The role of body composition and appetite-regulating hormones in idiopathic central precocious puberty and their changes during GnRH analog therapy.

PURPOSE: It was aimed to compare circulating levels of ghrelin, leptin, peptide YY (PYY), and neuropeptide (NPY) between girls with idiopathic central precocious puberty (ICPP) and prepubertal girls, as well as to evaluate alterations in these hormone levels and body composition during leuprolide acetate treatment in girls with ICPP. METHODS: This prospective study was conducted on girls with isolated premature thelarche (IPT), girls with ICPP, and age-matched prepubertal controls. Anthropometric measurements, body composition analysis and appetite-regulating hormone level measurements were performed in each group and also at the 6th and 12th months of the leuprolide acetate treatment for the girls with ICPP. RESULTS: Seventy-three girls participated in the study (24 girls with ICPP, 28 with IPT, and 21 prepubertal controls). No significant differences were observed in ghrelin, leptin, PYY, and NPY levels among the three groups. Leuprolide acetate treatment resulted in increased leptin, decreased PYY and NPY levels, and no significant changes in ghrelin. Despite no significant change in body mass index standard deviation score (BMI SDS), body fat percentage increased during treatment. CONCLUSION: While appetite-regulating hormones do not seem to directly contribute to precocious puberty pathogenesis, puberty blockade was shown to lead to altered levels of these hormones along with changes in body composition.

Relationship Between Menopausal Symptoms, Cancer Screening Behaviors, and Religion Attitudes of Women in the Climacteric Period: A Cross-Sectional Study.

BACKGROUND: Although it is known that religion is used to cope with health problems, there is a lack of information about the effect of religion on menopausal symptoms and cancer screening attitudes of climacteric women. AIM: This study was conducted to determine the relationship between the religious attitudes of women in the climacteric period and their attitudes toward menopausal symptoms and cancer screening. MATERIALS AND METHODS: This was a cross-sectional study of 381 women in the climacteric period in the Central Anatolia region of Türkiye. Data collection form, the Menopause Rating Scale (MRS), OK-Religious Attitude Scale (ORAS), and attitude for cancer screening (short form) (ASCS) were used to collect data. Correlation analysis assessed the relationship between MRS, ORAS, and ASCS. RESULTS: There was a low positive correlation between women's ORAS mean score (35.19 ± 4.80) and MRS mean score (12.68 ± 7.24) (r = 0.284, P < 0.001). There was no statistically significant relationship between the mean ORAS scores of the women and the mean ASCS scores (64.59 ± 10.47) (r = 0.089, P > 0.05). CONCLUSION: Women who experienced more severe menopausal symptoms had stronger religious attitudes. Women's religious attitudes did not affect their attitudes toward cancer screening. It is therefore recommended that health professionals organize counseling and training activities to protect and improve the health of menopausal women and increase their participation in screening and treatment programs.

Juglone can inhibit angiogenesis and metastasis in pancreatic cancer cells by targeting Wnt/ß-catenin signaling.

OBJECTIVES: We aimed to investigate the effects of juglone on angiogenesis, metastasis and cell proliferation processes in pancreatic cancer  (PC)  and to understand whether its possible effects occur via the Wnt signaling pathway by analyzing the expression levels of target genes of Wnt signaling. BACKGROUND: PC is a silent and lethal cancer type which can only be detectable after metastasis and angiogenesis processes occured. The Wnt signaling pathway is one of the pathways that plays an active role in many biological processes in the cell. Mutations in the genes of this signaling pathway are related to the development of many cancers. Juglone, a natural compound, is shown to have cytotoxic and apoptotic effects on various cancer cells. METHODS: PANC-1 and BxPC-3 pancreatic cancer cells were treated with juglone at

Botulinum toxin treatment of temporomandibular joint pain in patients with bruxism: A prospective and randomized clinical study.

