Carbetocin versus Oxytocin with or without Tranexamic Acid for Prophylactic Prevention of Postpartum Hemorrhage after a Vaginal Delivery: A Randomized Clinical Trial

OBJECTIVE

Our study's primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid.

DESIGN

A multicentric randomized controlled trial.

PARTICIPANTS/MATERIALS, SETTING, AND METHODS

This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient's bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75).

RESULTS

The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6).

LIMITATIONS

The most important limitation of the study is a relatively small number of participants.

CONCLUSION

In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery.

Investigation of Epidemiological Characteristics of Patients over Age 65 with Covid-19 ın a City

Background

The population aged ≥65 is important because of the higher mortality rate and a riskier clinical course of COVID-19 in this patient group. This study aimed to examine the epidemiological characteristics, clinical conditions and factors affecting the clinical status of patients over 65 with COVID-19 in the Bingol province.

Methods

Study was conducted between March and December 2020 in the Bingol province using the data of 3,521 patients over age 65 who were positive for SARS-CoV-2 as per RT-PCR results. The study commenced after obtaining necessary institutional permissions and the ethics committee approval. In the study, independent variables were age, gender, presence of chronic diseases whereas dependent variables were mortality status, presence of pneumonia. Chi-square test and binominal logistic regression analysis were used for statistical analysis. In all evaluations, p < 0.05 was considered significant.

Results

The median age of the patients participating in the study was 72(65-102) and the case fatality rate was 2%. The mortality rates were significantly higher in patients aged between 75-84 and those aged >85 as well as patients who had a chronic disease, diabetes and ischemic heart disease compared to the other groups (p < 0.05). According to the regression analysis, mortality rate was 2.6-fold higher in males than in females and 24.3-fold higher in patients with pneumonia than in those without pneumonia (p < 0.05).

Conclusions

Among the patients in the study group, mortality rate was found to be higher in males, those in the advanced age group and those with pneumonia and chronic diseases. Therefore, if possible, patients with these characteristics should be followed more closely in a hospital setting during the pandemic.

Key messages

Mortality rates are higher in patients with COVID-19 who have a chronic disease, diabetes or ischemic heart disease.

Age, gender and presence of pneumonia are among the important factors in the course of COVID-19.

Determining How Nutritional Status is related to Anger Level and Anxiety Status in Persons

Background

Nutriments affect psychology and psychological state affects nutritional status of people. The present study is, therefore, intended to find out how nutritional status is related to levels of anger and anxiety in people receiving nutritional consultation.

Methods

This descriptive-type cross-sectional study includes a universe of 180 individuals aged over 18 who received nutrition counseling between August-December 2018. The approval of the ethics committee and of the relevant institution was obtained in order to conduct the study. The questionnaire form used to retrieve the data herein consists of socio-demographic characteristics, Trait Anger and Anger Expression Style Scale, Beck Anxiety Inventory, food consumption frequency, and food consumption record. Chi-Square test, Student t-test, and One-way ANOVA test were used for statistical analysis. The significance level was set as p &lt; 0.05.

Results

In the study group, those who consumed milk once a month had a subscale score of trait anger (22.83±3.13) that was significantly higher than that of those consumed it 3-5 times a week (18.74±3.93)(p = 0.025). Those who consumed fast food 1-2 times a week and 3-5 times a week had an anger expression score of 16.17±2.81 and 16.43±3.69, respectively; which were significantly higher than that of those consumed fast food once a month(14.07±2.42) and once every 15 days(14.12±3.05) (p = 0.028). The anger control subscale score of those who consume red meat daily is significantly lower than those who consume red meat 1-2 times a week and 3-5 times a week(p = 0.048). The body mass index and anxiety level did not have a significant difference (p &lt; 0.05).

Conclusions

In the study group, it was found that the trait anger score was low in the groups with less consumption of milk, the anger expression score was higher in the groups with increased fast food consumption, and the anger management score was lower in the group with more frequent red meat consumption.

Key messages

People who consume fast food more frequently have increased anger expression. The level of trait anger increases as the milk consumption diminishes.

