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Background: The morphology of the circle of Willis in adults has been thoroughly discussed in scientific literature. However, the morphology of the circle of Willis in pediatric patients is under-researched.Objectives: We aimed to establish reference data for the morphology and variations of the circle of Willis in a population consisting of all pediatric age subgroups and to evaluate the possible temporal evolution of the circle of Willis in pediatric patients along with the variations between pediatric and adult populations.Materials and Methods: Our patient cohort included 263 pediatric patients ages 1-215 months. A total of 273 magnetic resonance (MR) angiography images were retrospectively analyzed for all circle of Willis vessels to compare the incidence of complete cases and variation frequency based on gender and age group.Result: In our study of 273 MR angiograms from all age ranges in the pediatric population, we found a 56.1% circle of Willis completion rate. Overall completion rates were statistically significantly higher in the toddler and preschool age groups. The lowest completion rate was in the newborn-infant group (40%).Conclusion: Circle of Willis completion rates and variations in pediatric populations are similar to those in adult populations; completion rates rise in toddler and preschooler age groups and decline as children grow into the school-age and adolescent period. [ABSTRACT FROM AUTHOR]

Objective: To assess antibody response to inactivated COVID-19 vaccine in patients with immune-mediated diseases (IMD) among hospital workers and people aged 65 and older. Methods: In this cross-sectional study, we studied 82 hospital workers with IMD (mean age: 42.2 ± 10.0 years) and 300 (mean age: 41.7 ± 9.9 years) controls. Among + 65 aged population, we studied 22 (mean age: 71.4 ± 4.5 years) patients and 47 controls (mean age: 70.9 ± 4.8 years). All study subjects had a negative history for COVID-19. Sera were obtained after at least 21 days following the second vaccination. Anti-spike IgG antibody titers were measured quantitatively using a commercially available immunoassay method. Results: Patients with IMD were significantly less likely to have detectable antibodies than healthy controls both among the hospital workers (92.7% vs 99.7%, p < 0.001) and elderly population (77.3% vs 97.9%, p = 0.011). Among patients with IMD, those using immunosuppressive or immune-modulating drugs (64/75, 85.3%) were significantly less likely to have detectable antibodies compared to those off treatment (29/29, 100%) (p = 0.029). Additionally, a negative association between age and the antibody titer categories among patients (r = − 0.352; p < 0.001) and controls (r = − 0.258; p < 0.001) were demonstrated. Conclusions: Among hospital workers, the vast majority of patients with IMD and immunocompetent controls developed a significant humoral response following the administration of the second dose of inactivated COVID-19 vaccine. This was also true for the elderly population, albeit with lower antibody titers. Immunosuppressive use, particularly rituximab significantly reduced antibody titers. Antibody titers were significantly lower among those aged ≥ 60 years both in patient and control populations. Whether these individuals should get a booster dose warrants further studies. [ABSTRACT FROM AUTHOR]

Experimental and clinical data strongly suggests that nitric oxide (NO) plays a pivotal role in migraine. This is also supported by studies of migraine induced by substances that release NO. NO is synthesized from L-arginine by endothelial NO synthase (NOS). Asymmetric dimethylarginine (ADMA) is the major endogenous competitive inhibitor of NOS. Symmetric dimethylarginine (SDMA) is an inactive stereoisomer of ADMA. It may reduce NO production by competing with arginine for cellular uptake. The aim of this study was to measure the levels of ADMA, SDMA and L-arginine in migraine patients during the interictal period. One hundred migraine patients and 100 healthy volunteers were recruited. The patients were in the interictal period and classified into two groups as having migraine with aura and migraine without aura. Their serum ADMA, SDMA and L-arginine levels were measured by high-performance liquid chromotography (HPLC) method. ADMA, SDMA and L-arginine levels were significantly higher in migraine patients compared to the control group. But there was no difference between the patients with and without aura. These results suggest that NOS inhibitors and L-arginine/NO pathway plays an important role in migraine pathopysiology. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this prospective study was to determine the efficacy of intraarticular levobupivacaine with and without intravenous dexketoprofen trometamol for postarthroscopy analgesia.Methods: Sixty patients who underwent arthroscopic knee surgery were randomly assigned to three treatment groups. When the surgical procedure was completed, patients received the following treatments: group I (n = 20) patients received 20 mL intraarticular normal saline and 2 mL intravenous dexketoprofen trometamol (50 mg); group II (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous normal saline; and group III (n = 20) patients received 20 mL intraarticular 0.5 % levobupivacaine (100 mg) and 2 mL intravenous dexketoprofen trometamol (50 mg). The visual analogue scale (VAS) was used, and the total analgesic consumption was assessed at 1, 2, 4, 6, 12, and 24 h post-operatively.Results: The VAS scores at 1, 2, 4, 6, 12, and 24 h post-operatively were significantly increased in group I and group II compared with group III (p < 0.05). The average VAS score during the first 24 h post-operatively was significantly lower in group III than in group I and group II (p < 0.001). Total meperidine consumption was significantly lower in group III than in groups I and II (p < 0.001).Conclusion: Intraarticular levobupivacaine with adjuvant intravenous dexketoprofen trometamol administration provided better pain relief and less analgesic requirement after arthroscopic knee surgery during the first 24 h than that induced by dexketoprofen alone or levobupivacaine intraarticular alone.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Purpose: Lumbar puncture (LP) is one of the most common procedures performed in medicine. The aim of this prospective study is to determine the success rate of LP in lateral decubitus with 45-degree head-up tilt position, and compare it with traditional positions like sitting and lateral decubitus. Methods: Three hundred and thirty patients between 25 and 85 years of age who had undergone abdominal, urologic, and lower limb extremities surgeries were enrolled and 300 patients were divided into three different groups. The LP was performed with a 25-G atraumatic needle, either in the standard sitting position (group S, n = 100), lateral decubitus, knee-chest position (group L, n = 100) or lateral decubitus, knee-chest position with a 45-degree head-up tilt (group M, n = 100). The free flow of clear cerebrospinal fluid (CSF) upon first attempt was considered to be evidence of a successful LP. Results: Total LP success rate was significantly higher in group M (85 %) than in groups S and L (70 and 65 %, respectively) ( p = 0.004). When the significance between the groups was evaluated according to age, the increase in the LP success rate was not significant for ≤65 and >65 age groups. There were no differences among the three groups in terms of bloody CSF ( p = 0.229) and the number of attempts before dural puncture ( p = 0.052). Conclusions: The lateral decubitus in knee-chest position with a 45-degree head-up tilt may be the preferred position for spinal anesthesia in young and elderly patients, due to the high success rate. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of and possible factors related to contrast-induced nephropathy (CIN) in hospitalised patients with cancer. Methods: Ninety adult patients were enrolled. Patients with risk factors for acute renal failure were excluded. Blood samples were examined the day before contrast-enhanced computed tomography (CT) and serially for 3 days thereafter. CIN was defined as an increase in serum creatinine (Cr) of 0.5 mg/dl or more, or elevation of Cr to 25 % over baseline. Relationships between CIN and possible risk factors were investigated. Results: CIN was detected in 18/90 (20 %) patients. CIN developed in 25.5 % patients who underwent chemotherapy and in 11 % patients who did not ( P = 0.1). CIN more frequently developed in patients who had undergone CT within 45 days after the last chemotherapy ( P = 0.005); it was also an independent risk factor ( P = 0.017). CIN was significantly more after treatment with bevacizumab/irinotecan ( P = 0.021) and in patients with hypertension ( P = 0.044). Conclusions: The incidence of CIN after CT in hospitalised oncological patients was 20 %. CIN developed 4.5-times more frequently in patients with cancer who had undergone recent chemotherapy. Hypertension and the combination of bevacizumab/irinotecan may be additional risk factors for CIN development. Key Points: • Contrast-induced nephropathy (CIN) is a concern for oncological patients undergoing CT. • CIN occurs more often when CT is performed <45 days after chemotherapy. • Hypertension and treatment with bevacizumab appear to be additional risk factors. [ABSTRACT FROM AUTHOR]

