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Abstract SCN4A gene mutations cause a number of neuromuscular phenotypes including myotonia. A subset of infants with myotonia‐causing mutations experience severe life‐threatening episodic laryngospasm with apnea. We have recently identified similar SCN4A mutations in association with sudden infant death syndrome. Laryngospasm has also been proposed as a contributory mechanism to some cases of sudden unexpected death in epilepsy (SUDEP). We report an infant with EEG‐confirmed seizures and recurrent apneas. Whole‐exome sequencing identified a known pathogenic mutation in the SCN4A gene that has been reported in several unrelated families with myotonic disorder. We propose that the SCN4A mutation contributed to the apneas in our case, irrespective of the underlying cause of the epilepsy. We suggest this supports the notion that laryngospasm may contribute to some cases of SUDEP, and implicates a possible shared mechanism between a proportion of sudden infant deaths and sudden unexpected deaths in epilepsy.

Abstract Objectives Acute central nervous system (CNS) infections in children can lead to neurological complications and mortality. This study aimed to identify the clinical manifestations, laboratory parameters, and cerebrospinal fluid characteristics indicative of CNS infections and define the risk factors that lead to pediatric intensive care unit (PICU) admission in the pediatric population of Şanlıurfa, a city in southeastern Turkey. Methods This retrospective analysis included patients aged 1 month to 18 years who were treated for acute CNS infections in the Şanlıurfa Training and Research Hospital between January 2020 and May 2023. Clinical data were obtained from the hospital electronic medical records. Results A total of 68 patients with acute CNS infections were included in this study. The median patient age was 3 (0.94–8.75) years. Fever was the most prevalent symptom in 92.6% of the patients. Of the total, 25% (n = 17) of the patients had an identified causative agent and 35.3% (n = 24) were admitted to the PICU. Serum C-reactive protein (CRP) levels were significantly higher in patients with bacterial meningitis than in those with viral meningitis (p = 0.007). Patients with impaired consciousness and seizure were significantly more likely to require admission to the PICU than patients without these conditions (both p

Abstract Two novel ibuprofen cystamine salts (IBU‐CYS 1 and IBU‐CYS 2) are synthesized by coupling the anion of ibuprofen with cystamine dihydrochloride in 1 : 1 and 2 : 1 ratio to improve the solubility and bioavailability of ibuprofen. The salts are characterized by 1H NMR, FT‐IR and UV‐Vis spectroscopy, differential scanning calorimetry (DSC), thermogravimetry (TGA, DTA) and X‐ray diffraction measurements. IBU‐CYS 1 and IBU‐CYS 2 show higher solubility (6.11 and 7.81 mg/mL) compared to ibuprofen (0.04 mg/mL) in water. IBU‐CYS2 was encapsulated into 2‐hydroxyethyl methacrylate: poly (ethylene glycol) acrylate hydrogels for enhanced delivery. The in vitro studies in PBS (pH 7.4) indicate that the salts are effective in relieving inflammatory responses induced by lipopolysaccharide in RAW264.7 macrophage cells (nitrite inhibition percentages of IBU‐CYS 1, IBU‐CYS 2 and ibuprofen: approximately 34.29, 27.03 and 31.50 respectively) while indicating no cytotoxicity. Therefore, these salts may be promising candidates for the development of effective formulations of this drug.

Background/aimArtificial Intelligence (AI) is the capability of computational systems to perform tasks that require human-like cognitive functions, such as reasoning, learning, and decision-making. Unlike human intelligence, AI does not involve sentience or consciousness but focuses on data processing, pattern recognition, and prediction through algorithms and learned experiences. In healthcare including neuroscience, AI is valuable for improving prevention, diagnosis, prognosis, and surveillance.MethodsThis qualitative study aimed to investigate the acceptability of AI in Medicine (AIIM) and to elucidate any technical and scientific, as well as social and ethical issues involved. Twenty-five doctors from various specialties were carefully interviewed regarding their views, experience, knowledge, and attitude toward AI in healthcare.ResultsContent analysis confirmed the key ethical principles involved: confidentiality, beneficence, and non-maleficence. Honesty was the least invoked principle. A thematic analysis established four salient topic areas, i.e., advantages, risks, restrictions, and precautions. Alongside the advantages, there were many limitations and risks. The study revealed a perceived need for precautions to be embedded in healthcare policies to counter the risks discussed. These precautions need to be multi-dimensional.ConclusionThe authors conclude that AI should be rationally guided, function transparently, and produce impartial results. It should assist human healthcare professionals collaboratively. This kind of AI will permit fairer, more innovative healthcare which benefits patients and society whilst preserving human dignity. It can foster accuracy and precision in medical practice and reduce the workload by assisting physicians during clinical tasks. AIIM that functions transparently and respects the public interest can be an inspiring scientific innovation for humanity.

Purpose: The C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU). Methods: The study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first. Results: The median age of the patients was 79 years (interquartile range (IQR), 69–85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06–4.4, p=0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01–1.14, p=0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07–1.35, p=0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 p=7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (p=0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %. Conclusion: CRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.

