Relationship between Gravidity, Parity, and Neurophysiological Features in Carpal Tunnel Syndrome (CTS) Patients with a History of Pregnancy.

BACKGROUND: It is not yet clear if gravidity and parity have any relationships with the electrodiagnostic parameters of carpal tunnel syndrome (CTS). OBJECTIVE: To determine whether there is a relationship between electrodiagnostic findings, gravidity, and parity number in CTS. MATERIALS AND METHODS: Female patients over 18 years of age with CTS were included in this retrospective cohort study. The gravidity/parity number, median nerve compound muscle action potential (CMAP), and compound nerve action potential (CNAP) of the patients were analyzed. The two subgroups of the Boston carpal tunnel syndrome questionnaire (BCTSQ): The Symptom Severity Scale (SSS) and Functional Severity Scale (FSS) were applied to the patients. CTS patients were divided into two groups aged at first pregnancy ≤20 years and >20 years. RESULTS: One hundred and eight CTS extremities (seven right-sided CTS, three left-sided CTS, 49 bilateral CTS) of 59 patients were included. The median (interquartile range: 25%-75%) number of gravidity, parity, and abortion were 3 (2-5), 3 (2-4), and 0 (0-0), respectively. Right-sided CTS patients at the age of first pregnancy ≤20 years had higher BCTSQ-SSS/FSS scores and median nerve CMAP latency compared to patients at the age of first pregnancy >20 years (P = 0.029 for SSS; P = 0.042 for FSS; and P = 0.041 for CMAP latency). A negative correlation was found between the gravidity/parity numbers and median nerve CNAP/CMAP amplitudes (P = 0.028/0.031, r = -0.293/-0.289 for CNAP amplitude; and P = 0.006/0.035, r = -0.363/-0.283 for CMAP amplitude). CONCLUSION: Neurophysiological findings worsen as the number of gravidity and parity increase. Electrodiagnostic and clinical features of CTS may be worsening in females below 20 years at first pregnancy.

Effect of Remote Ischemic Preconditioning in Total Knee Arthroplasty on Thiol-Disulfi de Balance: a Randomized Controlled Study.

PURPOSE OF THE STUDY The purpose of this study was to minimize tourniquet-induced ischemia-reperfusion injury (IRI) in total knee arthroplasty (TKA) surgery using the remote ischemic preconditioning (RIPC) model, as well as to assess antioxidant balance with thioldisulfi de homeostasis (TDH). The secondary goal is to evaluate the impact of RIPC on TKA clinical outcomes. MATERIAL AND METHODS Patients in the ASA I-III group who underwent elective TKA were enrolled in this prospective, randomized, double-blind clinical research. TDH parameters were measured individually in groups with (Group I) and without (Group K) RIPC at the following times: preoperative (T0), right before the pneumatic tourniquet was opened (T1), 1 (T2), 6 (T3), and 24 (T4) hours after it was opened. In addition, at 3-hour intervals, the postoperative pain level was assessed using a visual analog scale (VAS). RESULTS This study included 60 cases (Group K; n=30, Group I; n=30). Both groups had equal native thiol, total thiol, disulfi de levels, disulfi de/native thiol, disulfi de/total thiol, and native thiol/total thiol ratios (p>0.05 for each). The change in native thiol, total thiol, and disulfi de values at T0 and T4 periods, however, was not statistically signifi cant for Group K (p=0.049, p=0.047, p=0.037, and p=0.217, p=0.191, p=0.220, respectively). At the 15th hour, VAS values in group I were considerably lower than in Group K (p=0.002). DISCUSSION This prospective, randomized, controlled trial examined how RIPC affected tourniquet-induced IRI-induced oxidative stress in TKA surgery. Lower native, total, and disulfi de levels at each postoperative time point were signifi cant. RIPC may reduce tourniquet-induced IRI-induced oxidative stress and TDH in TKA surgery. RIPC also reduced postoperative discomfort. CONCLUSIONS Our fi ndings suggest that RIPC may protect against the oxidative stress caused by IRI during limb surgery with a tourniquet and improve postoperative clinical outcomes. Key words: remote ischemic preconditioning, ischemia-reperfusion injury, thiol-disulfi de balance, oxidative stress, total knee arthroplasty.

High/severe fear of childbirth and related risk factors among pregnant women: is vaginismus a risk factor?

