Left and right ventricular function by echocardiography, tissue doppler imaging, carotid intima media thickness, and asymmetric dimethylarginine levels in female adolescents with vitamin D deficiency

BACKGROUND

The aim of our study was to assess left and right ventricle systolic and diastolic functions in female adolescents with vitamin D deficiency using conventional echocardiography and pulsed-wave tissue Doppler imaging and to investigate carotid intima media thickness and asymmetric dimethylarginine levels.

METHODS

Sixty-six female adolescents were enrolled in this study. The female adolescents were divided into a vitamin D deficiency group (n: 34) and a control group (n: 32). All subjects underwent laboratory blood tests, including asymmetric dimethyl arginine, complete two-dimensional, pulse, and tissue Doppler echocardiography, and measurement of the carotid intima-media thickness.

RESULTS

The vitamin D-deficient female adolescent group had normal left and right ventricle systolic and diastolic functions and normal global systolic and diastolic myocardial performance. In the patients with vitamin D deficiency, the carotid intima-media thickness was higher than that in the controls. In the patients within the vitamin D deficiency group, vitamin D was found to be positively correlated with magnesium and negatively correlated with phosphorus and left atrial dimension.

CONCLUSIONS

The results of this study demonstrate that vitamin D deficiency in female adolescence is associated with normal myocardial geometry and function. Although it has been associated with normal levels of asymmetric dimethyl arginine concentration, high measured carotid intima-media thickness may reflect endothelial dysfunction.

Evaluation of Main Lacrimal Gland through Shear-wave Ultrasound Elastography in Patients with Low Schirmer Value

OBJECTIVE

To compare main lacrimal gland values through shear-wave elastography (SWE) in patients with low Schirmer value and unspecified Sjögren's syndrome (SS) with healthy controls.

MATERIAL AND METHOD

Admitted to the ophthalmology department with Schirmer value <10 mm, randomly selected 46 eyes of 46 patients evaluated for Sjögren's syndrome (SS) in the rheumatology department between December 2022 and April 2023 were classified as low Schirmer group (LSG). Randomly selected 48 eyes of 48 patients at a similar age with Schirmer value >10 mm were included as controls. Main lacrimal gland SWE measurements in LSG and control groups were recorded and compared as meter/second (m/sec).

RESULTS

Mean SWE values of the main lacrimal gland were measured as 2.78 ± 0.66 m/sec and 2.26 ± 0.29 m/sec in LSG and controls. SWE measurements were significantly higher in LSG patients than in controls (p<0.001). No significant correlation was found in the analysis between the Schirmer and the main lacrimal gland SWE values in LSG patients (p=0.702, r=0.058). No significant correlation was also detected between the Schirmer and main lacrimal gland SWE values in controls (p=0.097, r=0.242). No significant relationship was also found between age, gender, body mass index (BMI), and SWE values (p=0.351, p=0.493, p=0.328, respectively).

CONCLUSION

Mean SWE value of the main lacrimal gland was determined as significantly higher in patients with aqueous lacrimal insufficiency without SS than in controls. We consider that SWE measurements may be an imaging method to support the diagnosis of aqueous lacrimal insufficiency and used in follow-ups of those with dry eye syndrome (DES) in the future.

Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study

OBJECTIVE

A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic.

MATERIAL AND METHODS

All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded.

RESULTS

A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%).

CONCLUSION

The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Non-invasive hemoglobin estimation from conjunctival images using deep learning

Hemoglobin, a crucial protein found in erythrocytes, transports oxygen throughout the body. Deviations from optimal hemoglobin levels in the blood are linked to medical conditions, serving as diagnostic markers for certain diseases. The hemoglobin level is usually measured invasively with different devices using the blood sample. In the physical interpretation, some signs are traditionally used. These signs are the palms, face, nail beds, pallor of the conjunctiva, and palmar wrinkles. Studies have shown that conjunctival pallor can yield more effective results in detecting anemia than the pallor of the palms or nail beds. This study is aimed to predict the hemoglobin level by deep learning method, non-invasive, cheap, fast, high accuracy, and without creating medical waste. In this context, conjunctival images and age, weight, height, gender, and hemoglobin values were collected from 388 people who donated blood to the Turkish Red Crescent. A dataset was generated by augmenting the gathered data with body mass index data. Within the scope of this investigation, the limits of agreement (LoA) value at a 95% confidence interval was computed to be 1.23 g/dL, while the bias was established as 0.26 g/dL. The mean absolute percentage error (MAPE) values were determined to be 3.4%, and the root mean squared error (RMSE) was calculated to be 0.68 g/dL. These findings exhibit a successful outcome compared to similar investigations, signifying that this non-invasive method can be employed for hemoglobin level estimation. Furthermore, the estimated hemoglobin levels could aid in diagnosing several hemoglobin-related ailments.

Effects of infliximab against carbon tetrachloride-induced spleen toxicity in rats

OBJECTIVE

Carbon tetrachloride (CCl4) is a non-polar molecule used in industry in grain curing, insect-killing and especially in the production of chlorofluorocarbons. It is estimated that an average of 70,000 industry workers in Europe are exposed to this toxic compound.