BACKGROUND: To compare the reliability of the House–Brackmann (HB), Facial Nerve Grading System 2.0 (FNGS 2.0), and Sunnybrook Facial Grading System (SB) which are widely used in the evaluation of peripheral facial paralysis (PFP) patients. METHODS: Thirty-five video-recorded adult PFP patients were included in the study. The evaluators comprised 6 physicians. Evaluations were conducted twice independently, utilizing video recordings. Simultaneously, the evaluators were asked to keep time during the evaluation. For the analysis of reliability, Fleiss’ kappa coefficient was used for the HB, and the intraclass correlation coefficient (ICC) was used for the FNGS 2.0 and SB. RESULTS: The mean evaluation time of 1 patient was found to be 1.06 ± 0.24, 1.47 ± 0.23, and 2.32 ± 0.41 minutes for the HB, FNGS 2.0, and SB, respectively. For interrater reliability, Fleiss’ kappa for the HB was 0.495 and 0.403; ICC for the FNGS 2.0 was 0.966 and 0.958; ICC for the SB was 0.960 and 0.967 for the first and second measurements, respectively. For intrarater reliability, Fleiss’ kappa for the HB was 0.391, 0.446, 0.564, 0.502, 0.626, and 0.455; ICC for the FNGS 2.0 was 0.87, 0.982, 0.966, 0.929, 0.933, and 0.948; ICC for the SB was 0.935, 0.96, 0.895, 0.941, 0.96, and 0.94 for the 6 raters, respectively. CONCLUSION: In the present study, statistically high intra- and interrater correlations were found for the FNGS 2.0 and SB, while a moderate correlation was found for the HB. Although the HB seems to be more practical, it has been concluded that the FNGS 2.0 and SB are more reliable

FZR1, which encodes the Cdh1 subunit of the anaphase-promoting complex, plays an important role in neurodevelopment by regulating the cell cycle and by its multiple post-mitotic functions in neurons. In this study, evaluation of 250 unrelated patients with developmental and epileptic encephalopathies and a connection on GeneMatcher led to the identification of three de novo missense variants in FZR1. Whole-exome sequencing in 39 patient-parent trios and subsequent targeted sequencing in an additional cohort of 211 patients was performed to identify novel genes involved in developmental and epileptic encephalopathy. Functional studies in Drosophila were performed using three different mutant alleles of the Drosophila homologue of FZR1 fzr. All three individuals carrying de novo variants in FZR1 had childhood-onset generalized epilepsy, intellectual disability, mild ataxia and normal head circumference. Two individuals were diagnosed with the developmental and epileptic encephalopathy subtype myoclonic atonic epilepsy. We provide genetic-association testing using two independent statistical tests to support FZR1 association with developmental and epileptic encephalopathies. Further, we provide functional evidence that the missense variants are loss-of-function alleles using Drosophila neurodevelopment assays. Using three fly mutant alleles of the Drosophila homologue fzr and overexpression studies, we show that patient variants can affect proper neurodevelopment. With the recent report of a patient with neonatal-onset with microcephaly who also carries a de novo FZR1 missense variant, our study consolidates the relationship between FZR1 and developmental and epileptic encephalopathy and expands the associated phenotype. We conclude that heterozygous loss-of-function of FZR1 leads to developmental and epileptic encephalopathies associated with a spectrum of neonatal to childhood-onset seizure types, developmental delay and mild ataxia. Microcephaly can be present but is not an essential feature of FZR1-encephalopathy. In summary, our approach of targeted sequencing using novel gene candidates and functional testing in Drosophila will help solve undiagnosed myoclonic atonic epilepsy or developmental and epileptic encephalopathy cases. [ABSTRACT FROM AUTHOR]

In recent years livestream events have become increasingly popular, in part to cope with social isolation experienced during the COVID-19 pandemic. The potential of livestreams to mitigate the negative effects of isolation lacks empirical evidence. To address this gap, we compared the effect of watching a concert on livestream with watching a recording of the same event on viewer's social presence, enjoyment, social connectedness, and loneliness. Livestream viewing was expected to result in higher levels of enjoyment and social connectedness, and lower levels of loneliness compared to viewing the recording. The effect of concert viewing mode on viewers' experience was expected to be mediated by social presence. In line with expectations, participants reported higher social presence and enjoyment in the livestream condition compared to the recorded condition, although, participants reported similar levels of social connectedness and loneliness in both conditions. Moreover, we did not find support for social presence as a mediator. In sum, while livestreamed events can enhance feelings of social presence and be more enjoyable, further research is needed to understand whether and how this can be utilized to mitigate loneliness and lack of social connectedness.

