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Pompe disease, a rare genetic neuromuscular disorder, is caused by a deficiency of acid alpha-glucosidase (GAA), leading to an accumulation of glycogen in lysosomes, and resulting in the progressive development of muscle weakness. The current standard treatment, enzyme replacement therapy (ERT), is not curative and has limitations such as poor penetration into skeletal muscle and both the central and peripheral nervous systems, a risk of immune responses against the recombinant enzyme, and the requirement for high doses and frequent infusions. To overcome these limitations, lentiviral vector-mediated hematopoietic stem and progenitor cell (HSPC) gene therapy has been proposed as a next-generation approach for treating Pompe disease. This study demonstrates the potential of lentiviral HSPC gene therapy to reverse the pathological effects of Pompe disease in a preclinical mouse model. It includes a comprehensive safety assessment via integration site analysis, along with single-cell RNA sequencing analysis of central nervous tissue samples to gain insights into the underlying mechanisms of phenotype correction., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: The BIG score (base deficit + [2.5 × international normalized ratio] + [15 - Glasgow Coma Score]) was compared with the Pediatric Trauma Score (PTS) for predicting mortality in pediatric patients with multiple trauma., Methods: This retrospective, single-center study included 318 consecutive pediatric patients (aged 1-18 years) with multiple trauma who were admitted to the emergency department between January 1, 2021, and December 31, 2023. The demographic characteristics, clinical characteristics, and trauma scores (BIG score and PTS) were compared between survivors and nonsurvivors to identify factors associated with mortality., Results: A PTS of 7 had 100% sensitivity and 81.03% specificity for predicting mortality, with an area under the curve of 0.97 (95% confidence interval 0.9-0.99). Although the positive predictive value (PPV) was low (33.7%), the negative predictive value (NPV) was 100%. A BIG score of 13.7 was identified as the cutoff for mortality, with 92.86% sensitivity and 95.52% specificity (area under the curve 0.98, 95% confidence interval 0.96-0.99). The PPV was 66.7% and the NPV was 99.3%., Conclusions: Both the PTS and the BIG score were strong predictors of mortality in pediatric patients with multiple trauma. The BIG score had a higher specificity and PPV, whereas a PTS of 7 had 100% sensitivity and a higher NPV., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Federated learning is a collaborative machine learning paradigm where multiple parties jointly train a predictive model while keeping their data. On the other hand, multi-label learning deals with classification tasks where instances may simultaneously belong to multiple classes. This study introduces the concept of Federated Multi-Label Learning (FMLL), combining these two important approaches. The proposed approach leverages federated learning principles to address multi-label classification tasks. Specifically, it adopts the Binary Relevance (BR) strategy to handle the multi-label nature of the data and employs the Reduced-Error Pruning Tree (REPTree) as the base classifier. The effectiveness of the FMLL method was demonstrated by experiments carried out on three diverse datasets within the context of animal science: Amphibians, Anuran-Calls-(MFCCs), and HackerEarth-Adopt-A-Buddy. The accuracy rates achieved across these animal datasets were 73.24%, 94.50%, and 86.12%, respectively. Compared to state-of-the-art methods, FMLL exhibited remarkable improvements (above 10%) in average accuracy, precision, recall, and F-score metrics.

The early diagnosis of brain tumors is critical in the area of healthcare, owing to the potentially life-threatening repercussions unstable growths within the brain can pose to individuals. The accurate and early diagnosis of brain tumors enables prompt medical intervention. In this context, we have established a new model called MTAP to enable a highly accurate diagnosis of brain tumors. The MTAP model addresses dataset class imbalance by utilizing the ADASYN method, employs a network pruning technique to reduce unnecessary weights and nodes in the neural network, and incorporates Avg-TopK pooling method for enhanced feature extraction. The primary goal of our research is to enhance the accuracy of brain tumor type detection, a critical aspect of medical imaging and diagnostics. The MTAP model introduces a novel classification strategy for brain tumors, leveraging the strength of deep learning methods and novel model refinement techniques. Following comprehensive experimental studies and meticulous design, the MTAP model has achieved a state-of-the-art accuracy of 99.69%. Our findings indicate that the use of deep learning and innovative model refinement techniques shows promise in facilitating the early detection of brain tumors. Analysis of the model's heat map revealed a notable focus on regions encompassing the parietal and temporal lobes., (© 2024. The Author(s).)

Objectives and Aims: Neuromyelitis Optica Spectrum Disorder (NMOSD) is a disabling autoimmune disease of the central nervous system that requires immunosuppressants to control the relapses. The latter puts them at risk for more severe COVID-19 infection. Vaccines are an effective way to control the pandemic. However, we do not know how effective they are in immunologically compromised patients. We aimed to evaluate and compare antibody levels in NMOSD patients treated with disease-modifying therapies after two doses of inactivated and mRNA COVID-19 vaccines., Methods: Patients with NMOSD diagnosis and age-sex matched healthy controls who received two doses of either inactivated and mRNA COVID-19 vaccine were recruited in the study. Serum samples were collected at least two weeks after the second dose., Results: Serum samples from 24 NMOSD patients (Mean age-36.58, Female-70.83%) and 24 healthy controls (Mean age-36.71, Female-70.83%) were evaluated. Mean antibody titer was lower in the NMOSD group (Mean; SD (2.43 ± 1.51) than in healthy controls (Mean; SD 3.23 ± 0.80). Seronegativity was only seen in the rituximab group, there were no such cases in the azathioprine group. (9 vs 0)., Conclusions: The study shows that NMOSD patients treated with rituximab may still be susceptible to severe COVID-19 infection even after both inactivated and mRNA vaccines., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: Afamin is a protein that increases in gestational diabetes but its concentration in neonates hasn't been investigated. Our objective is to compare cord blood afamin levels in neonates born to mothers with and without diabetes, and to explore its relationship with maternal and neonatal variables., Methods: In this case control study, umbilical cord blood was collected for afamin measurement in pregestational/gestational diabetic pregnancies ( n  = 40) and healthy pregnancies ( n  = 45) after delivery. Correlation analysis was conducted to examine the relationship between afamin levels and maternal BMI, age, HbA1c, fasting and postprandial blood glucose, gestational age, birth weight., Results: The diabetic group had a higher median afamin level ( p  < 0.001). Afamin concentrations did not differ significantly between diabetic subgroups. The concentration of afamin in cord blood was independent of maternal BMI, age, HbA1c, blood glucose, gestational age, birth weight., Conclusion: The concentration of afamin in cord blood of diabetic pregnancies is significantly higher, irrespective of other clinical factors.

Background Cone beam computed tomography (CBCT) has revolutionized dental and maxillofacial imaging by providing high-resolution 3D visualizations, essential for accurate diagnosis and treatment planning. Despite its clinical advancements, the usability of CBCT viewer interfaces, which play a crucial role in the effective interpretation of imaging data, remains a critical concern. Objective This study aims to evaluate the usability of a CBCT viewer interface in clinical settings, focusing on the effectiveness, efficiency, and satisfaction perspectives, to identify potential areas for improvement. Methods Twenty-two participants (N=22) were assigned the task of locating the mental foramen in a mandible dataset, selected randomly, using the multiplanar reconstruction (MPR) mode of a CBCT viewer interface on a local network. The task's effectiveness was gauged by the completion rate, while efficiency was measured through the duration of the task, the number of mouse clicks, and the cursor's path in both pixels and meters. Satisfaction or perceived usability was evaluated using the system usability scale (SUS-TR), and computer system usability questionnaire (T-CSUQ), among other scales, with participants also providing open-ended feedback. Demographic characteristics served as classification variables. Results All participants completed the given task. No demography-related differences in efficiency were observed. Perceived usability (SUS-TR: 60.68±19.58, T-CSUQ: 43.63±16.34) was below the industry standards, categorizing the system as a detractor. Commonly reported issues included accessing the MPR window, cursor behavior, and unclear error messages. The mean SUS-TR score negatively correlated with efficiency-related variables (p<0.05 for each). Conclusions The study's findings indicate that the CBCT viewer interface does not fully meet dental professionals' usability expectations, as evidenced by the task's completion rate, efficiency metrics, and below-average usability scores. Despite the successful task completion by all participants, the identified issues in interface design, such as difficulties in accessing the MPR window and unclear error messages, highlight significant areas for improvement. To enhance user satisfaction and efficiency, future developments of CBCT viewer interfaces should incorporate feedback from end-users and prioritize user-friendly design principles., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Dogan et al.)

