Identification of transformation products during Doxylamine chloramination for NDMA mitigation

N-nitrosodimethylamine (NDMA) is a disinfection byproduct that forms at the presence of an organic nitrogen precursor. Doxylamine, an antihistaminic pharmaceutical, is a precursor of NDMA and has been shown to form NDMA in the presence of chloramine. In this study, the effect of Doxylamine as an NDMA precursor has been further studied during chloramination. The end product and byproducts during chloramination were investigated using a high-resolution mass spectrometer by taking samples at different time intervals. Results suggest that NDMA is not the only end product forming during chloramination of Doxylamine and several transformation products that do not end up as NDMA may form. A group of these transformation products have been selected based on their relative amounts during chloramination with time and notated as Focus Tentative Transformation Products (FTTPn). The identification of these byproducts will make it easier to study the conditions during chloramination that may favour these 'known' transformation products with the use of less sophisticated analytical instruments. Then, it might lead to the establishment of chloramination protocols that will minimise the formation of NDMA from its precursors.

Quantitative Analysis of the Olfactory System in COVID-19: An MR Imaging Study

BACKGROUND AND PURPOSE

Anosmia or hyposmia, often accompanied by changes in taste, is recognized as a common symptom that can assist in the diagnosis of coronavirus disease 2019 (COVID-19). The pathogenesis of olfactory dysfunction in COVID-19 is not yet fully understood. MR imaging represents a useful anatomic imaging method for the evaluation of olfactory dysfunction associated with varying etiologies, including viral infection, trauma, and neurodegenerative processes. This case-control study was conducted to compare quantitative measurements of olfactory anatomic structures between patients diagnosed with COVID-19 associated with persistent olfactory dysfunction and healthy controls.

MATERIALS AND METHODS

This study has a retrospective design. Cranial MR imaging was performed on all participants in both the patient and control groups. The bilateral olfactory bulb volume, olfactory tract length, and olfactory sulcus depth were measured in all patients.

RESULTS

A total of 116 people aged 18-60 years, including 36 patients diagnosed with COVID-19 and 80 controls, were included in the study. All measured values were compared between the patient and control groups. The right, left, and total olfactory bulb volume values were significantly lower in the patient group than in the control group. The patient group also had significantly lower right and left olfactory sulcus depth and olfactory tract length values compared with those in the control group.

CONCLUSIONS

MR imaging findings can be used to demonstrate olfactory injury in patients with COVID-19. The olfactory pathway may represent an alternative route for virus entry into the central nervous system.

Maternal steroid levels and the autistic traits of the mother and infant

BACKGROUND

Prenatal sex steroids have been associated with autism in several clinical and epidemiological studies. It is unclear how this relates to the autistic traits of the mother and how early this can be detected during pregnancy and postnatal development.

METHODS

Maternal serum was collected from pregnant women (n = 122) before or during their first ultrasound appointment [mean = 12.7 (SD = 0.7) weeks]. Concentrations of the following were measured via immunoassays: testosterone, estradiol, dehydroepiandrosterone sulphate, progesterone; and sex hormone-binding globulin which was used to compute the free fractions of estradiol (FEI) and testosterone (FTI). Standardised human choriogonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A) values were obtained from clinical records corresponding to the same serum samples. Mothers completed the Autism Spectrum Quotient (AQ) and for their infants, the Quantitative Checklist for Autism in Toddlers (Q-CHAT) when the infants were between 18 and 20 months old.

RESULTS

FEI was positively associated with maternal autistic traits in univariate (n = 108, Pearson's r = 0.22, p = 0.019) and multiple regression models (semipartial r = 0.19, p = 0.048) controlling for maternal age and a diagnosis of PCOS. Maternal estradiol levels significantly interacted with fetal sex in predicting infant Q-CHAT scores, with a positive relationship in males but not females (n = 100, interaction term: semipartial r = 0.23, p = 0.036) after controlling for maternal AQ and other covariates. The opposite was found for standardised hCG values and Q-CHAT scores, with a positive association in females but not in males (n = 151, interaction term: r = -0.25, p = 0.005).

LIMITATIONS

Sample size of this cohort was small, with potential ascertainment bias given elective recruitment. Clinical covariates were controlled in multiple regression models, but additional research is needed to confirm the statistically significant findings in larger cohorts.

CONCLUSION

Maternal steroid factors during pregnancy are associated with autistic traits in mothers and their infants.

