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Aylin Sari, 1 Zeynep Akdoğan Altun, 1 Cigdem Arifoglu Karaman, 1 Basak Bilir Kaya, 1 Bekir Durmus 2 1Department of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey; 2Department of Physical Medicine and Rehabilitation, Istinye University Medical Faculty, Istanbul, TurkeyCorrespondence: Aylin SariDepartment of Physical Medicine and Rehabilitation, Erenkoy Physical Medicine and Rehabilitation Hospital, Semsettin Gunaltay Avenue Sultan Street No. 14, Kadikoy, Istanbul, TurkeyTel +905058396368Fax +902164783123Email mdaylinsari@gmail.comPurpose: This randomized, placebo-controlled study examined the effect of vitamin D replacement therapy on neuropathic symptoms and balance in patients with diabetic neuropathic pain and low vitamin D levels.Patients and Methods: Among the 258 patients, the results in a total of 57 volunteers (32 in the treatment and 25 in the control arm) meeting the inclusion criteria are reported. Symptoms of neuropathic pain were assessed using Douleur Neuropathique 4 (DN4) questionnaire, and presence of polyneuropathy (PNP) was determined by performing electromyography (EMG). Balance was assessed using Berg balance test (BBT). After undergoing these examinations, the patients in the treatment group were intramuscularly (IM) injected with 300,000 IU vitamin D in a liquid formulation and those in the placebo group were IM injected with physiological saline. The DN4 and BBT were repeated after 12 weeks, and the results were compared.Results: The patients in the treatment group showed a significant decrease in total DN4 scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.008). The patients in the treatment group also showed a significant increase in BBT scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.001). Furthermore, in subgroup analysis, these patients showed a significant decrease in electric shock and burning sensation scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.006, p=0.001, respectively).Conclusion: In patients with diabetic neuropathic pain, vitamin D levels should be measured and vitamin D replacement therapy should be administered as required to resolve neuropathic symptoms and to improve balance.Keywords: diabetic neuropathic pain, vitamin D, balance, neuropathic pain symptoms

OBJECTIVE: Identifying reliable predictors of mortality in end-stage renal disease patients is crucial for patient outcomes. Aortic knob width is a radiographic parameter used to assess cardiovascular diseases and atherosclerosis. This study investigated the association between aortic knob width and mortality in hemodialysis patients. PATIENTS AND METHODS: The study included data collected between 2007 and 2022 from 103 patients aged between 18 and 85 who had been undergoing hemodialysis treatment for at least one year. Patients were divided into two groups: survivors and deceased. The aortic knob width was measured using a posterior-anterior chest radiograph after midweek hemodialysis. The relationship between aortic knob width and mortality was investigated. RESULTS: Deceased patients had significantly larger aortic knob widths compared with survivors. The deceased group's hemodialysis (HD) duration was shorter, median age was older, Kt/V, hemoglobin, and albumin levels were lower, and the frequency of patients with hypertension, diabetes, and aortic wall calcification was higher. Aortic knob width greater than 37.98 mm was identified as a predictor of mortality in hemodialysis patients. Survival rates for aortic knob width <37.98 mm are 98.1% for 1 year and 64.9% for 15 years. For aortic knob width larger than 37.98 mm, survival rates are 88% for three years, 68% for five years, 45.2% for ten years, and 25% for fifteen years. The most important risk factors for increased aortic knob width were age, male sex, aortic calcification, and hypertension. CONCLUSIONS: Age, male gender, aortic calcification, and hypertension are the primary risk factors for increased aortic knob width in hemodialysis patients. Aortic knob width greater than 37.98 mm, which can be measured simply and rapidly using posterior-anterior chest radiography, may be a predictor of mortality. [ABSTRACT FROM AUTHOR]

