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The goal of living guidelines is keeping recommendations in guidelines up-to-date as new evidence becomes available. This review aims at scoping the prevalence and formal characteristics of living guidelines in the field of medicine and explore differences between formats.A selective search of living guidelines in MEDLINE via PubMed, Google Scholar and six relevant online repositories for guidelines (MAGICApp, AWMF, GIN, NICE, WHO-Iris, BIGG) was conducted. Authors and editors were contacted to receive previous non-living guideline versions. Living guidelines were subsequently analyzed according to pre-defined methodological criteria as described below (inter-comparison). Differences between living and their conventional (non-living) versions were assessed (intra-comparison).83 living guidelines were identified and selected for further screening, out of which 26 were eligible for analysis. 61.5% were new publications (de-novo guidelines) and 38.5% updates of pre-existing guidelines. There are some concepts defining, for example, the update cycle (AWMF, maximum of 12 months) but not all living guidelines follow or refer to existing concepts. The analysis shows that living guidelines in line with the established standards for (non-living) clinical guidelines involve an evidence standard, an extensive consensus process (often in the form of a Delphi process), and the inclusion of stakeholders (patients/relatives) in the development process, despite the high frequency of updates. When comparing living and conventional guidelines with the descriptive approach changes were found in update frequency (being more frequent with living guidelines, annually at the latest) and publication format (towards more digital) and public consultation (living guidelines offered more possibilities), no substantial methodological differences were observed in the description of consensus processes, changes in number of recommendations, inclusion of patient representatives. Given the small number of comparable pairs, the results reflect a tendency in the analyzed sample.The definition and development of living guidelines varied. Standardization (i. e. in the form of a checklist, procedure template) is needed to assess quality of the living process.

Nicotine intake and cortical activity are closely related, as they can influence each other. Nicotine is implicated in the induction and modification of cortical plasticity and excitability, whereas a change on cortical plasticity and excitability can also lead to a modification of the smoking behaviour of an individual. The aim of this systematic review was, on the one hand, to evaluate the effects of nicotinergic modulation on cortical excitability and plasticity, and, on the other hand, to assess if modifying the brain's excitability and plasticity could influence one's smoking behaviour. Two systematic literature searches in the PubMed/MEDLINE and PsycINFO databases were conducted. Studies focusing either on the impact of nicotinergic modulation on cortical activity or the treatment effect of non-invasive brain stimulation techniques (NIBS) on smoking behaviour were included. A total of 22 studies for the first systematic search and 35 studies for the second one were included after full-text screening. Nicotine's effect on cortical activity appeared to depend on smoking status of the individual. While deprived smokers seem to generally profit from nicotine consumption in terms of cortical excitability and plasticity, the contrary was true for non-smokers. Regarding the questions of how changes in cortical excitability can influence smoking behaviour, a trend points towards NIBS being a potential intervention technique for smoking cessation.

Objectives: To predict the risk of retinopathy of prematurity (ROP) development according to routine complete blood count (CBC) parameters. Materials and Methods: The medical records and CBC results of 150 premature neonates were retrospectively evaluated. As ROP develops 1 month after birth, first month CBC profiles of neonates without ROP (non-ROP), with ROP (ROP group), and those with Type 1, Type 2, and Stage 1+2 ROP were compared. Besides known statistical methods like Student’s t test, logistic regression and classification & regression tree (C&RT) analysis were also done to identify a reliable quantitative predictive parameter. Results: Mean gestational age and birth weight of the ROP group (n=99) and non-ROP (n=43) group were 29.39±3.43 and 32.05±2.20 weeks and 1382.44±545.30 and 1691.51±360.84 grams, respectively (p

Nicotine intake and cortical activity are closely related, as they can influence each other. Nicotine is implicated in the induction and modification of cortical plasticity and excitability, whereas a change on cortical plasticity and excitability can also lead to a modification of the smoking behaviour of an individual. The aim of this systematic review was, on the one hand, to evaluate the effects of nicotinergic modulation on cortical excitability and plasticity, and, on the other hand, to assess if modifying the brain's excitability and plasticity could influence one's smoking behaviour. Two systematic literature searches in the PubMed/MEDLINE and PsycINFO databases were conducted. Studies focusing either on the impact of nicotinergic modulation on cortical activity or the treatment effect of non-invasive brain stimulation techniques (NIBS) on smoking behaviour were included. A total of 22 studies for the first systematic search and 35 studies for the second one were included after full-text screening. Nicotine's effect on cortical activity appeared to depend on smoking status of the individual. While deprived smokers seem to generally profit from nicotine consumption in terms of cortical excitability and plasticity, the contrary was true for non-smokers. Regarding the questions of how changes in cortical excitability can influence smoking behaviour, a trend points towards NIBS being a potential intervention technique for smoking cessation.

