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يهدف البحث الى تعرف مدى الحاجة الى المعرفة العلمية لدى طلبة جامعة دهوك وعلاقتها ببعض المتغيرات من وجهة نظرهم، تكونت عينة البحث من كليتي العلوم والادارة والاقتصاد في جامعة دهوك اذ بلغت(280) طالباً وطالبةً بواقع (135) طالباً وطالبةً من كلية العلوم و(145) طالباً وطالبةً من كلية الادارة والاقتصاد، ولتحقيق أهدافه أعد الباحث أداةً خاصة بتطبيق مدى الحاجة للمعرفة العلمية، حيث تكونت في صورتها النهائية من(32) فقرة، استخدام الباحث معامل ارتباط بيرسون، والمتوسط الحسابي والانحراف المعياري، واختبار (z-test)، توصل الى مايلي: 1- بلغت نسبة فقرات الاستبانة عند طلبة كلية العلوم للحاجة المعرفية العلمية عند الطلاب (%61.93) وعند الاناث (%64.23) وهي نسبة متوسطة . 2- بلغت نسبة فقرات الاستبانة عند طلبة كلية الادارة والاقتصاد للحاجة المعرفية العلمية عند الطلاب (%59.2) وعند الاناث (%61.82) وهي نسبة متوسطة. 3- لا توجد فروق ذات دلالة إحصائية بين درجات وجهتي نظر افراد عينة البحث في كليتي (العلوم، والادارة والاقتصاد) في الحاجة الى المعرفة العلمية. 4- لا توجد فروق ذات دلالة إحصائية بين درجات وجهتي نظر افراد عينة البحث من الطلاب (الذكور) في كليتي (العلوم، والادارة والاقتصاد) في الحاجة الى المعرفة العلمية. 5- لا توجد فروق ذات دلالة إحصائية بين درجات وجهتي نظر افراد عينة البحث من الطالبات (الاناث) في كليتي (العلوم، والادارة والاقتصاد) في الحاجة الى المعرفة العلمية.

The article presents an abstract of the research paper "Performance and egg quality of laying hen fed different sources of zinc," by A.A. Saki and colleagues.

We estimate methane emissions for urban waste treatment facilities from mobile in situ atmospheric concentration measurements using an inverse Gaussian plume methodology at facilities in Southern Ontario, Canada. We use these emission rates to assess and improve the existing high-resolution methane inventories for waste sources throughout Southwestern Ontario. Our measurements encompass tens of thousands of kilometres worth of mobile survey data collected over 7 years, including more than 650 downwind transects where we surveyed 14 active landfills, 11 closed landfills, 2 organic waste processing facilities, 3 open-air windrow compost facilities, and 11 water resource recovery facilities. These sources account for 77% of the active landfills within Southern Ontario, which is estimated in inventories to be the largest source of methane emissions in the region. Within the Greater Toronto Area (GTA) megacity, the measured facilities represent about 52% of the total inventoried non-wetland methane emissions. We find that emissions from closed landfills are lower than inventory estimates, with significant implications for the methane budget in the GTA. We update the Facility Level and Area Methane Emissions for the GTA inventory with our measured emissions rates, which results in a 54% decline in the solid waste emissions, effecting a 35% lower estimate for the total anthropogenic methane emissions in the region. We attribute the bulk of this difference to a single facility: the Keele Valley landfill. Our atmospheric measurements serve as a metric for evaluating the discrepancies between four facility level and two high resolution gridded methane emission inventories. We find that the facility level first-order decay model maintained by Environment and Climate Change Canada (ECCC) to be the most consistent with our measured emission rates at landfills, and the self-reported emissions to the Greenhouse Gas Reporting Program of ECCC to be the least consistent with our measurements. Implications: We present estimates of atmospheric measurement derived methane emissions for multiple waste processing facilities in Canada. We investigate six emission inventories and models. Based on our atmospheric observations of landfills, we show that the self-reported methane emissions are not well correlated with our measured emissions, and that the first order decay models used in official emissions reporting are much better correlated. One of the most critical findings in this work is that methane emissions from the Keele Valley Landfill, assumed in some inventories to be the second largest anthropogenic source of methane in the country, are significantly less than predicted.

Introduction: Brain cross-sectional images, tractography, and segmentation are valuable resources for neuroanatomical education and research but are also crucial for neurosurgical planning that may improve outcomes in cerebellar and brainstem interventions. Although ultrahigh-resolution 7-Tesla (7T) magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) reveal such structural brain details in living or fresh unpreserved brain tissue, imaging standard formalin-preserved cadaveric brain specimens often used for neurosurgical anatomic studies has proven difficult. This study sought to develop a practical protocol to provide anatomic information and tractography results of an ex vivo human brainstem-cerebellum specimen., Materials and Methods: A protocol was developed for specimen preparation and 7T MRI with image postprocessing on a combined brainstem-cerebellum specimen obtained from an 85-year-old male cadaver with a postmortem interval of 1 week that was stored in formalin for 6 months. Anatomic image series were acquired for detailed views and diffusion tractography to map neural pathways and segment major anatomic structures within the brainstem and cerebellum., Results: Complex white matter tracts were visualized with high-precision segmentation of crucial brainstem structures, delineating the brainstem-cerebellum and mesencephalic-dentate connectivity, including the Guillain-Mollaret triangle. Tractography and fractional anisotropy mapping revealed the complexities of white matter fiber pathways, including the superior, middle, and inferior cerebellar peduncles and visible decussating fibers. 3-dimensional (3D) reconstruction and quantitative and qualitative analyses verified the anatomical precision of the imaging relative to a standard brain space., Discussion: This novel imaging protocol successfully captured the intricate 3D architecture of the brainstem-cerebellum network. The protocol, unique in several respects (including tissue preservation and rehydration times, choice of solutions, preferred sequences, voxel sizes, and diffusion directions) aimed to balance high resolution and practical scan times. This approach provided detailed neuroanatomical imaging while avoiding impractically long scan times. The extended postmortem and fixation intervals did not compromise the diffusion imaging quality. Moreover, the combination of time efficiency and ultrahigh-resolution imaging results makes this protocol a strong candidate for optimal use in detailed neuroanatomical studies, particularly in presurgical trajectory planning., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hanalioglu, Bahadir, Ozak, Yangi, Mignucci-Jiménez, Gurses, Fuentes, Mathew, Graham, Altug, Gok, Turner, Lawton and Preul.)

