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11.
Carlos Collet Yosuke Miyazaki Nicola Ryan Taku Asano Erhan Tenekecioglu Jeroen Sonck Daniele Andreini Manel Sabate Salvatore Brugaletta Rodney H. Stables Antonio Bartorelli Robbert J. de Winter Yuki Katagiri Ply Chichareon Giovanni Luigi De Maria Pannipa Suwannasom Rafael Cavalcante Hans Jonker Patrick W. Serruys 《Journal of the American College of Cardiology》2018,71(24):2756-2769
Background
The functional SYNTAX score (FSS) has been shown to improve the discrimination for major adverse cardiac events compared with the anatomic SYNTAX score (SS) while reducing interobserver variability. However, evidence supporting the noninvasive FSS in patients with multivessel coronary artery disease (CAD) is scarce.Objectives
The purpose of this study was to assess the feasibility of and validate the noninvasive FSS derived from coronary computed tomography angiography (CTA) with fractional flow reserve (FFRCT) in patients with 3-vessel CAD.Methods
The CTA-SS was calculated in patients with 3-vessel CAD included in the SYNTAX II (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery II) study. The noninvasive FSS was determined by including only ischemia-producing lesions (FFRCT ≤0.80). SS derived from different imaging modalities were compared using the Bland-Altman and Passing-Bablok method, and the agreement on the SS tertiles was investigated with Cohen’s Kappa. The risk reclassification was compared between the noninvasive and invasive physiological assessment, and the diagnostic accuracy of FFRCT was assessed by the area under the receiver-operating characteristic curve using instantaneous wave-free ratio as a reference.Results
The CTA-SS was feasible in 86% of patients (66 of 77), whereas the noninvasive FSS was feasible in 80% (53 of 66). The anatomic SS was overestimated by CTA compared with conventional angiography (27.6 ± 6.4 vs. 25.3 ± 6.9; p < 0.0001) whereas the calculation of the FSS yielded similar results between the noninvasive and invasive imaging modalities (21.6 ± 7.8 vs. 21.2 ± 8.8; p = 0.589). The noninvasive FSS reclassified 30% of patients from the high- and intermediate-SS tertiles to the low-risk tertile, whereas invasive FSS reclassified 23% of patients from the high- and intermediate-SS tertiles to the low-risk tertile. The agreement on the classic SS tertiles based on Kappa statistics was slight for the anatomic SS (Kappa = 0.19) and fair for the FSS (Kappa = 0.32). The diagnostic accuracy of FFRCT to detect functional significant stenosis based on an instantaneous wave-free ratio ≤0.89 revealed an area under the receiver-operating characteristics curve of 0.85 (95% CI: 0.79 to 0.90) with a sensitivity of 95% (95% CI: 89% to 98%), specificity of 61% (95% CI: 48% to 73%), positive predictive value of 81% (95% CI: 76% to 86%), and negative predictive value of 87% (95% CI: 74% to 94%).Conclusions
Calculation of the noninvasive FSS is feasible and yielded similar results to those obtained with invasive pressure-wire assessment. The agreement on the SYNTAX score tertile classification improved with the inclusion of the functional component from slight to fair agreement. FFRCT has good accuracy in detecting functionally significant lesions in patients with 3-vessel CAD. (A Trial to Evaluate a New Strategy in the Functional Assessment of 3-Vessel Disease Using SYNTAX II Score in Patients Treated With PCI; NCT02015832) 相似文献12.
Erhan Tenekecioglu Fahriye Vatansever Agca Ozlem Arican Ozluk Kemal Karaagac Serafettin Demir Tezcan Peker Mustafa Kuzeytemiz Muhammed Senturk Mustafa Y?lmaz 《Arquivos brasileiros de cardiologia》2014,102(3):253-262
Background
Hypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties.Objective
In this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF).Method
We studied 57 hypertensive patients (age: 53±4 years; left ventricular ejection fraction: 76±6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson''s biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax−LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax− LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA−LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA.Results
The hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A'' was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044).Conclusion
Increased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF. 相似文献13.
