Assessment of quantitative zonal parameters of prostate gland in discrimination of normal, benign, and malignant conditions: are these the more reliable parameters in the diagnosis of prostate cancer?

OBJECTIVE: Prostate cancer diagnosis and treatment are increasing in current public healthcare programs. An improved resolution multiparametric magnetic resonance imaging (MRI) has shown the potential to enhance the detection and differentiation of this medical condition. In this study, MR perfusion parameters were investigated in different ages and diseases to differentiate clinically significant prostate cancer. PATIENTS AND METHODS: From January 2017 to December 2022, 72 consecutive patients, who had undergone multiparametric MR imaging were enrolled in this study. Four different patient groups were formed: (1) those with prostate cancer, (2) those with prostatitis, (3) those with benign prostate hyperplasia (BPH), and (4) a control group. Quantitative dynamic contrast-enhanced (DCE)-MRI pharmacokinetic parameters included Ktrans, Kep, Ve, and iAUG. Different measurements were obtained from both the peripheral and transitional zones (PZ and TZ, respectively). Means values were compared between groups based on a univariate analysis. RESULTS: Ktrans and Kep values in the PZ were found to be statistically significantly lower in the control group (p = 0. 003 and p = 0. 011, respectively). It was seen that Ktrans and Ve measurements obtained from PZ had a statistically significant determinant in detecting malignancy (p = 0. 013 and p = 0. 036, respectively). It was seen that Ktrans, Ve, and iAUG obtained from the TZ showed a statistically significant difference in prostate cancer (p = 0.025, p = 0.005, and p = 0. 011, respectively) in contrast to other cases. Peripheral Ve values were statistically significantly lower than those measured Ve values from the TZ in prostate cancer cases (p = 0.002) in contrast to the other cases. CONCLUSIONS: Quantitative DCE-MRI parameters may vary according to age, disease, and zonal anatomy. These differences may contribute to the diagnosis of clinically relevant prostate cancer.

Endometrial carcinoma detection with 3.0 Tesla imaging: which sequence is more useful.

OBJECTIVE: Detection of endometrial cancer (EC) is crucial in pre-operative EC management. The study aimed at determining the most reliable sequence in magnetic resonance imaging (MRI) evaluation at the EC. Different sequences were compared using histopathological results as the gold standard. PATIENTS AND METHODS: In this retrospective study, 62 women diagnosed with EC were examined using 3 Tesla MR and post-hysterectomy histopathological examination. The MRI protocol included diffusion-weighted imaging (DWI), T2 weighted images, Dynamic Contrast T1 weighted images, and ZOOMit DWI. Apparent diffusion coefficient (ADC) maps were also obtained. ADC maps were calculated for both DWI and ZOOMit DWI. All serial images were analyzed by endometrial distance to account for myometrial invasion and tumor size. All sequences and histopathological results were compared using the paired sample t-test. RESULTS: In all 32 women, post-hysterectomy histopathological confirmation was obtained. Mean myometrial invasion values were not significantly different after comparing DWI, ZOOM it DWI, and Dynamic contrast enhancement (DCE)-T1WI (p=0.054, p=0.039). The first strong correlation was found between DWI and ZOOMit DWI (0.943). The second was between ZOOMit DWI and DCE-T1 WI (0.949). Comparing each set of sequences, no statistically significant differences in tumor size (p > 0.05) were found. Also, no statistically significant differences between images and histopathological size were found. The ADC values of ZOOMit DWI indicated that this method detected significant differences between EC histological subtypes. CONCLUSIONS: Each sequence is essential and valuable, whereas priorities may vary depending on the desired information. The most valuable sequences for the myometrial invasion were ZOOMit and conventional DWI. T2WI and DCE T1 WI were more valuable sequences the size of EC.

Diffusion-weighted imaging of the liver in assessing chronic liver disease: effects of fat and iron deposition on ADC values.

