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In this case–control study, to determine the effect of early maladaptive schemas and childhood traumas under risk of alcohol and substance use in women was aimed. The case group of this study consisted of 40 women diag- nosed with alcohol use disorder and/or substance use disorder in Alcohol and Substance Addiction Treatment Centers (AMATEMs) and the control group consisted of 80 women with no diagnosis of alcohol use disorder and/or substance use disorder in Mother and Child Health and Family Planning (ACSAP) Center in a city. Sociodemographic information form, BAPI Alcohol and Substance Scale, Young Schema Questionnaire, and Childhood Trauma Questionnaire were used in study. Chi-square, Mann–Whitney U, Spearman’s correlation tests and logistic regression analysis was used for statistical analysis. According to the results of binary analyses results; being married, having children, living with spouses and children reduce the risk of alcohol or substance use in women; high income, smoking and having alcohol use disorder, or substance use disorder in relatives increase the risk of alcohol or substance use in women. According to the multiple analysis results, smoking is 22.6 fold (CI: 5.58–91.92), relatives substance use disorder 10.3 fold (CI: 1.79–59.73) increases the risk of alcohol or substance use in women. Twelve of 14 schemes and traumas increase the risk of alcohol or substance use in women. Schemas and traumas are risk factors of alcohol or substance use in women.

Geothermal brines contain high concentrations of ions and form a source of various valuable elements. The isolation of the elements from their water systems is a great challenge when the gradual depletion of ores in mining is considered. Attempts have been made for a long time to isolate valuable elements from aqueous mixtures prepared in the laboratory. However, those studies might not reflect the complexity of natural systems and might yield results that deviate significantly from the performance in real field systems. In this study, sorption is used to extract lithium ions from a representative field, Tuzla Geothermal Power Plant (TGPP) Turkey, using a mini-pilot reactor introduced to the reinjection well of the plant. Electrolytic manganese dioxide (γ-MnO2), a relatively inexpensive material widely used as the cathode material in lithium-ion batteries, was employed as a sorbent material for lithium. The sorption/desorption performance of the novel γ-MnO2 was investigated under various conditions. Sorption is performed at 360K and 2 bars. The maximum sorption performance was obtained at 1 h in Tuzla GPP. The desorption experiments were performed in acidic solutions. The concentration of Li+ in the desorption solution was found to be 25 mg/L on average when 10 g of γ-MnO2 was dispersed into 30 mL of the acidic aqueous solution. The first desorption solution was used consecutively for collecting more Li+ ions through the desorption of fresh brine-treated powder samples (cumulative desorption). By repeating this process four times consecutively, 230 mg/L of Li+ was obtained in the desorption solution. Moreover, the reusability of the γ-MnO2 sorbent was examined. The sorbent powder showed almost 40% performance efficiency compared to virgin powder under the conditions employed in this study. The use of electrolytic γ-MnO2 sorbent for lithium adsorption was found to be a promising process for practical use in the separation of lithium from geothermal brines.

Arka plan: 2019 sonunda ortaya çıktığından beri tüm dünyaya yayılan ve pandemiye neden olan solunum yolu virüsü SARS-CoV-2; gebelerde de normal popülasyonda olduğu gibi yüksek morbidite ve mortalite ile seyretti. Amaç: Bu çalışmadaki amaç; şiddetli solunum yolu enfeksiyonu ile seyreden SARS-CoV-2 virüsünün gebelerdeki risk faktörlerini, prognostik faktörlerini ve mortalite faktörlerini belirlemektir. Gereç Yöntem: 2021 yılı içerisinde Kadın Hastalıkları ve Doğum kliniğinde yatarak tedavi alan, 18 yaş üstü, SARS-CoV-2 PCR testi ile pozitif saptanan gebe hastaları içermektedir. Hastaların yatışındaki klinik özellikleri, vital bulguları, semptomları, laboratuvar bulguları not edildi. Mortaliteye etki eden faktörlerin istatistiksel analizi yapıldı. Bulgular: Çalışmaya dahil ettiğimiz 200 gebenin 74’ü hastalık esnasında doğum yaparken14’ünde anne ölümü gerçekleşti. Anne ölümüyle sonuçlananlarda ortalama saturasyon değeri %88 idi ve diğer gruba göre düşüktü. Ayrıca anne ölümü gelişen grubun, C-Reaktif Protein (CRP) ortalaması 68 mg/L olarak anlamlı düzeyde daha yüksekti. Anne ölümüyle sonuçlanan ve yaşayanların univariate testlerle karşılaştırılmasında, 37.8℃ ve üzerinde ateşin olmasının mortaliteyi arttırdığı, öksürük ve nefes darlığı olanlarda ölüm oranının anlamlı düzeyde daha yüksek olduğu, karaciğer fonksiyon testleri (KCFT) yüksek olanlarda ölüm oranının anlamlı düzeyde yüksek olduğu ve Hindistan (Delta) varyantında da ölüm oranının anlamlı düzeyde yüksek olduğu bulundu. 37.8℃ ve üzerinde ateş ile başvuran gebelerde mortalitenin 4.9 kat, Delta varyantı ile enfekte olanların mortalitesinin 3.5 kat arttığı görüldü. Saturasyonun ise her 1 birimlik yüksekliğinde mortalitenin 1.33 kat azaldığı sonucuna ulaşıldı. Tartışma: Covid-19 enfekte gebelerde klinik izlem parametreleri ve laboratuvar bulgularının derinleşmesi hastalığın prognozu ve maternal mortalite olasılığı ile doğrudan ilişkilidir. Bu sonuçların kullanılabilirliği açısından da çok sayıda literatür çalışmasının derlenmesi ve metaanalizine ihtiyaç vardır.

Objective:Neutrophil gelatinase-associated lipocalin (NGAL) is one of the new biomarkers for detecting acute renal injury. There are studies showing the relationship between NGAL and renal injury in obese children. The aim of this study was to investigate whether urinary levels of NGAL, kidney injury molecule-1, and serum cystatin C are increased in insulin resistance (IR) patients before the development of diabetes.Methods:Cross-sectional, case-controlled study that included non-diabetic obese children and adolescent patients with IR and a nondiabetic obese control group with no IR, who attended a tertiary center pediatric endocrinology outpatient clinic between 2016-2018. Those with diabetes mellitus and/or known renal disease were excluded. NGAL and creatinine (Cr) levels were evaluated in the morning spot urine from all participants. Serum renal function was evaluated.Results:Thirty-six control and 63 IR patients were included in the study, of whom 68 (68.7%) were girls. The mean age of all participants was 13.12±2.64 years and no statistically significant difference was found between the two groups in terms of age or gender distribution. Median (range) spot urinary NGAL (u-NGAL) values in the IR group were significantly higher at 26.35 (7.01-108.7) ng/mL than in the control group at 19.5 (3.45-88.14) ng/mL (p=0.018). NGAL/Cr ratio was also significantly higher in the IR group compared to the control group (p=0.018).Conclusion:Obese pediatric patients with IR were shown to have elevated levels of u-NGAL, a marker of renal injury. u-NGAL examination may show early renal injury before development of diabetes.

