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Objective: Our aim was to investigate the effectiveness of the dual-energy computed tomography (DECT) virtual noncalcium (VNCa) technique in avascular necrosis (AVN) for detecting bone marrow edema (BME) and staging., Methods: This prospective study included adult patients diagnosed with unilateral or bilateral femoral head AVN between January 2023 and December 2023, who had magnetic resonance imaging (MRI) and DECT. Two participants were excluded from the study due to undergoing surgical procedures during the period between the scans. Two reviewers, blinded to MRI images and clinical data, visually examined color-coded VNCa pictures to assess BME using a binary classification (0 = normal bone marrow, 1 = BME). Same 2 reviewers also used color-coded and nonmapped images to stage AVN in accordance to the "Association for Research on Osseous Circulation" (ARCO) staging system. Interobserver agreements for the visual evaluation and staging were calculated with κ coefficient. Following a visual assessment of BME and the staging of AVN, same 2 reviewers conducted CT density measurements on regions of BME regions utilizing DECT noncalcium images. An independent third investigator (reference standard) utilized MRI, x-ray, and clinical data to confirm the definitive diagnosis and staging of AVN. A P value less than 0.05 was considered statistically significant., Results: Fifty patients (28 men, 22 women, mean age: 44.2 ± 13.1 years, range: 25-75 years) were included in the final analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the VNCa technique in detecting BME were 96.0%, 94.4%, 97.9%, 89.4%, and 95.6%, respectively, for reviewer 1; and 96.0%, 88.9%, 96.0%, 88.9%, and 94.1%, respectively, for reviewer 2. Interobserver agreement was almost perfect ( κ = 0.84). Both reviewer 1 and reviewer 2 accurately classified 92.7% of the AVNs. The density measurements showed a statistically significant difference ( P = 0.001) between the edema regions and the normal marrow regions. No statistically significant difference was observed in the density measurements of edema regions at different stages ( P = 0.13)., Conclusions: DECT VNCa technique exhibits excellent performance in detecting BME in hip AVN cases, as well as accurately determining the stage of AVN., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

