COMPARISON OF C-PEPTIDE LEVELS IN MONOGENIC FORMS OF DIABETES WITH OTHER TYPES OF DIABETES: A SINGLE-CENTER STUDY.

Objective: This study aimed to evaluate the utility of C-peptide levels in the differentiation of monogenic forms of diabetes from type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in clinical practice. Subjects and Methods: A total of 104 patients aged >16 who visited the Dicle University's Faculty of Medicine between April 2011 and December 2020 and were diagnosed with monogenic diabetes by genetic analysis or with T1DM and T2DM were randomly selected for retrospective evaluation. The C-peptide levels of these patients at the time of diagnosis of diabetes were compared. Results: Of the 104 patients, 24 (23%) were diagnosed with maturity-onset diabetes of the young (MODY), 40 (38.5%) with T1DM, and 40 (38.5%) with T2DM. Median C-peptide levels (ng/mL) (interquartile range) were 1.78 (1.24-2.88) in MODY group, 0.86 (0.34-1.22) in T1DM group, and 2.38 (1.58-4.27) in T2DM group. Conclusions: There was a difference in C-peptide levels between MODY and T1DM groups but not between MODY and T2DM groups. As per clinical evaluations, although C-peptide levels of patients with MODY are similar to those of patients with T2DM patients, the possibility of C-peptide levels being similar to those required for T1DM diagnosis should also be considered.

The effect of Er,Cr:YSGG laser, fluoride, and CPP-ACP on caries resistance of primary enamel.

The aim of this in vitro study was to determine the effect of different remineralization agents and laser on caries resistance of primary enamel. In the study, 150 sound primary molars were used. The initial microhardness values were measured and the teeth were randomly assigned to ten treatment groups (n = 15): no treatment/negative control (C), NaF, APF, fluoride varnish (FV), CPP-ACP, laser (L), L + NaF, L + APF, L + FV, L + CPP-ACP. The microhardness values were measured after the treatments and the pH cycle. The obtained data were analyzed statistically. One sample from each group was examined before treatment, after treatment, and after the pH cycle with a scanning electron microscope. While microhardness values after treatment compared to baseline increased, microhardness after the pH cycle decreased compared to after treatment values in all experimental groups (p < 0.05). In regard to the difference in microhardness after the pH cycle and baseline, there were no statistically significant differences between groups C and NaF and between C and CPP-ACP (p > 0.05). There was a significant difference between groups L and L + FV (p < 0.05), while no significant difference was noted between groups L and L + NaF, L + APF, L + CPP-ACP (p > 0.05). As a conclusion, FV is more effective when used in combination with laser than laser alone. NaF, CPP-ACP, and laser may be insufficient in protecting the primary teeth against acid attacks compared to FV used with laser.

Nivolumab for relapsed or refractory Hodgkin lymphoma: real-life experience.

BACKGROUND: Reed-Sternberg cells of classical Hodgkin's lymphoma (cHL) are characterized by genetic alterations at the 9p24.1 locus, leading to over-expression of programmed death-ligand 1 and 2. In a phase 1b study, nivolumab, a PD-1-blocking antibody, produced a high response in patients with relapsed or refractory cHL, with an acceptable safety profile. PATIENTS AND METHODS: We present a retrospective analysis of 82 patients (median age: 30 years; range: 18-75) with relapsed/refractory HL treated with nivolumab in a named patient program from 24 centers throughout Turkey. The median follow-up was 7 months, and the patients had a median of 5 (2-11) previous lines of therapy. Fifty-seven (70%) and 63 (77%) had been treated by stem-cell transplantation and brentuximab vedotin, respectively. RESULTS: Among 75 patients evaluated after 12 weeks of nivolumab treatment, the objective response rate was 64%, with 16 complete responses (CR; 22%); after 16 weeks, it was 60%, with 16 (26%) patients achieving CR. Twenty patients underwent subsequent transplantation. Among 11 patients receiving allogeneic stem-cell transplantation, 5 had CR at the time of transplantation and are currently alive with ongoing response. At the time of analysis, 41 patients remained on nivolumab treatment. Among the patients who discontinued nivolumab, the main reason was disease progression (n = 19). The safety profile was acceptable, with only four patients requiring cessation of nivolumab due to serious adverse events (autoimmune encephalitis, pulmonary adverse event, and two cases of graft-versus-host disease aggravation). The 6-month overall and progression-free survival rates were 91.2% (95% confidence interval: 0.83-0.96) and 77.3% (0.66-0.85), respectively. Ten patients died during the follow-up; one of these was judged to be treatment-related. CONCLUSIONS: Nivolumab represents a novel option for patients with cHL refractory to brentuximab vedotin, and may serve as a bridge to transplantation; however, it may be associated with increased toxicity.

