Evaluation of Peripheral Lymphadenopathies in Children in a Single Center: Predictive Factors for Malignancy.

BACKGROUND: Lymphadenopathy (LAP) is a common finding in pediatric patients. It was aimed to determine predictive factors in distinguishing cases with malignant or benign lymphadenopathy in this study. SUBJECTS AND METHODS: Between January 2022 and January 2023, 101 patients (1-16 years old) with lymphadenopathy were retrospectively examined. RESULTS: LAP was localized in 80.2% (n=81) cases and generalized in 19.8% (n=20) cases. In 60 cases (59.4%), lymph node sizes were found to be greater than 20×20 mm in width and length. The most common infectious causative agent was Epstein Barr Virus (EBV). Seven (6.9%) patients underwent biopsy and all were diagnosed with malignancy. When the benign and malignant groups were compared, age, lymph node length, and width on physical examination, anteroposterior and longitudinal diameter of the lymph node on ultrasonography (USG) were statistically significantly higher in the malignant group (p<0.05). The presence of supraclavicular lymphadenopathy was found to be an important factor in differentiating the malignant group (p<0.003). The most important factors in distinguishing the groups are respectively were the anteroposterior diameter of the lymph node on ultrasonography and the presence supraclavicular lymph node in multivariate logistic regression analysis. CONCLUSION: It is not always easy to distinguish benign and malignant etiologies in patients with lymphadenopathy. A detailed history, a careful physical examination, laboratory studies, and excisional biopsy are guiding.

Intrauterine volvulus: systemic review of the literature with pooled analysis.

Our objective is to analyse the observations related to intrauterine volvulus and assess how clinical manifestations and treatment strategies impact prognosis. We conducted a comprehensive search on Pubmed and ClinicalTrials.gov from inception to July 2022, using search terms like "intrauterine volvulus" or "foetal volvulus," supplemented by manual scrutiny of reference lists in relevant texts and articles. Our review encompassed 57 case reports/case series, involving 88 cases. The presence of foetal bradycardia during prenatal visits (p = 0.002) and the existence of meconium cyst or pseudocyst (p = 0.038) significantly influence survival rates. Preterm labour occurred more frequently among cases resulting in mortality (54% vs 21%; p = 0.055). Our study's limitations include the inability to access all reported cases and reliance solely on available data. We advocate for vigilant monitoring of foetuses exhibiting signs of intestinal obstruction, and consideration of an emergent caesarean section as a pre-emptive measure before foetal biophysical profile deterioration worsens.

Comparison of Clinical Features of Intussusception in Terms of Age and Duration of Symptoms.

OBJECTIVES: Intussusception is one of the most common surgical emergencies in children. We aimed to analyze the current clinical characteristics of intussusception. METHODS: We retrospectively reviewed 209 children diagnosed with intussusception, who were admitted to our hospital between January 2009 and August 2022. We grouped the patients according to symptom duration (before and after 12 hours and before and after 24 hours) and age (younger and older than 1 year, and younger and older than 2 years). RESULTS: The median age at admission was 31 months (2-204 months). The median symptom duration was 12 hours (1-420 hours). Most patients (91.4%) were admitted due to abdominal pain, irritability, and/or vomiting. The most common symptoms were vomiting (70.8%) and abdominal pain (60.6%). The classical triad of symptoms was seen in 9 cases (4.3%). In patients aged younger than 1 year, bloody stool, abnormal abdominal radiography findings, and a longer intussusceptum segment were more frequent. In patients aged younger than 2 years, abdominal pain, fever, and defense on physical examination were less frequent, and irritability, bloody stool, and recurrence were more frequent. Patients aged younger than 2 years had a longer intussusceptum segment and less lymphadenopathy based on ultrasonography (USG). The patients admitted more than 12 hours after symptom onset had more diarrhea, fever, abnormal x-ray, peritoneal fluid on USG, and recurrences, and less vomiting. After the symptoms had lasted for 24 hours, fever, mass palpation, and abnormal abdominal radiography findings were more frequent. CONCLUSIONS: We recommend performing abdominal USG, especially in young children admitted to the emergency department with complaints of abdominal pain and/or vomiting, to rule out intussusception. In countries that have reported a high mortality rate from intussusception, we advise precautions such as increasing the availability of USG in emergency departments and educating the population to seek early medical assistance.

