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Objectives: This study aims to evaluate and compare the cost-effectiveness of inpatient physical therapy, outpatient physical therapy applications, and back school education in low back pain (LBP) treatment., Patients and Methods: Between March 2011 and September 2011, a total of 105 patients (43 males, 62 females; mean age 44.8±12.7 years; range, 27 to 58 years) who were treated for chronic LBP were included in this prospective study. Of the patients, 34 received inpatient physical therapy consisting of electrotherapy, superficial-deep heat application, and basic back exercise program, 35 received the same treatment in the outpatient setting, and 36 received back school education. Each patient was evaluated five times during the study using pain intensity Visual Analog Scale (VAS), spinal mobility measurements (inclinometer), general evaluation (VAS), functional disability measurement (Roland-Morris Disability Questionnaire [RMDQ]), and quality of life (Short Form-36 [SF-36]). All expenses and costs for treatment of LBP were estimated., Results: At the end of six months of follow-up, all study groups had a statistically significant improvement in all variables. Improvements in spinal mobility, RMDQ, and SF-36 scores were significantly higher in the inpatient physical therapy group (p<0.001). Direct and total costs were the highest in the inpatient treatment group and were the lowest in the back school education group (p<0.001). No statistically significant differences were observed in terms of additional cost of one-unit improvement in these variables among the study groups., Conclusion: Our study results suggest that all three treatment modalities are effective in chronic LBP. In patients with LBP-related impairment in functional status and quality of life, inpatient physical therapy and rehabilitation should be preferred., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish Society of Physical Medicine and Rehabilitation.)

Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas., Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used., Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies., Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

Background: The present study was designed to compare the effectiveness of topical silver sulfadiazine (SSD) and Ankaferd Blood Stopper® (ABS) usage in experimental partial-thickness burns in rats., Methods: Twenty-one male Wistar albino rats weighing 250-290 (range: 270+-19) g were used in the present study. A round brass probe that was specifically designed (3×3 cm diameter) was used to induce the burns in rats. After the presence of partial-thickness burns was confirmed, the rats were divided into three groups: Group 1 (ABS group) Ankaferd Blood Stopper® pad, Group 2 (SSD group) silver sulfadiazine (Silverdin®), and Group 3 (Control group) 1% isotonic saline solution-impregnated pad. The healing period was followed up clinically and histopathologically. The day on which 50% and 80% of re-epithelization at first were detected for each rat was also recorded., Results: The mean times of 50% and 80% of re-epithelization at first were 10.8 days, 13.8 days, and 16.8 days in Groups 1, 2, and 3, respectively (p<0.001), and 16.4 days, 19.7 days, and 25.2 days, respectively (p<0.001). The mean inflammatory scores were also found to be better in the ABS group than in other groups (p<0.05)., Conclusion: Our study showed that ABS has better results for the healing of the burn wound than SSD in experimental partial-thickness burns in rats.

Objectives: This study aims to compare the effects of single-task and dual-task training on balance performance in elderly patients with knee osteoarthritis (OA)., Patients and Methods: Fifty elderly osteoarthritic patients with balance impairment (16 males, 34 females; mean age 72.9±5.5 years; range 65 to 84 years) were included in this study. Patients were randomly assigned to single-task balance training (group 1) or dual-task balance training (group 2) groups. Balance activities were given to both groups for three times a week for four weeks. Patients in group 2 also performed cognitive tasks simultaneously with these exercises. Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer static and dynamic scores, timed up and go (TUG) test and walking speed (WS) for single and dual tasks, number of stopping and activities-specific balance confidence (ABC) scale at baseline and at the end of four weeks., Results: At the end of the therapy, there were statistically significant improvements in BBS, KAT 2000 static and dynamic scores, TUG test and WS for single and dual tasks, number of stopping and ABC scale in both groups (p<0.05). But there was no statistical difference in any parameter between the groups (p>0.05)., Conclusion: Both single- and dual-task trainings are effective in improving balance performance under single- and dual-task conditions in elderly patients with knee OA. Dual-task training is not superior to single-task training for balance improvement in elderly osteoarthritic patients., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish League Against Rheumatism.)

Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Novartis Foundation provided technical input in the design phase of the RACF approach and LPEP program, and ensures overall program coordination. All co-authors are either staff of the Novartis Foundation (AC) or work as paid consultants for the program described here (PS, HG, SSA, TF) or receive grants from the foundation (SL).

Objective: To investigate the effect of flamingo exercise with or without KAT 2000 device on the balance problems due to senile OA., Participants: Ninety elderly osteoarthritic patients with balance impairment., Interventions: Participants were randomly assigned into three groups; Kinesthetic ability trainer (KAT 2000) training group (Group 1) (n = 30), Flamingo training group (Group 2) (n = 30), Combined training group (Group 3) (n = 30) group. 45 minutes individualized training sessions as three times a week for 4 weeks were given to all participants., Main Outcome Measures: Patients were evaluated with Berg balance scale (BBS), kinesthetic ability trainer (KAT 2000) static and dynamic scores, timed up and go test (TUGT), walking speed (WS), Activities Specific Balance Confidence (ABC) Scale and Functional Reach Test (FRT) at the baseline and at the end of 4 weeks., Results: At the end of the therapy, there were statistically significant improvements in KAT 2000 static and dynamic scores, TUGT scores, WS and ABC Scale in all groups (p < 0.05). At the end of the therapy there were statistically significant differences in Group 3 for KAT 2000 static and dynamic scores, TUGT scores, WS and ABC Scale than the other groups (p < 0.05). But there were no statistical difference in BBS and FRT score between the groups (p > 0.05)., Conclusions: Both flamingo and KAT2000 exercises device have positive effects on the balance problems due to senile OA. Combined with the KAT2000 device, the effects of flamingo exercises on balance disorder in senile osteoarthritis patients are more pronounced., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: This study aims to assess the validity and reliability of a Turkish version of the identification (ID) pain (ID pain-T) questionnaire in Turkish patients., Patients and Methods: The Turkish version of ID pain questionnaire was obtained after translation from English into Turkish. The study included 194 patients of which 100 (34 males, 66 females; mean age 59.8±14.3 years; range, 28 to 88 years) were diagnosed as neuropathic pain (NP) and 94 (31 males, 63 females; mean age 47.2±16.5 years; range, 20 to 78 years) were diagnosed as non-neuropathic pain. Patients with mixed-type pain, cancer pain, headaches, substance abuse, severe depression or fibromyalgia syndrome were excluded., Results: The reliability and consistency of ID pain-T questionnaire were acceptable, with a Cronbach's alpha coefficient of 0.701. Statistical analysis of the ID pain-T questionnaire calculated an optimal cut-off score of ≥2 for determining NP with a sensitivity of 77.2% and a specificity of 85%. Further, with an excellent value of 0.92 for area under the curve, a good diagnostic value was indicated., Conclusion: The Turkish version of ID pain questionnaire assessed in the present study is a valid and reliable self-administered questionnaire to identify NP in Turkish patients., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2019, Turkish League Against Rheumatism.)

