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In this study, using flux cored wire, S235JR and S460MC structural steels with a thickness of 16 mm were joined by MAG welding method. Welding processes were carried out to join the same (S235JR-S235JR, S460MC-S460MC) and different types of materials (S235JR-S460MC). In the microstructure examinations, grain coarsening occurred in all conditions, from the base material to the weld metal. From the tensile test results, in all combinations, fracture occurred on the S235JR side. Since fractures are not from the weld zone (weld nugget and HAZ), the weld zone strengths are clearly understood to be higher than the main material tensile strengths. On microhardness tests, the highest microhardness was obtained from the welded metal in all combinations, followed by HAZ and base material. Also, the highest microhardness measured on dissimilar joints of S235JR-S460MC on weld metal was 269 HV (Vickers). The welded specimens were also subjected to fatigue tests; the failure occurred on the base material in all three joints. S460MC-S460MC joint had the highest fatigue strength at the most elevated stress, 625 MPa; however, S235JR-S235JR joint had the lowest fatigue strength at the lowest priority, 300 MPa. Although the fatigue strength results of the same and different combinations and the tensile test results have parallelism, the highest microhardness is seen in S460MC-S235JR dissimilar joints, and its fatigue strength is lower than S460MC-S460MC joints.

Ti2AlN MAX phase films produced at different N2flow rates and different annealing temperatures were deposited on 52100 steel substrates using the closed-field unbalanced magnetron sputtering technique. N2flow rates were changed to 2, 3.5, and 5 sccm. Due to the increasing N2flow rate, film thickness decreased from 2 to 1.3 µm. Then the produced films were subjected to annealing at temperatures of 700, 750, and 800°C. After the film produced at a flow rate of 2 sccm was annealed at 750°C, the presence of the Ti2AlN MAX phase was determined. The binding energies of Ti 2p, Al 2p, and N 1s determined in the XPS analysis confirmed the existence of the Ti2AlN film. The friction coefficient measured for Ti2AlN MAX phase films was calculated as 0.53, the hardness value as 22.8 GPa, the elastic modulus as 291.4 GPa, and the wear rate as 2.96 × 10−4mm3/(N·m).

Abstract Hunger strike is described as voluntary refusal of food and/or fluids. Prolonged starvation may produce many adverse events including even death in rare circumstances. Here, we present three fatal [...]

Byline: Tulay. Akman, Ilhan. Oztop, Yasemin. Baskin, Ilkay. Unek, Necla. Demir, Hulya. Ellidokuz, Ahmet. Yilmaz Background: KRAS mutations have a significant role in the consecutive activation of RAS.RAF.MEK.ERK pathway in [...]

BACKGROUND: Military vascular injuries frequently result from fragment wounds while civilian vascular injuries usually are caused by gunshot wounds. The natural history of untreated major injuries by small low velocity fragments is not well known. This study evaluated the nature of these wounds. METHODS: From 1990 to 1995, 40 patients with a delayed diagnosis of an arterial injury in the extremity, abdomen, or neck were treated. The median delay between injury and diagnosis was 60 days. All patients had been seen at other military hospitals immediately after trauma. RESULTS: During initial hospitalization, immediate exploration had been performed in 23 patients and arteriogram in 3 patients. According to analysis of the records of patients, none of them had hard signs of vascular injury at the time of initial evaluation after trauma. Complications of missed arterial injuries included the following: false aneurysm, 21 (52.5%); arteriovenous fistula, 14 (35%); and occlusion, 5 (12.5%). The superficial femoral artery (n = 11) was the most commonly injured vessel. The remaining arteries included the following: carotid, 2; vertebral, 1; subclavian, 5; axillary, 2; brachial, 3; radial or ulnar, 2; internal iliac, 2; common femoral, 1; profunda femoris, 2; popliteal, 1; tibioperoneal, 8. Thirty-eight patients had penetrating wounds (21 fragments, 9 gunshot, 3 shotgun, 5 stab wounds), and only 2 patients had blunt trauma. All patients underwent surgery. There were no deaths and no loss of extremity, but 10 patients had fair results and only 4 patients required later reoperation. CONCLUSION: Traumatic arterial injuries that particularly are caused by low-velocity small fragment wounds can result in serious delayed complications months or even years after the injury. Patients with penetrating injuries must be closely monitored, and arteriography is recommended to evaluate the conditions of patients with potential vascular injury even when overt clinical signs or symptoms of vascular injury are absent. Am J Surg. 1997;173:110-114. [C] 1997 by Excerpta Medica, Inc.

