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Hypertrophic obstructive cardiomyopathy requires surgical myectomy when heart failure symptoms persist despite best medical therapy. Minimally invasively myectomy with robotic surgery can be performed in experienced centers allowing for surgical correction of accompanying mitral valve pathologies. The extent of myectomy is important to relieve left ventricular outflow tract obstruction while care should be taken to prevent iatrogenic ventricular septal defects or heart blocks caused by excessive removal of septal tissue. We report the use of intracardiac ultrasound during robotic surgery to intraoperatively assess the myocardium before and after myectomy to increase the safety of this procedure. Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic myocardial disease characterized by thickened myocardium and obstruction of the left ventricular outflow tract (LVOT). 1 Patients with symptoms of heart failure resistant to drug treatment are candidates for surgical septal myectomy. Conventionally performed through a midline sternotomy, septal myectomy can be carried out via transapical, transaortic, or transmitral approaches. The transmitral approach allows surgical treatment of the concomitant mitral valve pathology through a left atriotomy. Robotic septal myectomy can be performed in experienced centers with results comparable to the classical sternotomy approach with the added benefits of minimally invasive surgery. 2 Excessive removal of septal tissue can result in a heart block or a ventricular septal defect while an inadequate myectomy can leave a high gradient in the LVOT. Intracardiac ultrasound can assist the surgeon in performing a safe and adequate myectomy. We describe our technique for intracardiac ultrasound guided robotic septal myectomy in a patient with HOCM and infective endocarditis.

An increasing number of publications have supported the determination of thrombosis associated with coronavirus disease 2019 (COVID-19). Despite prophylactic drug applications, post-COVID-19 thrombosis cannot be completely prevented. Thrombosis becomes a complex problem that is difficult to avoid, particularly in intensive care patients. It is also possible to see cases of thromboembolism secondary to quarantine and home isolation. In addition to the classical pathophysiological mechanisms in Virchow’s triad, more complex processes specific to COVID-19 may also trigger thrombosis. The aims of this review were to describe physical medicine and rehabilitation practices that can be applied in addition to medical recommendations for thrombosis in COVID-19 patients, and to explain the specific features and mechanism of action of these methods. This process, which starts with education sessions, should continue to reduce immobility as much as possible. Personalized exercise programs should be recommended after evaluating the individual’s condition, exercise history, risk of falling, and comorbid diseases. In parallel with technological progress, more innovative devices have been developed and thus mechanical compression methods and neuromuscular electrical stimulation have become available for this purpose. The most important features of physical medicine and rehabilitation practices are the relatively low cost and the low incidence of complications.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease 19 (COVID-19) pandemic, which is deeply affecting the whole world. In this new case for the scientific world, scientists are investigating the etiopathogenesis of viral infection-induced damage and have started to focus on the short and long-term immune system effects and alterations after SARS-CoV-2 infection. The case is here reported of a 53-year-old female patient with acute monoarthritis after SARS-CoV-2 infection, who responded adequately to 150 mg/day diclofenac treatment, and the available case reports are comprehensively reviewed. With the focus on arthritis after SARS-CoV2 infection, which emerges as a new pathological condition associated with COVID-19, it was aimed to examine the possible immunological mechanisms of post-COVID-19 arthritis based on the current data on SARS-CoV-2 and the known pathogenetic background of viral arthritis.

Mitral annular calcification (MAC) refers to calcium deposition in the fibrous skeleton of the mitral valve. It has many cardiovascular associations, including mitral valve dysfunction, elevated cardiovascular risk, arrhythmias, and endocarditis. Echocardiography conventionally is the first-line imaging modality for anatomic assessment, and evaluation of mitral valve function. Cardiac computed tomography (CT) has demonstrated importance as an imaging modality for the evaluation and planning of related procedures. It also holds promise in quantitative grading of MAC. Currently, there is no universally accepted definition or classification system of MAC severity. We review the multimodality imaging evaluation of MAC and associated valvular dysfunction and propose a novel classification system based on qualitative and quantitative measurements derived from echocardiography and cardiac CT.

Sodium phosphate-based enema preparations are low-volume, hyperosmotic agents commonly used in bowel preparation for sigmoidoscopy/colonoscopy and surgical operation. Although generally safe and well tolerated in adults, severe metabolic complications have been reported with use. The patient in this case report was admitted to the general surgery department with complaints of nausea, vomiting, and abdominal pain after oral sodium phosphate solution. After clinical evaluation, hemodialysis was started for acute kidney injury (AKI). Clinicians should be alert using sodium phosphate solution for bowel cleansing before sigmoidoscopy/colonoscopy and surgical operation, in terms of acute kidney damage and electrolyte imbalance.

The purpose of this study was to evaluate the responsiveness of Copenhagen Neck Functional Disability Scale (CNFDS), Neck Disability Index (NDI), Neck Bournemouth Questionnaire (NBQ), Neck Pain and Disability Scale (NPDS) in geriatric patients with non-specific chronic neck pain. A total of 52 geriatric patients with non-specific chronic neck pain were included in the present study. All participants were included in a physical therapy and rehabilitation program for five sessions per week that lasted 3 weeks. All participants were evaluated before and after the treatment. Pain and disability were assessed with the Visual Analog Scale-pain (VAS-pain), VAS-disability, muscle spasm, CNFDS, NDI, NBQ, NPDS scales. Additionally, patient satisfaction scores were questioned both before and after the treatment. Following the 3-week physical therapy and rehabilitation program, significant improvements were detected in the VAS-pain, VAS-disability, muscle spasm, CNFDS, NDI, NBQ, and NPDS scores (p

Objective This study aimed to examine the use of point-of-care ultrasonography (POCUS) in detecting diaphragmatic dysfunction (DD) and evaluate its ability to predict noninvasive mechanical ventilation (NIV) failure in patients presented to the emergency department with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods In this prospective cohort study, the diaphragm was examined using POCUS in patients with AECOPD. DD was defined as a diaphragm thickening fraction of less than 20% during spontaneous breathing. NIV failure was the primary outcome of the study, and duration of hospital stay and in-hospital mortality were the secondary outcomes. Specificity, sensitivity, positive predictive value, and negative predictive value were estimated for predicting NIV failure in DD and evaluating the diagnostic performance of POCUS. Results 60 patients were enrolled the study. NIV failure was found in 11 (73.3%) of 15 patients with DD and in 2 (4.4%) of 45 patients without DD. In predicting NIV failure, DD had a sensitivity of 84.6% (95% confidence interval [CI]:54.6–98.1), specificity of 91.5% (95% CI:79.6–97.6), positive predictive value of 73.3% (95% CI:51.2–87.8), and negative predictive value of 95.6% (95% CI:85.7–98.7). The duration of hospital stay was not different between groups (p = .065). No in-hospital mortality was seen in patients without DD. Conclusions DD has high sensitivity and specificity in predicting NIV failure in patients admitted to the emergency department with AECOPD. DD can be assessed by an experienced clinician noninvasively using POCUS in emergency departments.

