Surface characteristics of additively manufactured CoCr and Ti6Al4V dental alloys: The effects of carbon and gold thin film coatings, and alkali-heat treatment

This study investigates the impact of surface modifications on additively manufactured CoCr and Ti6Al4V dental alloys, focusing on surface properties. Thin film carbon (C) and gold (Au) coatings, as well as alkali-heat treatment, were applied to the high- and low-polished specimens. Scanning electron microscopy (SEM) showed that thin film coatings retained the underlying surface topography, while the alkali-heat treatment induced distinct morphological changes. Energy-dispersive x-ray spectroscopy (EDS) analysis revealed that C-coating enriched surfaces with C, and Au-coating introduced detectable amounts of Au. Nevertheless, signs of coating delamination were observed in the high-polished specimens. Alkali-heat treatment led to the formation of a sodium titanate layer on Ti6Al4V surfaces, confirmed by sodium presence and Fourier transform infrared spectroscopy (FTIR) results showing carbonate bands. Surface roughness measurements with atomic force microscopy (AFM) showed that C-coating increased surface roughness in both high- and low-polished alloys. Au-coating slightly increased roughness, except for low-polished Au-coated Ti6Al4V, where a decrease in roughness was observed compared to low-polished bare Ti6Al4V, likely due to surface defects present in the latter resulting from the additive manufacturing process. Alkali-heat treatment led to a pronounced increase in roughness for both alloys, particularly for Ti6Al4V. Both thin film coatings decreased the water contact angles in all specimens in varying magnitudes, indicating an increase in wettability. However, the alkali-heat treatment caused a substantial decrease in contact angles, resulting in a highly hydrophilic state for Ti6Al4V. These findings underscore the substantial impact of surface modifications on additively manufactured dental alloys, potentially influencing their clinical performance. RESEARCH HIGHLIGHTS: Thin film coatings and chemical/heat treatment modify the surface properties of additively manufactured dental alloys. The surfaces of the alloys get rougher and more hydrophilic after alkali-heat treatment. Thin gold coatings exhibit potential adhesion challenges.

Histopathological Evaluation of Bipolar and Microneedle Radiofrequency Energy on the Skin and Fat of the Abdominal Region of the Rat

BACKGROUND

Radiofrequency (RF)-based devices are frequently used in plastic surgeries. In the current literature, no comparative experimental study has demonstrated the histological and immunological effects of these devices that are frequently used in the facial area. In this study, we investigated the histological and immunological effects of Bipolar RF (BodyTite) and Microneedle RF (Morpheus 8) devices in the rat abdominal region.

METHODS

24 rats were used in this study. The rats were divided into four groups: group I: Control. In group II, BodyTite was applied to the abdominal region. Group III: Morpheus 8 was applied to the abdominal region. Group IV: Both Morpheus 8 and BodyTite were applied to the abdominal region. The histological and immunological features of the tissues in the groups were examined using light microscopy, and collagen formation and desmosome structures were examined using light microscopy.

RESULTS

Collagens in Group II were thinner than those in the other groups. In addition, there were fewer vessels in Group III. The collagen scores were as follows: Group II:1.5; Group III:2; and Group IV:3. The VEGF scores were II:2.5, group III:2, and IV:3, respectively. The collagen score in group II and VEGF score in group III were significantly lower than those in the other groups. In addition, the bonds between desmosomes in group III were found to be looser using electron microscopy. Collagen morphology in groups III and IV was found to be similar to that in group I.

CONCLUSIONS

The conclusion of comparison RF-based devices increased tissue regeneration and healing.

CLINICAL RELEVANCE STATEMENT

The use of radiofrequency devices has increased in plastic surgery practice over the past two decades, particularly emerging as a unique alternative for non-surgical candidates. There is a lack of experimental studies concerning these commonly used devices in clinical practice.

Characterization of Collagen from Jellyfish Aurelia aurita and Investigation of Biomaterials Potentials

Marine collagen sources are potent alternatives due to abundant yield, low pathogen infection risk, high biocompatibility, and any religious and ethical restrictions compared to terrestrial collagen sources. In this research, we aim to investigate the biomaterials potential of the collagen from Aurelia aurita, which is a native jellyfish species in the Marmara Sea. Spectroscopic techniques were used to investigate the structure of jellyfish collagen (JCol) from acid-soluble fraction and compared to Jellagen® from Rhizostoma pulmo. MALDI-TOF showed the main peak of Jellagen® at 276,765.161 Da and jellyfish collagen at 276,761.687 Da. SDS-PAGE indicated α1 and α2 bands at about 122 kDa and 140 kDa, respectively. In FTIR and Raman spectra, the locations of amide bands of both species were almost the same. The pI of JCol was determined as 4.46. The particle size decreased abruptly at 43 oC from 890 to 290 nm. Water, organic and inorganic ratios of collagen were determined at 7.14%, 63.59, and 29.27 respectively. In DSC, the denaturation temperature (Td) of JCol was found at 43.7 oC and found to be higher than that of the collagens from jellyfishes that have been reported so far in the literature. Biocompatibility testing by metabolic assay revealed significantly higher fibroblast proliferation on collagen film than on the Tissue Culture Plate. To conclude, Aurelia aurita collagen would be a suitable source of collagen when biomaterials are needed to have high biocompatibility and unique macromolecular properties such as high denaturation temperatures.

Survival of root canal-treated teeth adjacent to an implant: A retrospective case-control study

OBJECTIVES

To evaluate the survival of root canal treated (RCT) teeth adjacent to an implant compared with that of RCT teeth of the same patient non-adjacent to an implant.

MATERIALS AND METHODS

RCT tooth of each patient adjacent to an implant were included in the test group. The control group consisted of another RCT tooth of the same patient; the control RCT tooth was not adjacent to an implant and selected to be of the same type of the RCT tooth in the test group. 72 teeth of 36 patients with at least 4-year follow-up were included. In addition to survival, other clinical and demographic parameters investigated were age, sex, tooth type and position, presence of a crown, presence of retreatment, presence of a post-core, presence of adjacent edentulous area, presence of implant-supported fixed prosthetic restoration on the antagonist tooth and periapical health status. Pearson Chi-Square and Fisher Exact tests were used to compare the test and the control groups with categorical variables (α=0.05). Survival curves were obtained by the Kaplan-Meier method, and the Log-rank test was performed to compare the survival probabilities (α=0.05).

