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Aims: The aim of the study was to use Response Surface Methodology (RSM) to find optimal experimental design for wastewater treatments from office paper recycling. In this way, interactive effects of treatment factors were evaluated, including microwave power (MW) and durations with centrifuge time while turbidity of wastewater was chosen as the dependent output variable or an optimal response. Methodology: The RSM approach was utilized for optimization of the process parameters and identifying the optimal conditions for the removal of turbidity in paper recycling wastewater. In this regard, a three-factor RSM were selected, using MW irradiation power (Watts), durations (seconds) and centrifuge time (min). Statistical analysis of variance (ANOVA) was carried out to identify the adequacy of the developed model. In this case, specially prepared office papers (one-side laser printed) were subjected to standard paper recycling procedure for obtaining wastewater at laboratory conditions. The experimentally derived RSM model was validated using range of statistical parameters. Conclusions: The study revealed that under the RSM optimized conditions, a marked reduction in the turbidity of wastewater was observed for both groups studied. The R2, R2(adj) and R2(pred) values were indicates, the developed model was significant which revealed a well agreement between the experimental data and proposed model. In this approach, the R2=99.710% and lack-of-fit value were found to be 0.111 (p>0.05), which shows the model and the data consisted to each other. The lowest turbidity value was found with 150.000 Watts and 60.000 seconds in MW conditions with 15.000 minutes of centrifugation time, experimentally. With employing these variables, the turbidity value of 6.65 NTU was determined. However, the highest turbidity value of 18.013 NTU was found with MW power of 200.00 Watts with 40.000 seconds of durations and 1.591 minute of centrifugation time. It is important to note that with using optimized parameters, the turbidity value of 1.43 NTU was calculated while 1.47 NTU was found with experimentally.

Resumen Introduccion y objetivos Comparar, en terminos de eficacia y seguridad, los resultados del tratamiento endoscopico del reflujo vesicoureteral (RVU) en dos cohortes diferentes de RVU primario tratadas con Dexell y Vantris. Pacientes El estudio incluyo 128 unidades de reflujo renal (URR) en 87 pacientes con RVU primario (64 mujeres, 23 hombres). Se excluyeron los pacientes con RVU secundario y disfuncion vesical e intestinal severa. Un total de 22 ninos mayores ya continentes, con disfuncion vesico-intestinal leve, fueron sometidos a entrenamiento vesico-intestinal previo a la implantacion. Todos los procedimientos se realizaron en presencia de orina esteril mediante la tecnica convencional de inyeccion transuretral subureteral. Resultados No hubo diferencias estadisticamente significativas entre los dos grupos en cuanto a media de edad, sexo, lateralidad de la URR, captacion de 99mTc-DMSA y grado de reflujo. Las tasas de resolucion global con base en el numero de URR con hasta tres tratamientos endoscopicos fueron del 80% (56/70) en el grupo Dexell y del 94,8% (55/58) en el grupo Vantris (p = 0,012). No se observaron recidivas ni obstrucciones de la union vesicoureteral en el postoperatorio en ningun grupo. Conclusiones Dexell y Vantris proporcionaron un tratamiento endoscopico eficaz y seguro en el seguimiento a corto y medio plazo del RVU primario en ninos. Se requieren mas estudios para evaluar la eficacia de estas sustancias, cuyo efecto de volumen depende del tamano de sus particulas, en la resolucion segura del RVU.

Introduction and Objectives We aimed to point out the ureteral access facility and obstruction removal efficiency of mini-URS in the use of proximal ureteral stone management in children under five-year-old. Patients We retrospectively reviewed the data of 26 children who underwent mini-URS-LL for obstructive stones in proximal ureter between January 2016 and August 2018. The effectiveness of the mini-URS-LL was assessed based on the feasibility, reliability, and success of the technique. Results Mean age was 3 ± 1.3 years, and 11 (42.3%) patients were ≤2 years old, remaining 15 (57.7%) were aged 3−5 years. Mean stone size was 9.11 ± 3.02 mm. A stone-free status was obtained at the end of 31 ureteroscopic procedure in 24 (92.3%) patients. The mean age was found significantly higher in patients who had the procedure without pre-stenting than the others who did (P = .027). No perioperative complication was experienced. Conclusion In preschool-age children, laser lithotripsy with mini-URS may be a safe technique in the hands with advanced endo-urological skills but it has low efficacy with higher rates of prestenting causing additional anesthesia sessions.