Appendiceal intussusception caused by mucinous cystadenoma presenting as acute appendicitis

While appendiceal intussusception is an uncommon pathological condition, mucinous cystadenoma of the appendix is a particularly rare entity. We report a case of appendiceal intussusception induced by a mucinous cystadenoma presenting as acute appendicitis. A 37-year-old woman was admitted with a one-day history of acute onset, right lower abdominal pain. Computed tomography showed swelling of the appendix, a pathological mass in the ileocolic region and oedematous pericolonic fat stranding. Emergency laparotomy via a McBurney incision revealed that the base of the appendix was swollen and intussuscepting into the caecum. Palpation of the caecum demonstrated an intraluminal mass, 6cm in size, at the appendicocaecal junction. After extension of the McBurney incision, a caecotomy was performed to investigate the mass, following which a cauliflower-like tumour started to protrude. En bloc excision was undertaken of both the appendix and the tumorous mass with a clear surgical margin to send for frozen section analysis. The biopsy samples indicated a mucinous neoplasm. Ileocaecal resection was therefore performed with ileocolic anastomosis. The resected specimen contained a tumour arising from the appendix. The tumour measured 5.3cm x 5cm x 3cm in the caecal cavity and the appendix had invaginated into the caecum at its base. The cut surface of the appendix showed the mucinous tumour projecting into the caecal cavity. Microscopic examination revealed a low grade mucinous cystadenoma.

Prenatal Diagnosis of Organic Acidemias at a Tertiary Center

The aim of this study was to share our experience in the prenatal diagnosis (PND) of organic acidemias (OAs) in our clinic. This study consisted of 10 cases in whom an invasive prenatal diagnostic test (IPNDT) was performed by a single physician for the PND of OAs. Median maternal age, parity, gestational week of IPNDT, prenatal test indications, OA types, method of IPNDT, IPNDT results and gestational outcomes were evaluated. Targeted mutation analysis was performed in fetal DNA for the specific mutations by using polymerase chain reaction (PCR) and direct Sanger sequencing. The diagnosis was confirmed by genetic targeted mutation analysis after birth. Median maternal age, parity and gestational week of IPNDT values were 30 (range 21-35), one (range 0-4) and 11.5 (range 11-17), respectively. Indications for IPNDT were mother being a carrier of the disease for one case (10.0%) and at least one child with OA in the family for nine cases (90.0%). Organic acidemia types investigated were maple syrup urine disease (MSUD), methylmalonic acidemia (MMA) and isovaleric acidemia (IVA) in five (50.0%), three (30.0%) and two (20.0%) patients, respectively. Chorion villus sampling (CVS) was done in seven (70.0%) patients and amniocentesis was performed in three (30.0%) patients. Eight fetuses (80.0%) were found to be healthy and two fetuses (20.0%) were found to be affected (one case with IVA and one case with MMA). The two pregnancies (20.0%) with affected fetuses were terminated. Prenatal diagnosis of OAs is critical. Appropriate prenatal counseling should be given to families with known risk factors.

Impact of weight loss on epicardial fat and carotid intima media thickness after laparoscopic sleeve gastrectomy: A prospective study

BACKGROUND AND AIMS

Cardiovascular disease (CVD) is one of the leading causes of mortality in obese patients. We aimed to investigate the influence of significant weight loss following laparoscopic sleeve gastrectomy (LSG) on carotid intima media thickness (CIMT) and epicardial fat thickness (EFT) which are the independent predictors of subclinical atherosclerosis.

METHODS AND RESULTS

Patients were recruited for standard indications. A total of 105 patients (79 women and 26 men) with the mean age of 43.61 ± 12.42 were prospectively enrolled. On B-mode duplex ultrasound; the mean CIMT at the far wall of both left and right common carotid arteries were measured. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. Delta (Δ) values were obtained by subtracting sixth month values from the baseline values. Body mass index (BMI) was significantly reduced from 46.95 ± 7.54 to 33.54 ± 6.41 kg/m2 (p < 0.001) in sixth months after LSG. Both EFT and CIMT were significantly decreased after surgery (8.68 ± 1.95 mm vs. 7.41 ± 1.87 mm; p < 0.001 and 0.74 ± 0.13 mm vs. 0.67 ± 0.11 mm; p < 0.001 respectively). A significant correlation between ΔEFT and ΔBMI (r = 0.431, p < 0.001) was shown. ΔCIMT is significantly correlated with ΔEFT, ΔBMI and Δ systolic blood pressure (r = 0.310, r = 0.285 and r = 0.231 respectively, p < 0.05 for all). In multivariate stepwise linear regression analysis; among variables only ΔBMI was the independent predictor of ΔEFT (β = 153, p = 0.001).