OBJECTIVE: This study was designed to evaluate whether fat and iron affect the apparent diffusion coefficient (ADC) values of the liver parenchyma in the settings of fibrosis and inflammation. PATIENTS AND METHODS: We evaluated the diffusion-weighted images (DWIs) of 58 patients with chronic liver disease and 48 control subjects. Liver specimens of patients were assessed for fibrosis, necroinflammation, iron, and steatosis. Liver ADCs, spleen ADCs, and normalized liver ADCs (defined as the ratio of the liver ADC to spleen ADC) values were analyzed after stratifying patients with either fibrosis stages or histology activity index (HAI) scores. The relationship between ADC values and histopathological findings was studied using multiple linear regression analysis. RESULTS: The median liver and normalized liver ADC values were significantly lower in higher stages of fibrosis and HAI scores. Compared to the control group, patients with the highest stages of fibrosis and inflammation had significantly higher spleen ADCs. The effect of the fibrosis stage on liver ADC and normalized liver ADC values was significant in the setting of inflammation, whereas the degree of steatosis and iron grade did not affect these ADC values. CONCLUSIONS: ADC values can distinguish both later stages of liver fibrosis and inflammation. There is no significant effect of fat and iron on ADC values. Therefore, DWI may be reliable in evaluating liver fibrosis and inflammation.

Effect of surface flattening and phototherapy on shear bond strength immediately after bleaching with different modes of universal adhesive.

OBJECTIVE: The aim of this study was to compare to effect of phototherapy and surface flattening after immediately bleaching on the shear bond strength to bleached enamel. METHODS: Ninety-six human upper incisors were divided into 4 groups (n = 24). Group NB: no bleached, group P: phototherapy with YSGG laser, group F: 0.5 mm surface flattening, group PF: 0.5 mm surface flattening and phototherapy with Er;Cr:YSGG laser. Then, each group was assigned to 2 subgroups according to adhesive mode (n = 12) as; subgroup S (self-etching mode), subgroup T (total-etching mode) which are universal adhesives. All surface conditionings and restorations were performed with composite resin materials immediately after bleaching. Shear bond strength test was performed by using universal testing machine. The surfaces were also evaluated with SEM. The data were statistically analyzed with one-way ANOVA post-hoc Tukey tests. RESULTS: The lowest SBS values were achieved in FS (13.72 ± 2.29) while the highest ones in PT (28.01 ± 6.81). However, the differences were not significant (P > 0.05). All surface conditioning methods provided SBS values similar to the control (P > 0.05). All subgroups of self-etching mode were significantly lower than their total-etching counterparts (P < 0.05). CONCLUSIONS: The present study showed that surface removal and phototherapy have a potential clinical application for eliminate to undesirable effect of bleaching treatment. Surface conditioning with either flattening and/or phototherapy may provide clinicians to restore bleached teeth at the same visit with bleaching and reduce chair-time.

Evaluation of Chemical Mechanical Polishing-Based Surface Modification on 3D Dental Implants Compared to Alternative Methods.

Chemical mechanical polishing (CMP) has been introduced in previous studies as a synergistic technique to modify the surface chemistry and topography of titanium-based implants to control their biocompatibility. In this study, the effectiveness of CMP implementation on titanium-based implant surface modification was compared to machined implants, such as baseline and etching and biphasic calcium phosphate (BCP) particle-based sand blasting treatments, in terms of the surface chemical and mechanical performance. Initially, a lab-scale 3D CMP technique was developed and optimized on commercial dental implant samples. The mechanical competitiveness of the dental implants treated with the selected methods was examined with the Vickers microhardness test as well as pull-out force and removal torque force measurements. Furthermore, the surface structures were quantified through evaluation of the arithmetic mean roughness parameter (Ra). Subsequently, the surface chemistry changes on the treated implants were studied as wettability by contact angle measurement, and surface passivation was evaluated through electrochemical methods. In each evaluation, the CMP treated samples were observed to perform equal or better than the baseline machined implants as well as the current method of choice, the BCP treatment. The ability to control the surface topography and chemistry simultaneously by the use of CMP technique is believed to be the motivation for its adaptation for the modification of implant surfaces in the near future.

Distribution of hydrophilic and lipophilic antibacterial drugs in skim milk, cream, and casein.