Background: The optimal pain relief method for acute renal colic in the emergency department remains controversial., Objective: We compared the safety and efficacy of intradermal sterile water injection (ISWI) to treatment with intramuscular (IM) diclofenac, intravenous (IV) opioids, and IV paracetamol in patients with acute renal colic., Methods: This randomized, single-blind study included 320 patients with renal colic to one of four treatment groups. The first group received ISWI at four different points around the most painful flank area. Patients in the DI, PARA, and TRAM groups received 75 mg IM diclofenac, 1 g IV paracetamol, and 100 mg IV tramadol, respectively. Pain intensity was measured using a visual analog scale (VAS) before treatment and 15, 30, and 60 min after treatment., Results: VAS scores 15 and 30 min after treatment were significantly lower in group ISWI than in groups DI, PARA, and TRAM. However, there were no significant differences in the decrease in the pain score at baseline and at 60 min after treatment. In addition, fewer patients required rescue analgesia in group ISWI than in group TRAM. However, no significant differences were observed between group ISWI and group DI or PARA in terms of the need for rescue analgesia. Finally, there were significantly fewer adverse events in group ISWI than in groups DI and TRAM., Conclusions: ISWI had similar efficacy, faster pain relief, and lower need for rescue analgesia compared with diclofenac, paracetamol, and tramadol for the management of acute renal colic. In addition, ISWI was well-tolerated and had no adverse effects., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: We investigated predictors of mortality, including demographic, clinical, and laboratory parameters, in hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia., Patients and Methods: This retrospective, single-center study included 651 consecutive Turkish adults who had been admitted to the emergency department with a diagnosis of COVID-19. We recorded the demographic, clinical, and laboratory parameters of the patients. The patients were divided into two groups: patients aged ≥65 years and patients aged <65 years. The predictors of mortality for hospitalized COVID-19 patients were evaluated., Results: The study included 651 patients (354 [54.4%] men and 297 [45.6%] women; mean age, 56.40 ± 15.70 years). The most common comorbidities were hypertension (37.6%), diabetes mellitus (28.9%), and coronary artery disease (CAD) (16.1%). The overall mortality rate was 10.6% (n = 69); the mortality rate was higher in men than in women. Advanced age; chronic renal failure (CRF); prolonged activated partial thromboplastin time; high serum neutrophil and platelet counts; high C-reactive protein to albumin (CRP/albumin) ratio; and high levels of albumin, lactate dehydrogenase (LDH), and high-sensitivity troponin I (TnI-hs) were independent predictors of mortality in all age groups., Conclusion: Multivariate logistic regression analysis showed that chronic obstructive pulmonary disease (COPD), high serum platelet count, high CRP/albumin ratio, and high levels of albumin, TnI-hs, and D-dimer were independent predictors of mortality in patients aged <65 years. Conversely, advanced age, CAD, CRF, and high levels of serum CRP and LDH were independent predictors of mortality in patients aged ≥65 years., (Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.)

Objectives: The study aimed to evaluate the correlation between the clinical disease activity of axial spondyloarthropathy (axSpA) and magnetic resonance imaging findings of the sacroiliac joint., Patients and Methods: Thirty-two patients (21 males, 11 females; mean age: 39.3±9.2 years; range, 18 to 55 years) who were diagnosed with axSpA according to the Assessment in Spondyloarthritis International Society classification criteria between November 2015 and August 2017 were included in this cross-sectional study. Visual Analog Scale (VAS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS)-erythrocyte sedimentation rate (ESR), and ASDAS-C-reactive protein (CRP) were used as the indicators of clinical activity. Magnetic resonance imaging of the sacroiliac joint was performed and the Spondyloarthritis Research Consortium of Canada (SPARCC) score was evaluated by a radiologist who was blinded to the clinical and laboratory parameters of the patients., Results: The mean duration of symptom onset was 9.3±7.7 years, and the mean duration of diagnosis was 3.6±2.8 years. Human leukocyte antigen (HLA)-B27 was positive in 16 (50%) patients. There was no correlation between the SPARCC score and VAS, BASDAI, MASES, BASFI, ASDAS-CRP, ASDAS-ESR, ESR, and CRP values (p>0.05). In the HLA-B27 subgroup analyses, a statistically significant correlation was found between HLA-B27-negative patients and SPARCC score (r=0.639, p=0.008)., Conclusion: No relationship was found between other clinical disease parameters and sacroiliac joint imaging findings, except for the relationship between the SPARCC and BASDAI in HLA-B27- negative patients with axSpA., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish League Against Rheumatism.)

Plant ethnoveterinary uses are evident in various studies around the world, but the ethnoveterinary practices of forage species are not widely reported. Traditional knowledge is rapidly disappearing because of urbanization and commercial activities. The purpose of this study was to document plant species used by the local communities in Malakand Agency, Pakistan for foraging and ethnoveterinary purposes. Twenty different localities in the study area were surveyed for documentation of forage species and related traditional ethnoveterinary knowledge used for livestock. Semistructured questionnaires and field walks were used to conduct 67 interviews with local farmers and herdsmen. A total of 91 forage species from 26 families were documented, as well as their ethnoveterinary applications. Poaceae and Fabaceae were dominant families with 45% and 15% of species respectively. Among the forage species documented, 62 were highly palatable, 26 were moderately palatable and 12 were less palatable. The region's major veterinary diseases are flu, ringworms, inflammations, low milk production, constipation, bloat, mastitis, pneumonia and wounds. The 62 forage species were reported for the first time for various veterinary uses. This study revealed that local communities commonly use a diverse range of forage species in conjunction with indigenous knowledge of ethnoveterinary uses. These forage species have the potential to overcome the recent fodder shortage. Such studies will be beneficial to the commercial production of such forage species., (© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.)

Background: Acute pancreatitis (AP) is an inflammatory disease of the pancreas, the frequency of which increases in childhood., Aim: To investigate the demographic, etiological, clinical, laboratory, and radiological characteristics of children followed up with the diagnosis of AP. The study also included genetic studies of recurrent cases., Materials and Methods: This retrospective cohort study included pediatric patients <18 years of age with AP who were followed up with recurrent pancreatitis in the Pediatrics Department of a University Hospital between January 2010 and April 2021. Patients who met at least 2 of the 3 criteria defined by the International Pediatric Pancreatitis Study Group (INSPPIRE) were accepted as AP. Demographic, etiological, and clinical data of the patients, developing complications, pathological evaluation of the samples, and genetic analysis results were obtained from the patient files. The obtained data were statistically analyzed using the SPSS version 26.0 program. Descriptive statistics of the data were expressed as mean ± standard deviation, median, minimum and maximum values, number (n), and percentage (%). Kolmogorov-Smirnov test, Mann Whitney U test, Chi-square test and Fischer test were used., Results: Fifty-four (50%) female and 54 (50%) male patients with a mean age of 9.96 ± 4.8 years who met the study criteria were included in the study. In the follow-up, it was reported that acute recurrent pancreatitis developed in 23 (21%) patients and chronic pancreatitis developed in 8 (7%) patients. The most common complaints were abdominal pain (94.4%), and vomiting (60.2%), followed by malnutrition (36.1%), nausea (17.6%), diarrhea (13%), and fever (13%). Etiology could not be determined in 19.4% of the patients. It was noted that the genetic predisposition of the patients played a role in the development of recurrent and chronic pancreatitis. Amylase, lipase, and CRP values, which are among the laboratory parameters showing the severity and prognosis of AP, were found to be significant., Conclusions: Sociocultural and demographic data of the patients should also be taken into account. Gene sequences that cause to genetic predisposition should be determined in recurrent and chronic pancreatitis cases. Acute pancreatitis should be considered in the differential diagnosis of patients with frequent abdominal pain and vomiting., (Copyright © 2023 Copyright: © 2023 Nigerian Journal of Clinical Practice.)