Amaç: Periodontal prognoz açısından, aktif tedaviyi takiben destekleyici periodontal tedavinin önemi bilinmekle birlikte, bu süreçte hasta uyumuna etki eden faktörler tam olarak aydınlatılamamıştır. Bu çalışmanın amacı, aktif periodontal tedavi ve idame döneminde klinik indeksler, periodontitis şiddeti ve bireysel faktörler ile hasta uyumu arasındaki ilişkiyi belirlemektir. Gereç ve Yöntemler: Çalışmaya periodontitis tanısı almış 112 birey dahil edildi. Hastaların demografik özelliklerinin yanısıra başlangıç periodontal kayıtları alınarak periodontitis şiddeti ve derecesi belirlendi. Aktif periodontal tedavi süreci ve 1 yıllık idame periyodunda hasta uyumuna etki eden faktörler tek değişkenli ve çok değişkenli regresyon analizi ile değerlendirildi. Bulgular: Hastaların başlangıç klinik periodontal ölçümleri, periodontitis şiddeti ve derecesi yönünden aktif periodontal tedaviye uyumları benzerdi (p>0.05). Katılımcıların % 38’i destekleyici periodontal tedavi sürecine tamamen uyumsuzluk gösterdi. Periodontitis şiddeti arttıkça destekleyici periodontal tedaviye uyumun azaldığı tespit edildi. Aktif periodontal tedavi fazında uyumsuz olan hastalar, destekleyici periodontal tedavi döneminde de anlamlı derecede uyumsuzdu. Çok değişkenli regresyon analizi, sigara kullanımının ve aktif periodontal tedaviye uyumsuzluğun periodontal idame dönemindeki hasta uyumunu etkilediğini gösterdi. Sonuç: Hem başlangıç periodontal belirteçler hem de periodontitis şiddeti destekleyici periodontal tedavi fazında hasta uyumu ile anlamlı derecede ilişkilidir. Bununla birlikte, aktif tedaviye devamlılığı zayıf bireylerin idame döneminde de uyumsuz olduğu gözlenmiştir. Anahtar Kelimeler: Periodontitis, İdame, Hasta Uyumu, Periodontal Tedavi

The primary focus of this study was the Dağpazarı village in the Mut region of Mersin, southern Turkey. In this research area, two stratigraphic sections were meticulously measured. The study conducted a comprehensive examination of the Middle-Late Miocene period in the Dağpazarı, Ballı, and Mut Formations by analyzing the ostracod fauna and utilizing strontium isotope chemostratigraphic dating. This research determined that the upper levels of the Mut/Köselerli formations, specifically from the Burdigalian to Serravallian, signify the commencement of the Miocene succession in the study area.The Dağpazarı Formation, characterized by abundant silty-clay, Ostrea fossils, and lignite layers, is deposited unconformably just above these levels.This formation contains the following ostracod taxa; Bairdia subdeltoidea, C. glypta, Cytheridea acuminata acuminata, Acanthocythereis hystrix, Krithe monosteracensis, Neomonoceratina mouliana, Hemicyprideis sp., Cistacythereis caelatura, Cyherella terguemi, T. prava, K. langhiana, A. ulicznyi, Pokornyella deformis minor, Loxoconcha alata, Tenedocythere salebrosa. Furthermore, the planktonic foraminifera species are; O. universa, Globigerinoides trilobus, Glb. ruber, Orbulina bilobata, Glb. sacculifer, O. suturalis, and the formation includes abundant bryozoa, echinoid spines, gastropods such as Terebralia at distinct levels, and fish otolith. The formation, dating from the late Serravallian to the early Tortonian, exhibits the shallow reef characteristics that continued to develop in the late Miocene.The formation consists of dark green, bulbous weathered claystone, Bairdia subdeltoidea and Ostrea which are reduced in size at the levels that pass into hard clayey sandstone, abundant benthic foraminifera with abundant echinoid spines. The formation consists of benthic foraminifera, hard clayey sandstone, and weathered dark green claystone, which contains numerous echinoid spines.Ostrea and Bairdia subdeltoidea are also present. The upper section of the analyzed succession concludes with silty, compact, clayey limestone layers and light-colored limestone bands. The Tırtar Ballı Formation, which conformably overlays the Dağpazarı Formation, signifies the culmination of a relatively recent reef formation during the Tortonian period.Ostracod species such as Aurila pigadiana, Thalmannia hodgii, Buntonia sublatissima dertonensis, Bairdia subdeltoidea, Aurila sp. Bassiouni have been defined. The limestones also contain abundant benthic foraminifera and echinoid spines. The 87Sr/86Sr ratio analyzed from the carbonate sample obtained from the Dağpazarı formation is 0.708920. Based on these isotope data, the age of the Dağpazarı formation was calculated to be 8.7 million years (Ma).

