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Human low-molecular weight salivary mucin (MUC7) is a small, secreted glycoprotein coded by MUC7. In the oral cavity, they inhibit the colonization of oral bacteria, including cariogenic ones, by masking their surface adhesions, thus helping saliva to avoid dental caries. The N-terminal domain is important for low-molecular weight (MG2) mucins to contact with oral microorganisms. In this study, we aimed to identify the N-terminal coding region of the MUC7 gene between individuals with and without caries. Forty-four healthy dental students were enrolled in this study; 24 of them were classified to have caries [decayed, missing, filled-teeth (DMFT) = 5.6] according to the World Health Organization (WHO) criteria, and 20 of them were caries-free (DMFT = 0). Simplified oral hygiene index (OHI-S) and gingival index (GI) were used to determine the oral hygiene and gingival conditions. Total protein levels and salivary total protein levels and salivary buffer capacity (SBC) were determined by Lowry and Ericsson methods. DNA was extracted from peripheral blood cells of all the participants and genotyping was carried out by a polymerase chain reaction (PCR)-sequencing method. No statistical differences were found between two groups in the terms of salivary parameters, oral hygiene and gingival conditions. We detected one common single nucleotide polymorphism (SNP) that leads to a change of asparagine to lysine at codon 80. This substitution was found in 29.0 and 40.0%, respectively, of the groups with and without caries. No other sequence variations were detected. The SNP found in this study may be a specific polymorphism affecting the Turkish population. Further studies with extended numbers are necessary in order to clarify this finding.

Jiska M Balk,1 Guido RMM Haenen,1 Özgür M Koc,2 Ron Peters,3 Aalt Bast,1 Wim JF van der Vijgh,1 Ger H Koek,4 1Department of Toxicology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, 2Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 3DSM Resolve, Geleen, 4Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands Background: The combination of ribavirin (RBV) and pegylated interferon (PEG-IFN) is effective in the treatment of chronic hepatitis C infection. Reducing the frequency of RBV intake from twice to once a day will improve compliance and opens up the opportunity to combine RBV with new and more specific direct-acting agents in one pill. Therefore, the purpose of this study was to evaluate the pharmacokinetic profile of RBV in a once-daily to twice-daily regimen. The secondary aim was to determine tolerability as well as the severity and differences in side effects of both treatment regimens. Methods: In this randomized open-label crossover study, twelve patients with chronic type 1 hepatitis C infection and weighing more than 75 kg were treated with 180 µg of PEG-IFN weekly and 1,200 mg RBV daily for 24 weeks. The patients received RBV dosed as 1,200 mg once-daily for 12 weeks followed by RBV dosed as 600 mg twice-daily for 12 weeks, or vice versa. In addition to the pharmacokinetic profile, the hematological profile and side effects were recorded. The RBV concentrations in plasma were determined using liquid chromatography-tandem mass spectrometry. Results: Eight of twelve patients completed the study. Neither the time taken for RBV to reach peak plasma concentration nor the AUC0-last (adjusted for difference in dose) was significantly different between the two groups (P>0.05). Furthermore, the once-daily regimen did not give more side effects than the twice-daily regimen (P>0.05). No significant differences in the hematological profile were observed (P>0.05). Conclusion: The standard twice-daily RBV regimen is interchangeable with the once-daily regimen. The once-daily regimen will improve compliance and opens the opportunity to combine RBV with other drugs dosed once a day, in a single pill. Keywords: hepatitis C, dose regimen, ribavirin, pegylated interferon

Aim: The aim of this study was to investigate the pulmonary magnetic resonance angiography (MRA) imaging findings in Swyer- James syndrome (SJS) as a alternative imaging modalities. Methods: Thirteen patients had posteroanterior inspiratory/expiratory chest X-ray films and pulmonary MRA with SJS (6 males, 7 females) were retrospectively studied. Gradient-echo pulmonary MRA was performed in all patients with a 1.5 T MR unit. MRA imaging was performed in a single breath-hold during the injection of contrast media. Image analysis of the patients was performed. The results of pulmonary artery diameters and pulmonary peripheral vasculature were compared between normal sides versus the affected sides. Statistical analysis was performed with the Student t test. Results: The smaller pulmonary artery on the affected side with poor peripheral vasculature was observed with gadolinium-enhanced gradient-echo MRA in all patients. There was a significant difference between the diameters of the pulmonary arteries of the normal versus the disease sides (p< 0.0005). Conclusion: MRA successfully depicted the small pulmonary artery with diminished peripheral vasculature in patients with SJS. This study showed the pulmonary MRA imaging could be used as a alternative imaging modalities in the evaluation of patient with SJS. [ABSTRACT FROM AUTHOR]

There are few documented cases of bradycardia or asystole occurring during Onyx embolization of intracranial dural arteriovenous fistulas (DAVFs), although these events are more commonly observed in open neurosurgical procedures, particularly those involving the skull base. We present a case treated for a ruptured paramedian occipital DAVF. During the administration of Squid into the middle meningeal artery, while balloons were inflated in the large occipital arteries bilaterally to control the flow during embolization of the DAVF, the patient experienced an abrupt episode of sinus bradycardia, which recurred after a second injection of Squid. After temporarily halting the injections and deflating the balloons, a third injection was successfully administered without complications, allowing total exclusion of the fistula.

