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Background: Behcet disease (BD) presents with lymphocytic and neutrophilic vasculitis of unknown aetiology. HLA-B*51, the endoplasmic reticulum aminopeptidase 1 (ERAP1), and interleukin 23 receptor (IL23R)/IL12R are genetic risk factors. IL-23 regulates IL-17A, which controls the recruitment and activation of neutrophils. Objectives: to determine pathological changes in BD skin lesions related to the complex genetic predisposition. Methods : we characterized the expression of IL-17A and IL-23A in various cell types by immunohistological double staining of sections from papulopustular skin lesions of acute attacks of BD and psoriasis vulgaris lesions, another HLA-class I-associated T-cell-mediated autoimmune disease in which excessive T-cell-derived IL-17A production promotes neutrophil activation. Results: we found that in BD lesions, as in psoriasis, actively expanding CD8(+) T cells were the predominant source of IL-17A. IL-17A(+) CD8(+) T (T(c)17) cells outnumbered infiltrating IL-17A(+) CD4(+) T cells. Unlike the epidermal localization of CD8(+) T cells in psoriasis, T(c)17 cells in BD lesions mainly infiltrated the perivascular tissue and the blood vessel walls of dermis and subcutaneous tissue. They co-localised with a marked IL-23A expression by CD11c(+) dendritic cells and CD68(+) macrophages. IL-17A expression was associated with extensive recruitment of neutrophils around blood vessels that formed neutrophil extracellular traps (NETs). Conclusions: in BD, the genetic predisposition may mediate antigen-specific activation and differentiation of a T(c)17 response, possibly targeting endothelial (auto)antigens. Neutrophils recruited by IL-17A in this process may enhance tissue damage by extensive NET formation (NETosis). Thus, the IL-23/IL-17 axis presumably controls neutrophilic inflammation in BD vasculitis in the context of a predominant antigen-specific CD8(+) T-cell response., Deutsche Forschungsgemeinschaft; Scientific and Technological Research Council of Turkey (TÜBİTAK); 2219 Postdoctoral Research Grant; L'OREAL-UNESCO for Women in Science Fellowship of Turkey; LMU–China Scholarship Council Program Full Doctoral Study-Model; Projekt DEAL

A 29-year-old woman presented with dark-colored raised lesions on both eyelids since early childhood. Ophthalmological examination revealed pigmented verrucous lesions on her upper and lower eyelids bilaterally. The patient had a history of generalized tonic-clonic seizures. Dermatological examination revealed hyperpigmented verrucous plaques arranged along lines of Blaschko on the neck, trunk, and arms. On the basis of these findings, the diagnosis of epidermal nevus syndrome (ENS) was made. She had surgery for debulking of the lesions. Histological analysis revealed hyperkeratosis with foci of parakeratosis, acanthosis, and papillomatosis, consistent with linear verrucous epidermal nevus. Postoperative residual lesions did not respond to oral acitretin therapy (10 mg/kg/day for 2 months). Systematized ENS can rarely cause linear verrucous nevi on the upper and lower eyelids on both sides. These patients should be investigated for accompanying systemic anomalies and followed for potential malignant transformation of the skin lesions.

Magnetic resonance imaging (MRI) scanners do not provide only high-resolution medical imaging but also magnetic robot actuation and tracking. However, the rotational motion capabilities of MRI-powered wireless magnetic capsule-type robots have been limited due to the very high axial magnetic field inside the MRI scanner. Medical functionalities of such robots also remain a challenge due to the miniature robot designs. Therefore, a wireless capsule-type reversible orientation-locking robot (REVOLBOT) is proposed that has decoupled translational motion and planar orientation change capability by locking and unlocking the rotation of a spherical ferrous bead inside the robot on demand. Such an on-demand locking/unlocking mechanism is achieved by a phase-changing wax material in which the ferrous bead is embedded inside. Controlled and on-demand hyperthermia and drug delivery using wireless power transfer-based Joule heating induced by external alternating magnetic fields are the additional features of this robot. The experimental feasibility of the REVOLBOT prototype with steerable navigation, medical function, and MRI tracking capabilities with an 1.33 Hz scan rate is demonstrated inside a preclinical 7T small-animal MRI scanner. The proposed robot has the potential for future clinical use in teleoperated minimally invasive treatment procedures with hyperthermia and drug delivery capabilities while being wirelessly powered and monitored inside MRI scanners., Advanced Science, 8 (13), ISSN:2198-3844

Syntaxin-1 (STX1) and Munc18-1 are two requisite components of synaptic vesicular release machinery, so much so synaptic transmission cannot proceed in their absence. They form a tight binary complex through two major binding modes: one through STX1’s N-peptide, the other through STX1’s closed conformation driven by its Habc-domain. However, physiological roles of these two reportedly different binding modes in synapses are still controversial. Here we characterized the roles of STX1’s N-peptide, Habc-domain, and open conformation with and without N-peptide deletion using our STX1-null mouse model system and exogenous reintroduction of STX1A mutants. We show, on the contrary to the general view, that the Habc-domain is absolutely required and N-peptide is dispensable for synaptic transmission. However, STX1’s N-peptide plays a regulatory role, particularly in the Ca2+-sensitivity and the short-term plasticity of vesicular release, whereas STX1’s open conformation governs the vesicle fusogenicity. Strikingly, we also show that neurotransmitter release still proceeds when both the interaction modes between STX1 and Munc18-1 are presumably intervened together, necessitating a refinement of the conceptualization of STX1–Munc18-1 interaction.