Summary: We evaluated the impact of peer reviews in driving improvement in healthcare quality for people with haemoglobinopathy in the United Kingdom. We analysed compliance to four Quality Standards (QS)‐based peer reviews from 2010 to 2020 to evaluate its impact in driving healthcare quality. Seventeen paediatric and 29 adult haemoglobinopathy centres were reviewed in 2010/11 and 2012/13 respectively; 33 paediatric and 33 adult centres were reviewed in 2014/16, and 32 paediatric and 32 adult centres were reviewed in 2018/2020. Compliance with QS and participant feedback were analysed to assess the impact of peer review programmes to drive improvement in quality of care. We noted that haemoglobinopathy centres significantly improved their compliance to QS between the first two review programmes, but not in the final review programme. In comparison to other disease‐group reviews, the haemoglobinopathy departments were less able to address critical peer review recommendations in their own institutions. The peer review programme was unable to drive sustained improvement in healthcare quality, underscoring the need for sustained development and support for haemoglobinopathy services in the National Health Service. Further work is needed to understand why disparities exist among peer review‐driven improvement initiatives within different disease groups. [ABSTRACT FROM AUTHOR]

Mesenchymal stromal cells have proven capable of improving cardiac pump function in patients with chronic heart failure, yet little is known about their mode of action. The aim of the study was to investigate the short-term effect of cryopreserved allogeneic rat adipose tissue-derived stromal cells (ASC) on cardiac composition, cellular subpopulations, and gene transcription in a rat model of chronic ischemic cardiomyopathy (ICM). Myocardial infarction (MI) was induced by permanent ligation of the left anterior descending coronary artery. After 6 weeks, the rats were treated with ASCs, saline, or no injection, using echo-guided trans-thoracic intramyocardial injections. The cardiac tissue was subsequently collected for analysis of cellular subpopulations and gene transcription 3 and 7 days after treatment. At day 3, an upregulation of genes associated with angiogenesis were present in the ASC group. On day 7, increases in CCR2+ and CD38+ macrophages (p = 0.047 and p = 0.021), as well as in the CD4/CD8 lymphocyte ratio (p = 0.021), were found in the ASC group compared to the saline group. This was supported by an upregulation of genes associated with monocytes/macrophages. In conclusion, ASC treatment initiated an immune response involving monocytes/macrophages and T-cells and induced a gene expression pattern associated with angiogenesis and monocyte/macrophage differentiation.

Tuna liver meal (TLM) was tested to replace fish meal (FM) in diets for carp fry, Cyprinus carpio Linneus, 1758. Triplicate groups of fish with average weight of 0.32 ± 0.65g were fed each of six isonitogenous (42%), isolipidic (16%) and isoenergetic (18 KJ DE g-1) diets prepared to include 0, 10, 20, 30, 40 and 50% (diets 1- 6, respectively) of FM protein being substituted by TLM. The control diet contained fish meal (17.14%) and soybean meal (46.9%) as the main sources of dietary protein. After 13 weeks of feeding, fish fed diet 2 and diet 3 exhibited the highest (P0.05) differences in the crude protein and ash content in the whole-body. However, moisture and lipid contents were significantly (P

Predicting the behavior of fluid flow through the porous media is significantly important, especially in arid and semi-arid regions. In the present research, a novel numerical model based on the Implicit Differential Quadrature Method (IDQM) was developed to simulate the two-dimensional groundwater flow problems with the nonlinear Boussinesq equation. The data of the grid points were calculated from Chebyshev–Gauss–Lobatto formula. To evaluate the accuracy and the efficiency of the suggested model, three commonly reported in the literature groundwater problems were employed: (i) a problem related to the Boussinesq equation with an analytical solution, (ii) a hypothetical case of groundwater flow problem in a confined aquifer, and (iii) an aquifer pumping test. In addition, the results of the above-mentioned model were compared with the numerical predictions of the explicit and implicit schemes of the finite difference method (EFDM and IFDM). The findings demonstrated high accuracy, efficiency, and superiority of the numerical results of the IDQM. According to the results, the lowest values of root mean square error (RMSE) in the first, second, and third test cases with a range of (2.83E-23-5.65E-12), (0.072-0.065), and (0.230-0.100) were observed using IDQM. The values of dimensionless differences (DD) were also assigned the lowest values in this method in all tests. Briefly, the IDQM using less number of nodes provided more accurate results than EFDM and IFDM and as a result, is applicable to a wide range of problems in numerous fields of science and engineering. [ABSTRACT FROM AUTHOR]