The efficacy of non-invasive mechanical ventilation (NIMV) on the postoperative ARF is conflicting and the failure rate of NIMV in this patient population is high. In our study, we hypothesized that ...the use of dexmedetomidine during NIMV in major abdominal surgical patients can reduce NIMV failure without significant side affect.
Medical records of patients who underwent major abdominal surgery, admitted to our general surgery intensive care unit (ICU), developed postoperative ARF, received NIMV (with oro-nasal mask) and dexmedetomidine infusion were enrolled in this study. The infusion rate was adjusted to maintain a target sedation level of a Richmond Agitation-Sedation Scale (RASS) (-2)-(-3). The sedation was stopped when NIMV was discontinued.
A total of 60 patients, 42 (70.0%) male, and 18 (30.0%) female, with a mean age of 68 ± 11 years were included in the study. The mean APACHE II score was 20 ± 6. Dexmedetomidine was infused for a median of 25 h (loading dose of 0.2 mcg/kg for 10 min, maintained at 0.2-0.7 mcg/kg/h, titrated every 30 min). RASS score of all study group significantly improved at the 2 h of dexmedetomidine initiation (+3 vs. -2,
= 0.01). A targeted sedation level was achieved in 92.5% of patients. Six (10.0%) patients developed bradycardia and 5 (8.3%) patients had hypotension. The mean NIMV application time was 23.4 ± 6.1 h. Seven (11.6%) patients experienced NIMV failure, all due to worsening pulmonary conditions, and required intubation and invasive ventilation. Fifty-three (88.3%) patients were successfully weaned from NIMV with dexmedetomidine sedation and discharged from ICU. The duration of NIMV application and ICU stay was shorter in NIMV succeded group (21.4 ± 3.2 vs. 29.9 ± 6.4;
= 0.012).
Our study suggests that dexmedetomidine demonstrates effective sedation in patients with postoperative ARF during NIMV application after abdominal surgery. Dexmedetomidine can be considered safe and capable of improving NIMV success.
Cytokinins and auxins were studied in Lens culinaris before; however, there was lack of information about their
effects on vascular tissues and their relation with plant development. In this study, ...intact lentil seedlings were treated with
different doses of BAP (1 mg/L) and NAA (0.3, 0.6, 0.9, 1.2 mg/L) with periodic intervals of 7, 14, 21, 28, and 35 days under in
vitro conditions. The behaviors of plant height, number of shoots per plant, and rooting were investigated to find if their
regeneration behavior is related with the developmental behavior of phloem and xylem thickness and stem radius. In most
instances, seven-day culture conditions in all plant growth regulators (PGRs) doses demonstrated the best results. BAP and
NAA treatments with high doses on prolonged days of culture caused unhealthy growing on plant development and vascular
tissues. While phloem region thickness was the highest in control group, xylem region was found to have the highest thickness
in 1 mg/L BAP treatment used singly. Moreover, high doses of BAP and NAA caused deformity and shrinking in phloem and
xylem regions that also lead to shrinking in stem radius. These results reveal negative effects of BAP and NAA treatments on
prolonged days of culture and conclude that the time period of treatment must be optimized precisely to avoid damages to
vascular and other tissues and promote desirable growth and development of tissues.
In this study, the performances of type of demountable connectors used as connecting elements in the frame construction furniture are compared with the forces against shear force. The test samples ...were prepared from melamine-coated particle board (YL-Lam) and medium density fiberboard (MDF-Lam). Four types of demountable type of connection elements are used: metal L connection, plastic T connection, metal T connection and moon connection. The experimental samples were subjected to static stress tests under the critical loads that could be affected during the use. As a result of the experiments, the highest shear force was obtained from the test specimens prepared by using MDF-Lam and metal T connectors. The lowest was determined by using YL-Lam and plastic T connector. According to the results of the experiment, in the H type construction prepared with YL-Lam, when the shear force bearing capacity of the connection element is ordered from highest to lowest, respectively; Metal T, Moon, Metal L and Plastic T connectors were determined while in the construction prepared with MDF-Lam it is ordered as Metal T, Metal L, Plastic T and Moon connectors. In this study, the load-bearing capacity of the test samples and the load-deflection graph formed under this loading are given.