INTRODUCTION Robotic cardiac surgery offers mitigated risks for obese patients requiring mitral valve surgery. We aimed to study the safety of robotic mitral surgery in the obese patient population by analyzing the outcomes of mitral surgery patients in our center for robotic cardiac surgery. METHOD This study retrospectively included 123 consecutive patients who underwent robotic mitral valve operations in a single center for robotic cardiac surgery. Patients with body mass index (BMI) ≥ 30 were compared against patients with BMI

OBJECTIVE To evaluate breast cancer patients with low F18-fluorodeoxy-glucose positron emission tomography/computed tomography scan (FPET) of axilla standardised maximum uptake value (SUVmax) along with their histopathological findings regarding axillary lymph node metastasis (LNM). STUDY DESIGN A descriptive study. Place and Duration of the Study: Adana City Education and Research Hospital, Turkey, from January 2015 to October 2018. METHODOLOGY The current study analysed the findings of 113 patients according to age, histopathological axillary LNM, estrogen and progesterone receptor status, tumour size, histological grade, Ki-67, HER2 and preoperative FPET SUVmax findings. Histopathological and immunohistochemical comparisons were made between FPET axilla SUVmax and univariate and multivariate parameters in breast carcinoma in terms of LNM. RESULTS The authors analysed the receiver operator characteristic curve for the FPET axilla SUVmax and set the cut-off value to 1.84 to predict LNM. However, it was also found that the SUVmax detected metastases in the axilla at values lower than 1.84. In the multivariate analysis, a statistically significant relationship was found between axilla LNM cases that have FPET axilla SUVmax less than 1.84, a Ki-67 index greater than 15% and tumour size greater than 2 cm (p

Rehabilitation programs have an important place in the treatment of ankylosing spondylitis (AS), but there is no comprehensive bibliometric research that assesses publications on AS rehabilitation in a holistic way. The aim of this study was to investigate the quantity and quality of articles related to AS rehabilitation and to reveal the features of global productivity in this topic. This bibliometric study was conducted utilizing the Web of Science (WoS) database with the keywords 'ankylosing spondylitis rehabilitation', 'ankylosing spondylitis exercise', 'ankylosing spondylitis physical therapy' and 'ankylosing spondylitis physiotherapy'. The number of articles, citations, and main active countries were determined and trend analyses were performed. A total of 792 articles were reviewed. The articles originated from 51 different countries, 22 of which met the main active country criteria. A significant increase trend was detected in the number of articles between 2000 and 2019 (p < 0.001). The five most productive countries were Germany (n = 111; 14.02%), Turkey (n = 98; 12.37%), the United States (n = 71; 8.96%), the United Kingdom (n = 53; 6.69%) and the Netherlands (n = 53; 6.69%). The highest values in number of articles per million population were calculated in Norway, the Netherlands and Austria, respectively. In the analysis according to GDP, Norway, the Netherlands and Turkey were ranked as the first three. The top three countries for the average citation count were France, Netherlands and Germany. This bibliometric study can be considered as an assessment and summary of worldwide scientific production on AS rehabilitation. The data demonstrate an increasing trend in research productivity since 2000. European countries were seen to be at the forefront both quantitatively and qualitatively in this area.

Background Nonbacterial thrombotic endocarditis, or marantic endocarditis, is rare. Contemporary data on the etiology, echocardiographic evaluation, and management of nonbacterial thrombotic endocarditis are limited. Methods A single-center retrospective cohort study was performed. Electronic medical records and echocardiographic records were searched for patients ages ≥18 years with a confirmed diagnosis of nonbacterial thrombotic endocarditis between January 1999 and November 2019. Demographic, echocardiographic, and management data were collected. Results Of 600,577 transthoracic echocardiograms (TTEs) and 89,264 transesophageal echocardiograms (TEEs), 42 patients had nonbacterial thrombotic endocarditis (mean age: 54 ± 14.5 years; 66.7% were female). The median duration of follow-up was 8.2 (interquartile range 3.3-24.4) months. Seventeen patients (40.5%) had malignancy, 33.3% had systemic lupus erythematosus, and 35.7% had antiphospholipid antibody syndrome. Stroke was the most common presentation (59.5%). TTE enabled the diagnosis in 19 cases (45.2%), compared with TEE, which identified the condition in 33 of 34 (97.1%) cases in which it was utilized. Three-dimensional echocardiography was performed in 17 TEEs. The most common valves involved were mitral (61.9%), and aortic (23.8%) valves. Thirty-two patients were managed with anticoagulation. Ten patients underwent surgery. Sixteen (38.1%) patients died, most of whom had a diagnosis of advanced malignancy. Conclusion In a contemporary 20-year cohort, TTE and TEE played important roles in diagnosis, with superior diagnostic performance of TEE for nonbacterial thrombotic endocarditis. Mortality was high, and advanced malignancy portended a worse prognosis. Management in most cases was therapeutic anticoagulation. In select cases, surgery provided favorable outcomes.

In the length of time, a wide variety of drug combinations emerged in the management of post-transplantation therapy in order to improve the survival of the recipient and graft. However, the efficacy and safety of the applied combinations regarding the rejection and other complications are continuing to be the subject of research. In our study, our aim is to compare the effects of various combinations, namely cyclosporine with mycophenolate mofetil/mofetil mycophenolic acid with prednisolone and tacrolimus with mycophenolate mofetil/mofetil mycophenolic acid with prednisolone in a length of time. Methods. A total of 204 patients included into the study who received post-renal transplantation treatment in Scientific-Research Institute of Heart Surgery and Organs Transplantation and followed-up over a 10-year period. The estimated survival probabilities in the study were determined by the Kaplan-Meier method; whereas intragroup comparisons were evaluated by Log-rang, Breslow, and Tarone-Ware tests. Complications occurred in patients with combinations were analyzed by Chi-square and its alternatives. Hazard risk factors were tested by Cox regression analysis. Results. Of these 204 patients, 36 received Cyclosporin combination (CCG) and 168 Tacrolimus combination (TCG). The estimated life expectancy of the patients of TCG was significantly longer than the CCG ones. Furthermore, gender and age did not have a significant effect on survival depending on time, however, gender and age-related hazard factor showed a significant difference in the groups. It was determined that chronic rejection was significantly different in patients who used tacrolimus combinations, the difference was close to the significant value in acute rejection analysis. Other adverse events, namely, infection, tumour and organ damage were statistically less common in the patient group treated with tacrolimus combinations. Conclusion. In general, TCG showed better results in contrast to CCG.

This study aims to compare smartphone addiction level, temperament, and character and parental attitudes of adolescents with and without attention deficit hyperactivity disorder (ADHD). For this purpose, 143 adolescents with and without ADHD and their parents were included in the study. Participants completed the “Smartphone Addiction Scale-Short Form,” “Junior Temperament and Character Inventory,” and “Parental Attitude Research Instrument.” According to the analysis, the smartphone addiction scores of adolescents with ADHD were significantly higher than those in without ADHD group. Both groups differed in terms of temperament and character and parental attitudes. Hierarchical regression analyses revealed that high novelty seeking and low overprotection parental attitude were significantly associated with smartphone addiction scores in ADHD group, whereas high novelty seeking and low persistence were significantly associated with smartphone addiction scores in without ADHD group. This study is exceptionally important in terms of demonstrating the relationship between ADHD and smartphone addiction. Important findings related to parental attitude and temperament and character were also revealed.

Aim: Fistula occlusion is one of the most common causes of hospitalization and mortality in hemodialysis patients. While there are many factors that affect the preoperative success of the fistula, we examined the effect of calcium and phosphorus values from electrolytes. Materials and methods: A total of 100 patients were included in the study. The effectiveness of the preoperative calcium x phosphorus (Ca x P) value of these patients to fistula success in the first 4 weeks was examined. Results: Calcium and phosphorus values of the blood values taken before the fistula was opened, there was a significant difference between the two groups (8.7 +/- 0.7 vs. 9.3 +/- 0.9, p = 0.001, and 3.4 +/- 0.9 vs. 5.2 +/- 1.4, p = 0.001). The difference in the Ca x P value, which is the hypothesis of our study, was found to be quite significant between the two groups (34.1 +/- 8.9 vs. 48.5 +/- 13.7, p < 0.001). Conclusion: Ca x P value was found to be significantly higher in preoperative fistula success and can be a simple and reliable parameter in the evaluation of fistula success.