Integrative proteomics highlight presynaptic alterations and c-Jun misactivation as convergent pathomechanisms in ALS.

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease mainly affecting upper and lower motoneurons. Several functionally heterogeneous genes have been associated with the familial form of this disorder (fALS), depicting an extremely complex pathogenic landscape. This heterogeneity has limited the identification of an effective therapy, and this bleak prognosis will only improve with a greater understanding of convergent disease mechanisms. Recent evidence from human post-mortem material and diverse model systems has highlighted the synapse as a crucial structure actively involved in disease progression, suggesting that synaptic aberrations might represent a shared pathological feature across the ALS spectrum. To test this hypothesis, we performed the first comprehensive analysis of the synaptic proteome from post-mortem spinal cord and human iPSC-derived motoneurons carrying mutations in the major ALS genes. This integrated approach highlighted perturbations in the molecular machinery controlling vesicle release as a shared pathomechanism in ALS. Mechanistically, phosphoproteomic analysis linked the presynaptic vesicular phenotype to an accumulation of cytotoxic protein aggregates and to the pro-apoptotic activation of the transcription factor c-Jun, providing detailed insights into the shared pathobiochemistry in ALS. Notably, sub-chronic treatment of our iPSC-derived motoneurons with the fatty acid docosahexaenoic acid exerted a neuroprotective effect by efficiently rescuing the alterations revealed by our multidisciplinary approach. Together, this study provides strong evidence for the central and convergent role played by the synaptic microenvironment within the ALS spinal cord and highlights a potential therapeutic target that counteracts degeneration in a heterogeneous cohort of human motoneuron cultures.

Estimated daily intake and health risk assessment of toxic elements in infant formulas.

In this study, the heavy metal (Al, Mn, Co, Cu, Zn, As, Se, Cd, Sn, Pb and Hg) concentrations were determined in a total of seventy-two infant formula samples manufactured by sixteen different brands in Türkiye. During the analyses, inductively coupled plasma MS was used in evaluating the nutritional profile and the toxicological risk associated with the consumption of these products. Given the analysis results, the highest Pb content was found in milk-based 'beginner' formulas (0-6 months, three samples) packed in metal containers. The highest concentration of Mn was found in powdered infant formula (Brand 3) that is suitable for 9-12-month-olds. Mn level was found to be above the limit values in nine samples (12·5 %). Cd level exceeded the limit values in two infant formula samples of Brand 3 (0·038 µg/g) and Brand 15 (0·023 µg/g). Therefore, the mean Cd concentration found here reaches the maximum limit set by the European Union commission legislation. Cu was detected in all infant formulas. The highest concentration was determined in Brand 1 (9-12 months, seven samples) and found to be 2·637 (sd 1·928) µg/g. This value is much higher than the reference values set in the national and international standards. Based on the results achieved here, the estimated daily intake (EDI) and target hazard quotient values for all the metals in infant formulas were found lower than < 1. These findings suggest that the baby foods examined would not pose any health risk. The daily intakes exceeding the baby nutrition values recommended by the WHO would pose health risk since they would exceed the EDI levels.

A unique case of a newborn with a hemangioma on the omphalocele sac.

BACKGROUND: Mass lesions of the umbilical cord are rare anomalies. There have been rare reports of hemangiomas of the umbilical cord, but the co-occurrence of omphalocele and hemangioma of the umbilical cord has not been previously reported. Nonetheless, the condition is clinically significant as it may cause the disturbance of intrauterine fetal circulation, retardation of fetal growth and development, non-immune hydrops fetalis, morbidity and mortality. CASE: Here we aim to report a case that was prenatally diagnosed with an omphalocele and that presented after birth with a hemangioma on the omphalocele sac. CONCLUSIONS: When dealing with umbilical mass lesions in the prenatal and postnatal periods, a hemangioma on the omphalocele sac should be considered in the differential diagnosis of patients when an omphalocele is suspected.

Comparison of Optical Forceps-Assisted Single-Port Laparoscopic PIRS and Open Surgery in Morgagni Hernia Repair.