Background Allergic contact dermatitis (ACD) has been shown to adversely affect the quality of life of patients. Objective The aim of the study was to study the effect of patch test on the severity of dermatitis, the quality of life of patients, and the prognostic factors influencing the outcome. Methods The study included 111 patients patch tested with the preliminary diagnosis of ACD. Patients with clinically relevant positive patch test reactions were included in the ACD group. All patients were assessed with the Investigator Global Assessment and the Dermatology Quality of Life Index before and 6 months after patch testing. Results At the sixth-month control, more significant regressions in the mean Investigator Global Assessment and Dermatology Quality of Life Index scores were noted in the ACD group. The allergens were correctly remembered by 75% of the patients. The improvement was more significant in patients with ACD who correctly remembered the allergens and made appropriate lifestyle changes. Multiple allergen positivity was identified as a poor prognostic factor. Conclusions The effect of patch test on the prognosis of contact dermatitis depends not only on providing necessary information to patients but also on the number of positive reactions, patient's ability to recall the allergens, how much the avoidance was achieved, and patient-related factors such as sex.

Since the first successful organ transplant conducted between twins in 1954, kidney transplant has evolved considerably over the past 50 years. Kidney transplant plays an important role in the treatment of end-stage kidney disease to improve the quality of life and prolong the life of patients. Despite significant advances, postoperative medical and surgical complications still represent important causes of morbidity and mortality. Many problems can be avoided through prophylactic correction of abnormalities detected during the preoperative evaluation; however, it is critical that technical mishaps at all stages of the transplant process (donor nephrectomy, benchwork preparation, and implant) be prevented and that careful postoperative monitoring be carried out, including thorough examination by attending physicians. However, despite these advances, surgical complications still present serious problems in kidney transplant recipients.

Henoch-Schonlein purpura (HSP) is a small vessel vasculitis characterized by the presence of vascular immunoglobulin A deposition that usually presents as non-thrombocytopenic palpable purpura. It primarily affects children and is less common in adults. The incidence of hemorrhagic necrotic skin lesions increases with age, similarly to renal involvement. Warfarin is a widely used oral anticoagulant drug that has rarely been associated with leukocytoclastic vasculitis and allergic interstitial nephritis. We report a patient with HSP who presented with cutaneous ulcerative plaques and proteinuria in the setting of warfarin therapy. We would like to raise the awareness of this potential adverse effect of warfarin for prompt diagnosis.

The aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behçet’s syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 ± 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement. © 2020 Japanese Dermatological Association

Objective: Pancreaticoduodenal artery aneurysm is a rare vascular disorder that manifests with a clinical presentation ranging from asymptomatic cases to hemorrhagic shock due to aneurysm rupture. In this study, we aimed to evaluate the outcomes of patients treated with different methods for pancreaticoduodenal artery aneurysm. Material and Methods: A total of 5 patients who were treated and followed for pancreaticoduodenal artery aneurysm between January 2011 and January 2018 were enrolled in the study. Standard endovascular embolization and surgical resection were performed. The demographic findings and treatment outcomes were compared. Results: All patients were shown to have a pancreaticoduodenal artery aneurysm by radiological methods. The most common complaint was abdominal pain. The mean aneurysm size was 2.8 cm. Two patients had coeliac axis stenosis and occlusion, one had hypertension, one had Marfan syndrome, and one had chronic pancreatitis as the possible etiological cause. One patient with occlusion of the coeliac axis had thrombus, one patient with coeliac axis stenosis had median arcuate ligament compression. Three patients were treated with embolization, one with surgery, and one with low-molecular weight heparin. Conclusion: Different etiological factors and multiple vascular problems accompanying the disorder create difficulties for establishing a treatment algorithm. Due to the rare nature of the disease, studies available in the literature involve limited numbers of patients, as was also the case in our study. There appeared to be no significant differences between the treatment and follow-up duration among the different treatment methods we applied for our patients.

Background Epidermolysis bullosa pruriginosa (EBP) is rare a clinical variant of dystrophic epidermolysis bullosa characterized by trauma-induced bullae formation, milia and nail dystrophy accompanied by severe pruritus. Treatment pruritus of EBP focuses on immunosuppressive treatment with limited efficacy. Treatment strategies are not well-established. Aim To provide the genetic characterization of a multi-generational EBP family and discuss the efficacy of intravenous immunoglobulin treatment in EBP. Materials & methods The clinical characteristics of patients diagnosed with EBP in three consecutive generations were determined. The mutation is analyzed in the index patient's genomic DNA by Sanger sequencing, and this mutation was confirmed in other affected members of the family. Index case with severe phenotype was treated with intravenous immunoglobulin (IVIG). Results A heterozygous single nucleotide transition, c.6127G>A, in exon 73 of COL7A1 was identified in all affected members. Physical examination of patients revealed lichenoid papules on extensor surfaces of extremities, excoriations, milia formation and nail dystrophy. Majority of patients had elevated serum IgE levels (%86 (6/7)) without a medical history for atopy. Female patients had generalized involvement and severe phenotype. The skin lesions of the index case were refractory to high dose systemic steroids and cyclosporine treatment. Lesions improved significantly with intravenous immunoglobulin therapy. Conclusion In severe cases, unresponsive to other therapies, IVIG may be a preferable therapeutic approach to modulate the inflammatory response in patients with EBP.

