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Purpose: Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen. Methods: 58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl. Results: VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001). Conclusion: Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

Cancer stem cells (CSCs) are cancer cells responsible for cancer initiation, growth, metastasis, recurrence and resistance to treatment. OCT4 and c-MYC are widely accepted as CSC markers. In this study, we examined the immunohistochemical co-expression of c-MYC and OCT4 with Ki-67 in colorectal cancers (CRC) and the relationship between the results and prognostic and therapeutic data. c-MYC, OCT4 and Ki67 immunohistochemical staining was applied to 162 colectomy cases. Nuclear staining was considered for immunohistochemical staining. Survival in the c-MYC H /OCT4 H subtype, which is one of the subtypes based on c-MYC and OCT4 co-expression, was different from the other subtypes and statistically significant. Although these markers are enriched in cancer stem cells, their specificity in identifying them is limited. CSCs become dormant in the cell cycle, which is one of the mechanisms of escape in drug resistance. We hypothesized that including Ki67 immunohistochemical staining in our study would increase the specificity in detecting CSCs. Our results show that the Ki67 L /c-MYC H /OCT4 H subgroup was associated with lower survival and resistance to treatment compared to the other subgroups. This finding may provide insight into cases with a high number of CSCs and guide targeted treatments.

Primary intratracheal masses causing luminal obstruction are relatively rare, posing a challenge for anaesthesiologists in airway management. This case report describes a distinctive airway management approach in a 71-year-old female patient with an aorta-carotid artery bypass graft that significantly obstructed the trachea. The patient presented with worsening shortness of breath, and a thoracic computed tomography scan revealed a 19.2 mm×9.9 mm×19.3 contrast-enhancing mass penetrating the right anterolateral tracheal wall, resulting in 80% occlusion of the tracheal lumen. Awake fiberoptic bronchoscopy (FOB)-guided nasotracheal intubation was performed following topical upper airway anaesthesia, with the patient positioned at a 30º head-up angle and slight right-up tilt to minimize discomfort. A 6.0 mm ID cuffed endotracheal tube was successfully placed under fiberoptic guidance distal to the intratracheal vascular graft but proximal to the carina. Intratracheal masses can lead to severe tracheal obstruction followed by progressive airway obstruction, which can be life-threatening when effective ventilation cannot be established after the induction of general anaesthesia. We recommend the use of awake FOB-guided intubation in such cases. Additionally, contingency plans should be prepared and meticulously prepared in the event of intubation or ventilation failure.

Abstract Background The diagnosis of dry eye and other common ophthalmological conditions can be supported using patient reported symptoms, which is increasingly useful in contexts such as telemedicine. We aim to ascertain visual symptoms that differentiate dry eye from cataract, glaucoma, or glaucoma suspects. Methods Adults with dry eye, glaucoma, cataract, and suspected glaucoma (controls) completed a questionnaire to rate the frequency and severity of 28 visual symptoms. Univariate, followed by multivariable logistic regression with backward stepwise selection (p

Aim: The aim of this study was to compare inpatient and outpatient cases diagnosed with autism spectrum disorder (ASD) and to show which factors were more associated with hospitalization in children and adolescents. Materials and Methods: We included 85 outpatient and 34 inpatient children and adolescents with ASD. Psychiatric diagnoses were assessed with the K-SADS-PL. Factors relevant to the hospitalization of ASD cases were evaluated with a logistic regression model. Results: The Childhood Autism Rating Scale scores (p=0.002), comorbid psychopathology (p=0.04), multiple psychotropic medication (p=0.001), and psychopathology of the parents (p

Summary: Maternal immune activation is associated with adverse offspring neurodevelopmental outcomes, many mediated by in utero microglial programming. As microglia remain inaccessible throughout development, identification of noninvasive biomarkers reflecting fetal brain microglial programming could permit screening and intervention. We used lineage tracing to demonstrate the shared ontogeny between fetal brain macrophages (microglia) and fetal placental macrophages (Hofbauer cells) in a mouse model of maternal diet-induced obesity, and single-cell RNA-seq to demonstrate shared transcriptional programs. Comparison with human datasets demonstrated conservation of placental resident macrophage signatures between mice and humans. Single-cell RNA-seq identified common alterations in fetal microglial and Hofbauer cell gene expression induced by maternal obesity, as well as sex differences in these alterations. We propose that Hofbauer cells, which are easily accessible at birth, provide insights into fetal brain microglial programs and may facilitate the early identification of offspring vulnerable to neurodevelopmental disorders.

Aim:This study aimed to understand how the pandemic has affected the mental health of adolescents with a previous psychiatric diagnosis.Materials and Methods:Fifty-nine patients aged 12-18 years who had been previously followed up in the adolescent mental health unit were included in this study. The participants were interviewed via telephone between June-July, 2020 and December, 2020-January 2021. Their socio-demographic data, psychiatric diagnoses and the previous Clinical Global Impression (CGI) scores were obtained from the patient files. The clinical global follow-up scale was scored by the interviewing physician.Results:Past CGI scores before the pandemic were significantly greater for those participants with more than one psychiatric condition (p=0.024). For those participants with more than one psychiatric condition, the difference between the CGI scores prior to the pandemic and during the early stages of the pandemic were significant (p=0.004). The total satisfaction scores for telepsychiatry services assessed via the telemedicine evaluation form were statistically higher for those participants with a single psychiatric disorder (p=0.023). The past and early pandemic CGI scores were found to be inversely correlated with the telemedicine evaluation form with r=-0.338, p=0.019, r=-0.353 p=0.014, respectively.Conclusion:The present study offers a perspective for adolescent mental health during the pandemic, underlining the importance and caveats of healthcare delivery to the youth with mental health problems during lockdown.

