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Background 5q spinal muscular atrophy (SMA) is a disabling and life-limiting neuromuscular disease. In recent years, novel therapies have shown to improve clinical outcomes. Yet, the absence of reliable biomarkers renders clinical assessment and prognosis of possibly already affected newborns with a positive newborn screening result for SMA imprecise and difficult. Therapeutic decisions and stratification of individualized therapies remain challenging, especially in symptomatic children. The aim of this proof-of-concept and feasibility study was to explore the value of 1H-nuclear magnetic resonance (NMR)-based metabolic profiling in identifying non-invasive diagnostic and prognostic urinary fingerprints in children and adolescents with SMA. Results Urine samples were collected from 29 treatment-naïve SMA patients (5 pre-symptomatic, 9 SMA 1, 8 SMA 2, 7 SMA 3), 18 patients with Duchenne muscular dystrophy (DMD) and 444 healthy controls. Using machine-learning algorithms, we propose a set of prediction models built on urinary fingerprints that showed potential diagnostic value in discriminating SMA patients from controls and DMD, as well as predictive properties in separating between SMA types, allowing predictions about phenotypic severity. Interestingly, preliminary results of the prediction models suggest additional value in determining biochemical onset of disease in pre-symptomatic infants with SMA identified by genetic newborn screening and furthermore as potential therapeutic monitoring tool. Conclusions This study provides preliminary evidence for the use of 1H-NMR-based urinary metabolic profiling as diagnostic and prognostic biomarker in spinal muscular atrophy.

Maternal cannibalism is a serious condition, which negatively affects the well-being of the puppies and the mother as well as the owner. Although this condition has been found to be related to low oxytocin (OXT) levels and administration of OXT was found to be effective for decreasing postpartum anxiety in humans, no treatment procedure was recommended for dogs yet. In this study, carbetocin, a synthetic analog for OXT, was used in 19 Kangal dogs with a previous history of maternal cannibalism. The same treatment procedure, that is, administration of carbetocin every 6 hours, was applied to all dogs for 10 days after the birth. As a result, none of the dogs showed abnormal maternal behavior toward their puppies during and after the treatment. No adverse effect of carbetocin was detected in any of the dogs. This study is the first to provide an effective treatment protocol for dogs displaying maternal cannibalism.

Midbrain infarction rarely causes partial fascicular oculomotor palsy, which is characterised by bilateral midriasis and loss of vertical gaze movements. We describe a patient with acute ischemic infarcts involving both uppermost part of the midbrain, presenting with marked vertical gaze palsy and mydriasis bilaterally as the only neurological abnormality. These features are suggestive of partial fascicular oculomotor palsies involving the pupil, inferior rectus, superior rectus, inferior oblique muscles and sparing medial rectus, levator palpebrae muscles. These neuro-ophthalmological and radiological findings in our case support the model that the fibers to medial rectus and levator palpebrae muscles might be located in the more caudal portion of the oculomotor fascicles.

WOS: 000443586500005, Maternal cannibalism is a condition whereby a dam consumes her own offspring after killing them. Although biological factors such as low levels of serum oxytocin and lipid levels have been shown to link to failure in maternal behaviors in different animals, underlying mechanisms responsible for abnormal maternal behavior has not yet been investigated in detail in dogs. To fill this gap, this study aimed to investigate serum lipid and oxytocin levels of the dogs having a previous history of maternal cannibalism. Mature female Kangal dogs with a history of maternal cannibalism (n = 15) and with a normal postpartum history (n = 15) were enrolled in the study. Serum oxytocin and lipid levels were significantly lower in dogs with a previous history of maternal aggression (P < 0.05). Findings of this study suggest that oxytocin is an important neuroendocrine factor in dogs for the normal onset of maternal behavior. Furthermore, low levels of high-density lipoprotein, low-density lipoprotein, and cholesterol might be contributing factors for development of abnormal maternal behavior. Thus, low levels of oxytocin and lipids should be taken into consideration in dogs with abnormal maternal behavior. (C) 2018 Elsevier Inc. All rights reserved., Commission of the Scientific Research Projects by Cumhuriyet University [V-025], This research was supported by the Commission of the Scientific Research Projects by Cumhuriyet University (project number: V-025).