Investigation of Epidemiological Characteristics of &lt; 18-Year-Old Patients with Covid-19 ın a City

Background

After the coronavirus disease 2019 (COVID-19) became a pandemic, the World Health Organization declared it to be a public health emergency. The population aged >of 18 years in Bingol province is 72766 and constitutes 25.8% of the entire population. This study aimed to examine the epidemiological characteristics of < 18-year-old patients with COVID-19 in Bingol Province.

Methods

In this study 1431 people aged <18 who tested positive on reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 in Bingol province between March and December 2020 were studied.The necessary institutional permission and ethics committee approval were obtained to conduct the study. The independent variables of the study were age, gender and place of residence, whereas the dependent variable was the development of pneumonia. Descriptive data were expressed as numbers and percentages, and Chi-Square test was used for statistical analysis. P < 0.05 was considered statistically significant.

Results

The median age of the study patients was 14 (0-17) years. Of the patients, 99.8% did not have any comorbidity and 96% presented with a good clinical condition. Of the patients, 91.1% were home-isolated and 6.9% developed pneumonia. Pneumonia developed at significantly higher rate in the age groups of 0-4 and 5-9 years compared with other age groups (p = 0.004). There was no significant difference in the development of pneumonia according to gender and comorbidity (p > 0.05).

Conclusions

The rate of pneumonia development was low in the study group. The clinical condition of most of the patients was good, and they isolated at home. Pneumonia developed at a higher rate in younger patients.

Key messages

COVID-19 has a milder prognosis in patients aged<18 years.

Among the patients aged <18 years, pneumonia develops at a higher rate in younger patients.

Role of cervical length and placental alpha microglobulin-1 to predict preterm birth

INTRODUCTION

Preterm labor is the leading cause of premature mortality and morbidity. Therefore, to rule-in and rule-out preterm delivery is a very important issue in our clinical practice.

OBJECTIVE

The aim of this study was to investigate the value of placental alpha microglobulin-1 (PAMG-1) molecule positivity in cervicovaginal secretions of women who have a CL <25 mm and presenting with preterm labor symptoms to predict spontaneous preterm birth within seven days.

MATERIALS AND METHODS

This was a prospective cohort study conducted in Ankara University Department of Obstetrics and Gynecology between August 2017 and February 2019 on the patients who had Preterm labor symptoms, <25 mm transvaginal cervical length (CL), clinically intact membranes. The primary outcome of the study was the power of CL and PAMG-1 positivity on the prediction of preterm birth in seven days.

RESULTS

Sensitivity and specificity values of PAMG-1 in our study population to predict spontaneous preterm birth in seven days were calculated 52.94% and 98.84%, respectively, negative predictive value (NPV) and positive predictive value (PPV) were calculated 91.4% and 90%, respectively. When we investigated our data according to different CL cutoffs, sensitivity and NPV for 20 mm cutoff were 88.24% and 96.3% that was better than PAMG-1, but specificity and PPV were 60.47% and 30.61%, respectively, that was more ineffective than PAMG-1. If we calculate the values according to 15 mm and 10 mm CL cutoffs sensitivity values were 58.8% and 23.53%, specificity values were 81.4% and 91.86%, NPV were 90.9% and 85.87%, PPV were 38.46% and 36.36%, respectively. Finally, accuracy value of PAMG-1 to predict spontaneous preterm birth in seven days was 91.26% that was better than other CL cutoffs (20 mm, 15 mm, and 10 mm).

CONCLUSION

PAMG-1 molecule with high NPV and PPV (91.4% and 90%) combination will contribute our clinical decision on the population who had preterm labor symptoms and a CL shorter than 25 mm.

Investigating the Knowledge, Attitudes and Behaviours of Parents Regarding Vaccine Rejection

Background

With an escalating prevalence, vaccine rejection is one of the ten threats to global health as identified by the World Health Organization in 2019. Vaccine rejection and hesitancy can be defined as the hesitancy of individuals to get vaccinated against diseases that can be prevented by vaccination. This study aimed to investigate the knowledge, attitudes and behaviours of parents who use primary healthcare services.

Methods

Conducted between August and September 2019, this study adopted a descriptive cross-sectional design. The sample size of the study was calculated to be 378, considering a 95% confidence interval and 80% power. The survey form, the data collection tool of the study, included questions concerning sociodemographic characteristics of individuals and their knowledge, attitudes and behaviours regarding vaccination. The data were analysed on SPSS 22.0. Chi-square test was used in statistical analyses, and the significance level was set as p &lt; 0.05.

