.6 652 65 65.2% area 0.798 0798 798 95 CI 0.705–0.891 07050891 705 891 <0.0001. 00001 <0.0001 . 0001 <0.0001) OR 1019 1 019 1.019 1.0091.028, 10091028 1.009 1.028, 009 028 1.009-1.028 0.001 Creactive C reactive CRP 1010 010 1.010 1.0011.021, 10011021 1.001 1.021, 021 1.001-1.021 0.046 0046 046 method Conclusion (sST 00 0. 138. 13 (138 7236 56.7236. 567236 567 56. 2368 236. 5 23 (56.7-236. 375 26.375. 26375 263 26. 754 75. (26.3-75.4 p<0.00 p000 >89 90. 65.2 0.79 079 79 0.705–0.89 0705089 70 0000 <0.000 000 101 01 1.01 0091 1.0091.028 1009102 1009 1.00 1028 1.028 02 1.009-1.02 0.00 0011 1.0011.021 1001102 1001 1021 1.021 1.001-1.02 0.04 004 04 (13 723 56.7236 56723 (56.7-236 37 26.375 2637 (26.3-75. p<0.0 p00 >8 65. 0.7 07 0.705–0.8 070508 <0.00 1.0 1.0091.02 100910 102 1.02 1.009-1.0 1.0011.02 100110 1.001-1.0 (1 72 56.723 5672 (56.7-23 26.37 (26.3-75 p<0. p0 > 0.705–0. 07050 <0.0 1. 1.0091.0 10091 1.009-1. 1.0011.0 10011 1.001-1. ( 56.72 (56.7-2 (26.3-7 p<0 0.705–0 0705 <0. 1.0091. 1.009-1 1.0011. 1.001-1 (56.7- (26.3- p< 0.705– 070 <0 1.0091 1.009- 1.0011 1.001- (56.7 (26.3 0.705 < (56. (26. 0.70 (56 (26 (5 (2