Heart failure is an increasing public health issue with substantial morbidity and mortality rates. This study aimed to evaluate the efficacy, safety, and long-term outcomes of angiotensin receptor neprilysin inhibitor (ARNi) in the treatment of heart failure with reduced ejection fraction (HFrEF) 5 years after treatment initiation. This retrospective study analyzed a cohort of 75 patients diagnosed with HFrEF over a period of 5 years after the initiation of ARNi therapy. The initial clinical condition, laboratory and echocardiographic measurements including left ventricular ejection fraction (LVEF), New York Heart Association functional classes (NYHA-FC) and the prognostic nutritional index were compared to the corresponding values obtained after a 5-year period of ARNi therapy. In addition, the number of annual hospitalizations, mortality rates and any history of adverse effects during the follow-up period were recorded. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level, LVEF, and NYHA-FC values demonstrated significant improvement at the end of the 5-year follow-up period (all parameters, P < .001). Although the observed increase in the prognostic nutritional index was not statistically significant (P = .077), it is worth noting. A significant reduction in daily diuretic doses and hospitalizations due to heart failure was observed following the use of ARNi (all comparisons, P < .001). The prevalence of hypotension was around 16% (being symptomatic in 4%), making it the most frequently observed adverse event. The 5-year cardiovascular mortality rate was 17.3%. The use of ARNi in HFrEF patients was associated with a notable improvement in NYHA-FC, LVEF, and NT-proBNP levels in the long-term, while also leading to a better nutritional status and reduced need for diuretics and annual hospitalization. Additionally, ARNi usage has been associated with improved nutritional status, decreased reliance on diuretics, and reduced frequency of annual hospitalizations. These effects were associated with a lack of significant increase in adverse effects. These results may contribute to a better understanding of ARNi's long-term effects on patient outcomes., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To determine the mechanistic roles of oxidative stress, inflammation, and genotoxicity parameters in patients with work-related asthma (WRA) and silicosis., Methods: Thirty-eight healthy office workers, 27 employees with a history of exposure and no disease, 24 employees with WRA, and 23 employees with silicosis were included in this study. Superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, and interleukins (IL) 17, 23, and 27 levels were measured in the serum. Genotoxic damage was evaluated by calculating the frequency of micronuclei in swab samples and 8-hydroxy-2'-deoxyguanosine in serum., Results: Serum superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, 8-hydroxy-2'-deoxyguanosine, and IL-17, IL-23, and IL-27 levels were found to be statistically significantly higher in the exposure, WRA, and silicosis groups compared with the control group. The frequency of micronuclei in buccal epithelial cells of the patient group was found to be significantly higher than that of the control group., Conclusion: These results may provide information for molecular mechanisms and early diagnosis of WRA and silicosis and will be a guide for taking precautions in the early period., Competing Interests: Conflict of interest: None declared., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Background: While cytomegalovirus (CMV) infection usually causes disease in immunosuppressed individuals, it mostly progresses as an asymptomatic infection in healthy adults. However, very rarely, immunocompetent individuals may also suffer from encephalitis and stroke., Methods: Nine patients who were admitted to the Neurology Clinic of Abant Izzet Baysal University Faculty of Medicine from 2016 to 2020 who had various neurological symptoms and were diagnosed with CMV infection were retrospectively analyzed. Symptoms, examination findings, laboratory results, radiologic imaging, and treatments were recorded and evaluated., Results: Although severe infections because of CMV generally occur in newborns and immunosuppressed adults, it is estimated that the disease is more common in immunocompetent adults than known. This may be associated with unrecognized risks, in part because of immune dysfunction or comorbidities such as renal failure or diabetes mellitus. Also, CMV replication in arterial endothelial cells can restrict blood flow, inducing an atherosclerotic environment and causing stroke. Diagnosis is based on clinical suspicion and serology. Ganciclovir is administered for treatment., Conclusion: CMV infection should be considered in the differential diagnosis of patients presenting with neurological symptoms, even among immunocompetent individuals, because of the high possibility that patients can greatly benefit from antiviral treatment at the early stage., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Schwannomas are benign tumors originate from nerve sheath. In this article, the authors aimed to share our experience and review the literature on endonasal endoscopic intervention for a maxillary sinus schwannoma. A 30-year-old Caucasian female patient applying to ophthalmology clinic due to exophthalmos and proptosis in her left eye for the last 6 months. A well-defined mass was detected in left maxillary sinus that was filling and expanding the sinus. Endoscopic biopsy from the patient was reported as ancient schwannoma. The encapsulated mass was completely removed by performing a combined endoscopic medial maxillectomy and Caldwell-Luc procedure under general anesthesia. The authors have been following the patient for 2 years and there was no evidence of recurrence, however, a decrease in the volume of the maxillary sinus occurred, suggesting chronic maxillary atelectasis. In conclusion, schwannoma should be considered in the differential diagnosis of sinonasal masses., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Fanconi aplastic anemia (FAA) is a rare inherited bone marrow failure disorder characterized by congenital defects and pancytopenia. Hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with FAA due to the risk of cancer and pancytopenia. Blood transfusions are the best supportive therapy. Oxymetholone (5 mg/kg daily) is most commonly used; however, it is not curative. Extensive transfusions should be avoided because of alloimmunization and graft-versus-host disease because they have poor outcomes in patients with HSCT. This is a case report of a 5-year-old Syrian male patient with FAA, who was successfully treated with eltrombopag (50 mg daily) in conjunction with oxymetholone (5 mg/kg daily). The patient required platelet transfusions despite oxymetholone therapy and there was no suitable donor for HSCT. After the addition of eltrombopag therapy, platelet transfusions were no longer required. Eltrombopag can be effectively used as a bridge to HSCT in patients with FAA., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Stroke is one of the major complications of sickle cell disease (SCD). Stroke features either occlusion of, or stenosis at, the origin of one of the large intracerebral arteries, the internal carotid artery (ICA), and/or the middle cerebral artery (MCA)., Purpose: We sought correlations between cerebral blood flow velocities and the laboratory and clinical findings of patients with SCD., Materials and Methods: Fifty-three pediatric SCD patients (39 with HbSS, 14 with HbSβ0) were analyzed. The mean patient age was 12.9±3.9 years. The control group contained 24 healthy individuals. The time-averaged maximum mean velocity (TAMMV) and resistive index (RI) of the MCA, the TAMMVs of the ICA and vertebral artery (VA), and the diameter of the VA were estimated through transcranial Doppler ultrasonography using a 2.5 MHz transducer, in accordance with the Stroke Prevention Trial in Sickle Cell Anemia (STOP) protocol. We evaluated the relationships between the TAMMVs, laboratory parameters, and clinical findings., Results: The mean±SD MCA TAMMV was 161.2±35.4 cm/s in patients with HbSS and 185.8±62.9 cm/s in patients with HbSβ0. The mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 168.5±43.9 cm/s, 0.63±0.06, 116.8±25.5 cm/s, 69.2±18.5 cm/s, and 3.5±0.61 mm for all SCD patients, respectively. In the control group, the mean MCA TAMMV, RI, ICA TAMMV, VA TAMMV, and VA diameter were 103.8±28.8 cm/s, 0.53±0.04, 96.4±27.8 cm/s, 40.3±12.1 cm/s, and 3.4±0.6 mm, respectively. Although the differences were not significant, TAMMVs were higher in HbSβ0 patients taking hydroxyurea; those with hemoglobin levels <8 g/dL, ferritin levels >1000 ng/dL, mean platelet volume >12 fL, or red cell distribution width >18%; or required chelation, or were below the third percentiles of weight and height. The TAMMV was significantly higher only in SCD patients who complained of headache., Conclusions: High ferritin and low hemoglobin levels, a high mean platelet volume, a high red cell distribution width, low weight (below the third percentile), and a short height (below the third percentile) may be associated with elevated cerebral blood flow velocities and an increased stroke risk in children with SCD. Children with such features should be closely followed-up through transcranial Doppler ultrasonography examination., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Minimally invasive sacrocolpopexy (SCP) is a compelling surgical procedure that requires advanced laparoscopic suturing and dissection skills and knowledge of pelvic retroperitoneal anatomy. The aim of this study was to develop a low-cost laparoscopic SCP model and educational curriculum to improve dissection and suturing skills along with anatomic knowledge to avoid complications., Methods: The pelvic SCP model was developed with easily available material that was placed on the commercial pelvic bone model to construct a vagina, major vessels, ureter, peritoneum, and areolar tissue. A comprehensive curriculum encompassing didactic and technical skills components on the pelvic model was used to teach laparoscopic SCP. Participants completed precurriculum and postcurriculum multiple-choice questionnaires to evaluate the didactic component. A modified Objective Structured Assessment of Technical Skills (OSATS) tool was used to measure technical skills before and after technical skills curriculum., Results: Among the 10 senior residents, 6 (60%) were studying at their fourth postgraduate year, and 3 (30%) were studying at their third postgraduate year. Postcurriculum test scores (14.5 vs 10.6) for assessment of cognitive knowledge were significantly improved (P < 0.001). The median postcurriculum OSATS scores (26.5; range, 18-30) were significantly improved (P = 0.005). Laparoscopic SCP OSATS scores increased from median 21 to median 26.5 after cognitive and technical curriculum, showing a 21.4% improvement. The majority (70%) of residents believed that the SCP model would be useful to enhance skills acquisition before performing the skill in the operating room., Conclusions: A low-fidelity laparoscopic SCP curriculum showed improvement in cognitive knowledge and technical skills., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2021 American Urogynecologic Society. All rights reserved.)

Objective: To determine whether there is a difference between healthy control group and children with neurofibromatosis type 1 (NF1) in terms of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in different regions of the brain associated with neurocognitive functions and to investigate the correlation between diffusion tensor imaging parameters and neurocognitive dysfunctions., Methods: The study included 28 children with NF1 and 21 controls. Nine distinct areas related to cognitive functions were selected for the analysis. The ADC and FA values were compared., Results: There was a significant difference between NF1 and healthy control in terms of ADC values obtained from all areas. The ADC values at obtained from thalamus and striatum were positively correlated with the full-scale intelligence quotient (IQ), verbal IQ, and performance IQ., Conclusions: We are speculated that the development of microstructural damage in the thalamostriatal pathway may lead to neurocognitive dysfunction., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Diabetic retinopathy (DRP) is the formation of edema and small vessels in the retina due to high blood glucose levels. Asprosin is a hormone that stimulates the release of glucose from the liver into the circulation. Considering the relationship between oxidative stress and DRP, our study aimed to determine the levels of the oxidative stress markers 4-hydroxynonenal (4-HNE) and 8-hydroxy-2'-deoxyguanosine (8-OHdG), as well as asprosin, in the blood and aqueous humor (Aq) of patients with and without DRP., Methods: Thirty patients with single-eye DRP and cataract (DRP + C), 30 patients with diabetes mellitus and cataract without DRP (DM + C), and 30 healthy control (CON) participants were enrolled into this retrospective study. Except for healthy controls, Aq and blood samples were taken from these patients during their cataract operation. Asprosin, 4-HNE, and 8-OHdG concentrations were analyzed using enzyme-linked immunosorbent assays., Results: In patients with DRP, the levels of asprosin, 4-HNE, and 8-OHdG were significantly higher in both Aq and blood samples compared with the group of patients without DRP., Conclusion: These findings suggest that the measurement of asprosin, 4-HNE, and 8-OHdG levels may support clinicians in determining the risk of DRP development.