Results

In the study group, 15.5% of the parents stated that they were hesitant about vaccines in childhood, 81.3% stated that their source of information on vaccines was healthcare staff and 28% stated that it was the internet. The hesitancy level was significantly high among those who believed that vaccines led to autism and infertility and those who did not trust pharmaceutical companies (p &lt; 0.05). The hesitancy level regarding vaccines was significantly lower among those whose source of information was healthcare staff, whereas it was significantly higher among those whose source of information was the internet (p &lt; 0.05).

Conclusions

Parents' beliefs that vaccines led to autism and infertility increased their hesitancy levels. The inaccurate information on the internet and social media increased their hesitancy levels. Hesitancy levels were lower among the parents who received information from healthcare staff.

Key messages

Healthcare staff should organise public trainings on vaccines to reduce the hesitancy levels of parents. Anti-vaccination statements on the internet and social media influence individuals’ vaccination behaviours.

Knowledge and Behavior of Nurses on Childhood Vaccine Refusal in a Hospital of Eastern Turkey

Background

Among 10 global problems of 2019 determined by the World Health Organization, vaccine refusal was one of the problems mentioned. In this context, health services and health personnel whose main objectives are to keep individuals healthy and to prevent diseases have major responsibilities. This study aims to analyze knowledge and behavior of nurses working in Malatya Turgut Özal Hospital on childhood vaccine refusal.

Methods

This study, conducted between June-July 2019, is a descriptive cross-sectional study and its universe is composed of 850 nurses working in Turgut Özal hospital. Sample size was calculated to be 263 at a confidence interval of 95% and strength of 80%. In the questionnaire, sociodemographic questions on nurses and children as well as questions determining nurses' knowledge and behavior on childhood vaccine refusal were asked. Chi-square test and Fisher's Exact Test were used in statistical analyses. p &lt; 0.05 was determined to be significant.

Results

31.7% of nurses participating in the study stated that they had concerns on childhood vaccines. Two-thirds of nurses stated that their knowledge on vaccines were from their education, one-thirds of them knew that childhood vaccines were mandatory by law while three out of four stated they knew the vaccination schedule recommended by the Ministry of Health. The level of concern in those agreeing to the fact that vaccines caused autism and infertility, those stating that they did not trust vaccine-producing companies, and those stating that catching the disease was a better immunization method than vaccination was significantly higher than those not agreeing to these and those who were indecisive (p &lt; 0.05).

Conclusions

One-thirds of nurses was proven to have concerns on childhood vaccines and this rate is rather high. Nurses, being both health personnel and the communication channel for guiding parents, should be provided necessary trainings and practices in order to ease their concerns on vaccination.

Key messages

In-service trainings should be given importance in order to reduce nurses’ concern. Due to the fact that the information source for nurses on vaccination was their education, subjects that would eliminate their concerns should be highlighted.

Examining the relationship between Orthorexia Nervosa and healthy lifestyle behaviors in students

Background

Orthorexia Nervosa (ON) is an eating disorder characterized by a pathological obsession to healthy eating and excessive preoccupation with the consumption of healthy food. The ON levels of individuals are affected by their healthy lifestyle behaviors. The aim of this study is to determine the relationship between ON levels as well as associated factors and healthy lifestyle behaviors in female students at Malatya Battalgazi Dormitory.

Methods

Our descriptive cross-sectional study was conducted in 2019 and included 300 female dormitory students. The survey form used in the study consisted of questions regarding sociodemographic characteristics and eating habits; the Orthorexia Nervosa Evaluation Scale and Healthy Lifestyle Behaviors Scale were also utilized. The Chi-Square, Student t, One Way ANOVA, Mann-Whitney U and Kruskal Wallis tests were used in the statistical analysis of data and p &lt; 0.05 was found to be significant.

Results

It was found that 16.7% of students had an inclination towards ON. Students who had 2 meals a day or less exhibited significantly lower ON tendencies compared to those who had 3 meals a day or more (p &lt; 0.05). The groups showed statistical variations in total Healthy Lifestyle Behavior scores and sub-class scores when compared according to levels of parental education (p &lt; 0.05). While the average Healthy Lifestyle Behavior score total was 124.8±14.61 in students who displayed ON tendencies, those that did not show such tendencies had a mean score of 120.0±19.74.