Objective: The optimal treatment of giant liver hemangiomas is controversial. Although surgery is the usual treatment for symptomatic giant hemangiomas, minimally invasive techniques have been recently recommended as an alternative therapy. Aim: we aimed to assess the effect of bleomycin embolization with lipiodol on symptomatic improvement and hemangioma size among patients with symptomatic giant liver hemangiomas. Methods: This study retrospectively involved 17 patients [10 women, 7 men; Age range 35 - 67 years (mean 46.41 ± 2.6 years)] with giant liver hemangioma who presented to our clinic between August 2014 and October 2016. Bleomycin mixed with lipiodol was administered using selective arterial embolization. The patients were followed by clinical, laboratory, ultrasonography and abdominal tomographic examination (mean 14.47 ± 2.21 months). All statistical analyses were performed using SPSS 15.0; a p value of less than 0.05 was considered statistically significant. Results: The mean volume of hemangiomas was 1799.3 cm3 (range 480 - 9925.1 cm3) before the procedure and 405.7 cm3 (range 38.7 - 3856 cm3) after the procedure. No treatment-related death was observed. All patients demonstrated symptomatic improvement and significant volume reduction (p = 0.001). Conclusions: Minimally invasive bleomycin embolization is an effective alternative to surgery for patients with giant liver hemangiomas.

Oral liken planus (OLP), etiyolojisi henuz tum yonleriyle aydinlatilamamis kronik immun aracili bir dermatozdur. Oral mukozanin en sik hastaliklari arasinda kabul edilen OLP, premalign bir durum olarak tanimlanmasindan bu yana cok daha fazla ilgi goren bir hastalik haline gelmistir. Oral likenoid kontakt reaksiyonlar (OLKR), OLP’den gerek klinik, gerekse histopatolojik olarak neredeyse ayirt edilemez, bu nedenle OLP lezyonlarinin analogu olarak gorulurler. Hali hazirda, OLP iliskili malign oral skuamoz hucreli karsinomaya neden olan tetikleyici hastaligin, OLP ya da OLKR’den hangisinin oldugu konusunda suregelen tartismalar vardir. Dahasi, gunumuzde halen kayda deger sayida OLKR tanili hasta, altta yatan spesifik etiyolojiler arastirilmadan OLP olarak kabul edilmekte ve tedavi gormektedir. Dental restoratif materyaller OLKR’in en onemli tetikleyicileri arasindadir. Biz de burada, dental restoratif materyal iliskili OLKR tanisi koydugumuz ve bize basvurmadan once OLP’nin neden oldugu oral mukozanin iyi diferansiye malign oral skuamoz hucreli karsinoma tanisiyla marjinal mandibulektomi ve boyun diseksiyonu uygulanan bir olguyu sunmak istiyoruz. Biz, her OLP ve OLKR olgusunda olasi etiyolojik faktorlerin aydinlatilmasi gerektigi kanaatindeyiz, cunku yapilacak bir bazal yama testi hastaligin klinik seyrini tamamiyla degistirebilir.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that causes a significant decline in quality of life. There are numerous treatment options; however, real-life data on the efficacy of these treatments is limited. This study was performed in two centers to describe clinical characteristics and assess treatment outcome in a cohort of 139 patients with HS. Data on demographic and clinical characteristics, Hurley stage and comorbidities were collected from patient charts and evaluated retrospectively. Treatment response was measured with HS clinical response index (HISCR). Mean body mass index was 27.8±4.88. Inflammatory comorbidities were present in 23%. Among first-line drugs systemic doxycycline resulted in 60% HISCR followed by rifampicin-clindamycin combination (46.4%). Isotretinoin had the lowest HISCR (30.7%) in this group. For second-line therapies, all acitretin treated patients achieved response and patients treated with tumor necrosis factor alpha (TNF-α) inhibitors had the highest HISCR. Currently recommended first-line therapies have moderate efficacy in HS. Acitretin appears to be a reasonable alternative for the highly effective TNF-α inhibitors in patients with severe and resistant HS. Overall, these results support that excessive inflammatory response play an important role in pathogenesis of HS.

Objectives Ureteral complications remain a major source of morbidity and occasional mortality in renal transplant. Among all ureteral complications, leaks are the most frequently encountered in the early posttransplant period. The routine use of a double-J ureteric stent remains controversial, with reported increased incidence of urinary tract infection. Here, we retrospectively compared the efficacy of a double J stent in kidney transplant patients to investigate ureteral complication incidence in our center. Materials and methods Our study included 382 kidney transplant patients. At 5 weeks after transplant, the double J stent was removed under sedation. Patients were divided into 2 groups: 125 patients with double J stent placement (group 1) and 257 patients without double J stent placement (group 2). Results We observed no significant demographic differences between the 2 groups with regard to patient age (median patient age of 30 y [range, 2-73 y] for group 1; median patient age of 33 y [range, 4-69 y] for group 2), patient sex (30.2% females in group 1, 32.4% females in group 2), and body mass index (median of 25.1 vs 24.9 kg/m2 in groups 1 and 2, respectively). Cold and warm ischemia time for donor organ, delayed graft function, and episodes of acute rejection did not differ significantly between the groups. Urinary tract infection was observed in 25/125 (20.4%) and 50/257 patients (19.2%) in groups 1 and 2, respectively. Urinary leak was present in 8/125 group 1 (6.4%) and 6/257 group 2 patients (2.3%). Conclusions A double J stent in ureteral anastomosis was not likely to decrease the frequency of leakage but is likely to reduce the gravity of the complication and the need for reoperation. In addition, the use of a double J stent was not associated with increased urinary tract infections in renal transplant recipients.