Bu makale, Fransız Dördüncü Cumhuriyeti’nin siyasal yapısının dış politika üzerindeki etkisini analiz etmeyi amaçlamaktadır. Bu analizi, Süveyş Krizi’ne giden yolda Fransa’nın İsrail’e karşı izlediği politika üzerinden yapmaktadır. Fransa’nın bu krizde kritik bir rol oynadığını savlayan makale, Paris’in bu politikasını açıklayabilmek için Dördüncü Cumhuriyetin zayıf ve istikrarsız siyasal yapısı içerisinde öne çıkan savunma ve dışişleri bürokrasileri arasında bürokratik siyaset modeli çerçevesinde cereyan eden iç mücadeleye odaklanmaktadır. Bu mücadelede Savunma Bakanlığı bürokrasisinin galip gelmesinde bir dizi bölgesel gelişme etkili olmuş ve sonuçta Fransa, Mısır’a yönelik ortak askerî müdahalenin planlanmasında öncü bir rol oynamıştır.

ABD’nin Almanya sorununa ilişkin politikası, Alman sanayisinin yokedilmesini öngören Morgenthau Planı’ndan, onu Avrupa’nın yeniden inşasınınçekirdeği olarak öngören Schuman Planı yönünde radikal bir değişim göstermiştir.Almanya’nın sanayisizleştirilmesi düşüncenin savunucusu Başkan Roosevelt’in aniölümü esas alındığında ilk bakışta, Amerikan Hükümetinde meydana gelen liderdeğişikliğin politika değişikliğini belirlediği düşünülebilecektir. Öte yandan görecekısa sürede ortaya çıkan bu radikal politika değişikliği sadece lider değişikliği ileaçıklanamayacak bir derinlikte siyasal kaymayı işaret etmektedir. Makale,uluslararası olguların nedenlerinin hükümetlerin davranışlarına indirgenmedenaçıklanması gerektiği varsayımından hareketle, Almanya Sorunu ile ilgili yaşananpolitika değişikliğinin yapısal nedenlerini ortaya koymayı hedeflemektedir.Makalede iki kutupluluğun bir sonucu olarak ABD ve Sovyetler’in yeni karşılıklıkonumlanması ve daha da önemlisi bu konumlanmanın etkisi altında Batı Avrupa’dahegemonik bir liberal düzen inşa süreci yapısal belirleyenler olarak incelenecektir.

Background: Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the characteristics of RML atelectasis in asthma during childhood. Methods: Children with asthma who had recently developed RML atelectasis were included; anti-inflammatory medications, clarithromycin, and inhaled salbutamol were prescribed, chest-physiotherapy (starting on the sixth day) was applied. Patients were reevaluated on the sixth, fourteenth, thirtieth, and ninetieth days, chest X-rays were taken if the atelectasis had not resolved at the time of the previous visit. Results: Twenty-seven patients (6.8 (4.8–8.3) years, 48.1% male) with RML atelectasis were included. Symptoms started 15 (7–30) days before admission. The thickness of the atelectasis was 11.8 ± 5.8 mm; FEV1% was 75.9 ± 14.2 and Childhood Asthma Control Test scores were 11.8 ± 5.6 at the time of admission. The atelectasis had been resolved by the sixth (n = 3), fourteenth (n = 9), thirtieth (n = 10), and ninetieth days (n = 3). The treatment response of the patients whose atelectasis resolved in fourteen days was better on the sixth-day (atelectasis thickness: 4.7 ± 1.7 vs. 11.9 ± 7.3 mm, p = 0.021) compared to those whose atelectasis resolved later. Nearly half (54.5%) of the patients whose atelectasis had resolved by fourteen days were using controller medications at the time of admission. However, only two patients (13.3%) were on controller treatment in the latter group (p = 0.032). Regression analysis didn't reveal any prognostic factors for the early resolution of atelectasis. Conclusions: Early diagnosis and treatment of RML atelectasis prevents complications. Patients who had early resolution of atelectasis had already been on anti-inflammatory medications, and responded better to aggressive treatment within the first week.

Siyasal istikrarsızlık, III. Cumhuriyet’in son dönemindeki temel sorundur. II. Dünya Savaşı’nın başlaması, Fransa’daki istikrarsızlığı daha da artırmıştır. Özellikle, “Tuhaf Savaş” döneminin belirsizliği, Paris’teki güç mücadelesini daha karmaşık hale getirmiştir. Bu karmaşık yapıda devam eden liderlik mücadelesi, yenilgi sonrasında Vichy ile Londra arasındaki kamplaşma ekseninde daha belirgin hale gelmiştir. Bu kamplaşmada açıkça görünen taraflar, Almanya ile işbirliği yapan kadro ile İngiltere’den mücadeleyi sürdüren kadrodur. Dolayısıyla ilk bakışta, Vichy Fransası ile Özgür Fransa arasında ve Pétain ile de Gaulle arasında net biçimde görülebilen bir mücadeleden bahsedilebilir. Oysa hem iki kampın kendi içinde, hem de de Gaulle ve Müttefiklerin Vichy Fransası’na müdahaleleriyle, liderlik mücadelesi göründüğünden daha karmaşıktır. Bu mücadele, işgalin doğal sonucu olarak değerlendirilebileceği gibi, III. Cumhuriyet’in son döneminde ortaya çıkan yapısal sorunların ve kadrolar arası mücadelenin bir uzantısı olarak da değerlendirilebilir

The EU member States declared at the Cologne European Council in June 1999, their "determination to play a full role on the intemational stage and to obtaın the necessary means and capabılities regarding a coromon European policy on security and defence"* 1 and furthermore they defıned at the Helsinki Summit ın December 1999 the guidelines of a future European security and defence pohcy. The objective was to "create an autonomous capacity for the EU to take decisions and, where NATO as a whole is not engaged, to launch and then to conduct EU-led military operations in response to International crises"2.