BACKGROUND: Bruxism is a parafunctional habit, usually performed in sleep, by rhythmic and involuntary teeth being squeezed or squeaked. The most common methods of treatment are the use of occlusal splints. AIMS: The aim of this study was to compare the efficacy of occlusal splinting with botulinum toxin administration in the treatment of TMJ pain. SUBJECTS AND METHODS: For this purpose, 40 patients with bruxism were divided into two groups and one group was treated with occlusal splint and the other group received masseter muscle botulinum toxin injection. Then, the participants in both groups were evaluated in terms of pain, functional movement, and maximum bite force change at 2 weeks, 6 weeks, 3 months, and 6 months. Mann-Whitney U test was used to examine the differences between two independent groups. While Friedman test was used for differences between dependent groups, the Wilcoxon test was used for the differences between two repetitive measurements. Chi-square test was used to examine the relationship between categorical variables. Results: When pain was evaluated, both methods were effective in pain reduction, botulinum toxin injection was found to be less effective in reducing pain but no difference was found between the two methods. The maximum bite force decreased in the 2nd and 6th weeks and increased in the 3rd and 6th months in patients receiving botulinum toxin. In patients using occlusal splints, there was no change until the 3rd month and an increase was seen in the 6th month. In this study, it was observed that low dose BTX-A and occlusal splint use were effective in eliminating bruxism-related pain but not superior to each other. CONCLUSIONS: According to these results, low dose botulinum toxin can be considered as an alternative treatment in patients who cannot use occlusal splint for various reasons.

Expression of GnRH receptor in the canine corpus luteum, and luteal function following deslorelin acetate-induced puberty delay.

The goals of this study were as follows: (Experiment 1) to examine the basic capability of canine corpora lutea (CL) to respond to GnRH by assessing expression of gonadotropin-releasing hormone receptor (GnRH-R) in luteal samples collected throughout the luteal lifespan from non-pregnant dogs, and (Experiment 2) to investigate the effects of pre-pubertal application of the GnRH agonist deslorelin acetate on luteal function following the first oestrus. Mature CL were collected during the mid-luteal phase (days 30-45) from treated and control bitches. Transcript levels of several factors were determined: estrogen receptors (ESR1/ERα, ESR2/ERß), progesterone (P4)-receptor (PGR), prolactin receptor (PRLR), PGE2-synthase (PTGES) and PGE2 receptors (PTGER2/EP2, PTGER4/EP4), vascular endothelial growth factor (VEGFA) and VEGF receptors (VEGFR1 and VEGFR2), cyclooxygenase 2 (COX2/PTGS2), steroidogenic acute regulatory protein (STAR) and 3ß-hydroxysteroid dehydrogenase (3ßHSD). Additionally, levels of Kisspeptin 1 (Kiss1) and its receptor (KISS1-R) were evaluated. Although generally low, GnRH-R expression was time dependent and was elevated during early dioestrus, with a significant decrease towards luteal regression. In deslorelin-treated and control dogs, its expression was either low or frequently below the detection limit. EP2 and VEGFR1 were higher in the treated group, which could be caused by a feedback mechanism after long-term suppression of reproductive activity. Despite large individual variations, 3ßHSD was higher in the deslorelin-treated group. This, along with unchanged STAR expression, was apparently not mirrored in increased luteal functionality, because similar P4 levels were detected in both groups. Finally, the deslorelin-mediated long-term delay of puberty does not have negative carry-over effects on subsequent ovarian functionality in bitches.

Kisspeptin-10 and the G protein-coupled receptor 54 are differentially expressed in the canine pregnant uterus and trophoblast cells.