Clinical performance of aesthetic restorative materials in primary teeth according to the FDI criteria.

AIM: The purpose of this study is to evaluate the clinical performance of three different restorative materials in primary teeth according to the FDI criteria. MATERIALS AND METHODS: Resin-modified glass ionomer cement, compomer and composite resin restorations (n=93) were made in 31 patients. The restorations were clinically evaluated at baseline, 6th, 12th and 18th month with the FDI criteria. RESULTS: The cumulative survival rate after 18 months was found to be 90.3% for resin modified glass ionomer cement restorations, 100% for compomer restorations and 80.6% for composite resin restorations. Statistically significant increase in surface roughness, colour mismatch, anatomic form loss and marginal deterioration were detected in resin- modified glass ionomer group (p<0.05). The most frequent reason for restoration failure in composite resin group was restoration fractures. CONCLUSIONS: The resin-modified glass ionomer restorations necessitates close follow-up because of the risk of increase in surface roughness, changes in colour and loss in anatomic form and marginal adaptation. The clinical performance of compomer restorations is superior to resin-modified glass ionomer and composite resin restorations in primary teeth.

Three-dimensional nanostructured bilayer solid oxide fuel cell with 1.3 W/cm(2) at 450 °C.

Obtaining high power density at low operating temperatures has been an ongoing challenge in solid oxide fuel cells (SOFC), which are efficient engines to generate electrical energy from fuels. Here we report successful demonstration of a thin-film three-dimensional (3-D) SOFC architecture achieving a peak power density of 1.3 W/cm(2) obtained at 450 °C. This is made possible by nanostructuring of the ultrathin (60 nm) electrolyte interposed with a nanogranular catalytic interlayer at the cathode/electrolyte interface. We attribute the superior cell performance to significant reduction in both the ohmic and the polarization losses due to the combined effects of employing an ultrathin film electrolyte, enhancement of effective area by 3-D architecture, and superior catalytic activity by the ceria-based interlayer at the cathode. These insights will help design high-efficiency SOFCs that operate at low temperatures with power densities that are of practical significance.

Simultaneous Performance and Stability Enhancement in Intermediate Temperature Solid Oxide Fuel Cells by Powder-Atomic Layer Deposited LSCF@ZrO2 Cathodes.

Employing porous structures is essential in high-performance electrochemical energy devices. However, obtaining uniform functional coatings on high-tortuosity structures can be challenging, even with specialized processes such as atomic layer deposition (ALD). Herein, a novel method for achieving a porous composite electrode for solid oxide fuel cells by coating La0.6 Sr0.4 Co0.2 Fe0.8 O3 -δ (LSCF) powders with ZrO2 using a powder ALD process is presented. Unlike conventional ALD, powder ALD can be used to fabricate extremely uniform coatings on porous electrodes with a thickness of tens of micrometers. The powder ALD ZrO2 coating is found to effectively suppress chemical degradation of the LSCF electrodes. The cell with the powder ALD coated cathode shows a 2.2 times higher maximum power density and 60% lower thermal degradation in activation resistance than the bare LSCF cathode cell at 700-750 °C. The result demonstrated in this study is expected to have significant implications for high-performance and durable electrodes in energy conversion/storage devices.