Objectives: We aim to assess whether severely frail patients have an increased risk of complications and worse surgical outcomes after retrograde intrarenal surgery. Methods: The data of 340 consecutive patients undergoing retrograde intrarenal surgery to treat upper tract urinary stones were analyzed retrospectively. The 5-item modified frailty index (mFI-5) was used to assess the frailty status. Using a cutoff value of score 2 in the mFI-5 score, patients were divided into two groups: patients with an mFI-5 score <2 were assigned to a non-frail (Group 1) group, and patients with an mFI-5 score ≥2 were assigned to a frail (Group 2) group. The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the surgical outcomes were much better in non-frail patients. Results: After matching confounding factors, Group 1 comprised 255 patients, and Group 2 comprised 85 patients. The baseline characteristics were similar between the groups. There were no statistically significant differences in terms of the median operation time and length of hospital stay among groups. There were no significant differences between groups for intraoperative complication rates (7.6% and 9.4%, respectively; P = .47) and postoperative complication rates (13.8% and 11.8%, respectively; P = .71), and stone-free rates (70.9% versus 72.9%, respectively; P = .73). Conclusions: Retrograde intrarenal surgery is an efficient and feasible treatment option for upper urinary tract stones in severely frail patients.

Purpose: Postoperative fever (POF)/urinary tract infection (UTI) is one of the most unpleasant and undesirable conditions for surgeons after retrograde intrarenal surgery (RIRS). RIRS is not recommended for any patient with a positive urine culture to avoid POF and UTI, but some patients may develop postoperative UTI even if the urine culture is sterile. This study investigated the predictive factors of fever and UTIs after RIRS., Methods: In total, 1240 patients who underwent RIRS for proximal ureteral stones and/or kidney stones were analyzed. After case-control matching, 168 patients were included in the study. Demographic data, preoperative/peroperative/postoperative data, and hematological parameters were compared. Patients with sterile urine cultures were included in the study. Postoperative fever was defined as fever ≥ 38 °C within 72 h after RIRS. Patients were divided into two groups: those with and without POF/UTI. Demographic data, preoperative and postoperative findings, and inflammatory parameters of the patients were compared retrospectively., Results: POF/UTI was observed in 61 (36.3%) of 168 patients who underwent RIRS. After case-control matching, increased body mass index (BMI) and longer operation time were found to be significant predictors of POF/UTI (p = 0.001 and 0.016 respectively). Preoperative systemic immune-inflammation index (SII) (PxN/L), high Platelet/Lymphocyte Ratio (PLR), and urine leukocyte positivity were found to be significant predictors of POF/UTI (p = 0.037, 0.025 and 0.038 respectively)., Conclusion: Hematological parameters are simple and feasible to use to evaluate POF/UTI in patients undergoing RIRS. High SII and PLR may predict POF and early infection after RIRS. In addition, according to demographic data and per-operative status, high BMI and prolonged operation time are risk factors for infection., Competing Interests: Declarations. Ethical approval: The study was approved by the Ethics Committee of Tekirdağ Namık Kemal University (Approval number: 2020.242.11.02). Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: There are conflicting results in the literature regarding the efficacy of retrograde intrarenal surgery (RIRS) in lower pole stones. This study aimed to evaluate RIRS outcomes in lower pole stones by forming matched case-control groups., Methods: The data of 491 patients who were diagnosed with kidney stones and underwent RIRS were retrospectively included in the study. A total of 209 patients with lower pole stones (Group 1) and 282 patients with pelvic stones (Group 2) were matched at a 1:1 ratio in terms of stone burden, stone density, preoperative double-J stenting status, and a previous history of shock wave lithotripsy, yielding 159 patients in each group. A computed tomography scan was performed to evaluate the stone-free status. The primary outcome was stone-free status 1 month after RIRS., Results: After case-control matching, the median age was 49 years (interquartile range [IQR]: 40-58) in Group 1 and 50 years (IQR: 35-60) in Group 2 (p = 0.388). The median stone burden values of Group 1 and Group 2 were 415.3 mm3 (IQR: 176.1-858.2) and 503.3 mm3 (IQR: 282.5-864), respectively (p = 0.100). After RIRS, stone-free status was achieved by 126 of the 159 (79.2%) in Group 1 and 133 of the 159 (83.6%) patients in Group 2 (p = 0.387). The groups were similar in terms of perioperative complications (4.4% in Group 1 and 3.8% in Group 2, p = 0.777), postoperative complications (13.8% in Group 1 and 10.3% in Group 2, p = 0.393), and median operation time (60 min in both, p = 0.230). A longer median fluoroscopy time was noted in Group 1 compared to Group 2 (26 s and 3 s, respectively, p = 0.013)., Conclusions: Stone-free rates and complications were comparable between the patients with lower pole and pelvic stones after RIRS. However, lower pole stones are associated with longer fluoroscopy time. RIRS can be performed effectively for the treatment of lower pole stones., (© 2024 S. Karger AG, Basel.)

Objective: To compare the predictive effects of stone size and volume on the efficacy and safety of retrograde intrarenal surgery (RIRS) and to determine the cutoff values of stone volume for prediction of RIRS efficacy and safety. Methods: Patients who underwent RIRS between 2017 and 2021 in six referral centers were retrospectively included in the study. The database of the RIRsearch group, which was formed prospectively, was used for this retrospective analysis. The surgical results and complications of RIRS were evaluated according to stone size and stone volume and compared between these groups. Results: A total of 1128 patients were included. Operation time, intraoperative complication rate, and postoperative complication rate increased significantly as stone size and stone volume increased ( P < .05). Stone size and volume were significant indicators for stone-free rates, but pairwise comparison showed that stone volume was a significantly better predictor of surgical success compared with stone size ( P < .001). Stone size was not sufficient to predict postoperative complications, whereas stone volume predicted these complications with low performance. Conclusions: Stone volume was a better predictor for surgical success than stone size, and it was as reliable as stone size in predicting postoperative complications.

