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Objective: A preliminary investigation of the impact of a serotonergic agent (fluoxetine) on symptom profile and neural response in youths with disruptive behavior disorders (DBDs) and a history of trauma exposure. Methods: There were three participant groups: (i) Youths with DBDs and trauma exposure who received fluoxetine treatment for 8 weeks (n = 11); (ii) A matched group of youths with DBDs and trauma exposure who received routine regular follow-up in an outpatient clinic (n = 10); and (iii) Typically developing youths (n = 18). All participants conducted an expression processing functional magnetic resonance imaging task twice, 8 weeks apart: (pretreatment and post-treatment for youths with DBDs). Results: Youths with DBDs and trauma exposure who received fluoxetine treatment compared to the other two groups showed: (i) significant improvement in externalizing, oppositional defiant disorder, irritability, anxiety-depression, and trauma-related symptoms; (ii) as a function of fearful expression intensity, significantly decreased amygdala response and increased recruitment of regions implicated in top-down attention control (insula cortex, inferior parietal lobule, and postcentral gyrus) and emotional regulation (ventromedial prefrontal cortex [vmPFC]); and (iii) correlation between DBD/irritability symptom improvement and increased activation of top-down attention control areas (inferior parietal lobule, insula cortex, and postcentral gyrus) and an emotion regulation area (vmPFC). Conclusions: This study provides preliminary evidence that a serotonergic agent (fluoxetine) can reduce disruptive behavior and mood symptoms in youths with DBDs and trauma exposure and that this may be mediated by enhanced activation of top-down attention control and emotion regulation areas (inferior parietal lobule, insula cortex, and vmPFC).

Minimal residual disease (MRD) diagnostics are implemented in most clinical protocols for patients with acute lymphoblastic leukaemia (ALL) and are mostly performed using rearranged immunoglobulin (IG) and/or T-cell receptor (TR) gene rearrangements as molecular polymerase chain reaction targets. Unfortunately, in 5–10% of patients no or no sensitive IG/TR targets are available, and patients therefore cannot be stratified appropriately. In the present study, we used fusion genes and genomic deletions as alternative MRD targets in these patients, which retrospectively revealed appropriate MDR stratification in 79% of patients with no (sensitive) IG/TR target, and a different risk group stratification in more than half of the cases.

Proteinuria is a component of preeclampsia, and the presence of proteinuria without an increase in blood pressure can precede preeclampsia. This study aims to investigate the perinatal effects of isolated proteinuria detected in a 24-h urine sample after the 20th week of pregnancy. This is a prospective study of the perinatal outcomes of 60 pregnancies without proteinuria and matched 58 pregnancies with isolated proteinuria in patients consecutively admitted to the department of obstetrics at a university hospital in Turkey. The pregnant patients with proteinuria and without proteinuria were statistically similar with respect to age, gravidity, parity and the number of living children on enrolment. There were no significant differences in terms of gestational age at enrolment, gestational age at delivery, or intrauterine growth restriction (IUGR) between patients with isolated proteinuria and patients without proteinuria. However, preeclampsia developed significantly more frequently in patients with isolated proteinuria (20.6% vs 6.6%, p = 0.048). There were no significant differences in terms of newborn weight, Apgar scores, need for the neonatal intensive care unit (NICU), or umbilical artery blood pH in patients with proteinuria and without proteinuria. Isolated proteinuria after 20 weeks of pregnancy does not appear to impair maternal or foetal outcomes. Identifying pregnant women with risk factors for preeclampsia, ensuring they attend meticulous follow-up schedules and performing their delivery at tertiary health care centres would help to improve maternal and foetal morbidity and prevent perinatal mortality.

Women with stress urinary incontinence (SUI) often require combined pelvic reconstructive surgeries because of shared risk factors of pelvic organ prolapse. The purpose of this study was to evaluate efficacies of Burch colposuspension, transobturator tape (TOT), and single-incision needleless (DynaMesh®-SIS minor) procedures in patients with SUI who also underwent combined pelvic reconstructive surgery or hysterectomy. We performed this retrospective cohort study that comprising 122 patients who either underwent Burch colposuspension (n:43), TOT (n:40), or SIS (n:39) procedures along with pelvic reconstructive surgery or hysterectomy between January 2010 and July 2018. During the clinical follow-up, we analyzed cure rates, and surgical success rates of SUI surgery, quality of life, and symptom severity by IIQ-7, UDI-6, SSI, SSQ-8, OAB-V8, and PGI-I scale scores. The primary outcome was surgical success, whereas secondary outcomes included complications and patient-reported outcomes in the quality of life. We found that surgical success rates were higher in Burch group than SIS group and higher in TOT group than in SIS group (88.4% vs 61.5% and 87.5% vs 61.5%, p = 0.003). The quality of life was lower in SIS group than in Burch group. Both Burch and TOT are effective procedures in patients with SUI who require additional pelvic surgeries. Although surgical outcomes of SIS procedure in patients with SUI who underwent concomitant pelvic surgeries in our study were not promising, further studies with SIS are needed to clarify these observations.

Background and aim Gestational trophoblastic disease (GTD) is a heterogeneous group of disorders characterised by abnormal proliferation of trophoblastic tissue. Since GTD and its malignant sequel gestational trophoblastic neoplasia (GTN) are rare diseases, little evidence is available from randomised controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centres within countries. One of the goals of the ‘European Organisation for Treatment of Trophoblastic Diseases’ (EOTTD) is to harmonise treatment in Europe. To provide a basis for European standardisation of definitions, treatment and follow-up protocols in GTD, we composed a set of guidelines for minimal requirements and optimal management of GTD. Methods Members from each EOTTD country attended multiple workshops during annual EOTTD meetings. Clinical guidelines were formulated by consensus and evidence where available. The following guidelines were discussed: diagnostics of GTD and GTN, treatment of low-risk GTN, high-risk GTN, ultra-high-risk GTN, placental site and epithelioid trophoblastic tumours and follow-up. Results Between 40 and 65 EOTTD members from 17 European countries and 7 non-European countries attended the clinical workshops held on 6 occasions. Flow diagrams for patient management were composed to display minimum and best practice for most treatment situations. New agreed definitions of recurrence and chemotherapy resistance were formulated. Conclusions Despite the many differences between and within the participating countries, an important step in uniform treatment of GTD and GTN within Europe was made by the Clinical Working Party of the EOTTD. This is an example on how guidelines and harmonisation can be achieved within international networks.

Amac: Bu calismanin amaci Turk toplumundaki gebe kadinlarinda Helicobacter pylori (HP) seropozitivitesinin GDM ile iliskisini arastirmaktir. Gerec ve Yontemler: Eylul 2019- Kasim 2019 tarihleri arasinda, Zonguldak Bulent Ecevit Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum AD’na basvuran 18-40 yas arasi, 26-37 haftalar arasinda tekil gebeligi bulunan gebeler calismaya dahil edildi. Cogul gebelikler, gebelik oncesi diyabet, hipertansiyon, hiperlipidemi, anemi ve ek sistemik hastaligi bulunan gebeler dislandi. GDM tanisi almis 46 gebe GDM Grubu, diger 28 gebe kontrol grubu olarak ayrildi. Gebelerde HP IgA ve IgG antikorlari ELISA yontemi ile calisildi. IgA ve IgG antikorlarindan herhangi biri pozitif olan hastalar HP(+), IgA ve IgG antikorlarindan her ikisi de negatif olan hastalar HP(-) kabul edildi. Bulgular: Yas, gravida, parite, abortus, gestasyonel yas, ultrasonografik yas, ve tahmini fetal agirlik her iki grupta da benzerdi. VKI, AKS, aclik insulin ve HOMA-IR degerleri GDM grubunda kontrol grubuna gore anlamli olarak yuksekti (sirasiyla p=0,018; p=