INTRODUCTION: This study aimed to compare the results of classical surgery (CS) and optical forceps-assisted single-port laparoscopic percutaneous internal ring suturing (SP-PIRS) repair for the treatment of Morgagni hernia. MATERIALS AND METHODS: Patients with Morgagni hernia who were operated on between January 2005 and July 2020 were included in the study. Patients were divided into two groups (CS or SP-PIRS) and compared retrospectively in terms of demographic data, defect size, duration of hospitalization, costs, postoperative complications, and recurrence. RESULTS: Thirty-two patients were included in this study. There were no statistically significant differences between the groups in terms of gender, defect size, postoperative complications, and recurrence (p > 0.05). The SP-PIRS group had a shorter operation time (p < 0.01), shorter hospital stay (p = 0.02), and lower cost (p < 0.01) than the CS group. The average follow-up was 24 months, and recurrence was detected in two patients in each group. CONCLUSION: SP-PIRS repair is recommended because it is practical to perform and reduces the duration of surgery, hospital stay, and cost. It is superior to other laparoscopic techniques, as there is no need to use additional study forceps, except in extreme cases, and the surgeon can perform the procedure without an assistant to hold the laparoscope.

Physicochemical water quality of Karabel, Çalti, and Tohma brooks and blood biochemical parameters of Barbus plebejus fish: assessment of heavy metal concentrations for potential health risks.

The present study aims to comparatively examine the physical quality parameters of water samples taken from Karabel, Çalti, and Tohma brooks in Sivas province and the blood biochemical parameters of blood samples of Barbus plebejus fish obtained from these waters. In periods when chemical pollution in water increased and decreased, it was determined that GLU and UA among blood biochemical parameters were significantly affected. Moreover, the potential risk levels of lead (Pb), copper (Cu), cadmium (Cd), and ferrous (Fe) for human health were compared to the international standards. Metal (Fe, Pb, Cu, and Cd) concentrations in the water were determined using atomic absorption spectrophotometer. The highest HQingestion values of Cd were found in Brook Çalti, which were 0.0018 for adults and 0.1980 for children. THQ upper limit set by the United States Environment Protection Agency (USEPA) is < 1. It was determined that HQingestion, HQdermal, and THQ values of all the heavy metals were much lower than this limit. It was concluded that water quality parameters of samples taken from Karabel, Çalti, and Tohma brooks on monthly basis for 12 months were not higher than the limits and the water qualities of brooks were determined to be "good".

Antioxidant, Antimicrobial and Metmyoglobin Reducing Activity of Artichoke (Cynara scolymus) Powder Extract-Added Minced Meat during Frozen Storage.

The present study aimed to investigate the bioactive compounds in artichoke (Cynara scolymus) powder, having antioxidant and antimicrobial activity, and to determine the effectiveness of artichoke (C. scolymus) powder extract within the minced meat. C. scolymus was extracted using two different methods. The method incorporating high phenolic and flavonoid content levels was used in other analyses and the phenolic and flavonoid contents in C. scolymus extract was determined using LC-QTOF-MS. Antioxidant, antimicrobial, and metmyoglobin (metMb) reducing activities and pH values of the extract-added minced meat samples were measured for 10 days during storage. DPPH, FRAP, and ABTS were used in the antioxidant analyses. The antimicrobial activity of C. scolymus extract was evaluated on five different food pathogens by using the disc diffusion method. The most resistant bacterium was found to be Listeria monocytogenes (18.05 mm ± 0.24). The amount of metMb was measured in the minced meat sample that was added to the extract during storage (p < 0.05). MetMb formation and pH value on the sixth day of storage were found to be at lower levels than in the control group. In conclusion, C. scolymus exhibited a good antimicrobial and antioxidant effect and can be used in storing and packaging the food products, especially the meat and meat products.

Evaluation of dynamic/thiol disulphide balance and ischaemia modified albumin in children with trauma.