Objective: Assess the capabilities of ChatGPT-3.5 and 4 to provide accurate diagnoses, treatment options, and treatment plans for brain tumors in example neuro-oncology cases., Methods: ChatGPT-3.5 and 4 were provided with twenty example neuro-oncology cases of brain tumors, all selected from medical textbooks. The artificial intelligence programs were asked to give a diagnosis, treatment option, and treatment plan for each of these twenty example cases. Team members first determined in which cases ChatGPT-3.5 and 4 provided the correct diagnosis or treatment plan. Twenty neurosurgeons from the researchers' institution then independently rated the diagnoses, treatment options, and treatment plans provided by both artificial intelligence programs for each of the twenty example cases, on a scale of one to ten, with ten being the highest score. To determine whether the difference between the scores of ChatGPT-3.5 and 4 was statistically significant, a paired t-test was conducted for the average scores given to the programs for each example case., Results: In the initial analysis of correct responses, ChatGPT-4 had an accuracy of 85% for its diagnoses of example brain tumors and an accuracy of 75% for its provided treatment plans, while ChatGPT-3.5 only had an accuracy of 65% and 10%, respectively. The average scores given by the twenty independent neurosurgeons to ChatGPT-4 for its accuracy of diagnosis, provided treatment options, and provided treatment plan were 8.3, 8.4, and 8.5 out of 10, respectively, while ChatGPT-3.5's average scores for these categories of assessment were 5.9, 5.7, and 5.7. These differences in average score are statistically significant on a paired t-test, with a p-value of less than 0.001 for each difference., Conclusions: ChatGPT-4 demonstrates great promise as a diagnostic tool for brain tumors in neuro-oncology, as attested to by the program's performance in this study and its assessment by surveyed neurosurgeon reviewers., Competing Interests: Declaration of Competing Interest The authors report no personal, financial, or institutional interest in the materials or devices described in this article., (Copyright © 2024 Elsevier B.V. All rights reserved.)

CD73-derived adenosine suppresses anti-cancer immunity, and CD73 inhibitors are currently evaluated in several clinical trials. Here, we have assessed enzyme kinetics of all key purinergic ectoenzymes in five cancer cell lines (Hodgkin lymphoma, multiple myeloma, pancreas adenocarcinoma, urinary bladder carcinoma, and glioblastoma) under normoxia and hypoxia. We found that adenosine metabolism varied considerably between individual cancer types. All cell lines investigated exhibited high ecto-adenosine deaminase (ADA) activity, which critically influenced the kinetics of adenosine accumulation. Combining kinetics data with single-cell RNA sequencing data on myeloma and glioblastoma cancerous tissue revealed that purine metabolism is not homogeneously organized, but it differs in a cancer type-specific fashion between malignant cells, stromal cells, and immune cells. Since purine metabolism in cancerous tissue is most likely spatially heterogeneous and differs between the various cell types, diffusion distances in the microenvironment as well as ADA activity may be important variables that influence the level of bioactive adenosine., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Studies in humans and mice have determined that distinct subpopulations of adipocytes reside even within individual adipose tissue depots. Previously, our lab defined three white adipocyte subpopulations with stable and unique gene expression profiles, which were termed type 1, 2, and 3 adipocytes, respectively. Our previous studies demonstrated that type 2 adipocytes were highly responsive to the inflammatory cytokine, tumor necrosis factor alpha (TNFα). This study extends these findings to investigate the role of type 2 adipocytes in obesity. We found that treatment with TNFα increased lipolysis specifically in type 2 adipocytes, at least in part, through the reduction of fat-specific protein 27 (FSP27) expression. To assess the physiological role of lipolysis from this adipocyte subpopulation, a type2Ad-hFSP27tg mouse model was generated by overexpressing human FSP27 specifically in type 2 adipocytes. Glucose and insulin tolerance test analysis showed that male type2Ad-hFSP27tg mice on 60% high-fat diet exhibited improved glucose tolerance and insulin sensitivity, with no change in body weight compared to controls. These metabolic changes may, at least in part, be explained by the reduced lipolysis rate in the visceral fat of type2Ad-hFSP27tg mice. Although FSP27 overexpression in primary type 2 adipocytes was sufficient to acutely reduce TNFα-induced apoptosis in vitro, it failed to reduce macrophage infiltration in obesity in vivo. Taken together, these results strongly suggest that type 2 adipocytes contribute to the regulation of lipolysis and could serve as a potential therapeutic target for obesity-associated insulin resistance.

Treatment of landfill leachate is still a current problem due to the high treatment costs in addition to the difficulty of meeting the discharge criteria. However, there is a more important issue that should be underlined; it is also valuable compounds that leachate contains. Conventional methods used for treatment of leachate such as membrane filtration, advanced oxidation processes, biological processes and their combinations have largely focused on treatment. However, the recovery of ammonia and volatile organic acids (VFA) in leachate is a promising approach both to overcome high treatment costs and to sustainably manage leachate. In this study, leachate treatment potential was investigated by mechanical vapor recompression (MVR) process, which offers an operational opportunity to recover high value-added products from leachate while providing an effective treatment for wastewater. Optimum operating conditions for the pilot-scale MVR process have been determined by laboratory-scale studies. VFAs were recovered as organic acid salts from the pilot-scale MVR distillate, while ammonia recovery was accomplished as ammonium sulfate from a highly contaminated concentrate stream. VFA and ammonia recovery rates were 89% and 99%, respectively. The treatment cost of leachate with MVR process was calculated according to the data obtained in pilot scale MVR studies considering the operating cost, chemical cost and economical contribution of value-added products. The results showed that the integrated MVR-crystallization process, all treatment costs are covered, with a net gain of 3.8 USD/m 3 . Consequently, MVR integrated crystallization process offers an economical and sustainable solution for the treatment of leachate by recovering valuable products., 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 Elsevier Ltd. All rights reserved.)

In adipose tissue, growth hormone (GH) stimulates lipolysis, leading to an increase in plasma free fatty acid levels and a reduction in insulin sensitivity. In our previous studies, we have found that GH increases lipolysis by reducing peroxisome proliferator-activated receptor γ (PPARγ) transcription activity, leading to a reduction of tat-specific protein 27 (FSP27, also known as CIDEC) expression. In previous studies, our laboratory uncovered 3 developmentally distinct subpopulations of white adipocytes. In this manuscript, we show that one of the subpopulations, termed type 2 adipocytes, has increased GH-induced signaling and lipolysis compared to other adipocyte subtypes. To assess the physiological role of GH-mediated lipolysis mediated by this adipocyte subpopulation, we specifically expressed human FSP27 (hFSP27) transgene in type 2 adipocytes (type2Ad-hFSP27tg mice). Systemically, male type2Ad-hFSP27tg mice displayed reduced serum glycerol release and nonesterified fatty acids levels after acute GH treatment, and improvement in acute, but not chronic, GH-induced glucose intolerance. Furthermore, we demonstrate that type2Ad-hFSP27tg mice displayed improved hepatic insulin signaling. Taken together, these results indicate that this adipocyte subpopulation is a critical regulator of the GH-mediated lipolytic and metabolic response. Thus, further investigation of adipocyte subpopulations may provide novel treatment strategies to regulate GH-induced glucose intolerance in patients with growth and metabolic disorders., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: This study aimed to evaluate the perioperative outcomes of patients with benign and malignant liver lesions scheduled for laparoscopic and open surgery using a propensity score-matched approach to analyze additional cofactors influencing outcomes., Patients and Methods: In this study, we retrospectively reviewed 270 patients who underwent laparoscopic or open liver resection at our institute between October 2016 and November 2021. Patients were divided into open and laparoscopic liver resection groups and compared according to the intention to treat principle. In the purification process for the nonrandom nature of the study, a matching analysis was performed at a 1:1 case-control ratio. The PS model included selected data on body mass index, additional data on the American Society of Anesthesiology score, cirrhosis, lesion <2 cm from the hilum, lesion <2 cm from the hepatic vein or inferior vena cava, and type of neoadjuvant chemotherapy., Results: The operation time and 30- and 90-day mortality rates were similar between the groups. The average length of hospital stay was 11 days in the open surgery group and 9 days in the laparoscopic surgery group after matching ( P =0.011). The 30-day morbidity rate was statistically different between the groups before and after matching, favoring the laparoscopic group ( P =0.001 and 0.006, respectively). After the propensity score-matched approch, the open group's Pringle time was shorter than that of the laparoscopic group. The total operative time was longer in the laparoscopic than in the open surgery group. This did not change after matching (300 vs. 240 min)., Conclusions: Laparoscopic surgery is a feasible and safe treatment option for patients with liver tumors, with promising results in terms of morbidity and hospital stay., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