Objective:In our study, we analyzed the most cited 101 articles on nutrition from the intensive care literature.Materials and Methods:Using an advanced mode of the Web of Science (WOS), the keys “WC = Critical Care Medicine and TS = nutr* or WC = Critical Care Medicine and TI = nutr* or WC = Nutrition & Dietetics and TS = intensive care or WC = Nutrition & Dietetics and TI = intensive care or WC = Nutrition & Dietetics and TS = critical care or WC = Nutrition & Dietetics and TI = critical care” were used to identify the articles on June 2021.Results:From 1975 to the present a total of 7,093 articles related to nutrition of critical care were published in the WOS. The most cited article received 1,011 citations; the least cited articles received 166 citations. The average number of citations was determined as 287.77±178.57. The mean annual citation number was 21.86±35.46. The most cited article was by McClave, Stephen et al. “Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition.” The three most cited areas of critical care nutrition articles focused on “Enteral Nutrition,” “Immune-nutrition,” and “Outcomes of the Nutrition” and were conducted in 20.8%, 20.8%, and 17.8% studies, respectively. The three most frequently journals in the top 101 position were Critical Care Medicine (43.6%), Intensive Care Medicine (10.9%), Clinical Nutrition (7.9%), and the Journal of Parenteral and Enteral Nutrition (7.9%) happened. The USA (38.6%), Canada (%12.9), and England (7.9%) took the top three places for authors. A total of 36.6% of the authors were from the European continent and 63.4% were from outside the European continent. No significant difference was found between the continent of authors, the journal’s index, the total number of citations and the annual average number of citations.A significant relationship was found between the year of publication of the article, the journal in which it was published, the country of the journal in which it was published, continent of the journal, type of the study, the subject area, number of citations per year, and between the type of study and the total number of citations of the article (p

Objective: Hypospadias is defined as incomplete closure of the penile structures during embryogenesis. Surgical correction induces various complications, including urethrocutaneous fistula (UCF). The aim of this study was to determine the risk factors for the occurrence of UCF in children undergoing hypospadias repair under caudal anesthesia. Method: The medical records of children undergoing hypospadias repair between January 2013 and July 2018 were included. Data on patients’ age, body weight, height, type of repair procedure, type of hypospadias, duration of surgery, and hospitalization, and postoperative complications were analyzed. Results: The mean age of the 122 patients was 4.8±3.7 years. The type of surgery performed was tubularized incised plate urethroplasty (Snodgrass) in 90 (73.8%) and meatal advancement and glanuloplasty (MAGPI) in 32 (26.2%) children. Sixteen (13.1%) children had postoperative complications, all of which were UCF. No statistical association was found between postoperative UCF and patient variables. The most common complication of hypospadias repair is UCF, which occurs mostly in the immediate postoperative period. Conclusion: Hypospadias repair can result in complications. UCF remains a significant problem in the postoperative period. All patients underwent caudal block and despite the previous literature, we experienced lower rates of penile engorgement and postoperative UCF. These results showed that there was no cause-and-effect relationship between the caudal block and UCF. We think that the development of a urethrocutaneous fistula is mostly related to surgical causes and well-designed, prospective, and controlled studies are required to elucidate this issue.

(1) Background: Schroth exercise can reduce the deformity of the spine and improve the life quality and the body image of patients with adolescent idiopathic scoliosis (AIS). (2) Methods: The study began with 49 participants, aged 10–16 years old, who were diagnosed with AIS. At the end of the study, 37 patients were randomly assigned to either the Supervised (n = 19) or Home-Based Schroth Exercise Group (n = 18) and completed the study. Both groups were treated for seven days a week over twelve weeks. For all patients, body rotation measurements were performed with a scoliometer, surface asymmetry analysis was carried out using an Artec Eva 3D scanner, health-related quality of life was evaluated by the Scoliosis Research Society-22 (SRS-22) questionnaire, and the perception of the cosmetic deformity was assessed by the Walter Reed Visual Assessment Scale (WRVAS). All the measurements were repeated before and after the 12-week treatment. (3) Results: Post-treatment scoliometric measurements showed a significant decrease in body rotation in both groups (p < 0.05). Similarly, both groups observed significant positive changes in SRS-22 and WRVAS scores (p < 005). RMS values were statistically significant in both groups; the difference was only statistically significant in the thoracic anterior arm subparameter (p < 0.05). (4) Conclusion: The Schroth exercise for both groups with AIS improved body symmetry, quality of life, and body image.

Background: Mönckeberg Medial Calcific Sclerosis (MMCS) is a rare condition that can mimic giant cell arteritis (GCA). It may be misinterpreted as giant cell arteritis by the clinician and cause unnecessary treatments. Therefore, it is a disease that should be differentiated from giant cell arteritis with its clinical, radiological, and pathological findings. Case Presentation: A 56-year-old female patient was admitted to our clinic with sudden unilateral vision loss on the right, pain in the right temporal artery trace, scalp sensitivity in the section corresponding to that area, difficulty chewing, and temporal artery sensitivity. He had a history of hemodialysis for 13 years due to hypertension, osteoporosis, a history of renal stones, and end-stage renal failure. In routine blood tests, White Blood Cell: 7.86X109/L, Hemoglobulin: 10.9 g/dL, C-reactive protein: 3.03 mg/L, Erythrocyte sedimentation rate: 53 mm/hour came. As a result of temporal artery biopsy performed for GCA, absence of giant cells, absence of epithelioid histiocytes, absence of pathological findings in the internal elastic lamina, diffuse calcification in the tunica media, and sclerosis was diagnosed as MMCS. Conclusions: In the literature, 4 case reports resemble giant cell arteritis and are diagnosed as MMCS. This case report is a rare case report showing that MMCS can completely mimic GCA findings.

Objective: Coronavirus disease-2019 (COVID-19) changed the status-quo in psychiatric interview with the advent of telemental health practices, save for a select group of patients; forensic psychiatric interviews among them. The present study aimed to identify the predictors of completing forensic psychiatric evaluations mandated by the judicial authorities in the hospital setting during the COVID-19 outbreak. Method: Twenty-six patients who had completed an initial forensic psychiatric assessment and were required to complete a child and adolescent forensic psychiatry board interview during the height of the COVID-19 pandemic were recruited. Their records were retrospectively examined, sociodemographic data, Beck Depression Inventory (BDI), the Screen For Child Anxiety Related Disorders (SCARED), and Wecshler Intelligence Scale for Childrenrevised scores were recorded and analyzed. Results: Statistical analysis revealed an association between conduct disorder and concomitant substance use with missed appointments, and maternal employment and completed interviews. BDI and SCARED total scores showed no difference between the patients who missed or completed their mandatory forensic psychiatry board assessment. BDI individual items of loss of pleasure (item 4), suicidality (item 9), and loss of interest (item 12) were associated with missed appointments. Conclusion: The results of this study support the established relationship between conduct problems and depressive symptoms, and this demographic group may be among the most affected by the limitation of access to mental health services during the COVID-19 pandemic, as they are already less likely to seek help overall.

