A comparison of early clinical outcomes of off-pump and on-pump coronary artery bypass grafting surgery in elderly patients

Background: The reply of question of “which coronary artery bypass grafting (CABG) technique is superior in elderly patients, off-pump or on-pump CABG surgery?” is controversial. We aimed to compare the early clinical outcomes in elderly patients undergoing off-pump and on-pump CABG.

Methods: From January 2009 to January 2015, 344 elderly patients (aged 70 or older) underwent off-pump (n?=?137) or on-pump (n?=?207) CABG. Patients’ medical records were retrospectively reviewed, and their baseline preoperative characteristics, operative data and postoperative outcomes were analyzed, thereby a comparison of early outcomes between off-pump and on-pump patients was performed.

Results: Mean age of patients was 74.4?±?3.8 years. Both groups were statistically similar in terms of baseline preoperative characteristics. Number of distal bypass was significantly lower in off-pump group than in on-pump group. Postoperative length of intensive care unit and hospital stay were similar between two groups. Amounts of transfused blood products were significantly lower in off-pump CABG group. There were no significant differences in terms of postoperative complications and mortality between two groups.

Conclusions: Our results did not reveal a significant benefit of either surgical technique with respect to early-term clinical outcomes in elderly CABG patients. Further investigations are needed to determine whether off-pump CABG is superior than on-pump CABG in elderly patients.     

Assessment of Genotoxic Effects of Boron on Wheat (Triticum aestivum L.) and Bean (Phaseolus vulgaris L.) by Using RAPD Analysis

In boron-rich soils of Turkey, boron tolerant wheat (Triticum aestivum L.) and sensitive bean (Phaseolus vulgaris L.) are most widely cultivated crops. In this study they have been studied to elucidate the probable genotoxic effects of boron by using RAPD analysis. During the study, root and stem lengths have been measured and inhibitory rates (%) of root growth have been found to be significant, starting from 10 (13%) and 5 ppm (19%) for wheat and bean, respectively, which is in strong correlation with the root DNA alterations; RAPD variations starting from 100 ppm for wheat and 25 ppm for bean. The preliminary findings encourage the use of these tools in investigation of genotoxic effects of boron on wheat, bean and the other crops.     

The effectiveness of training for breast cancer and breast self-examination in women aged 40 and over

Background. Training on breast health is required to increase awareness of early detection of breast cancer, especially in countries with limited resources.Methods. Of the 784 invited women, 462 participated in the study (58.9%). The training included both theoretical and breast self-examination (BSE) training between preeducation and posteducation tests. Following the theoretical presentation, breast examination training was performed using a breast simulator. The competency of the participants on breast examination was assessed by an evaluation guide.Results. All breast cancer symptoms were stated at significantly higher rates compared to those before education (P<.05). The most commonly stated risk factor in both preeducation and posteducation tests was “no breast-feeding,” with ratios of 15.2% and 56.3%, respectively. Early detection modalities for breast cancer were also stated more often in the posteducation test compared to the preeducation (P<.05). In the preeducation test, only 4.3% to 18.7% of the participants women could state most of the BSE steps. After BSE training, 85% to 92% of the participants were competent in BSE steps.Conclusions. Theoretical education on breast cancer and BSE training in low-educated women, even illiterate, is highly effective.     

LA reservoir strain: a sensitive parameter for estimating LV filling pressure in patients with preserved EF

The International Journal of Cardiovascular Imaging - An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction (HFpEF),...     