As in other types of cancer, tumor markers are used in pancreatic ductal adenocarcinoma (PDAC) for disease follow-up, especially after surgery. There has been shown to be a significant correlation between the tumor marker levels and poor prognosis in locally or systemic advanced stage PDAC patients. However, there is no significant correlation between prognosis and marker levels in patients with early stage PDAC patients. This study aimed to examine the effect of the carbohydrate antigen 19-9 (Ca19-9)/carcinoembryogenic antigen (CEA) ratio in ductal adenocarcinoma of the pancreatic head on disease prognosis and mean survival. This retrospective study was conducted with 129 pancreatic head adenocarcinoma patients who were treated with whipple procedure at the Ankara University Surgical Oncology Clinic between 2010 and 2020. All patients' demographics, stage of the disease, CEA, CA 19-9 levels, and CEA/Ca 19-9 ratio were enrolled and compared statistically. A new cutoff value was calculated for the Ca19-9/CEA ratio. A Ca19-9/CEA ratio >29.77 showed 69.9% sensitivity and 70.9% specificity for the probability of the T3 and T4 stages. The cutoff value for the Ca19-9/CEA ratio was 27.18. This cutoff value had a sensitivity of 79.4% and a specificity of 80.3% for lymph node metastasis. Patients with a Ca19-9/CEA ratio below the cutoff value of 28.475 had a mean survival of 93.161 months and those with a value higher than the cutoff value had a mean survival of 28.541 months (P < .001). A simple combination of tumor markers was determined to have higher accuracy rates in predicting tumor prognosis and in determining mean survival, which are particularly needed in early stage cancers., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Advances in computer sciences, including novel 3-dimensional rendering techniques, have enabled the creation of cloud-based virtual reality (VR) interfaces, making real-time peer-to-peer interaction possible even from remote locations. This study addresses the potential use of this technology for microsurgery anatomy education., Methods: Digital specimens were created using multiple photogrammetry techniques and imported into a virtual simulated neuroanatomy dissection laboratory. A VR educational program using a multiuser virtual anatomy laboratory experience was developed. Internal validation was performed by five multinational neurosurgery visiting scholars testing and assessing the digital VR models. For external validation, 20 neurosurgery residents tested and assessed the same models and virtual space., Results: Each participant responded to 14 statements assessing the virtual models, categorized under realism ( n = 3), usefulness ( n = 2), practicality ( n = 3), enjoyment ( n = 3), and recommendation ( n = 3). Most responses expressed agreement or strong agreement with the assessment statements (internal validation, 94% [66/70] total responses; external validation, 91.4% [256/280] total responses). Notably, most participants strongly agreed that this system should be part of neurosurgery residency training and that virtual cadaver courses through this platform could be effective for education., Conclusion: Cloud-based VR interfaces are a novel resource for neurosurgery education. Interactive and remote collaboration between instructors and trainees is possible in virtual environments using volumetric models created with photogrammetry. We believe that this technology could be part of a hybrid anatomy curriculum for neurosurgery education. More studies are needed to assess the educational value of this type of innovative educational resource., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Surgical Neurology International.)

Objectives: Kidney transplant is the treatment of choice for end-stage renal disease. Because of the insufficient supply of donor organs for transplant, the number of patients on the transplant wait list is increasing. We analyzed demographic and clinical factors including sensitization status of patients on the kidney transplant wait list in our center., Materials and Methods: Patients on the kidney transplant wait list at Ankara University School of Medicine by July 2018 were evaluated. Data on demographics, comorbidities, treatment characteristics, and immunologic properties were collected., Results: The study included 528 kidney transplant candidates whose mean time on the deceased donor organ wait list was 57 ± 47 months. Enlisted patients were aged 53 ± 13 years, and 95% of them were on dialysis. Dialysis vintage was longer and percentage of patients who had anti-HLA antibodies was higher in women than men (P = .004 and P < .001, respectively). Levels for median fluorescence intensity were higher in women compared with men (class I, P < .001; and class II, P = .011). Transfusion (P < .001), pregnancy (P = .001), transplant (P < .001), longer dialysis vintage (P = .021), and longer time on wait list (P = .001) were associated with anti-HLA antibody positivity. Multiple regression analysis revealed that a history of transplant and blood transfusion were independent risk factors of a positive panel reactive antibodies., Conclusions: In our kidney transplant candidates on the wait list, sensitization by transplant has a significant impact on development of anti-HLA antibodies. Updates of the organ allocation system to consider sensitized candidates and strategies to expand the deceased donor organ pool and donation rates are needed to increase the rate of deceased donor kidney transplant in Turkey.

Background: Cardiopulmonary complications and liver dysfunction are also specific complications and problems associated with laparoscopic surgery. The main causes of postoperative liver dysfunction, which may often occur after laparoscopic surgery, include carbon dioxide pneumoperitoneum and ligation of the aberrant left hepatic artery. Hepatic steatosis may develop as a natural consequence of neoadjuvant therapy, although rarely, owing to chemotherapy. Nathanson retractor may cause a prolonged elevation in liver enzymes of these patients compared with those who do not receive neoadjuvant therapy. Materials and Methods: The data of 151 patients who underwent laparoscopic radical gastrectomy between January 2017 and January 2022 for histologically proven primary gastric cancer in our clinic were retrospectively reviewed. Results: The mean length of hospital stay was 6.21 days. The mean time normalization of the aspartate aminotransferase (AST) value was 2.45 ± 1.83 (range, 0-12) days postoperatively. The analysis of the correlation between the preoperative and postoperative 1-day values of alanine aminotransferase (ALT) and AST revealed a significant difference between the preoperative and postoperative 1-day median values of both parameters ( P  < .001). Each one unit increase in ALT led to an increase of 0.338 days in the length of intensive care stay and an increase of 0.345 days in the overall length of hospital stay. As the time to normalization of the AST value increased, the length of both intensive care stay and hospital stay increased. Each one unit increase in AST resulted in an increase of 0.316 days in the length of intensive care stay and an increase of 0.376 days in the overall length of hospital stay. Conclusion: Alternative retraction methods can be used safely in laparoscopic surgery for gastric cancer patients receiving neoadjuvant therapy. We are of the opinion that the Nathanson retractor should be used only during dissection of the relevant regions to shorten the intraoperative intermittent release or the time of use.

