One-year follow-up of the oxidative stress profile of patients after laparoscopic sleeve gastrectomy

OBJECTIVE

Obesity is a major risk factor for developing a number of serious diseases, such as cardiometabolic changes and cancer. An increase in adipose tissue and a decrease in antioxidant capacity both contribute to the etiopathogenesis of these comorbidities. The most effective method in the treatment of morbid obesity is bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is the most preferred method in bariatric surgery today. In this study, the potential improvement effect of laparoscopic sleeve gastrectomy (LSG) surgery in the restoration of weight loss and endocrine and tissue-based deterioration was obtained by evaluating changes in oxidative stress, antioxidant agents, and lipid oxidation levels.

PATIENTS AND METHODS

Fifty patients who had LSG surgery were chosen, along with 50 healthy volunteers who were the same age and gender as these patients. Serum total antioxidant capacity measurement, total oxidant capacity measurement, malondialdehyde (MDA) for the measurement of lipid peroxidation degree, and superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels for the measurement of antioxidant levels were measured colorimetrically with the help of a commercial kit.

RESULTS

Oxidative stress indices, MDA levels, and GPx levels of patients with morbid obesity treated with LSG were observed to decrease significantly compared to the preoperative period, while no significant changes were observed in SOD levels.

CONCLUSIONS

In patients with morbidly obese conditions, the weight control achieved by sleeve gastrectomy, which is a restrictive method and thus causes a decrease in adipose tissue, causes a decrease in oxidative stress and an increase in the antioxidant response.

The effect of preemptive magnesium sulfate on postoperative pain in patients undergoing mastectomy: a clinical trial

OBJECTIVE

The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were evaluated.

PATIENTS AND METHODS

American Society of Anesthesiologists (ASA) I-II female patients aged 18 years and over who underwent mastectomy were randomized into 2 groups, including 34 individuals each. The study group (Group I) was given 50 mg/kg MgSO4 in 250 ml isotonic 30 minutes before the induction, and the control group (Group II) was given 250 ml of normal isotonic solution. Standardized anesthesia was applied. Perioperative oxygen saturation, mean arterial pressure (MAP), pulse (HR), sedation scores (ss) in the recovery unit, Verbal Numeric Rating Scale (VNRS), need for rescuer fentanyl, and analgesic needs in the surgical period were evaluated.

RESULTS

Demographic variables were similar. There was no statistical difference between the two groups in terms of the MAP, HR, and oxygen saturation values measured at entry, post-intubation, 15th, 30th, 45th, 60th minutes, and after extubation. There was a statistically significant difference between the two groups in terms of VNRS scores in the recovery unit and at the 2nd, 4th, 8th, and 12th hours during the postoperative surgical period (p=0.0001, 0.001, 0.001, 0.004, 0.021, respectively). The need for rescue analgesics in the first 2 hours of recovery was found to be lower in the study group (p=0.005). The need for postoperative analgesics in the surgical period was not statistically significant (p=0.1).

CONCLUSIONS

Preemptive use of MgSO4 reduces postoperative VNRS scores without affecting hemodynamic parameters during induction and maintenance of general anesthesia.

Investigation of the effect of rhamnetin on mice injected with solid and ehrlich ascites tumor

Rhamnetin is a flavonoid which contained in especially clove, such as apple, tea, and onion plant. Rhamnetin has been used in cancer research due to its antitumor and antioxidant properties. In this study, effects of rhamnetin administration at different doses on ascites and solid tumors were investigated in Balb/C mice bearing EAT model that originating from rat breast adenocarcinoma. Experimental procedure: Overall, 92 Balb-c mice were used in this study. EAT cells (1 × 10⁶ cells) that harvested from stock animals were injected to all rats via intraperitoneal and subcutaneous route. Rhamnetin (100 µg/kg-200 µg/kg) were given intraperitoneally and subcutaneously during 10 and 15 days to the animals bearing ascites tumor and solid tumor, respectively. Throughout experiments, weight changes were recorded in all groups. The maximum weight increase was observed in the control group among all groups (ascites and solid tumor groups). In the treatment groups, the least weight increase were determined in 200-µg/kg rhamnetin applied. The lowest increase in tumor volume was observed in the group that received 200-µg/kg rhamnetin (2.84) when compared to tumor control group (3.67). Result and conclusion: We determined that the number of live and dead cells in the treatment groups administered with the mean rhamnetin dose (2.5 µg/ml) was found in the count made in the EAT cell line after the incubation periods. We observed that rhamnetin plays an important role against cancer formation. We have obtained important results in our study, but detailed studies on the relationship between rhamnetin and cancer are needed.