Objectives This study aims to compare the sensitivity of the intradermal application of the pathergy test with the "three-step pathergy test". Patients and methods The study included 60 patients with Behcet's disease (BD) (23 males, 37 females; mean age 33.9±9.7 years; range, 11 to 57 years) and 100 patients with recurrent aphthous stomatitis as the control group (39 males, 61 females; mean age 32.4±12.1 years; range, 11 to 66 years). Simultaneous intradermal pathergy test and three-step pathergy test were applied to each patient. Results Twenty-six patients (43.3%) with BD had positive three-step pathergy test and 18 (30%) of them had positive intradermal pathergy test. A statistically significant relationship was found between the three-step pathergy test positivity and male sex while no relationship was detected between the disease activity and the positivity of the pathergy test. In the three-step pathergy test, pathergy positivity with intramuscular method was statistically significantly higher than with intravenous method. Conclusion The three-step pathergy test in patients with BD was found to have higher sensitivity compared with the intradermal pathergy test. The intramuscularly applied pathergy test was the main cause of increase in sensitivity. Further studies are needed to develop new applications of pathergy test that would increase the sensitivity and which are also easy to apply.

Irreversible electroporation (IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically unresectable. We present the first case of acute superior mesenteric artery (SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature. A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal adenocarcinoma. IRE procedure was applied to the patient during laparotomy under general anesthesia. After finishing the procedure, an acute intestinal ischemia was detected. A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was maintained. It is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor.

Magnetic resonance imaging (MRI) system–driven medical robotics is an emerging field that aims to use clinical MRI systems not only for medical imaging but also for actuation, localization, and control of medical robots. Submillimeter scale resolution of MR images for soft tissues combined with the electromagnetic gradient coil–based magnetic actuation available inside MR scanners can enable theranostic applications of medical robots for precise image‐guided minimally invasive interventions. MRI‐driven robotics typically does not introduce new MRI instrumentation for actuation but instead focuses on converting already available instrumentation for robotic purposes. To use the advantages of this technology, various medical devices such as untethered mobile magnetic robots and tethered active catheters have been designed to be powered magnetically inside MRI systems. Herein, the state‐of‐the‐art progress, challenges, and future directions of MRI‐driven medical robotic systems are reviewed.

BACKGROUND Hidradenitis suppurativa (HS) is a rare, debilitating neutrophilic dermatosis characterized by chronic inflammation of hair follicles. Many inflammatory conditions may accompany HS. OBJECTIVES To investigate the association of variants of the MEFV gene with a complex HS phenotype. METHODS Firstly, we identified the clinical characteristics of 119 patients with HS with a complex phenotype (Hurley stage III disease and/or additional inflammatory symptoms). Then, we searched for MEFV variants among these patients. The odds ratios (ORs) for pathogenic MEFV mutations were calculated using data from these patients with HS and 191 healthy controls. RESULTS The male/female ratio was higher, and the mean age of onset was earlier, in our complex HS group compared with patients with HS in general. Five of the patients with HS (4·2%) had a diagnosis of familial Mediterranean fever (FMF) with a standardized morbidity ratio of 45 [95% confidence interval (CI) 16·50-99·84, P < 0·001] when compared with the frequency of FMF in the general Turkish population. Of the patients with complex HS, 38% were positive for pathogenic variants of MEFV. The OR for carrying a pathogenic MEFV allele was 2·80 (95% CI 1·31-5·97, P < 0·001). CONCLUSIONS The frequency of MEFV mutations in the group of patients with complex HS was higher than that in healthy controls, suggesting that MEFV mutations may contribute to the pathogenesis of HS. Understanding the role of autoinflammation in HS is of fundamental importance for the development of novel therapies.