Background: Increased exposure of humans to toxic metals and high-fat diet (HFD) consumption severely damages brain health. Natural plant extracts have shown huge potential to treat multiple human diseases., Objective: The present study was designed to evaluate the protective effects of Shogaol (an active component of ginger) in neuroinflammation and behavioral paradigms in mice treated with metals and HFD., Methods: 8-11 weeks old male mice model was developed by giving a combination of metals, i.e., Arsenic (As), Lead (Pb) and Aluminum (Al), 25mg/kg each mixed in drinking water with laboratory prepared HFD (40% fat) for a total duration of 72 days. Shogaol treated groups received two doses (2mg/kg & 12mg/kg) of Shogaol along with metals and HFD. The biochemical parameters, including body weights, blood glucose, and kidney and liver functions, were assessed along with the integrity of the blood-brain barrier (BBB). The expression analysis of neuroinflammatory genes (TNF-α, IL-1β & GFAP) was performed using q-PCR in the hippocampus and cortex. The exploratory and anxiety-like behavior was assessed using an open field test, and depressive behavior was assessed through the forced swim test, while learning and memory were assessed using the Morris water maze test and y-maze test., Results: Shogaol (2mg/kg & 12mg/kg) treatment improved metabolic profile and reduced expression of neuroinflammatory genes in the cortex and the hippocampus. Shogaol treatment improved BBB integrity. Results of the behavioral analysis showed that Shogaol treatment (2mg/kg & 12mg/kg) rescued behavioral impairment and improved anxiety and depression., Conclusion: Shogaol treatment showed strong therapeutic potential in metals & HFD induced neuroinflammation and improved cognitive functions; thus, can be considered a potential drug candidate in the future., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: Graph theory applications are commonly used in connectomics research to better understand connectivity architecture and characterize its role in cognition, behavior and disease conditions. One of the numerous open questions in the field is how to represent inter-individual differences with graph theoretical methods to make inferences for the population. Here, we proposed and tested a simple intuitive method that is based on finding the correlation between the rank-ordering of nodes within each connectome with respect to a given metric to quantify the differences/similarities between different connectomes. Methods: We used the diffusion imaging data of the entire HCP-1065 dataset of the Human Connectome Project (HCP) ( n = 1,065 subjects). A customized cortical subparcellation of HCP-MMP atlas (360 parcels) (yielding a total of 1,598 ROIs) was used to generate connectivity matrices. Six graph measures including degree, strength, coreness, betweenness, closeness, and an overall "hubness" measure combining all five were studied. Group-level ranking-based aggregation method ("measure-then-aggregate") was used to investigate network properties on population level. Results: Measure-then-aggregate technique was shown to represent population better than commonly used aggregate-then-measure technique (overall r s : 0.7 vs 0.5). Hubness measure was shown to highly correlate with all five graph measures (r s : 0.88-0.99). Minimum sample size required for optimal representation of population was found to be 50 to 100 subjects. Network analysis revealed a widely distributed set of cortical hubs on both hemispheres. Although highly-connected hub clusters had similar distribution between two hemispheres, average ranking values of homologous parcels of two hemispheres were significantly different in 71% of all cortical parcels on group-level. Conclusion: In this study, we provided experimental evidence for the robustness, limits and applicability of a novel group-level ranking-based hubness analysis technique. Graph-based analysis of large HCP dataset using this new technique revealed striking hemispheric asymmetry and intraparcel heterogeneities in the structural connectivity of the human brain., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hanalioglu, Bahadir, Isikay, Celtikci, Celtikci, Yeh, Oguz and Khaniyev.)

Introduction: Infections can play an important role in the mortality and morbidity of patients with glomerulonephritis. However, the frequency of infectious complications in primary glomerulonephritis and their burden to the healthcare managements are not clear., Methods: We evaluated the infectious complications in patients with biopsy-proven focal segmental glomerulosclerosis, membranous glomerulonephritis, IgA nephropathy, minimal change disease, membranoproliferative glomerulonephritis, and chronic glomerulonephritis during the last 10 years in a single center. We recorded the demographic, clinical, and laboratory characteristics; treatment modalities; infectious episodes; and infection-related mortality and morbidity of the patients., Results: Of the patients, 154 (63.6%) received immunosuppressive treatment and 88 (34.4%) were followed up under conservative treatment. Overall, 118 infectious episodes were noted in 64 patients, with an infection rate of 0.20 per patient-year. Total infectious complications were higher in the immunosuppressive group than in the conservative group (42.1 vs. 23.3%, p = 0.005). Infection-related hospitalizations were also higher in the immunosuppressive group ( p = 0.01). The most frequently infected area was the lungs (15.7%). Although bacterial infections were the most common in both groups, 14.9% of the immunosuppressive group had cytomegalovirus (CMV) replication. Age >50 years (OR 2.19, p = 0.03), basal serum albumin <2.5 g/dL (OR 2.28, p = 0.02), cyclophosphamide (OR 2.43, p = 0.02), and cyclosporine (OR 2.30, p = 0.03) were independently associated with experiencing infectious episodes., Conclusions: Because of high seropositivity for CMV in Turkey, it might be a wise approach to use prophylactic antiviral drugs in patients treated with immunosuppressive treatments. Close monitoring of patients with primary glomerulonephritis, especially those treated with immunosuppressive therapy, is important for reducing infection-related morbidity and mortality., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2020 by S. Karger AG, Basel.)

Objectives: Fabry disease is a rare X-linked multisystemic lysosomal storage disorder of the glycosphingolipid metabolic pathway. Nephropathy is one of the most important complications of Fabry disease, and patients with classical phenotype are at risk of developing endstage kidney disease. In this study, we investigated the use of screening for Fabry disease in kidney transplant recipients at our center., Materials and Methods: We screened 301 kidney transplant recipients with functioning grafts. Analyses for α-galactosidase A gene mutation were performed in all female and male kidney transplant recipients. We also measured leukocyte α-galactosidase A enzyme activity in patients with identified GLA mutation., Results: In 301 kidney transplant recipients, mean age was 42.9 ± 12.5 years, and the number of male patients was 180 (60%). Mean time after transplant was 79 ± 56 months, and estimated glomerular filtration rate was 66.8 ± 21 mL/min/1.73 m². One male patient who was diagnosed with Fabry disease before kidney transplant was also evaluated (mutation in the α-galactosidase A gene, c.1093&#95;1101dup [p.Tyr365&#95;lle367dup]). In 2 female patients, p.A143T (c.427G>A) mutation of unknown significance and p.D313Y (c.937G>T) heterozygous mutation were identified; however, leukocyte ?-galactosidase A enzyme activity was normal in these patients (63.7 and 67.3 nmol/h/mg protein). In the patient diagnosed with Fabry disease, family screening revealed 4 additional affected family members., Discussions: Although prevalence was shown to be low in our center (1/301 patients; 0.33%), screening studies in kidney transplant recipients may help to detect new patients before they develop life-threatening complications such as renal involvement.