Uterine tissue was collected from bitches after ovariohysterectomy at different times after ovulation. Samples were assigned to four groups: metestrous non-pregnant, day 10-12, n = 4; pre-implantation, day 10-12, n = 9; post-implantation, day 18-25, n = 13; mid-gestation, day 30-40, n = 7. RT-qPCR detection was performed for kiss1 and the G protein-coupled receptor 54 (GPR54, specific receptor for kisspeptin). In addition, immunohistochemistry was performed for detection of kisspeptin-10 (KP-10), GPR54, as well as pan-cytokeratin and vimentin. The latter two were included to differentiate the different placental cell types. The percentage of positive stained cells was evaluated, and an immunoreactivity score (IRS) was obtained by multiplying the labelling intensity score (0-3) with the percentage of immunolabelled cells (range: 0-300). In non-pregnant and pre-implantation tissues, gene expression was highly variable for kiss1 and GPR54. Expression of GPR54 was higher before embryo adhesion than during post-implantation and mid-gestation (p < .05), whereas there was no difference found between groups for kiss1. Except during the pre-implantation period, KP-10 expression was higher in the non-pregnant uterus compared to all gestational periods investigated, indicating a pregnancy-related downregulation. In the pre-implantation period, KP-10 was present in larger vessels only, whereas the presence of GPR54 in vessels was found in all samples, with most labelling in the post-implantation period. KP-10 was present in superficial uterine glands, GPR54 in superficial and deep uterine glands of the post-implantation uterus. In myocytes, the highest staining for KP-10 was seen in the non-pregnant uterus, whereas the highest staining for GPR54 was seen in post-implantation and mid-gestation. Syncytiotrophoblast cells stained for both KP-10 and GPR54 in post-implantation and mid-gestation, with maximum intensity for GPR54 in the latter. We conclude that KP-10 and GPR54 are expressed in the canine uterus and trophoblast cells. However, during pregnancy, expression of both proteins seems to be differentially regulated.

Suppression of fertility in pre-pubertal dogs and cats.

Pre-pubertal gonadectomy in dogs and cats is still controversially discussed because some consequences cause health problems. Nevertheless, postponement of puberty, that is, prevention of an increase in sexual hormones and thereby prevention of their manifold effects, is of major importance, not only in controlling overpopulation but also to preserve the genetic base for future breeding stock and pets. Therefore, alternatives for surgical suppression of fertility in pre-pubertal animals were critically reviewed. As a promising alternative, the slow-release GnRH agonist deslorelin and other GnRH analogues have been investigated. In female dogs and cats, puberty could be significantly postponed without initial flare-up effect and without disturbance of body development. First trials to delay puberty in female and male cats by application of a 4.7-mg deslorelin implant 24 h after birth so far are promising. In female dogs, a previous investigation showed that when the implant was inserted at the age of 4 months, the initial flare-up effect was prevented. Body development was normal in the studies reviewed here, and with the 9.4-mg implant, puberty was significantly delayed until the age of 21 months or older. In one study, bitches either received a 4.7- or a 9.4-mg implant at the age of 4 months and the epiphyses were mostly closed before the time of first oestrus. Using a 4.7-mg deslorelin implant in pre-pubertal male dogs significantly postponed puberty, and age at puberty was >2 years when a 9.4-mg implant was used. However, further investigations are required, especially concerning the effect of different GnRH agonist dosages and resorption rates on the duration of postponement of puberty as well as long-term effects in both dogs and cats.

Short-term clinical and hormonal effects of a deslorelin implant on late-prepubertal bitches - Based on flare-up signs.

