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Introduction Comorbidities in addiction: It is a rule rather than an exception. The story starts in childhood; even before, in infancy, may be in utero. The dimensional traits have been already there, existing obviously far before any DSM-5 diagnosis. Developmental qualities of stress sensitivity, impulsivity and emotion dysregulation are the leading ones. Besides, comorbidity research (NESARC being one of the prominents) (Hasin and Grant. Soc Psychiatry Psychiatr Epidem, 2015;50 (11): 1609-1640) addressed childhood abuse, neglect or other childhood adverse experiences as a definite risk factor for adolescence and adult mental disorders, particularly substance use disorders. Developmental and environmental adversities in a mutually amplifying pattern make a vicious cycle in which the individual finally finds an illusionary exit, a pathway to addiction. Objectives This presentation aims to discuss the complexities and challenges for the diagnosis and treatment of a patient with a twenty five year follow-up, a survival period for the patient herself as well as for the therapeutic alliance (Ulug, Arch Neuropsychiatr, 2015;52: 213-215). Methods Case study: The history and the life chart of her, diagnosed as having at least seven DSM diagnoses, indicate the depth of pyschopathology and the intensity of interventions, most of which failed due to the lack of a transdiagnostic and holistic perspective. A specific focus of the case study will be on the problematic use of Borderline Personality Disorder formulation/diagnosis and its negative, somehow short-coming, impact on the treatment, course and recovery. Results The challenges brought by comorbid transdiagnostic cases, similar to the subject of this presentation, have become a common practice for addiction professionals. While big data or empirical large datasets can have their own limitations to help the practitioner for overcoming such challenges, as stated in Stein’s article “it is important to recognize the value of a wide range of complementary research designs including the age-old single-case study, which may sometimes provide clinical insights that outweigh those from big data analyses.” (Stein et al. World Pychiatry, 2022; 21(3): 393-414). Conclusions The case study indicates the necessity for transdiagnostic and holistic approach in the management and long term treatment of such difficult-to-diagnose and difficult-to-treat patients. Disclosure of Interest None Declared

In December 2019, cases of pneumonia of unknown origin were detected in Wuhan, Hubei Province, China. It was later determined that the pathogen SARS-CoV, which causes these cases of pneumonia, has been identified as the new enveloped RNA Betacoronavirus 2, now called severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2). In Turkey, the first case was detected on March 10, 2020. This study aimed to evaluate the factors that will enable rapid diagnosis of the disease through comparison of COVID-19 RT PCR results, thorax computed tomography (CT) findings, and laboratory results of patients suspected with COVID-19 who visited Başkent University Ankara Hospital Emergency Medicine Clinic. In our sample of 515 patients (280 female and 235 male patients), infiltration was detected in 113 patients (21.9%) The ratio of females to males increased with age. When the sex distribution of the thoracic CT findings was examined, the incidence of infiltration was higher in male patients. Conversely, no statistically significant dependence was found between the two categories using the chi-squared test. Shortness of breath was observed in 32.7% of patients with positive thoracic CT findings. Other common complaints were chest pain, 12.4%; fever, 10.6%; and weakness, 9.7%, respectively. The other category, which covered unclassified arrival complaints, had the highest percentage in the entire sample. When the thoracic CT distribution of comorbidities was examined (hypertension, 29.2% and diabetes, 25.2%) were more common than the other comorbidities in terms of the presence of infiltration. Thoracic CT results with RT-PCR, which were analyzed using the chi-square test, showed a statistically significant dependence between them. Conversely, COVID-compatible thorax CT findings were detected in 80 of 260 patients who tested negative in the PCR test. No complaints of fever, cough, weakness, shortness of breath, or chest pain associated with COVID were found in 48.6% of patients who were thoracic CT positive. PCR showed a low sensitivity rate. Therefore, thoracic CT is a better choice than PCR for the detection of asymptomatic cases in emergency patients. Because its selectivity rate is high, using PCR as a diagnostic test is more significant. [Med-Science 2023; 12(3.000): 741-5]