Resumo Fundamento: A associação de supressão solúvel da tumorigênese-2 (sST2) com prognóstico em embolia pulmonar (EP) é desconhecida. Objetivo: Este estudo teve como objetivo investigar a relação entre os níveis de sST2 em pacientes com EP aguda e mortalidade em 6 meses e hospitalizações recorrentes. Métodos: Este estudo prospectivo incluiu 100 pacientes com EP aguda. Os pacientes foram classificados em dois grupos de acordo com a mortalidade em 6 meses e a presença de hospitalizações recorrentes relacionadas a doenças cardiovasculares. Dois grupos foram comparados. Um valor de p de 0,05 foi considerado estatisticamente significativo. Resultados: Os níveis de ST2 solúvel foram significativamente maiores no grupo com mortalidade e internações recorrentes. (138,6 ng/mL (56,7-236,8) vs. 38 ng/mL (26,3-75,4); p<0,001) O melhor limite de corte para níveis de sST2 na previsão de um desfecho composto de mortalidade em 6 meses e/ou a hospitalização recorrente relacionada a doenças cardiovasculares foi >89,9, com especificidade de 90,6% e sensibilidade de 65,2%, de acordo com a curva Receiver Operating Characteristic (área sob a curva = 0,798; IC 95%, 0,705–0,891; p <0,0001). Após ajuste para fatores de confusão que foram estatisticamente significativos na análise univariada ou para as variáveis correlacionadas com os níveis de sST2, nível de sST2 (OR = 1,019, IC 95%: 1,009-1,028, p 0,001) e proteína C reativa (PCR). (OR = 1,010, IC 95%: 1,001-1,021, p = 0,046) continuaram a ser preditores significativos de mortalidade em 6 meses e/ou hospitalização recorrente relacionada a doenças cardiovasculares no modelo de regressão logística múltipla através do método backward stepwise. Conclusões: O nível de ST2 solúvel parece ser um biomarcador para prever mortalidade em 6 meses e/ou hospitalização recorrente relacionada a doenças cardiovasculares em pacientes com EP aguda. Fundamento tumorigênese2 tumorigênese 2 tumorigênese- sST (sST2 (EP desconhecida Objetivo Métodos 10 comparados 005 0 05 0,0 significativo Resultados ST 138,6 1386 138 (138, ngmL ng mL 56,7236,8 5672368 56,7 236,8 56 7 236 8 (56,7-236,8 vs 3 26,375,4 263754 26,3 75,4 26 75 4 (26,3-75,4) p<0,001 p0001 001 eou 899 89 9 >89,9 906 90 90,6 652 65 65,2% área 0,798 0798 798 95 95% 0,705–0,891 07050891 705 891 <0,0001. 00001 <0,0001 . 0001 <0,0001) OR 1019 1 019 1,019 1,0091,028, 10091028 1,009 1,028, 009 028 1,009-1,028 0,001 PCR. PCR (PCR) 1010 010 1,010 1,0011,021, 10011021 1,001 1,021, 021 1,001-1,021 0,046 0046 046 stepwise Conclusões (sST 00 0, 138, 13 (138 7236 56,7236, 567236 567 56, 2368 236, 5 23 (56,7-236, 375 26,375, 26375 263 26, 754 75, (26,3-75,4 p<0,00 p000 >89, 90, 65,2 0,79 079 79 0,705–0,89 0705089 70 0000 <0,000 000 101 01 1,01 0091 1,0091,028 1009102 1009 1,00 1028 1,028 02 1,009-1,02 0,00 (PCR 0011 1,0011,021 1001102 1001 1021 1,021 1,001-1,02 0,04 004 04 (13 723 56,7236 56723 (56,7-236 37 26,375 2637 (26,3-75, p<0,0 p00 >89 65, 0,7 07 0,705–0,8 070508 <0,00 1,0 1,0091,02 100910 102 1,02 1,009-1,0 1,0011,02 100110 1,001-1,0 (1 72 56,723 5672 (56,7-23 26,37 (26,3-75 p<0, p0 >8 0,705–0, 07050 <0,0 1, 1,0091,0 10091 1,009-1, 1,0011,0 10011 1,001-1, ( 56,72 (56,7-2 (26,3-7 p<0 > 0,705–0 0705 <0, 1,0091, 1,009-1 1,0011, 1,001-1 (56,7- (26,3- p< 0,705– 070 <0 1,0091 1,009- 1,0011 1,001- (56,7 (26,3 0,705 < (56, (26, 0,70 (56 (26 (5 (2

Abstract: This study aimed to examine the relationship between the burnout of physicians and nurses and their moral sensitivity during the pandemic. This was a descriptive and correlational study. This study was carried out with physicians and nurses who were continuing to work actively during the pandemic. Snowboard sampling method was utilized. The total mean score of the participants on the MSQ was 90.78±19.10. The total mean score of the COVID-19 Burnout Scale was 34.52±9.65. A statistically weak and significant correlation was found between the COVID-19 Burnout Scale and the MSQ total score, as well as the “benefit” and “conflict” sub-dimensions. It was determined that as MSQ total scores, “benefit” and “conflict” scores decreased in healthcare workers, COVID-19 burnout scores increased. In our study, the moral sensitivity of the participants was found to be moderate, and their burnout levels were found to be high. Although there was a weak relationship, it was observed that burnout levels increased as moral sensitivity levels increased. It is crucial that we learn from pandemic experiences and transfer this knowledge to future generations. In particular, we must assimilate these important lessons into training in order to develop and protect the moral sensitivity of healthcare professionals.

