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As a result of the Covid-19 pandemic, all theoretical courses and practices held face-to-face in all medical faculties in the world and in our country have been terminated, and distance education has begun to be provided with digital education opportunities. In our faculty, most of the courses in the spring semester of 2019-2020 were held asynchronously. With the pandemic, in line with the decision not to make face-to-face exams at universities, the exams were conducted online via Trakya University Distance Education Center and Medu-Trakya. Immediately after the publication of the national core education program 2020, the arrangement of the theoretical courses and practices, the rates of face-to-face, asynchronous or synchronous courses under pandemic conditions were planned by the relevant course and internship committees. In conclusion, we believe that the COVID-19 pandemic has raised the need to rethink the competencies required of medical school graduates. In addition, we think that while the importance of face-to-face education is revealed once again in medical faculties, it is experienced that distance education opportunities can also be used effectively. From this point of view, it can be predicted that medical education programs will be revised and restructured to different dimensions with the normalization process in the future., Küresel olarak yaşadığımız Covid-19 pandemisi sonucunda, dünyada ve ülkemizde tüm tıp fakültelerinde yüz yüze yapılan tüm teorik dersler ve uygulamalar sonlandırılmış, uzaktan eğitim, dijital eğitim olanakları ile verilmeye başlanmıştır. Fakültemizde 2019-2020 bahar döneminde derslerin büyük bir çoğunluğu asenkron olarak yapıldı. Pandemi ile üniversitelerde sınavların yüz yüze yapılmaması kararları doğrultusunda sınavlar, Trakya Üniversitesi Uzaktan Eğitim Merkezi ve Medu-Trakya üzerinden online (asenkron) olarak yapılmıştır. Ulusal çekirdek eğitim programı 2020 yayınlandıktan hemen sonra teorik derslerin ve uygulamaların düzenlenmesi, pandemi koşullarında derslerin yüz yüze, asenkron veya senkron olarak hangi oranlarda yapılacağı ilgili ders ve staj kurulları tarafından planlandı. Sonuç olarak, COVID-19 pandemisinin tıp fakülteleri mezunlarında bulunması gereken yetkinlikler ve yeterlikler üzerinde yeniden düşünme ihtiyacını ortaya çıkardığı kanısındayız. Ayrıca tıp fakültelerinde yüz yüze eğitimin önemi bir kez daha ortaya çıkarken, uzaktan eğitim olanaklarının da etkin bir şekilde kullanılabileceğinin deneyimlendiği düşüncesindeyiz. Buradan hareketle gelecekte normalleşme süreciyle birlikte tıp eğitimi programlarının gözden geçirilerek yeniden yapılandırılmak suretiyle farklı boyutlara taşınacağı öngörülebilir.

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Right heart failure (RHF) following left ventricular assist device implantation (LVAD) remains the primary cause of postoperative mortality and morbidity, and prediction of RHF is the main interest of the transplantation community. In this review, we outline the role and impact of right ventricular strain in the evaluation of the right ventricle function before LVAD implantation. Accumulating data suggest that measurement of right ventricular longitudinal strain (RVLS) has a critical role in predicting RHF preoperatively and may improve morbidity and mortality following LVAD implantation. However, the significant intraobserver, interobserver variability, the lack of multicenter, prospective studies, and the need for a learning curve remain the most critical limitations in the clinical practice at present. This review highlighted the importance of right ventricular strain in the diagnosis of RHF preoperatively and revealed that RVLS might have a crucial clinical measurement for the selection and management of LVAD patients in the future with the more extensive multicenter studies.

Objectives:Acute mesenteric ischemia and other end organ emboli are serious life-threatening complications after open-heart surgery. In this study, we evaluated the outcome of patients with mesenteric ischemia and splenic infarction after cardiac surgery.Materials and Methods:From January 2010 to November 2017, all patients (5607) who underwent open-heart surgery were analysed, and patients with registered acute mesenteric ischemia and splenic infarct (32) were retrospectively reviewed.Results:Five thousand six hundred and seven patients were included in this study, of which 32 (0.57%) patients suffered from acute mesenteric ischemia and splenic infarct. Intraoperatively, splenic infarction was detected in six patients who were pre-diagnosed as mesenteric ischemia. In these patients, the symptoms completely improved after the splenectomy and all the patients survived. Only two of 26 patients were survived after segmentary bowel resection. Overall mortality was 24 (%75). Age (p=0.03), need for dialysis (p=0.01), emergency cardiac operation (p=0.05), peripheral arterial disease (p=0.001), and high risk Euroscore (p=0.0001) were significantly different compared to the control group. Mesenteric ischemia was significantly higher in off- pump coronary artery bypass patients (p=0.0001). The time of cardiopulmonary bypass in mesenteric ischemia group was significantly higher than the control group (p=0.0001).Conclusion:Acute mesenteric ischemia is still highly mortal, after cardiac surgery. Splenic infarct symptoms may mimic mesenteric ischemia. Mesenteric ischemia is more common in high-risk cardiac operations. Prompt diagnosis and treatment can be life-saving.