A JJ stent placed before retrograde intrarenal surgery (RIRS) may ease the procedure. However, it is important to note that a prolonged duration of double J stent (DJS) placement before RIRS may increase the risk of postoperative urinary tract infection (UTI). Various publications have established this association, although the duration of the DJS before surgery is scarce. Our study investigates the relationship between the pre-stenting period and postoperative UTI and establishes a cut-off period to minimize this risk. We included a total of 500 cases with preoperative DJS prior to RIRS. The patients were divided into five groups according to their preoperative stenting duration (Group 1: 0-15 days; Group 2: 16-30 days; Group 3: 31-45 days; Group 4: 46-60 days; Group 5: >60 days). Demographic and clinical data of the patients, stone properties, operation data, perioperative and postoperative complications (including fever and UTI), hospitalization time, and stone-free rates (SFR) were compared. The groups contained 53, 124, 102, 63, and 158 patients. The demographics of the patients in each group were similar. There was no statistically significant difference between DJS duration, perioperative/postoperative complications, and SFR, except for the ureteral access sheath (UAS) insertion rate. (p = 0.001). The postoperative fever/UTI rate was the lowest in Group 1 (p = 0.046) compared to other durations. Stent duration does not impact SFR. Longer stents enhance UAS insertion success but increase postoperative infection risk. Our results suggest that RIRS should be performed within two weeks, ideally 20 days following stent insertion, to minimize postoperative infection risk., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The aim of the study was to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) in elderly patients by comparing them with propensity score-matched age-groups., Methods: Patients who underwent RIRS to treat upper urinary tract stone disease at seven centers were included in the study and were divided into four groups. The age intervals of the patients in group 1, group 2, group 3, and group 4 were 18-29 years old, 30-49 years old, 50-64 years old, and over 65 years old, respectively. Propensity score matching analysis was used to homogenize the groups in terms of demographic and clinical properties. Operative results, preoperative complications, perioperative complications, postoperative complications, duration of hospitalization time, and stone-free status were compared between groups., Results: A total of 1,017 patients were included in the study. There were 69 (9.9%) patients in group 1, 324 (46.5%) in group 2, 217 (31.1%) in group 3, and 87 (12.5%) in group 4 after propensity score matching. The operation time and postoperative complication rates were significantly different among groups, whereas the hospitalization time, perioperative complication rates, and stone-free status were similar. The operation time was significantly higher in patients over 65 years old (p = 0.001). The postoperative complication rates were significantly higher in group 1 with Clavien I-II complication predominance (p = 0.003)., Conclusion: The efficacy and safety of RIRS did not change with aging, and RIRS was an effective option for the treatment of upper urinary system stones in elderly patients., (© 2024 S. Karger AG, Basel.)

Background: This study reports our seven-year experience of one-year follow-up results after scrotal and testicular trauma, classified according to the Gülhane Grading System (GGS). We provide detailed hormonal analyses, ultrasound (US) evaluations, and spermiogram results. There are no previous studies that focus on all these detailed topics in relation to a grading system., Methods: Between October 2016 and October 2022, a total of 41 patients with testicular trauma were classified according to GGS. Patients with Grade 1 (G1) trauma were followed up without surgical intervention. Patients with Grade 2 (G2) trauma underwent surgical repair, while patients with Grade 3 (G3) trauma underwent orchiectomy. After the resolution of the emergency period, we recorded the following parameters at the one-year follow-up: follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone, free testosterone; testicular size, other testicular size, testicular parenchyma appearance in ultrasound; total sperm count, sperm concentration, total motility, progressive motility, and morphology in the spermiogram., Results: A total of 41 patients with a mean age of 25.56±6 years (range: 16-39) had testicular trauma. The trauma was bilateral in 10 patients (25%), right-sided in 14 patients (34%), and left-sided in 17 patients (41%). At the one-year follow-up, patients with unilateral G1 trauma had normal FSH, LH, total testosterone, and spermiogram levels. Patients with unilateral G2 or G3 trauma had slightly elevated FSH and LH levels, but normal testosterone and sperm parameters. Patients with combined G3 and G1 trauma had significantly elevated FSH and LH levels to maintain normal testosterone levels, though their morphology was lower than in the normal population. Patients with G3 + G2 trauma had significantly elevated FSH and LH levels to maintain normal testosterone levels, but all sperm counts were lower than the normal population. Patients with G3 + G3 trauma had significantly elevated FSH and LH levels, but all other hormonal and sperm parameters were zero., Conclusion: Our new grading system provides a practical and usable grading scale for evaluating scrotal and testicular trauma. Patients with unilateral trauma experienced good recovery, regardless of trauma grade. Bilaterally affected patients, however, were more likely to experience testosterone deficiency and poor spermiogram parameters.

Objective: To evaluate the effect of ureteral access sheath (UAS) use and calibration change on stone-free rate and complications of retrograde intrarenal surgery (RIRS)., Methods: Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included. Firstly, patients were compared after 1:1 propensity score matching, according to UAS usage during RIRS (UAS used [ + ] 87 and UAS non-used [ - ] 87 patients). Then all UAS +  patients ( n =481) were subdivided according to UAS calibration: 9.5-11.5 Fr, 10-12 Fr, 11-13 Fr, and 13-15 Fr. Primary outcomes of the study were the success and complications of RIRS., Results: Stone-free rate of UAS +  patients (86.2%) was significantly higher than UAS - patients (70.1%) after propensity score matching ( p =0.01). Stone-free rate increased with higher caliber UAS (9.5-11.5 Fr: 66.7%; 10-12 Fr: 87.0%; 11-13 Fr: 90.6%; 13-15 Fr: 100%; p <0.001). Postoperative complications of UAS +  patients (11.5%) were significantly lower than UAS - patients (27.6%) ( p =0.01). Complications (8.7%) with 9.5-11.5 Fr UAS was lower than thicker UAS (17.2%) but was not statistically significant ( p =0.09). UAS usage was an independent factor predicting stone-free status or peri- and post-operative complications (odds ratio [OR] 3.654, 95% confidence interval [CI] 1.314-10.162; OR 4.443, 95% CI 1.350-14.552; OR 4.107, 95% CI 1.366-12.344, respectively)., Conclusion: Use of UAS in RIRS may increase stone-free rates, which also increase with higher caliber UAS. UAS usage may reduce complications; however, complications seemingly increase with higher UAS calibration., Competing Interests: The authors declare no conflict of interest., (© 2024 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.)