Background: Acoustic noise may have adverse effects, even in patients under general anesthetic. Objective: We aimed to determine the effect of headphones on sevoflurane requirements in children undergoing general anesthesia for an MRI scan. Materials and methods: Children scheduled for MRI were enrolled in the study. Sevoflurane was used for general anesthesia in all children. Patients were randomly divided into two groups, one to wear headphones and the other none. After reaching a predetermined end-tidal concentration, the MRI scan was initiated, and the patient was evaluated by an observer blinded to the concentration of sevoflurane. Awakening was defined as eye opening, onset of continued purposeful movement or phonation. Using the Dixon up-and-down method, each target concentration was determined by the response of the previous child in the same group. Results: The study included 28 children undergoing MRI. There was a significant difference in ED50 between the two groups (0.92, 0.81-1.02, vs. 0.47, 0.42-0.63; P < 0.001). The times to spontaneous arm and leg movements, eye opening and discharge from the post-anesthesia care unit were significantly shorter in patients with headphones than in those without ( P < 0.001). However, there was no difference in times to hospital discharge ( P = 0.056). Conclusion: Noise-concealing headphones decrease inhalational anesthetic requirements and facilitate recovery. We recommend the routine use of headphones in children undergoing an MRI scan. [ABSTRACT FROM AUTHOR]

Purpose: Several studies performed on pancreatic-duodenal homeobox 1 (PDX1) have demonstrated a loss of expression and negative tumor modulator effect in gastric carcinoma. Relations between PDX1 and gastric metaplasia, differentiated type of gastric carcinoma, and the early stage of the disease have been exhibited in previous reports. The aim of this study was to examine expressions of PDX1, caudal type homeobox 2 (CDX2) and mucin (MUC) profiles to address the role of PDX1 in gastric carcinogenesis and its relationship with CDX2. Methods: Seventy gastrectomy specimens were analyzed immunohistochemically for PDX1, CDX2, MUC2, MUC5AC, and MUC6 expressions. The sum of cytoplasmic and nuclear PDX1 immunostaining and PDX1 positivity were assessed. All of the antibodies were examined for a correlation with tumor type, clinicopathologic parameters, and metaplasias. The relation of Ki-67 proliferation index with the expression profiles was also investigated. Results: Neither PDX1 (66/70) nor CDX2 (37/70) and the mucin profiles (MUC2:11/70, MUC5AC:48/70, MUC6:41/70) showed a significant difference between differentiated and undifferentiated types of gastric carcinoma and clinicopathologic parameters. The PDX1 expression frequency was 94.3%, with an average PDX1 score of 8.8 ± 4.2. PDX1 and CDX2 expression showed a significant difference ( P = 0.026 and P = 0.002, respectively) among the phenotypic classification of gastric carcinomas. All of the gastric and intestinal mixed-phenotype gastric carcinomas (GI-type) showed both PDX1 and CDX2 immunopositivity. Except for the relation of PDX1 score with MUC6 expression, no significant difference was detected between PDX1 and CDX2, MUC2, and MUC5AC expressions. A relationship between CDX2 and MUC2 and also between MUC5AC and MUC6 was found statistically. The Ki-67 proliferation index revealed a significant positive correlation with PDX1, CDX2, and MUC2 positivity. Conclusions: PDX1 expression revealed a higher positivity in gastric carcinomas than the previous studies and showed no relation with tumor type, clinicopathologic parameters, CDX2 expression, or mucin profiles. However, a significant relation of PDX1 and CDX2 expressions among phenotypic classification of gastric carcinomas reveals an idea about similar functions for PDX1 and CDX2 in the evolution of gastric carcinoma. [ABSTRACT FROM AUTHOR]

Background Although the causes of striae distensae (SD) remain to be elucidated, the condition is known to relate to changes in the structures that provide the skin with its tensile strength and elasticity. Objective This study was conducted to evaluate whether premature birth is a risk factor for SD. Methods A total of 15,475 parous women ranging in age from 18-45 years were interviewed between January 2007 and June 2009. After exclusion criteria were applied, a total of 1336 women were included in the study. Group 1 consisted of 1231 women of reproductive age who had been born at term. Group 2 included 105 women of reproductive age who had been born prematurely. The main outcome measure was the prevalence of SD. Results The overall prevalence of SD was 34.6% (462/1336). Mild SD was significantly more common ( P < 0.01) in women who had been born prematurely (49.5%) than in women who had been born at term (31.8%). A multivariate analysis using backward stepwise logistic regression analysis identified that height, weight, gravidity, parity and abortion were found to be significantly associated with SD. Conclusions Striae distensae was significantly more common in women who had been born prematurely than in women who had been born at term. [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to determine the reliability of temporomandibular joint (TMJ) mobility measurements for predicting difficult intubation. To evaluate the accuracy in predicting difficult intubation by TMJ mobility measurement, 762 patients requiring general anesthesia with tracheal intubation for elective surgery were enrolled in this prospective, observational, single-blind study. Maximum mouth opening, right-left jaw excursion, and degrees of protraction were determined with a digital inclinometer. Incisor gap was measured using a vernier caliper during full mouth opening. After induction of anesthesia using a standard protocol, the patient's grade of laryngeal view by Cormack-Lehane classification was documented by an anesthesiologist. We found that the degrees of protraction and incisor gap in the easy intubation group were significantly higher than those in the difficult intubation group. The incisor gap was found to be more sensitive (88.37%) and more specific (95.71%) than protraction degrees (58.14% and 59.76%, respectively). The results revealed that measurements of the incisor gap and degrees of protraction may be useful routine screening tests for preoperative prediction of difficult intubation. [ABSTRACT FROM AUTHOR]

Background: Intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with significant morbidity and mortality in critically ill patients. Our aim was to assess the effects of IAH on liver function using the noninvasive liver function monitoring system LiMON and to assess the prognostic value of IAP in critically ill patients. Methods: We conducted a retrospective analysis of critically ill patients who were treated in the intensive care unit (ICU). The IAP and indocyanine green plasma disappearance rate (ICG-PDR) measurements were made within 24 hours after admission to the ICU and repeated 12 hours later. Intra-abdominal pressure was measured via a Foley bladder catheter, and ICG elimination tests were conducted concurrently using the LiMON. Results: We included 30 critically ill patients (17 women and 13 men aged 28-89 yr) in our analysis. Statistical analysis showed that the baseline IAP values were significantly higher among nonsurvivors than survivors (19.38 [standard deviation; SD 2.08] v. 13.07 [SD 0.99]). The twelfth-hour IAP values were higher than baseline measurements among nonsurvivors (21.50 [SD 1.96]) and lower than baseline measurements among survivors (11.71 [SD 1.54]); the difference between groups was significant (p < 0.001). The baseline ICG-PDR values were significantly lower among nonsurvivors than survivors (10.86 [SD 3.35] v. 24.51 [SD 6.78]), and the twelfth-hour ICG-PDR values were decreased in all groups; the difference between groups was significant (p < 0.001). Conclusion: Our results suggest that measurement of ICG-PDR with the LiMON is a good predictor of the effects of IAP on liver function and, thus, can be recommended for the evaluation of critically ill patients. [ABSTRACT FROM AUTHOR]

To investigate the effectiveness of melatonin and rosiglitazone in reducing postoperative adhesion formation in a rat uterine horn model. Thirty non-pregnant female Wistar albino rats, weighing 180–220 g, were used as a model for postoperative adhesion formation. The rats were randomised into three groups after seven standard lesions were inflicted in a 2-cm segment of each uterine horn and lower abdominal sidewall using bipolar cauterisation. The rats were treated with 10 mg/kg, intraperitoneal melatonin, and 1 mg/kg per day peroral rosiglitazone. No medication was given to the control group. As much as 20 uterine horns of 10 rats were evaluated in each group. Extent, severity, and degree of the adhesions to the uterine horns and, inflammation and fibrosis scores (histopathologically) were evaluated after 2 weeks of the treatment. There was no mortality in the groups and all of the rats recovered without incident after operation. Rosiglitazone group had lower adhesion scores [median (min–max ranges)] regarding extent, severity, and degree of the adhesions [0 (0–3), 0 (0–3) and 0 (0–3), respectively], which were significantly different ( P < 0.001, P < 0.05 and P < 0.01, respectively) from those of the controls [1 (0–3), 2 (0–2) and 2 (0–3), respectively]; however, there were no statistically significant differences between rosiglitazone versus melatonin groups [1 (0–4), 2 (0–3) and 1 (0–3), respectively] and melatonin versus control groups. Moreover, no significant differences were determined between groups regarding histopathologic findings. Rosiglitazone, but not melatonin, is effective in prevention of adhesion formation in a rat uterine horn model. [ABSTRACT FROM AUTHOR]