Objective: To evaluate growth, tolerance and safety outcomes with use of an extensively hydrolyzed casein-based formula (eHCF) in infants with cow's milk protein allergy (CMPA)., Methods: A total of 226 infants (mean ± SD age: 106.5 ± 39.5 days, 52.7% were girls) with CMPA who received eHCF comprising at least half of the daily dietary intake were included. Data on anthropometrics [weight for age (WFA), length for age (LFA) and weight for length (WFL) z -scores] were recorded at baseline (visit 1), while data on infant feeding and stool records, anthropometrics and Infant Feeding and Stool Patterns and Formula Satisfaction Questionnaires were recorded at visit 2 (on Days 15 ± 5) and visit 3 (on Days 30 ± 5)., Results: From baseline to visit 2 and visit 3, WFA z -scores (from -0.60 ± 1.13 to -0.54 ± 1.09 at visit 2, and to -0.44 ± 1.05 at visit 3, p  < 0.001) and WFL z -scores (from -0.80 ± 1.30 to -0.71 ± 1.22 at visit 2, and to -0.64 ± 1.13 at visit 3, p  = 0.002) were significantly increased. At least half of infants never experienced irritability or feeding refusal (55.7%) and spit-up after feeding (50.2%). The majority of mothers were satisfied with the study formula (93.2%), and wished to continue using it (92.2%)., Conclusions: In conclusion, eHCF was well-accepted and tolerated by an intended use population of infants  ≤ 6 months of age with CMPA and enabled adequate volume consumption and improved growth indices within 30 days of utilization alongside a favorable gastrointestinal tolerance and a high level of parental satisfaction., Competing Interests: AS and SE are Abbott employees. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Kansu, Urganci, Bukulmez, Kutluk, Gulcu Taskin, Sahin Keskin, Igde, Molon, Dogan, Sekerel, Yuksek, Bostanci, Gerenli, Polat, Dalgic, Ayyildiz, Usta, Basturk, Yuce Kirmemis, Tuna Kirsaclioglu, Gulerman, Alptekin Sarioglu and Erdogan.)

We aim to evaluate the clinical course and outcome of cases with a prenatal diagnosis of ectopia cordis in our center. In this retrospective study, we analyzed clinical variables including gestational age at diagnosis, maternal age, associated cardiac, extracardiac, genetic anomalies and, outcome in prenatally diagnosed ectopia cordis cases in our tertiary referral center. Eight ectopia cordis cases from seven pregnancies were included in the study. All fetuses had complete type of ectopia cordis and pentalogy of Cantrell. Five multiple pregnancies were found, four were twin pregnancies (three dichorionic diamniotic, one monochorionic monoamniotic) and one was triplet (trichorionic triamniotic). In the monochorionic monoamniotic twin pregnancy, both fetuses have pentalogy of Cantrell. Two cases had intracardiac structural defects including Tetralogy of Fallot and hypoplastic right heart syndrome. Three pregnancies were terminated, four cases delivered alive could not survive beyond the neonatal period. The striking feature in our study is its association with multiple pregnancies., (© 2023 Japanese Teratology Society.)

Background: Clinical studies suggest that warmer climates slow the spread of viral infections. In addition, exposure to cold weakens human immunity., Aim: This study describes the relationship between meteorological indicators, the number of cases, and mortality in patients with confirmed coronavirus disease 2019 (COVID-19)., Patients and Methods: This was a retrospective observational study. Adult patients who presented to the emergency department with confirmed COVID-19 were included in the study. Meteorological data [mean temperature, minimum (min) temperature, maximum (max) temperature, relative humidity, and wind speed] for the city of Istanbul were collected from the Istanbul Meteorology 1 st Regional Directorate., Results: The study population consisted of 169,058 patients. The highest number of patients were admitted in December (n = 21,610) and the highest number of deaths (n = 46) occurred in November. In a correlation analysis, a statistically significant, negative correlation was found between the number of COVID-19 patients and mean temperature (rho = -0.734, P < 0.001), max temperature (rho = -0.696, P < 0.001) or min temperature (rho = -0.748, P < 0.001). Besides, the total number of patients correlated significantly and positively with the mean relative humidity (rho = 0.399 and P = 0.012). The correlation analysis also showed a significant negative relationship between the mean, maximum, and min temperatures and the number of deaths and mortality., Conclusion: Our results indicate an increased number of COVID-19 cases during the 39-week study period when the mean, max, and min temperatures were consistently low and the mean relative humidity was consistently high., Competing Interests: None

Objective: Vitamin D insufficiency/rickets is a metabolic bone disease that leads to insufficient mineralization of bone. Chronic neurological diseases, including cerebral palsy (CP), convulsive disorders, neural tube defects, myopathy, immobility, lack of sun exposure, inadequate nutrition, and antiepileptic drugs (AEDs) can cause vitamin D insufficiency and osteopenia in children., Materials & Methods: In this study, the authors searched the frequency and causative factors of vitamin D insufficiency in children with chronic neurological diseases such as CP, hypoxic-ischemic encephalopathy, mental motor retardation, epilepsy, neurodegenerative and neuromuscular diseases, meningitis-encephalitis sequelae, neural tube defects, paralysis, and paresis. This cross-sectional study included 108 children (forty-five (41.6%) females; sixty-three (58.4%) males), aged between one and 18 years with chronic neurological diseases, and a control group of thirty age-matched healthy children (16 (53.3%) females; 14 (46.7%) males., Results: Vitamin D levels were significantly lower, and parathyroid hormone (PTH) levels were significantly higher in the patient group than in the control group (p<0.05). The patient group was divided into four subgroups: (i) Epilepsy (n=41; 38%), (ii) Neural tube defects (n=14; 13%), (iii) CP (n=21; 19%), and (iv) other diseases (neurodegenerative and neuromuscular diseases, meningitis sequelae, intracranial hemorrhage, psychomotor retardation, hypoxic-ischemic. encephalopathy) (n=32; 30%) to identify any differences in the measured levels. In the patient group, eighty-three (76.9%) had vitamin D deficiency, and 17 (15.7%) had vitamin D insufficiency, while in the control group, twenty-one (70%) had vitamin D insufficiency. The use of AEDs had no significant effect on serum Ca, P, ALP, PTH, or vitamin D levels (p>0.05), and serum Ca levels were significantly higher in ambulant patients than in non-ambulant patients (p<0.05). Vitamin D levels were significantly higher in the non-ambulant than in the ambulant patients (p<0.05). No rickets was determined in the control group, while in the patient group, nine (8.3%) had level-1 rickets, six (5.6%) had level-2 rickets, and two (1.9%) had level-3 rickets., Conclusion: Children with chronic neurological diseases have low serum vitamin D levels, and vitamin D prophylaxis is essential in this group., Competing Interests: None declared.