Postoperative pain cannot be treated adequately in all patients, even though there are new developments in analgesic agents and treatment techniques. Thisstudy investigates the effect of pre-incisional and post-incisional electro- acupuncture on mechanical hyperalgesia in rat incisional pain model. This study was carried out with 40 healthy Sprague-Dawley male rats. The rats were divided into 5 groups: Group 1; first electro-acupuncture, then incision. Group 2; first incision, then electro-acupuncture. Group 3; first sham electro-acupuncture, then incision. Group 4; first incision, then sham electro-acupuncture. Group 5; control (incision only). Electro-acupuncture was applied to the ST36 and SP6 acupuncture points on the right hind paw. Sham electro- acupuncture was applied to the right thigh. Von Frey filaments were used to measure hyperalgesia at baseline and at 4th, 6th, 24th and 48th hours. Shapiro Wilk test was used to determine whether the distribution of continuous variables was close to normal. Levene's test was used for homogeneity of variances. Bonferroni Correction Wilcoxon Sign test was used to determine whether the differences between follow-up times were statistically significant or not. Bonferroni Correction on Kruskal Wallis test was used to determine whether there was any difference between groups. If the Kruskal Wallis test statistics were significant, analysis was performed using Conover's multiple comparison test. p<0.05 was considered statistically significant. This study found that electro-acupuncture decreases hyperalgesia, and there was no significant difference between pre-incisional and post-incisional application in terms of the anti-hyperalgesic effectiveness of electro-acupuncture, except for the duration of action. Pre-incisional applications are more effective than post-incisional applications. Pre-incisional sham electro-acupuncture has also been found to have anti-hyperalgesic effect. Our findings support the studies that electro-acupuncture can be used for preemptive purposes in surgical patients. We think that researches should be continued in order to provide alternative methods for pain treatment.

Since improvement in reinforced expanded polytetrafluoroethylene (ePTFE) grafts, true aneurysm and pseudoaneurysm formation have become relatively rare complications after axillofemoral reconstruction. This is a case report of a true aneurysm [...]

Aim of the study:Ultrasonographic examination of intraosseous jaw pathologies may reveal interesting incidental, mobile hyperechoic particles (“snowflakes”) in anechoic areas. Purpose of this study is to explain and discuss this snowing-like ultrasonographic feature of intraosseous jaw pathologies. Material and methods:This study included 113 patients admitted to our clinic for examination: 43 (38.05%) males and 70 (61.9%) females with a mean age of 34.9 ± 17.2 years (range: 6–72 years). A total of 120 intraosseous lesions were evaluated prior to surgery using ultrasonography; these included non-neoplastic, odontogenic, and non-odontogenic lesions. Results:In total, 5 (4.1%) of the 120 lesions exhibited snowing-like feature on ultrasonography, including 2 (1.6% of total) of 3 incisive canal cysts, 2 (1.6% of total) of 7 dentigerous cysts, and 1 (0.8% of total) of 19 odontogenic keratocysts. Conclusions:Snowflakes evident on ultrasonography of intraosseous jaw lesions may be specific to certain pathologies. Future studies correlating radiologic and pathologic features of intraosseous jaw lesions should focus on ultrasonographic snowing-like appearance in different types of lesions and explore why they occur.

Small aorta syndrome (SAS) is defined as a syndrome of peripheral obliterating arterial disease characterized by aortoiliac steno-occlusion. It typically occurs in young women of small stature with relatively typical risk factors. We present here, a 51-year-old female with 2-year history of bilateral intermittent claudication who was referred to our clinic and diagnosed as having SAS. The patient was successfully treated by aortic thromboendarterectomy and inverted 'Y' dacron patchplasty. Additionally, we discussed this topic with the current literature knowledge. Keywords: Aorta | vascular disease and surgery, Introduction Congenital aortoiliac stenosis/occlusion or SAS was shown to induce peripheral obliterating arterial disease. Although it remains unclear whether SAS represents a separate entity, the small size of the distal [...]