This study aimed to investigate the prevalence of fear of childbirth (FOC) and associated factors including vaginismus in pregnant women with high/severe FOC. In the study, 407 women who were at 24-40 weeks of gestation were included. The Wijma Delivery Expectancy/Experience Questionnaire Version A (WDEQA), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and vaginismus sub-scale of the Golombok Rust inventory of sexual satisfaction (GRISS) were used. 186 (46%) participants had high/severe FOC. Pregnant women with high/severe FOC had a significantly higher fear of pain during sexual intercourse, higher scores in the WDEQA, BDI, BAI, and vaginismus sub-scale of GRISS. Depression and anxiety level, educational level, access to information on delivery during pregnancy, presence of medical disease, and expression of FOC were predictors of high/severe FOC. Assessment of FOC and associated risk factors, including vaginismus, during pregnancy, will enable the identification of risk groups and the creation of support programmes.Impact StatementWhat is already known on this subject? The range of fear of childbirth (FOC) changes from mild anxiety to severe fear. The prevalence and severity of FOC and related risk factors vary in the studies due to cultural factors, differences in the definition of FOC and measurement tools. The relationship between FOC and vaginismus has not been sufficiently investigated.What do the results of this study add? This study aimed to investigate the prevalence of fear of childbirth (FOC) and associated factors including vaginismus in pregnant women with high/severe FOC.What are the implications of these findings for clinical practice and/or further research? This is the first study that evaluates vaginismus as a risk factor for FOC. Assessment of FOC and associated risk factors, including vaginismus, in pregnant women, will enable the identification of risk groups and the creation of support programs for risk reduction.

Relationship of depression, impulsivity, distress intolerance and coping styles with maladaptive eating patterns in bariatric candidates.

PURPOSE: The study aimed to investigate the problematic eating patterns and understand their relationship to psychological constructs, including stress intolerance, coping mechanisms and impulsivity, and psychiatric symptoms among bariatric surgery candidates. METHODS: The bariatric candidates were evaluated by psychiatric interview and standard scales assessing maladaptive eating behaviors (Eating Attitudes Test (EAT), Bulimia Investigatory Test-Edinburgh (BITE), Dutch Eating Behavior Questionnaire (DEBQ)), depression (Beck Depression Inventory (BDI)), psychiatric symptoms (Brief Symptom Inventory (BSI)), and psychological constructs (Distress Intolerance Index (DSI), Coping Styles Scale (CSS), UPPS Impulsive Behavior Scale(UPPS)). RESULTS: More than half (57.8%) had maladaptive eating behaviors, and 23.6% had binge-eating behavior. Depression and anxiety predicted EAT, BITE, and DEBQ emotional and external eating sub-scale scores; distress intolerance, helpless coping style, and impulsivity predicted maladaptive eating behaviors in bariatric candidates. CONCLUSION: Maladaptive eating patterns play an essential role in the failure to lose weight and regain weight and are predicted by depression, anxiety, and psychological constructs in this study. Evaluation of pathological trait characteristics besides discrete psychiatric syndromes should be recommended in the pre-operation process to plan relevant interventions in the long-term management of weight. LEVEL OF EVIDENCE: Level III, evidence obtained from well-designed cohort analytic studies.

The prognostic significance of vitamin D deficiency in patients with COVID-19 pneumonia.

BACKGROUND: Vitamin D has anti-inflammatory and immunomodulatory effects via the downregulation of pro-inflammatory cytokines. We aimed to demonstrate the effect of vitamin D levels on survival in COVID-19 patients. MATERIALS AND METHODS: 207 COVID-19 patients were included in the study. Serum vitamin D levels were measured, and patients with levels <20 ng/ml or 21 to 30 ng received a single 300.000 IU dose of vitamin D. RESULTS: Of 207 patients, 37 received vitamin D, while 170 did not. Demographic, radiologic and mean laboratory values were similar between the groups. The mean plasma vitamin D level without vitamin D support (n=170) was 50.82±16.12 ng/ml (30.28-81.35) vs. 16.98±6.2 ng/ml (4.20-28.30) in vitamin D group. The most remarkable finding were the mortality rates; while only 1 patient (2.7 %) died in the vitamin D group, 24 patients (14.1 %) died in no vitamin D supplementation group (p=0.038). CONCLUSION: Although a few retrospective studies put forth a relation between vitamin D deficiency and COVID-19 course severity there is still paucity of data about the efficacy of vitamin supplementations in COVID-19 patients. A single 300.000 IU dose of vitamin D seems to represent a useful, practical, and safe adjunctive approach for the treatment or prevention of COVID-19 (Tab. 1, Fig. 1, Ref. 30).