Glioblastoma, as an invasive tumor, is one of the most common primary malignant brain tumors. Despite maximum aggressive treatment, patients with glioblastoma have a dismal prognosis. Thymoquinone (TQ) has been found to show anti-cancer effects on different types of cancer. There are a few in vitro studies on the effect of TQ on glial tumors. However, the molecular mechanism of TQ-s anti-cancer effect has not been fully elucidated. In the present study, we aimed to investigate the genotoxic, apoptotic, and cytotoxic effects of TQ on C6 rat glioma cells. C6 glioma cells were analyzed after 24 h of exposure to different concentrations of TQ by the ATP cell viability assay for cytotoxicity, comet assay for genotoxicity, 2′,7′dichlorodihydrofluorescein diacetate (H2DCF-DA) for intracellular reactive oxygen species (iROS) generation, 3.3′dihexyloxacarbocyanine iodide (DiOC6(3)) for mitochondrial membrane potential, GSH/GSSG-Glo Assay for glutathione level and Fura-2AM for intracellular calcium levels. Apoptosis induction was studied by acridine orange/ethidium bromide double staining, flow cytometry, and western blotting analyses. Caspase-3, Caspase-9, Bax, Bcl-2, and pSTAT3 protein levels were determined by the western blotting method. Cytotoxicity was enhanced by TQ in C6 glioma cells in a concentration-dependent manner. TQ also induced DNA damage, apoptosis, and increased iROS. Also, MMP and GSH levels were decreased by TQ. It inhibited pSTAT3, resulting in apoptosis induction through the regulation of anti-apoptotic and pro-apoptotic proteins. Our results suggest that TQ would be an effective treatment in glioma. Further studies should support these findings. Bezmiâlem Vakıf Üniversitesi

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease which occurred in China in late 2019 and caused pandemia is an important public health problem. The virus has been found to be a member of the beta-coronavirus family of the same species as the SARS-CoV and SARS-related bat CoV’s. The way it spreads indicates that SARS-CoV-2 can be transmitted from person to person and be more contagious than SARS-CoV. In general, SARSCoV- 2 is an acute disease, but it can be fatal and its mortality is around 2-3%. Acute respiratory distress syndrome (ARDS) is the most important cause of death. Due to cytokines storm, hyper-inflammation is a distinctive feature of ARDS, leading to cellular injury, organ failure and death. A fast, accessible, effective and safe treatment is required to save lives and reduce spreading. However, there is still no vaccine or drug developed for the prevention or definitive treatment of SARS-CoV-2. In addition to broad-spectrum antivirals and some other substances for the treatment of the disease, high-dose intravenous (i.v.) vitamin C (VC) is also recommended to take advantage of the antiviral and antioxidant effect. However, it has a pro-oxidant effect rather than an antioxidant. The cumulative effect of oxidative stress caused by inflammation and VC, besides the antiviral effect, can cause serious inflammation and oxidative damage to the tissues. In this review, the function, antiviral efficacy and possible negative consequences of high dose i.v. VC recommended for SARS-CoV2 treatment will be discussed in the light of the literature.

Background Tunneled catheters can be used as an alternative vascular access in patients with limited health expectancy,vascular access problems and several comorbidities. We aimed to present a patient with venous stenosis related- reversible acute Budd-Chiari syndrome after catheter malposition. Case presentation After changing of tunneled catheter insertion, 36-year old man was admitted to our hospital with sudden onset of nausea, fever, chills and worsening general condition In computed tomography (CT) imaging, a hypodense thrombus was observed in which the distal end of the catheter is at the level of drainage of the hepatic veins in the inferior vena cava and that blocked hepatic vein drainage around the catheter. The catheter was removed and a new catheter was inserted in the same session. Because patient’s general condition was good and without fever, he was discharged with advices on the 9th day of hospitalization. Conclusion Although catheter malposition and thrombosis are not a common complication, clinicians should be alert of these complications.

Background and Aim Attempting to place an aortic cross-clamp may complicate surgery and postoperative outcomes in patients who have mediastinal adhesions or in those with extensive aortic calcification. Although right-sided cardiac surgery via thoracotomy is not a new technique in these patients, robotic-assisted intracardiac repair without cross-clamping was not reported in a large group of patients previously. In this study, the safety of robotic-assisted cardiac surgery without aortic cross-clamping was examined. Methods From January 2010 to March 2020, 304 patients underwent robotic-assisted cardiac surgery in our center and in 25 of these patients (8.2\%) with a mean age of 65.5 +/- 20 years myocardial protection was succeeded with moderate hypothermic ventricular fibrillatory arrest. Severe pericardial adhesions or existence of highly calcified ascending aorta were the indications for fibrillatory arrest during robotic assistant surgery. Results Most patients were in New York Heart Association Class >= II (88.0\%) and the mean logistic Euroscore value was 18.5 +/- 22.3. The type of operations were mitral/tricuspid valve repair/replacement, cryoablation, atrial septal defect closure, and pericardiectomy. Cardiopulmonary bypass times were 141.5 +/- 47 (minimum 77-maximum 252) min. There was no case of conversion to open thoracotomy or sternotomy. Hemiparesis was observed in one patient. Two patients with 78.2 and 81.9 Euroscore values had mesenteric ischemia and multiorgan failure, respectively, and died at postoperative period. Conclusions Robotic-assisted cardiac surgery without cross-clamping may provide reasonable outcomes in patients with severe aortic calcification or mediastinal adhesions undergoing intracardiac repair. These acceptable outcomes may encourage surgeons to perform this approach in appropriate group of patients.

ObjectiveIntake of various fruits is quite significant for maintaining the human body, due to their supply of useful constituents.V. opulushas been found to have outstanding antioxidant activity while showing a pro-oxidant effect at high doses. Due to this feature,V. opuluswould be anticipated to have a healing impact on cancer treatment. In this study, it has been proposed to examine the cytotoxic, genotoxic, and apoptotic effects ofV. opuluson human colorectal cancer cell.MethodDifferent concentrations ofV. opulusmethanolic extract (5–2000 μg/mL) were incubated for 24 h with colorectal cancer cell line (Lovo). The cell viability, intracellular reactive oxygen species (iROS), DNA damage, and apoptosis were measured after incubation.ResultsThe obtained results of this research demonstrate decreased cell viability and increased DNA damage, iROS, and apoptosis levels ofV. opulusin Lovo cells in a concentration-dependent manner in the range of 14.88–52.06%. There were strong positive relationships between apoptosis, genotoxicity, and cytotoxicity inV. opulusmethanolic extract treated cancer cell line.DiscussionThisin vitroresearch clearly demonstrated thatV. opulusmethanolic extract induces DNA damage, apoptosis, and cytotoxicity in a dose-dependent manner in cancer cells due to its pro-oxidant activity.ConclusionAlthoughin vitroresults are favorable,in vivoand further studies are needed.