Extracorporeal life support (ECLS) is an essential component of a modern congenital cardiac surgery program. The circuit components and bedside management team may, however, vary among institutions. Here, we evaluate our initial experience with a modified ventricular assist device-based ECLS circuit primarily managed by the bedside nurse. We hypothesize that our outcomes are comparable to Extracorporeal Life Support Organization (ELSO) registry data. All patients who received ECLS from January 1, 2016 to December 31, 2019 at a single institution were included. Primary outcomes were survival to ECLS decannulation and discharge or transfer. Secondary outcomes included complications from ECLS. Data were compared to available ELSO registry data. Thirty-seven patients underwent 44 ECLS runs during the study period. Forty percent of patients had single ventricle physiology. Nearly 46% of patients received ECLS as part of extracorporeal cardiopulmonary resuscitation (eCPR). Survival to ECLS decannulation (68.2%) and survival to discharge or transfer (61.4%) did not differ from overall ELSO outcomes (69.7%, P = .870 and 50.7%, P = .136), as well as survival to discharge or transfer in a comparable cohort of ELSO centers (53.1%, P = .081). Patients with complications had a lower rate of survival to discharge or transfer but this did not reach statistical significance (47.7% vs. 75.0%, P = .455). Neurologic (50.0%), hemorrhagic (45.5%), and renal complications (31.8%) were most common in this cohort. A modified ventricular assist device-based ECLS circuit with primary management by the bedside nurse can provide comparable support in a neonatal and pediatric cardiac surgery population. Cost analyses and further delineation of the complication profile are necessary for a complete characterization of this system.

Background and aims This study aimed to evaluate whether there is a difference in human papillomavirus (HPV), smear, and cervical biopsy results between patients with and without diabetes mellitus (DM). Methods Retrospectively, 136 patients with positive high risk (HR) HPV screening results with and without DM who underwent colposcopy between 2015 and 2019 were identified. The clinicopathological characteristics and HR HPV screening results were reported and analyzed. The results of the patients with and without DM were compared. Results HPV 16 positivity, Atypical Squamous Cells of Undetermined Significance (ASCUS), and Cervical Intraepithelial Neoplasia 1 (CIN 1) in smear and biopsy results were higher in patients with DM than patients without DM. Conclusions The higher HPV positivity in patients with diabetes may require reforming the frequency and method of cervical cancer screening to be applied to this patient group.

Objective: Toinvestigate the efficacy of oral 10 mg Hyoscine N Butyl Bromur (HBB) on painperception of the patients who underwent endometrial biopsy with Pipelle.Material and Method: Thecharts of the patients who were 18-49 years and underwent endometrial biopsy with Pipelle for evaluation ofabnormal uterine bleeding at xxxxxxxxxxxxxxxxxxxxxxxxxxxxx between September 2018and September 2019 were retrospectively evaluated. 48 patients were seperated asHBB Group who used oral 10 mg HBB 30 minutes before endometrial biopsy and 56patients as Control Group who did not used any pain relief medication before endometrialbiopsy. Results: Therewere no statistically significant difference between two groups in age, BMI,parity, number of vaginal and cesarean births, nulliparity, multipartiy, andmenopausal status. On the other hand, VAS (0) scores which were recordedimmediately after endometrial biopsy and VAS (30) scores which were recorded 30minutes after endometrial biopsy of the patients of the HBB Group were lowerthan the Control Group (59,3 ± 21,12 vs 86,42 ± 10.95, ve 19,09 ± 23,85 vs55,71 ± 21,67 respectively; p≤0,001).Conclusion: 10mg oral HBB when taken 30 minutes before intervention, significantly decreasespain associated with Pipelle endometrial biopsy. This data might help toincrease the endication spectrum of HBB for analgesic purposes in gynecologyfield., Amaç: Buçalışmanın amacı Pipelle ile yapılan endometrial biyopsi işlemi öncesinde oralyoldan alınan 10 mg Hyosine N Butil Bromur (HBB)’nin analjezik etkinliğinideğerlendirmektir.Gerek ve Yöntem: Eylül2018- Eylül 2019 tarihleri arasında, xxxxxxxxxxxxx, anormal uterin kanamanındeğerlendirilmesi için Pipelle ile endometriyal biyopsi yapılmış, 18-49 yaşarasındaki hastaların dosyaları retrospektif olarak incelendi. Endometriyalbiyopsi işleminin 30 dakika öncesinde oral yoldan 10 mg HBB kullanan 48hasta HBB Grubu, endometriyal biyopsi işlemi öncesinde hiçbir analjezikkullanmayan 56 hasta ise Kontrol Grubu olarak ayrıldı.Bulgular: Yaş,vücut kitle indeksi, parite, vajinal ve sezaryen doğum sayısı, nulliparite,multiparite ve menopozal durum parametreleri açısından 2 grup arasında farkgözükmezken endometriyal biyopsinin hemen sonrasında kaydedilmiş VAS (0) veendometriyal biyopsiden 30 dakika sonra kaydedilmiş olan VAS (30) skorları HBBGrubunda Kontrol Grubuna göre daha düşük saptandı (sırasıyla 59,3 ± 21,12 vs86,42 ± 10.95, ve 19,09 ± 23,85 vs 55,71 ± 21,67; p≤0,001)Sonuç: Endometriyalbiyopsi işleminden 30 dakika önce oral yoldan alınan 10 mg HBB’nin,endometriyal biyopsi sırasında ve işlemden 30 dakika sonrasında analjeziketkinliği vardır. Bu data HBB’nin diğer jinekolojik endikasyonlar ilekullanımının yaygınlaşmasına yardımcı olabilir.

Amac: Kontrasepsiyon istenmeyen gebeligi onler. Dogum kontrolu eski zamanlardan beri kullanilmaktadir. Bu olgu sunumunda servikal kitleyi taklit eden eski moda bir dogum kontrol yontemini tartisacagiz. Olgu sunumu: Akrabalarina gore 100 yasinda, ancak kimlik kartina gore 96 yasindaki, bir kadin tenesmus sikayeti ile Zonguldak Bulent Ecevit Universitesi Saglik Uygulama ve Arastirma Hastanesi Jinekoloji Klinigine kabul edildi. Genel anestezi altinda kontrollu bir sekilde 4x4x3 cm servikal kitle ekstrakte edildi. Rengi gri, yuvarlak ve sert naturdeydi. Muhtemelen 60 yil once dogum kontrolu icin kullanilan bir balmumu parcasiydi. Sonuc: Osmanli doneminde, hibiscus koku gibi bazi bitki kokleri kontraseptif bariyer yontemi olarak kullanilmistir. Ancak bazi Turk kadinlari hala hastamizda goruldugu gibi geleneksel yontemleri kullanmaktadir. Istenmeyen gebeliklerin onlenmesi icin, ozellikle evlilik oncesi, guvenli dogum kontrol yontemleri hakkinda halk egitimi verilmesi onemlidir.

