Evaluation of heart rate recovery index in heavy smokers

I read the article entitled “Evaluation of heart rate recovery index in heavy smokers” by Erat et al. (1), which has been recently published in Anatolian Journal of Cardiology 2016; 16: 667-72, with great interest. The authors have successfully manifested a statistically significant relationship between smoking and the heart rate recovery index (HRRI) even though the study population was small in number. HRRI, which is indicator of the autonomic nervous system (ANS), is not routinely evaluated in daily clinical practice even though it is an independent risk factor for cardiovascular (CV) diseases. Several studies have shown that HRRI plays an important role in all-cause mortality and CV events (2, 3). The authors have done a good job by investigating the relationship between HRRI and smoking because the potential harmful effects of smoking on the autonomic nervous system apart from those on the vascular biology needed to be proved. HRRI calculation is a simple and beneficial way to evaluate autonomic nervous system function. Therefore, this trial will help us understand the harmful effects of smoking on ANS using HRRI. To our knowledge, HRRI is calculated by extracting the heart rate during the 1st, 2nd, 3rd, and 5th minutes after finalizing the test from the patient’s maximum heart rate during exercise. However, the authors have described HRRI in the “Introduction” section as being calculated by extracting the maximum heart rate from the heart rate in the 1st, 2nd, 3rd, and 5th minutes in the post-exercise period. In case of this type calculation, the study results will change, and it will forward us wrongly. I wonder if it was miswritten or miscalculated in this article. I wanted to emphasize on the importance of right usage of medical formulas.

Serum nitric oxide level in patients with coronary artery ectasia

We read the article entitled ”Serum nitric oxide levels in patients with coronary artery ectasia” written by Gürlek et al. (1) and published in Anatol J Cardiol 2016;16:947-52 with great interest. Though prevalence of coronary artery ectasia (CAE) has increased with use of advanced imaging techniques in cardiology practice, the main etiological factor and mechanism is still uncertain. While atherosclerosis is the main etiological factor in adults, Kawasaki disease is the most common cause in children and young adults. Many trials have been performed, both prospectively and retrospectively, to understand the underlying mechanism and related conditions of CAE. Prospective studies are always more valuable and significant. Prospective study is a longitudinal study that follows over time a group of similar individuals who differ with respect to certain factors under study to determine how these factors affect rates of a certain outcome (2). In prospective studies, results are collected at regular time intervals moving forward, so recall error is minimized. In retrospective studies, selection and information bias can negatively impact the veracity of the study (3). In this trial, the authors stated in the methods section that it was designed as a prospective protocol. But in the second paragraph, they explained that they had evaluated the coronary angiograms (CA) and selected patients retrospectively. We think this discrepancy will create questions for readers. If serum nitric oxide (NO) level detection was done long after CA, the results of the study will be affected, since risk factors for coronary artery disease (CAD) such as diabetes mellitus, hypertension, and smoking alone may increase NO levels in CAE patients. In addition, CAE, which is attributed to atherosclerosis in 50% of cases (4), may progress to CAD over time, and CAD can also increase NO level. Follow-up angiograms are needed to demonstrate absence of CAD in both groups, and most particularly in CAE patients. Authors should explain if blood samples were taken just after CA or later. In either case, this trial can be accepted as a cross-sectional study but not a prospective study. A second issue is control group selection. We wonder if they were selected consecutively, like the CAE patients, or randomly assigned. If the authors would share the power analysis status with us it would be valuable and informative for readers. Meanwhile, we are grateful to the authors. They performed a great study that helps to clarify an uncertain issue.

P2Y12 inhibition after thrombotic thrombocytopenic purpura remission

Impact of early (3 months) dual antiplatelet treatment interruption prior to renal transplantation in patients with second-generation DES on perioperative stent thrombosis and MACEs

Early cessation of dual antiplatelet therapy (DAPT) is related to stent thrombosis (ST). The use of second-generation everolimus- and zotarolimus-eluting stents is associated with low restenosis rates and short duration of clopidogrel usage. Non-cardiac surgery in recently stent-implanted patients is associated with major adverse cardiac events (MACEs). Chronic renal failure patients awaiting renal transplantation may also undergo coronary stent implantation prior to surgery. Here we aimed to investigate the safety of early (3 months) DAPT interruption in second-generation drug-eluting stent (DES)-implanted renal transplant recipients.