Introduction: The "All-on-four" technique addresses this by placing two vertical implants in the anterior region and two posterior implants angled up to 45°. This study evaluates stress distribution on bone, implants, abutments, gingiva, and prostheses based on posterior implant angulation, using both standard and angled neck implants. Additionally, angled neck implants were used alongside standard implants., Methods: To evaluate the biomechanical stress and displacement behavior of implants placed at 15°, 30°, 45°, and 30° neck-angled in the interforaminal region of using the All-on-four technique, under a 200 N masticatory force on bone, implant, abutment, and prosthesis, using the FEA method with a nonlinear solver., Results: The stress values measured in the neck region of the angled implant and abutment placed in the distal region were highest in model IV (305 and 420 MPa), followed model III (282 and 359 MPa), model II (192 and 337 MPa) and lowest in model I (177 and 225 MPa), respectively. The mean elemental von Mises stress in the mandibular bone region where the implant was placed was highest in model I (56 MPa) and lowest in model III (40.4 MPa)., Conclusion: As the angle of insertion of the implant into the bone increases, the biomechanical stress value on the implant and abutment also increases. Among the models, the lowest von Mises stress values on the implant and abutment were measured in model I and model II. Models with low stress values can be recommended for patients with clinical conditions and biomechanical risk factors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Lenalidomide and rituximab (R 2 ) is an effective frontline treatment for patients with indolent B-cell non-Hodgkin lymphoma (iNHL). We investigated the safety and efficacy of addition of the proteasome inhibitor ixazomib to R 2 for treatment of iNHL through a phase I/II clinical trial for high-risk patients. Twenty patients were enrolled, 18 were treated. The target dose of ixazomib 4 mg weekly was achieved during dose escalation. The most common treatment-related adverse events (AEs) were low grade gastrointestinal, rash, neuropathy, and myalgia/arthralgia. There were 33% grade 2 and 17% grade 3 infections. With median follow-up of 5.2 years, four patients discontinued treatment due to lymphoma progression. Best overall response rate (ORR) was 61.2% [55.6% CR, 5.6% PR): 22.2% had stable disease and 16.7% had disease progression. Kaplan-Meier estimates of progression free and overall survival (OS) were 73% and 87% at 36 months, respectively. R 2 can safely be combined with ixazomib for treatment-naïve iNHL patients.

Background: Flow diversion is an innovative and increasingly used technique for the treatment of intracranial aneurysms. New flow diverters (FDs) are being introduced to improve the safety and efficacy of this treatment. The aim of this study was to assess the safety, feasibility, and efficacy of the new Pipeline Vantage (PV) FD., Methods: Patients with intracranial aneurysms treated with the PV at 10 international neurovascular centers were retrospectively analyzed. Patient and aneurysm characteristics, procedural parameters, complications, and the grade of occlusion were assessed., Results: 60 patients with 70 aneurysms (5.0% with acute hemorrhage, 90.0% located in the anterior circulation) were included. 82 PVs were implanted in 61 treatment sessions. The PV could be successfully implanted in all treatments. Additional coiling was performed in 18.6%, and in-stent balloon angioplasty (to enhance the vessel wall apposition) in 24.6%. Periprocedural technical complications occurred in 24.6% of the treatments, were predominantly FD deployment problems, and were all asymptomatic. The overall symptomatic complication rate was 8.2% and the neurological symptomatic complication rate was 3.3%. Only one symptomatic complication was device-related (perforator artery infarctions leading to stroke). After a mean follow-up of 7.1 months, the rate of complete aneurysm occlusion was 77.9%. One patient (1.7%) died due to aneurysmal subarachnoid hemorrhage which occurred before treatment, unrelated to the procedure., Conclusions: The new PV FD is safe and feasible for the treatment of intracranial aneurysms. The short-term occlusion rates are promising but need further assessment in prospective long-term follow-up studies., Competing Interests: Competing interests: DFV has received travel support outside this work from MicroVention and Stryker GmbH & Co. KG. SC is shareholder of NDI Technologies and Vesalio LLC, non-paid member of Siemens Senior Advisory Board, and reports consultancy proctorship agreements with Medtronic and MicroVention. IS reports consultancy and proctorship agreements with Medtronic and MicroVention, and is Associate Editor for JNIS. RR is consultant for Stryker Neurovascular, Medtronic, MicroVention and Acandis. MMG is consultant and proctor for Medtronic. VMP is consultant for Medtronic. MB reports board membership: DSMB Vascular Dynamics; consultancy: Roche, Guerbet, Codman; grants/grants pending: DFG, Hopp Foundation, Novartis, Siemens, Guerbet, Stryker, Covidien; payment for lectures (including service on speakers bureaus): Novartis, Roche, Guerbet, Teva, Bayer, Codman. MM has received consulting honoraria, speaker honoraria, and travel support outside this work from Codman, Covidien/Medtronic, MicroVention, Phenox, and Stryker., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Awareness of risk factors for asthma exacerbation can reduce the morbidity and mortality of the disease. The current study aimed to investigate the risk factors associated with current asthma exacerbations in school-age children., Methods: This study enrolled children who were admitted to a tertiary outpatient paediatric allergy and asthma department and were diagnosed with asthma. Patients and their caregivers underwent an interviewer-administered questionnaire, which obtained information regarding the demographic features and parameters to determine environmental exposures along with previous disease history. Laboratory examinations, including complete blood count with differential, total IgE levels, skin prick tests, and pulmonary function tests, were also performed., Results: A total of 431 children (288 male, 66.8%) with a median age (interquartile range) of 8.1 (6.3-11.2) years were included, among whom 265 (61.5%) had aeroallergen sensitization. Asthma was controlled, partially controlled, and uncontrolled in 154 (35.7%), 53 (12.3%), and 143 (33.2%) patients, respectively. A total of 81 patients (18.8%) experienced asthma exacerbation. Multivariate logistic regression analysis revealed that a history of asthma exacerbation within the last year (odds ratio [confidence interval]) (20.73 [9.95-43.20]; p < 0.001), a shorter asthma duration (<2.5 years) (2.58 [1.44-4.61]; p = 0.001), and a lack of regular controller therapy (4.12 [1.54-10.98]; p = 0.005) were associated with current asthma exacerbation., Discussion/conclusion: Awareness of risk factors for asthma exacerbation may help physicians treat school-age children with asthma by providing prompt and rational interventions in order to prevent asthma exacerbations., (© 2022 S. Karger AG, Basel.)