Conclusions

Students with ON tendencies have a higher healthy lifestyle behavior score. In addition, students consuming less than 2 main meals daily showed less signs of ON. In this case, it is necessary to prioritise updating and improving the methods evaluating the ON trends. It is thought that ON tendencies can be reduced and healthy lifestyle behaviors can be improved in students with education concerning nutritional awareness.

Key messages

The female students staying at Malatya Battalgazi Dormitory show low signs of ON. Healthy lifestyle behaviors of female students staying at Malatya Battalgazi Dormitory are above average.

Knowledge, Attitudes And Behaviors Of Faculty Members On Childhood Vaccine Refusal A University

Introduction

Vaccines stimulate the immune system and provides protection against a large number of diseases. Although there is a lot of scientific evidence that the benefits of vaccines are higher than their risks, concerns can occur in every segment of the community about the safety of vaccines.In this study, we aimed to examine the knowledge, attitudes and behaviors of the faculty members working at Inonu University regarding vaccine rejection.

Methods

This study is a descriptive cross-sectional study, conducted between July and August 2019. The universe of this study consists of 799 faculty members working at Inonu University. Sample size was calculated as 258 with 95% confidence interval and 80% power. The questionnaire used in the study consists of the questions including the sociodemographic characteristics of the faculty members and their knowledge, attitudes and behaviors about childhood vaccine rejection. Chi-square test was used for statistical analysis. p &lt; 0.05 was determined to be significant.

Results

99.1% of the faculty members had their children vaccinated during their childhood. 31.8% of faculty members stated that they were worried about childhood vaccines.As a source of information about vaccines, faculty members stated the scientific articles in highest rate (49.4%).It was found in comparison that parents who applied alternative medicine for their children were more worried about vaccines than those who did not, and those who did not read scientific publications about vaccines were more worried than to those who read (p &lt; 0.05).The levels of anxiety are significantly lower in those who do not think that vaccines cause autism and infertility, and those who trust vaccine producing companies (p &lt; 0.05).

Conclusions

Almost all of the faculty members have their children vaccinated, but their level of anxiety about vaccines is high. In our study, we observed that those who obtained their knowledge about vaccines from scientific articles were less anxious.

Key messages

Faculty members, who are among the most educated groups of the society, have a high level of anxiety about childhood vaccination. By keeping faculty members informed about the scientific publications about vaccines, their concerns about the vaccine can be eliminated.

The Knowledge and Behaviours of the Healthcare Staff Regarding Vaccine Rejection

Background

Vaccination is a cost-effective method to protect individuals from diseases and complications that might emerge due to diseases. The healthcare staff in primary healthcare services, as the primary body concerned with vaccines, are notably more likely to encounter families who reject vaccines in childhood. This study aimed to investigate the knowledge, attitudes and behaviours of the healthcare staff in primary healthcare services regarding vaccine rejection in childhood.

Methods

Conducted between July and August 2019, this study adopted a descriptive cross-sectional design. The population of the study comprised 392 healthcare staff working in primary healthcare services in Malatya City Centre. The sample size was calculated as 193, considering a 95% confidence interval and 80% power. The survey form used in the study included questions concerning sociodemographic characteristics of individuals, their views on vaccination and the views of parents regarding vaccine rejection according to the perspectives of the healthcare staff. Chi-square test was used in statistical analyses, and the significance level was set as p &lt; 0.05.

Results

In the study group, 25.4% of the healthcare staff stated that they were hesitant about vaccines in childhood. Also, 18.2% of the individuals indicated that they were hesitant about vaccines due to the chemicals in vaccines, 14.4% were hesitant due to the pharmaceutical industry and the relationships based on self-interest and 10.5% were hesitant due to the side effects. The hesitancy level was significantly higher among those whose source of information regarding vaccines in childhood was the internet (37.0%) compared with those whose source was not the internet (21.6%) (p = 0.004).

Conclusions

One-fourth of the healthcare staff, who are supposed to be the most informed group about vaccines, were hesitant about them. Moreover, the inaccurate information acquired from the internet and social media could be increasing the hesitancy level.