DergiPark: 584646 tmsj Aims: Esophageal atresia is the most common congenital malformation of the esophagus. It can be diagnosed in the prenatalperiod, during the delivery or at the neonatal intensive care unit. With the operation, the respiratory system and digestive tractare being corrected to the anatomic position. In this case, we wanted to emphasize that patients with esophageal atresia maycontinue to have functional problems even after successful surgical treatment. Case Report: After preterm delivery, a femalepatient was consulted to Trakya University Department of Pediatric Surgery, at one day of age with the symptom of regurgitationof saliva. There were no abnormalities on physical examination. Due to the inability to pass an orogastric tube to the stomach,esophageal atresia was suspected. Thus, radiocontrast x-ray study was performed: the proximal esophageal pouch was identified,and malformation was diagnosed. After the diagnosis, tracheoesophageal fistula has been ligated. The patient received physicaltherapy after the operation, and she was followed-up for 10 months. A full recovery was observed, and the patient was able toswallow food. Conclusion: Esophageal atresia with distal tracheoesophageal fistula is not an uncommon malformation. Thepatients can have problems with swallowing in their infancy even they are treated surgically in the neonatal period.Keywords: Esophageal atresia, tracheoesophageal fistula, newborn

We aimed to evaluate the ultrastructural effect of reversing cellular damage, occurring in rats due to ischemia-reperfusion (I/R) in the intestine, with naringin implementation through biochemical parameters. Rats were divided the sham/control, I/R and the naringin groups (n = 7). For I/R group, 120 min of ischemia and 120 min of reperfusion was applied to the superior mesenteric artery. In the naringin group, after 120 min, 50 mg/kg naringin was implemented, and then 120 min of reperfusion was applied. Morphological evaluation was performed via Chiu score and electron microscopy. The antioxidant parameters were examined. Chiu score in I/R (p

OBJECTIVES Right heart failure (RHF) is an important prognostic factor in continuous-flow left ventricular assist device (LVAD) therapy. We aimed to assess the clinical variables associated with RHF after LVAD implantation and to compare their performance against currently available RHF predictive scoring systems. METHODS The study cohort comprised 57 patients who underwent LVAD therapy between January 2012 and May 2018 in our centre. The mean age of the patients was 39.9 ± 18.3 years, and 43 (81.1%) of them were men. Thirty-eight patients (66.6%) were in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile I or II. The study cohort was divided into the patients with RHF postoperatively (n = 20, 35.1%) and without RHF (n = 37, 64.9%). RESULTS Independent predictors for RHF were preoperative right ventricular ejection fraction

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of tricuspid valve repair using aortic cross-clamping versus using beating heart surgery. METHODS: A total of 208 patients (67 males, 141 females; mean age 61.5±9.2 years; range, 29 to 81 years) who underwent concomitant cardiac surgery and tricuspid valve repair between January 2007 and January 2016 at a single center were included. Two surgical strategies for tricuspid valve repair with aortic cross-clamping (n=102) or on beating heart (n=106) were compared. Primary endpoints were in-hospital mortality and the rate of permanent pacemaker placement after surgery. Secondary endpoints were cross-clamp and cardiopulmonary bypass times, postoperative inotropic support, temporary pacemaker requirement, and residual tricuspid regurgitation at discharge and at one year. RESULTS: Overall hospital mortality was 7% (n=14) (cross-clamping 7% vs. beating heart 7%; p>0.05). The mean cross-clamp and cardiopulmonary bypass times were significantly longer in the aortic cross-clamping group (p=0.0001). Also, a higher number of patients in this group needed inotropic support (78/102) than the beating heart group (57/106) (p2 tricuspid regurgitation was more commonly seen in the cross-clamping group (16% vs. 3%, respectively; p=0.0023). At one year of follow-up, residual >2 tricuspid regurgitation was present in 22 patients (23%) in the aortic crossclamping group and in eight patients (8%) in the beating heart group (p=0.0048). CONCLUSION: Tricuspid valve repair on beating heart offers less inotropic support and a lower rate of postoperative permanent pacemaker placement requirement and residual tricuspid regurgitation, although both techniques yield similar postoperative clinical outcomes. These results support the use of tricuspid valve repair on a beating heart in concomitant left-sided valvular heart surgery.

Objectives Sutureless aortic valve replacement (SU-AVR) is an alternative technique to standard aortic valve replacement. We evaluated our experience with the Perceval SU-AVR with concomitant mitral valve surgery, with or without tricuspid valve surgery, and aimed to discuss the technical considerations. Methods From January 2013 through June 2016, 30 patients with concomitant severe mitral valve disease, with or without tricuspid valve disease, underwent SU-AVR with the Perceval prosthesis in a single center. Results The mean age was 73.0 ± 6.6 years, ranging from 63 to 86 years, and 60% (n = 18) were male. Mean logistic EuroScore of the study cohort was 9.8 ± 4.6. Concomitant procedures consisted of mitral valve repair (n = 8, 26.6%), mitral valve replacement (n = 22, 73.3%), tricuspid valve repair (n = 18, 60%), tricuspid valve replacement (n = 2, 6.6%), and cryoablation for atrial fibrillation (n = 21, 70%). Median prosthesis size was 25 mm (large size). At 1 year, there were 2 deaths from noncardiac causes. One patient (3.3%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Three patients (10%) had intraoperative supra-annular malpositioning of the aortic prosthesis, which was safely removed and reimplanted in all cases. Mean follow-up was 18 ± 4.5 for months (maximum 3 years). During the postoperative period, sinus rhythm restoration rate in patients who underwent the cryo-maze procedure was 76.1% (n = 16) at discharge. There was no structural valve deterioration or migration of the prosthesis at follow-up. Conclusions Perceval SU-AVR is a technically feasible and safe procedure in patients with severe aortic stenosis with good results even in the presence of multivalvular disease and atrial fibrillation surgery.