Evaluation of children and adolescent with cystic fibrosis by pancreatic elastography

BACKGROUND

Cystic fibrosis (CF) is an autosomal recessively inherited disease. Clinical findings vary by age of the patient, the organ systems involved, and the severity of the CFTR gene mutation. Pancreatic and liver involvement is prominent and exocrine pancreatic insufficiency is observed in the majority of patients. Point shear wave elastography (pSWE) is a non-invasive method that can quantitatively determine tissue elasticity and stiffness. In this study, the morphological evaluation of the pancreas was performed using the pSWE technique in pediatric patients diagnosed with CF. The effectiveness of this method for the early detection of pancreatic insufficiency was investigated.

METHODS

Fifty-five patients with CF (24 girls, 31 boys) and 60 healthy children (29 girls, 31 boys) without any chronic diseases and who were suitable for the pSWE examination were included in the study.

RESULTS

The mean value of pSWE was 1.12 ± 0.16 in the healthy group and 0.97 ± 0.16 in the patients with cystic fibrosis. There was a statistically significant difference between the two groups (P < 0.001). Significant negative correlations were found between pSWE and age (r = -0.319; P = 0.018), height (r = -0.293; P = 0.03), serum glucose (r = -0.346; P = 0.01), HbA1C (r = -0.592; P = 0.02), and duration of the disease (r = -0.806; P < 0.001).

CONCLUSIONS

Investigating pancreatic elasticity and detecting pancreatic insufficiency using pSWE (a simple, inexpensive, and non-invasive method) in the early period before overt laboratory and clinical symptoms of EPI appear can contribute positively to long-term results in young patients with CF.

Comparison of serratus plane block alone and in combination with pectoral type 1 block for breast cancer surgery: a randomized controlled study

BACKGROUND/AIM

Concurrent application of ultrasound-guided pectoral type 1 (PECS I) and serratus plane block (SPB) is one of the most appropriate multimodal analgesic strategies for reducing acute post-mastectomy pain. The purpose of the present study was to compare the analgesic efficacy of SPB alone, or in combination with PECS I block for post-mastectomy pain following breast cancer surgery.

MATERIALS AND METHODS

Sixty participants undergoing breast cancer surgery were randomly assigned to two groups. After anesthesia induction, group S (n =30) received SPB alone, whereas the SPECS group (n =30) received a combination of PECS I and SPB. Pain scores at 0, 1, 2, 6, 12, 24 h postoperatively, intra-operative fentanyl consumption, postoperative time to first rescue analgesia, nausea, vomiting, patient satisfaction, and anesthesia-related complications were recorded.

RESULTS

Pain scores in the SPECS group were significantly lower than group S throughout the follow-up period (p <0.001). A significant reduction in postoperative rescue morphine consumption (p =0.01, median difference 7 mg, 95 % confidence interval: 5.1-7.9 mg) and intraoperative fentanyl consumption (p =0.01) in the SPECS group compared with group S. Moreover, postoperative nausea and vomiting were lower, and patient satisfaction was higher in the SPECS group compared with that of the group S.

CONCLUSIONS

These results suggest that SPB application and PECS I provide more effective and reliable perioperative analgesia and increase patient satisfaction in breast cancer surgery. HIPPOKRATIA 2021, 25 (1):8-14.

TRIAL REGISTRATION NUMBER

NCT03899545.