Metode Agile merupakan salah satu bentuk pendekatan metode pengembangan sistem yang berkembang saat ini untuk pemodelan perangkat lunak yang mengutamakan fleksibilitas dan kedinamisan setiap prosesnya terhadap perubahan-perubahan yang terjadi, dimana perubahan-perubahan tersebut dapat dilakukan pada setiap tahapan proses yang ada. Salah satu metode Agile yang ada adalah pendekatan Extreme Programming (Extreme Programming Approach). Perbedaan Extreme Programming Approach (XP) dibandingkan dengan metode lainnya yaitu tidak memiliki dokumentasi secara formal dalam setiap tahapan proses konstruksinya. Adapun tahapan-tahapan yang harus dilalui dalam XP Approach antara lain: Tahapan explorasi, perencanaan, iterasi pengembangan sistem, dan tahapan akhir. Keunggulan dari XP Approach ini adalah perancangan perangkat lunak yang dilakukan tidak akan diubah, hanya sistem yang sedang dibangun saja yang berubah, dengan kata lain XP Approach memungkinkan tidak adanya dokumentasi formal yang dapat digunakan sebagai alat ukur bahwa aplikasi telah selesai dibangun, namun aplikasi dikatakan telah selesai apabila klien tidak melakukan penambahan analisis kebutuhan (requirement) pada aplikasi. Penambahan atau perubahan requirement ini tidak dibatasi, sehingga apapun keinginan klien akan dipenuhi. Melalui pendekatan XP ini akan dibangun sebuah aplikasi yang diperuntukkan untuk sistem penjualan berbasis online (E-commerce) dengan prinsip business to customer (B2C). E-commerce ini diperuntukkan bagi penjual khususnya yang bergerak di bidang UMKM pada wilayah Kabupaten Musirawas Utara yang ingin mengembangkan kegiatan jual beli barang dagangan kepada customer secara online.

The purpose of this research to see how The Role of Local Government in Improving the Quality of Terminal Management (Study at the Office of Transportation, Communication and Information, Tebo Regency). This type of research used in this research is descriptive research with a qualitative approach. The results of this study show that the 1. The Department of Transportation, Communication and Information Technology of Tebo Regency has managed terminal quality such as establishing a terminal as an UPTD so that it can further maximize public services in the transportation sector, provide facilities to UPTD in improving the quality of terminal management, giving authority to UPTD for terminal management both in the service sector and in the area of local revenue, directing public transportation to utilize the terminal.

An ideal dressing should ensure that the wound remains moist with exudates but not macerated. Currently, there is no dressing available to suit all wounds, at all stages of the healing process. Although silver-containing dressings are the gold standard for burn wound care, few high-level trials have been completed comparing the clinical utilities of these dressings. In our study, five different types of wound dressings: carboxymethyl cellulose hydrofiber dressing with ionized silver (CMCH-Ag), polyethylene-polyethylene terephthalate aqua fiber dressing with elementary silver (PPAF-Ag), calcium alginate (CA), calcium + zinc alginate (CZA), and 0.2% nitrofurazone-embedded (NF) gauze dressings were compared in regard to histopathological parameters. Children aged between 0 and 18 years with small or middle-sized partial-thickness burns that affected less than 30% of the total body surface area were included in this study. The study groups (CMCH-Ag, PPAF-Ag, CA, and CZA) and the control group (NF) were randomly attained. Wound healing was evaluated by punch biopsies on the 21st day. The thickness of the stratum corneum and the epithelium, the number of papillae, and the papillary length were calculated and compared. The histological parameters of healing, except the stratum corneum thickness, did not show any statistical significance among the groups (P > .05). The dressings that included silver, calcium, or zinc showed useful and similar effects in noninfective burn wounds when compared with nitrofurazone-only dressings. Thus, it may be concluded that silver-containing wound dressings should not be considered as the gold standard in noninfective partial-thickness burn wounds in children.

BACKGROUND Donors with drowning or asphyxiation (DA) as a mechanism of death (MOD) are considered high risk in pediatric lung transplantation. We sought to evaluate whether recipients of DA donors had negatively impacted outcomes. METHODS Pediatric recipients recorded in the United Network for Organ Sharing registry between 2000 and 2019 were included. Primary stratification was donor MOD. Propensity matching with a 1:1 ratio was performed to balance the DA and non-DA MOD donor cohorts. Cox multivariable regression was used to determine the risk-adjusted impact of donor MOD. A subanalysis of the effect of lung allocation score was also evaluated. RESULTS A total of 1016 patients underwent bilateral lung transplantation during the study period, including 888 (85.6%) from non-DA donors and 128 (14.4%) from DA donors. Survival at 90 days, 1 year, and 2 years were similar in the matched and unmatched cohorts regardless of the donor MOD. Moreover, separate risk-adjusted analysis of drowning and asphyxiated donors was similar to other MOD donors at 30 days, 1 year, and 5 years. Similar survival findings persisted regardless of pretransplant lung allocation score. Although the rates of posttransplant stroke (1.0% versus 3.1%, P = 0.04) and the length of hospital stay (19 versus 22 d, P = 0.004) were elevated in the unmatched DA MOD recipients, these differences were mitigated after propensity matching. CONCLUSIONS This study evaluated the impact of DA MOD donors in pediatric lung transplant recipients and found similar rates of complications and survival in a propensity-matched cohort. These data collectively support the consideration of DA MOD donors for use in pediatric lung transplantation.

Background: Despite significant improvement in outcomes with truncus arteriosus (TA) repair, right ventricular outflow tract (RVOT) reconstruction with a right ventricular to pulmonary artery (RV-to-PA) conduit remains a source of long-term reintervention and reoperation. This study evaluated our experience with reintervention in homograft and polytetrafluoroethylene (PTFE) RV-to-PA conduits in neonates. Methods: Primary TA repairs from 2004 to 2016 at a single institution were included. Stratification was based on RVOT reconstruction with PTFE or homograft conduit. Primary outcome was operative conduit replacement. Secondary outcomes included the rates and types of catheter-based conduit interventions. Results: Twenty-eight patients underwent primary TA repair and 89.3% (n = 25) of them had RVOT reconstruction with a homograft (28.0%, n = 7) or PTFE (72.0%, n = 18) conduit. Rates of reoperation for conduit replacement and catheter-based interventions were similar between those with PTFE and homograft conduits (85.7% vs 72.2%, P = .49 and 57.1% vs 83.3%, P = .11, respectively). Additionally, the median time to conduit replacement and catheter-based conduit interventions were comparable. In multivariable analysis, conduit size, but not conduit type, was a predictor of conduit revision (hazard ratio: 1.66, 95% confidence interval: 1.11-2.49, P = .02). At five-year and ten-year follow-up, patients with PTFE conduits had better survival than those with homograft conduits (100.0% vs 71.4%, P = .02); however, no mortalities were associated with conduit reoperations or catheter-based reinterventions. Conclusions: Polytetrafluoroethylene and homograft RVOT reconstruction in neonatal TA repair demonstrate similar durability as defined by reoperation and reintervention rates. The validation of the durability of PTFE conduits in neonatal TA repair requires confirmatory studies in larger cohorts.

In routine diagnostic pathology, cancer biopsies are preserved by formalin-fixed, paraffin-embedding (FFPE) procedures for examination of (intra-) cellular morphology. Such procedures inadvertently induce DNA fragmentation, which compromises sequencing-based analyses of chromosomal rearrangements. Yet, rearrangements drive many types of hematolymphoid malignancies and solid tumors, and their manifestation is instructive for diagnosis, prognosis, and treatment. Here, we present FFPE-targeted locus capture (FFPE-TLC) for targeted sequencing of proximity-ligation products formed in FFPE tissue blocks, and PLIER, a computational framework that allows automated identification and characterization of rearrangements involving selected, clinically relevant, loci. FFPE-TLC, blindly applied to 149 lymphoma and control FFPE samples, identifies the known and previously uncharacterized rearrangement partners. It outperforms fluorescence in situ hybridization (FISH) in sensitivity and specificity, and shows clear advantages over standard capture-NGS methods, finding rearrangements involving repetitive sequences which they typically miss. FFPE-TLC is therefore a powerful clinical diagnostics tool for accurate targeted rearrangement detection in FFPE specimens., Preservation of cancer biopsies by FFPE introduces DNA fragmentation, hindering analysis of rearrangements. Here the authors introduce FFPE Targeted Locus Capture for identification of translocations in preserved samples.

