Protective effect of rutin on mercuric chloride-induced reproductive damage in male rats

This study investigated the effects of rutin against reproductive damage caused by toxic mercury in male rats. Thirty-five Sprague Dawley rats were used. Control group was injected with saline for 7 days. The rutin-100 group received 100 mg/kg/b.w. rutin for 7 days. Mercuric chloride (HgCl₂) group received 1.23 mg/kg/b.w. of HgCl₂ for 7 days. Mercury chloride + rutin-50 group received 50 mg/kg/b.w. rutin and HgCl₂ 1.23 mg/kg/b.w. for 7 days. HgCl₂ + rutin-100 group received 100 mg/kg/b.w. rutin and HgCl₂ 1.23 mg/kg/b.w. for 7 days. It was detected that HgCl₂ treatment increased malondialdehyde (MDA) levels, tumour necrosis factor-α (TNF-α) and cyclooxygenase-2 (COX-2) expressions, necrosis and degeneration of spermatogonium, dead and abnormal sperm percentages; tubular walls thinning; and decreased antioxidant enzyme activities and sperm motility. It was determined that rutin application reduced testicular damage caused by HgCl₂. In conclusion, rutin administration may treat HgCl₂ toxicity in testes.     

Comparison of the flap survival with ischemic preconditioning on different pedicles under varied ischemic intervals in a rat bilateral pedicled flap model

The study was undertaken to search whether pedicle selection for ischemic preconditioning (IP) and duration of global ischemia applied after IP influenced efficacy of IP on flap viability in epigastric adipocutaneous island flap with bilateral pedicles in rat model. In total, 159 rats were divided into one control and three (primary, secondary, or bilateral pedicle) IP treatment groups. IP was performed on different pedicles by three cycles of 10 minutes of pedicle clamping and 10 minutes of release. After IP procedure secondary pedicle was ligated in all groups, and flaps were exposed to 0, 1, 2, 4, or 6 hours of global ischemia by clamping primary pedicle. In control groups, after the perfusion of bipedicled flaps for 1 hour, left pedicle was ligated and flaps were exposed to global ischemia as in IP groups. On day 5 post‐surgery, tissue samples and topographic measurements were taken. No significant differences in semi‐quantitative scorings of polymorphonuclear leukocytes infiltration, chronic inflammation, interstitial edema, neovascularization, VEGF, and CD105 expression levels among groups were found (P > 0.05). Percentages of necrosis were consistently smaller in IP groups compared to controls for the same duration of global ischemia, with exception of the no‐ischemia. Area of necrosis was significantly smaller in primary IP group versus secondary IP group in the absence of global ischemia (P < 0.01). In the presence of global ischemia, both primary and secondary pedicle IP groups had significantly smaller percentage of necrosis than controls (P < 0.05) and there was no significant difference between primary and secondary IP groups (P > 0.05). Thus, IP performed on different pedicles may ameliorate flap survival in a comparable fashion, depending on the duration of global ischemia. Secondary pedicle IP was as effective as primary pedicle IP and may be feasible in free flap transfers. © 2013 Wiley Periodicals, Inc. Microsurgery 34:129–135, 2014.     

Treatment of renal stones with flexible ureteroscopy in preschool age children

The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age (<7 years) children. From September 2005 to May 2013, a total of 65 children (31 boys and 34 girls) with 72 renal stones were treated using RIRS. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. In the presence of residual calculi >4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 ± 1.99 years (6 months–7 years) were included in the present study. The mean stone size was 14.66 ± 6.12 mm (7–30 mm). The mean operative time was 46.47 ± 18.27 min. In 5 (7.69 %) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3 % after the first and second procedures, respectively. Complications were observed in 18 (27.7 %) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2 %) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4 %) patients, and ureteral wall injury (Clavien III) was noted in 2 (3 %) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children.     

A scale-development study: Exploration of intensive-care nurses’ attitudes towards futile treatments

The study was conducted to determine the validity and reliability of the tool used to assess nurses’ attitudes towards futility, and to explore intensive-care nurses’ attitudes towards futility. Principal components analysis revealed that 18item scale was made up of four subdimensions that assess Identifying(beliefs), Decision-Making, Ethical Principles and Law, and Dilemma and Responsibilities related to futile treatments. The internal consistency of the scale was in the acceptable range, with a total Cronbach’s alpha value of 0.72. Overall the results of study suggest that scale can be used as a valid and reliable assessment tool to assess nurses’ attitudes towards futility.     

Cardiac Memory after Radiofrequency Ablation of Accessory Pathways: The Post-ablation T Wave Does not Forget the Pre-excited QRS.