Yurttutan S Ozdemir R Erdeve O Calisici E Oncel MY Oguz SS Dilmen U 《Acta haematologica》2012,127(3):189-192
Intrauterine ischemia of the limbs is a rare condition involving thrombosis and ischemia of the extremities before birth. The clinical presentation depends on the extremity affected as well as the timing of thrombosis. Very few cases with extremity hypoperfusion and gangrene due to intrauterine thrombosis have been reported in the literature, and therefore there is no consensus on the optimal therapeutic strategy for such cases. Presented here is a case of a newborn with intrauterine brachial arterial thrombosis of the right upper extremity who was successfully treated by a combination of recombinant tissue plasminogen activator, enoxaparin and collagenase application followed by surgery. 相似文献
14.
Ahmet Yalcin Gungor Erhan Ozcan Huseyin Alkis Hakan Turkkahraman 《The Angle orthodontist》2013,83(4):686
Objective:To evaluate the effects of different bleaching methods on the shear bond strength (SBS) of orthodontic brackets.Materials and Methods:Forty-five freshly extracted premolars were randomly divided into three groups (n = 15 per group). In group I, bleaching was performed with the office bleaching method. In group II, bleaching was performed with the home bleaching method. Group III served as the control. Orthodontic brackets were bonded with a light cure composite resin and cured with an LED light. After bonding, the SBS of the brackets were tested with a Universal testing machine.Results:Analysis of variance indicated a significant difference between groups (P < .001). The highest values for SBS were measured in group III (20.99 ± 2.32 MPa). The SBS was significantly lower in groups I and II than in group III (P < .001). The lowest values for SBS were measured in group II (6.42 ± 0.81 MPa). SBS was significantly higher in group I than in group II (P < .001).Conclusions:Both of the bleaching methods significantly affected the SBS of orthodontic brackets on human enamel. Bleaching with the home bleaching method affected SBS more adversely than did bleaching with the office bleaching method. 相似文献
15.
Erhan Özcan Ali Riza Çetin İsmail Davut Çapar Ali Riza Tunçdemir Hale Ari Aydinbelge 《Odontology / the Society of the Nippon Dental University》2013,101(2):204-209
This study evaluated the influence of eugenol on the push-out bond strengths of fiber posts cemented with different types of resin luting agents. Seventy-two extracted maxillary single-rooted canine teeth were randomly divided into two groups of 36 teeth. Group 1, the control group, was filled with gutta-percha only (i.e., did not receive eugenol), whereas group 2 was filled with a eugenol-containing sealer. All root canals were filled and each group was divided into three subgroups. The posts in each subgroup were cemented with the following materials: subgroup 1 with a 2-step self-etching adhesive system (Clearfil Liner Bond 2V + Panavia F); subgroup 2 with a 1-step self-etching adhesive (Panavia F); and subgroup 3 with a self-adhesive (Clearfil SA Cement). Dislodgement resistance was measured using a universal testing machine. All data were subjected to ANOVA using a factorial design and Tukey test (α = 0.05). The use of the eugenol-containing sealer significantly reduced the push-out bond strength of the fiber post (P < 0.05). The push-out bond strength of Panavia F was significantly higher than those of the other groups filled with the eugenol-containing sealer (P < 0.05). The Panavia F group was less susceptible to the inhibiting effect of eugenol than were the other evaluated groups when the fiber post was cemented in the canals filled with the eugenol-containing sealer. 相似文献
16.
Tevfik Yavuz Erhan Dilber Haluk Baris Kara Ali Riza Tuncdemir A Nilgun Ozturk 《Lasers in medical science》2013,28(5):1233-1239
The purpose of this study was to evaluate the influence of different surface treatments (sandblasting, acid etching, and laser irradiation) on the shear bond strength of lithium disilicate-based core (IPS Empress 2) and feldspathic ceramics (VITA VM 9). One hundred ceramic discs were divided into two groups of 50 discs each for two ceramic systems: IPS Empress 2 (group I) and VITA VM 9 (group II). Each of the two groups was further divided into five surface treatment groups (ten each) as follows: group SB, sandblasting with alumina particles (50 μm); group HF, 5 % hydrofluoric acid etching; group L, Er:YAG laser irradiation (distance, 1 mm; 500 mJ; 20 Hz; 10 W; manually, noncontact R14 handpiece); group SB–L, sandblasting + Er:YAG laser; and group HF–L, 5 % hydrofluoric acid + Er:YAG laser. Luting cement (Panavia 2.0) was bonded to the ceramic specimens using Teflon tubes. After 24 h of water storage, a shear bond strength test was performed using a universal testing machine at a crosshead speed of 0.5 mm/min. The data were analyzed with a two-way analysis of variance (ANOVA) and Tukey's honestly significant difference tests (α?=?0.05). The two-way ANOVA indicated that the shear bond strength was significantly affected by the surface treatment methods (p?<?0.05), but there was no significant interaction between the ceramic systems. Group SB–L had the highest mean values for each ceramic system. Sandblasting, followed by Er:YAG laser irradiation, enhanced the bond strength, indicating its potential use as an alternative method. The atomic force microscopic evaluation revealed that group SB had the most distinct sharp peaks among the groups. 相似文献
17.