Background and Aims: The aim of the present study was to determine incident cases of extrahepatic malignancy in patients with nonalcoholic fatty liver disease (NAFLD) and to identify whether the factors are associated with cancer development., Methods: Between 15 January 2001 and 14 March 2021, a total of 1365 patients had been diagnosed with NAFLD were enrolled in the study., Results: The median follow-up period was 59.5 months. The mean age was 50.9 ± 10.9 years. The female gender was predominant (57%). During the follow-up period, 62 extrahepatic malignancies and 11 hepatocellular carcinomas were identified. Of all extrahepatic malignancies, 51 were solid organ malignancies and 11 were hematological malignancies. Female breast cancer was the most frequent (25.8%), followed by thyroid cancer (19.4%), lymphoma (12.9%), and lung cancer (9.7%). In univariate and multivariable analyses, after adjusting for age and sex, the presence of diabetes and high initial baseline gamma glutamyl transpeptidase (GGT) levels were significantly associated with the development of extrahepatic malignancies [hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.04-3.20, P = 0.036] and HR = 1.96, 95% CI: 1.14-3.38, P = 0.015, respectively). In 424 biopsy-proven NAFLD patients, the development of extrahepatic cancer was significantly associated with the severity of hepatic fibrosis (HR = 3.31, 95% CI: 1.36-8.07; P = 0.008)., Conclusion: Extrahepatic malignancies are frequently seen in patients with NAFLD. Diabetes mellitus, high baseline GGT levels, and significant hepatic fibrosis are associated with the development of extrahepatic cancer in patients with NAFLD., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Many children encounter unusual or "exaggerated" reactions such as large local, atypical or systemic reactions after mosquito bites., Objective: The aim of this study was to document the clinical features of children with mosquito allergy and investigate the possible associations between demographic features and type of reactions in this population., Methods: Children with large local or unusual reactions after mosquito bites who attended to our outpatient pediatric allergy department were enrolled in the study along with control subjects., Results: A total of 180 children (94 with mosquito allergy and 86 age and sex-matched control subjects) with a median age of 6.8 years (IQR 5.5-9.3) were enrolled. Atopy (35.1% vs. 11.6%, p < 0.001) and grass pollen sensitization (28.7% vs. 8.1%, p < 0.001) were significantly more frequent in children with mosquito allergy. Skin prick test with mosquito allergen was positive in only 6 children (6,4%). Grass pollen sensitization was most common in children (28.7%) followed by sensitization to house dust mite (9.6%). 30 children (31.9%) had an accompanying atopic disease such as allergic rhinitis, asthma or atopic dermatitis. Bullae were significantly more frequent in children with asthma (41.7% vs.15.9, p = 0.034). The median duration of symptoms after onset were significantly longer in patients with ecchymosis, with immediate wheals and in children whose symptoms start in 20 min to 4 hours after mosquito bites., Conclusion: There is an association between unusual, large local or exaggerated reactions after mosquito bites and allergic diseases in children. The severity of reactions increases with age and particularly in children with atopic background., Competing Interests: The authors declare no potential conflicts of interest with respect to research, authorship, and/or publication of this article.The authors warrant that the article is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by any other journal, and has not been previously published.The authors confirm that they have reviewed and approved the final version of the manuscript. The requirements for authorship have been met by each listed author.