Background This study examines spinal muscular atrophy (SMA), a neuromuscular disease associated with malnutrition. Our goals are to assess how effectively screening tools can detect malnutrition and evaluate the impact of nutritional interventions on neurological outcomes, particularly motor functions. Methods Thirty-seven genetically diagnosed SMA patients (types 1, 2, and 3) under nusinersen therapy were included in the study. The nutritional status of these patients was assessed by using anthropometric measurements, including height for age (HFA), weight for height (WFH), and body mass index (BMI) before and after the study. Additionally, the risk of malnutrition was determined using screening tools, namely the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP). Nutritional counseling followed the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines and considered the patients’ dietary history, including content and administration method. Motor functions were assessed by validated tests: the Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) and the Hammersmith Functional Motor Scale—Expanded (HFMSE). Result The study showed an improvement in HFA, by a change from −0.95 to −0.65 (p = 0.015). Conversely, BMI scores decreased from 0.08 to −0.54 (p = 0.015), while WFH and MUAC showed no significant alterations (p = 0.135, p = 0.307). Following nutritional interventions, HFMSE demonstrated a median increase from 29.5 to 30.5 (p = 0.023). Patients identified as being at high risk for malnutrition based on PYMS and STAMP belonged to the moderate-to-severe malnutrition group (BMI Z-score ≤ −2, p = 0.001). Conclusions Use of screening tools in SMA patients is highly beneficial for the early detection of malnutrition. Future research should highlight the importance of combining nutritional management with nusinersen therapy to potentially alter the disease trajectory, especially in motor and neurological functions.

Background: Injury patterns in hypoxic-ischaemic brain injury (HIBI) are well recognised but there are few studies evaluating cerebral injury using neuroquantification models. Objectives: Quantification of brain volumes in a group of patients with clinically determined cerebral palsy. Method: In this retrospective study, 297 children with cerebral palsy were imaged for suspected HIBI with analysis of various cerebral substrates. Of these, 96 children over the age of 3 years with a clinical diagnosis of cerebral palsy and abnormal MRI findings underwent volumetric analyses using the NeuroQuant® software solution. The spectrum of volumetric changes and the differences between the various subtypes (and individual subgroups) of HIBI were compared. Results: Compared with the available normative NeuroQuant® database, the average intracranial volume was reduced to the 1st percentile in all patient groups (p 0.001). Statistically significant differences were observed among the types and subgroups of HIBI. Further substrate volume reductions were identified and described involving the thalami, brainstem, hippocampi, putamina and amygdala. The combined volumes of five regions of interest (frontal pole, putamen, hippocampus, brainstem and paracentral lobule) were consistently reduced in the Rolandic basal ganglia-thalamus (RBGT) subtype. Conclusion: This study determined a quantifiable reduction of intracranial volume in all subtypes of HIBI and predictable selective cerebral substrate volume reduction in subtypes and subgroups. In the RBGT subtype, a key combination of five substrate injuries was consistently noted, and thalamic, occipital lobe and brainstem volume reduction was also significant when compared to the watershed subtype. Contribution: This study demonstrates the value of integrating an artificial intelligence programme into the radiologists’ armamentarium serving to quantify brain injuries more accurately in HIBI. Going forward this will be an inevitable evolution of daily radiology practice in many fields of medicine, and it would be beneficial for radiologists to embrace these technological innovations.

Abstract The diffuse nature of Glioblastoma (GBM) tumors poses a challenge to current therapeutic options. We have previously shown that Acyl-CoA Binding Protein (ACBP, also known as DBI) regulates lipid metabolism in GBM cells, favoring fatty acid oxidation (FAO). Here we show that ACBP downregulation results in wide transcriptional changes affecting invasion-related genes. In vivo experiments using patient-derived xenografts combined with in vitro models demonstrated that ACBP sustains GBM invasion via binding to fatty acyl-CoAs. Blocking FAO mimics ACBPKD-induced immobility, a cellular phenotype that can be rescued by increasing FAO rates. Further investigation into ACBP-downstream pathways served to identify Integrin beta-1, a gene downregulated upon inhibition of either ACBP expression or FAO rates, as a mediator for ACBP’s role in GBM invasion. Altogether, our findings highlight a role for FAO in GBM invasion and reveal ACBP as a therapeutic vulnerability to stall FAO and subsequent cell invasion in GBM tumors.