MATERIALS AND METHODS

Twenty-four male Sprague-Dawley rats were randomly allocated into four groups: control group (saline only, Group I), infliximab (INF) group (Group II), CCl4 group (Group III) and CCl4+INF group (Group IV).

RESULTS

While there was an increase in the numerical density of CD3, CD68, and CD200R positive T lymphocytes and macrophages in the CCl4 administration group (p=0.000), this was not the case in the CCl4+INF administration group (p=0.000).

CONCLUSIONS

TNF-α inhibitors have a protective effect against CCl4-induced spleen toxicity/inflammation as seen by the reduction in CD3, CD68, CD200R positive T lymphocytes and macrophages.

Prediction of Gastric Cancer by Machine Learning Integrated with Mass Spectrometry-based N-glycomics

Early and accurate diagnosis of gastric cancer is vital for effective and targeted treatment. It is known that glycosylation profiles differ in the cancer tissue development process. This study aimed...

Ancient DNA from Mesopotamia suggests distinct Pre-Pottery and Pottery Neolithic migrations into Anatolia

We present the first ancient DNA data from the Pre-Pottery Neolithic of Mesopotamia (Southeastern Turkey and Northern Iraq), Cyprus, and the Northwestern Zagros, along with the first data from Neolithic Armenia. We show that these and neighboring populations were formed through admixture of pre-Neolithic sources related to Anatolian, Caucasus, and Levantine hunter-gatherers, forming a Neolithic continuum of ancestry mirroring the geography of West Asia. By analyzing Pre-Pottery and Pottery Neolithic populations of Anatolia, we show that the former were derived from admixture between Mesopotamian-related and local Epipaleolithic-related sources, but the latter experienced additional Levantine-related gene flow, thus documenting at least two pulses of migration from the Fertile Crescent heartland to the early farmers of Anatolia.

The genetic history of the Southern Arc: A bridge between West Asia and Europe

By sequencing 727 ancient individuals from the Southern Arc (Anatolia and its neighbors in Southeastern Europe and West Asia) over 10,000 years, we contextualize its Chalcolithic period and Bronze Age (about 5000 to 1000 BCE), when extensive gene flow entangled it with the Eurasian steppe. Two streams of migration transmitted Caucasus and Anatolian/Levantine ancestry northward, and the Yamnaya pastoralists, formed on the steppe, then spread southward into the Balkans and across the Caucasus into Armenia, where they left numerous patrilineal descendants. Anatolia was transformed by intra-West Asian gene flow, with negligible impact of the later Yamnaya migrations. This contrasts with all other regions where Indo-European languages were spoken, suggesting that the homeland of the Indo-Anatolian language family was in West Asia, with only secondary dispersals of non-Anatolian Indo-Europeans from the steppe.

A genetic probe into the ancient and medieval history of Southern Europe and West Asia

Literary and archaeological sources have preserved a rich history of Southern Europe and West Asia since the Bronze Age that can be complemented by genetics. Mycenaean period elites in Greece did not differ from the general population and included both people with some steppe ancestry and others, like the Griffin Warrior, without it. Similarly, people in the central area of the Urartian Kingdom around Lake Van lacked the steppe ancestry characteristic of the kingdom's northern provinces. Anatolia exhibited extraordinary continuity down to the Roman and Byzantine periods, with its people serving as the demographic core of much of the Roman Empire, including the city of Rome itself. During medieval times, migrations associated with Slavic and Turkic speakers profoundly affected the region.

The effect of carrier system materials used in an Olympic swimming pool on the perceptual evaluations of respondents

Purpose

This study aims to determine the effects of three different carrier system materials (laminated wooden beams, post-tensioned concrete beams and steel beams) used widely in interior spaces on the perceptual evaluations of respondents.

Design/methodology/approach

The large opening Olympic swimming pool space was chosen as the research environment. A total of 376 university graduates participated. After experiencing the 360-degree virtual images of the experimental spaces, a “spatial perception” questionnaire was applied to these respondents.

Findings

The spaces using the laminated wood beams in the carrier system were perceived as warmer, lighter, more attractive, more spacious, more informal, closer, more well-planned, freer, simpler, more peaceful, more exciting, and uncrowded compared to the spaces that used post-tensioned concrete beams and steel beams. The architect respondents made more negative perceptual evaluations for all the adjective pairs compared to the respondents in the other professional groups. Respondents who were males, and in the 26–35 years of age group, perceived more positively the physical environmental factors of the virtual swimming pools compared to females, and the 36 years of age or above age group.

Originality/value

The results set forth that the structural elements of buildings, such as ceilings, walls and furnishings, were not only systematic elements used in the formation of the structure, they were also important environmental factors in the perceptual evaluation of the space.