BACKGROUND: The principal aim of the present study was to determine whether Acinetobacter spp. pneumonia differs from hospital-acquired pneumonias (HAPs) caused by other agents with respect to therapeutic success and survival rate. METHODS: This study includes 140 adult patients diagnosed with HAPs caused by identified etiologic agents between March 2005 and February 2006. These patients were divided into two groups according to the agent responsible for their infection (Acinetobacter spp. [n = 63] or non-Acinetobacter spp. [n = 77]). The groups were compared in terms of risk factors, therapeutic success and six-week survival rates. RESULTS: Previous antibiotic use and the risk of aspiration were independent factors responsible for the development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp. pneumonia. The clinical success rate at the end of therapy was 41.6% and, at the sixth week, the survival rate was 35% among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the control group, these values were 43 and 32%, respectively (P > 0.05). We found that the use of the appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival (P < 0.001). CONCLUSION: The outcomes of Acinetobacter spp. pneumonia do not differ from HAPs associated with non-Acinetobacter spp. in terms of therapeutic success and survival rates. [ABSTRACT FROM AUTHOR]

Endometriotic implants were induced surgically in female Wistar albino rats, which were randomly divided into three groups. The rats in group I (n = 10) and group II (n = 9) were given 2.5 mg/kg/day intraperitoneal and oral atorvastatin, respectively, for 28 days. Group III (n = 9) was given no medication (control). The mean volume and weight of explants in group I were significantly lower (both P < 0.05) compared with group III. Histopathological score of the implants was significantly lower in groups I and II, when compared with group III (P < 0.01 and P < 0.05, respectively). There were significant reductions in explant concentrations of vascular endothelial growth factor and matrix metalloproteinase 9 in group I (P < 0.01 and P < 0.001, respectively) and group II (both P < 0.01) compared with group III while staining due to tissue inhibitor of metalloproteinase 2 was significantly higher in group I (P < 0.01) and group II (P < 0.01) compared with group III. Moreover, explant concentration of superoxide dismutase was signifi- cantly increased in groups I and II compared with group III (both P < 0.05). In conclusion, atorvastatin causes significant regression of endometriotic implants in rats. Moreover, intraperitoneal atorvastatin seems to be more effective than oral atorvastatin. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the efficacy and safety of meperidine hydrochloride and valethamate bromide against placebo in shortening the duration of active labor. Method: We randomly assigned 160 nulliparous women with a singleton pregnancy at term who needed induction of labor to one of 3 treatments: 50 mg of meperidine (n=53), 16 mg of valethamate bromide (n=53), or a normal saline solution as placebo (n=54). All medications were given by slow intravenous infusion. Labor duration was the main outcome measure. Results: The intervals between infusion and complete cervical dilation and between infusion and delivery were significantly reduced (P <0.001 and P <0.01) in the meperidine group (103.0±64.5 minutes and 119.8±70.2 minutes), in contrast to the placebo group (173.9±74.8 minutes and 192.2±82.8 minutes). However, differences were not significant between the 2 treatment groups (139.6±63.1 minutes and 160.6±71.9 minutes), or between the valethamate bromide and the placebo group. Conclusion: Meperidine, but not valethamate bromide, significantly shortened the duration of active labor in nulliparous women with a singleton pregnancy at term. [Copyright &y& Elsevier]

Introduction: This study assessed the short- and long-term effects of a 3-month family-based group treatment in the management of childhood obesity versus individual treatment.Materials and Methods: Eighty obese children, aged between 6 and 14 years, and their parents were included in this prospective controlled clinical study. Forty participants were randomly assigned for group treatment and the other 40 for individual treatment. A 3-month intervention program was focused on implementing healthy eating behaviors. The weight and height of the children were measured initially and at each treatment session and at follow-up visits. Body mass index was calculated and expressed as standard deviation score.Results and Discussion: At the end of 3-month treatment program, there was a significant decline in BMI SDS in both groups (p < 0.001). After 1 year of follow-up period, there was still a significant decrease in BMI SDS in the study group (p < 0.001), whereas the decrease in BMI SDS was not maintained over the follow-up period in the standard group. There was a significantly increased consumption of vegetable and fruit and reduced consumption of carbonated drinks and fruit juice in both groups (p < 0.001).Conclusion: These findings demonstrate that the group treatment is more successful than the individual treatment in the management of childhood obesity. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine whether atorvastatin and metformin are effective in preventing adhesions in a rat uterine horn model. A total of 40 non-pregnant, female Wistar albino rats, weighing 180-210 g, were used as a model for post-operative adhesion formation. The rats were randomized into four groups after seven standard lesions were inflicted in each uterine horn and lower abdominal sidewall using bipolar cauterization. The rats were given atorvastatin 2.5 mg/kg/day, p.o. (10 rats), atorvastatin 30 mg/kg/day, p.o. (10 rats), metformin 50 mg/kg/day, p.o. (10 rats) and no treatment was applied in the control group (10 rats). The animals were killed 2 weeks later and adhesions were scored both clinically and pathologically by authors blinded to groups. One rat in the control group died before the end of the 2 week period. Total clinical adhesion scores regarding extent, severity and degree of adhesions and histopathological findings including inflammation and fibrosis were significantly lower in the metformin (P < 0.001 and P < 0.01, respectively) and atorvastatin 30 mg/kg/day (P < 0.001 and P < 0.01, respectively) groups when compared with control group. Metformin and atorvastatin are both effective for prevention of adhesion formation in a rat uterine horn model. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Curcumin has antioxidant, antitumor, and anti-inflammatory properties. However, it remains unknown whether curcumin has any protective effects on sepsis. The purpose of this study was to demonstrate whether curcumin prevents organ dysfunction in animals with sepsis. Methods: Rats were randomized into four groups. The control group (group I, n = 7) did not receive any treatment. The curcumin group (group II, n = 10) only received 1.2 g/kg of curcumin. Escherichia coli were injected into the remaining groups intraperitoneally after general anesthesia. Five hours after injection, 12 rats received placebo (group III), and 10 rats received 1.2 g/kg of curcumin (group IV) for 7 d. All rats were sacrificed on postsepsis day 8 and a midline laparotomy was performed. Livers, kidneys, and small bowels were excised for evaluation of the degree of inflammation and tissue alterations histopathologically. Results: In the liver, widespread hydropic degeneration of hepatocytes were seen in the sepsis group. There was no hydropic degeneration of hepatocytes and no portal inflammation in the sepsis/curcumin group. With respect to the small bowel, the sepsis group showed edema and prominent intraepithelial infiltration of neutrophil leucocytes and plasma cells. Inflammation and hyperemia in the lamina propria in the sepsis/curcumin group were less than those in the sepsis group. With respect to the kidneys, the sepsis group showed severe acute tubular necrosis that was more restricted in the sepsis/curcumin group than in the sepsis group. Conclusion: Curcumin reduced organ dysfunction in rats with experimentally formed sepsis. We propose that curcumin may be useful in the therapy of organ dysfunction due to sepsis, shock, and other diseases associated with local or systemic inflammation. [Copyright &y& Elsevier]

In this retrospective study, symphysis pubis (SP) distance was measured by transverse computed tomography scans. The relation between the SP distance and age, gender, number of birth and body-mass index was studied. Symphysis pubis joint distances were evaluated for the patients who had undergone abdominal or pelvic computed tomography examination for other medical reasons between the dates of March and May 2007. Anterior, middle, and posterior SP joint distances were measured at transverse planes. Normal joint width in women and men was determined. The relation between obtained values, and age, gender, number of birth, as well as body-mass index was studied. Symphysis pubis narrows at anterior concurrently with ageing ( r = −0.115; P = 0.007). Narrowing, though less, is also observed at posterior ( r = −1.50 P = 0.000); however, middle part does not change ( r = 0.030; P = 0.489). Number of birth and body-mass index values do not affect SP width. The widths measured at anterior and middle of the SP were significantly higher in women ( P = 0.010 and P = 0.002). Osteoarthritic changes develop in SP with ageing. However, osteoarthritis in SP, was found to be clinically and radiologically different from that in other symphyseal joints, as SP hardly ever moves, and vertically processing interpubic disc combines pelvis girdle with counterforces, and is supported by very strong ligaments and muscles. Anterior and middle part of the SP joint is wider in women, because fibrocartilaginous disc is too thick to provide the mobility. [ABSTRACT FROM AUTHOR]

The article presents a study to determine the effects of sleep deprivation induced anxiety on anaerobic performance. Participants performed an anaerobic test for three times, following a full-night of habitual sleep, following 30 hours of sleep deprivation, and following partial-night sleep deprivation. Findings proposed that 30 hours continuous wakefulness may increase anxiety level, whereas one night of partial sleep deprivation was ineffective on both state anxiety and anaerobic performance.