Investigation of the Importance of Knee Position during Femoral Tunnel Reaming; Figure 4 versus Hyperflexion.

Introduction: We aimed to compare whether the visualisation provided by arthroscopic hyperflexion and Figure 4 has an effect on femoral tunnel placement in patients undergoing single bundle Anterior Cruciate Ligament Reconstruction (ACLR). Material and methods: We retrospectively evaluated 93 patients who underwent single-band ACLR for Anterior Cruciate Ligament (ACL) injury between 2016 and 2019. Eighty patients met the inclusion criteria with a minimum follow-up of 12 months. We divided the patients into Group 1 (figure 4) and Group 2 (hyperflexion). We analysed the demographic, radiological and functional outcomes of the patients. The functional Lysholm score, operative time, radiological Quadrant method (% proximal-distal and % anterior-posterior) measurements, tunnel lengths, axial and coronal plane angles, and iatrogenic chondral injury in the medial femoral condyle were evaluated. Results: Iatrogenic chondral injury developed in the medial femoral condyle in a total of seven patients in both groups: one patient in group 1 (Figure 4) and six patients in group 2 (Hyperflexion). Although statistically insignificant, iatrogenic medial femoral condyle damage was less in group 1. The statistical analysis between surgical operation time (p = 0.046) and tunnel lengths (p = 0.042) was significant. Conclusion: The position of figure 4 provides visualisation of lateral intercondylar notch better than hyperflexion. In the reaming stage, the medial femoral condyle is less damaged in group 1 (Figure 4). In ACLR, which has a long learning curve, short surgery time is seen as an important advantage for surgeons who have just started doing ACLR. We think that it can be used as an alternative method to hyperflexion in the learning process and maybe shorten the learning curve process.

Evaluation of the effects of Ankaferd haemostat application on bone regeneration in rats with calvarial defects: histochemical, immunohistochemical and scintigraphic study.

BACKGROUND: Bone wax, a haemostatic agent, is widely used in craniospinal surgical procedures for a long time, in spite of controversial results regarding its negative influence upon bone regeneration. In this experimental study, the effects of Ankaferd Blood Stopper (ABS), as an alternative haemostatic agent, were evaluated through histochemical, immunohistochemical and scintigraphic studies. MATERIALS AND METHODS: The total of 30 adult female Wistar albino rats was randomly divided into three groups: intact control group (n = 10), bone wax group (n = 10), and ABS group (n = 10). Surgically, a 3.0 mm hole in diameter was drilled on the right side of calvarium of the rats using a Class Mini Grinder set in all three groups, as described previously. At the end of 8 weeks, bone healing and connective tissue alterations surrounding drilled calvarial defect areas of the rats were determined via haematoxylin and eosin and the Mallory's trichrome staining and anti-bone sialoprotein immunohistochemistry. Image Pro Express 4.5 programme was used for histomorphometric calculation of new bone and fibrotic tissue areas. All statistical analyses were made with SPSS 25.0 and analysis of variance (one-way ANOVA) followed by Bonferroni post hoc test was performed, p < 0.001 was considered as significance level. RESULTS: Histomorphometrically, it was found that he had the largest hole diameter and the least fibrotic scar area in the bone-wax group. In the bone wax group, it was observed that the material closed the hole and there was only a fibrotic scar tissue in the area between the bone tissue at the edge of the hole and bone wax, and a fibrotic tissue was formed in the bone wax area. During the histological procedure, this bone-wax material was poured and the sections were seen as a gap in this area. In the ABS haemostat group, the smallest hole diameter and the least fibrotic scar tissue were observed. Fibrotic scar tissue close to each other was found in the ABS haemostat and bone wax groups. Histological analysis of samples also showed a statistical significance for fibrotic connective tissue area between groups (p < 0.05). Scintigraphically, osteoblastic activity related to blood flow in the animal taken from the group with application of ABS haemostat was more pronounced compared to the other two groups. CONCLUSIONS: In our study, it has been concluded that the ABS yields affirmative effects on the bone healing, while bone wax leads to negative impact on the bone regeneration. Scintigraphic, histochemical and immunohistochemical data support the affirmative impact of the ABS haemostat application upon the bone regeneration apart from the quick stop of haemorrhage.