This study determined the distribution of drugs to different milk fractions according to their physicochemical properties. Hydrophilic drugs tend to concentrate in skim milk, whereas lipophilic drugs tend to concentrate in cream. The concentration of a drug in casein is related to its degree of binding to milk proteins. Thus, we aimed to determine whether withdrawal time in whole milk differs from that in cream, casein, and skim milk. Amoxicillin and tylosin were selected as prototype hydrophilic and lipophilic drugs, respectively. The study was conducted in vitro and in vivo to determine whether in vitro conditions reflect the distribution of drugs in the different milk fractions in vivo. The in vivo study was conducted using a crossover design on 6 healthy Holstein dairy cattle. First, amoxicillin (i.m., single dose, 14 mg/kg) was administered to cows. Following a 1-wk washout period, tylosin (i.m., single dose, 15 mg/kg) was administered. Concentrations of amoxicillin and tylosin in milk and milk fractions were measured using HPLC-UV. In the in vitro study, 0.04 to 400 µg/g of amoxicillin and 0.05 to 50 µg/g of tylosin were spiked to drug-free milk and the concentrations in milk and milk fractions were measured. In addition, the percentage of total protein in milk and milk fractions was determined. Amoxicillin accumulated more in skim milk than in cream and casein, both in vitro (92%) and in vivo (73%, skim milk-to-whole milk ratio). The distribution of tylosin in whole and skim milk was similar to that of amoxicillin in the in vitro study, in contrast to the accumulation of tylosin in cream seen in vivo. However, the accumulation ratio of tylosin in cream was lower than expected. By either method, tylosin was less concentrated in casein than in skim milk and cream. The percentage of total protein was similar in skim milk and whole milk and higher than in cream. Thus, amoxicillin accumulates less in cream and casein, suggesting that these fractions would pose a lower risk to the consumer. Tylosin was still present at the maximum residue limit (50 µg/kg) 24 h after injection in the casein fraction and 48 h after injection in the cream fraction.

Microorganisms isolated from cultures and infection focus and antibiotic treatments in febrile neutropenic children from Sanliurfa, Turkey.

Chemotherapy induced febrile neutropenia predisposes patients to life threatening infections. We aimed to determine the causative microorganisms, infection focus and antibiotic treatment success in febrile neutropenic children with leukemia. A total of 136 febrile neutropenic episodes in 48 leukemic children were reviewed retrospectively from records. Among 136 febrile neutropenic episodes, 68 (50%) episodes were microbiologically documented. Methicillin sensitive coagulase (-) Staphylococcus aureus were the most common isolates from hemoculture (20.5%). The most frequently documented infection focus was mucositis (31.9%). Ceftazidime plus amikacin was the most commonly used antimicrobial treatment for the empirical therapy (52.9%). The overall response rates were 70.5%, 86.9%, and 66.6% of first line, second line and third line therapies, respectively. The spectrum of isolates among febrile neutropenic children in our hematology clinic appears to be gram positive pathogens which are the most common agents. Therefore the, documentation of the flora in each unit could help to decide appropriate empirical therapy which is life saving.

Application of chemical mechanical polishing process on titanium based implants.

Modification of the implantable biomaterial surfaces is known to improve the biocompatibility of metallic implants. Particularly, treatments such as etching, sand-blasting or laser treatment are commonly studied to understand the impact of nano/micro roughness on cell attachment. Although, the currently utilized surface modification techniques are known to improve the amount of cell attachment, it is critical to control the level of attachment due to the fact that promotion of bioactivity is needed for prosthetic implants while the cardiac valves, which are also made of titanium, need demotion of cells attachment to be able to function. In this study, a new alternative is proposed to treat the implantable titanium surfaces by chemical mechanical polishing (CMP) technique. It is demonstrated that the application of CMP on the titanium surface helps in modifying the surface roughness of the implant in a controlled manner (inducing nano-scale smoothness or controlled nano/micro roughness). Simultaneously, it is observed that the application of CMP limits the bacteria growth by forming a protective thin surface oxide layer on titanium implants. It is further shown that there is an optimal level of surface roughness where the cell attachment reaches a maximum and the level of roughness is controllable through CMP.

Progressive Multifocal Leukoencephalopathy after Three Consecutive Liver Transplantations.

Progressive multifocal leukoencephalopathy (PML) is a lytic infection of the central nervous system caused by the reactivation of John Cunningham Virus (JCV) in severely immunosuppressed patients. Occurrence of PML after solid organ transplantations, especially after liver transplantation, is rare. If a patient has poor prognostic factors such as atypical radiological involvements or high viral load in cerebrospinal fluid (CSF), overall survival rates could be poor. Herein, we report on a patients who underwent liver transplantation three times and developed PML with unexpected radiological findings; he was also positive for JCV DNA with a high viral load. Although there are limited data about efficacy of cytarabine against JCV, it was given to the patient for five days. Despite the initiation of cytarabine and complete cessation of the immunosuppressive therapy, we lost the patient, unfortunately.

On backward dispersion correction of Hopkinson pressure bar signals.

Elastic theory shows that wide spectrum signals in the Hopkinson pressure bar suffer two forms of distortion as they propagate from the loaded bar face. These must be accounted for if accurate determination of the impact load is to be possible. The first form of distortion is the well-known phase velocity dispersion effect. The second form, which can be equally deleterious, is the prediction that at high frequencies, the stress and strain generated in the bar varies with radial position on the cross section, even for a uniformly applied loading. We consider the consequences of these effects on our ability to conduct accurate backward dispersion correction of bar signals, that is, to derive the impact face load from the dispersed signal recorded at some other point on the bar. We conclude that there is an upper limit on the frequency for which the distortion effects can be accurately compensated, and that this can significantly affect the accuracy of experimental results. We propose a combination of experimental studies and detailed numerical modelling of the impact event and wave propagation along the bar to gain better understanding of the frequency content of the impact event, and help assess the accuracy of experimental predictions of impact face load.

Whole natal cleft excision and flap : an alternative surgical method in extensive sacrococcygeal pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease (PSD) is a benign disease caused by hair follicles in sacrococcygeal -region. Despite the use of different methods in treatment, there is no consensus reached for treatment modalities. In this study, we used a whole natal cleft excision and flap (WNCEF) method to remove the natal cleft in cases of extensive sacrococcygeal PSD. METHODS: 243 patients with PSD were evaluated retrospectively. 47 patients with extensive sacrococcygeal PSD were included in the study. In these patients, the natal cleft was excised by using a whole natal cleft excision and flap -(WNCEF) method which was performed by an incision to include all the natal cleft (Kite incision) and the remaining defect was closed with a single fasciocutaneous flap by sliding along the midline intergluteal sulcus. RESULTS: The mean age of patients was 25.7 years (17-43). The average hospital stay of patients was 2.7 days (2-4), mean operative time was 59 min (35-80), mean duration of drain removal was 2.7 days (2-4), mean postoperative follow-up was 16.4 months (3-24) and mean BMI was 26.9 (22-30). Flap edema occured in one patient (2.1%), seroma in three patients (6.3%) and surgical site infection requiring re-use of antibiotics were observed in two patients (4.2%). Flap -necrosis and failure did not occur in our patients. No recurrence was observed in any patient during an average follow-up of 16 months. CONCLUSIONS: In sacrococcygeal PSD treatment, removal of the natal cleft with Kite incision by WNCEF method and shifting of the midline completely are thought to be an effective method that can reduce recurrence.

[Celiac disease in adults]. / Cøliaki hos voksne.

Studies from western countries have shown that coeliac disease (CD) is common with prevalence figures about 1:300. The clinical spectrum varies greatly, steatorrhoea and weight loss affecting less than half of the patients. CD should be suspected in case of positive gliadin (IgA and IgG) and endomysial (IgA) antibodies. The diagnosis is based upon histological examination of duodenal biopsies taken during upper gastrointestinal endoscopy. Most patients respond quickly and satisfactorily to treatment with a gluten-free diet. This treatment also eliminates the excess risk of small bowel malignancy. Screening among first degree relatives and patients with insulin-dependent diabetes mellitus should be considered.

[Overlooked celiac disease in a 59-year old woman with severe osteomalacia]. / Overset cøliaki hos en 59-årig kvinde med svaer osteomalaci.

Coeliac disease in adults is an overlooked and undiagnosed illness. We present a case where a woman was diagnosed at the age of 59 despite symptoms suggestive of coeliac disease since childhood. At the time of diagnosis the patient had severe osteomalacia with multiple vertebral fractures of the thoracic and lumbar spine.