Background. The aim of this study was to investigate the frequency of sleep problems in adolescents with epilepsy and their caregivers. We also examined the behavioural difficulties in adolescents with epilepsy and compared these behaviors with healthy controls. Methods. This observational case-control study included 37 adolescents with epilepsy and their caregivers, and 43 healthy age-matched adolescents and their caregivers. The Children`s Sleep Habits Questionnaire (CSHQ), DSM-5 Level 2 Sleep Disorders Scale for Children, and Strengths & Difficulties Questionnaire (SDQ) were used to evaluate sleep habits, sleep problems, and behavioural difficulties in adolescents. The DSM-5 sleep disorder scale for adults was used to evaluate the caregivers` sleep problems. Results. Adolescents with epilepsy had higher sleep problem scores such as daytime sleepiness and overall sleep problems compared with healthy controls. The psychopathological symptoms such as conduct problems, hyperactivity/inattention, and total behavior were also more frequent in adolescents with epilepsy. There was a nonsignificant increase in DSM-5 sleep disturbance score in caregivers of adolescents with epilepsy. Sleep onset delay had a significant negative correlation with total behavioral difficulties (r = -0.44, p < 0.01), and emotional problems (r = -0.47, p < 0.05) in adolescents with epilepsy. Sleep duration was negatively correlated with conduct problems (r = -0.33, p < 0.05), but positively correlated with prosocial score (r = 0.46, p < 0.01) in adolescents with epilepsy. Night waking was positively correlated with total behavioral difficulties (r = 0.35, p < 0.05) and hyperactivity score (r = 0.38, p < 0.05) in adolescents with epilepsy. Conclusions. Adolescents with epilepsy have more frequent sleep disturbances and maladaptive behaviors such as hyperactivity/inattention, and conduct problems compared with healthy controls, and their caregivers are more vulnerable to sleep problems. Moreover, we also demonstrated a strong association between sleep disturbances and behavioral problems in adolescents with epilepsy.

Coronavirus disease-2019 (COVID-19) has been associated with multiple skin lesions as well as causing common respiratory symptoms. We presented a case of pityriasis rubra pilaris that developed after COVID-19 infection and treated with anti-tumor necrosis factor (adalimumab), which was not previously reported in an adult.

Management of heat stress and metabolic cost is vital for preventing any work-related disorders. In this paper, we integrated rest time formulations for heat strain and metabolic cost to develop a new lot sizing model for preventing heat exposure and work-related musculoskeletal disorders. The effects of heat strain and rest allowance on the total cost of the production supply process were investigated. The problem studied in this paper was the handling of the raw materials placed in boxes by manual material handling in order to supply the material requirement of a production line placed in a production area. For the realisation of the material handling transactions between the raw material warehouse and the production line, Electric Pallet Jack (EPJ) was used. The study covers the investigation of picking, storing, and carrying motions for the manual handling of these materials. The result of the analysis has shown that 8.5% savings were achieved by using the heat strain and rest time in comparison to the total cost of this part of the production line supply process with the ISO 7243 maximum metabolic work limit. Consequentially, the analysis results showed that the developed method demonstrated the viability of lot sizing model optimisation with multiple objectives and complex constraints with regards to the metabolic cost and heat strain.

Abstract Objective Mismatch between a depleted intrauterine environment and a substrate‐rich postnatal environment confers an increased risk of offspring obesity and metabolic syndrome. Maternal diet‐induced obesity (MATOB) is associated with the same outcomes. These experiments tested the hypothesis that a mismatch between a nutrient‐rich intrauterine environment and a low‐fat postnatal environment would ameliorate offspring metabolic morbidity. Methods C57BL6/J female mice were fed either a 60% high‐fat diet (HFD) or a 10% fat control diet (CD) for 14‐week pre‐breeding and during pregnancy/lactation. Offspring were weaned to CD. Weight was evaluated weekly; body composition was determined using EchoMRI. Serum fasting lipids and glucose and insulin tolerance tests were performed. Metabolic rate, locomotor, and sleep behavior were evaluated with indirect calorimetry. Results MATOB‐exposed/CD‐weaned offspring of both sexes had improved glucose tolerance and insulin sensitivity compared to controls. Males had improved fasting lipids. Females had significantly increased weight and body fat percentage in adulthood compared to sex‐matched controls. Females also had significantly increased sleep duration and reduced locomotor activity compared to males. Conclusions Reduced‐fat dietary switch following intrauterine and lactational exposure to MATOB was associated with improved glucose handling and lipid profiles in adult offspring, more pronounced in males. A mismatch between a high‐fat prenatal and low‐fat postnatal environment may confer a metabolic advantage. The amelioration of deleterious metabolic programming by strict offspring adherence to a low‐fat diet may have translational potential.

Objective: The aim of the presented study is to evaluate the adaptive process and psychiatric symptoms in the 7-12 age group followed-up with telemedicine interviews during the height of the pandemic. Method: Patients between the ages of 7-12 who were followed up in our outpatient clinic were called by telemedicine service at the appointment date. The questionnaire prepared by the researchers in order to investigate the adaptation process to the pandemic was administered, the answers provided by the patients and their families were recorded in the case data form together with Clinical Global Impression (CGI) Scale score appraised by the interviewing psychiatrist. Medical records pertaining to each patient were also reviewed, their psychiatric diagnoses, according to DSM 5 criteria and CGI scores recorded in their last face-to-face interviews during the pandemic period, were included in the case data form. Results: Fifty patients were included in the study. The mean age of the participants was 9.14+-1.61 years. Attention deficit hyperactivity disorder (60%) was the most common psychiatric diagnosis detected in the participants before the pandemic, followed closely by anxiety and related disorders (20%) and specific learning difficulty (16%). The CGI scores of the cases before, and during the pandemic were 2.72+-0.75, and 2.92+-0.94, respectively. The difference between the mean scores was statistically significant (p=0.024). Conclusion: Our study emphasizes the importance of follow-up by telemental health practices in cases where face-to-face psychiatric interviews are not applicable, i.e., due to the risk of transmission of COVID-19 disease during the current pandemic.

Castleman disease (CD) is a rare benign disease with unknown etiology. It is also called angiofollicular lymph node hyperplasia, giant lymph node hyperplasia, lymph node hamartoma, benign giant lymphoma. Histologically, it is classified as hyaline vascular and plasma cell variant, but rarely features of two types can coexist. Most of the cases with unisentric disease are hyaline vascular and most of the cases with multicentric disease are in plasma cell histological type. Although it is frequently located in thorax, it can be found throughout the body. Salivary glands, lungs, pancreas, larynx, parotid gland, meninges, and even limb muscles can be affected as extralymphatic spread. Since it is localized in the middle and anterior mediastinum in the thorax, it should be differentiated from mediastinal autoimmune and neoplastic diseases. In this case report, we aimed to present the radiological findings of a CD case with a rare intraabdominal location.