OBJECTIVES Although biopsy is the most important method for diagnosing the cause of renal allograft dysfunction, sonoelastography, a new ultrasonography method, can be used to distinguish between the soft or hard nature of lesions. In this study, our aim was to investigate whether sonoelastography could diagnose fibrosis in renal transplant patients. MATERIALS AND METHODS In this prospective study, we included patients over 18 years old who were recommended for clinical biopsy. Sonoelastographic evaluation was made by conducting acoustic radiation force impulse measurements for each patient after they were admitted to the clinic for biopsy. Measurements were performed just before the biopsy procedure. All results were examined by 2 experienced radiologists using the Siemens S3000 Ultrasound Machine (Erlangen, Germany). Comparisons of ultrasonographic values with biopsy results were made with SPSS software (SPSS: An IBM Company, version 20, IBM Corporation, Armonk, NY, USA). RESULTS Of the 65 patients included in this study, pathology showed acute T-cell-mediated rejection in 37 patients. There was a significant correlation between the pathologic Banff scores and the sonographic acoustic radiation force impulse values (P = .002), where the degree of Banff increased as the mean acoustic radiation force impulse values elevated. A rise in mean impulse values correlated with increased degree of interstitial fibrosis in renal allografts. Renal parenchymal echogenicity of patients significantly differed by sex (P = .009), with an average renal echogenicity of grade 1 in women and grade 0 in men. Also, a statistically significant difference was found between age of the renal transplant recipient and resistive index values. CONCLUSIONS Our study showed a significant correlation between Banff degree and the acoustic radiation force impulse values of renal transplant patients. In addition to biopsy, sonoelastography can be beneficial for the diagnosis of fibrosis in renal transplant patients.

Oral lichen planus (OLP) is a chronic immune-mediated dermatosis of unknown origin. Considered as one of the most common diseases of the oral mucosa, OLP has been subject of intense interest since its first identification as a premalignant condition. Oral lichenoid contact reactions (OLCRs) are distinct analogs of OLP lesions, in that they are nearly indistinguishable from OLP both clinically and histologically. There is an on-going debate about whether the underlying condition causing OLP-induced malignant oral squamous cell carcinoma is OLP or OLCR. Even currently, a considerable number of patients with OLCR are diagnosed and managed as OLP without searching for specific causative agents. Dental restorative materials are one of the most common inducers of OLCR. Here, we describe a case with dental material-induced OLCR, who had previously undergone marginal mandibulectomy and neck dissection with a diagnosis of invasive well differentiated squamous cell carcinoma associated with OLP. We emphasize the need for investigation of possible etiological factors in every case of OLP or OLCR, as a basal patch test may completely change the course of the disease., Oral liken planus (OLP), etiyolojisi henüz tüm yönleriyle aydınlatılamamış kronik immün aracılı bir dermatozdur. Oral mukozanın en sık hastalıkları arasında kabul edilen OLP, premalign bir durum olarak tanımlanmasından bu yana çok daha fazla ilgi gören bir hastalık haline gelmiştir. Oral likenoid kontakt reaksiyonlar (OLKR), OLP’den gerek klinik, gerekse histopatolojik olarak neredeyse ayırt edilemez, bu nedenle OLP lezyonlarının analoğu olarak görülürler. Hali hazırda, OLP ilişkili malign oral skuamöz hücreli karsinomaya neden olan tetikleyici hastalığın, OLP ya da OLKR’den hangisinin olduğu konusunda süregelen tartışmalar vardır. Dahası, günümüzde halen kayda değer sayıda OLKR tanılı hasta, altta yatan spesifik etiyolojiler araştırılmadan OLP olarak kabul edilmekte ve tedavi görmektedir. Dental restoratif materyaller OLKR’ın en önemli tetikleyicileri arasındadır. Biz de burada, dental restoratif materyal ilişkili OLKR tanısı koyduğumuz ve bize başvurmadan önce OLP’nin neden olduğu oral mukozanın iyi diferansiye malign oral skuamöz hücreli karsinoma tanısıyla marjinal mandibulektomi ve boyun diseksiyonu uygulanan bir olguyu sunmak istiyoruz. Biz, her OLP ve OLKR olgusunda olası etiyolojik faktörlerin aydınlatılması gerektiği kanaatindeyiz, çünkü yapılacak bir bazal yama testi hastalığın klinik seyrini tamamıyla değiştirebilir.

Background and Design: Humanized monoclonal antibody omalizumab was developed for the treatment of moderate-to-severe asthma. However, recently, reports on the successful use of omalizumab in the treatment of resistant chronic urticaria are increasing in the literature. Materials and Methods: We retrospectively evaluated treatment response, adverse effects and duration of remission in 13 chronic spontaneous urticaria patients treated with omalizumab between May 2010 and January 2014. Results: In ten of the thirteen patients treated with omalizumab, urticarial lesions were suppressed and no side effects were observed. Conclusion: Our observations support the findings in the literature indicating that omalizumab is an effective and safe option in the management of treatment-resistant chronic urticaria.

The genus Enterovirus (e.g. poliovirus, coxsackievirus, rhinovirus) of the Picornaviridae family of positive-strand RNA viruses includes many important pathogens linked to a range of acute and chronic diseases for which no approved antiviral therapy is available. Targeting a step in the life cycle that is highly conserved provides an attractive strategy for developing broad-range inhibitors of enterovirus infection. A step that is currently explored as a target for the development of antivirals is the formation of replication organelles, which support replication of the viral genome. To build replication organelles, enteroviruses rewire cellular machinery and hijack lipid homeostasis pathways. For example, enteroviruses exploit the PI4KIIIβ-PI4P-OSBP pathway to direct cholesterol to replication organelles. Here, we uncover that TTP-8307, a known enterovirus replication inhibitor, acts through the PI4KIIIβ-PI4P-OSBP pathway by directly inhibiting OSBP activity. However, despite a shared mechanism of TTP-8307 with established OSBP inhibitors (itraconazole and OSW-1), we identify a number of notable differences between these compounds. The antiviral activity of TTP-8307 extends to other viruses that require OSBP, namely the picornavirus encephalomyocarditis virus and the flavivirus hepatitis C virus. publisher: Elsevier articletitle: Uncovering oxysterol-binding protein (OSBP) as a target of the anti-enteroviral compound TTP-8307 journaltitle: Antiviral Research articlelink: http://dx.doi.org/10.1016/j.antiviral.2017.01.008 content_type: article copyright: © 2017 The Authors. Published by Elsevier B.V. ispartof: Antiviral Research vol:140 pages:37-44 ispartof: location:Netherlands status: published