CONCLUSION

Early atherosclerotic structural changes may be reversed or improved by sustained weight loss after LSG in asymptomatic obese patients.

Association of Plasma Homocysteine and Macular Edema in Type 2 Diabetes Mellitus

Purpose

The aim of this study was to assess the association of macular edema (ME) with plasma homocysteine, vitamin B6, vitamin B12, and folic acid levels in patients with Type 2 diabetes.

Methods

Sixty-five diabetic subjects with no retinopathy and nonproliferative diabetic retinopathy (NPDR) (no DR, without ME, with ME: 16, 25, 24, respectively), 28 with proliferative diabetic retinopathy (PDR) (with and without ME: 14, 14, respectively), and 19 healthy subjects as control were recruited in this cross-sectional study Plasma homocysteine, vitamin B12, vitamin B6, and folate levels were determined after 8-hour of fasting for all subjects. The levels of serum homocysteine and vitamin B6 were measured using high performance liquid chromatography (HPLC) with fluorescence detection, and the levels of serum vitamin B12 and folic acid were measured by electrochemiluminescence immunoassay.

Results

When diabetic groups with ME were compared with diabetic groups without ME for homocysteine, vitamin B12, vitamin B6, and folic acid, the only significant difference was detected in homocysteine levels (p=0.001). There was no significant difference between NPDR with ME group compared with NPDR without ME group and no DR group for plasma homocysteine, vitamin B12, vitamin B6, and folic acid (p=0.200, p=0.660; p=0.999, p=0.678; p=1.0, p=0.248; p=1.0, p=0.982, respectively). On the other hand, when PDR with ME group was compared with PDR without ME group, there was only significant difference in homocysteine levels (p=0.023).

Conclusions

Mild to moderate elevation of homocysteine may explain the role of vascular dysregulation and endothelial dysfunction in patients with DR. The present study suggests hyperhomocysteinemia may be one of the crucial risk factors for development of ME.

Relationship between fluid status as assessed by bioimpedance analysis and NT-pro BNP, blood pressure and left ventricular mass index in hemodialysis patients

AIMS

Maintenance of fluid status within an optimal range and accurate assessment of dry weight (DW) is essential in patients on intermittent haemodialysis (HD) treatment. In this study, we aimed to investigate the association of fluid status measured by bioimpedance analysis (BIA) with N-terminal pro-B natriuretic peptide (NT-proBNP), blood pressure and left ventricular mass index (LVMI) in hemodialysis patients.

MATERIALS AND METHODS

A total of 45 hemodialysis patients were enrolled in the study. N-terminal pro-B natriuretic peptide (NT-proBNP) was measured by immunoassay. Blood pressure (BP) was recorded. Echocardiographic examinations were performed in all patients. Multifrequency bioimpedance analysis was used to assess pre- and post-dialysis fluid status. Overhydration/ extracellular water (OH/ECW) ratio was used as fluid status index and OH/ECW ratio >0.15 was defined as clinical overhydration. Patients were divided into two groups; overhydrated (OH/ECW>0.15) and non-overhydrated (OH/ECW≤0.15).

RESULTS

OH/ECW, systolic blood pressure (SBP), diastolic blood pressure (DBP), LVMI and NT-proBNP levels were significanly reduced after hemodialysis session. The presence of overhydration was more frequent in pre-HD patients compared to post-HD patients (31.1% vs 13.3%, p=0.004). OH/ECW was positively correlated with pre-and post-HD SBP, DBP, LVMI and NT-proBNP (p<0.05). Overhydrated patients had significantly higher values of pre-HD and post-HD SBP, DBP, LVMI and NT-proBNP compared to non-overhydrated patients. In addition, SBP, DBP, LVMI and NT-proBNP levels were significantly reduced after hemodialysis in both overhydrated and non-overhydrated patients group.

CONCLUSIONS

This study revealed that OH/ECW ratio was significantly associated with SBP, DBP, LVMI and NT-proBNP.

DETERMINATION OF VOLUME OVERLOAD BY BIOELECTRICAL IMPEDANCE ANALYSIS AND NT-PROBNP IN DIABETIC PRE-DIALYSIS PATIENTS

Introduction

Diabetic chronic kidney disease has more fatal clinical progresses and this situation can be related to volume overload, which is seen more commonly in diabetic chronic kidney disease patients than in non-diabetic chronic kidney disease patients. Therefore, we examined the effect of diabetes mellitus on volume overload in newly diagnosed stage 5 chronic kidney disease patients whose volume overloads were not showing signs of improvement from renal replacement therapy.