Key messages

Vaccination hesitancy is high among the healthcare staff in primary healthcare services. The source of information regarding vaccination influences the hesitancy levels of individuals.

Surgical outcomes of sleeve resections performed for non-small cell lung cancer; A single center experience

Background

Although bronchial sleeve resections were performed instead of pneumonectomy in patients with insufficient pulmonary function initially, it is currently available as an alternative to pneumonectomy even in patients with adequate pulmonary reserve.

Aims

In this study, we aimed to evaluate the sleeve resections performed for lung cancer in terms of technical, postoperative complication mortality, survival rates and survival factors, complication and to compare them with the literature.

Methods

Patients who underwent sleeve lung resection with diagnosis of non-small cell lung cancer at our department between January 2012 and December 2017 were included in the study. Patients' data were analyzed according to tumor size, tumor histopathology, hilar/mediastinal lymph nodes invasion status, postoperative complications, operative mortality, resection type, overall survival and diseases-free survival, tumor location, and length of stay in intensive care unit.

Results

A total of 71 patients included the study. Right upper sleeve lobectomy was applied to 40 (56.3%) patients and left upper sleeve lobectomy was performed to 19 (26.8%) patients. The most common histopathological diagnosis was squamous cell carcinoma. The mean tumor diameter was 3.39 (SD: 2.25) cm. There was no nodal invasion in 41 (57.7%) patients and N1 nodal positivity was detected in 18 (25.4%) patients and N2 positivity in 12 (16.9%) patients. Median survival time was 43.6 months (35.4-51.8 months), the 3- and 5-year overall survival were 65.7% and 40.6%, respectively. There was a statistically significant correlation relationship between nodal invasion and recurrence, but this relation was not found in overall survival.

Conclusion

In our study, no significant correlation was found between mediastinal lymph node invasion and overall survival. Supporting this result with multi-centered and prospective studies may encourage surgeons for sleeve resection in indicated patients had lung cancer with nodal invasion.

Attitudes and behaviours of theology faculty students on organ donation An Eastern City Of Turkey

Background

Transplantation is the process by which a solid tissue or organ from a living donor or cadaver is transplanted to replace an organ that cannot function properly in the body. Religious beliefs of individuals affect their attitudes and behaviours regarding organ donation. The aim of the study is to determine the knowledge, attitudes, behaviours of Theology Faculty students about organ donation.

Methods

The study is cross-sectional study which carried out on students in Faculty of Theology.Total number of students was 800 at the time of study. Sample selection was not performed in this study,70% of the population was included. The first part of the questionnaires, which we created as data collection tools, comprised socio-demographic questions, whereas the second part comprised questions, prepared according to the literature that measures the knowledge, attitudes and behaviours on organ donation. Chi-square test was used for statistical analysis.

Results

0.7% Of the students participating in the study stated that they were organ donors, whereas 56.4% said that they considered organ donation as religiously appropriate behaviour, and 38.6% said that they have not become organ donors before because the subject of organ donation was not brought to their attention previously. A comparison of whether the students viewed organ donation as religiously appropriate behaviour with the students’ level of knowledge on organ donation revealed to be 65.8% among students with knowledge on organ donation and 49.5% among students who lacked knowledge on organ donation(p &lt; 0.05).

Conclusions

The ratio of organ donors among the participants was 0.7%. Students with knowledge on organ donation also said that they viewed organ donation as religiously appropriate behaviour. Through training activities, the aim should be to increase the level of knowledge and awareness on organ donation of future religious staff and to thereby increase the level of organ donation in the society.

Key messages

The ratio of organ donation among Theology Faculty students is low. The subject of organ donation should be added to the curriculum of Theology Faculty students.

Effects of thoracic epidural or intravenous analgesia on the neutrophil-to-lymphocyte ratio in thoracotomy cases

Background and Purpose

Postoperative pain is a significant problem in thoracotomy patients. Our aim in this study was to investigate the relationship between postoperative pain and neutrophil-to-lymphocyte ratio (NLR) which is a marker of acute inflammatory response.