This is a scientific article detailed information about the essence, principles, rules, elements, basic principles and methods of costume design. The features and tools of costume design are not only found in clothes, but also in works of art. It is presented as a broad theoretical information about color, styles in costume, details about styles and styles, ensembles are discussed in detail.The methods of artistic design of the costume are widely covered with information about decor and plastic and decorative features of selected materials, fashion functions, and accessories used in costume design. Teaches basic concepts of the concept of fashion and the functions of design and ensures the correct and intelligent use of design in future creative work.

Abstract Natural products have been proven to be important starting points for the development of new drugs. Bacteria in the genera Photorhabdus and Xenorhabdus produce antimicrobial compounds as secondary metabolites to compete with other organisms. Our study is the first comprehensive study screening the anti-protozoal activity of supernatants containing secondary metabolites produced by 5 Photorhabdus and 22 Xenorhabdus species against human parasitic protozoa, Acanthamoeba castellanii, Entamoeba histolytica, Trichomonas vaginalis, Leishmania tropica and Trypanosoma cruzi, and the identification of novel bioactive antiprotozoal compounds using the easyPACId approach (easy Promoter Activated Compound Identification) method. Though not in all species, both bacterial genera produce antiprotozoal compounds effective on human pathogenic protozoa. The promoter exchange mutants revealed that antiprotozoal bioactive compounds produced by Xenorhabdus bacteria were fabclavines, xenocoumacins, xenorhabdins and PAX peptides. Among the bacteria assessed, only P. namnaoensis appears to have acquired amoebicidal property which is effective on E. histolytica trophozoites. These discovered antiprotozoal compounds might serve as starting points for the development of alternative and novel pharmaceutical agents against human parasitic protozoa in the future.

Objective: Vaginal length (VL), size and width may show individual differences among women. Hysterectomy causes VL shortening in patients, and this shortening varies according to the type of hysterectomy performed. Some studies in literature have shown that the shortened VL after hysterectomy may cause dyspareunia and have a negative effect on female sexuality. The aim of this study is to compare preoperative and postoperative vaginal lengths, vaginal shortening rate (VSR) not used before in the literature, and postoperative sexual functions according to hysterectomy types. Materials and methods: In the study, which included 136 [55 Total Abdominal Hysterectomy (TAH), 33 Vaginal Hysterectomy (VH), 48 Total Laparoscopic Hysterectomy (TLH)] sexually active patients under the age of 60 who underwent hysterectomy, the patients were divided into three groups according to the type of hysterectomy performed. Groups were compared in terms of demographic variables, preoperative/postop and control VL, vaginal shortening rate and The Female Sexual Function Index (FSFI) scores. Results: Vaginal lengths measured after TLH was longer and vaginal lengths measured after VAH was shorter, the difference was significant (p 15% had statistically significantly lower FSFI scores in lubrication, orgasm, pain and total score than both the VSR

Abstract Purpose Etiology could not be determined in approximately 50% of recurrent pregnancy loss cases, and it was named unexpected recurrent pregnancy loss(URPL). A body shape index(ABSI), body roundness index(BRI), and waist‐to‐hip ratio(WtHR) are new indexes that are superior to BMI in showing body fat distribution. We aimed to investigate the potency of ABSI, BRI, and WtHR in URPL, their superiority to BMI, and their suitability for clinical use. Methods One hundred and thirty‐eight patients between the ages of 20‐40 who applied to our hospital for URPL between January 2016 and December 31, 2020 were included in our study. Weight, height, waist circumference, and hip circumference were measured, and indexes were calculated. Differences between the URPL and control groups were calculated using the IBM SPSS program. Results There was a significant difference between the two groups for BRI, ABSI, and WtHR values, while there was no significant difference in BMI. BRI(4.4 ± 1.7vs3.9 ± 1.5), ABSI(0.08 ± 0.005 vs 0.078 ± 0.004), and WtHR(0.84 ± 0.06vs0.82 ± 0.05) values were higher in the URPL group. ROC analysis showed us that BRI, ABSI, and WtHR have a diagnostic value for URPL(P

Transversal problems such as crowding and crossbite are one of the most common problems dealt with in early orthodontic treatments. Early correction of these problems may ease or even eliminate the future need for treatment. This paper presents the management of 2 cases with transverse discrepancy using the Ni-Ti Memory Leaf Expander––a new compliance-free slow maxillary expansion appliance. The total treatment time for both cases was 9 months. In both cases, the inter-canine, inter-premolar, and inter-molar distances, as well as the arch length, have all increased.

