Histological assessment of endometrial polyps resected by hysteroscopy

OBJECTIVE

This study aimed to analyze the clinical data and pathologic aspects of endometrial polyps (EMPs) excised completely during surgical hysteroscopy and assess the connection between premalignant and malignant EMPs.

PATIENTS AND METHODS

This retrospective study includes 489 participants who underwent hysteroscopy due to endometrial polyps, and the clinical features and histological findings of the resected polyps analyzed.

RESULTS

Participants with EMPs were divided into six groups according to histologic findings. The histologic finding of most cases was simple benign endometrial polyp [397 patients (81.2%)]. Malignant polyp was detected in 3 patients (0.6%). The histologic findings according to age, menopausal status, and menstrual bleeding patterns at the time of presentation to the outpatient clinic were compared; however, no significant difference was observed. 237 patients were observed to have menometrorrhagia, which was the most prevalent symptom reported. The distribution of polyp sizes observed at hysteroscopy according to histologic findings was compared, but no significant difference was observed.

CONCLUSIONS

EMPs are often benign but can include premalignant or malignant tissue changes. Hysteroscopy is used for direct observation of the uterine cervix and resection of existing polyps, considering the increasing frequency of its use as a diagnostic and treatment tool.

Asprosin improved neuronal survival by suppressing apoptosis and enhancing the activity of the autophagy pathway in the MCAO model in rats

OBJECTIVE

Cerebral ischemia (CI) is a condition in which metabolic stress increases when blood flow is interrupted in a part of the brain, resulting in oxygen and glucose deprivation. It is known that asprosin (Asp), secreted from adipose tissue during fasting, has an effect on some metabolic processes such as apoptosis, autophagy, and glucose metabolism. This study aimed to explain which of the cell death/survival Asp induces in the CI/reperfusion model.

MATERIALS AND METHODS

In the study, 48 male Wistar Albino rats were divided into 6 groups: Sham, CI, Asp+CI, CI+Asp, CI+Asp+3-MA, and Asp+CI+3-MA (n=48). CI was created using the intraluminal filament technique for 60 minutes, autophagy inhibitor 3-MA (15 mg/kg/day) and Asp (1 µg/kg/day) injections were administered 3 days before or 3 days during reperfusion. Beclin-1, ATG5, ATG7, p62, Bcl-2, Bax, active-caspase-3, and active-caspase-9 protein levels from brain tissues were determined by the Western-Blot method. The infarct area was determined by triphenyl tetrazolium chloride (TTC) staining. The Kruskal-Wallis' test was used to compare differences between groups. p<0.05 was considered statistically significant.

RESULTS

Compared to the Sham group, the increase in ischemic area and the decrease in Beclin-1, ATG-5, ATG-7, Bcl-2, Bax, active-caspase-3 and active-caspase-9 levels in the CI groups are statistically significant (p<0.05). The increase of Beclin-1, ATG-7, Bcl-2, and Bax levels in the Asp groups is statistically significant compared to the CI group (p<0.05). When Asp+CI groups and CI+Asp groups are compared, an increase in Beclin-1 levels in the Asp+CI group and the increase in Bcl-2, Bax, active-caspase-3/9 and ATG-5 levels in the CI+Asp groups are statistically significant (p<0.05).

CONCLUSIONS

Asp has protective and therapeutic effects against CI/R damage. While applying Asp before ischemia activates the autophagy pathway more, applying it after ischemia protects the neuronal death/survival balance by activating the apoptosis pathway more.

Comparison of gait and sagittal plane arm swing between individuals with adolescent idiopathic scoliosis and healthy individuals

Arm swing and energy consumption play an important role in the realization of an effective gait. However, research on arm swing and energy consumption during gait in individuals with adolescent idiopathic scoliosis (AIS) is limited. The aim of this study was to investigate the spatiotemporal characteristics of gait, arm swing angles in the sagittal plane, energy consumption in individuals with AIS, to compare them with their healthy peers in this regard. 26 diagnosed with AIS and 21 healthy were included in this study. Evaluation measures were based on the Cobb angle, axial trunk rotation, trunk symmetry, sagittal curve measurements, spatiotemporal characteristics of gait with the GAITRite electronic walkway, sagittal plane arm swing with two video-camera recordings, and energy consumption. There were a decrease in right- sided sagittal arm swing, an increase in energy consumption, in left-side step time and right-side double support time in the scoliosis group compared to the control group. The other spatiotemporal characteristics of the gait were similar in both groups. The evaluation of arm swing, energy consumption, and gait of individuals with AIS may contribute to the development of rehabilitation programs by better identifying the deficiencies of individuals with AIS.

Hypersensitivity reactions to COVID-19 vaccines: a case of Eosinophilic pneumonia following Sinovac/CoronaVac vaccination

Summary

Hypersensitivity reactions has been reported with COVID-19 vaccines. Acute eosinophilic pneumonia has not been reported yet after Sinovac/CoronaVac vaccine. A 73-year-old woman presented with maculopapular rash, cough and dyspnea following Sinovac/CoronaVac injection. The complete blood count (CBC) indicated eosinophilia and further evaluation of the eosinophilia with CT and bronchoscopy confirmed a diagnosis of acute eosinophilic pneumonia. After methylprednisolone therapy, her rash resolved with marked improvement of the dyspnea. She is still on treatment and on the follow up period, we plan to continue steroid treatment at least 3 months.

Evulation of prolidase enzyme, and galectin levels as a marker for fibrosis in patients with chronic hepatitis B

OBJECTIVE

The fibrosis can be detected using non-invasive methods including prolidase activity, proline levels and galectin-3 (GAL-3) detection in the serum. The aim of this study was to investigate the liver fibrosis through non-invasive methods in chronic hepatitis B patients.

PATIENTS AND METHODS

This prospective case control study includes 56 patients with Chronic Active Hepatitis B (CAHB), 57 patients with Inactive Hepatitis B (IHB), and 60 healthy matched control subjects. The first group included the CAHB [hepatitis B surface antigen (HBsAg): positive; HBV DNA >2,000 IU/mL; normal or high alanine aminotransferase (ALT) value] undergo a liver biopsy, while the second group included the IHB (HBsAg: positive; HBV DNA: negative; normal ALT value). The third group comprised the healthy controls. Serum prolidase enzyme activities (SPEA), proline and galectin-3 levels were measured for each group.

RESULTS

Patients with CAHB had significantly higher SPEA levels (1,004.3±186.8 IU/L) than did the controls (196.5±306 IU/L) (p<0.001). Significantly higher serum GAL-3 levels were found in the CHB group compared with HBV carrier and the control groups (27.4±32.2 ng/mL, 6.5±13.4 ng/mL, 3.1±5.7 ng/mL, respectively, p<0.001). The relationship between serum prolidase activity, hidroxiprolyne and fibrosis (p<0.05). There were no significant differences in ALT levels between inactive HBV carriers and the control groups (p>0.05).