The objective of this study was to assess the difference in irritability and perceived expressed emotion (EE) between adolescents with iron deficiency (ID) or iron deficiency anemia (IDA) and their healthy peers. In addition, we aimed to investigate the relationship between hemogram parameters, irritability, and perceived EE in adolescents with ID and IDA. The sample of this single-center cross-sectional case-control study consisted of 89 adolescents from 12 to 17 years of age. Of the participants, 19 had been diagnosed with ID, 31 had IDA, and 39 were healthy controls. Significant differences in the self-reported and parent-reported irritability scores were observed between the ID group and the control group and between the IDA group and the control group. There was also a significant difference in the subscale of irritability between the ID group and the control group. The difference between the IDA and control groups in the intrusiveness subscale was found to be significant as well. Adolescents with IDA and ID exhibited significantly perceived irritability compared with the control group. In terms of irritability, adolescents with IDA and ID revealed greater irritability than their healthy peers. The results of this study suggest that irritability and perceived EE should be investigated in cases of ID, whether with or without anemia. As chronic diseases may benefit substantially from psychiatric consultation, psychosocial evaluation and intervention should be considered a complementary treatment option in the management of ID and IDA.

Background: The optimal perfusate partial pressure of oxygen (PO2) during hypothermic machine perfusion (HMP) is unknown. The aims of the study were to determine the functional, metabolic, structural, and flow dynamic effects of low and high perfusate PO2 during continuous HMP in a pig kidney ischemia-reperfusion autotransplant model., Methods: The left kidneys of a ±40 kg pigs were exposed to 30 minutes of warm ischemia and randomized to receive 22-hour HMP with either low perfusate PO2 (30% oxygen, low oxygenated HMP [HMPO2]) (n = 8) or high perfusate PO2 (90% oxygen, HMPO2high) (n = 8), before autotransplantation. Kidneys stored in 22-hour standard HMP (n = 6) and 22-hour static cold storage (n = 6) conditions served as controls. The follow-up after autotransplantation was 13 days., Results: High PO2 resulted in a 3- and 10-fold increase in perfusate PO2 compared with low HMPO2 and standard HMP, respectively. Both HMPO2 groups were associated with superior graft recovery compared with the control groups. Oxygenation was associated with a more rapid and sustained decrease in renal resistance. While there was no difference in functional outcomes between both HMPO2 groups, there were clear metabolic differences with an inverse correlation between oxygen provision and the concentration of major central metabolites in the perfusion fluid but no differences were observed by oxidative stress and metabolic evaluation on preimplantation biopsies., Conclusions: While this animal study does not demonstrate any advantages for early graft function for high perfusate PO2, compared with low perfusate PO2, perfusate metabolic profile analysis suggests that aerobic mechanism is better supported under high perfusate PO2 conditions.

Background: Hemophilia, which is a chronic illness associated with recurrent bleeding, may occur with psychosocial and behavioral problems., Aim: The aim of this study was to evaluate the clinical characteristics and demographic features and changes in the self-image of adolescents with hemophilia., Materials and Methods: Data about hemophilia type, the severity of hemophilia, secondary prophylaxis received, and annual bleeding rate (ABR) were recorded from patient files. Hemophilia Joint Health Score (HJHS) and the Offer Self-Image Questionnaire (OSIQ) (as a measure of self-esteem) were applied to hemophilia patients and a healthy control group., Results: Thirty-two hemophilia patients (mean age=16.2±3.06 y) and 35 healthy male individuals (mean age=16.02±1.4 y) were enrolled in the study. Hemophilia patients had lower total OSIQ score than their peers (P=0.007). There was no difference between patients who received and who did not receive secondary prophylaxis (P=0.408) in terms of total OSIQ score. The median total OSIQ score of patients with pathologic HJHS (>0 points) was lower than that of patients with normal HJHS (0 points) (P=0.010). The median of ABR was 6 (range: 0 to 20) in the whole hemophilia group. There were no differences between hemophilia patients with ABR≤4 and >4 (P=0.084). All of the subscale parameters of the OSIQ were lower for hemophilia patients compared with their peers, besides one. The subscale of sexuality attitudes was better for hemophilia patients than for the healthy control group (P=0.028)., Conclusions: Low self-esteem in hemophilia patients indicates the importance of lifelong psychosocial support. Patients with pathologic HJHS are at risk of low-esteem. Using OSIQ with HJHS during follow-up of hemophilia patients may be useful for management.

Ultrasonography (US) is the main imaging method to assess thyroid nodules. In the pediatric population, thyroid nodules are less prevalently seen than those in adults. However, approximately 25% of the nodules can be malignant. Validation of Thyroid Image Reporting and Data System (TI-RADS) classification has been mostly tested in adults, and information on pediatric cases is limited. In the current study, we aim to define the diagnostic power of the TI-RADS risk stratification method in pediatric thyroid nodules.The study population consists of 68 nodules of 64 patients (20 malignant, 48 benign). We have included patients at least 18 years and with a pathological diagnosis. The researchers evaluated the US images of the patients, if available. If US images cannot be found, US reports of the patients were evaluated to define TI-RADS points and category.Mean age of the population is 15.15 ± 2.66 years. There were 10 (17.7%) male patients and 58 (85.3%) female patients. Median nodule size was 8 mm. Final diagnosis was benign in 48 nodules (70.6%) and malignant in 20 nodules (29.4%). There were 5 follicular carcinoma cases and 15 papillary carcinoma cases. The area under the curve estimate was 0.89 (95% confidence interval, 0.80-0.98), and the area under the curve value confirmed the diagnostic efficacy of TI-RADS categorization in pediatric thyroid nodules. A TI-RADS category of 4 or 5 seemed to be a good cutoff point to predict malignancy.To conclude, TI-RADS categorization can be effectively used to assess pediatric thyroid nodules. Nodules with TI-RADS categories of 4 and 5 have the greatest risk of malignancy, and they should be evaluated pathologically.