Narcolepsy is a childhood and adolescence disorder, that until recently remained unidentified until adulthood, with a reported time from onset to diagnosis of around a decade. This disorder affects approximately 0.05% of the population and starts in childhood and adolescence about half of the time. The main symptom of hypersomnia is excessive daytime sleepiness or prolonged night-time sleep that has occurred for at least 3 months prior to diagnosis. Patients with narcolepsy also exhibit hallucinations and delusions, however the differential diagnosis between the disorders is often unclear. Case presented in our study is an example of atypical narcolepsy with coexistence of psychotic symptoms. In our case upon the set-off of the second attack of excessive daytime sleepiness, the differential diagnosis of recurrent hypersomnia was not considered. This is due to the fact that the first attack of narcolepsy with hallucinatory component of the patient could have been misdiagnosed as acute transient psychotic attack. Hallucinations and delusions sometimes appear in patients with narcolepsy. The differential diagnosis between the disorders is not always simple. In our study we present the case which illustrate this overlap. Child and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be concidered in case of evaluation for a diagnosis of primary hypersomnia following a multidisciplinary cooperation of neurologists, paediatricians and psychiatrists.

Aim:The aim of this study was to evaluate the place of clinical symptoms and findings, and radiological imaging in the diagnosis of foreign body aspiration (FBA) in children, and to investigate the validity of existing diagnostic algorithms.Materials and Methods:The medical records of 120 children with a diagnosis of FBA who underwent rigid bronchoscopy were examined. The sensitivity and specificity of the parameters used in the diagnosis of FBA and their predictive values were calculated.Results:78.9% of the patients were younger than 3 years and 63.8% were male. The peak incidence was 18 months. The rate of negative bronchoscopy was 30.8% and 87.3% of these patients were younger than 3 years. It was observed that the value with the highest diagnostical sensitivity and diagnostic accuracy (DA) rate (sensitivity; 92.54% and DA; 85.7%) had positivity for any of the radiological findings, and among these, there was the detection of one-sided excessive ventilation on chest X-ray (sensitivity; 70.0% and DA; 70.01%). Patients with positivity of any of the radiological findings who additionally had wheezing together with cyanosis or dyspnea had 100% specificity.Conclusion:Particularly male children under the age of 3 years have an increased risk of FBA. Neither clinical symptoms nor radiological findings alone are sufficiently specific and sensitive in the diagnosis of FBA. The most important factor in the decision to perform bronchoscopy is the evaluation of radiological findings together with physical examination and history.

Purpose: Ovarian ischemia, which is known as one of the most common gynecologic surgery emergencies in women of all ages, is the distruption of the ovarian perfusion. Herein, we aimed to investigate the effect of tadalafil, a phosphodiesterase-5 inhibitor, at different doses and durations in the management of ovarian survival in ischemia-reperfusion injury model in rats. Materials and Materials and Methods: Thirty female Wistar albino rats were divided into five groups. Ovarian ischemia was induced by clamping the adnex of uterine tuba for three hours and reperfused for one hour. Drug treatments were given as follows: Group 1: saline (ischemic control), Group 2: tadalafil 1 mg/kg, Group 3: tadalafil 10 mg/kg, Group 4: tadalafil 1 mg/kg for 7 days, Group 5: tadalafil 10 mg/kg for 7 days. At the end of the treatments, ovaries were removed and evaluated for histopathological analysis. Results: Group 4 and Group 5 showed significant decrease in vascular congesion, hemorrhage, edema, neutrophilic infiltration compared to Group 1. All groups showed significant decrease in neutrophilic infiltration compared to Group 1. We found that treatment with tadalafil for 7 days significantly decreased the ovarian tissue damage scores in rats compared to the ischemic control. Conclusion: Our results showed that tadalafil treatment in ischemic ovarian injury is effective in limiting ovarian damage. The reduction in the tissue damage scores suggested that treatment with PDE5 inhibitors, such as tadalafil, may contribute to the healing of conservatively treated ovaries and may play a role in the treatment of adnexal torsion.

Abstract Aripiprazole contributes an increase in body mass index and attenuation in anorexia nervosa (AN) symptoms, leading clinical improvements with lower side‐effect profile; but it is not enough to cure comorbid depressive symptoms in AN.

Amaç: Hipospadias, üretral meanın daha proksimalde lokalize olduğu bir anomalidir. Cerrahi olarak tedavi edilir. Hipospadias cerrahisi geçiren çocuklar, duygusal bozukluklara diğer cerrahi yöntemlere göre daha fazla yatkın olmaktadırlar. Bu çalışmada normal sünnet yapılan ve hipospadias cerrahisi geçiren çocukların ebeveynlerinin duygusal ve karakteristik mizaçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Bu çalışmaya hipospadias cerrahisi geçiren çocukların ve normal sünnet yapılan çocukların ebeveynlerinden gönüllü olanların tümü dahil edilmiştir. Ebeveynlerden veri toplamak için yarı yapılandırılmış sosyodemografik veri formu, Memphis, Pisa, Paris ve San Diego Mizaç Değerlendirme Anketi (The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, TEMPS-A), Durumluluk-Süreklilik Kaygı Envanteri (State-Trait Anxiety Inventory, STAI) I-II ve Beck Depresyon Ölçeği (BDÖ) kullanılmıştır.Bulgular: Ebeveynler arasında klinik ve sosyodemografik özellikler açısından anlamlı bir fark yoktu. Hipospadiaslı olan ve normal sünnet olan çocukların ebeveynleri TEMPS-A mizaç ölçeği puanları, STAI toplam ve I-II alt ölçek puanları ve BDÖ puanları açısından karşılaştırıldığında da istatistiksel olarak anlamlı bir fark bulunmadı.Sonuç: Hipospadias karmaşık bir biyolojik gelişme defektidir. Hipospadias ameliyatı geçiren erkeklerde, ileriki dönemde gelişen cinsel işlev bozuklukları genellikle psikolojik nedenlerle gelişir. Ebeveynlerin kaygı düzeyleri dikkate alınmalı ve operasyonu erken dönemde planlanan ve gelecekte birçok etkisi olabilecek olan hipospadias tedavi sürecinde herkes birlikte hareket etmelidir. Bu alanda ebeveynlerle yaptığımız bu çalışmanın diğer çalışmalara rehberlik edebileceğini düşünüyoruz.