Method

One hundred and five patients (46 diabetic, 59 non-diabetic) with end-stage chronic kidney disease, who had glomerular filtration rate (GFR) under 15 mL/min for at least three months were enrolled in this prospective study. We determined the body volume overload and configuration using a bioimpedance device. NT-proBNP levels were recorded.

Results

There was a statistically significant difference between diabetic and non-diabetic groups according to overhydration (OH, p=0.003), extracellular water (ECW, p=0.045), intracellular water (ICW, p<0.001) and OH/ECW (p=0.003). In addition, there was a statistically significant difference between groups in terms of N-terminal Pro-brain Natriuretic Peptide (NT-proBNP levels, p=0.008).

Discussion

We compared diabetic and non-diabetic end-stage chronic kidney disease patients who were not in renal replacement therapy yet. We found more volume overload and extracellular fluid volume in the diabetic group.

Delayed diagnosis of Eosinophilic Fasciitis: a case report and review of the literature

Eosinophilic fasciitis is an uncommon entity characterized by edema, skin thickening and hyperpigmentation of extremities. Laboratory findings are variable and may include hypergammaglobulemia, peripheral eosinophilia and elevated acute phase reactants. A full-thickness skin/fascia/muscle biopsy is the gold standart for diagnosis. Since EF is an uncommon disorder and the clinic presentation mimics scleroderma, it takes a long time to make definitive diagnosis. We present a case diagnosed two years after its onset and responded well to the treatment. We also include herein the results of our literature survey regarding delayed diagnosis of Eosinophilic Fasciitis.

Late coronary stent dislodgement following coronary artery stenting

Recently, coronary artery stenting has been successful when used as an intervention for percutaneous coronary artery disease. However, the procedure may frequently produce complications. Although rare, stent dislodgement is one such complication, which may result in serious problems including coronary artery dissection, myocardial infarction, peripheral embolisation and death. Stent dislodgement is known to be an early complication of the coronary artery stenting procedure. In this case report, we present a 53-year-old male with late coronary stent dislodgement. To the best of our knowledge, no such case has been addressed in the literature to date.

Effect of hypothermia in patients undergoing simultaneous carotid endarterectomy and coronary artery bypass graft surgery

Purpose

We sought to determine whether hypothermia provided any benefit in patients undergoing simultaneous coronary artery bypass graft surgery (CABG) and carotid endarterectomy (CEA) using one of two different surgical strategies.

Methods

Group 1 patients (n = 34, 88.2% male, mean age 65.94 ± 6.67 years) underwent CEA under moderate hypothermia before cross clamping the aorta, whereas group 2 patients (n = 23, 69.6% male, mean age 65.78 ± 9.29 years) underwent CEA under normothermic conditions before initiating cardiopulmonary bypass (CPB). Primary outcome of interest was the occurrence of any new neurological event.

Results

The two groups were similar in terms of baseline characteristics. Permanent impairment occurred in one patient (2.9%) in group 1. One patient from each group (2.9 and 4.3%) had transient neurological events and they recovered completely on the sixth and 11th postoperative days, respectively. Overall, there was no statistically significant difference between the two groups with regard to occurrence of early neurological outcomes (n = 2, 5.8% vs n = 1, 4.3%, p = 0.12).

Conclusions

This study could not provide evidence regarding benefit of hypothermia in simultaneous operations for carotid and coronary artery disease because of the low occurrence rate of adverse outcomes. The single-stage operation is safe and completion of the CEA before CPB may be considered when short duration of CPB is required.

Clinical and characteristic features of surgically treated endobronchial hamartoma cases: analysis of twenty-two cases

PURPOSE

Endobronchial hamartomas are tumors originating from peribronchial mesenchymal tissues. Generally, endobronchial methods are used in the treatment of these tumors, which are usually benign. Surgery is used in cases of endobronchial hamartoma that cannot be fully treated with endobronchial methods, or that developed parenchyma destruction due to bronchial obstruction. The objective of this study is to assess clinical and characteristic features of surgically treated cases of endobronchial hamartoma.

MATERIALS AND METHODS

Twenty-two patients who underwent anatomic resection between 1988 and 2011 in our clinic were diagnosed with hamartoma. Clinical and characteristic features of these patients (17 males and 5 females) were assessed retrospectively via patient records.