Background: Congenital afibrinogenemia is characterized by the absence of fibrinogen. Congenital fibrinogen disorders result from several mutations in FGA, FGB, or FGG. Their epidemiology is not well known., Observation: The present study reports on 2 children with congenital afibrinogenemia. The first child, a male who is now 9 years old, was diagnosed with afibrinogenemia after spontaneous intracranial bleeding at the age of 3 years. The second child is a 2-year-old female cousin of the first patient, who was diagnosed with afibrinogenemia after coagulation tests were carried out due to frequent epistaxis and mucocutaneous bleeding. At follow-up, blood samples of the patients and their parents were sent to the Department of Genetic Medicine and Development, University Medical Center, Switzerland, for polymerase chain reaction analysis. In both patients, the novel homozygous frameshift mutation in the FGA exon 3: c.196 delT was detected. The parents of the patients were both heterozygous for the same mutation., Conclusions: Congenital afibrinogenemia is a rare coagulation disease. The molecular epidemiology of congenital fibrinogen disorders is complex, and the identification of new mutations will help shed light on this complex molecular structure. Therefore, a genetic analysis that includes more centers is needed.

Introduction: Developmental dysplasia of the hip (DDH) is still a common and important disorder of childhood, with a prevalence of 0.1 to 2/1000 children. Using ultrasonography (US) in screening of DDH reduces the rates of open reductions and complications. In the current study, we aim to detect the optimal time for US examination for detecting DDH to prevent unnecessary repeating US examinations and treatments., Methods: Children referred to US examination for a healthy child screening program, according to the health policy of our country, are included in the current prospective study. Both hips of each child were sonographically examined by the same radiologist using Graf's method at 4th, 8th, 12th weeks of life., Results: A total of 2020 hips of 1010 children were examined. Fourth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 75.7%; left hip: sensitivity 100%, specificity 78.3%). Eighth-week US results can predict 12th-week results (right hip: sensitivity 100%, specificity 87.5%; left hip: sensitivity 100%, specificity 83.9%). In predicting 12th-week US results, 8th-week results are found to be more successful than 4th-week results., Conclusions: Late diagnosis of DDH might cause serious public health problems. On the other hand, early US examinations can result in false-positive diagnosis. Unfortunately, there is still confusion about the optimal time for DDH screening with US, especially among radiologists who are not specialized in DDH sonography. A US scan performed at eighth week of life can predict any pathology presence safely and correctly.

Cervical lymphangiomas are benign congenital malformations of lymphatic system usually seen in children under 2 years of age. It is rare in adults. They can be seen in any part of the body but the most common area in the neck region is posterior triangle. They usually present as asymptomatic masses. There are various ways of treatment, but the most common treatment modality is surgical resection. Here, the authors present a giant lymphangioma in the neck region of an adult who is treated with surgical resection without any complication.

Background: Acute viral respiratory infections are common causes of febrile episodes in children. There are still limited data about distribution of acute viral respiratory infections in children with cancer., Objective: The first aim of this study was to evaluate the viral etiology and seasonality of acute viral respiratory infection in pediatric patients with cancer in a 3-year study. Our second aim was to evaluate the impact of viral infections on delaying the patients' chemotherapy or radiotherapy., Materials and Methods: This cross-sectional study was conducted from January 2014 to July 2017. Nasopharyngeal aspirates were analyzed in patients younger than 21 years with acute respiratory infections. Patients were treated in the Pediatric Hematology and Oncology Department of Dr. Behçet Uz Children's Hospital with real-time multiplex polymerase chain reaction. Data were analyzed to determine the frequency and seasonality of infections. The χ or the Fisher exact tests were used., Results: A total of 219 samples of nasopharyngeal aspirates and blood were analyzed. The mean patient age was 76.8±59.3 months, with 46.3% female and 53.7% male children in a total of 108 patients. Of this total, 55% (60/108 cases) had multiple acute respiratory infections. Acute lymphoblastic leukemia (48.1%) was the most prevalent disease. The 3 most prevalent viruses were human rhinovirus (HRV) (33.1%), parainfluenza (PI) (18.7%), and coronavirus (CoV) (14.8%). In terms of the seasonal distribution of viruses, PI was most common in winter 2014, HRV in spring 2014, HRV in fall 2014, PI in winter 2015 and summer 2015, CoV in spring 2015, HRV in fall 2015, both influenza and HRV in winter 2016, both human metapneumovirus and bocavirus in spring 2016, HRV in summer 2016, both HRV and PI in fall 2016, both respiratory syncytial virus and influenza in winter 2017, HRV in spring 2017, and both HRV and adenovirus in summer 2017. The mean duration of neutropenia for patients with viral respiratory infection was 17.1±13.8 (range: 2 to 90) days. The mean duration of symptoms of viral respiratory infection was 6.8±4.2 (range: 2 to 31) days. A delay in chemotherapy treatment owing to viral respiratory infection was detected in 73 (33.3%) patients. The mean duration of delay in chemotherapy treatment was 9.6±5.4 (range: 3 to 31) days., Conclusions: In conclusion, we report our 3-year experience about the frequency and seasonality of respiratory viruses in children with cancer.

Pyruvate kinase deficiency (PKD) is the most common glycolytic defect leading to hemolytic anemia. PKD is caused by the mutations in the PKLR gene; however, the detection of a decreased PK activity should be first measured for rapid diagnosis. We report here the case of a 1-year-old girl with mild hemolysis and PKD. At the time of the study, the patient showed a hemoglobin level of 9.5 g/dL, mean corpuscular volume of 93 fL, reticulocyte of 6.7%, and lactate dehydrogenase of 218 IU/L. Peripheral blood smear showed polychromasia, anisocytosis, tear drop cells, fragmented eyrtrocytes, and target cells. When a biochemical analysis was performed in our patient and her parents who had consanguinity, a decreased PK activity was detected in the patient and her father. After the molecular study of PKLR gene, a new homozygote variant, c.1708G>T (pVal570Leu), was found in our patient and her father. Her father had a misdiagnosis of Gilbert syndrome because he had unconjugated hyperbilirubinemia and not anemia. Her mother was also a carrier of the mutation in heterozygous state. Patients presenting with hemolytic anemia, either severe or mild hemolytic anemia, should be screened for PKD in the first year of life. Patients with mild hemolytic findings can be followed-up with misdiagnoses.

