Predictive factors in the differential diagnosis of benign and malignant causes in patients undergoing endoscopic retrograde cholangiopancreatography for extrahepatic cholestasis

OBJECTIVE

Diagnosing benign vs. malignant extrahepatic cholestasis is challenging despite the currently available advanced imaging and endoscopic techniques. This study aims to determine the predictive accuracy of initial biochemical data and bile duct dilatation findings in transabdominal ultrasound (US) to differentiate between benign and malignant disease in patients with extrahepatic cholestasis.

PATIENTS AND METHODS

We reviewed the case records of 814 patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (in cases of unsuccessful ERCP) for extrahepatic cholestasis. The etiology of biliary obstruction was determined based on ERCP, endoscopic ultrasonography, radiology, cytology, biopsy, and/or clinical follow-up at one year. The patients were divided into benign and malignant groups according to the underlying etiology of biliary obstruction. A complete biochemical profile, transabdominal ultrasonography at presentation, and other demographic data were recorded.

RESULTS

Alkaline phosphatase (p = 0.002), aspartate aminotransferase (p = 0.038), and bilirubin levels were significantly higher in malignant patients. The mean age of patients with malignancy was 69.5 years, vs. 60.6 years in benign patients (p < 0.001). The likelihood of malignancy increased with the increased bilirubin levels (> 200 µmol/l: 30.0% sensitivity, 97.6% specificity). The total bilirubin level predicting malignancy as the best cut-off value was 111 mmol/L with optimum sensitivity and specificity (61.8% and 83.8%, respectively) and area under the curve = 0.756, (p < 0.001). Intrahepatic bile duct (IHBD) dilatation was significantly higher in malignant patients (p < 0.001).

CONCLUSIONS

A serum bilirubin level of 111 µmol/L or higher and the detection of IHBD dilatation on abdominal ultrasonography are important predictors in the differential diagnosis of benign and malignant causes of extrahepatic cholestasis.

The hidden cochlear implant

OBJECTIVE

The hidden cochlear implant concept has two data transmission methods: Bluetooth low energy and transtympanic optical data transfer systems. This study aimed to present the hidden cochlear implant and compare the test results with the existing fully implanted cochlear implant.

METHOD

The Bluetooth low energy module was implanted into the implant bed. For the transtympanic optical data transfer tests, a receiver was passed through the posterior tympanotomy, and the transmitter was placed in the ear canal.

RESULTS

The Bluetooth low energy module range was 5.2-17.5 m. Transtympanic optical data transfer reached a rate of 1 Mbit/s and had 99.22 per cent accuracy. Despite various obstacles, the accuracy of the transtympanic optical data transfer was more than 99 per cent with a 250 Kbit/s rate. The average power consumption was 310 mW for the implanted Bluetooth low energy module and 41 mW for the transtympanic optical data transfer receiver.

CONCLUSION

Bluetooth low energy is suitable to be used transcutaneously. Transtympanic optical data transfer is an effective and promising technology. Hidden use cochlear implants aim to have the aesthetics of a fully implantable cochlear implant with higher reliability and a magnet-free design with smart device integration.

An Explainable Vision Transformer Model Based White Blood Cells Classification and Localization

White blood cells (WBCs) are crucial components of the immune system that play a vital role in defending the body against infections and diseases. The identification of WBCs subtypes is useful in the detection of various diseases, such as infections, leukemia, and other hematological malignancies. The manual screening of blood films is time-consuming and subjective, leading to inconsistencies and errors. Convolutional neural networks (CNN)-based models can automate such classification processes, but are incapable of capturing long-range dependencies and global context. This paper proposes an explainable Vision Transformer (ViT) model for automatic WBCs detection from blood films. The proposed model uses a self-attention mechanism to extract features from input images. Our proposed model was trained and validated on a public dataset of 16,633 samples containing five different types of WBCs. As a result of experiments on the classification of five different types of WBCs, our model achieved an accuracy of 99.40%. Moreover, the model's examination of misclassified test samples revealed a correlation between incorrect predictions and the presence or absence of granules in the cell samples. To validate this observation, we divided the dataset into two classes, Granulocytes and Agranulocytes, and conducted a secondary training process. The resulting ViT model, trained for binary classification, achieved impressive performance metrics during the test phase, including an accuracy of 99.70%, recall of 99.54%, precision of 99.32%, and F-1 score of 99.43%. To ensure the reliability of the ViT model's, we employed the Score-CAM algorithm to visualize the pixel areas on which the model focuses during its predictions. Our proposed method is suitable for clinical use due to its explainable structure as well as its superior performance compared to similar studies in the literature. The classification and localization of WBCs with this model can facilitate the detection and reporting process for the pathologist.

Review of Deep Learning-Based Atrial Fibrillation Detection Studies

Atrial fibrillation (AF) is a common arrhythmia that can lead to stroke, heart failure, and premature death. Manual screening of AF on electrocardiography (ECG) is time-consuming and prone to errors. To overcome these limitations, computer-aided diagnosis systems are developed using artificial intelligence techniques for automated detection of AF. Various machine learning and deep learning (DL) techniques have been developed for the automated detection of AF. In this review, we focused on the automated AF detection models developed using DL techniques. Twenty-four relevant articles published in international journals were reviewed. DL models based on deep neural network, convolutional neural network (CNN), recurrent neural network, long short-term memory, and hybrid structures were discussed. Our analysis showed that the majority of the studies used CNN models, which yielded the highest detection performance using ECG and heart rate variability signals. Details of the ECG databases used in the studies, performance metrics of the various models deployed, associated advantages and limitations, as well as proposed future work were summarized and discussed. This review paper serves as a useful resource for the researchers interested in developing innovative computer-assisted ECG-based DL approaches for AF detection.

Accurate deep neural network model to detect cardiac arrhythmia on more than 10,000 individual subject ECG records

BACKGROUND AND OBJECTIVE

Cardiac arrhythmia, which is an abnormal heart rhythm, is a common clinical problem in cardiology. Detection of arrhythmia on an extended duration electrocardiogram (ECG) is done based on initial algorithmic software screening, with final visual validation by cardiologists. It is a time consuming and subjective process. Therefore, fully automated computer-assisted detection systems with a high degree of accuracy have an essential role in this task. In this study, we proposed an effective deep neural network (DNN) model to detect different rhythm classes from a new ECG database.

METHODS

Our DNN model was designed for high performance on all ECG leads. The proposed model, which included both representation learning and sequence learning tasks, showed promising results on all 12-lead inputs. Convolutional layers and sub-sampling layers were used in the representation learning phase. The sequence learning part involved a long short-term memory (LSTM) unit after representation of learning layers.

RESULTS

We performed two different class scenarios, including reduced rhythms (seven rhythm types) and merged rhythms (four rhythm types) according to the records from the database. Our trained DNN model achieved 92.24% and 96.13% accuracies for the reduced and merged rhythm classes, respectively.

CONCLUSION

Recently, deep learning algorithms have been found to be useful because of their high performance. The main challenge is the scarcity of appropriate training and testing resources because model performance is dependent on the quality and quantity of case samples. In this study, we used a new public arrhythmia database comprising more than 10,000 records. We constructed an efficient DNN model for automated detection of arrhythmia using these records.

Convolutional neural networks for multi-class brain disease detection using MRI images

The brain disorders may cause loss of some critical functions such as thinking, speech, and movement. So, the early detection of brain diseases may help to get the timely best treatment. One of the conventional methods used to diagnose these disorders is the magnetic resonance imaging (MRI) technique. Manual diagnosis of brain abnormalities is time-consuming and difficult to perceive the minute changes in the MRI images, especially in the early stages of abnormalities. Proper selection of the features and classifiers to obtain the highest performance is a challenging task. Hence, deep learning models have been widely used for medical image analysis over the past few years. In this study, we have employed the AlexNet, Vgg-16, ResNet-18, ResNet-34, and ResNet-50 pre-trained models to automatically classify MR images in to normal, cerebrovascular, neoplastic, degenerative, and inflammatory diseases classes. We have also compared their classification performance with pre-trained models, which are the state-of-art architectures. We have obtained the best classification accuracy of 95.23% ± 0.6 with the ResNet-50 model among the five pre-trained models. Our model is ready to be tested with huge MRI images of brain abnormalities. The outcome of the model will also help the clinicians to validate their findings after manual reading of the MRI images.

A new approach for arrhythmia classification using deep coded features and LSTM networks

BACKGROUND AND OBJECTIVE

For diagnosis of arrhythmic heart problems, electrocardiogram (ECG) signals should be recorded and monitored. The long-term signal records obtained are analyzed by expert cardiologists. Devices such as the Holter monitor have limited hardware capabilities. For improved diagnostic capacity, it would be helpful to detect arrhythmic signals automatically. In this study, a novel approach is presented as a candidate solution for these issues.

METHODS

A convolutional auto-encoder (CAE) based nonlinear compression structure is implemented to reduce the signal size of arrhythmic beats. Long-short term memory (LSTM) classifiers are employed to automatically recognize arrhythmias using ECG features, which are deeply coded with the CAE network.

RESULTS

Based upon the coded ECG signals, both storage requirement and classification time were considerably reduced. In experimental studies conducted with the MIT-BIH arrhythmia database, ECG signals were compressed by an average 0.70% percentage root mean square difference (PRD) rate, and an accuracy of over 99.0% was observed.

CONCLUSIONS

One of the significant contributions of this study is that the proposed approach can significantly reduce time duration when using LSTM networks for data analysis. Thus, a novel and effective approach was proposed for both ECG signal compression, and their high-performance automatic recognition, with very low computational cost.

Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit

BACKGROUND

The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered.

OBJECTIVE

Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests.

METHODS

Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Mιrioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, ιtagθre, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATB TM Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system,bioMιrieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation.

RESULTS

C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients' blood cultures were clonally same strains. PFGE analysis further confirmed this clonality.

CONCLUSION

According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.

The role of the eNOS G894T and T-786C gene polymorphism in the development of ascites in cirrhosis

OBJECTIVE

Increased nitric oxide (NO) production in cirrhotic patients causes splanchnic vasodilation, leading to the development of the hyperdynamic circulatory syndrome. One factor that influences plasma NO concentration is eNOS gene polymorphism; consequently, the aim of this study was to investigate whether the eNOS gene G894T and T-786C polymorphisms play any role in the development of ascites in such patients.

PATIENTS AND METHODS

Three groups were created: 70 cirrhotic patients with ascites, 69 cirrhotic participants without ascites (stable cirrhosis), and 60 healthy controls. Polymorphisms were determined using polymerase chain reaction (PCR) and melting curve analysis. The plasma nitrite (NO marker) level was measured by deploying the spectrophotometric Griess reaction.

RESULTS

Plasma nitrite levels in the cirrhosis with ascites and stable cirrhosis groups were significantly higher than in the controls (p < 0.0001). The frequency of GG, GT, and TT genotypes for the eNOS G894T polymorphism in the cirrhosis with ascites group was 55.7%, 38.6%, and 5.7% respectively, while in the stable cirrhosis group these figures were 60.9%, 36.2%, and 2.9%. In the controls, the distribution was 63.3%, 33.3%, and 3.3%, respectively. The frequency of TT, TC, and CC genotypes for the eNOS-786C polymorphism in the first group was 52.9%, 34.2%, and 12.9% respectively; in the second group, this was 46.4%, 42%, and 11.6%, and in the controls, 48.3%, 46.7%, and 5%. There were no significant differences in genotype and allele distributions of the eNOS-786C and eNOS G894T polymorphisms among the groups.

CONCLUSIONS

Plasma nitrite concentration is enhanced in cirrhotic patients, and there is no relationship between the G894T and eNOS-786C polymorphisms and the development of ascites.

Relapsing hydatid disease involving the vertebral body and paravertebral soft tissues

Hydatid disease involving the vertebral body and paravertebral soft tissues is rare even in rural areas where echinococcosis is endemic. We report a case with hydatid disease in the T11-L1 vertebral bodies and involvement in bilateral psoas muscles.

Comparison of colorectal neoplastic polyps and adenocarcinoma with regard to NLR and PLR

OBJECTIVE

Cancer-related inflammation affects many aspects of malignancy, including proliferation and survival of malignant cells, angiogenesis, and therapeutic response. Some biomarkers representing the degree of systemic inflammation, such as the Glasgow prognostic score, NLR and PLR, have been shown to have prognostic value in many kinds of cancer patients. Aim of this study to investigate to compare neutrophil/leukocyte (NLR) and platelet/lymphocyte (PLR) ratios of the patients with colorectal neoplastic polyps and colorectal cancer (CRC) and tried to determine whether this could be used as a biomarker in follow up of the patients with neoplastic polyps.

PATIENTS AND METHODS

A total of 100 colorectal polyps, 113 colorectal cancers and 124 healthy controls were included in the study. Exculusion criteria were endocrinologic or metabolic diseases, acute or chronic diseases, hypertension and atherosclerotic heart diseases, renal diseases. Blood count parameters of the patients were measured. The NLR was calculated as a simple ratio between the absolute neutrophil and the absolute lymphocyte counts. The PLR was defined as the platelet counts to lymphocyte ratio.

RESULTS

A statistically significant difference was not detected between Group A and C with regard to NLR and PLR. NLR and PLR were found statistically significantly high in Group B (CRC), Group A (colorectal polyp) and Group C (healthy individuals) (p < 0.001 and p < 0.001). Our study showed that the optimum NLR cut-off point for neoplastic polyps was 2.28 (sensitivity: 68.7%, specificity: 42.3%). When the sensitivity and specificity levels of the PLR were assessed, they were 68.7% and 46.5% for neoplastic polyps, 80% and 68.9% for colorectal cancer.

CONCLUSIONS

NLR and PLR may be used for follow up conversion of colonic and rectal neoplastic polyps to invasive tumor.

Association of colon adenomas and skin tags: coincidence or coexistence?

OBJECTIVES

Skin tag (STs) are benign connective tissue tumors of the dermis. Some researchers have argued that there is a relationship between skin tag and colon polyps, although the physiopathological mechanisms underlying this relation were not well elucidated. In this study we aimed to investigate the co-existence of colonic adenomatous polyps and ST, additionally to shed light on the physiopathological mechanisms underlying this coincidence.

PATIENTS AND METHODS

A total of 45 patients aged between 18 and 60 diagnosed with adenomatous colonic polyps and 45 sex, age, and socio-demographically matched subjects, had no polyps, were enrolled as the control group. Routine blood analysis of all participants, including serum glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), (high-density lipoprotein cholesterol (HDL-C), triglyceride, insulin, IGF-1, and EGF, were performed. The chi-square and independent sample t or Mann Whitney U test were used to determine differences between groups.

RESULTS

The number of participants with ST was significantly higher in the patient group (OR 7.067, p < 0.01). Serum levels of IGF-1 and EGF were statistically similar between the groups. In the subgroup analyses, no difference was found in serum levels of insulin, IGF-1, or EGF between patients with and without ST. However, higher serum levels of insulin and EGF were found in control subjects with ST (p < 0.01 and p < 0.01, respectively). For the entire study group, 67 participants had ST and 23 patients did not. Serum insulin, and IGF-1 were similar, while serum EGF levels were higher in patients with ST (p < 0.01).

CONCLUSIONS

Findings of the present study may show a co-existence of colonic polyps and ST. Although previous studies have indicated that insulin resistance may play a role in the pathogenesis of both lesions in diabetic and obese patients, we found no indication of a relationship in nondiabetic and nonobese patients with increased levels of EGF in patients with ST, suggesting an alternative pathogenesis in this patient group.

The effect of orthodontic extraoral appliances on depression and the anxiety levels of patients and parents

BACKGROUND

Psychosocial consequences and post-operative anxiety in patients after fixed orthodontic treatment are important parameters that must be evaluated by clinicians not to effect patient and their parent's psychosocial mood negatively.

OBJECTIVE

The aim of this study was to evaluate the changes in depression and anxiety levels of orthodontic patients and their parents before the extraoral appliance therapy, and at a 1-year follow-up.

MATERIALS AND METHODS

Patients and one of their parents responded to a series of questionnaires and evaluation scales in order to assess depression and anxiety levels. Two groups of patients and their parents were surveyed; one group that had not yet embarked on the treatment and another that had commenced extra-oral appliance therapy 1 year prior to the study.

RESULTS

The 1-year-treatment group scored significantly higher than the pre-treatment group on the depression scale and the trait-anxiety scale. State-trait anxiety inventory scores did not differ significantly between the groups. The parents of the 1-year-treatment group also scored significantly higher on the Beck depression inventory than those of the pre-treatment group.

CONCLUSION

The results of this study emphasize the need for due consideration of psychological parameters before and during treatment with extra-oral appliances, particularly with regard to depression and anxiety.

Carotid intima-media thickness and serum paraoxonase-1 activity in patients with Helicobacter pylori

AIM

To evaluate serum paraoxonase(PON)-1 activity and carotid intima-media thickness (CIMT) in patients with Cytotoxin-associated antigen(CagA)-positive and negative Helicobacter pylori strains.

PATIENTS AND METHODS

The study group included a total of 134 individuals, of whom 103 were H. pylori positive, and 31 were H. pylori negative. Five biopsies were collected from each patient for histological examination: two from the antrum, two from the corpus, and one from the incisura angularis. The presence of H. pylori was determined using a modified Gram staining protocol. Peripheral blood was collected from each patient to determine levels of triglyceride, TC, HDL-cholesterol and LDL-cholesterol. IgG antibodies against CagA protein were analyzed by enzyme immunoassays. PON-1 activity was measured by colorimetric method. Carotid intima-media thickness and atherogenic plaques were measured using a grey scale color Doppler ultrasound. Data were analyzed by descriptive and inferential statistics.

RESULTS

The right, the left and the mean CIMT were significantly higher in H. pylori (+) group versus H. pylori (-) group (p < 0.001 for all). However, the mean PON-1 concentration was significantly lower in H. pylori (+) group versus H. pylori (-) group (p < 0.001). The right, the left and the mean CIMT of CagA (+) group were significantly higher than that of CagA (-) group and controls, while PON-1 concentrations of CagA (+) group were significantly lower than that of CagA (-) group and controls (for all p = 0.0001). The right, the left and the mean CIMT of CagA (-) group were significantly higher than that of the control group, while the mean PON-1 concentration were significantly lower (for all p = 0.0001).

CONCLUSIONS

Decreased PON-1 activity may be an etiopathogenetic factor in increased atherosclerosis in patients with H. pylori infection, especially in those infected with the CagA positive strain.

Assesment life quality of familial Mediterranean fever patients by short form-36 and its relationship with disease parameters

BACKGROUND

Familial Mediterranean fever is an auto-inflammatory disorder. Long term complications of the disease include decreased quality of life. The measurement of quality of life in the patients with chronic disease has become an important research topic during the last years.

AIM

We aimed to evaluate life quality of the FMF patients by SF-36, and examine its relationship with the disease parameters.

PATIENTS AND METHODS

One hundred voluntary patients (69 female, 31 male) admitted to the rheumatology clinic were included in the study. The control group consisted of 100 healthy individuals. All subjects in the study were asked to complete SF-36 questionnaire. Age of onset of FMF, age at diagnosis, age at the beginning of colchicine therapy, number of attacks per month, family history of FMF and dialysis were inquired of patients with FMF. Disease severity was determined using the FMF severity score.

RESULTS

The mean age of the patient group was 31±12 and that of the control group was 29±9. Sixty-nine patients (69%) were female, and 31 patients were male (31%) in both groups. The mean scores of the physical function, physical role function, emotional role function, mental health, and general health parameters of the patients were statistically significantly lower than those of healthy volunteers (p < 0.05). The difference in social function and vitality between two groups was found to be insignificant (p > 0.05).

CONCLUSIONS

We have shown that FMF had a negative impact on SF-36. FMF reduces quality of life both in physical and mental dimensions.

The effect of radiofrequency ablation treatment on quality of life and anxiety in patients with supraventricular tachycardia

AIM

Paroxysmal supraventricular tachycardia (PSVT) has been shown to be associated with poor outcome in psychological status and quality of life. This study aimed to assess the quality-of-life and anxiety in patients with PSVT and to investigate the influence of radiofrequency ablation (RFA) treatment on these parameters.

MATERIALS AND METHODS

Fifty patients with newly diagnosed PSVT with electrophysiologic study and treated with RFA, were enrolled in the study and 50 healthy age-and sex-matched individuals. The brief version of World Health Organization Quality of Life Scale and the state-trait anxiety inventory were administered to controls and all patients before and three months after the RFA procedure.

RESULTS

At baseline, in comparison with the control group, the patients with PSVT exhibited greater anxiety average scores (p < 0.05). After RFA procedure, the patients with PSVT exhibited significant improvement in anxiety, quality of life and health satisfaction scores. Statistically significant difference between the controls and the patients in respect to state and trait anxiety average scores disappeared after treatment (p > 0.05).

CONCLUSIONS

In this study, normalization of anxiety and quality of life is associated with RFA treatment for patients with PSVT. This finding need to be confirmed by larger scale clinical trials with long-term quality of life follow-up in higher number of patients.

Multiple dural arteriovenous fistulas involving the cavernous sinus, transverse sinus, sigmoid sinus and spinal drainage: CT angiography findings in 14-year-old boy

Dural arteriovenous fistulas (DAVF) are rare and constitute 10% to 15% of all intracranial arteriovenous malformations. Only few cases of DAVFs are reported in children. Here is the first case report describing CT angiographic findings in a 14 year old child having multiple DAVFs involving spinal canal, both cavernous and cerebral sinuses.

Ethyl pyruvate protects colonic anastomosis from ischemia-reperfusion injury

Ethyl pyruvate is a simple derivative in Ca(+2)- and K(+)-containing balanced salt solution of pyruvate to avoid the problems associated with the instability of pyruvate in solution. It has been shown to ameliorate the effects of ischemia-reperfusion (I/R) injury in many organs. It has also been shown that I/R injury delays the healing of colonic anastomosis. In this study, the effect of ethyl pyruvate on the healing of colon anastomosis and anastomotic strength after I/R injury was investigated. Anastomosis of the colon was performed in 32 adult male Wistar albino rats divided into 4 groups of 8 individuals: (1) sham-operated control group (group 1); (2) 30 minutes of intestinal I/R by superior mesenteric artery occlusion (group 2); (3) I/R+ ethyl pyruvate (group 3), ethyl pyruvate was administered as a 50-mg/kg/d single dose; and (4) I/R+ ethyl pyruvate (group 4), ethyl pyruvate administration was repeatedly (every 6 hours) at the same dose (50 mg/kg). On the fifth postoperative day, animals were killed. Perianastomotic tissue hydroxyproline contents and anastomotic bursting pressures were measured in all groups. When the anastomotic bursting pressures and tissue hydroxyproline contents were compared, it was found that they were decreased in group 2 when compared with groups 1, 3, and 4 (P < .05). Both anastomotic bursting pressure (P = .005) and hydroxyproline content (P < .001) levels were found to be significantly increased with ethyl pyruvate administration when compared with group 2. When ethyl pyruvate administration doses were compared, a significant difference was not observed (P > .05). Ethyl pyruvate significantly prevents the delaying effect of I/R injury on anastomotic strength and healing independent from doses of administration.

Preserving effects of melatonin on the levels of glutathione and malondialdehyde in rats exposed to irradiation

In this study we investigated whether pretreatment with melatonin was protective against the injury of the central nervous system (CNS) in rats receiving LD(50) whole body irradiation. The wistar rats were randomized into four groups: i) the control group (CG), ii) melatonin-administered group (MG; 1 mg/kg body weight), iii) irradiated group (RG; 6.75 Gy, one dose), and iv) melatonin-administered and irradiated group (MRG). Blood samples were drawn from the rats 24 h after the treatment and plasma glutathione levels were assayed. Plasma glutathione level was significantly higher in RG than CG. The melatonin pretreatment prevented GSH increase induced by irradiation. Lipid peroxidation and glutathione levels of rat cerebral cortex were determined in all groups after 24 h. Cortical malondialdehyde (MDA) was significantly higher in the RG. The melatonin pretreatment prevented cortical MDA increase induced by irradiation. Cortical GSH was significantly lower in RG than the CG. The melatonin pretreatment prevented cortical GSH decrease induced by irradiation. Tissue samples were obtained from cerebral cortex and hypothalamus which also were affected by ionizing irradiation in the CNS and were evaluated with electron microscopy. Histopathological findings showed that LD(50) whole body irradiation resulted in damage of the neuronal cells of CNS. The results obtained from this study demonstrated that pretreatment with melatonin prevented the damage that develops in CNS following irradiation. The beneficial effect of melatonin can be related to protection of the CNS from oxidative injury and preventing the decrease in the level of cortical glutathione.

Giant well-differentiated liposarcoma of retroperitoneum

Liposarcoma is a malignancy of fat cells that occurs in deep soft tissue and mostly seen in limbs and retroperitoneum. It is the most common mesenchymal tumor of the retroperitoneum. It is detected at very late stages especially when the tumor gains substantial size, weight of several pounds at the time of diagnosis because it is grows very silently in deep tissues in the retroperitoneal area. Therefore, most of the patients with liposarcoma have no symptoms until the tumor is getting very large and pressurizes on neighboring structures which causes tenderness, pain, or functional disturbances. A 61 year-old male patient admitted with one-year history of abdominal pain, distention. Computed tomography demonstrated a large retroperitoneal mass in fat density filling the pelvic cavity extending to epigastric region especially in the left side of abdomen, and displacing intestines to the right and left kidney and pancreas gland posteriorly. At laparotomy the retroperitoneal tumor weighed 13.2 kg, Histologically it was a well-differentiated liposarcoma. Total extirpation surgery is still the most effective treatment in well-differentiated liposarcomas. Close follow-up after surgery is mandotary due to high rates of recurrence (Fig. 3, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

Trial of a new pain assessment tool in patients with low education: the full cup test

AIMS AND SCOPE

Pain is subjective and pain assessment depends on the patient's self-report. The measurement of pain needs simple tools, especially in patients with low education. There are limited reports about pain assessment in this type of patient. The aims of the present study were to develop a pain scale that is easy for patients with low education to understand and to evaluate its usefulness in these patients.

METHODS

A total of 128 adult non-demented patients presenting with headaches or rheumatologic pain were included in this study. The first phase of the study involved 114 patients and aimed to estimate the usefulness of the full cup test (FCT) compared with the visual analogue scale (VAS). The second phase of the study involved 23 patients with headaches selected randomly from the 114 patients and assessed the usefulness of the FCT for detecting changes in pain levels. The third phase of the study involved 14 patients with low education suffering from headaches and examined the usefulness of the FCT in these patients.

RESULTS

The mean VAS and FCT scores were statistically correlated and reliable and did not differ significantly. Patients with low education understood the FCT more easily than the VAS.

CONCLUSION

We concluded that the FCT is useful for both assessing and differentiating changes in pain, and is suitable for assessing pain in patients with low education.

Melatonin treatment for prevention of oxidative stress: involving histopathological changes

This study was undertaken to test the effect of irradiation on the histopathology of the hypothalamus and cerebral cortex. In addition, the probable effects of radiotherapy on the activities of antioxidant enzymes and levels of nitric oxide (NO) in the plasma were investigated as well. The effects of melatonin treatment on radiotherapy-based central nervous system (CNS) damage were also studied. For this purpose, the rats were randomized into four groups. The first group was the control group (sham-exposed group), the second group received only melatonin, the third group was irradiated and the fourth group received both melatonin and irradiation. Plasma samples of rats were collected for measuring the activities of superoxide dismutase (SOD), catalase (CAT) and the levels of NO. 24 h after the interventions, tissue samples were obtained from the hypothalamus and the cerebral cortex for the light microscopic investigations. These tissues were mostly affected by radiation. The results indicated that the application of radiation significantly enhanced the levels of plasma SOD and NO. On the other hand, melatonin pretreatment prevented the decrease in plasma CAT activity induced by irradiation. It was found that the application of melatonin could significantly prevent the irradiation-induced damages. Light microscopic results revealed that the damage of the CNS by radiation was prevented by the application of melatonin.

Effect of separate and mixed rearing according to sex on fattening performance and carcass characteristics in Japanese quails (<i>Coturnix coturnix Japonica</i>)

Abstract. The objective of this study was to investigate the effect of sex of Japanese quails (Coturnix coturnix Japonica) on fattening performance and carcass characteristics. The quail chicks were divided into three groups, made up of 96 males or 92 females or 36 individuals of each sex, resulting in a total of 256 chicks. The chicks in the groups were raised using the same feeding regime (24% CP, 2900 kcal/kg ME) and housing conditions for 42 days. There were significant (P<0.01) differences between male and female groups in weekly live body weight (lbw) gain values on day 35, in average live body weight gain on days 35 and 42, and in lbw gain values between days 14 and 42. Slaughter weight and liver weight were significantly different between groups (P<0.01). The differences between the two sex in mixed group in average body weight gain, average lbw on days 35 and 42, average lbw gain, lbw gain between days 14 and 42, slaughter weight, hot carcass yield, and liver weight were found significant (P<0.01). Lbw, lbw gain, feed consumption, slaughter weight, hot carcass yield, weights of heart, liver and giblets were higher in female quails while feed conversion rate was lower. As a result, these data suggest that separate raising of male and female Japnese quails might be more advantageous.

Glutathione s-transferase m1, t1, and p1 gene polymorphism in exudative age-related macular degeneration: a preliminary report

PURPOSE

To elucidate whether the gene polymorphisms of glutathione S-transferase (GST) M1, T1, and P1 are associated with the development of exudative age-related macular degeneration.

METHODS

The authors genotyped 35 white patients with exudative age-related macular degeneration and 159 healthy controls. Genomic DNA from peripheral blood was examined using polymerase chain reaction and defined for the genetic polymorphisms of GST.

RESULTS

No association was observed between GSTM1, GSTT1, and GSTP1 polymorphisms and age-related macular degeneration risk (p>0.05). The frequencies of the combination of the GSTM1 (null) and GSTP1 (mutant), GSTM1 (null), and GSTT1 (null) genotype polymorphisms in patients with exudative age-related macular degeneration differed greatly from those of the control group (p=0.001 OR [95% CI]: 7.70 [2.28-25.98] and p=0.007 OR [95% CI]: 3.88 [1.51-10.02], respectively).

CONCLUSIONS

The present study suggests that the GSTM1 (null) and GSTT1 (null), GSTM1 (null), and GSTP1 (mutant) combinations may be a genetic risk factor for the development of exudative age-related macular degeneration. However, the potential role of GST polymorphisms as a marker of susceptibility to age-related macular degeneration needs further studies in a larger number of patients. (Eur J Ophthalmol 2006; 16: 105-10).

Glutathione S-transferase M1, T1, and P1 gene polymorphism in exudative age-related macular degeneration: a preliminary report

PURPOSE

To elucidate whether the gene polymorphisms of glutathione S-transferase (GST) M1, T1, and P1 are associated with the development of exudative age-related macular degeneration.

METHODS

The authors genotyped 35 white patients with exudative age-related macular degeneration and 159 healthy controls. Genomic DNA from peripheral blood was examined using polymerase chain reaction and defined for the genetic polymorphisms of GST.

RESULTS

No association was observed between GSTM1, GSTT1, and GSTP1 polymorphisms and age-related macular degeneration risk (p>0.05). The frequencies of the combination of the GSTM1 (null) and GSTP1 (mutant), GSTM1 (null), and GSTT1 (null) genotype polymorphisms in patients with exudative age-related macular degeneration differed greatly from those of the control group (p=0.001 OR [95% CI]: 7.70 [2.28-25.98] and p=0.007 OR [95% CI]: 3.88 [1.51-10.02], respectively).

CONCLUSIONS

The present study suggests that the GSTM1 (null) and GSTT1 (null), GSTM1 (null), and GSTP1 (mutant) combinations may be a genetic risk factor for the development of exudative age-related macular degeneration. However, the potential role of GST polymorphisms as a marker of susceptibility to age-related macular degeneration needs further studies in a larger number of patients.

Role of oxidative stress enzymes in open-angle glaucoma

PURPOSE

To investigate the role of oxidative stress and lipid peroxidation in the pathogenesis of primary open-angle glaucoma (POAG).

MATERIALS AND METHODS

The activities of myeloperoxidase (MPO), catalase (CAT), and the levels of plasma malondialdehyde (MDA) were measured in 40 (15 men and 25 women) patients with POAG and 60 (30 men and 30 women) healthy controls.

RESULTS

There was no significant difference in the activities of CAT and MPO between the POAG patients and the controls. However, the plasma MDA level was significantly higher in patients than the controls.

CONCLUSION

The results of this preliminary study suggest that the possible alterations of plasma MDA levels may be associated with the pathogenesis of POAG, but further research is needed to understand the role of oxidative damage in this important disorder of aging.

Plasma catalase activity and malondialdehyde level in patients with cataract

PURPOSE

Oxidative mechanisms play a major role in the aetiology and pathogenesis of cataract, especially in age-related cataract. Our study aims to investigate systemic oxidant and antioxidant markers in cataract patients.

METHODS

The activity of erythrocyte catalase and the level of malondialdehyde in plasma were measured in 40 patients with cataract and 60 healthy control subjects. The malondialdehyde level, as an index of lipid peroxidation, was determined by thiobarbitüric acid reaction according to Yagi. The determination of catalase activity was measured by a method that was defined by Beutler. Catalase enzyme activity and malondialdehyde level were evaluated to find out whether there was a significant difference in these variables. Analysis of variance was used by forming a general linear model that takes age and gender as the covariate.

RESULTS

CAT activity was found to be 13 920.2 +/- 847.9 U/l in cataract patients and 16 061.3 +/- 1126.6 U/l in control subjects. CAT activity in cataract patients was significantly lower than the control subjects (P = 0.008). Plasma MDA level is significantly higher in patients with cataract 4.47 +/- 0.35 nmol/ml compared to the control subjects 2.94 +/- 0.26 nmol/ml (P = 0.0001). There was no significant difference between different cataract subgroups when erythrocyte CAT activities and plasma MDA levels were compared (P = 0.322, 0.062).

CONCLUSION

This study shows that oxidant/antioxidant balances alter in the presence of cataract.

In vivo effect of vitamin C with cobalt on oxidative stress in experimental diabetic rat kidney

In the present study, kidney superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) activities, vitamin C and lipid peroxidation levels were investigated in diabetic rats. Diabetes was induced in rats by streptozotocin and the treated rats received 1 g/l vitamin C with 0.5 mM CoCl2 in drinking water at 2-week intervals for 6 weeks. Kidney SOD, GSH-Px, CAT activities and lipid peroxidation levels were significantly increased in diabetic rats at the end of the 2nd, 4th and 6th weeks (p < 0.05), whereas vitamin C level was decreased significantly (p < 0.05) at the end of the 6th week compared to those of controls. Vitamin C with cobalt treatment of diabetic rats resulted in partial restoration of SOD and CAT activities, thiobarbituric acid reactant substances and vitamin C levels at all times studied, whereas treatment did not change GSH-Px activity. These results suggest that vitamin C with cobalt effectively normalized hyperglycemia (at the end of the 6th week) but could not completely restore the altered endogenous defence systems in diabetic rat kidney.

Uveitis associated with granuloma annulare

PURPOSE

To report a case of uveitis associated with granuloma annulare (GA). GA is a benign, usually self-limited dermatosis of unknown origin, causing necrobiotic dermal and subcutaneous papules. So far, ocular involvement has not been reported in GA.

METHODS

We describe a case of uveitis with GA. Ocular examination findings were consistent with uveitis. Histopathologic studies on lower extremity lesions revealed features consistent with GA.

RESULTS

The patient was successfully treated with systemic and topical corticosteroids. After two months, however, the skin and eye lesions relapsed. When the same treatment was restarted, her lesions regressed within four weeks.

CONCLUSIONS

This case provides an example of concomitant uveitis and GA. To our knowledge, this is the first report of this combination.

Stability and storage conditions of NADH-cytochrome b5 reductase cross-linked into gelatin by chromium (III) acetate

NADH-cytochrome b5 reductase was isolated and partially purified from rabbit liver microsomes. It was immobilized into gelatin by chemical cross-linking. Chromium (III) acetate was used as cross-linker. The effects of pH and temperature on the immobilized cytochrome b5 reductase were investigated. The reusability and storage stability of immobilized enzyme were also tested. Immobilized NADH-cytochrome b5 reductase activities were found to be stable for at least 72 d and 24 uses. The storage stability of NADH-cytochrome b5 reductase was improved with immobilization at 25 degrees C.