Application of the Kvaal method to CBCT reconstructed panoramic images for age estimation.

As the teeth are more durable than other parts of the skeleton, they provide valuable data for age estimation. Age estimation from adult teeth is mainly based on secondary dentin production. The present study aimed to devise a regression formula for age estimation specific to the Anatolian population using the Kvaal method on CBCT reconstructed panoramic images. In total, 201 individuals aged between 20 and 69 were divided into two groups: data from the study group (n = 101) were used to create the regression formulae, and data from the control group (n = 100) were used to test the formulae. Pearson's correlation coefficients and linear regression analyses were performed. Maxillary teeth provided more accurate age estimates than mandibular teeth. The regression formulae derived in this study are found to be statistically applicable and reasonably accurate. However, these results should be interpreted with caution.

Sliced vs crushed cartilage for camouflage: long-term graft survival and histological outcomes.

PURPOSE: In this study, we proposed a "sliced-partial thickness cartilage graft" for nasal contour restoration purposes and compared the long-term graft survival and histological changes of sliced, crushed, and intact cartilage grafts. METHODS: Nasal septal and auricular cartilage grafts were harvested from 8 rabbits. Sliced, crushed, or intact cartilage grafts were measured in thickness with a micrometer and re-implanted. 4 months later, specimens were histologically evaluated and thickness were measured. RESULTS: Both nasal septal and auricular crushed cartilage lost significantly more chondrocytes than sliced samples together with fibrosis, multiple fracture lines, and even ossification. Sliced and intact cartilages were histologically similar except sliced cartilage had some minor changes limited to its cut surface. Sliced cartilages retained their thickness, histology, and structural properties in the long term similar to intact cartilages whereas -contrary to expectations- crushed specimens had significantly higher thickness measurements at the end of 4 months. CONCLUSION: Sliced cartilage grafts prepared with an atraumatic cartilage slicer are an ideal camouflaging material with its uniform thickness, and malleability. Crushed cartilages seemingly getting thicker without histological findings could be explained by lower than actual initial measurements due to its structural weakness and getting squeezed when the standard pressure of the micrometer was applied.

The Impact of First Trimester TSH Level on Fetal Growth and Post-Term Pregnancy.

Objective:  First trimester thyroid-stimulating hormone (TSH) level is an important determiner of neonatal outcome. In this study we investigated the relationship between first-trimester TSH level and fetal birthweight. Materials-Methods: First-trimester serum TSH, age, gravidity, parity, body mass index (BMI), gestational age, and birth weight were analyzed. Patients were divided two ways. The first division- group 1 with TSH < 2.5 mU/l, group 2 with TSH > 2.5 mU/l). The second division- group 3 with TSH < 4 mU/l and group 4 with TSH > 4 mU/l). Results: The study included 302 patients. High TSH levels are associated with an increased risk of macrosomic and post-term babies. A significant association was found for both thresholds of 2.5 and 4.0 mU/l. However, this relation was not significant after binary logistic regression. Conclusion: High maternal first trimester TSH levels are not associated with birth weight after separating out macrosomia-related factors.

Copper and levonorgestrel containing intrauterine devices: comparison of their effect on oxidative stress markers.

OBJECTIVE: We aimed to evaluate the oxidative stress by measuring the thiol-disulfide balance in women who use either T380A or LNG-IUD as a contraceptive method. Material and method: The study included two groups; 30 women with LNG-IUD and 30 women with copper-IUD. Thiol-disulfide homeostasis as a marker of oxidative stress was analyzed before the IUD insertion and on the 6th month after insertion. Results: The LNG-IUD group had similar native thiol levels with Cu-IUD (293.1 ± 43.5 µmol/l vs. 290.4 ± 42.4 µmol/l respectively, p = 819). In the copper-IUD group total thiol levels were higher than LNG-IUD group (345.5 ± 58.2 µmol/l vs. 319.5 ± 52.4 µmol/l, p = .031). A significant increase was observed after 6 months in LNG-IUD patients in terms of disulfide/native thiol (7.9 ± 4.4% vs. 11.2 ± 2.6%, p = .006), disulfide/total thiol (6.2 ± 1.8% vs. 8.7 ± 1.9%, p = .004) and Native thiol/total thiol (87.1 ± 12.1% vs. 82.3 ± 8.2%, p = .004) levels. After 6 months in copper-IUD patients, disulfide (22.3 ± 7.3 µmol/l vs. 27.5 ± 6.9 µmol/l respectively, p = .006), disulfide/native thiol (7.7 ± 3.8% vs. 9.8 ± 2.4% respectively, p = .007), disulfide/total thiol (6.4 ± 2.03% vs. 8.2 ± 1.8% respectively, p = .007) and native thiol/total thiol (86.3 ± 9.4% vs. 83.8 ± 10.6% respectively, p = .007) levels were increased. Conclusion: An increase in oxidative stress markers were observed in both groups. Studies evaluating the long term subclinical risks of IUD's are needed to understand the outcomes of the increased oxidative stress.