Background: The aim of this study was (1) to explore effect of ureteral access sheath (UAS) use on primary retrograde intrarenal surgery (RIRS) outcomes, short-term kidney functions, radiation exposure, and ureteroscope lifetime (URS-LT) and (2) to reveal factors that predict UAS insertion failure. Materials and Methods: Patients ( n  = 1318) who underwent RIRS without UAS (Group 1), those who had operation with a <11-13 Fr (Group 2), and those with a ≥11-13 Fr UAS were matched (1:1:2) and compared. Stone-free rate (SFR), intra- and postoperative complications, acute kidney injury (AKI), fluoroscopy time, URS-LT, and UAS insertion failure were the outcomes. Results: SFR, which was highest in Group 3 (75%, 71% and 87.3%, respectively; P  = .001), was significantly associated with use of ≥11-13 Fr (odds ratio [OR]: 4.2, P  < .001), but was not with use of <11-13 Fr UAS (OR: 1.3, P  = .3). Group 3 had less need for auxiliary procedure (15%, 16%, and 7.4%, respectively; P  = .03). Five percent of patients had a risk of AKI, but only 0.3% developed AKI. Although UAS use was protective against creatinine increase (OR: 0.65, P  = .02), increased risk of AKI was only associated with female gender (OR: 5.5, P  < .001). Fluroscopy times were 5, 15, and 87 sn, respectively ( P  < .001). Short URS-LT was strongly associated with high frequency of lower calix stones ( r  = -0.94, P  = .005), but URS-LT was not correlated with sheathless case rate ( r  = 0.59, P  = .22). UAS insertion success in first attempt was more likely in younger (OR: 0.99, P  = .03), hydronephrotic (OR: 3.4, P  < .001), and female cases (OR: 1.5, P  = .008). But absolute UAS insertion failure was associated with female gender (OR: 2.7, P  = .017). Conclusions: Not any UAS use but a higher caliber UAS use may improve SFR and protect against AKI after RIRS. Although UAS insertion failure is seen mostly in men, it may be more challenging in women owing to less efficacy of preoperative Double-J stent.

Objectives: To complement our previous findings regarding effect of ureteral access sheath (UAS) use, we checked RIRSearch database for patients who operated without using UAS. The aim of the study was to understand these new data better by comparing outcomes of retrograde intrarenal surgery (RIRS) that continued sheathless after a failed UAS insertion vs those planned and completed sheathless. Materials and Methods: Data of 195 patients who underwent sheathless RIRS for kidney and/or ureteral stones between 2011 and 2021 were retrieved from the database. Patients divided into two groups: cases who were planned and completed sheathless ( n  = 110, Group 1) and those who proceeded without UAS after insertion failure ( n  = 85, Group 2). After propensity score matching (PSM), each group consisted of 76 patients. Results: After PSM, stone-free rate for Group 1 (90.8%) was significantly higher than stone-free rate of Group 2 (76.3%) in sheathless RIRS ( p  = 0.02). Also postoperative complication rate was significantly lower in Group 1 (10.5%) than in Group 2 (27.6%) ( p  = 0.007). In Group 2, median operating time was longer (60 minutes, interquartile range [IQR]: 40-80) and more unplanned auxilliary procedure (22.4%) was needed than Group 1 (45 minutes, IQR: 40-50 and 3.9%) (both p  = 0.001). Stone burden (odds ratio [OR]: 1.002, p  = 0.019) and stone density (OR: 1.002, p  = 0.003) were associated with high risk of residual stones after RIRS. Higher hydronephrosis grades were associated with increased stone-free rates (OR: 0.588 for residual stone risk, p  = 0.024). Cases who completed sheathless by dusting all available stones, as planned preoperatively, were more likely to have stone-free status after RIRS than those who proceeded sheathless after UAS insertion failure (OR: 2.645, p  = 0.024). Conclusions: Operation course after UAS insertion failure may be more challenging. In cases who performed without using UAS, surgeons who proceed with procedure sheathless after UAS insertion failure may more frequently run into complications and may fail achieving stone-free status compared with sheathless-planned cases.

Neuroligin-4 (NLGN4) loss-of-function mutations are associated with monogenic heritable autism spectrum disorder (ASD) and cause alterations in both synaptic and behavioral phenotypes. Microglia, the resident CNS macrophages, are implicated in ASD development and progression. Here we studied the impact of NLGN4 loss in a mouse model, focusing on microglia phenotype and function in both male and female mice. NLGN4 depletion caused lower microglia density, less ramified morphology, reduced response to injury and purinergic signaling specifically in the hippocampal CA3 region predominantly in male mice. Proteomic analysis revealed disrupted energy metabolism in male microglia and provided further evidence for sexual dimorphism in the ASD associated microglial phenotype. In addition, we observed impaired gamma oscillations in a sex-dependent manner. Lastly, estradiol application in male NLGN4 -/- mice restored the altered microglial phenotype and function. Together, these results indicate that loss of NLGN4 affects not only neuronal network activity, but also changes the microglia state in a sex-dependent manner that could be targeted by estradiol treatment., 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 © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: The Modified Seoul National University Renal Stone Complexity Score (S-ReSC) is a simple model based solely on stone location regardless of stone burden. The aims of this study were to validate S-ReSC for outcomes and complications of retrograde intrarenal surgery (RIRS) and to evaluate its predictive power against the stone burden., Material and Methods: Data of 1007 patients with kidney stones who had undergone RIRS were collected from our RIRSearch database. Linear-by-linear association, logistic regression, ANOVA/post hoc analysis and ROC curve (with Hanley and McNeil's test) were used for evaluation. The main outcomes were stone-free status and complications of RIRS., Results: The overall stone-free rate was 76.8% (773/1007). Higher S-ReSC scores were related to lower stone-free rates and higher total, perioperative and postoperative complication rates ( p <.001, p <.001, p =.008 and p <.001, respectively). S-ReSC score ( p =.02) and stone burden ( p <.001) were independent predictors of stone-free status. But stone burden (AUC = 0.718) had a more powerful discriminating ability than the S-ReSC score (AUC = 0.618)., Conclusions: The S-ReSC score is able to predict not only stone-free status but also complications of RIRS. Although this location-only based scoring system has a fair discriminative ability, stone burden is a more powerful predictor of stone-free status after RIRS. An ideal scoring system aiming to predict outcomes of RIRS must include stone burden as a parameter.

Objective: The aim of the study was to assess whether severely obese patients have an increased risk of complications during and after retrograde intrarenal surgery (RIRS). Materials and Methods: The data of 639 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were analyzed retrospectively. The patients were divided into two groups according to their body mass index numbers (Group 1, <35; Group 2, ≥35). The patients' demographics, stone characteristics, operative outcomes, and complication rates were compared between the groups. The primary objective was to examine whether the intraoperative and postoperative complication rates were higher in patients with a body mass index of ≥35 kg/m 2 . Results: After matching of confounding factors, Group 1 comprised 135 patients, and Group 2 comprised 47 patients. The baseline characteristics were similar between the groups. There were no significant differences between groups for intraoperative complication rates (11.8% and 12.8%, respectively; p  = 0.97). There was statistically significant difference in favor of Group 2 for postoperative complication rates (12.6% and 29.7%; respectively, p  < 0.01), overall complication rates (22.9% and 38.2%; respectively, p  = 0.02), mean operation time (56.15 vs 66.45 minutes; respectively, p  = 0.01), and length of stay (1.4 vs 2.1 days; p  = 0.03). Stone-free rates (75.5% vs 85.1%; respectively, p  = 0.17) did not differ between groups. Conclusions: RIRS is an efficient and feasible treatment option for upper urinary tract stones in severely obese patients. However, higher possibility of postoperative, especially infectious, complication rates should be considered in these patients.