Purpose: The aim was to evaluate the effectiveness of bacterial cellulose membrane (BCM) in preventing fibrosis in trabeculectomy and the biocompatibility of BCM with conjunctiva and sclera., Materials and Methods: Twenty-one eyes of 21 adult rabbits underwent fornix-based trabeculectomy. Standard surgery was done to control group (CG, n=7). Mitomycin-C (MMC) (0.3 mg/mL, 3 min) was applied to MMC group only (MMCG, n=7). BCM (~100 µm thick, 10×10 mm, single layer) was covered on the sclerotomy area before conjunctiva was closed in BCM group (BCMG, n=7). Intraocular pressures (IOP) were measured before, and 7, 14, 28, and 45 days after surgery (IOP-POD7, POD14, POD28, POD45). The IOP decrease were expressed as DIOP%-POD7, DIOP%-POD14, DIOP%-POD28, and DIOP%-POD45. The rabbits were sacrificed on the 45th day. Conjunctival vessel number, degrees of fibrosis, total inflammation, foreign body reaction, inflammatory cell types (B cells, T cells, plasma cells), macrophages, bleb spaces and the expression of α-smooth muscle actin were studied using histopathology and immunohistochemistry techniques. The groups were compared using nonparametric tests., Results: There was no statistically significant difference between the groups regarding baseline IOP and DIOP%-POD7 (P>0.05). While DIOP%-POD14, 28 and 45 were similar between BCMG and MMCG, they were significantly lower in CG (P<0.05). The lowest conjunctival vessel number was detected in the MMCG but the difference was not significant. There was no difference between BCMG and CG with regard to the numbers of B cells, T cells, and macrophages, however, these cells were significantly lower in MMCG (P<0.05). Five cases had mild and 2 cases had moderate foreign body reaction in the BCMG. There was mild to moderate inflammation in all BCM cases. While fibrosis and α-smooth muscle actin staining were higher in the CG (P<0.001), they were minimal in the BCM and MMCGs., Conclusions: BCM showed good biocompatibility and provided better control of IOP with minimal fibrosis at the trabeculectomy site compared with the control group., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity worldwide. The aim of this study was to reveal the trend in direct costs related to COPD between 2012 and 2016, and to evaluate hospital costs in 2016, together with their subcomponents., Material and Methods: A population-based descriptive study was conducted using administrative healthcare data in Turkey. The total direct cost of COPD diagnosis-treatment for each year from 2012 to 2016, was calculated. The distribution of the hospital's COPDrelated costs for the year 2016 was also examined, together with morbidity data., Results: The direct costs of the patients who were admitted to step 1, step 2, and step 3 health care centers between 2012 and 2016 increased by 41% [895 041 403TL ($496 930 501) in 2012 to 1 263 288 269TL ($417 834 197) in 2016]; the increase was 60% and 24%, for inpatient and outpatient groups respectively. In the year 2016, the direct total cost was 1003TL ($332) per patient. In 2016, mean specialist consultations per patient with mean cost per specialist consultation, and mean emergency visits per patient with mean cost per emergency visit, were 1.7, 42 TL ($14), and 0.4, 71TL ($23) respectively. For the inpatient group, the mean number of hospitalizations per patient, mean number of hospitalization days, and the mean cost per hospitalization were 0.4, 6.5, and 1926TL ($637), respectively., Conclusion: When the readmissions of patients with COPD were evaluated together with the costs, and compared with the statistics from other countries, it was found that the costs per patient were lower in Turkey. However, the reasons for the significant rise in inpatient costs compared to outpatient costs should be investigated. Further investigations are required regarding pulmonary rehabilitation, home health care services, preventive measures for infections, management of comorbidities, and treatment optimization, which may reduce hospitalizations.

Purpose: Our aim was to determine the long-term safety and efficacy of the Flow Re-Direction Endoluminal Device (FRED) in this multicenter study with prospective design., Materials-Method: This study included 136 consecutive patients with 155 aneurysms treated between March 2013 and June 2016 in 10 centers. Twenty-two (16.2%) patients presented with rupture of the index aneurysm. Large/giant aneurysms comprised 1/3 of the cohort. Adjuvant coil use during the treatment was 15.5%. The effectiveness measure in the study was the percentage of aneurysms with stable occlusion at follow-up., Results: Vascular imaging follow-up was performed at least once in 131/136 (96.3%) patients with 148/155 (95.5%) aneurysms up to 75 months (mean: 37.3 months; median: 36 months according to latest follow-up), and 102/155(65.8%) aneurysms in 90/136 (66.2%) patients had ≥ 24-month control. According to the latest controls, the overall stable occlusion rate was 91.9% (95% CI, 87.5 to 96.3%). Three out of 148 aneurysms with follow-up were retreated (2%, 95% CI 0.0 to 4.3%). Adverse events were noted in 19/136 (14%, 95% CI, 9 to 21%) patients with a morbidity of 1.5% (95% CI, 0.0 to 3.5%). Mortality was 1/136 (0.7%, 95% CI, 0.02 to 2.2%) and was unrelated to aneurysm treatment. In-stent stenosis (ISS) was detected in 10/131 of the patients with follow-up (7.6%, 95% CI; 3.1 to 12.2%), only one being symptomatic. No adverse events have occurred in any of the patients with follow-up after 24 months, except the one resulting from ISS., Conclusion: In the treatment of cerebral aneurysms which were candidates for flow diversion technique, this study showed long-term efficacy of FRED with good safety and occlusion rates.