We investigated the effects of naringin on small intestine, liver, kidney and lung recovery after ischemia/reperfusion (I/R) injury of the gut. Rats were divided randomly into four groups of eight. Group A was the sham control; group B was ischemic for 2 h; group C was ischemic for 2 h and re-perfused for 2 h (I/R); group D was treated with 50 mg/kg naringin after ischemia, then re-perfused for 2 h. Endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expressions were detected by immunolabeling. We also measured arginase activity, amounts of nitric oxide (NO) and total protein. iNOS was increased significantly in the small intestine, liver and kidney in group C. iNOS was decreased significantly only in small intestine and lung in group D. eNOS was increased significantly in the small intestine, liver and lung in group C. eNOS was decreased in small intestine, liver and lung in group D; however, eNOS was decreased in the kidney in group C and increased in the kidney in group D. The amount of NO was decreased significantly in all tissues in group D, but arginase activity was decreased in the small intestine and lung, increased in the kidney and remained unchanged in the liver in group D. The total protein increased in the small intestine and liver in group D, but decreased significantly in the kidney and lung in group D. Naringin had significant, salutary effects on the biochemical parameters of I/R by decreasing the NO level, equilibrating iNOS and eNOS expressions, and decreasing arginase activity.

Bu çalışmanın amacı, ciddi boş zaman faaliyeti olarak amatör futbol oynayan kişilerin rekreasyonel etkinlik beklentilerinin araştırılmasıdır. Aynı zamanda, araştırmaya katılım sağlayanların demografik özellikleri ile ciddi boş zaman düzeyleri arasında ilişki olup olmadığını tespit etmek amaçlanmıştır. Araştırma Ankara ili sınırları içerisinde bulunan Sincan, Keçiören, Altındağ ve Yenimahalle ilçelerinde amatör futbolculuk yapan 334 kişi üzerinde gerçekleştirilmiştir. Çalışmada Gould ve ark. (2008) tarafından geliştirilen `Measuring Serious Leisure` envanteri kullanılmıştır. Ölçeğin yapı geçerliliği ve uyum istatistikleri için AMOS programından faydanılmıştır. İstatistiki olarak, demografik verilerin yüzde ve frekansları tespit edilmiştir. Ayrıca Kayıtsız Boş Zaman Ölçeği'nin demografik verilere göre farklılaşıp farklılaşmadığının tespiti için t-test ve ANOVA,MANOVA analizlerine yer verilmiştir. Ayrıca değişkenler arası ilişkilerin belirlenmesinde korelasyon analizi kullanılmıştır. Verilerin değerlendirilmesinde SPSS for Windows 21 ve AMOS Paket programları kullanılmıştır. Anahtar Kelimeler: Ciddi Boş Zaman, Amatör Futbolcu, Rekreasyonel Etkinlik The aim of this study is to investigate the recreational activity expectations of amateur football players as a serious leisure activity. At the same time, it was aimed to determine whether there is a relationship between the demographic characteristics of the participants and the serious leisure time. The research is located in Ankara, Sincan, Kecioren. Altındağ and Yenimahalle districts of amateur football players were carried out on 334 people. In the study, `Measuring Serious Leisure` that developed by Gould et al. (2008) scale was used. The construct validity and fit statistics of the scale were used from the AMOS program. In addition, t-test and ANOVA,MANOVA analyzes were performed to determine whether the Serious Leisure Scale differs according to demographic data. SPSS for Windows 21 and AMOS package programs were used to evaluate the data.Key Words: Serious Leisure, Amateur Football Player, Recreational Activity 101

Bu filmde demans hastası Necla teyzenin bir günü canlandırılmıştır. Kocasını iki sene önce kaybeden Necla, hala onun yaşadığını zannederek hayatını sürdürür. Ölen kocasının son sözleri `Necla beni Üsküdar iskelede bekle` olmuştur. Necla hastalığının da vermiş olduğu yanılgıyla, her fırsatta iskeleye gitmek isteyeceği bir döngünün içine girmiştir. Duyarlı ve yardımsever bir genç olan Kadir, kız arkadaşıyla buluşmak üzere otobüs durağına giderken Necla teyzeyle karşılaşarak kendini bu döngünün içinde bulur. Yaşlı kadına yardım ederek iskeleye kadar eşlik eden Kadir sonunda onu şaşkına çevirecek bir sürprizle karşılaşır. İn this movie, one day of Necla, who has dementia, is portrayed. She lives her life supposing her husband is still alive although he passed away two years ago. Her husband's last words were `Necla, wait me at Üsküdar Pier.` Since she is in a delusional state of mind, she gets into a kind of vicious cycle and goes to the pier constantly. One day, Kadir, who is a sensitive and helpful young man, comes across with Necla when he is on the road to meet his girlfriend at the bus stop. And he finds himself in this cycle. He accompanies Necla in order to help her, and in the end, he encounters a surprise which astonishes him very much. 39