Background: To present our findings obtained from the treatment of wide-necked intracranial neurysms with flow diverter stents. Patients and Methods: Intracranial aneurysms were determined in 19 patients (14 females, 5 males; mean age, 56.6 years) between May 2011 and June 2014, and the patients were treated using flow diverter stents. A total of 28 flow diverter stents, including 9 Silk and 19 Pipeline stents were used. Occlusion rates evaluated with computed tomography at the end of month 6 and digital subtraction angiography after one year, intraoperative success, morbidity and mortality rates were determined. Results: A total of 20 endovascular interventions, including two interventions in two different aneurysms in one patient were performed in 19 patients. Flow diverter stents were successfully implemented for wide-necked aneurysms at a success rate of 100%. Coil treatment had previously been performed in four patients. Aneurysm occlusion rates were 77.2% at month 6 and 90.9% at the end of month 12. Conclusion: The use of flow diverter stents is a reliable and effective method in the treatment of wide-necked intracranial aneurysms with high aneurysm occlusion, and low morbidity and mortality rates.

We report a baby with intralobar pulmonary sequestration who was successfully treated with a new embolization agent, Onyx. A 1.5-month-old female infant was admitted to our hospital with sweating and fatigue. Telecardiography showed cardiomegaly, dextrocardia, and increased pulmonary vascular markings. In thoracic computerized tomography, pulmonary sequestration, right pulmonary hypoplasia, and large collateral arteries were seen. The collateral arteries were originating from the celiac trunk and aorta. Echocardiography revealed enlargement of the left atrium and ventricle and left ventricle systolic dysfunction. Angiography revealed a large feeding artery and three branches originating from the aorta and another feeding artery originating from the celiac trunk. We performed embolization of the feeding arteries and their branches, with coils and Onyx. The procedure was performed without complications, and all feeding arteries were completely occluded. The infant started to gain weight. One year later, the infant's body weight had increased and she had no respiratory problems or signs of congestive heart failure. In this case report, we suggest that embolization with Onyx is a reliable alternative method to surgery for infants with pulmonary sequestration. With future studies, pulmonary sequestration embolization with Onyx may become an acceptable and easy treatment option in pediatric patients.

Aim: To investigate the safety and effectiveness of endo-vascular stents to treat carotid artery stenosis (CAS).Material and Methods: One-hundred fourteen patients who underwent selective endo-vascular stenting following selective carotid angiography between 2000 and 2014 were analyzed retrospectively. Demographic characteristics; stenosis degree; stent type; use of anti-coagulants and embolism protection system (EPS) during the procedure; pre-dilation and post-dilation during the procedure; use of a vascular occlusion device after the procedure; early complications (30 days); prevalence of re-stenosis of the stent; sixth-month, first-year, second-year, and fifth-year controls; radiologic imaging results; and discharge time were analyzed.Results: Among the patients, 83 (72.8%) were males and 31 (27.2%) were females, and the age range was 41–86 years (mean age: 69±8.7 years). The proportion of concurrent hypertension was higher among females with CAS (p 0.01). The proportion of early complications was higher among the patients with the Nitinol stent than among those with the Wall stent (p = 0.062). Embolic events and infarct development were observed in 13 (11.4%) patients within the first 30 days. Occlusion was detected in 4 of 97 patients (4.1%) who represented controls. While less than 50% stenosis that did not require intervention developed in four (4.1%) patients, more than 50% stenosis was detected in three (3.09%) patients. The likelihood of not developing stenosis was found to be 98% at the end of the first year, 96% at the end of the second year, and 87% at the end of the fifth year. The mean duration of stenosis was 4.86±0.11 years.Conclusion: The proportions of potency and early complications in endo-vascular treatment applied for CAS were similar to those in the literature. Further studies with a larger patient number and a longer duration of follow-up would provide better data concerning the effectiveness of treatment and complications. Keywords: Carotid artery; stenosis; stenting.

PurposeTo describe our experience with the use of ultrasound-guided supraclavicular brachiocephalic vein approach for central vein catheterization in infants weighing less than 5 kg.MethodsA retrospective review was performed for infants who underwent ultrasound-guided central vein catheterization from January 2012 to November 2014. Infants weighing less than 5 kg with supraclavicular brachiocephalic vein access were included in the study. Indications for central venous access, venous access side, catheter type and complications were evaluated.ResultsThirty-four catheterizations in 34 infants weighing from 1.5 to 4.9 kg (median 3.48 kg) were included in the study (aged 11 days to 7 months and 10 days, weight range 1.5 to 4.9 kg). Technical success rate was 97% (33 of 34 infants). No technical or clinical major complications were observed.ConclusionsUltrasound-guided supraclavicular brachiocephalic vein access is a favorable alternative for central venous catheterization in low-weight infants with regard to high technical success rate and absence of major complications.