The aim of this study was to investigate whether the expression levels of endometrial NFκB p65 differ between normal weight and overweight PCOS women and to compare them with BMI-matched control subjects without PCOS. The study group comprised 20 normal weight (BMI: 18.5-24.9 kg/m 2 ) and 15 overweight PCOS women (BMI: 25-29.9 kg/m 2 ) with infertility. Healthy fertile women without PCOS were recruited as the control group. The patients in the normal weight PCOS group and control group were age and BMI-matched. Endometrial samples were obtained during the mid-luteal phase for immunohistochemical staining. The H-Score method was used to evaluate NF-κB p65 (Rel A) expression. Both normal and overweight PCOS women demonstrated significantly higher endometrial NF-κB p65 expression than the women without PCOS. The H-scores of endometrial NF-κB p65 expression were similar in both groups of PCOS women. NF-κB p65 was positively correlated with serum insulin, HOMA-IR and total testosterone levels in PCOS women. By leading to pathological inflammation, an increase in NF-κB p65 expression in the endometrium of normal and overweight PCOS women may contribute to PCOS-related subfertility. Impact statement What is already known on this subject: Although the pathogenesis of PCOS has not yet been clarified, low-grade chronic inflammation is gradually being established as an important pathogenetic factor. Increased levels of inflammatory cytokines such as IL-6 and TNF-α have been reported in women with PCOS. Causes of pathological endometrial inflammation may arise from either a local endometrial disease or linked to diseases which are located in a distant reproductive tissue. Nevertheless, possible role of endometrial NF-κB, basic cellular regulatory of inflammation, in the pathophysiology of PCOS related implantation defect has not been elucidated yet. What do the results of this study add: This study provides first and novel insights into the relationship between PCOS related infertility and pathological endometrial inflammation. We demonstrated that there is a close association between PCOS and pathological endometrial inflammation. Moreover, we clearly showed that pathological endometrial inflammation occurs in both normal and overweight women with PCOS. Further, endometrial NF-κB p65 (Rel A) expression were found to be positively correlated with serum insulin levels and hyperandrogenism in overweight PCOS women. What are the implications of these findings for clinical practice: If we can analyse pathological endometrial inflammation by measuring endometrial NF-κB p65 (Rel A) expression, treatment could be directed towards eliminating the source of pathological endometrial inflammation.

As with other organs endometrial functions are altered with the advancing age. Age related decrease in reproductive functions leads to decline in the number of oocytes retrieved and the synthesis of endometrial receptivity molecules. Despite the significant improvement in assisted reproductive technologies we do not have so many options to enhance endometrial receptivity. Due to lack of drugs having endometrium receptivity enhancement properties, oocyte donation seems to be the only solution for women with implantation failure. The euploid oocytes come from young and healthy donors may overcome age associated endometrial receptivity defect. Nevertheless, many reasons restrict us from using oocyte donation in women with implantation failure. We, therefore, hypothesized that by mimicking a young blastocyst's effect on endometrium, the transfer of genuine embryos and implantation-promoting compounds together might be the new treatment option for infertile women with recurrent implantation failure. Artificial beads, MI or GV oocytes, and empty zona can be used as a container for intrauterine replacement of implantation-promoting compounds., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts., Methods: Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates., Results: Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374)., Conclusion: This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.

Behcet's disease is a multisystemic vasculitis of unknown etiology with a chronic relapsing course. Vasculitis in Behcet's disease with predominant vascular involvement is the only vasculitis that affects both arteries and veins of any size. Involvement of the renal artery and inferior vena cava is rare among the arteries and veins, respectively. When disease affect the veins, it is in the form of thrombosis. Arterial complications include aneurysms, stenosis and occlusions. Both rupture of arterial aneurysm and occlusion of suprahepatic veins, causing Budd-Chiari syndrome, are associated with a high mortality rate. Vascular involvement is more common in male patients than in female patients. Men and patients with a younger age of onset present with a more severe prognosis. In this case report, we describe a very rare cause of intrarenal arterial aneurysm's rupture with previous Budd-Chiari syndrome due to Behcet's disease and successful angiographic embolization of actively bleeding aneurysm.

Objective: Endovascular coil embolization has become an effective treatment modality for most intracranial aneurysms. However, complex aneurysms including large and giant aneurysms, fusiform shaped aneurysms, wide necked aneurysm, or small aneurysm that are unsuitable for coil embolization are still deterrent to be treated. Flow diversion is a novel concept that is applied in the treatment of these complex intracranial aneurysms., Method: We review the results and important features of 25 aneurysms in 24 patients who underwent endovascular treatment by using the pipeline flow-diverter embolization device., Result: At 6 month follow-up, all aneurysms (100%) showed total occlusion in our series. Only one patient who had giant vertebrobasilar aneurysm experienced major complication related to endovascular treatment., Discussion: We suggest that parent artery reconstruction via flow diversion with the PED is a valid and safe treatment modality.

