84. According to the principal factor analysis of the tetrachoric correlation matrix, the three factors with the highest Eigenvalues were associated with (i) Relatively easy clinical observations, (ii) the signs which require a longer observation time and detailed anamnesis, and (iii) the signs, which require detailed examination and observation. The factors explained cumulatively 65.98% of the total variance. CONCLUSION The findings obtained in this study showed that the adapted questionnaire addressed in the scope of this study is a valid measure for Turkish society. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.OBJECTIVE Fractional flow reserve (FFR) provides more useful information regarding myocardial metabolism and demand-supply convenience as compared to anatomical measurements. In this study, we aimed to investigate FFR predictors after propensity score matching (PSM) analysis in patients with intermediate coronary lesions. METHODS Patients who underwent coronary angiography between January 2014 and March 2015 due to suspicion of coronary artery disease were included in this study. Patients were divided into two groups according to the FFR status and predictors of FFR before and after PSM analysis were investigated. RESULTS A total of 290 patients (a total of 310 lesions) were included in this study (61±12 years, 75.5% male). In univariate analysis, after PSM analysis, Diameter stenosis (DS) and proximal LAD lesion (PLL) were associated with lower FFR values. CONCLUSION This study indicated that the majority of traditional FFR predictors did not reach the limit of significance after PSM analysis and we suggest that DS and PLL are one step ahead of predicting lesion severity compared to other traditional risk factors. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.OBJECTIVE This study aimed to investigate the effects of γ-butyrolactone (GBL), a prodrug of gamma-Hydroxybutyric acid -induced absence seizures on the development of kindling in Wistar rats. METHODS Three groups of adult male Wistar rats under anesthesia were implanted with bilateral cortical recording electrodes for the GBL group (GBL) and/or bipolar stimulation electrodes into the right basolateral amygdala for the Kindling group (KI) alone and Kindling plus GBL group (GBL+KI). Rats in the KI and GBL+KI groups were stimulated twice daily at the afterdischarge threshold until they reached Racine’s stage 5 seizure state. The animals in the GBL + group had an i.p injection of GBL 20 minutes before each electrical stimulation, and the effects of GBL-induced seizures on the development of kindling were investigated. The animals in the GBL group were injected GBL twice daily i.p. for 15 days without receiving any electrical stimulation. RESULTS The KI animals reached stage 5 seizure stage at 12th stimulations, whereas the GBL+KI rats reached at 27th stimulations. The mean numbers of stimulations needed for the development of the first stage 3, 4, or 5 generalized seizures were significantly higher in the GBL+KI group than the KI group. CONCLUSION The resistance to amygdala kindling in the GBL model can be modulated by the absence seizure mechanism alone, without the intervention of an abnormal genetic background. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.OBJECTIVE Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF). METHODS Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared. RESULTS PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E’, pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI 1.08-1.42; p=0.001). ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95% 0.724-0.927; p less then 0.001]. CONCLUSION The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.OBJECTIVE The lateral oblique approach is a novel needle-in-plane technique for ultrasound-guided catheterization of the internal jugular vein. In this study, we aimed to compare the oblique approach with the classical short-axis technique for facilitating the procedure and reduction of mechanical complications. METHODS This research was planned as a prospective study. Eighty-four open-heart surgery patients requiring a central venous catheter were randomly allocated into two groups Oblique approach group (n=42) and short-axis group (n=42). Time to cannulate, the number of necessary puncture attempts, and frequency of carotid artery puncture, hematoma, puncture site bleeding, pneumothorax, and hemothorax in each group were recorded. Visualization of the vein and the needle using ultrasound were also evaluated by a subjective scale. RESULTS The patient’s characteristics were comparable between the two groups. The mean time of catheterization was 52.00±70.18 seconds in the oblique approach group and 40.76±49.30 seconds in short-axis group. The mean number of needle puncture attempts was 1.21±0.61 in oblique approach and 1.12±0.50 in short-axis group. The results did not differ significantly. There was an improved visualization of the needle in the oblique approach group, but this was not proved as statistically significant. CONCLUSION The results of our study suggest that the lateral oblique approach is a safe and effective technique, which can be a strong alternative to the classical short-axis technique for ultrasound-guided catheterization of the internal jugular vein. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.OBJECTIVE Human immunodeficiency virus (HIV) infection is a significant health problem. Many studies reported that HIV was mainly transmitted through parenteral exposure, sexual activity, and body secretions, such as saliva and semen. Many people, including health-care providers and patient relatives, may easily contact with the sweat of HIV-infected patients. Although reference books assert that HIV does not transmit through sweat, to our knowledge, there is no systemic study which this statement is based upon. This study aims to investigate the potential of sweat to transmit HIV infection. METHODS This study included 31 treatment-naive HIV RNA-positive patients who were in the acute phase of the infection and 26 subjects with a negative HIV RNA test who had received antiviral treatment. A total of 57 sweat samples collected from intact skin areas were prospectively evaluated by polymerase chain reaction (PCR) for the presence of HIV RNA. HIV RNA levels in the blood samples were also noted. RESULTS HIV RNA was not detected by PCR in any sweat sample taken from HIV-infected HIV RNA-negative and -positive subjects. CONCLUSION The findings obtained in this study suggest that sweat by itself has no potential for transmitting HIV infection. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.OBJECTIVE Colorectal cancer (CRC) is the third most common type of cancer observed in cancer-related mortality because it has a high metastasis ratio. This study aims to investigate the expression levels of several genes, including metastasis-related colon cancer 1 (MACC1), Filamin A (FLNA), F-box/WD repeat-containing protein 7 (FBXW7), which has an important role in cell signaling, migration and adhesion through the remodeling of the cell skeleton. METHODS In this study, 21 patients with a precise diagnosis of CRC and 21 controls were included. Gene expressions were examined using the RT-PCR technique. To define the relationship of the genes with metastasis, blood samples were collected from all patients with colon/rectal cancer diagnosis without metastasis at six months before and after the medication with Xelox. RESULTS Our findings showed that no significant difference was observed in the pre-treatment values compared to the control group, whereas FLNA (p=0.001) expression was observed to be significantly increased following treatment with Xelox. CONCLUSION To our knowledge, our study is the first study to investigate the effects of Xelox treatment on the expression levels of MACC1, FBXW7 and FLNA genes in non-metastatic colorectal cancer patients in Turkey. Copyright © 2020 by Istanbul Northern Anatolian Association of Public Hospitals.The greatest advantage of deep anterior lamellar keratoplasty over full-thickness corneal transplantation is the elimination of graft failure caused by endothelial rejection. Despite this advantage, a deep anterior lamellar keratoplasty graft can fail because of several factors, such as complications related to the donor-recipient interface, graft epithelial abnormalities, graft vascularization, stromal graft rejection, and recurrence of herpetic keratitis. Increased deep anterior lamellar keratoplasty graft survival is mainly built upon optimization of the ocular surface to provide a hospitable environment for the graft. Any predisposing factors for graft epithelial abnormalities, corneal neovascularization, and preexisting vernal keratoconjunctivitis should be identified and treated preoperatively. Prompt recognition and appropriate treatment of interface-related complications and stromal graft rejection usually result in good anatomic outcomes, with no detrimental effects on vision. © The Author(s), 2020.Milk-secreting epithelial cells of the mammary gland are functionally specialized for the synthesis and secretion of large quantities of neutral lipids, a major macronutrient in milk from most mammals. Milk lipid synthesis and secretion are hormonally regulated and secretion occurs by a unique apocrine mechanism. Neutral lipids are synthesized and packaged into perilipin-2 (PLIN2) coated cytoplasmic lipid droplets within specialized cisternal domains of rough endoplasmic reticulum (ER). Continued lipid synthesis by ER membrane enzymes and lipid droplet fusion contribute to the large size of these cytoplasmic lipid droplets (5-15 μm in diameter). Lipid droplets are directionally trafficked within the epithelial cell to the apical plasma membrane. Upon contact, a molecular docking complex assembles to tether the droplet to the plasma membrane and facilitate its membrane envelopment. This docking complex consists of the transmembrane protein, butyrophilin, the cytoplasmic housekeeping protein, xanthine dehydrogenase/oxidoreductase, the lipid droplet coat proteins, PLIN2, and cell death-inducing DFFA-like effector A. Interactions of mitochondria, Golgi, and secretory vesicles with docked lipid droplets have also been reported and may supply membrane phospholipids, energy, or scaffold cytoskeleton for apocrine secretion of the lipid droplet. Final secretion of lipid droplets into the milk occurs in response to oxytocin-stimulated contraction of myoepithelial cells that surround milk-secreting epithelial cells. The mechanistic details of lipid droplet release are unknown at this time. The final secreted milk fat globule consists of a triglyceride core coated with a phospholipid monolayer and various coat proteins, fully encased in a membrane bilayer.