BackgroundThe erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation.MethodsAn individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention.ResultsThe analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0-6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization.ConclusionThe early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.

Abstract Our study aimed to identify the novel acaricidal compound in Xenorhabdus szentirmaii and X. nematophila using the easyPACId approach (easy Promoter Activated Compound Identification). We determined the (1) effects of cell-free supernatant (CFS) obtained from mutant strains against T. urticae females, (2) CFS of the acaricidal bioactive strain of X. nematophila (pCEP_kan_XNC1_1711) against different biological stages of T. urticae, and females of predatory mites, Phytoseiulus persimilis and Neoseiulus californicus, (3) effects of the extracted acaricidal compound on different biological stages of T. urticae, and (4) cytotoxicity of the active substance. The results showed that xenocoumacin produced by X. nematophila was the bioactive acaricidal compound, whereas the acaricidal compound in X. szentirmaii was not determined. The CFS of X. nematophila (pCEP_kan_XNC1_1711) caused 100, 100, 97.3, and 98.1% mortality on larvae, protonymph, deutonymph and adult female of T. urticae at 7 dpa in petri dish experiments; and significantly reduced T. urticae population in pot experiments. However, the same CFS caused less than 36% mortality on the predatory mites at 7dpa. The mortality rates of extracted acaricidal compound (xenocoumacin) on the larva, protonymph, deutonymph and adult female of T. urticae were 100, 100, 97, 96% at 7 dpa. Cytotoxicity assay showed that IC50 value of xenocoumacin extract was 17.71 μg/ml after 48 h. The data of this study showed that xenocoumacin could potentially be used as bio-acaricide in the control of T. urticae; however, its efficacy in field experiments and its phytotoxicity need to be assessed in future.

Abstract Aim of this study is to investigate whether the risk of miscarriage increases in pregnant women who had COVID-19 in first trimester. Our study included 52 patients with SARS-CoV-2 infection detected by RT-PCR and 53 patients with negative RT-PCR test in samples taken with nasopharyngeal swab in the first trimester between March 1 and December 31, 2020. Complete abortion, incomplete abortion, blighted ovum, intrauterine exitus, biochemical pregnancies were accepted as in the miscarriage group (MG). Pregnant women with COVID-19 and control group were compared in terms of demographic data, miscarriage rate and laboratory results. Patients were divided into MG and ongoing pregnancy groups (OPG) and compared in terms of the diagnosed weeks, clinical findings, laboratory results, treatments, and hospitalization. While miscarriage was observed in 15 (28.8%) of pregnant women infected with SARS-CoV-2 in the first trimester, this number was 7 (13.2%) in the control group. While the common symptoms in the MG were cough (60%), fever (53.3%), shortness of breath (53.3%), and fatigue (46.7%) (p

Introduction This prospective randomized controlled trial aimed to evaluate the effect of intrauterine insemination (IUI) before frozen-thawed elective single embryo transfer (FT-eSET). Material and methods A total of 200 couples with unexplained subfertility underwent in-vitro fertilization (IVF) treatment. Patients were randomly assigned to either FT-eSET or IUI preceding FT-eSET. Both groups were composed of 100 women. IUI was timed 6 days before FT-eSET in the IUI preceding FT-eSET group. Implantation rates (IR), biochemical and clinical abortion rates (AR), clinical pregnancy rates (PR), ongoing pregnancy rates (PRs), and live birth rates were measured in this study. Results The IUI preceding FT-eSET group was associated with higher rates of clinical pregnancy, 54% vs. 42%, but not significantly. Similarly, IR, PR and live birth rate were higher in the IUI preceding FT-eSET group but not significantly. In the IUI preceding FT-eSET group, the biochemical and clinical abortion rates were lower than in the control group (9.5% vs. 14.2% and 5.5% vs. 5.2%, respectively). However, no statistically significant difference was found between the two groups, either. Conclusions This is the first study showing that IUI may precede FT-eSET to improve PR in couples with unexplained subfertility. Also, performing IUI before FT-eSET may decrease biochemical and clinical abortion rates.