The purpose of this study is to examine the relationship between psychological resilience, cognitive emotion regulation and life satisfaction variables of women who have and have not been exposed to violence. The sample of the study consists of 411 women between the ages of 18-60 living in Turkey with at least literacy level. Sociodemographic data of all participants were collected. Resilience Scale for Adults (RSA), Cognitive Emotion Regulation Questionnaire (CERQ) and Satisfaction With Life Scale (SWLS) were used to compare the psychological resilience, cognitive emotion regulation and life satisfaction scores of women who were exposed to violence and those who were not. The scores of the women who were exposed to violence from the Resilience Scale for Adults and the sub-dimension of family adjustment in the scale were lower than those who were not exposed to violence. The scores of the women who were exposed to violence in the sub-dimension of self-blame, rumination, catastrophizing and blaming others were found to be higher than those who did not experience violence, and the scores of the positive reappraisal sub-dimension of the women who were exposed to violence were found to be lower. The Satisfaction With Life Scale scores of the women exposed to violence are significantly lower than the women who are not exposed to violence. It is important to define the sociodemographic characteristics of women who have been subjected to violence, the characteristics of the violence they have experienced, the risk factors and protective factors against violence.

Myxomatous mitral valve disease (MMVD) is one of the most common heart diseases in Cavalier King Charles spaniel (CKCS) dogs. The American College of Veterinary Internal Medicine (ACVIM) uses clinical, echocardiographic, and radiographic criteria to diagnose the disease, but measurement of vertebral left atrial size (VLAS) provides a simpler assessment. The aim of this study was to determine VLAS values in MMVD cases of CKCS and to investigate their clinical significance at different MMVD stages. Eighteen CKCS dogs of both sexes, different ages and weights, and different MMVD stages (6 at B1 stage, 6 at B2 stage, and 6 at C stage) were included in the study, as well as 6 healthy CKCS as control group A. We performed clinical, radiological, and echocardiographic examinations. VHS and VLAS values were significantly higher in the MMVD group than in the control group (p

BACKGROUND: This study aims to evaluate the effects of education on home care of infected or suspected COVID-19 patients on the levels of knowledge, anxiety, and awareness of nursing students in Turkey. MATERIALS AND METHODS: The study is in quasi-experimental design. A sample of 158 volunteer students studying nursing at a private university in Turkey was formed. Data were collected using, descriptive information form, “Coronavirus Anxiety Scale,” “COVID-19 Awareness Scale,” and the “Knowledge of COVID-19 Home Care Test.” Pre-test was performed before the participants received education. Post-test was performed seven days after the intervention. SPSS version 25.0 was used for data analysis. “TREND checklist” was used for quasi-experimental/non-randomized evaluations to report the findings of the study. RESULTS: Anxiety levels decreased and the levels of awareness and knowledge on COVID-19 increased after receiving education on home care of infected or suspected COVID-19 patients (p < 0.001), indicating the effectiveness of the education. Education on home care of infected or suspected COVID-19 patients was an effective method to reduce anxiety and increase knowledge and awareness in nursing students. CONCLUSIONS: To contribute to community health, home care training can be given to nursing students, other people receiving home care, or providing home care to COVID-19 patients, infected or suspected COVID-19 patients.

Objective: This study investigated the impact of different local corticosteroid applications on impedance measurements in patients with cochlear implants. Methods: The study was designed as a controlled, randomized, and prospective study in which 34 consecutive patients who had undergone cochlear implant surgery were divided into three groups. The first group received intracochlear dexamethasone, in the second group the middle ear cavity was filled with dexamethasone, and the third group did not receive dexamethasone. Intraoperative, postoperative 1st week, 1st month, 3rd month, 6th-month neural response telemetry, and impedances were measured. The measurements were compared by electrode groups representing the different regions of cochlea like basal (1–7), middle (8–13), and apical (14–22) regions. Results: The intergroup analysis showed no statistically significant differences in impedance measurements of the basal, middle, and apical regions (p>0.05). However, the impedances were lower in the two dexamethasone groups, especially in the basal and middle parts. Sixth month impedances were also lower in the dexamethasone groups. There was apparent stability in the impedance of the basal region with the intracochlear application during the first week. Conclusion: Local dexamethasone applications had a potentially positive impact on the impedance of the basal and middle regions. Patients had lower impedances than the control group during follow-up and at the endpoint. The increase in the apical region may indicate that dexamethasone was not reaching the apical zone in local applications.

Background: Risk assessment is recommended for patients with congenital heart disease-associated pulmonary arterial hypertension. This study aims to compare an abbreviated version of the risk assessment strategy, noninvasive French model, and an abridged version of the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management 2.0 risk score calculator, Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2. Methods: We enrolled a mixed prevalent and incident cohort of patients with congenital heart disease-associated pulmonary arterial hypertension (n = 126). Noninvasive French model comprising World Health Organization functional class, 6-minute walk distance, and N-terminal pro-hormone of brain natriuretic peptide or brain natriuretic peptide was used. Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 includes functional class, systolic blood pressure, heart rate, 6-minute walk distance, brain natriuretic peptide/N-terminal pro-hormone of brain natriuretic peptide, and estimated glomerular filtration rate. Results: The mean age was 32.17 +- 16.3 years. The mean follow-up was 99.41 +- 58.2 months. Thirty-two patients died during follow-up period. Most patients were Eisenmenger syndrome (31%) and simple defects (29.4%). Most patients received monotherapy (76.2%). Most patients were World Health Organization functional class I-II (66.6%). Both models effectively identified risk in our cohort (P =.0001). Patients achieving 2 or 3 noninvasive low-risk criteria or low-risk category by Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 at follow-up had a significantly reduced risk of death. Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2 approximates noninvasive French model at discriminating among patients based on c-index. Age, high risk by Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management Lite 2, and the presence of 2 or 3 low-risk criteria by noninvasive French model emerged as an independent predictors of mortality (multivariate hazard ratio: 1.031, 95% CI: 1.005-1.058, P =.02; hazard ratio: 4.258, CI: 1.143-15.860, P =.031; hazard ratio: 0.095, CI: 0.013-0.672, P =.018, respectively). Conclusions: Both abbreviated risk assessment tools may provide a simplified and robust method of risk assessment for congenital heart disease-associated pulmonary arterial hypertension. Patients not achieving low risk at follow-up may benefit from aggressive use of available therapies.

