Özer Tuç

Background and Objectives: Crush injury frequently leads to acute kidney injury (AKI) through rhabdomyolysis, and the choice of anesthetic agent may influence renal outcomes in patients requiring surgery after such injury. This study aimed to compare the effects of remifentanil and dexmedetomidine on renal injury following crush injury using biochemical markers and histopathological examination. Materials and Methods: In this experimental study, 28 male Wistar-Albino rats were allocated to four groups (n = 7 each): Control, Sham (crush injury and surgery without drug), Dexmedetomidine, and Remifentanil. Bilateral gastrocnemius compression for two hours induced crush injury, followed by a one-hour intravenous drug infusion and simulated laparotomy. Blood samples were collected at 0, 2, and 6 h; animals were sacrificed at 6 h and kidney tissue was harvested. Serum urea, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), (TIMP-2) × (IGFBP7), total antioxidant capacity (TAC), and total oxidative status (TOS) were measured, and renal histopathology was evaluated. One Sham-group animal died during the experiment; the final analysis included 27 animals. Results: When all time points were evaluated together, serum creatinine and NGAL levels were significantly higher in the Remifentanil group than in the Dexmedetomidine group (although creatinine was already higher in the Remifentanil group at 2 h, before drug administration), whereas KIM-1 and (TIMP-2) × (IGFBP7) did not differ significantly between groups. The correlation between TAC and TOS was weakly positive early after injury and became weakly negative by 6 h. Histopathological analysis showed more pronounced necrosis, brush-border loss, and congestion in the Remifentanil group, whereas renal tissue preservation was more evident in the Dexmedetomidine group; these mixed biochemical results do not uniformly support a renoprotective conclusion. Conclusions: In this experimental crush injury model, dexmedetomidine was associated with more favorable early renal biochemical and histopathological findings than remifentanil, suggesting a potential renoprotective association. However, the mixed biomarker findings, small sample size, and short observation period preclude a definitive conclusion regarding direct renal protection.

Endoscopic retrograde cholangiopancreatography (ERCP) can be particularly challenging for anesthesiologists because of the increased difficulty in airway access when it is performed in the prone position, alongside typically older patients with increased comorbidities. This study aimed to compare the effectiveness of high-flow nasal oxygen (HFNO) versus standard nasal oxygen (NO) in preventing hypoxemia in patients undergoing deep sedation monitored by Bispectral Index (BIS) during ERCP procedures. This prospective clinical study included 187 patients. Patients were allocated to the NO or HFNO group. Frailty levels were evaluated using the Modified Frailty Index-11 (mFI-11) before the procedure. Sedation was adjusted to maintain BIS values between 60 and 80. The SpO2 levels at 5 and 10 min were higher in the HFNO group than in the NO group (p=0.002 and p=0.003, respectively). The changes in SpO2 over time differed significantly between the groups (F=7.315, p<0.001). The frequency of interventions, such as chin lift, increasing O2 flow, SpO2<90, and SpO2 75-90, was higher in the NO group than in the HFNO group (p<0.001, p=0.006, p=0.006, and p<0.001, respectively). Administration of HFNO under deep sedation to ERCP patients with a higher rate of comorbidities may prevent desaturation and provide safe anesthesia.

Objectives: The aim of this study was to investigate the relationship between MMP13 rs3819089, ADAM12 rs3740199 and rs1871054, and ADAMTS14 rs4747096 genotypes in patients with radiologically diagnosed knee osteoarthritis (OA). Patients and methods: A total of 300 patients (68 males, 232 females; mean age: 61.6 years; range, 25 to 89 years) who were admitted to the orthopedics and traumatology clinic and diagnosed with knee OA according to the 2000 American College of Rheumatology (ACR) criteria between October 2018 and March 2019 were prospectively analyzed. Patients with Grades III-IV OA according to the Kellgren- Lawrence (K-L) grading system were included in the patient group (n=150) and those without radiological features of knee OA (K-L Grades I-II) were included in the control group (n=150) voluntarily. The presence of single nucleotide polymorphisms (SNPs) in the targeted genes in both groups was assessed by real-time polymerase chain reaction in the peripheral blood sample. Results: The most common nucleotides in both the control and patient groups were CG for rs3740199 and CT for rs1871054 in the ADAM12 gene, and the most common nucleotides in alleles were GG for MMP13 rs3819089 and AA for ADAMTS14 rs4747096. No statistically significant relationship was detected between the gene polymorphisms and advanced OA. Conclusion: The study results suggest that ADAM12 rs3740199 and rs1871054, MMP13 rs3819089, and ADAMTS14 rs4747096 polymorphisms have no relationship with knee OA susceptibility in the Turkish population. However, as this is the first study to investigate the relationship between the SNPs of ADAM12, ADAMTS14, and MMP13 genes and the development of OA in the Turkish population, it would contribute to our understanding of the molecular bases of OA.