Canine transmissible venereal tumour (TVT) is a contagious cancer and sexually transmitted one dog to another by allogenic transfer of living cancer cells. The aim of this study is to examine the relationship between antioxidative metabolism and venereal tumour at Kangal Dogs and to show the size of oxidative damage it causes through 8-hydroxy-2’deoxyguanosine (8-OHdG). The materials of this study included the blood sera of 15 Kangal Dogs with TVT, and as a control group of 15 healthy Kangal Dogs. The sera levels of 8-OHdG were determined by competitive enzyme linked immunosorbent assay (ELISA) method. The level of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) which are antioxidative enzymes were investigated by spectrophotometric methods as described. Serum 8-OHdG and MDA levels of dogs with TVT were found to be significantly increased compared to the control group (P, Transmissible (bulaşıcı) venereal tümör (TVT), canlı kanser hücrelerinin allojenik transferiyle bir köpekten diğer bir köpeğe çiftleşme ile bulaşan bir kanser türüdür. Bu çalışmada, Kangal köpeklerinde önemli bir bulaşıcı kanser türü olan venereal tümör ile antioksidatif metabolizmanın arasındaki ilişkinin incelenmesi ve oksidatif hasarın boyutunun 8 hidroksi-2’deoksiguanozin (8-OHdG) düzeyleri üzerinden gösterilmesi amaçlandı. Bu amaçla, 15 adet TVT’li, kontrol grubu olarak 15 adet sağlıklı Kangal köpeklerinden alınan toplam 30 adet kan serumu çalışmanın materyalini oluşturdu. Bu hayvanlara ait kan serumlarında 8-OHdG kompetitif enzim bağımlı immunosorbent analiz (ELISA) yöntemi ile belirlendi. Malondialdehit (MDA), antioksidan enzimler olan süperoksit dismutaz (SOD), glutatyon peroksidaz (GPx) ve katalaz (CAT) seviyeleri ise spektrofotometrik yöntemlerle analiz edildi. TVT teşhisli köpeklerin serum 8-OHdG ve MDA düzeyleri kontrol grubundaki köpeklere göre istatiksel olarak anlamlı derecede artış gösterdiği tespit edildi (P

Introduction: Clinical research is a key component of drug development with a significant economic value. It has been reported that the development of a new molecule requires 10 - 15 years and costs almost $1.3 billion. Around 75% of the cost is spent on the Phase I-IV clinical research process. This study aimed to show the economic value of clinical research in Turkey. Methods: Clinical trial budgets were estimated from the raw data of the Report of Istanbul Medical Faculty Clinical Research (ITFKAR). In the research, the estimated cost of drugs used in the clinical trials for the Turkish reimbursement agency (SGK) was calculated to show the cost of medicines acquired through clinical research. Results: The total budget for sponsored pharmaceutical research was $107 million in Turkey, and the government saved close to $311,096,130 during 2006-2010, due to not reimbursing the patients for the drugs in the clinical trials. Conclusion: Despite the limitations of the study, the findings are unique for Turkey. The results can lead to revisiting the importance and economic value of clinical trials in Turkey.