Background: Diabetic polyneuropathy is a very common complication of diabetes. Numerous studies are available in terms of pathogenesis. But examination methods with low reliability are still not standardized and generally time consuming. High-sensitive, easy-to-access methods are expected. Biochemical markers are one of the subjects of research. We aimed to discover a potential biomarker that can be used for this purpose in patients with diabetes who have not yet developed symptoms of neuropathy. Aim: To determine the place and availability of visfatin and thiol-disulfide homeostasis in this disorder. Methods: A total of 392 patients with type 2 diabetes mellitus were included in the study. The polyneuropathy clinical signs were evaluated with the Subjective Peripheral Neuropathy Screen Questionnaire and Michigan Neuropathy Screening Instrument questionnaire and examination. The biochemical parameters, oxidative stress markers, visfatin, and thiol-disulfide homeostasis were analyzed and correlated with each other and clinical signs. Results: Subjective Peripheral Neuropathy Screen Questionnaire and Michigan Neuropathy Screening Instrument questionnaire with examination scores were correlated with each other and diabetes duration (P < 0.005). Neuropathy related symptoms were present in 20.7% of the patients, but neuropathy related findings were observed in 43.9% of the patients. Serum glucose, glycated hemoglobin, and visfatin were positively correlated with each other. Also, these parameters were positively correlated with the total oxidative stress index. Total and native thiol was positively correlated with total antioxidant status and negatively with oxidant status. Inversely thiol-disulfide positively correlated with higher glucose and oxidant status and negatively with total antioxidant status (P < 0.005). There was no correlation between visfatin and thiol-disulphide (P = 0.092, r = 0.086). However, a significant negative correlation was observed between visfatin and total with native thiol (P < 0.005, r = -0.338), (P < 0.005, r = -0.448). Conclusion: Diagnosis of neuropathy is one of the issues studied in patients with diabetes. Visfatin and thiol-disulfide balance were analyzed for the first time in this study with inspiring results.

IgA nephropathy (IgA-N) is the most common glomerulonephritis type globally. IgA-N is usually accepted as a kidney disease; however, IgA-N has been reported with infections, autoimmune diseases, and malignancies in the literature. In this report, we present a case of a 33-year-old man diagnosed with IgA nephropathy first and then with B-cell acute lymphoblastic leukemia (B-ALL). He was admitted to our hospital with complaints of nausea, vomiting, fatigue, and headache. Laboratory investigations revealed increased levels of blood urea nitrogen and creatinine, hypercalcemia, anemia, and thrombocytopenia. Kidney biopsy was performed, and IgA nephropathy was detected. Atypical lymphocytes and erythroblasts were present in the peripheral blood smear. Bone marrow biopsy was performed and demonstrated B-ALL. Kidney function tests normalized after 1 month of chemotherapy, including steroid treatment with intravenous fluid administration. In conclusion, it has been speculated that IgA nephropathy is associated with B-ALL.

Purpose Because of the increase in globalization, clinicians all over the world are confronted the questions about safety of Ramadan fasting. However, there is no clear information about whether there is an obstacle for fasting patients with chronic disease. Hence, in the present study, we aimed to investigate the effects of Ramadan fasting on kidney and the factors affecting this relationship in patients with chronic kidney disease. Methods This study involving 117 patients [36 females, 81 males; mean age, 60 (46.0-70.0) years] with stage 2-3 chronic kidney and fasting. Patients were evaluated every 10 days for acute kidney injury (AKI) in Ramadan month. And, patients with acute kidney injury and patients without AKI were grouped. Results When the patients were evaluated for AKI, we observed that in 27 patients had acute kidney injury. While patients without AKI fasted for more days (p < 0.001), urea levels and frequency of hypertension were higher in the group with AKI (p = 0.019;p = 0.025 respectively). We also performed univariate and multiple binary logistic regression analysis to identify the risk factors of AKI. Hypertension and number of fasting day were found to be predictive of AKI (p = 0.02;p < 0.001 respectively). Conclusions We found a significant relationship between hypertension, the number of fasting days and acute kidney injury. Patients with chronic kidney damage and hypertension should be evaluated more carefully, informed about the importance of hydration after fasting and should be followed frequently for AKI.

Cardiac hypertrophy has been continuing as the subject of the ‘hottest’ topic in research field for a long time since it creates pathophysiologic and clinical issues by structural and functional alterations of heart. Probably, it is explained by the prevalence of cardiovascular disorders in all-cause mortality. It seems that, on the basis of a contemporary data, the perception of ‘benign’ nature of the cardiac hypertrophy in athletic population is blurred. The improvement of imaging modalities and assessment tools largely contributed to comprehensive integration of scientific and clinical standpoints of athletic hypertrophy. Conventionally pathologic hypertrophy believed to be developed in a case of cardiovascular diseases, while the athlete’s heart resulted by long-standing physical training. According to recent evidence, a gray zone of hypertrophy became emerged between physiological and pathological entities, which require further extensive investigations. The emerging huge challenges in sports cardiology are overtraining and doping abuse of elite athletes by the development of an excessive cardiac hypertrophy with the increased risk of cardiovascular adverse outcomes. Additionally, the higher prevalence of sudden cardiac death in sportsmen compared to sedentary matches, especially in case of athletes with known or suspected cardiovascular diseases necessitated scrupulous investigation of athletic heart syndrome. The development, variety and severity of cardiac hypertrophy fluctuate by sportive branch and training mode. The significance of problem is more emphasized when cohort studies represented survival differences by means of cardiovascular parameters between athletes and sedentary subjects and cardiac patients. In this review, we aimed to represent recent physiological and clinical standpoints regarding to athletic heart syndrome as well as its difference from sedentary heart changes and pathological hypertrophy, its association with sudden cardiac death.

Autosomal dominant polycystic kidney disease (ADPKD), characterized by the development of multiple cysts in the kidneys and other organs, is the most common hereditary renal disorder and the fourth leading cause of end-stage renal disease. In adults with a positive family history, the diagnosis of ADPKD is made based on the radiologic evidence of bilateral, fluid-filled renal cysts. Furthermore, initial symptoms including pain, increased thirst, polyuria, nocturia, and increased urinary frequency may lead to the diagnosis of ADPKD. An easily accessible, applicable, and cost-effective biomarker is needed to predict the clinical course of ADPKD due to its progressive pattern. Urine is an easily obtainable and widely used test specimen for diagnosis and follow-up in several renal diseases. Thus, the aim of the present study was to review and assess new urinary biomarkers and urinary findings in ADPKD.

Traumatic brain injury (TBI) is one of the important reason of morbidity and mortality. While the primary injury due to mechanical impact is unavoidable, the secondary injury which is formed as a result of primary injury and thought to occur due to neuroinflammation in the forefront can be prevented and by this way mortality and morbidity can be reduced. High mobility group box-1 (HMGB1) is a protein that triggers the neuroinflammatory process by being released from the nucleus of necrotic tissues after primary injury. The aim of this study is to investigate the effects of HMGB1 on its receptors TLR4 and RAGE, cerebral edema, blood-brain barrier, oxidative stress and apoptosis causing secondary damage in an experimental traumatic brain injury model. Weighing between 280–320 g, 10 to 12 weeks-old, a total of 30 adult male Sprague-Dawley rats were used for the experiments. The rats were randomly assigned to 3 groups: 1) Control, 2) TBI and 3) TBI + ethyl pyruvate group (n = 10 per group). Right parietal cortical contusion was made by using a weight-dropping TBI method. Brain samples were harvested from pericontusional area at 24 h after TBI. HMGB1, TLR4, RAGE, occludin, claudin-5, ZO-1 levels are investigated by western blot analyses and immunohistochemistry examinations. HMGB-1, TLR4 and RAGE expressions increased after TBI. Major tight junction proteins in the blood-brain barrier: occludin, claudin-5 and ZO-1 expressions decreased after TBI. Brain edema increased after TBI. Also, proapoptotic bax and active caspase 3 expressions increased, antiapoptotic bcl-2 levels decreased after TBI. Total oxidant status and oxidative stress increased, total antioxidant status decreased after TBI. HMGB-1 protein plays a key role in the pathophysiology of traumatic brain injury.