Background: With aging, an increase is observed in some geriatric syndromes as well as sleep disorders. Objective: The aim of this study is to investigate the relationship between sleep quality and geriatric syndromes (dementia, depression, sarcopenia, malnutrition, and frailty) in nursing home residents. Methods: The participants’ demographic characteristics, comorbid diseases, number of drugs, cognitive performance, mood and nutritional states, sarcopenia and fraility screening tests and sleep quality test were evaluated by two geriatricians. The participants were divided into two groups as good sleep quality and poor sleep quality. Correlation analysis of sleep quality and geriatric and mental functionality tests was performed with Spearman correlation analysis. Results: A total of 104 nursing home residents (34 females, 74 males, aged 61-98) participated in the study. Sleep quality was found to be worse in the elderly between the ages of 75-84, with a higher number of children, using assistive devices, and taking selective serotonin reuptake inhibitors. In addition, in participants with poor sleep quality, SARC-f (strength, assistance with walking, rising from a chair, climbing stairs, and falls) and geriatric depression scale scores were significantly higher. The Pittsburgh Sleep Quality Index global score was negatively associated with total sleep time and positively associated with geriatric depression scale score and SARC-f score. Conclusion: Findings from the present study in relation between poor sleep quality and some geriatric evaluation parameters suggests that there may be a common pathophysiological alteration with aging.

Abstract Background Diltiazem stands out as one of the front-line drugs administered in the emergency department to achieve acute rate control in patients suffering from atrial fibrillation with rapid Ventricular Response. One of the cytochrome enzymes involved in the metabolism of diltiazem is cytochrome P450 2D6 (CYP2D6). Interindividual differences can act on drug metabolism and thus drug efficacy due to the genetic polymorphism induced by the CYP2D6 enzyme. This study explores the association between the efficacy of diltiazem and the genetic polymorphism of CYP2D6 in patients with atrial fibrillation with rapid ventricular response. Results 87 out of 93 individuals with ventricular rate > 120 beats/min constituted the patient cohort. The patients were administered 0.25 mg/kg diltiazem intravenously. As a second dose, 0.35 mg/kg diltiazem was administered to patients who reportedly did not receive adequate drug efficacy. Heart rate control was considered to be achieved in patients whose heart rate fell below 110 beats/min and did not rise above 110 beats/min for 2 h. CYP2D6 *2, *3, *4 and *10 represent allele variants and *1 represents wild type (wt) allele. Achieving rate control after one or two doses of diltiazem in normal allele (wt/wt) carriers proved significantly higher than wt/*2, wt/*4 and wt/*10 heterozygous variant carriers. No significant difference was noted in wt/*3 heterozygous variant carriers. Conclusion The presence of *2, *4 and *10 alleles was observed to significantly compromise the drug efficacy. *3 allele was found to bear no relation to the effect of diltiazem on achieving rate control.

Abstract Background Lung cancer is known as the most common and highly metastatic form of cancer worldwide. Tumour node metastasis (TNM) staging is the gold standard classification system for the decision-making process for appropriate treatment. Particularly N status has the most important prognostic value in the absence of distant metastasis. Traditional diagnostic methods are capable of detecting metastasis; however, they may fail to detect micrometastasis, which plays a role in disease recurrence and patients' long-term survival. Occult micrometastasis can change the tumour's TNM staging and, consequently, the patient's treatment regimen. Methods The median number of three lymph node tissues were collected from 30 patients who underwent surgery for non-small cell lung cancer. Lymph node tissues were collected from different lymph node stations according to the location of the patient's tumour. CK19, EpCAM and CEACAM5 gene expressions were analysed in tissues using quantitative real-time polymerase chain reaction to detect micrometastasis in distant lymph nodes. Results Triple positivity was seen in 26 out of 30 patients which 19 patients were upstaged from N0 to N2. While survival was not significantly affected between upstaged and non-upstaged patients, patients upstaged with multiple-station N2 had a significantly higher recurrence and lower survival compared to single-station N2. Conclusion A combination of CK19, EpCAM and CEACAM5 gene expressions in lymph nodes can be used to identify micrometastasis which postoperatively may be used as a tool to predict patients’ recurrence and survival.