Aim: The purpose of this study is to search the effects and treatment efficacies of topotecan and folic acid on the choriocarcinoma cultures generated in JAR cell culture. Material and Methods: Human choriocarcinoma-like JAR cell is augmented in the 10% fetal bovis serum and RPMI-1640 media, 95% air at 37°C with the existence of penicillin and streptomycin. Groups to apply topotecan or folic acid are identified as below:Topotecan dissolved in dimethyl sulphoxide (DMSO) and prepared as separate doses of 1, 5, 10 and 50 μg/ml. Substances are given to cells simultaneously. Results: In this study, the apoptotic effect of the use of topotecan only, in residual doses on JAR cell series is statistically significant. The use of folic acid only, in residual doses has found to decrease the apoptosis. In the combination of these two drugs in residual doses, the apoptotic effect of this drug is even more increased, and statistically significant. Conclusion: This is the first study which use the topotecan and folic acid separately and combined on JAR, a human choriocarcinoma cell line model, and evaluation of β-hCG and h-hCG by the means of immunoenzymatic method on the both two cell lines. Synergistic and apoptotic data gathered indicates that topotecan and folic acid can be one of the treatment options in order to struggle multi-drug resistance which is an enormous obstacle on treatment. However, the efficacy of drugs and effects of combination therapies might be disparate in vivo; therefore data must be supported by animal experiments and after that by clinical evaluations.

Objective: The aim was to investigate the effectiveness of pegylated liposomal doxorubicin (PLD), beta-carotene, and a combination of PLD and beta-carotene on JAR and JEG-3 human choriocarcinoma (CC) cell lines for the treatment of CC. Material and Methods: JAR and JEG-3 cells were cultured. PLD and beta-carotene trial groups were determined with different doses (for single drug trial; PLD 1, 2, 5 μg/mL and beta-carotene 1, 5, 10 μg/mL, and for combined drug trial; all PLD doses combined with beta-carotene 5 μg/mL). Drugs were administered to cultures simultaneously, and 72 hours later the cells were detached using trypsin-ethylenediamine tetraacetic acid solution. The percentage of apoptotic cells was determined by flow cytometry after annexin V staining. One set of the supernatant was collected before trypsin application to investigate beta-human chorionic gonadotropin (β-hCG) and hyperglycosylated hCG (H-hCG) levels. Statistical analyses of the apoptotic ratios were performed using Shapiro-Wilk, Kruskal-Wallis and Mann-Whitney U tests. Results: Apoptosis increased in JAR and JEG-3 cultures after treatment with all doses of PLD (p

Amaç: Preterm doğumu önlemek amacıyla servikal yetmezlik saptanıp proflaktik serklaj ve acil serklaj operasyonu yapılmış olan olguların perinatal sonuçlarını karşılaştırmak Gereç ve Yöntem: Ocak 2009 - Ocak 2019 arasında Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde serklaj yapılmış olan hastaların medikal bilgileri retrospektif olarak incelendi. Servikal yetmezlik ile ilişkili bir veya daha fazla ikinci trimester gebelik kaybı hikayesi bulunan ya da servikal yetmezlik nedeniyle daha önce serklaj yapılmış olan hastalar proflaktik serklaj grubu olarak, ikinci trimesterde ağrısız servikal dilatasyon ve/veya membranların vajene prolabe olduğu saptanarak serklaj yapılan olgular ise acil serklaj grubu olarak ayrıldı. Gruplar arasında gebelik süresince gelişen komplikasyonlar, perinatal sonuçlar ve inflamatuar belirteçlerden lökosit (WBC), periferik kan nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranı (PLR) karşılaştırıldı. Bulgular: Yirmi yedi olgudan oluşan proflaktik serklaj grubunda canlı doğum oranı %96,6 iken, 16 olgudan oluşan acil serklaj grubunda canlı doğum oranı yine oldukça yüksek bir oran olan %81,3 olarak saptandı. Proflaktik serklaj ve acil serklaj yapılan hastaların canlı doğum oranı, doğum haftası, preterm doğum oranı ve doğum kilosu her iki grupta da benzerdi (p=0,137; p=0,179; p= 0,085; p=0,602). Acil serklaj yapılan olguların servikal dilatasyonları 1-4 cm arasında değişmekteydi. Beş olguda servikal dilatasyon ≥3 cm ve membranlar prolabe idi, bu olguların sadece biri (%20) canlı term doğumla sonuçlandı. Acil serklaj grubunda lökosit (WBC) sayısı proflaktik serklaj grubundan daha yüksek bulundu (p=0,037). Buna karşılık NLR, PLR, nötrofil, lenfosit ve trombosit sayıları ise her iki grupta farksız saptandı. Tüm olgular içinde preterm doğumlar ile term doğumlar arasında yapılan karşılaştırmada ise WBC, NLR ve PLR değerleri açısından fark saptanmadı. Sonuç: Acil serklaj operasyonunun perinatal sonuçları proflaktik serklaj operasyonu ile benzer ve her iki grupta da canlı doğum ve term doğum oranları yüksek saptanmıştır. Bununla beraber acil serklaj yapılan grupta servikal dilatasyonun ≥3 cm olduğu olgularda ise neonatal mortalite, abortus ve preterm prematür membrane rüptürü oranı yüksektir. Bu bulgular özellikle acil serklaj yapılacak hastaların seçiminde dikkatli olmak gerektiğini göstermektedir. Objective: To compare perinatal outcomes of prophylactic cerclage and emergency cerclage operations in patients with cervical insufficiency to prevent preterm birth. Material and Method: A retrospective study was conducted between June 2009 and June 2019 in University of xxxxxxxxxx Obstetrics and Gynecology Department. All medical records were evaluated. Patients with history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labor or abruptio placentae or history of prior cerclage due to painless cervical dilation in the second trimester were included to prophylactic cerclage group and patients with painless cervical dilation and/or prolabed membranes at physical examination in the second trimester were included to emergency cerclage group. Pregnancy complications, perinatal outcomes and inflammatory markers such as WBC count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) were assessed. Results: Live birth rate were 96,6% in prophylactic cerclage group which was consisted of 27 patients and 81,3% in emergency cerclage group which was consisted of 16 patients. Similarity were observed in comparison of live birth rate, gestational age at birth, preterm birth rates and birthweight between both groups (p=0,137; p=0,179; p= 0,085; p=0,602). Cervical dilatation was between 1 and 4 cm in emergency cerclage group. Cervical dilatation were ≥3 cm and membranes were prolabed in 5 patients. Only one of five patient’s pregnancy was resulted with term birth. WBC count were higher in emergency cerclage group than prophylactic cerclage group (p=0,037). On the contrary, no difference was seen in comparison of NLR, PLR, neutrophil, lymphocyte, and platelet count between groups. Likewise, WBC, NLR and PLR were not different between the patients who were delivered preterm and term in all groups. Conclusion: Our study suggests that, both prophylactic cerclage and emergency cerclage increases the live birth and term birth rates. However increased neonatal mortality, abortus and preterm premature membrane rupture rates were observed in patients with cervical dilatation ≥3 cm. Patients must be evaluated carefully before emergency cerclage operation.