Sterol-C4-methyl oxidase (SC4MOL) deficiency was recently described as an autosomal recessive cholesterol biosynthesis disorder caused by mutations in the MSMO1 (sometimes also referred to as SC4MOL) gene. To date, 5 patients from 4 unrelated families with SC4MOL deficiency have been reported. Diagnosis can be challenging as the biochemical accumulation of methylsterols can affect global development and cause skin and ocular pathology. Herein, we describe 2 siblings from a consanguineous Turkish family with SC4MOL deficiency presenting with psoriasiform dermatitis, ocular abnormalities (nystagmus, optic hypoplasia, myopia, and strabismus), severe intellectual disability, and growth and motor delay. We undertook whole-exome sequencing and identified a new homozygous missense mutation c.81A>C; p.Asn27Thr in MSMO1. Segregation analysis in all available family members confirmed recessive inheritance of the mutation. The siblings were treated with a combination of oral and topical statin and cholesterol which resulted in clinical improvement. This study demonstrates how genomics-based diagnosis and therapy can be helpful in clinical practice.

Cardiovascular disease (CVD) is the leading cause of death. Although once considered merely as a lipid storage disease, studies indicate the role of inflammation in initiation and progression of atherosclerotic CVD, as well as the development of thrombotic complications. Despite significant advances in treatment of atherosclerosis, there still exists a residual risk for CVD-related morbidity and mortality. Even with optimal treatment, the rate of a new event after an index acute coronary syndrome event, such as myocardial ischemia or infarction, in the first three years has been reported to be as high as 20%. In the last decades, inflammation due to apoB-lipoproteins and other traditional risk factors, such as hypertension, diabetes and smoking, is accepted as a new target for CVD prevention. Up to now, several anti-inflammatory drugs have been tested for use in atherosclerosis. This review focuses on the current status of anti-inflammatory drug therapy for atherosclerotic CVD in humans.

Familial Mediterranean fever (FMF) is a systemic autoinflammatory disease, which presents with recurrent episodes of fever, serositis, synovial inflammation and various different clinical features. In parallel with the geographical distribution of FMF, the prevalence is notably higher in some population groups including Turks, Jews, Armenians and Arabs. The aim of this study was to assess FMF articles published between 2010 and 2019 bibliometrically and to present up-to-date data. This bibliometric research was conducted on the Scopus database. The key term ''familial Mediterranean fever'' was utilized to generate the publication list. The number of articles, active countries journals, prolific authors and citation data were determined. Visualization maps that revealed collaboration networks were also created. The number of FMF articles displayed a stable trend between 2010 and 2019 (p > 0.05). The top five countries according to the number of articles were Turkey (n = 473; 52.90%), Israel (n = 86; 9.61%), Japan (n = 39; 4.36%), Italy (n = 38; 4.25%) and the USA (n = 37; 4.13%. Italy, the USA and France were ranked as the top three countries for the average number of citations per article. Rheumatology International, Clinical Rheumatology, Clinical and Experimental Rheumatology, Annals of Rheumatic Diseases and Pediatric Rheumatology were the top five journals according to the number of FMF articles. The geographical distribution of FMF was seen to affect the article production of countries. Although Turkey dominated the field in the number of articles, it was not at the forefront in the average number of citations. To increase the production of articles in the field of FMF, it is necessary to support researchers in countries other than those which are already strongly active.

Objectives This study aims to analyze the G-protein coupled estrogen receptor (GPER/GPR30) activity in patients with fibromyalgia syndrome (FMS). Patients and methods We enrolled 40 female patients with FMS (mean age 42.9±11.2 years; range, 18 to 64 years) diagnosed according to the 2010 American College of Rheumatology classification criteria and 30 age- and body mass index-matched female healthy controls (mean age 43.7±13.6 years; range, 19 to 64 years). Sex hormones of patients (morning) including estradiol, follicle stimulating hormone, luteinizing hormone, and prolactin (PRL) were recorded. FMS severity was assessed by Fibromyalgia Impact Questionnaire (FIQ). Serum GPER levels were measured by using a quantitative sandwich enzyme-linked immunosorbent assay method with a commercial kit. Results G-protein coupled estrogen receptor levels were 0.11 (0.02-0.9) ng/mL in the FMS patients and 0.059 (0.01-0.13) ng/mL in controls, with a statistically significant difference (p=0.037). GPER levels were positively correlated with age and negatively correlated with PRL, while they were not correlated with FIQ. Differential diagnosis for FMS with receiver operating characteristic (ROC) analysis for the serum GPER levels was statistically significant (area under the ROC curve: 0.653, confidence interval: 0.522-0.785, p=0.029). High values indicated FMS, with a threshold of >0.075, sensitivity of 60%, and specificity of 60%. Conclusion The GPER levels of FMS patients were higher than those of the controls. Thus, GPER levels may be considered as a biomarker in the diagnosis of FMS independent of disease severity.

Introduction: To compare the bioelectric impedance analysis (BIA) with indirect measurement methods in the evaluation of obese children. To determine the diagnostic value of BIA in the fatty liver and metabolic syndrome (MS) in obese children. Population and methods: One hundred thirty-four obese children whom ≥10 years of age were prospectively assessment. All patients were evaluated by foot to foot BIA and indirect measurement methods. Blood biochemical parameters such as glucose, lipids and insulin levels were studied and oral glucose tolerance test was performed. Fatty liver was assessed by ultrasonography. Compared BIA records and indirect measurements findings according to fatty liver and MS. Results: The study included females/males: 77/57, mean age of 13.3 ± 2.2 years. Fatty liver was detected in 94 patients, MS was diagnosed in 58 cases. There were no gender difference in terms of fatty liver and MS. Fatty liver was seen more frequently in patients with metabolic syndrome than in those without metabolic syndrome (p < 0.001). Fat Mass (FM) of ≥ 97th percentile was observed in 63% of the 94 patients with fatty liver versus 37.5% of 40 patients without fatty liver. A FM of ≥97th percentile was observed in 72% (n=42) of the 58 patients with metabolic syndrome, 42% (n=33) of 76 patients without MS. Body mass index, upper mid-arm circumference, waist circumference (WC), and hip circumference values were significantly increased in patients with fatty liver. There was a better correlation was determined between FM and FM Index with fatty liver compared to indirect measurement methods. BIA records were found moderately correlated with indirect measurements. Conclusion: Our results revealed that FM and FMI have a better correlated in obese children with fatty liver and metabolic syndrome than indirect measurement methods. The measurement of body FM by BIA can be used together with the indirect measurement methods to detect the fatty liver. FMI may be an alternative diagnostic criterion instead of WC for diagnosis of MS in children.