The development of atrial fibrillation (AF) during the course of acute coronary syndrome (ACS) is related to poor prognosis. Possible predictors of new-onset AF (NOAF) have not been adequately investigated in elderly patients with ACS undergoing percutaneous coronary intervention (PCI). We aimed to identify the factors associated with NOAF in such patients. A total of 308 elderly patients with ACS undergoing PCI were enrolled in the study. Patients were divided into two groups: without NOAF [254 patients, 64.6% men, age: 73.5 (69.0–79.0) years] and with NOAF [54 patients, 70.4% men, age: 75.0 (68.7–81.2) years]. Clinical, angiographic, and laboratory features including neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-high-density lipoprotein ratio (MHR) were compared between the groups. The percentages of prior myocardial infarction (MI) (20.4 vs. 5.9%) and Killip III/ IV (24.1 vs. 7.1%), NLR [4.5 (2.6–7.2) vs. 3.2 (2.0–6.0)], and MHR [19.4 (15.7–26.5) vs. 12.9 (9.9–18.5)] were higher in patients with NOAF compared to the others (p= 0.020, < 0.001, 0.030, and < 0.001, respectively). In multivariate regression analysis, prior MI (OR 4.509, 95% CI 1.679–12.106, p= 0.003) and MHR (OR 1.102, 95% CI 1.054–1.152, p< 0.001) independently predicted NOAF. In addition, Killip III/IV was found to be an independent predictor of 6-month overall mortality (HR 2.949, 95% CI 1.218–7.136, p= 0.016). Prior MI and MHR are independent predictors of NOAF in elderly patients with ACS undergoing PCI. Killip III/IV predicts 6-month overall mortality in such patients.

IMPORTANCE: Universal tumor screening for Lynch syndrome (LS) in colorectal cancer (CRC) is recommended and involves up to 6 sequential tests. Somatic gene testing is performed on stage IV CRCs for treatment determination. The diagnostic workup for patients with CRC could be simplified and improved using a single up-front tumor next-generation sequencing test if it has higher sensitivity and specificity than the current screening protocol. OBJECTIVE: To determine whether up-front tumor sequencing (TS) could replace the current multiple sequential test approach for universal tumor screening for LS. DESIGN, SETTING, AND PARTICIPANTS: Tumor DNA from 419 consecutive CRC cases undergoing standard universal tumor screening and germline genetic testing when indicated as part of the multicenter, population-based Ohio Colorectal Cancer Prevention Initiative from October 2015 through February 2016 (the prospective cohort) and 46 patients with CRC known to have LS due to a germline mutation in a mismatch repair gene from January 2013 through September 2015 (the validation cohort) underwent blinded TS. MAIN OUTCOMES AND MEASURES: Sensitivity of TS compared with microsatellite instability (MSI) testing and immunohistochemical (IHC) staining for the detection of LS. RESULTS: In the 465 patients, mean age at diagnosis was 59.9 years (range, 20-96 years), and 241 (51.8%) were female. Tumor sequencing identified all 46 known LS cases from the validation cohort and an additional 12 LS cases from the 419-member prospective cohort. Testing with MSI or IHC, followed by BRAF p.V600E testing missed 5 and 6 cases of LS, respectively. Tumor sequencing alone had better sensitivity (100%; 95% CI, 93.8%-100%) than IHC plus BRAF (89.7%; 95% CI, 78.8%-96.1%; P = .04) and MSI plus BRAF (91.4%; 95% CI, 81.0%-97.1%; P = .07). Tumor sequencing had equal specificity (95.3%; 95% CI, 92.6%-97.2%) to IHC plus BRAF (94.6%; 95% CI, 91.9%-96.6%; P > .99) and MSI plus BRAF (94.8%; 95% CI, 92.2%-96.8%; P = .88). Tumor sequencing identified 284 cases with KRAS, NRAS, or BRAF mutations that could affect therapy for stage IV CRC, avoiding another test. Finally, TS identified 8 patients with germline DPYD mutations that confer toxicity to fluorouracil chemotherapy, which could also be useful for treatment selection. CONCLUSIONS AND RELEVANCE: Up-front TS in CRC is simpler and has superior sensitivity to current multitest approaches to LS screening, while simultaneously providing critical information for treatment selection.