We report a case of 53-year-old woman with the parathyroid adenoma (PA) located in the aortopulmonary window with an aberrant right subclavian artery. Her preoperative calcium level was 11.3 mg/dL (reference range = 8.8–10.6 mg/dL). The parathyroid hormone level was significantly elevated at 127.4 pg/mL (reference range = 12–88 pg/mL) as measured on immunoradiometric assay. Dual-phase technetium-99m–labeled sestamibi parathyroid scintigraphy and fluorine-18 18F-fluorocholine positron emission tomography/computed tomography revealed a mediastinal tumor measuring 3 × 5 × 6 mm located anterolateral to the aortopulmonary window. Minimally invasive removal of PA was performed through 3.5-cm reverse J-shaped partial upper sternotomy to the third intercostal space. Postoperative recovery was uneventful, and serum calcium and parathyroid hormone levels normalized within 24 hours of surgery. Our case represents the rare occurrence of a mediastinal PA associated with aberrant right subclavian artery treated with targeted minimally invasive approach using different imaging modalities including technetium-99m–sestamibi scintigraphy and fluorine-18 18F-fluorocholine positron emission tomography/computed tomography, and intraoperative use of gamma probe for precise localization PA.

Background The aim of this study was to investigate lead endocarditis-related tricuspid valve regurgitation, to identify underlying causes, and to report our surgical approaches to tricuspid valve endocarditis. Methods Between March 2010 and August 2016, medical records of a total of 43 patients (23 males, 20 females; mean age: 63.2±13.6 years; range 48 to 72 years) who underwent tricuspid valve surgery for severe tricuspid regurgitation caused by lead endocarditis, which was previously placed as an implantable cardiac electronic device were reviewed. We removed all systems including infected leads and generators, revised infected wounds and tissues, performed tricuspid valve surgery for lead endocarditis, and applied long-term intravenous antibiotic regimen for the culprit agent, as confirmed by the culture. Results Of 43 patients, 18 underwent tricuspid valve repair and 25 underwent tricuspid valve replacement for lead endocarditisrelated severe tricuspid valve regurgitation. During followup (range, 2 to 62 months), two patients required temporary mechanical support due to postoperative acute right heart failure, while eight patients died due to sepsis (n=6; 14%) and stroke (n=2; 4.6%) in the early postoperative period. The remaining patients showed significant improvement in signs and symptoms of heart failure. Conclusion Our study results suggest that incompetent experience and inaccurate decision for valve repair may result in delayed valve replacement and prolonged operation time.

Zn2+-homoeostasis including free Zn2+ ({[}Zn2+](i)) is regulated through Zn2+-transporters and their comprehensive understanding may be important due to their contributions to cardiac dysfunction. Herein, we aimed to examine a possible role of Zn2+-transporters in the development of heart failure (HF) via induction of ER stress. We first showed localizations of ZIP8, ZIP14 and ZnT8 to both sarcolemma and S(E)R in ventricular cardiomyocytes (H9c2 cells) using confocal together with calculated Pearson's coefficients. The expressions of ZIP14 and ZnT8 were significantly increased with decreased ZIP8 level in HF. Moreover, {[}Zn2+](i) was significantly high in doxorubicin-treated H9c2 cells compared to their controls. We found elevated levels of ER stress markers, GRP78 and CHOP/Gadd153, confirming the existence of ER stress. Furthermore, we measured markedly increased total PKC and PKC alpha expression and PKC alpha-phosphorylation in HF. A PKC inhibition induced significant decrease in expressions of these ER stress markers compared to controls. Interestingly, direct increase in {[}Zn2+](i) using zinc-ionophore induced significant increase in these markers. On the other hand, when we induced ER stress directly with tunicamycin, we could not observe any effect on expression levels of these Zn2+ transporters. Additionally, increased {[}Zn2+](i) could induce marked activation of PKC alpha. Moreover, we observed marked decrease in {[}Zn2+](i) under PKC inhibition in H9c2 cells. Overall, our present data suggest possible role of Zn2+ transporters on an intersection pathway with increased {[}Zn2+](i) and PKC alpha activation and induction of HF, most probably via development of ER stress. Therefore, our present data provide novel information how a well-controlled {[}Zn2+](i) via Zn2+ transporters and PKC alpha can be important therapeutic approach in prevention/treatment of HF.