Various aspects of the in vitro culture conditions can impact the functional response of immune cells. For example, it was shown that a Ca2+ concentration of at least 1.5 mM during in vitro stimulation is needed for optimal cytokine production by conventional αβ T cells. Here we extend these findings by showing that also unconventional T cells (invariant Natural Killer T cells, mucosal-associated invariant T cells, γδ T cells), as well as B cells, show an increased cytokine response following in vitro stimulation in the presence of elevated Ca2+ concentrations. This effect appeared more pronounced with mouse than with human lymphoid cells and did not influence their survival. A similarly increased cytokine response due to elevated Ca2+ levels was observed with primary human monocytes. In contrast, primary human monocyte-derived macrophages, either unpolarized (M0) or polarized into M1 or M2 macrophages, displayed increased cell death in the presence of elevated Ca2+ concentrations. Furthermore, elevated Ca2+ concentrations promoted phenotypic M1 differentiation by increasing M1 markers on M1 and M2 macrophages and decreasing M2 markers on M2 macrophages. However, the cytokine production of macrophages, again in contrast to the lymphoid cells, was unaltered by the Ca2+ concentration. In summary, our data demonstrate that the Ca2+ concentration during in vitro cultures is an important variable to be considered for functional experiments and that elevated Ca2+ levels can boost cytokine production by both mouse and human lymphoid cells., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Eskiocak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives and Aims: Disease modifying therapies used in multiple sclerosis can decrease humoral response after COVID-19 vaccines. This problem must be adequately addressed because new variants evolve, and COVID-19 still poses a risk to patients with comorbidities and immunosuppression. We aimed to evaluate the antibody response after the third dose of the COVID-19 vaccine in people with multiple sclerosis on disease-modifying therapies., Methods: People with multiple sclerosis who received the third dose of either mRNA or inactivated vaccine after two doses of inactivated vaccine were recruited for the study. Blood samples were collected at least two weeks after the third dose., Results: Blood samples of 339 (female 72.5%) people with multiple sclerosis and 52 (female 71.2%) healthy controls were evaluated. Healthy controls (mean: 4.07 ± 0.66) have higher antibody titers than people with multiple sclerosis (mean: 2.79 ± 2.95). Seronegative cases were observed only in the fingolimod and ocrelizumab treatment groups. Patients on fingolimod who received mRNA as a third dose had significantly higher antibody titer than those who had inactivated vaccines. Longer disease duration, having inactivated vaccine as a third dose, and DMT use was associated with lower antibody response., Conclusions: The study shows that even after inactivated vaccine schedule, mRNA still offers more protection in people with multiple sclerosis on disease-modifying therapies., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: Classic galactosemia is a galactose metabolism disorder due to galactose-1-phosphate uridyltransferase deficiency. In this study we report the clinical features of a cohort of children with classic galactosemia., Methods: A retrospective evaluation was made of the files of 42 cases followed up for a diagnosis of classic galactosemia between January 2000 and December 2021. The data were collected of clinical, laboratory and genetic characteristics., Results: The cases comprised of 25 (59.5%) girls and 17 (40.5%) boys with a median age of 15 days (range, 1 day to 9 years) at diagnosis. In addition, thirty-six cases (92.3%) could be diagnosed before they were 4 months old by hospitalization with various clinical findings, primarily liver dysfunction. The most common complaints on presentation were jaundice (78.4%) and vomiting (27%) and the most frequently seen genetic pathogenic variant was c.563A>G (p.Gln188Arg) (92.4%)., Conclusions: It can be emphasized that there is a need for a neonatal screening program for classic galactosemia to be able to increase the possibility of early diagnosis and to be able to start treatment before the development of a severe clinical picture., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Pompe disease is a rare genetic neuromuscular disorder caused by acid α-glucosidase (GAA) deficiency resulting in lysosomal glycogen accumulation and progressive myopathy. Enzyme replacement therapy, the current standard of care, penetrates poorly into the skeletal muscles and the peripheral and central nervous system (CNS), risks recombinant enzyme immunogenicity, and requires high doses and frequent infusions. Lentiviral vector-mediated hematopoietic stem and progenitor cell (HSPC) gene therapy was investigated in a Pompe mouse model using a clinically relevant promoter driving nine engineered GAA coding sequences incorporating distinct peptide tags and codon optimizations. Vectors solely including glycosylation-independent lysosomal targeting tags enhanced secretion and improved reduction of glycogen, myofiber, and CNS vacuolation in key tissues, although GAA enzyme activity and protein was consistently lower compared with native GAA. Genetically modified microglial cells in brains were detected at low levels but provided robust phenotypic correction. Furthermore, an amino acid substitution introduced in the tag reduced insulin receptor-mediated signaling with no evidence of an effect on blood glucose levels in Pompe mice. This study demonstrated the therapeutic potential of lentiviral HSPC gene therapy exploiting optimized GAA tagged coding sequences to reverse Pompe disease pathology in a preclinical mouse model, providing promising vector candidates for further investigation., Competing Interests: All authors are current or former employees of AVROBIO, Inc., Cambridge, MA, USA during the conception and writing of the manuscript, except A.S. AVROBIO, Inc. has a preclinical gene therapy program for Pompe disease (AVR-RD-03) based on a genetically modified HSPC platform using lentiviral vectors. Collection of data and analysis was performed as part of the program. This research received no external funding and was sponsored by AVROBIO, Inc., (© 2022 The Authors.)

Background: Left ventricular hypertrophy (LVH) is potentially modifiable cardiovascular risk factor often overlooked in clinical practice. For this reason, we planned to LVH-TR (Left Ventricular Hypertrophy in Turkish Population) trial to determine the aetiological causes and demographic characteristics of LVH patients., Methods: Our study was a multicentre, national, observational study and included 886 patients who applied to the cardiology clinics in 22 centres between February 2020 and August 2021. In the initial evaluation, the Fabry disease (FD) and cardiac amyloidosis (CA) algorithm was followed in patients whose definitive etiologic cause(s) could not be identified., Results: The most common aetiological causes of LVH in our study were hypertension with a rate of 56.6%, heart valve disease with 8.2%, and hypertrophic cardiomyopathy with 7.5%. Athlete's heart was detected in eight patients, LV non-compaction was detected in four patients. The rate of LVH of unknown cause was 18.8%. FD was suspected in 143 patients, and CA was suspected in 16 patients. There were 43 (4.85%) patients with low α-galactosidase A enzyme levels. GLA gene mutation analysis was positive in 1.58% of all patients, and these patients were diagnosed with FD, and 15 (1.69%) patients were diagnosed with CA by endomyocardial biopsy method., Conclusion: In the aetiology of LVH, the rate of LVH of unknown cause was high. FD and CA should be considered primarily in this patient group. Early diagnosis of the disease by following the schemes leading to FD and CA was essential in starting treatment before the progression of the disease.

Hematopoietic stem/progenitor cell gene therapy (HSPC-GT) has shown clear neurological benefit in rare diseases, which is achieved through the engraftment of genetically modified microglia-like cells (MLCs) in the brain. Still, the engraftment dynamics and the nature of engineered MLCs, as well as their potential use in common neurogenerative diseases, have remained largely unexplored. Here, we comprehensively characterized how different routes of administration affect the biodistribution of genetically engineered MLCs and other HSPC derivatives in mice. We generated a high-resolution single-cell transcriptional map of MLCs and discovered that they could clearly be distinguished from macrophages as well as from resident microglia by the expression of a specific gene signature that is reflective of their HSPC ontogeny and irrespective of their long-term engraftment history. Lastly, using murine models of Parkinson's disease and frontotemporal dementia, we demonstrated that MLCs can deliver therapeutically relevant levels of transgenic protein to the brain, thereby opening avenues for the clinical translation of HSPC-GT to the treatment of major neurological diseases., Competing Interests: Declaration of interests All authors are current employees of AVROBIO, Inc., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Although warfarin is the most effective treatment approved to prevent atrial fibrillation-associated stroke, it remains underused in clinical practice due to patient noncompliance. Therefore, novel oral anticoagulants (NOACs) have been developed., Aims: This study aimed to identify bleeding complications in patients who were taking oral anticoagulants and compare the rates of major and minor bleeding events between NOACs and warfarin groups., Patients and Methods: We conducted a retrospective, observational study of warfarin- and NOAC-treated patients who presented to an emergency department between January 2015 and December 2019 with bleeding events. We compared patients with major and minor bleeding in terms of age, gender, comorbid diseases, type of anticoagulant, and site of bleeding., Results: An electronic search yielded 95 (21.9%) cases of patients taking a NOAC (i.e., dabigatran [19], rivaroxaban [45], apixaban [29], or edoxaban [6]) and 354 taking warfarin. There were no significant differences between the warfarin and NOACs groups in the frequency of minor bleeding complications. Similarly, there were no significant differences between the groups in the frequency of major bleeding complications. No significant difference in intracranial bleeding was seen between the NOACs- and warfarin-treated patients, although the incidence of gastrointestinal bleeding was significantly higher in the NOACs (P = 0.102 and P = 0.021, respectively)., Conclusion: Our findings indicate that rates of major and minor bleeding complications in patients taking NOACs are similar to those in patients taking warfarin. While warfarin was associated with fewer complications than NOACs in terms of gastrointestinal bleeding, the risk of intracranial bleeding, was similar between the groups., Competing Interests: None

