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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.

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.

The main aim of this study is to investigate whether there are relationships between perceived partner responsiveness (PPR), co-regulation of negative affect between romantic partners and binge eating. Data were collected from 148 opposite-sex romantic partners (18-61 years old) with the mean relationship duration being 8.04 years. Dyadic data were analysed through the actor-partner interdependence model framework. We proposed a model where co-regulation between partners has indirect effects on the relationship between PPR and binge eating. Results showed that there was no direct association between PPR and binge eating scores of the participants. However, significant direct associations were found regarding both actor and partner effects of PPR on co-regulation between romantic partners. In addition, there were four significant indirect effects: Women's co-regulation had an indirect effect on the link between PPR and women's binge eating scores. Similarly, women's co-regulation had also a significant indirect effect on the link between PPR and men's binge eating. These findings are the first to illustrate a relationship between PPR and binge eating. This study is the first attempt to examine binge eating in terms of co-regulation processes. Kadir Has University School of Graduate Studies

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.

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.

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.

Background People with orthopedic disability experience limitations in physical ability, which can cause psychological problems such as depressive feelings. This paper investigates the role of family environment, caregiver characteristics, and personal resources in the acceptance of disability and depressive feelings of persons with orthopedic disability. Participants and procedure Data were collected from 161 Turkish people with orthopedic disability (mean age = 35.60 years, SD = 10.18) and their family caregivers (e.g., parent, spouse). The participants with disability completed scales for functional independence, acceptance of disability, family environment, locus of control, learned resourcefulness, and depression. The family caregivers completed measures of social support, their own depression, burden of caregiving, and acceptance-rejection of their care recipient. Results Analyses via multivariate statistics and SEM showed that depressive feelings of individuals with orthopedic disability and their acceptance of the disability were predicted by multiple factors, including the affected persons’ learned resourcefulness and locus of control, family environment, and interactions with their family caregiver, but not by their functional independence. Conclusions Overall, a supportive family environment and acceptance of disability appear to lower the risk of having depression for individuals with orthopedic disability. Family caregivers’ attitudes towards their care recipients were related to the family environment, and feelings of burden appeared to impair the affected individuals’ acceptance of their condition.

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.

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.

Introduction Models of attention suggest that endogenous and exogenous factors can bias attention. However, recent data suggest that reward can also enhance attention towards relevant stimulus features as a function of involuntary biases. In this study, we utilized the additional singleton task to determine the neural circuitry that biases perceptual processing as a function of reward history. Methods Participants searched for a unique shape amongst an array of differently shaped objects. All shapes, including the target shape, had the same color except one distractor shape. Participants randomly received a low or high reward after correct trials. From one trial to the next, target colors could stay the same or swap with the distractor color. Interestingly, and despite the irrelevancy of reward magnitude for task accuracy, the difference in reaction time between swap and non-swap trials usually is more pronounced following a high compared to a low reward. Results In the current study, we showed that reward modulated attention is larger for individuals with enhanced reward magnitude sensitivity in the ventral striatum. In addition, connectivity data shows that ventral striatum was more positively connected with visual cortex during high reward non-swap trials compared to high reward swap trials for participants showing stronger reward modulated attention. Conclusions This suggests that involuntary reward modulated attention might be implemented by direct influences of the ventral striatum on visual cortex.