RESULTS

No significant difference in survival rates was observed between the test and the control groups (p = 0.72). Similarly, no significant relationship was found between the investigated clinical variables and the survival rates of RCT teeth (p>0.05). Survival times differed depending on the presence of an adjacent edentulous area (p<0.001) and the periapical health status (p = 0.026).

CONCLUSIONS

RCT teeth with unhealed periapical tissues had a shorter cumulative survival time. Similarly, those adjacent to an edentulous area had shorter cumulative and complication-free survival times.

CLINICAL SIGNIFICANCE

This is the first study to determine the survival outcome of a RCT tooth adjacent to an implant compared to a non-adjacent one in the same patient. Being adjacent to an implant did not have a detrimental effect on the survival time and rate of RCT teeth.

Neurophysiologic cut off values for safe resection of patients with supratentorial gliomas

BACKGROUND

Gliomas have infiltrative nature and tumor volume has direct prognostic value. Optimal resection limits delineated by high-frequency monopolar stimulation with multipulse short train technique is still a matter of debate for safe surgery without (or with acceptable) neurological deficits. It is also an enigma whether the same cut-off values are valid for high and low grades. We aimed to analyze the value of motor mapping/monitoring findings on postoperative motor outcome in diffuse glioma surgery.

METHODS

Patients who were operated on due to glioma with intraoperative neuromonitorization at our institution between 2017 and 2021 were analyzed. Demographic information, pre- and post-operative neurological deficit, magnetic resonance images, resection rates, and motor evoked potential (MEP) findings were analyzed.

RESULTS

Eighty-seven patients of whom 55 had high-grade tumors were included in the study. Total/near-total resection was achieved in 85%. Subcortical motor threshold (ScMTh) from resection cavity to the corticospinal tract was ≤ 2mA in 17; 3 mA in 14; 4 mA in 6; 5 mA in 7, and ≥5mA in 50 patients. On the 6th month examination, six patients (5 with high-grade tumor) had motor deficits. These patients had changes in MEP that exceeded critical threshold during monitoring. Receiver operating characteristic analysis revealed 2.5 mA ScMTh as the cut-off point for limb paresis after awakening and 6 months for the groups.

CONCLUSIONS

Subcortical mapping with MEP monitoring helps to achieve safe wider resection. The optimal safe limit for SCMTh was determined as 2.5 mA. Provided that safe threshold values are maintained in MEP, surgeon may force the functional limits by lowering the SCMTh to 1 mA, especially in low-grade gliomas.

Determination of the degree of conversion, the diffuse reflectance, and the color stability after different aging processes of gingiva-colored composite resins

PURPOSE

To determine the degree of conversion (DC) and spectral diffuse reflectance of four different gingiva-colored composites and to evaluate their color stability after various aging processes.

MATERIALS AND METHODS

The gingiva-colored composites were assigned to four experimental groups (Anaxgum (AG), Crea.lign paste Gum (CB), Gradia Gum (GR), SR Nexco Gum (NC)). A total of 120 disc-shaped specimens (10 × 2 mm) (n = 30/group) were polymerized in a Teflon mold. The nature of chemical bonding was studied by Fourier transform infrared spectroscopy (FTIR). Diffuse reflection spectra of the polymerized specimens were gathered using an ultraviolet-visible-near infrared (UV-Vis-NIR) spectrophotometer. Specimens subjected to aging methods were divided into three subgroups (n = 10): ultraviolet aging, hydrothermal aging, and autoclave aging. Color differences (ΔE*ab and ΔE00 ) were determined by colorimetry before and after aging. The statistical analysis was done using a two-way ANOVA along with paired sample t-test and Bonferroni's post hoc test.

RESULTS

Conversion degrees varied between 26.9% and 59.7% and all groups showed 3 or 4 maxima at different positions in the visible region of the spectrum. Both ΔE*ab and ΔE00 values were significantly different from the groups of different brands for all types of aging processes. Similarly, there were significantly different ΔE*ab and ΔE00 values according to the aging procedure for all groups of particular brands, except for ΔE00 of SR Nexco Gum (NC).

CONCLUSIONS

The aging procedures resulted in significant color differences between similar shades of four commercial gingiva-colored composites. The composite resins showed different degrees of conversion and diffuse reflectance spectra. The aging conditions tested affected the color stability. Patients with gingiva-colored indirect restorations should be informed about time-dependent discoloration.

EVALUATION OF FETUIN-A LEVELS IN THE EARLY STAGE OF AUTOIMMUNE THYROIDITIS

Context

Fetuin-A is a multifunctional protein and is known to be related to metabolic syndrome, vascular calcification, and inflammation.

Objective

The purpose of this study was to determine the effects of serum fetuin-A levels on autoimmune thyroiditis without thyroid dysfunction.

Subjects and Methods

This prospective case-control study was performed at the pediatric endocrinology outpatient clinic of a tertiary health institution in Istanbul, Turkey between July 2022 and October 2022. Serum fetuin-A levels were assessed using a human fetuin-A enzyme-linked immunosorbent assay (ELISA) kit (Elabscience Biotechnology, Houston, TX, USA).

Results

The study included 86 participants, of which 42 were patients with Hashimoto's thyroiditis (HT) and 44 were controls. Autoimmune thyroiditis without thyroid dysfunction was found to be related to lower plasma fetuin-A levels. There were no statistically significant differences in the neutrophil-to-lymphocyte ratio, fasting blood glucose level, insulin level, or HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) value between the groups. A fetuin-A level of ≤162.22 µg/mL (80.95% sensitivity and 70.45% specificity) was found to support the identification of autoimmune thyroiditis.

Conclusions

The findings of our study suggest that autoimmune thyroiditis without thyroid dysfunction is related to lower fetuin-A levels. Low fetuin-A levels are known to be associated with an increased risk of cardiovascular disease, suggesting that careful monitoring is required in patients with low fetuin-A levels.