Aim: The sacral canal has been frequently used as "a passage" for minimally invasive diagnostic and therapeutic procedures for spinal diseases. The aim of the present study was to investigate morphometric analyses of the sacral canal, hiatus, and surrounding structures according to different age groups and gender by using the "multidetector computed tomography" method., Material and Methods: Multiplanar-reconstructed images from 300 adult (150 females and 150 males, between 20 and 80 years old) were divided into three groups according to age and retrospectively examined. Various anatomic measurements of the sacral hiatus, surrounding structures, and sacral canal were performed. Sacral curvature angle and lumbosacral lordotic angle were noted., Results: Bony anatomic abnormalities such as absent hiatus (0.3%), complete agenesis (1%), and bony septum (2.6%) were detected in some cases. The anteroposterior (AP) diameter of the hiatus was less than 2 mm in 5% of cases. In all groups, the mean values of the hiatus AP diameter and area, and the shortest distance of the sacral canal AP diameter were shorter in the 60-80 years age group when compared with those in 20-39 years age group (p=0.01). The shortest sacral canal AP diameter was commonly located at the S2 and S3 levels in 59.2% and 33.9% of cases, respectively. The levels of maximum curvature were at S3 and S2 in 63.3% and 26.7% of cases, respectively. Median sacral curvature angles and lumbosacral lordotic angles were measured as 164° and 134°, respectively., Conclusion: Sacral structures have morphometric variations. Understanding of the detailed anatomy may improve the reliability of interventional procedures.

Background: Retinopathy of prematurity (ROP) is a significant cause of childhood blindness., Aim: The aim of this study is to determine the feasibility of remifentanil analgesia during laser treatment of ROP performed in the neonatal intensive care unit (NICU)., Patients and Methods: Remifentanil was infused continuously during the procedure starting with a dose of 0.2 µg/kg/min and increased gradually to 0.6 µg/kg/min to provide an adequate level of analgesia., Results: We enrolled 64 infants. Remifentanil was infused continuously at a mean rate of 0.4 ± 0.1 μg/kg/min. No major adverse effects were observed except in two patients with reversible bradycardia and hypotension. Premature infant pain profile (PIPP) scores revealed no pain. Patients with bronchopulmonary dysplasia had similar remifentanil dosage, intubation duration, and extubation time., Conclusions: Remifentanil analgesia for ROP treatment performed in the NICU by pediatricians is a safe and effective modality. This modality offers a practical solution in hospitals without readily available pediatric anesthetists., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: The presence of blood in the subarachnoid space is an acute pathology with a serious risk of death and complications. The most common etiology (approximately 80%) is intracranial aneurysm., Objectives: The aim of this study was to assess the role of bone subtracted computed tomographic angiography (BSCTA), a novel and noninvasive method for determining and characterizing intracranial aneurysms., Patients and Methods: Sixty consecutive patients with clinically suspected non-traumatic subarachnoid hemorrhage (SAH) were considered to enter the study. The subtraction quality was inadequate in ten patients; thus, they were excluded, leaving 50 patients (84.4%) in the study. Bone subtracted and non-subtracted 3D images were obtained from the BSCTA raw data sets. All images obtained by digital subtraction angiography (DSA), BSCTA, and computed tomographic angiography (CTA) were evaluated for the presence or absence of an aneurysm and the location, minimal sac diameter, and neck size ratio of the aneurysm. DSA was considered as the gold standard during the evaluation of the data., Results: Of the 50 patients who participated in this study, 11 had no aneurysms as determined by both CTA and DSA. Examination of the remaining 39 patients revealed the presence of 51 aneurysms. While 3D-CTA could not detect six aneurysms that were located in the base of the skull, 3D-BSCTA easily detected them. Moreover, five aneurysms were only partially detected by 3D-CTA. According to this data, the sensitivity of 3D-BSCTA and 3D-CTA was calculated as 98% and 86.3%, respectively; the specificity was calculated as 100% and 90.9%, respectively, per aneurysm; and the sensitivity of 100% for 3D-BSCTA and 98% for 3D-CTA was achieved by using combined images with multi-planar reconstruction (MPR) and maximum intensity projection (MIP). BSCTA detected and characterized the aneurysms as well as DSA, and BSCTA and DSA gave concordant results in detecting aneurysms., Conclusions: BSCTA is easily accessible, less time consuming, and most importantly, a non-invasive technique for detecting intracranial aneurysms. It is also suitable for patients who have been referred to emergency services. Therefore, it can be used in emergency conditions and as a first-line diagnostic method in patients with non-traumatic SAH.

