Radial artery (RA) is widely used in coronary artery bypass (CABG) surgery and the prevention of spasm is crucial for graft patency. Botulinum toxin A (BTX-A) and B are commonly used for aesthetic reasons and neuromuscular disorders. They are proven to raise blood flow and increase survival of ischemic skin flaps. In this study we evaluated and compared the vasodilator effects of BTX-A and papaverine on human RA grafts. After resting 60 min in isolated organ baths, human RA grafts were examined. Contraction responses for different doses of serotonin (5-HT) and endothelin-1 (ET-1) were evaluated as a percent of maximum contraction response elicited by 80 mM potassium chloride (KCl). The inhibitory effects of BTX-A and papaverine on contraction responses taken at the 0th hour were compared with the 1st and 2nd hour responses. Inhibitory effects of BTX-A and papaverine against the contractile agent were evaluated by comparing the results of the first and last (0th and 2nd hour) application. In low concentrations, when we compared the effects of BTX-A (10− 8 M) and papaverine (10− 6 M) on 5-HT, papaverine was found to be more effective at both the 0th and 2nd hour (p < 0.05). Both BTX-A and papaverine inhibited the maximum contractile effect of ET-1 to the same extent at the 0th hour; but, the inhibitory effect of BTX-A was significantly stronger at the 2nd hour (p < 0.05). In high concentrations, when we compared the effects of BTX-A (10− 6 M) and papaverine (10− 4 M) on 5-HT, papaverine showed stronger inhibition (p < 0.05), whereas both agents had similar action of inhibition on ET-1 mediated maximum contraction responses. BTX-A inhibits both ET-1 and 5-HT induced contractions and its effectiveness does not decrease over time as observed with papaverine. This study is the first in the literature using human RA for prevention of vasospasm by BTX-A.

Objective: To increase vaccine awareness, we aimed to determine individuals’ knowledge and behavioral approach to the COVID-19 vaccine. Methods: The data of this cross-sectional study were obtained online between June and July 31, 2021. One thousand one hundred seventy-six people over the age of 18 were included in the study. The researchers developed a data collection form consisting of 27 questions. Mean±standard deviation and median (1st quarter-3rd quarter) values, numbers, and percentages were used to summarize the data. Chi-square (χ2) test was used to show the relationship between categorical variables. Independent predictors of participants’ vaccine hesitancy/rejection were analyzed using logistic regression. Statistically, data with p<0.05 were considered significant. Results: A total of 1176 people, 55.7% of whom were women, with a mean age of 39.75±11.27 years, were included in the study. 71.6% of the participants were married, and 78.9% had a university/postgraduate degree. 9.7% of the participants stated that they were hesitant about the COVID-19 vaccine, and 7.1% refused the COVID-19 vaccine or would not be vaccinated when it was their turn. According to the logistic regression model established to examine the factors that may affect vaccine rejection; Age, the resources used to obtain information about the vaccine, the thought that it would not protect for two years, or the vaccine side effects were high, and the most effective way to get rid of the pandemic was not vaccination, were determined as the factors affecting vaccine rejection. Conclusion: As a result of the research, it was found that the participants had a positive attitude towards the COVID-19 vaccine. It was determined that 9.7% of the study group had vaccine hesitancy, and 7.1% had vaccine rejection.

Introduction: Autologous saphenous vein (SV) and internal mammary ar-tery (IMA) are used as bypass conduits during coronary artery bypass graft surgery. Vasospasm of the arterial and venous grafts may constitute a sig-nificant clinical problem. Pretreatment with a vasodilator drug of the graft ex vivo or intraluminal injection before implantation may be used for spasm prophylaxis. This in vitro study was designed to assess the vasoactive ef-fects and time-dependent changes of botulinum toxin A (BTX-A) and pa-paverine pretreatment on vasospasm of human SV and IMA grafts. Also, histomorphology of the vessels was assessed.Material and methods: SV and IMA segments were suspended in organ baths, and isometric contraction responses to 2 different concentrations of 5-hydroxytryptamine (5-HT) and endothelin-1 (ET-1) were recorded after in-cubation with 2 different concentrations of BTX-A and papaverine at 2 time points (0 h and 2 h).Results: The results revealed the following: 1) incubation with BTX-A and papaverine relaxes both SV and IMA rings contracted with 5-HT and ET-1; 2) the duration of the relaxant effect of BTX-A lasts longer than papaverine; and 3) no apparent histomorphological changes were observed in the grafts under light microscopy.Conclusions: This study demonstrates that in human SV and IMA grafts, pretreatment with both BTX-A and papaverine are safe and have a potent inhibitory effect depending on the vessel and vasoconstrictor agent. The long-lasting vasodilatory effect of BTX-A on vascular smooth muscle may provide promising results in the prevention of venous and arterial graft spasm.

