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Aims: The study objective was to prospectively assess clinical outcomes for a pilot cohort of tibial shaft fractures treated with a new tibial nailing system that produces controlled axial interfragmentary micromotion. The hypothesis was that axial micromotion enhances fracture healing compared to static interlocking. Methods: Patients were treated in a single level I trauma centre over a 2.5-year period. Group allocation was not randomized; both the micromotion nail and standard-of-care static locking nails (control group) were commercially available and selected at the discretion of the treating surgeons. Injury risk levels were quantified using the Nonunion Risk Determination (NURD) score. Radiological healing was assessed until 24 weeks or clinical union. Low-dose CT scans were acquired at 12 weeks and virtual mechanical testing was performed to objectively assess structural bone healing. Results: A total of 37 micromotion patients and 46 control patients were evaluated. There were no significant differences between groups in terms of age, sex, the proportion of open fractures, or NURD score. There were no nonunions (0%) in the micromotion group versus five (11%) in the control group. The proportion of fractures united was significantly higher in the micromotion group compared to control at 12 weeks (54% vs 30% united; p = 0.043), 18 weeks (81% vs 59%; p = 0.034), and 24 weeks (97% vs 74%; p = 0.005). Structural bone healing scores as assessed by CT scans tended to be higher with micromotion compared to control and this difference reached significance in patients who had biological comorbidities such as smoking. Conclusion: In this pilot study, micromotion fixation was associated with improved healing compared to standard tibial nailing. Further prospective clinical studies will be needed to assess the strength and generalizability of any potential benefits of micromotion fixation.

In this study, it is studied that the augmented Wind-FLOWER numerical modelling skill’s applications and land-surface (orographic) air flows’ numerical modelling on mountain areas by using real topography datas which are defined on geographic areas. This numerical modelling skill’s simulation results show that 3-D specifications are very important for being of time-dependant quick-change vortex which are included by landsurface air flows. In the numerical modelling skill’s applications topographical numerical altitude datas that include informations and datas of really “Numerical Altitude Model (NAM)” are used. These real topographic datas, used in application part, are examinated very tightly and seperated same size topographic datas before using as initial/beginning datas for Wind-FLOWER numerical modelling. Then, these topographical datas are used as land-surface data for modelling applications. This modelling applications include a pro-precessor and a post-processor. The pro-precessor runs land-surface numerical datas and uses them in numerical modelling applications. The post-processor constitutes 2-D and 3-D images by using the numerical modelling applications’ datas of land-surface air flow and determined vortex formations and vortex-density distrubitions. Furthermore, a “Graphical User Interface (GUI)” is constituted which is required to work with pre-processor and postprocessor and is practiced for easy usage of numerical modelling.

In this study, it is studied that the augmented Wind-FLOWER numerical modelling skill's applications and land-surface (orographic) air flows' numerical modelling on mountain areas by using real topography datas which are defined on geographic areas. This numerical modelling skill's simulation results show that 3-D specifications are very important for being of time-dependant quick-change vortex which are included by landsurface air flows. In the numerical modelling skill's applications topographical numerical altitude datas that include informations and datas of really "Numerical Altitude Model (NAM)" are used. These real topographic datas, used in application part, are examinated very tightly and seperated same size topographic datas before using as initial/beginning datas for Wind-FLOWER numerical modelling. Then, these topographical datas are used as land-surface data for modelling applications. This modelling applications include a pro-precessor and a post-processor. The pro-precessor runs land-surface numerical datas and uses them in numerical modelling applications. The post-processor constitutes 2-D and 3-D images by using the numerical modelling applications' datas of land-surface air flow and determined vortex formations and vortex-density distrubitions. Furthermore, a "Graphical User Interface (GUI)" is constituted which is required to work with pre-processor and postprocessor and is practiced for easy usage of numerical modelling. [ABSTRACT FROM AUTHOR]