Myxomatous mitral valve disease (MMVD) is one of the most common heart diseases in dogs. The disease progresses faster in Cavalier King Charles Spaniel (CKCS) dogs and occurs at an earlier age. QT interval length reflects abnormalities in ventricular repolarization which may predispose to the formation of fatal arrhythmias such as torsades de pointes. A fast and accurate assessment is therefore essential. The study aimed to examine the changes in QT duration in MMVD cases of CKCS and to calculate the corrected QT durations with Bazett’s formula in various stages of the disease. The study included 20 CKCS dogs of both genders, various ages and weights, and different stages of MMVD (n=6 in B1 stage, n=6 in B2 stage, and n=8 in C stage), and 5 healthy CKCS which were included in the control group. Clinical, radiological, hematological, biochemical, echocardiographic, and electrocardiographic examinations were performed. The corrected QT interval duration in the MMVD group was longer than the control (p

Objective:We evaluated and compare sleep quality and disorders according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) A, B, C, D groups in patients with Chronic Obstructive Pulmonary Disease (COPD) and to determine sleep disorders.Materials and Methods:Our study included 94 patients who applied to Pamukkale University Medical Faculty Hospital Chest Diseases Polyclinic between January 2016 and January 2017, were diagnosed with COPD according to GOLD criteria, were not in a COPD attack at the time of admission and agreed to participate in the study.Results:In patients with COPD, as the severity of stages increased, a decrease in mean FEV1 values was detected and as the FEV1 values decreased, the mean oxygen values measured during the night decreased. According to the GOLD stage, there was no significant difference between total sleep periods, sleep activity, sleep latency, rapid eye movement (REM) sleep duration, and non-REM sleep duration. According to polysomnography results, apnea-hypopnea index (AHI) was found to be below 5 in 40% of the patients. There was no statistically significant difference between the AHI and COPD stages (p=0.581).Conclusion:No significant difference was found between the COPD stage and AHI severity. However, as COPD stages increased, a decrease in mean nocturnal oxygen saturation was detected. Nocturnal oxygen desaturation is the main cause of comorbidities observed in patients COPD. As a result, careful attention should be given to night desaturation in advanced patients with COPD, and the necessary procedures must be performed to prevent comorbidities.

Textile wastewater is polluted by inorganic/organic substances, polymers, dyes, and microfibers (MFs), which are microplastics (MPs) and natural fibers. This work is aimed at the preliminary investigation of MFs and MPs in textile industrial wastewater, and at evaluating the removal efficiency of an on-site wastewater treatment plant (WWTP). Ten samples of inflows and outflows of the WWTP of a textile company (applying a physic-chemical process) have been analyzed. Firstly, the samples underwent a pretreatment with 15% hydrogen peroxide at 25 °C for 5 days to remove organic compounds. Secondly, the MFs were recovered from the aqueous phase by pre-screening centrifugation, density separation, and filtration as alternative options. Filtration obtained the best performances, compared to the other recovery processes. Thirdly, the MFs were counted through optical microscopy and the MPs were identified through micro-FTIR. The MFs amount in the inflow samples was in the range of 893–4452 MFs/L. The outflow samples (310–2404 MFs/L) exhibited a 38–65% reduction compared to the inflows, demonstrating that up to 62% of residual MFs can enter the sewer network or the receiving water body. Cotton and wool, and numerous MPs (acrylic, polyester, polypropylene, polyamide, and viscose/rayon) were identified in the inflow and outflow samples (with the only exception of “dense” viscose (rayon), not detected in the outflows, and probably retained by the WWTP with the sludge). This study, even if just preliminary, offers interesting hints for future research on MFs/MPs detection in textile wastewater, and on the performance of a full-scale WWT process for their removal.

Introduction: Little is known about how the newly regenerated limb tissues in the Mexican axolotl seamlessly integrate with the remaining stump tissues to form a functional structure, and why this doesn't occur in some regenerative scenarios. In this study, we evaluate the phenomenological and transcriptional characteristics associated with integration failure in ectopic limb structures generated by treating anterior-located ectopic blastemas with Retinoic Acid (RA) and focusing on the “bulbus mass” tissue that forms between the ectopic limb and the host site. We additionally test the hypothesis that the posterior portion of the limb base contains anterior positional identities.Methods: The positional identity of the bulbus mass was evaluated by assaying regenerative competency, the ability to induce new pattern in the Accessory Limb Model (ALM) assay, and by using qRTPCR to quantify the relative expression of patterning genes as the bulbus mass deintegrates from the host site. We additionally use the ALM and qRTPCR to analyze the distribution of anterior and posterior positional identities along the proximal/distal limb axis of uninjured and regenerating limbs.Results: The bulbus mass regenerates limb structures with decreased complexity when amputated and is able to induce complex ectopic limb structure only when grafted into posterior-located ALMs. Expressional analysis shows significant differences in FGF8, BMP2, TBX5, Chrdl1, HoxA9, and HoxA11 expression between the bulbus mass and the host site when deintegration is occuring. Grafts of posterior skin from the distal limb regions into posterior ALMs at the base of the limb induce ectopic limb structures. Proximally-located blastemas express significantly less HoxA13 and Ptch1, and significantly more Alx4 and Grem1 than distally located blastemas.Discussion: These findings show that the bulbus mass has an anterior-limb identity and that the expression of limb patterning genes is mismatched between the bulbus mass and the host limb. Our findings additionally show that anterior positional information is more abundant at the limb base, and that anterior patterning genes are more abundantly expressed in proximally located blastemas compared to blastemas in the more distal regions of the limb. These experiments provide valuable insight into the underlying causes of integration failure and further map the distribution of positional identities in the mature limb.