Introduction: Several scoring systems and nomograms have been developed to predict the success of retrograde intrarenal surgery. But no meta-analysis for the performance of scoring systems has yet been performed. The aim of this study was to compare predictive ability of recent scoring systems for stone-free rate of retrograde intrarenal surgery., Material and Methods: PubMed and Web of Science databases were searched systematically between April and May 2021. The scoring systems which were validated externally or studied at least by two different researcher groups were selected for further analysis. Of 59 records, 14 studies met the inclusion criteria (n = 4137). Area under curve (AUC) values of selected scoring systems were pooled in random or fixed effects. The I 2 test was used to quantify heterogeneity., Results: Eight, 5, 8, 4 and 3 studies included in meta-analyses for the modified Seoul National University Renal Stone Complexity Score (S-ReSC), R.I.R.S., Resorlu-Unsal Score (RUS), S.T.O.N.E., and Ito's Nomogram, respectively. We found pooled AUC values 0.709 (95% CI 0.670-0.748), 0.704 (95% CI 0.668-0.739), 0.669 (95% CI 0.646 to 0.692), and 0.771 (95% CI 0.724 to 0.818), for first four of them, respectively. Heterogeneity was very high to pool AUC values for Ito's nomogram., Conclusions: Although S.T.O.N.E. score showed higer pooled AUC value, this systematic review and meta-analysis has not revealed superiority of any scoring system. High heterogeneity between studies and dependencies between scoring systems make it difficult to design a comparative statistical model to generalize the findings. Also, limitations aside, neither scoring system has demonstrated good predictive/discriminative performance., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)

Background: Adoptive transfer of engineered T cells has shown remarkable success in B-cell malignancies. However, the most common strategy of targeting lineage-specific antigens can lead to undesirable side effects. Also, a substantial fraction of patients have refractory disease. Novel treatment approaches with more precise targeting may be an appealing alternative. Oncogenic somatic mutations represent ideal targets because of tumor specificity. Mutation-derived neoantigens can be recognized by T-cell receptors (TCRs) in the context of MHC-peptide presentation., Methods: Here we have generated T-cell lines from healthy donors by autologous in vitro priming, targeting a missense mutation on the adaptor protein MyD88, changing leucine at position 265 to proline (MyD88 L265P), which is one of the most common driver mutations found in B-cell lymphomas., Results: Generated T-cell lines were selectively reactive against the mutant HLA-B*07:02-restricted epitope but not against the corresponding wild-type peptide. Cloned TCRs from these cell lines led to mutation-specific and HLA-restricted reactivity with varying functional avidity. T cells engineered with a mutation-specific TCR (TCR-T cells) recognized and killed B-cell lymphoma cell lines characterized by intrinsic MyD88 L265P mutation. Furthermore, TCR-T cells showed promising therapeutic efficacy in xenograft mouse models. In addition, initial safety screening did not indicate any sign of off-target reactivity., Conclusion: Taken together, our data suggest that mutation-specific TCRs can be used to target the MyD88 L265P mutation, and hold promise for precision therapy in a significant subgroup of B-cell malignancies, possibly achieving the goal of absolute tumor specificity, a long sought-after dream of immunotherapy., Competing Interests: Competing interests: AP and ÖÇ are inventors on a filed patent application for the T-cell receptors described in the study (WO 2020/152161 A1)., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An emergency operation was planned for a patient who developed pneumothorax, subcutaneous emphysema and pneumomediastinum, which was thought to develop secondary to acute diverticulitis. Polymerase chain reaction (PCR) test for coronavirus disease 2019 (COVID-19) diagnosis could not be performed before the operation. In COVID-19 infection, it has been reported that pneumonia, pneumomediastinum and subcutaneous emphysema could be seen in thoracic computed tomography (CT) scan in addition to classic ground-glass opacities. In this study, a modified closed chest drainage system (CCDS) is presented to prevent COVID-19 aerosolisation in a patient undergoing intraoperative tube thoracostomy., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (© Copyright 2021 by Turkish Anaesthesiology and Intensive Care Society.)

Background/aim: A synchronized dialogue between maternal and embryonic tissues is required for successful implantation. Low uterine receptivity is responsible for two-thirds of implantation failures and leptin is effective in the physiology of reproduction by binding to specific receptors. In this study, we investigateleptin receptor expression in cases of embryo transfer to endometrial coculture., Materials and Methods: Biopsy materials were taken from 20 females with indication for coculture application and were cultured in an appropriate medium after the epithelial cells were isolated. The grown cells were cultured in chamber slides as the first group. For the second group, day 3 embryo was added to chamber slides and the development was observed. The embryo was transferred 1 or 2 days later and other cells (after the transfer process) were used to form the second group. After fixation, immunohistochemical staining was performed with anti-leptin primary antibody., Results: Regarding the coculture without embryo transfer, moderate leptin receptor immunoreactivity was seen in the perinuclear region and the cell membrane. Also, regarding the coculture with embryo transfer, moderate leptin receptor immunoreactivity was seen in the cytoplasm and strong leptin receptor immunoreactivity was seen in the cell membrane., Conclusion: Embryo transfer to endometrium coculture triggers leptin receptor expression, (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Objective: To investigate the prevalence of Burnout syndrome (BS) with its emotional exhausting (EE), depersonalization (DP), and personal accomplishment (PA) dimensions among Turkish urologists., Material and Methods: A total of 2,259 certified Turkish urologists were invited by e-mail to participate in this cross-sectional survey-based study. An online survey was conducted to evaluate three dimensions of BS ie: -EE, DP and PA-and their association with socio-demographic variables of Turkish urologists using the Maslach Burnout Inventory (MBI)., Results: Of the 2259 urologists contacted, 362 (with a mean age of 44±9.9 years) completed the survey. The mean EE, DP and PA scores were 16.8±8.7, 6.6±4.6 and 8.2±5.6, respectively. Cronbach's α reliability co-efficiencies were 0.920 for EE, 0.819 for DP and 0.803 for PA. Antidepressant drug usage was quite prevalent among participants (21.9%), and the most common comorbidity was hypertension (13%). The academic title, age, smoking status, monthly income and relationships between colleagues and employers were associated with BS (p<0.05)., Conclusion: The prevalence of BS among Turkish urologists is quite prevalent in terms of EE and DP subscales and may negatively affect the psychosocial status and well-being of the urologists. In this study, a high prevalence of BS has been reported among Turkish urologists. In conclusion the BS could become an important occupational and health problem, if it is not properly managed.