Association of serum elabela levels with carotid artery stenosis in patients with non-cardioembolic ischemic stroke

Aim: Elabela (ELA) is a peptide of the apelinergic system and is known to play a role in endothelial homeostasis and vascular pathobiology. In this study, the relationship between carotid artery stenosis, which is the main culprit, and ELA level in patients with non-cardioembolic ischemic stroke was investigated. Materials & methods: Cross-sectional observation included two groups of 40 patients with critical carotid artery stenosis and 40 patients with age-sex matched noncritical carotid artery stenosis. Results: ELA levels were significantly higher in the noncritical stenosis group. ELA had a significantly moderate negative correlation with the carotid score (r = -0.334, p = 0.003), maximal carotid plaque length (r = -0.413, p < 0.001) and degree of stenosis (r = -0.397, p < 0.001). Conclusions: There is a significant inverse correlation between critical carotid artery disease and ELA level in patients with non-cardioembolic ischemic stroke.

Investigating the effect of bruxism on maxillary arch length and width in children using three-dimensional digital model analysis

Background

Bruxism is defined as repetitive jaw-muscle activity characterized by the grinding and clenching of teeth. The prevalence of bruxism in children is extensive, and it can cause irregularities in dental arches. The study aimed to investigate the presence of any effects of bruxism on maxillary arch length and width in children using three-dimensional (3D) digital model analysis.

Method

This study evaluated 30 children with bruxism. For every child with bruxism, a case control without bruxism was selected and matched for gender, age, and dentition. Digital models of the patients’ maxilla were obtained with a 3D intraoral scanner, and width and length measurements between the reference points on the maxilla were obtained on the digital models.

Results

The mean age of the study group was 9.13 ± 1.27. Insıgnificance differences were found between females and males within and between groups in terms of maxillary width and length. Insignificant difference was found between the control and study groups when the lengths of 3R-3L, 4R-4L, 5R-5L, 6R-6L, and IP-M were compared (p > 0.05).

Conclusion

Based on the study results, there were no differences in the maxillary arch length and width in patients with bruxism and patients without bruxism.

The Validity and Reliability of the Turkish Version of the Brief Irritability Test

OBJECTIVE

Although irritability is a widely used term, it has no universal definition. Irritability is an emotional process that can be defined by a tendency to negative emotional states. No Turkish scale has been developed or adapted to measure irritability in adults. Consequently, this paper aims to conduct a validity and reliability study of the Turkish version of the Brief Irritability Test (BITe) with 5 items, which was developed by Holtzman et al. in 2015 to measure irritability rapidly and appropriately.

METHODS

The Turkish BITe's internal consistency and validity analysis were studied on 136 volunteering undergraduate and postgraduate students. Cronbach's alpha value was calculated for internal consistency. Concurrent, convergent, discriminant validity analyses, and confirmatory factor analysis (CFA) were conducted to calculate structural validity. Moreover, the scale was applied to 24 people 2 weeks later to determine the temporal reliability of the Turkish BITe.

RESULTS

When the fit indices of the scale related to the CFA were examined, it was observed that it had a good fit (χ 2 = 7.517, χ 2/df = 1.503, df = 5; RMSEA = 0.061; CFI = 0.992, GFI = 0.977, NFI = 0.976; TLI = 0.984, IFI = 0.992). In the reliability analysis, the Cronbach's alpha value was 0.86, and the correlation coefficient between test-retest scores was 0.74 (P < .001).

CONCLUSION

This study reveals that the Turkish form of the BITe shows sufficient psychometric properties in the non-clinical population.

The Validity and Reliability of the Turkish Version of the Brief Irritability Test

OBJECTIVE

Although irritability is a widely used term, it has no universal definition. Irritability is an emotional process that can be defined by a tendency to negative emotional states. No Turkish scale has been developed or adapted to measure irritability in adults. Consequently, this paper aims to conduct a validity and reliability study of the Turkish version of the Brief Irritability Test (BITe) with 5 items, which was developed by Holtzman et al. in 2015 to measure irritability rapidly and appropriately.

METHODS

The Turkish BITe's internal consistency and validity analysis were studied on 136 volunteering undergraduate and postgraduate students. Cronbach's alpha value was calculated for internal consistency. Concurrent, convergent, discriminant validity analyses, and confirmatory factor analysis (CFA) were conducted to calculate structural validity. Moreover, the scale was applied to 24 people 2 weeks later to determine the temporal reliability of the Turkish BITe.

RESULTS

When the fit indices of the scale related to the CFA were examined, it was observed that it had a good fit (χ ² = 7.517, χ ²/df = 1.503, df = 5; RMSEA = 0.061; CFI = 0.992, GFI = 0.977, NFI = 0.976; TLI = 0.984, IFI = 0.992). In the reliability analysis, the Cronbach's alpha value was 0.86, and the correlation coefficient between test-retest scores was 0.74 (P < .001).

CONCLUSION

This study reveals that the Turkish form of the BITe shows sufficient psychometric properties in the non-clinical population.

The Psychological Effects of COVID 19 on Medical and Non-medical University Students

BACKGROUND

The COVID 19 pandemic has had significant psychological effects on university students as well as in all segments of society. The aim of this study is to examine the relationship between education fields (medical-non medical), education styles (online-face to face), sociodemographic characteristics of university students and their levels of depression, anxiety, stress, fear of COVID-19.