The aim of this randomized prospective study was to compare efficacy and side effects of saline moistened misoprostol with dry misoprostol, administered 800 μg intravaginally every 6 h up to a maximum of 3 doses in 24 h for second trimester pregnancy termination. A total of 81 women seeking termination of second trimester pregnancy (55 fetal death, 17 fetal structural anomaly, 5 chromosomal abnormality, 4 other reasons) were randomly assigned to one of two treatment groups: (1) intravaginal non-moistened (dry) misoprostol in group A ( n = 40) or (2) misoprostol moistened with 3 ml of saline in group B ( n = 41). All of the patients in either group aborted within 48 h (100% success rate). Delivery was achieved in a median (interquartile range) of 13 (40) h with the group A protocol and 12 (36) h with the group B protocol ( P = 0.652). Delivery with first dose, delivery within 12 h and delivery within 24 h were similar ( P > 0.05) in group B (34.1, 87.5 and 60%, respectively) and group A (25, 82.9, 46.3, respectively). Both treatment regimens were tolerable and with similar side effects. Misoprostol moistened with saline was not more effective than dry misoprostol for second trimester pregnancy termination. [ABSTRACT FROM AUTHOR]

Objective: Shock index (SI) and predictive score grading system including it for predicting medical treatment failure of tubal pregnancies have been studied. Study Design: Eighty-eight patients were diagnosed as nonruptured tubal pregnancies. Shock index was calculated as the ratio of heart rate to systolic arterial pressure. A predictive score was used based on four parameters including initial level of beta-human chorionic gonadotropin (betahCG), aspect of the image on ultrasound, size of the ectopic mass and shock index value at admission. Results: Forty patients have undergone to surgery because of tubal gestational sac size > or =4 cm and/or presence of fetal heart activity. Nineteen patients were managed expectantly. Twenty-four patients received single dose methotrexate (MTX) and five patients received second dose MTX. Success rate for single dose MTX therapy was 72% (21/29). The cut-off shock index value for tubal rupture was 0.77 with 89% sensitivity and 61% specifity. Conclusion: In this study, we demonstrated that tubal pregnancy patients who were managed with nonsurgical measures at admission and who had SI values lower than 0.77 and predictive score grades greater and equal to 6.5 did not experience tubal rupture and did not need surgical intervention during nonsurgical management. [ABSTRACT FROM AUTHOR]

Background: Breast cancer has been a disease in which treatment strategy has changed over time under the influence of different hypotheses and evidence for more than a century. We analyzed the contribution of radiotherapy to disease-free survival and overall survival by classifying according to stage, 1-3 lymph node involvement, and molecular subgroups., Methods: Following the approval of the Institutional Review Board, records of patients with breast cancer who were admitted to University School of Medicine Departments of Radiation Oncology and Medical Oncology between July 1999 and December 2020 were reviewed. Using data propensity score matching was performed between the groups that did and did not receive radiotherapy using an optimal matching algorithm (optimum, 1:1). Disease-free survival and overall survival after propensity score matching were calculated using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis was used to estimate hazard ratios., Results: In the radiotherapy and non-radiotherapy groups, disease-free survival was 257.42 ± 5.46 (246.72- 268.13), 208,96 ± 8,15 (192,97-224,94) months respectively, (p = < 0.001), overall survival was 272,46 ± 8,68 (255,43-289,49), 219,05 ± 7,32 (204,70-233,41) months respectively (p = .002). We compared the 19 N1 patient groups who received radiotherapy with the 19 patients who did not receive radiotherapy and calculated the disease-free survival times was 202,21 ± 10,50 (181,62-222,79) and 148,82 ± 24,91 (99,99-197,65) months respectively (p = .011) and overall survival times was 200,85 ± 12,79 (175,77-225,92) and 166,90 ± 20,39 (126,93-206,82) months respectively (p = .055). We examined disease-free survival and overall survival times in both groups according to Luminal A, Luminal B, TNBC, and HER2-enriched subgroups. In the Luminal B subgroup, the disease-free survival duration in the groups receiving radiotherapy and not receiving radiotherapy was 264.83 ± 4.95 (255.13-274.54) and 187.09 ± 11.06 (165.41-208.78) months (p < .001), and overall survival times were 252.29 ± 10.54 (231.62-272.97) and 197.74 ± 9.72 (178.69-216.80) months (p = .001) respectively., Conclusions: Thanks to studies proving that RT increases long-term survival rates in breast cancer as a result of reducing locoregional recurrence and systemic metastasis rates, it has been understood that the spectrum hypothesis is the hypothesis that most accurately describes breast cancer to date. We found that patients with Luminal B invasive breast cancer benefited significantly more from RT compared to other subgroups., (© 2024. The Author(s).)

Significant interobserver variabilities exist for Bethesda category III: atypia of undetermined significance (AUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thus, subcategorization of AUS including AUS "nuclear" and AUS "other" is proposed in the recent 3rd edition of TBSRTC. This study investigated the impact of the nuclear features/architectural features/nuclear score (NS) (3-tiered)/subcategories and subgroups on risk of malignancy (ROM) in thyroid fine-needle aspirations (FNA). 6940 FNAs were evaluated. 1224 (17.6%) cases diagnosed as AUS were reviewed, and 240 patients (initial FNAs of 260 nodules and 240 thyroidectomies) were included. Subcategories and subgroups were defined according to TBSRTC 2nd and 3rd editions. Histological diagnostic groups included nonneoplastic disease, benign neoplasm, low-risk neoplasm, and malignant neoplasm. Overall, ROM was 30.7%. ROM was significantly higher in FNAs with nuclear overlapping (35.5%), nuclear molding (56.9%), irregular contours (42.1%), nuclear grooves (74.1%), chromatin clearing (49.4%), and chromatin margination (57.7%), and these features were independent significant predictors for malignancy. FNAs with NS3 had significantly higher ROM (64.2%). Three-dimensional groups were significantly more frequent in malignant neoplasms (35.7%). ROM was significantly higher in AUS-nuclear subcategory (48.2%) and in AUS-nuclear and architectural subcategory (38.3%). The highest ROM was detected in AUS-nuclear1 subgroup (65.2%). ROM was significantly higher in the group including AUS-nuclear and AUS-nuclear and architectural subcategories, namely "high-risk group" than the group including other subcategories, namely "low-risk group" (42.0%vs 13.9%). In conclusion, subcategorization may not be the end point, and nuclear scoring and evaluation of architectural patterns according to strict criteria may provide data for remodeling of TBSRTC categories., (© 2024. The Author(s).)

Purpose: The literature contains different information about the prognosis of invasive lobular carcinoma of breast cancer (BC). We aimed to address the inconsistency by comparatively examining the clinical features and prognosis of invasive lobular carcinoma patients in our university and to report our experience by dividing our patients into various subgroups., Patients and Methods: Records of patients with BC admitted to Trakya University School of Medicine Department of Oncology between July 1999 and December 2021 were reviewed. The patients were divided into three groups (No-Special Type BC, Invasive Lobular Special Type BC, No-Lobular Special Type BC). Patient characteristics, treatment methods and oncological results are presented. Survival curves were generated using the Kaplan-Meier method. Statistical significance of survival among the selected variables was compared by using the log-rank test., Results: The patients in our study consisted of 2142 female and 15 male BC patients. There were 1814 patients with No-Special Type BC, 193 patients with Invasive Lobular Special Type BC, and 150 patients with No-Lobular Special Type BC. The duration of disease-free survival (DFS) was 226.5 months for the No-Special Type BC group, 216.7 months for the No-Lobular Special Type BC group, and 197.2 months for the Invasive Lobular Special Type BC group, whereas the duration of overall survival (OS) was 233.2 months for the No-Special Type BC group, 227.9 for the No-Lobular Special Type BC group, and 209.8 for the Invasive Lobular Special Type BC group. The duration of both DFS and OS was the lowest in the Invasive Lobular Special Type BC group. Multivariate factors that were significant risk factors for OS were Invasive Lobular Special Type BC histopathology (p = .045), T stage, N stage, stage, skin infiltration, positive surgical margins, high histological grade, and mitotic index. Modified radical mastectomy, chemotherapy, radiotherapy and use of tamoxifen and aromatase inhibitors for more than 5 years were significant protective factors for overall survival., Conclusion: The histopathological subgroup with the worst prognosis in our study was Invasive Lobular Special Type BC. Duration of DFS and OS were significantly shorter in Invasive Lobular Special Type BC than No-Lobular Special Type BC group. The classification of Invasive Lobular BC under the title of Special Type BC should be reconsidered and a more accurate treatment and follow-up process may be required., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Cosar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Due to their semiological similarities, psychogenic nonepileptic seizures (PNESs) can occasionally hardly be differentiated from epileptic seizures (ESs), and long-term video-electroencephalographic monitoring (VEM) is needed for the differential diagnosis., Objective: To investigate the time of the first clinical event and its distribution on the days of VEM in ES and PNES patients., Methods: In total, a consecutive series of 48 PNES and 51 ES patients matched for gender and age were retrospectively and consecutively evaluated. The time distribution of the seizures during the day was noted. Seizure latency was determined as the time in hours from the start of the video-electroencephalographic recording to the first clinical event., Results: The seizure latency was significantly shorter in PNES patients compared to ES patients ( p  < 0.001). Seventy-two percent of PNES patients and 49.1% of ES patients had their first seizure in the 24 hours of video-EEG recording ( p  = 0.023). Recording longer than 48 hours was required for 12.5% of PNES patients and 37.3% of ES patients ( p  = 0.006). While ESs were almost evenly distributed throughout the day, most PNESs occurred during the evening hours ( p  = 0.011)., Conclusion: We observed that the PNESs appeared earlier than the ESs in the VEM and were concentrated during daylight hours. Although not strictly reliable, seizure latency can contribute to the differential diagnosis of ES and PNES., Competing Interests: The authors have no conflict of interest to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