The Relationship Between Severity of Liver Cirrhosis and Pulmonary Function Tests

Pulmonary complications, mainly hepatopulmonary syndrome (HPS), are frequently observed in liver cirrhosis. In this study, the aim was to investigate the frequency of hypoxemia and impairment of pulmonary function tests (PFT) in patients with liver cirrhosis and to examine the relationships of these impairments with liver failure. A total of 39 patients with cirrhosis, 24 males and 15 females, were included in our study. The mean age of the patients was 47.5 +/- 17.2 years. Arterial blood gases, PFT, and carbon monoxide diffusion tests (DLCO) were performed in all patients. Out of 39 cirrhotic patients, 21 (53.8%) had ascites, whereas 18 (46.2%) did not. Seven patients were in the Child-Pugh A group, 21 in the Child-Pugh B group, and 11 patients were in the Child-Pugh C group. Hypoxia was found in 33.3% of the patients. Although the PaO2 and SaO2 values of patients with ascites were lower compared to those without ascites (P < 0.05), no statistically significant difference was determined in the comparison of hypoxia between the groups (P > 0.05). Among the PFT parameters, FEV1/FVC and FEF25-75% values were found to be lower in patients with ascites than those without (P < 0.05). No differences were established between these two groups of patients in terms of DLCO (P > 0.05). While no differences were found in comparison of the DLCO values in between the groups (P > 0.05), there was a statistically significant difference in the ratio of DLCO to the alveolar ventilation (DLCO/VA) in between the groups (P < 0.05). On the other hand, a negative correlation was found between the DLCO/VA and Child points when the relationship between the Child-Pugh score and PFT parameters were investigated (r = -0.371, P < 0.05). Consequently, a relationship was established between the severity of liver failure and diffusion tests showing pulmonary complications invasively. We believe diffusions tests should be performed in addition to the PFT in order to determine pulmonary involvements particularly in patients who are candidates for liver transplantation.     

Fabrication of cyclo olefin polymer microfluidic devices for trapping and culturing of yeast cells

A microfluidic platform is designed and fabricated to investigate the role of uncharacterized YOR060C (Sld7) protein in aging in yeast cells for the first time. Saccharomyces cerevisiae yeast cells are trapped in the series of C-shaped regions (0.5 nL) of COP (cyclo olefin polymer), PMMA (poly methylmethacrylate), or PS (polystyrene) microbioreactors. The devices are fabricated using hot embossing and thermo-compression bonding methods. Photolithography and electrochemical etching are used to form the steel mold needed for hot embossing. The cell cycle processes are investigated by monitoring green fluorescent protein (GFP) tagged Sld7 expressions under normal as well as calorie restricted conditions. The cells are loaded at 1 μL/min flowrate and trapped successfully within each chamber. The medium is continuously fed at 0.1 μL/min throughout the experiments. Fluorescent signals of the low abundant Sld7 proteins could be distinguished only on COP devices. The background fluorescence of COP is found 1.22 and 7.24 times lower than that of PMMA, and PS, respectively. Hence, experiments are continued with COP, and lasted for more than 40 h without any contamination. The doubling time of the yeast cells are found as 72 min and 150 min, and the growth rates as 9.63 × 10^?3 min^?1 and 4.62 × 10^?3 min^?1, in 2% glucose containing YPD and YNB medium, respectively. The product concentration (Sld7p:GFP) increased in accordance with cell growth. The dual role of Sld7 protein in both cell cycle and chronological aging needs to be further investigated following the preliminary experimental results.     

Vitamin D deficiency might pose a greater risk for ApoEɛ4 non-carrier Alzheimer’s disease patients

Vitamin D is a secosteroid hormone that shares a synthetic pathway with cholesterol. ApoE, which is involved in the transport of cholesterol, is the most significant genetic risk factor for sporadic Alzheimer’s disease (AD). Surprisingly, recent studies have indicated the presence of an evolutionary juncture between these two molecules. To demonstrate this possible relationship, we investigated serum levels of 25-hydroxyvitamin-D₃ (25OHD) in patients with early onset-AD (EOAD; n:22), late onset-AD (LOAD; n:72), mild cognitive impairment (MCI; n:32) and in healthy subjects (n:70). We then analyzed the correlation between 25OHD and cytokines, BDNF and Hsp90 with respect to ApoE alleles, as these molecules were investigated in our previous studies. The LOAD patients had low levels of 25OHD, but these low levels originated only from ApoE?4 non-carrier patients. Negative correlations were observed between serum 25OHD and TNFα, IL-1β or IL-6 levels in healthy subjects or MCI patients, but these same correlations were positive in LOAD patients. ApoE alleles indicated that these positive correlations exist only in ?4 carrier LOAD patients. Consequently, our results indicate that vitamin D deficiency presents a greater risk for ApoE?4 non-carrier AD patients than for ?4 carriers. Therefore, it might be beneficial to monitor the vitamin D status of ApoE?4 allele non-carrier AD patients.     