Erhan Sari Abdulkadir Tepeler Emrah Yuruk Berkan Resorlu Tolga Akman Murat Binbay Abdullah Armagan Ali Unsal Ahmet Yaser Muslumanoglu 《Urological research》2013,41(6):499-504
The aim of the study to compare outcomes of flexible ureterorenoscopy in patients with different body mass index (BMI) scores and to explore whether the BMI has an effect on outcomes of RIRS. Five hundred and two patients who underwent flexible URS in 3 centers between 2008 and 2012 for the management of single upper urinary tract calculi were retrospectively reviewed. Patients were categorized as normal weight BMI 18.5 to 24.99 kg/m2, overweight 25 to 29.99 kg/m2, obese 30 to 39.99 kg/m2 and morbid obese >40 kg/m2.The groups were assessed in terms of demographic parameters including age, gender, stone size, intraoperative and postoperative variables. The mean patient age was 41.3 ± 15.51 (18–81) years and with an average BMI 26.68 ± 5.2 kg/m2 (16.64–55.15 kg/m²). Of the patients, 43.2 % had normal weight (NW), 32.2 % were overweight (OW), 21.9 % were obese (O) and 2.5 % were morbidly obese (MO). Stone-free rates after single procedure in NW, OW, O, MO groups were 60.8, 61.7, 73.6, 61.5 %, respectively (p = 0.079). Overall targeted stone-free rates were also similar in four groups (88.9, 90.1, 93.6, 90.4 %, p = 0.586). There were no statistically significant differences in the frequency of complications and mean hospitalization time among the groups (p > 0.05). In conclusion, this study demonstrated that flexible URS is a valuable option for the treatment of kidney stone in both obese and non-obese patients. BMI did not influence the postoperative outcomes. 相似文献
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20.
Christoph Kraus Darin Quach David M. Sholtes Erhan Kavakbasi Renske De Zwaef Maxine Dibué John Zajecka Bernhard T. Baune 《Neuromodulation》2022,25(3):316-326
BackgroundA substantial number of patients with major depressive disorder (MDD) do not sufficiently remit after the first lines of antidepressant treatments, making them vulnerable to poor clinical outcomes. Patients who have not had adequate resolution of their depressive symptoms after four antidepressant treatments and/or have been experiencing their current episode of MDD for two years or more (with insufficient responses to adequate antidepressant treatments) should be evaluated for antidepressant vagus nerve stimulation (VNS Therapy). Adjunctive VNS Therapy is a promising long-term treatment option for patients with difficult-to-treat depression (DTD), offering significantly improved remission rates in comparison with usual treatments. However, VNS Therapy requires specialized treatment centers to support patients.Materials and MethodsIn this narrative review, we aim to outline the necessary steps for setting up an antidepressant VNS Therapy service in an efficient manner.ResultsEstablishing a VNS Therapy service requires several high-level considerations: initiation of a collaborative multidisciplinary team of health care professionals; developing a surgical pathway for implantation; consideration of reimbursement and health care coverage; setting up a specialist clinic to identify optimal candidates for VNS Therapy; educating patients and their families about VNS Therapy; and training health care providers on patient-specific VNS Therapy treatment and long-term treatment management.ConclusionsAntidepressant VNS Therapy is a promising treatment option for the long-term treatment of patients with DTD. We have successfully initiated four VNS Therapy service centers for DTD in the United States, Austria, and Germany. Based on our experiences and lessons learned, herein, we have provided advice to psychiatric centers planning to set up a VNS Therapy service for their patients with DTD. 相似文献