Co-axial electrospinning of PLLA shell, collagen core nanofibers for skin tissue engineering

The main functions of wound dressing biomaterials are to promote a moist environment in the wound while protecting the area from mechanical injury and microbial contamination. Furthermore, the scaffold used for skin tissue engineering must mimic epidermal and dermal layers as well as support the growth of keratinocytes and fibroblasts. In this study, PLLA (shell) and EGF-encapsulated collagen (core) nanofibers were produced by coaxial electrospinning at 25 kV potential, 12 cm collector distance, and 0.125 mL/h flow rate of PLLA (15%) and collagen (4%). The bilayer structure was produced by gelling GeIMA in between two nanofiber membranes to imitate the epidermal and dermal layers of skin. Cytocompatibility properties of nanofiber membrane and bilayer structure were characterized by mono- and coculture of keratinocytes (HaCaT) and fibroblasts (3T3), respectively. TEM revealed that the PLLA shell and collagen core thicknesses were about 60 and 115 nm, respectively. Oxygen and water vapor could pass through the GeIMA- integrated bilayer nanofiber membranes. The presence of EGF in nanofibers could increase cell proliferation. Fluorescence and SEM imaging showed that HaCaT and 3T3 could cover the membrane after 14 days of monoculture. Cocultures showed a reduction in the proliferation of cells in the first week and a recovery during the second and third weeks. In a mechanical bioreactor, cocultured bilayer membranes formed interlocked polygonal keratinocyte cells. These results showed that the bilayer nanofiber membrane and GeIMA combination provided cell compatibility. Furthermore, the use of a mechanical reactor was found to be effective in the formation of a functional keratinocyte layer by stimulating cells.

PRELIMINARY FINDINGS OF TLR2 AND TLR4 EXPRESSION IN PRETERM NEONATES WITH NECROTIZING ENTEROCOLITIS

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Despite significant advances made in the prevention and treatment of disease so far, there has not been much change in the rate of mortality and morbidity associated with NEC. Although the factors affecting the development of necrotizing enterocolitis are not yet known precisely, prematurity is thought to be the most important risk factor for the development of NEC. This study aims to determine toll-like receptor (TLR) 2 and TLR4 expression levels in preterm neonates. A total of 50 preterm infants (patient: 42, control: 8) were included in the study. TLR2 and TLR4 expression levels were analysed by the RT-qPCR method. While there was no difference in infants' birth weight (g), gestational age (months), mother's age (years), father's age (years), and WBC (109/L); HGB (g/dL) and RBC (1012/L) were found to be significantly higher in the group with NEC (p<0.05). When TLR2 and TLR4 relative gene expression levels of neonates were evaluated (log2), it was determined that there was a significant difference between the two groups (below 1500 g) (p<0.001). TLR4 relative expression (2^-ddCt, above 1500 g) was higher in the NEC group than in the healthy group, while TLR2 relative expression (2^-ddCt, above 1500 g) was higher in the healthy group. TLR2 and TLR4 have been shown to have prominent roles in the development of NEC in experimental animal models and it would be significant to support this with human studies/animal models for a better understanding of the disease. Thus, it is recommended that future studies be carried out on experimental models that better replicate the human body, and dietary factors should be examined in detail.

Mathematical surface function-based design and 3D printing of airway stents

BACKGROUND

Three-dimensional (3D) printing is a method applied to build a 3D object of any shape from a digital model, and it provides crucial advantages especially for transferring patient-specific designs to clinical settings. The main purpose of this study is to introduce the newly designed complex airway stent models that are created through mathematical functions and manufactured with 3D printing for implementation in real life.

METHODS

A mathematical modeling software (MathMod) was used to design five different airway stents. The highly porous structures with designated scales were fabricated by utilizing a stereolithography-based 3D printing technology. The fine details in the microstructure of 3D printed parts were observed by a scanning electron microscope (SEM). The mechanical properties of airway stents with various designs and porosity were compared by compression test.

RESULTS

The outputs of the mathematical modeling software were successfully converted into 3D printable files and airway stents with a porosity of more than 85% were 3D printed. SEM images revealed the layered topography of high-resolution 3D printed parts. Compression tests have shown that the mathematical function-based design offers the opportunity to adjust the mechanical strength of airway stents without changing the material or manufacturing method.

CONCLUSIONS

A novel approach, which includes mathematical function-based design and 3D printing technology, is proposed in this study for the fabrication of airway stents as a promising tool for future treatments of central airway pathologies.

Comparison of 3 Cell-Free Matrix Scaffolds Used to Treat Osteochondral Lesions in a Rabbit Model

BACKGROUND

Various cell-free scaffolds are already in use for the treatment of osteochondral defects (OCDs); however, a gold standard material has not yet been defined.

PURPOSE

This study compared the macroscopic, histological, and scanning electron microscopy (SEM) characteristics of Chondro-Gide (CG), MaioRegen (MA), and poly-d,l-lactide-co-caprolactone (PLCL) cell-free scaffolds enhanced with small-diameter microfractures (SDMs) for OCDs in a rabbit model.

STUDY DESIGN

Controlled laboratory study.

METHODS

In total, 54 knees from 27 rabbits were used in this study. Three rabbits were sacrificed at the beginning of the study to form an intact cartilage control group (group IC). An OCD model was created at the center of the trochlea, and SDMs were generated in 24 rabbits. Rabbits with OCDs were divided into 4 groups (n = 12 knees per group) according to the cell-free scaffold applied: CG (group CG), MA (group MA), PLCL (group PLCL), and a control group (group SDM). Half of the rabbits were sacrificed at 1 month after treatment, while the other half were sacrificed at 3 months after treatment. Healed cartilage was evaluated macroscopically (using International Cartilage Regeneration & Joint Preservation Society [ICRS] classification criteria) and histopathologically (using modified O'Driscoll scores and collagen staining). Additionally, cell-free scaffold morphologies were compared using SEM analysis.

RESULTS

ICRS and modified O'Driscoll classification and staining with collagen type 1 and type 2 demonstrated significant differences among groups at both 1 and 3 months after treatment (P < .05). The histological characteristics of the group IC samples were superior to those of all other groups, except group PLCL, at 3 months after treatment (P < .05). In addition, the histological properties of group PLCL samples were superior to those of group SDM samples at both 1 and 3 months after treatment in terms of the modified O'Driscoll scores and type 1 collagen staining (P < .05). Concerning type 2 collagen staining intensity, the groups were ranked from highest to lowest at 3 months after treatment as follows: group PLCL (30.3 ± 2.6) > group MA (26.6 ± 1.2) > group CG (23.3 ± 2.3) > group SDM (18.9 ± 0.9).