RESULTS

Patients were aged between 43 and 72 (average 54.4). Fifteen patients underwent lobectomy (lobectomy for 13 patients, bilobectomy for 1), 6 patients underwent bronchotomy, 1 patient underwent tracheotomy and 1 underwent pneumonectomy. Pathologic diagnosis was chondromatosis hamartoma for 9 patients and lipomatosis hamartoma for 6 patients; dominant cell type was not detected for 7 patients. No surgery-related mortality was observed. No recurrence was observed for patients after the surgery.

CONCLUSIONS

Endoscopic treatment methods yield successful results in endobronchial hamartomas. However, surgery is required in cases that develop irreversible parenchymal destruction due to chronic obstruction and suppuration, or those that cannot be treated via endobronchial methods.

A patient with steroids and antihistaminic drug allergy and newly occurred chronic urticaria angioedema: what about omalizumab?

In this case report, successful use of omalizumab in the treatment of chronic urticarial and angioedema in a 24-year-old female patient with an allergic reaction history to almost every drug including steroids and antihistamines was presented. She also had allergy against a large number of foods, which were confirmed by oral provocation, specific Immunoglobulin E and allergy skin test.

Relationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis

BACKGROUND

The immunological mechanism in aetiology of atopic dermatitis (AD) shows significant differences from other allergic diseases. Allergen inhalation exacerbates AD lesions and AD patients' complaints decrease in house dust mite (HDM) low level environments, which reveals the importance of inhalant allergens.

OBJECTIVE

We evaluated the skin prick test (SPT) and atopy patch test (APT) positivity rates with aeroallergens and studied the effect of test results, and aimed to determine the value of allergic test reactivity on the clinical characteristics of children with AD.

METHODS

Forty-five children aged 2-15 years with AD were included to study between May 2006 and May 2007 in GATA Haydarpasa Teaching Hospital, Allergy Department. The reactivity to inhalant allergens using SPT and APT was evaluated. The severity of AD, which was assessed with SCORAD, was compared with aeroallergen hypersensitivity.

RESULTS

The highest positivity of APT was seen against HDM (48.9%). HDM SPT positivity and subjective symptoms score were statistically correlated (P<0.05). Patients with strong SPT positivity to HDM had a higher total SCORAD score (P<0.05). Although there was no statistical correlation between HDM APT and SCORAD parameters, APT positive patients had generally higher SCORAD parameters. The statistical significance was only shown between the extent of the disease and strong APT positive reactions to Dermatophagoides pteronyssinus.

CONCLUSION

HDM allergens play an important role in determining the clinical severity of AD and strong APT positivity could be more meaningful clinically.

Radiation therapy for resistant sternal hydatid disease

Hydatid disease is a zoonotic infectious disease for which there are known treatment procedures and effective antibiotics; however, there are resistant cases that do not respond to medication or surgery. We report a case diagnosed as hydatid disease of the chest wall and treated with radiation therapy (RT) after medical and surgical therapy had failed. In conclusion, RT represents an alternative treatment modality in resistant cases.

Public awareness of and support for smoke-free legislation in Turkey: a national survey using the lot quality sampling technique

Six months after new legislation in Turkey banning smoking in all public places, a national survey was carried out to assess its implementation. This paper summarizes the main findings on the public's awareness of and support for the new law. In a household interview survey of 32 972 adults representative of the Turkish adult population, a high proportion of both non-smokers and current smokers (91.4% and 67.2% respectively) strongly supported the new law. Knowledge about the health hazards of passive smoking and support for the law, however, were relatively lower among smokers than non-smokers. After controlling for smoking status, people with better knowledge about passive smoking were over 5 times more likely to support the new law. Tobacco control activities should be tailored to local needs, with afocus on increasing awareness about the health hazards of passive smoking. The study also demonstrated application of the lot quality sampling technique (LQT) for monitoring tobacco control activities in a national survey.