Objective: This was an investigation of the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and mortality in patients with stage 3-4 chronic kidney disease (CKD)., Methods: This study was designed as a subgroup analysis of the Heart Failure Prevalence and Predictors in Turkey (HAPPY) study. The HAPPY study included 4650 randomly selected individuals from the 7 geographical regions of Turkey. A total of 191 subjects from the original cohort with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.1.73 m² were enrolled in this study and the relationship between NT-proBNP and mortality was investigated. Prognostic variables for total and cardiovascular mortality were also examined using Cox regression analysis., Results: The mean length of follow-up was 76.12±22.45 months. The mean NT-proBNP level was 423.54±955.88 pg/mL. During follow-up, 51 subjects (26.7%) died from any cause and 36 subjects (18.8%) died from a cardiovascular cause. The presence of hypertension (hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.01-3.50; p=0.048), anemia (HR: 2.49; 95% CI: 1.20-5.15; p=0.014), male gender (HR: 2.64; 95% CI: 1.44-4.86; p=0.002) and log NT-proBNP (HR: 4.93; 95% CI: 2.83-8.58; p<0.001) were independent variables for total mortality. The presence of hypertension (HR: 2.47; 95% CI: 1.09-5.56; p=0.029), male gender (HR: 2.79; 95% CI: 1.38-5.62; p=0.004), eGFR (HR: 0.94; 95% CI: 0.91-0.98; p=0.005) and log NT-proBNP (HR: 6.31; 95% CI: 3.11-12.81; p<0.001) were independent predictors of cardiovascular mortality., Conclusion: NT-proBNP was found to be an independent prognostic marker in patients with stage 3-4 CKD.

This study outlines the first investigation of application of machine learning to distinguish "skilled" and "novice" psychomotor performance during a virtual reality (VR) brain tumor resection task. Tumor resection task participants included 23 neurosurgeons and senior neurosurgery residents as the "skilled" group and 92 junior neurosurgery residents and medical students as the "novice" group. The task involved removing a series of virtual brain tumors without causing injury to surrounding tissue. Originally, 150 features were extracted followed by statistical and forward feature selection. The selected features were provided to 4 classifiers, namely, K-Nearest Neighbors, Parzen Window, Support Vector Machine, and Fuzzy K-Nearest Neighbors. Sets of 5 to 30 selected features were provided to the classifiers. A working point of 15 premium features resulted in accuracy values as high as 90% using the Supprt Vector Machine. The obtained results highlight the potentials of machine learning, applied to VR simulation data, to help realign the traditional apprenticeship educational paradigm to a more objective model, based on proven performance standards. Graphical abstract Using several scenarios of virtual reality neurosurgical tumor resection together with machine learning classifiers to distinguish skill level.

Objective: Assessment of physiological tremor during neurosurgical procedures may provide further insights into the composites of surgical expertise. Virtual reality platforms may provide a mechanism for the quantitative assessment of physiological tremor. In this study, a virtual reality simulator providing haptic feedback was used to study physiological tremor in a simulated tumor resection task with participants from a "skilled" group and a "novice" group., Design: The task involved using a virtual ultrasonic aspirator to remove a series of virtual brain tumors with different visual and tactile characteristics without causing injury to surrounding tissue. Power spectral density analysis was employed to quantitate hand tremor during tumor resection. Statistical t test was used to determine tremor differences between the skilled and novice groups obtained from the instrument tip x, y, z coordinates, the instrument roll, pitch, yaw angles, and the instrument haptic force applied during tumor resection., Setting: The study was conducted at the Neurosurgical Simulation and Artificial Intelligence Learning Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada., Participants: The skilled group comprised 23 neurosurgeons and senior residents and the novice group comprised 92 junior residents and medical students., Results: The spectral analysis allowed quantitation of physiological tremor during virtual reality tumor resection. The skilled group displayed smaller physiological tremor than the novice group in all cases. In 3 out of 7 cases the difference was statistically significant., Conclusions: The first investigation of the application of a virtual reality platform is presented for the quantitation of physiological tremor during a virtual reality tumor resection task. The goal of introducing such methodology to assess tremor is to highlight its potential educational application in neurosurgical resident training and in helping to further define the psychomotor skill set of surgeons., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Colorectal cancer (CRC) screening rates are low in the general population and among health care providers. The aim of this study was to evaluate the CRC screening practices of general surgeons who provide specialized diagnostic testing and CRC treatment and to examine the CRC screening behaviors of their first-degree family members., Methods: A cross-sectional survey was conducted among general surgeons who attended the 21st National Surgical Congress in Turkey held from April 11th to 15th, 2018. The survey included items on demographics, screening-related attitude, CRC screening options, barriers to CRC screening, and surgeons' annual volumes of CRC cases., Results: A total of 530 respondents completed the survey. Almost one-third of the responding surgeons (29.4%, n = 156) were aged over 50 years, among whom approximately half (47.1%, n = 74) reported having undergone CRC screening and preferring a colonoscopy as the screening modality (78.4%). Among general surgeons aged 50 years and older, high-volume surgeons (≥25 CRC cases per year) were more likely to undergo screening compared with low-volume surgeons (< 25 CRC cases per year). The respondents aged below 50 years reported that 56.1% (n = 210) of their first-degree relatives were up-to-date with CRC screening, mostly with colonoscopy. Compared to low-volume surgeons aged below 50 years, high-volume surgeons' first-degree relatives were more likely to be up-to-date with CRC screening., Conclusion: The survey results demonstrated that routine screening for CRC among surgeons and/or their first-degree relatives is currently not performed at the desired level. However, high-volume surgeons are more likely to participate in routine screening.