SUBJECTS AND METHODS

In the cross-sectional designed research, 1213 university students studying in Turkey was reached online. A sociodemographic form, the Depression Anxiety Stress Scale (DASS 21) and the Fear of COVID-19 Scale (FCV-19S) was applied to the participants.

RESULTS

Of all participants 887 (73%) were women. 647 (53%) students were studying in the medical field. The scores of FCV-19S and all subscales of DASS 21 were significantly higher in women. In the comparison between the field and style of education, no difference was found. DASS 21 scores were higher in the participants whose relatives had COVID-19 or who had a mental disorder in the past or medical disease.

CONCLUSIONS

In this study, it was observed that while there was no significant difference in the scores of DASS 21 among university students in terms of the field and style of education, variables such as gender, not having COVID-19 so far, having lost a relative due to COVID-19 could cause significant differences. Identifying sensitive groups will create early intervention opportunities.

Relationship Between Degeneration or Sagittal Balance With Modic Changes in the Cervical Spine

Objective: This study evaluates the relationship between degenerative and Modic changes (MCs) in the cervical spine and compares the results with the cervical sagittal balance parameters.

Methods: We retrospectively reviewed 275 patients with neck pain who applied to our outpatient clinic and underwent cervical magnetic resonance imaging (MRI) and cervical anteroposterior (AP)/lateral (Lat) X-ray radiography between January 2016 and January 2018. The clinics, demographic information, and radiological findings of the patients were examined. Modic changes, disc degeneration, and facet degeneration (FD) were examined by cervical MRI, and T1 slope and Cobb angle were measured by cervical AP/Lat X-ray radiography. These results were compared to evaluate their relations with each other.

Results: No relationship between the presence or absence of degenerative changes (Modic changes, facet degeneration, and disc degeneration) and sagittal balance parameters (T1 slope and Cobb angle) was found. However, when each cervical segment was examined separately, facet degeneration at the C4-C5 level and Modic changes at the C3-C4, C4-C5, and C6-C7 levels were statistically significant with the Cobb angles, and the Modic changes at the C3-C4 level and disc degeneration at the C2-C3 level were found to be significant with T1 slope values.

Conclusions: Our findings indicate that MCs increased with decreased cervical curvature, increasing disc and facet degeneration, although the causal mechanisms are not clear.

Celiac disease does not influence markers of ovarian reserve in adolescent girls

PURPOSE

The aim of the study was to determine whether celiac disease affects ovarian reserve assessed by antral follicle counting, ovarian volume, and anti-müllerian hormone in adolescent patients.

METHODS

This case-control multicenter trial was performed from January 1, 2017 to May 31, 2018 and included 45 girls. On days 2-5 of the menstrual cycle, measurements of serum follicle stimulating hormone, luteinizing hormone, estradiol, prolactin, and anti-müllerian hormone were performed. Antral follicle counts and ovarian volumes were determined on the same day.

RESULTS

Evaluation was made of 21 (47.7%) celiac patients with a mean age of 15.8 ± 1.3 years, and 24 (52.3%) healthy control subjects with a mean age of 16.2 ± 1.2. There was no difference between the groups in respect of right and left ovarian volumes (p = 0.790 and p = 0.670, respectively). Serum levels of anti-müllerian hormone of the celiac patients and controls were found comparable [(3.7 ± 2.9 (0.5-12) and 3.6 ± 1.8 (1.2-8.1)] ng/mL, respectively, p = 0.915).

CONCLUSIONS

Celiac disease may not affect the ovarian reserve determined with established ovarian reserve markers including antral follicle counting, ovarian volume, and anti-müllerian hormone in adolescent patients.

TRIAL REGISTRATION

ClinicalTrials.gov identifier (NCT number): NCT04024449 https://clinicaltrials.gov/ct2/show/NCT04024449.

Evaluation of the Relationship Between Clinical Symptoms and Modic Changes

Purpose The aim of this study was to evaluate the association between changes in the type of Modic change (MC) and newly developed MCs and low back symptoms. Methods This retrospective study includes all the patients suffering from low back pain who has at least two magnetic resonance studies between 2013 and 2016. Patients with MC in at least one vertebra in magnetic resonance imaging (MRI) images were included in the study. The patients who have periods of two MRIs less than six months were excluded. Results A total of 129 patients were included in the study and 774 vertebrae were evaluated. At the time of the first admission, MC was observed in 283 out of the 774 vertebrae (37%), whereas in the second admission, MC was observed in 343 of 774 (43%) vertebrae. New MCs were observed in 59 vertebrae. Two patients showed complete resolution of MC in the second admission. It was observed that patients with type 1 change were more associated with pain than other types (p=0.001). Conclusion In our retrospective case-control study, we have found that MCs can transform into different types or disappear completely over time. A significant positive correlation was found between the presence of MC type 1 changes in the visual analog scale(VAS).