The influence of functional pinealectomy and exogenous melatonin application on healing of a burr hole in adult rat calvaria: a histological and immunohistochemical study.

BACKGROUND: Even today, repair of the cranial defects still represents a significant challenge in neurosurgery and various options have been used for their reconstruction to date. However, there are very few studies investigating the effects of exogenous administration of melatonin (MEL) as an agent that promotes bone regeneration. The goal of this study was to investigate the effects of functional pinealectomy (Px) and exogenous MEL administration on the bone repair properties and surrounding connective tissue alterations in a rat calvaria model. MATERIALS AND METHODS: The total of 30 adult female Wistar-Albino rats was randomly divided into three groups (n = 10): control group (CO; 12 h light/12 h dark exposure), functional Px group (24 h light exposure, light-induced functional Px), and Px+MEL group (light-induced Px + MEL, 20 mg/kg/day for 12 weeks). Critical-sized burr-hole defects (diameter: 3.0 mm) were surgically created by a single operator in the calvarium of all rats, using an electric drill. Animals in Px+MEL group received MEL 20 mg/kg/day for 12 weeks. At the end of the study, bone healing and connective tissue alterations surrounding drilled defect area in the rat calvaria were determined in haematoxylin-eosin-stained and Mallory Azan slices applied in anti-bone sialoprotein. Image Pro Express 4.5 programme was used for histomorphometric calculation of areas of new bone and fibrotic tissue. Normality control was performed by Shapiro-Wilk test. Variance homogeneities were examined by Shapiro-Wilk and Levene tests; Tukey HSD test was used as a post hoc method since there was no homogeneity problem. All hypothesis tests were performed at the 0.05 significance level. RESULTS: Histological analysis showed that the bone repair process in the Px+MEL group was similar to that of the CO group, whereas the functional Px group showed a delay. Histomorphometrically, it was found that the Px group had the largest hole diameter and the most fibrotic scar area, although no binary statistical significance was found between the CO and Px+MEL groups (p = 0.910). In terms of vascularisation, it was observed that the most vascular structure was found in the Px+MEL group among the scar tissue and ossification areas, while the vascularisation was the least in the Px group (p < 0.001). CONCLUSIONS: Our findings revealed that bone repair process was impaired in functional Px group, but exogenous MEL replacement was able to restore this response. Thus, it is concluded that utilisation of MEL may improve the bone repair in calvarial defects.

Complete recovery of acute paraplegia due to pyogenic thoracic spondylodiscitis with an epidural abscess.

Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9-10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.

Inheritance of a translocation between chromosomes 12 and 16 in a family with recurrent miscarriages and a newborn with Down syndrome carrying the same translocation.

Reciprocal translocation carriers have reduced fertility, increased risk of spontaneous abortion or unbalanced karyotype in their offspring. Here, we report the inheritance of a translocation between chromosomes 12 and 16 in a family with recurrent miscarriages and a newborn with Down syndrome carrying the same translocation. Chromosomal analysis from fetal amniotic fluid and peripheral blood lymphocytes from the family were performed at the Cukurova university hospital in Turkey. We assessed a family in which the translocation between chromosomes 12 and 16 segregates; one of the eight progenies with the karyotype 47,XY,+21,t(12;16)(q24;q24) was heterozygote for the translocation and presented with Down syndrome. His mother is phenotypically normal, one brother and one sister were also carrying the same translocation. Apparently, this rearrangement occurred due to the unbalanced chromosome segregation of the mother [t(12;16)(q24;q24)mat]. This case will enable us to explain the behavior of segregation patterns and the mechanism for each type oftranslocation from carrier to carrier and their effects on reproduction and numerical aberrations. The t(12;16) is also associated with fetal wastage and may play a role in the etiology of the family's miscarriages. These findings can be used in clinical genetics and may be used as an effective tool for reproductive guidance and genetic counseling.