CONCLUSIONS

We suppose that hidroxiprolyne levels and prolidase enzyme activity might be an indicator as a marker for fibrosis in CAHB and the evaluation of response to treatment.

MOTS-c as a predictor of coronary lesions and complexity in patients with stable coronary artery disease

OBJECTIVE

Atherosclerosis plays a major role in the development of coronary artery disease (CAD). It has been shown that mitochondrial open-reading-frame of the twelve S rRNA-c (MOTS-c), a mitochondrial-derived peptide, has preventive effects on atherosclerosis. The aim of this study was to determine the relationship between MOTS-c levels and CAD presence and severity using SYNTAX score (SS) in patients with stable angina pectoris.

PATIENTS AND METHODS

Ninety-two consecutive patients with stable coronary artery disease (CAD+) and ninety-two consecutive patients with normal coronary artery (CAD-) were included. Presence and severity of coronary artery disease were determined using the SS.

RESULTS

We observed that the MOTS-c levels was lower in the CAD group (111±13 vs. 161±23, p<0.001). The MOTS-c levels were also found to be significant independent predictors for CAD in multiple regression analysis (p<0.001). A MOTS-c levels ≥130.9 had 80.3% sensitivity and 73.2% specificity (area under the curve [AUC]: 0.858, 95% CI: 0.895-0.999, p<0.001) for predicting CAD.

CONCLUSIONS

The authors revealed that there is a strong correlation between MOTS-c levels and CAD. Therefore, MOTS-c may help identify patients with CAD, thus allowing for early preventive treatment.

Maternal and perinatal outcomes of SARS-CoV-2 infection in unvaccinated pregnancies during Delta and Omicron waves

OBJECTIVE

There is little evidence related to the effects of the Omicron severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant on pregnancy outcomes, particularly in unvaccinated women. This study aimed to compare pregnancy outcomes of unvaccinated women infected with SARS-CoV-2 during the pre-Delta, Delta and Omicron waves.

METHODS

This was a retrospective cohort study conducted at two tertiary care facilities: Sancaktepe Training and Research Hospital, Istanbul, Turkey, and St George's University Hospitals NHS Foundation Trust, London, UK. Included were women who tested positive for SARS-CoV-2 by real-time reverse-transcription polymerase chain reaction (RT-PCR) during pregnancy, between 1 April 2020 and 14 February 2022. The cohort was divided into three periods according to the date of their positive RT-PCR test: (i) pre-Delta (1 April 2020 to 8 June 2021 in Turkey, and 1 April 2020 to 31 July 2021 in the UK), (ii) Delta (9 June 2021 to 27 December 2021 in Turkey, and 1 August 2021 to 27 December 2021 in the UK) and (iii) Omicron (after 27 December 2021 in both Turkey and the UK). Baseline data collected included maternal age, parity, body mass index, gestational age at diagnosis and comorbidities. The primary outcome was the need for oxygen supplementation, classified as oxygen support via nasal cannula or breather mask, non-invasive mechanical ventilation with continuous positive airway pressure (CPAP) or high-flow oxygen, mechanical ventilation with intubation, or extracorporeal membrane oxygenation (ECMO). Inferences were made after balancing of confounders, using an evolutionary search algorithm. Selected confounders were maternal age, body mass index and gestational age at diagnosis of infection.

RESULTS

During the study period, 1286 unvaccinated pregnant women with RT-PCR-proven SARS-CoV-2 infection were identified, comprising 870 cases during the pre-Delta period, 339 during the Delta wave and 77 during the Omicron wave. In the confounder-balanced cohort, infection during the Delta wave vs during the pre-Delta period was associated with increased need for nasal oxygen support (risk ratio (RR), 2.53 (95% CI, 1.75-3.65); P < 0.001), CPAP or high-flow oxygen (RR, 2.50 (95% CI, 1.37-4.56); P = 0.002), mechanical ventilation (RR, 4.20 (95% CI, 1.60-11.0); P = 0.003) and ECMO (RR, 11.0 (95% CI, 1.43-84.7); P = 0.021). The maternal mortality rate was 3.6-fold higher during the Delta wave compared to the pre-Delta period (5.3% vs 1.5%, P = 0.010). Infection during the Omicron wave was associated with a similar need for nasal oxygen support (RR, 0.62 (95% CI, 0.25-1.55); P = 0.251), CPAP or high-flow oxygen (RR, 1.07 (95% CI, 0.36-3.12); P = 0.906) and mechanical ventilation (RR, 0.44 (95% CI, 0.06-3.45); P = 0.438) with that in the pre-Delta period. The maternal mortality rate was similar during the Omicron wave and the pre-Delta period (1.3% vs 1.3%, P = 0.999). The need for nasal oxygen support during the Omicron wave was significantly lower compared to the Delta wave (RR, 0.26 (95% CI, 0.11-0.64); P = 0.003). Perinatal outcomes were available for a subset of the confounder-balanced cohort. Preterm birth before 34 weeks' gestation was significantly increased during the Delta wave compared with the pre-Delta period (15.4% vs 4.9%, P < 0.001).

CONCLUSIONS

Among unvaccinated pregnant women, SARS-CoV-2 infection during the Delta wave, in comparison to the pre-Delta period, was associated with increased requirement for oxygen support (including ECMO) and higher maternal mortality. Disease severity and pregnancy complications were similar between the Omicron wave and pre-Delta period. SARS-CoV-2 infection of unvaccinated pregnant women carries considerable risks of morbidity and mortality regardless of variant, and vaccination remains key. Miscommunication of the risks of Omicron infection may impact adversely vaccination uptake among pregnant women, who are at increased risk of complications related to SARS-CoV-2. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Relationships Between Strategies Of Stress Coping And Temperament-Character Traits In Subjects With Bipolar Disorder

Introduction

Bipolar disorder (BD) is a severe mood disorder, which is characterized by a cycling between the mania and major depression. The relationship between coping strategies and temperament-character traits in BD is unclear at this time.

Objectives

The aim of our study was to assess the relationship between strategies of coping stress and temperament-character traits in individuals with BD.

Methods

168 patients diagnosed with BD in full remission were included. All participants were diagnosed by an experienced consultant psychiatrist based on DSM-5 and were assessed with Young Mania Rating Scale (YMRS) for confirmation to remission. Sociodemographic datas of all participants was obtained and Temperament Evaluation of Memphis, Pisa, Paris and San Diego–Autoquestionnaire (TEMPS-A) and Coping with Stress Scale (CSS) were applied.

Results

75 patients (44.6%) were female and the mean age of the sample was 32.64±10.74 years, the mean duration of illness was 8.23±5.52 years and was found that the mean score of YMRS 5.35±4.19. It was presented Table 1 whether there was a statistically significant correlation between TEMPS-A and CSS subscales.