Objective: Virtual reality simulators track all movements and forces of simulated instruments, generating enormous datasets which can be further analyzed with machine learning algorithms. These advancements may increase the understanding, assessment and training of psychomotor performance. Consequently, the application of machine learning techniques to evaluate performance on virtual reality simulators has led to an increase in the volume and complexity of publications which bridge the fields of computer science, medicine, and education. Although all disciplines stand to gain from research in this field, important differences in reporting exist, limiting interdisciplinary communication and knowledge transfer. Thus, our objective was to develop a checklist to provide a general framework when reporting or analyzing studies involving virtual reality surgical simulation and machine learning algorithms. By including a total score as well as clear subsections of the checklist, authors and reviewers can both easily assess the overall quality and specific deficiencies of a manuscript., Design: The Machine Learning to Assess Surgical Expertise (MLASE) checklist was developed to help computer science, medicine, and education researchers ensure quality when producing and reviewing virtual reality manuscripts involving machine learning to assess surgical expertise., Setting: This study was carried out at the McGill Neurosurgical Simulation and Artificial Intelligence Learning Centre., Participants: The authors applied the checklist to 12 articles using machine learning to assess surgical expertise in virtual reality simulation, obtained through a systematic literature review., Results: Important differences in reporting were found between medical and computer science journals. The medical journals proved stronger in discussion quality and weaker in areas related to study design. The opposite trends were observed in computer science journals., Conclusions: This checklist will aid in narrowing the knowledge divide between computer science, medicine, and education: helping facilitate the burgeoning field of machine learning assisted surgical education., (Copyright © 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: High panel-reactive antibody (PRA) levels limit patients' access to kidney transplantation from potential living donor candidates and decrease renal graft survival by causing acute antibody-mediated rejection (AAMR). In this article, we report our experiences about the efficiency of plasmapheresis (PP) and intravenous immunoglobulin (IVIG) in reduction of serum PRA levels in candidates for renal transplantation and in patients with AAMR., Methods: We examined retrospectively 47 patients with high PRA levels (18 for desensitization (DS) and 29 with AAMR) at Ankara University. The reduction in PRA class 1 and PRA class 2 levels before and after the PP, IVIG, and rituximab or eculizumab therapy were evaluated., Results: In the DS group, mean reduction in PRA class I ± SD was 28.0 ± 9.10 to 22.1 ± 8.14 (P <.05), and mean reduction in PRA class II ± SD was 40.3 ± 6.89 to 32.2 ± 5.68 (P < .05). In the AAMR group; mean reduction in PRA class I ± SD was 23.9 ± 9.56 to 17.8 ± 8.64 (P > .05), and mean reduction in PRA class II ± SD was 28.1 ± 8.37 to 26.7 ± 7.96 (P > .05). In total, mean reduction in PRA class I was 25.7 ± 6.66 to 19.7 ± 6.00 (P < .01). Mean reduction in PRA class II was 33.8 ± 5.93 to 29.2 ± 4.96 (P > .05). In the DS group, 3 (16.7%) patients were treated with rituximab. In the AAMR group, 9 (31.0%) patients were treated with rituximab, and 1 (5.5%) patient received eculizimab.In the DS group, the mean follow-up period in years ± SD was 5.06 ± 3.01 and no patient had graft loss. In the AAMR group, the mean follow-up period in years was 5.06 ± 2.74 and 6 (33.3%) patients had graft loss with acute rejection., Conclusions: PP and IVIG treatment provide significant reduction in PRA levels and can be used in DS protocols., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Importance: Despite advances in the assessment of technical skills in surgery, a clear understanding of the composites of technical expertise is lacking. Surgical simulation allows for the quantitation of psychomotor skills, generating data sets that can be analyzed using machine learning algorithms., Objective: To identify surgical and operative factors selected by a machine learning algorithm to accurately classify participants by level of expertise in a virtual reality surgical procedure., Design, Setting, and Participants: Fifty participants from a single university were recruited between March 1, 2015, and May 31, 2016, to participate in a case series study at McGill University Neurosurgical Simulation and Artificial Intelligence Learning Centre. Data were collected at a single time point and no follow-up data were collected. Individuals were classified a priori as expert (neurosurgery staff), seniors (neurosurgical fellows and senior residents), juniors (neurosurgical junior residents), and medical students, all of whom participated in 250 simulated tumor resections., Exposures: All individuals participated in a virtual reality neurosurgical tumor resection scenario. Each scenario was repeated 5 times., Main Outcomes and Measures: Through an iterative process, performance metrics associated with instrument movement and force, resection of tissues, and bleeding generated from the raw simulator data output were selected by K-nearest neighbor, naive Bayes, discriminant analysis, and support vector machine algorithms to most accurately determine group membership., Results: A total of 50 individuals (9 women and 41 men; mean [SD] age, 33.6 [9.5] years; 14 neurosurgeons, 4 fellows, 10 senior residents, 10 junior residents, and 12 medical students) participated. Neurosurgeons were in practice between 1 and 25 years, with 9 (64%) involving a predominantly cranial practice. The K-nearest neighbor algorithm had an accuracy of 90% (45 of 50), the naive Bayes algorithm had an accuracy of 84% (42 of 50), the discriminant analysis algorithm had an accuracy of 78% (39 of 50), and the support vector machine algorithm had an accuracy of 76% (38 of 50). The K-nearest neighbor algorithm used 6 performance metrics to classify participants, the naive Bayes algorithm used 9 performance metrics, the discriminant analysis algorithm used 8 performance metrics, and the support vector machine algorithm used 8 performance metrics. Two neurosurgeons, 1 fellow or senior resident, 1 junior resident, and 1 medical student were misclassified., Conclusions and Relevance: In a virtual reality neurosurgical tumor resection study, a machine learning algorithm successfully classified participants into 4 levels of expertise with 90% accuracy. These findings suggest that algorithms may be capable of classifying surgical expertise with greater granularity and precision than has been previously demonstrated in surgery.

Background: Falls are one of the major health problems in adults with Rheumatoid Arthritis (RA). Interventions, such as the Otago Exercise Programme (OEP), can reduce falls in community dwelling adults by up to 35%. The cost-benefits of such a programme in adults with RA have not been studied. The aims of this study were to determine the healthcare cost of falls in adults with RA, and estimate whether it may be cost efficient to roll out the OEP to improve function and prevent falls in adults living with RA., Methods: Patients with Rheumatoid Arthritis aged ≥18 years were recruited from four rheumatology clinics across the Northwest of England. Participants were followed up for 1 year with monthly fall calendars, telephone calls and self-report questionnaires. Estimated medical cost of a fall-related injury incurred per-person were calculated and compared with OEP implementation costs to establish potential economic benefits., Results: Five hundred thirty-five patients were recruited and 598 falls were reported by 195 patients. Cumulative medical costs resulting from all injury leading to hospital services is £374,354 (US$540,485). Average estimated cost per fall is £1120 (US$1617). Estimated cost of implementing the OEP for 535 people is £116,479 (US$168,504) or £217.72 (US$314.34) per-person. Based on effectiveness of the OEP it can be estimated that out of the 598 falls, 209 falls would be prevented. This suggests that £234,583 (US$338,116) savings could be made, a net benefit of £118,104 (US$170,623)., Conclusions: Implementation of the OEP programme for patients with RA has potentially significant economic benefits and should be considered for patients with the condition.

Objective: In epidemiological studies of amyloid A (AA) amyloidosis from Turkey, the most frequently cause was familial Mediterranean fever (FMF) and it occurs generally in young age population. However, there are no sufficient data regarding aetiology, clinical presentation and prognosis of renal AA amyloidosis in advanced age patients. In this study, we aimed to investigate demographic, clinical presentation, aetiology and outcomes of adults aged 60 years or older patients with biopsy-proven renal AA amyloidosis., Methods: This is a retrospective study involving 53 patients who were diagnosed with AA amyloidosis by kidney biopsy from 2006 to 2016. In all patients, kidney biopsies were performed due to asymptomatic proteinuria, nephrotic syndrome and/or renal insufficiency. The patients were separated into two groups on the basis of age (group I: ≥60 years and group II: <60 years). Outcomes of patients in terms of the requirement of renal replacement therapy and mortality were recorded., Results: In patients with group I, the causes of AA amyloidosis were as follows: FMF 16 (50%), bronchiectasis 7 (23%), chronic osteomyelitis 2 (6%), inflammatory bowel disease 2 (6%), rheumatoid arthritis 2 (6%), ankylosing spondylitis 1 (3%) and unknown aetiology 2 (6%). The underlying disorders of AA amyloidosis in group II patients were as follows: FMF 17 (81%), Behcet's disease 1 (5%) and unknown aetiology 3 (14%). No statistically significant differences were detected between two groups with regard to systolic and diastolic blood pressures, albumin, proteinuria and lipids. The combination of chronic kidney disease and nephrotic syndrome was the most common clinical presentation in group I (73%) and group II (43%) (p = .05). Compared to the group II, estimated glomerular filtration rate was significantly lower in group I at the time of kidney biopsy (p = .003). At 12-month follow-up, 61% of the group I and 33% of the group II developed end-stage kidney disease requiring dialysis, while 11% of the group I died., Conclusion: Our results indicated that renal AA amyloidosis is a rare disease in advanced age patients. At baseline and follow-up period, advanced age patients had worse kidney disease and outcomes.