Materials and Methods

Thoracic epidural or intravenous analgesia was administered to thoracotomy patients who elected to undergo a planned surgery. Patients were divided into two groups according to the analgesia method applied postoperatively. Thoracic epidural analgesia was recorded as Group 1 and intravenous analgesia as Group 2. Whole blood counts were recorded from preoperative and postoperative 24^th- and 48^th-hour routine blood samples, and NLRs were recorded as retrospective file scanning. Postoperative 24^th- and 48^th-hour NLRs and preoperative NLR values were recorded.

Results

Demographic data of the patients included in the study were similar except for age. Preoperative NLR was significantly higher in Group 1 at 3.50 (P = 0.004) than in Group 2 at 2.51. Postoperative NLRs were similar among both groups. Postoperative NLR values at both the 24^th- and 48^th-hour increased by4.9 times in Group 1 and 9.23 times in Group 2 from the 24^th-hour preoperative period, when the preoperative NLRs were evaluated. The rate of increase in Group 1 was significantly lower than in Group 2 (P = 0.006).

Conclusion

Postoperative NLR alterations when compared with preoperative values were related to the analgesic regimen used.

Adipose tissue-derived stem cell therapy for prevention and treatment of erectile dysfunction in a rat model of Peyronie's disease

Peyronie's disease (PD) is a localized connective tissue disorder that involves the tunica albuginea (TA) of the penis. While surgical correction remains the gold standard, the search for an effective and less invasive therapy continues. The objective of this study was to evaluate the effects of intratunical injection of adipose tissue-derived stem cells (ADSCs) for the prevention and treatment of erectile dysfunction in a rat model of PD. Twenty-four male Sprague-Dawley rats (300-350 g) were randomly divided into four groups: sham, PD, PD + ADSC (prevention) and PD + ADSC (treatment). All rats underwent penile injections into the TA with 50 μL vehicle (sham) or 0.5 μg transforming growth factor (TGF)-β1 (remaining groups). The ADSC groups received intratunical injections with 0.5 million rat-labelled ADSCs on day 0 (prevention) or day 30 (treatment). Forty-five days following TGF-β1 injection, rats underwent cavernous nerve stimulation (CNS) with total intracavernous-to-mean arterial pressure ratio (ICP/MAP) and total ICP recorded to measure response to therapy. Tissues were evaluated histologically and for mRNA expression of tissue inhibitors of metalloproteinases (TIMPs), matrix metalloproteinases (MMPs) and zymographic activity of MMPs. Statistical analysis was performed by analysis of variance followed by the Tukey test for post hoc comparisons. In both prevention and treatment groups, intratunical injection of ADSCs resulted in significantly higher ICP/MAP and total ICP in response to CNS compared with the PD group. Local injection of ADSCs prevented and/or reduced Peyronie's-like changes by decreasing the expression of TIMPs, and stimulating expression and activity of MMPs. This study documents the preventive and therapeutic benefits of ADSC on penile fibrosis and erectile function in an animal model of PD.

PDE5 inhibitors: considerations for preference and long-term adherence

INTRODUCTION

Erectile dysfunction (ED) is a highly prevalent condition affecting nearly one in five men worldwide. The advent of phosphodiesterase type 5 inhibitors (PDE5i) has revolutionised the ED treatment landscape and provided effective, minimally invasive therapies to restore male sexual function.

MATERIALS AND METHODS

A pubmed search was performed of all English language articles from 1996 to present reviewing PDE5i, including pharmacokinetics, efficacy profiles and comparisons, where available.

RESULTS

Currently available PDE5i in the United States include sildenafil, vardenafil, tadalafil and avanafil, each of which has unique side effect, pharmacokinetic and outcome profiles. Sildenafil is associated with increased rate of visual changes, vardenafil with QT prolongation and tadalafil with lower back pain. Avanafil and vardenafil orodispersible tablet rapidly achieve peak plasma concentration, which results in faster onset of action, whereas tadalafil exhibits the longest half-life. First time response to PDE5i is approximately 60-70%, with no significant differences in efficacy noted among therapies. The literature does not clearly demonstrate a preference for one drug. High-treatment success rates (89%) were reported when patients were prescribed all available PDE5i. Daily dosing with tadalafil is associated with improved erectile function (EF) over time. Finally, novel modes of patient-provider interaction, including internet-based education, communication and prescribing, may also improve long-term adherence.