The Free Café is a citizen-driven collective in the city of Groningen, the Netherlands that serves a free meal biweekly, using food that would otherwise be thrown away. While principally attempting to create a space where financial pressures and social status are lifted, the group also works to raise awareness about the environmental and societal impacts of food. Using Gibson-Graham’s community economies (CE) lens to analyse the Free Café, this paper aims to understand how urban citizen collectives are organised and governed, to better facilitate local action in food initiatives. Through participant observation and in-depth interviews, this research focuses on the daily practices, interactions, organisation and challenges surrounding the Free Café, to draw lessons about urban collective action and CE. Though findings indicate internal conflicts and contradictions, through sharing its vision and opportunities, the café is found to be valuable to food-waste awareness-raising and experimentation towards sustainable post-capitalist societies.

Background: The TRAM flap has proven to be the autogenous tissue of choice for breast reconstruction. The progressive improvement of the aesthetic results in long-term follow-up of patients with well-executed TRAM flap breast reconstructions is observed to be highly satisfactory for both patients and the surgeon. Aims and Objectives: In this article, I aimed to present long term results of cases with pedicles TRAM flap reconstruction. Material and Methods: Between January 1999 and July 2001 period, 22 pedicled TRAM flap breast reconstructions were performed to 21 patients with breast carcinoma. The mean age of the patients was 42 (28-53) years. In this study, the contralateral rectus abdominis muscle was preferred as a pedicle in patients who had received adjuvant radiotherapy- (10 patients) and vertical or oblique flap inset was applied in most of them- (9 patients). In patients without adjuvant radiotherapy but with infraclavicular tissue losses, or with small opposite breast, again vertical or oblique flap inset was preferred- (4 patients). In all patients with vertical or oblique flap inset, the contralateral rectus abdominis muscle was used as a pedicle- (13 patients). In patients with full and attractive opposite breast, horizontal flap inset was preferred- (7 patients). In patients with horizontal flap inset, ipsilateral rectus abdominis muscle was used as a pedicle unless the patient had received adjuvant radiotherapy- (6 patients); contralateral rectus abdominis muscle was used as a pedicle if the patient had received adjuvant radiotherapy- (1 patient). Results: The follow-up period is 18-20 years for this series. During the early postoperative days, highly satisfactory results have been obtained. Eighteen of the cases were totally satisfied. Three of the cases had dissatisfactions mostly related to complications. During 18 to 20 years period follow-up of 12 patients has been performed regularly. Oncologic tracing, the degree of maintenance of the breast shape of the flap and symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin, color and shape changes over nipple areola complex have all been periodically observed. Conclusion: TRAM flap is still the gold standard among all breast reconstruction modalities. Progressive improvement in all measures such as breast, symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin are very satisfactory for patients and the surgeon.

The article provides information on the preparation of polyelectrolytes and swelling polymeric hydrogels with different specified properties. The analysis of domestic and foreign scientific literatures is presented. Particular attention of researchers is paid to rare cross-linked polyelectrolytes, the so-called supermoisture absorbents or hydrogels. Thanks to a complex of variable unique properties, supermoisture absorbents have found the widest application on the world market in medicine, industry, agriculture, and in solving water and environmental problems.

Introduction The aim of this prospective trial was to evaluate the ovarian reserve with anti-Müllerian hormone (AMH), which is the best predictor of ovarian reserve, and perform histological analysis after exposure to cisplatin with a GnRH agonist or antagonist. Material and methods Twenty-four Wistar albino rats were randomly divided into three groups, each consisting of eight rats. In the GnRH agonist group (group 1), rats received a single dose of 50 mg/m2 cisplatin with 1 mg/kg triptorelin. In the GnRH antagonist group (group 2), rats received a single dose of 50 mg/m2 cisplatin with 1 mg/kg cetrorelix. In the control group (group 3), rats received 50 mg/m2 cisplatin. Ovarian reserve was assessed by AMH and histology. Results Primary follicle counts were higher in group 2 (4.50 ±1.47 vs. 3.50 ±1.70 vs. 3.00 ±3.54) and secondary follicle counts were higher in group 1 (2.96 ±1.11 vs. 1.74 ±1.03 vs. 1.37 ±3.11). Numbers of tertiary follicles were higher both in groups 1 and 2 than the control group (1.36 ±0.83 vs. 0.84 ±0.99 vs. 0.50 ±0.75). The total follicle count of the study groups were significantly higher compared with the control group (14.32 ±5.96 vs. 12.48 ±4.12 vs. 10.63 ±6.80). AMH was significantly higher in groups 1 and 2 compared with the control group (18.56 ±25.33 vs. 16.48 ±24.66 vs. 9.37 ±26.54). Conclusions This is the first prospective randomized controlled study showing the protective effects of GnRH agonist and antagonist on ovarian reserve after cisplatin exposure in an animal model.