Background/aims: Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM) is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP) phenotypes at a tertiary care hospital in Turkey., Methods: The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP) ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1) sustained normotensive (SNT) patients (both office BP and ABPM were normal), (2) sustained hypertensive (SHT) patients (both office BP and ABPM were high), (3) masked hypertensive (MHT) patients (office BP were normal, but ABPM were high), (4) white coat hypertensive (WCHT) patients (office BP were above limits, but ABPM were normal)., Results: A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years). The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001). Hypertension was more frequent in females (p=0.009). The rates of history of diabetes mellitus (DM), hyperlipidemia (HL), and chronic kidney disease (CKD) were higher in patients with hypertension (p< 0.0001). Among patients with hypertension (n=853, 81%), ABPM results showed that 388 (45%) of patients had SHT, 92 (11%) had MHT, and 144 (17%) had WCHT, whereas 229 (27%) had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025). The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in women than in men (p< 0.0001). There was no significant difference between 4 groups with regard to body mass index (p=0.142), a history of DM (p=0.189) and smoking status (self-reported) (p=0.306). Patients with SHT had the highest prevalence of history of hypertension, HL and CKD (p< 0.0001). Among patients without hypertension, 26 (13%) of patients had MHT and none of those patients was on antihypertensive treatment., Conclusion: Potential usages of ABPM in Turkey may include screening of high risk individuals who have traditional cardiovascular risk factors. It also provides clinicians valuable information on abnormal ABP phenotypes. Future studies are needed to clarify the risk factors of different ABP phenotypes and to evaluate the role of ABPM on detection and control of hypertension., (© 2018 The Author(s). Published by S. Karger AG, Basel.)

In AA amyloidosis, while kidney biopsy is widely considered for diagnosis by clinicians, there is no evidence that the detailed investigation of renal histopathology can be utilized for the prognosis and clinical outcomes. In this study, we aimed to obtain whether histopathologic findings in kidney biopsy of AA amyloidosis might have prognostic and clinical value. This is a retrospective cohort study that included 38 patients who were diagnosed with AA amyloidosis by kidney biopsy between 2005 and 2013.The kidney biopsy specimens of patients were evaluated and graded for several characteristics of histopathological lesions and their relationship with renal outcomes. Segmental amyloid deposition in the kidney biopsy was seen in 29%, global amyloid deposition in 71, diffuse involvement of glomeruli in 84.2%, focal involvement in 7%, glomerular enlargement in 53%, tubular atrophy in 75% and interstitial fibrosis in 78% of patients. Histopathologically, glomerular enlargement, interstitial fibrosis, tubular atrophy, interstitial inflammation and global amyloid deposition were significantly associated with lower estimated glomerular filtration rate (eGFR) (p = .02, p < .001, p = .001, p = .009, p = .002, respectively) in univariate analysis. In multivariate analysis, tubular atrophy was the only predictor of eGFR (p = .019 B = -20.573). In the follow-up at an average of 27 months, 18 patients developed end-stage renal disease (ESRD). Among them, global amyloid deposition was the only risk factor for the development of ESRD (p = .01, OR = 18.750, %95 CI= 2.021-173.942). This is the first study showing that the histopathological findings in kidney biopsy of AA amyloidosis might have a prognostic and clinical value for renal outcomes.

Background/aims: Diabetic kidney disease (DKD) is one of the most frequent microvascular complications of diabetes and is the leading cause of end-stage kidney disease worldwide. In patients with diabetes, non-diabetic kidney disease (NDKD) can also occur. NDKD can be either alone or superimposed with the DKD. In this study, we aimed to investigate the utility of kidney biopsy in patients with type 2 diabetes mellitus (T2DM) and the predictability of diagnosing DKD versus NDKD from clinical and laboratory data. We also evaluated the prevalence and etiology of NDKD in patients with T2DM., Methods: We retrospectively reviewed type 2 diabetic patients who had kidney biopsy in the last 10 years for diagnosing possible NDKD in our center. In all patients kidney biopsies were performed because of atypical clinical features and biopsy samples were examined by light and immunofluorescence microscopy. Clinical parameters, laboratory workup and office blood pressures were recorded for each patient at the time of biopsy., Results: Eight patients were excluded due to missing data. A total of 48 patients (female/male: 26/22 and mean age: 59±8 years) were included in the study. According to the biopsy findings, 24 (50%) patients had NDKD alone, 20 (41.7%) had DKD alone and 4 (8.3%) had coexisting DKD and NDKD. The most common NDKD diagnoses were membranous nephropathy (29.2%), tubulointerstitial nephritis (20.8%) and IgA nephropathy (12.5%). There were no significant differences in three groups with respect to the duration of diabetes, proteinuria, hematuria and glycated hemoglobin A1c levels. Diabetic retinopathy (DR) was the most significant finding, which was associated with DKD. Positive and negative predictive values of DR for DKD were 88 and 81%, respectively., Conclusion: This study demonstrated a high prevalence of NDKD in patients with T2DM. The absence of DR strongly predicted NDKD. Clinical decision alone can lead to wrong diagnosis and delay in appropriate therapy. Clinicians should consider the kidney biopsy more liberally when there is uncertainty on the exact etiology of the kidney disease. However, prospective multicenter studies are needed to clarify the prognosis and outcomes of patients with diabetics., (© 2017 The Author(s). Published by S. Karger AG, Basel.)

Objective: This study was designed to test the effects of different types of preconditioning and postconditioning methods on spinal cord protection following aortic clamping., Methods: The animals (rabbits) were divided into sham-operated, ischemic preconditioning, remote ischemic preconditioning, simultaneous aortic and ischemic remote preconditioning, and ischemic postconditioning groups. After neurological evaluations, ultrastructural analysis and immunohistochemical staining for caspase-3 were evaluated after 24 h following ischemia., Results: The neurological outcomes of the remote ischemic preconditioning (4.2 ± 0.4) and ischemic postconditioning (4.6 ± 0.8) groups were significantly improved when compared with the ischemia group (2.2 ± 04). The immunohistochemical analysis revealed that the lowest percentage of apoptosis was in-group ischemic preconditioning at 12.5 ± 30.6%. In the comparison of intracellular edema in an ultrastructural analysis, the ischemic preconditioning and ischemic postconditioning groups had significantly lower values than the ischemia group., Conclusion: The conditioning methods attenuate ischemia-reperfusion injury for spinal cord injury. Ischemic and remote preconditioning and also postconditioning methods are simple to perform and inexpensive., (© The Author(s) 2015.)