Background Cortical plasticity – the ability to reorganize synaptic connections and adapt to environmental changes – appears to be impaired in schizophrenia patients. Results suggest the dysfunctional plasticity to be a key pathophysiological mechanism. Different non-invasive brain stimulation (NIBS) techniques have been used to modulate and induce cortical plasticity. In healthy subjects, nicotine was shown to play an important role in plasticity induction and is capable to alter cortical excitability and plasticity, induced by NIBS techniques. Our goal was to investigate the promising effects of a nicotine receptor activation done by Varenicline and the combination with anodal transcranial direct current stimulation (a-tDCS) on neuroplastic changes in schizophrenia patients. Methods Our sample consisted out of twenty-four individuals with schizophrenia, twelve smokers and twelve non-smokers. Every participant received Varenicline and Placebo, combined with anodal transcranial direct current stimulation (a-tDCS), to induce non-focal plasticity. We inferred plasticity changes by monitoring changes in cortical excitability. This was done via motor-evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS). The MEPs were recorded before and three hours after Varenicline/Placebo intake. Following the direct current stimulation, we monitored excitability changes for up to one hour. Results Significant effects through the mere Varenicline consumption or withdrawal effects could not be found in any group. However, we observed a numeric temporary decrease of excitability after a-tDCS in non-smokers following Varenicline intake. This decrease compared to the placebo condition was visible 20 minutes after a-tDCS but vanished over time. Smokers did not show any excitability changes after a-tDCS and the nicotinic receptor stimulation did not show any influence. Excitability changes after stimulation in contrast to the baseline measurement were not evident. Discussion Our results show that an activation of nicotinic receptors in schizophrenia patients does not induce excitability changes. The modulating effect of nicotine in plasticity induction via anodal transcranial direct current stimulation could not be confirmed for patients with schizophrenia. We could show that chronic nicotine consumption in patients with schizophrenia or nicotine withdrawal does not lead to fundamental excitability changes. Acute nicotine consumption has only small effects on cortical excitability in non-smokers.

Akyuz-Unsal AI, Key O, Guler D, Bekmez S, Sagus M, Akcan AB, Kurt-Omurlu I, Anik A, Oruc-Dundar S, Turkmen M. Retinopathy of prematurity risk factors: Does human milk prevent retinopathy of prematurity? Turk J Pediatr 2019; 61: 13-19. The aim of this study was to investigate the risk factors for Retinopathy of Prematurity (ROP) development and the potential effect of human breast milk among these factors. For this purpose, infants admitted to a tertiary referral clinic for ROP screening and treatment between April 2013 and May 2015, were included in this retrospective study. The demographic data, accompanying diseases, previous surgery, type of feeding and duration of human breast milk intake were recorded. According to the ROP screening examination results, infants were divided into two groups as those with ROP (infants at any stage of ROP) and those without ROP. Relationship between the risk factors and ROP were evaluated. The comparison of 221 infants without ROP and 99 infants with ROP; revealed that gestational age at birth, birth weight, mechanical ventilation support, bronchopulmonary and cardiac diseases, hydrocephaly, any previous surgery, infections, steroid treatment percentages were high and human breast milk intake percentage was low among infants with ROP. Mean breast feeding time for infants with ROP (3.81 ± 2.33 month) was shorter than the infants without ROP (5.51 ± 1.43 month) (p < 0.001). In logistic regression analysis, the duration of breast feeding was inversely related with ROP (OR 0.744; 95% CI 0.621-0.891; p < 0,001). These results suggest that gestational age at birth and accompanying diseases are the main risk factors for the development of ROP. As the duration of the breast feeding of the infants without ROP was longer than the infants with ROP; breast feeding may have a preventive effect on ROP development.