In our study, we aimed to investigate the relationship between microRNA (miRNA) expression levels and serum iron (Fe), copper (Cu), and zinc (Zn) levels in Multiple sclerosis (MS) patients. Total RNA was isolated from peripheral venous blood containing ethylenediaminetetraacetic acid (EDTA) of MS patients and controls. Total RNA was labeled with Cy3-CTP fluorescent dye. Hybridization of samples was performed on microarray slides and arrays were scanned. Data argument and bioinformatics analysis were performed. Atomic absorption spectrophotometer method was used to measure serum Fe, Cu, and Zn levels. In our study, in bioinformatics analysis, although differently expressed miRNAs were not detected between 16 MS patients and 16 controls, hsa-miR-744-5p upregulation was detected between 4 MS patients and 4 controls. This may be stem from the patient group consisting of MS patients who have never had an attack for 1 year. Serum iron levels were detected significantly higher in the 16 MS patients compared to the 16 controls. This may be stem from the increase in iron accumulation based on inflammation in MS disease. According to the findings in our study, hsa-miR-744-5p upregulation has been determined as an early diagnostic biomarker for the development together of insulin resistance, diabetes mellitus associated with insulin signaling, and Alzheimer's diseases. Therefore, hsa-miR-744-5p is recommended as an important biomarker for the development together of diabetes mellitus, Alzheimer's disease, and MS disease. In addition, increased serum Fe levels may be suggested as an important biomarker for neurodegenerative diseases such as Parkinson's disease, Alzheimer's disease, and MS disease., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Aim: To compare the incidence of postoperative neuropsychological dysfunction in patients managed with cerebral saturation monitoring versus traditional approaches., Material and Methods: A hundred patients undergoing elective intracranial surgery were divided into two groups to receive intraoperative management via cerebral saturation monitoring (Group O) or the conventional approach (Group C). The postoperative neuropsychological function was evaluated by the antisaccadic eye movement test (ASEM) and the Mini-Mental State Examination (MMSE). These tests were performed preoperatively and postoperatively on the first, second, and fifth days. The time for the modified Aldrete score to reach 9 (MAS 9), adverse effects, and pain using a Visual Analog Scale (VAS) scores were recorded., Results: Patient characteristics and surgery data were not statistically different. The MAS 9 of group O was significantly lower than that of group C (p < 0.001). The MMSE at the postoperative 1, 2, and 5 days were significantly higher in Group O compared to Group C (p < 0.001). ASEM was similar between groups. Group O was subdivided according to the type of surgery applied with diagnosis, and there were no statistically significant between-group differences in terms of areas under the curve for the cerebral regional oxygen saturation. There was no between-group difference regarding the mean arterial pressure at any time perioperatively. The heart rate at 80, 90, 100, and 110 min intraoperatively was significantly higher in group C than in Group O., Conclusion: Intraoperative cerebral oxygenation monitoring can reduce patient mortality and morbidity by allowing early postoperative neurological evaluation to detect potential neurocognitive deficits.

Purpose: Many studies report the triple negative breast cancer (TNBC) as the worst subgroup, as such patients do not benefit from anti-hormonal therapy and human epidermal growth factor receptor 2 (HER2) antagonists. While HER2 overexpression was a poor prognostic factor in breast cancer before trastuzumab (Herceptin) was available, TNBC is often reported as the worst BC subgroup since targeted therapy is currently not possible. Since the patience-specific experiences and the current literature did not always align, we aimed to determine the BC subgroup with the shortest survival in our center., Methods: The records of patients with BC who were admitted to Trakya University Faculty of Medicine Department of Medical and Radiation Oncology between July 1999 and December 2019 were reviewed. Patients were divided into four main groups (Luminal A, Luminal B, TNBC, and HER2-enriched) according to the St Gallen International Consensus Panel and four subgroups in accordance with estrogen receptor, progestin receptor and HER2 positivity. Patient characteristics, treatment characteristics and clinical outcomes of the four main subgroups were evaluated. Survival curves were generated using the Kaplan-Meier method, and the significance of survival differences among the selected variables was compared by using the Log rank test. Factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed by Cox regression analysis., Results: Statistical analysis was performed on 2017 patients, after excluding patients with phyllodes tumor, carcinoma-in-situ and missing information from a total of 2474 patients with BC. There were 952 (47.1%) patients in the Luminal A group, 236 (34.1%) in the Luminal B group, 236 (11.7%) in the TNBC group and 142 (7.1%) patients in the HER2 enriched group. HER2-enriched patients had the shortest survival (p < 0.001), with 113.70 ± 7.17 months of DFS and 125.45 ± 3.03 months of OS. For patients who received Herceptin, DFS was 101.50 ± 6.4 months and OS was 118.14 ± 6.16. Patients who did not receive Herceptin had 92.79 ± 18 months of DFS and 94.44 ± 15.23 months of OS., Conclusion: The HER2-enriched subgroup had the worst prognosis despite receiving targeted therapy. While the duration of DFS and OS had no significant difference between TNBC and Luminal A-B subgroups, HER2 enriched subgroup had significantly shorter survival when compared to any other subgroup. HER2-enriched subgroup had a 10-fold greater risk of death compared to the Luminal A subgroup., Competing Interests: The authors declare that they have no conflicts of interest., (© 2022 Cosar et al.)

Background/aim: Exercise enhances endothelium-dependent vasodilation; however, it is unclear whether intermittent exercise has a different effect on vascular endothelial function compared to continuous exercise. This study aimed to compare vascular endothelial function following intermittent exercise including short rest intervals with continuous exercise, both at the anaerobic threshold level., Materials and Methods: Peak oxygen consumption (VO 2 peak) and anaerobic threshold were measured in physically active healthy young men (n = 12) by breath-by-breath analysis. After completion of intermittent exercise consisting of eight 1-min long intervals at the anaerobic threshold intensity with 75-s rest periods, total work was calculated. Equivalent work was done during continuous exercise. Immediately after the two exercise periods, venous blood lactate, endothelial nitric oxide synthase (eNOS), endothelin-1, N-terminal proANP (NTproANP), N-terminal proBNP (NTproBNP), and N-terminal proCNP (NTproCNP) levels were measured. Brachial artery flow-mediated dilatation (FMD) was measured before exercise and 30 min after exercise., Results: Mean VO 2 peak level was 33.42 ± 5.9 ml/min/kg and anaerobic threshold level was 47.33 ± 5.85%. Lactate levels following continuous exercise were higher than levels following intermittent exercise (27.76 ± 7.43 mg/dl, 18.54 ± 4.87 mg/dl respectively; p˂0.05). Endothelin-1, eNOS, NTproANP, NTproBNP, and NTproCNP levels were similar after both modalities of exercise (p > 0.05). No significant difference was found in FMD response when comparing intermittent and continuous exercise (7.05 ± 15.11%, 2.49 ± 16.24% respectively; p > 0.05)., Conclusion: Since blood lactate levels are higher following continuous exercise, individuals who find difficulty exercising may prefer an intermittent form of exercise. However, both intermittent and continuous exercise at the anaerobic threshold level seem to not produce a significant acute change in endothelial function in healthy men., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Selma Arzu Vardar reports financial support and equipment, drugs, or supplies were provided by 10.13039/501100007104Trakya University., (© 2022 The Authors. Published by Elsevier B.V.)