Although a high percentage of foetuses with supraventricular tachycardia respond to single or dual antiarrhythmic therapy, on occasion when there is no response to these combination regimens, direct intra-foetal therapy remains the only choice, albeit such an approach carries a potential risk to the foetus.Data with regard to the safety and efficacy of triple antiarrhythmic combination have not been reported before. Here, we present a foetus with intractable tachycardia in whom arrhythmia termination was successfully achieved with triple oral antiarrhythmic therapy.

Macrophages are highly plastic cells that can polarize into functionally distinct subsets in vivo and in vitro in response to environmental signals. The development of protocols to model macrophage polarization in vitro greatly contributes to our understanding of macrophage biology. Macrophages are divided into two main groups: Pro-inflammatory M1 macrophages (classically activated) and anti-inflammatory M2 macrophages (alternatively activated), based on several key surface markers and the production of inflammatory mediators. However, the expression of these common macrophage polarization markers is greatly affected by the stimulation time used. Unfortunately, there is no consensus yet regarding the optimal stimulation times for particular macrophage polarization markers in in vitro experiments. This situation is problematic, (i) as analysing a particular marker at a suboptimal time point can lead to false-negative results, and (ii) as it clearly impedes the comparison of different studies. Using human monocyte-derived macrophages (MDMs) in vitro, we analysed how the expression of the main polarization markers for M1 (CD64, CD86, CXCL9, CXCL10, HLA-DR, IDO1, IL1β, IL12, TNF), M2a (CD200R, CD206, CCL17, CCL22, IL-10, TGM2), and M2c (CD163, IL-10, TGFβ) macrophages changes over time at mRNA and protein levels. Our data establish the most appropriate stimulation time for the analysis of the expression of human macrophage polarization markers in vitro. Providing such a reference guide will likely facilitate the investigation of macrophage polarization and its reproducibility., Competing Interests: The authors have declared that no competing interests exist.

Background: Disease-modifying therapy could weaken the immune system and decrease the immune response to vaccines. It is essential to know which vaccine is more protective against SARS-CoV-2 in the multiple sclerosis population., Objective: To assess immune response after messenger RNA BNT162b2 (Pfizer/BioNTech) and inactivated Sinovac vaccines in people with multiple sclerosis (pwMS) treated with a disease-modifying therapy (DMT) compared to healthy controls., Methods: This single-center cross-sectional study included 526 MS patients treated with DMT, 44 healthy controls, and 21 untreated patients with MS between May 2021 and September 2021. Serum samples were collected at least two weeks after the second dose of the vaccine., Results: Participants vaccinated with BNT162b2 had a higher antibody titer than the Sinovac group (95%CI=1.023 - 1.473; p< .001). No significant difference between antibody titer of pwMS without treatment and HC was found [95%CI= -0.882; - 0.935 p > .99]. In 65 adults without DMT use (HC+pwMSwithout treatment), no seronegative cases were observed in any vaccine group. In patients treated with DMT, BNT162b2 was associated with a 16.3% greater absolute risk of seropositivity than Sinovac., Conclusion: The mRNA vaccine could be a preferred choice of protection against SARS-CoV-2 in pMS treated with DMT., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To determine the difference in serum Elabela level in hypertensive patients with and without nephropathy compared to the healthy control group. Study Desing:  Cross-sectional descriptive study., Place and Duration of Study: Fırat University Medical School, Elazig, Turkey between December 2018 and November 2020., Methodology: The cross-sectional descriptive study consisted of 37 patients with hypertensive nephropathy (group 3), 50 hypertensive patients without nephropathy (group 2), and 50 healthy controls (group 1). Hypertensive nephropathy was defined as serum creatinine ≥1.8 mg / dl or  GFR <40 ml / minute. Biochemical parameters (Glucose, AST, ALT, urea, creatinine, lipid levels, hemogram, calcium, phosphorus, parathormone) and the levels of serum Elabela were evaluated and compared., Results: There was no significant difference in age (0.270) and gender (0.951) between groups. The median Elabela levels of the three groups were 40.3 ng/mL (22.5-54.6), 5.1 ng/mL (3.7-8.3), 9.2 ng/mL (6.1-23.1), respectively with a significant difference (p<0.001)., Conclusion: The plasma levels of Elabela were lower in the case of hypertension, independent of nephropathy. However, this decrease is not specific for nephropathy and may be due to other accompanying chronic diseases. Key Words: Hypertension, Hypertensive nephropathy, Elabela.

Colony-stimulating factor 1 (CSF1) is a primary regulator of the survival, proliferation, and differentiation of monocyte/macrophage that sustains the protumorigenic functions of tumor-associated macrophages (TAMs). Considering current advances in understanding the role of the inflammatory tumor microenvironment, targeting the components of the sarcoma microenvironment, such as TAMs, is a viable strategy. Here, we investigated the effect of PLX3397 (pexidartinib) as a potent inhibitor of the CSF1 receptor (CSF1R). PLX3397 was recently approved by the Food and Drug Administration (FDA) to treat tenosynovial giant cell tumor and reprogram TAMs whose infiltration correlates with unfavorable prognosis of sarcomas. First, we confirmed by cytokine arrays of tumor-conditioned media (TCM) that cytokines including CSF1 are secreted from LM8 osteosarcoma cells and NFSa fibrosarcoma cells. The TCM, like CSF1, stimulated ERK1/2 phosphorylation in bone marrow-derived macrophages (BMDMs), polarized BMDMs toward an M2 (TAM-like) phenotype, and strikingly promoted BMDM chemotaxis. In vitro administration of PLX3397 suppressed pERK1/2 stimulation by CSF1 or TCM, and reduced M2 polarization, survival, and chemotaxis in BMDMs. Systemic administration of PLX3397 to the osteosarcoma orthotopic xenograft model significantly suppressed the primary tumor growth and lung metastasis, and thus improved metastasis-free survival. PLX3397 treatment concurrently depleted TAMs and FOXP3 + regulatory T cells and, surprisingly, enhanced infiltration of CD8 + T cells into the microenvironments of both primary and metastatic osteosarcoma sites. Our preclinical results show that PLX3397 has strong macrophage- and T-cell-modulating effects that may translate into cancer immunotherapy for bone and soft-tissue sarcomas., (©2021 American Association for Cancer Research.)