Prenatal diagnosis of type I sacrococcygeal teratoma and its management.

PURPOSE: To report a case of type I sacrococcygeal teratoma (SCT) diagnosed prenatally and managed surgically successfully in the neonatal period. CASE REPORT: A gravida 2, para 1, woman at 32 week's gestation was referred for suspected fetal anomaly. On US a 14 x 12 cm mass with solid and cystic components was detected in the sacral region of the fetus. On MRI the tumor had no apparent intrapelvic or intraabdominal extent, indicating type I SCT. Cesarean section was performed at 34 weeks' gestation due to signs of deteriorating high output cardiac compromise in the fetus. In the neonatal period stabilization of the infant was achieved. At age ten days the mass was successfully excised surgically. CONCLUSION: Prenatal determination of SCT, follow-up with sonography, time, and mode of delivery are indicative factors for prognosis in SCT.

Illustrations of neurosurgical techniques in early period of Ottoman Empire by Serefeddin Sabuncuoglu.

BACKGROUND: Serefeddin Sabuncuoglu (A.D. 1385-1468) was the author of the first illustrated surgery atlas Cerrahiyyetü'l Haniyye (Imperial Surgery), which was written in Turkish in 1465. The purpose of this report is to present his unique contribution to modern neurological surgery. METHODS: Cerrahiyyetü'l Haniyye consists of 412 pages in three chapters, in which there are a total of 191 sections dealing with a variety of surgical specialties, including neurosurgery. In each section of the book, a sentence written in rhyme and meter gives the diagnosis, classification and surgical technique in detail. Serefeddin Sabuncuoglu describes medical and surgical management of neurological diseases such as spinal trauma, epilepsy, migraine, facial palsy, hemiplegia, low back pain, cranial fracture, hydrocephalus and abscesses of the head in his textbook. CONCLUSIONS: Serefeddin Sabuncuoglu was a great surgeon in Turkish medical history and the sections on neurological diseases in Cerrahiyyetü'l Haniyye are of great importance in neurosurgery. Today, he is justified as a pioneer of surgery, an investigator and a medical illustrator in the early period of Ottoman Empire. His atlas is a modification of original contributions from earlier treatises.

Protective effect of high-dose thiamine (B1) on rat detrusor contractility in streptozotocin-induced diabetes mellitus.

We investigated the effect of thiamine (B1) treatment on bladder dysfunction in streptozotocin (STZ)-induced diabetic rats. A total of 40 rats were randomly divided into four groups: a control group, a group given thiamine only, a diabetic group and a diabetic group given thiamine therapy. Diabetes was induced in the rats by 65 mg/kg STZ via an intraperitoneal injection. Thiamine was given 50 mg/kg/day. Diabetic cystopathy was confirmed on cystometry 8 weeks later in diabetic groups. Rats' body and bladder weights were measured. Contractile response to carbachol and potassium chloride (KCl) of detrusor strips in all groups was studied in vitro. The body weights were significantly decreased (p<0.01), the bladder weights were significantly increased (p<0.01), and the cystometric bladder capacity and the residual urine volumes were significantly increased (p<0.001, p<0.01 respectively) in STZ-induced diabetic groups compared to the control group and the group given thiamine only. Contractile responses increased in the diabetic group in high carbachol and KCl concentrations (p<0.01, p<0.01, respectively). On the other hand, there were no differences in the other groups. These data suggest that high-dose thiamine (B(1)) treatment may be beneficial in delaying the progression of diabetic cystopathy in this experimental animal model.

Effect of smoking on semen parameters of men attending an infertility clinic.