The Effects of Septorhinoplasty Techniques and Poly-P-Dioxanone Plate Use on Maxillofacial Growth: An Experimental Study.

ABSTRACT: Since the septum plays a key role in maxillofacial growth, the effect of septorhinoplasty maneuvers and the use of poly-p-dioxanone plate during growth on maxillofacial growth was investigated in our study. Thirty-three New Zealand rabbits each with an age of 8 weeks were included in the study. Maxillofacial computed tomography was performed on all 8-weeks old rabbits. Then, the rabbits were divided into 5 groups randomly. No intervention was done on the rabbits in group 1. Nasal dorsum of the rabbits in the 2nd group were opened, and the mucosae were bilaterally elevated. In the third group underwent limited cartilage resection by preserving the nasal dorsum. Removed cartilage was crushed and placed back between the mucoperichondrial flaps for the rabbits in the 4th group. Crushed cartilage with Poly-P-Dioxanone plate was used for the rabbits in the 5th Group. Maxillofacial computed tomography was performed at the end of the 20th week and growth parameters were investigated. When the group 2 was compared with the control group, the nasal bone length was observed to be significantly shorter (P < 0.05). Group 5 compared with group 4, incisive bone volume remained significantly low (P < 0.05) and malocclusion developed. Nasal bone length was affected negatively in the group that underwent osteotomy and mucosa elevation. Although positive results related to poly-p-dioxanone plate use have been reported for adults, incisive bone development retarded in noses that had not yet reached adult size in our study and the maxillofacial development was affected adversely.

Correlation of Maternal Neck/Waist Circumferences and Fetal Macrosomia in Low-Risk Turkish Pregnant Women, a Preliminary Study.

Goals: Our aim in this study was to determine if the maternal neck and waist circumference measured in the first three months of pregnancy were effective in prediction of fetal macrosomia.Material and methods In this retrospective cohort study; body mass index, neck circumference (NC) and waist circumference (WC) was measured in low risk pregnant women at 11-13+6th weeks of pregnancy.Results Among the 361 women, 8% of newborns were over 4000 grams. The rate of fetal macrosomia increased with the increased NC and WC. In ROC analysis, optimum cutoff value of NC was >36.5 cm to predict fetal macrosomia with 68.97% sensitivity and 66.97% specifity and for WC it was >88 cm with 62.07% sensitivity and 61.26% specifity.Conclusion Risk of fetal macrosomia increased with the increased maternal NC and WC.

Optimal maternal neck and waist circumference cutoff values for prediction of gestational diabetes mellitus at the first trimester in Turkish population; a prospective cohort study.