Prevention of COVID-19 is of paramount importance for public health. Some natural extracts might have the potential to suppress COVID-19 infection. Therefore, this study aimed to design a standardised, efficient, and safe chewable tablet formulation (with propolis and three herbal extracts) for possible prevention against two variants (Wuhan B.1.36 and Omicron BA.1.1) of SARS-CoV-2 virus and other viral infections. Green tea, bilberry, dried pomegranate peel, and propolis extracts were selected for this purpose. Cytotoxicity and antiviral activity of each component, as well as the developed chewable tablet, were examined against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus using Vero E6 cells with the xCELLigence real-time cell analyser-multiple plates system. Anti-inflammatory and analgesic activities, as well as mutagenicity and anti-mutagenicity of the chewable tablet were also analysed. Compared to the control, it was observed that the chewable tablet at concentrations of 110 and 55 µg/mL had antiviral activity rates of 101% and 81%, respectively, for the Wuhan variant and 112% and 35%, respectively, for the Omicron variant. The combination of herbal extracts with propolis extract were synergically more effective (∼7-fold higher) than that of individual extract. The present work suggests that a combination of herbal extracts with propolis at suitable concentrations can effectively be used as a food supplement for the prevention of both variants of the SARS-CoV-2 virus in the oral cavity (the first entry point of the SARS-CoV-2 virus).

With 30 antennas and a maximum baseline length of 25 km, the Giant Metrewave Radio Telescope (GMRT) is the premier low-frequency radio interferometer today. We have carried out a study of possible expansions of the GMRT, via adding new antennas and installing focal plane arrays (FPAs), to improve its point-source sensitivity, surface brightness sensitivity, angular resolution, field of view, and UV coverage. We have carried out array configuration studies, aimed at minimizing the number of new GMRT antennas required to obtain a well-behaved synthesized beam over a wide range of angular resolutions for full-synthesis observations. This was done via two approaches, tomographic projection and random sampling, to identify the optimal locations for the new GMRT antennas. We report results for the optimal locations of the antennas of an expanded array (the 'EGMRT'), consisting of the existing 30 GMRT antennas, 30 new antennas at short distances, ≲2.5 km from the GMRT array centre, and 26 additional antennas at relatively long distances, ≈5–25 km from the array centre. The collecting area and the field of view of the proposed EGMRT array would be larger by factors of, respectively, ≈3 and ≈30, than those of the GMRT. Indeed, the EGMRT continuum sensitivity and survey speed with 550–850 MHz FPAs installed on the 45 antennas within a distance of ≈2.5 km of the array centre would be far better than those of any existing interferometer, and comparable to the sensitivity and survey speed of Phase-1 of the Square Kilometre Array. [ABSTRACT FROM AUTHOR]

This article examines European residential responses to migrations after 2015. The literature meticulously analyzes their historically-contextually changing variances and inner diversities while imposing a binary view: the anti-immigration response is the negation, and the solidarity response is the affirmation of liberal tolerance. Contrarily, I argue that both responses utilize the liberal tolerance idea and its operational principles. First, they border the European Self and the migrant Other; re-border “the intolerable” and “the tolerable” migrant; and then exclude the former while only partially including the latter. Refugees’ inclusion and exclusion are seen either as a zero-sum (i.e., they are either included or excluded) or a dialectical state (i.e., the inclusion of some means the exclusion of others), but I claim that even the most inclusive responses are excluding the very subjects they claim to include. Inclusion is partial, while exclusion is constant. Thus, I discuss the migrants’ permanent yet differential exclusions in three modalities of liberal tolerance: Liberal intolerance, differentiating tolerance, and indifferent tolerance.