Objectives: This study aims to investigate the effectiveness of Kinesio taping (KT) and sham KT on pain, lumbar range of motion (ROM) and disability in chronic non-specific low back pain., Patients and Methods: This is a randomized, placebo controlled study. Sixty patients (22 males, 38 females; mean age 21.5±1.7 years, range, 19 to 25 years) with chronic low back pain were randomized into either intervention or placebo groups. Group 1 (n=30) was treated with KT and group 2 (n=30) was treated with sham taping six times by intervals of three days. Patients were evaluated according to pain, modified Schober's test value, hand-ground distance and lumbar ROM and disability at baseline and at the end of the first and sixth months of intervention. Pain was assessed by using Visual Analog Scale (VAS), while ROM was assessed by modified Schober's test value, hand-ground distance and lumbar lateral flexion ROM. Disability was assessed with Oswestry Disability Index (ODI)., Results: Statistically significant improvements for all parameters were found for both groups after one month of intervention (p<0.05). These effects were sustained after six months of follow-up for modified Schober's test, hand-ground distance and ODI. There were statistically significant differences between the groups for all outcome measures at the first month of intervention (p<0.05). However, at sixth-month follow-up, only modified Schober's test, hand-ground distance and ODI values were significantly different between groups (p<0.05) except VAS (p>0.05)., Conclusion: Kinesio taping provided significant improvements in pain, ROM and disability at short term. These positive effects were sustained for ROM and disability at long term but not for pain., Competing Interests: Conflict of Interest: The authors received no financial support for the research and/or authorship of this article.

Objective: Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an ideal treatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques., Material and Methods: In this randomized prospective trial, 100 patients were divided into two groups: onlay and sublay groups. Recurrences were evaluated by performing a physical examination., Results: The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time was significantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantly better results. The recurrence rates were found to be similar in both groups (6% in the onlay group and 2% in the sublay group)., Conclusion: In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms of postoperative pain and wound complications. Both techniques have similar recurrence rates., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Aim: The results of previous studies regarding the role of adiponectin in the pathogenesis of osteoarthritis (OA) are controversial. The aim of this study is to investigate the relation of plasma adiponectin levels with clinical and radiological disease severity in knee OA patients., Method: Sixty patients with knee OA and 25 healthy controls were included in the study. Patients were divided into two subgroups: lean (Group 1, n = 30) and obese (Group 2, n = 30). Healthy controls were accepted as Group 3 (n = 25). Pain intensity was measured with a visual analogue scale (VAS), functional disability with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Quality of Life (QoL) with Short Form-36 (SF-36). Also all patients were radiologically evaluated and graded according to Kellgren-Lawrence (KL) scale. Plasma concentrations of adiponectin levels were measured by enzyme-linked immune-sorbent assay (ELISA)., Results: Serum adiponectin levels were higher in OA patient subgroups than those in the control group but the difference did not reach a significant level after adjustments for age, gender and body mass index (P = 0.078). There was a positive correlation between adiponectin concentration and KL grading scores. Additionally, there was a positive correlation between adiponectin levels and clinical variables (VAS and WOMAC total scores) in patient subgroups (r = 0.326 P = 0.012, r = 0.583 P < 0.001, respectively). SF-36 scores were inversely associated with adiponectin levels., Conclusion: Plasma adiponectin concentrations were associated with both clinical and radiological disease severity in knee OA patients. Thus, adiponectin hormone might be a potential clinically useful biomarker while assessing disease severity in the future., (© 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

Objective: The present study aims to determine the effect of laser acupuncture in patients with subacromial impingement syndrome (SAIS)., Design: Randomized, double-blind, sham-controlled study., Setting: Physical medicine and rehabilitation outpatient clinic., Subjects: A total 73 patients with SAIS were randomly assigned into a treatment group (n = 36) and a control group (n = 37)., Methods: The treatment group received laser acupuncture, and the control group received sham laser acupuncture. Eleven acupuncture points (GB 21, LI 4, LI 11, LI 14, LI 15, LI 16, SI 9, SI 10, SI 11, TE 14, and TE 15) were irradiated using a gallium-aluminium-arsenide continuous wave diode-laser, with a wavelength of 850 nm and a power output of 100 mV. The laser acupuncture treatment at each acupuncture point was administered at 4 joules/cm 2 (total dose = 40 joules). All patients were also treated with a hot pack. The patients were assessed at baseline and after 15 sessions of laser treatment. Pain severity and doctor's and patient's global assessments were measured via visual analog scale (VAS). Range of motion (ROM) and functional status were measured using a digital inclinometer and the Shoulder Pain Disability Index, respectively., Results: Statistically significant improvements were observed in all parameters in the treatment group. All parameters of pain and functional status in the treatment group were significantly better than those in the control group at week 3., Conclusions: To the best of our knowledge, this is the first study that investigates the effect of laser acupuncture in SAIS. The positive results of the present study should lead to further laser acupuncture studies with combinations of different acupuncture points, at different wavelengths, and with long-term follow-up periods., (© 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Uterine tissue was collected from bitches after ovariohysterectomy at different times after ovulation. Samples were assigned to four groups: metestrous non-pregnant, day 10-12, n = 4; pre-implantation, day 10-12, n = 9; post-implantation, day 18-25, n = 13; mid-gestation, day 30-40, n = 7. RT-qPCR detection was performed for kiss1 and the G protein-coupled receptor 54 (GPR54, specific receptor for kisspeptin). In addition, immunohistochemistry was performed for detection of kisspeptin-10 (KP-10), GPR54, as well as pan-cytokeratin and vimentin. The latter two were included to differentiate the different placental cell types. The percentage of positive stained cells was evaluated, and an immunoreactivity score (IRS) was obtained by multiplying the labelling intensity score (0-3) with the percentage of immunolabelled cells (range: 0-300). In non-pregnant and pre-implantation tissues, gene expression was highly variable for kiss1 and GPR54. Expression of GPR54 was higher before embryo adhesion than during post-implantation and mid-gestation (p < .05), whereas there was no difference found between groups for kiss1. Except during the pre-implantation period, KP-10 expression was higher in the non-pregnant uterus compared to all gestational periods investigated, indicating a pregnancy-related downregulation. In the pre-implantation period, KP-10 was present in larger vessels only, whereas the presence of GPR54 in vessels was found in all samples, with most labelling in the post-implantation period. KP-10 was present in superficial uterine glands, GPR54 in superficial and deep uterine glands of the post-implantation uterus. In myocytes, the highest staining for KP-10 was seen in the non-pregnant uterus, whereas the highest staining for GPR54 was seen in post-implantation and mid-gestation. Syncytiotrophoblast cells stained for both KP-10 and GPR54 in post-implantation and mid-gestation, with maximum intensity for GPR54 in the latter. We conclude that KP-10 and GPR54 are expressed in the canine uterus and trophoblast cells. However, during pregnancy, expression of both proteins seems to be differentially regulated., (© 2016 Blackwell Verlag GmbH.)