We report a very rare case of a 55-year-old man with chest wall metastatic tumor caused by seeding of hepatocellular carcinoma after percutaneous radiofrequency ablation (RFA) for hepatic tumor 42 months after the initial operation. The patient was managed with aggressive full-thickness chest wall resection and reconstruction with a Prolene (Ethicon, Somerville, NJ) and methyl methacrylate sandwich graft and subsequent musculocutaneous free-flap transposition.

Bu yazida, alt ekstremite iskemisi ile basvuran primer oksalozis tip 1’li 22 yasinda kadin olgu sunuldu. Hastanin arteriyogramlarinda abdominal aort, iliyak arterler ve alt ekstremite arterlerinde yaygin arteriyel daralma goruldu. Surekli nitroprusid infuzyonu iskemi semptomlarinda ani rahatlama sagladi. Takipte yurume kapasitesinde iyilesme ve damar kalibrasyonunda artis ile sonuclanan nifedipin tedavisine baslandi. Ani hastalik baslangici ve semptomlarda hizli iyilesme saglayan nitroprusid infuzyonu, vaskuler semptomlari olan oksalozis hastalarinda denenebilir. Anah tar soz cuk ler: Arteriyel vazokonstruksiyon; kan damarlari; nifedipin; nitroprussid; oksalozis. In this article, we report a 22-year-old female case with primary oxalosis type 1 who was admitted with ischemic lower extremities. The arteriogram revealed diffuse arterial narrowing involving the abdominal aorta, iliac arteries and lower limb arteries. Continuous nitroprusside infusion resulted in immediate relief of ischemic symptoms. She was put on nifedipine treatment which resulted in improved walking ability and increased vascular calibration on her follow-up. The instant onset of action and rapid improvement of symptoms recommend nitroprusside trial in oxalosis patients with vascular symptoms.

Amac: Topikal ilaclar kontakt allerjenler arasinda onemli bir gruptur. Calismamizda, kontakt dermatitli olgularda topikal ilaclara bagli kontakt duyarliligin degerlendirilmesi amaclanmistir. Gerec ve Yontemler: 2003 ve 2008 yillari arasinda Ankara Universitesi Tip Fakultesi Dermatoloji Anabilim Dali’nda topikal ilac kullanimina bagli kontakt dermatit gelistiginden suphelenilen 129 hasta calismaya alindi. Calismada Avrupa standart yama testi serisi ve Medikament yama testi serisi ve hastalarin kullanmis oldugu topikal ilaclarla yapilan test sonuclari degerlendirmeye alindi. Test sonuclarinin klinik tablo ile uyumlulugu degerlendirildi. Bulgular: Calismaya alinan 129 hastanin 80’inde (%62,0) bir veya birden fazla allerjene karsi pozitiflik saptandi. Pozitiflik saptanan 80 hastanin 61’inde (61/129, %47,3) medikament pozitifligi oldugu goruldu. Klinik olarak anlamli medikament duyarlilik sikligi %37,9 (49/129) olarak saptandi. Nitrofurazon (%18,6) en sik allerjen olarak saptandi. Sonuc: Calismamizda topikal olarak uygulanan ilaclara karsi allerjik kontakt dermatit gelisiminin sik goruldugu saptanmistir. Bu nedenle kontakt dermatit suphesi ile degerlendirilen hastalarda topikal ilaclara bagli kontakt duyarlilik ihtimali akilda tutulmali ve gerekli durumlarda sorumlu antijenin saptanmasi amaciyla yama testleri ile ileri arastirmalar yapilmalidir. (Turkderm 2013; 47: 19-25) Anah tar Ke li me ler: Allerjik kontakt dermatit, medikament duyarliligi, nitrofurazon, topikal ilaclar, yama testi

Objective Behcet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no pathognomonic test. Low sensitivity of the currently applied International Study Group (ISG) clinical diagnostic criteria led to their reassessment. Methods An International Team for the Revision of the International Criteria for BD (from 27 countries) submitted data from 2556 clinically diagnosed BD patients and 1163 controls with BD-mimicking diseases or presenting at least one major BD sign. These were randomly divided into training and validation sets. Logistic regression, ‘leave-one-country-out’ cross-validation and clinical judgement were employed to develop new International Criteria for BD (ICBD) with the training data. Existing and new criteria were tested for their performance in the validation set. Results For the ICBD, ocular lesions, oral aphthosis and genital aphthosis are each assigned 2 points, while skin lesions, central nervous system involvement and vascular manifestations 1 point each. The pathergy test, when used, was assigned 1 point. A patient scoring ≥4 points is classified as having BD. In the training set, 93.9% sensitivity and 92.1% specificity were assessed compared with 81.2% sensitivity and 95.9% specificity for the ISG criteria. In the validation set, ICBD demonstrated an unbiased estimate of sensitivity of 94.8% (95% CI: 93.4–95.9%), considerably higher than that of the ISG criteria (85.0%). Specificity (90.5%, 95% CI: 87.9–92.8%) was lower than that of the ISG-criteria (96.0%), yet still reasonably high. For countries with at least 90%-of-cases and controls having a pathergy test, adding 1 point for pathergy test increased the estimate of sensitivity from 95.5% to 98.5%, while barely reducing specificity from 92.1% to 91.6%. Conclusion The new proposed criteria derived from multinational data exhibits much improved sensitivity over the ISG criteria while maintaining reasonable specificity. It is proposed that the ICBD criteria to be adopted both as a guide for diagnosis and classification of BD.