In this paper, a computational approach test (CAT) was proposed to test the equality of two multivariate normal mean vectors under heterogeneity of covariance matrices. The proposed test was compared with the other popular tests as well as their CAT versions in terms of estimated type I error rate and power. Simulation study shows that the proposed test and CAT versions of tests can be used as a good alternative test to test the equality of two multivariate normal mean vectors under heterogeneity of covariance matrices.

Background. Twin-to-twin transfusion syndrome (TTTS) is a significant cause of perinatal morbidity and mortality. Fetoscopic laser photocoagulation (FLP) is the optimal treatment option for twin-to-twin transfusion syndrome; but can cause central nervous system, extremity and intestinal system injury. Case. We report the case report of ileal atresia and severe cerebral infarction co-occurrence after fetoscopic laser photocoagulation treatment. It is uncertain as to whether ileal atresia occurred due to ischemia associated with TTTS, the treatment with FLP, or a combination of both. Conclusions. Cases with prenatal ultrasonographic abnormalities after FLP should have a close assessment to detect bowel complications. Despite many developments in its management, TTTS remains an important risk factor for cerebral injury.

Abstract Background Phosphatase and tensin homolog (PTEN) germline mutations are associated with cancer syndromes (PTEN hamartoma tumor syndrome; PHTS) and in pediatric patients with autism spectrum disorder (ASD) and macrocephaly. The exact prevalence of PTEN mutations in patients with ASD and macrocephaly is uncertain; with prevalence rates ranging from 1% to 17%. Most studies are retrospective and contain more adult than pediatric patients, there is a need for more prospective pediatric studies. Methods We recruited 131 patients (108 males, 23 females) with ASD and macrocephaly between the ages of 3 and 18 from five child and adolescent psychiatry clinics in Turkey from July 2018 to December 2019. We defined macrocephaly as occipito‐frontal HC size at or greater than 2 standard deviations (SD) above the mean for age and sex on standard growth charts. PTEN gene sequence analysis was performed using a MiSeq next generation sequencing (NGS) platform, (Illumina). Conclusion PTEN gene sequence analyses identified three pathogenic/likely pathogenic mutations [NM_000314.6; p.(Pro204Leu), (p.Arg233*) and novel (p.Tyr176Cys*8)] and two variants of uncertain significance (VUS) [NM_000314.6; p.(Ala79Thr) and c.*10del]. We also report that patient with (p.Tyr176Cys*8) mutation has Grade 1 hepatosteatosis, a phenotype not previously described. This is the first PTEN prevalence study of patients with ASD and macrocephaly in Turkey and South Eastern Europe region with a largest homogenous cohort. The prevalence of PTEN mutations was found 3.8% (VUS included) or 2.29% (VUS omitted). We recommend testing for PTEN mutations in all patients with ASD and macrocephaly.

Background and Objectives. Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, inflammatory and demyelinating disorder of the central nervous system. There have been a few studies in recent years on the fact that these cases have neurocognitive impairment. The purpose of this study is to evaluate the neurocognitive outcome and quality of life in cases with ADEM. Methods. Eleven cases who were on follow-up between 2008 and 2017 were included in the study, systemic, neurological and psychiatric examinations were done. All magnetic resonance images were re-evaluated. The neuropsychiatric evaluation was performed by clinical examination and psychometric scales; (1) The Pediatric Quality of Life Inventory 4.0, (2) Child Behavior Checklist, (3) Children`s Depression Inventory, (4) The Wechsler Intelligence Scale for Children-Revised and (5) Continuous Performance Test. The cases in our study underwent neuropsychiatric evaluation 3-42 months after the diagnosis of ADEM had been established. Results. Nine cases (81.8%) fully recovered without neurologic deficit. One case (9.1%) had a psychiatric disorder. During follow-up, cognitive and psychiatric problems were encountered in half of the cases (54.5%). Most of the cases with basal ganglia involvement (80%) displayed attention deficit and cognitive problems. Conclusion. In particular, cases with basal ganglia involvement should be followed carefully in terms of attention and cognitive problems.

In today’s world, Internet and smartphones have become an essential part of our lives. Besides their advantages, there are also some drawbacks regarding their usage. To investigate these drawbacks, problematic Internet and smartphone use has been separately investigated within the scope of behavioral addiction in the literature. In parallel to this, present study aims to investigate the relationship between problematic Internet and smartphone use and psychological factors that were related to diverse addictive disorders in a Turkish sample. It was hypothesized that emotion regulation, self-control, depression and social anxiety symptoms, and novelty seeking would predict problematic Internet and smartphone use. Data was collected from 337 adults between the ages of 18 and 66 (M = 28.86, SD = 9.72). The results showed that although social anxiety and depression symptoms as well as low self-control predict problematic Internet and smartphone use; novelty seeking predicts only problematic smartphone use. Additionally, difficulties in emotion regulation did not predict problematic Internet and smartphone use.

Bu çalışmanın amacı, Osmanlı Devletinde 19. yüzyıl ortalarından itibaren hu- kuksal anlamda şekillenen ‘muhasım devlet’ ve tebaasına yönelik uygulamaları, Trablusgarp Savaşı sırasında İzmir İtalyanları özelinde ortaya koymaktır. Osman- lı Devleti, İtalyan kurumları ve tebaasına yönelik uygulamaları gerçekleştirirken bir takım hukuksal yükümlülüklere uygun davranmak zorunda kalmıştır. İtalyan konsolosluğunun kapatılması, yetkilerinin ne şekilde ve hangi devlete devredile- ceği, İtalyan tebaanın durumu, savaş içerisinde güvenliğin sağlanması gibi bir takım konular Osmanlı Devletinin hukuki çizgide takip ettiği muhasım devlete yö- nelik savaş uygulaması örneklerinden olmuştur. Çalışmanın kaynaklarını Osmanlı Arşivi belgeleri ve İzmir şehrinde yayın yapmış bir takım Türkçe süreli yayınlar oluşturmaktadır. Bunun yanı sıra konuyla ilgili bir takım kitaplar da değerlendirilmiştir.