IMPORTANCE: Hereditary cancer syndromes infer high cancer risks and require intensive cancer surveillance, yet the prevalence and spectrum of these conditions among unselected patients with early-onset colorectal cancer (CRC) is largely undetermined. OBJECTIVE: To determine the frequency and spectrum of cancer susceptibility gene mutations among patients with early-onset CRC. DESIGN, SETTING, AND PARTICIPANTS: Overall, 450 patients diagnosed with colorectal cancer younger than 50 years were prospectively accrued from 51 hospitals into the Ohio Colorectal Cancer Prevention Initiative from January 1, 2013, to June 20, 2016. Mismatch repair (MMR) deficiency was determined by microsatellite instability and/or immunohistochemistry. Germline DNA was tested for mutations in 25 cancer susceptibility genes using next-generation sequencing. MAIN OUTCOMES AND MEASURES: Mutation prevalence and spectrum in patients with early-onset CRC was determined. Clinical characteristics were assessed by mutation status. RESULTS: In total 450 patients younger than 50 years were included in the study, and 75 gene mutations were found in 72 patients (16%). Forty-eight patients (10.7%) had MMR-deficient tumors, and 40 patients (83.3%) had at least 1 gene mutation: 37 had Lynch syndrome (13, MLH1 [including one with constitutional MLH1 methylation]; 16, MSH2; 1, MSH2/monoallelic MUTYH; 2, MSH6; 5, PMS2); 1 patient had the APC c.3920T>A, p.I1307K mutation and a PMS2 variant; 9 patients (18.8%) had double somatic MMR mutations (including 2 with germline biallelic MUTYH mutations); and 1 patient had somatic MLH1 methylation. Four hundred two patients (89.3%) had MMR-proficient tumors, and 32 patients (8%) had at least 1 gene mutation: 9 had mutations in high-penetrance CRC genes (5, APC; 1, APC/PMS2; 2, biallelic MUTYH; 1, SMAD4); 13 patients had mutations in high- or moderate-penetrance genes not traditionally associated with CRC (3, ATM; 1, ATM/CHEK2; 2, BRCA1; 4, BRCA2; 1, CDKN2A; 2, PALB2); 10 patients had mutations in low-penetrance CRC genes (3, APC c.3920T>A, p.I1307K; 7, monoallelic MUTYH). Importantly, 24 of 72 patients (33.3%) who were mutation positive did not meet established genetic testing criteria for the gene(s) in which they had a mutation. CONCLUSIONS AND RELEVANCE: Of 450 patients with early-onset CRC, 72 (16%) had gene mutations. Given the high frequency and wide spectrum of mutations, genetic counseling and testing with a multigene panel could be considered for all patients with early-onset CRC.

We aimed to investigate the demographical features, anxiety levels and clinical findings of the patients admitted to our Emergency department (ED) due to chest pain.

AbstractThe researchers have attempted to compare muscle damage in soccer players after matches played on artificial and natural turf fields. The study was performed on 16 male soccer players. A match was played on an artificial turf field, and another one was played on a natural turf field.Visual analogue scale scores, myoglobin, creatine kinase, aspartate transaminase and lactate dehydrogenase levels were measured before the match, after the match and at the 72ndhour. The 2x3 repeated measure ANOVA test was performed for statistical analysis. Comparing the artificial turf and natural turf field values, the post-match and 72ndhour visual analogue scale scores for artificial turf field were found to be statistically significant and higher than the natural turf field values. Based on these findings, the researchers claim that muscle damage is not significantly different when comparing matches played on both fields.

Crimean-Congo hemorrhagic fever (CCHF) is a systemic viral disease that also affects the endothelium. Thrombocytopenia and hemorrhage are seen in this disease. But, the cause of thrombocytopenia is not clear. We hypothesized that endothelium dysfunction may be the cause of thrombocytopenia. We evaluated the endothelium functions by flow-mediated dilatation (FMD) in CCHF.

BackgroundThis study aims to assess the eff ects of bileafl et preservation versus conventional technique during mitral valve replacement (MVR) on left ventricular functions and end-systolic stress (ESS).MethodsBetween September 2005 and January 2009, sixty-fi ve patients with mitral regurgitation underwent MVR surgery. In a non-randomized fashion, 34 patients had conventional MVR without chordal/leafl et preservation (group I, c-MVR), and 31 had MVR with total chordal/bileafl et preservation (group II, b-MVR). A prospective clinical and echocardiographic follow-up of patients was performed preoperatively, at 3 months and by 1 year postoperatively.ResultsLeft ventricular end-systolic/end-diastolic dimensions and volumes decreased by 1 year in the b-MVR group. Left ventricular ESS decreased only in the bileafl et sparing MVR group after surgery, and this decrease was signifi cant by 1 year, compared with the c-MVR group (P= 0.008). Left atrial diameter signifi cantly decreased in both groups. Only one patient died, due to posterior wall rupture after a c-MVR procedure. One patient undergoing a b-MVR procedure needed re-operation because of prosthetic valve endocarditis.ConclusionBileafl et preservation during MVR has a benefi cial eff ect on left ventricular function, compared with conventional MVR. Left ventricular ESS improves after bileafl et-sparing MVR and may be an important indicator of myocardial function after mitral valve surgery.