Congenital dyserythropoietic anemias (CDAs) are rare hereditary blood disorders characterized by ineffective erythropoiesis, hemolysis, and erythroblast morphologic abnormalities in the bone marrow. The 3 main types of CDA, I to III, and variant types of CDA, IV-VIII, have been described. The causative genes have been identified as CDAN1, C15ORF41, SEC23B, KIF23, KLF1, and GATA1. CDA type II is the most frequent form. Typical symptoms are jaundice, hepatosplenomegaly, mild-to-severe normocytic anemia, and inadequate reticulocyte response. We report an 18-year-old boy who had chronic mild congenital anemia, jaundice, and splenomegaly mimicking nonautoimmune hemolytic anemia since 18 months of age. Compound heterozygous mutations in SEC23B gene were detected by the use of a gene-targeted next-generation sequencing panel: the already reported missense mutation c.40C>T (p.Arg14Trp), and a new frameshift deletion (c.489&#95;489delG, p.Val164Trpfs*3), confirming the diagnosis of CDA type II. The study underlines the molecular heterogeneity of CDA II and the importance of a precise diagnosis in rare congenital diseases such as CDA II. In consequence, it can be difficult to diagnose because of limited resources, financial constraint, and rarity of disease in the developing country. Advanced laboratories and new molecular approaches may help in diagnosing rare anemias.

Mucocele is benign, slow-growing, mucous-filled cystic lesions that arise in the paranasal sinuses. It causes progressive distension of the bony walls and induces compressive symptoms. Surgical treatment of paranasal sinus mucoceles includes endoscopic approach or external approach. The authors report a patient of frontal mucocele who presented with a history of progressive unilateral protrusion. Computed tomography scan revealed a large mucocele of the frontal sinus with orbital extension on the same side. He was successfully treated with endoscopic marsupialization without any serious complications.

Endometrial polyps are benign pathologies originating as localized overgrowths of basal endometrium. Risk factors include endogenous and exogenous estrogen excess and tamoxifen (TAM) exposure. Our main objective was to investigate the role of an apoptosis-inhibiting protein, survivin, in endometrial polyps. We performed a cross-sectional, analytical study; our samples were obtained from the archives of the Department of Pathology. Sixty samples were included, comprising 20 TAM polyps, 20 simple endometrial polyps, and 20 cases of simple endometrial hyperplasia without atypia not associated with TAM use. Immunohistochemical staining with rabbit monoclonal anti-human survivin, clone EP 119, was performed. Survivin staining score was highest in the endometrial polyp group and lowest in the TAM polyp group (P<0.001). There was no correlation between survivin staining score and the age of patient (r=0.09), TAM exposure (r=-0.02), nor endometrial thickness (r=0.25). Endometrial polyps are frequently associated with TAM. The low expression of the antiapoptotic marker survivin in TAM polyps but high expression in other polypoid endometrium illustrates that different mechanisms are responsible in the pathogenesis of endometrial polyps. It is possible that there is a direct effect of TAM on apoptosis or indirect effect through a progesterone-related mechanism.

Objective: The aim of this study is to investigate the association of sexual functions with levator hiatus biometry measurements and levator ani muscle defect., Methods: In 62 heterosexual, sexually active premenopausal women without pelvic floor disorders or urinary incontinence, 3-dimensional transperineal ultrasound imaging was used. Two 3-dimensional volumes were recorded, one at rest and one on Valsalva maneuver. Levator biometry measurements and levator defect were evaluated in an axial plane. Sexual function was assessed by a validated questionnaire, Female Sexual Function Index (FSFI). The primary outcome measure was correlation of sexual functions with the levator hiatus area, transverse and anteroposterior diameters, levator ani muscle thickness, vaginal length, and changes in measurements with Valsalva and levator defect., Results: Forty-two women (67.7%) had low total FSFI scores (<26.55). Levator defect rates were similar in female sexual dysfunction (7/42, 16.7%) and women without female sexual dysfunction (5/20, 25%). The FSFI was negatively and weakly correlated with Δhiatal anteroposterior diameter (r = -0.33, P < 0.009) in the study population. There was a weak and inverse correlation between Δhiatal anteroposterior diameter and arousal (r = -0.35, P < 0.002), desire (r = -0.38, P < 0.001), and orgasm (r = -0.33, P < 0.007). Pain and lubrication did not correlate with any measurement., Conclusions: Hiatal area and diameters at rest are not related to sexual functions. Changes in anteroposterior diameter of the levator hiatus during Valsalva, which may be a sign of pelvic floor laxity or levator muscle weakness, are weakly associated with sexual functions, particularly desire, arousal, and orgasm domains.

Background: Scleroderma renal crisis (SRC) is a life-threatening complication of systemic sclerosis characterized by abrupt onset of hypertension, thrombotic microangiopathy, and kidney injury. The mechanisms of the disease remain ill-defined, but a growing body of evidence suggests that activation of the complement system may be involved., Methods: Here, we report the case of a patient presenting with severe SRC and strong evidence of complement activation, both in serum and in the kidney, in the absence of genetic defect of the complement system., Results: Immunofluorescence studies on kidney biopsy showed significant deposits of C1q and C4d in the endothelium of renal arterioles, pointing toward activation of the classical pathway. Because of the dramatic clinical and histological severity, and the lack of response to early treatment with angiotensin-converting enzyme inhibitors, calcium channel blockers and plasma exchange, the patient was treated with the specific C5 blocker eculizumab.Contrarily to conventional treatment, eculizumab efficiently blocked C5b-9 deposition ex vivo and maintained hematological remission. Unfortunately, the patient died from heart failure a few weeks later. Postmortem examination of the heart showed diffuse patchy interstitial fibrosis, the typical lesion of systemic sclerosis-related cardiomyopathy, but normal coronary arteries and myocardial microvasculature., Conclusion: SRC may lead to complement system activation through the classical pathway. Early administration of C5 inhibitor eculizumab may have therapeutic potential in patients with life-threatening SRC refractory to conventional treatment using angiotensin-converting enzyme inhibitors., Competing Interests: The remaining authors have no conflicts of interest to disclose.