Association between parity and lumbar spine degenerative disorders in young women

Introduction: Estrogen helps to maintain the health of collagen-containing tissues including the intervertebral disc. Estrogen deficiency after menopause negatively affects the quality of vertebral end plates and induces development of degenerative disc disease (DDD). However, there is no study examining the relationship between parity and spinal degeneration in young women. The aim of this study was to define the relationship between parity and development of vertebral endplate signal changes and DDD in young premenopausal women.Materials and methods: This case-control case study included 224 patients aged 20-40 years with a history of low back pain for at least 3 months. Pfirrmann's grade, Modic changes (MCs), and Schmorl's nodes (SNs) were graded based on magnetic resonance images. Patients' parity, demographics, body mass index, physical activity level, and disability scores were assessed using a questionnaire.Results: The prevalence of abnormal total Pfirrmann's score (>10) and MCs was higher in primiparous patients than multiparous and grand-multiparous; however, it was not statistically significant. The presence of SN was statistically significantly associated with low parity. According to multivariate logistic regression analysis, it was found that the number of births increases by 1 unit, the abnormality in Pfirrmann's score decreases by 1.36 times.Conclusions: This cross-sectional study shows that parity is associated with DDD and vertebral end plate changes. SNs were significantly associated with parity. Modic changes and DDD were less common in grand multipara and multipara young women than in primipara women. These results indicate that low parity may possibly be associated with the development of spinal degeneration.

Efficiency and Accuracy of Three-Dimensional Models Versus Dental Casts: A Clinical Study

Objective

The aim of this study was to compare the accuracy of digital and plaster model methods and the time required for analysis.

Methods

A total of 30 subjects (20 females, 10 males; mean age, 14.36±6.30 years), who required plaster models for the construction of either a fixed or a removable orthodontic appliance, were randomly selected. As part of the diagnostic records, digital impressions with a three-dimensional (3D) intra-oral scanner (TriosColor-P13 Shape) were taken from all subjects. Conventional impressions for the orthodontic appliances were taken with alginate (Orthoprint, Zhermack, Italy), and the plaster models were obtained (Scheu-Dental, GmbH.D-58642, Iserlohn, Germany). Two groups were formed. In the conventional measurement group, manual measurements were taken on the plaster models, while in the digital measurement group, the 3Shape OrthoAnalyzer 2013 software was used to make the measurements on the 3D models. In both groups, the total time required to perform the Bolton analysis and space analysis was recorded, and the results were compared.

Results

There was no statistically significant difference found between the two groups in terms of the measurement values. The total time to perform all the analyses was determined to be shorter with digital models compared to conventional plaster models (p<0.001).

Conclusion

The Bolton analysis and space analysis measurements carried out on 3D models did not show any statistically significant difference compared to plaster models. The time taken to perform the analyses was shorter using digital models than for conventional plaster models.

The levels of matrix metalloproteinase-9 and neutrophil gelatinase-associated lipocalin in different stages of endometriosis

This study was designed to explore matrix metalloproteinase-9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) levels and MMP-9/NGAL ratio in women with and without endometriosis diagnosed surgically and/or histopathologically. The correlation between biomarkers and the severity of the disease is analysed. The revised American Fertility Society classification system was used to determine the severity of endometriosis. Serum MMP-9 and Ca125, urine NGAL levels were measured in all participants. Serum MMP-9 levels were significantly higher in the study group (n = 60) compared to controls (n = 31) (15.0 pg/mL (6.0-143.0) vs. 12.0 (4.0-18.0), respectively; p=.002). MMP-9 levels were significantly higher in severe endometriosis compared to mild endometriosis subgroups (p<.001). No significant difference was found between NGAL levels in study and control groups (p>.05). The diagnostic value of MMP-9 and NGAL is not superior than CA-125 for endometriosis. Nevertheless, MMP-9 might be a potential predictive marker for advanced stage of the disease. Impact Statement What is already known on this subject? The gold standard diagnostic test for diagnosis of endometriosis is laparoscopy combined with histopathological confirmation of eutopic endometrial glands and/or stroma. Both invasiveness and possible accompanying complications limit the preference regarding the surgical approach. Among non-invasive markers none has been accepted as gold standard neither for diagnosis nor for determining the severity of the disease. MMPs are extracellular endopeptidases, which have a significant role in degradation and remodelling of extracellular matrix for cellular migration and invasion. Among these, MMP-9 has been shown to be higher in eutopic/ectopic endometrial tissue in women with endometriosis and has been suggested to have a role in pathogenesis of endometriosis by promoting invasion of the endometriotic lesions. NGAL is an acute phase protein, which is involved in a variety of physiological and pathophysiological processes. The molecule has also been revealed to correlate with endometriosis pathophysiology through the epithelial-mesenchymal transition process which is the basis for the onset of endometriosis. But also, NGAL which composes a complex with MMP-9 (MMP-9 and NGAL complex), has been shown to protect MMP-9 from autodegradation in vitro which might be a contributing factor for endometriosis pathophysiology. What the results of this study add? MMP-9 cut-off level for prediction of severe endometriosis is a novel finding obtained from this study with acceptable sensitivity and specificity. On the other hand, NGAL seems to have no significant value either for diagnosis of for determining severity of the disease. After all, MMP-9 might be an easy use acceptable biomarker for endometriosis but further studies on larger populations are needed. What the implications are of these findings for clinical practice and/or further research? MMP might be a potential non-invasive predictive marker for advanced stage disease.