Objective: The aim of this study was to investigate the effectiveness of Kinesio Taping and sham Kinesio Taping on pain, pressure pain threshold, cervical range of motion, and disability in cervical myofascial pain syndrome patients (MPS)., Methods: This study was designed as a randomized, double-blind placebo controlled study. Sixty-one patients with MPS were randomly assigned into two groups. Group 1 (n=31) was treated with Kinesio Taping and group 2 (n=30) was treated sham taping five times by intervals of 3 days for 15 days. Additionally, all patients were given neck exercise program. Patients were evaluated according to pain, pressure pain threshold, cervical range of motion and disability. Pain was assessed by using Visual Analog Scale, pressure pain threshold was measured by using an algometer, and active cervical range of motion was measured by using goniometry. Disability was assessed with the neck pain disability index disability. Measurements were taken before and after the treatment., Results: At the end of the therapy, there were statistically significant improvements on pain, pressure pain threshold, cervical range of motion, and disability (p<0.05) in both groups. Also there was a statistical difference between the groups regarding pain, pressure pain threshold, cervical flexion-extension (p<0.05); except cervical rotation, cervical lateral flexion and disability (p>0.05)., Conclusion: This study shows that Kinesio Taping leads to improvements on pain, pressure pain threshold and cervical range of motion, but not disability in short time. Therefore, Kinesio Taping can be used as an alternative therapy method in the treatment of patients with MPS., (Copyright © 2016 Elsevier Editora Ltda. All rights reserved.)

Objective: The purpose of this study was to compare the effectiveness of two different laser therapy regimens on pain, lumbar range of motions (ROM) and functional capacity in patients with chronic low back pain (CLBP)., Methods: Forty nine patients with CLBP were randomly assigned into two groups. Group 1 (n= 20) received hot-pack + laser therapy 1 (wavelength of 850 nm Gallium-Aluminum-Arsenide (Ga-Al-As) laser); group 2 (n= 29) received hot-pack + laser therapy 2 (wavelength of 650 nm Helyum-Neon (He-Ne), 785 ve 980 nm Gal-Al-As combined plaque laser) for 15 sessions. Pain severity, patient's and physician's global assessments were evaluated with visual analogue scale (VAS). Modified Schober test, right and left lateral flexion measurements were done. Modified Oswestry Disability Questionnaire (MODQ) was used for evaluation of functional disability. Measurements were done before and after the treatment., Results: After treatment there were statistically significant improvements in pain severity, patient's and physician's global assessment, ROM and MODQ scores in both groups (P< 0.05). After the treatment there were statistically significant differences between the groups in lateral flexion measurements and MODQ scores (P< 0.05) except in pain severity, Modified Schober test, patient's and physician's global assessments (P> 0.05) in favor of those patients who received combined plaque laser therapy (group 2)., Conclusion: Laser therapy applied with combined He-Ne and Ga-Al-As provides more improvements in lateral flexion measurements and disability of the patients, however no superiority of the two different laser devices to one another were detected on pain severity.

Objective: Chronic lymphocytic leukemia (CLL) is a disease of nonproliferating and mature-appearing B lymphocytes. Insulin-like growth factor-1 (IGF-1) is a small peptide hormone and has mitogenic and antiapoptotic effects, and insulin-like growth factor binding protein-3 (IGFBP-3) has antiproliferative effects on cells. In this study, we investigated plasma levels of both IGF-1 and IGFBP-3 in patients with CLL compared with controls, and we compared these plasma levels according to prognostic factors., Materials and Methods: Patients with newly diagnosed CLL who were being followed at the Haseki Training and Research Hospital, İstanbul, Turkey, and volunteers were included in this study. Patients were stratified according to the Rai staging system. Statistical analysis was conducted using SPSS 17.0 for Windows., Results: Forty-three patients [16 women (37%) and 27 men (63%)] were enrolled in this study. Twenty-one volunteers (11 women, 10 men) were included in the control group. The median age of the patients was 65±9 years (range: 18-63 years), and subjects in the control group were 68±8 years old (range: 18-63 years). Even though the plasma levels of IGF-1 were higher and those of IGFBP-3 were lower and the ratio of IGF-I/IGFBP-3 was higher in comparison with the control group, these differences were not statistically significant (p>0.05). In the study group, IGF-1 levels appeared to be increased in parallel to more advanced Rai stages. There were no significant differences between the other groups (p=0.105)., Conclusion: Plasma IGF-I levels were found higher in patients than in the control group and plasma IGFBP-3 levels were lower; however, neither result was statistically significant. Plasma IGF level increment was observed in concordance with Rai staging. These results prompted us to think that plasma IGF-1 levels in CLL patients are correlated with tumor burden and Rai staging and therefore could be a valuable prognostic factor. Further comprehensive studies are required to support our results., Competing Interests: The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included.

The aim of this study is to histologically compare effects of blue light-emitting diode (LED) light (400-490 nm) and Ga-Al-As low-level diode laser light (980 nm) on bone regeneration of calvarial critical-sized defects in rats. Thirty Wistar Albino rats were included in the study. The experimental groups were as follows: blue LED light (400-490 nm) group (LED); 980-nm low-level laser light group (LL); and no-treatment, control group (CL). A critical-sized defect of 8 mm was formed on calvaria of rats. Each animal was sacrificed 21 days after defect formation. Calvarias of all rats were dissected and fixated for histological examination. Histomorphometric measurements of total horizontal length of the newly produced bone tissue, total vertical length of the newly produced bone tissue, and diameter of the newly produced longest bone trabecula were performed with a computer program in micrometers. There was a statistically significant increase in the total horizontal length and total vertical length in LL and LED groups compared to that in the CL group (P < 0.05), while there was no statistical difference between LED and LL groups (P > 0.05). A statistically significant difference was observed in the longest bone trabecula and LL groups compared to that in CL (P < 0.05), but not between LED-CL and LED-LL groups (P > 0.05). In conclusion, blue LED light significantly enhances bone regeneration in critical-sized defects when compared with CL group, but does not have a statistically significant effect on bone regeneration when compared with 980-nm low-level laser light.