Conclusions

As coping strategies may be related to temperament-character traits and that could be important for psychological interventions in patients with BD.

	Depressive	Hypertimic	Cyclothymic	Irritable	Anxious
Avoidance	-,067	-,159	,098	-,150	-,083
	,485	,095	,305	,115	,387
Problem-focused coping strategies	-,268	-,153	,366	-,246	-,134
	,004	,109	,000	-,009	,161
Social support	-,191	-,495	-,060	-,646	-,416
	,044	,000	,535	,000	,000
Total	-,256	-,399	,149	-,370	-,324
	,007	,000	,118	,000	,001

Disclosure

No significant relationships.

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Amisulpride-induced late-onset rabbit syndrome: Case report and literature review

Introduction

Amisulpride is an atypical antipsychotic. Rabbit syndrome(RS) may be seen after antipsychotics use a few days or long‐term application. RS occurs after more frequent typical antipsychotics and also in rare cases atypical antipsychotics.Its characterized by the involuntary rhythmic movements of the lips however involves no tongue movements.

Objectives

Case report and reflection on its etiology

Methods

Case report and literature review

Results

A 28-year-old female with a diagnosis of schizophrenia applied with the complaints and symptoms of withdrawal, do not want to leave the house, physical anergy and avolition that started after stopped taking her medications. She was admitted to the psychiatry service and amisulpride treatment was started and was gradually increased to 800 mg/day. After 30 days of hospitalization, the patient was discharged with mild recovery. 14 days after the discharge, because of the abnormal involuntary movements in mouth, the patient applied. In clinical examination without tounge involvement, rhythmic motions were observed in the lips and jaw.Neurological examination, labrotory tests and cranial screening were all normal. She was evaluated by a private psychiatrist and was diagnosed with RS. Amisulpride treatment changed to olanzapine treatment with 15 mg/day. After two months, RS spontaneously regressed.

Conclusions

The resolution of the involuntary movements following discontinuation of amisulpride in our case, supported the diagnosis of RS. Although the mechanism by which RS emerges as a side‐effect of amisulpride is not fully understood, the drug’s high affinity for and selective binding to dopaminergic D2 and D3 receptors are thought to be responsible for this involuntary motion disorder.

Disclosure

No significant relationships.

Comparison of Metacognitions in Obsessive-Compulsive Disorder, Generalized Anxiety Disorder, and Healthy Controls

Introduction

Generalized anxiety disorder (GAD) and Obsessive compulsive disorder (OCD) are common psychiatric disorders. Researchers studying the pathophysiology of these two disorders evaluated the effect of metacognition. However, there is no research examining the metacognition differences of these two psychiatric conditions.

Objectives

This study was performed to compare the metacognitions in OCD, GAD and healthy controls.

Methods

The sample of this study consisted of 158 GAD and 137 OCD patients aged 18-65 years who presented to outpatient psychiatry clinic and applied to the health committee 168 healthy controls without psychopathology. Sociodemographic data form, Meta-Cognitions Questionnaire-30 scale(MCQ-30), Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI) were applied to the volunteer participants who met the criteria for participation in the study. The data obtained were evaluated statistically and subjected to statistical analysis.

Results

The mean age was 31.89 ± 10.86 years and was 60.5% (n = 208) women. There was statistical difference between marital status, occupation and income(p <0.05). In addition, there was a statistically significant difference between MCQ-30 total and subscales, BDI and BAI (p <0.001). According to the comparison of OCD and GAD patients, ’positive belief’, MCQ-30 total and BAI scores were found to be statistically different (p <0.05), ’Uncontrollability and danger’, ’Cognitive Confidence’, ’Beliefs about The Need to Control Thoughts’, ’Cognitive Self-Consciousness’, BDI there was no statistical difference between them (p> 0.05).

Conclusions

Our results are contributing to the understanding of the uncertainty of development and maintenance of OCD and GAD. Additionally, metacognitions could be important for the diagnosis and treatment of OCD and GAD.

Disclosure

No significant relationships.

Venlafaxine-induced spontaneous ejaculation: Case report and literature review

Introduction

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor and its extensive use for major depressive disorder and anxiety disorders. Although it has been reported that venlafaxine may have various side effects, as far as we know, spontaneous ejaculation(SE) has not been reported yet.

Objectives

We aim to describe this clinical case with venlafaxine-induced SE and to discuss the possible etiological factors.

Methods

Case report and literature review.

Results

A 53-year-old male with generalized anxiety disorder was initiated venlafaxine treatment with 75 mg/day. After two months patient’s complaints partially regressed and the dose of venlafaxine treatment was increased to 150 mg/day. 10 days after the dose increase, the patient applied with the complaint of SE 2-3 times a day. No urological etiology was found. During outpatient follow-ups, after the 5 days from reducing the daily dose to 75 mg/day, SE complaint completely regressed. After following couple of months, the patient by himself, increased the dose of venlafaxine to 150 mg/day without consulting a psychiatrist. Then SE recurred approximately 15 days later. Venlafaxine treatment dose was reduced again to 75 mg/day and urological complaints spontaneously regressed.

Conclusions

SE, a rare sexual side effect, represents ejaculation that occurs involuntarily and in the absence of any sexual stimuli. The possible mechanism of SE, detected as a side effect in our case, may be that increased adrenergic activity reduces ejaculatory latency and triggers spontaneous ejaculation. Antidepressant-associated sexual dysfunction could be a dose-dependent adverse event. Therefore, reducing the dosage of the treatment to a minimum effective dose could be an option.

Disclosure

No significant relationships.

Predictors of fatality in influenza A virus subtype infections among inpatients in the 2015-2016 season

BACKGROUND

Infection with the influenza A virus can cause severe disease and mortality. The effect of the different subtypes of influenza on morbidity and mortality is not yet known in Turkey. The aim of this study was to describe the predictors of fatality related to influenza A infection among hospitalized patients in Istanbul during the 2015-2016 influenza season, and to detail the differences between infections caused by H3N2 and H1N1.

METHODS

This was a multicenter study performed by the Istanbul Respiratory Infections Study Group of The Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK), among patients hospitalized for influenza in Istanbul during the 2015-2016 influenza season.

RESULTS

A total of 222 patients hospitalized with laboratory-confirmed influenza during the 2015-2016 season were included in the study, of whom 25 (11.2%) died. The fatality rate was significantly higher among patients older than 65 years of age and those with chronic heart and kidney diseases (p<0.001), chronic neurological diseases (p=0.009), and malignancies (p=0.021). Thrombocyte counts were lower in those who died than in those who survived (p<0.004). The median alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase, and C-reactive protein levels were higher among fatal cases. In the multivariate analysis for the prediction of fatality, being >65years old (odds ratio (OR) 6.9, 95% confidence interval (CI) 2.07-23.08, p=0.002), being infected with influenza A(H3N2) (OR 4.2, 95% CI 1.27-14.38, p=0.019), and a 1-day delay in antiviral use (OR 1.28, 95% CI 1.01-1.63, p=0.036) were found to be associated with an increased likelihood of fatality.