The use of prone positioning in severe COVID-19 outside the intensive care unit.

OBJECTIVES: It was aimed to demonstrate the applicability of the prone position with high-flow oxygen to COVID-19 patients with severe respiratory failure in the service in September when the number of cases and the need for intensive care were increased. MATERIAL AND METHODS: The prone position was applied for a minimum of 30-minute periods for at least four hours a day. The patients' oxygen saturation levels and respiration rates were monitored before and 30 minutes after prone positioning. RESULTS: Ten patients, nine males (9/1, M/F), were included in the study. Mean oxygen saturation at baseline was 75.8±12.14 (min: 50 %; max: 90 %) and all patients had high oxygen demand. The oxygen saturation of the patients differed significantly before and after (83.4±6.38 %; 90±5.31 %, p <0.001) prone positioning. Similarly, respiration rates differed significantly before and after (23.9±6; 21.4±4.97, p <0.001) prone positioning. Two patients died during treatment. CONCLUSION: This study highlights the promise of prone positioning performed in ward conditions for improving oxygenation in COVID-19. While the study contains a small group, it may provide guidance for the clinical management of COVID-19 patients to prevent the need for intensive care in the challenging course of therapy (Tab. 2, Fig. 2, Ref. 15).

Mechanic ileus due to retroperitoneal migration of total hip prosthesis; A case report.

Intrapelvic migration of total hip prosthesis is a rare but severe complication of total hip arthroplasty that can cause severe outcomes for elderly patients. A 78-year-old female patient was referred to our hospital with the complaint of no gas-stool excretion for 3-4 days, abdominal distension, nausea, vomiting, and a preliminary diagnosis of ileus. Computed tomography showed the migration of the left total hip prosthesis to the pelvis, causing a hematoma around the prosthesis and mechanical ileus due to the compression of the hematoma. To our knowledge, this case report is the only reported mechanic ileus due to migration of total hip prosthesis. Although postop paralytic ileus is one of the complications of total hip arthroplasty, mechanical ileus has not been described before. This case report shows that mechanical ileus might be an unreported complication of total hip arthroplasty. It should be kept in mind that mechanical ileus complications may also occur after hip arthroplasty.

Vitamin D binding protein genotype frequency in familial Mediterranean fever patients.

Objective: Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent short episodes (1-3 days) of inflammation and fever. FMF is associated with MEFV gene mutations but some patients with FMF symptoms do not have a mutation in the coding region of the MEFV gene. Vitamin D binding protein (VDBP) has important functions, including transporting vitamin D and its metabolites to target cells. Circulating levels of vitamin D are decreased in several inflammatory conditions, including FMF. Thus, we hypothesize that VDBP may play a crucial role in FMF pathogenesis, in addition to the MEFV gene. Method: VDBP genotyping was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism in 107 FMF patients and 25 healthy individuals without FMF or family history. For this, after amplification of genomic DNA, PCR products were digested with restriction enzymes HaeIII and StyI and evaluated electrophoretically. Results: We observed a statistically significant difference in the frequency of the 1F-2 genotype. The frequency of allele 2 was significantly higher and allele 1S was significantly lower compared to the [MEFV(-)] group and healthy controls (p = 0.034, 0.001, and 0.012, respectively). We observed a significant association between the presence of allele 2 and amyloidosis (p = 0.026) and arthritis (p = 0.044) in the [MEFV(-)] group. Conclusion: Our results suggest that FMF symptoms in the absence of MEFV gene mutations may be due to the presence of VDBP allele 2. Therefore, VDBP genotype may explain the symptoms in FMF [MEFV(-)] patients.

Genotype-phenotype correlation, gonadal malignancy risk, gender preference, and testosterone/dihydrotestosterone ratio in steroid 5-alpha-reductase type 2 deficiency: a multicenter study from Turkey.