Background: This randomized controlled study aims to determine the effect of pilates mat exercises on dynamic and static balance, hamstring flexibility, abdominal muscle activity and endurance in healthy adults., Methods: Female healthy volunteer university students randomly assigned into two groups. Group 1 followed a pilates program for an hour two times a week. Group 2 continued daily activities as control group. Dynamic and static balance were evaluated by Sport Kinesthetic Ability Trainer (KAT) 4000 device. Hamstring flexibility and abdominal endurance were determined by sit-and-reach test, curl-up test respectively. Pressure biofeedback unit (PBU) was used to measure transversus abdominis and lumbar muscle activity. The physical activity of the participants was followed by International Physical Activity Questionnaire-Short Form., Results: Twenty-three subjects in pilates group and 24 control subjects completed the study. In pilates group, statistical significant improvements were observed in curl-up, sit-and-reach test, PBU scores at sixth week (P<0.001), and KAT static and dynamic balance scores (P<0.001), waist circumference (P=0.007) at eighth week. In the comparison between two groups, there were significant improvements in pilates group for sit-and-reach test (P=0.01) and PBU scores (P<0.001) at sixth week, additionally curl-up and static KAT scores progressed in eighth week (P<0.001). No correlation was found between flexibility, endurance, trunk muscle activity and balance parameters., Conclusions: An eight-week pilates training program has been found to have beneficial effect on static balance, flexibility, abdominal muscle endurance, abdominal and lumbar muscle activity. These parameters have no effect on balance.

Objective: In this study, different concentrations of boron have been evaluated for genotoxic and antigenotoxic properties by using the somatic mutation and recombination test (SMART) on Drosophila melanogaster., Study Design: The treatment concentrations were chosen to a pretest. Third-instar larvae trans-heterozygous for two genetic markers, multiple wing hair (mwh) and flare (flr3), were treated at different concentrations (0.1, 5, 10, 20, and 40 mg/mL) of boron. In addition to investigating antigenotoxic effects, the same boron concentrations were co-administered with 0.1 mM Ethyl Methane Sulfonate (EMS). Distilled water was used as a negative control; 0.1 mM of EMS was used as a positive control. For the chronic feeding study, small plastic vials were prepared with 1.5 g of dry Drosophila Instant Medium and 5 mL of the respective test solution. Hundreds of trans-heterozygous larvae were embedded into this medium. Feeding ended with pupation of the surviving larvae. After metamorphosis, all surviving flies were collected and stored in a 70% ethanol solution. Preparation and microscopic analyses of wing were made after the treatment. Then the observed mutations were classified according to size and type of mutation per wing., Results: Results indicated that there is no significant genotoxic effect with all of the boron concentrations. In addition, the antigenotoxic activities of boron against EMS were tested. Results indicated that all boron concentrations (0.1, 5, 10, 20 and 40 mg/mL) were able to abolish the genotoxic effects induced by the EMS., Conclusion: It is suggested that the observed effects can be linked to the antioxidant properties of boron. Moreover, these in vivo results will contribute to the antigenotoxicity database of boron.

Background: Pilonidal sinus is a chronic inflammatory disorder of the intergluteal sulcus. The disorder often negatively affects patients' quality of life, and there are numerous possible methods of operative treatment for pilonidal sinus. The aim of our study was to compare the results of 3 different operative procedures (tension-free primary closure, Limberg flap, and Karydakis technique) used in the treatment of pilonidal disease., Methods: The study was conducted via a prospective randomized design. The patients were randomized into 3 groups via a closed envelope method. Patients were included in the study after admission to our clinic with pilonidal sinus disease and operative treatment already were planned. The 2 main outcomes of the study were early complications from the methods used and later recurrences of the disease., Results: A total of 150 patients were included in the study, and the groups were similar in terms of age, sex, and American Society of Anesthesiologists scores. The median follow-up time of the study was 24.2 months (range, 18.5-34.27) postsurgery. The recurrence rates were 6% for both the Limberg and Karydakis groups and 4% for the tension-free primary closure group. Therefore, there was no substantial difference in the recurrence rates., Conclusion: The search for an ideal treatment modality for pilonidal sinus disease is still ongoing. The main conclusion of our study is that a tension-free healing side is much more important than a midline suture line. Also, tension-free primary closure is as effective as a flap procedure, and it is also easier to perform., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Aim of this study is to compare the clinical and radiographic success of non-surgical endodontic therapy in patients receiving intravenous zolendronate less than 1 year and more than 1 year., Methods: The clinical and radiographic follow-up data of 24 patients who were receiving IV zolendronate with 37 teeth were retrieved from the archives to evaluate clinical and radiographic healing at the end of 12 months after non-surgical endodontic therapy. The clinical and radiographic scores of teeth treated with non-surgical endodontic therapy were analyzed., Results: The amount of non-healed and incomplete healed teeth in patients receiving zolendronate more than 1 year were more than the amount of teeth of non-healed and incomplete healed in patients receiving bisphosphonates less than 1 year (p <0.05)., Conclusions: There was a strong relationship between the duration of the bisphosphonate medication and endodontic success.

Carbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.

Background: Ghrelin is a 28-amino acid peptide that is isolated mainly from the oxyntic glands of the stomach, especially fundus. Ghrelin administration, either centrally or peripherally, increases food intake and body weight in both rodents and humans. This study evaluates the effects of fundus resection and sclerosing agent injection on ghrelin level and weight loss., Material and Methods: Thirty rats were divided into three groups. In group 1, NaCl was injected into the submucosal space at the gastric fundus while in Group 2, a sclerosing agent was injected into the latter site. In group 3, gastric fundus was resected. Ghrelin levels and weight were recorded., Results: In group 1, rats continued gaining weight and ghrelin levels stayed stable. In group 2, rats' weight and ghrelin levels stayed stable and in group 3, while weight stayed stable, ghrelin levels decreased significantly., Conclusion: In rats, the resection of fundus stabilizes weight gain and decreases ghrelin levels. However, in sclerotherapy, although weight gain was stabilized, there was no decrease in ghrelin levels. In humans, the effect of fundus resection on weight gain can usher in a new era of investigation (Tab. 2, Ref. 16).