Objective: To investigate bone resorption and formation markers as well as bone mineral density in women with restless legs syndrome (RLS)., Methods: This was a prospective cross-sectional case-control study involving drug-naive women with RLS and age- and body mass index (BMI)-matched female controls. Routine blood analyses, markers of bone formation, procollagen 1 n-terminal peptide, bone resorption, c-telopeptide of type 1 collagen (CTX), sclerostin, and bone mineral density (BMD) were compared between the 2 groups. Pregnant or breastfeeding women and individuals with comorbidities other than iron deficiency, type 2 diabetes mellitus, or hypertension were excluded., Results: A significant increase in lumbar BMD was found among 78 women with RLS as compared to 78 age- and BMI-matched controls (p = 0.001). The proportion of patients with osteopenia as defined by a lumbar T score was significantly lower among patients with RLS (p = 0.040). CTX and sclerostin were significantly lower in patients with RLS (p = 0.006 and p = 0.011, respectively), as were the levels of 25-hydroxy vitamin D3, calcemia, and free T3 (p = 0.017, p = 0.017, and p = 0.002, respectively)., Conclusions: Despite lower 25-hydroxy vitamin D3, patients with RLS had lower bone resorption markers, higher lumbar BMD, and lower frequency of lumbar osteopenia. As patients with RLS make movements night and day to decrease the severity of their symptoms, they unconsciously perform exercise, which may potentially explain the better bone profile among patients with RLS than in controls., (© 2016 American Academy of Neurology.)

Background: Aristolochic acids (AA) are nephrotoxic and carcinogenic. The aim of this study was to assess the long-term outcome of patients with AA nephropathy (AAN) after kidney transplantation., Methods: Observational study. Patients' characteristics, long-term surveillance and follow-up data, patient and graft survival, as well as outcomes with respect to rejection, cardiovascular complications, infections, and cancers with a focus on urothelial carcinomas, are reported., Results: Twenty patients transplanted for AAN were included. All were submitted to prophylactic bilateral ureteronephrectomy and annual surveillance of the bladder. Median duration of posttransplant follow-up was 12.5 (3-19) years. Time from diagnosis of AAN to renal replacement therapy was relatively short (1 [0-15] years). Immunosuppression consisted of a triple therapy in the majority of patients. Nineteen patients had upper urinary tract multifocal atypia. Eleven patients presented with urothelial carcinomas of the upper tract; 2 of them with additional bladder urothelial carcinomas. Of these 2 patients, one required radical cystectomy. One patient developed a hepatocarcinoma. Patient survival was 100% in AAN patients at 5, 10, and 15 years after transplantation. Graft survival at 5, 10, and 15 years was 95%, 83%, and 75%., Conclusions: Despite a high prevalence of urothelial carcinoma and the risk of bladder carcinoma, the long-term patient and kidney graft survival is excellent in patients with AAN, provided that prophylactic bilateral ureteronephrectomy and lifelong surveillance of the bladder are performed.

Lymphangioma is a congenital malformation of the lymphatic system, which is located mostly on the head and neck region. Most of the cases are seen at age younger 2 years. It is rare in adult population and when detected, it can be treated with surgical excision. We present a 50-year-old patient with giant lymphangioma on the posterior cervical region of the neck treated by surgical treatment successfully.

Purpose: Along with contour interaction, inaccurate and imprecise eye movements and attention have been suggested to contribute to poorer acuity for "crowded" versus uncrowded targets. To investigate the role of eye movements in foveal crowding, we compared percent correct letter identification for short and long lines of near-threshold letters with different separations., Methods: Five normal observers read short (4 to 6 letters) and long (10 to 12 letters) lines of near-threshold, Sloan letters with edge-to-edge letter separations of 0.5, 1, and 2 letter spaces. Percent correct letter identification for the 2 to 4 interior letters in short strings and the 8 to 10 interior letters in long strings was compared with a no-crowding condition., Results: Letter identification was significantly worse than the no-crowding condition for long letter strings with a separation of 1 letter space and for both long and short letter strings with a separation of 0.5 letter spaces. Observers more often reported the incorrect number of letters in long than in short letter strings, even for a separation of 2 letter spaces. Similar results were obtained during straight-ahead gaze and while viewing in 30 to 40 degrees left gaze, where two of the five observers exhibited an increase in horizontal fixational instability., Conclusions: We argue that lower percent correct letter identification and more frequent errors in reporting the number of letters in long compared with short letter strings reflect an eye-movement contribution to foveal crowding.

Skull-base metastasis is rarely reported in thyroid carcinoma. We are presenting an unusual interesting case mimicking metastatic renal cell carcinoma with intense clear cell morphology, the thyroid origin of which was detected via positron emission tomography/computerized tomography scan proposed by the oncology council, while we were monitoring the subject with the initial diagnosis of paranasal sinus tumor. A mass was detected in the left nasal cavity in the endoscopic examination of the 68-year-old female patient referred by the ophthalmology clinic with the preliminary diagnosis of retro-orbital tumor upon being admitted with proptosis. A soft tissue lesion at a size of 68 × 39 × 53 mm located intracranially was detected by the brain computerized tomography. The biopsy taken and the immunohistochemical results were not satisfactory. Intense fluorodeoxyglucose involvement was observed in both lobes of the thyroid gland at positron emission tomography/computerized tomography taken with the recommendation of the council. Moreover, hypermetabolic nodules were seen in both lung parenchyma areas, whereas intense hypermetabolic lytic lesions were observed in the skeletal system. Thyroglobulin and thyroid transcription factor 1 stains displayed a strong staining on paraffin block. On the basis of these characteristics, the case was regarded as compatible metastatic follicular thyroid carcinoma, with skull-base, cranial, retro-orbital, paranasal sinus, lung, and bone metastases. This case showed us that multidisciplinary work and assessment of the oncology council play a highly critical role in making the diagnosis and guiding the treatment.

Laryngocele is a benign abnormal dilatation of the laryngeal saccule. We present a 30-year-old male patient who complained with hoarseness since 1 year. Paraglottic laryngocele is detected on medical examination. The patient is operated on successfully with our new thyroid cartilage preserved technique (modified lateral thyrotomy method).

A number of external and radical procedures have been the only surgical approaches for the treatment of frontal sinus mucoceles. However, these procedures have major complications including high surgical morbidity, esthetic concerns of postoperative scar formation, and difficulty in radiologic diagnosis of recurrence after obliteration. In this clinical report, we demonstrated an endoscopic marsupialization technique that could easily be applied to a very large mucocele that has extended to the intracranial region, without any serious complications.