BACKGROUND: Studies regarding genetic and clinical characteristics, gender preference, and gonadal malignancy rates for steroid 5-alpha-reductase type 2 deficiency (5α-RD2) are limited and they were conducted on small number of patients. OBJECTIVE: To present genotype-phenotype correlation, gonadal malignancy risk, gender preference, and diagnostic sensitivity of serum testosterone/dihydrotestosterone (T/DHT) ratio in patients with 5α-RD2. MATERIALS AND METHODS: Patients with variations in the SRD5A2 gene were included in the study. Demographic characteristics, phenotype, gender assignment, hormonal tests, molecular genetic data, and presence of gonadal malignancy were evaluated. RESULTS: A total of 85 patients were included in the study. Abnormality of the external genitalia was the most dominant phenotype (92.9%). Gender assignment was male in 58.8% and female in 29.4% of the patients, while it was uncertain for 11.8%. Fourteen patients underwent bilateral gonadectomy, and no gonadal malignancy was detected. The most frequent pathogenic variants were p.Ala65Pro (30.6%), p.Leu55Gln (16.5%), and p.Gly196Ser (15.3%). The p.Ala65Pro and p.Leu55Gln showed more undervirilization than the p.Gly196Ser. The diagnostic sensitivity of stimulated T/DHT ratio was higher than baseline serum T/DHT ratio, even in pubertal patients. The cut-off values yielding the best sensitivity for stimulated T/DHT ratio were ≥ 8.5 for minipuberty, ≥ 10 for prepuberty, and ≥ 17 for puberty. CONCLUSION: There is no significant genotype-phenotype correlation in 5α-RD2. Gonadal malignancy risk seems to be low. If genetic analysis is not available at the time of diagnosis, stimulated T/DHT ratio can be useful, especially if different cut-off values are utilized in accordance with the pubertal status.

In vitro Fracture strength and hardness of different computer-aided design/computer-aided manufacturing inlays.

OBJECTIVE: The purpose of this study was to examine the fracture strength and surface microhardness of computer-aided design/computer-aided manufacturing (CAD/CAM) materials in vitro. MATERIALS AND METHODS: Mesial-occlusal-distal inlays were made from five different CAD/CAM materials (feldspathic ceramic, CEREC blocs; leucite-reinforced ceramic, IPS Empress CAD; resin nano ceramic, 3M ESPE Lava Ultimate; hybrid ceramic, VITA Enamic; and lithium disilicate ceramic, IPS e.max CAD) using CEREC 4 CAD/CAM system. Samples were adhesively cemented to metal analogs with a resin cement (3M ESPE, U200). The fracture tests were carried out with a universal testing machine. Furthermore, five samples were prepared from each CAD/CAM material for micro-Vickers hardness test. Data were analyzed with statistics software SPSS 20 (IBM Corp., New York, USA). RESULTS: Fracture strength of lithium disilicate inlays (3949 N) was found to be higher than other ceramic inlays (P < 0.05). There was no difference between other inlays statistically (P > 0.05). The highest micro-Vickers hardness was measured in lithium disilicate samples, and the lowest was in resin nano ceramic samples. CONCLUSION: Fracture strength results demonstrate that inlays can withstand the forces in the mouth. Statistical results showed that fracture strength and micro-Vickers hardness of feldspathic ceramic, leucite-reinforced ceramic, and lithium disilicate ceramic materials had a positive correlation.

SCREENING OF PROP-1, LHX2 AND POU1F1 MUTATIONS IN PATIENTS WITH ECTOPIC POSTERIOR PITUITARY GLAND.

OBJECTIVE: Ectopic posterior pituitary gland (EPP) is usually characterized by an abnormal pituitary stalk and hypoplasia of the anterior hypophysis. The genetic mechanisms involved in the development of EPP remain uncertain. The aim of this study is to determine whether mutations in the three genes, PROP-1, LHX2, and POU1F1, are associated with the risk for and the characteristics of EPP. METHODS: In the Endocrinology Outpatient Clinic of "Dr. Behcet Uz" Children's Hospital, 27 patients with EPP were submitted to sequencing analyses of the PROP-1, LHX2, and POU1F1 genes. RESULTS: Growth hormone, thyrotropin, corticotropin, gonadotropin, and vasopressin deficiency were observed in 22 (81.5%), 23 (85.2%), 17 (63%), 14 (51.9%), and two (7.4%) patients. Thirteen patients (48.1%) presented with hyperprolactinemia. Fourteen patients (51%) had a history of birth dystocia, and 12 cases (42.1%) had a history of breech presentation. Central nervous system abnormalities included five cases with corpus callosum agenesis, one case with schizencephaly, and one case with Chiari type 1 malformation. We identified a homozygous p.S109* mutation in exon 2 in one male patient with EPP and two different PROP1 gene polymorphisms (A142T or c.109+3 G>A polymorphism) in thirteen patients. CONCLUSIONS: Our results suggest that PROP1 gene abnormalities might explain the genetic mechanisms involved in the development of EPP.