CONCLUSION

OCDs treated with enhanced SDM using cell-free PLCL scaffolds had superior histopathological and microenvironmental properties, more hyaline cartilage, and more type 2 collagen compared with those treated using CG or MA scaffolds.

CLINICAL RELEVANCE

OCDs treated with PLCL cell-free scaffolds may have superior histopathological properties and contain more type 2 collagen than do OCDs treated with CG or MA cell-free scaffolds.

Evaluation of coronavirus disease (COVID-19) awareness of patients undergoing dental interventions in Turkey

Aims

We aimed to objectively assess the COVID-19 awareness of the patients requiring dental interventions in our dental clinic by utilizing a newly generated questionnaire, which may serve helpfully in the hard battle against the pandemic in our country.

Materials and Methods

This study included 306 volunteer adults who applied to our dental clinic for dental interventions during the early days of COVID-19 outbreak in Turkey. All patients responded to a newly created questionnaire composed of four sections with 19 questions those mostly assessing the social and demographic details; like the participant's age, gender, marital status, education status, medical history, basic dental hygiene habits, occupation, and general information about the COVID-19 infection and its protection methods.

Results

The outcomes of 306 participants revealed that their gender, age, and education status showed significant distinctions about the dissemination of coronavirus via dental interventions. Higher education status was linked to a loftier level of social awareness about the COVID-19 infection and its potential associations with dental interventions. It was observed that the participants were unsatisfactorily cautious against the COVID-19 infection and its dissemination pathways in their social environment, particularly in the specific case of systematic diseases and preventive measures. The primary way of obtaining information about the COVID-19 infection was the electronic websites.

Conclusion

Deplorably, accentuating the urgent need for further intensive training programs on the relationship between the systemic diseases and COVID-19 infection, and explicit daily care methods in the social environment.

Protective effect of Coenzyme Q10 on oxidative ovarian and uterine damage induced by methotrexate in rats

Methotrexate (MTX) has toxic effects on the uterus and ovaries via oxidative stress. Coenzyme Q10 (CoQ10) is an important component in electron transport in the mitochondria and an antioxidant in cellular metabolism through the inhibition of lipid peroxidation. The aim of this study was to investigate the preventive effects of CoQ10 on MTX-induced utero-ovarian damage and oxidative stress in rats.In this experimental study, 30 albino Wistar female rats were divided randomly into three groups. Once a day for a month, 10 mg/kg of CoQ10 was orally administered to the rats in the MTX+CoQ10 group, while the same volume of olive oil was administered orally to the other two groups. One hour thereafter, 20 mg/kg of MTX was injected intraperitoneally into the rats in the MTX and MTX+CoQ10 groups; the remaining group was the control. At the end of the month, biochemical and histopathologic examinations were performed on the extracted uteri and ovaries. In the uterine ovarian tissues of the animals in the MTX group, there was an increase in oxidative stress mediators and a decrease in antioxidant and anti-inflammatory mediators, but these trends were reversed in the MTX+CoQ10 group, demonstrating the antioxidant effects of CoQ10. MTX leads to oxidative stress-related ovarian and uterine injury, and CoQ10 may be useful for protecting ovarian and uterine tissue from such injury.

Non-functional recurrent pituitary adenoma with intracranial metastasis-Pituitary carcinoma: A case report and review of the literature

INTRODUCTION

Pituitary carcinomas are rare, with only a few case reports to date. We present a null cell type non-functioning pituitary carcinoma (NFPC) with intracranial metastases and a review of the literature.

CASE REPORT

A 56-year-old male with a history of an aggressive pituitary adenoma was admitted. Initial MRI highlighted a large intracranial mass with leptomeningeal involvement, simulating meningioma. Based on his previous pathology report of the sellar mass, a diagnosis of null cell type non-functioning pituitary carcinoma has been made.

CONCLUSIONS

An aggressive recurrent pituitary tumor with suprasellar and/or cavernous sinus invasion is the main characteristics of the NFPC. Single or multiple enhancing dural-based mass(es) mimicking meningioma is the most common MRI finding. The proof of malignancy is the same histopathological features of the recurrent aggressive pituitary tumor in the metastases. The histology alone is not distinctive in terms of malignancy. Most patients require a combined surgery, radiotherapy and chemotherapy.

Retrospective evaluation of cone-beam computed tomography findings of odontogenic cysts in children and adolescents

Background

Odontogenic cysts develop from the epithelium of dental structures and generally grow slowly. In children and adolescents, cysts usually grow faster than adults and require much knowledge for diagnoses and treatments.

Aims

This study aimed to determine the diagnosis and treatment of odontogenic cysts in different age groups by evaluating the type of lesions, age, gender, and anatomical distribution of odontogenic cysts seen in children and adolescents by cone-beam computed tomography.

Materials and Methods

A total of 42 odontogenic cysts (radicular, dentigerous cyst, and odontogenic keratocyst) were determined in children and adolescents aged 7-18 years. Cone-beam computed tomography images of odontogenic cysts were analyzed in terms of types, age, sex, anatomical location, height, width, depth, scalloped borders, lesion shapes, tooth displacement, root resorption, and association with an unerupted tooth.

Results

There was a significant correlation between odontogenic cyst types and age groups, scalloped borders, lesion shape, tooth displacement, root resorption, and association with an unerupted tooth.

Conclusion

When odontogenic cysts seen in children and adolescents are examined with cone-beam computed tomography, the radicular cyst was the most common form and was predominated in the 13-18 years age group and in boys. Differences in terms of scalloped borders, lesion shape, tooth displacement, root resorption, and association with unerupted teeth were noticed. The knowledge of the distribution and properties of odontogenic cysts in pediatric patients will help diagnose the lesions during clinical and radiological examinations and make appropriate treatment planning.

Potantial clinical application of potassium binders in patients with chronic heart failure in real life clinical practice: results from TREAT HF study

Purpose

Hyperkalemia is increasingly prevalent and life-threatening condition in heart failure (HF). In clinical practice, hyperkalemia is also an important barrier to optimal application of RAASi. New potassium binders, sodium zirconium cyclosilicate and patiromer, were developed for the treatment of hyperkalemia. TREAT HF data were analyzed for the evaluation of potential clinical application of potassium binders in real life clinical care in HF patients.