Objective: To assess the prevalence, types and risk factors for urinary incontinence (UI) and to evaluate the impact of incontinence on quality of life by using validated and objective questionnaires in the western and eastern parts of Turkey., Methods: In this multicenter observational study, 6,473 women from 38 cities in the western and eastern parts of Turkey were included. UI was assessed by ICIQ-SF (International Consultation on Incontinence Questionnaire Short Form) and IIQ-7 (Incontinence Impact Questionnaire)., Results: The UI rate was 20.9% (10% for stress, 8.3% overactive bladder and 2.6% for mixed type). In all, stress incontinence was the most common type. The rate of UI in women residing in the west was higher than in women living in the east (p < 0.001). ICIQ scores were comparable in the two groups but women in the west scored higher in each item of the IIQ. Age >40 years (p < 0.001), number of siblings >5 (p < 0.001) and low educational status (p < 0.001) increased the rate of incontinence. In binary logistic regression analysis menopausal status, age >40 years, number of siblings >5, being overweight, region of residence, and educational status were associated with UI., Conclusion: The rate of UI in women residing in the western part of Turkey was higher than women living in the east. Residing in a different geographical region (in our case living either in the western or eastern part of Turkey) seemed to be an independent risk factor for UI. Moreover, UI deteriorates quality of life and more attention should be paid to this vulnerable population., (2013 S. Karger AG, Basel.)

Aim: This study was designed to examine the efficacy of moxonidine, a centrally acting antihypertensive agent that is a selective ligand for I1-imidazoline sites, in a rabbit cerebral vasospasm model., Material and Methods: Twenty-four white, male New-Zealand rabbits weighing 2500-3200 gr. were randomly allocated into three groups as group 1= control group, group 2=subarachnoid hemorrhage (SAH) alone group, and group 3=SAH + moxonidine (treatment) group. Cerebral angiography was performed to all rabbits before (Day=0, basal angiography) and 72 hours after the induction of SAH. Intraperitoneal moxonidine (0.5 mg/kg) treatment was started after the induction of SAH and continued once a day for 72 hours in the treatment group., Results: No statistically significant difference was determined in basal angiographic luminal diameter of the basilar artery between groups (p > 0.005). After SAH, the follow-up angiographic basilar artery luminal diameter significantly changed in treatment group when compared with the SAH alone group (p < 0.001). The pathologically examined basilar artery luminal area was different between these groups (p < 0.005)., Conclusion: Moxonidine treatment as a centrally acting antihypertensive agent was found to be very beneficial in the treatment of vasospasm by increasing the angiographic diameter and the pathologic luminal area and reducing muscular wall thickness.

Implants provide patients with a safe and reliable method for anchoring auricular prostheses that enable restoration of their normal appearance and offer improved quality of life. In this case report, an auricular prosthesis was fabricated for a patient who had lost his right external ear in a traffic accident. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to the implant were used.

Introduction. Continuous ambulatory peritoneal dialysis (CAPD) is widely accepted for the management of end-stage renal disease (ESRD). Although not as widely used as hemodialysis, CAPD has clear advantages, especially those related to patient satisfaction and simplicity. Peritoneal dialysis (PD) catheter insertion can be accomplished by several different techniques. In this study, we aimed to evaluate our results obtained with peritoneal dialysis catheter placement by combination of pelvic fixation plus preperitoneal tunneling. Material and Methods. Laparoscopic peritoneal catheter implantation by combining preperitoneal tunneling and pelvic fixation methods was performed in 82 consecutive patients with end-stage renal disease. Sex, age, primary disease etiology, complications, mean duration of surgery, mean duration of hospital stay, morbidity, mortality, and catheter survival rates and surgical technique used were assessed. Analysis of catheter survival was performed using the Kaplan-Meier method. Results. Mean follow-up period was 28.35 ± 14.5 months (range of 13-44 months). Mean operative time was 28 ± 6 minutes, and mean duration of hospital stay was 3 ± 1 days. There were no conversions from laparoscopy to other insertion methods. None of the patients developed serious complications during surgery or the postoperative period. No infections of the exit site or subcutaneous tunnel, hemorrhagic complications, abdominal wall hernias, or extrusion of the superficial catheter cuff was detected. No mortality occurred in this series of patients. Catheter survival was found to be 92% at 3 years followup. Conclusions. During one-year followup, we had seven patients of migrated catheters due to separation of pelvic fixation suture from peritoneal surface, but they were reimplanted and fixated again laparoscopically with success. Over a three-year followup period, catheter survival was found to be 92%. In the literature, similar catheter survival rates without combination of the two techniques are reported. As a conclusion, although laparoscopic placement of PD catheters avoids many perioperative and early complications, as well as increasing catheter free survival period and quality of life, our results comparing to other studies in the literature indicate that different laparoscopic placement methods are still in debate, and further studies are necessary to make a more accurate decision.

Introduction: About 70% of well-differentiated endocrine tumors arise from the gastrointestinal tract. Duodenal well-differentiated endocrine tumors account for only 2.6% of all neuroendocrine tumors. Following the first two case reports of somatostatin-secreting tumors in 1977, fewer than 200 cases of somatostatinoma have been reported. These tumors of the duodenum are usually silent and asymptomatic, but can cause gastrointestinal symptoms. Depending on the localization of the tumor, multiple surgical procedures can be performed, ranging from local resection to pancreaticoduodenectomy., Case Presentation: Here, we report a case of a submucosal duodenal mass in a 42-year-old Turkish White man presenting with nausea, vomiting, fatigue and abdominal pain. The treatment decision of pancreaticoduodenectomy made preoperatively was later altered to intraoperative removal via local resection with sphincteroplasty., Conclusion: Tumors of the periampullary region are considered highly malignant, and the Whipple operation is usually the only procedural treatment. In the current case, we decided not to perform pancreaticoduodenectomy but to excise the mass intraoperatively, and consequently avoided unnecessary resection of the pancreas and anastomosis to undilated hepatic and pancreatic ducts. This protective strategy prevented duodenum- and pancreas-related morbidity.