Background Behcet's disease (BD) is a systemic vasculitis accompanied by oral-genital ulcers, ocular, cerebral, and gastrointestinal disorders. The aim of this study was to evaluate BD articles published between 2010–2019 bibliometrically and to provide up-to-date data. A secondary aim was to present a different perspective using altmetric assessments. Methods This bibliometric and altmetric research was performed with data obtained from the Web of Science database. The key terms “Behcet's disease,” “Behcet's syndrome,” and “Behcet” were used for listing the articles. The number of articles, citation data, and active countries were determined. Trend and correlation analyses were performed. Altmetric attention scores (AASs) and Mendeley readers count (MRC) of the articles were acquired for the altmetric evaluations. Results A total of 5,201 articles were listed. After the exclusion criteria, a total of 2,163 articles were obtained for further analysis. A significant and increasing trend was detected in the number of articles from 2010 to 2019 (P < 0.001). Turkey (28.24%), China (9.57%), South Korea (9.20%), Japan (6.38%), and Italy (5.64%) were the five most productive countries. France, the United States and, the United Kingdom were the top three countries in respect of the average number of citations per article. A weak significant correlation was detected between the number of citations and AAS (P < 0.001). The number of citations was significantly and strongly correlated with the MRC (P < 0.001). Conclusion An increasing trend was found in BD research productivity. Although the Silk Road countries were prominent in the number of articles, a similar ranking was not valid for the average number of citations per article., Graphical Abstract

Introduction Robotic valve surgery utilizes the femoral vessels to set up cardiopulmonary bypass (CPB) which translates to groin wound and lower extremity vascular complications. A less invasive technique is a totally percutaneous bypass using vascular closure devices (VCDs) with concerns for lower limb ischemia and arterial stenosis. Since April 2018, we have adopted the standard use of total percutaneous CPB in our robotic mitral cases. We report our institutional results with this technique. Methods All consecutive patients who underwent robotic mitral valve surgery between April 2018 and December 2020 in our institution were included in our study. Hospital database data on demographics, operative variables, and surgical outcomes were recorded and analyzed. Results Robotic mitral valve surgeries were performed on 32 consecutive patients (mean age 57.2 ± 14.8) between April 2018 and December 2020. None of our patients developed an infection at any site. Seroma, hematoma, or pseudoaneurysm were not observed at puncture sites. Surgical repair of the femoral vessels or an additional VCD was not necessary for any of our patients. Patients were followed up for a mean duration of 23.5 months. Our patients did not present with a late wound infection, a seroma, or a pseudoaneurysm, nor had complaints of limb ischemia or claudication. Conclusion Total percutaneous bypass is the least invasive method of establishing extracorporeal circulation for cardiac surgery and can be performed with excellent results. The benefits of robotic surgery can be expanded with better results in groin cannulation by the adoption of total percutaneous CPB.

Although initially introduced as a novel oral glucose-lowering agent class, cumulative evidence from randomized controlled trials (RCTs) have led sodium-glucose cotransporter-2 inhibitors (SGLT2i) to become a component of primary and secondary prevention from atherosclerotic cardiovascular disease in patients with type 2 diabetes mellitus (T2DM). Dapagliflozin, one of the agents of this class, was investigated in 2019 in patients with heart failure (HF) independent of being diagnosed with T2DM at baseline. Since then, many other studies are being undertaken in this class of drugs. Herein, we aimed to review the RCTs, their subgroup and post-hoc analyses that examined the effects of SGLT2i on cardiovascular outcomes (including HF-related outcomes) in patients diagnosed with HF that were published until June 2020. We also summarized the ongoing trials that aim to assess the impact of SGLT2i on cardiovascular outcomes in patients with HF and listed available guideline recommendations regarding the use of SGLT2i for cardiovascular disease management.

This study aimed to investigate the relationship between fluid and sodium excretion and blood pressure, echocardiographic parameters, and arterial stiffness in peritoneal dialysis (PD) patients and to evaluate the effect of sodium excretion on patients’ survival. This study was conducted as a single-centered, prospective study in the Department of Nephrology in Erciyes University. The patients included in the study were followed up for 3 years. Seventy PD patients were included in the study. We recorded demographic characteristics, biochemical parameters, urine and peritoneal ultrafiltration volumes, peritoneal equalization tests, ambulatory blood pressure measurements, and echocardiographic measurements. We measured the amount of total sodium excretion of the patients and arterial stiffness using pulse wave velocity (PWV). Patients were divided into two groups based on the amount of total sodium excretion: low group and high group. We compared these groups in terms of cardiac and biochemical parameters. When demographic data and biochemical values were compared, there was no significant difference between the two groups. NT-proBNP level, systolic blood pressure, and mean arterial pressure were significantly higher in the low group (p: 0.02, p: 0.031, p: 0.05, respectively). Net ultrafiltration was significantly higher in the high group (p: 0.03), was also found to be high in patients with high sodium excretion (p: 0.001). Negative correlations were found between sodium excretion and net ultrafiltration, NT-Pro BNP, and PWV. At the end of the 3-year follow-up, the survival rate was shorter and the mortality rate was higher in the low group (p: 0.042). Fluid status in PD patients can affect arterial stiffness both directly and through hypertension. Correction of hypervolemia has the potential to not only prevent hypertension and left ventricular hypertrophy, but also to improve arterial stiffness, a well-known cardiovascular risk factor. The mortality rate was higher in PD patients with low total sodium excretion. Therefore, these patients should be followed more closely to ensure volume control.

Summary Introduction Various agents have been tested as preventive treatments for ischemia/reperfusion (IR) damage. In this study, we have investigated for the first time in the literature the efficacy of injection of amniomax (AMX) into testicular parenchyma, which is a commercial medium of rat amniotic fluid, in preventing testicular IR damage related to testicular torsion. Objective This study aims to evaluate whether or not amniomax has an effect on experimental IR damage in rat testes using biochemical and histopathological methods based on data in the literature. Even if testicular torsion is repaired surgically in early term injury because of de IR damage still occurs. Is it possible to reduce the ischemia reperfusion injury with amniotic fluid and increase the success of treatment? Study design 40 male Wistar albino rats were included. Four groups were formed with 10 rats in each group: Sham, Ischemia/Reperfusion (IR), injection 1 min before detorsion (AMX-BD), injection 1 min after detorsion (AMX-AD). Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) were computed for oxidative stress, and Total Antioxidant Status (TAS) levels were computed for the antioxidant system, for both serum and tissue. Necrosis and microcalcification levels were assessed in the evaluation of testicular histology. P Results AMX-AD group has low necrosis degree than IR, Mean serum and tissue levels of TAS, TOS, and OSI parameters were respectively determined as; for TAS: 0.64 ± 0.11 and 0.96 ± 0.25 mmol Trolox Equivalent/L; for TOS: 6.71 ± 0.87 and 9.40 ± 1.03 μmol H2O2 equivalent/L; for OSI: 11.94 ± 3.74 and 10.70 ± 4.23 arbitrary unit. Discussion Our study has investigated for the first time in the literature the efficacy of amniotic fluid in preventing testicular IR damage, and used amniomax (AMX) for this purpose. The limitation of our study may be the small number of rat in the groups. Conclusion We think an injection after detorsion is more favorable considering that the AMX-AD group demonstrated significantly lower levels of TOS in serum and tissue and OSI in serum, and significantly higher serum levels of TAS compared to the AMX-BD group, as well as the fact that the morphological protection effect was only observed for injections performed immediately after detorsion. Download : Download high-res image (178KB) Download : Download full-size image Summary Figure . Statistical outcomes concerning necrosis and microcalcification for the three dependent groups (IR, AMX-BD, AMX-AD).