Objective: The management of childhood thyroid nodules is still a big challenge for clinicians. In this study, we aimed to present our surgical and endocrinological experience in more than one hundred pediatric cases. Methods: A retrospective analysis of patients admitted with a thyroid nodule between 2006 and 2014 was performed. Detailed ultrasonography and fine-needle aspiration biopsy (FNAB) were the cornerstones of the diagnostic approach. Results: One hundred-three children (72 female, 31 male) with a mean age of 13.1±3.6 years (3-18 years) were admitted to our center. Management strategy was surgery in 58 patients and follow-up in 45 patients. Mean nodule size was 17±12.7 mm (2-45 mm). The diagnoses were listed as benign solitary nodule (48 patients), thyroid carcinoma (26 patients), multinodular goiter (23 patients), Hashimoto thyroiditis (4 patients), and Graves’ disease (2 patients). Surgical procedures were nodulectomy/lobectomy (32 patients), total thyroidectomy (TT) (13 patients), or TT+ neck dissection (13 patients). The rate of malignancy was 25% in the total group and 44% in the surgery group. The malignancy rate was higher in patients younger than 12 years compared to older children (41% vs. 17%, p=0.040). Metastasis was seen in 38% of the malignant nodules. Postoperative complications were transient hypocalcemia (8%), permanent hypocalcemia (1.7%), and unilateral vocal cord paralysis (1.7%). Recurrence or mortality was not encountered in the 5.4±1.2-year follow-up period. Conclusion: Thyroid nodule in a child requires an aggressive diagnostic approach due to increased risk of malignancy and metastasis. Intraoperative frozen section examination must be done as a useful adjunct to determine the surgical strategy. Incidence of complications is small in thyroid surgery when performed by experienced surgeons.

Objectives: This study was designed to compare vascular complications and the outcomes of ultrasound (US)-guided percutaneous cannulation with distal perfusion catheter (PC-DP) and arterial side-graft perfusion (SGP) techniques in patients who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock (RCS). Methods: We conducted a retrospective, observational cohort study of consequtive patients with RCS treated with VA-ECMO at a single transplant center from March 2010 until August 2015. Overall, 148 patients underwent VA-ECMO for RCS (99 men, aged 56.6 ± 12.0 years; BSA, 1.85 ± 0.19). Patients were categorized based on VA-ECMO perfusion technique into PC-DP via femoral artery and SGP via axillary/femoral artery groups. Results: The median duration of VA-ECMO support was 5 days (range, 8 hours–80 days). Hospital mortality (PC-DP group, 54.7%; SGP group, 64.4%; p=0.23) and overall ECMO survival (PC-DP group, 36.9%; SGP group, 32.2%; p=0.47) was similar between the groups. There were no significant between-group differences in the rate of acute limb ischemia (PC-DP group, 4/75, 5.3%; SGP group, 2/73, 2.7%; p=0.68). However, the rate of surgical/cannulation site bleeding (PC-DP, 9/75 (12%) vs SGP, 18/73 (24.7%), p=0.05) and hyperperfusion syndrome (PC-DP, 2/75 (2.7%) vs SGP, 22/73 (30.1%),p=0.001) were higher in the SGP group than in the PC-DP group. Conclusions: We observed no significant difference in major vascular complications or survival between patients who underwent the PC-DP technique and those who underwent arterial SGP.

Background: Many of the previous studies on tricuspid valve surgery were on the materials that were used and the advantages and disadvantages of them. In this study, effects of preoperative tricuspid valve diameter on early postoperative outcomes were investigated. Methods: A total of 43 patients who underwent tricuspid valve repair surgery with the ring between the years 2012-2014 were included in this study. Tricuspid valve diameters and other cardiac functions of patients undergoing tricuspid intervention were evaluated with transthoracic echocardiography.Patients included in this study were divided into 2 groups: those with minimal, minimal-to-1st degree and 1st-degree tricuspid valve regurgitation found on thoracic echocardiography in the early postoperative period were considered as having a successful tricuspid repair (Group 1). Those with 1st-2nd degree and higher degrees of tricuspid regurgitation were considered as having an unsuccessful tricuspid repair (Group 2).The relationship between tricuspid valve dimensions and early tricuspid valve regurgitation was assessed with the help of preoperative, intraoperative, and postoperative data.Results: Thirty patients (Group 1) were found to have a successful tricuspid valve repair in the postoperative period. The mean annulus diameter of the tricuspid valve at end-diastole in patients from Group 1 was similar to Group 2 (4.24 ± 0.44 cm versus 3.99 ± 0.40; P = .080). Also, tricuspid valve end-systolic diameter in Group 1 was similar to patients in Group 2 (3.59 ± 0.38 cm versus 3.42 ± 0.33 cm; P = .151). Conclusion: A direct relationship was not found between tricuspid valve diameter and post-operative development of moderate to severe regurgitation in tricuspid valve surgery in this study.