Aims: To investigate if the maternal neck (NC) and waist (WC) circumferences measured in the first trimester of pregnancy have a predictive value in diagnosing gestational diabetes mellitus (GDM).Materials and methods: In this prospective study NC and WC of pregnant women were measured at 11-14th weeks. GDM was evaluated with a two-step oral glucose tolerance test at 24-28th weeks.Result: A total of 525 women were recruited; 49(9%) developed GDM. NC was positively correlated with WC (r: 0.583, p < .001), BMI (r: 0.533, p < .001), age (r: 0.123, p = .002), parity (r: 0.170, p < .001), and 50 g OGTT levels (r: 0.206, p < .001). Regarding the area under receiver operating characteristic (ROC) curve (AUC) analysis of NC and WC for predicting GDM were 0.585 (95% confidence interval (CI): 0.50-0.66, p = .043), and 0.693 (95%CI: 0.61-0.76, p < .001). The optimal cut off level of maternal NC was >38.5 cm, with 69% sensitivity and 45% specificity, and WC was >84.50 cm with a sensitivity of 78% and a specificity of 54%. Increased WC >84.50 cm (OR: 3.58, 95% CI:1.77-7.27; p < .001) and age >25 (OR: 3.05, 95% CI:1.38-6.72; p = .006) were independent predictors for the development of GDM adjusted for age, gravidity, parity, BMI, and NC.Conclusion: Maternal NC and WC were significantly higher in women with GDM; however, only maternal WC was a significant predictive marker for GDM in low-risk pregnant women.

Hearing Screening Test Results of Newborns Conceived by Intracytoplasmic Sperm Injection: A Retrospective Study of Tertiary Referral Center.

Objective: Assisted reproductive technologies (ART), especially intracytoplasmic sperm injection (ICSI), is associated with birth defects. However, there are few reports on hearing screening tests of these babies. We aimed to determine the association between ART and hearing loss in newborns.Materials and methods: This retrospective study examined 246 ICSI newborns between 2013 and 2015. All the patients conceived by ICSI. We examined the hearing screening results of the babies.Results: A total of 25 newborns did not pass the first screening test, including 17 by transient evoked otoacoustic emission (TEOAE) and 8 by auditory brainstem response (ABR). Ten babies did not pass the advanced examination. Total hearing loss affected 4% of ART babies.Conclusion: Hearing screening tests exposed deficient results in 4% of ICSI babies, which is ten times more frequent than spontaneously conceived newborns.

Two cases of acute urinary retention caused by large cervical leiomyoma with review of literature.

OBJECTIVE: Large uterine or cervical leiomyomas may cause acute urinary retention due to bladder outlet obstruction. We report two cases with acute urinary retention caused by cervical leiomyoma. Myomectomies were performed due to their desire of fertility and frozen-section examinations were reported as benign leiomyomas in both cases. The urinary symptoms completely resolved in two patients following myomectomies. In patients who are admitted with the complaint of acute urinary retention, cervical leiomyomas should be considered in differential diagnosis.

Histopathological effects of septoplasty techniques on nasal septum mucosa: an experimental study.

OBJECTIVE: The aim of this study is to evaluate the histopathological effects of septoplasty techniques on the nasal septal mucosa of rabbits with light and electron microscope. METHODS: The study was performed on 21 rabbits between August 2016 and February 2017. Rabbits were randomly divided into three groups. In Group-1, while preserving the L-strut structure of the septum, cartilage resection, was performed by open technique septoplasty. In Group-2, the same procedure was done except the resected cartilage was crushed and put back in place. No surgical procedure was performed on the Control group. Postoperative 2nd month; the specimens were histopathologically evaluated by light and electron microscope in terms of changes in the morphology of septum mucosa, perichondrial thickness, cilia and goblet cell deprivation, loss in glands, fibrosis and inflammatory cell infiltration in the lamina propria. RESULTS: The deprivation in cilia, goblet cells, serous gland and increase in the amount of collagen fibers were examined in both Group-1 and 2. The difference in Group-1 and Group-2 were statistically significant in terms of presence of cilia, number of goblet cells and glands and increase in collagen fibers when compared to control (p < 0.001, p = 0.002, p = 0.020, p = 0.002, respectively). In terms of perichondrium thickness, statistically significant difference was found between the Control and Group-2 (p < 0.001). CONCLUSiON: In this study, histopathological findings supported that the presence of cartilage in the septum is necessary to prevent the mucosal changes. Long-term studies are needed to observe whether changes in the morphology of epithelium and gland proceed more than 2 months follow-up.

Effect of Prolonged Fasting Duration on 50 Gram Oral Glucose Challenge Test in the Diagnosis of Gestational Diabetes Mellitus.

The aim of this study was to investigate the association between fasting duration before screening with 50 g glucose challenge test (GCT) and the test outcome. For this cross-sectional study, we enrolled 508 low-risk pregnant women who underwent 50 g GCT between the 24 and 28 weeks of gestation. We excluded women with pregestational diabetes, multiple gestations or a history of gestational diabetes mellitus (GDM), and macrosomia. We evaluated fasting durations, GCT results, and demographic features. A significant positive correlation was found between fasting duration and 50 g GCT values (r=0.122; p=0.006), and the best cut-off value was found to be 6.5 h, with 85.85% sensitivity and 38.61% specificity (relative risk, 2.73; 95% CI, 1.893-3.936; p<0.0001). Further, we divided the patients into two groups: study (fasting, <6.5 h; n=146) and control (fasting,>6.5 h; n=362) groups. Notably, the mean glucose levels, number of patients with GCT>140 mg/dl, and rates of unnecessary 100 g loadings were significantly higher in the study group. We found no significant differences between the groups in terms of the fasting plasma glucose levels and GDM prevalence. According to our findings, fasting duration of>6.5 h resulted in 2.7 times more unnecessary 100 g glucose tolerance tests (GTT). We recommend that patients having fasted for>6.5 h receive a one-step 75 g GTT after completing 8-h fasting.

Toxicity assessment of pesticide triclosan by aquatic organisms and degradation studies.

Triclosan is considered as an important contaminant and is widely used in personal care products as an antimicrobial agent. This study demonstrates the biodegradation of triclosan by two freshwater microalgae and the acute toxicity of triclosan and 2,4-dichlorophenol. The effects of culture media and light on biodegradation of triclosan and the changing morphology of microalgae were systematically studied. Geitlerinema sp. and Chlorella sp. degraded 82.10% and 92.83% of 3.99 mg/L of triclosan at 10 days, respectively. The microalgal growth inhibition assay confirmed absence of toxic effects of triclosan on Chlorella sp., even at higher concentration (50 mg/L) after 72 h exposure. HPLC analysis showed that 2,4-dichlorophenol was produced as degradation product of triclosan by Geitlerinema sp. and Chlorella sp. This study proved to be beneficial to understand biodegradation and acute toxicity of triclosan by microalgae in order to provide aquatic environmental protection.

Expression of CD44 variant 6 and its prognostic value in benign and malignant endometrial tissue.

PURPOSE: CD44 expression in both the early and metastatic phases of many epithelial and non-epithelial cancers is strongly prognostic. The objective of the study is to evaluate whether there is any relationship between the expression of CDD44v6 and endometrial cancer (EC) staging and prognosis. METHODS: This retrospective study included 60 EC patients for whom surgical staging was performed between 2000 and 2006. Twenty-eight randomly selected patients with normal endometria served as the control group. We immunohistochemically evaluated membranous and cytoplasmic CD44v6 staining in tissue paraffin blocks. The results were graded as positive or negative. RESULTS: Membranous staining in both advanced and early stage EC patients was significantly higher than that in the control group (p = 0.002). The extent of either membranous or cytoplasmic staining in both advanced- and early stage patients did not differ significantly by age, tumor grade, stage, extent of myometrial invasion, lymph node involvement, cytology, adnexal involvement, or omental spreading. In advanced-stage patients, neither papillary serous not clear cell cancers exhibited cytoplasmic staining. CONCLUSIONS: CD44v6 membranous staining can be useful for differentiating malignant from benign endometrial tissue. However, staining is not associated with EC staging or prognosis.

Comparing neonatal respiratory morbidity in neonates delivered after 34 weeks of gestation with and without antenatal corticosteroid.

OBJECTIVE: To investigate the effect of antenatal corticosteroid prophylaxis on neonatal respiratory morbidity between 34 and 37 weeks of gestation. METHODS: This retrospective study evaluated the neonatal respiratory complications of 683 low risk singleton pregnancies delivered at 34-37 weeks of gestation in a tertiary care center between Jan 2012 and Sept 2015. Group-I (n=294) comprised data of woman who did not receive betamethasone and Group-II(n=396) comprised those who received betamethasone after 34 weeks of gestation for cases at risk of preterm birth. Primary outcome was neonatal respiratory morbidity (NRM). NRM was defined as any respiratory disease that required medical support including supplemental oxygen, nasal continuous positive airway pressure, endotracheal intubation, or exogenous surfactant, with more than 25% oxygen for > 10 minute to maintain neonate oxygen saturation >90% Demographic characteristics, mode of delivery, fetal birth weight and neonatal respiratory complications was compared between the two groups. RESULTS: There was no statistically significant difference for neonatal respiratory morbidity development rate between patients who received betamethasone or those who did not receive it. The incidence of neonatal respiratory morbidity was similar (15.3% in the control group and 14.9% in the intervention group; p=0.88). CONCLUSION: We found no improvement with betamethasone administration empirically in late preterm birth as regards prevention of Neonatal Respiratory Morbidity(NRM).

The prognostic value of first-trimester cystatin C levels for gestational complications.

AIMS: This study is designed to evaluate predictive value of first-trimester cystatin C levels for long-term pregnancy complications. METHODS: The cross-sectional study population consisted of patients who admitted to outpatient clinic of a Maternity Hospital between September 2013 and December 2014. Among the 203 participants who accepted to participate in the study, 174 subjects who continued antenatal follow-up in the same clinic were included in the final analyses. Cystatin C, blood urea nitrogen, Creatinine levels and estimated glomerular filtration rates were evaluated in the first-trimester routine antenatal visit. Mode of delivery and gestational complications were noted. RESULTS: First-trimester cystatin C levels were significantly higher in cases complicated with preterm delivery and premature rupture of membrane (PROM) compared to uncomplicated ones (0.58±0.07 vs. 0.55±0.07, P=0.041, and 0.58±0.07 vs. 0.55±0.07, P=0.036). With a cutoff value of 0.505 mg/L, sensitivity of cystatin C for preterm delivery and PROM was 91.9% and specificity was 27.7% with a negative predictive value of 92.3% and a positive predictive value of 26.6%. CONCLUSION: Detection of cystatin C levels in the first trimester of pregnancy for the prediction of preterm/PROM seems as a promising preliminary data. The relatively higher first-trimester cystatin C levels in complicated pregnancies are conspicuous. The results imply that in pregnancy cystatin C might be more than a marker for renal function.

The effects of different environmental pH on healing of tympanic membrane: an experimental study.

In this study, we investigated the effect of environmental pH on healing of acute rat tympanic membrane perforations. Twenty Wistar albino rats were divided into four groups and used in the study. A large myringotomy was performed in the posteroinferior quadrants of both tympanic membranes. In left ears, topical pH 4 standard calibration solution was used in groups 1 and 3, and pH 7 standard calibration solution was used in groups 2 and 4. Right ears served as controls, and allowed for spontaneous healing. The solutions were applied for 2 days in groups 1 and 2, and for 7 days in groups 3 and 4. Healing was assessed by macroscopic closure of the tympanic membrane perforation, and histopathological analysis of lamina propria edema, neovascularization, inflammatory cells, and fibroblastic reaction in the temporal bones. pH 7 and pH 4 groups were similar for macroscopic closure of perforation on day 2; however difference was significant on day 7. The fibroblastic activity was significantly less on days 2 and 7 in pH 4 group. On day 7, there were significant differences between pH 4 and pH 7, and pH 7 and control groups for inflammatory cell infiltration. In conclusion, clinical and histopathological results of this study indicated that acidic environmental pH speeded up and shortened wound-healing process. By building up optimum environmental pH, a healthy healing may be achieved in acute tympanic membrane perforations.

Massive subcutaneous emphysema in robotic sacrocolpopexy.

The advent of robotic surgery has increased the popularity of laparoscopic sacrocolpopexy. Carbon dioxide insufflation, an essential component of laparoscopy, may rarely cause massive subcutaneous emphysema, which may be coincident with life-threatening situations such as hypercarbia, pneumothorax, and pneumomediastinum. Although the literature contains several reports of massive subcutaneous emphysema after a variety of laparoscopic procedures, we were not able to identify any report of this complication associated with laparoscopic or robotic sacrocolpopexy. Massive subcutaneous emphysema occurred in 3 women after robotic sacrocolpopexy in our practice. The patients had remarkable but reversible physical deformities lasting up to 1 week. A valveless endoscopic dynamic pressure system was used in all 3 of our cases. Our objective is to define the risk of massive subcutaneous emphysema during robotic sacrocolpopexy in light of these cases and discuss probable predisposing factors including the use of valveless endoscopic dynamic pressure trocars.