OBJECTIVE: To assess the effects of smoking on total sperm count, progressive sperm motility and sperm morphology among couples attending an infertility clinic. METHODS: A total of 223 sperm samples (126 smokers and 97 nonsmokers) from men attending an infertility clinic for routine infertility workup were compared on the basis of standard semen analysis. RESULTS: Cigarette smoking is negatively correlated with progressive motile sperm count (r = -0.1464, p = 0.042), but not with sperm concentration (p = 0.961), total motile sperm count (p = 0.890) and sperm morphology (p = 0.838). Furthermore, packages/ year (cumulative dose of cigarettes) did not correlate with any of the sperm parameters including sperm density (p = 0.976), total (p = 0.559) and progressive (p = 0.406) motile sperm count and sperm morphology (p = 0.449). CONCLUSIONS: Although the effect of smoking on male infertility remains inconclusive, smoking had an adverse effect on the progressive sperm motility, irrespective of total amount of cigarettes smoked per day.

The association between mean platelet volume and infants with meconium stained amniotic fluid.

OBJECTIVE: The exact pathophysiology of meconium passage into the amniotic fluid is unknown, but it is frequently associated with fetal hypoxia. The mean platelet volume (MPV) seems to be a marker of platelet production and consumption and may be related to the severity of some diseases associated with bone marrow, hypoxia, and perinatal infections. We aimed to investigate the association between MPV levels and meconium-stained amniotic fluid (MSAF) in infants. PATIENTS AND METHODS: MPV, serum-reactive protein and hemoglobin levels, and leukocyte and thrombocyte counts were measured in 106 infants with MSAF and a comparison group of 78 healthy control infants. RESULTS: The mean MPV values of the infants with MSAF were statistically significantly lower than those of the control group (p < 0.001). There was no statistically significant difference in the hemoglobin levels or leukocyte and thrombocyte counts in the study group compared to the control group (p > 0.05). There was also no statistically significant difference in the MPV levels of the infants with meconium aspiration syndrome (MAS) compared to the infants with MSAF without MAS (p = 0.107). The optimal cut-off value for the MPV was 9.90 fl (area under the curve [AUC: 0.788]) in the infants with MSAF, with a sensitivity of 78.1% and specificity of 74.3%. CONCLUSIONS: Our data suggest that the MPV levels of infants with MSAF were significantly lower than those of healthy infants. This might be associated with a hypoxic process. However, the MPV levels of infants with MSAF and MAS were statistically similar. Thus, the MPV level could not be used to detect patients with or without severe disease.

Mean platelet volume in hepatitis A.

OBJECTIVE: Hepatitis A virus (HAV) still continues to be a serious public health problem worldwide. Mean platelet volume (MPV) is a marker of platelet function and activation. This study aimed to evaluate the relationship between MPV in acute hepatitis A patients as compared to the control group and to assess MPV as an acute phase reactant in acute hepatitis A. PATIENTS AND METHODS: Seventy-six patients were enrolled in this study. The control group consisted of 41 healthy age- and sex-matched individuals. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, prothrombin time (PT), platelet count (PC), serum albumin (ALB), and mean platelet volume (MPV) levels were recorded. The diagnosis of HAV infection was based on anti-HAV Ig M positivity. RESULTS: The mean levels of MPV in the study group were significantly statistically lower than in the control group (p < 0.001). The MPV levels revealed no correlation with the ALT, AST, ALP, and GGT levels (p > 0.05), but the MPV levels correlated with the platelet counts (p < 0.05). A 9.75 fL [area under the curve (AUC: 0.756)] optimal cutoff level of MPV with a sensitivity of 69.7% and specificity of 68.3% was determined in the children with acute hepatitis A. CONCLUSIONS: MPV levels were significantly lower in the patients with acute hepatitis A as compared to the healthy control group. This study demonstrated that MPV may be a negative acute phase reactant for acute hepatitis A. Further studies will explain the role that MPV plays in inflammation and other viral infections.