Methods

TREAT HF is a network which undertakes multicenter, national, observational studies designed to evaluate HF patients' clinical characteristics and current treatment modalities. 1028 patients with the diagnosis of chronic HF, median age 64 years and median LVEF 30% who had potassium and GFR data were included in this analysis. In this patient population, 847 patients (82.6%) were receiving beta blockers, 739 (71.9%) were receiving ACE inhibitors or ARBs and 518 (50.4%) were receiving MRA. Patients with hyperkalemia (serum potassium ≥5.1 mEq/L) were considered candidate for potassium binders based on the criteria of HARMONIZE study. According to eGFR (mL/min) level, renal dysfunction was subclassified as: stage-1 (eGFR ≥90) (n=211), stage-2 (eGFR 60-&lt;90) (n=398), stage-3 (eGFR 30-&lt;60) (n=306) and stage 4–5 (eGFR &lt;30) (n=113).

Results

In study population, median potassium level was 4.5 mEq/L, median creatinin level was 1.1 mg/dL and median eGFR was 65.5 mL/min. Overall, 82.9% of patients had normal serum potassium levels (≥3.5–5 mEq/l) and 14.3% of patients (n=147) were found to have hyperkalemia (≥5.1 mEq/L) and, hypokalemia was found in 2.8% of patients (n=30). Hyperkalemia was present in 10.9% (n=23) of patients with stage-1, 12.6% (n=50) of patients with stage-2, 17.0% (n=52) of patients with stage-3 and 19.5% (n=22) of patients with stage 4–5 renal dysfunction. In patients with eGFR &lt;60 ml/min (n=419), hyperkalemia was much more prevalent than those with eGFR ≥60 ml/min (n=609) (17.6% and 11.9% respectively, p=0.011). In patients with stage 4–5 renal dysfunction who were receiving ACEI/ARB or combination of ACEI/ARB and MRA (RAASi), more patients had hyperkalemia than those not receiving RAASi therapy (23.4%, 20.0% and 12.5%, respectively).

Conclusions

This study suggested that in real life clinical practice, 14.3% of HF patients have hyperkalemia and seem to be eligible for the treatment of potassium binders. The risk of hyperkalemia increases with advanced stages of renal dysfunction and the use of RAASi, showing an increased clinical need for potassium binders in HF patients with renal dysfunction and in those receiving RAASi.

Funding Acknowledgement

Type of funding source: None

Role of acoustic radiation force-based elasticity imaging in endometrium pathologies

Backround

Ultrasonography is difficult to distinguish between endometrial pathologies and often requires curettage. ARFI (Acoustic Radiation Force-Based Elasticity Imaging) is a new ultrasonography elastography method. Using ARFI, it is possible to obtain information about the likelihood of the tissue benign or malignant.

Aim

The aim of this study is to evaluate the contribution of ARFI to differentiate endometrial pathologies in hysterectomy specimens.

Subjects and Methods

Our study was prospectively, January-May 2017, performed in randomly 45 cases of 41-91 years of age (mean 58.3 years) who have decided to have hysterectomy. Hysterectomy was performed for uterine prolapse and endometrial hyperplasia in elderly patients and menorrhagia in young patients. Pathology results were compared with ARFI values and endometrial thickness. ANNOVA test was used for the comparison of ARFI values.

Results

Pathology revealed 14 cases of endometrial atrophy, 11 cases of proliferative phase, 10 cases of polyp, 6 cases of endometrial hyperplasia, and 4 cases of endometrium cancer. There is a statistically significant difference between mean ARFI values of endometrium, subendometrium, and myometrium of the groups (P < 0.05). There was a statistically significant difference between the mean endometrial thickness of the groups (P < 0.05).

Conclusion

Endometrium ARFI contributes to the differential diagnosis of endometrial pathologies. Subendometrial and myometrial ARFI values decrease in polyps and increase in hyperplasia. Our study shows that the addition of subendometrium ARFI to gray-scale sonography before deciding on invasive procedures in endometrial pathologies may improve diagnostic accuracy. We concluded that further in vivo studies will establish the usefulness of this technique for preoperative diagnostic measures.

Surface modification strategies for hemodialysis catheters to prevent catheter-related infections: A review

Insertion of a central venous catheter is one of the most common invasive procedures applied in hemodialysis therapy for end-stage renal disease. The most important complication of a central venous catheter is catheter-related infections that increase hospitalization and duration of intensive care unit stay, cost of treatment, mortality, and morbidity rates. Pathogenic microorganisms, such as, bacteria and fungi, enter the body from the catheter insertion site and the surface of the catheter can become colonized. The exopolysaccharide-based biofilms from bacterial colonies on the surface are the main challenge in the treatment of infections. Catheter lock solutions and systemic antibiotic treatment, which are commonly used in the treatment of hemodialysis catheter-related infections, are insufficient to prevent and terminate the infections and eventually the catheter needs to be replaced. The inadequacy of these approaches in termination and prevention of infection revealed the necessity of coating of hemodialysis catheters with bactericidal and/or antiadhesive agents. Silver compounds and nanoparticles, anticoagulants (e.g., heparin), antibiotics (e.g., gentamicin and chlorhexidine) are some of the agents used for this purpose. The effectiveness of few commercial hemodialysis catheters that were coated with antibacterial agents has been tested in clinical trials against catheter-related infections of pathogenic bacteria, such as Staphylococcus aureus and Staphylococcus epidermidis with promising results. Novel biomedical materials and engineering techniques, such as, surface micro/nano patterning and the conjugation of antimicrobial peptides, enzymes, metallic cations, and hydrophilic polymers (e.g., poly [ethylene glycol]) on the surface, has been suggested recently.

Three-dimensional evaluation of treatment results of the Alt-RAMEC and facemask protocol in growing patients

PURPOSE

The aim of this retrospective study was to evaluate the skeletal, dental, and soft tissue effects of the alternating rapid maxillary expansions and constrictions (Alt-RAMEC) protocol combined with a facemask in prepubertal patients.