PURPOSE This article will examine the usefulness of diffusion tensor imaging (DTI) and diffusion-weighted imaging (DWI) on the assessment of axillary lymph nodes (ALN) of breast cancer patients. METHODS Axillary lymph nodes in 66 breast cancer patients were examined by DTI and DWI, and the largest lymph node with increased cortical thickness in axilla was selected. Morphological features, apparent diffusion coefficient (ADC), volume anisotropy, and fractional anisotropy values were measured by using a special software. Imaging findings and histopathological results were recorded. RESULTS Metastatic ALN were detected in 43 (65.1%) patients. Cortical thickness of the metastatic ALN was significantly higher than the non-metastatic ALNs (P < .001), and the long-axis-to-shortaxis ratio was significantly lower in metastatic ALNs (P < .001). There was a statistically significant difference between the ALN status and fatty hilum presence (P < .001). Apparent diffusion coefficient values of metastatic ALNs were statistically lower than those of non-metastatic ALNs (P < .001) using a cutoff value of 1.26 × 10-3 mm2 /s for b=500 ADC and 1.21 × 10-3 mm2 /s for b=800 ADC which had 97.7% sensitivity and 91.3% specificity. Fractional anisotropy and volume anisotropy values were significantly different between both groups. A cutoff value of 0.47 for b-500 fractional anisotropy had 83.7% sensitivity, 69.6% specificity 69.6% positive predictive value, and 83.7% negative predictive value. A cutoff value of 0.33 for b=500 volume anisotropy had 76.7% sensitivity, 78.3% specificity, 86.8% positive predictive value, and 64.3% negative predictive value. CONCLUSION Apparent diffusion coefficient value of metastatic ALNs was found to be significantly lower than those of non-metastatic ALN, and DTI metrics of metastatic ALN were found to be significantly higher than those of non-metastatic ALN. Overall, ADC had a better diagnostic performance than morphological features, fractional anisotropy, and volume anisotropy. Diffusion tensor imagingderived diffusion metrics may be used to complement breast magnetic resonance imaging in the future after further standardization of the imaging parameters.

Several studies have reported differences in radiation toxicity between the sexes, but these differences have not been tested with respect to histopathology and genes. This animal study aimed to show an association between histopathological findings of radiation-induced lung toxicity and the genes ATM, SOD2, TGF-β1, XRCC1, XRCC3 and HHR2. In all, 120 animals were randomly divided into 2 control groups (male and female) and experimental groups comprising fifteen rats stratified by sex, radiotherapy (0 Gy vs. 10 Gy), and time to sacrifice (6, 12, and 24 weeks postirradiation). Histopathological evaluations for lung injury, namely, intra-alveolar edema, alveolar neutrophils, intra-alveolar erythrocytes, activated macrophages, intra-alveolar fibrosis, hyaline arteriosclerosis, and collapse were performed under a light microscope using a grid system; the evaluations were semi quantitatively scored. Then, the alveolar wall thickness was measured. Real-time quantitative reverse transcription PCR (RT-qPCR) was used to determine gene expression differences in ATM, TGF-β1, XRCC1, XRCC3, SOD2 and HHR2L among the groups. Histopathological data showed that radiation-induced acute, subacute, and chronic lung toxicity were worse in male rats. The expression levels of the evaluated genes were significantly higher in females than males in the control group, but this difference was lost over time after radiotherapy. Less toxicity in females may be attributable to the fact that the expression of the evaluated genes was higher in normal lung tissue in females than in males and the changes in gene expression patterns in the postradiotherapy period played a protective role in females. Additional data related to pulmonary function, lung weights, imaging, or outcomes are needed to support this data that is based on histopathology alone., (©2022 by Radiation Research Society. All rights of reproduction in any form reserved.)

Background: The noise in an operating room may have a detrimental effect on human cognitive functions, and it may cause perioperative anxiety with prolonged exposure. The aim of this study was to investigate the effects of music therapy and use of earplugs and normal noise level in the operating room under general anesthesia of pediatric patients on hemodynamic parameters and postoperative emergence delirium., Methods: One hundred and five pediatric patients were involved in this study. The patients were randomly divided into three groups. Group N was exposed to the ambient operating room noise, group S received earplugs from an independent anesthesiologist, and group M used a CD player. The preoperative anxiety levels of children were evaluated with the Modified Yale Preoperative Anxiety Scale (M-YPAS). Mean arterial pressure (MAP) and heart rate were recorded at 30-minute periods until the completion of surgery, end of surgery and postoperatively. During each measurement, noise level recordings were performed using sonometer. Pediatric Anesthesia Emergency Delirium (PAED) score was evaluated after postoperative extubation., Results: M-YPAS was similar between groups. The MAP at 30 and 60 min intraoperatively, at end of surgery, and at 5, 10, and 15 min postoperatively was significantly lower in group S than in group N. There were no differences in heart rate among the groups. Postoperative PAED score was not significantly different among the groups., Conclusions: The music therapy was not more effective than silence and operating noise room in reducing PAED score postoperatively in pediatric patients., Trial Registration Number: ClinicalTrials.gov Registry (NCT03544502)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The aim of this study is to investigate of the relationship between GSTM1 gene variations and serum trace elements, plasma malondialdehyde levels in patient with colorectal cancer. Mateials and Methods. Genotype distributions of GSTM1 gene variations were determined using real-time polymerase chain reaction method. Serum trace element levels were determined using atomic absorption spectrophotometer method and plasma MDA levels were measurement by spectrophotometric method., Results: Serum Cu levels, plasma MDA levels and Cu/Zn ratio were determined significantly higher in the group of CRC patient carrying the GA heterozygous genotype of the GSTM1 (rs 112,778,559) gene variation compared to healthy controls (p < 0.05). Serum Cu, Zn levels, plasma MDA levels and Cu/Zn ratio were determined significantly higher in patients carrying GG homozygous genotype of the GSTM1 (rs 112778559) gene variation compared to healthy controls carrying same genotype (p < 0.05). Serum Cu, Zn levels, plasma MDA levels and Cu/Zn ratio were determined significantly higher in the group of CRC patient carrying the GG homozygous genotype of the GSTM1 (rs 12068997) gene variation compared to healthy controls (p < 0.05). On the other hand, serum Se levels were detected significantly lower in CRC patients carrying GA heterozygous and GG homozygous genotypes for GSTM1 (rs 112,778,559) and (rs 12,068,997) gene variations compared to healthy controls (p < 0.05)., Conclusion: In our study, the evaluation of serum Cu, Zn and Se trace element levels and plasma MDA levels according to GSTM1 gene variations genotype distributions were enabled to obtain important biomarkers in terms of CRC development and progression., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objectives: The p-value is commonly misused. We hypothesised that a close cooperation with a statistician would go along with a more proper use of p-values. We considered a close cooperation present, when a statistician was a coauthor, or a formal statistical help was acknowledged in a study report., Methods: Randomised controlled trials published in 2015-16 in 4 widely read rheumatology journals were searched for a close cooperation with a statistician, the inclusion of effect sizes, confidence intervals, exact rather than relative p-values and the omission of p-values in tables depicting trial entry data., Results: There were only 28/133 (21%) articles in which a formal statistical help was acknowledged (Group I). The rest (Group II) gave no acknowledgement of a close cooperation. Reporting of effect sizes (96% vs. 71%) and exact p-values (88% vs. 69%) were more in Group I (p=0.01, and p=0.08, respectively)., Conclusions: While a formal acknowledgement of a close cooperation was notably infrequent at 21%, this went along with improvement in some aspects of p-value reporting. If substantiated by further studies, we propose that a formally acknowledged statistical help should improve p-value reporting. Like all professionals, statisticians would like their name/office to be formally associated with their good work.

Objective: The aim of this study was to investigate the frequency of renal calculi in patients with ankylosing spondylitis (AS) and to determine its relationship with disease assessment variables., Methods: The study was designed retrospectively, and it included a cohort of 320 patients with AS diagnosed using the Modified New York Criteria. A total of 119 patients who underwent renal ultrasonography (USG), in who the erythrocyte sedimentation rate, C-reactive protein, blood calcium, phosphorus, Vitamin D, parathormone, and urinary calcium excretion were measured, and who also had lateral cervical and lumbar radiography in the same time period were extracted from the cohort. All patients' demographic characteristics and the results of blood and urine tests were recorded. The Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Mobility Index (BASMI), and Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) were evaluated in all patients., Results: Thirteen of the 119 patients had renal calculi confirmed by USG data. The frequency of nephrolithiasis detected by USG was 10.9% in patients with AS. The disease lasted significantly longer in patients with renal calculi ([nephrolithiasis (+): 18.39±8.72 years; nephrolithiasis (-): 12.02±8.43 years, p=0.01]). The BASMI total score was significantly higher in the group of patients with renal calculi. There was not any significant difference in terms of blood samples, HLA-B27, BASDAI, BASFI, and mSASSS between groups., Conclusion: The frequency of renal stones is increased in patients with AS compared to healthy population. Especially patients who had AS for a long time and higher BASMI values are more susceptible to renal calculi. It is important to point out that the results of this type of studies would be more reliable if the study is conducted on large patient groups and population-based prevalence., Competing Interests: Conflict of Interest: The authors declare no conflict of interest., (Copyright: © 2019 by Istanbul Northern Anatolian Association of Public Hospitals.)