Low Serum Triglyceride Levels as Predictors of Cardiac Death in Heart Failure Patients

Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients.From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, the mean age was 64 ± 13 years, and the mean left ventricular ejection fraction was 0.27 ±0.11.By the end of the study, both sexes had similar cardiovascular mortality rates (36% men vs 37% women, P=0.559). In Cox regression analysis, NYHA functional class, triglyceride level, and history of coronary artery disease were independent predictors of cardiovascular death for women with chronic heart failure. For men with chronic heart failure, the patient''s age, ejection fraction, and sodium level were independent predictors of cardiovascular death.In a modern tertiary referral heart failure clinic, decreased triglyceride levels were, upon univariate analysis, predictors of poor outcomes for both men and women. However, upon Cox regression analysis, reduced triglyceride levels were independent predictors of cardiac death only in women.Key words: Cachexia/blood, chronic disease, heart failure/mortality, female, follow-up studies, male, predictive value of tests, prognosis, risk assessment, sex factors, survival analysis, triglycerides/blood, univariate analysisThe 5-year survival rate for chronic heart failure (CHF) remains at 50%, with mortality rates higher for men than for women (relative risk=1.33, P < 0.001). After diagnosis with heart failure, women tend to have a better prognosis and to survive longer than men.¹ Given the greater life expectancy of women in the developed world, the overall impact of heart failure is still very important for them.² Although the CHF death rate seems to be lower or the same in women, most available scientific evidence regarding the influence of male versus female sex on the prognosis of CHF patients derives from observational studies and retrospective analyses, and women are known to be underrepresented in clinical trials.³ These studies report divergent findings concerning the prognosis of CHF patients according to sex, mainly attributable to the study characteristics, the cause of the heart failure, and the type of population studied.^2,4–6 Few reports deal with the differences between men and women in specialized heart failure clinics or units.Chronic heart failure can lead to a catabolic state and eventually to cachexia in advanced cases. There is preferential loss of fat but also a decline in lean body mass. Reduced efficiency of adenosine triphosphate production by mitochondria, reduced appetite, malabsorption, and reduced levels of anabolic steroids might play a role.⁷ Patients with advanced heart failure have severe symptoms, a high mortality rate, and a low cholesterol level.⁸ This can be due to inflammation, endotoxins, adrenergic activation, oxidative stress, tissue injury, and cachexia.^9,10 Liver-function abnormalities are most commonly seen in patients with low cardiac indices and resolve with compensation of heart failure; they are not associated with clinically apparent hepatic disease.¹¹ It has been determined that liver dysfunction is frequent in CHF and is characterized by a predominantly cholestatic enzyme profile that worsens with disease severity.¹² Functional liver mass was significantly decreased in New York Heart Association (NYHA) functional class IV patients, in comparison with NYHA II and III patients and with subjects in a control group. The functional liver mass in patients with systolic CHF did not show any correlations with left ventricular ejection fraction (LVEF), but it did correlate strongly with left atrial diameter.¹³ Dysfunction of the liver during heart failure syndrome can be another explanation of decreased cholesterol level in CHF.Triglycerides are neutral lipids consisting of a glycerol backbone and 3 long-chain fatty acids. These molecules are a major source of stored energy in such diverse tissues as adipose tissue and skeletal muscle, and they are integral components of lipoprotein particles synthesized by the liver and small intestine.¹⁴ In advanced heart failure, mechanisms similar to those that cause low cholesterol levels might cause low triglyceride levels. It seems that heart failure might alter both the production and the storage of triglycerides. Loss of a major energy source can adversely affect the survival of patients with CHF. The aim of this study was to determine the prognostic significance of triglyceride levels for both men and women who have CHF.