Aims: Our aim was to investigate the apelin-12 levels in patients with atrioventricular tachyarrhythmias and compare with those in patients with lone atrial fibrillation., Methods: Forty four patients with supraventricular tachycardia as atrial fibrillation, 44 patients with paroxysmal supraventricular tachycardia (P-SVT) as atrioventricular tachyarrhythmias, including atrioventricular nodal reentrant tachycardia or atrioventricular reentrant tachycardia, and 30 age- and sex-matched healthy individuals were included in the study., Results: The apelin-12 levels were significantly lower in both atrial fibrillation and P-SVT groups than control group. In post-hoc analysis, there was no significant difference in apelin-12 levels between atrial fibrillation and P-SVT groups (P = 0.9). Patients in atrial fibrillation group and patients in P-SVT group had significantly lower apelin-12 levels than control group, separately (P < 0.001 and P < 0.001, respectively). The sensitivity and specificity values of the apelin-12 levels for predicting SVT, including both atrial fibrillation and atrioventricular reentrant tachycardia or atrioventricular nodal reentrant tachycardia were 64.77 and 90%, respectively (cut-off value was 0.87). The area under the receiver operator characteristic curve was 0.834 for the apelin-12 levels (P = 0.0001)., Conclusion: Apelin-12 levels are lower in patients with atrial fibrillation and P-SVT than control groups. Lower apelin levels in patients with atrial fibrillation and P-SVT would be expected to result in a decrease in the conduction velocity.

Objective: The aim of this study was to investigate the tympanometric changes and eustachian tube function (ETF) in patients with hypothyroidism., Methods: Automatic ETF tests were performed and tympanometric measurements were evaluated to assess ETF in 40 patients diagnosed with hypothyroidism and a 40-patient euthyroid control group. Levothyroxine sodium tablet treatment was started in patients with hypothyroidism. After achieving a euthyroid state in these patients, the tympanometric measurements and automatic ETF tests were repeated., Results: When the patient groups (hypothyroid and control) were compared in terms of ETF, a statistically significant ET dysfunction was observed in the hypothyroid patient group (P < 0.01).When hypothyroid patients were evaluated in terms of ETF before and after treatment, whereas 61.3% of cases had ET function before treatment, this ratio increased to 78.8% after treatment. Furthermore, according to pressure and compliance measurements, statistically significant increases were found in the after treatment measurements (P < 0.05)., Conclusions: As a result of this study, we have come to the opinion that hypothyroidism can change tympanometric measurements and also cause ET dysfunction. However, more comprehensive and detailed studies researching the effects of hypothyroidism on tympanometric measurements are needed.

Objective: Pharyngocutaneous fistula (PCF) is the most common postoperative complication after total laryngectomy. The aim of this study was to determine the relationship between PCF with pharyngeal repair time and the number of mucosal sutures., Methods: The medical records of 47 patients who underwent total laryngectomy were assessed prospectively. The pharyngeal repair time and the number of horizontal, vertical, and cricopharyngeal muscle sutures were recorded. We observed the occurrence of PCF in 14 patients (29.8%). The mean time for pharyngeal repair in the PCF group was 22 minutes 59 seconds ± 5 minutes, and the mean number of vertical, horizontal, and cricopharyngeal muscle sutures was 8.57 ± 2.6, 11.14 ± 2.1, and 8.45 ± 1.9, respectively. The mean time for pharyngeal repair in the non-PCF group was 22 minutes 21 seconds ± 5 minutes, and the mean number of vertical, horizontal, and cricopharyngeal muscle sutures was 9.54 ± 2.6, 10.84 ± 2.3, and 7.36 ± 2.7, respectively. The differences in the pharyngeal repair time and the number of vertical, horizontal, and cricopharyngeal sutures between the 2 groups were not statistically significant (P > 0.05). Besides, there was no statistically significant difference between the mean suture counts per centimeter in horizontal plane (1.46 ± 0.35) and vertical plane (0.98 ± 0.25) in the PCF group and the mean suture counts per centimeter in horizontal plane (1.42 ± 0.37) and vertical plane (1.13 ± 0.3) in the non-PCF group (P > 0.05)., Conclusions: There was no relation between PCF development with pharyngeal repair time, mucosal suture count, and suture frequency after total laryngectomy.

Dieffenbachia is a common domestic plant. Oral contact with the plant generally causes slight effects, but when chewed it may result in painful oropharyngeal edema. Even though the mechanism through which this plant causes toxicity is not known, calcium oxalate crystals (rhaphides) and protease in the idioblast of the plant are considered to be the causes. Our aim was to show the lethal effects of a common domestic plant named Dieffenbachia.A 70-year-old male patient applied to our clinic with aphasia, dysphagia, sialorrhea, wounds on the lips and tongue, and swelling on the face. There was edema on his tongue, soft palate, uvula, anterior pharyngeal plica, epiglottis and aryepiglottic fold, and ulceration on the right side of his tongue, the right cheek mucosa, right-lower gingival, soft palate, tongue base, epiglottis anterior surface, and free edge.Dieffenbachia toxicity presents both minimal and serious problems, which can be life threatening, as in our case. Toxic cases resulting in serious clinical pictures due to Dieffenbachia are rare.

Aneurysms of the extracranial portion of the carotid artery are extremely rare. Internal carotid artery aneurysm is an uncommon cause of tonsillary asymmetry. Although internal carotid artery aneurysms usually remain asymptomatic, the clinical manifestation requires the tonsillar enlargement. Asymmetry as a sole determining factor for tonsillectomy may lead to unnecessary operations. We report a patient with a giant internal carotid artery aneurysm presenting as tonsillary asymmetry that might be mistaken for a tonsillar neoplasia. When faced with a tonsillar asymmetry, an otolaryngologist must keep aneurysms in mind.

Mucoceles are expansile, encapsulated, benign cystic lesions with the potential for adjacent bony remodeling and resorption. Previous nasal surgery, recurrent infections, allergies, and facial traumas are all possible causes of mucoceles involving mainly paranasal sinuses. When the mucocele is infected, it is referred to as mucopyocele. Nasal septal mucoceles seen in only very seldom cases might develop from pneumatized and infected nasal septa. In the current article, we present an interesting primary giant septal mucopyocele that destroys all paranasal cells as a tumoral lesion. The perpendicular plate of ethmoidal bone, vomer, and bilateral anterior and posterior ethmoidal cells were destroyed by mucopyocele. The nasal cavity was totally obstructed by lesions on both sides. On the left side, the lesion also eroded the left lateral nasal wall causing external swelling at the medial canthal region. This is the first case of a giant septal mucopyocele of its kind in the literature. Although nasal septal mucocele is very rare, it should be considered in differential diagnosis of intranasal masses.