The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the palliative care system is in its early stages of development.

In reproductive tissues, GnRH participates in the regulation of cell growth and proliferation by direct binding to the GnRH-R, which is essential for embryo implantation. However, there is no study on the expression and cellular localization of GnRH and GnRH-R in the canine uterus and placenta. Therefore, bitches were ovariohysterectomized 10 to 12 days after mating (vaginal cytology and progesterone measurement), the uteri were flushed, and if embryos were detectable, bitches were allocated to the embryo positive group (E-pos.; preimplantation, n = 5). Other bitches were operated at later stages and, dependent on the gestational age, either allotted to the post-implantation group (Day 18-25 after mating, n = 9), or the mid-gestation group (Day 30-40 after mating, n = 3). Dogs negative in embryo flushing served as controls (E-neg.; controls, n = 5). Samples of the entire uterine wall were taken from the middle of the horn in E-neg. and E-pos. groups, and from placental and interplacental uterine sites in post-implantation and mid-gestation groups. GnRH-R expression was localized at the mRNA and protein levels by immunohistochemistry and in situ hybridization. The expression of GnRH and GnRH-R mRNA was assessed by semiquantitative polymerase chain reaction. Additionally, both GnRH and GnRH-R mRNA were expressed in all tissues examined until mid-gestation. Relative expression of GnRH was higher than that of GnRH-R (P < 0.05). During the post-implantation stage, GnRH-R expression was significantly higher in uteroplacental than in interplacental tissues. In the uterus, GnRH-R stained strongly in the surface and glandular epithelial cells, and seemed to be weaker in myometrium and stroma. Placental signals were predominantly localized in fetal trophoblast cells and to a lesser extent in maternal decidual cells. These findings suggest a local regulatory function of GnRH during early canine pregnancy., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To determine the effectiveness of balance exercises on the functional level and quality of life (QOL) of patients with fibromyalgia syndrome (FMS) and to investigate the circumstances associated with balance disorders in FMS., Design: Randomized controlled trial., Setting: Physical medicine and rehabilitation clinic., Participants: Patients (N=57) (age range, 18-65y) with FMS were randomly assigned into 2 groups., Interventions: Group 1 was given flexibility and balance exercises for 6 weeks, whereas group 2 received only a flexibility program as the control group., Main Outcome Measures: Functional balance was measured by the Berg Balance Scale (BBS), and dynamic and static balance were evaluated by a kinesthetic ability trainer (KAT) device. Fall risk was assessed with the Hendrich II fall risk model. The Nottingham Health Profile, Fibromyalgia Impact Questionnaire (FIQ), and Beck Depression Inventory (BDI) were used to determine QOL and functional and depression levels, respectively. Assessments were performed at baseline and after the 6-week program., Results: In group 1, statistically significant improvements were observed in all parameters (P<.05), but no improvement was seen in group 2 (P>.05). When comparing the 2 groups, there were significant differences in group 1 concerning the KAT static balance test (P=.017) and FIQ measurements (P=.005). In the correlation analysis, the BDI was correlated with the BBS (r=-.434) and Hendrich II results (r=.357), whereas body mass index (BMI) was correlated with the KAT static balance measurements (r=.433), BBS (r=-.285), and fall frequency (r=.328)., Conclusions: A 6-week balance training program had a beneficial effect on the static balance and functional levels of patients with FMS. We also observed that depression deterioration was related to balance deficit and fall risk. Higher BMI was associated with balance deficit and fall frequency., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of our study was to compare short-term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid-low RC after NCRT.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used in both the diagnosis and the treatment of biliary and pancreatic disorders. The aim of this study is to evaluate the effects of OB usage during ERCP on duodenal motility, the tolerability of the procedure (by patients) and the difficulty of the procedure (by the endoscopist)., Method: The study was conducted in Konya Training and Research Hospital General Surgery Endoscopy Unit in randomized prospective pattern. The patients were divided into the two groups as spasmolytic and control groups. The procedure was performed under topical anesthesia and sedation., Results: There were 100 cases included into the study (50 cases in each group). The mean duodenal motility score was found to be 1.9 ± 0.5 in the study group and 3 ± 0.6 in the control group. In the study group, the tolerability of the procedure score by the endoscopist was moderate in 16 % and well/very well in 78 % of the cases. On the other hand, in the control group, the scores were poor in 21 %, moderate in 71 %, and well/very well in 24 % of the cases. In terms of patient satisfaction, in study group 42 % of the cases reported the procedure as moderate and 58 % reported as well/very well. However, in the control group 16 % of the cases reported the procedure as poor, 58 % moderate, and 26 % as well/very well., Conclusion: Otilonium bromide is a safe agent with low side effects. It can be used before the ERCP procedure to decrease the duodenal motility. It eases the procedure, moreover, it increases the patients' satisfaction.

Purpose: To clarify the role of medical treatment in the management of acute appendicitis and the value of C-reactive protein (CRP) for predicting its failure., Materials and Methods: Patients with clinically diagnosed acute appendicitis, confirmed by imaging studies, were enrolled in this study. We measured leukocyte counts and CRP levels and recorded success and recurrence rates and the efficiency of medical treatment during follow-up. The efficiency of CRP values to predict failure of medical treatment was evaluated using receiver operating characteristics (ROC) curve analysis., Results: The subjects comprised 193 patients (mean age 30.9 years) who received medical treatment for acute appendicitis. The mean follow-up period was 12.3 (6-24) months and the early success rate of medical treatment was 86.5 % (160/185). Fifteen (9.3 %) patients suffered recurrence during follow-up. The leukocyte and CRP levels in these two groups of patients were not significantly different at the beginning of the treatment, but the increase in the CRP value differed significantly between the two groups during the follow-up period (p < 0.001). ROC curve analysis suggested that the optimum CRP cut-off point for unsuccessful medical treatment was 80.8 mg/L, with 81.82 % sensitivity and 84.34 % specificity (p < 0.001)., Conclusion: The success rate for treating acute appendicitis medically is high, with antibiotic treatment being effective as the firstline therapy for many unselected patients. An increase in CRP levels to 80.8 mg/L and above seems to be a meaningful parameter for determining a lack of response to medical treatment.