Chromosome line and characterization of nine Turkish alfalfa (Medicago sativa L.) lines were investigated using karyological techniques in this study. Root tips were obtained from germinated alfalfa seeds in petri dishes at room temperature (25°C) for visualizing somatic chromosomes. The chromosome numbers of nine alfalfa lines were determined as 2n=4x=32. The karyotype formula of 2n=32= 30m+ 2sm (30 median + 2 submedian) were noted for Line 1, 2and 3. Whereas, Line 4, 6, 8, 9 showed the karyotype formula of 2n=32=32m (32 median). The karyotype formula of Line 5 and 7 were 2n=32=28m+4sm (28 median + 4 submedian). Satellite chromosome pairs were observed from Line 5. The results of the karyotype asymmetry index analysis showed that intrachromosomal asymmetry is higher than interchromosomal asymmetry in the karyotypes of alfalfa lines.

Children with constitutional mismatch repair deficiency syndrome (CMMRDS) are prone to different types of cancers. A 16-year-old girl who was misdiagnosed with neurofibromatosis Type-I (NF-I) for 1 years had experienced glioblastoma and colonic adenocarcinoma. After operation, chemotherapy and radiotherapy were started for adenocarcinoma. Genetic analysis from the patient, effected brother, and mother showed heterozygote (c.479 + 36A> G) mutation in the intron 4 region of NF-1 gene. Initially, it was thought that this genetic variant was causative. Furthermore, next generation sequencing showed that the index patient and his brother have homozygote (c.1444 C>T) mutations in the MSH6 gene which are associated with CMMRDS both died because of colonic adenocarcinoma, and T cell non-Hodgkin lymphoma, respectively. Patients with CMMRDS may resemble NF-I. The physicians must not be confused with the previous diagnosis. Increased awareness of CMMRDS, and prompt evaluation for an underlying genetic background is advised if there are unexpected cancer in patients with NF-I.

Background: Mungbean [Vigna radiata (L.) Wilczek] is known as one of the important crop of the Vigna group. In order to determine morphological traits of mungbean, multivariate analysis will provide important advantages in the selection phase of future breeding programs. Multivariate statistical analysis was used to determine and classify these traits. Multivariate analysis, that includes principal component analysis (PCA) and cluster analysis (CA), is considered the best tool for selecting promising genotypes in the future breeding programs. Methods: Eighteen landraces and two species were used to classify morphological traits in this study. Nine different morphological traits were observed during the research period. These are; days to 50% flowering (DFT), plant height (PH), branches per plant (BPP), clusters per plant (CPP), number of pods per cluster (PPC), seed yield per plot (SYPP), biomass yield per plot (BYPP), harvest index (HI), 1000 seed weight (SW). Result: Principal component analysis (PCA) revealed a high level of variation among the genotypes. Therefore, high variability was observed in DFT (36-59 day), PH (39-76 cm), BPP (3-7), CPP (4-21), SYPP (231-824 g), BYPP (3300-10300 g), HI (6.77-11.25%) and 1000 SW (19.95-50.50 g). According to cluster analysis, landraces with the least genetic diversity distance between them in terms of morphological traits examined were determined as 2 and 3.

To the Editor Sodium-glucose co-transporter 2 (SGLT2) inhibitor therapy is a specific mode of anti-diabetic strategy that significantly improves cardiovascular outcomes.1 The recently published article by Joshi et al 1 has focused on beneficial effects of SGLT2 inhibitors in the setting of heart failure (HF). We fully agree that complex cellular mechanisms, beyond diuresis,1 seem to underlie pleitrophic actions of these agents. More specifically, it also seems likely that SGLT2 inhibitors might potentiate favourable effects of certain metabolic agents including cellular anti-ischaemics (and vice versa) in patients with diabetes with cardiovascular disease. Accordingly, combination of SGLT2 inhibitors with cellular anti-ischaemic regimens might have important implications in these …

In clinical practice, cardiac myxomas constitute the majority of benign cardiac neoplasms, and might potentially present with a variety of embolic, obstructive as well as constitutional symptoms. On the other hand, these neoplasms might be potentially associated with the evolution of takotsubo cardiomyopathy (TTC) that is universally considered as a transient form of acute myocardial dysfunction. Accordingly, the present paper primarily aims to focus on potential mechanisms and associated clinical implications of TTC evolution in the setting of cardiac myxomas.