Objectives Patients on venoarterial or venovenous extracorporeal membrane oxygenation (ECMO) support may require venoarterial-venous (VAV-ECMO) configuration during follow-up. We report 12 cases of VAV-ECMO with significant outflow steal. Methods Between October 2014 and November 2016, a total of 97 patients (56.6 ± 12.0 years; 59 men/38 women; body surface area 1.84 ± 0.36 m2) were supported with venoarterial ECMO (n = 85) or venovenous ECMO (n = 12). Among the 97 patients, 12 patients (age 61.5 ± 3.5 years; 8 men/4 women; body surface area 1.8 ± 0.8 m2) required hybrid use of VAV-ECMO. Control and monitoring of flow ratios in supplying cannulae using flow sensors were performed, and occluder devices were used according to patient requirements to achieve optimum haemodynamics and oxygenation. Results Among the 85 venoarterial ECMO-supported patients, Harlequin syndrome was detected in 9 cases (10.6%) who required switching to VAV-ECMO. Among the 12 patients, 3 (25%) patients required VAV-ECMO while on venovenous ECMO support as a result of initial respiratory failure subsequently developed cardiac decompensation. Mean duration of VAV-ECMO support was 6.4 ± 1.8 days. Overall, on VAV-ECMO support, 70.0 ± 4.6% of blood flow was detected within the supplying right internal jugular vein cannula as a result of lower afterload in venous system. We partially occluded the internal jugular vein cannula and directed flow to the common femoral artery. After adjustment, 34.3 ± 7.4% flow was directed to internal jugular vein and 65.6 ± 7.4% to common femoral artery. Conclusions Non-invasive monitoring of flow rates within the supplying cannulae of VAV-ECMO and the use of partial occlusion for venous-supplying cannula enable individualized patient management and effective weaning from VAV-ECMO.

Objective To investigate the effect of desferrioxamine (DFX) on ipsilateral and contralateral testis damage caused by experimental testis torsion and detorsion. Materials and methods Forty rats were divided into five groups (n = 8): control, torsion (T), torsion + desferrioxamine (T + DFX), torsion/detorsion (T/D), and torsion/detorsion + desferrioxamine (T/D + DFX). The right testes of the rats were subjected to torsion and detorsion for 3 h each. Thirty minutes before the application of torsion and detorsion, DFX (100 mg/kg) was administered intramuscularly. Blood samples and testicular tissues were examined using specific biochemical and histopathological methods. Results Ipsilateral and contralateral testis tissue glutathione levels in the T group decreased compared with the control and T + DFX groups. Plasma glutathione peroxidase activity in the T, T/D, and T/D + DFX groups was lower than in the control group. Plasma catalase activity in the T and T/D groups decreased compared with the control group. Ipsilateral mean seminiferous tubule diameter of the T group was lower than that of the T + DFX group. The ipsilateral mean testis biopsy scores in the T and T/D groups were lower than in the control group. Conclusion The administration of DFX prior to torsion may be useful only for preventing ischemic damage in ipsilateral and contralateral testes.

Malignant hyperthermia (MH) is a rare and potentially life threatening fatal complication of anaesthesia. We present a 2-year-old boy with late onset MH after colon interposition to replace the oesophagus under sevoflurane anaesthesia. The patient was treated with intravenous dantrolene sodium as well as cooling and controlled ventilation. Despite treatment, the patient developed cardiopulmonary arrest at 21 hours after the operation and died. It should be kept in mind that post-operative MH may develop during these types of operations with ischaemia-reperfusion injuries.

The aim of this study was to evaluate the role of vitamin E in follicular degeneration and to assess histopathological and biochemical changes following ischemia-reperfusion (IR) injury in rat ovaries. Twenty-eight Wistar albino rats were randomly divided into four groups: sham, 4. h torsion, 24. h detorsion, and a vitamin E group. Thirty minutes before detorsion, a single dose of 200. mg/kg vitamin E was administered intraperitoneally. The ovarian histology score was determined, serum levels of malondialdehyde (MDA) and myeloperoxidase (MPO) were measured. The apoptosis of granulosa cells and the phospho-c-jun N-terminal kinase (p-JNK) and phospho-p38 (p-p38) immunoreactivities of these cells were determined. MDA and MPO levels were significantly increased in the torsion and detorsion groups. Hemorrhage, edema, and congestion were also apparent in these groups. In addition, the apoptotic index and the immunoreactivity of p-JNK were highest in the detorsion group, which also showed marked follicular degeneration. However, p-p38 activity was not affected by torsion-detorsion (TD) induction. Vitamin E ameliorated TD-induced histological alterations. It also decreased serum levels of MDA and MPO, reduced the activity of p-JNK in the ovaries, and reduced numbers of apoptotic follicular cells. In conclusion, these data indicate that vitamin E attenuated ovarian follicular degeneration by inhibiting the immunoreactivity of p-JNK and reducing the apoptosis of granulosa cells. © 2013 Elsevier Inc., 2011-121, The authors acknowledge Trakya University Research Center, Edirne, Turkey for the financial support (project no: 2011-121 ).