CONCLUSIONS

The case fatality rate of influenza A(H3N2) was significantly higher than that of influenza A(H1N1). Detection of the infection, allowing the opportunity for the early use of antiviral agents, was found to be important for the prevention of fatality. The vaccination should be prioritized for at-risk groups.

Results of Real-time Multiplex Polymerase Chain Reaction Assay in Renal Transplant Recipients With Sterile Pyuria

Urinary tract infections are a major cause of morbidity and hospitalization after renal transplantation. Patients treated with immunosuppressive drugs suffer not only from common uropathogens but also from opportunistic infections caused by unusual uropathogens. Sterile pyuria is associated with numerous infectious agents including viruses, fungi, and atypical or fastidious organisms. The objective of this study was to investigate the pathogens using real-time multiplex polymerase chain reaction (rtMPCR) assay in sterile pyuria of renal transplant recipients. In this prospective controlled study, pathogen detection was performed with rtMPCR assay on October 2016 in 60 patients with sterile pyuria who had undergone kidney transplantation. A total of 40 renal transplant patients were determined as the control group. Male-to-female ratio was same. The mean age of the subjects with sterile pyuria was 45.7 ± 12.1 (25-74). The mean duration after transplantation was 28.8 ± 3.97 (3-102) months. Pathogens were detected with rtMPCR in 61.7% of sterile pyuria group. This rate was significantly higher compared with the control group (P < .001). Two or more different pathogens were found in 13 (21.7%) patients in sterile pyuria group. The pathogens found included cytomegalovirus in 10 patients (19%), Gardnerella vaginalis and obligate anaerobes in 20 patients (38%), Ureaplasma spp in 17 patients (33%), Candida spp in 2 patients (4%), Mycoplasma hominis in one patient (2%), herpes simplex virus-2 in one patient (2%), and Trichomonas vaginalis in one patient (2%). Sterile pyuria may indicate the presence of genitourinary pathogens that cannot be detected with conventional urine culture method in renal transplantation patients. rtMPCR is an accurate and convenient method for detection of multiple potential pathogens of sterile pyuria in renal transplant patients.

Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.

Pregnancy and Delivery in the Sequel of Kidney Transplantation: Single-Center Study of 8 Years' Experience

BACKGROUND

Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL.

METHODS

If a pregnancy is expected in the sequel of kidney transplantation (KT), a multidisciplinary team approach should be adopted and both the gynecologist and the nephrologist should follow the patient simultaneously. Among 3883 patients who underwent KT at Antalya Medical Park Hospital Transplantion Department between November 2009 and October 2016, the records of 550 female patients between the ages of 18 and 40 years were examined retrospectively; 31 patients who complied with these criteria were included in the study group. In 6 of these patients who had an unplanned pregnancy, medical abortion was performed after the families were informed about the possible fetal anomalies caused by the use of everolimus in the first trimester, and they were excluded from the study (pregnant group). The control group consisted of 43 patients who had a KT and became pregnant, and of those who had recently undergone KT and shared similarities regarding age, CKD etiology, duration of dialysis, and number of transplants.

RESULTS

In both groups, the ages of the patients, their follow-up span and dialysis duration, tissue compatibility, age of the donor, and time elapsed until the pregnancy was analyzed, whereas in the control group, creatinine levels in the first, second, third, and fourth years after the KT were reviewed. Additionally, in the pregnant group, creatinine levels of the first, second, and third trimesters; delivery week; birth weight of the baby; APGAR scores of the first minute; postnatal creatinine levels of first, second, and third years; and prenatal, maternal, and postnatal acute rejections were reviewed. We measured the creatine clearance by use of the Cockcroft-Gault formula in the pregnancy group before pregnancy and during delivery [Cockcroft-Gault formula: (140 - age) × body weight (kg)/72 × plasma creatine level (mg/dL) × 0.85].

CONCLUSIONS

Pregnancy after KT is risky both for the mother and the baby; however, if planned and followed in coordination within an experienced center, both the pregnancy period and the birth process can occur without distress.

Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation

BACKGROUND

Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers.

METHODS

This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal.

RESULTS

For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding.

CONCLUSIONS

There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.

Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality

This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

Investigation of biological effects of some Mannich Bases containing Bis-1,2,4- Triazole

In this study, the effects of Mannich bases containing bis-1,2,4-triazole on the levels of in vivo malondialdehyde (MDA) and antioxidant vitamins (A, E, C) were examined in serum, livers and kidneys of rats. DA and vitamin (A, E, C) levels were determined by high performance liquid chromatography (HPLC). Antioxidant effect was investigated by determining the MDA levels in Saccharomyces cerevisiae cells as in vitro. Furthermore, the antitumor effects of compounds were investigated against MCF-7 human breast cancer cells. Interrelations of results among control and compound groups were evaluated using SPSS statistical software package. As a result, some of the compounds showed effective biological activity when compared to control conditions. The test compounds used in this study may be effective for utilization in the selection and design of model compounds for further studies.

Middle Hepatic Vein Tributary Reconstruction of a Right Hepatic Graft in Adult Living Donor Liver Transplantation: A Case Report

In adult living donor (right liver) lobe transplantations (LDLT), the removal of the middle hepatic vein (MHV) with the graft and reconstruction carried out in the donor are of great importance. Here a 44-year-old male patient with hepatitis B-related end-stage liver failure is reported of whom his 34-year-old brother was evaluated as a donor candidate. At routine preoperative screening tests, neither the patient nor the donor candidate was found to have any pathological findings that might interfere with the transplantation. The donor candidate was assessed using multislice computed tomography for a standard liver volume measurement and anatomical structure evaluation and extended right hepatectomy including MHV was planned. MHV of the donor removed together with the graft was reconstructed to the common orifice of MHV-left hepatic vein using a cryopreserved aortic graft. In conclusion, if the MHV is removed with the graft in adult LDLT, appropriate reconstruction in the donor is also an important issue. Reconstruction carried out without creating tension and folding in the right hepatic vein is crucial for avoiding congestion and of great importance for the prevention of graft dysfunction.

First International Paired Exchange Kidney Transplantations of Turkey

OBJECTIVE

We estimated that many patients on the waiting list for kidney transplantation in Turkey have immunologicaly incompatible suitable living donors. Paired exchange kidney transplantation (PETx) is superior to desensitization for patients with incompatible donors. Recently we decided to begin an international PETx program.

METHODS

We report three international living related paired kidney transplantations which occurred between May 14,2013, and March 7, 2014. The international donor and recipient operations were performed at Medical Park Hospital, Antalya, Turkey. All pairs were living related and written proofs were obtained according to Turkish laws. As with the donor procedures, the transplantation procedures were performed at the same time.

RESULTS

The uniqueness of these transplantations was that they are the first international exchange kidney transplantations between Turkey and Kirghizia. Currently all recipients are alive with wel-functioning grafts.

CONCLUSION

In our institute, a 5% increase was obtained in living-related kidney transplantations by the help of PETx on a national basis. We believe that international PETx may also have the potential to expand the donor pool.

An Investigation of Post-Traumatic Growth Experiences Among Living Kidney Donors

More than 1 million patients are estimated to have undergone transplantation in the past years. In recent years, living-donor kidney transplantation accounted for more than 50% of all transplantations. Kidney transplantation from living donors is regarded as a contradictory case to the "do no harm" principle as a major surgical intervention is performed on a normal and healthy person at the expense of recovery of the organ recipient. The purpose of this study was to investigate positive psychological experiences, specifically post-traumatic growth (PTG), among living kidney donors. The sample consisted of a total of 184 kidney donors. The age of donors ranged between 21-76 (mean, 50.76; SD, 10.93). In this study 67.9% of donors were female. The recipients on dialysis group had higher scores than the recipients who did not have dialysis; the mean difference was significant on the subscales of change in life philosophy, change in relationships, change in self-perception, and in the PTGI score. The donors with higher education levels received higher scores on the subscale of change in relationships in comparison with donors with low education. The donors who were married and older than 51 years had higher scores than donors who were not married or younger on the subscale of change in self-perception. This is a single-center study; this center performs more than 500 kidney transplantations per year. There is a good system and experience at each step before and after transplantation for donor and recipient and relatives. It is a really big potential trauma to donate a kidney to your relative; you can change this negative effect to a positive effect with a good system. The present study also showed that when compared with the scale's absolute midpoint, kidney donors in the study sample experienced moderate-to-high levels of PTG.

Renal Transplantation in Recipients Older Than 65 Years: Retrospective Analysis of the Results of a 4-year (2008-2012) Experience

BACKGROUND

We analyze the results of renal transplantation among recipients older than 65 years old over a 4-year period (2008-2012) from a single renal transplantation unit and compare results with younger recipients.

METHODS

We retrospectively analyzed the outcomes of 2018 renal transplantations performed between November 2008 and December 2012. The χ(2) test was used for the comparison of categorical data, and the Student t test was used for the analysis of continuous variables. Patient and graft cumulative actuarial survivals were calculated using the Kaplan-Meier analysis and we tested for differences with the Mantel-Cox log-rank test.

RESULTS

Seventy-five (3.7%) recipients were aged ≥ 65 years with a median age of 68 (range, 65 to 82) years. Actuarial graft survivals at 1, 2, and 3 years were 93.8%, 92.5%, and 90.3%, respectively, for the <65 group and 89.7%, 88.1%, and 83.1%, respectively, for the ≥ 65 group (P < .03). Actuarial patient survivals at 1, 2, and 3 years were 96.3%, 95.5%, and 94.7%, respectively, for the younger and 91.8%, 90.2%, and 88%, respectively, for the older samples (P < .03). When graft survival was censored for patient death with a functioning kidney at 1, 2, and 3 years, the results were similar between groups with 95.5%, 94%, and 92.8%, respectively, for recipients aged <65 years and 94.7%, 89.2%, and 89.2%, respectively, for recipients aged ≥ 65 years (P = .213).

CONCLUSIONS

Our results showed that renal transplantation in selected patients older than 65 years was associated with good outcomes; this indicates that it seems safe and effective to treat end-stage renal disease in the elderly knowing there are acceptable rates of graft and patient survival.

Aspartame induces angiogenesis in vitro and in vivo models

Angiogenesis is the process of generating new blood vessels from preexisting vessels and is considered essential in many pathological conditions. The purpose of the present study is to evaluate the effect of aspartame on angiogenesis in vivo chick chorioallantoic membrane (CAM) and wound-healing models as well as in vitro 2,3-bis-2H-tetrazolium-5-carboxanilide (XTT) and tube formation assays. In CAM assay, aspartame increased angiogenesis in a concentration-dependent manner. Compared with the control group, aspartame has significantly increased vessel proliferation (p < 0.001). In addition, in vivo rat model of skin wound-healing study showed that aspartame group had better healing than control group, and this was statistically significant at p < 0.05. There was a slight proliferative effect of aspartame on human umbilical vein endothelial cells on XTT assay in vitro, but it was not statistically significant; and there was no antiangiogenic effect of aspartame on tube formation assay in vitro. These results provide evidence that aspartame induces angiogenesis in vitro and in vivo; so regular use may have undesirable effect on susceptible cases.

Species diversity of ixodid ticks feeding on humans in Amasya, Turkey: seasonal abundance and presence of Crimean-Congo hemorrhagic fever virus

Ticks (Acari:Ixodidae) are important pests transmitting tick-borne diseases such as Crimean-Congo hemorrhagic fever (CCHF) to humans. Between 2002 and 2009, numerous CCHF cases were reported in Turkey, including Amasya province. In the current study, species diversity, seasonal abundance of ticks, and presence of CCHF virus (CCHFV) in ticks infesting humans in several districts of Amasya province were determined. In the survey, a total of 2,528 ixodid ticks were collected from humans with tick bite from April to November 2008 and identified to species. Hyalomma marginatum (18.6%), Rhipicephalus bursa (10.3%), Rhipicephalus sanguineus (5.7%), Rhipicephalus (Boophilus) annulatus (2.2%), Dermacentor marginatus (2.5%), Haemaphysalis parva (3.6%), and Ixodes ricinus (1.6%) were the most prevalent species among 26 ixodid tick species infesting humans in Amasya province. Hyalomma franchinii Tonelli & Rondelli, 1932, was a new record for the tick fauna of Turkey. The most abundant species were the members of Hyalomma and Rhipicephalus through summer and declined in fall, whereas relative abundances of Ixodes and Dermacentor ticks were always low on humans in the province. Of 25 Hyalomma tick pools tested, seven pools were CCHFV positive by reverse transcription-polymerase chain reaction. Results indicated diversity of ixodid tick species infesting humans was very high, abundance of ticks changed by season, and ticks infesting humans had potential for transmitting CCHFV.

Switching from oral cholinesterase inhibitors to the rivastigmine transdermal patch

Oral cholinesterase inhibitors (ChEIs) are associated with side effects such as nausea and vomiting. The use of transdermal patches for ChEI delivery may help to minimize these problems. The objective of this review was to consider available data from patients switching from oral ChEIs to transdermal rivastigmine treatment, and to suggest practical guidelines for patients wishing to do this. Literature database and reference list searches were performed to identify suitable publications. Data from two clinical trials and a series of open observational studies, in which patients were switched to the rivastigmine patch from oral rivastigmine, donepezil tablets, or galantamine, were evaluated. Adverse events were tabulated. In the studies reported here, nausea was reported in up to 3.2% and vomiting in up to 1.9% of patients switching to the rivastigmine patch from oral rivastigmine. Similar rates (up to 3.8% of patients for nausea and 0.8% of patients for vomiting) were reported when switching to the rivastigmine patch from donepezil tablets, and no nausea or vomiting was reported in a case study of patients switching to the rivastigmine patch from galantamine tablets. Switching regimes used in clinical trials appeared well tolerated. Data support recommendations for patients on high rivastigmine capsule doses to switch directly to the 9.5 mg/24 h rivastigmine patch, while those on lower oral rivastigmine doses should start on the 4.6 mg/24 h patch for 4 weeks before increasing to the 9.5 mg/24 h patch. This latter regimen is recommended for patients on other oral cholinesterase inhibitors if switching is medically indicated or requested by the patient or the caregiver.

Hemolysis after mitral valve repair: a report of five cases and literature review

BACKGROUND AND AIM OF THE STUDY

Hemolytic anemia is known to be a rare complication after the prosthetic replacement of the mitral valve, especially in the presence of perivalvular leaks, and even more rarely after mitral valve repair. Following repair, certain distinct patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Early echocardiographic recognition of these flow patterns may be important to diagnose the condition and may lead to re-repair or replacement of the valve.

METHODS

During the past eight years, mitral valve repair was performed by the present authors in 159 patients, with a prosthetic ring being placed in 130 cases. In five of the patients receiving rings (3.8%) however, intractable hemolytic anemia quickly developed, due to recurrent or residual mitral regurgitation, and this necessitated reoperation.

RESULTS

The valve was replaced in all five patients. One patient died from respiratory and renal failure leading to multiorgan failure. The other four patients were followed up and are currently in good health, with no evidence of hemolysis.

CONCLUSION

Hemolysis frequently occurs immediately or soon after mitral valve repair, and may even appear in mild regurgitation. Thus, following repair with a prosthetic ring it is essential to clearly visualize the dynamic flow patterns postoperatively with transesophageal echocardiography, focusing especially on probable fragmentation, collision and rapid acceleration jets. These findings may lead the surgeon to revise the repair, or to replace the valve.

Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress

OBJECTIVE

To explore the profile of neuropsychiatric symptoms in patients with dementia associated with Parkinson's disease (PDD).

METHODS

537 patients with PDD drawn from an international multicentre clinical trial of rivastigmine were assessed using the 10-item Neuropsychiatric Inventory (NPI). A cluster analysis was used to investigate the inter-relationship of NPI items. Associations between the clusters and demographic and clinical variables were analysed.

RESULTS

89% of the patients presented at least one symptom on the NPI, 77% had two or more symptoms and 64% had at least one symptom with a score > or = 4. The most common symptoms were depression (58%), apathy (54%), anxiety (49%) and hallucinations (44%). Patients with more severe dementia and advanced Parkinson's disease had more neuropsychiatric symptoms. Nearly 60% of the care givers reported at least one NPI symptom to be of at least moderate severe distress. Five NPI clusters were identified: one group with few and mild symptoms (52%); a mood cluster (11%, high scores on depression, anxiety and apathy); apathy (24%; high apathy and low scores on other items); agitation (5%, high score on agitation and high total NPI score); and a psychosis cluster (8%; high scores on delusions and hallucinations). The psychosis and agitation clusters had the lowest Mini-Mental State Examination score and the highest Unified Parkinson's Disease Rating Scale and care giver distress scores.

CONCLUSION

Neuropsychiatric symptoms are common in patients with PDD. The profile of these symptoms differs from that in other types of dementia. Subgroups with different neuropsychiatric profiles were identified. These subgroups may be associated with distinct neurobiological changes, which should be explored in future studies.

Attentional deficits affect activities of daily living in dementia-associated with Parkinson's disease

OBJECTIVE

To investigate the effects of attentional deficits on activities of daily living (ADL) in patients with dementia associated with Parkinson's disease (PDD).

METHOD

461 patients were assessed neuropsychologically. Factor analyses were used to differentiate attention from other cognitive functions and to differentiate different aspects of ADL functions. The effects of the attentional measure on ADL were examined using sequential multiple regression, controlling for age, sex, education, severity of motor symptoms and other cognitive functions.

RESULTS

Three cognitive factors were identified, with one factor emerging as a measure of vigilance and focused attention. This factor predicted different aspects of ADL status even after controlling for motor functions and other cognitive factors. The attention factor was the single strongest cognitive predictor of ADL status, matching the strength of the effects of motor functions on ADL status.

CONCLUSION

Impaired attention is an important determinant of ADL functions in patients with PDD.

Cardiac safety of rivastigmine in Lewy body and Parkinson's disease dementias

Cholinesterase inhibition in patients with Alzheimer's disease (AD) may affect heart rate, sometimes inducing bradycardia. Additional cardiac safety considerations apply in patients with dementia with Lewy bodies (DLB) and Parkinson's disease (PDD), in whom cardiovascular autonomic nervous system dysfunction is common. We conducted a review of the safety data available for rivastigmine in these two conditions. A modest reduction in the mean heart rate of 1.5-2 bpm was seen. No clinically meaningful treatment differences in bradycardia or ECG abnormalities were apparent. Compared with placebo, rivastigmine appeared to be associated with fewer vascular disorder adverse events (AEs) (p = 0.002) and fewer AEs of syncope (p = 0.018) in PDD patients (n = 541). A smaller randomised, placebo-controlled study of rivastigmine in DLB (n = 120) showed similar findings. Rivastigmine appears to have a favourable cardiac safety profile in PDD and DLB patients.

Wirksamkeit von Clonidin und Fentanyl als Zusatz bei der postoperativen patientenkontrollierten Epiduralanalgesie mit Bupivacain

BACKGROUND AND OBJECTIVES

The aim of this prospective randomized double-blinded study was to compare the analgesic and side-effects of bupivacaine in combination with clonidine or fentanyl during patient-controlled-epidural analgesia (PCEA) in the postoperative period after abdominal hysterectomy.

METHODS

75 patients from 18 to 65 years of age with ASA status I - II were investigated. After preoperative epidural catheterization, the patients were operated in general anesthesia. After surgery, the patients were randomly allocated to 3 PCEA-groups: Group B 0.125 % bupivacaine, Group F 0.125 % bupivacaine plus 1 microg x ml (-1) fentanyl, Group C 0.125 % bupivacaine plus 0.75 microg x ml (-1) clonidine (10 ml loading dose, 5 ml repetitive bolus dose, 10 min lockout time, 30 ml limit within 4 h). During the following 24 hours, hemodynamic parameters, pain score using visual analog scale (VAS), total analgesic consumption, additional analgesic requirements, sedation, satisfaction, nausea scores and probable side-effects were evaluated.