Oncogenic MYD88 mutations, most notably the Leu 265 Pro (L265P) mutation, were recently identified as potential driver mutations in various B-cell non-Hodgkin Lymphomas (NHLs). The L265P mutation is now thought to be common to virtually all NHLs and occurs in between 4 and 90% of cases, depending on the entity. Since it is tumor-specific, the mutation, and the pathways it regulates, might serve as advantageous therapeutic targets for both conventional chemotherapeutic intervention, as well as immunotherapeutic strategies. Here, we review recent progress on elucidating the molecular and cellular processes affected by the L265P mutation of MYD88, describe a new in vivo model for MyD88 L265P-mediated oncogenesis, and summarize how these findings could be exploited therapeutically by specific targeting of signaling pathways. In addition, we summarize current and explore future possibilities for conceivable immunotherapeutic approaches, such as L265P-derived peptide vaccination, adoptive transfer of L265P-restricted T cells, and use of T-cell receptor-engineered T cells. With clinical trials regarding their efficacy rapidly expanding to NHLs, we also discuss potential combinations of immune checkpoint inhibitors with the described targeted chemotherapies of L265P signaling networks, and/or with the above immunological approaches as potential ways of targeting MYD88-mutated lymphomas in the future.

Objective: A debate is open on the effects of lipid-lowering drugs on sexual function. We aimed to investigate the effect of atorvastatin use on penile intracavernosal pressure (ICP) and cavernosal morphology., Material and Methods: Fourteen mature male Sprague-Dawley-rats were randomly assigned to either the control group (which received standard food and water ad libitum) or the atorvastatin group (which received standard food, water, and statin) for twelwe weeks. At the end of the study, ICPs were measured with cavernosometry. Penectomy specimens were histologically examined., Results: The following mean values were obtained for the control and atorvastatin groups, respectively: pre-study body weights (350±16.9 g and 331.4±24.9 g); post-study body weights (356±18 g and 368±22.5 g (p>0.05); ICPs at 5 V (5.96±5.16 mmHg and 2.11±1.22 mmHg (p=0.07)); ICPs at 10 V (18.28±14.1 mmHg and 5.56±5.58 mmHg) (p=0.09); testosterone (1.23±0.78 and 0.78±0.58 mmol/dL) (p=0.39); blood glucose (151±22 mg/dL and 168.6±16.2 mg/dL) (p=0.12); triglyceride (93.4±19.8 mg/dL and 52.1±18.6 mg/dL) (p=0.01); total cholesterol (50.2±7.2 mg/dL and 47.7±6.6 mg/dL) (p=0.51); and low-density lipoprotein (LDL) cholesterol (10.0±4.4 mg/dL and 3.5±2.1 mg/dL) (p=0.01). The mean collagen thickness was similar (p=0.09); but the mean elastin thickness increased in the atorvastatin group (p=0.01)., Conclusion: The present study showed that the use of atorvastatin reduced the intracavernosal pressure in 10 V stimulation, and minimally decreased testosterone levels in rats, within a short period of time. When statin treatment is considered for its protective properties on cardiovascular system or for its lipid-lowering effect. It should be kept in mind that atorvastatin may also adversely contribute to erectile dysfunction.

Objective: We aimed to show the effect of retrograde JJ stenting and intraoperative antegrade JJ stenting techniques on operative time in patients who underwent laparoscopic pyeloplasty., Material and Methods: A total of 34 patients were retrospectively investigated (15 male and 19 female) with ureteropelvic junction obstruction. Of the patients stentized under local anesthesia preoperatively, as a part of surgery, 15 were retrogradely stentized at the beginning of the procedure (Group 1), and 19 were antegradely stentized during the procedure (Group 2). A transperitoneal dismembered pyeloplasty technique was performed in all patients. The two groups were retrospectively compared in terms of complications, the mean total operative time, and the mean stenting times., Results: The mean ages of the patients were 31.5±15.5 and 33.2±15.5 years (p=0.09), and the mean body mass indexes were 25.8±5.6 and 26.2.3±8.4 kg/m 2 in Group 1 and Group 2, respectively. The mean total operative times were 128.9±38.9 min and 112.7±21.9 min (p=0.04); the mean stenting times were 12.6±5.4 min and 3.5±2.4 min (p=0.02); and the mean rates of catheterization-to-total surgery times were 0.1 and 0.03 (p=0.01) in Group 1 and 2, respectively. The mean hospital stays and the mean anastomosis times were similar between the two groups (p>0.05)., Conclusion: Antegrade JJ stenting during laparoscopic pyeloplasty significantly decreased the total operative time., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objectives: The aim of the study was investigate the pain palliation effect of 2% dose of lidocaine on the periprostatic nerve block in prostate biopsy patients., Methods: Extended (12 cores) and saturation (22 cores) biopsy patients were included. The patients were separated into three groups: extended biopsy patients (Group I), saturation biopsy patients (Group II), and control group patients undergoing a biopsy procedure for the first time (Group III). All patients received 2% lidocaine (10 mL) on both the seminal vesicular junction and apex of the prostate with transrectal ultrasonography guidance. Following the procedure, the pain levels of patients were assessed using a 10-cm linear Visual Analog Scale (VAS)., Results: Following the procedure, the VAS values of each group were 2.96±1.06, 3.2±1.47, and 2.93±0.94, respectively (p>0.05). While the highest pain score was seen in the saturation group patients (II), the lowest pain level was seen in the control biopsy group (III). However, no statistical di erence was observed among the groups., Conclusion: Herein, we observed that a local injection using 2% lidocaine was effective as local anesthetic in recurrent prostate biopsies. In addition, it was found that the pain level increases as the number of cores taken in recurrent prostate biopsies increases; however, this has not been established statistically.

Axillo-axillary bypass grafting is considered the operation of choice for patients with subclavian steal syndrome. Anesthetic management of high-risk patients with coronary-subclavian steal syndrome presents safety and technical challenges. Presently described is case of chronic obstructive lung disease and coronary artery disease in a 52-year-old man who required axillo-axillary bypass surgery to treat stenosis at the origin of left subclavian artery. Successful anesthetic management was achieved for patient undergoing axillary-axillary bypass surgery using a cervical epidural technique.