Effects of Modic Type 1 Changes in the Vertebrae on Low Back Pain

OBJECTIVE

The present study examined the physical extent of Modic type 1 (MT1) changes and other phenotypic magnetic resonance imaging (MRI) findings in the vertebrae of patients with low back pain (LBP) and MT1 changes. We also identified any correlations of these findings with the severity of pain and the Oswestry Disability Index (ODI). The relationship between the presence of pain and MT1 changes has been examined in several studies. However, to the best of our knowledge, no study has assessed the relationships between pain severity and ODI and the total vertebral area of MT1 involvement.

METHODS

After excluding any patient with MT2 or MT3 changes, 49 patients with a diagnosis of LBP and MT1 changes demonstrated on MRI were included. MT1 involvement area, disc height, number of Schmorl's nodes, disc degeneration (Pfirrmann grade), and cross-sectional area of the lumbar muscles were obtained via MRI. Additionally, patient demographic data, body mass index, physical activity level, and disability (ODI) scores were assessed.

RESULTS

The total vertebral area of MT1 involvement correlated significantly and positively with the ODI (P = 0.001). In the multivariate linear regression model, with ODI as the dependent variable and age, mean Pfirrmann grade, total vertebral area of MT1 involvement, and sex as independent variables, only the total vertebral area of MT1 involvement was significantly associated with the ODI.

CONCLUSIONS

A significant positive correlation was noted between the vertebral MT1 involvement extent and changes in the ODI. Other MRI features of patients with LBP were not related to pain severity or ODI.

Single center experience with intralesional bleomycin sclerotherapy for lymphatic malformations

PURPOSE

The purpose of our study was to evaluate the efficacy of percutaneous sclerotherapy using bleomycin in treatment of lymphatic malformations.

METHODS

Between January 2009 and January 2013, ten patients with lymphatic malformations who were admitted to the interventional radiology department were included in this retrospective study. Intralesional bleomycin was administered by percutaneous injection through 21-23 Gauge needles with a dose of 1 mg/kg body weight. Patients were clinically and radiologically assessed at baseline and followed at first and third months after treatment. Response to treatment was measured visually by using photographs and by radiological images. Symptomatic improvement was also evaluated either by patients or parents.

RESULTS

Excellent resolution was obtained visually in 80% of patients with lymphatic malformation. Significant resolution was achieved in 20% of patients. The percentage of radiographic resolution in size and the improvement in symptoms evaluated by patients or parents were similar with visual outcomes. No side effects were recorded except for fever in one patient and transient erythema in another patient.

CONCLUSION

Intralesional bleomycin is a safe and effective treatment for patients with lymphatic malformations.

Obestatin improves oxidative brain damage and memory dysfunction in rats induced with an epileptic seizure

Obestatin was shown to alleviate renal, gastrointestinal and haemorrhage-induced brain injury in rats. In order to investigate the neuroprotective effects of obestatin on seizure-induced oxidative brain injury, an epileptic seizure was induced with a single intraperitoneal (i.p.) dose of pentylenetetrazole (PTZ, 45mg/kg) in male Wistar rats. Thirty minutes before the PTZ injection, rats were treated with either saline or obestatin (1μg/kg, i.p.). Seizure was video-taped and then evaluated by using Racine's scoring (0-5). For the assessment of memory function, passive-avoidance test was performed before seizure induction, which was repeated on the 3rd day of seizure. The rats were decapitated at the 24th or 72nd hour of seizures and brain tissues were obtained for histopathological examination and for measuring levels of malondialdehyde (MDA), glutathione (GSH), reactive oxygen radicals and myeloperoxidase (MPO) activity. Obestatin treatment reduced the average seizure score, decreased the occurrence and duration of generalized tonic-clonic seizures, presenting with a shorter latency to their onset. Increased lipid peroxidation and enhanced generation of oxygen-derived radicals detected at the post-seizure 72nd h were suppressed by the consecutive treatments of obestatin, but no changes were observed by the single obestatin treatment in the 24-h seizure group. Neuronal damage and increased GFAP immunoreactivity, observed in the hippocampal areas and cortex of PTZ-induced rats were alleviated in 3-day obestatin-treated PTZ group. PTZ-induced memory dysfunction was significantly improved in obestatin-treated PTZ group as compared to saline-treated rats. The present data indicate that obestatin ameliorated the severity of PTZ-induced seizures, improved memory dysfunction and reduced neuronal damage by limiting oxidative damage.

Intraorbital foreign bodies: Clinical features and outcomes of surgical removal

BACKGROUND

The present study is an evaluation of clinical features and management outcomes of patients operated on for intraorbital foreign bodies (FBs).

METHODS

Medical records of 24 patients who underwent surgery for intraorbital FBs within a 10-year period were reviewed.

RESULTS

Twenty patients (83%) were male and 4 (17%) were female (mean age: 28 years; range: 4-69 years). Ten patients (42%) presented within 48 hours of injury, 7 (29%) within 3 days to 1 month, and 7 (29%) more than 1 month after injury. FBs were inorganic in 19 patients (79%), and organic in 5 (21%). Major ocular morbidities were orbital cellulitis (n=5), traumatic optic neuropathy (n=3), globe perforation (n=2), and rupture of rectus muscle (n=2). FBs could be completely removed in all cases. Mean follow-up time was 26 months (range: 1 month-10 years).