AIM: Trauma is the most common cause of death in childhood. Tissue damage, ischaemia-reperfusion injury and inflammatory response are mainly responsible for increasing free oxygen radicals. In this study, we aimed to investigate the use of thiol-disulphide and ischaemia-modified albumin levels as a diagnostic laboratory parameter in trauma children. METHODS: Of 202 children, 101 were hospitalised in the paediatric surgical intensive care unit with trauma, and 101 were healthy children. Levels of native thiol (-SH), total thiol (SH + SS), dynamic disulphide (SS), dynamic disulphide (SS)/total thiol (SH + SS), albumin and ischaemic modified albumin (IMA) were measured from the sera of patients and healthy volunteers. For statistical analyses, SPSS 17.0 was used. Mann-Whitney U and paired correlation tests were used where appropriate. P < .05 was considered significant. RESULTS: The mean age of the patients in the trauma group (boys: 61 girls: 40) was 7.88 years and the control group was 8.00 years. In the trauma group, 86 children were exposed to blunt trauma, 15 children had penetrating trauma and 54 patients had multiple trauma. Surgical procedures were performed on 17 patients. In the trauma group, native thiol, total thiol, dynamic disulphide/total thiol, albumin and IMA levels were significantly lower than that of the control (P < .001), and their dynamic disulphide (P = .001) was higher compared with the control. There was no difference thiol-disulphide parameters in trauma groups sub-division as surgery (n = 17) vs follow-up (n = 84) groups or multiple trauma (n = 54) vs isolated organ trauma (n = 47) groups or penetrating (n = 15) or blunt trauma (n = 86) groups. CONCLUSION: Thiol-disulphide balance and IMA levels show changes in favour of oxidative stress in children with trauma; however, it cannot be used as a laboratory marker that helps to show the system and organ affected by the trauma and to decide the surgical intervention.

Effects of Green Tea Powder, Pomegranate Peel Powder, Epicatechin and Punicalagin Additives on Antimicrobial, Antioxidant Potential and Quality Properties of Raw Meatballs.

Alternative technologies, which have been developed in order to meet the consumers' demand for nourishing and healthy meat and meat products, are followed by the food industry. In the present study, it was determined, using the HPLC method, that green tea contains a high level of epicatechin (EP) under optimal conditions and that pomegranate peel contains a high level of punicalagin (PN). Green tea, pomegranate peel, EP and PN were added to meatballs at different concentrations in eight groups. The antioxidant capacities of extracts were measured. The antimicrobial activity was examined for 72 h using three different food pathogens. The highest level of antimicrobial activity was achieved in the 1% punicalagin group, whereas the minimum inhibition concentration (L. monocytogenes, S. typhimurium) was found to be 1.87 mg/mL. A statistically significant decrease was found in FFA, POV and TBARS levels of meatballs on different days of storage (p < 0.05). When compared to the control group, the bioactive compounds preserved the microbiological and chemical properties of meatballs during storage at +4 °C (14 days). It was concluded that the extracts with high EP and PN concentrations can be used as bio-preservative agents for meat and meat products.

Conservative management of iatrogenic tracheal rupture in a 19-month-old child.

Up to date, only five cases of iatrogenic tracheal rupture during rigid bronchoscopy have been reported in children. Herein, we report the first case who has recovered with spontaneous respiration without intubation. Rigid bronchoscopy of a 19-month-old girl revealed a foreign body at the right main bronchus. While the bronchoscope was being withdrawn, we identified a 0.5-cm longitudinal mucosal laceration along the right wall of the membranous trachea. As her spontaneous respiration was adequate, she was treated conservatively. For the treatment of tracheal lacerations, while early surgical repair has traditionally been acceptable, evidence supporting conservative treatment is increasing, particularly in paediatric cases. If spontaneous respiration is sufficient, bridging the laceration with an endotracheal tube may not be required.

Halloysite nanotube blended nanocomposite ultrafiltration membranes for reactive dye removal.

In this paper, ultrafiltration (UF) flat sheet membranes were manufactured by introducing two diverse halloysite nanotubes (HNT) size (5 µm and 63 µm) and five different (0, 0.63, 1.88, 3.13, 6.30 wt %) ratios by wet phase inversion. Some characterization methods which are contact angle, zeta potential, viscosity, scanning electron microscopy (SEM) and Young's modulus measurements were used for ultrafiltration membranes. Synthetic dye waters which were Setazol Red and Reactive Orange were used for filtration performance tests. These dye solutions were filtered in three different pH conditions and three different temperature conditions for pH and temperature resistance to understand how flux and removal efficiency change. The best water permeability results were obtained as 190.5 LMH and 192 LMH, for halloysite nanotubes (HNT) sizes of 5 µm and 63 µm respectively. The best water and dye performance of UF membrane contains 1.88% w/w ratio of HNT, which showed increased water flux and dye flux of membranes according to different HNT concentrations including ultrafiltration membranes.

Electrical Injuries in Children: A 10-Year Experience at a Tertiary Pediatric Burn Center.

Electrical injuries comprise 4% of cases but have higher morbidity and mortality. This study aims to share our experiences with pediatric electrical injuries and propose strategies to prevent them. The files of pediatric electrical injuries between 2010 and 2020 were reviewed retrospectively. The following were investigated: age, gender, cause, length of stay in the pediatric burn center, total burned surface area, voltage-type, and surgical procedures performed. The patients from low- and high-voltage groups were compared. Eighty-five patients were treated in the last 10 years. Seventy were males, the mean age was 9.9 years, the average length of stay in pediatric burn center was 18.2 days, and the average total burned surface area was 11.7%. Forty-three patients were injured with high-voltage and 42 with low-voltage electricity. Fasciotomy was performed in 25 patients, grafting in 40 patients, and amputation in 12 patients. The most often amputated limb was the right arm/forearm. Psychiatric disorders developed in 24 patients. One patient died. In conclusion, the incidence of high-voltage electrical injuries increases with age. They are more prevalent in males, more often accompanied by additional trauma, and have higher total burned surface area, surgical procedures are performed more often, and hospitalization times are longer. For prevention, precautions should be taken by governments and families, and education is critical.

First Report of Treatment with Pancreas-Sparing Duodenectomy in a Child with Primary Intestinal Lymphangiectasia.

Pancreas-sparing duodenectomy (PSD) is a known surgical technique used in patients with duodenal pathologies in the adult age group. We present a 3-year-old female patient with intestinal lymphangiectasia who underwent PSD. This is the first case in which this surgical technique was used in childhood. We believe that PSD can be used in the pediatric age group for benign pathologies. Introducing a stent to the common bile duct and the main pancreatic duct is not a requirement, especially if the ampulla is preserved as a "button" duodenal patch.

The long term effects of intrascrotal low dose and high dose N-acetylcysteine on testis damage in rat model of testicular torsion.

BACKGROUND/PURPOSE: During testicular torsion, the testes face oxidative damage owing to ischemia/reperfusion. We studied the long term effects of the intrascrotal administration of N-acetylcysteine (NAC) during detorsion procedure in a rat model of testicular torsion. METHODS: Twenty-eight rats were divided into 4 groups: (1) Control group: No procedure was done (2): Torsion-detorsion group: Testis torsion applied for 3 h (3): Low Dose Group: After testis torsion-detorsion (for 3 h) 10 mg/kg NAC was given into tunica vaginalis (4): High Dose Group: After testis torsion-detorsion (for 3 h) 100 mg/kg NAC was given into tunica vaginalis. We measured dimensions of the testes and examined pathological findings and Johnsen and Cosantino Scores. RESULTS: For testes height and volume, high dose NAC group had better results than the torsion-detorsion group (p = 0.019, p = 0.049). Testes weight showed no difference (p = 0.204). Sertoli cell number per tubule in the high dose NAC group was statistically different than the torsion-detorsion group (p = 0.017). CONCLUSIONS: When NAC was given intrascrotally at a dose of 100 mg/kg, it decreased the loss of testis volume and height, and Sertoli cell number per tubule was similar to the control group. These results suggest that the higher dose intrascrotal NAC administered during detorsion may have a protective effect.

Key-and-lock commodity self-healing copolymers.

Self-healing materials are notable for their ability to recover from physical or chemical damage. We report that commodity copolymers, such as poly(methyl methacrylate)/n-butyl acrylate [p(MMA/nBA)] and their derivatives, can self-heal upon mechanical damage. This behavior occurs in a narrow compositional range for copolymer topologies that are preferentially alternating with a random component (alternating/random) and is attributed to favorable interchain van der Waals forces forming key-and-lock interchain junctions. The use of van der Waals forces instead of supramolecular or covalent rebonding or encapsulated reactants eliminates chemical and physical alterations and enables multiple recovery upon mechanical damage without external intervention. Unlike other self-healing approaches, perturbation of ubiquitous van der Waals forces upon mechanical damage is energetically unfavorable for interdigitated alternating/random copolymer motifs that facilitate self-healing under ambient conditions.