RESULTS

Total analgesic consumption was not different between Group F and Group C, but lower than in Group B (p < 0.05). Additional analgesic use was not different between the groups. Group F and Group C had lower VAS-scores in 24 hours than Group B (p < 0.05). Hemodynamic and sedation scores of patients were not different. In Group C, incidence of nausea was lower and satisfaction of patients was higher (p < 0.05).

CONCLUSIONS

Addition of clonidine or fentanyl to local anesthetics for PCEA can reduce the analgetic demand. Epidural clonidine can reduce postoperative nausea and is connected with higher patients' satisfaction.

Impact of APOE in mild cognitive impairment

OBJECTIVE

The authors aimed to use baseline data of an ongoing large, prospective study in subjects with mild cognitive impairment (MCI) to investigate the impact of APOE genotype on the symptom profile of the condition.

METHODS

Cognitive assessments included the AD Assessment Scale cognitive subscale (ADAS-cog), the Mini-Mental State Examination (MMSE), and a cognitive battery for assessment of memory, attention, and executive function. Behavioral assessments included the Neuropsychiatric Inventory and Beck Depression Inventory. Activities of daily living were assessed by the AD Cooperative Study Activities of Daily Living (ADCS-ADL) scale. Hippocampal volumes were measured with MRI.

RESULTS

A total of 494 of 1,018 study subjects provided APOE data. Approximately 40% of the subjects were APOE epsilon4 carriers. APOE epsilon4 carriers had lower MMSE (p = 0.01) and higher ADAS-cog (p < 0.0001) scores than noncarriers, indicating worse cognitive impairment. APOE epsilon4 carriers also had greater deficits on New York University delayed paragraph recall and Buschke free and cued selective reminding tests, and on the ADCS-ADL scale (p < 0.001). They also had smaller hippocampal volumes (p = 0.002). Behavioral scores were similar across the subgroups.

CONCLUSION

MCI subjects carrying the APOE epsilon4 allele showed distinct cognitive and imaging profiles, which appeared to resemble those of early Alzheimer patients. APOE epsilon4 genotype was associated with greater impairments in memory and functional activities as well as hippocampal atrophy.

Influence of tacrolimus plus mycophenolate mofetil regimens on acute rejection rate and diabetes mellitus development in renal transplant recipients

In this study we investigated the influence of a tacrolimus (TAC) plus mycophenolate mofetil (MMF) immunosuppressive regimen on the acute rejection rate and side effect profile in renal transplant recipients. The study included 80 living-related and 40 cadaveric donor renal transplant recipients (82 men, 38 women) of mean age 35 +/- 10 years (range, 16 to 58) who were operated between August 1999 and September 2002. The mean HLA mismatches was 3 +/- 1 (range, 0 to 5). All patients received prednisolone, MMF (2 g/d for the first 14 days posttransplant and then 1 g/d) plus TAC (0.2 mg/kg/d). They were followed for the development of rejection attacks and side effects. Diabetes mellitus developed in 13 patients (9 men, 4 women; 10.8%). Initially, patients required insulin therapy but after 6 months, 5 recipients no longer needed insulin therapy and were switched to oral hypoglycermic agents and diet control. Hypertension was diagnosed in 58 patients (48.3%). Neither gender nor donor origin (P =.14; P =.79, respectively) produced a significant difference in diabetes mellitus development. Biopsy proven acute rejection episodes were observed in 16 out of 120 patients (13.3%). Six out of 120 patients lost their grafts throughout the study period including one death because of suicide, one because of cytomegalovirus disease and hemophagocytic syndrome, one due to posttransplant lymphoproliferative disease and two to a cardiac arrhythmia. Only one patient lost his graft due to acute accelerated vascular rejection. Biopsy-proven chronic rejection appeared in one patient. In conclusion, although the incidence of insulin-dependent diabetes mellitus during posttransplant 6 months, seems high it decreased to 1.6% upon reduction of the TAC dosage. TAC plus MMF immunosuppression seems effective and safe in terms of acute rejection rates and side effect profiles.

Behavioral symptoms in mild cognitive impairment

The authors investigated neuropsychiatric symptoms in mild cognitive impairment (MCI) from baseline data of the Investigation in the Delay to Diagnosis of AD with Exelon (InDDEx) study (n = 1,010). Neuropsychiatric symptoms were reported in 59% of subjects (Neuropsychiatric Inventory [NPI]). NPI+ subjects had significantly greater impairment on global, cognitive, and functional scores than NPI- subjects. The presence of neuropsychiatric symptoms appears to be a marker of MCI severity.

Pericardial collar modification for Ross procedure

Although the surgical technique of the Ross operation has been improved over the years, there are still some technical difficulties: (1) The possibility of damage to first septal artery during harvesting and reconstruction of right ventricular outflow tract (RVOT). (2) Weak posterior anastomotic area during RVOT reconstruction. (3) Persistent bleeding from septal dissection site of pulmonary autograft. To deal with these difficulties, we used a 1-cm wide pericardial strip (pericardial collar) which was sutured to epicardium at the posterior and septal edge of the RVOT. The conduit used for the reconstruction of pulmonary outflow was then sutured to this pericardial strip at the posterior part of the anastomosis. We found this technique very useful to create a safe and strong margin for the posterior suture line. Persistent bleeding from septal dissection site can be also avoided using this modification by diverting the bleeding site into the right ventricular cavity.

Genetic divergence in cellular resistance to heat shock in cattle: differences between breeds developed in temperate versus hot climates in responses of preimplantation embryos, reproductive tract tissues and lymphocytes to increased culture temperatures

The detrimental effects of heat stress on fertility in cattle are less pronounced in heat-tolerant breeds. Although these genetic differences reflect differences in thermoregulation, cells from heat-tolerant breeds are less adversely compromised by increased temperature (that is, heat shock) than cells from heat-sensitive breeds. Experiments were performed to test the hypothesis that cells and tissues from two thermotolerant breeds (Brahman and Senepol) are better able to survive and function after exposure to increased temperature than cells and tissues from two thermosensitive breeds (Holstein and Angus). Exposure of embryos at>eight-cell stage at day 5 after insemination to heat shock of 41.0 degrees C for 6 h decreased development to the blastocyst stage and the number of cells per embryo. However, the deleterious effect of heat shock on blastocyst formation and the number of cells per embryo was less pronounced for Brahman than for Holstein and Angus breeds. Embryos from Senepol cows had very low development and it was not possible to determine heat shock effects in this breed. In contrast to the sensitivity of embryos to heat shock, there was no effect of a 41.0 degrees C heat shock on [(3)H]leucine incorporation into proteins secreted by oviductal or endometrial explants. Lymphocytes from Brahman and Senepol cows were more resistant to heat-induced apoptosis than lymphocytes from other breeds. Heat shock reduced lymphocyte glutathione content but the magnitude of the decrease was not affected by breed. In conclusion, embryos from Brahman cows are more resistant to heat shock than embryos from Holstein or Angus cows. Genetic differences are also present in thermotolerance for apoptosis response in lymphocytes, with Brahman and Senepol cattle being more resistant to heat shock than Angus and Holstein breeds. It is likely that the evolutionary forces that led to the Brahman and Senepol breeds being adapted to hot climates resulted in the selection of genes controlling resistance to cellular heat shock.

