31 research outputs found
Perioperative outcome of left atrial appendage amputation in coronary artery bypass grafting.
No full textGercek M, Skuljevic T, Borgermann J, Gummert J, Gercek M. Perioperative outcome of left atrial appendage amputation in coronary artery bypass grafting. Clinical research in cardiology : official journal of the German Cardiac Society. 2024.BACKGROUND: Left atrial appendage (LAA) amputation performed alongside cardiac surgery has become an increasingly established procedure to reduce stroke risk in patients with atrial fibrillation. As the recommendation levels for LAA amputation continue to rise, ample evidence assessing its perioperative safety and risk factors is of utmost interest.; METHODS: All patients who underwent isolated coronary artery bypass grafting (CABG) between 2018 and 2021 at two high-volume centers were retrospectively included in the study. Patients were divided into two groups-the CABG and CABG+LAA groups-based on whether they underwent concomitant LAA amputation. Propensity score matching (PS matching) was applied to ensure comparability between the groups. The primary endpoint was defined as a composite outcome comprising of all-cause mortality, stroke, and reoperation. Secondary endpoints included the components of the primary endpoint, perioperative outcome parameters, transfusion rates, and laboratory parameters.; RESULTS: A total of 3904 patients were included with 3038 and 866 in the CABG and CABG+LAA group, respectively. After PS matching each group consisted of 856 patients. The primary endpoint showed no significant differences between the CABG and CABG+LAA group (7.0% vs. 6.5% (OR 0.9 95% CI [0.64; 1.35], p=0.70)). Similarly, there were no notable differences in the individual components of the composite endpoint: all-cause mortality (p=0.84), stroke (p=0.74), and reoperation (p=0.50). Subgroup results did not show any relevant dissimilarity.; CONCLUSION: The concomitant performance of LAA amputation is not associated with worse in-hospital outcomes, as measured by the composite endpoint of all-cause mortality, stroke, and reoperation. © 2024. The Author(s)
Exercise testing in patients with tricuspid regurgitation undergoing transcatheter tricuspid valve intervention
No full textGercek M, Ivannikova M, Goncharov A, et al. Exercise testing in patients with tricuspid regurgitation undergoing transcatheter tricuspid valve intervention. Clinical Research in Cardiology. 2024.BACKGROUND: Transcatheter tricuspid valve intervention (TTVI) has shown promising results with persistent reduction of tricuspid regurgitation (TR) and improvements in functional class and quality of life (QOL).; OBJECTIVES: To analyze the impact of TTVI on maximal and submaximal exercise capacity (SEC).; METHODS: Constant work-rate exercise-time (CWRET) testing reflects SEC, which is more likely to be relevant for daily life activities and provides more differentiated physiological insight into the nature of exercise intolerance. Thus, 30 patients undergoing TTVI (21 direct annuloplasty and 9 edge-to-edge repair) received cardiopulmonary exercise testing (CPET) and CWRET (at 75% of maximum work rate in the initial CPET) before and 3months after TTVI.; RESULTS: Patients' age was 80.5 [74.8-82.3] years and 53.3% were female. TR reduction≥2 grades was achieved in 93.3% (TR grade≤moderate in 83.3%). Echocardiography revealed improved right ventricular (RV) characteristics with decreased RV basal diameter (47.0mm [43.0-54.3] vs. 41.5mm [36.8-48.0]; p<0.001) and decreased inferior caval vein diameter. CWRET testing showed a significantly improved SEC (246.5s [153.8-416.8] vs. 338.5s [238.8-611.8] p=0.001). Maximum oxygen uptake showed a positive trend without statistically significant differences (9.9ml/min/kg [8.6-12.4] vs. 11.7ml/min/kg [9.7-13.3]; p=0.31). In contrast to the six-minute-walking distance (6MWD), SEC correlated moderately with effective regurgitation orifice area reduction (r=0.385; p=0.036), increased cardiac output (r=0.378; p=0.039), and improved QOL (r=387; p=0.035).; CONCLUSION: Improvements in exercise capacity after TTVI mainly occur in the submaximal rather than in the maximal exercise range and correlate with hemodynamic effects and QOL. This may have a methodological impact on assessment of exercise capacity in these patients. © 2024. The Author(s)
Can skin islands of free muscle flaps be used as pedicled perforator flaps years after free flap transfer?