The entomopathogenic bacterium Bacillus thuringiensis is the most widely used biopesticide. In this study, to find and identify the more toxic B. thuringiensis strains against coleopteran pests, we isolated a B. thuringiensis strain (Xd3) from European shot-hole borer, Xyleborus dispar (Coleoptera: Scolytidae), a higly damaging pest of hazelnut. Based on various morphological, physiological, biochemical, and molecular characteristics, the bacterial isolate was identified as B. thuringiensis subsp. tenebrionis (morrisoni) serovar H8a8b. This isolate was compared with the reference strains by scanning electron microscopy, SDS-PAGE analysis, cry gene content, and insecticidal activity. Isolate Xd3 forms a flat-square inclusion containing a protein component of c. 70 kDa. PCR analysis showed that the Xd3 has a cry gene, cry3. Toxicity tests were performed against coleopteran species. One hundred percent mortality was observed against larvae of Agelastica alni (Coleoptera, Chrysomelidae). The others were 90% for Amphimallon solstitiale (Coleoptera, Scarabaeidae), and Melolontha melolontha (Coleoptera: Scarabaeidae). Our results indicate that B. thuringiensis subsp. tenebrionis (Xd3) may be valuable as biological control agent for coleopteran insects. [ABSTRACT FROM AUTHOR]

Melolontha melolontha larvae are susceptible to several pathogens indigenous to the area in which these insects occur in Turkey. We isolated and identified seven bacterial strains from M. melolontha and evaluated their pathogenic activity during three hazelnut seasons from 2002 to 2004 on larvae of M. melolontha. Using various morphological, physiological, and biochemical characteristics in detail, bacterial isolates were identified as Pseudomonas sp., Bacillus thuringiensis, Pseudomonas sp., Enterobacter sp., B. sphaericus, Acinetobacter sp., and B. weihenstephanensis. The insecticidal activity of isolates at 1.8 x 109 bacteria/ml dose, within 10 days on the larvae of M. melolontha are 40% for Pseudomonas sp., 80% for Bacillus thuringiensis, 50% for Pseudomonas sp., 20% for Enterobacter sp., 60% for B. sphaericus, and 80% for B. weihenstephanensis. We also purified crystals from B. thuringiensis and B. sphaericus and tested the insecticidal activity on the larvae of M. melolontha. In crystal protein bioassays, the highest insecticidal effect detected was 70% with crystals of B. thuringiensis. Our results indicate that indigenous B. thuringiensis and B. weihenstephanensis isolates and crystal of B. thuringiensis may be valuable as biological control agents. [ABSTRACT FROM AUTHOR]

Osmanlı topraklarında yaşamış olan Ermeniler ile ilgili mevcut yerli ve yabancı çalışmaların pek çoğu 1915 Tehcirini konu edinmiş ve bu konuda bilinen Türk ya da Ermeni bakış açısını yansıtmış, hatta bu bakış açılarından birinin haklılığını ispatlamaya çalışmıştır. Ancak bunlardan çok azı her iki bakış açısından uzak, farklı bir bakış açısı ortaya koyabilmiştir. Bu noktadan hareketle araştırmamızda, Mayıs 1915- Ekim 1918 tarihleri arasındaki Bundesarchiv belgelerinde yer alan Osmanlı Ermenileri ile ilgili bir takım gözlem ve tespitler üçüncü bir gözle ele alınacaktır. Bu tespitler; tercüman olarak Osmanlı topraklarında görev yapan Ermenilere karşı Türklerin duyduğu şüphe ve bu nedenle ortaya çıkan bir takım diplomatik ve askeri sorunlar, Ermeniler ile Türkler arasında yaşanan düşmanlığın altında yatan bir takım ekonomik gerekçeler, Ermenilerin ticaretteki üstün ve zayıf yönleri ve diğer gayrimüslim tüccarlardan farklılıkları, Enver Paşa’nın Ermenilere karşı özel hassasiyeti nedeniyle alınan bir takım tedbirler, posta ve telgraf hizmetlerinde çalışan Ermeni memurlardan duyulan şüphe yüzünden yaşanan olumsuzluklar ve İzmir’de bombalı bir saldırı planlamaktan tutuklanan Ermenilerin salıverilmesine yönelik yabancı misyon teşebbüsü ve bu teşebbüsün yarattığı kriz gibi birçok siyasi, sosyal ve ekonomik konuların yanı sıra bir Ermeni ile bir Fransızın yaşadığı sıra dışı ilişki ve Osmanlı topraklarında yaşayan Danimarkalı bir kadının Ermeni evlatlığını ülkesine götürmesi sırasında yaşananlara dair günlük hayattan kesitler de içermektedir. Çalışmamızda söz konusu arşiv belgeleri ışığında Ermeniler ile ilgili elde edilen ve pek bilinmeyen izlenim ve tespitler yorumlanıp değerlendirilecektir.

Attention deficit hyperactivity disorder (ADHD), while characterized by attention problems, hyperactivity and impulsivity, essentially is a phenotypically heterogenous disorder. Social cognition disorders are important in ADHD, particularly in children due to their role in difficulties in social relations. Social cognition is crucial for the individual to build relations with others and through such relations inform social behavior. It has been suggested that sub-units of social cognition such as facial recognition and empathy are related to oxytocin. It is thought that individuals diagnosed with ADHD, for whom such skills are less readily available, have difficulties communicating on a social scale. PubMed medical search engine was used to identify the studies and review articles on oxytocin and ADHD. While the oxytocin gene and the oxytocin receptor gene are extensively studied in autism spectrum disorders, data on ADHD is scarce. Oxytocin, known as a mediator of social behavior, also affects the phenotype of ADHD, a disease subject to genetic and environmental influences determining its phenotype and individual case differences.

Aim: To evaluate the value of vagal nerve stimulation (VNS) in improving the quality of life, seizure frequency and mood in children with pharmacoresistant epilepsy. Materials and Methods: Eleven pharmacoresistant epileptic children implanted with the VNS therapy device between 2010-2014 were included in this prospective longitudinal study. Clinical assessment for the Diagnostic and Statistical Manual of Mental Disorders-IV psychiatric disorders, schedule for affective disorders, and schizophrenia for school children were applied. Childhood Depression Inventory (CDI), Beck Depression Inventory (BDI) were filled. Child Behavior Checklist (CBCL) and the Pediatric Quality of Life Inventory (PedsQL) were filled in by parents before the implantation. All of these tests were repeated in the first and second year of implantation. Results: Mean age at the first implantation of the VNS therapy device was 11.5 (2.5-16). Mean age was 13.9 (2.5-18) years. Mean duration of epilepsy prior to VNS implantation was 6.6 years, and VNS usage period was 30.4 months (10-96). International League Against Epilepsy classification of predominant seizure type was partial in seven, and generalized in four patients. Decrease in the number of seizures was 42% and 43% in the first and the second year respectively. While four of 11 patients had no psychopathology, different problems were determined in seven patients. There was no statistically significant difference between the scores of CDI/BDI, scores of CBCL and PedsQL prior to implantation, and also did not differ 1 year and 2 years after implantation. Conclusion: VNS is partially effective in controlling drug-resistant epilepsy. Although a positive effect on depression and quality of life is reported in literature, the results of this study were not statistically significant. We think that the scores of depression inventory should gradually decrease in years as it is reported for seizure frequency.