This study aims to investigate the effects of co-administration of nano-Curcumin on anticancer effect of nano-Pirarubicin considering the fact that the clinical use of Pirarubicin and other anthracyclines has been limited by development of multidrug resistance (MDR) and based on previous data which have shown that Curcumin can down-regulate MDR proteins and suppress the activity of Nuclear factor-kappa B (NF-κB) a protein involved in chemoresistance. Nano micellar formulations of both Curcumin and Pirarubicin were separately synthesized using 1,2-Distearoyl-sn-glycero-3-phosphoethanolamine-N-methoxy-[poly(ethylene glycol); PEG MW 2,000] (DSPE-PEG2000). The produced sterically stabilized micelles (SSM) are very well known drug delivery systems in terms of their enhanced efficacy and good toxicity profile. We measured the differences of NF-κB levels in two different situations: when Pirarubicin is used alone and when it is co-administered with Curcumin. This study showed that co-administration of SSM-Curcumin (CSSM) and SSM-Pirarubicin (PSSM) with size of 12.81 nm enhances the efficacy of Pirarubicin by suppressing P65, an NF-κB subunit. Furthermore, we showed that SSM is able to successfully enhance water solubility and therapeutic stability of curcumin for using as a complementary agent.

Introduction: Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. Objective: The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. Methods: Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1 mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. Results: Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p

16th World Congress of Neurosurgery of the World-Federation-of-Neurosurgical-Societies (WFNS) -- AUG 20-25, 2017 -- Istanbul, TURKEY BACKGROUND: Verapamil a calcinarn channel blacker, has shown promising results on cerebral vasospasm. However, it has not yet been accepted for treatment or prevention purposes because of the associated side effects, Although the effective results of nimodipine and nicardipine's intrathecal administration are well known, intrathecal verapamil has not been considered earlier. We used an experimental subarachnoid hemorrhage induced vasospasm model for the evaluation of vasodilator and neuroprotective effects of intrathecal verapamil, METHODS: A total of 24 Sprague-Davvley rats were randomly divided into the following 3 groups: group 1 (sham), group 2 (subarachnoid hemorrhage), and group 3 {verapamil). A double hemorrhage method was used. Group 2 did not receive any treatment. Verapamil (Eporon, Hem Ilac, Turkey) at a dose of 1000 mu g/kg was given intrathecally to group 3 rats. The animals were euthanized on day 7 of the procedure. Arterial wall thickness and lumen diameter in the basilar arterial cross-sectional areas, endothelin-1 serum level, oxidative stress index, and apoptosis were measured in all groups. RESULTS: In the verapamil group, wall thickness, endothelin-1 level, oxidative stress index, and apoptosis were found to be significantly lower than the subarachnoid hemorrhage group, but the lumen diameter was found to be greater, Intrathecal verapamil was found to decrease vasospasm parameters and apoptosis and increase the antioxidant and antiapoptotic pathways. CONCLUSIONS: Our findings suggest that intrathecal verapamil can prevent vasospasnt oxidative stress, and apoptosis after experimental subarachnoid hemorrhage. World Federat Neurosurg Soc Bezmialem Vakif University FundBezmialem Vakif University [3.2015/40] This work was supported by the Bezmialem Vakif University Fund (Project Number: 3.2015/40). WOS:000473128300136 30980985 Q3

Background: The vulnerable brain regions to isotretinoin are represented as hippocampus and prefrontal cortex, involved in mood regulation as well as coordination of cognitive functions. Adolescenc...

Secondary and tertiary hyperparathyroidism is an important problem of chronic kidney disease. Brown tumor is a benign, unusual, reactive lesion as a result of disturbed bone remodeling, from long-standing increase in parathyroid hormone level. Brown tumors may cause morbidity due to pressure symptoms on neural structures and spontaneous bone fractures. Herein, we presented a peritoneal dialysis patient with tertiary hyperparathyroidism under calcand calcitriol treatment for 4 years due to refusing of the parathyroidectomy operation. She admitted to hospital for sudden onset back pain with difficulty in gait and walking, and imaging studies showed an expansile mass lesion in the thoracic spine. She was operated for mass and diagnosed with brown tumor. After operation, she lost the ability of walking than become paraplegic and she underwent rehabilitation program. Preventive measures including calcitriol and cinacalcet may cause a modest decrease in parathyroid hormone levels but it should be remembered for the development of bone complications such as brown tumor formation in patients with moderate elevated PTH levels, especially those with tertiary hyperparathyroidism. Parathyroidectomy should be performed without delay in these cases.

To evaluate the accuracy of US in calculating renal volumes and renal resistive index (RRI) that was obtained using a new method in patients with autosomal dominant polycystic kidney disease (ADPKD). In this prospective study, US and MRI were performed in 57 patients with ADPKD (31 female and 26 male; age range, 19–79 years) between August 2017 and May 2018. The volumes determined using US and MRI were compared. The ellipsoid formula was re-evaluated using different multipliers. RRI was obtained 1.5–2 cm distal to the outlet of main renal arteries. The relationship between mean RRI, renal function tests, and kidney volumes and difference between mean RRI of ADPKD patients with and without renal failure were investigated using a two-sided independent samples t test and Pearson correlation test. Interobserver agreements for volume assessments and RRI measurements were determined. By changing the ellipsoid formula, a very good agreement was found (ICC 0.970 for the right kidney and ICC 0.973 for the left kidney). The mean RRI in the right renal artery was 0.61 ± 0.07 and in the left renal artery 0.63 ± 0.06. The mean RRI of ADPKD patients with renal failure was significantly higher than that of patients without renal failure (p = 0.005). There was a significant correlation between mean RRI and renal function tests. The accuracy of the US in calculating renal volumes increases by adapting the ellipsoid formula. RRI may be used for the management of ADPKD independently of volumes. •The accuracy of ultrasonography for renal volume measurement increases by changing the classical ellipsoid formula. •Renal resistive index measured by color Doppler ultrasonography is helpful for the management of autosomal dominant polycystic kidney disease. •The role of Doppler US in autosomal dominant polycystic kidney disease should increase as a result of our findings.

Aim:The aim of our study was to determine the existence of neuropathic pain (NP) inknee OA and its association with risk factors, functional status, quality oflife, and depression.Materialand Methods: This was a descriptive study. Atotal of 100 patients (90 female, 10male) with knee OA were enrolled. Data including age, gender, educationalstatus, working status, body mass index, and symptom duration were obtainedfrom patients. Patientswere divided into three groups according to the PainDETECT scores: likely NP,possible NP, unlikely NP. Patients'pain severity was assessed using visual analogue scale (VAS). For the presenceof NP, PainDETECT scale was used. Functional status was evaluated by WesternOntario and McMaster University Osteoarthritis Index (WOMAC). Quality of lifewas assessed using Short Form-36 questionnaire (SF-36) and depression level wasevaluated using Hamilton Depression Scale (HAM-D). Kellgren-Lawrence gradingsystem was used to determine the radiologic severity. Pain,functional status, quality of life and depression were compared among thegroups.Results: Of the total, 18 patients (18%) werein the likely NP group; 23 patients (23%) were in the possible NP group and 59(59%) patients were in the unlikely NP group. Nosignificant differences were detected between the groups in sociodemographicdata (p > 0.05). Significant differences were detected in symptom duration, VAS,WOMAC, SF-36 physical functioning subscale, physical role functioning subscale,social role functioning subscale, vitality subscale, bodily pain subscale,general health perceptions subscale and HAM-D scores among the groups (p, Amaç:Çalışmamızın amacı, diz OA'da nöropatik ağrı (NA) varlığını ve risk faktörleri,fonksiyonel durum, yaşam kalitesi ve depresyon ile ilişkisini belirlemektir.Gereçve Yöntemler: Bu tanımlayıcı bir çalışmadır. DizOA’i tanılı toplam 100 hasta (90 kadın, 10 erkek) çalışmaya alındı. Hastalardanyaş, cinsiyet, eğitim durumu, çalışma durumu, vücut kütle indeksi ve semptomsüresini içeren veriler elde edildi. PainDETECT skorlarına göre hastalar üçgruba ayrıldı: pozitif NA, muhtemel NA, negatif NA. Hastaların ağrı şiddeti görselanalog skala (GAS) ile değerlendirildi. NA varlığı için PainDETECT ölçeğikullanıldı. Fonksiyonel durum WesternOntario ve McMaster Üniversitesi Osteoartrit İndeksi (WOMAC) iledeğerlendirildi. Yaşam kalitesi Kısa Form-36 anketi (KF-36), depresyon düzeyiHamilton Depresyon Skalası (HAM-D) kullanılarak değerlendirildi. Radyolojikdeğerlendirme için Kellgren-Lawrence evreleme sistemi kullanıldı. Gruplararasında ağrı, fonksiyonel durum, yaşam kalitesi ve depresyon karşılaştırıldı.Bulgular:Toplam 18 hasta (%18) pozitif NA grubunda, 23 hasta (%23) muhtemel NA grubunda,59 hasta negatif NA grubundaydı. Sosyodemografik verilerde gruplar arasındaanlamlı fark saptanmadı (p > 0.05). Semptom süresi, GAS, WOMAC, KF-36fiziksel fonksiyon alt ölçeği, fiziksel rol işleyişi alt ölçeği, sosyalfonksiyon alt ölçeği, canlılık alt ölçeği, ağrı alt ölçeği, genel sağlık durumualt ölçeği ve HAM-D skorları arasında gruplar arasında anlamlı fark bulundu (p