Objectives Muscle relaxants are used in anaesthesia to obtain adequate muscle relaxation for intubation and operations. A goal of hospital management is to improve the hospital's budget by selecting adequate neuromuscular blocking agents for short-term operations. Methods A basic investigation was conducted of the time required to reach maximal blocking (MB) with administration of atracurium and rocuronium during anaesthesia induction and recovery time (RT). Patients were divided into random groups. Group R received rocuronium 0.6 mg/kg IV and group A received atracurium 0.5 mg/kg IV. Time required to reach MB and RT was measured with a train-of-four (TOF) device where MB and RT were named TOF0 and TOF75 respectively. Direct expenses were used to evaluate the effect on hospital budget. Key findings Mean times calculated to reach TOF75 in recovery with rocuronium and atracurium were 38 and 51 min respectively. Mean durations of operations where atracurium and rocuronium were used were 47 and 46 min respectively. In group R, patients reached TOF75 before the operation time and eventually extubated safely. In group A, the time to reach TOF75 was 51 min but operation time was 46 min and patients needed an additional 5 min for recovery and safe extubation. Preparation period was determined as 14 min. These results indicate that 60 min in group R and 65 min in group A were needed from the start of one operation to the start of the next. Conclusions This study showed that if a hospital's usage ratio is 100% performance capacity, and there are no other problems, in 1 month by using rocuronium it could perform an extra 15 paediatric surgical operations gaining additional income of US$2436 for one operation room per month.

Introduction Middle East Respiratory Syndrome (MERS) is a major global health threat. Prehospital professionals face the risk of infection as they work to save lives. They should be made aware of the disease and be prepared to handle such cases. The aims of our study are to develop a training program about the prehospital management of a MERS case using standardized patient (SP) scenarios, to evaluate the awareness and preparedness of the participants about MERS, and to evaluate the effectiveness of this training. Methods We developed 5 scenarios using SPs and an observation form. We included paramedic students and emergency medical service (EMS) providers in our study. They were involved in the simulations. Results A total of 24 paramedic students and 33 EMS providers participated in our study. Sixteen (84%) of 19 teams recognized the possibility of MERS as a measure of their awareness in the baseline evaluation. The participants lacked donning and doffing personal protective equipments, which revealed their baseline level of preparedness for MERS. Certain improvements in donning and doffing personal protective equipment were observed in the posttraining evaluation. The participants provided positive feedback on the training program. Conclusions The training program was appropriate for both paramedic students and EMS providers. A positive educational climate was created. Because the main concerns of this study were awareness and preparedness, which required human interaction, the SP methodology was the optimal simulation modality.

Amaç: Akkaraman Kangal koyunlarında geç gebelik ve erken laktasyon dönemlerine ait serum konsantrasyonlarındaki bazı biyokimyasal belirteçlerin ve makro elementlerin üreme durumları üzerindeki etkilerini incelenmesi amaçlanmıştır.Gereç ve Yöntem: Çalışmanın materyalini mera koşulların-da herhangi bir ek rasyona tabi tutulmayan 12 Akkaraman Kangal koyunu oluşturdu. Serum örnekleri geç gebelik ve erken laktasyon dönemlerinde alındı. Kan glikoz, kolesterol, kreatinin, trigliserit, alkalen fosfataz, total protein, albümin, çok düşük dansiteli lipoprotein, kan üre atozu, kalsiyum, fos-for ve magnezyum konsantrasyonları analizatörle ölçüldü.Bulgular: Laktasyon dönemindeki koyunlarda alkalen fosfa-taz, albümin ve kalsiyum konsantrasyonları gebe koyunlara göre anlamlı derecede yüksek bulundu (P, Aim: The aim of this study to investigate the influence in rep-roductive status on the serum concentration of biochemical markers and some macro elements in sera of Akkaraman Kangal ewes during late pregnancy and early lactation.Materials and Methods: Twelve Akkaraman Kangal ewes were included in this study. The sheep were raised under pasture conditions and without any dietary complementa-tion. Samples were taken during late pregnancy and early lactation from each ewe. Serum concentrations of glucose, cholesterol, creatinine, triglyceride, alkaline phosphates, to-tal protein, albumin, very low density lipoprotein, blood urea nitrogen, calcium, phosphorus and magnesium were deter-mined with analyzer. Results: In the ewes during lactation, the concentrations of alkaline phosphates, albumin and calcium were significantly higher (P