Bowen's disease (BD) is an in situ form of squamous cell carcinoma (SCC), often occurring in the chronically UV-damaged skin of elderly people. The risk of progression of BD to invasive SCC varies between 3% and 5%, and one-third of invasive tumors may metastasize. Herein we discuss the dermatoscopic findings of a case of giant Bowen's disease, which progressed to poorly differentiated invasive SCC.

Oxysterol-binding protein (OSBP) and its related protein homologs, ORPs, constitute a conserved family of lipid-binding/transfer proteins (LTPs) expressed ubiquitously in eukaryotes. The ligand-binding domain of ORPs accommodates cholesterol and oxysterols, but also glycerophospholipids, particularly phosphatidylinositol-4-phosphate (PI4P). ORPs have been implicated as intracellular lipid sensors or transporters. Most ORPs carry targeting determinants for the endoplasmic reticulum (ER) and non-ER organelle membrane. ORPs are located and function at membrane contact sites (MCSs), at which ER is closely apposed with other organelle limiting membranes. Such sites have roles in lipid transport and metabolism, control of Ca(2+) fluxes, and signaling events. ORPs are postulated either to transport lipids over MCSs to maintain the distinct lipid compositions of organelle membranes, or to control the activity of enzymes/protein complexes with functions in signaling and lipid metabolism. ORPs may transfer PI4P and another lipid class bidirectionally. Transport of PI4P followed by its hydrolysis would in this model provide the energy for transfer of the other lipid against its concentration gradient. Control of organelle lipid compositions by OSBP/ORPs is important for the life cycles of several pathogenic viruses. Targeting ORPs with small-molecular antagonists is proposed as a new strategy to combat viral infections. Several ORPs are reported to modulate vesicle transport along the secretory or endocytic pathways. Moreover, antagonists of certain ORPs inhibit cancer cell proliferation. Thus, ORPs are LTPs, which mediate interorganelle lipid transport and coordinate lipid signals with a variety of cellular regimes.

Objectives Splenic arterial steal syndrome is an important cause of morbidity and mortality after orthotopic liver transplant. Splenic arterial steal syndrome is characterized by arterial hypoperfusion of the graft; and if left untreated, causes ischemic biliary tract injury. Selective arterial embolization is important when treating splenic arterial steal syndrome. Doppler ultrasound has been used to follow-up liver transplant patients. This study sought to analyze alterations in portal vein velocity, peak systolic velocity, and resistivity index of the hepatic artery before diagnosis and after treatment of splenic arterial steal syndrome. Materials and methods We analyzed the Duplex Doppler ultrasonography results of 20 liver transplant recipients who developed angiographically proven splenic arterial steal syndrome between January 2005 and March 2009. Peak systolic velocity and resistivity index of the hepatic artery were noted during transplant surgery, before selective arterial embolization, and after embolization procedures. Results A statistically significant decrease was found in peak systolic velocity and resistivity index of the hepatic artery between the intraoperative and pre-embolization values. In contrast to the statistically significant increase in peak systolic velocity of the hepatic artery, there were no significant changes in resistivity index after the selective arterial embolization. Portal vein velocity did not show a statistically significant change between intraoperative and preprocedure values. Portal vein velocity did show a tendency to decrease after coil embolization, but this was not significant. Conclusions Doppler ultrasound surveillance is a valuable tool in early detection of hepatic arterial complications. A decrease in peak systolic velocity and resistivity index compared to the corresponding intraoperative data should raise suspicion of splenic arterial steal syndrome. Also Doppler ultrasound can be effectively used to examine the hepatic arterial inflow after selective arterial embolization.

Background: Diagnosing immediate hypersensitivity to β-lactam antibiotics is still a significant problem. Recently, a new penicillin testing reagent was introduced to the market. In this study, the recommendations of the European Network of Drug Allergy (ENDA) for the diagnosis of immediate reactions to β-lactams were followed, and the negative predictive value of this approach with currently available reagents was assessed. Methods: Eighty patients (age range: 6–74 years) with a history of immediate reactions to β-lactams were included. All cases underwent skin testing with benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM), followed by the culprit drug if necessary. If this step was negative, a drug provocation test was offered. If this step also yielded a negative result, then the patients were recommended to use β-lactam antibiotics in future whenever their use was indicated. Results: Overall, 29 patients (36.2%) were diagnosed as β-lactam allergic. The majority of the cases (72.4%) were diagnosed by positive skin tests to either PPL or MDM, whereas 10.3% were diagnosed by skin testing with culprit drugs and 17.2% with drug provocation tests. Regarding the use of the tested drug in the long term, almost half of the contacted patients had had an indication to use the tested drug and the majority had taken the whole course without problems. Conclusions: Although currently available new penicillin tests provide sufficient allergy data, all the steps recommended by ENDA should be followed in the diagnosis of immediate reactions to β-lactams. If these steps are negative, the patients usually tolerate β-lactams and only a few develop mild, non-life-threatening reactions in the long term.