Objectives: Parathyroid carcinoma is a rare malignant disease of the parathyroid glands that appears in less than 1% of patients with primary hyperparathyroidism. In the literature, the generally recommended treatment is en bloc tumor excision with ipsilateral thyroid lobectomy. Based on our 12 years of experience, we discuss the necessity of performing thyroid lobectomy on parathyroid carcinoma patients., Results: Eleven parathyroid carcinoma cases were included in the study. All operations were performed at the Department of Endocrine Surgery at Ankara University Medical School. Seven of the patients were male (63.6%), and the mean patient age was 48.9 ± 14.0 years. Hyperparathyroidism was the most common indication for surgery (n ϝ 10, 90.9%). Local disease was detected in 5 patients (45.5%), invasive disease was detected in 5 patients (45.5%) and metastatic disease was detected in 1 patient (9.1%). The mean follow-up period was 99.6 ± 42.1 months, and the patients' average disease-free survival was 96.0 ± 49.0 months. During the follow-up period, only 1 patient died of metastatic parathyroid carcinoma., Conclusion: Parathyroid carcinoma has a slow-growing natural progression, and regional lymph node metastases are uncommon. Although our study comprised few patients, it nevertheless showed that in selected cases, parathyroid carcinoma could be solely treated with parathyroidectomy.

Background: Although several lines of evidence suggest that renin angiotensin system (RAS) proteins are synthesized by cyst epithelium and dilated tubules, role of intrarenal RAS in the progression of otozomal dominant polycystic kidney disease (ADPKD) is not well known. We aimed to study the levels and clinical correlations of urinary angiotensinogen (UAGT) in normotensive ADPKD patients compared with age- and sex-matched healthy subjects., Methods: The study included 20 normotensive ADPKD patients (F/M: 11/9) and 20 age and sex matched healthy controls (F/M: 9/11). Diagnosis of ADPKD was made based on Ravine criteria. Twenty-four hours ambulatory blood pressure monitoring (ABPM) was performed. Serum concentrations of creatinine, Na, K, uric acid, and urinary concentrations of Na, K, uric acid, creatinine, protein and albumin were measured. UAGT were measured via commercially available ELISA kit., Results: ADPKD patients had higher urinary albumin:creatinine ratio (UAIb/UCrea) than healthy controls (p < 0.01). UAGT/UCrea levels significantly positively correlated with urinary protein: creatinine ratio (UPro/UCrea) (r = 0.785, p = 0.01), and UAIb/UCrea (r = 0.681, p = 0.01) in normotensive ADPKD patients., Conclusion: This pilot study demonstrates that UAGT levels tend to be elevated and are correlated with proteinuria and albuminuria in normotensive ADPKD patients during relatively early stages of the disease.

Background: The mortality and morbidity rates of even extensive thoracoabdominal replacement have improved markedly in recent years. We investigated the effects of a temporary occlusion of the aorta as a direct precondition and temporary occlusion of the axillary artery for remote preconditioning to determine any effects that preconditioning may have on indirect (nonischemic) injuries to visceral organs (indirect effects of remote ischemia/reperfusion injury)., Methods: Thirty-seven New Zealand white rabbits were divided into five groups: controls (sham-operated; group 1); direct ischemia to the infrarenal aorta without preconditioning (group 2); direct ischemic preconditioning to the infrarenal aorta (group 3); remote ischemic preconditioning before clamping the infrarenal aorta (group 4); and simultaneous direct aortic and remote ischemic preconditioning before the clamping and during clamping of the infrarenal aorta (group 5). We used a 30-minute ischemia period for aortic occlusion for spinal cord ischemia/reperfusion. The axillary artery was used for remote preconditioning. After 24 hours, tissue specimens of the internal organs were obtained., Results: Myocardial congestion was the main pathology detected in all groups. Histopathologic evaluation of tissue samples taken from the hearts showed no significant differences in terms of the degree of polymorphonuclear leukocyte (PMNL) infiltration and edema between the groups. Lung congestion and pneumonic cell infiltration were detected in all the groups. Pneumonic cell infiltration was significantly high in groups 2 and 3. Cell infiltration was lowest in group 4 at 71.4% of normal values, which differed from the normal values of 25-33.3% in the other groups (P < 0.05). Although there is a difference between the groups in case of renal congestion, there is not any difference as tubular damage and PMN. There was a significant difference with regard to renal congestion between groups 2 and 3. Renal congestion was normal in 80% of the kidneys in group 3. This differed from the normal values observed in the other groups (14.3-57.1%, P < 0.05). Liver congestion was detected in all groups., Conclusions: Different preconditioning methods may play an important role in distinct organ injuries during aortic cross-clamping. The visceral organs that exhibited positive and constructive results with direct and remote preconditioning included the lungs and kidneys during indirect ischemia/reperfusion injury. Remote ischemic conditioning was determined to be especially advantageous as a protection method, due to the fact that it is easy to use and effective for indirect ischemia/reperfusion injury., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Ninety hens were divided into six groups as a 2 x 3 factorial design and fed diets containing Wheat Bran (WB) at two levels of 0 and 5% and the enzyme phytase at three levels of 0, 150 and 300 FTU kg(-1). Egg weight, egg production, feed intake and Feed Conversion Ratio (FCR) were determined. Eggs were collected on two consecutive days at fortnightly intervals to measure egg size and egg component weights. Shell thickness was measured. Egg production, egg weight, FCR and feed intake were not affected by WB. Egg production, egg weight and feed intake were significantly higher in phytase-supplemented groups than unsupplemented groups. FCR differed significantly between dietary treatments as phytase supplementation significantly decreased FCR. Inclusion of WB to the diets had no effect on egg size and albumen weight. Phytase supplementation did not affect yolk weight, although albumen and shell weight were significantly affected.

Eighty layer hens were assigned in a completely randomized design to four dietary treatments containing zinc sulphate or organic zinc as Albino-Zn in two levels of 25 or 50 ppm. Feed intake was expressed on a per hen basis. Daily egg collection was expressed on a hen-day basis. Eggs were weighed to calculate egg mass. Feed conversion ratio was calculated as feed consumed per egg mass. Also all eggs produced on days 14, 28 and 42 were collected and used for egg quality parameters. Albumen height was measured and HU was calculated. The yolk and dried shell were weighed then albumen weight was calculated. There was no effect of zinc source or zinc level on egg production, egg weight or feed conversion ratio. However, feed intake was lower in the group receiving 50 mg kg(-1) organic zinc. There were no significant treatment differences for weight of egg components or shell thickness, but albumen height and HU were higher in the second fortnight for the groups receiving organic zinc at 25 or 50 mg kg(-1) than in the un-supplemented group.