CONCLUSIONS

PDE5i represent first line therapy for ED with excellent overall efficacy and satisfactory side effect profiles. Enhanced communciation, coupled with increased knowledge of drug characteristics, comparative treatment regimens and optimal prescribing patterns, offer compelling tools to improve long-term treatment success.

The effect of ankaferd to stop bleeding in experimental partial nephrectomy

AIMS

In kidney surgery, bleeding is one of the most important issues. In partial nephrectomy, as a "blood stopper", we used surgycell and ankaferd which is used traditionally in Turkish medicine.

MATERIAL AND METHODS

24 Wistar-Albino rats were grouped randomly. Laparotomy was performed in the first group, sham group. In the second group, partial nephrectomy was performed to lower-kidney pole and then, serum physiology was given to the lower part of the kidney. In the third group, partial nephrectomy was performed and surgycell was given over the kidney. In the fourth group, partial nephrectomy was performed and then ABS was applied. In all groups, the gauze was weighted on sensitive lift before and after the operation in order to determine the amount of bleeding. After the subjects were left alive for 5 hours, the levels of blood urea, and creatinine and kidney histopathology were evaluated.

RESULTS

No meaningful difference between the groups was found as for the levels of blood urea, and creatinine and the kidney histopathology. Bleeding amount was diminished significantly in the group 4, to which ankaferd was applied.

CONCLUSION

Ankaferd is a substance which can be used effectively for controlling acute bleeding in kidney surgery (Tab. 2, Ref. 19). Full Text in free PDF www.bmj.sk.

The surgical treatment and outcomes of high-pressure injection injuries of the hand

High-pressure injection injuries to the hand are uncommon soft tissue traumas of the hand which are frequently underestimated. They are, however, not uncommon among workers in industry using paint, automotive grease, solvents and diesel oil. The prognostic factors are the type, amount and temperature of the material and the pressure of injection. The results of 14 surgically treated high-pressure injection injuries of the hand with a minimum of two years follow-up are reported. Ten cases required soft tissue debridement and foreign body removal. Six required reconstructive microsurgical procedures and one underwent digital tip amputation, which followed major and devastating soft tissue problems. In the present study, we describe the mechanism of the soft tissue damage and the principles of treatment. This study confirms the fact that high-pressure injection injury to the hand is a significant problem, which can easily lead to serious sequelae and, even, amputation.

Double antibody immunoradiometric assay of hGH employing a terminal labeling technique

A method is described, and validated for hGH, using a double antibody immunoradiometric assay and a universal antibody coupled to a chelating moiety that can be labeled as the terminal step in the assay procedure. This technique, usable for any antigen, precludes the need for radiolabeled specific antibodies, and because of the short-lived radionuclide used in the terminal labeling step, generates no radioactive waste. The assay itself uses a specific first antibody coupled to a solid support (paper disc) to which the antigen binds. A specific second antibody from a second species is then attached to the solid phase retained antigen. Now a third antibody is attached, which has been generated from a third species against the second antibody acting as an antigen, and which carries transferrin as a chelating moiety. This final complex is labeled with 113mIn and the plot of the percentage of the total activity bound against the hGH concentration provides the derived values for the antigen levels present in the assay solution.

Synthesis of indium-labeled antibody-chelate conjugates for radioassays

A method has been developed to achieve rapid and reproducible complexation of indium to transferrin at pH 7.4. The system consists of nitrilotriacetic acid (NTA) as the intermediate carrier ligand, whose function is to allow the 113m In ion, in a solution in Tris buffer, pH 7.4, to be transferred rapidly to the specific binding sites on transferrin. Just as in the case of iron, this complexation requires the presence of a synergistic ion such as bicarbonate. The present system can be used to allow the binding of 113mIn to transferrin when coupled to an antibody. This method has been tested by studying the conjugation of an antibody, the IgG fraction of goat anti-rabbit-IgG, with either transferrin or desferoxamine, using glutaraldehyde as the coupling agent. Optimization in terms of total protein concentration and glutaraldehyde levels lead to products where the specific metal binding capacity of the transferrin moiety remains unchanged, and where the antibody retains 70% of its antigenic activity. The present system can be considered an extension of the ELISA techniques and can be used to determine, by a terminal 113mIn labeling technique, the level of specific binding of an antibody to its antigen.