WOS: 000489909000001, Purpose of Review This paper focuses on the epidemiologic factors that are effective on the pathology of the endometrial malignancy. Based on previous reviews and recent articles on endometrial cancer, we sought to define risk factors and related diseases to endometrial malignancies. Recent Findings Previous studies have shown that phosphoinositide 3-kinase (PI3K) activity is stimulated by diverse oncogenes and growth factor receptors, and elevated PI3K signaling is considered a hallmark of cancer. A major antagonist of PI3K activity is phosphatase and tensin homolog (PTEN), a tumor suppressor which is often mutated or lost in type I endometrial cancer cells. Endometrial cancer is still a problem in developed countries since adiposity and sedentary way of life. However, we have not found a feasible way to screen endometrial malignancies. In the future, with the advancing of genetic studies, screening could be applicable.

WOS: 000446055200010, PubMed: 30338082, AimCesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The gestational sac is implanted in the myometrium at the site of a previous cesarean section. Mothers with CSP are faced with risks of unpredictable massive bleeding or more fatal complications. The purpose of this retrospective study was to assess the feasibility, efficacy, and reliability of the intraoperative ultrasound-guided vacuum aspiration method as an effective treatment option for CSP. MethodsWe undertook a retrospective analysis of CSP patients who had undergone the vacuum aspiration method, by reviewing patient records from the period October 2015 to January 2018. All of the operations were carried out under general anesthesia, with patients in the lithotomy position, using suprapubic ultrasonography guidance. A vacuum aspirator was used to aspirate the whole pregnancy material without perforating the previous cesarean section scar. ResultsTen women with CSP were managed successfully by ultrasound-guided vacuum extraction without complications or further interventions, such as reoperation or methotrexate administration. Three of the 10 patients needed uterine Foley catheter tampon (50cc) for 4h after vacuum extraction alone was applied. During the study period, two additional patients who did not meet the criteria for the vacuum extraction method alone were managed with methotrexate plus vacuum application. Because of the rarity of the condition, the majority of CSPs are case reports or small case series reported in published works, with no consensus on the preferred course of treatment. ConclusionThe vacuum extraction method seems to be a good and practical way of treating CSP. Comparisons of efficacy should be undertaken but large sample sizes are required. We hope this study brings a new perspective for larger sample-sized studies, considering the technique is feasible and applicable.

Yuksek enerjili fotonlardan olusan iyonlastirici radyasyon (Rontgen isinlari, X isinlari, X-ray) canlilarda DNA hasarina ve serbest radikal olusumuna yol acarak zararli etkiler meydana getirir. Radyasyonun embriyo uzerindeki baslica etkileri; teratogenezis, mutagenezis, karsinogenezistir. Calismamizda, gebe oldugunu bilmeyen kadinlarin erken gebelik doneminde X isini maruziyetinden sonra gebeliklerinin devami konusunda yaptiklari secimi arastirdik. Calismaya, 01.01.2015 ile 01.06.2016 tarihleri arasinda Bulent Ecevit Universitesi Saglik Uygulama ve Arastirma Merkezi Gebe Poliklinigi’ne basvuran, gebelikte X isini maruz kalimi on tanisi olan toplam 42 gebe alindi. Olgular 32±8 yasinda idi. Olgularin 31’inde cok sayida direkt grafi, 9’unda bilgisayarli tomografi, 2’sinde sintigrafi cekimi oykusu vardi. Radyasyon maruziyeti sonrasi 42 ilk trimester gebeden 26’si gebeliginin devamina, 16’si ise tahliyesine karar verdi. Gebelik sirasinda fetus icin maruz kalinacak iyonlastirici radyasyonun maksimal limiti, kumulatif olarak 5 Rad (50 mGy)’dir ancak birden fazla veya 5 Rad uzeri dozlarda olmasi durumunda fetus uzerine risk tasidigi kabul edilir. Hastanin gebelik testi pozitif ciktigi olgularda radyolojik bir inceleme yapilmasi geregi dogdugunda; hekim, gerekli incelemenin yarar ve zararlarini tartmali, radyolojik incelemelerin guvenirliligi hakkinda hasta ve yakinlarini bilgilendirmeli, onamlarini alarak gerekli incelemeyi o sekilde yapmalidir.

COVID-19 has introduced a monumental challenge to the routine delivery of healthcare and protection of healthcare professionals. Conditions that are life threatening and need urgent intervention add another layer of complexity. This brief report reviews the management of a large cardiac fibroma found in the setting of COVID-19.

Activities carried out in the warehouse include material handling. Generally, the costs involved in material handling activities are quite large. One method that can be used in managing the layout of raw material placement in raw material warehouses is the class based storage method. Class based storage is a policy that divides storage into three classes A, B and C based on Pareto law. Pareto law is the principle of putting items that have the greatest accessibility near the Input-Output point. The distance of material handling to the initial layout raw material warehouse is 3,513,337 meters / month and the material handling costs are Rp. 134,534,765 / month, because the initial layout of the raw material warehouse still uses random storage and the raw materials that are widely used are not placed close to the intake floor of the production, so that the distance to get raw materials for production needs is far. After the re-layout design was made based on the placement of raw materials in the class based storage method, the material handling transfer distance was reduced to 2,644,459 meters / month and the material handling cost for the repair raw material warehouse layout fell to Rp. 99,949,520 / month. In other words, there was a decrease in material handling distance by 25% and material handling costs by 26%.

The incidence of cornual or interstitial pregnancy is approximately 2% of all pregnancies. Interstitial pregnancy is one of the rare form of ectopic pregnancies, with 1-6% of all ectopic pregnancies. In our case report, we present successful laparoscopic resection of a cornual pregnancy with positive fetal cardiac activity and laparoscopic suturing of cornu uteri. A 26-year-old pregnant; gravida 2, para 0, abortus 1; was admitted with a complaint of left lower quadrant abdominal pain. An ultrasound examination was performed. The ultrasound examination revealed a 4-cm ectopic gestational sac with positive cardiac activity in the left adnexa. Laparoscopy was planned. A left uterin approximately 3x4 cm cornual pregnancy was observed, under direct visualization, one 5-mm coagulating dissector was used to perform the resection and seal of the cornu uteri. After the sealing, two times laparoscopic suturing was applied. Detecting interstitial pregnancy is more difficult than revealing other ectopic pregnancy types. Severe hemorrhage could occur during the resection of the cornu uteri. Therefore, a laparoscopic approach should only be attempted if the surgeon is well skilled in laparoscopic technique, and has the capability to convert the operation quickly to a laparotomy.

WOS: 000462506200002, Aim: The aim was to investigate the effects of preoperative anxiety and general anesthetic administrations on intraoperative awareness among patients undergoing cesarean section. Methods: This prospective randomized study included 90 pregnant subjects. Preoperative anxiety was assessed using the Beck Anxiety Inventory. The patients were divided into three groups: group P received propofol 2.5 mg/kg, group T thiopental 5 mg/kg and group K received ketamine 1 mg/kg. Data on intraoperative hemodynamics, isolated forearm (IFA) responses and time to first pain and to first analgesic requirement evaluated using postoperative numerical rating scale were recorded. The Modified Brice Scale (MBS) was used to assess awareness. Results: The preoperative anxiety levels in the groups were low and demographic data were similar (p>0.05). There was no statistically significant difference in IFA response between the groups (p>0.05). Group T had higher MAP at all times and NRS values at hour 0 compared to the other groups (p

Adneksiyal kitle yaygin jinekolojik sorundur ve kitleler icin malignite net bir sekilde dislanmalidir. Over kanserleri en mortal jinekolojik kanserlerdir. Benign ve malign adneksiyal kitlelerin ayirici tanisi, hastanin jinekolojik onkologa yonlendirilmesinde onemlidir. Over kanseri tanisinda serum biyomarkerlarinin kullanilmasi yaygin olarak arastirilmaktadir. Calismamiz Ekim 2014 – Ocak 2017 tarihleri arasinda yapildi. Pelvik kitlesi olan 18 ve 90 yaslari arasinda 95 hasta secildi. Her hasta icin preooperatif CA 125, HE4, SMRP, FOLRα seviyeleri olculdu ve patoloji sonuclari ile kan sonuclari arasindaki iliski incelendi. HE4 ve SMRP malign kitlelerde onemli olcude yuksek bulundu. Fakat Ca 125 ve FOLRα seviyeleri malingnitede anlamsiz saptandi. Calismamiza gore; HE4 ve SMRP over kanserini on gormede kullanilabilir. Fakat daha fazla calismalar ile desteklenmelidir.