Resumen: Este estudio pretendía examinar la relación entre el burnout de médicos y enfermeras y su sensibilidad moral durante la pandemia. Se trató de un estudio descriptivo y correlacional, y se llevó a cabo con médicos y enfermeras que seguían trabajando activamente durante la pandemia. Se utilizó el método de muestreo de Snowboard. La puntuación media total de los participantes en el MSQ fue de 90,78±19,10. La puntuación media total de la Escala de Burnout COVID-19 fue de 34,52±9,65. Se encontró una correlación estadísticamente débil y significativa entre la Escala de Burnout COVID-19 y la puntuación total del MSQ, así como las subdimensiones “beneficio” y “conflicto”. Se determinó que, a medida que disminuían las puntuaciones totales del MSQ y las puntuaciones de “beneficio” y “conflicto” en los trabajadores sanitarios, aumentaban las puntuaciones de burnout de la COVID-19. En nuestro estudio, se observó que la sensibilidad moral de los participantes era moderada y que sus niveles de burnout eran elevados. Aunque existía una relación débil, se observó que los niveles de burnout aumentaban a medida que lo hacían los de sensibilidad moral. Es crucial que aprendamos de las experiencias pandémicas y transmitamos estos conocimientos a las generaciones futuras. En particular, debemos asimilar estas importantes lecciones en la formación para desarrollar y proteger la sensibilidad moral de los profesionales sanitarios.

Resumo: Esse estudo objetivou examinar a relação entre o burnout de médicos e enfermeiras e sua sensibilidade moral durante a pandemia. Esse era um estudo descritivo e correlacional. Esse estudo foi realizado com médicos e enfermeiras que continuaram trabalhando ativamente durante a pandemia. O método da amostragem em snowboard foi utilizado. A média total dos participantes no MSQ foi 90,78±19,10. A média total na Escala de Burnout pela COVID-19 foi 34,52±9,65. Uma correlação fraca e significante foi encontrada entre os escores totais na Escalas de Burnout pela COVID-19 e MSQ, assim como nas subdimensões “benefício” e “conflito”. Determinou-se que como os escores totais na MSQ e os escores “benefício” e “conflito” diminuiram em trabalhadores de cuidados à saúde, os escores de burnout pela COVID-19 aumentaram. Em nosso estudo, a sensibilidade moral dos participantes foi considerada ser moderada e seus níveis de burnout considerados serem altos. Embora tenha havido uma correlação fraca, foi observado que os níveis de burnout aumentaram quando os níveis de sensibilidade moral aumentaram. É essencial que aprendamos das experiências com a pandemia e passemos esse conhecimento para as futuras gerações. Em particular, nós devemos assimilar essas importantes lições em treinamentos, de forma a desenvolver e proteger a sensibilidade moral de profissionais de cuidados à saúde.

SUMMARY OBJECTIVE: Intervention in chronic total occlusion lesions involves long procedure time, a serious contrast load, and complex procedures. In this study, we aimed to investigate mortality rate of patients who had procedural coronary angiography done for chronic total occlusion lesions in coronary angiography series and who developed contrast-induced nephropathy. METHODS: A total of 218 patients with chronic total occlusion lesion in at least one coronary artery, from three different medical centers, who underwent procedural coronary angiography were recruited for the study. Patient population was divided into two groups: those who developed contrast-induced nephropathy and those who did not. Mortality due to all causes was investigated between both groups throughout a 100-month follow-up. RESULTS: Mean age of patients with incidence of contrast-induced nephropathy was 66.7±11.8, and 23.8% of them were comprised by female. We found a significantly higher mortality in long-term follow-up in the patient group with contrast-induced nephropathy (42.9 vs. 57.1%, p≤0.001). According to Kaplan-Meier analysis performed additionally, survival during follow-up was significantly shorter in this group and, in logistic regression analysis, it was an independent predictor of mortality (OR 3.02; 95%CI 1.41–6.45, p=0.004). CONCLUSION: We identified that the development of contrast-induced nephropathy is associated with long-term mortality. It might be possible to reduce adverse events with prophylactic approaches before the procedure and close follow-up of such patients after the procedure.