Background: It is known that chemotherapeutic agents cause myocardial cell damage leading to left ventricular dysfunction and heart failure. Fragmented QRS is an indication of fibrosis developing as a result of myocardial cell damage. The aim of this study is to assess whether there is a relationship between the chemotherapeutic treatment and the development of the fragmented QRS complex in electrocardiography (ECG). Patients and Methods: Among 130 patients who were diagnosed with non-Hodgkin lymphoma and received an R-CHOP treatment regimen, the potential emergence of fragmented QRS on ECG as well as the changes in the left ventricular ejection fraction (LVEF) (on transthoracic echocardiography) in response to various chemotherapeutic regimens were sought. Results: New development of a fragmented QRS pattern was observed in 53 of the 130 patients (40.8%). These patients were found to have lower LVEF values along with higher numbers of chemotherapy courses and cumulative doses. In the logistic regression analysis, age (OR = 1.042; 95% CI 1.009–1.076; p = 0.012) and number of courses (OR = 1.848; 95% CI 1.409–2.423; p < 0.001) were found to be the most important predictors of fragmented QRS development. In subjects with a fragmented QRS pattern, there was a significant difference between the initial and repeat LVEF values (p < 0.001). Importantly the emergence of a fragmentation pattern occurred much earlier compared to the drop in LVEF values (10.62 ± 4.04 vs. 15.24 ± 7.49 months). Conclusion: Development of a fragmented QRS pattern in response to cancer therapy emerges as a new parameter potentially predictive of chemotherapy-induced cardiotoxicity.

Introduction and objectives To compare the results in terms of efficacy and safety of the endoscopic management for vesicoureteral reflux (VUR) in two different standardized primary VUR cohorts treated with Dexell and Vantris. Patients 128 refluxing renal units (RRU) in 87 patients with primary VUR (64 females, 23 males). Patients with secondary VUR and severe bladder and bowel dysfunction were excluded. A total of 22 continent children with mild bladder-bowel dysfunction underwent bladder-bowel training before the implantation. All procedures were performed in the presence of sterile urine using a conventional subureteral transurethral injection technique. Results There were no statistically significant differences between groups in terms of mean age, sex, RRU side, 99mTc-DMSA uptake, and reflux grade. The overall resolution rates based on the number of RRUs for up to three endoscopic treatments were 80% (56/70) in Dexell group and 94.8% (55/58) in Vantris group (P = .012). No postoperative recurrences or vesicoureteral junction obstructions were seen in any group. Conclusions Dexell and Vantris provided an effective and safe endoscopic VUR treatment in the early and mid-term follow up of children with primary VUR. The effectiveness of these substances, which can produce different mass effects with different particle sizes, in safe VUR resolution, needs further investigations.

Altay D, Ozcan A, Unal E, Deniz K, Ozkan KU, Patiroglu T, Arslan D. A rare cause of vomiting in an adolescent: gastric Burkitt`s lymphoma. Turk J Pediatr 2019; 61: 431-435. Burkitt`s lymphoma, which is the most commonly diagnosed pediatric gastrointestinal tumor, usually affects the intestinal tract. However, the diagnosis of gastric Burkitt`s lymphoma in childhood is extremely rare. Here, we have reported the case of an adolescent male patient with vomiting and weight loss symptoms who was diagnosed with Burkitt`s lymphoma of the pyloric antrum. The patient responded very well to chemotherapy and he did not develop tumor lysis syndrome. Based on this case report, gastric Burkitt`s lymphoma might be included in the differential diagnoses of pediatric patients who experience vomiting that results in significant weight loss.