Objective: This meta-analysis investigates the effect of aromatherapy massage on pain in primary dysmenorrhea., Methods: Randomized controlled trials were searched by keywords in several databases (Pubmed, ISI Web of Sciences, and Google Scholar). Six randomized controlled trials that included 362 participants with primary dysmenorrhea, comparing abdominal aromatherapy massage (n = 184) with massage with placebo oils (n = 178), were analyzed in the meta-analysis. The change in the visual analogue scale (VAS) pain score from the first menstruation cycle to the second cycle at the first menstruation day was used as the primary outcome., Results: Aromatherapy massage with essential oils was superior to massage with placebo oils (standardized mean difference = -1.06 [95% CI: -1.55 to -0.55])., Conclusion: Abdominal aromatherapy massage with essential oils is an effective complementary method to relieve pain in primary dysmenorrhea., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Epilepsy patients whose seizures cannot be controlled by treatment have a lower quality of life (QoL). The aim of the present study was to compare the potential factors affecting the QoL in patients who were seizure-free with medication or who had drug-resistant epilepsy. The study included 46 drug-resistant and 42 seizure-free epilepsy patients. The demographic and clinical features of the patients were investigated for their effects on patient QoL. The QoL was assessed by the QoL in Epilepsy Inventory-89 and depression was detected by the Beck Depression Inventory. The QoL was significantly lower in the drug-resistant patients than in the seizure-free epilepsy patients (p < 0.001). Depression, lower education level, and unemployment were associated with lower QoL scores (p < 0.001, p < 0.01, p < 0.001, respectively). After adjusting for lower education level and unemployment, depression remained as an independent factor affecting QoL (p < 0.05). In addition to their efforts to control and stop seizures, clinicians should remain aware of depression and treat it effectively to improve the QoL of drug-resistant epilepsy patients.

Objectives: To investigate the frequency of Behçet's syndrome (BS) with pulmonary artery aneurysms (PAA) publications, the most lethal complication of BS, as reported from different countries and to provide a review of diagnostic techniques, treatment approaches and prognosis., Methods: Countries from each continent with a population of 4 million and over were chosen (n=128). A PubMed search for "BS, PAA and the country name" was conducted and 23 countries with BS and PAA were identified. The full texts of articles (n=91) were analysed for data including gender, age, accompanying vascular findings, diagnostic techniques, treatment modalities and mortality rates., Results: A total of 207 (183 males, 24 females) patients with BS and PAA were reported in 91 articles originating from 23 countries. As expected there was a significant correlation (r=0.88, p<0.001) between the total number of articles about BS (n=4431) and those related to PAA and BS. In a simple linear regression analysis the number of BS and PAA articles from Japan was significantly below the identity line while in Turkey there was a propensity to publish more articles related to PAA than expected. One hundred and sixteen patients (56%) were treated with immunosuppressive therapy. Biologics were used only in 5 patients (2%). Of the 207 patients, 62 (30%) died., Conclusions: PAA is mostly reported as case reports from countries where BS is common. PAA might be uncommon in Japan. The prognosis of PAA could be getting better.

Prophylactic lymph node dissection is still controversial due to the potentially surgery-related morbidity in management of papillary thyroid carcinomas. So, some histopathological predictors for lymph node metastasis in thyroidectomy specimens may reveal importance. The objective of this study was to define histomorphological indicators of lymph node metastasis in the patients who had been performed thyroidectomy without lymph node dissection. Clinicopathological features of patients archived in Department of Pathology at Trakya University Medical Faculty were reviewed. A total of 211 patients who had been diagnosed as papillary carcinoma and had been performed total thyroidectomy/lobectomy with central/cervical lymph node dissection were included in the study. Clinical features (age, gender, preoperative/postoperative clinical, and laboratory findings) and histopathological features (histological variant, tumor size, focality, extrathyroidal extension, tumor border, lateral tubular growth, intraglandular dissemination, stromal and lymphocytic tumor response, lymphocytic thyroiditis, lymphovascular invasion, lymph node metastasis, number of metastatic lymph nodes, extranodal extension, size of the metastatic foci) were evaluated. Male gender, conventional variant, tumor size greater than 10 mm, multifocality, extrathyroidal extension, lateral tubular growth, intraglandular dissemination, lymphocytic and stromal tumor response, and absence of lymphocytic thyroiditis were predictive, and older age (≥45 years) and follicular variant PTC were protective for lymph node metastasis. In order to optimize the management of papillary thyroid carcinomas, pathologists should search for the clues of lymph node metastasis particularly intraglandular dissemination, lateral tubular growth, tumor border and lymphocytic/stromal tumor response, multifocality, concomitant lymphocytic thyroiditis besides the actual prognostic criteria especially in younger aged male patients.

The goal of this study was to evaluate the efficacy of CA-125 area under the curve (CA-125 AUC) as a prognostic factor following surgical treatment for ovarian cancer patients. A retrospective analysis was conducted on ninety-five patients with ovarian cancer who had primary treatment in a tertiary center between 2000 and 2010. After either optimal or cytoreductive surgery, all patients underwent adjuvant chemotherapy. CA-125 AUC was calculated for each patient that had a minimum of three CA-125 serum measurements during the treatment period. The mean age at diagnosis and mean survival were 53.9 years (range, 16-75 years) and 35.6 ± 22.9 months (range, 3.1-95.4 months), respectively. The mean (and median) CA-125 AUC of patients of FIGO stages I, II, III, and IV was 53.0 (42.5), 58.06 (58.06), 97.8 (54.6), and 405.2 (149.3) IU/ml day, respectively (p = 0.004). The mean CA-125 AUC was 57.7, 410.1, and 636.3 IU/ml day for patients with a complete response, partial response, and no response/progressive disease to first-line chemotherapy, respectively (p < 0.001). The CA-125 AUC cut-off level for an overall survival of ≥5 years was 99.75 IU/ml day with a sensitivity of 90.9 % (95 % CI, 70.8-98.6) with 1.27 as positive likelihood ratio. Patients who suffer from ovarian cancer, with a lower CA125 AUC, have a better overall survival than those with a higher CA125 AUC. CA-125 AUC could be used as an independent factor for evaluating the treatment efficacy and chemotherapy response.

Objectives: The aim of the study was cultural adaptation, validation, and test for responsiveness of the short forms of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7) in a Turkish population., Study Design: To evaluate their validity, questionnaires were applied to 248 women. The questionnaires were compared with prolapse stage according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The responsiveness of the questionnaires was assessed in 103 women with prolapse who also completed the questionnaires after reconstructive surgical treatment, with standardized response mean (SRM), effect size (ES), and the Wilcoxon signed-rank test., Results: Cronbach alpha coefficients of the Turkish PFDI-20 and PFIQ-7 questionnaires were 0.908 and 0.830, respectively. Significant correlations were observed between the scores of the questionnaires with the vaginal examination findings. The PFDI-20 and PFIQ-7 scores were significantly improved after vaginal reconstructive surgery., Conclusions: Turkish translated versions of the PFDI-20 and PFIQ-7 are reliable, valid and responsive instruments for assessing symptom severity, impact on QoL in women with pelvic organ prolapse. They can be easily administered and self-completed by Turkish women., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

We aimed to compare the protective effect of L-carnitine (CAR) and amifostine (AMF) against cisplatin (CDDP)-induced nephrotoxicity through biochemical markers and histopathological evaluation. Fifty-seven Wistar albino male rats were randomly classified into six groups, which were AMF+CDDP (n = 11; 200 mg/kg AMF 30 min prior to 7 mg/kg CDDP), CAR+CDDP (n = 11; 300 mg/kg CAR 30 min prior to 7 mg/kg CDDP), CDDP (n = 11; 1 mL/kg isotonic saline 30 min prior to 7 mg/kg CDDP), AMF (n = 8; 200 mg/kg AMF alone), CAR (n = 8; 300 mg/kg CAR alone), and control (n = 8; 1 mL/kg isotonic saline alone). All drugs were given intraperitoneally. Five days after medication, animals were killed, and samples of blood and kidney tissues were collected for biochemical and histopathological evaluation. The serum urea level was highest in AMF+CDDP group among CDDP-applied groups without statistical significance (median, range: 88, 56-21 mg/dL; P > 0.05). There was no statistical significance among CDDP-applied groups in terms of creatinine level (P > 0.05). In the AMF+CDDP group, the median glomerular, tubular, and tubulointerstitial inflammatory damage scores were significantly higher than the other CDDP-applied groups (P < 0.001). The difference between CAR+CDDP and CDDP groups was not statistically significant in terms of renal damage scores. AMF+CDDP group had significantly higher median total nephrotoxicity score than all the other groups (P < 0.001). To conclude, AMF or CAR has no protective effect on CDDP-induced nephrotoxicity. Furthermore, our findings suggest that application of AMF before CDDP may enhance CDDP-induced nephrotoxicity histopathologically.