Vascular inflammation plays an important role in the pathophysiology of hypertension and high levels of endocan may reflect ongoing vascular inflammation in hypertensive patients. In the present hypothesis-generating study, we aimed at investigating the comparative effects of amlodipine and valsartan on endocan levels in newly diagnosed hypertensive patients. The study population consisted of 37 untreated hypertensive patients who were randomized to the two treatment arms. After baseline assessment, each patient was randomly allocated to either 10 mg daily of amlodipine (n = 18, 7 males) or 160 mg daily of valsartan (n = 19, 3 males) and treated for a 3-month period. Sphygmomanometric blood pressure (BP) and serum endocan were measured before and every 2 weeks during drug treatment. There was no statistically significant difference between the two treatment arms as far as baseline socio-demographic and clinical characteristics are concerned. After a 3-month treatment period, systolic and diastolic BP values significantly reduced by antihypertensive treatment (p < 0.001). Furthermore, endocan levels were significantly decreased in both treatment arms (p < 0.05). However, amlodipine caused a greater percent decrease in circulating endocan levels compared with valsartan at the end of the treatment period. Both drugs reduced high sensitivity C-reactive protein values. However, the statistical significant difference vs baseline was achieved only in the group treated with amlodipine. No correlation was found between endocan plasma levels and BP reduction. The results of this hypothesis-generating study suggest that amlodipine and valsartan decrease endocan levels in newly diagnosed hypertensive patients. The effects, which are more evident with amlodipine, may contribute to the anti-inflammatory effects exerted by the two drugs on the vascular target.

Herpes zoster (HZ) infections rarely affect the mandibular branches of the trigeminal nerve. When the mandibular branches are involved, lesions may appear on the face, in the mouth, in the eye, or on the tongue. Additionally, this condition may be associated with devitalized teeth, internal resorption and spontaneous exfoliation of the teeth, and osteomyelitis of the alveolar bone. In this paper, the treatment of a case HZ of the mandibular branch of the trigeminal nerve is reported, and 22 articles on HZ cases with involvement of the mandibular branch are reviewed. This is the first literature review of HZ cases involving only the mandibular branch of the trigeminal nerve.

Aim: To present the effectiveness of minimal invasive vascular zet ligation in the surgical treatment of haemorrhoidal disease (HD)., Methods: Among 138 patients with 2(nd)-4(th) grade internal HD having several complaints and operated at our hospital between 2003-2013; 116 patients who regularly attended 1-year control were included in the study. Operation times, postoperative early period pain, satisfaction score, complications and relapse details were obtained from computer records retrospectively. Visual Analogous Scale (VAS) scores were used for patient satisfaction on the 3(rd), 7(th) and 21(st) days. Technique; fixed suture which is constituted by the first leg of the Z-shaped suture (to pass by the mucosa and muscular layer) was put in the pile root in order to ensure vascular ligation and fixation. The second leg of the Z-shaped suture is constituted by mobile suture and it passes by the pile mucosa and submucosa which prolapses 5-10 mm below the first suture., Results: Seventy-five of the patients (65%) were male, 41 of them (35%) were female and their age average was 41. The mean operation time was 12 ± 4.8 min. VAS/satisfaction score was found as 2.2/4.3, 1.8/4.0, 1.2/4.4 respectively on the 3(rd), 7(th), and 21(st) days. Four of the patient (3.5%) had relapse., Conclusion: This technique is an easily applicable, cost efficient way of operation which increases patient satisfaction.

Background: Red cell distribution width (RDW) is one of the standard parameters with blood cell counts. Much previous research has indicated that it increases in cases of systemic inflammation or cardiametabolic incident. However, information on the relation of RDW with solid tumors causing systemic inflammation is limited. In the present research, we examined the relation of RDW with malignant and benign lesions of the colon., Materials and Methods: 115 patients with colon polyps (group 1), and 30 with colon cancer (group 2) who were diagnosed histopathologically in our clinic between January 2010-January 2013 were scanned retrospectively. Patients with anemia, hematologic diseases and active inflammation were excluded. RDW, mean corpuscular volume (MCV), hemoglobin (Hgb) and platelet (Plt) measurements were recorded and their relations with the malignant and benign lesions of the colon were examined., Results: Both groups were similar in age and gender distribution. RDW values of patients with colon cancer were significantly higher than the patients with colon polyp (p=0,01). No significant differences were detected between the two groups in terms of MCV and Plt values (p>0,05)., Conclusions: RDW can be used as an early warning biomarker for solid colon tumors. Further prospective research is required on the relations of cheap and easily measured RDW parameters with colon malignancies.

This study was designed to assess endocrine changes associated with termination of mid-term pregnancy after use of two different protocols. For this purpose we compared the effects of aglepristone (AGL) alone and in combination with cloprostenol (CLO) on serum concentrations of progesterone (P4), estradiol (E2) and relaxin (RLN) measured at short-term intervals during the abortion period in bitches. Fourteen pregnant bitches between day 25 and 32 of gestation were used in the study. In the AGL group (n=7), aglepristone was administered solely (10mg/kg body weight (BW), subcutaneously, once daily on two consecutive days) whereas in the AGL-CLO group (n=7), aglepristone (dosage as in AGL group) and cloprostenol (1μg/kg BW, subcutaneously, same with aglepristone) were combined. All pregnancies were successfully terminated 5.2±1.6 days after initiation of treatments, which was significant in both groups (P>0.05). At the time of the start of abortion (SA) and the end of abortion (EA), the mean P4 concentrations were 26.6±7.3 and 12.0±6.4ng/ml in AGL group, and 2.7±0.7 and 0.9±0.1ng/ml, in AGL-CLO group, respectively (P<0.01). Serum E2 concentrations were significantly higher (P<0.05) in AGL group at 42, 48, 54h and SA after initiation of treatment. In the AGL-CLO group, serum RLN concentrations did not significantly change from the initiation of treatment to EA (P>0.05). However, markedly higher RLN concentrations (P<0.05) were observed in the AGL group at 48h (1.5±0.7ng/ml) and at SA (1.6±0.5ng/ml). The results of the present study indicate that changes in the hormonal concentrations affect the mechanism of abortion in different ways. Further in depth studies investigating changes in the expression of hormone receptors inside the ovary, endometrium and placenta might be helpful to our understanding of the endocrinological differences observed in this study., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Common arterial trunk (persistent truncus arteriosus) is a rare cardiac defect requiring surgical repair early in life because of the fast development of pulmonary vascular obstructive disease. We present our institutional experience with patients having common arterial trunk who are diagnosed after one year of age., Patients and Methods: Between August 2010 and May 2013, a total of 1,436 patients were treated for congenital cardiac defects at our institution. Common arterial trunk was treated surgically in seven patients older than one year of age (three males, four females; age: 13 months to 5 years, mean: 2.8 ± 2.04 years). All patients underwent cardiac catheterization in order to determine operability., Results: All patients had the aortic dominant type of common arterial trunk. The pulmonary vascular resistance and Qp/Qs ratio before and after oxygen inhalation were mean 9.04 + 4.2 (range: 3.8 and 10.7) wood units and 4.67 ± 2.3 (range: 3 and 6.5) wood units and 3.3 + 1.8 (range: 1.42 and 5.3) and 4.98 + 2.2 (range: 4 and 6.2), respectively. All patients underwent elective primary repair. The ventricular septal defect was closed in all patients, five with a nonvalved patch and two with a unidirectional check-valved patch. Early postoperatively, patients were sedated, hyperventilated, and received nitric oxide for a minimum of 24 hours. There was no early or late mortality. The mean length of hospital stay was 9.3 ± 5.7 days, and mean duration of follow-up was 214 ± 59 days., Conclusion: Complete repair of common arterial trunk in patients older than one year of age is feasible in appropriately selected cases. Preoperative cardiac catheterization to assess reactivity of the pulmonary vascular bed is important as are appropriate strategies for postoperative management. Together, these elements make it possible to achieve primary repair with excellent outcomes despite late presentation.