Assessment of end-tidal carbon dioxide and vena cava collapsibility in volume responsiveness in spontaneously breathing patients

BACKGROUND

The benefit of end-tidal carbon dioxide (ETCO2) and inferior vena cava collapsibility index (IVCCI) in predicting fluid responsiveness in mechanically ventilated patients has been demonstrated. However, the data on spontaneously breathing patients is controversial. This study aims to investigate the accuracy of variations in the ETCO2 (∆ETCO2) and IVCCI (∆IVCCI) gradient in predicting volume responsiveness in spontaneously breathing patients with hypovolemia.

METHODS

This was a prospective observational study conducted in an academic emergency department (ED). Spontaneously breathing patients who required fluid resuscitation due to hypovolemia were included in the study. Cardiac output (CO), IVCCI and ETCO2 were measured before and after the passive leg raise (PRL). A change in the CO of ≥15% after the PLR were considered volume responsive. The difference in the ∆ETCO2 and ∆IVCCI were compared between the volume responsive and nonresponsive groups.

RESULTS

A total of 31 patients were included in the study, of whom 15 patients were volume responsive. The difference in the ∆ETCO2 was 4 mm Hg in the volume responsive and 2 mm Hg in the nonresponsive group (p = 0.02). There was no significant difference in ∆IVCCI between the groups. A moderate correlation was detected between the difference in ∆ETCO2 and CO (0.585; p = 0.001).

CONCLUSION

∆ETCO2 can be an alternative method in predicting volume responsiveness in spontaneously breathing patients with hypovolemia.

Detection of antitumoral effects of quercetin through protein synthesis associated with argyrophilic nucleolar-regulating region

Quercetin is a natural flavonoid with potential anticancer properties without significant cytotoxicity in normal tissues. However, the effects of quercetin on Ehrlich ascites carcinoma (EAC) have not yet been clarified. The study aimed to show the antitumoral effect of quercetin through argyrophilic nucleolar organizer region (AgNOR) protein synthesis in mice carrying EAC. Thirty mice were used in the experiment (negative control (n = 6), tumor control (n = 8), quercetin 50 mg/kg (n = 8), and quercetin 100 mg/kg (n = 8) intravenously). The animals were euthanized on the 14th day, and the solid tumors were removed. Then, the total AgNOR area/nuclear area (TAA/NA) and average AgNOR number were calculated for each mice and the immunoreactivity of the factor VIII protein in tumor was evaluated. Tumor volumes and animal weights were statistically significant compared to the tumor control group (p < 0.05). Statistically significant differences were observed between the groups in terms of TAA/NA ratio (p < 0.05). Factor VIII expressions decreased in quercetin groups compared to control tumor tissue (p < 0.05). The current study showed that quercetin has an important function against cancer development.

Effect of novel oral anticoagulants on Hospital Anxiety and Depression Scale scores

BACKGROUND

The negative impact of atrial fibrillation (AF) on health-related quality of life has been extensively documented. The aim of this study was to compare the Hospital Anxiety and Depression Scale (HADS) scores of patients with non-valvular AF during warfarin administration and after switching to novel oral anticoagulants (NOACs).

METHODS

The study comprised 100 consecutive patients on warfarin treatment between July 2018 and January 2019 for whom a transition to NOACs was planned. All patients completed the HADS at the start of the study and at least 3 months after that date.

RESULTS

The mean value of HADS-A (5.9 ± 2.1 vs. 4.4 ± 1.6, p < 0.001) and HADS-D (4.4 ± 1.7 vs. 3.7 ± 1.4, p < 0.001) scores was significantly higher in patients when they used warfarin than when they switched to NOACs. Analysis revealed that there was a significant correlation between HADS-A and HADS-D scores with age and history of bleeding (p < 0.001). The highest scores were found for patients with a history of bleeding and age ≥75 years (p < 0.001).

CONCLUSION

Our study demonstrates that patients with nonvalvular AF under treatment with NOACs had lower HADS-A and HADS-D scores compared with patients on warfarin treatment. These findings suggest that NOACs may increase the quality of life and decrease morbidity and mortality by reducing anxiety and depression.

Examination of inclinations of the spine at childhood and adolescence

BACKGROUND

Spine is a column that consists of consecutively lined up vertebras. It includes medulla spinalis. It contributes the motions of head, neck and body. Spine is not a straight column. There is a convexity towards the front of the spine (lordosis) at cervical and lumbar areas in adults and a convexity towards the back of the spine (kyphosis) at thoracic and sacral spine areas.

MATERIALS AND METHODS

In this study, lateral magnetic resonance images of 731 children between 1 and 16 years of age were examined and their cervical lordosis, thoracic kyphosis and lumbar lordosis angles were measured with Cobb method using ImageJ programme for every age group.

RESULTS

The mean calculated cervical lordosis angles in 1-16-year-old children were found to be 20.51o ± 6.11o (minimum 17.96o ± 6.29o, maximum 23.50o ± ± 4.14o). It has been observed that cervical angle values decrease with age. The mean thoracic kyphosis angle measured was 28.71o ± 6.99o (minimum 24.55o ± ± 5.65o, maximum 30.44o ± 4.68o). Lumbar lordosis angle was 28.08o ± 7.39o (minimum 20.36o ± 6.59o, maximum 32.68o ± 6.03o). Thoracic kyphosis and lumbar lordosis angle values increased with age. In our study, a statistical differ- ence was found in increasing thoracic kyphosis angle between 1-year-old group and 14-year-old group. Statistical difference was also found in decreasing cervical lordosis angle value between 1-year-old group and 16-year-old group. When we compare our study results with literature values, cervical lordosis values were similar, but lumbar lordosis values were lower.

CONCLUSIONS

In summary, we think that knowing sagittal plane inclinations of the spine developing in childhood and adolescence will contribute to earlier de- termination of pathologies. We also hope that it will contribute to clinical stages and other studies in this field.

Effect of human development index parameters on tuberculosis incidence in Turkish provinces

INTRODUCTION

A country's development level is measured with a quantitative parameter called the human development index (HDI). The present study researched the effects of HDI parameters (such as healthcare standards, income, and education level) on the incidence of tuberculosis.

METHODOLOGY

HDI data of 36 provinces of Turkey and the tuberculosis surveillance data were obtained from the Ministry of Development and the Ministry of Health, respectively. The associations between the incidence of tuberculosis and other HDI parameters were analyzed.

RESULTS

Higher population density (n/km2) (CI = 0.05 to 0.40) and higher relapse rate of tuberculosis (CI = 0.36 to 1.48) were identified to be independent predicting factors that increased the incidence of tuberculosis, whereas higher gross national product (CI = -0.06 to 0.00), the population that holds a green Medicare card (CI=-0.58 to -0.04), increased general practitioners per 100,000 people (CI=-0.66 to -0.01), female population (CI = -0.70 to -0.06), married population (CI = -1.34 to -0.03), were found to be significant negative predicting factors that were relevant to the incidence (protective against tuberculosis).

CONCLUSIONS

Tuberculosis is a disease that is affected by multiple factors, including the components of HDI. Improvement of income level, facilitation of access to health services via health insurance, urbanization with lower population density strategy, and provision of enough general practitioners may be useful in reducing the incidence of TB' in provinces of developing countries such as Turkey.

Histopathological and Biochemical Effects of Ecballium elaterium on Sepsis-Induced Lung Injury

PURPOSE

The aim of this study was to investigate the role of Ecballium elaterium (EE) on sepsis-induced lung injury.

MATERIALS AND METHODS

A total of 30 male rats were divided into three groups as follows: control, sepsis, and treatment groups (sepsis + EE) with each group containing 10 rats. A rat model of sepsis induced by cecal ligation and puncture (CLP) was used. In the treatment group, rats were injected intraperitoneally with 2.5 mg/kg EE after CLP. Interleukin-6 (IL-6), tumor necrosis factor (TNF)-α, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values after a 24-hr period were measured via cardiac puncture. Animals were harvested after the procedure and biochemical analysis was done and histopathological changes of the tissue sections of lungs were examined thereafter.

RESULTS

A statistically significant decrease was observed in the IL-6 (p < .05), TNF-α (p < .05), and TOS (p < .01) levels in the sera of the treatment group compared to those of the sepsis group. Following the treatment, the TOS (p = .01) and OSI (p < .05) levels in the lung tissue of rats indicated a statistically significant decrease compared to those of the sepsis group. The histopathological follow-up undertaken after the administration of the EE treatment to septic rats showed significantly lower values of alveolar wall thickness (p < .001), interstitial edema (p = .018), and neutrophil infiltration (p = .047).

CONCLUSION

EE treatment may have beneficial effects on sepsis-induced lung injury, and therefore has potential for clinical use.

Effects of two different techniques of postoperative analgesia management in liver transplant donors: a prospective, randomized, double-blind study

The aim of this study was the compare the donor patients who received intravenous (IV) morphine with patient-controlled analgesia (PCA) or epidural morphine during the early postoperative period who underwent liver transplantation. Forty patients were included in the study and randomly divided into 2 groups in a double-blinded manner. They were given IV morphine 5 mg (Group C), or epidural anesthesia adding morphine (2 mg; Group E) by epidural anesthesia technique starting 15 minutes before the estimated time of completion of surgery. All of the patients received PCA with IV morphine (Group C; PCA device was set to deliver 1 mg morphine with a lockout of 15 minutes and a 4-hour limit of 20 mg, and no continuous infusion) or epidural morphine (Group E; patient-controlled epidural analgesia [PCEA] device was set to deliver 0.5 mg morphine with a lockout of 30 minutes and a 4-hour limit of 10 mg, and no continuous infusion) and were followed up for 24 hours, and pain scores were evaluated by study nurses who were blinded to the study protocol. The visual analogue scale (VAS) scores at rest and at movement and morphine consumption at 12 and 24 hours after operation evaluation time points were significantly higher in Group E than those in Group C (P < .05). Furthermore, total morphine consumption in Group C was significantly higher than that in Group E (P < .05). Epidural morphine via PCEA was associated with decreased postoperative VAS scores and morphine consumption. These findings may be beneficial for managing postoperative analgesia protocols in liver transplant donor patients.

Acquired IgE-mediated food allergy after liver transplantation in children

BACKGROUND

In recent years, the number of studies regarding newly-diagnosed food allergies after liver transplantation has been increasing. In this study, we aimed to investigate the frequency, aetiology, risk factors, and severity of IgE-mediated food allergies after liver transplantation in children.

METHODS

Paediatric patients who underwent liver transplantation at Inonu University Faculty of Medicine, Organ Transplantation Institute were included in the study.

RESULTS

Forty-nine paediatric patients were enrolled in the study; 26 (53.1%) were female, the median age at transplantation was five years, and median follow-up time after transplantation was 16 months. Six patients (12.2%) developed IgE-mediated food allergies after transplantation; four had urticaria and/or angio-oedema and two developed anaphylaxis after food intake. Patients with and without IgE-mediated food allergies were similar in terms of sex, age at transplantation, comorbid atopic disease, immunosuppressant therapy with tacrolimus, and blood tacrolimus level (p>0.05 for each). Serum total IgE levels ≥100 IU/mL (p=0.02) and peripheral eosinophilia (p=0.026) were more common in the patients who developed IgE-mediated food allergies. In five of the six patients who developed IgE-mediated food allergies, reaction occurred within the first year after transplantation; the risk of developing a reaction was 2.7 times higher within the first year after transplantation than in subsequent years (95% CI, 1.546-4.914; p=0.026). No Epstein-Barr virus or cytomegalovirus infections were detected in any of the patients who developed IgE-mediated food allergies after liver transplantation.

CONCLUSION

The risk of developing IgE-mediated food allergies is approximately three times higher within the first year after transplantation than in subsequent years.

Implementation of a User-Friendly, Flexible Expert System for Selecting Optimal Set of Kidney Exchange Combinations of Patients in a Transplantation Center

INTRODUCTION

For end-stage renal disease patients, kidney transplantation is the only long-term solution. The number of deceased donors is limited. Living kidney donation is subject to strict regulations, limiting possible donors only to the extended family of the patient for preventing the organ trade. There may be incompatibilities between the patients and their related donors, such as ABO blood type incompatibility, positive cross-match, and so on.

METHODS

Pairwise exchanges between donors and recipients increase both the quality and the quantity of feasible transplantations. The maximum benefit in kidney exchanges could only be yielded by developing a central kidney exchange program supported by a nation wide living donor pool database. In the absence of a central kidney exchange program, each transplantation center arranges the kidney allocations using spreadsheets manually. Selecting best possible combination of exchanges simultaneously is a difficult task when performed manually. It is a proven NP-Hard combinatorial optimization problem. However, using mixed integer programming methods the best combination can be found in seconds.

RESULTS

We developed a user-friendly decision support system that can be used in transplantation centers, facilitating their operations.

CONCLUSIONS

The decision support system can be modified for according to the matching preferences of transplantation centers and it can be used as a simulation tool for analyzing different allocation methods.

Effects of different positive end-expiratory pressure values on liver function and indocyanine green clearance test in liver transplantation donors: a prospective, randomized, double-blind study

INTRODUCTION

The aim of this study was demonstrate the influence of different positive end-expiratory pressure (PEEP) values on blood flow of the liver by indocyanine green (ICG) clearance test in donor patients.

METHODS

ICG clearance tests were conducted concurrently using a noninvasive monitor that tracks the plasma disappearance rate of ICG (PDR-ICG%/min) and 15-minute retention rate after administration of ICG (ICG-R15%). This study was performed in 40 patients who underwent right hepatectomy.

RESULTS

The positive end-expiratory pressure (PEEP) was 0 cm H20 in the first (control) group (group K) and 10 mm Hg in the second study group (group P). ICG clearance test values before general anesthesia (T0), after induction of general anesthesia (T1), after transection (T2), 24 hours postoperative (T3), and 72 hours postoperative (T4) were recorded. Simultaneously, hemoglobin (Hgb), hematocrit (Hct), platelet count, plasma levels of prothrombin (PT), International Normalized Ratio (INR), total bilirubin, direct bilirubin, albumin, aspartate aminotransferase, and alanine aminotransferase values were analyzed. In terms of the plasma disappearance rate and retention rate of ICG 15 minutes after administration, significant difference was not observed between groups. PT and INR values were different within comparisons groups (P < .05). There were significant differences in Hgb and Hct values compared with the baseline values (T0) within group (T1, T2, T3, T4) measurements and between group comparisons at T0 and T4 (P < .05). Systemic arterial pressure, mean arterial pressure, and central venous pressure were significantly different between the groups (P < .05).

CONCLUSIONS

Given the small magnitude and limited clinical significance of these changes, we conclude that PEEP values between 0 and 10 cm H2O have no effect on global liver function and liver-related liabilities tests in patients undergoing elective liver donor surgery.

To see bruxism: a functional MRI study

OBJECTIVE

Since the pathophysiology of bruxism is not clearly understood, there exists no possible treatment. The aim of this study is to investigate the cerebral activation differences between healthy subjects and patients with bruxism on behalf of possible aetiological factors.

METHODS

12 healthy subjects and 12 patients with bruxism, a total of 24 right-handed female subjects (aged 20-27 years) were examined using functional MRI during tooth-clenching and resting tasks. Imaging was performed with 3.0-T MRI scanner with a 32-channel head coil. Differences in regional brain activity between patients with bruxism and healthy subjects (control group) were observed with BrainVoyager QX 2.8 (Brain Innovation, Maastricht, Netherlands) statistical data analysis program. Activation maps were created using the general linear model: single study and multistudy multisubject for statistical group analysis. This protocol was approved by the ethics committee of medical faculty of Kirikkale University, Turkey (02/04), based on the guidelines set forth in the Declaration of Helsinki.