Background
Neutrophil‐to‐lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the ...association between NLR and nutritional status in geriatric patients.
Methods
This cross‐sectional study included 95 geriatric (age ≥ 65 years) patients from general internal medicine outpatient clinic of a university hospital. Nutritional status of the patients was evaluated using Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index, albumin, total cholesterol, body mass index, mid‐arm circumference, and calf circumference. NLR was calculated from the complete blood count results.
Results
A total of 59 patients were female, and the mean age was 73 ± 9.8 years. According to the MNA, 51.6% of patients had a normal nutritional status, and 48.4% were malnourished or at risk of malnutrition. The mean NLR of patients with malnourished or at risk of malnutrition was significantly higher than that of patients with normal nutritional status (P = 0.004). There was a negative correlation between NLRs and the MNA scores (r = −0.276, P = 0.007). Optimal NLR cutoff point for patients with malnourished or at risk of malnutrition was 1.81 with 71.7% sensitivity and 63.3% specificity 95% confidence interval (CI): 0.562‐0.780, P = 0.004. Logistic regression analysis revealed that elevated NLR was an independent factor in prediction of malnutrition or risk of malnutrition in geriatric patients.
Conclusion
These results demonstrated that NLR was associated with the nutritional status of geriatric patients. NLR may be a useful nutritional marker for evaluating the nutritional status of geriatric outpatients.
Position changes and increased intra-abdominal pressure in laparoscopic interventions lead to some physiopathological changes. There is no definite information in the literature regarding cerebral ...oxygen saturation in patients undergoing colorectal surgery. Our aim was to investigate whether there is oxygen saturation change in the brain tissue in pneumoperitoneum and the Trendelenburg position during laparoscopic rectal surgery.
Cerebral oxygen saturation was measured in 35 patients who underwent laparoscopic rectal surgery in the Trendelenburg position. Measurements were made under general anesthesia in the pneumoperitoneum and the Trendelenburg position.
The values that are statistically affected by the position are systolic blood pressure, mean arterial blood pressure and cerebral oxygen saturation. The Trendelenburg position does not disturb the cerebral oxygen saturation and it causes an increase in saturation. After pneumoperitoneum occurred, changes in systolic blood pressure, mean arterial blood pressure and brain oxygen saturation were detected. Cerebral oxygen saturation increases with the formation of pneumoperitoneum.
The Trendelenburg position and increased intraabdominal pressure during laparoscopic rectal surgery do not impair brain oxygen saturation.
Psoriasis is a chronic inflammatory disease that is associated with many inflammatory conditions such as atherosclerosis, hypertension, among others. SCUBE-1 is a protein that plays a role in ...angiogenesis.
The present study aimed to investigate whether SCUBE-1 could indicate subclinical atherosclerosis in psoriatic patients, and to compare SCUBE-1 levels, measurement of carotid artery ıntima-media thickness (CIMT), and metabolic parameters in psoriasis patients and healthy controls.
Forty-six patients with psoriasis and 43 healthy controls were included. The severity of the disease was assessed with Psoriasis Area Severity Index (PASI) in the patient group. Levels of SCUBE-1, CRP, lipids, and fasting glucose were measured with the enzyme-linked ımmunosorbent assay (ELISA) method, and CIMT measurements were performed by the same cardiologist.
SCUBE-1 levels and CIMT values were significantly higher in the patient group (for both p < 0.05). Moreover, systolic blood pressure, CRP levels, and waist circumference were higher in the patient group even though both groups had similar BMIs (for all p < 0.05). A positive correlation was found between SCUBE-1 and CIMT values among patients, and multiple regression analyses revealed that SCUBE-1 and CIMT are significantly associated with psoriasis as well.
A low number of participants and not including any other inflammatory marker related to angiogenesis or atherosclerosis such as VEGF, adiponectin are the main limitations of the present study.
Despite the severity of the disease, even in psoriasis patients with mild disease the SCUBE-1 level may be an indicator of subclinical atherosclerosis and indicate the risk of cardiovascular disease in the future.