Background This study evaluated the protective effect of sildenafil on liver injury induced by intestinal ischemia-reperfusion. Methods Forty female Sprague Dawley rats were divided into 4 groups: sham-control (SC), ischemia (I), ischemia-reperfusion (IR), and ischemia-reperfusion + sildenafil (SIL; sildenafil gavaged at 50 mg/kg before operating). A 2-h ischemia-reperfusion was performed by clamping the superior mesenteric artery. Liver function, plasma alanine (ALT) and aspartate (AST) aminotransferase, and intestinal and liver malondialdehyde (MDA) were measured at the end of the experiment. Intestinal and liver tissue damage was examined by histology. Liver samples were immunologically stained for endothelial nitric oxide synthase (eNOS) and proliferating cell nuclear antigen (PCNA). Results The ALT and AST levels were highest in the IR group and were lower in the SIL group (p < 0.05). Intestinal MDA levels were statistically higher in the IR group than in the SC, I and SIL groups. Liver MDA levels were significantly higher in the IR group than in the I and SC groups (p < 0.05) and higher than in the SIL group (p > 0.05). Intestinal damage based on Chiu scoring was more severe in the IR than in the SIL group (p < 0.05). Sildenafil reduced damage and also increased eNOS and PCNA immunoreactivity in liver tissue. Conclusions Sildenafil shows a protective effect on intestinal ischemia-reperfusion-induced liver injury, possibly by decreasing vascular resistance through increased nitric oxide levels. © 2013 Elsevier Inc.

BACKGROUND This study aims to evaluate the efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of upper extremity deep vein thrombosis (UEDVT). METHODS We conducted a prospective, observational cohort study of consecutive patients with acute UEDVT with low-dose UACDT using the Ekosonic® Endovascular System (EKOS Corporation, Bothell, WA, USA) at a single center from September 2012 until October 2014. Overall, sixteen patients (11 males and 6 females, age range 18 to 70 years, mean age, 45.6 years) were included in the study protocol. The primary efficacy outcome was complete thrombus clearance. The primary safety outcomes were recurrence of thrombosis within the follow-up visit and major bleeding within 96 hours of the procedure initiation. RESULTS The median tissue plasminogen activator (tPA) dose for all patients in our study was 16.81±2.51 mg (range 15 to 28 mg) and the median infusion time was 15 hours. Complete thrombus clearance was achieved in 11 (68.8%) patients, and partial clearance was detected in 3 (18.8%) patients. Of 16 patients with UEDVT, two had gastrointestinal bleeding, and two had puncture site bleeding. CONCLUSIONS This prospective study demonstrates effectiveness and safety of ultrasound accelerated thrombolysis in patients with UEDVT.

Poplitealarter tuzak sendromu genellikle genç erkeklerde görülen, popliteal arteringastroknemius kas ve çevresindeki fibröz doku ile normal komşuluğu sonucundaortaya çıkan nadir bir hastalıktır. Bu yazımızda, ileri yaşta bir erkek hastadapopliteal arter tuzak sendromuna bağlı gelişen tromboze popliteal arteranevrizma olgusuna yaklaşımımızı sunmayı amaçladık., Poplitealartery entrapment syndrome (PAES) is a rare disease among young malescharacterised by the abnormal relationship between PA and the bundles of thegastrocnemius muscle and surrounding fibrous structures. In this case report,we aim to present our approach to a thrombosed PA aneurysm due to PAES in anold man.

Background: Mesenchymal stemcells (MSCs) may have beneficial effects in reversing intestinal damage resulting fromcirculatory disorders. The hypothesis of this study is thatMSCs increase antioxidant capacity of small bowel tissue following intestinal ischemia reperfusion (I/R) damage. Methods: A total of 100 rats were used for the control group and three experimental groups, as follows: the sham control, local MSC, and systemic MSC groups. Each group consisted of 10 animals on days 1, 4, and 7 of the experiment. Ischemiawas established by clamping the superior mesenteric artery (SMA) for 45min; following this, reperfusion was carried out for 1, 4, and 7 days in all groups. In the local and systemic groups, MSCs were administered intravenously and locally just after the ischemia, and they were investigated after 1, 4, and 7 days. The superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (Gpx) activities, as well as malondialdehyde (MDA) and total protein levels, were measured. Histopathological analysis was performed using light and electron microscopy. The indicators of proliferation from the effects of anti-and pro-inflammatory cytokines were evaluated using immunohistochemistry. Results: MDA was increased (P < 0.05) in the sham control group and decreased (P < 0.05) in the MSC groups. SOD, CAT, and Gpx were decreased in the localMSC group (P < 0.05). The highest level of amelioration was observed on day 7 in the local MSC group via light and electron microscopy. It was found that the MSCs arrived at the damaged intestinal wall in the MSC groups immediately after injection. Pro-inflammatory cytokines interleukin-1 beta(IL1 beta), transforming growth factor-beta 1 (TGF beta 1), tumor necrosis factor-alpha (TNF alpha), IL6, MIP2, and MPO decreased (P < 0.05), while anti-inflammatory cytokines EP3 and IL1ra increased (p < 0.05) in the local and systemic MSC groups. In addition, proliferation indicators, such as PCNA and KI67, increased (P < 0.05) in the local and systemic MSC groups. Conclusions: Parallel to our hypothesis, MSC increases the antioxidant capacity of small bowel tissue after intestinal I/R damage. The MSCs migrated to the reperfused small intestine by homing and reduced oxidative stress via the effects of SOD, CAT, and Gpx, as well as reducing the MDA level; thus, they could increase antioxidant capacity of intestine and have a therapeutic effect on the damaged tissue. We think that this effectwas achieved via scavenging of oxygen radicals, suppression of pro-inflammatory cytokines, and increasing the expression of anti-inflammatory cytokines. (C) 2017 Elsevier Inc. All rights reserved. Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [112S124] The authorswould like to thank the Scientific and Technological Research Council of Turkey (TUBITAK), as this project was supported by grants from this institution (no. 112S124). The authors would also like to thank the staff of KOGEM, Kocaeli, Turkey, for their support in the isolation, characterization, identification, and monitoring of MSCs, as well as the preparation of histological sections; the Electron Microscope Laboratory of Osmangazi University, Eskisehir, Turkey, for preparation of electron microscopic sections; and the Experimental Animal Breeding and Research Unit of Trakya University, Edirne, Turkey for the care and preparation of rats for the experimental surgical procedure. WOS:000405362500025 28118930 Q2