Background: We investigated potential predictive factors for mortality and disease severity from demographic and clinical data, comorbidities, and laboratory findings in patients with confirmed COVID-19 who were consecutively admitted to our tertiary hospital., Methods: In this retrospective, single-center, observational study, we enrolled consecutive 540 adult patients who had COVID-19 confirmed by a molecular method. Patients were categorized into three groups based on disease severity. Patients' demographic and clinical characteristics, mortality rates, and mortality-associated factors were analyzed., Results: The overall mortality rate was 4.3% (23/540). Disease severity was mild in 40.9% (n = 221), severe in 53.7% (n = 290), and critical in 5.4% (n = 29) of the patients. There were significant differences among groups in terms of median white blood cell (WBC), hemoglobin, neutrophil, lymphocyte, and thrombocyte counts, as well as C-reactive protein (CRP), procalcitonin, lactate dehydrogenase (LDH), creatinine, albumin, D-dimer, ferritin, troponin, and fibrinogen levels. Furthermore, there were significant differences between surviving and non-surviving patient groups in terms of median WBC, hemoglobin, neutrophil, and lymphocyte counts, as well as CRP, procalcitonin, LDH, creatinine, albumin, D-dimer, and ferritin levels. CRP level (odds ratio [OR]: 1.020, 95% confidence interval [CI]: 1.009-1.032; p < 0.001), and CURB-65 score (OR: 4.004, 95% CI: 1,288-12,447; p = 0.017) were independently associated with disease severity and mortality., Conclusion: On admission, WBC, neutrophil, lymphocyte, and platelet counts can be used to predict disease severity in patients with COVID-19. CRP, ferritin, LDH, creatinine, troponin, D-dimer, fibrinogen, and albumin levels can also be used to predict disease severity in these patients. Finally, elevated CRP level and high CURB-65 score were predictors of disease severity and mortality., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Az et al.)

The use of wastewater in irrigation weakens the beneficial properties of the soil and leads to a threat to food safety standards. The present research was designed to explore the cobalt toxicity associated with the ingestion of wastewater irrigated wheat. Wheat plants of five different varieties were collected from 7 different sites of Punjab, Pakistan, which were irrigated with three different sources of water. The sampling was done in two cropping years. The cobalt values in water, soil and wheat samples (root, shoot, grain) ranged from 0.46 to 1.24 mg/l, 0.15 to 1.20, 0.29 to 1.30, 0.08 to 0.76 and 0.12 to 0.57 mg/kg, respectively. All the water samples showed high cobalt concentration than the maximum permissible value. However, all the soil and wheat plant samples were found within the maximum allowable range. The high cobalt concentration in irrigating water showed that the continuous usage of such type of water may lead to cobalt toxicity in living organisms with the passage of time and may results in severe health risks.

Background: Atrial fibrillation (AF) prevalence in patients with acute myocardial infarction (MI) ranges from 3% to 25%. However demographic, clinical, and angiographic characteristics of AF patients who admitted with de novo MI are unclear. The aim of this study was to investigate the prevalence of patients presenting with de novo MI with AF., Methods: The study was performed as a sub-study of the MINOCA-TR (Myocardial Infarction with Non-obstructive Coronary Arteries in Turkish Population) Registry, a multicenter, cross-sectional, observational, all-comer registry. MI patients without a known history of stable coronary artery disease and/or prior coronary revascularization were enrolled in the study. Patients were divided into AF and Non-AF groups according to presenting cardiac rhythm., Results: A total of 1793 patients were screened and 1626 were included in the study. The mean age was 61.5 (12.5) years. 70.7% of patients were men. The prevalence of AF was 3.1% (51 patients). AF patients were older [73.4 (9.4) vs. 61.0 (12.4) years, p<0.001] than non-AF patients. The proportion of women to men in the AF group was also higher than in the non-AF group (43.1% vs. 28.7%, p=0.027). Only 1 out of every 5 AF patients (10 patients, 19.6%) was using oral anticoagulants (OAC)., Conclusions: AF prevalence in patients presenting with de novo MI was lower than previous studies that issued on AF prevalence in MI cohorts. The majority of AF patients did not have any knowledge of their arrhythmia and were not undergoing OAC therapy at admission, emphasizing the vital role of successful diagnostic strategies, patient education, and implementations for guideline adaptation.

Purpose: The aim of this study was to compare volumetric parameters in the abnormal and normal posterior fossa using the Virtual Organ Computer-aided AnaLysis (VOCAL™) technique to determine whether fetuses with an abnormal posterior fossa have different volumes. Methods: A prospective study was conducted on 17 fetuses with an abnormal posterior fossa including, Dandy Walker malformation (DWM) ( n  = 6), vermian hypoplasia (VH) ( n  = 3), mega cisterna magna (MCM) ( n  = 8), and 99 healthy control fetuses from 20 to 34 weeks' gestation. Measurement of the fetal cisterna magna and cerebellar volume was performed in the standard transcerebellar plane through the VOCAL™ method. To establish the correlation of volumes with gestational age, polynomial regression analysis was performed. For comparison between groups, univariate ANCOVA was performed using gestational age as a covariate. The reliability was analyzed by the intraclass correlation coefficient (ICC). Results: Cerebellar volume and cisterna magna volume were correlated with gestational age. Posterior fossa volume was significantly larger in DWM ( p  < .0001) and MCM ( p  < .0001) in comparison to the control group. In VH group, cisterna magna volume does not seem to expand ( p  = .298). Cerebellar volume does not seem to change in subgroups when the influence of gestational age is discarded ( p  = .09). The ratio of cerebellar volume to the cisterna magna volume decreases significantly in abnormal fetuses ( p  < .0001). Good intraobserver and interobserver reliabilities were found for both cerebellum and cisterna magna measurements. Conclusions: Volume analysis may have a role in discrimination of different posterior fossa pathologies.

Introduction: Whereas body-contouring surgery after massive weight loss in women receives much attention, little attention has been devoted to accentuating the male physique. Male patients after massive weight loss often suffer from redundant skin and soft tissue in the anterior and lateral chest region, causing various deformities of pseudogynecomastia. The authors present their approach to high-grade pseudogynecomastia correction with preservation of the NAC on an inferior dermoglandular pedicle with transverse scar only closure and without any meaningful liposuction., Materials and Methods: A description of comprehensive pseudogynecomastia correction with the aforementioned technique followed by review of 58 consecutive patients operated on in our clinic from January 2017 to June 2018. Epidemiological data such as age, weight, height, body mass index (BMI), weight loss, and the medical history of each patient were collected. All patients were photo-documented preoperatively and postoperatively in a standard manner. During the operation, weight of resected tissue and operative time were noted., Results: Fifty-eight patients were operated on in a single stage. In our series, one patient had unilateral partial necrosis on nipple-areola complex, and two patients had minimal to moderate amounts of hematoma which were followed up without intervention. We did not encounter any infection-related complications or skin redundancy in our patients. Out of 58 patients, 55 of all the patients were highly satisfied with the aesthetic results. Three patients were mildly satisfied with the results, but they stress that moderate scar widening was the reason for the displeasure, not the definition of the chest which was deemed as satisfactory like the rest., Conclusion: Our technique obviates the need for skin resection in a second operation, allows immediate skin recontouring, and provides a viable nipple-areola complex at the desired location. The patient does not have to suffer prolonged stress while awaiting skin retraction and is protected from a second dose of anesthesia and hospitalization., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Introduction: Meteorin-like (Metrnl), also known as subfatin, is a recently discovered adipokine with a favourable effect on insulin sensitivity. Studies have shown lower Metrnl levels in obese patients. However, data on its circulating levels in type 2 diabetes mellitus (T2DM) patients are contradictory. This study aims to evaluate serum Metrnl levels in T2DM patients and determine the relationship between serum Metrnl levels and insulin resistance in these patients., Material and Methods: This cross-sectional study was conducted among 150 participants. The study was carried out between June 2019 and December 2019 at the internal medicine outpatient clinic of a tertiary university hospital. The participants were divided into three groups: group 1 (control group, n = 50), group 2 (newly diagnosed T2DM, n = 50), and group 3 (long-standing diagnosed T2DM, n = 50). An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of Subfatin (Metrnl), and the correlations of Metrnl level with anthropometric parameters, HOMA index, and biochemical measurements were assessed., Results: There was no statistically significant difference between the gender (p = 0.468) and age (p = 0.067) characteristics of the three groups. The Metrnl (subfatin) levels of the participants were as follows: control group - 20.05 (1.56-103.78); newly diagnosed T2DM group - 2.62 (1.25-103.78); and long-standing diagnosed T2DM group - 2.01 (0.80-19.84) pg/mL. The Metrnl (subfatin) levels of the participants in the control group were higher than in the participants in the newly diagnosed T2DM and long-standing diagnosed T2DM groups (p < 0.001). Subfatin demonstrated a negative correlation with insulin and HOMA-IR in the control group and long-standing diagnosed T2DM group., Conclusions: The subfatin level was found to be higher in the healthy control group than in both diabetic patient groups. Subfatin level showed negative correlation with both insulin level and HOMA index. There was a relationship between subfatin and insulin resistance. Low levels of subfatin in the diabetic patient groups may play a role in the pathogenesis of T2DM by increasing insulin resistance.