The first radio identification systems appeared already during World War II for military applications, namely, for identification of planes. However, it is only now that the technical conditions are right for a wide use of radio frequency identification (RFID). The two key issues for the RFID technology are the number of different codes that can be ‘written’ on a tag and the possibility to store, transfer, and communicate information. Due to the ongoing miniaturization of semiconductor integrated devices, mass production of such devices at a low cost has become possible. More specifically, microand nanometer lithographic technology allows for the fabrication of very small tags (with a chip size on the order of 1 mm and smaller) operating at the GHz-range where sufficiently wide frequency bands are available. These industrial, scientific, and medical (ISM) frequency bands can be used without licensing with a limited radiated power. The wide frequency bands finally allow for a practically infinite number of different codes to be written and read at microsecond time intervals. As to the second key issue, the omnipresent internet, intranet, and similar communication networks enable the processing of databases and developing of smart systems that use the information automatically read from RFID tags. It is interesting to point out that the dramatic development of mobile phones (that only combine a transmitter and a receiver, both used in radio communications for a century by now) was based exactly on the same two reasons: first, the development of technology allowing the use of high frequencies, wide frequency bands and, finally a large number of subscribers and, second, computer databases with high-speed data links enabling fast communication. The type of RFID tag introduced in this chapter, the surface acoustic wave (SAW) tag, is in many aspects similar to RF SAW filters, that are widely used in mobile phones. SAW tags and SAW filters use the same technology.

Aortic root translocation (Nikaidoh), Rastelli, and réparation à l'etage ventriculaire (REV) are repair options for transposition of the great arteries (TGA) with ventricular septal defects and left ventricular outflow tract obstruction (VSD-LVOTO) or double outlet right ventricle TGA type (DORV-TGA).This retrospective study using The Society of Thoracic Surgeons Congenital Heart Surgery Database evaluates surgical procedure utilization and outcomes of patients undergoing repair of TGA-VSD-LVOTO and DORV-TGA with a Nikaidoh, Rastelli, or REV procedure.A total of 293 patients underwent repair at 82 centers (January 2010 to June 2019). Most patients underwent a Rastelli (n = 165, 56.3%) or a Nikaidoh (n = 119, 40.6%) operation; only 3.1% (n = 9) underwent a REV. High-volume centers performed the majority of the repairs. Fewer Nikaidoh than Rastelli patients had prior cardiac operations (n = 57 [48.7%] vs n = 102 [63.0%]; P = .004). Nikaidohs had longer median cardiopulmonary bypass time (227 [interquartile range (IQR), 167-299] minutes vs 175 [IQR, 133-225] minutes; P.001) and median aortic cross-clamp times (131 [IQR, 91-175] minutes vs 105 [IQR, 82-141] minutes; P = .0015). Operative mortality was 3.1% (95% confidence interval [CI], 1.0%-7.0%; n = 5) for Rastelli, 4.4% (95% CI, 1.4%-9.9%; n = 5) for Nikaidoh, and 11.1% (95% CI, 0.3%-48.3%, n = 1) for REV. The rates of cardiac arrest, unplanned reoperation, mechanical circulatory support, prolonged ventilation, and permanent pacemaker placement were higher in the Nikaidoh population but with 95% CIs overlapping those of the other procedures.Rastelli and Nikaidoh procedures are the prevalent repair strategies for patients with DORV-TGA and TGA-VSD-LVOTO. Most are performed at high-volume institutions, and early outcomes are similar.

The aim of this study was to determine the accuracy of the 24-h urine collection in preeclamptic pregnant women. This study included 65 singletons with preeclampsia and 53 singleton patients in a control-matched group. The ratio of inaccurate 24-h urine collection was measured by calculating expected urine creatinine excretion according to the proportion of pre-pregnancy weight and the lean body mass (LBM) of the patients. Comparisons were made between the accurately-collected 24-h urine protein excretion rates and the instant and 24-h urine protein/creatinine (P/Cr) and albumin/creatinine (A/Cr) ratios. Twenty-four-hour urine collection used to diagnose patients with preeclampsia was incorrectly collected 15–73.5% of the time among the patients and the control group. Instant and 24-h urine P/Cr and A/Cr ratios were correlated with total 24-h proteinuria among the patients in whom urine was collected correctly. Considering the 24-h urine P/Cr ratio, rather than the 24-h urine protein excretion value, is a better way to diagnose preeclampsia.IMPACT STATEMENTWhat is already known on this subject? Twenty-four-hour urine collection is considered as the gold standard of diagnosing proteinuria in preeclampsia, in case of the correctly collected. What do the results of this study add? Generally, in the literature the correctness of 24-h proteinuria is not questioned. However, it is actually quite important in daily practice to make the correct diagnosis of the proteinuria not to misdiagnose preeclampsia. What are the implications of these findings for clinical practice and/or further research? In this article, we aimed to show the importance of accurately collected 24-h urine in preeclampsia. We consider and advise to change the gold standard of this technique to 24-h protein/creatinine (P/Cr) ratio, in order to make correct diagnosis of the preeclampsia. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Two of the most commonly used substances by adolescents in the United States are cannabis and alcohol. Cannabis Use Disorder (CUD) and Alcohol Use Disorder (AUD) are associated with impairments in decision-making processes. One mechanism for impaired decision-making in these individuals is thought to be an inability to adequately represent future events during decision-making. In the current study involving 112 adolescents, we used a comparative optimism task to examine the relationship between relative severity of CUD/AUD (as indexed by the CUD/AUD Identification Tests [CUDIT/AUDIT]) and atypical function within neural systems underlying affect-based neural represenation future events. Greater CUDIT scores were negatively related to responses within subgenual anterior and posterior cingulate cortex when processing high-intensity potential future positive and negative events. There was also a particularly marked negative relationship between CUD symptoms and blood oxygen level-dependent (BOLD) responses within visual and premotor cortices to high-intensity, negatively valenced potential future events. However, AUD symptom severity was not associated with dysfunction within these brain regions. These data indicate that relative risk/severity of CUD is associated with reduced responsiveness to future high-intensity events. This may impair decision-making where future significant consequences should guide response choice.

We aimed to explore the concept of coregulation in adulthood based on the analyses of vocal cues in conversations. Moderators which potentially affect vocal coordination between romantic partners were also examined. Twenty- four heterosexual dating couples (Mage = 21.25; SD = 1.03) from Cornell University were recruited for the Study. Participants communicated with their romantic and stranger partner in a balanced order. Their conversations were recorded and vocal features were extracted. Granger-causality analyses yielded that close partner conversations were bidirectional, signifying that female participants’ previous F0 responses caused male participants’ subsequent F0 responses and vice versa. In the stranger partner conversations, however, only female participants’ previous F0 responses caused male participants’ subsequent F0 responses, implying that there was unidirectional association between stranger partners. In sum, findings suggested that coregulation process can be observed at the vocal level using synchronous speech patterns. Implications for attachment-in-the-making between romantic partners and the literature on behavioral mimicry were discussed.