Atovaquone, an antiprotozoal and antipneumocystic agent, is predominantly cleared by biliary excretion of unchanged parent drug. Atovaquone is ≥10,000-fold concentrated in human bile relative to unbound plasma. Even after correcting for apparent nonspecific binding and incomplete solubility in bile, atovaquone is still concentrated ≥100-fold in bile, consistent with active biliary excretion. Mechanisms of atovaquone hepatobiliary disposition were studied using a multiexperimental in vitro and in vivo approach. Atovaquone uptake was not elevated in HEK293 cells singly overexpressing OATP1B1, OATP1B3, OATP2B1, OCT1, NTCP, or OAT2. Hepatocyte uptake of atovaquone was not impaired by OATP and OCT inhibitor cocktail (rifamycin and imipramine). Atovaquone liver-to-blood ratio at distributional equilibrium was not reduced in Oatp1a/1b and Oct1/2 knockout mice. Atovaquone exhibited efflux ratios of approximately unity in P-gp and BCRP overexpressing MDCK cell monolayers and did not display enhanced uptake in MRP2 vesicles. Biliary and canalicular clearance were not decreased in P-gp, Bcrp, Mrp2, and Bsep knockout rats. In the present study, we rule out the involvement of major known basolateral uptake and bile canalicular efflux transporters in the hepatic uptake and biliary excretion of atovaquone. This is the first known example of a drug cleared by biliary excretion in humans, with extensive biliary concentration, which is not transported by the mechanisms investigated herein.

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]

BackgroundPrevious work has shown that amygdala responsiveness to fearful expressions is inversely related to level of callous-unemotional (CU) traits (i.e. reduced guilt and empathy) in youth with conduct problems. However, some research has suggested that the relationship between pathophysiology and CU traits may be different in those youth with significant prior trauma exposure.MethodsIn experiment 1, 72 youth with varying levels of disruptive behavior and trauma exposure performed a gender discrimination task while viewing morphed fear expressions (0, 50, 100, 150 fear) and Blood Oxygenation Level Dependent responses were recorded. In experiment 2, 66 of these youth performed the Social Goals Task, which measures self-reports of the importance of specific social goals to the participant in provoking social situations.ResultsIn experiment 1, a significant CU traits-by-trauma exposure interaction was observed within right amygdala; fear intensity-modulated amygdala responsesnegativelypredicted CU traits for those youth with low levels of trauma butpositivelypredicted CU traits for those with high levels of trauma. In experiment 2, a bootstrapped model revealed that the indirect effect of fear intensity amygdala response on social goal importance through CU traits is moderated by prior trauma exposure.ConclusionsThis study, while exploratory, indicates that the pathophysiology associated with CU traits differs in youth as a function of prior trauma exposure. These data suggest that prior trauma exposure should be considered when evaluating potential interventions for youth with high CU traits.

It has been previously demonstrated that IC50 values for inhibition of digoxin transport across confluent polarized cell monolayers are system-dependent. Digoxin IC50 data from five laboratories participating in the P-glycoprotein (P-gp) IC50 Initiative, using Caco-2, MDCKII-hMDR1 or LLC-PK1-hMDR1 cells, were fitted by the structural mass action kinetic model for P-gp-mediated transport across confluent cell monolayers. We determined their efflux-active P-gp concentration [T(0)], inhibitor elementary dissociation rate constant from P-gp (krQ), digoxin basolateral uptake clearance (kB), and inhibitor binding affinity to the digoxin basolateral uptake transporter (KQB). We also fitted the IC50 data for inhibition of digoxin transport through monolayers of primary human proximal tubule cells (HPTCs). All cell systems kinetically required a basolateral uptake transporter for digoxin, which also bound to all inhibitors. The inhibitor krQ was cell system-independent, thereby allowing calculation of a system-independent Ki. The variability in efflux-active P-gp concentrations and basolateral uptake clearances in the five laboratories was about an order of magnitude. These laboratory-to-laboratory variabilities can explain more than 60% of the IC50 variability found in the principal component analysis plot in a previous study, supporting the hypothesis that the observed IC50 variability is primarily due to differences in expression levels of efflux-active P-gp and the basolateral digoxin uptake transporter. HPTCs had 10- to 100-fold lower efflux-active P-gp concentrations than the overexpressing cell lines, whereas their digoxin basolateral uptake clearances were similar. HPTC basolateral uptake of digoxin was inhibited 50% by 10 μM ouabain, suggesting involvement of OATP4C1.