The irrigation with sewage water can be useful if it has no negative effects on food crop yield, soil pollution, and health of humans. However, it includes various types of contaminants like heavy metals that pollute the soil and crops. In this regard, the aim of this study was to evaluate the possible health risks of heavy metals in forages. Forages both of summer and winter were grown with different water treatments (sewage water and tap water) in Department of Botany, University of Sargodha. The concentration of iron (Fe) in water, soil, and plant samples was determined. The Fe values in tap and sewage water were observed as 0.090 and 0.115 mg/L, respectively. The highest mean concentration of Fe was 9.608 mg/kg in the soil where Trifolium alexandrinum is grown, and the lowest mean concentration was 0.154 mg/kg which occurred in the soil where Trifolium resupinatum is grown in winter. The maximum mean concentration of Fe in the root samples of plants was observed as 2.483 mg/kg in Pennisetum typhoideum, and the minimum mean concentration occurred as 0.390 mg/kg in Zea mays grown in summer. The maximum bioconcentration factor value of Fe was observed for T. resupinatum (5.259) grown in winter. The maximum pollution load index value of Fe was observed for T. alexandrinum (0.1688). The maximum value of daily intake of metals was observed as 0.0731 in Medicago sativa, and the maximum health risk index value was determined as 0.1091 in P. typhoideum.

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, β-hCG level, the type of scar pregnancy and the clinical status of the patient. IMPACT STATEMENT What is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity. What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies. What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP.

Pakistan is an agricultural country and due to the shortage of clean water, most of the irrigated area (32,500 ha) of Pakistan was supplied with wastewater (0.876 × 109 m 3 /year). Concentrations of heavy metals in radish (Raphanus sativus) and turnip (Brassica rapa) taken from vegetable fields in Sargodha, Pakistan, were measured. Untreated wastewater was used persistently for a long time to irrigate these vegetable fields. A control site was selected that had a history of fresh groundwater irrigation. Mean metal concentrations were found for irrigation water, soil, and vegetables. In irrigation water, concentrations of Mo and Pb at three sites and Se at sites II and III were higher than the recommended limits. In vegetables, concentrations of Mo and Pb were above the maximum permissible limits. High bioconcentration factor was observed for Zn (12.61 in R. sativus and 11.72 in B. rapa) at site I and high pollution load index was found for Pb (3.89 in R. sativus and 3.87 in B. rapa) at site II. The differences in metal concentrations found in samples depended upon different soil nature and assimilation capacities of vegetables at different sites which in turn depended upon different environmental cues. The entrance of metal and metalloids to human body may happen through different pathways; however, the food chain is the chief route through which metals are transferred from vegetables to individuals. Health risk index observed for metals, (Mo, As, Ni, Cu, and Pb) higher than 1 indicated high risk through consumption of these vegetables at three sites.

Competing Interests: There are no conflicts of interest.

Background: Studies of ethnobotanical usages in south-eastern Turkey are rare. To widen this field of knowledge, we conducted an ethnobotanical study in Midyat (Mardin Province), Turkey., Methods: The field study was completed during three years (2007-2010). Our aim was to document the ethnobotanical uses of local plants and to make an ethnobotanical inventory of uncommon plants using qualitative interviews., Results: During field studies, 368 voucher specimens were collected in the investigated area. Ninety-two traditionally used plant species were reported from Midyat and surrounding vicinities in Turkey. Among the 92 taxa (129 usages), 35% were used for medical purposes, 22% for food, 13% for animal fodder, 7% as ornamental plants and dyes, 6% as brooms, 4% for latex and as fragrance, 4% for herbal tea, molasses and wine preparation, 3% for agricultural purposes, and 6% for other purposes. Comparative assessment showed that Teucrium polium (0.51), Matricaria aurea (0.26), Alcea setosa (0.21), and Malva neglecta (0.21) have the highest recorded UVs , and the following taxa had UVs between 0.10-0.20: Anthemis cotula (0.12), Allium cepa (0.13), Alcea striata subsp. striata (0.14), Crupina crupinastrum (0.12), Papaver rhoeas (0.13), Salvia multicaulis (0.14), Thymbra spicata (0.11), and Vicia pannonica subsp. striata (0.15). We reported the ethnobotanical usages of 21 taxa for the first time, in addition to indicating usages previously recorded in the literature. We also recorded four endemic plant usages in the area: Alkanna trichophila var. mardinensis, Centaurea kurdica, Centaurea stapfiana, and Sideritis libanotica subsp. linearis. They have variable leaf and flower morphology that are used traditionally. They are present as well-developed populations and thus their conservation status is not compromised. Additionally, Thymbra sintenisii is a recorded species that is classified as a rare and extensively used species in the region., Conclusions: These results contribute to the fundamental knowledge of ethnobotanical usages in Midyat. To date, ethnobotanical studies have not been carried out in this region. This investigation uncovered usages of endemic medicinal plant species and traditional knowledge of Midyat communities living in a mixed culture. The people of Midyat, Batman, and Şırnak are Turkish citizens from various ethnic backgrounds, such as Kurdish, Arabic, and Syriac. We compared our data with results from other studies conducted in Turkey, particularly in south-eastern and eastern regions, as well as with studies from bordering countries, Iraq, Jordan, Syria, and Iran. Nonetheless, more work needs to be conducted to extend the present knowledge for locals to contribute to and evaluate economic potential in the region.

[Purpose] The aim of this study was to determine the frequency, type, and location of pain in hemiplegic patients and the effects on rehabilitation results in our inpatient rehabilitation unit. [Subjects and Methods] Patients rehabilitated between January 2010 and July 2012 were investigated retrospectively. Properties of pain were recorded. Pre- and post-rehabilitation motor evaluation and achievement in daily activities were considered, and differences in scores between groups classified as with and without pain were examined. [Results] The number of patients included in the study was 156. The mean age was 64.28 ± 12.45 years, the mean disease duration was 11.10 months, and the gender distribution was 75 males (48%) and 81 females (52%). Fortysix (29.5%) patients had pain complaints. The nociceptive pain ratio was 86.7%, and the neuropathic pain ratio was 13.3%. Pain was mostly localized at the shoulder joint, with the proportion being 86.9%. In the pain group, statistically significant improvement was found in pain scores after the treatment. There was no significant difference between groups in the pre- and post-rehabilitation Brunnstrom motor evaluation and functional independence measurement scores. [Conclusion] Nociceptive pain is more common than neuropathic pain in patients with hemiplegia, and the shoulder joint is the most frequent location of nociceptive pain.