Purpose: Renal artery embolization (RAE) is a minimally invasive therapeutic technique that is utilized in a number of disorders. Ankaferd is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We used Ankaferd for RAE in a sheep model., Methods: Seven adult female sheep were included in the study. Selective renal arteriogram using 5-F diagnostic catheter was performed to make sure that each kidney was fed by a single renal artery and the animal had normal renal vasculature. Coaxial 2.7-F microcatheter was advanced to the distal main renal artery. Under fluoroscopic guidance, 2 mL of Ankaferd mixed with 2 mL of nonionic iodinated contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration of flow and stagnation. Control renal angiograms were performed just after embolization. After the procedure, the animals were observed for 1 day and then sacrificed with intravenous sodium thiopental., Results: The technical success was observed in seven of the seven animals.. After embolization procedure, none of the animals died or experienced a major systemic adverse event. On macroscopic examination of the embolized kidneys, thrombus at the level of main renal artery formed after Ankaferd embolization was more compact compared with the thrombi that was not Ankaferd-associated, which was observed elsewhere. Microscopically, majority of the renal tubular cells (80-90 %) were necrotic, and there was epithelial cell damage in a small portion of the cells (10-20 %)., Conclusions: RAE was safe and effective in the short-term with Ankaferd in studied animals. Further studies should be conducted to better delineate the embolizing potential of this novel hemostatic agent.

Aim: To compare the efficacy and safety of high-dose intravenous oxytocin and sustained-release dinoprostone vaginal pessaries for cervical ripening and labor induction in pregnant patients at term with poor Bishop scores., Material and Methods: Women at term with a Bishop score ≥ 4 and ≤ 6 were randomized into two groups to undergo induction of labor with either high-dose oxytocin administered intravenously (n = 90) or dinoprostone-only vaginal pessary without oxytocin augmentation (n = 90). The main outcome measures were rate of cesarean delivery, induction to delivery interval, number of deliveries achieved within 4, 8, 12, and 16 h of labor induction, maternal complications during induction, fetal outcome, and total hospital stay. In this study, per-protocol analysis was performed., Results: There were fewer cesarean deliveries with oxytocin compared to dinoprostone-only groups (7/79 vs 14/89); however, the difference was not statistically significant. The induction-delivery intervals (7.9 h vs 12.0 h, P < 0.001; and 5.7 vs 10.4 h, P < 0.001; oxytocin vs dinoprostone-only for primiparous and multiparous patients, respectively) were significantly shorter in oxytocin-induced patients compared to dinoprostone-only. A significantly higher percentage of patients delivered in the oxytocin group compared to the dinoprostone-only group in 4, 8, 12, 16, and 20 h., Conclusion: Intravenous oxytocin is effective to stimulate labor at term for patients with Bishop scores ≥ 4 and ≤ 6, with a shorter time interval from induction to vaginal delivery., (© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.)

Introduction. Thyroidectomy creates a potential risk for all parathyroid glands and the recurrent laryngeal nerve (RLN). The identification and dissection of the RLN is the gold standard for preserving its function. In some cases, it may be quite difficult to identify the nerve localization. In such elusive locations, we aimed to identify RLNs using peroperative injection of a blue dye into the inferior thyroid artery. Materials and Methods. This study included 10 selected patients whose RLN identification had been difficult peroperatively during the period from April 2008 to June 2009. When the RLNs became elusive in location, the branches of the inferior thyroid artery (ITA) on the capsule of the thyroid lobe were isolated, and then 0.5 mL isosulphan blue dye was injected into the artery. Results. RLN was carefully dissected in the tracheoesophageal groove. RLN was clearly visualized, in all patients. All RLNs were identified along their course in the dyed surrounding tissue. No RLN palsy was encountered. Conclusion. The injection of blue dye into the ITA branches can be used as an alternate method in case of difficulty in identification of RLNs.

Digital subtraction angiography (DSA) is the best method of evaluating carotid cavernous fistulas (CCF). DSA, however, has the disadvantage of being an invasive procedure. Computerized tomography (CT) angiography which is noninvasive, have been shown to provide more information about the size and location of fistulas. As a new method, Bone-Subtraction CT Angiography (BSCTA), than conventional CT angiography, is a method that improves the detection and interpretation of vascular lesions near to the cavernous segment of carotid artery. In this case report, we report a case of a dural carotico-cavernous fistula (CCF), appearances of pre and postembolization BSCTA images, confirmed by on DSA. As far as we know, CCF demonstrated by BSCTA has not been reported yet.

Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented.