Association Between Articular Eminence Structure and Joint Spaces in Temporomandibular Joints with Anterior Disc Displacement

BACKGROUND AND AIMS

The association among the joint spaces, articular eminence morphology, and disc displacement is not well documented in the literature. This study aims to evaluate and compare the joint spaces and the articular eminence structure (eminence height [Eh] and inclination [Ei]) using cone-beam computed tomography (CBCT) of temporomandibular joints (TMJs) with anterior disc displacements and joints with normal disc position.

METHODS

The study groups consisted of 75 TMJs of 39 patients. The disc status of TMJs was diagnosed with magnetic resonance imaging, and the measurements were performed on CBCT. Three groups, that is, normal disc position (NDP) group, anterior disc displacement with reduction (ADDWR) group, and anterior disc displacement without reduction (ADDWoR) group, were established. Anterior, superior, posterior joint spaces (AJS, SJS, and PJS, respectively), articular Eh, and articular Ei were measured. Statistical Package for the Social Sciences version 22 was used for statistical analysis. Shapiro-Wilk test was used to check the normality of data. Intergroup comparisons of categorical variables were assessed with Fisher-Freeman-Halton test. For comparison of continuous variables parameters, Mann-Whitney U test and Kruskal-Wallis test were used. Statistical significance level was determined as P < 0.05.

RESULTS

Significant differences were not found in intergroup comparisons for PJS. However, the difference between groups was found to be significant for AJS, SJS, Eh, and Ei. Intergroup comparisons were performed for these parameters. No significant difference was found between the NDP group and the ADDWR group for AJS, SJS, Eh, and Eİ. The mean AJS, SJS, Eh, and Ei values in ADDWoR were found to be significantly lower compared to the corresponding values in both NDP and ADDWR groups.

CONCLUSION

Decreased AJS and SJS when TMJ is evaluated with CBCT may be an indicator of ADDWoR. Authors suggest that narrowed articular Ei and reduced articular Eh can be one of the predisposing factors for anterior disc displacement.

Hydrogen peroxide signaling modulates neuronal differentiation via microglial polarization and Wnt/β-catenin pathway

OBJECTIVE

Reactive oxygen species (ROS) are generated within the cell and serve as second messengers in fundamental cellular processes under physiologic conditions. Although the deleterious effects of high-level ROS associated with oxidative stress are well established, it is unclear how the developing brain reacts to redox changes. Our aim is to investigate how redox alteration affects neurogenesis and the mechanism that underlies it.

MATERIALS AND METHODS

We investigated in vivo microglial polarization and neurogenesis in zebrafish after hydrogen peroxide (H2O2) incubation. To quantify intracellular H2O2 levels in vivo, a transgenic zebrafish line that expresses Hyper and termed Tg(actb2:hyper3)ka8 was used. Then, in vitro studies with N9 microglial cells, 3-dimensional neural stem cell (NSC)-microglia coculture, and conditioned medium experiments are carried out to comprehend the mechanism underlying the changes in neurogenesis upon redox modulation.

RESULTS

In zebrafish, exposure to H2O2 altered embryonic neurogenesis, induced M1 polarization in microglia, and triggered the Wnt/β-catenin pathway. N9 microglial cell culture experiments revealed that exposure to H2O2 resulted in M1 polarization in microglial cells, and this polarization was mediated by the Wnt/β-catenin pathway. Redox modulation of microglia interfered with NSC differentiation in coculture experiments. Neuronal differentiation was significantly higher in NSCs cocultured with H2O2-treated microglia when compared to control microglia. Wnt inhibition prevented the effects of H2O2-treated microglia on NSCs. No significant alterations were observed in conditioned medium experiments.

CONCLUSIONS

Our findings point to a robust interplay between microglia and neural progenitors influenced by the redox state. Intracellular H2O2 levels can interfere with neurogenesis by altering the phenotypic state of the microglia via the Wnt/β-catenin system.

Dental caries severity and related factors of 1307 Turkish boarding school children

Background

In Turkey, dental caries is a disease which still has been considering as a real public health problem. School children of lower socioeconomic status had greater caries experience and higher caries severity in both primary and permanent dentitions.

Aims

To determine the frequency of dental caries and its related factors among boarding school children.

Patients and Methods

Cross-sectional study. We examined 1307 boarding school children aged 7-14 for caries status and its related factors. Data on dental health and its related factors were obtained from the archive of Ege Oral Health and Dentistry Association. Comparisons of caries severity (as decayed/missing/filled primary teeth, dmft/decayed/missing/filled permanent teeth, DMFT and significant caries index,) and examination years were made. Caries trend were also identified. Correlations between caries severity and its related factors were also performed. SPSS 20.0 was used for statistical analysis.

Results

DMFT and SiC for DMFT of all children were 2.35 and 5.04, respectively. 70-year-old had the highest dmft, whereas 14-year-olds had the highest DMFT. No correlation was found between decreased dmft and tooth brushing frequency, regular dental check-ups, and oral hygiene status. There was a weak correlation between decreased DMFT and increased number of dental visits in 2008 and 2009. In children received more than one examination and/or treatment (n = 269), the SiC index for dmft was 10.52 in 2002. In 2004, the index decreased to 3.57. The SiC for DMFT was 4.09 in 2002 and 2004. No correlation was identified between decreased dmft and DMFT and tooth brushing frequency, regular dental check-ups, and oral hygiene status both for the years of 2002 and 2004. The mean dmft of 32 children had prophylaxis for dental caries in 2002 was significantly decreased in 2004.

Conclusion

Caries prevalence and severity of boarding school children were high even they were followed-up regularly.

A study on the spectral, microstructural, and magnetic properties of Eu-Nd double-substituted Ba0.5Sr0.5Fe12O19 hexaferrites synthesized by an ultrasonic-assisted approach

In this study, an examination on the spectral, microstructural, and magnetic characteristics of Eu-Nd double-substituted Ba_0.5Sr_0.5Fe₁₂O₁₉ hexaferrites (Ba_0.5Sr_0.5Nd_xEu_xFe_12-2xO₁₉ (x = 0.00-0.05) HFs) fabricated by an ultrasonic-assisted approach has been presented. An UZ SONOPULS HD 2070 ultrasonic homogenizer with frequency of 20 kHz and power of 70 W was used. The chemical bonding, structure and the morphology of the products were evaluated by Fourier-Transform Infrared (FT-IR) Spectroscopy, XRD (X-ray diffraction), scanning and transmission electron microscopy and techniques. The textural properties of the prepared nanomaterials were examined by using the Brunauer-Emmett-Teller (BET) method. The magnetic properties were studied using a vibrating sample magnetometer (VSM) at room temperature (RT) and low temperature 10 K. The magnitudes of various magnetic parameters including M_s (saturation magnetization), M_r (remanence) and H_c (coercivity) were estimated and evaluated. The M-H loops revealed the hard ferrimagnetic nature for all products at both temperatures. The M_s and M_r values showed a decreasing tendency with increasing degree of Eu³⁺ and Nd³⁺ substitutions whereas H_c values displayed an increasing trend. At RT, M_s, M_r and H_c values lie in the ranges of 63.0-68.8 emu·g^-1, 24.6-39.2 emu·g^-1 and 2252.4-2782.1 Oe, respectively. At 10 K, the values of M_s, M_r and H_c lie between 87.5-97.1 emu·g^-1, 33.5-40.1 emu·g^-1 and 2060.6-2417.2 Oe, respectively. The observed magnetic properties make the prepared products promising candidates to be applied in the recording media.

Sonochemical synthesis of Dy3+ substituted Mn0.5Zn0.5Fe2-xO4 nanoparticles: Structural, magnetic and optical characterizations

Mn_0.5Zn_0.5Dy_xFe_2-xO₄ (x ≤ 0.03) nanoparticles (NPs) were fabricated by using Ultrasonic irradiation using UZ SONOPULS HD 2070 ultrasonic homogenizer (frequency of 20 kHz and power of 70 W). Structural and morphological analyses were performed via XRD (X-ray powder diffractometer), TEM (Transmission electron microscopy) and SEM (Scanning electron microscopy). XRD presented the formation of Mn-Zn ferrite with average crystal size in 11 to 18 nm range. Direct optical energy band gaps (E_g) were specified applying diffuse reflectance investigations. E_g values are in a small band range of 1.61-1.67 eV. Low (10 K) and room temperature VSM data were recorded applying ±90 kOe external magnetic field. All samples exhibit superparamagnetic properties at RT. Magnetization parameters significantly increase due to coordination of Dy³⁺ rare earth ions. Magnetic moment per molecule (n_B) increases from 0.952 μ_B to 1.137 μ_B and from 2.312 μ_B to 2.547 μ_B at RT and at 10 K data respectively. 10 K coercivity (H_c) values decrease from 260 Oe to 43 Oe. All samples have squareness ratios (SQR) of 0.231-0.400 range assigning the multi-domain structure at 10 K. ZFC-FC magnetization curves that were registered for two selected samples exhibit a divergence and a sharp drop below their T_peak positions. This event is typically correlated to the collective freezing of system and spin-glass-like phase. Real part AC susceptibility data slightly shift toward high temperature regions with increasing frequencies. Critical Slowing Down (CSD) model explained the spin dynamics of interacting NPs consistently with literature and proved the spin-glass behavior of samples at low temperatures.

Sonochemical synthesis of Eu3+ substituted CoFe2O4 nanoparticles and their structural, optical and magnetic properties

Magnetic, optic and microstructural properties of ultrasonically synthesized CoEu_xFe_2-xO₄ (x ≤ 0.1) nanoferrites (NFs) have been examined in this study. After sonochemical synthesis, XRD and FT-IR analyses confirmed the purity, the structure (cubic spinel structure and Fd3m space group) and the spectral properties of the spinel ferrite samples. The spherical morphology and chemical compositions of the products were observed via transmission and scanning electron microscopes along with EDX and elemental mapping. Percent diffuse reflectance (%DR) was used for optical investigation. Optical band gaps (E_g) were estimated utilizing Kubelka-Munk theory and Tauc equation. E_g values are in a narrow band of 1.34 to 1.44 eV. The magnetic parameters like M_s (saturation magnetization), SQR = M_r/M_s (squareness ratio), n_B (magnetic moment), H_c (coercivity) and M_r (remanence) have been evaluated by analyzing measurements of magnetization versus magnetic field performed at room (RT; T = 300 K) and low (T = 10 K) temperatures. It is showed that the different produced CoEu_xFe_2-xO₄ (0.00 ≤ x ≤ 0.10) nanospinel ferrites present superparamagnetic (SPM) nature at RT. At low temperature, the various produced CoEu_xFe_2-xO₄ (x ≤ 0.08) nanospinel ferrites display ferrimagnetic (FM) nature. With exception, the x = 0.10 sample exhibit SPM behavior at T = 10 K. It is noticed that the Eu³⁺ substitutions alter in a significant way on the magnetic data. A decreasing trend in the M_s, M_r and n_B values was noted with Eu³⁺ substitutions.

Structural, magnetic, optical properties and cation distribution of nanosized Co0.7Zn0.3TmxFe2-xO4 (0.0 ≤ x ≤ 0.04) spinel ferrites synthesized by ultrasonic irradiation

This study expressed the influence of Tm substitution on the structural, optical and magnetic properties of Co-Zn spinel ferrites (Co_0.7Zn_0.3Tm_xFe_2-xO₄ (0.0 ≤ x ≤ 0.04)). The different compositions were synthesized by sonochemical method using Qsonica ultrasonic homogenizer, frequency: 20 kHz and power: 70 W for 60 min. XRD patterns proved the presence of single-phase spinel ferrites with crystallites size in the 8-10 nm range. Cation distribution approved the occupancy of octahedral (B) site by Tm. The morphology and the elements stoichiometry are obtainable through FE-SEM, EDX and elemental mapping. Optical band gap (E_g) values were estimated via DR % (percent diffuse reflectance) investigations and Kubelka-Munk theory. Tauc plots revealed that direct E_g values are ranging between 1.49 and 1.68 eV. The analyses of magnetization versus magnetic field, M(H), were performed. The following magnetic parameters like saturation magnetization M_s, squareness ratio (SQR = M_r/M_s), magnetic moment n_B, coercivity H_c and remanence M_r have been evaluated. M(H) curves revealed the superparamagnetic (SP) at RT and ferromagnetic property at 10 K. It was showed that the Tm³⁺ substitutions significantly affect the magnetic properties of host spinel ferrites. An increasing trend in the M_s, M_r, H_c, and n_B values was noticed for lower Tm³⁺ substitution content.

Structural, magnetic, optical properties and cation distribution of nanosized Ni0.3Cu0.3Zn0.4TmxFe2-xO4 (0.0 ≤ x ≤ 0.10) spinel ferrites synthesized by ultrasound irradiation

In this study, Tm³⁺ ion substituted NiCuZn nanospinel ferrites, Ni_0.3Cu_0.3Zn_0.4Tm_xFe_2-xO₄ (0.0 ≤ x ≤ 0.10), have been synthesized sonochemically. The structural, spectroscopic, morphological, optic and magnetic investigation of the samples were done by X-ray powder diffractometry (XRD), Fourier transform infrared spectrophotometry (FT-IR), UV-Vis diffused reflectance (%DR) spectrophotometry, transmission and scanning electron microscopies (TEM and SEM) along with EDX, Vibrating sample magnetometry (VSM), respectively. The purity of prepared products were confirmed via XRD, FT-IR, EDX and elemental mapping analyses. The analyses of magnetization versus M(H) (applied magnetic field) were performed at 300 and 10 K. The following magnetic parameters like M_s (saturation magnetization), SQR = M_r/M_s (squareness ratio), n_B(magnetic moment), H_c (coercivity) and M_r (remanence) have been discussed. M(H) loops revealed superparamagnetic property at RT and soft ferromagnetic nature at 10 K. It is showed that the Tm³⁺ substitutions significantly affect the magnetizations data. A decreasing trend in the M_s, H_c, M_r, and n_B values was detected with Tm³⁺ substitution.

Magnetic Attributes of NiFe2O4 Nanoparticles: Influence of Dysprosium Ions (Dy3+) Substitution

This paper reports the influence of dysprosium ion (Dy³⁺) substitution on the structural and magnetic properties of NiDy_xFe_2-xO₄ (0.0 ≤ x ≤ 0.1) nanoparticles (NPs) prepared using a hydrothermal method. The structure and morphology of the as-synthesized NPs were characterized via X-ray diffraction (XRD), scanning and transmission electron microscope (SEM, and TEM) analyses. ⁵⁷Fe Mössbauer spectra were recorded to determine the Dy³⁺ content dependent variation in the line width, isomer shift, quadrupole splitting, and hyperfine magnetic fields. Furthermore, the magnetic properties of the prepared NPs were also investigated by zero-field cooled (ZFC) and field cooled (FC) magnetizations and AC susceptibility measurements. The M_ZFC (T) results showed a blocking temperature (T_B). Below T_B, the products behave as ferromagnetic (FM) and act superparamagnetic (SPM) above T_B. The M_FC (T) curves indicated the existence of super-spin glass (SSG) behavior below T_s (spin-glass freezing temperature). The AC susceptibility measurements confirmed the existence of the two transition temperatures (i.e., T_B and T_s). Numerous models, e.g., Neel-Arrhenius (N-A), Vogel-Fulcher (V-F), and critical slowing down (CSD), were used to investigate the dynamics of the systems. It was found that the Dy substitution enhanced the magnetic interactions.

Microincisional Cataract Surgery (MICS) with Pulse and Burst Modes

PURPOSE

To compare the amount of ultrasound (US) energy and balanced solution (BS) required for burst mode and pulse mode during bimanual phacoemulsification surgery.

METHODS

One hundred cases were divided into two groups (the pulse mode Group 1 [50 eyes], the burst mode Group 2 [50 eyes]). One surgeon (M.B.) performed phaco notemulsification procedures using topical anesthesia with the AMO Sovereign in all patients. The technique was based on the nuclear hardness and surgeon's criteria and performed bimanually. The surgery time, total ultrasound time (UST) and effective US power (USP), and used balanced solution (BS) were retrospectively compared.

RESULTS

The mean surgery time, mean UST, and mean used BS volume were not statistically different in both groups (p>0.05). The mean EPT was statistically highly different in both groups (p>0.001). There was a slight tendency toward more surgery time in Group 2 than in Group 1, although the difference was not significant (p=0.146). Statistically significant higher results (Group 1: r=0,889, p<0.001, and Group 2: r=0,834, p<0.001) were seen in Group 1 when both groups were evaluated for the surgery time and used BS volume. When UST and used BS volume were evaluated in Groups 1 and 2, significant relation was seen in both but the correlation is statistically higher in Group 1 (Group 1: r=0,765, p<0.001, and Group 2: r=0,544, p<0.001).

CONCLUSIONS

The very low energy modes with the WhiteStar technology are suitable for bimanual cataract surgery.

Fournier's gangrene: an analysis of 80 patients and a novel scoring system

BACKGROUND

To create a better scoring system for outcome prediction for patients with Fournier's gangrene in order to design more appropriate and feasible management strategies.

METHODS

Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier's gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with the Fournier's gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score.

RESULTS

The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P < 0.001). The receiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002).

CONCLUSIONS

The power of the novel scoring system introduced in this study proves that in patients with Fournier's gangrene, the extent of the gangrene as well as the patient's age and physiological status have a significant effect on the outcome.

Expression of p16 in serous ovarian neoplasms

PURPOSE

We aimed to examine p16 protein expression in ovarian serous neoplasms along with normal ovarian tissues.

MATERIALS AND METHODS

P16 expression was immunhistochemically evaluated in 86 ovarian serous neoplasms (21 cystadenomas, 20 borderline tumors and 45 carcinomas) and 21 non-neoplastic ovarian tissue. The results were also compared with histopathological grade in serous adenocarcinomas.

RESULTS

P16 expression rates for benign, borderline ovarian tumors and ovarian cancer were 14.2%, 85% and 86.6%, respectively. It was significantly higher in carcinomas (p < 0.001) and borderline tumors (p < 0.001) compared to cystadenomas. No immunoreactivity was found in the non-neoplastic ovarian surface epithelial cells. The percentage of p16 expression did not change significantly with histological grade in carcinomas.

CONCLUSION

P16 expression is strong and widespread involving most tumor cells in serous papillary ovarian carcinomas, and is probably an early event.

Identification of distinct swallowing patterns for different bolus volumes

OBJECTIVE

To investigate the time interval between glottic closure and the opening of upper esophageal sphincter during swallowing, by means of the coupling of electromyographical (EMG) recordings on the thyroarytenoid (TA) and the cricopharyngeus (CP) muscles.

METHODS

TA-EMG and CP-EMG pause were recorded by concentric needle electrodes using time-locked delay-line circuitry of the EMG apparatus. EMG data obtained from a total of 273 swallows of saliva, 3, 5, 10 and 15 ml volumes of water, were compared.

RESULTS

The relation between the onsets of TA-EMG activity and the CP-EMG pause demonstrated three different patterns of swallows. Pattern A was the delay of the onset of TA-EMG between 50-500 ms, and pattern B was the overlap of its activity with the CP-EMG pause. Pattern C was the earlier occurrence of the TA-EMG 50-550 ms before the CP-EMG pause. Pattern A was the most frequent type of swallows whereas the pattern C appeared during swallowing of larger volumes.

CONCLUSIONS

Physiologically, there is a delay of the TA activation after the onset of CP-EMG pause during swallowing of small amounts in healthy subjects.

SIGNIFICANCE

This physiological phenomenon could be a potential risk of aspiration in patients with neurogenic dysphagia.

The investigation of the efficacy of insulin glargine on glycemic control when combined with either repaglinide or acarbose in obese Type 2 diabetic patients

Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >or= 7.7 mmol/l [corrected] and hemoglobin glycated (A1C) >or=9% under maximal OAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9+/-1.4% to 7.7+/-1.1% in group 1 and 11.0+/-1.4% to 8.1+/-1.4% in group 2. FBG levels were significantly decreased from 11.9+/-2.7 to 7.1+/-2.3 mmol/l in group 1 and 11.1+/-2.5 to 6.8+/-1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3+/-3.8 to 10.3+/-3.0 mmol/l in group 1 and 14.0+/-3.1 to 8.9+/-2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Symptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulence incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.

Frequency of atopy and allergic disorders among adults with Type 1 diabetes mellitus in the southern Marmara region of Turkey

AIM

Autoimmune disorders are considered to be associated with a Th1 immune response whereas allergic diseases with a Th2 response. Studies mainly performed on children revealed conflicting results regarding the association of atopy/allergic disease and autoimmune disorders. Therefore, we aimed to investigate the prevalence of allergic diseases in adult Type 1 diabetic patients.

METHODS

Eighty-nine Type 1 diabetic patients and 64 controls were enrolled into the study. Skin-prick test and European Community Respiratory Health Survey questionnaire were performed on all cases. Patients who gave at least one positive answer to questions about asthma in the questionnaire underwent pulmonary function test and methacholine challenge test.

RESULTS

Patients' mean age were similar in diabetic patients and controls (28.2+/-8.9 and 28.1+/-5.2 yr; respectively). In skin-prick test, the rate of positive response to at least one allergen was not significantly different in diabetes (29.2%) and in the control group (31.3%). In European Community Respiratory Health Survey questionnaire, diabetic patients waked up by an attack of cough more than controls did. The rate of physician-diagnosed asthma was similar in both groups. There was no difference between the 2 groups based on the answers of other questions about asthma and other allergic diseases such as allergic rhinitis, eczema, and drug allergy.

CONCLUSION

We found that atopy frequencies were similar in an adult population of Type 1 diabetic patients and controls. Although asthmatic symptom prevalence is increased in diabetic patients, the incidence of current asthma was similar in both groups.

Relationship between the affected ear in benign paroxysmal positional vertigo and habitual head-lying side during bedrest

OBJECTIVE

To assess the association between the habitual head position during bedrest and the affected ear in benign paroxysmal positional vertigo (BPPV).

STUDY DESIGN

Prospective trial of patients with active BPPV of the posterior semicircular canal, confirmed on physical examination.

METHODS

Seventy-five patients were asked to explain the head position and lying side they were accustomed to before falling asleep in bed.

RESULTS

Fifty patients (67 per cent) habitually adopted a lateral head position during bedrest. The ear affected by BPPV was found to be consistent with the head-lying side during bedrest in 43 cases (86 per cent) (29 cases for the right ear and 14 cases for the left ear).

CONCLUSION

Habitual lateral head-positioning during bedrest can be a major factor leading to the development of BPPV in the ipsilateral ear.

Detection of parvovirus B19 DNA in the lesional skin of patients with Behçet's disease

BACKGROUND

There is disagreement in the current evidence for viral aetiologies in the pathogenesis of Behçet's disease (BD).

OBJECTIVES

To investigate the presence of B19 DNA in skin lesions of patients with BD, compare with the skin of healthy controls and evaluate its role in the pathogenesis.

METHODS

In total, 40 patients diagnosed with BD according to the criteria proposed by the International Study Group for Behçet's Disease and routinely followed up at our centre were enrolled into the study. All the patients selected were in the active phase of disease. Skin and blood samples of patients with BD and of the healthy volunteers were examined for B19 serology, histopathology and genome expression.

RESULTS

The quantity of B19 DNA in nonulcerative BD lesions of was significantly different from ulcerative lesions in the study group and from the skin of the healthy controls (P < 0.01). For the nonulcerative lesions, real-time PCR analysis for B19 DNA was found to be 64% sensitive (95% CI 42.5-82.0) and 85% specific (95% CI 62.1-96.6) with a cut-off value of > 154 IU/mL (P < 0.001).

CONCLUSIONS

To the best of our knowledge, this is the first study that provides evidence for a possible causal link between BD and parvovirus B19, and our data suggest the presence of the virus, particularly in intact, nonulcerative skin lesions of BD. Limitations to this study include the limited number of participants, and the fact that the exact source of B19 DNA was undetected.

Vitiligo and ocular findings: a study on possible associations

OBJECTIVE

In this study, we aimed to evaluate the ocular findings in vitiligo patients and reveal any clinical feature that might suggest an association or a risk factor.

BACKGROUND

Very few reports in the literature are available about the ocular findings in vitiligo and the possible associations of the ocular findings in vitiligo patients have not been studied so far.

METHODS

A total of 45 patients with previously documented cutaneous vitiligo were examined for ocular findings. Demographic features including age, gender, duration of vitiligo, presence of associated autoimmune diseases, type of vitiligo and the anatomical distributions of vitiligo were recorded to evaluate a possible relationship with the ocular findings. Univariate and multivariate analyses as well as cluster analysis were performed. After description of the clusters, the Mann-Whitney U-test and Fisher's exact test were used to determine the variables. Concordance among the variables in each group was evaluated with the McNemar test.

RESULTS

Ten patients had ocular findings that included anterior segment (iris) involvement, ring-like peripapillary atrophy around the optic nerve, atrophy of pigment epithelium, focal hypopigmented spots and diffuse hypopigmentation. The presence of periorbital vitiligo was significantly related to the ocular findings. Cluster analysis revealed concordances between periorbital and genitalial localizations of vitiligo and ocular findings.

CONCLUSION

The number of patients and the range of ocular findings in our study are insufficient to make definite conclusions but anatomical localizations, primarily periorbital and to a lesser extent genitalial vitiligo, seem to be the most probably alerting features for ocular findings.

High-grade and low-grade gliomas: differentiation by using perfusion MR imaging

AIM

Relative cerebral blood volume (rCBV) is a commonly used perfusion magnetic resonance imaging (MRI) technique for the evaluation of tumour grade. Relative cerebral blood flow (rCBF) has been less studied. The goal of our study was to determine the usefulness of these parameters in evaluating the histopathological grade of the cerebral gliomas.

METHODS

This study involved 33 patients (22 high-grade and 11 low-grade glioma cases). MRI was performed for all tumours by using a first-passage gadopentetate dimeglumine T2*-weighted gradient-echo single-shot echo-planar sequence followed by conventional MRI. The rCBV and rCBF were calculated by deconvolution of an arterial input function. The rCBV and rCBF ratios of the lesions were obtained by dividing the values obtained from the normal white matter of the contralateral hemisphere. For statistical analysis Mann-Whitney testing was carried out. A p value of less than 0.05 indicated a statistically significant difference. Receiver operating characteristic curve (ROC) analysis was performed to assess the relationship between the rCBV and rCBF ratios and grade of gliomas. Their cut-off value permitting discrimination was calculated. The correlation between rCBV and CBF ratios and glioma grade was assessed using Pearson correlation analysis.

RESULTS

In high-grade gliomas, rCBV and rCBF ratios were measured as 6.50+/-4.29 and 3.32+/-1.87 (mean+/-SD), respectively. In low-grade gliomas, rCBV and rCBF ratios were 1.69+/-0.51 and 1.16+/-0.38, respectively. The rCBV and rCBF ratios for high-grade gliomas were statistically different from those of low-grade gliomas (p < 0.001). The rCBV and CBF ratios were significantly matched with respect to grade, but difference between the two areas was not significant (ROC analysis, p > 0.05). The cut-off value was taken as 1.98 in the rCBV ratio and 1.25 in the rCBF ratio. There was a strong correlation between the rCBV and CBF ratios (Pearson correlation = 0.830, p < 0.05).

CONCLUSION

Perfusion MRI is useful in the preoperative assessment of the histopathologicalal grade of gliomas; the rCBF ratio in addition to the rCBV ratio can be incorporated in MR perfusion analysis for the evaluation.

Therapy, outcome and analysis of c-kit expression in patients with extrapulmonary small cell carcinoma

In this study, we aimed to investigate the clinicopathological characteristics with special emphasis on c-kit expression and the treatment results of patients with extrapulmonary small cell carcinoma (EPSCC). The medical records of the patients with EPSCC were reviewed, and the data regarding patient and tumour characteristics, treatment and clinical outcome were retrieved and analysed. A total of 28 patients with the diagnosis of EPSCC were identified. There were 19 males and 9 females, with a mean age of 56.5 years. Patients with limited disease (LD) (n = 13) were treated with surgery, chemotherapy (CT) and radiotherapy with different sequences. Patients with extensive disease (ED) (n = 15) were mainly treated with combination CT. The median overall survival was 14.5 months in patients with LD compared to 11 months in those with ED (p = 0.029). Ten patients (36%) showed c-kit overexpression. There was no significant difference between the survival of c-kit-positive and c-kit-negative patients (p = 0.367). In conclusion, our study demonstrates that the prognosis of EPSCC is poor despite currently available treatments. C-kit may be considered as a potential target for novel therapeutical approaches.

Necrotizing pneumonia in children

AIM

Clinical features and outcome of 36 patients with necrotizing pneumonia (NP) as well as 36 children with parapneumonic effusions (PPE) and 36 with severe control pneumonia (CP) were investigated. The mean age of the patients in the NP, PPE and CP groups were similar (3.8 +/- 3.3 (mean +/- SD), 4.2 +/- 3.0 and 4.2 +/- 3.0 y, respectively (p > 0.05)). The duration of symptoms at presentation were 11.9 +/- 8.5, 9.2 +/- 7.2 and 6 +/- 3.6 d, respectively (p < 0.01). The diagnosis of NP was established by computerized tomography. The mean (mean +/- SD) laboratory results in patients with NP revealed a white blood cell (WBC) count of 19,300 +/- 8700/mm3, erythrocyte sedimentation rate (ESR) of 71 +/- 22 mm/h, C-reactive protein (CRP) of 13.6 +/- 11.7 mg/dl and aspartate aminotransferase (AST) of 66 +/- 132 U/L. The values of WBC, ESR, CRP and AST in the NP group were significantly higher than those of the other groups (p < 0.001). The duration of hospitalization in the NP, PPE and CP groups was 26 +/- 9, 16 +/- 6 and 10 +/- 5 d, respectively (p < 0.001). The number of febrile days was 8 +/- 4, 4 +/- 3 and 3 +/- 3 (p < 0.001), and the duration of normalization of CRP was 14 +/- 4, 11 +/- 4 and 7 +/- 3 d (p < 0.001), respectively. The average cost of treatment was 3476 US dollars, 1646 US dollars and 844 US dollars, respectively (p < 0.001).

CONCLUSION

All NP patients except two (94%) were complicated with PPE. The effusion in patients with NP and PPE was complicated with bronchopleural fistula (55% and 0%, respectively, p < 0.001). Surgical treatment was required in 66%, 8% and 0% in patients with NP, PPE and CP, respectively (p < 0.001). The mortality rate was 5.5%, 2.7% and 0% (p > 0.05).

Comparison of the serum erythropoietin levels in chemotherapy-naive and cisplatin-treated cancer patients

There are conflicting data about the effects of cisplatin on erythropoietin (EPO) response to anemia. Aim of our study was to investigate whether endogenous EPO response to anemia in cisplatin treated patients was insufficient in comparison to the anemic chemotherapy-naive cancer patients and non cancer patients with iron deficiency anemia. Patients who had hemoglobin (Hb) levels of less than 110 g/l were included in the study. Fifteen chemotherapy- naive cancer patients were enrolled in Group A. Group B consisted of 15 patients who had been treated with three cycles of cisplatin chemotherapy and then became anemic and in Group C were included 15 patients who had iron deficiency anemia, without any malignancy. The mean Hb values were not different between all groups (102.8+/-39.8 g/l, 103.1+/-2.5 g/l and 99.3+/-3.6 g/l in Group A, Group B and Group C, respectively). However, EPO levels were found to be significantly lower in Group A and Group B than Group C (29.63+/-9.09 mU/ml, 20.87+/-2.43 mU/ml and 85.38+/-25.72 mU/ml, respectively; p=0.017 Group A vs. Group C, p=0.005 Group B vs. Group C). No significant difference was found between Group A and B (p=0.917). Opposite the iron deficiency anemia, cancer anemia is associated with an inadequate EPO response to anemia and administration of cisplatin does not lead to it further deterioration.

Randomized Phase 2 Study of Radiotherapy Alone versus Radiotherapy with Paclitaxel in Non-Small Cell Lung Cancer

This randomized phase 2 study aimed to assess and compare the toxicity and response rates in patients with unresectable non-small cell lung cancer treated with radiotherapy (1.8-2 Gray [Gy] daily, five fractions a week, total 63 Gy) or radiotherapy + paclitaxel administered weekly (1.8 Gy daily, five fractions a week, total 59.4 Gy). Twelve patients in the latter arm received 30 mg/m2 paclitaxel (median six cycles) over a 3-h infusion once weekly. After assessing toxicity, the remaining nine patients received 60 mg/m2 paclitaxel weekly (median six cycles). Response was evaluated radio-logically 1 month after treatment. Grade 3 toxicity was 20% and 38% in the radiotherapy and chemoradiotherapy groups, respectively. Overall survival rates in complete and objective (complete plus partial) responders and progression-free survival rate of the objective responders were significantly better in the chemoradiotherapy arm. We believe that using paclitaxel in concurrent chemoradiotherapy regimens may be effective in patients with unresectable, locoregionally advanced non-small cell lung cancer.

The progression of maternal RSV antibodies in the offspring

The concentrations of maternal anti-RSV IgG antibodies were followed in 49 healthy newborns over the first six months of life. At birth, 41 mothers (83%) tested positive for anti-RSV IgG and all of their babies carried maternal anti-RSV IgG. Anti-RSV IgG positivity dropped to 73% at 1 month, 6% at 3 months, and 2% at 6 months. Between 3 and 6 months, 8% did acquire RSV infection, half of them as acute bronchiolitis and half as non-specific respiratory infection. All of the patients who acquired clinical RSV disease had an antibody concentration of <20 RU/ml which may be the cut off value for protection.

Survival analysis of the factors affecting in mortality in injured patients requiring dialysis due to acute renal failure during the Marmara earthquake: survivors vs non-survivors

BACKGROUND

We reviewed medical records of dialyzed patients admitted to our hospital after the Marmara earthquake and evaluated the factors affecting mortality in survivors and non-survivors according to the survival times.

PATIENTS AND METHODS

Crush syndrome (CS) was diagnosed in 110 patients. Dialysis treatment was initiated in 60 patients; 21 of all died. The patients were divided into 2 groups which consisted of 39 survivors (Group A, 25 male, 14 female, mean age: 31 +/- 2.2 years) and 21 non-survivors (Group B, 9 male, 12 female, mean age: 27 +/- 3.0 years). Victims treated by any form of renal replacement therapy, including daily or intermittant hemodialysis and/or continuous venovenous hemodiafiltration. Clinical and laboratory findings were recorded regularly. Statistical analysis was performed with Kaplan-Meier method, log rank test and Cox regression analysis for the survival functions.

RESULTS

APACHE II scores were 13.5 +/- 0.5 for Group A and 13 +/- 0.9 for Group B. Dialysis support was started to patients in Group A in a mean period of 2.8 +/- 0.2 days and in Group B in a mean period of 3.7 +/- 0.6 days after the earthquake (p > 0.05). The most frequent site of trauma was lower extremity (61.5%) and upper + lower extremities (23%) in Group A, and lower extremity (38.1%) and trunk + lower extremity (23.8%) in Group B. The frequencies of abdominal trauma, pelvic fracture and thoracic trauma in Group B were 23.8%, 19% and 14.2%, respectively. Multiple trauma was more frequent in Group B than in Group A (42.8% vs 2.5%). The rates of fasciotomy, amputation and surgery were similar in both groups. The frequency of sepsis was higher in non-survivors. In our center, the overall mortality rate was 8%, mortality rate in CS was 21% and in dialyzed patients it was 35%. Mortality was mainly associated with sepsis. Survival periods (52.3 +/- 4.0 days) in Group A were longer than in Group B (17.3 +/- 2.5 days). With Cox regression analysis, the parameters such as systolic hypotension on admission, female gender, high serum peak creatine kinase (> 20,000 U/l) and multiple trauma including thoracic and abdominal regions, were factors increasing risk of mortality.