METHODS

The study group (mean age 9.74 ± 1.46 years) consisted of 20 patients with class III malocclusion characterized by maxillary retrognathism. They were treated with a facemask for 7 months following a 9‑week Alt-RAMEC protocol. Cone-beam computed tomography (CBCT) records and three-dimensional (3D) photographs taken before (T0) and after the protraction and retention period (T1) were evaluated. The study group was compared with a well-matched control group of 16 untreated patients (mean age 9.44 ± 0.79 years) with the same malocclusion. The records for the control group included cephalometric radiographs and 3D photographs.

RESULTS

In the study group, significant forward movements of A point (3.49 mm), nasal (2.91 mm) and zygomatic bones were achieved. Intermolar, internasal, and interzygomatic widths increased. Soft tissue points followed the hard tissue movements, apart from b and pog. In the control group, A (0.97 mm), B (1.69 mm), Pog, and b points presented forward movement. Significant differences were found regarding the forward movement of the maxilla between the groups.

CONCLUSION

The Alt-RAMEC/facemask protocol was effective not only in the maxillary region but also in the midface.

Comparison of clinical and magnetic resonance imagining data of patients with temporomandibular disorders

Background

There are important criteria in the diagnosis of temporomandibular disorders (TMDs). These become significant if supported by magnetic resonance imaging (MRI). Otherwise, these findings alone may not be sufficient to diagnose TMD.

Aim

This study compared the relationship between clinical findings indicated by patient and physician and MRI results in the diagnosis of TMD.

Materials and Methods

Clinical examinations were performed in patients suspected of TMD for pain, difficulty in mouth opening, masticatory muscle tenderness, deviation (during mouth opening), normal mouth opening, and presence of bruxism. The MRI findings of the patients were compared with the clinical examinations.

Results

MRI and clinical examination data of 136 patients were examined. The results showed significant correlations between deviation, normal mouth opening, and MRI results of TMD (P < 0.05). No correlation was found between age groups and clinical findings of TMD. TMJ was determined in normal limits in 61% of MRI results.

Conclusions

Except for deviation and normal mouth opening, complaints and clinical findings determined by the clinicians do not support TMD. This may be due to the subjective nature of the clinical findings, and MRI results are needed for precise results.

Investigation of the Optimal Interval for Staged Total Knee Arthroplasty for the Treatment of Advanced Bilateral Gonarthrosis

PURPOSE OF THE STUDY This study investigated whether there was an optimal interval between two operations for total knee arthroplasties in patients with advanced bilateral gonarthrosis scheduled to undergo staged total knee arthroplasty (TKA). MATERIAL AND METHODS A prospective cohort of 219 patients (136 females, 83 males) undergoing staged total knee arthroplasty for the treatment of advanced bilateral gonarthrosis were followed for up to 12 months. The mean was 69.51±5.02 (56-80) years. Patients were categorized into five groups based on the time between the first and second operations; Group I (21-90 days), Group II (91-180 days), Group III (181-270 days), Group IV (271-360 days), and Group V (more than 360 days). Patients were evaluated based on time from surgery and were assigned to corresponding groups. The data recorded included age, body mass index (BMI), side of operated knee, complications, and radiological and clinical findings. Visual analog scale (VAS) for non-operated knees was applied. Activities of Daily Living Score (ADLS) was applied to the patients at last follow-up. RESULTS No statistically significant difference was noted in BMI values (p=0.634), range of joint motion (RJM) (p=0.940) and age (p=0.785) distribution between the five groups. In Group I, the mean VAS score increased by 7.83 to 7.98, 7.86 to 8.53 in Group II, by 7.85 to 8.54 in Group III, 7.85 to 8.59 in Group IV, and 7.88 to 8.64 in Group V. There was no statistically significant difference in preoperative ADLS between the groups (p=0.064), but there was a statistically significant difference in postoperative ADLS (p=0.001). Group I patients had significantly lower postoperative ADLS compared to the other groups (p=0.001). The mean increase in postoperative ADLS versus preoperative scores of all groups were statistically significant The most significant improvements occurred in Groups II and III. Similarly, preexisting pain in the non-operated knee started to increase in Group II and continued in all groups. DISCUSSION Given all these findings, we believe that it is reasonable to advise patients to receive their second TKA, 3-6 months after their initial TKA, as this interval will allow for the greatest improvements in functional and daily living activities, and pain in the non-operated knee simultaneously becomes more severe. This recommended interval would minimize both the functional problems with the operated extremity due to pain, and deformity and dysfunction in the non-operated knee and the subsequent overloading. CONCLUSIONS Even though a number of factors influence the optimal interval for staged TKAs in bilateral gonarthrosis, an interval of 91-270 days appears to be the optimal interval between surgeries in terms of minimizing pain and maximizing ADL s and knee scores. Key words: bilateral total knee arthroplasty, optimal interval, knee society scores, activities of daily living.

The traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths: The Turkey Sample

Objective

Studies related to traditional practices and benefits have been usually performed among women. The literature regarding the traditional practices used by men in Turkey and around the world and their expected benefits is more limited. The aim of this study was to examine the traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths.

Materials and Methods

The descriptive study was performed between May and July 2017 in Izmir, Turkey. In total, 151 women with infertility were included. The data related to the use of this practice by men were obtained from women partners. "Personal information form" and "traditional practices evaluation form" were used to obtain the data.

Results

In total, 35.8% of the women and 25.8% of the men used traditional practices. The 24.4% of women and 52.1% of men used other practices such as figs, onion cures, and hacamat, whereas 18.2% of women and 14.9% of men used various herbs. The benefits they expected from traditional practices were facilitating conception, ensuring follicle development in women, increasing sperm count, and quality and facilitating conception in men. Overall, 37.0% of women learned of these practices from their friends, 30.7% of men learned from their partners, 20.4% of women and 20.6% of men learned from the internet.

Conclusion

The couples in this study widely used traditional practices to solve fertility problems and learned from their friends and partners.