Study of Objective: To compare the effects of oral tramadol+paracetamol combination on morphine consumption following coronary artery bypass grafting (CABG) in the patient-controlled analgesia (PCA) protocol., Design: A prospective, double-blind, randomized, clinical study., Setting: Single-institution, tertiary hospital., Patients: Fifty cardiac surgical patients undergoing primary CABG surgery., Interventions: After surgery, the patients were allocated to 1 of 2 groups. Both groups received morphine according to the PCA protocol after arrival to the coronary intensive care unit (bolus 1 mg, lockout time 15 minutes). In addition to morphine administration 2 hours before operation and postoperative 2nd, 6th, 12th, 18th, 24th, 30th, 36th, 42th, and 48th hours, group T received tramadol+paracetamol (Zaldiar; 325 mg paracetamol, 37.5 mg tramadol) and group P received placebo. Sedation levels were measured with the Ramsay Sedation Scale, whereas pain was assessed with the Pain Intensity Score during mechanical ventilation and with the Numeric Rating Scale after extubation. If the Numeric Rating Scale score was ≥3 and Pain Intensity Score was ≥3, 0.05 mg/kg morphine was administered additionally., Measurements: Preoperative patient characteristics, risk assessment, and intraoperative data were similar between the groups., Main Results: Cumulative morphine consumption, number of PCA demand, and boluses were higher in group P (P<.01). The amount of total morphine (in mg) used as a rescue analgesia was also higher in group P (5.06±1.0), compared with group T (2.37±0.52; P<.001). The patients who received rescue doses of morphine were 8 (32%) in group T and 18 (72%) in group P (P<.001). Duration of mechanical ventilation in group P was longer than group T (P<.01)., Conclusion: Tramadol+paracetamol combination along with PCA morphine improves analgesia and reduces morphine requirement up to 50% after CABG, compared with morphine PCA alone., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The case of a 77-year-old patient with severe coronary heart disease who underwent radical mastectomy with axillary lymph node dissection by ultrasound-guided continuous paravertebral block (CPVB) is described in the present report. Radical mastectomy with axillary dissection is a surgical procedure that necessitates endotracheal intubation and is usually performed under general anesthesia, which carries heightened risk for patients with coronary heart disease (CHD) and sleep apnea syndrome (SAS). Ultrasound-guided CPVB is a simple and safe alternative technique that allows for the use of anesthesia and postoperative analgesia with minimal side effects.

Fungal brain abscesses are a rare but serious complication in transplant recipients. Phialemonium organisms are rare causes of invasive mold infections. Here, we present the first case of a renal transplant recipient with multiple brain abscesses caused by Phialemonium infection A. A 51-year-old female kidney transplant recipient was admitted with pneumonia of an unknown cause and treated with empiric intravenous antibiotics. Her treatment was uneventful, and she was discharged 1010 days later. After 5 days, she was readmitted with fever, cerebral palsy, and speech disorder. The patient had undergone living-donor renal transplant 7 months earlier. A cranial computed tomography and magnetic resonance imaging were performed for a possible cerebrovascular pathology. The magnetic resonance imaging scan showed multiple brain abscesses located at the left parietal, frontal and occipital lobes; right parietal and occipital lobes; right basal ganglia; and left cerebellum. The patient received meropenem, linezolid, sulfamethoxazole and trimethoprim, and AmBisome for probable pathogenic infection, and immunosuppressive agents dosage was reduced increasingly immunosuppressed. We identified Phialemonium in cerebrospinal fluid culture. The patient received voriconazole 200 mg twice daily. Lesions could not be drained due to lack of capsula formation. The patient died on the 30th day of antifungal therapy. Phialemonium organisms, although a rare cause of fungal infections, are associated with a high mortality rate in immunocompromised patients. To our knowledge, this is the first case report in the literature describing multiple brain abscesses due to Phialemonium in a transplant recipient. Clinicians recipient should be alert about these rare opportunistic fungi in the differential diagnosis of brain abscess, and bronchoscopy and bronchoalveolar lavage are recommended for transplant patients when they are admitted with pneumonia exclude fungal infections.

This study aims at comparatively evaluating anaerobic and aerobic MBRs for the treatment of azo-dye containing synthetic wastewater. Also, the filtration performances of AnMBR and AeMBR were compared under similar operating conditions. In both MBRs, high COD removal efficiencies were observed. Although almost complete color removal was observed in AnMBR, only partial (30-50%) color removal was achieved in AeMBR. AnMBR was successfully operated up to 9 L/(m(2)h) (LMH) and no chemical cleaning was required at 4.5 LMH for around 50 days. AeMBR was operated successfully up to 20 LMH. The filtration resistance of AnMBR was generally higher compared to AeMBR although reversible fouling rates were comparable. In both MBRs, offline chemical cleaning with NaOCl and sulfuric acid almost completely removed irreversible fouling and the resistances of chemically cleaned membranes were close to those of new membranes., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Reactive oxygen species (ROS) produced by the inducible NADPH oxidase type 2 (NOX2) complex are essential for clearing certain infectious organisms but may also have a role in regulating inflammation and immune response. For example, ROS is involved in myeloid derived suppressor cell (MDSC)- and regulatory T cell (T(reg)) mediated T- and NK-cell suppression. However, abundant ROS produced within the tumor microenvironment, or by the tumor itself may also yield oxidative stress, which can blunt anti-tumor immune responses as well as eventually leading to tumor toxicity. In this study we aimed to decipher the role of NOX2-derived ROS in a chemically (by methylcholanthrene (MCA)) induced sarcoma model. Superoxide production by NOX2 requires the p47(phox) (NCF1) subunit to organize the formation of the NOX2 complex on the cell membrane. Homozygous mutant mice (NCF1*/*) have a functional loss of their super oxide burst while heterozygous mice (NCF1*/+) retain this key function. Mice harboring either a homo- or a heterozygous mutation were injected intramuscularly with MCA to induce sarcoma formation. We found that NOX2 functionality does not determine tumor incidence in the tested MCA model. Comprehensive immune monitoring in tumor bearing mice showed that infiltrating immune cells experienced an increase in their oxidative state regardless of the NOX2 functionality. While MCA-induced sarcomas where characterized by a T(reg) and MDSC accumulation, no significant differences could be found between NCF1*/* and NCF1*/+ mice. Furthermore, infiltrating T cells showed an increase in effector-memory cell phenotype markers in both NCF1*/* and NCF1*/+ mice. Tumors established from both NCF1*/* and NCF1*/+ mice were tested for their in vitro proliferative capacity as well as their resistance to cisplatin and radiation therapy, with no differences being recorded. Overall our findings indicate that NOX2 activity does not play a key role in tumor development or immune cell infiltration in the chemically induced MCA sarcoma model.