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In patients with mechanical aortic and mitral valves and left ventricular (LV) tachycardia (VT), catheter ablation is technically challenging due to the limited access to the LV. Promising new alternatives to radiofrequency ablation include pulsed-field electroporation, percutaneous or surgical sympathetic neuromodulation, and noninvasive stereotactic radioablation therapy (SBRT). We herein describe the effect of SBRT as a bailout therapy on the management of a challenging VT case in the presence of double left-sided mechanical valves.

Background Several countries have increasingly focused on improving care for acute myocardial infarction (AMI), heart failure (HF), and pneumonia to reduce their readmissions and mortality rates. Frailty is becoming increasingly important to accurately predict healthcare utilization for the aging population. The preferred method for the measurement of frailty remains unclear, and current risk-adjustment models do not account for frailty. We sought to compare commonly used frailty indices in terms of the ability to predict clinical adverse outcomes in AMI, HF, and pneumonia patients. Methods A nationwide cohort study included AMI, HF, and pneumonia with 65 years and older patients in the Turkey between January 1 and December 31, 2018. The primary predictor of interest was frailty. We used two claims-based frailty indices (Johns Hopkins Claims-Based Frailty Index and Hospital Frailty Risk Score) to assess frailty. The main outcome was all-cause long-term mortality up to 3 years. Time to death was calculated as the time period between the date of first admission and the date of death. Patients were censored as of September 30, 2020, which marked the end of the follow-up period. Findings Of the 200,948 patients, 35,096 (17.5%) had AMI, 62,403 (31.1%) had HF, and 103,449 (51.5%) had pneumonia. Johns Hopkins Claims-Based Frailty Index (c-statistics for long-term mortality: 0.68 in AMI, 0.61 in HF, 0.64 in pneumonia) was better compared to Hospital Frailty Risk Score (c-statistics for long-term mortality: AMI=0.62, HF=0.58, pneumonia=0.62) (DeLong p Interpretation Readmission and mortality rates after AMI, HF, and pneumonia gradually increases with increasing frailty score. While the Hospital Frailty Risk Score had a better discrimination for predicting readmissions, Johns Hopkins Claims-Based Frailty Index had a better discrimination for predicting mortality. These findings should be taken into account for a better evaluation of hospital performance. Funding This study was supported by funding from The Scientific and Technological Research Council of Turkey (grant 120S422, HK).

In this study, we aimed to investigate the effects of chronic sleep deprivation on mucociliary clearance, which is the primary defence mechanism of the upper airway tract and nasal mucosal histology. Forty-two Wistar Albino rats (250-300 g), 8 or 12 weeks old, were randomly assigned into three groups as follows. The first sleep-deprivation group consisted of 14 rats (A), another 14 of them were assigned to platform group (B), and the remaining 14 were included to the home cage control group (C). For the two deprivation groups (A and B), the modified multiple platform method (MMPM) was used to induce sleep deprivation for 21 days. Tc-99m MAA rhinoscintigraphy was performed to assess mucociliary clearance and the nasal histopathological changes of the sacrificed rats were also examined. Mucociliary clearance was significantly higher in sleep deprivation (A) and deprivation control (B) groups than the control group (C) (p = .037). The ratio of columnar ciliary was significantly higher in group A and B than in the control group (p = .003). The transitional epithelial ratio in groups A and B was also significantly increased compared with group C (p = .04). The control group's squamous epithelial ratio was increased compared to the sleep-deprived groups (p = .003). There was a significantly increased inflammatory response in the ciliated columnar epithelium in groups A and B compared to group C (p = .02). For the first time in the literature, we demonstrated that chronic sleep deprivation has caused a significant increase in mucociliary clearance speed and in the number of ciliary cells.

Stress fractures are injuries most commonly seen in the lower limbs and are usually caused by repetitive stress. While the distal and middle third of the tibia is the most frequent site for stress fractures (almost 50%), stress fractures of the proximal tibia is relatively rare and could be confused with other types of tibial fractures, thus altering management plans for the clinician. Early diagnosis of stress fractures is also important to avoid complications. Imaging plays an important role in the diagnosis of stress fractures, especially bone scan. Combined with single-photon emission computed tomography/computed tomography (SPECT/CT) it is an important imaging technique for stress fractures in both upper and lower extremities, and is widely preferred over other imaging techniques. In this case, we present the case of a 39-year-old male patient diagnosed with stress fracture of the proximal tibia and demonstrate the contribution of CT scan fused with SPECT imaging in the early diagnosis of stress fracture prior to other imaging modalities.Stres kırıkları çoğunlukla alt ekstremitede görülen ve genellikle tekrarlayan strese bağlı gelişen yaralanmalardır. Tibia orta kesimi ve distali stres kırıklarının en sık görüldüğü bölgeler iken (yaklaşık %50), proksimal tibianın stres kırıkları nispeten nadirdir, diğer kırık türleriyle karıştırılabilir ve bu durum klinisyenin tedavi planını etkileyebilir. Stres kırıklarının erken tanısı komplikasyonları önlemek açısından önemlidir. Görüntüleme yöntemleri, stres kırıklarının teşhisinde önemli bir rol oynamaktadır. Özellikle tek-foton emisyon bilgisayarlı tomografi/bilgisayarlı tomografi (SPECT/BT) ile birleştirilen kemik sintigrafisi hem üst hem de alt ekstremite stres kırıkları için önemli bir görüntüleme tekniğidir ve diğer görüntüleme tekniklerine göre çok daha fazla tercih edilmektedir. Bu yazıda proksimal tibiada stres kırığı tanısı alan 39 yaşındaki bir erkek hastanın hikayesini sunuyor ve stres kırığının erken tanısında SPECT/BT taramasının katkısını gösteriyoruz. Anahtar kelimeler: Stres kırığı, proksimal tibia, kemik sintigrafisi, tek-foton emisyonlu bilgisayarlı tomografi/bilgisayarlı tomografi.