A retrospective analysis of the women hospitalized and treated due to anemia caused by gynecological pathologies: the role of intravenous iron (ferric carboxymaltose) and blood transfusion in clinical practice.

BACKGROUND: Gynecological pathologies are an important cause of anemia in women. In this study, we aimed to evaluate women who had been hospitalized because of anemia (Hb level <10 g/dL) caused by gynecologic pathologies and treated with either intravenous iron (ferric carboxymaltose) or blood transfusion. METHODS: This retrospective cross-sectional study was performed in a tertiary care center. Women who were hospitalized with the diagnosis of anemia with Hb level<10 g/dL and abnormal uterine bleeding between March 2015- September 2017 in the gynecology clinic were enrolled in the study. Hemoglobin levels, hemoglobin changes, uterine pathology and treatment of patients were recorded and compared. RESULTS: One hundred and fifteen women received red blood cell transfusion and 100 women were treated with intravenous ferric carboxymaltose. The mean age of the women was 45.1±6.1 (22-57) years. Although the mean Hb levels were higher in the iv-iron replacement group at the end of the one month (P=0.001), the mean increase in Hb levels was similar between two treatment modalities (P=0.101). Among the anemic women who required surgery, iv iron replacement was the first choice in 75.9% of women; 34.1% received red blood cell transfusion in the preoperative period. CONCLUSIONS: Gynecological pathologies are a common cause of anemia in reproductive age women and intravenous carboxymaltose treatment is a safe and cheaper alternative of blood-transfusion in appropriate cases to elevate the Hb levels in the preoperative period.

Maternal irisin level in last trimester isolated intrauterine growth-restriction.

PURPOSE: Intrauterine Growth Restriction (IUGR) is the inability of the fetus to achieve the biologically accessible growth potential. Irisin is a recently discovered adipomyokine with a crucial role in energy metabolism. Our current study aimed to investigate the relationship between the isolated IUGR in the third trimester and maternal serum irisin level. MATERIALS AND METHODS: This prospective case-control study included total 137 pregnant women who were between the 24th and 39th gestational weeks and who applied to the University of Health Sciences, Ankara Zekai Tahir Burak Women's Health Training and Research Center, between 2016 October-2017 May. The Study Group consisted of 68 pregnant women who were diagnosed with Isolated IUGR with Estimated Fetal Weight (EFW) <10th percentile. The Control Group consisted of 69 low-risk uncomplicated pregnant women, matched with the Study Group in terms of gestational week, and with EFW between 10th and 90th percentiles. Demographic data, clinical findings, fetal Doppler parameters, and obstetric-neonatal outcomes were evaluated. Maternal serum irisin levels were measured by ELISA (Enzyme-Linked Immunosorbent Assay) Method and compared between the groups. RESULTS: Maternal serum irisin level was found to be significantly lower in IUGR Group as compared to the Control (3.83 ng/ml vs. 4.78 ng/ml, p < .001, respectively). There was a positive correlation between maternal serum irisin level and duration of pregnancy, the weight gain during pregnancy, birth weight, fetal abdominal circumference measurement and cerebroplacental ratio (r = 0.18, p = .03; r = 0.17, p = .04; r = 0.37, p < .001; r = 0.35, p < .001; r = 0.27, p = .001, respectively). Binary Logistic Regression Analysis showed that maternal serum irisin level is an independent estimator of IUGR [OR %95 CI: 8.33 (3.22 - 25.01)]. AUC (Area Under the Curve) analysis of maternal irisin for IUGR estimation was 0.75 (p < .001, 95% CI = 0.67 - 0.82). The optimal cutoff value was below 3.86 ng/ml for maternal irisin level with a sensitivity of 54.41% and a specificity of 88.41%, positive predictive value of 82.22% and negative predictive value of 66.30%. CONCLUSION: Low level of maternal serum irisin in pregnancies with isolated IUGR was consistent with the role of irisin in metabolic pathways and with the increased risk of metabolic diseases in the future life of IUGR fetuses and their mothers.