Objective: To investigate the relation of Mallampati classification with a new alternative method suggested for use in the estimation of tongue movements., Methods: This study was conducted in the Department of Anesthesiology, Faculty of Medicine, Trakya University, Edirne, Turkey from April to October 2009. Two hundred and thirty patients were enrolled in this study. The modified Mallampati score (MMS) was devised by an anesthetist. To define tongue movements, horizontal and vertical lines were utilized. Horizontal lines passing through the mid points of the upper lip and mandible, and vertical lines passing through the right and left infraorbital points were constituted on each subject. Subjects were asked to elevate, depress, and abduct (right-left) the tip of the tongue. The scores corresponding with the movements of the tongue were determined., Results: Depression of the tip of the tongue (DTT) and elevation of the tip of the tongue (ETT) levels were significantly different between MMS 1, MMS 2, and MMS 3, MMS 4 groups (p=0.001). The risk of being MMS 3 or MMS 4 for the groups that cannot reach the borderline for the DTT or ETT are 5.5 times and 5.4 times higher consequently than the groups that can reach the borderline., Conclusion: This new method can be combined with MMS classification, which requires clinical experience and knowledge in predicting difficult intubation.

Background: This study assessed the analgesic efficacy, side effects, and time to extubation of intravenous paracetamol when administered as an adjuvant to intravenous meperidine after major surgery in intensive care unit (ICU)., Material: Patients were randomized postoperatively into 2 groups in ICU. Patients received either 100 mL of serum saline intravenous (IV) every 6 hours and IV meperidine (n = 20 group M) or IV paracetamol 1 g every 6 hours and IV meperidine (n = 20, group MP) into a peripheral vein for 24 hours. Behavioral Pain Scale (BPS) is used until extubation, and visual analog score (VAS) is used after extubation. When BPS and VAS values were more than 4, meperidine, 1 mg/kg IV, was administered and noted in 2 groups. Pain scores, total meperidine consumption, time to extubation, sedation scores, and side effects are 24-hour postoperatively noted., Results: Behavioral Pain Scale and VAS scores are significantly lower in group paracetamol-meperidine at 24 hours (P < .05). In group MP, postoperative meperidine consumption (76.75 ± 18.2 mg vs. 198 ± 66.4 mg) and extubation time (64.3 ± 40.6 min vs. 204.5 ± 112.7 min) were lower than in group M (P < .01). In addition to, postoperative nausea-vomiting and sedation scores were significantly lower in group MP when compared with group M (P < .05)., Conclusion: We have demonstrated important clinical benefits by the addition of 4 g/d of paracetamol to meperidine after major surgery. This benefit has been shown in a range of patients under routine clinical conditions and therefore has important practical consequences in ICU. These data suggest that intravenous paracetamol is a useful component of the multimodal analgesia model, especially after major surgery., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: Sepsis is the most frequent infection with high mortality rates in intensive care units (ICUs), and the prediction of outcome is important in the decision-making process., Objective: To assess the value of the Acute Physiology and Chronic Health Evaluation II (APACHE II) and indocyanin green (ICG) plasma disappearance rate (ICG-PDR) in septic patients., Design: Retrospective analysis., Measurements and Results: We analyzed 40 septic patients (17 female and 23 male; age range, 20-89 years) who were treated in our ICU. The ICG-PDR measurement and APACHE II score measurement were made within 24 hours after admission to the ICU. Indocyanine green elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON, Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg ICG was given through a cubital fossa vein as a bolus., Results: Statistical analysis showed that ICG-PDR was significantly lower in nonsurvivors (n = 18) than in survivors (n = 22) (mean, 12.1% +/- 7.6%/min; median, 9%/min, vs mean, 21.2% +/- 10.1%/min; median, 20%/min, respectively [P = .004]). The area under the curve as a measure of accuracy was 0.765 for ICG-PDR and 0.692 for APACHE II. Mortality was 80% in patients with ICG-PDR below 8% per minute, and survival was approximately 89% in patients with ICG-PDR above 24% per minute., Conclusion: The results suggest that ICG-PDR, assessed with a user-friendly noninvasive bedside LiMON device, is a good predictor of survival in septic patients. Sensitivity and specificity of the noninvasive measurement of ICG-PDR on ICU admission was comparable to that obtained by APACHE II scores.

Background: Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition associated with obesity and insulin resistance (IR). Leptin plays a key role in the control of energy balance, and insulin sensitivity. In this study, we aimed to examine whether serum leptin levels correlate with insulin resistance, oxidative stress parameters and the severity of histological changes in NAFLD., Methods: Fifty-two patients (M/F: 28/24) with no alcohol intake and biopsy-proven diagnosis of NAFLD were studied. Serum leptin levels were measured by radioimmunoassay. HOMA (homeostasis model assessment) IR index was calculated. Comparisons between the patients with NAFLD and non-alcoholic steatohepatitis (NASH) were performed using the Student's t test. Multivariate regression analysis and the area under the receiver operating characteristic (ROC) curve were used to identify the independent predictors for NASH., Results: We found no association between serum leptin, fasting insulin levels, and oxidative stress parameters. ROC curve and multiple regression analysis revealed no association between the severity of histological changes and serum leptin levels. During six months followed-up period only NASH group with elevated leptin levels had significant reductions of ALT and AST values (p = 0.03, and 0.005, respectively)., Conclusion: Our findings show a preventive effect of leptin against progressive liver injury in NAFLD.

Background and Aim: Delta hepatitis is characterized by rapidly progressive liver disease with adverse prognosis in most patients. Patients benefit from high doses and prolonged courses of interferon (IFN) therapy; however, lamivudine as a single agent has been disappointing. Data relating to the efficacy of IFN and lamivudine in combination is limited. The aim of this study was to test the efficacy of IFN-alpha 2b and lamivudine combination treatment in comparison to IFN-alpha 2b alone in patients with chronic delta hepatitis., Methods: Twenty-six patients with chronic delta hepatitis were randomized into two groups. Twelve patients received IFN-alpha 2b alone (eight men, four women; mean +/- SD age: 43.83 +/- 8.57 years), and 14 patients received IFN-alpha 2b plus lamivudine combination (seven men, seven women; mean +/- SD age: 42.5 +/- 11.02 years). The dose of IFN-alpha 2b was 10 MU t.i.w. and of lamivudine was 100 mg/day. The groups were comparable in reference to serum alanine aminotransferase (ALT), aspartate aminotransferase, bilirubin, albumin levels, histological activity and stage. Four patients (33.3%) in the IFN group and two (14.3%) in the combination group had cirrhosis (P = 0.2). The duration of treatment was 48 weeks with an untreated follow-up period of at least 96 weeks (mean +/- SD, 3.1 +/- 1.9 years). A liver biopsy was performed at the end of treatment., Results: Eight patients from the IFN group and 11 from the combination group completed treatment. Serum ALT values became normal in 8/14 patients (57.1%) treated with IFN plus lamivudine and in 5/12 patients (41.7%) treated with IFN alone (P = 0.43). Serum hepatitis delta virus RNA was no longer detectable in nine of 14 (64.3%) patients treated with IFN plus lamivudine as compared to five of 12 (41.6%) patients treated with IFN alone (P = 0.024). In both groups female patients had significantly better virological response rate (P = 0.007). There was a significant improvement in histological activity in the combination group (mean decrease 5.27 +/- 1.08 score, P = 0.001), but not in the IFN group (mean decrease 1.44 +/- 1.59 score, P = 0.39). No significant improvement was observed in regards to fibrosis. Four of the 14 patients (28.6%) treated with combination therapy as compared to two of 12 patients treated with IFN (16.7%) were sustained virological responders (P = 0.47). The 5-year survival rate was 65% in the IFN group and 85% in the combination group (P > 0.05)., Conclusion: Interferon and lamivudine in combination is an encouraging treatment method and may be superior to IFN alone in chronic delta hepatitis.