Aim: Callous and unemotional traits such as the inability to make emotional communication, and the lack of feelings of guilt and empathy are frequently found in the young with antisocial manners, who are at increased risk for violent behavior in the future. We aimed to identify the psychometric properties of the Turkish version of the “Inventory of Callous-Unemotional Traits-Youth Form” (ICU-TR). Materials and Methods: The ICU-TR was administered to 301 students, and only 250 completely filled out forms have been included in the study. One hundred students filled out the ICU-TR 3 weeks later for test-retest reliability. The factor structure of the scale has been studied with principle component analysis, and reliability measured with Cronbach’s alpha. Pearson correlation is used for criterion-related validity and test-retest reliability. Results: The mean age of the cases was 14.38, with 68% male and 32% female. Factor analysis supported a two factorial structure. The first factor (callousness) had 12 items (Eigen value=4.8; r=0.58, p

OBJECTIVES: Pervasive developmental disorders (PDDs) are neurodevelopmental disorders characterized by deficits in social interactions, communication impairments, and the presence of restricted interests and stereotyped behaviours. The issue of diagnostic stability, course, and prognosis of PDDs is an increasing focus of research studies. The aim of this study is to evaluate the individuals who were previously diagnosed with pervasive developmental disorders–not otherwise specified (PDD–NOS) (one of the sub-diagnoses of PDDs) under age six years with respect to their current diagnoses. METHODS: The participants were selected among the patients who were diagnosed with PDD–NOS under six years of age in our outpatient clinic. We obtained 208 patients’ file records. We were able to reach 92 patients’ parent by telephone and 58 parents accepted to voluntarily participate. After the excluded cases, finally 51 patients were evaluated in this cross-sectional naturalistic follow-up study. Children Autism Rating Scale (CARS) and Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) were administered to participants; Autism Behavior Checklist (ABC) was completed by their parents. RESULTS: There were 44 (86.3%) male and 7 (13.7%) female participants in the study. The current mean age was 8.62 years (SD = 2.25). The mean age at the time of first diagnosis was 3.56 years (SD = 1.22). The mean duration of the follow-up period was 5.05 years (SD = 2.27). Forty-five (88.2%) of 51 patients remained to have one of the PDDs (23 autistic disorder, 22 PDD–NOS) according to DSM-IV-TR. Six patients (11.8%) did not meet the diagnostic criteria of any PDDs. Two of these six patients diagnosed with attention-deficit/hyperactivity disorder and one with mild-level intellectual disability. CONCLUSIONS: It was observed that 11.8% patients who diagnosed as PDD–NOS less than six years old were found to be off the PDD spectrum. PDD–NOS diagnosis stability was found 43.1% and 45.1% of the patients moved to another PDD diagnosis. These findings should be supported with further studies in Turkey, by increasing sample size, and follow-up duration for understanding the course.

OBJECTIVES: Stimulants are recommended as the first-line pharmacotherapy in attention deficit/hyperactivity disorder (ADHD). Methylphenidate (MPH) is the most used stimulant. Medikinet Retard has modified-release capsules of MPH (MRC-MPH). In this study, we aimed to report observations on a sample of outpatients, who had been previously treated with other agents, but switched to MRC-MPH treatment. These observations focus on the treatment course, efficacy, side effects, and switching reasons. METHODS: We included 20 out of the 163 patients with ADHD, who were previously treated with other medications, and switched to MRC-MPH. Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening as diagnosing tool and Rating Scale, Barkley’s Stimulants Side Effects Rating Scale for screening side effects and Clinical Global Impression Scale-Severity and -Improvement were administered. RESULTS: Patients’ ages ranged between 9 and 17 years. Mean Clinical Global Impression Scale-Severity (CGI-S) score before the MRC-MPH treatment was 3.2, whereas after treatment it was 3.15. CGI-S scores were not significantly different (p = .593). Loss of appetite (n = 4, 20%) and drowsiness (n = 4, 20%) were the most common adverse events during the MRC-MPH treatment. CONCLUSIONS: We did not observe significant difference between other treatment options and MRC-MPH with respect to efficacy. In terms of side effect profile, Osmotic Release Oral System-MPH was observed to be more problematic than immediate-release MPH and MRC-MPH formulations, while these two regimens did not differ significantly.

In present study, geostatistical techniques were applied to assess the spatial variability of DTPA-extractable micronutrients which are named heavy metals as chemistry such as; iron (Fe), copper (Cu), manganese (Mn) and zinc (Zn) in the non-tillaged layer in Ordu province- Altınordu district, Black sea region, Eastern part of Turkey. Study area was approximately 40095.8 ha where was divided into grids with 2500 x 2500 m spacing with including 66 sampling points from 0-0.2 m in depth. Soil reaction (pH) was the least variable property while electrical conductivity (EC) was the most variable. While the highest nugget effect occurred for Ext-Cu with moderate spatial dependence, the lowest for Ext-Mn with strong spatial dependence. The greatest range of influence (17424 m) occurred for Ext-Cu and the least range (692 m) for Ext-Zn.

Eating disorders are a growing health problem among adolescents and have increasingly become the focus of studies due to their prevalence. Both obesity and anorexia nervosa are associated maladaptive eating behaviours that may be relevant to development. With this case report, it is intended to discuss the diagnosis and management of a female adolescent patient, diagnosed with obesity and attention deficit-hyperactivity disorder (ADHD). A 16-year-old, female, obese adolescent was referred to our in-patient clinic due to maladaptive eating styles, depressive symptoms and ADHD symptoms. Her early course of illness, diagnostic process, treatment and short-term outcome are described. At the time of discharge, the patient’s Clinical Global Impression (CGI) scale severity item score was 2 (borderline mentally ill) and CGI improvement item score was 2 (much improved). We report the present case with the purpose of establishing a pediatric approach to obesity, a disease not included in Diagnostic and Statistical Manual-5 under eating disorders, yet we believe it shares common underlying genetic and environmental causes.