An antidote for imazalil-induced genotoxicity in vitro: the lichen, Dermatocarpon intestiniforme (Körber) Hasse

Imazalil (IMA), a commonly used fungicide in both agricultural and clinical domains, is suspected to produce serious toxic effects in vertebrates. In recent years, a number of studies have suggested that lichens might be easily accessible sources of natural drugs that could be used as a possible food supplement. Extensive research is being performed to explore the importance of lichen species, which are known to contain a variety of pharmacological active compounds. In this context, the antigenotoxic effect of aqueous Dermatocarpon intestiniforme (Körber) Hasse. extract (DIE) was studied against the genotoxic damage induced by IMA on cultured human lymphocytes (n = 6) using chromosomal aberration (CA) and micronucleus (MN) as cytogenetic endpoints. Human peripheral lymphocytes were treated in vitro with varying concentrations of DIE (0, 25, 50 and 100 μg/ml), tested in combination with IMA (336 μg/ml). DIE alone were not genotoxic and when combined with IMA treatment, it reduced the frequency of CAs and the rate of MNs. A clear dose-dependent decrease in the genotoxic damage of IMA was observed, suggesting a genoprotective role of DIE. The results of the present study suggest that this plant extract per se does not have a genotoxic potential, but can alleviate the genotoxicity of IMA on cultured human lymphocytes. In conclusion our findings may have an important application for the protection of cultured human lymphocyte from the genetic damage and side effects induced by medical and agricultural chemicals hazardous for people.

Role of aqueous Bryoria capillaris (Ach.) extract as a genoprotective agent on imazalil-induced genotoxicity in vitro

In recent years, a number of studies have suggested that lichens might be the easily accessible sources of natural drugs that could be used as a possible food supplement. Extensive research is being carried out to explore the importance of lichen species, which are known to contain a variety of pharmacological active compounds. On the other hand, imazalil (IMA), a commonly used fungicide in both agricultural and clinical domains, is suspected to produce very serious toxic effects in vertebrates. In this context, the antigenotoxic effect of aqueous Bryoria capillaris (Ach.) extract (BCE) was studied against the genotoxic damage induced by IMA on cultured human lymphocytes using chromosomal aberrations (CA) and micronucleus (MN) as cytogenetic parameters. Human peripheral lymphocytes were treated in vitro with varying concentrations of BCE (5, 10, 25, 50 and 100 µg/mL), tested in combination with IMA (336 µg/mL). BCE alone was not genotoxic, and when combined with IMA treatment, it reduced the frequency of CAs and the rates of MN. A clear dose-dependent decrease in the genotoxic damage of IMA was observed, suggesting a genoprotective role of BCE. The results of the present study suggest that this plant extract per se do not have genotoxic potential, but can modulate the genotoxicity of IMA on peripheral human lymphocytes in vitro. In conclusion, our findings may have an important application in the protection of cultured human lymphocyte from the genetic damage and side effects induced by agricultural and medical chemicals that are hazardous to people.

Nanobiomaterials: a review of the existing science and technology, and new approaches

Nanotechnology has made great strides forward in the creation of new surfaces, new materials and new forms which also find application in the biomedical field. Traditional biomedical applications started benefiting from the use nanotechnology in an array of areas, such as biosensors, tissue engineering, controlled release systems, intelligent systems and nanocomposites used in implant design. In this manuscript a review of developments in these areas will be provided along with some applications from our laboratories.

Xanthoria elegans (Link) (lichen) extract counteracts DNA damage and oxidative stress of mitomycin C in human lymphocytes

Several lichen species have been used for medicinal purposes throughout the ages, and they are reported to be effective in the treatment of different disorders including ulcer and cancer. It is revealed that lichens may be easily accessible sources of natural drugs and possible food supplements after their safety evaluations. The main objective in this study was to evaluate the roles of aqueous extracts of Xanthoria elegans (at 25, 50 and 100 μg/ml) upon mitomycin C (MMC; at 10(-7) M) induced genotoxic and oxidative damages in cultured human lymphocytes. X. elegans were collected from the Erzurum and Artvin provinces (in Turkey) during August 2010. After the application of MMC and X. elegans extract (XEE), separate and together, human whole blood cultures were assessed by four genotoxicity end-points including chromosomal aberration, micronucleus, sister chromatid exchange (SCE) and 8-oxo-2-deoxyguanosine (8-OH-dG) assays. In addition, biochemical parameters [total antioxidant capacity (TAC) and total oxidative stress (TOS)] were examined to determine oxidative effects. According to our results, the frequencies of cytogenetic endpoints and 8-OH-dG levels were significantly increased by MMC compared with controls in human peripheral lymphocytes. MMC caused oxidative stress by altering TAC and TOS levels. On the contrary, XEE led to increases of TAC level without changing TOS level. XEE had no genotoxic effect. Furthermore, our findings revealed that MMC induced increases in the mean frequencies of four genotoxic indices were diminished by XEE in dose dependent manner, indicating its protective role towards cells from MMC exerted injury. In conclusion, the results obtained in the present study indicate for the first time that XEE is a potential source of natural antigenotoxicants.