Gonadotropin-releasing hormone (GnRH) agonists offer an alternative to surgical sterilization in prepubertal dogs, preserving ovarian and uterine functions. However, the clinical and hormonal effects of GnRH agonist application during the late-prepubertal stage remain insufficiently understood. This study aimed to investigate the clinical effect (flare-up) and hormonal changes, specifically serum progesterone (P4) and estradiol (E2) levels, in bitches treated with 4.7 mg deslorelin acetate (DA) implants (Suprelorin®, Virbac, F) during the late prepubertal period. Sixteen clinically healthy kangal cross-breed bitches, aged 7-8 months, with a mean body weight of 20.5 ± 0.8 kg, were implanted with DA. Estrus signs were monitored daily, and blood and vaginal cytological samples were collected every other day for four weeks. Cytological changes were analyzed for overall and superficial cell index. Six out of sixteen DA-treated bitches (EST group; n = 6) exhibited clinical proestrus 8.6 ± 0.6 days after implant insertion. The mean serum concentrations of P4 and E2 at the onset of estrus were 1.38 ± 0.32 ng/ml and 37.38 ± 10.07 pg/ml, respectively. Notably, all non-estrus (N-EST group; n = 10) bitches demonstrated an increase in superficial cell index, in addition to expected cytological changes observed in the EST group. On the 18th day post-implantation, the EST group exhibited a significantly higher number of superficial cells compared to the N-EST group (p < 0.001). DA implantation resulted in cytological profile alterations accompanied by a slight increase in estrogen concentrations in all dogs. However, the flare-up response exhibited significant variability, differing from that observed in adult dogs. This study highlights the importance of meticulous timing and breed-specific considerations when utilizing DA for puberty manipulation in late-prepubertal bitches. The observed cytological and hormonal changes in response to DA implants provide valuable insights, but the variability in flare-up responses warrants further investigation.

Is apoptosis a regulatory mechanism during early canine pregnancy?

Fas is a membrane-bound protein which upon activation causes programmed cell death. Fas ligand (FasL) binds Fas on target cells. Both these factors are known to regulate apoptosis at implantation in different species and thus might be involved in the regulation of implantation in dogs. The aim of the study was to assess the expression of Fas and FasL in canine uterine tissue throughout pregnancy as well as in pre-implantation embryos using RT-PCR and RT-qPCR. Uterine tissues was collected from of 21 healthy pregnant bitches (group I: days 10-12, n = 5; group II: days 18-25, n = 6; group III: days 28-45, n = 6) and from 4 non-pregnant bitches (controls: days 10-12). Pregnancy stage was determined by days after mating, that is, 2-3 days after ovulation as determined by vaginal cytology and progesterone measurement. After ovariohysterectomy, uteri from group I bitches were flushed with PBS and the embryos washed and stored frozen at -80°. Tissues from the other groups were taken from the implantation and placentation sites, respectively, covered with Tissue Tek(®) and frozen at -80°. Extraction of RNA was performed with Trizol Reagent and RT-qPCR using SYBR green probes. In pre-implantation embryos, only FasL but not Fas could be detected. In all tissues from pregnant and non-pregnant bitches, both parameters were detectable. Before implantation (group I) expression of FasL resembled that of non-pregnant bitches in early dioestrus and decreased significantly during implantation and thereafter (p < 0.05). Expression of Fas did not change significantly until day 45. The relative expression of Fas exceeded that of FasL at each stage investigated, which is comparable to observations of other species; however, high standard deviations indicate high individual differences. These preliminary results point towards a regulatory function of the Fas/FasL system during early canine pregnancy.

Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection.

PURPOSE: The aim of this study is to report the outcomes of the treatment of talar osteochondral lesions with arthroscopic microfracture technique and postoperative intra-articular hyaluronan injection. METHOD: Fifty-seven patients (29 men, 28 women) with osteochondral lesions of the talus were included in this prospective randomized clinical study between the years 2003 and 2009. The patients were treated with arthroscopic debridement and microfracture technique. Randomly selected 41 patients were injected intra-articular hyaluronan (injection group). The remaining 16 patients did not receive postoperative injection (non-injection group). Assessment of the pain and functional outcomes was performed using the Freiburg and AOFAS ankle/hindfoot scoring systems. RESULTS: In the injection group, the mean postoperative Freiburg functional and pain scores were significantly higher compared to preoperative functional and pain scores (P < 0.001). Similarly, for the patients in non-injection group, the mean postoperative Freiburg functional and pain scores were significantly higher compared to preoperative functional and pain scores (P < 0.001). The AOFAS functional and pain scores of the patients in the injection group were significantly higher (P < 0.001) postoperatively compared to preoperative scores. Scoring the patients in the non-injection group according to AOFAS system also revealed significantly higher (P < 0.001) postoperative functional and pain scores over preoperative scores. The increase in the postoperative scores was found to be significantly higher in the injection group compared to non-injection group in both Freiburg and AOFAS systems (P < 0.001). CONCLUSION: Treatment of osteochondral lesions of the talus using microfracture technique significantly improved functional and pain scores postoperatively. Additional treatment with intra-articular hyaluronan injection as an adjunct to microfracture technique may offer better clinical outcomes over microfracture technique alone. LEVEL OF EVIDENCE: Randomized, controlled trial, Level I.