AIM: To compare the effects of sevoflurane and propofol anesthesia on perioperative cerebral oxygenation in patients undergoing carotid endarterectomy (CEA) under general anesthesia by using near-infrared spectroscopy (NIRS) monitoring. MATERIAL and METHODS: Institutional approval was obtained, and the perioperative data of 33 patients undergoing CEA were retrospectively evaluated. The study groups were organized according to the anesthesia drugs used for maintenance: sevoflurane (n=17) and propofol (n=16). The regional cerebral oxygen saturation (rScO(2)) of the ipsilateral and contralateral hemispheres was monitored continuously using a NIRS instrument and analyzed at specific time points starting from induction to the 12th hour postoperation. The data were analyzed using the appropriate tests, and a p value of <0.05 was considered significant. RESULTS: Compared with those of groups with non-clamped hemispheres, the rScO(2) values of the sevoflurane and propofol groups decreased significantly during clamping (p<0.05) and increased to above-preoperative values after declamping (p<0.05). When the sevoflurane and propofol groups were compared, a significant decrease in rScO(2) was noted during extubation in the sevoflurane group (p<0.05). In the propofol group, female patients had significantly lower rScO(2) values compared with male patients during clamping of the carotid artery (p<0.05). None of the observed decreases was greater than 20%, which is considered an indication for shunting. CONCLUSION: Our NIRS monitoring results indicate that sevoflurane or propofol anesthesia does not generally cause significant differences in cerebral oxygenation during and after cross-clamping in patients undergoing CEA. The finding of sex-related differences in cerebral oxygenation in patients receiving propofol and decreased oxygenation during extubation in patients receiving sevoflurane warrants further studies.

Background: Cystic fibrosis (CF) is a genetic disorder, in which defective clearance of airway secretions leads to progressive lung function loss. Inhaled mannitol is used to increase sputum and mucociliary clearance. There are little data from real-world studies on the effectiveness of mannitol in children. Our objective was to evaluate the spirometry and clinical results of mannitol in pediatric patients. Methods: We retrospectively reviewed the records of 30 children and adolescents with CF receiving inhaled mannitol who were already on recombinant human deoxyribonuclease (rhDNase) treatment. The change in forced expiratory volume in 1 second (FEV ₁ ) from baseline at 2–4 months was the primary outcome. Secondary measures were other spirometry results, body mass index (BMI), hospital admissions, sputum characteristics, and positive bacterial colonization. Results: Compared to baseline, we found significant improvement in percent predicted FEV ₁ at 2–4 months of treatment; 84.50 (58.00–99.00) vs. 96.00 (66.00–106.00) ( P = 0.0007). The absolute change in FEV ₁ was +11.5% at 2–4 months, +6.5% at 5–7 months, and +4% at 8–12 months. Also, significant improvements in other spirometry results were observed. Adolescents had significantly lower FEV ₁ results, but the improvement in their lung function was sustained for a more extended period than children. Mannitol provided easier sputum removal, increased sputum volume, significant decline in hospitalizations, and significantly fewer patients with positive sputum cultures. A significant increase in BMI at 8–12 months was observed. Cough was the most frequent adverse effect. Conclusion: In a real-world setting, our results demonstrated that adding mannitol to rhDNase therapy is tolerable in pediatric patients with CF and may provide improved spirometry and clinical outcomes. In addition, our results showed that mannitol provided recovery in overall lung function at 2–4 months, which was sustained up to 12 months together with improved BMI, easier sputum removal, and a decline in bacterial colonization and hospital admissions. However, cough was the most frequent side effect.