Background and objectives: Cranial magnetic resonance imaging findings of patients considered to be cryptogenic stroke may be useful in determining the clinical and prognostic significance of arrhythmias, such as atrial premature beats and atrial run attacks, that are frequently encountered in rhythm Holter analysis. This study was conducted to investigate the relationship between short atrial runs and frequent premature atrial contractions detected in Holter monitors and infarct distributions in cranial magnetic resonance imaging of patients diagnosed with cryptogenic stroke. Materials and Methods: We enrolled the patients with acute ischemic stroke whose etiology were undetermined. We divided the patients in two groups according to diffusion-weighted magnetic resonance imaging as single or multiple vascular territory acute infarcts. The demographic, clinical, laboratory, echocardiographic, and rhythm Holter analyses were compared. Results: The study investigated 106 patients diagnosed with cryptogenic stroke. Acute cerebral infarctions were detected in 31% of the investigated patients in multiple territories and in 69% in a single territory. In multivariate logistic regression analysis, the total premature atrial contraction count (OR = 1.002, 95% CI: 1.001&ndash, 1.004, p = 0.001) and short atrial run count (OR = 1.086, 95% CI: 1.021&ndash, 1.155, p = 0.008) were found as independent variables that could distinguish between infarctions in a single or in multiple vascular territories. Conclusions: Rhythm Holter monitoring of patients with infarcts detected in multiple vascular territories showed significantly higher premature atrial contractions and short atrial run attacks. More effort should be devoted to the identification of cardioembolic etiology in cryptogenic stroke patients with concurrent acute infarcts in the multiple vascular territories of the brain.

Introduction:Myocardialinjury after percutaneous coronary intervention (PCI) is seen frequently.Ischemia/reperfusion injury, side branch occlusion and distal embolization ofatherothrombotic debris are the main causes of myocardial injury. Remoteischemic preconditioning (RIPC) is a promising technique for protection fromischemia/reperfusion injury, but sufficient data of long-term clinical outcomesis not available. In this study we planned to investigate the effect of onecycle of RIPC on major cardiovascular events one year after elective PCI.Patientsand Methods: 102 patients, undergoing elective PCI, with normalbaseline cTroponin-I (cTn-I) values, were randomized equally into two groups.Five minutes of ischemic preconditioning was applied before the intervention tothe preconditioning group, by inflating blood pressure cuff up-to 200 mmHg onnon-dominant arm. After 1 year, the clinical outcomes of these patients(angina, heart failure, death, myocardial infarction, repeat revascularization)were questioned.Results: From a total of 102patients, 90 could be reached after an year. The mean duration of follow-up was432 vs. 423.5 days (p= 0.793). Post-PCI 16th hour cTn-I was insignificantlylower in the preconditioning arm (0.079 μg/L vs. 0.069 μg/L, p= 0.074). Theincidence of cTn-I elevation 5 fold above the URL (> 0.115 μg/L) was lowerin the preconditioning group; however, it was also insignificant (24.4% vs.13.3%, p= 0.301). Death, MI or repeat revascularization rates did not differbetween the groups., Giriş: Perkütan koroner girişim sonrası miyokart hasarı sıklıklagörülmektedir. Miyokart hasarı iskemi/reperfüzyon hasarına, yan dal tıkanmasınave aterotrombotik debrisi distal embolizasyonuna bağlı gelişmektedir. Uzaktaniskemik ön koşullanma iskemi reperfüzyon hasarından korunmada ümit vericiteknikledendir ancak uzun dönem sonuçları ile ilgili yeterli veri henüzbulunmamaktadır. Biz bu çalışmadaperkütan koroner girişim öncesi uygulanan tek sefer uzaktan önkoşullanmanın bir yıl sonunda majör kardiyovasküler olaylar üzerine etkisiniaraştırmayı planladık.Hastalar ve Yöntem: Elektif perkütan koroner girişimplanlanan 102 hasta çalışmaya alındı ve hastalar iki gruba randomize edildi. Önkoşullanma grubundaki hastalara girişimden önce, kan basıncı manşonu 5 dakikaboyunca 200 mmHg’da şişirilerek ön koşullanma uygulandı. İşlem öncesi vesonrası cTroponin-I değerlerine bakıldı. Birinci yıl sonunda hastaların klinikdurumları sorgulandı (angina, kalp yetersizliği, ölüm, miyokart infarktüsü,tekrar revaskülarizasyon).Bulgular: Yüz iki hastanın 90’ına ulaşılabildi. Ortalama takipsüresi 432 vs. 423.5 gün (p= 0.793). Ön koşullanma grubunda koroner girişimsonrası 16. saat cTroponin-I değeri kontrol grubuna göre daha düşük bulunduancak istatistiksel anlamlılık saptanmadı (0.079 μg/L vs. 0.069 μg/L, p=0.074). cTroponin-I beş kat arttığı hasta oranı da ön koşullanma grubunda dahaazdı ancak bu fark da istatistiksel olarak anlamlı saptanmadı (24.4% vs. 13.3%,p= 0.301). Ölüm, miyokart infarktüsü ve tekrar revaskülarizasyon açısındangruplar arasında fark saptanmadı.Sonuç: Tek sefer uzaktan iskemikön koşullanmanın elektif perkütan koroner girişim sonrası majör kardiyovaskülerolaylar üzerine etkisi saptanmamıştır.