This study was aimed to create a bioactive hydrogel form with PVA/PVP (polyvinyl alcohol/poly(N-vinylpyrrolidone) polymer using acetone and ethanol extractions of Jania rubens red algae and investigate some pharmaceutical properties. The anti-candidal activity and some inhibition performance of J. rubens/PVA/PVP hydrogel were investigated on Candida tropicalis which is one of the important causes of bloodstream infections. The physicochemical properties of J. rubens/PVA/PVP hydrogel were revealed using FTIR and swelling-absorption tests. The volatile compounds of J. rubens extracts were examined by GCMS. By mixing the extracts in equal proportions, PVA/PVP-based hydrogel was prepared. According to the results, Cumulative Drug Release was stable at 25 °C for the first 5 h. The IZ (inhibition zone) and MIC (minimum inhibitory concentration) of J. rubens/PVA/PVP hydrogel were 9.01 mm and 80.20 mg/mL, respectively. It was found that logarithmic reduction and percent reduction were seen as 1.5 CFU/mL and 97.5%, respectively, on C. tropicalis exposed to J. rubens/PVA/PVP hydrogel in the first 5 min of the incubation. After exposure of C. tropicalis to J. rubens/PVA/PVP, the number of viable cells transferred from the gel to water was between 76.1 and 73.1% in high glucose medium, while it was between 92.2 and 80.8% for the PVA/PVP hydrogel under the same conditions. As a result, PVA/PVP hydrogel was made bioactive with J. rubens extracts for the first time in this study, and its potential for use as a functional anticandidal hydrogel on C. tropicalis has been demonstrated., Competing Interests: Declarations. Ethical Approval: Not applicable. Competing Interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic., Material and Methods: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded., Results: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%)., Conclusion: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear., Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19., Study Design: Multicenter prospective observational clinical study., Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated., Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores ( p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) ( p = 0.004)., Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Background: Pain control is very important to ensure the comfort of patients and increase their quality of life., Objectives: The purpose of this randomized controlled trial was to examine the effects of cold therapy in patients with chest tube before deep breathing and coughing exercises., Methods: The study participants were patients with chest tubes, who were treated at a training and research hospital in Turkey between May 2, 2017, and October 24, 2019. Seventy patients participated in the study in accordance with the inclusion criteria. The intervention group, patient identification form, and visual analogue scale were used to collect data. Cold therapy was applied for the intervention group before deep breathing and coughing exercises, and not for the control group., Results: The pain rates of the intervention group participants were lower (3.31) after the deep breathing and coughing exercises, than the rates (4.24) before the exercises (p<0.01). The pain rate (5.29) among the control group participants after the deep breathing and coughing exercises was significantly higher than those before (3.47) the exercises (p<0.01)., Conclusions: The study revealed that cold therapy before deep breathing and coughing exercises effectively relieves pain in patients with chest tubes., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier's gangrene., Methods: A retrospective evaluation was made of 113 patients operated on because of Fournier's gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters., Results: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001)., Conclusion: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients' general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

Aim: To determine the psychological resilience and perceived stress levels of healthcare workers in COVID-19 intensive care units., Methods: The study was conducted with 418 physicians and nurses in Turkey between July and August 2020. The data were collected with an online survey consisting of a personal information form, the Brief Resilience Scale, and the Perceived Stress Scale., Results: The study sample comprised 32.5% physicians and 67.5% nurses. Fear of transmission of COVID-19 from the patients in their care was stated by 92.6% of the physicians and 95.7% of the nurses. Almost all of the participants (99.3%) were afraid of transmitting COVID-19 to their families. The psychological resilience level of the physicians (18.42 ± 2.25) participating in the study was higher than that of the nurses (17.88 ± 2.00), and the perceived stress level was lower. It was determined that most physicians and nurses strengthened their team/work friendship bonds during the pandemic, but the motivation to work decreased., Conclusion: The study results suggest that frontline intensive care workers should be closely monitored as a high-risk group for psychological problems. The provision of better personal protective equipment, together with on-going monitoring and provision of psychological support, and strong family support will increase the resilience of frontline healthcare workers., (© 2021 Japan Academy of Nursing Science.)