Amaç: Maternal parametrelerin Prematüre Retinopatisi (ROP)gelişimindeki olası etkilerini araştırmak.Gereç-Yöntem: Merkezimizde doğmuş prematürelerin anneleriningebelik yaşları, beden kitle indeksleri (BKİ), gebelik sayısı, kaçıncı gebelikolduğu, erken membran rüptürü (EMR) ve preterm eylem gelişimi, gestasyoneldiabet tanısı, sigara ve ilaç kullanımı, doğumdan hemen önceki sistolik vediastolik kan basınçları, kan şekeri, kan sayımı, karaciğer ve böbrek fonksiyonparametreleri ve obstetrik ultrason bulguları, ROP gelişen ve gelişmeyenlerarasında bağımsız gruplarda t-testi, Pearson ki-kare ve Mann-Whitney U testlerikullanılarak karşılaştırıldı.Sonuçlar: ROP gelişen 98 bebeğin ortalama doğum haftası29.61±3.45 iken, ROP gelişmeyen 41 bebeğin ise 32.14±2.15 haftaydı. Annegebelik yaşı, BKİ, gebelik sayısı, gebelik sıralaması, gestasyonel diabettanısı, preterm eylem, sigara kullanımı, doğumdan hemen önceki sistolik vediastolik kan basınçları, hemoglobin, hematokrit, üre, kreatinin, ALT, ASTdeğerleri arasında gruplar arası anlamlı fark yokken (p>0.05); Evre 1 ve Evre 3’deki ROP grupları arasında kan şekeriaçısından istatistiksel fark saptandı (p=0.016).Oligohidroamnios, anhidroamnios, fetal distres, intrauterin gelişme geriliği,plasenta dekolmanı, plasenta previa, umbilikal arterde end diastolik akımkaybı, umbilikal ve uterin arter direnç artışı gibi patolojik US bulgusuvarlığında %75.8 oranında ROP görüldüğü, EMR gelişenlerin %83.3’ünde de ROPgeliştiği saptandı (p=0.033).Tartışma: Çalışmamızdaki ROP-kan şekeri ilişkisine ait verilerliteratürle uyumlu olup; tip 1 ROP’a ilerleyen prematürelerin annelerinin kanşekerlerinin Evre 1’dekilerden yüksek olması, maternal kan şekeri yüksekliğinintedavi gerektiren ROP için bir risk faktörü olabileceğini düşündürmüştür. Erkenmembran rüptürü ile obstetrik ultrasonda patolojik bulguların tespitedilmesinin de ROP açısından risk faktörü olduğunun ortaya konmasıyla birlikte,bu ön çalışmanın ışığında yapılacak prospektif çalışmalara ihtiyaç vardır.

Background Tobacco dependence is the most common substance use disorder in schizophrenia patients. Research suggests that prevalence rates for patients with schizophrenia are 40 to 80 percent. It is believed that these patients smoke to improve cognitive deficits. This assumption is supported by several neurophysiological and behavioral studies. The aim of the current study is to assess the physiological fundamentals and the behavioral effects of smoking in patients with schizophrenia. Methods The present randomized double-blind and controlled study is ongoing and focusses on enhancing cognitive functioning in schizophrenia patients. Nicotinic receptors of participating patients are stimulated by the substance varenicline. The resulting changes are assessed by non-invasive brain stimulation (NIBS) and cognitive performance tests. Additionally, anodal transcranial direct current stimulation (a-tDCS) is applied for inducing plasticity to examine the interaction between tobacco consumption and brain stimulation. The treatment consists of twice daily 1 mg of varenicline (or placebo) and 20-minute a-tDCS (or sham tDCS) over a period of five days. Sixty patients with schizophrenia will be recruited for this pilot study. Results This is a double-blind study. Therefore no results can be shown so far. To this date 18 patients have been recruited (female = 6). There haven’t been major side effects and patients are tolerating the interventions well. Discussion During the conference we will present the concept and design of the combined “varenicline x tDCS” trial for the treatment of cognitive deficits in schizophrenia.