Background: Dysregulation of microRNAs is associated with pulmonary hypertension. The present study aimed to determine the alterations in microRNA and microRNA expressions and their role in signaling pathways and investigate the relationship with serum levels of apelin, kynurenine, and endocan in pulmonary hypertension. Methods: The study design was prospective and single-centered. The study included 32 consecutive treatment-naive patients with precapillary pulmonary hypertension and 55 age and sex-matched healthy controls. All subjects underwent right heart catheterization. mRNA expressions of hypoxia-inducible factor-1 alpha, hypoxia-inducible factor-2 alpha, signal transducer and activator of transcription-3, fibroblast growth factor-2, fibroblast growth factor receptor-1, and poly-ADP-ribose polymerase-1 and microRNA expressions of miRNA-210, miRNA-130a, miRNA-424, miRNA-204, and miRNA-223 were determined by RT-PCR. Concentrations of kynurenine, apelin, and endocan were analyzed by ELISA. Results: mRNA expressions of hypoxia-inducible factor-2 alpha, signal transducer and activator of transcription-33, and FGF-2 were increased; miRNA-210 and miRNA-130a were increased; miRNA-223 and miRNA-204 were decreased in pulmonary hypertension. Apelin and kynurenine concentrations were decreased in pulmonary hypertension. There were positive correlations: hypoxia-inducible factor-2 alpha-miRNA-424, ApelinmiRNA-424, kynurenine-miRNA-210, signal transducer and activator of transcription-3-PVR, miRNA-210-right atrial pressure, and kynurenine-right atrial pressure. There were negative correlations: poly-ADP-ribose polymerase-1-miRNA-210 and poly-ADP-ribose polymerase-1-right atrial pressure. On multiple logistic regression analyses, miRNA-130a and Apelin were independent risk factors for PH. Conclusions: We report a novel relationship between the kynurenine and poly-ADPribose polymerase-1 signaling pathways that could be mediated by miRNA-210. We also report a connection between the Apelin and hypoxia-inducible factor-2 alpha signaling pathways that could be mediated by miRNA-424. Reduced levels of Apelin and elevated levels of miRNA-130a are associated with pulmonary hypertension. We also find that elevated levels of signal transducer and activator of transcription-3, miRNA-210, and kynurenine and reduced levels of poly-ADP-ribose polymerase-1 correlate with more severe hemodynamics

In a developing and increasing world, the increment in the consumption of natural resources brings environmental problems together. The use of plant raw materials has great importance in the construction industry, which has a high consumption rate. Increasing demand to develop sustainable and environmentally friendly materials has increased the use of natural fibers in sustainable building materials (sound absorption, heat and sound insulation). The fact that hemp fiber does not have high water consumption in the production, can be grown without the need for fertilizers and pesticides, as well as leaving a rich soil structure for the next crop by destroying weeds ensures the protection of the soil and the environment. From this point of view, in this study sound insulation properties of hemp fiber reinforced composites were investigated. Polypropylene fiber was used as a matrix material. To compare the performance of hemp fiber, cotton fiber was also utilized and different constructions were produced from these materials. The composites were produced by the hot-press method. It was found that the composites made of hemp fiber showed significantly higher sound insulation than the cotton fiber reinforced composites and can be used as a sound isolation material at specific high frequencies.

Aim Joint hypermobility is a term used to describe an excessive range of joint motion. Joint hypermobility can be symptomatic or not. The present study aimed primarily to define the prevalence of joint hypermobility in healthy schoolchildren, and secondly, to determine the relationship between hypermobility and pain, physical activity, joint injury, quality of life, and balance. Materials and Methods In this cross-sectional study, the joints of 737 schoolchildren, aged 8 to 15 years, were examined according to the Beighton score (BS). Generalized joint hypermobility was defined by using a cut-off point of ≥6 joints. The participants with a BS between 1 and 5 were accepted as localized hypermobile. If the Beighton score was 0, the participants were accepted as non-hypermobile. Participants were evaluated using questionnaires or tests for pain, balance, physical activity, and quality of life. Results The 350 (47.5%) males and 387 (52.5%) females had a mean age of 11.47 ± 1.3 (8-15) years. The prevalence of generalized hypermobility was 13.4%, and we observed localized hypermobility in 65.9% of children and non-hypermobility in 20.6% of children. The most common pain localizations in children were neck (15.9%), lower back (13.7%), upper back (10.6%), shoulders (10.2%), and knees (7.9%). There was no association between pain and hypermobility in children aged 8 to 15 years. Conclusion The generalized joint hypermobility group was younger, shorter, and thinner than other groups. Additionally, we observed that hypermobility did not make a difference in terms of pain, quality of life, physical capacity, and balance in school-age Turkish children.

Abstract Background Diabetic neuropathy is one of the most common causes of neuropathic pain. LANSS, sLANSS, DN4 and painDETECT are scales which are commonly used worldwide. There are not many studies comparing these screening tools in specific neuropathic pain subgroups. The aim of this study is to compare the utilities of LANSS, sLANSS, DN4 and PainDETECT for the diagnosis of diabetic neuropathic pain. Methods One hundred-one individuals without diabetic neuropathic pain were included in control group, 102 patients with diabetic neuropathic pain to DNP group. LANSS, sLANSS, DN4 and painDETECT scores of the groups were compared. Results The difference between the groups was significant for all questionnaires and for all questions/titles they included. DN4 had the highest sensitivity and painDETECT had the highest specificity. Conclusions All questionnaires seemed to be useful for detecting diabetic neuropathic pain. DN4 had a high specificity and sensitivity. PainDETECT, also had a high sensitivity and specificity when cut off value was accepted more than 12.