No full textNumerical solution of a two dimensional elliptic-parabolic equation with Dirichlet-Neumann condition
No full textIn the present paper, a two dimensional elliptic-parabolic equation with Dirichlet-Neumann boundary condition is studied. The first and second order of accuracy difference schemes for the numerical solution of this problem are presented. Illustrative numerical results of these difference schemes are provided by using a procedure of modified Gauss elimination method. © 2018 Author(s)
Numerical solution of a two dimensional elliptic-parabolic equation with Dirichlet-Neumann condition
No full textIn the present paper, a two dimensional elliptic-parabolic equation with Dirichlet-Neumann boundary condition is studied. The first and second order of accuracy difference schemes for the numerical solution of this problem are presented. Illustrative numerical results of these difference schemes are provided by using a procedure of modified Gauss elimination method. © 2018 Author(s)
The effects of financial liberalization and new bank entry on market structure and competition in Turkey
No full textUntil 1980 Turkey's financial system was shaped to support state-oriented development. After the 1960s the financial system, dominated by commercial banks, became an instrument of planned industrialization. Turkey had an uncompetitive financial market and an inefficient banking system. Controlled interest rates, directed credit, high reserve requirements and other restrictions on financial intermediation, and restricted entry of new banks -plus the exit of many banks between 1960 and 1980- created a concentrated market dominated by banks owned by industrial groups with oversized branch networks and high overhead costs. Turkey since 1980 has seena trend toward liberalization of its financial market. Reforms eliminated interest rate controls, eased the entry of new financial institutions, and allowed new types of instruments. Regulatory barriers were relaxed, attracting many banks (both Turkish and foreign) into the system, and Turkey's banking system became integrated with world markets. The author examines how reform has changed the system, focusing on Turkey's commercial retail banking market. He finds that: (1) Although reform reduced concentration in the industry, leading banks are still able to coordinate their pricing decisions overtly. High profitability appears to have resulted from the banks uncompetitive pricing rather their efficiency. Deregulation and liberalization should be continued and strengthened. (2) The entry of small-scale firms alone is not enough to increase competition, so new banks should probably not be expected to alter the market structure. (3) To promote competition will require addressing barriers to both entry and mobility. The main barrier to mobility seems to be the size of the large banks, which exerts a significant negative effect on competition. (4) Interbank rivalry among the leading banks cannot be facilitated without creating new banks of a certain size with a reasonable number of branches. Breaking up public banks (which hold 30 percent of sectional assets, excluding the Agricultural Bank and three development banks) could help create 15 to 20 new banks with 40 to 50 branches. This would reduce concentration and improve mobility in retail banking. (5) Breaking up public banks before privatization would probably also improve their governance structures and efficiency. (6) Promoting the entry of nonbanks and local banks would also increase the number of institutions competing for deposits. Turkey lacks a healthy variety of credit institutions and should consider developing a mortgage market and creating institutions for housing finance.Payment Systems&Infrastructure,Financial Intermediation,Economic Theory&Research,Banks&Banking Reform,Markets and Market Access,Banks&Banking Reform,Financial Intermediation,Economic Theory&Research,Markets and Market Access,Access to Markets
Mortality after cardiac resynchronization therapy or right ventricular pacing in transcatheter aortic valve replacement recipients.
No full textKirchner J, Gercek M, Sciacca V, et al. Mortality after cardiac resynchronization therapy or right ventricular pacing in transcatheter aortic valve replacement recipients. Clinical research in cardiology : official journal of the German Cardiac Society. 2024.BACKGROUND: Permanent pacemaker implantation (PMI) is associated with increased morbidity after transcatheter aortic valve replacement (TAVR). Cardiac resynchronization-therapy (CRT) is recommended for patients if left ventricular ejection fraction (LVEF) is≤40% and ventricular pacing is expected in favor to sole right ventricular (RV) pacing. Meanwhile, LVEF may recover after TAVR in patients with aortic valve disease and the benefit of CRT is unknown.; OBJECTIVE: To analyze the impact of CRT implantation as compared to RV pacing after TAVR.; METHODS AND RESULTS: Between 2012 and 2022, 4385 patients (53.1% female, mean age 81±6years) without prior PMI undergoing TAVR were retrospectively identified in our institutional registry. After stratification of patients in LVEF≤40%, 41-49% and≥50%, Kaplan-Meier analysis revealed significantly different survival rates in each subgroup at 5years (37.0% vs. 43.5% vs. 55.1%; P≤0.021). At multivariate regression, LVEF and new PMI after TAVR were not relevant for survival. A total of 105 patients with LVEF≤40% received PMI after TAVR (86 patients with RV pacing and 19 with CRT). At 5years, all-cause mortality was significantly lower in patients with CRT-device as compared to patients without CRT-device (Kaplan Meier estimate of 21.1% vs. 48.8%; HR 0.48, CI 0.204 - 1.128; log rank p=0.045). In multivariate analysis CRT remained a significant factor for 5-year survival in these patients (HR 0.3, CI 0.095-0.951, p=0.041).; CONCLUSION: In patients undergoing TAVR, PMI did not influence 5-year survival. In patients with LVEF≤40%, CRT-device implantation was associated with improved survival compared to non-CRT-device implantation. © 2024. The Author(s)
The stratigraphical position of Kemiklitepe fossil locality (Esme, Usak) revised: Implications for the Late Cenozoic sedimentary basin development and extensional tectonics in western Turkey
No full textUnlike earlier studies attributing the Kemiklitepe fossil locality to the Inay Group, the present study indicates that it is to be assigned to the Asartepe Formation that unconformably overlying the. Inay Group. This seems to verify the early Middle Miocene age of the Inay Group, previously determined by isotopic dating and palynological analyses. However, the early Middle Miocene age and the overall undeformed nature of the Inay Group do not concur with the regional two-stage extension model proposing a compressional phase during the Miocene/Pliocene interval. The correlation of the Asartepe Formation hearing the Kemiklitepe fossil locality further to the north indicates that a NE-SW trending fault was active during the Late Miocene. Recent Studies modelling the uplift history of the region are unconvincing because they ignore Late Miocene activity on the NE-SW trending faults and assume a timing of incision of the may Group after the Late Pliocene (similar to 3Ma) in their calculations.TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [104Y156, 105Y280]The field work for this paper was supported by TUBITAK-104Y156 and 105Y280 research grants. We thank SEVKET SEN and GERCEK SARAC for their encouragement to study the stratigraphic position of the Kemiklitepe fossil locality. We also thank UWE RING, Mainz, and two anonymous referees for then, Constructive comments
Axial sarcoidosis mimicking radiographic sacroiliitis
No full textInvolvement of the axial skeleton in sarcoidosis is a rare condition. Herein we report a case with an extensive axial sarcoidosis whose plain radiographs were non-informative. The present case suggested that osseous lesions on sacrum and iliac bones might cause misdiagnosis of sacroiliitis in plain radiographs and advanced imaging may be necessary to make an accurate diagnosis. Our case also underscores the importance of magnetic resonance imaging in selection of a suitable biopsy site to establish diagnosis