CONCLUSION

Intraorbital FBs are usually inorganic and metallic, and occur more frequently in young males. Orbital cellulitis, considered typical for organic FBs, may also occur with metallic that perforate lacrimal sac or paranasal sinuses. With appropriate caution, intraorbital FBs can be removed safely with current orbitotomy techniques.

Two photon absorption properties of four coordinated transition metal complexes of tetraarylazadipyrromethene compounds

New tetraarylazadipyrromethene metal complexes with four coordinate metals (cobalt(ii), nickel(ii), copper(ii) and zinc(ii)) and with three moieties (4-methylphenyl,4-methoxyphenyl and 1-naphthyl) were designed and synthesized targeting applications utilizing two photon absorption. The effects of metals with filled or unfilled d orbitals and substituents with various electron donor properties on the charge transfer mechanism and two photon absorption properties of tetraarylazadipyrromethene compounds were investigated by ultrafast pump-probe spectroscopy and open aperture Z-scan experiments as well as density functional theory (DFT) calculations. Ultrafast transient absorption spectra provide evidence of an efficient photoinduced intramolecular charge transfer between the ligand and metals which is independent of filled or unfilled d orbitals of metals. Although zinc has filled d orbitals, its complexes possess an absorption maximum including a shoulder which is attributed to partial ligand to metal L(π) → M(d*) charge transfer character (LMCT). Due to the charge transfer mechanism, metal complexes of tetraarylazadipyrromethene compounds exhibited two photon absorption properties in the femtosecond regime at 800 nm wavelength. The greatest two photon absorption cross section value was measured as 2690 GM for Zn(L(2))2 and 2374 GM for Co(L(3))2 complexes.

Enhancement of two photon absorption properties and intersystem crossing by charge transfer in pentaaryl boron-dipyrromethene (BODIPY) derivatives

Indication of charge transfer and an intersystem crossing mechanism for the B4 compound by using ultrafast pump probe spectroscopy.

Coagulation parameters and platelet function analysis in patients with acromegaly

OBJECTIVE

Acromegaly is associated with increased cardiovascular morbidity and mortality. The data about the evaluation of coagulation and fibrinolysis in acromegalic patients are very limited and to our knowledge, platelet function analysis has never been investigated. So, we aimed to investigate the levels of protein C, protein S, fibrinogen, antithrombin 3 and platelet function analysis in patients with acromegaly.

METHODS

Thirty-nine patients with active acromegaly and 35 healthy subjects were included in the study. Plasma glucose and lipid profile, fibrinogen levels, GH and IGF-1 levels and protein C, protein S and antithrombin III activities were measured in all study subjects. Also, platelet function analysis was evaluated with collagen/ADP and collagen-epinephrine-closure times.

RESULTS

Demographic characteristics of the patient and the control were similar. As expected, fasting blood glucose levels and serum GH and IGF-1 levels were significantly higher in the patient group compared with the control group (pglc: 0.002, pGH: 0.006, pIGF-1: 0.001, respectively). But lipid parameters were similar between the two groups. While serum fibrinogen and antithrombin III levels were found to be significantly higher in acromegaly group (p fibrinogen: 0.005 and pantithrombin III: 0.001), protein S and protein C activity values were significantly lower in the patient group (p protein S: 0.001, p protein C: 0.001). Also significantly enhanced platelet function (measured by collagen/ADP- and collagen/epinephrine-closure times) was demonstrated in acromegaly (p col-ADP: 0.002, p col-epinephrine: 0.002). The results did not change, when we excluded six patients with type 2 diabetes in the acromegaly group. There was a negative correlation between serum GH levels and protein S (r: -0.25, p: 0.04)) and protein C (r: -0.26, p: 0.04) values. Likewise, there was a negative correlation between IGF-1 levels and protein C values (r: -0.39, p: 0.002), protein S values (r: -0.39, p: 0.001), collagen/ADP-closure times (r: -0.28, p: 0.02) and collagen/epinephrine-closure times (r:-0.26, p: 0.04). Also, we observed a positive correlation between IGF-1 levels and fibrinogen levels (r: 0.31, p: 0.01).

CONCLUSION

Acromegaly was found to be associated with increased tendency to coagulation and enhanced platelet activity. This hypercoagulable state might increase the risk for cardiovascular and cerebrovascular events in acromegaly.