Orthodontic and surgical treatment of a patient with Apert syndrome.

The aim of this case report was to present the combined orthodontic and surgical treatment of a patient with Apert syndrome in an adult stage. A 15 years old male patient with Apert syndrome was concerned about the appearance of his face and malocclusion. His profile was concave with a retruded maxilla and prominent lower lip. He had an Angle class I molar relationship with a 9.5 mm anterior open bite. The amount of crowding was 20.4 mm in the maxilla and 6 mm in the mandible. Cephalometric analysis revealed a skeletal Class III relationship due to maxillary hypoplasia with a dolichofacial growth pattern. Orthodontic treatment and orthognathic surgery were planned for the patient. After 45 months of presurgical orthodontics, the patient underwent two surgeries sequentially. The first surgery was performed to advance the maxilla and the second surgery was performed to correct the mandibular rotation and increase the overbite at the time of removing halo device. The amount of maxillary advencement was 8 mm. Mandibula was moved 1.5 mm anteriorly and rotated 1° to 1.5° (SNB and facial depth) in a counterclockwise direction. After a relatively long treatment, an esthetically pleasing and functional occlusion and correction of the skeletal problem was achieved in this adult case.

Pattern formation in drying droplets of polyelectrolyte and salt.

We have discovered spectacular patterns formed by drying aqueous drops of sodium poly(styrene sulfonate) containing fixed amounts of sodium chloride. Crystallization of salt molecules takes place at a critical concentration and several factors such as the polyelectrolyte concentration and humidity affect the final patterns formed. The observed patterns include concentric rings, needle-like structures, chains of triangular-shaped crystallites, etc. We describe the observed phenomenology accompanied by a theoretical model for the occurrence of concentric rings.

Socio-demographic parameters in screening for breast cancer: Lessons from a population-'based women's Health Project held in a province in Turkey.

PURPOSE: to inform healthy women about breast cancer and screen them, as well as to look for any relationship between demographic and clinical findings and breast cancer. METHODS: thirty-five health teams were created prior to the study. The teams were primarily trained for breast examination and for screening methods to detect breast cancer. RESULTS: a total of 77,934 subjects were evaluated. Clinical breast examination (CBE) was performed in 66% (n=51,706) of the participants. The characteristics of the subjects in the examined group were similar to those in the group refusing examination. The percentage of the subjects who declined examination was 2-fold higher in the ≥ 60 year age group compared to younger women. A breast mass was detected in 2,838 (6%) subjects who had undergone breast examination. Lower educational level and urban dwellers showed higher incidence of suspicious mass in CBE. Fifty-eight women were diagnosed with breast cancer. The cumulative incidence of breast cancer was 7.5/10.000 for all of the study population and 10.1/10.000 for women with CBE. CONCLUSION: elderly subjects, those living in rural areas and women with low educational and lower socio-economic levels should be convinced to undergo screening for breast cancer.

Extremely rare R-I subtype coronary artery anomaly and accompanying incomplete myocardial bridging on the left anterior descending artery in a symptomatic patient: multidetector computed tomography and coronary angiography findings.

Myocardial bridging and single coronary artery (SCA) may both lead to myocardial ischemia and related secondary complications. We present multidetector computed tomography (MDCT) and catheter coronary angiography (CCA) findings of R-I subtype SCA, which is a distinctively rare congenital coronary anomaly, and accompanying incomplete myocardial bridging in a case with dyspnea and chest burning. In addition, CCA showed a thin milking effect at the tunneled artery.

Cytokines, growth factors and prostaglandin synthesis in the uterus of pregnant and non-pregnant bitches: the features of placental sites.

Uterine tissue from pregnant bitches was investigated by qualitative RT-PCR for the gene expression of local factors potentially important for the implantation of canine embryos. For this purpose, 10 bitches identified as being at the time of implantation or early placentation by means of ultrasonography before ovariohysterectomy (days 20-35, n = 10) provided tissues for comparison to tissue collected in a previous study and identified as early pregnant (n = 10) or non-pregnant (n = 4) by embryo flushing after ovariohysterectomy (days 10-12 after mating; Schäfer-Somi et al. 2008). Uterine tissue was excised from the middle of the left horn from early pregnant and non-pregnant animals, including from interplacental and placentation sites. The following genes were investigated: CD-4, -8; cyclooxygenase (COX)-1, -2; granulocyte macrophage-colony stimulating factor (GM-CSF); hepatocyte growth factor (HGF); insulin-like growth factor (IGF)-1, -2; transforming growth factor (TGF) and tumour necrosis factor (TNF)-alpha; interferon (IFN)-gamma; interleukin (IL)-1beta, -2, -4, -6, -8, -10, -12; leukaemia inhibitory factor (LIF) and leptin. Gene expression for CD-8, COX-1, TGF-beta, HGF, IGF-1, IL-2, -4,-10, IFN-gamma and LIF were detected in the pre-implantation uterus, and all except IL-2 and -10 were still detectable during the implantation and placentation stage. During implantation, mRNA for IGF-2 and GM-CSF were additionally detected. The dioestrous uterus differed from the pregnant uterus because of the absence of CD-8, IL-4 and IFN-gamma and the expression of CD-4, TNF-alpha and IL-6. The results suggest that IL-4, IFN-gamma, CD-8, GM-CSF and IGF-2 are regulated in a pregnancy-specific manner and that GM-CSF and IGF-2 probably have growth supporting and immune modulating functions during implantation of the canine embryo.

Expression of MHC-I and -II in uterine tissue from early pregnant bitches.

The aim of the study was to investigate the expression of major histocompatibility complex (MHC)-I and -II in uterine tissues from pregnant and non-pregnant bitches, taken at different time periods after mating. The pregnant bitches were ovariohysterectomized during the pre-implantation (group 1, n = 4), implantation (group 2, n = 7) and placentation stage (group 3, n = 7). Non-pregnant animals in diestrus served as controls (group 4, n = 7). The expression of MHC- I and -II in salpinx, apex, middle horn, corpus uteri and at implantation sites was investigated by immunohistochemistry as well as qualitative and quantitative RT-PCR; MHC-I mRNA was detected in all tissues and with quantitative RT-PCR, and no significant changes were detected until placentation. Immunohistologically, at the apex and corpus site, the average number of MHC-II positive cells increased from the pre-implantation to the post-implantation stage (apex: 1.54 +/- 1.21 to 3.82 +/- 2.93; corpus: 1.62 +/- 1.9 to 5.04 +/- 4.95; p < 0.05). The greatest numbers of MHC-II positive cells were observed at placentation sites (6.64 +/- 5.9). In parallel, a marked increase in the relative mRNA expression of MHC-II in uterine tissues was assessed from the pre-implantation to the placentation stage (relative to Glycerinaldehyd-3-phosphate-Dehydrogenase (GAPDH): 6.9 +/- 9.5, 8.4 +/- 5.8, p > 0.05). Immunohistologically, in the salpinx, significantly greater numbers of MHC-II positive cells were found in the tissues of pregnant animals than in the control group (p < 0.05). It is proposed that the increase in MHC-II is pregnancy-related, even though the impact on maintenance of canine pregnancy is still unclear.

Uterine progesterone receptor and leukaemia inhibitory factor mRNA expression in canine pregnancy.

The study investigated the expression of genes for progesterone receptor (PR) and for the cytokine leukaemia inhibitory factor (LIF) in the uterine tube and uterine horn tissues from pregnant and non-pregnant bitches. The aim was to study whether a relation existed between the likely biological effectiveness of progesterone (P(4)) and the change in the uterine expression of LIF mRNA during pregnancy, as has been described in primates. For this purpose, 20 pregnant bitches were ovariohysterectomized after being allotted to three groups according to gestational age (pre-implantation: days 10 to 12, n = 7; peri-implantation: days 18 to 25, n = 7; post-placentation: days 28 to 45, n = 7). Tissue samples were obtained from the uterine tubes, one uterine horn (including placentation sites and interplacental sites in bitches that had already implanted) and the corpus uteri, stored at -80 degrees C, and then analysed by qualitative and quantitative PCR for PR and LIF mRNA expression. From the pre-implantation to the placentation stage, a decrease in the relative expression of PR mRNA in uterine tissue was obvious and significant when expressed relative to beta-actin (11.2 +/- 6.8 vs 2.7 +/- 1.9; p < 0.05). However, over the same period, the relative expression of LIF mRNA increased (10.1 +/- 16.1 vs 50.0 +/- 32.3; p < 0.05). In addition, PR mRNA went from being detectable to no longer detectable in the uterine tube, and no longer detectable in interplacental-site uterine tissue. We conclude that LIF is important for the establishment of canine pregnancy; that decreased uterine PR mRNA expression may contribute to the increase in uterine LIF mRNA; and, that the ability of the embryo to preserve PR mRNA expression at implantation and placentation sites while expression is lost in the remainder of the uterus represent an effect important to the establishment and maintenance of pregnancy. We additionally propose that canine embryo secretory proteins have a regulatory effect on both PR and LIF before as well as at and after implantation.

Neuroprotective Drugs in Infants With Severe Congenital Heart Disease: A Systematic Review.

Background: Perinatal and perioperative brain injury is a fundamental problem in infants with severe congenital heart disease undergoing neonatal cardiac surgery with cardiopulmonary bypass. An impaired neuromotor and neurocognitive development is encountered and associated with a reduction in quality of life. New neuroprotective drugs during surgery are described to reduce brain injury and improve neurodevelopmental outcome. Therefore, our aim was to provide a systematic review and best-evidence synthesis on the effects of neuroprotective drugs on brain injury and neurodevelopmental outcome in congenital heart disease infants requiring cardiac surgery with cardiopulmonary bypass. Methods: A systematic search was performed in PubMed, Embase and the Cochrane Library (PRISMA statement). Search terms were "infants," "congenital heart disease," "cardiac surgery," "cardiopulmonary bypass," and "neuroprotective drug." Data describing the effects on brain injury and neurodevelopmental outcome were extracted. Study quality was assessed with the Cochrane Risk of Bias Tool. Two reviewers independently screened sources, extracted data and scored bias. Disagreements were resolved by involving a third researcher. Results: The search identified 293 studies of which 6 were included. In total 527 patients with various congenital heart diseases participated with an average of 88 infants (13-318) per study. Allopurinol, sodium nitroprusside, erythropoietin, ketamine, dextromethorphan and phentolamine were administered around cardiac surgery with cardiopulmonary bypass. Allopurinol showed less seizures, coma, death and cardiac events in hypoplastic left heart syndrome (HLHS) infants (OR: 0.44; 95%-CI:0.21-0.91). Sodium nitroprusside resulted in lower post cardiopulmonary bypass levels of S100ß in infants with transposition of the great arteries after 24 (p < 0.01) and 48 (p = 0.04) h of treatment. Erytropoietin, ketamine and dextromethorphan showed no neuroprotective effects. Phentolamine led to higher S100ß-levels and cerebrovascular resistance after rewarming and at the end of surgery (both p < 0.01). Risk of bias varied between studies, including low (sodium nitroprusside, phentolamine), moderate (ketamine, dextromethorphan), and high (erytropoietin, allopurinol) quality. Conclusions: Allopurinol seems promising for future trials in congenital heart disease infants to reduce brain injury given the early neuroprotective effects in hypoplastic left heart syndrome infants. Larger well-designed trials are needed to assess the neuroprotective effects of sodium nitroprusside, erytropoietin, ketamine and dextromethorphan. Future neuroprotective studies in congenital heart disease infants should not only focus on the perioperative period, however also on the perinatal period, since significant brain injury already exists before surgery.