Aim: Fecal incontinence is a condition that has social and economic effects and that disrupts the quality of life. A complete definition of fecal
incontinence is difficult. However, it can be defined ...as the failure to control the anal discharge of intestinal content at an appropriate time and place.
The diagnosis of fecal incontinence is challenging and complex. One of the most important causes of fecal incontinence is trauma in the perianal
region. The most important cause of such trauma is birth trauma. We examined our cases who had sphincter repair due to acute injury in the perianal
region during delivery.
Method: The data of 10 female patients who were admitted to Necmettin Erbakan University, Meram Faculty of Medicine, Department of General
Surgery with perianal injuries between 2010 and 2015 were analyzed retrospectively. Data regarding age, severity of injury, first intervention time,
repair type, wound problems and post-operative complications were investigated. Long-term results were analyzed.
Results: It was observed that 10 female patients underwent emergency surgery due to acute perianal injury. Tenpatients were included in the study
and their files were analyzed retrospectively. The mean age of the patients was 24 (range: 19-36) years. Four patients had type 4 injury, two had type
3a injury, one had type 3b injury, and three had type 3c injury.
Conclusion: We believe that it is important to perform surgical treatment before tissue edema develops.
A series of fluorene Schiff bases and their oligophenol derivatives were successfully synthesized using the condensation and graft copolymerization reactions, respectively. The synthesized compounds ...were good soluble in common organic solvents. Photoluminescence (PL) properties of the synthesized materials were determined in solution forms. As to the fluorene copolymers (FPs), higher PL intensities were obtained when compared with the monomeric models. Solvent effects on the fluorescence spectra and possible usages in spectrofluorometric ion sensors of the FPs were discussed. Optical and electrochemical band gaps of the polymers were lower than those of the Schiff bases indicating the more conjugated structures of the FPs. The oxidized states of the novel fluorene compounds were also examined by cyclic voltammetry (CV) technique. The solid state conductivity measurements showed that the synthesized FPs were semiconductors and when exposed to the iodine vapour their conductivities could be increased up to four orders of magnitude. The polymer having the lower band gap (FP-3) had also the highest undoped conductivity. Thermal characterizations of the synthesized compounds were carried out by TG-DTA and DSC methods. The initial degradation temperatures of the FPs were found quite high in the range of 220–300
°C.
Soluble kinds of coordination polymers containing Cr(III) ion in the backbone were synthesized. Structures of the polymers were characterized by FT-IR, UV–vis, 1H and 13C NMR, and size exclusion ...chromatography (SEC). Thermal degradation data were obtained by TG–DTA and DSC techniques. Cyclic voltammetry (CV) measurements were carried out and the HOMO–LUMO energy levels and electrochemical band gaps (Eg′) were calculated. Additionally, the optical band gaps (Eg) were determined by using UV–vis spectra of the materials. Electrical conductivity measurements of doped (with iodine) and undoped polymers related to temperature were carried out by four-point probe technique using a Keithley 2400 electrometer. Measurements were made by using the polymeric films deposited on ITO glass plate by dip-coating method. Also, absorption spectra of doped polymeric films were recorded by a single beam spectrophotometer showing that doping procedure causes shifting in absorption spectra. Their abilities of processing in gas sensors were also discussed. According to obtained results the synthesized chelate polymers are semi-conductors having polyconjugated structures. Also, P-2 is the most electro-conductive polymer among the synthesized, while P-1 is the most thermally stable one.
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Today, chronic wounds continue to be a problem for patients and in the budget expenditures allocated to health by countries. Although chronic wounds occur due to predisposan factors, they are mainly ...caused by deterioration in the healing process of the skin. According to the definition that has gained prominence recently, a wound is deemed chronic when its volume has not decreased by 50% in the end of four weeks or its size not decreased 10 - 15% per week.1 With the prolongation of the average life expectancy and the increase in diseases such as diabetes mellitus, peripheral vascular diseases, pressure ulcers and chronic complications, the incidence of chronic wounds that impair skin integrity has also increased.
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