The change score on a test or questionnaire that represents an important improvement or deterioration for a patient, is referred to as the minimal clinically important difference (MCID). MCIDs are a mandatory lower limit for the approval and evaluation of new treatments. It is therefore very important that correct MCIDs are determined. In this thesis, the MCIDs of several questionnaires were calculated, compared with each other and investigated for factors influencing this measurement. The study was conducted in people with chronic obstructive pulmonary disease (COPD) with the three main health status questionnaires. Data were collected from (1) a literature review; (2) a clinical study in a German pulmonary rehabilitation clinic; and (3) a questionnaire study in Dutch COPD patients treated by their general practitioner and/or pulmonary physician.Small differences were observed for the questionnaire MCIDs between multiple approaches used and during various follow-up periods. Despite minor differences, the MCIDs for people with an improved health status were found to be fairly similar to those for people with an experienced deterioration. Furthermore, the MCIDs for patients in the German pulmonary rehabilitation study were higher than for Dutch routine care patients. Moreover, a larger relevant improvement in health status (a higher MCID) was noted for patients, who already had many symptoms and limitations at the start of the study. This was similar for women, participants aged 60 years or over, patients with a good lung function, and people with fewer co-morbid diseases. However, these patient groups needed only little additional deterioration in health status (a lower MCID) to actually feel worse.

Intrathoracic left subclavian to common carotid artery translocation is advocated for patients undergoing vascular ring division in the setting of an enlarged Kommerell’s diverticulum and aberrant left subclavian artery. This approach poses technical challenges in larger patients and patients with unfavorable body habitus. Supraclavicular left subclavian artery to common carotid translocation greatly simplifies this procedure in select patients.

This study aims at evaluating gender, age range and seasonal differences in patients who developed articular infection after undergoing joint prosthesis in our clinic. This study is a retrospective screening of advanced articular arthrosis patients who had undergone total joint arthroplasty of the upper and lower extremities between 2009 and 2016. Of 504 patients who had been treated with total joint replacement, our study includes 468 patients we could follow up or contact by phone and who had been applied 559 primary or revision total knee arthroplasty. The mean age of these patients was 58.9 (ranging from 41 to 74). We detected infection in 22 (3.9%) total joint arthroplasty patients. Of these 14 (63.63%) were females and 8 (36.36) were males. There was no statistically significant difference between infection rates in terms of seasonal distribution nor gender or age range. In the light of our findings, we concluded that gender, age range and seasonal differences have no effect on infection rates in total joint replacement cases. [Med-Science 2018; 7(1.000): 210-213]

Background Delirium in critically ill children is a severe neuropsychiatric disorder which has gained increased attention from clinicians. Early identification of delirium is essential for successful management. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale was developed to detect Paediatric Delirium (PD) at an early stage. Objective The aim of this study was to determine the measurement properties of the PD component of the SOS-PD scale in critically ill children. Methods A prospective, observational study was performed in patients aged 3 months or older and admitted for more than 48 h. These patients were assessed with the SOS-PD scale three times a day. If the SOS-PD total score was 4 or higher in two consecutive observations, the child psychiatrist was consulted to assess the diagnosis of PD using the Diagnostic and Statistical Manual-IV criteria as the “gold standard”. The child psychiatrist was blinded to outcomes of the SOS-PD. The interrater reliability of the SOS-PD between the care-giving nurse and a researcher was calculated with the intraclass correlation coefficient (ICC). Results A total of 2088 assessments were performed in 146 children (median age 49 months; IQR 13–140). The ICC of 16 paired nurse-researcher observations was 0.90 (95% CI 0.70–0.96). We compared 63 diagnoses of the child psychiatrist versus SOS-PD assessments in 14 patients, in 13 of whom the diagnosis of PD was confirmed. The sensitivity was 96.8% (95% CI 80.4–99.5%) and the specificity was 92.0% (95% CI 59.7–98.9%). Conclusions The SOS-PD scale shows promising validity for early screening of PD. Further evidence should be obtained from an international multicentre study.

Background: Postpartum hemorrhage (PPH) is one of the emergency situations of obstetrics practice that constitutes of 1 to 5% of vaginal and cesarean deliveries. Uterine atony is the number one cause of PPH and is responsible for at least 75% of PPH cases. Uterine compression sutures have been regarded as an effective method in PPH cases, as well as preserving fertility by preserving the uterus. Aims: The main purpose of this study was to report on our results with a new uterine compression suture technique that was developed by us. Subjects and Methods: In this study we included all women who needed uterine compression sutures because of uterine atony while cesarean section from January 2014 to December 2018. Fifteen cases with PPH with uterine atony were reported, who were treated with our uterine compression suture technique after conservative medical and uterine massage treatment failure. Results: All of the cases in this study were managed successfully namely none of the patients needed a hysterectomy or reoperation because of bleeding again. One week, one month, three months later all patients were followed up. Six months later 11 patients were examined, four patients lost to follow-up, but they were reached by phone since they were outside of the city, they reported no complaints. Ultrasound examination was performed to follow up patients. Short-term follow-up revealed no complications such as pyometra, endometritis, reoperation, amenorrhea, or uterine necrosis. Conclusions: We described our practice with our uterine compression suture that is easy to learn and apply. All of the cases that participated in our study showed improvement to the compression sutures, so no other surgical interventions were applied. The same suture technique was applied by only one physician. This is a feasible and easy way to stop bleeding in uterine atony and in uterine preservation, especially in rural areas when help may not be available in case of complications.

Ectopic pregnancy is the most common cause of morbidity and mortality in the first trimester of pregnancy. Interstitial pregnancy is one of the rarest form of ectopic pregnancies that constitutes of 2-4% of ectopic pregnancies. In this paper, we discussed the case of the interstitial pregnancy that successfully treated with systemic Methotrexate without requiring operation. Serial β-hCG were regressed without any need to further manipulations including operation. According to our clinical experience, in cases of interstitial pregnancies that hemodynamically stabilized and not having severe abdominal nor pelvic pain, systemic MTX treatment could be applied under serial USG and β-hCG follow-ups, that contribute low morbidity and mortality rates and lesser requirement to surgical approach, Ektopik gebelik ilk trimesterde morbidite ve mortalitenin en sık nedenidir. İnterstisyal gebelik ektopik gebeliğin en nadir formlarından olup tüm ektopik gebeliklerin %2-4’ünü oluşturmaktadır. Bu yazımızda girişime gerek kalmadan sistemik Metotreksat ile başarılı şekilde tedavi edilmiş interstisyal gebelik olgusunu tartıştık. Seri β-hCG ölçümlerinde yeterli regresyon izlendi ve operasyona ihtiyaç kalmadı. Klinik deneyimimize göre hemodinamik olarak stabil, batında ve pelviste ağrısı olmayan interstisyal gebeliği olan hastalarda sistemik MTX tedavisi seri β-hCG ölçümleri ile izlem yapılarak uygulanması cerrahiye gereksinimi azaltmakta ve de böylece morbidite ve mortaliteye de olumlu yönde katkıda bulunmaktadır.