CONCLUSION

As a result, sepsis, multiple trauma and severe crush injury were the main factors increasing mortality risk in dialyzed injuries after the earthquake.

The role of triple therapy, age, gender and smoking on the genotoxic effects of Helicobacter pylori infection

The role of age, gender and smoking on both the genotoxic effects of Helicobacter pylori and the efficacy of eradication therapy in a group of patients with gastritis was investigated. Gastritis was confirmed by endoscopy and biopsy, and the presence of H. pylori by urease testing. Pre- and post-treatment peripheral blood lymphocyte cultures were prepared from 17 patients and 25 metaphases per patients were analysed for sister chromatid exchange (SCE), a well-established technique for the evaluation of human exposure to toxic agents. Treatment with omeprazole, clarithromycin and amoxycillin triple therapy eradicated H. pylori in 94% of patients and significantly reduced the SCE frequency. Pre-treatment SCE frequency was found to be positively correlated with age. Female smokers tended to have higher post-treatment SCE frequencies than male smokers, and pre- and post-treatment SCE frequencies were higher in older males than in older females. Eradication therapy decreased the genotoxicity of H. pylori, but age in males and smoking in females may decrease treatment efficacy.

C-banding visualized by atomic force microscopy

C-banding is a method used for studying chromosome rearrangements near centromeres and for investigating polymorphisms. In human chromosomes, the C-bands are located at the centromere of all the chromosomes and the distal long arm of the Y chromosome. In this study, we aimed to detect the structural changes in chromosomes during the stages of C-banding by atomic force microscopy. We observed crater-like structures in the chromosomes after 2xSSC (saline sodium citrate) treatment and measured the relative difference between the heights of chromatid and centromere of the chromosomes. Results showed that the relative difference was 3 nm in chromosomes 1, 9, 16, and Y, whereas in the other chromosomes this value was 11.6 nm. After Giemsa staining, the relative difference increased by a factor of 16 in chromosomes 1, 9, 16, and Y. The other chromosomes showed no such increase, which is in accordance with our suggestion that nonhiston proteins associated with DNA in constitutive heterochromatin can make the constitutive heterochromatin resistant to C-banding.

First experience with transnasal and transseptal endoscopic and microscopic repair of anterior skull base CSF fistulae

Currently, endoscopic endonasal surgery is a valuable and safe procedure routinely performed for treatment of paranasal sinus disorders. Since the endoscopic technique has become popular in this area, interest has been increased in its possible use for some other indications such as transsphenoidal pituitary and anterior skull base surgery. In this paper, we present our experience in using the nasal endoscope for repair of anterior skull base cerebrospinal fluid (CSF) fistulae. Between 1994-1999, we observed 44 patients with CSF rhinorrhea. Out of 44 patients, 34 had improved with the conservative treatment in two weeks, in 10 patients endoscopic surgery was performed and in one patient endoscopic surgery failed and the defect was repaired with transsphenoidal microscopic surgery. The remaining 9 patients were doing well and no problem was encountered concerning the surgery.

Effects of iron deficiency anemia on hemoglobin A1c in type 1 diabetes mellitus

BACKGROUND

The relationship between hemoglobin A1c (HbA1c) and iron status in type 1 diabetes mellitus (DM) has not been adequately studied. In this prospective investigation, we aimed to determine the effect of iron deficiency on HbA1c in diabetic patients who also had insufficient iron stores.

METHODS

Thirty-seven patients with type 1 DM were included in the study. Eleven of them were also iron deficient (ID) and the remaining 26 were iron-sufficient (IS). Two non-diabetic control groups were selected for the ID and IS groups. All patients with ID were treated with iron at 6 mg/kg per day for 3 months. Glycemia in diabetic patients was monitored at home before breakfast and supper by a glycometer. Hemoglobin A1c was measured in all subjects at the beginning and the end of the study.

RESULTS

Patients with ID DM had higher levels of HbA1c than those in the control group (P < 0.001). There were no significant differences in the weekly average glucose concentration of the patients with ID DM before and after iron supplementation. In contrast, HbA1c decreased from a mean of 10.1 +/- 2.7% to a mean of 8.2 +/- 3.1% (P < 0.05). Additionally, HbA1c in ID non-diabetic patients decreased from a mean of 7.6 +/- 2.6% to 6.2 +/- 1.4% after iron therapy (P < 0.05).

CONCLUSIONS

We conclude that among type 1 DM patients with similar level of glycemia, iron deficiency anemia is associated with higher concentrations of HbA1c. In addition, iron replacement therapy leads to a drop in HbA1c in both diabetic and non-diabetic patients. The iron status of the patient must be considered during the interpretation of HbA1c concentrations in type 1 DM.