The global bioactive peptides’ market has been rising steadily due to the increased awareness of consumers about the positive association between functional foods/health foods and health. Bioactive peptides are short sequences of food proteins, mostly composed of 2–20 amino acid residues, with demonstrated positive physiological effects on human health. Different countries have developed various regulatory frameworks in order to protect the consumers from risks, misleading and false claims of the bioactive peptides. Scientific substantiation of safety and efficacy of bioactive peptides is an important aspect that can significantly impact the approval of health claims of bioactive peptides for market release. For regulatory approvals, the data from in-vitro and animal studies are alone not adequate to claim health benefits of bioactive peptides. Health claims of bioactive peptides must be supported by substantial evidence from human studies. Bioactive peptides derived from various food protein sources such as milk, whey, fish, and soybean have been on market in several countries. This review summarizes the important regulatory policies related to the bioactive peptides in various major countries.

Introduction: The most critical tissue in abdominoplasty is the midsagittal part of the supraumbilical region with the highest risk of hemodynamic disturbance. Here, the skin is also thinner compared to the neighboring lateral tissues. This may result in postoperative suprapubic depression. Methods: An easy technique is designed to prevent this suprapubic depression. While making the transverse incision, deepithelialized suprapubic flap is kept in place attached to the suprapubic region. The medial supraumbilical deficient tissue is brought down with the abdominoplasty flap and lowered over the deepithelialized suprapubic flap. Results: Follow-up with the patients is between 1 month and 2 years. We have no longer observed any concave deformity. Discussion: Another technique described in the literature designed to prevent the concave deformity is deepithelization of the tongue of tissue projecting from the lower end of the abdominal flap and folding this back to double up the thickness of fat in this area. Nevertheless, the median distal end of the abdominal flap is hemodynamically the poorest part of the flap. Preparing deepithelialized tongue and folding it back raises the vascular insufficiency risk. Suturing the upper edge and the sides of the supraumbilical flap to deep tissues of the abdominal flap distribute the tissue tension to deeper parts, thus reduce the incision tension with reduced scar tension at the midline. Conclusion: The suprapubic random flap is an assurance for prevention of concave deformity and helps to reduce the tension of transverse incision at the midline, thus may reduce the risk of scar formation.

Aim of the study : The present study aims to estimate the prevalence and distribution of HPV genotypes and identify related risk factors among Turkish women. Material and methods : 11 624 Turkish women attending our gynaecological clinic and expressing a desire for access to cervical cancer screening were assessed during the years 2014–2016. Cervical specimens were collected and transported using the HC2 HPV DNA Collection Device (consisting of a cervical brush and digene Specimen Transport Medium). Results : Among these 11 624 individuals, positive HPV test results were obtained for 325 (2.79%), and negative results were observed for 11 299 (97.2%). The vast majority of patients were between the 3rd and 5th decades and the mean age of the patients was 44 ±9.12 (range 27–66). Among the HPV-positive women, 205 were positive for a single HPV type (205/325 = 63.1% of HPV infections; 205/11624 = 1.76% of all samples) and 120 were positive for multiple types (120/325 = 36.9% of HPV infections; 120/11624 = 1.03% of all samples). The four most prevalent high-risk types were HPV 16, 31, 51 and 52, with frequencies of 11.25%, 7.83%, 6.06% and 3.16%, respectively. Conclusions : There appears to be geographic variation in the distribution of HPV genotypes. In this study, the four most prevalent high-risk types were HPV 16, 31, 51 and 52, with frequencies of 11.25%, 7.83%, 6.06% and 3.16%, respectively.