Introduction: Normalization of the pre-excited QRS following ablation is accompanied by repolarization changes but their directional relationship to changes in ventricular activation has not been well characterized.Methods: Accordingly, we measured QRS and T wave vectors and QRS-T angles from 12 lead ECG recordings immediately before and after accessory pathway (AP) radiofrequency ablation in 100 consecutive patients. Patients with bundle branch block, intraventricular conduction defect or intermittent pre-excitation were excluded, leaving a study group of 45 patients: 35 with pre-excitation and 10 with concealed APs.Results: With AP ablation, changes occurred in the QRS and T wave vectors and QRS-T angles that were essentially equal and opposite, so that the newly normalized QRS complex and QRS vector were accompanied by a T wave whose vector approximated that of the pre-ablation QRS vector. This tended to maintain a large QRS-T angle: 72° ± 50° before, and 54° ± 34° after QRS normalization (p = NS). A QRS-T angle >40° was found before and after ablation in 22/35 patients (63%) with baseline pre-excitation; but never in patients with a concealed AP (p = 0.001). The angle between the pre-excited QRS and the post-ablation T wave was 35° ± 37°, and 40° in 25/35 patients (71%). The change in T wave axis with QRS normalization correlated in magnitude with the QRS-T angle before ablation (r = 0.73, p < 0.0001). The change in QRS axis correlated with the QRS-T angle after ablation (r = 0.37, p < 0.03). Shorter AP effective refractory periods (ERPs) correlated with wider QRS-T angles after ablation (r = –0.39, p < 0.03). The ECG leads manifesting these changes depend on AP location.Conclusion: T-wave changes after ablation of APs (1) are dependent on anterograde AP conduction at baseline and are not observed with concealed APs; (2) correlate in magnitude directly with the change in QRS axis and inversely with the anterograde AP-ERP; (3) are related to AP location. With termination of pre-excitation secondary repolarization changes immediately disappear and the post ablation T wave axis approximates that of the pre-excited QRS. Recognition of this sequence may prevent unnecessary clinical interventions.     

Pulse wave analysis of the aortic pressure waveform in patients with vasovagal syncope

Vascular reflex mechanisms contribute to vasovagal syncope. However, the alterations in central haemodynamics in patients with vasovagal syncope are unknown. 30 consecutive patients (36.5 ± 15 years, 14 females) with recurrent vasovagal syncope (VVS) and a positive tilt table test were compared to 39 age- and sex-matched controls (36.9 ± 16 years, 15 females) with a negative tilt table result and no history of syncope. Central aortic pressure parameters including augmentation index and central pulse pressure as markers of aortic stiffness were generated non-invasively by applanation tonometry of the radial artery and use of a validated mathematical transfer function. No difference in aortic augmentation index was observed between groups. (VVS 9 ± 2.6 vs. Control 11 ± 2.4, p = 0.8). However, in patients with vasovagal syncope the aortic pressure waveform significantly differed from healthy controls. A prolonged time to the peak of aortic pressure wave (aortic T2) was observed in patients with vasovagal syncope (226 ± 24 vs. 208 ± 21 ms, p = 0.001). Furthermore time to the first shoulder of the aortic pressure wave (aortic T1) was slightly shorter compared to healthy controls, but did not reach statistical significance (106 ± 22 vs. 110 ± 12 ms, p = 0.33). Patients with vasovagal syncope have an altered aortic pressure waveform at rest, but no signs of elevated aortic stiffness. The underlying mechanisms for these findings may potentially result from a complex imbalance of the autonomic nervous system with a continuous deregulation of the sympathetic and parasympathetic reflex arcs.     

Typhoid fever as a rare cause of hepatic, splenic, and bone marrow granulomas

During the course of typhoid fever, the usual histologic finding of the liver is "nonspecific reactive hepatitis." Hepatic granuloma (HG) is a rare complication of typhoid fever. We present two cases of typhoid fever with HG and review the relevant literature. Case 1 (a 53-year-old female) was found to have both hepatic and splenic granulomas. This is the first case of typhoid fever with splenic granulomas in the English language literature. Case 2 (a 66-year-old male) developed granulomas in the bone marrow in addition to HG. It should be considered that typhoid fever may lead to granulomas in several organs.     

Evaluation of silicosis in ceramic workers

This study is aimed to evaluate the incidence of silicosis and the relation of it with personal and work-related factors among workers exposed to silica in ceramic factory. Workers were evaluated by respiratory symptoms, physical examination, pulmonary function and radiological findings. Occupational and Enviromental Pulmonary Disease Evaluation Questionnaire of the Turkish Thoracic Society Enviromental and Occupational Pulmonary Diseases Working Group was used. 365 of 626 workers had exposure to silica and the rest 261 were concerned as control group. There was no difference between mean age, duration of work and smoking pack year among the groups (p> 0.05). Cough and sputum rates were higher in silicosis group FEV1 and FVC values were lower in silica group but this was not statistically significant. When the two subgroups of silica group (the workers in high dust concentration and the ones in low concentration) were compared, the high concentrated group had significantly more sputum but the other symptoms and pulmonary functional parameters were not different significantly. 24 workers had parenchymal densities adjusted with pneumoconiosis. The workers with the pneumoconistic finding, had a higher mean age and longer duration of work. As a conclusion, ceramic industry has risk for silicosis. And the risk increase by time and age.