Evaluation of the clinical efficiency of transforaminal epidural steroid injection in the treatment of sciatica

Objective: Evaluation of clinical efficiancy of fluoroscopy-accompanied transforaminal epidural steroid injection in patients with symptomatic lumbar foraminal intervertebral disc herniation and foraminal stenosis. Methods: Fifty patients, who underwent fluoroscopic-guided epidural steroid injection between 19.12.2013 - 28.02.2014, were evaluated retrospectively. Pain levels of patients before the procedure, after 3 weeks and after 6 months were compared using visuel analog scale (VAS). Fifty percent or more decrease, less than 50% decrease and no change in VAS were evaluated as sufficient response, insufficient response and unresponsiveness, respectively. The patients were asked whether they would undergo this process again and “Yes”, “Maybe” and “No” answers were evaluated for patient satisfaction score. Results: In 50 patients (32 female, 18 male), average pain levels were found to be 8.4 (VAS 7-9), 4.3 (VAS 1-9) and 4.4 (VAS 0-9) before the procedure, 3 weeks after the procedure and 6 months after the procedure, respectively. While thirty-seven (74%) of the patients were found to have sufficient response to treatment 3 weeks after the procedure, 10 (20%) patients were found to have insufficient response. There was no response to treatment in 3 (6%) patients. While thirty-five (70%) of the patients were found to have sufficient response to treatment 6 months after the procedure, 10 (20%) patients were found to have insufficient response. Six months after the procedure, there was no response to treatment in 5 patients (%10). Statistically significant improvement was observed when the pre and post-procedure VAS scores were compared. Forty (80%) patients gave the answer “Yes” to the question whether they would undergo this procedure again. Conclusion: We found that fluoroscopic guided transforaminal epidural steroid injection is effective in pain relief in patients with lumbar foraminal intervertebral disc herniation and foraminalstenosis that are resistant to pharmacological and physical therapy and have no absolute indication for surgery.

Spectral and thermal characterization of salophen type Schiff base and its implementation as solid contact electrode for quantitative monitoring of copper(II) ion

Salophen templated Schiff base 2,3-bis(salicylaldimino)pyridine (H2IF) has been synthesized and fully characterized by a series of different spectroscopic methods and thermogravimetric analysis (TGA). It has been also further probed electrochemically and explored as a cation recognition ionophore in the form of a polymeric membrane as selective sensor for quantitative monitoring of Cu(2+). Dielectric properties of the membrane have been studied by electrochemical impedance spectroscopy (EIS). The potentiometric results have demonstrated that the sensor exhibits very good selectivity and sensitivity towards Cu(2+) over a wide variety of cations. The electrode has a linear response to Cu(2+) with a detection limit of 4.46×10(-8) and displays a Nernstian slope (29.14 mV/decade) between pH 3.0 and 6.0 with a fast response time less than 10s. The solid contact electrodes have been exploited over five mounts period with good reproducibility. The analytical availability of the proposed electrode has been evaluated by applying in the determination of Cu(2+) ions in water samples. The structural features and complexation of ionophore with Cu(2+) have been monitored by UV-Vis spectroscopy and spectral findings have been further supported by DFT and TD-DFT calculations.

Validation of a severity grading score (SGS) system for predicting the course of disease and mortality in patients with Crimean-Congo hemorrhagic fever (CCHF)

We aimed to validate a severity grading score (SGS) system for predicting the course of disease and fatality in Crimean-Congo hemorrhagic fever (CCHF). This SGS was established using several variables that were assumed to be associated with mortality and had clinical importance. We included patients diagnosed with CCHF from different centers. Patients who had symptoms of CCHF for <5 days were included. The patients were grouped into three categories according to mortality risk. An SGS ≤4 showed no association with mortality [n = 323 (79.9 % of the total study population), and all survived]. An SGS between 5 and 8 points was classified into the intermediate risk group (20 %), and 14 of 70 patients in this group died. An SGS ≥9 was classified as the high risk of mortality group and 11 of 11 patients in this group died (p = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for an SGS >9 points at admission were 96, 100, 97, 100, and 44 %, respectively. This SGS system may help appropriate the triage of patients, decrease the cost of treatment, and improve the functionality of healthcare staff. The present study is the first investigation about the validation of an SGS system in patients with CCHF.

Clinical evaluation of submerged and non-submerged implants for posterior single-tooth replacements: a randomized split-mouth clinical trial

The aim of this study was to evaluate clinical and radiographic results of submerged and non-submerged implants for posterior single-tooth replacements and to assess patient-based outcomes. Twenty patients were included in the study. A split-mouth design was used; implants inserted using a submerged technique were compared to those inserted with a non-submerged technique. Implants were restored with metal-ceramic crowns after 3 months. Reconstructions were examined at baseline, 6, 12, and 24 months. Standardized radiographs were made. Radiographic crestal bone level changes were calculated, as well as soft tissue parameters, including pocket probing depth, bleeding on probing, plaque index, and gingival index. Results were analyzed by two-way repeated measures of variance (ANOVA). To evaluate patient-based outcomes, patients were asked to complete a questionnaire at the 6-month follow-up; the Wilcoxon paired signed rank test was used to compare scores. The data of 18 patients were reviewed. During 24 months, non-submerged implants (0.57 ± 0.21 mm) showed significantly lower bone loss than submerged implants (0.68 ± 0.22 mm) (P<0.01). Patient satisfaction with non-submerged implants (median 87.5) was significantly higher than with submerged implants (median 81.5) (P<0.01). Non-submerged implants showed comparable clinical results to submerged implants and resulted in higher patient satisfaction due to decreased surgical intervention.