Effects of agomelatine on electrocorticogram activity on penicillin-induced seizure model of rats

Agomelatine is a new antidepressant drug acting as an antagonist of 5-hydroxytryptamine receptor 2C (5-HTR_2C) and agonist of melatonergic receptors 1 and 2 (MT₁ and MT₂). Because of this dual action, it is an atypical antidepressant. The aim of this study was to investigate chronic anticonvulsant effects of agomelatine on penicillin-induced epilepsy model. Adult male Sprague-Dawley rats divided into four groups and were administered with tap water (vehicle), and agomelatine doses of 10 mg/kg, 50 mg/kg and 100 mg/kg for 14 days via oral gavage. After the last doses were given, epileptic seizures were induced by intracortical penicillin (500 IU/2.5 μl) application in rats under urethane (1.25 g/kg intraperitoneal) anesthesia. Electrocorticogram (ECoG) recordings were obtained from the somatomotor cortex through 90 min, and spike frequencies and amplitudes were analyzed. The spike frequency analyses revealed that only 50 mg/kg agomelatine administration decreased the spike frequencies of hypersynchronous discharge of neurons caused by penicillin (p < 0.05). No significant differences in amplitudes between experimental groups were observed. In addition, mRNA expressions of vesicular glutamate transporter 1 (VGLUT1) and vesicular gamma-aminobutyric acid transporter (VGAT) in response to the agomelatine active dose, 50 mg/kg, showed no significant effect of agomelatine on the mRNA expression. Our results indicate that chronic treatment with agomelatine may have potential anticonvulsant effects. Agomelatine may be a promising drug for epilepsy patients having depression due to its antiepileptic and antidepressant effects.

Effects of erythropoietin on spontaneous and oxytocin induced myometrial contractions in the nonpregnant rat

OBJECTIVE

Erythropoietin (EPO) is a glycoprotein hormone that regulates erythropoiesis. EPO activity has also been detected in a variety of tissue including the nervous system, and female and male reproductive organs. It has been shown that EPO causes relaxation in vascular smooth muscle. In the present study, we have investigated effects of EPO on spontaneous and oxytocin-induced contractions of non-pregnant rat myometrium.

MATERIALS AND METHODS

Myometrial stripes were obtained from adult Wistar rats at the oestrous stage. The samples were placed in an isolated organ chamber under physiological conditions and 1 g passive tension. Epoetin beta (rEPO) was added cumulatively at 0.1, 1 and 10 IU/ml concentrations to the myometrial samples showing regular spontaneous contractions for periods of 30 min. Frequency and amplitude of contractions were electrophysiologically recorded and analyzed by using a BIOPAC data acquisition system.

RESULTS

rEPO inhibited both area under curve and frequency of spontaneous contractions (ANOVA, n1, 2 = 9, f1 = 20.938, f2 = 20.492, p1,2 = 0.000). The inhibitory effect was insignificant at 0.1 mIU/ml rEPO level (Tukey HSD, p1 = 0.051, p2 = 0.581). In the oxytocin treated myometrial samples, a single dose of 1 IU/ml rEPO was studied. The area under curve and frequency values of these samples were inhibited by rEPO (Student's t-test, n = 9, t1 = 4.776, p1 = 0.000; t2 = 2.835, p2 = 0.012, respectively).

CONCLUSIONS

rEPO inhibited spontaneous and oxytocin-induced rat myometrial contractions at 1 and 10 IU/ml concentrations. It appeared that the effect was dose-dependent.

Anticonvulsant activity of resveratrol-loaded liposomes in vivo

Resveratrol (3,5,4'-stilbenetriol), a natural polyphenol produced by various plants, has attracted attention over the past decade because of its multiple beneficial properties, including anti-inflammatory, anti-oxidant and chemopreventive, yet, there is limited information about its antiepileptic effects. Moreover, its poor solubility in water and low bioavailability are the challenging issues. In the present study, we aimed to investigate effects of free resveratrol and resveratrol delivered in amphipathic liposomal delivery system, which has a high blood-brain barrier crossing potential, on penicillin-induced epileptic seizure model. For this purpose, adult male Sprague-Dawley rats were divided into four groups as saline (Control), liposome (LIP), free resveratrol (RES) and resveratrol+liposome (RES+LIP). Penicillin-induced epileptic activity was recorded for 120 min by electrocorticography. Glutathione S-transferase (GST), Glutathione (GSH), Superoxide dismutase (SOD) and Malondialdehyde (MDA) assays were performed in brain tissues collected. Our results showed that RES+LIP was the most effective anticonvulsant treatment on penicillin-induced epileptic seizures when compared to control, as RES+LIP immediately decreased the number of spikes per minute. GST and SOD activity, as well as the GSH levels, were significantly increased in the RES+LIP group as compared with the control group. Also, the MDA levels were significantly higher in the RES+LIP compared to RES and control groups. In conclusion, RES+LIP treatment was more effective on the decrease in spike frequency and spike amplitudes than other treatments. Our results suggest that the RES+LIP is more effective than RES on penicillin-induced epileptiform activity.

Direct bladder hernia after indirect hernia repair in extremely low birth weight babies: two case reports and a review of the literature

BACKGROUND

Inguinal hernia repair is the most common surgical procedure in babies. Despite a meticulous technique, relapses may occur. The occurrence of a direct bladder wall hernia in relapses has never before been reported in the literature.

CASE PRESENTATION

Here, we report two cases of direct bladder herniation: a white baby boy born after 25 weeks of gestation and a white baby boy born after 26 weeks of gestation. Both of the formerly extremely low birth weight babies were affected after open bilateral hernia repair. Recurrent hernias developed on the right side, and direct bladder herniation was identified intraoperatively. In one case, laparoscopy was applied to identify a supravesical type of hernia. Immaturity and a difficult postnatal course might have contributed to hernia relapse in these cases.

CONCLUSIONS

Misinterpretation of bladder herniation might have disastrous consequences. Laparoscopy is a helpful tool in comparable cases.

The effect of autonomic nervous system dysfunction on oxygen consumption during daily living activities in patients with spinal cord injury

STUDY DESIGN

Case-control study.

OBJECTIVES

To investigate the level of autonomic nervous system dysfunction in patients with spinal cord injury and to determine its effect on the basal metabolic rate and oxygen consumption during daily living activities.

SETTING

Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.