Activities of daily living in Alzheimer's disease: neuropsychiatric, cognitive, and medical illness influences

Using a retrospective data analysis, the authors investigated the relationships between instrumental activities of daily living (IADLs) and neuropsychiatric symptoms, cognitive impairment, and medical illness burden in patients with Alzheimer's disease (AD). One hundred forty-three patients fulfilling the clinical criteria for probable or possible AD in an outpatient clinic were assessed for IADLs, neuropsychiatric symptoms, cognitive impairment, and medical illness burden with the Functional Activities Questionnaire (FAQ), Neuropsychiatric Inventory (NPI), Mini-Mental State Exam (MMSE), and Cumulative Illness Rating Scale-Geriatric (CIRS-G). Both MMSE and NPI scores related significantly to IADLs as measured by the FAQ. Several psychiatric symptoms were correlated significantly with IADLs. FAQ scores had no correlation with CIRS-G. Neuropsychiatric findings also were associated significantly with MMSE and had a weak correlation with CIRS-G scores. IADLs changed with cognition and neuropsychiatric disturbances in AD. Medical illness burden had little influence on functional status and a limited impact on neuropsychiatric symptoms.

Orbitofrontal and anterior cingulate cortex neurofibrillary tangle burden is associated with agitation in Alzheimer disease

Few studies evaluate neuropathological correlates of behavioral changes in Alzheimer disease (AD). We identified 31 autopsy patients with a diagnosis of definite AD. Behavioral changes were assessed with the Neuropsychiatric Inventory. Brain sections were collected from bilateral orbitofrontal and left anterior cingulate, superior temporal, inferior parietal, occipital, and hippocampal cortices for quantification of neurofibrillary tangles (NFTs) and diffuse and neuritic plaques. Sections from frontal, cingulate, and hippocampal cortices were reviewed for the presence of Lewy bodies (LBs). Hypothesis-driven correlational analyses were performed by the bootstrap method. Subgroup analyses contrasted a group with high scores of one specific behavior to a group with low scores after equating groups for other behaviors. NFT burden in the left orbitofrontal cortex across all 31 patients significantly correlated with agitation scores (r = 0.41, p < 0.015) and NFTs correlated significantly (r = 0.66, p = 0.004) with higher agitation scores in the subgroup analysis. Left anterior cingulate NFTs, although not within our hypotheses, also showed a significant relationship to agitation within the subgroups (r = 0.76, p = 0.0003; Bonferroni p = 0.02). Seven patients, including three in the agitation subgroup, had cortical LBs. Aberrant motor behavior and NFT density in the left orbitofrontal cortex showed a significant relationship for the entire group (r = 0.38, p < 0.03) and for subgroups (r = 0.49, p = 0.04), whereas apathy and left anterior cingulate NFTs showed a significant relationship only for the entire group (r = 0.25, p < or = 0.01). These observations suggest that agitation and aberrant motor behavior are correlates of greater NFT pathology in the orbitofrontal cortex in AD, whereas increasing apathy may relate to greater NFT burden in the anterior cingulate.

Local versus systemic control of numbers of endometrial T cells during pregnancy in sheep

Pregnancy in sheep is associated with changes in numbers of specific T-lymphocyte populations in the uterine endometrium. These changes probably contribute to evasion by the conceptus of maternal immunological rejection and indicate a possible role for T cells in placental growth, parturition and post-parturient uterine defence against infection. The purpose of the present experiment was to evaluate the relative importance of systemic signals (i.e. those present throughout the uterus or from the circulation, including conceptus hormones secreted into the maternal blood) versus locally acting conceptus signals for regulating changes in numbers of endometrial lymphocytes during pregnancy. The approach taken was to surgically confine pregnancy to one uterine horn and compare differences in lymphocyte numbers between the two uterine horns as well as between both horns of pregnant ewes with those of ovariectomized ewes. As compared with ovariectomized ewes, there was a decline in numbers of CD45R+ lymphocytes within glandular epithelium and an increase in gammadelta T-cell number within the luminal epithelium. These changes occurred in both the pregnant and non-pregnant uterine horns of unilaterally pregnant ewes. Moreover, there were no significant differences in lymphocyte numbers between the two uterine horns of unilaterally pregnant ewes. Expression of CD25 was absent in tissues from both uterine horns. In conclusion, changes in numbers of endometrial lymphocytes during pregnancy, rather than due to locally acting signals of conceptus origin, are the result of hormonal signals of maternal or conceptus origin that either act directly on endometrial lymphocytes or stimulate the uterine endometrium to induce synthesis of regulatory molecules that affect lymphocyte dynamics.

Gastric tonometer monitoring in infants undergoing repair of coarctation of the aorta

OBJECTIVE

To evaluate gastric tonometer monitoring for splanchnic hypoperfusion in infants during surgical intervention for aortic coarctation, especially within aortic cross-clamp periods.

DESIGN

A prospective study.

SETTING

Cardiovascular intensive care unit in a university hospital.

PARTICIPANTS

Fourteen infant patients after elective, uncomplicated repair of coarctation of the aorta.

INTERVENTIONS

After the anesthesia induction, a 7F tonometry catheter was inserted into the stomach oropharyngeally. Gastric carbon dioxide, arterial blood gases, blood pressure of upper extremities, and hematocrit values were measured in 5 different time intervals. Time periods were as follows: T1 (after the anesthesia induction), T2 (before aortic cross-clamp), T3 (immediately after aortic cross-clamp removal), T4 (40 minutes after aortic cross-clamp removal), and T5 (as the patient reached the intensive care unit). Intramucosal pH was measured by means of the Henderson-Hasselbach equation. The mean values of all parameters were calculated. According to T1 time, T2, T3, T4, and T5 times were compared with Student's t-test.

MEASUREMENTS AND MAIN RESULTS

Mean aortic cross-clamp time was 19.4 +/- 6.6 minutes. Intramucosal pH values of T3 (p < 0.001) and T4 (p < 0.01) were found to be lower than values of T1. The gastric carbon dioxide values of T3 were significantly higher than T1 (p < 0.01), and bicarbonate and arterial pH values of T3 were significantly lower (p < 0.01). There were no significant differences in other parameters over time intervals.

CONCLUSION

Splanchnic hypoperfusion exists during aortic cross-clamping in infant aortic coarctation surgery, and the tonometric catheter is considered to be a safe method for monitoring this hypoperfusion.