Isolated left subclavian artery from the pulmonary trunk is a rare congenital cardiovascular malformation. In this report, we present the images of ascending aortic aneurysm and left subclavian artery originating from the pulmonary artery in a 4-year-old girl in addition to her congenital cardiac pathology.

Objective: The purpose of this retrospective study was to analyze clinic and radiologic features and the prevalence of jaw cysts in southeast region of Turkey., Materials and Methods: This study was carried out in 149 cysts of the jaw diagnosed among 407 individuals who were taken biopsy in our department from October 2008 to December 2012. All cysts were treated by enucleation, marsupialization, or combination, and all cases were histologically examined., Results: One-hundred-and-forty-eight cases were classified odontogenic, one was non-odontogenic. There were 89 cysts (59.7%) in men, 60 (40.3%) in women. The mean age was 32.72 years. We found 80 cysts (35 F, 45 M) in the maxillary and 69 (28 F, 41 M) in mandible. It is observed that 94 were radicular cysts (63%), 40 were dentigerous cysts (26.9%), 9 were odontogenic keratocysts (OKC) (6.1%), 5 were residual radicular cysts (3.4%), and 1 was nasopalatine cyst (0.6%). In radicular cysts, 56 of them (59.5%) were located in the anterior region of the jaws; 18 dentigerous cysts and 2 OKCs were found in the posterior region of mandible. Clinically, the chief complaint of patients was expansion and pain. Radiographically, scalloping of the lesion between the teeth was found in 1 case, root resorption was seen in 3 cases, and displacement of the teeth and follicles was observed in 16 cases., Conclusions: We found similar prevalence of jaw cysts that reported in the literature, in which most odontogenic cysts (OCs) were inflammatory origin.

Objective: In this study, we aimed at investigating the effect of placing hyaluronate- carboxymethyl-cellulose membrane (HCMC) on the formation of adhesion postoperatively in a damaged area in the peritoneum of the anterior stomach wall., Methods: The study was conducted on 30 rabbits. A transverse peritoneal damage was inflicted on the stomach anterior walls of all rabbits. In the first treatment group, HCMC was placed on the sutured anterior wall of stomach of 15 rabbits. In the second control group, on the other hand, no treatment was conducted on 15 rabbits. On the 30th day after the operation, relaparatomy was performed on the rabbits and adhesions were evaluated by an independent surgeon according to seriousness and prevalence scores., Results: There were postoperative adhesions (POA) in 12 (80 %) rabbits in the control group. On the other hand, there were POA in 5 rabbits (33.3 %) in the treatment group. In the treatment group, adhesion was totally prevalent in 2 rabbits (13.3 %), whereas this ratio was 7 (46.6 %) in the control group (p < 0.01)., Conclusions: The study suggested that the use of hyaluronate-carboxymethyl-cellulose could be beneficial on damaged peritoneum surfaces following abdominal surgery in order to reduce POA development to a minimum (Tab. 3, Fig. 3, Ref. 22).

Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies characterized by an anomalous pulmonary vein (scimitar vein) that drains into the inferior vena cava, a hypogenetic right lung, and dextroposition of the heart. It has been reported in 3% to 6% of patients with partial anomalous pulmonary venous connection. Patients are either diagnosed early with severe symptoms (infantile type) or late with minimal symptoms (childhood/adult type). In this chapter we reviewed the history, pathophysiology, presentation, diagnosis, and treatment methods of Scimitar syndrome in the current era., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Pain is one of the most terrifying symptoms for cancer patients. Although most patients with cancer pain need opioids, complete relief of pain is hard to achieve. This study investigated the factors influencing persistent pain-free survival (PPFS) and opioid efficiency., Materials and Methods: A prospective study was conducted on 100 patients with cancer pain, hospitalized at the medical oncology clinic of Akdeniz University. Patient records were collected including patient demographics, the disease, treatment characteristics, and details of opioid usage. Pain intensity was measured using a patient self-reported visual analogue scale (VAS). The area under the curve (AUC) reflecting the pain load was calculated from daily VAS tables. PPFS, the primary measure of opioid efficacy, was described as the duration for which a patient reported a greater than or equal to two-point decline in their VAS for pain. Predictors of opioid efficacy were analysed using a multivariate analysis., Results: In the multivariate analysis, PPFS was associated with the AUC for pain (Exp (B)=0.39 (0.23-0.67), P=0.001), the cumulative opioid dosage used during hospitalisation (Exp (B)=1.00(0.99-1.00), P=0.003) and changes in the opioid dosage (Exp (B)=1.01 (1.00-1.01), P=0.016). The change in VAS score over the standard dosage of opioids was strongly associated with current cancer treatment (chemotherapy vs. others) (β=-0.31, T=-2.81, P=0.007) and the VAS for pain at the time of hospitalisation (β=-0.34, T=-3.07, P= 0.003)., Conclusions: The pain load, opioid dosage, concurrent usage of chemotherapy and initial pain intensity correlate with the benefit received from opioids in cancer patients.