Background: COVID-19, which is characterised by life-threatening symptoms, difficulty in breathing, and pneumonia symptoms and requires global emergency intervention, may cause psychological problems such as phobia, fear and anxiety. This study aims to examine the psychometric properties of the Fear of COVID-19 Scale (FCV-19S) in Turkish people and to determine the level of fear of COVID-19 among Turkish people., Methods: The research was carried out between March and April 2020. A Personal Information Form and the FCV-19S were used to collect the research data. In the validity and reliability stage, 84 people were contacted randomly for data collection. After the validity and reliability analyses of the scale, a total of 431 Turkish people volunteered to participate in the study and answered the questions in the online questionnaire form using a convenience and snowball sampling method. Confirmatory factor analysis, item-total correlation and Cronbach's alpha coefficient were calculated for psychometric evaluation. Bivariate analysis was applied to determine the level of fear of COVID-19., Results: Cronbach's alpha coefficient was 0.89, which is stated to have high reliability. FCV-19S scores of participants were determined to be 21.47 ± 6.28. FCV-19S scores of females were determined as 20.48 ± 6.33 and FCV-19S scores of males were determined as 19.78 ± 7.34 according to the bivariate analysis (p < .05). Age, marital status, having children and living alone or with others, tobacco use and anxiety about going to the hospital during the pandemic did not affect on fear of COVID-19 (p > .05). Particularly being female, the presence of chronic disease requiring long-term medication and rarely taking protective measures recommended by the Ministry of Health and having a chronic disease had a significant effect on higher levels of fear of COVID-19 (p < .05)., Conclusion: The FCV-19S is a valid and reliable tool for determining the fear of COVID-19. It was found that the fear level of COVID-19 infection was high in Turkish people., (© 2020 John Wiley & Sons Ltd.)

Background/aim: It is claimed that aberrant immune response has a more important role than the cytopathic effect of the virus in the morbidity and mortality of the coronavirus disease 2019 (COVID-19). We aimed to investigate the possible roles of tumor necrosis factor-like weak inducer of apoptosis (TWEAK)/Fn14 pathway and leukotrienes (LT) in uncontrolled immune response that occurs in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)., Materials and Methods: This study included 25 asymptomatic patients and 35 patients with lung involvement who were diagnosed with COVID-19 as well as 22 healthy volunteers. Lung involvement was determined using computed-tomography. Serum TWEAK, LTE4, and prostaglandin F2α (PGF2α) levels were determined., Results: Compared with the healthy control group, TWEAK, LTE4, and PGF2α levels were higher in the group of SARS-CoV-2 infection without lung involvement. In the group of SARS-CoV-2 infection with lung involvement, age, fibrinogen, sedimentation, C-reactive protein and ferritin, TWEAK, LTE4, and PGF2α levels were higher, and lymphocyte levels were lower compared with the asymptomatic group., Conclusions: In the study, TWEAK and LTE4 levels increased in cases with COVID-19. These results support that TWEAK/Fn14 pathway and LT may involved in the pathology of aberrant immune response against SARS-CoV-2. Inhibition of each of these pathways may be a potential target in the treatment of COVID-19., Competing Interests: All authors declare that they have no conflicts of interests., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Aim: To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit., Methods: A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube-related complications, early stage local complications and late-stage complications., Results: The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early- and seven late-stage complications developed in group 1, and three early- and three late-stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality., Conclusion: Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••-••., (© 2020 Japan Geriatrics Society.)

The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Boran et al.)

Background: The onset of proteinuria in renal transplant recipients may be associated with an increased risk of allograft failure. Little is known about the relationships between factors influencing proteinuria and the Doppler ultrasound (DU) intrarenal resistive index (RI) and pulsatility index (PI) among donor recipients with proteinuria <1000 mg/24 h., Methods: We assessed correlations between the DU RI and PI and protein content in 93 selected renal transplant recipients: 62 patients with proteinuria 100 to 299 mg/24 h, 16 patients with proteinuria 300 to 499 mg/24 h, and 15 patients with proteinuria 500 to 999 mg/24 h. All patients underwent transplantation in a single center and were monitored by DU for at least 28 months post-transplantation., Results: The DU RI values of the proteinuria 100 to 299 mg/24 h, 300 to 499 mg/24 h, and 500 to 999 mg/24 h groups were 0.67 ± 0.05; 0.65 ± 0.04, and 0.64 ± 0.07, respectively, and the PI values were 1.21 ± 0.20, 1.10 ± 0.14, and 1.15 ± 0.22, respectively. Multivariate logistic regression analysis revealed a correlation between group 100 to 299 mg/24 h and RI values, serum creatinine, living donor (R 2  = 19.6%, P = .05); group 300 to 499 mg/24 h and the RI, PI values, cadaver donor (R 2  = 17.5%, P = .001); and group 500 to 999 mg/24 h and the RI, PI values, serum creatinine, graft survival (R 2  = 15.4%, P = .005)., Conclusions: Among donor recipients with proteinuria <1000 mg/24 h, DU RI values were <0.72 and PI values were <1.41 and correlations were revealed between the incidence of proteinuria and factors such as the RI, PI, and serum creatinine level., (Copyright © 2018 Elsevier Inc. All rights reserved.)

BACKGROUND The aim of this study was to find a simple and easily accessible scoring system that could predict the development of sepsis in the preseptic period. MATERIAL AND METHODS The study included 161 patients with a basal sequential organ failure assessment (SOFA) value of 2 or more. The sepsis group (n=83) comprised patients with infection reported in culture results; the control group (n=78) comprised patients not showing evidence of infection in blood, urine, and phlegm cultures; samples were taken on three consecutive days. RESULTS The patients in both groups were divided into subgroups of non-survivor and survivor patients. The preseptic and septic SOFA score, neutrophil lymphocyte ratio (NLR), and procalcitonin (PRC) and lactate (Lac) values were determined to be statistically significantly higher in the sepsis group than in the control group. When the values related to sepsis were examined, a strong relationship was determined between sepsis and SOFA score, PRC values, and Lac values in the preseptic period and a weak relationship with NLR. In the model formed using multiple regression analysis with defined cutoff values for the preseptic and the septic periods, we found that in the septic period, a diagnosis of sepsis could be made with 83.8% accuracy. The diagnostic value of the same parameters evaluated in the preseptic period was 77.9%. CONCLUSIONS The diagnostic value of the combination of Lac, PRC, SOFA, and NLR were found to be similar in the preseptic period as the sepsis period; thus these combined values could safely be used for the early diagnosis of sepsis.

Objective: The purpose of this study was to determine the characteristics of paratracheal air cysts (PACs) and their relationship with upper lobe pulmonary fibrosis., Materials and Methods: The routine thoracic computed tomography scans of 3549 patients carried out between January 2014 and April 2015 were retrospectively evaluated. The presence, location, structural characteristics (uniloculated or multiloculated), number of cysts, and anterior-posterior and transverse dimensions of the PAC and its communication with the tracheal lumen were evaluated. The presence of upper lobe fibrosis, emphysema, and bronchiectasis was also evaluated. The relationship between upper lobe fibrosis, emphysema, bronchiectasis, and the presence of paratracheal cysts was evaluated in all patients. An equal number of randomized patients with no paratracheal cysts were selected as a control group., Results: A total of 190 PAC cases were diagnosed, with a prevalence rate of 5.35%: 146 (76.8%) of the cases were men, 44 (23.2%) were female, and the mean (SD) age was 53.79 (16.64) years (range, 12-89 years). The control group included 105 men (57.4%) and 78 women (42.6%), and the mean (SD) age was 53.87 (16.65) years (range, 13-87 years). The groups were similar in terms of age (P = 0.876), whereas the proportion of men in the PAC group was significantly higher (P < 0.001). Most of the PACs were located on the right side (n = 188, 98.9%). The incidence of fibrosis in the paratracheal cyst group was 45.8% (n = 87) compared with 19.5% (n = 37) in the control group; this difference was statistically significant (P < 0.001). The prevalence rates of emphysema in the cyst group and the control group were 29.5% (n = 56) and 11.6% (n = 22), respectively, and the difference was statistically significant (P < 0.001). When the groups were compared regarding bronchiectasis (scar and non-scar related), the rate of bronchiectasis in the paratracheal cyst group was 17.9% (n = 34), compared with 3.7% (n = 7) in the control group; this difference was statistically significant (P < 0.001)., Conclusions: Paratracheal air cysts are relatively common, but the etiology is still unclear. We detected increased rates of cyst formation that may result from the traction effect on the tracheal wall in the presence of upper lobe fibrosis.

We present a case of 63-year-old man who was referred to the emergency department with a right-sided pneumothorax. He had a history of spontaneous pneumothorax for 2 times. The chest computed tomographic scan showed tracheobronchomegaly with an increase in the diameter of the trachea and right and left main bronchus. Fiberoptic bronchoscopy revealed enlarged trachea and both main bronchus with diverticulas. These findings are consistent with a diagnosis of Mounier-Kuhn syndrome. Mounier-Kuhn syndrome is a rare clinical and radiologic condition. It is characterized by a tracheal and bronchial dilation. Diagnosis is made by computed tomography and bronchoscopy. Mounier-Kuhn syndrome should be kept in mind in the differential diagnosis of recurrent spontaneous pneumothorax.