Correction to: Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

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Evaluation and application of a passive air sampler for polycylic aromatic hydrocarbons (PAHs).

Sampling of 15 PAHs by the use of both passive air sampler developed (D-PAS) in our research group and PAS (C-PAS) having widespread use in the literature was conducted to compare the performances of the samplers. Sampling was carried out for 1-year period (February 2013-February 2014), in different sampling periods by employing D-PAS and C-PAS. D-PAS and C-PAS were run in parallel for 10, 20, 30, 40 and 60 days. Sampling rates were calculated for both PASs by the use of concentration values obtained from a high-volume air sampler (HVAS). It was determined that calculated sampling values are different from each other by definition of design of C-PAS and D-PAS and difference in environment as velocity of wind and temperature are having different effects upon sampling rates. Collected σ15PAHs amounts of 10-day periods in spring, summer, autumn and winter were obtained as 576 ± 333, 209 ± 29, 2402 ± 910 and 664 ± 246 ng for D-PAS and 1070 ± 522, 318 ± 292, 6062 ± 1501 and 6089 ± 4018 ng for C-PAS, respectively. In addition, according to seasons, when collected PAHs in two different samplers were considered, similar results were obtained for the summer time in which no combustion takes place with the aim of domestic heating, while there were differences determined for the seasons with combustion in need of domestic heating. Gas-phase σ15PAHs' concentrations were reported depending on seasons in the spring, summer, autumn and winter sequences as 46 ± 32, 9 ± 3, 367 ± 207 and 127 ± 93 ng m-3 for HVAS, respectively.

Effectiveness of Jigsaw learning compared to lecture-based learning in dental education.

AIM: The objective of this study was to evaluate the success levels of students using the Jigsaw learning method in dental education. METHOD: Fifty students with similar grade point average (GPA) scores were selected and randomly assigned into one of two groups (n = 25). A pretest concerning 'adhesion and bonding agents in dentistry' was administered to all students before classes. The Jigsaw learning method was applied to the experimental group for 3 weeks. At the same time, the control group was taking classes using the lecture-based learning method. At the end of the 3 weeks, all students were retested (post-test) on the subject. A retention test was administered 3 weeks after the post-test. Mean scores were calculated for each test for the experimental and control groups, and the data obtained were analysed using the independent samples t-test. RESULTS: No significant difference was determined between the Jigsaw and lecture-based methods at pretest or post-test. The highest mean test score was observed in the post-test with the Jigsaw method. In the retention test, success with the Jigsaw method was significantly higher than that with the lecture-based method. CONCLUSION: The Jigsaw method is as effective as the lecture-based method.

Utilization of glial fibrillary acidic protein and galectin-3 in the diagnosis of cerebral infarction patients with normal cranial tomography.

OBJECTIVE: It was aimed to determine whether levels of glial fibrillary acidic protein (GFAP) and Galectin-3 contribute to the diagnosis of cerebral infarction in clinically suspected ischemic stroke patients with normal computerized cranial tomography (CCT) in the emergency department. MATERIALS AND METHODS: In this study, patients above the age of 18 years who presented to emergency department of Firat University between December 2011-November 2012 and were diagnosed with cerebral infarction were included. Exclusion criteria were as follows: symptom onset exceeding 24 hours, trauma, pregnancy, acute myocardial infarction, acute pulmonary embolism, chronic renal insufficiency and steroid therapy. RESULTS: A total of 90 participants, forty patients with ischemic infarction who were diagnosed by CCT and clinical findings (Normal CCT in 17 patients and CCT with an area of infarction in 23 patients) and fifty healthy controls, were included in this study. Compared with the control group, levels of Galectin-3 and GFAP were found to be significantly increased in patients with ischemic infarction (P <0.001 and P = 0.01, respectively). It was found that levels of Galectin-3 and GFAP were significantly increased in ischemic stroke patients with normal CCT compared to the control group (P = 0.04 and P = 0.025, respectively). In ROC curve analysis, we detected %70.59 sensitivity and 70% specificity (AUC = 0.684, P = 0.0213, 95% CI: 0,558-0.792) with a cutoff value of 33.24 ng/ml for GFAP and 76.47% sensitivity and 68% specificity (AUC = 0.734, P = 0.0048, 95% CI: 0.611-0.834) with a cutoff value of 0.84 ng/ml for Galectin-3. No correlation was found between National Institutes of Health Stroke Scale (NIHSS) scores and Galectin-3 and GFAP (r = 0.251, P = 0.118 and r = 0.164, P = 0.311, respectively). CONCLUSION: The levels of Galectin-3 and GFAP were increased in acute ischemic stroke patients.

Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

BACKGROUND: The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. METHODS: This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. RESULTS: Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. CONCLUSIONS: Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

A prospectively validated nomogram for predicting the risk of chemotherapy-induced febrile neutropenia: a multicenter study.

PURPOSE: There is clinical need to predict risk of febrile neutropenia before a specific cycle of chemotherapy in cancer patients. METHODS: Data on 3882 chemotherapy cycles in 1089 consecutive patients with lung, breast, and colon cancer from four teaching hospitals were used to construct a predictive model for febrile neutropenia. A final nomogram derived from the multivariate predictive model was prospectively confirmed in a second cohort of 960 consecutive cases and 1444 cycles. RESULTS: The following factors were used to construct the nomogram: previous history of febrile neutropenia, pre-cycle lymphocyte count, type of cancer, cycle of current chemotherapy, and patient age. The predictive model had a concordance index of 0.95 (95 % confidence interval (CI) = 0.91-0.99) in the derivation cohort and 0.85 (95 % CI = 0.80-0.91) in the external validation cohort. A threshold of 15 % for the risk of febrile neutropenia in the derivation cohort was associated with a sensitivity of 0.76 and specificity of 0.98. These figures were 1.00 and 0.49 in the validation cohort if a risk threshold of 50 % was chosen. CONCLUSIONS: This nomogram is helpful in the prediction of febrile neutropenia after chemotherapy in patients with lung, breast, and colon cancer. Usage of this nomogram may help decrease the morbidity and mortality associated with febrile neutropenia and deserves further validation.

Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection.

INTRODUCTION: Inflammation has been reported to be associated with aortic dissection (AD), from the development to the prognosis of AD. In this study we aimed to find the role of the neutrophil-lymphocyte ratio (NLR) in the prediction of clinical events in patients with acute AD type A. PATIENTS AND METHODS: The study comprised 37 patients who were hospitalized at our center between 2009 and 2013 with the diagnosis of acute AD type A. RESULTS: The mean NLR was significantly higher in patients with pericardial effusion than those without effusion (15.6 ± 11.4 vs. 7.5 ± 4.8, p = 0.005). An NLR value > 8.51 yielded an area under the curve (AUC) value of 0.829 [95 % confidence interval (CI) 0.674-0.984, p = 0.004], which demonstrated a sensitivity of 77 % and specificity of 74 % for the prediction of mortality. CONCLUSIONS: The novel inflammatory marker NLR could be used to predict pericardial effusion and in-hospital mortality in patients with acute AD type A.

Genetic bottlenecks in Turkish okra germplasm and utility of iPBS retrotransposon markers for genetic diversity assessment.

Lack of requisite genetic variation in Turkish okra has necessitated the use of different types of markers for estimating the genetic diversity and identifying the source of variation. Transposable elements, present abundantly in plant genomes, generate genomic diversity through their replication and are thus an excellent source of molecular markers. We hypothesized that inter-primer binding site (iPBS)-retrotransposons could be the source of variation because of their genome plasticity nature. In the present study, genetic diversity of 66 okra landraces was analyzed using iPBS-retrotransposon markers. iPBS-retrotransposons detected 88 bands with 40.2% polymorphism and an average of 6.8 bands per primer. Gene diversity and Shannon's information index ranged from 0.01 to 0.13 and 0.02 to 0.21 for iPBS-retrotransposons and from 0.06 to 0.46 and 0.14 to 0.65 for simple sequence repeat (SSR) markers, respectively. Polymorphism information content value for retrotransposons varied between 0.12 and 0.99, while that for SSR was from 0.52 to 0.81. Neighbor joining analysis based on retrotransposons and SSRs divided all the accessions into four clusters; however, SSR markers were more efficient in clustering the landraces based on their origin. Using the STRUCTURE software for determining population structure, and two populations (at the number of hypothetical subpopulations, K = 2) were identified among the landraces. Low genetic diversity in Turkish okra highlights the need for the introduction of plants from countries with greater genetic diversity for these crops. This study also demonstrates the utility and role of iPBS-retrotransposons, a dominant and ubiquitous part of eukaryotic genomes, for diversity studies in okra.