Author(s): Hwang, Soonjo; Meffert, Harma; VanTieghem, Michelle R; White, Stuart F; Sinclair, Stephen; Bookheimer, Susan Y; Blair, James | Abstract: ObjectiveIn the current study we investigated neurodevelopmental changes in response to social and non-social reinforcement.MethodsFifty-three healthy participants including 16 early adolescents (age, 10-15 years), 16 late adolescents (age, 15-18 years), and 21 young adults (age, 21-25 years) completed a social/non-social reward learning task while undergoing functional magnetic resonance imaging. Participants responded to fractal image stimuli and received social or non-social reward/non-rewards according to their accuracy. ANOVAs were conducted on both the blood oxygen level dependent response data and the product of a context-dependent psychophysiological interaction (gPPI) analysis involving ventromedial prefrontal cortex (vmPFC) and bilateral insula cortices as seed regions.ResultsEarly adolescents showed significantly increased activation in the amygdala and anterior insula cortex in response to non-social monetary rewards relative to both social reward/non-reward and monetary non-rewards compared to late adolescents and young adults. In addition, early adolescents showed significantly more positive connectivity between the vmPFC/bilateral insula cortices seeds and other regions implicated in reinforcement processing (the amygdala, posterior cingulate cortex, insula cortex, and lentiform nucleus) in response to non-reward and especially social non-reward, compared to late adolescents and young adults.ConclusionIt appears that early adolescence may be marked by: (i) a selective increase in responsiveness to non-social, relative to social, rewards; and (ii) enhanced, integrated functioning of reinforcement circuitry for non-reward, and in particular, with respect to posterior cingulate and insula cortices, for social non-reward.

When the researchers conducted studies Implementation Method Waterfall In Registration Information System Web-Based Outpatient Mobile, researchers found that the health center belongs to the municipality located in the village of Lubuk Tanjung Lubuk Linggau felt the need for development in line with increased demand for health services for the community. PHC Tanjung Lubuk Housing is in the process of registration of outpatients manuallyor still use conventional manner, includes data recording the identity of the patient, make a list of queues, search medical records of patients, as well as card making patients. When enrollment of patients when treatment would still be written in a ledger and patient data and data ever experienced disease (medical records) was recorded in the general ledger and certain records and stored in a special file. This often times lead to errors and writing the name of the same patient when treated umpteenth time and the difficulty in grouping the data requires considerable time as well as the lack of assurance of data security. If we want to find the patient data needed to be looking in the archives of books one by one to determine such data. With the support of information technology, manual processing in the clinic can be replaced using a computer. In addition to fast and easy with the information system has been made of data processing has also become more accurate. The method used in the information system of registration of outpatient-based mobile web in BPS town Lubuklinggau this, and to know the running system, using a structured approach using several tools like Uml, use case diagrams, activity, sequence diagram, class diagram , while for the system development method using a sequential linear or often called "the development cycle of the classic" or "waterfall model / waterfall". Support software used is Xampp, Adobe Dreamweaver CS3, PHP, and MySQL databases as well as the builder of program documentation and reports. With a system based on the mobile web, which is already connected to the Internet, of course, would greatly facilitate the processing of census data suseda to be stored and will be very helpful in terms of data storage census suseda, because each finished data can be collected more quickly, accurately and save time with the specified schedule.

Resumo Objetivo As mulheres com sindrome de Sjogren (SS) muitas vezes experimentam secura vaginal e dispareunia, juntamente com sintomas glandulares e extraglandulares. Este estudo objetivou avaliar a funcao sexual e a qualidade de vida de mulheres com SS. Metodos Estudaram‐se 46 mulheres pre‐menopausicas com SS e 47 controles pareados por idade. Avaliaram‐se a idade, a duracao da doenca, os medicamentos usados e as comorbidades. As participantes preencheram o questionario de qualidade de vida 36‐Item Short Form Health Survey (SF‐36) e o Female Sexual Function Index (FSFI). As pacientes foram perguntadas quanto a presenca de corrimento e prurido vaginal no ultimo mes e se haviam informado a seus reumatologistas sobre quaisquer problemas sexuais. Fizeram‐se exames ginecologicos e esfregacos vaginais de todas as participantes. Resultados A mediana do escore total do FSFI foi significativamente menor no grupo SS do que no grupo controle [17,12 (2,4 a 27,8) e 27,4 (16,9 a 36), respectivamente, p Conclusoes As mulheres com SS tem menor satisfacao com a atividade sexual, o que pode ser afetado pela idade, secura vaginal, dor fisica e funcao prejudicada em razao da doenca. Portanto, os reumatologista devem prestar atencao a esses sintomas e seu tratamento.

ObjectivesChronic Obstructive Pulmonary Disease (COPD) is a progressive disease. Preventing deterioration of health status is therefore an important therapy goal. (Minimal) Clinically Important Differences ((M)CIDs) are used to interpret changes observed. It remains unclear whether (M)CIDs are similar for both deterioration and improvement in health status. This study investigates and compares these clinical thresholds for three widely-used questionnaires.Design and settingData were retrospectively analysed from an inhouse 3-week pulmonary rehabilitation (PR) randomised controlled trial in the German Klinik Bad Reichenhall (study 1), and observational research in Dutch primary and secondary routine clinical practice (RCP) (study 2).ParticipantsPatients with COPD aged ≥18 years (study 1) and aged ≥40 years (study 2) without respiratory comorbidities were included for analysis.Primary outcomesThe COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and St George’s Respiratory Questionnaire (SGRQ) were completed at baseline and at 3, 6 and 12 months. A Global Rating of Change scale was added at follow-up. Anchor-based and distribution-based methods were used to determine clinically relevant thresholds.ResultsIn total, 451 patients were included from PR and 207 from RCP. MCIDs for deterioration ranged from 1.30 to 4.21 (CAT), from 0.19 to 0.66 (CCQ), and from 2.75 to 7.53 (SGRQ). MCIDs for improvement ranged from −3.78 to −1.53 (CAT), from −0.50 to −0.19 (CCQ), and from −9.20 to −2.76 (SGRQ). Thresholds for moderate improvement versus deterioration ranged from −5.02 to −3.29 vs 3.89 to 8.14 (CAT), from −0.90 to −0.72 vs 0.42 to 1.23 (CCQ), and from −15.85 to −13.63 vs 7.46 to 9.30 (SGRQ).ConclusionsMCID ranges for improvement and deterioration on the CAT, CCQ and SGRQ were somewhat similar. However, estimates for moderate and large change varied and were inconsistent. Thresholds differed between study settings.Trial registration numberRoutine Inspiratory Muscle Training within COPD Rehabilitation trial: #DRKS00004609; MCID study: #UMCG201500447.

Despite extensive behavioral evidence of impairments in face processing and expression recognition in adults with alcohol or cannabis use disorders (AUD/CUD), neuroimaging findings have been inconsistent. Moreover, relatively little work has examined the relationship of AUD or CUD symptoms with face or expression processing within adolescents. Given the high prevalence of alcohol and cannabis use during adolescence, understanding how these usage behaviors interact with neural mechanisms supporting face and expression processing could have important implications for youth social and emotional functioning. In this study, adolescents (N = 104) responded to morphed fearful and happy expressions during fMRI and their level of AUD and/or CUD symptoms were related to the BOLD response data. We found that AUD and CUD symptom severity were both negatively related to responses to faces generally. However, whereas this relationship was shown for AUD within ventromedial prefrontal cortex and lingual gyrus, it was shown for CUD within rostromedial prefrontal cortex including anterior cingulate cortex. Additionally, AUD symptom levels were associated with differential responses within medial temporal pole and inferior parietal lobule as a function of expression. These results have potential implications for understanding the social and emotional functioning of adolescents with AUD and CUD symptoms.

We simulated the optical and electrical response of a planar HgCdTe 5 x 5 pixel miniarray with 5 μm-wide square pixels, illuminated by narrow Gaussian beams. The compositional grading of the HgCdTe absorber required particular techniques to obtain combined three-dimensional, realistic full-wave electromagnetic and electrical simulations. The simulation results suggest that, by avoiding quasi-neutral regions in the detector's absorber through majority carriers depletion, not only the Auger contribution to dark current results suppressed, but also the inter-pixel crosstalk due to the diffusion of photogenerated carriers is significantly reduced.