Ankylosing spondylitis (AS) is a rheumatic disorder characterized by structural impairments and postural deformities which restrict daily life activities. Nonpharmacologic methods, particularly exercise therapies, play a key role in the treatment. Obtaining online health-related information has become increasingly popular. We aimed to assess the quality of the most viewed YouTube videos on AS exercises. We searched for the key words “ankylosing spondylitis exercise,” “ankylosing spondylitis rehabilitation,” “ankylosing spondylitis physical therapy,” and “ankylosing spondylitis physiotherapy” on YouTube on October 10th, 2018. The educational quality of YouTube videos was evaluated according to the Global Quality Scale, and three groups were formed: high quality, intermediate, and low quality. Video parameters were compared between the groups. Of the 56 videos evaluated, 48.2% (n = 27) were of high quality, 17.9% (n = 10) were of intermediate quality, and 33.9% (n = 19) were of low quality. When video parameters compared among the groups, no significant differences were found in the number of views per day, likes per day, and comments per day (p > 0.05). Significant differences were found in the number of dislikes per day and DISCERN scores between the groups (p = 0.02, p

The purpose of this study is to assess the effect of vitamin D replacement on cognitive function in older adults. A total of 560 patients who underwent comprehensive geriatric assessment including Global cognitive assessment, Basic Activities of Daily Living (BADL), and Instrumental Activities of Daily Living (IADL) twice in 6-month period were retrospectively reviewed. Oral cholecalciferol was replaced to patients with vitamin D deficiency routinely. In baseline cognitive scores, BADL-IADL scores were lower in the severe deficiency group than in the deficiency and adequate groups ( P < .05). With regard to the relation between changes in cognitive functions, BADL-IADL scores on the 6-month versus baseline, no difference was determined in patients with and without dementia ( P > .05). Vitamin D replacement may not improve cognitive performance in older adults, even if vitamin D is raised to adequate level, suggesting that longer term replacement therapy may be needed to improve cognitive function.

Fingolimod, a sphingosine-1-phosphate receptor agonist, is used for treatment of relapsing-remitting multiple sclerosis (RRMS). S1P receptors that fingolimod acts upon have also been shown to be expressed on atrial myocytes. This expression pattern has been linked with the drug's cardiovascular effects, such as bradycardia. We aimed to evaluate the clinical and electrocardiographic predictors of heart rate (HR) reduction in patients receiving first-dose fingolimod.We retrospectively analyzed subjects diagnosed with RRMS who were allocated to fingolimod treatment. HR, systolic and diastolic blood pressure values and electrocardiography during the first dose of fingolimod were accessed.A total of 114 RRMS patients (65.8% female, 33.58 ± 8.63 years) were included. After the initial dose of fingolimod, the heart rate decreased significantly at each hour (each p 0.001). Nadir heart rate was reached at 4 h. The multivariate binary logistic regression analysis revealed that BMI (OR: 0.878, p = 0.045), optic nerve involvement (OR: 3.205, p = 0.018), baseline HR (OR: 1.079, p = 0.002) and T-peak-T-end interval (OR: 1.046, p = 0.030) were independent predictors of greater HR reduction. During 6-h monitorization, none of the patients had relevant adverse reactions.Our findings provide an insight on clinical and electrocardiographic predictors of HR reduction that occurs in RRMS patients receiving first dose of fingolimod.

Background and Objectives: Cyst pressure induces renin-angiotensin-aldosterone system activation and kidney hypoxia in autosomal dominant polycystic kidney disease (ADPKD). Lipopolysaccharide-induced Toll-like receptor activation causes metabolic disturbances that are triggered by increased succinate levels and hypoxia inducible factors, which results in inflammation via IL-1β activation. Since we aimed to investigate the role of both inflammation and hypoxia in the clinical course of ADPKD, via succinate levels from sera samples, HIF-1α gene expression from whole blood and urine samples and IL-1βgene expression from whole blood were measured. Methods: One hundred ADPKD patients and 100 matched healthy controls were enrolled to this cross-sectional study. Twenty-four-hour ambulatory blood pressure monitoring was conducted in all participants. Blood, serum, and urine samples were taken after 12-h fasting for the measurement of biochemical parameters and succinate levels. Whole blood and urine samples were used for HIF-1α and IL-1β geneexpression by using quantitative real-time PCR. Results: There were significant differences in whole blood HIF-1α, IL-1β geneexpression, and serumsuccinate levels between the ADPKD patients and the control subjects. Whole blood HIF-1αgene expression, IL-1β geneexpression, and serumsuccinate levels were also significantly different in ADPKD patients with hypertension in comparison with normotensive ones (p < 0.05). Serum succinate levels and blood IL-1β geneexpression were increased in ADPKD patients with high levels of HIF-1α geneexpression (p = 0.018 and p = 0.029, respectively). Conclusions: Increased age,low eGFR, and HIF-1α and IL-1β geneexpressions were also independently associated with hypertension in ADPKD patients. Inflammation and hypoxia are both relevant factors that might be associated with hypertension in ADPKD.

A high prevalence of obesity in fibromyalgia syndrome (FMS) predisposes patients to metabolic changes. It is not clear how the clinical manifestations of the disease affect metabolism. This study aimed to investigate leptin, growth hormone (GH), and insulin-like growth factor (IGF-1) levels in FMS, and their relationship with body mass index (BMI) and disease severity. This case–control study included 60 patients with FMS and 42 age- and sex-matched healthy controls. BMIs were recorded for all participants. The disease severity was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and a visual analog scale (VAS). The serum levels of leptin, GH, and IGF-1 of all participants were measured using specific enzyme-linked immunosorbent assays. Both groups had similar age (p = 0.058), sex (p = 0.25), and BMI (p = 0.29) distribution. The mean age of the FMS and the control groups was 40.7 ± 10.8 years and 36.2 ± 13.6 years, respectively. The mean BMI was 26.7 kg/m2 in the FMS group. The GH (p = 0.037) and IGF-1 (p = 0.002) levels were statistically lower, and leptin (p = 0.002) levels were considerably higher in the FMS group than in the control group. The leptin values were positively correlated with age (p = 0.001; r = 0.386) and BMI (p