Healthcare workers’ burn-out, hopelessness, fear ofCOVID-19 and perceived social support levels

Background and objectivesDuring the pandemic, all healthcare workers have tried to cope with mental challenges. This study evaluated the healthcare workers' levels of burn-out, hopelessness, fear of COVID-19 and perceived social support, the relation between these factors, and other possible related components.MethodsFour hundred and fifty-one HCW (healthcare workers) all across Turkey were included in the study. Sociodemographic information form, Maslach Burn-out Inventory, Beck Hopelessness Scale, Multidimensional Scale of Perceived Social Support, and the Fear of COVID-19 Scale were given to the participants. This was a cross-sectional study via various online platforms.ResultsThe participants who were on duty in the COVID-19 clinic, complaining about the low salary or not having enough time for themselves or their own family, had significantly higher scores on three subscales of burn-out scale, and hopelessness scale. Working at governmental hospitals, working at departments containing a high risk of COVID-19 infection, and having a history of COVID-19 infection were found to be significantly associated with emotional exhaustion, depersonalization, and hopelessness. Feeling control of your profession and getting social support from others were the two factors that tackle burnout in HCW. Family support is the only support that tackles all 3 subscales of burn-out and hopelessness.ConclusionThe findings emphasized that to tackle the burn-out and hopelessness of HCW, it is important for HCW to receive financial compensation for their hard work, to work under improved conditions, and to receive adequate social support. (AU)

The effect of 8-week different-intensity walking exercises on serum hepcidin, IL-6, and iron metabolism in pre-menopausal women.

Objective Hepcidin may be an important mediator in exercise-induced iron deficiency. Despite the studies investigating acute exercise effects on hepcidin and markers of iron metabolism, we found no studies examining the chronic effects of walking exercises (WE) on hepcidin and markers of iron metabolism in premenopausal women. The chronic effects of two 8-week different-intensity WE on hepcidin, interleukin 6 (IL-6), and markers of iron metabolism in pre-menopausal women were examined. Methods Exercise groups (EG) [moderate tempo walking group (MTWG), n = 11; brisk walking group (BWG), n = 11] walked 3 days/week, starting from 30 to 51 min. Control group (CG; n = 8) did not perform any exercises. BWG walked at ∼70%-75%; MTWG at ∼50%-55% of HRRmax. VO2max, hepcidin, IL-6, and iron metabolism markers were determined before and after the intervention. Results VO2max increased in both EGs, favoring the BWG. Hepcidin increased in the BWG (p < 0.01) and CG (p < 0.05). IL-6 decreased in the BWG and the MTWG (p < 0.05; p < 0.01). While iron, ferritin, transferrin, and transferrin saturation levels did not change in any group, total iron binding capacity (p < 0.05), red blood cells (p < 0.05), and hematocrit (p < 0.01) increased only in the BWG. Conclusion Both WE types may be useful to prevent inflammation. However, brisk walking is advisable due to the positive changes in VO2max and some iron metabolism parameters, which may contribute to prevent iron deficiency. The increase in hepcidin levels remains unclear and necessitates further studies.