METHODS

Thirty-six patients with chronic spinal cord injury (SCI) were allocated into two groups according to the presence of autonomic nervous system dysfunction. Autonomic nervous system dysfunction was investigated with the measurements of blood pressure and heart rate during urodynamic examination and several provocative maneuvers (standing at tilt table, forcing deep respiration and Valsalva). Groups were compared in terms of the basal metabolic rate and oxygen consumption during daily living activities. Measurement of the basal metabolic rate was determined by indirect calorimetry under standardized conditions. Total body fat mass and lean tissue mass were measured in all participants using dual-energy X-ray absorptiometry by standard methods. Telemetric intrapulmonary gas exchange analyzer was used to measure oxygen consumption during daily living activities.

RESULTS

There was no statistically significant difference between the groups in age, time since injury, body mass lean and fat rates, or sensory and motor scores (P>0.05). Basal metabolic rates and oxygen consumption during daily living activities were not different between the groups (P>0.05).

CONCLUSIONS

These results suggest that the presence of autonomic dysfunction does not change oxygen consumption at rest and during daily living activities.

Polymorphisms in the IL28B gene (rs12979860, rs8099917) and the virological response to pegylated interferon therapy in hepatitis D virus patients

AIM

Few data are available regarding the effects of interleukin 28B (IL28B) polymorphisms in chronic hepatitis D (CHD) patients. This study investigated the relationship between IL28B poly-morphisms and the response of patients with CHD infections to pegylated interferon (PEG-IFN) therapy.

MATERIALS AND METHODS

A total of 101 CHD patients were -selected, 80 of whom (46 males ; median age 41 years) satisfied the inclusion criteria and were enrolled in the study. Thirty-seven patients were treated with peg-IFNα for at least 12 months and were followed for a median of 18 months (range, 12-30 months). The primary treatment endpoint was the suppression of HDV replication, as documented by the loss of detectable HDV RNA in serum. Genotyping was used to analyse the IL28B polymorphisms rs12979860 and rs8099917 according to the virological response.

RESULTS

After treatment, a sustained viral response (SVR) was achieved in 19 (51%) of the patients treated with PEG-INF. The IL28B genotypes in the 80 patients were as follows : CC in 36 (45%), CT in 33 (41%) and TT in 11 (14%) for rs12979860, and GG in 4 (5%), GT in 27 (34%) and TT in 49 (61%) for rs8099917. SVR was achieved in 5 (26%), 10 (53%) and 4 (21%) patients with CC, CT and TT at rs12979860, respectively, and one (5%), nine (47%) and nine (47%) patients with GG, GT and TT at rs8099917, respectively. There were differences in the SVR among genotypes (rs12979860 and rs8099917 ; chi-squared test, p = 0.047).

CONCLUSION

IL28B predicts the PEG-IFN response in patients with CHD infection.

The effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in the first SCID-mouse endometriosis-model developed in Turkey

OBJECTIVE

To evaluate the effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in SCID mice.

MATERIALS AND METHODS

Prospective, randomized, controlled, experimental study. Experimental Research Center of Yeditepe University (YUDETAM). Thirty female, non-pregnant, nulligravid severe combined immunodeficient (SCID) mice. Endometriotic cells collected from patients with endometriosis were implanted subcutaneously in 30 SCID mice. These mice were randomized into two study groups: in the first group, mice were administered melatonin (20 mg/kg/day) following induction of endometriosis for four weeks; in the second group, nothing was administered. All the mice were given a high dose of exogenous estradiol (50 µg/kg/d, twice weekly). Four weeks after inoculation, necropsies were performed and endometriotic lesions were collected. All the lesions were evaluated histopathologically and the levels of SOD and MDA were assessed in the lesions.

RESULTS

Successful implantation was observed in the 28 mice that survived. Mean MDA level was 5.0 ± 1.7 and 8.8 ± 2.6 in the melatonin and control groups, respectively (p = 0.01); mean SOD level was 1.1 ± 0.1 and 1.0 ± 0.1 in the melatonin and control groups, respectively (p = 0.49). Mean histopathological score was lower in the melatonin group (p = 0.04).

CONCLUSIONS

Melatonin was effective in the treatment of experimental endometriosis induced in SCID mice.

Effects of caffeic acid phenethyl ester on cisplatin ototoxicity

PURPOSE

To report histological and electrophysiological data in rats treated with cisplatin and caffeic acid phenethyl ester.

METHODS

We randomly divided 28 Wistar rats into four groups of seven, to be treated as follows: control (saline), cisplatin, CAPE and cisplatin-CAPE. Distortion product otoacoustic emission (DPOAE) measurements were performed on day one (before drug administration) and day five under anaesthesia. All animals were killed under general anaesthesia on day five after the DPOAE measurement. The cochleae of each rat were histopathologically and immunohistochemically evaluated.

RESULTS

The outer hair cells were mostly preserved in the control and CAPE groups. Moderate-to-severe and mild-to-moderate hair cell losses were detected in the cisplatin and cisplatin-CAPE groups, respectively. DPOAE assessments revealed significant deterioration in the cisplatin group (P < 0.05). The difference between the cisplatin and cisplatin-CAPE groups was statistically significant (P < 0.05).

CONCLUSION

CAPE prevents cisplatin ototoxicity.

Chronic hepatitis B associated with hepatic steatosis, insulin resistance, necroinflammation and fibrosis

BACKGROUND

The effect of hepatitis B virus (HBV) infection on fatty liver disease is unclear.

OBJECTIVES

The aim of this study was to investigate the viral and host causes of fatty liver in chronic hepatitis B (CHB) patients. This study included 88 CHB patients of which 17 were not treated. Liver biopsy was performed in each patient. Group 1 included those with hepatic steatosis (n=28) and group 2 those without hepatic steatosis. The groups were compared in terms of age, body mass index (BMI), Homeostasis Model Assessment- Insulin Resistance (HOMA-IR), viral load, biochemical parameters and histological findings. Patients in group 1 were subdivided according to the degree of steatosis as follows: grade 1 (15 patients, 53.6%), grade 2 (6 patients, 21.4%), and grade 3 (7 patients, 25%).

RESULTS

In group 1 (n=28), mean age, BMI, cholesterol, and HOMA-IR were found to be significantly higher than in group 2 (n=60). There were no significant differences in the positivity of viral load, HbeAg, treatment, fibrosis and other laboratory parameters between the two groups. HOMA-IR was the only independent predictive factor of liver steatosis in patients with CHB in logistic regression analysis.

CONCLUSION

Hepatic steatosis in CHB patients was associated with host metabolic factors.