Objective: We sought to investigate whether serum choline levels are increased across the spectrum of coronary artery disease (CAD) manifestations and correlate with the severity of coronary stenosis., Methods: A total of 36 patients with acute coronary syndrome (ACS) [22 patients with non-ST-segment elevation ACS and 14 patients with ST-segment elevation acute myocardial infarction (STEMI)], 22 patients with stable angina pectoris (SAP), and 18 controls were recruited for the study. In ACS patients, serum choline levels were measured on admission, and at 24 and 48 h thereafter, using high-performance liquid chromatography. The severity of CAD was assessed using the Gensini score., Results: Serum choline levels on admission were significantly higher in the entire group of patients with ACS than in controls. The highest level of choline was observed in the STEMI group, followed by the SAP, and the non-ST-segment elevation ACS groups. Serum choline levels decreased gradually in patients with STEMI over the 48-h period. Serum choline levels on admission, and at 24 or 48 h thereafter, did not correlate with the presence of CAD neither in patients with ACS (P=0.78, 0.98 and 0.98, respectively) nor in those with SAP (P=0.92)., Conclusion: Our results suggest that serum choline levels are increased in ACS patients. However, there was no clear correlation between levels of choline and the severity and extent of CAD in this patient group.

Objectives: Mobile medical teams (MMTs) provide specialized care on-scene with the purpose to improve outcome. However, this additional care could prolong the on-scene time (OST), which is related to mortality. The purpose of this study was to assess the effects of MMT involvement on the mortality rate and on the OST, in a Dutch consecutive cohort of Level I trauma patients., Methods: All patients who required presentation in the trauma resuscitation room in an urban Level I trauma center were included in this prospective study during the period of November 2005 till November 2007. For data collection, we used both pre- and in-hospital registration systems. Outcome measures were 30-day mortality and OST., Results: In total, 1,054 patients were analyzed. In 172 (16%) patients, the MMT was involved. Mortality was significantly higher in the MMT group compared with patients treated without MMT involvement; 9.9% versus 2.7%, respectively (p < 0.001). Significantly higher Injury Severity Scores, intervention rates, and a significantly lower Triage Revised Trauma Score were found in patients treated by MMT. After adjustment for patient and injury characteristics, no association could be found between MMT involvement and higher mortality (95% CI, 0.581-3.979; p = 0.394). In patients with severe traumatic brain injury (GCS score ≤ 8) in whom a MMT was involved, the mortality was 25.5%, compared with 32.7% in those without MMT involvement (p = 0.442). The mean OST was prolonged (2.7 minutes) when MMT was involved (26.1 vs. 23.4 minutes; p = 0.003)., Conclusions: In this study, OSTs were long compared with PHTLS recommendations. MMT involvement slightly prolonged the OST. Trauma patients with MMT involvement had a high mortality, but after correction for patient and injury characteristics, the mortality rate did not significantly differ from patients without MMT involvement.

Background: Recently, several studies have shown an elevation of serum prostate-specific antigen (PSA) levels after the events associated with presumed pelvic ischemia. Although it has been shown that CO2 pneumoperitoneum during laparoscopic surgery causes splanchnic ischemia, no study has investigated the PSA levels after this procedure. This study aimed to evaluate the effects of CO2 pneumoperitoneum on serum total PSA (tPSA) and free PSA (fPSA) levels in patients undergoing laparoscopic cholecystectomy., Methods: This study involved 30 men who underwent elective laparoscopic cholecystectomy. Serum tPSA and fPSA levels and f/tPSA ratios were determined the day before surgery (baseline), immediately before insufflation, after desufflation, and 24 hours and 7 days after surgery., Results: Serum tPSA and fPSA values after desufflation and 24 hours after surgery were significantly higher than the values before insufflation and at baseline (P<0.01), whereas the f/tPSA ratio did not change (P>0.05). PSA levels decreased to baseline levels after 7 days., Conclusions: Our study showed that CO2 pneumoperitoneum during laparoscopic surgery can cause a rise in serum tPSA and fPSA levels. We think that CO2 pneumoperitoneum during laparoscopic surgery should be added to list of the events in which PSA measurements must be interpreted with caution.

Background: Mirror movements (MM) are involuntary movements during the voluntary movements of the contralateral homologous body parts., Review Summary: We report a patient with an increase in MM after suffering an epileptic seizure of his upper and lower limbs due to the right frontoparietal polymicrogyria, including the supplementary motor area as evidenced by magnetic resonance imaging. MM have been investigated using transcranial magnetic stimulation and other electrophysiological techniques in our case., Conclusion: This case is notable in that it is the first recorded observation of a patient manifesting mirroring after apparently suffering an epileptic seizure. In our case, we suggest that epileptic seizure increases MM by inducing cortical reorganization.

The aim of this study was to compare laparoscopic totally extraperitoneal approach (TEP) repair with tension-free open mesh repair in inguinal hernia. One hundred thirty-four patients were allocated randomly to undergo TEP repair (n = 67) or open mesh repair (n = 67). Operative and postoperative outcomes were determined. The mean of operating time (49.67 +/- 14.11 vs. 56.64 +/- 12.32; P = 0.001), visual analog scale score (2.73 +/- 1.69 vs. 4.61 +/- 1.77; P = 0.001), hospital stay (1.8 +/- 0.7 vs. 2.7 +/- 1.6; P = 0.001), and duration of recovery (10.8 +/- 7.4 vs. 15.2 +/- 8.5; P = 0.001) was significantly less for TEP repair when compared with open mesh repair. The incidence of complications (13.4% vs. 16.4%; P = 0.631) and recurrence (2.9% vs. 5.9%; P = 0.407) was approximately equal in each group. Our results showed that laparoscopic TEP repair is superior to open mesh repair.

Objective: To investigate the plasma and placental levels of interleukin-10 (IL-10), transforming growth factor-beta1 (TGF-beta1), and epithelial-cadherin (E-cadherin) in normotensive and preeclamptic pregnancies., Methods: The study population consisted of 33 women with normotensive pregnancy and 35 women with preeclampsia. Peripheral venous blood samples were collected before labor (35.3 +/- 1.1 and 34.2 +/- 3.4 weeks' gestation for normotensive and preeclamptic pregnancies, respectively), and placental tissues were obtained after delivery. Maternal plasma and placental homogenate IL-10, TGF-beta1, and E-cadherin levels were determined by enzyme-linked immunosorbent assay., Results: The mean plasma and placental levels of IL-10, TGF-beta1, and E-cadherin were significantly higher in preeclamptic than normotensive patients (P <.001). The plasma and placental levels of IL-10, TGF-beta1, and E-cadherin significantly increased with the increments in diastolic blood pressure (P <.001)., Conclusion: IL-10, TGF-beta1, and E-cadherin may be involved in the pathologic process of preeclampsia. The pathophysiologic changes associated with preeclampsia may stem in part from the overproduction of these placental mediators.