The Association Between Aspirin Resistance and Extend and Severity of the Coronary Atherosclerosis

Uncontrolled inflammatory responses could contribute to the pathogenesis of many leading causes of human morbidity and mortality. Aspirin is an anti-inflammatory and antithrombotic drug that is used in the primary and secondary protection in atherothrombotic diseases and complications. The aim of the present study was to analyze the effect of aspirin resistance on the extent and severity of atherosclerosis.

Echocardiographic Epicardial Fat Thickness Measurement: A new Screening Test for Subclinic Atherosclerosis in Patients With Inflammatory Bowel Diseases

Inflammatory bowel diseases (IBD) consist of a number of chronic inflammatory diseases. Inflammatory process is known to be involved in all stages of atherosclerosis. Early atherosclerosis is reflected by increased levels of carotid artery intima media thickness (c-IMT) and high-sensitivity C-reactive protein (hs-CRP). Epicardial fat thickness (EFT) strongly influences both the formation and progression of atherosclerosis. Recent studies have demonstrated a relationship between c-IMT and hs-CRP levels and the risk of atherosclerosis in patients with IBD. However, no study has yet compared EFT between patients with IBD and the general healthy population. Hence, this study was designed to further evaluate whether patients with IBD have higher EFT values with increased c-IMT and hs-CRP levels compared to those in the healthy population.

Bir özgürleşme sorunsalı olarak politik iktisadın eleştirisi

Interval-Valued Intuitionistic Fuzzy Confidence Intervals

Confidence intervals are useful tools for statistical decision-making purposes. In case of incomplete and vague data, fuzzy confidence intervals can be used for decision making under uncertainty. In this paper, we develop interval-valued intuitionistic fuzzy (IVIF) confidence intervals for population mean, population proportion, differences in means of two populations, and differences in proportions of two populations. The developed IVIF intervals can be used in cases of both finite and infinite population sizes. The developed fuzzy confidence intervals are equivalent decision-making tools to fuzzy hypothesis tests. We apply the proposed confidence intervals to the differences in the mean lives and failure proportions of two types of radiators used in automobiles, and a sensitivity analysis is given to check the robustness of the decisions.

Fundamentals and applications of SERS‐based bioanalytical sensing

Abstract Plasmonics is an emerging field that examines the interaction between light and metallic nanostructures at the metal‐dielectric interface. Surface‐enhanced Raman scattering (SERS) is a powerful analytical technique that uses plasmonics to obtain detailed chemical information of molecules or molecular assemblies adsorbed or attached to nanostructured metallic surfaces. For bioanalytical applications, these surfaces are engineered to optimize for high enhancement factors and molecular specificity. In this review we focus on the fabrication of SERS substrates and their use for bioanalytical applications. We review the fundamental mechanisms of SERS and parameters governing SERS enhancement. We also discuss developments in the field of novel SERS substrates. This includes the use of different materials, sizes, shapes, and architectures to achieve high sensitivity and specificity as well as tunability or flexibility. Different fundamental approaches are discussed, such as label‐free and functional assays. In addition, we highlight recent relevant advances for bioanalytical SERS applied to small molecules, proteins, DNA, and biologically relevant nanoparticles. Subsequently, we discuss the importance of data analysis and signal detection schemes to achieve smaller instruments with low cost for SERS‐based point‐of‐care technology developments. Finally, we review the main advantages and challenges of SERS‐based biosensing and provide a brief outlook.

The neutrophil-to-lymphocyte ratio as a diagnostic marker for malignant thyroid diseases

Background: The neutrophil-lymphocyte ratio (NLR) is a good marker of malignant diseases. The aim of this study was to investigate NLR as a diagnostic marker of thyroid cancer in patients with malignant thyroid diseases compared to those with benign thyroid diseases. Methods: Two hundred and fifty three patients were divided into two groups: benign and malignant thyroid disease patients. Malignant thyroid disease group was not sub-grouped further into differentiated and undifferentiated. The preoperative complete blood count and biochemical parameters, including NLR, were evaluated. Results: The mean neutrophil count was found to be significantly higher, whereas the mean lymphocyte count was found to be significantly lower in the malignant group which includes 40 of the patients. As a result, NLR was significantly higher in the malignant group than in the benign group (p<0.001). Conclusion: This is the first study to show the value of NLR as a marker for malignant thyroid diseases including all subtypes.