Objective To assess recurrence of saphenous veins and their tributaries following endovenous laser ablation (EVLA) and define primary or secondary ablation ratios as a result of misinterpretation, new incompetency formation, and re-canalization. Methods The EVLA procedure was applied for vein insufficiency to 50 symptomatic patients (range, 22–78 years; mean age 45 ± 14 years; gender, 18 [36%] men, and 32 [64%] women). Before and after the procedure, a total of 80 legs were prospectively evaluated for recanalization of the great and small saphenous vein, anterolateral, posteromedial, intersaphenous thigh, and the calf veins by Doppler ultrasonography. EVLA was performed on the saphenous veins along with their tributaries, and was defined as the primary ablation. EVLA and alcohol ablation after the first procedure was defined as the secondary ablation. We evaluated the veins according to re-canalization and secondary ablation, and also measured the primary and secondary ablation ratios. Results Seventy-three (97.0%) VSM and 39 (95.0%) VSP were treated with primary ablation and 2(3.0%) VSM and 2 (5.0%) VSP were treated with secondary ablation because of newly developed incompetency. In addition, 15 (71.0%) saphenous tributaries were treated with primary and 6 (29.0%) with secondary ablation. After primary or secondary ablation, 9 (12.0%) misinterpretation or new incompetency formation was found during a one-year follow-up. Seven (9.0%) VSM were re-canalized at the mean length of 46 ± 15 cm (range 32–65 cm) in one year. The laser energy in the re-canalized VSM was 78 ± 25 joules/cm (range 61–83) and all were retreated with laser or foam sclerotherapy. Conclusions VSM re-canalization and new vessel incompetency formation are reasons for secondary ablation, which is not a rare condition. Follow-up examinations and anatomical mapping are crucial for detecting new vessel formation or miss-interpretation after sclerotherapy or EVLA treatment.

OBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography. MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA. RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors. CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH.

We report two newborns with female external genitalia and bilateral inguinal swelling who were diagnosed with 17 beta-hydroxysteroid dehydrogenase type 3 deficiency, a rare cause of 46,XY disorder of sexual development. The first case had normal clitoral size and vaginal and urethral openings, palpable gonads in the inguinal region, low testosterone, and low levels of basal and GNRH-stimulated gonadotropin. The second case had similar external genitalia, low testosterone but borderline basal and normal stimulated gonadotropin levels. Low testosterone/androstenedione ratios (0.22 and 0.24, respectively; normal, >0.8) after human chorionic gonadotropin stimulation indicated 17 beta-hydroxysteroid dehydrogenase type 3 deficiency. HSD17B3 sequencing revealed a homozygous novel mutation (c.464A>C, p.H155P) in exon 6 in the first case and homozygous c.239G>A (p.R80Q) in exon 3 in the second.

Two varieties of fiddleneck (Phacelia tanacetifolia Benth.) plant were determined for visualizing somatic chromosomes. The 4-5 days old root tips were pre-treated in 6% α-monobromonaphtalane in +4 °C for 7.5 h, then fixed in glacial acetic acid for 30 min and transferred to 70% ethanol for long storage. When the root tips were analyzed, they were hydrolyzed with 1 N HCl for 13 min at room temperature (25 °C). After hydrolyzing, root tips were stained with 2% aceto orcein in darkness for 2.5 h. The squash method for preparation was used for chromosomal investigations. The chromosome length (C), relative length (RL), the long arm (L) and short arm (S) lengths, arm ratio (AR; L/S) and centromeric index (S/C) were calculated for caryologic parameters. The ideograms and detailed chromosome morphology measurements of the species were performed by the use of MicroMeasure 3.3. According to results, fiddleneck (Phacelia tanacetifolia Benth.) has 2n = 22 chromosomes and the karyotype formulas of two varieties of fiddleneck were 16 median and 6 submedian (16 m + 6 sm).

[Arch Clin Exp Surg 2015; 4(3.000): 176-177]