Anti-genotoxic role of eicosapentaenoic acid against imazalil-induced DNA damage in vitro

Eicosapentaenoic acid (EPA) is a polyunsaturated n-3 fatty acid and is essential to the health of mammals. Recent data show that EPA can act as anti-mutagenic agent. On the other hand, pesticides comprise a new and important class of environmental pollutants nowadays. Imazalil (IMA), a commonly used fungicide in both agricultural and clinical domains is suspected to produce very serious toxic effects in vertebrates. The present study investigated the anti-genotoxic effect of EPA against the genotoxic damage induced by IMA on cultured human lymphocytes using chromosomal aberration (CA) and micronucleus (MN) tests as cytogenetic endpoints. Peripheral blood cells were treated in vitro with varying concentrations of EPA (2.5, 5, 10, 20 and 40 μg/ml), tested in combination with IMA (336 μg/ml). Our results revealed that the rates of CAs and MNs in lymphocytes were significantly (p < 0.05) increased by IMA as compared to the controls. The results also showed that EPA alone was not genotoxic. Moreover, when combined with IMA treatment, EPA reduced the frequencies of CAs and MNs. A clear dose-dependent decrease in the genotoxic damage of IMA was observed, suggesting a genoprotective role of EPA. In conclusion, our data may have an important application for the protection of cultured human lymphocyte from the genetic damage and repercussions induced by agricultural and industrial chemicals hazardous in people.

The evaluation of the genotoxic and oxidative damage potentials of Ulothrix tenuissima (Kutz.) in vitro

Several alga species are known to produce a variety of toxic metabolites that pose a threat to aquatic organisms, animals and humans. Moreover, these metabolites have been thought to cause serious diseases including certain cancers and neurodegenerative disorders. On the other hand, Ulothrix is a genus of filamentous green algae, generally found in fresh water and marine and abundantly available in some lakes and rivers of Turkey. To our best knowledge, no study has been performed to assess the genotoxic and biochemical effects of U. tenuissima on cultured human blood cells. Therefore, in order to determine clastogenic or aneugenic effects of aqueous alga extracts the micronucleus assay was carried out. Nuclear division index (NDI) in peripheral lymphocytes was also analyzed for cytotoxicity evaluations. In addition, biochemical parameters (total antioxidant capacity (TAC) and total oxidative stress (TOS)) were examined to determine oxidative effects. For this aim, we obtained heparinized blood samples from three healthy persons. The alga samples were collected from Porsuk Pond in Hasankale (Erzurum, Turkey) in summer period of the year 2010. The aqueous extracts of this species were added to cultures at different concentrations (0 to 5000 ppm) for 72 h. Our results showed that this alga did not cause any statistically important changes in the rates of studied genotoxicity endpoint. But dose-dependent alterations were observed in TAC and TOS levels and NDI rates. In conclusion, U. tenuissima was found to be non-genotoxic but caused sterility at higher concentrations due to oxidative stress.

Diagnosing common parotid tumours with magnetic resonance imaging including diffusion-weighted imaging vs fine-needle aspiration cytology: a comparative study

OBJECTIVES

the purpose of this study was to evaluate the accuracy of MRI combined with diffusion-weighted imaging (DWI) vs fine-needle aspiration cytology (FNAC) in diagnosing common parotid masses.

METHODS

25 consecutive patients (mean age 61 years) with parotid masses were included in this study. Informed consent and ethical approval was obtained. 22 patients underwent both MRI combined with DWI and FNAC. From DWI data, apparent diffusion coefficient maps were generated. The MRI study protocol consisted of T(1) weighted spin echo; T(2) weighted and T(2) weighted fat-suppressed turbo spin echo; DWI; and T(1) weighted fat-suppressed post-contrast images. MRI and FNAC diagnoses were compared with histopathology. Youden's index was used to compare the two methods.

RESULTS

masses comprised eight Warthin tumours, eight adenomas (six pleomorphic adenomas, two basal cell adenomas), five carcinomas, two lipomas, one haemagioma and one benign lymphadenopathy. Technically, MRI was successful in 24 of the 25 patients (96%), FNAC was successful in 20 of the 23 patients (87.0%). The accuracy, sensitivity and specificity of MRI without DWI were 96%, 80% and 100%, respectively. Diagnostic accuracy did not increase by adding DWI to conventional MRI; however, DWI was helpful for diagnosing benign tumour histology. MRI combined with DWI was successful for determining accurate tumour typing in all benign masses except one lymphadenopathy. When FNAC had adequate material the accuracy, sensitivity and specificity were 95%, 75% and 100%, respectively. Youden's index was 0.80 for MRI and 0.75 for FNAC.