Objective: Non-operative management of abdominal injuries has recently become more common. Especially non-operative treatment of blunt abdominal trauma is gaining wide acceptance. In this study, the efficacy of non-operative treatment in abdominal trauma (blunt penetrating) is discussed., Material and Methods: All patients who received treatment due to abdominal trauma from November 2008 to January 2013 were retrospectively analyzed. The demographic characteristics, type of injury, injured organ, type of treatment (operative vs. nonoperative) and mortality data were evaluated., Results: The study includes 115 patients treated for abdominal trauma in our department. The mechanism of trauma was stab wounds in 60%, blunt abdominal trauma in 23.5% and gunshot wounds in 16.5%. Forty-two patients (36.5%) were operated for hemodynamic instability and/or peritonitis on admission. The remaining 63.5% of patients (n=73) were treated nonoperatively, 10 of whom required laparotomy during follow-up. The remaining 63 patients were treated with non-operative management. The success rate for non-operative treatment was 86.3% and there was no difference in terms of the types of injuries. The mortality rate was 4.3% (n= 5) in the whole series, but there were no deaths among the patients who had received non-operative treatment. In the whole patient group 54.2% (n=63) were treated nonoperatively., Conclusion: Nonoperative treatment in abdominal trauma is safe and effective. Patients with clinical stability and normal physical examination findings can be treated nonoperatively with close monitoring.

Tuberculosis is a major cause of death among adults infected by HIV. The CAMELIA (ANRS 1295/CIPRA KH001) randomized clinical trial aimed to determine the optimal timing of ARV initiation after tuberculosis treatment onset to reduce mortality. Here, we describe the trial implementation in five hospitals in Cambodia under the coordination of the Institut Pasteur in Cambodia, its conduct, the challenges and public health benefits in Cambodia and beyond., (© 2013 médecine/sciences – Inserm.)

Congenital absence of unilateral pulmonary artery, either as a primary defect or in combination with other congenital cardiovascular malformations, is very rare. Double outlet right ventricle pathology in combination with unilateral absence of pulmonary artery has only been reported once in the literature. In this report, we present our experience with double outlet right ventricle with unilateral absence of left pulmonary artery in a 3-year-old female patient who underwent a palliative procedure and was scheduled for correction.

Background: Tetralogy of Fallot is a common congenital cardiac malformation. A rare subgroup includes unilateral absence of the pulmonary artery, either the left or the right main branch. The literature lacks an established treatment for these cases, and surgical options carry certain mortality and morbidity., Patients and Methods: There were five patients who had single pulmonary artery and received surgical treatment among the 126 patients with the diagnosis of Tetralogy of Fallot, who were admitted to our institution between July, 2010 and November, 2011. All the patients were male. Ages ranged between 12 months and 8 years. The mean body mass index was 17.1 plus or minus 3.4 kilograms per square metre. Pulmonary artery Nakata index, Nakata index Z-score, and the McGoon index were used for the quantitative assessment of the pulmonary artery and to determine the surgical strategy., Results: Urgent modified Blalock-Taussig shunt operations were performed in two patients with very low oxygen saturation and haemodynamic instability. These patients are scheduled for corrective procedures on an elective basis. There was one patient who received an elective shunt procedure; however, the post-operative course was complicated with the overflow phenomenon and the patient underwent total correction with a check-valved patch used to close the ventricular septal defect. The patient required extracorporeal membrane oxygenator support in the post-operative period. There were two patients who underwent total correction of the pathology uneventfully. Mortality did not occur. Mean durations of hospital stay and follow-up were 14 plus or minus 13.4 days and 184.5 plus or minus 89.3 days, respectively., Conclusion: Our modest series with Tetralogy of Fallot with unilateral absent pulmonary artery indicates the feasibility of surgical correction in patients with appropriate unilateral pulmonary artery size and palliative procedures when the pulmonary artery size is smaller than that predicted for the age. Multi-centre long-term data of larger series are warranted in order to establish a treatment protocol.

Aims and Objectives: To determine awareness, use and attitudes of Turkish women towards prenatal screening tests (PST) for Down syndrome (DS)., Background: The technology of screening and diagnosing congenital diseases and abnormalities of foetuses has rapidly developed in the past few decades and prenatal screening for DS in early pregnancy is a valued component representing a cost-effective public health intervention in modern developed countries., Design: Cross-sectional and descriptive study., Methods: The study was carried out in 518 women in the early postpartum period at the Maternity and Children's Hospital between 1 September 2010 and 1 March 2011 using a questionnaire developed by the researchers., Results: Awareness about the first- and second-trimester PST [nuchal translucency (NT), triple test] was 21·6 and 59·7%, whereas use of them was 13·7 and 44·8%, respectively. Women who had lower education, were unemployed, had a patriarchal family type, had a low income status, were unmarried, had consanguineous marriage and did not have a private doctor were less aware and had less use of NT and/or triple test. Women who did not have a genetic disease in their family, were multiparous, had an unplanned pregnancy and did not receive antenatal care were less aware and had less use of the triple test. In case, the foetus was diagnosed as DS, women made the following decisions: continuing the pregnancy, terminating the pregnancy, leaving the decision to the doctor and being not sure 34·9, 12·0, 29·9 and 23·2%, respectively., Conclusion: Women's knowledge about and attitudes towards PST are important. This study shows that Turkish women have limited knowledge about and use of PST. Therefore, health professionals play a significant role in improving patients' information about PST. They should dedicate more time to discussions with women, provide appropriate and understandable information tailored to women's socio-economical level and should emphasise the indications, purposes and limitations of PST., Relevance to Clinical Practice: Discovering women's opinions and knowledge about PST will help healthcare providers determine their information needs., (© 2012 Blackwell Publishing Ltd.)

Objective: To assess the prevalence and associated risk factors for antenatal depression., Methods: From April to September 2011, a total of 651 pregnant women who had no chronic diseases, were at low risk for obstetric complications and who had no diagnosed depression before pregnancy were recruited for interview at Merkez Efendi Hospital, Maternal and Child out-patient department in western Turkey. The evaluation of depression was scored according to the Beck Depression Inventory. Statistical analysis was carried out using Chi-square, Fisher exact, t test and stepwise multiple regression analyses., Result: Of the total, 71 (10.9%) women scored > or = 17 on the inventory. Low level of education, unplanned pregnancy, lack of social support and pregnancy-related physical symptoms were found to be the most important risk factors for antenatal depression., Conclusion: Early identification and treatment of antenatal depression may improve pregnancy outcomes, and healthcare providers need to be sensitive to the risk factors for depression and strengthen the women's skills in coping with stress to improve their emotional health.