RESULTS

The group analysis revealed a statistically significant increase in blood oxygenation level-dependent signal of three clusters in the control group (p<0.005), which may indicate brain regions related with somatognosis, repetitive passive motion, proprioception and tactile perception. These areas coincide with Brodmann areas 7, 31, 39 and 40. It is conceivable that there are differences between healthy subjects and patients with bruxism.

CONCLUSIONS

Our findings indicate that there was a decrease of cortical activation pattern in patients with bruxism in clenching tasks. This indicates decreased blood flow and activation in regional neuronal activity. Bruxism, as an oral motor disorder concerns dentistry, neurology and psychiatry. These results might improve the understanding and physiological handling of sleep bruxism.

Prevalence, presentation and occupational risk factors of chronic venous disease in nurses

OBJECTIVE

In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored.

METHODS

Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria.

RESULTS

Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical-Etiology-Anatomy-Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left-right ankles and the mean duration of hospital stay.

CONCLUSIONS

Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency.

Generation of picosecond pulses directly from a 100 W, burst-mode, doping-managed Yb-doped fiber amplifier

Burst-mode laser systems offer increased effectiveness in material processing while requiring lower individual pulse energies. Fiber amplifiers operating in this regime generate low powers in the order of 1 W. We present a Yb-doped fiber amplifier, utilizing doping management, that scales the average power up to 100 W. The laser system produces bursts at 1 MHz, where each burst comprises 10 pulses with 10 μJ energy per pulse and is separated in time by 10 ns. The high-burst repetition rate allows substantial simplification of the setup over previous demonstrations of burst-mode operation in fiber lasers. The total energy in each burst is 100 μJ and the average power achieved within the burst is 1 kW. The pulse evolution in the final stage of amplification is initiated as self-similar amplification, which is quickly altered as the pulse spectrum exceeds the gain bandwidth. By prechirping the pulses launched into the amplifier, 17 ps long pulses are generated without using external pulse compression. The peak power of the pulses is ∼0.6 MW.

Psychiatric symptomatology and health-related quality of life in children and adolescents with alopecia areata

BACKGROUND

There is a very limited amount of data available regarding the relationship between alopecia areata (AA) and psychiatric morbidity and quality of life (QoL) in children and adolescents.

OBJECTIVES

The aim of this study was to determine the psychiatric state and health-related quality of life (HRQL) of children and adolescents with AA, as well as their relationships with clinical parameters.

METHODS

The sample consisted of 74 children with AA aged 8-18 years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients. The study and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological condition.

RESULTS

In the child group, patients had higher state anxiety and trait anxiety scores; they also had lower parent-rated psychosocial and total area HRQL scores than the controls did. In addition, the depression score was prone to show a positive relationship with having AA in the children. In the adolescent group, however, only the state anxiety score had a significant association with AA. All of the parent-rated HRQL scores were also prone to being lower compared with controls in this age group. Regarding determinants of HRQL, prolonged disease duration and later disease onset had positive effects, whereas severity of scalp involvement, trait anxiety and depression had negative effects, for the sample as a whole.

CONCLUSIONS

Alopecia areata is associated with poor psychiatric status and QoL, especially in childhood. The impact of the disease on QoL occurs through both clinical and psychiatric parameters.

Replacement of the vena cava with aortic graft for living donor liver transplantation in Budd-Chiari syndrome associated with hydatid cyst surgery: a case report