Partial fascicular oculomotor palsy, the combination of bilateral midriasis with loss of vertical gaze movements, is rarely a consequence of midbrain infarction. We describe a patient with acute ischemic infarcts involving both upper most part of the midbrain, presenting with marked vertical gaze palsy and mydriasis bilaterally as the only neurological abnormality. These features are suggestive of partial fascicular oculomotor palsies involving the pupil, inferior rectus(IR), superior rectus(SR), inferior oblique(IO) muscles and sparing medial rectus(ML), levator palpebrae(LP) muscles. These neuro-ophthalmological and radiological findings in our case support the model that the fibers to medial rectus and levator palpebrae muscles might be located in the more caudal portion of the oculomotor fascicles.

The percentage of mortality caused by cardio-vascular events in European Countries and European Union Countries is respectively 49% and 42% of all mortality causes. Our estimates about cardiovascular mortality in Turkey depend on TEKHARF (Hearth Disease and Risk Factors in Turkish Adults) which depended on a 12 year observation. It has been reported that cardio-vascular mortality rates for Turkey in men and women were 0.082% and 0.043% respectively. In Turkey, Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin and Simvastatin are the different alternatives found in the statin market. All stat-ins are reimbursed by insurance companies. The aim of this study is to determine the cost- effectiveness of statins. In conclusion, simvas-tatin and rosuvastatin comprised the optimal two statin alternatives.

Primary lingual dystonia is a rare condition, especially when it is only induced by speaking. Trihexyphenidyl failed to improve the symptoms. Several case series have demonstrated the effectiveness of botulinum toxin injection for the management of focal lingual movement disorders. Only 1 case of botulinum toxin injection for primary lingual dystonia induced by speaking has been reported, but this treatment has limited effectiveness. Our patient was treated with botulinum toxin using a superficial approach for injection into the tongue with continuing excellent results. Lingual botulinum toxin injection is a fairly simple, safe and viable treatment option for lingual dystonia induced by speaking.

IEEE 16th Signal Processing and Communications Applications Conference -- APR 20-22, 2008 -- Aydin, TURKEY, WOS: 000261359200040, Multicarrier direct sequence-code division multiple access (MC DS-CDMA) is a novel radio access scheme that combines time domain spreading and multicarrier modulation. However, MC DS-CDMA systems suffer strongly from the interference among users, which is called as multiple access interference. This interference depends mainly on the correlation properties of the spreading sequences as well as the shape of the chip waveforms employed. In this paper, bit error rate (BER) performance analysis of the generalized MC DS-CDMA system that employs Blackman chip waveform over Nakagami-m fading channels is realized. Simulation results show that the use of Blackman chip waveform can improve the BER performance of the generalized MC DS-CDMA system, as compared to the performances achieved by using different chip waveforms such as rectangular, half-sine and raised cosine., IEEE

PIN21 Cost ReduCtIoN AssoCIAted wIth use of subglottIC AsPIRAtIoN to ReduCe VeNtIlAtoR-AssoCIAted PNeumoNIA IN tuRkey Kockaya G.1, Erslon M.G.2, Can H.3, Akin O.1, Ozcan S.1 1Covidien, Istanbul, Turkey, 2Covidien, Boulder, CO, USA, 3Covidien, Ankara, Turkey Objectives: Ventilator-associated pneumonia(VAP) is a serious complication risk for patients who require invasive mechanical ventilation(IMV). VAP is associated with longer intensive care unit and hospital stays, which may increase health care expenditures. VAP may occur in 8% of IMV patients. Subglottic aspiration (SA) may decrease VAP by up to 45% in IMV patients. The goal of this analysis is to calculate the potential cost reduction associated with SA use for VAP reduction in IMV patients in Turkey. MethOds: A literature analysis was conducted in PubMed(2000-present) to determine the published cost of VAP in Turkey. Published costs were used for the conversion to Turkish Lira(TL). An annual inflation rate of 3% was applied to the cost data to project the estimated cost in 2013. The exchange rate for USD to TL was estimated at 1.8. A weighted average of the number of patients in each study was used to calculate the cost of treatment. The cost of SA to the Social Security Institution (SGK) was calculated as 33.94 TL, which includes the cost of the SA tube(TaperGuard EVAC; 25 TL) and the SA service reimbursement amount from the SGK of 8.94 TL. 8% and 45% were taken as the VAP rate and reduction with SA rate in IMV patients, respectively. The number of patients requiring IMV in a hospital was estimated at 1000 per year. Results: The average inpatient costs of IMV patients with and without VAP were calculated to be 13.556 TL and 3.971 TL, respectively. The total VAP cost, based on 80 VAP cases in 1,000 IMV cases without SA, was calculated as 1.085.297 TL. A hospital using SA for all IMV cases is estimated to have VAP costs equal to 488.384 TL and SA costs of 33.940 TL for a total cost of 522.324 TL. Cost reduction from SA use was calculated as 562.973 TL. cOnclusiOns: VAP increases health expenditures by 9.595 TL per patient. A hospital with 1,000 IMV patients per year that uses SA in all IMV patients may realize an estimated cost reduction of 562.973 TL associated with use of SA in IMV patients.