Abstract Despite a wealth of genomic information, a comprehensive alternative splicing (AS) analysis of pancreatic ductal adenocarcinoma (PDAC) has not been performed yet. In the present study, we assessed whole exome-based transcriptome and AS profiles of 43 pancreas tissues using Affymetrix exon array. The AS analysis of PDAC indicated on average two AS probe-sets (ranging from 1–28) in 1,354 significantly identified protein-coding genes, with skipped exon and alternative first exon being the most frequently utilised. In addition to overrepresented extracellular matrix (ECM)-receptor interaction and focal adhesion that were also seen in transcriptome differential expression (DE) analysis, Fc gamma receptor-mediated phagocytosis and axon guidance AS genes were also highly represented. Of note, the highest numbers of AS probe-sets were found in collagen genes, which encode the characteristically abundant stroma seen in PDAC. We also describe a set of 37 ‘hypersensitive’ genes which were frequently targeted by somatic mutations, copy number alterations, DE and AS, indicating their propensity for multidimensional regulation. We provide the most comprehensive overview of the AS landscape in PDAC with underlying changes in the spliceosomal machinery. We also collate a set of AS and DE genes encoding cell surface proteins, which present promising diagnostic and therapeutic targets in PDAC.

Xenorhabdus and/or Photorhabdus bacteria produce antibacterial metabolites to protect insect cadavers against food competitors allowing them to survive in nature with their nematode host. The effects of culture supernatant produced by Xenorhabdus and Photorhabdus spp. were investigated against the multidrug-resistant dental root canal pathogen Enterococcus faecalis. The efficacy of seven different cell-free supernatants of Xenorhabdus and Photorhabdus species against E. faecalis was assessed with overlay bioassay and serial dilution techniques. Additionally, time-dependent inactivation of supernatant was evaluated. Among the seven different bacterial species, X. cabanillasii produced the strongest antibacterial effects. Loss of bioactivity in a phosphopantetheinyl transferase-deficient mutant of X. cabanillasii indicated that this activity is likely based on non-ribosomal peptide synthetases (NRPSs) or polyketide synthases (PKSs). Subsequent in silico analysis revealed multiple possible biosynthetic gene clusters (BGCs) in the genome of X. cabanillasii including a BGC homologous to that of zeamine/fabclavine biosynthesis. Fabclavines are NRPS-derived hexapeptides, which are connected by PKS-derived malonate units to an unusual polyamine, also PKS-derived. Due to the known broad-spectrum bioactivity of the fabclavines, we generated a promoter exchange mutant in front of the fabclavine-like BGC. This leads to over-expression by induction or a knock-out by non-induction which resulted in a bioactive and non-bioactive mutant. Furthermore, MS and MS2 experiments confirmed that X. cabanillasii produces the same derivatives as X. budapestensis. The medicament potential of 10-fold concentrated supernatant of induced fcl promoter exchanged X. cabanillasii was also assessed in dental root canals. Calcium hydroxide paste, or chlorhexidine gel, or fabclavine-rich supernatant was applied to root canals. Fabclavine-rich supernatant exhibited the highest inactivation efficacy of ≥3 log10 steps CFU reduction, followed by calcium hydroxide paste (≤2 log10 step). The mean percentage of E. faecalis-free dental root canals after treatment was 63.6, 45.5, and 18.2% for fabclavine, calcium hydroxide, and chlorhexidine, respectively. Fabclavine in liquid form or preferably as a paste or gel formulation is a promising alternative intracanal medicament.

Yakup Altas, Ali Veysel Ulugg Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Abstract: ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. Keywords: electrocardiography, myocardial infarction, coronary circulation