SUMMARY OBJECTIVES: While studies on the treatment for the coronavirus disease 2019 (COVID-19) pandemic continue all over the world, factors that increase the risk of severe disease have also been the subject of research. Malnutrition has been considered an independent risk factor. Therefore, we aimed to investigate the clinical effect of dietary habits and evaluate the prognostic value of the Controlling Nutritional Status score in the COVID-19 patients we followed up. METHODS: A total of 2760 patients hospitalized for COVID-19 were examined. Patients were retrospectively screened from three different centers between September 1 and November 30, 2020. A total of 1488 (53.9%) patients who met the criteria were included in the study. Risk classifications were made according to the calculation methods of prognostic nutritional index and Controlling Nutritional Status scores and total scores. The primary outcome of the study was in-hospital mortality. RESULTS: The groups with severe Controlling Nutritional Status and prognostic nutritional index scores had a significantly higher mortality rate than those with mild scores. In the multivariable regression analysis performed to determine in-hospital mortality, the parameters, such as age (OR 1.04; 95%CI 1.02–1.06, p<0.001), admission oxygen saturation value (SaO2) (OR 0.85; 95%CI 0.83–0.87, p<0.001), and Controlling Nutritional Status score (OR 1.34; 95%CI 1.23–1.45, p<0.001), were independent predictors. The patient groups with a low Controlling Nutritional Status score had a higher rate of discharge with recovery (p<0.001). CONCLUSIONS: Higher Controlling Nutritional Status scores may be effective in determining in-hospital mortality in patients with COVID-19. Nutrition scores can be used as a useful and effective parameter to determine prognosis in patients with COVID-19.

SUMMARY OBJECTIVE: Severe inflammation is reportedly associated with subsequent cardiovascular events, including in patients with coronary artery disease. This study aimed to examine the prognostic value of systemic immune-inflammation index and determine mortality and clinical outcomes in patients with chronic coronary total occlusion. METHODS: Our study evaluated 366 consecutive coronary total occlusion patients. The clinical end points were all-cause mortality and major adverse cardiovascular events, which include target vessel revascularization, myocardial infarction, and cerebrovascular events during 105 months follow-up. RESULTS: The study findings showed 59 (16.1%) all-cause death, 22 (6%) target vessel revascularization cases, 32 (8.7%) myocardial infarction cases, and 13 (3.6%) cerebrovascular events cases, with a median follow-up of 49 months (26–74). Multivariate logistic regression analysis showed that systemic immune-inflammation index was not associated with target vessel revascularization, myocardial infarction, and cerebrovascular events. Multivariate Cox regression analysis found systemic immune-inflammation index to be associated with all-cause death. Kaplan-Meier analysis showed a lower survival rate and myocardial infarction-free survival time in patients with higher systemic immune-inflammation index scores. CONCLUSION: Although systemic immune-inflammation index is a preferable tool for the detection of mortality, it failed to give adverse outcomes. Larger multicenter studies are thus warranted to investigate the effect of systemic immune-inflammation index on clinical outcomes.

Caper (Capparis ovata Desf. and Capparis spinosa L.) is naturally widespread in Turkey. Traditionally, buds, fruits, seeds and roots of this plant are used as tonic, diuretic, anti-rheumatic, expectorant, antidiabetic, and antifungal. The aim of this study is to evaluate potential hypoglycemic effect of C. ovata var. palaestina extracts in alloxan-induced diabetic mice. For this purpose; diabetic mice were administered with 100, 300, 500 mg/kg (i.p.) doses of methanol extract of bud and fruit. Blood glucose levels were screened 60, 120, 240 and 360 min. after treatment. Furthermore, high resolution mass spectrometry (HRMS) analysis, ABTS and DPPH free radical scavenging activity test, and phenolic and flavonoid compounds analysis of extracts were carried out. The data obtained from in vivo study revealed that fruit-methanol 500 mg/kg (FM3), bud-methanol 300 mg/kg (BM2), bud-methanol 500 mg/kg (BM3) extracts showed significant hypoglycemic activity. All extracts indicated significant antioxidant activity, however bud-methanol (BM) extract demonstrated the most potent antioxidant activity. Moreover high levels of phenolic substances and flavonoids were involved in all extracts, but the highest levels were found in FM extract. HRMS study showed that rutin, quercetin 3-O-glucoside (isoquercitrin) and stachydrine substances had seen in BM extract. The results of this study showed that the C. ovata var. palaestina extracts which, indicate hypoglycemic, antioxidant activities, might provide additional support in diabetes.