Purpose: Diagnosis of tuberculosis (TB) in children is more challenging than in adults. This study aimed to describe demographical, clinical and laboratory findings of children diagnosed with tuberculosis in Turkey, including the issues of contact tracing, culture positivity and forms of the disease. Materials and Methods: Clinical and laboratory data of 51 children with a mean age of 8.0±4.6 years who were diagnosed with TB were retrospectively reviewed. Main diagnostic tools included tuberculin skin test, chest X-ray, sputum/gastric aspirate culture with sensitivity testing, and direct microscopy for acid-fast bacilli on available samples. Clinical characteristics and outcomes of the patients were examined. Results: Thirty-six (70.6%) children were diagnosed with intra-thoracic and 15 (29.4%) with extra-thoracic tuberculosis. Twenty-eight of the patients had a positive Bacillus CalmetteGuerin vaccine scar (28/51, 54.9%) and 23/51 (45.1%) had a positive tuberculin skin test. An adult TB contact was identified in 27 (52.9%) of the cases. On direct microscopy, acid-fast bacilli were found in nine (17.6%) patients and positive culture for Mycobacterium tuberculosis was found in 19 (37.3%). Drug resistance to isoniazid was detected in four (7.8%). One patient with nephrotic syndrome and miliary tuberculosis died during follow-up. All other patients responded well to the treatment. Conclusion: Focusing on active contact tracing among all household contacts of tuberculous cases may be helpful in early identification and controlling childhood disease, even in regions with low disease prevalence. Adopting a suspicious and proactive approach in this particular age group is warranted.

WOS: 000470964400003, The aim of this study was to compare Kangal shepherd dogs with and without ankyloglossia in terms of various physiological and behavioral changes. A total of 24 dogs were used, 11 of which have had ankyloglossia and 13 of which did not have ankyloglossia. Heart rates, respiratory rates, and body temperatures of the dogs were measured at three different environmental temperatures (18, 23, and 28 degrees C), resting state, and different exercise durations (5, 10, and 15 min). In addition, resting state and some behavioral parameters were recorded with a video camera. Mann-Whitney U, Kruskal-Wallis, and Wilcoxon tests were used to analyze the data. While no statistical difference was detected in the two groups in terms of all parameters during the resting state at all temperatures, the difference between the resting state and exercising was statistically significant (P < 0.05, P < 0.01). Except for 15 min of exercise for the respiration rates, statistical differences were detected in both groups in parameters at both different temperatures and different exercise durations at each temperature. While some of the stress behavior parameters were not detected at any of the temperatures in normal dogs, the number of the dogs showing other stress behavioral parameters increased in both groups as the temperature increased, but the number was higher in the dogs with ankyloglossia. This study is the first study on physiological and stress behavioral parameters in Kangal shepherd dogs with ankyloglossia.

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