A 12-year-old girl, operated because of a hydatid cyst of the liver, with Budd-Chiari syndrome was evaluated for postoperative development of ascites and paraumbilical varicose veins. A vena caval stent was placed for the relief of inferior vena caval obstruction. The patient was admitted because of progressive deterioration in ascites and liver functions. Imaging techniques showed degeneration adjacent to the right hepatic vein in liver segments 7 to 8, a partially calcified 5-cm hydatid cyst, and a thrombosis in the inferior vena cava was that addressed with a 10-cm metal stent. A living donor segments 2 to 3 liver transplantation was obtained from the patient's mother. After completion of the donor operation without complications, the vena caval stent was removed following the recipient hepatectomy. Suprarenal flow continued after resection of the fibrotic vena cava and placement of a cadaveric cryopreserved aortic graft for the vena cava, anastomosed between the suprarenal and subdiaphragmatic segments of the vena cava. An end-to-side anastomosis was performed between the left hepatic vein of the donor liver and the aortic graft. There was no complication and the patient was discharged on postoperative day 19. Follow-up Doppler ultrasonography showed the aortic vena caval graft to be open, along with the hepatic/portal vein and hepatic artery. This case demonstrated that operations for liver hydatid cyst surgeries can iatrogenically induce Budd-Chiari syndrome; a cryopreserved aortic graft can be an alternative to ensure the continuity of the vena cava in living donor liver transplantation.

Doping management for high-power fiber lasers: 100 W, few-picosecond pulse generation from an all-fiber-integrated amplifier

Thermal effects, which limit the average power, can be minimized by using low-doped, longer gain fibers, whereas the presence of nonlinear effects requires use of high-doped, shorter fibers to maximize the peak power. We propose the use of varying doping levels along the gain fiber to circumvent these opposing requirements. By analogy to dispersion management and nonlinearity management, we refer to this scheme as doping management. As a practical first implementation, we report on the development of a fiber laser-amplifier system, the last stage of which has a hybrid gain fiber composed of high-doped and low-doped Yb fibers. The amplifier generates 100 W at 100 MHz with pulse energy of 1 μJ. The seed source is a passively mode-locked fiber oscillator operating in the all-normal-dispersion regime. The amplifier comprises three stages, which are all-fiber-integrated, delivering 13 ps pulses at full power. By optionally placing a grating compressor after the first stage amplifier, chirp of the seed pulses can be controlled, which allows an extra degree of freedom in the interplay between dispersion and self-phase modulation. This way, the laser delivers 4.5 ps pulses with ~200 kW peak power directly from fiber, without using external pulse compression.

Quality of life measures in Islamic rectal carcinoma patients receiving counselling

AIM

This prospective study was conducted to compare changes in the health-related quality of life (HRQoL) and religious practices of patients who underwent surgery for rectal cancer.

METHOD

We prospectively followed 93 Muslim patients after surgery for colorectal carcinoma: abdominoperineal excision (APE, n = 50), sphincter-saving resection (LAR, n = 22) or anterior resection including sigmoid colectomy (AR, n = 1). The HRQoL was measured pre- and postoperatively at 15-18 months with the Medical Outcomes Study Short Form 36 Health Survey (SF-36) and a modified version of the American Society of Colorectal Surgeons (ASCRS) Fecal Incontinence questionnaire. Life standards, including religious practice, were measured using the Ankara University Life Standard Questionnaire.

RESULTS

No difference was detected in any SF-36 Health Survey HRQoL domain among the groups, although there were differences within groups before and after surgery. The ASCRS Fecal Incontinence questionnaire scales of lifestyle, coping/behaviour and depression/self-perception were similar in the APE and AR groups and were significantly worse than in the AR group (P ≤ 0.004). The embarrassment scale was worse in the APE than in the LAR and AR groups (P < 0.001). Religious worship (praying alone, praying in mosques, fasting during Ramadan and purifying alms) was not significantly different among the groups.

CONCLUSION

HRQoL measured by the SF-36 questionnaire and religious practices were not significantly different after APE compared with AR. Ostomy support and pre- and postoperative health-related and religious counselling may have had beneficial effects.

Isolated Acquired FX Deficiency: A Case Report

A female with no previous history of bleeding presented with active bleeding from multiple body sites, declining hemoglolobin levels, and markedly prolonged prothrombin times (PT), and activated partial thromboplastin times (APTT) with incomplete correction on PT mix assays. This patient showed a severe deficiency of factor X. FX levels and bleeding were refractory to multiple transfusions of fresh frozen plasma. Although plasmapheresis was started with concomitant intravenous immunoglobulin and steroid therapy, the patient died.