Giriş: Bu çalışmanın amacı miyokard koruma yöntemlerinden topikal hipoterminin postoperatif solunumsal fonksiyonlarına etkisini değerlendirmektir. Materyal Metod: Hastalar 2 gruba ayrıldı: Grup A’da (n=258) topikal hipotermi olmaksızın miyokard koruması uygulanan hastalar bulunurken, Grup B’de (n=473) topikal hipotermi uygulanan hastalar mevcuttu. Topikal hipotermi kardiyopleji verilmesi esnasında epikardiyal olarak tekrarlandı. Hastaların postoperatif entübe kalış süreleri, reentübasyon sayısı, yoğun bakım ve hastanede kalış süreleri, morbidite ve mortalite ve diğer klinik bulgular retrospektif olarak değerlendirildi. Sonuçlar: Her iki grubun demografik dataları benzerdi. Ortalama entübasyon süresi her iki grup arasında istatistiksel olarak anlamlı değildi (6.8±3.1 saat Grup A, 7.4±2.8 saat Grup B, p>0.05). Ortalama yoğun bakım kalış ve hastane kalış süreleri kıyaslandığında her iki grup arasında belirgin bir fark bulunmamaktaydı (p>0.05). Mortalite oranları gruplar arasında benzerdi ve hiçbiri solunum problemlerine bağlı değildi. Solunum yetmezliği sebebiyle Grup A’da 10 hasta reentübe edilirken Grup B’de 18 hasta reentübe edildi ve istatistiksel olarak gruplar arasında anlamlı bir fark bulunmadı (p>0.05). Tartışma: Kalp cerrahisinde topikal hipoterminin yararı oluşabilecek muhtemel komplikasyonlara rağmen halen kabul edilebilir düzeydedir. Bununla birlikte, hastanın preoperative durumunun de- ğerlendirilerek cerrahi için uygun miyokard koruma metoduna karar vermek akılcı olacaktır.

OBJECTIVE: Brucellosis is frequently seen in Mediterranean and Middle East countries, including Turkey. We report the medical and surgical management of 31 cases of native endocarditis. MATERIAL AND METHOD: Thirty‐one patients were admitted to our clinic with suspected Brucella Endocarditis. The diagnosis was established by either isolation of Brucella species, or the presence of antibodies. Following preoperative antibiotic therapy patients underwent valve replacement with excessive tissue debridment. Patients were followed up with Brucella titers, blood cultures, and echocardiography. RESULTS: On admission all patients were febrile and mostly dyspneic (NYHA Class 3 or 4). The blood tests were normal except for elevated ESR, CRP and serological tests. The aortic valve was involved in 19 patients, mitral valve in 7 patients, and both valves in 5. After serological confirmation of BE, antibiotic therapy was maintained. Twenty‐five of the patients received rifampicine, doxycycline, and cotrimaxozole; 2 of them received a combination of rifampicine, streptomycin, and doxycycline; and 4 of them received rifampicine, tetracycline, and cotrimaxozole. Tissue loss in most of the affected leaflets and vegetations were presenting all patients. Valve replacements were performed with mechanical and biologic prostheses. All the patients were afebrile at discharge but received the antibiotics for 101, 2±16, 9 days. The follow‐up was 37, 1±9, 2 months. DISCUSSION: In our retrospective study, combination of adequate medical and surgical therapy resulted in declined morbidity and mortality rate. The valve replacement with aggressive debridement is the most important part of the treatment, which should be supported with efficient preoperative and long term postoperative medical treatment. Copyright © 2010 Wiley Periodicals, Inc.

Constipation is a common problem in children. However, there is much controversy surrounding the etiology, diagnosis and treatment of functional constipation observed in childhood. Despite the high frequency of this problem documented in the literature, there is little research that assesses the direct relationship between the food consumed and the eventual stool consistency. Breastfeeding is an excellent way to prevent constipation in infants and toddlers, as is fruit and vegetable consumption in older children. The aim of this review is to investigate available tools in the literature concerning constipation in children and to discuss the relationship between constipation and diet in childhood.