Data on the factors that contribute to the antibody response to hepatitis B virus vaccination in peritoneal dialysis patients are scarce. The current study was conducted on a group of peritoneal dialysis patients to learn how the response to hepatitis B virus vaccination varies according to the patient's clearance of urea normalized to total body water (Kt/V).

Records of 33 patients (group 1) who received 19-mm or 21-mm ATS aortic valve prostheses were retrospectively reviewed and compared with those of 26 patients who received 25-mm ATS valves (group 2). Group 1 patients were younger (20 ± 2 years versus 43 ± 15 years) and had a smaller mean body surface area (1.6 m2versus 1.83 m2). Valve pathology was usually congenital aortic stenosis in group 1 and rheumatic in group 2. There was no operative mortality. The mean postoperative Doppler resting gradient was higher in group 1 (21 mm Hg versus 7 mm Hg). Total follow-up was 294 patient-years. There was no perivalvular leak, valve thrombosis, or endocarditis in either group. In group 2, there was 1 anticoagulant-related hemorrhage and 1 late death due to congestive heart failure. We concluded that in spite of the higher transprosthetic gradient, 19-mm and 21-mm ATS aortic valve prostheses performed satisfactorily in adult patients with a body surface area of less than 1.6 m2. This valve can be used in a small aortic annulus as an alternative to performing an annular enlargement procedure.

Autologous blood conservation reduces postoperative morbidity and mortality. In elective abdominal aortic aneurysm repair, the blood within the aneurysm sac is generally neglected during surgery. We present a simple method of additional blood conservation in elective abdominal aortic surgery, which involves reinfusion of autologous blood within the aneurysm sac in the perioperative period.

Hibernoma is a benign soft-tissue tumor, which arises from the remnants of fetal brown adipose tissue. Out of less than 300 cases of hibernoma described to date, pericardial sac is an unusual localization to develop. When the tumor increases in size, this benign pathology can lead to compression of cardiac chambers and cause life-threatening complications in an asymptomatic patient. Here, the authors present the case of a 20-year-old male who underwent an operation for the treatment of constrictive pericarditis, in which an intrapericardial sessile lesion over diaphragmatic surface of pericardial sac was incidentally discovered. The tumor was excised and diagnosed as hibernoma. No recurrence was evident two years after the procedure.

Bullet embolization of the pulmonary artery is a very rare event. When a bullet enters the pulmonary vasculature, it may cause haemorrhage, thrombosis, sepsis, intimal erosion and eventually occlusion. Locating the bullet with several imaging methods is important to confirm the diagnosis. If due care is taken, the appropriate surgical technique for removing the bullet embolus will be uncomplicated and safe. We report our experience of bullet embolism to the left pulmonary artery.

J Thorac Cardiovasc Surg 2003;125:206-8

We report 3 patients with primary cardiac hydatid cysts, all of which were located on the wall of the right ventricle. In one case, an intramyocardial cyst protruded into the right ventricular chamber and in the other 2 cases, cysts protruded into the intrapericardial space. The diagnosis was confirmed by serologic tests, two-dimensional echocardiography, tomographic scanning and cardiac angiography. The patients underwent successful enucleation of the cysts with the aid of cardiopulmonary bypass. There was no morbidity or mortality and late results were satisfactory.

Several types of left anterior descending artery anomalies have been detected. In these anomalies, left anterior descending artery usually originates from the right coronary artery or right sinus of Valsalva. A case of left anterior descending artery arising as a terminal extension of posterior descending artery presented. This anomaly seems rather rare.

Several letters to the editor are presented concerning various topics, including socialism, the decision of the Turkish government to ban a left-wing Kurdish party (TDP), and the demand of Members of the European Parliament (MEPs) to have their 3.7% salary increase.