Purpose: Diagnostic criteria for monoclonal gammopathy of undetermined significance (MGUS) do not currently include ocular phenotypic changes. Here, we offer a new diagnostic approach that is useful in patients with posteriorly located corneal depositions and present evidence to support the theory that the aqueous humor is a source for monoclonal proteins accumulated in the cornea. Observations: A 77-year-old woman presented to the clinic with a gradual decrease in visual acuity over 6 months. Slit lamp examination revealed bilateral central guttae consistent with Fuchs corneal dystrophy, peripheral circular band-like corneal opacities in the deep stroma, and bilateral nuclear sclerotic and cortical cataracts. Anterior segment optical coherence tomography confirmed corneal opacities in the posterior stroma and Descemet membrane. Immunological studies revealed increased serum IgG levels of 3220 mg/dL and serum electrophoresis showed an abnormal monoclonal band of 2.4 g/dL identified as IgG lambda by immunofixation electrophoresis. The patient was referred to the hematology clinic where she underwent further systemic workup and was diagnosed with MGUS. Immunofixation electrophoresis of aqueous sampling, which was performed at the time of cataract surgery, confirmed the presence of the IgG lambda gammopathy in the anterior chamber. Conclusions and importance: Monoclonal gammopathy, although rare, should be included in the differential diagnosis of corneal opacities, as the ocular finding can be the initial manifestation of a systemic disease that can potentially be life-threatening. When corneal biopsy is not feasible due to the location of corneal pathology, aqueous sampling may be an alternative approach towards a clinical diagnosis. We propose a new terminology, “monoclonal gammopathy of ocular significance,” for patients diagnosed with MGUS, however, their only significant clinical finding is ocular manifestation. Keywords: Cornea, Deposition, Monoclonal gammopathy of undetermined significance, Paraproteinemic keratopathy, Lambda, Immunofixation

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. Cotard’s syndrome is characterized by the appearance of nihilistic delusions concerning one’s own body or life. By presenting this case, we aim to discuss the differential diagnosis and treatment plan of a patient with catatonia and Cotard’s syndrome, which were noted after NMS, in light of the literature.

Many studies in the literature have shown the assosiation between serum analits of first and second trimester screening test with intra uterin growth retardation and abrubtio placenta.However these markers role in the predicting of placental abrubtion is unclear. We aimed in this study,is there any relationship between placental abrubtion without risk factors and first and seconder trimester screening markers. 120 term pregnant women who gave birth by Caesarean section has been included in this retrospective study, patients and controls were compared for the 1st and 2nd trimester serum markers levels. Fetal nuchal translucency measurements were significantly higher in the study group than control group. This study emphasizes that increased fatal nuchal transluency is more important than serum biomarkers of first and second trimester screening tests. [Med-Science 2016; 5(2.000): 411-9]

The economic and environmental sustainability issues in supply chain management have integrated by many researchers in the past decades. The ergonomics as a social aspect of sustainability had received a little attention by researchers. Therefore, the aim of the paper is analyzing the flexibility of developed inventory cost model with relaxation allowance and endurance time as a social aspect of sustainability. The effects of distance, unit weight of item and total number of items on relaxation allowance, the total cost of logistics operation and the EOQ model were investigated. The analyzed mathematical model was a single operator-single material model which covered transportation of fixed amount of raw materials from storage plant to production plant by manual material handling with simple cart and picking, storing, pushing and pushing back with empty cart for manual handling of the products. The different parameter values applied for analysis such as total amount of handled items (Q) changes between 500 pcs to 2750 pcs, unit weight of item (w) changes between 0.1 kg to 1 kg, distance of movement by manual material handling for picking and storing motions (d1) changes between 2 m to 3 m and the distance between the storing equipment and the supermarket of the production line for pushing motion (d2) changes between 15 m to 20 m. The results of the analysis indicated that the longer the distance of movement for all motions leads to decrease in savings of the model compared to EOQ model. The increase in unit weight of item is increase the savings obtained from application of our model and decrease the optimal lot size. There was no specific change on savings or optimal lot size as the total amount of handled item is increase. The compared results indicated that an increase in d1 and d2 lead to an increase in optimal lot size and increase in total cost of the model. Consequently, the analysis has shown that a decrease in lot size would be the better way to improve both ergonomic conditions and total cost of production in any different parameter values. Finally, the analysis of the inventory model with ergonomics were proved that this model is suitable for different industrial practices.

Background. Diagnostic criteria for Sjögren’s syndrome (SS) are continually being updated in pursuit of more precise and earlier diagnosis to prevent its complications. Owing to the high rate of false negative traditional serological markers, the need for better serological testing remains. Objective. To investigate the clinical significance of three recently discovered novel autoantibodies, anti-salivary gland protein 1 (SP1), anti-carbonic anhydrase 6 (CA6), and anti-parotid secretory protein (PSP), in a cohort of dry eye patients with suspected underlying inflammatory/autoimmune disease. Methods. Medical records of 136 patients with a primary diagnosis of dry eye who underwent laboratory testing between April 2014 and July 2017 were reviewed retrospectively. Data regarding demographic information, ocular and systemic symptoms, previous medical diagnoses, serological test results, and minor salivary gland biopsy results were collected. Dry eye evaluations included tear osmolarity, Schirmer test without anesthesia, conjunctival lissamine green staining, and corneal fluorescein staining in the order listed here. Results. Of the 136 patients, 9 (9/136, 6.6%) presented with a history of SS, and 9 additional patients (9/127, 7%) received a new diagnosis of SS as a result of evaluations. Fifty-six patients (56/136, 41%) tested positive for at least one of the novel autoantibodies. Fifty-four percent (6/11) of patients with primary SS who underwent the novel serological testing had a positive anti-PSP. Of those, 2 (2/11, 18%) had negative traditional serology and had to undergo minor salivary gland biopsy for definitive diagnosis. Anti-CA6 was associated with increased corneal and conjunctival staining after adjusting for age, sex, and other serologic markers (HR=1.5, 95% CI=1.20-1.97, and p=0.009 and HR=1.4, 95% CI=1.04-1.76, and p=0.02, respectively). Conclusions. This cross-sectional study demonstrated that anti-CA6 is seen in patients with severe aqueous-deficient dry eye. Whether these patients have an early stage of SS or a different type of autoimmune condition may be determined through longitudinal studies.