Background: Abdominal aortic aneurysm (AAA) screening programmes have been established for men in the UK to reduce deaths from AAA rupture. Whether or not screening should be extended to women is uncertain. Objective: To evaluate the cost-effectiveness of population screening for AAAs in women and compare a range of screening options. Design: A discrete event simulation (DES) model was developed to provide a clinically realistic model of screening, surveillance, and elective and emergency AAA repair operations. Input parameters specifically for women were employed. The model was run for 10 million women, with parameter uncertainty addressed by probabilistic and deterministic sensitivity analyses. Setting: Population screening in the UK. Participants: Women aged ≥ 65 years, followed up to the age of 95 years. Interventions: Invitation to ultrasound screening, followed by surveillance for small AAAs and elective surgical repair for large AAAs. Main outcome measures: Number of operations undertaken, AAA-related mortality, quality-adjusted life-years (QALYs), NHS costs and cost-effectiveness with annual discounting. Data sources: AAA surveillance data, National Vascular Registry, Hospital Episode Statistics, trials of elective and emergency AAA surgery, and the NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP). Review methods: Systematic reviews of AAA prevalence and, for elective operations, suitability for endovascular aneurysm repair, non-intervention rates, operative mortality and literature reviews for other parameters. Results: The prevalence of AAAs (aortic diameter of ≥ 3.0 cm) was estimated as 0.43% in women aged 65 years and 1.15% at age 75 years. The corresponding attendance rates following invitation to screening were estimated as 73% and 62%, respectively. The base-case model adopted the same age at screening (65 years), definition of an AAA (diameter of ≥ 3.0 cm), surveillance intervals (1 year for AAAs with diameter of 3.0–4.4 cm, 3 months for AAAs with diameter of 4.5–5.4 cm) and AAA diameter for consideration of surgery (5.5 cm) as in NAAASP for men. Per woman invited to screening, the estimated gain in QALYs was 0.00110, and the incremental cost was £33.99. This gave an incremental cost-effectiveness ratio (ICER) of £31,000 per QALY gained. The corresponding incremental net monetary benefit at a threshold of £20,000 per QALY gained was –£12.03 (95% uncertainty interval –£27.88 to £22.12). Almost no sensitivity analyses brought the ICER below £20,000 per QALY gained; an exception was doubling the AAA prevalence to 0.86%, which resulted in an ICER of £13,000. Alternative screening options (increasing the screening age to 70 years, lowering the threshold for considering surgery to diameters of 5.0 cm or 4.5 cm, lowering the diameter defining an AAA in women to 2.5 cm and lengthening the surveillance intervals for the smallest AAAs) did not bring the ICER below £20,000 per QALY gained when considered either singly or in combination. Limitations: The model for women was not directly validated against empirical data. Some parameters were poorly estimated, potentially lacking relevance or unavailable for women. Conclusion: The accepted criteria for a population-based AAA screening programme in women are not currently met. Future work: A large-scale study is needed of the exact aortic size distribution for women screened at relevant ages. The DES model can be adapted to evaluate screening options in men. Study registration: This study is registered as PROSPERO CRD42015020444 and CRD42016043227. Funding: The National Institute for Health Research Health Technology Assessment programme.

Background: Ruptured abdominal aortic aneurysm (AAA) is a common vascular emergency. The mortality from emergency endovascular repair may be much lower than the 40–50% reported for open surgery. Objective: To assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality (including costs and cost-effectiveness) among patients with a suspected ruptured AAA. Design: Randomised controlled trial, with computer-generated telephone randomisation of participants in a 1 : 1 ratio, using variable block size, stratified by centre and without blinding. Setting: Vascular centres in the UK (n = 29) and Canada (n = 1) between 2009 and 2013. Participants: A total of 613 eligible participants (480 men) with a ruptured aneurysm, clinically diagnosed at the trial centre. Interventions: A total of 316 participants were randomised to the endovascular strategy group (immediate computerised tomography followed by endovascular repair if anatomically suitable or, if not suitable, open repair) and 297 were randomised to the open repair group (computerised tomography optional). Main outcome measures: The primary outcome measure was 30-day mortality, with 30-day reinterventions, costs and disposal as early secondary outcome measures. Later outcome measures included 1- and 3-year mortality, reinterventions, quality of life (QoL) and cost-effectiveness. Results: The 30-day mortality was 35.4% in the endovascular strategy group and 37.4% in the open repair group [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.66 to 1.28; p = 0.62, and, after adjustment for age, sex and Hardman index, OR 0.94, 95% CI 0.67 to 1.33]. The endovascular strategy appeared to be more effective in women than in men (interaction test p = 0.02). More discharges in the endovascular strategy group (94%) than in the open repair group (77%) were directly to home (p