CONCLUSIONS

MRI combined with DWI seems to have similar diagnostic potential as FNAC in differentiation of benign vs malignant parotid masses.

Integration of environmental and human health risk assessment for industries using hazardous materials: a quantitative multi criteria approach for environmental decision makers

Environmental management, for which environmental and human health risk assessment is the first stage, is a requirement for industries both before construction and during operation in order to sustain improved quality of life in the ecosystem. Therefore, the aim of this study is to propose an approach that integrates environmental and human health risk assessment for industries using hazardous materials in order to support environmental decision makers with quantitative and directive results. Analytic hierarchy process and fuzzy logic are used as tools to handle problems caused by complexity of environment and uncertain data. When the proposed approach is implemented to a scenario, it was concluded that it is possible to define risk sources with their risk classes and related membership degrees in that classes which enable the decision maker to decide which risk source has priority. In addition, they can easily point out and rank the factors contributing those risk sources owing to priority weights of them. As a result, environmental decision makers can use this approach while they are developing management alternatives for unfounded and on-going industrial plants using hazardous materials.

Spectral changes in electrical activity of pylorus due to L-NAME induced hypertrophic pyloric stenosis

OBJECTIVES

To investigate the relation between hypertrophic pyloric stenosis (HPS) and the changes in the myoelectrical activity of the pyloric and gastric areas.

METHODS

Three pregnant females, at 14 days of gestation two of which were named as D14n (NOS inhibitor group) and one was named as D14c (control). From the beginning of the study until the end of gestation, rats in D14n group received nitric oxide synthase inhibitor L-NAME for administrating their pups, and the rat in D14c group was drinking water for 21 days. The pups of each group underwent laparotomy at 42 days of their life and myoelectrical signals of their pyloric and gastric regions were recorded via bipolar electrodes and then evaluated through signal processing.

RESULTS

Signal analysis showed that HPS induced pyloric segment reveals a suppressed spectral component that was detected in normal pyloric segment. The HPS induced pyloric segment also revealed higher power/ min and +/- SD compared to that of normal and gastric areas. In the pyloric segment, while the number of interstitial cells of Cajal (ICC) was lesser, the number of smooth muscle cells was higher than in the pyloric segment of controls.

CONCLUSIONS

The spectral differentials depend on the type, population and condition of locally specialized muscular mechanism which can be affected from HPS. The HPS also has a relation to specific cells, such as ICC that generates NO, provoke the spontaneous pacemakers and biological slow waves (Tab. 1, Fig. 1, Ref. 19).

Ectopic primary B cell lymphoma of the thyroid presenting as an anterior mediastinal mass. A case report

Ectopic thyroid tumours arising in the mediastinum without connection to the cervical thyroid gland are very rare. Follicular adenoma, papillary carcinoma and follicular carcinoma in the mediastinum has been reported, but primary ectopic thyroid B cell lymphoma has not been reported previously. We report mediastinal primary ectopic thyroid large B cell lymphoma in an 80-year-old man. Differential diagnosis from primary mediastinal large B cell lymphoma and clinicopathologic features are discussed.

Medial circumflex femoral artery with different origin and course: a case report and review of the literature

The femoral artery (FA) and its branches play important roles in the arterial supply of the lower extremity. If the femoral artery is occluded, the circulation of the extremity is maintained by certain anastomoses. Therefore, identification of variations of these arteries is critical from a clinical and surgical point of view. During routine anatomical dissections for student education at the Department of Anatomy of the School of Medicine at Ondokuz Mayls University, a variation of the medial circumflex femoral artery (MCFA) was observed and photographed in a male, formalin-fixed cadaver aged 55 years. In this case, MCFA branched off from the posterolateral aspect of the FA, 32 mm distal to the inguinal ligament. A frequency rate of 17-26% has been reported regarding this variation. However, MCFA emerging from the postero-lateral aspect of the FA and its course, as in this case, is not that frequent. Knowledge of anomalies in the emergence and course of the arteries that join the cruciate anastomosis and are important in the arterial supply of the head and neck of the femur appear to be a critical component that requires caution during surgical interventions towards this region.