Objective: In this study we aimed to investigate heart rate recovery (HRR) in patients with inflammatory bowel disease (IBD)., Subjects and Methods: A total of 40 patients with IBD and 30 healthy controls were included in this study. A treadmill stress test was performed in all the patients to calculate the HRR index based on the age-specific maximum heart rate. The HRR indices were calculated as follows: HRR1, 2, 3, 4, 5 = heart rate at peak exercise - heart rate at 1, 2, 3, 4, and 5 min. The independent samples t test was used to compare HRR indices between the patient and control groups. The Pearson correlation coefficient was used to examine the association between the duration of IBD and the HRR indices. Multivariate regression analysis was carried out to identify predictors of impaired HRR in patients with IBD., Results: HRR indices at various time intervals were significantly lower in the patients with IBD than in the controls: HRR1 (1.18 ± 8 vs. 31 ± 7, p < 0.001), HRR2 (36 ± 12 vs. 51 ± 8, p < 0.001), HRR3 (46 ± 12 vs. 62 ± 11, p < 0.001), HRR4 (54 ± 7 vs. 65 ± 8, p < 0.001), and HRR5 (55 ± 13 vs. 71 ± 15, p < 0.001). Mean duration of IBD was 7.8 ± 3.6 years. In addition, there was a significant negative correlation between disease duration and HRR at the first minute (r = -0.704, p < 0.001). Multivariate logistic regression analysis showed that symptom duration (OR: 1.742, 95% CI: 1.148-2.636, p = 0.009) was an independent predictor of impaired HRR in patients with IBD., Conclusion: In this study, the data showed that the HRR was impaired in patients with IBDs. Hence, given the prognostic value of the test, patients with IBD should be monitored for future cardiovascular events., (© 2016 S. Karger AG, Basel.)

Background: There is no ideal sedation technique that can be used during transoesophageal echocardiography (TEE), and the data concerning the effects of available sedation techniques on heart rate variability (HRV) are limited., Aim: To compare the effects of sedation through hypnotherapy with medical sedation achieved by midazolam on HRV., Methods: We recruited 76 patients with an indication of TEE; the age range was 18-83 years. In Group T there were 26 patients who had the procedure under topical pharyngeal anaesthesia, in Group D there were 23 patients who received midazolam, and in Group H there were 27 patients receiving hypnosis. All patients had an IV access; throughout the procedure heart rate, rhythm electrocardiography, and peripheric O2 saturation were monitored with a non-invasive monitor, and blood pressure measurements were taken every 3 min. Rhythm Holter recordings were obtained from all patients and TEE was performed., Results: When time domain parameters for HRV were compared in all three groups, the hypnosis group had significant increases in pNN50 and RMSSD compared to Groups D and T (p < 0.05). As concerns frequency domain parameters, there were no significant differences between groups where low frequency (LF) was decreased in hypnosis group and high frequency (HF) was increased (p > 0.05). However, LF/HF was decreased statistically significantly (p < 0.05) when compared with the midazolam group., Conclusions: Contrary to standard sedation in TEE patients, when hypnosis is used autonomic cardiac tone is modified to a significant extent. Hypnotic sedation achieves this by increasing the parasympathetic activity, decreasing the sympathetic activity, and changing the sympathovagal interaction balance.

Ethnopharmacological Relevance: Fermented food and beverages represent an important part of the worldwide foodscape, medicinal food domain and domestic strategies of health care, yet relevant traditional knowledge in Europe is poorly documented., Methods: Review of primary ethnographic literature, archival sources and a few ad-hoc ethnobotanical field studies in seven selected Eastern European countries (Albania, Belarus, Bulgaria, Estonia, Hungary, Kosovo, and Poland) were conducted., Results: Current or recently abandoned uses of 116 botanical taxa, belonging to 37 families in fermented food or medicinal food products were recorded. These findings demonstrate a rich bio-cultural diversity of use, and also a clear prevalence of the use of fruits of the tannin- and phenolic-rich Rosaceae species in alcoholic, lactic- and acetic acid fermented preparations. In the considered countries, fermentation still plays (or has played until recent years) a crucial role in folk cuisines and this heritage requires urgent and in-depth evaluation., Discussion: Future studies should be aimed at further documenting and also bio-evaluating the ingredients and processes involved in the preparation of homemade fermented products, as this can be used to support local, community-based development efforts to foster food security, food sovereignty, and small-scale local food-based economies., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

The objectives of the present study were to determine Helicobacter pylori via culture, polymerase chain reaction and histopathological diagnosis in 101 children ranging in age from 4 to 18 years, to identify the association among restriction fragment length polymorphism types and clinical disease and to investigate the relationships among different isolates of H. pylori in different age groups. We observed a high prevalence of H. pylori infections in children between the ages of 13 and 18 (75.8%), while children aged 4 to 6 years had the lowest prevalence of infection (40%). H. pylori was detected in 30.7% (31 of 101), 66.3% (67 of 101) and 63.2% (60 of 95) of children as determined by culture methods, PCR and histological examination, respectively. H. pylori isolates with RFLP types I and III were the most common among children with antral nodularity, whereas RFLP types II and IV were the least detected types. Interestingly, all isolates from peptic ulcer patients were type III. Although our results show a high prevalence of H. pylori infections in the pediatric population in eastern Turkey, no association was identified between H. pylori infection with antral nodularity and recurring abdominal pain. In addition, we found low genetic variation among H. pylori isolates from children and no association between RFLP types and antral nodularity (p > 0.05). Additionally, we found that H. pylori isolates with specific RFLP types were predominant in different age groups.

Objectives: The incidence of heart failure is higher in patients with rheumatoid arthritis (RA) than in the general population and contributes to elevated cardiovascular mortality and morbidity rates. Impaired myocardial function can be detected by a novel echocardiographic method, speckle tracking echocardiography (STE), when conventional methods have yielded normal findings. The aim of our study was to investigate the effect of disease duration on myocardial strain and strain rate parameters in patients with RA., Methods: This cross-sectional study included 37 RA patients [n=16, female gender n=16, mean age, 45.7 ± 9 years in the early-stage disease (ESD); n= 21, female gender n=19, 45.7 ± 16.8 years in the advanced-stage disease (ASD) group] who were compared according to early disease duration and advanced-stage disease (2.8 ± 1.2 vs. 14.6 ± 6.8 years, respectively). Hypertension, diabetes mellitus, and other cardiovascular risk factors were excluded. Offline analysis of STE was performed and data between the two groups were compared., Results: RS, RSR-E, and RSR-E/A values were statistically significantly lower in patients with ASD. Circumferential strain and strain rate were similar between the two groups. Except for LSR-E/A values, LS, LSR-S, LSR-E, and LSR-A values were decreased in patients with ASD., Conclusion: RA patients without clinical evidence of cardiovascular disease and in the absence of traditional cardiovascular risk factors can be followed up with STE. In this way, early impairment of myocardial deformation can be detected before the appearance of any clinical evidence of cardiac involvement.

Objective: Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI., Methods and Results: A total of 266 consecutive patients presenting with STEMI within the first 12 h of symptom onset were included in this study. Patients were divided into two groups based on the postinterventional Thrombolysis In Myocardial Infarction (TIMI) flow grade score. Postinterventional TIMI grades of 0, 1, or 2 were defined as no-reflow (group 1) and angiographic success was defined as TIMI 3 flow (group 2). D-dimer levels were significantly higher in patients with postinterventional no-reflow than in patients with postinterventional TIMI grade 3 flow (686 ± 236 μg/ml-418 ± 164 μg/ml, p < 0.001). Multivariate logistic regression analysis showed that D-dimer level was an independent predictor of postinterventional no-reflow (OR: 1.005; 95 % CI: 1.003-1.007; p < 0.001) and in-hospital major adverse cardiovascular events (MACE; OR: 1.002; 95 % CI: 1.000-1.004; p = 0.029). Receiver operator characteristics analysis provided a cut-off value of 549 μg/ml for D-dimer for predicting no-reflow with an 83 % sensitivity and an 81 % specificity, and 544 μg/ml for predicting in-hospital MACE with a 69 % sensitivity and a 67 % specificity., Conclusion: In conclusion, D-dimer levels measured on admission may be an independent predictor of no-reflow, which is also a predictor of adverse outcomes in patients with STEMI.