Expanding the phenotypic and genotypic characteristics of trichohepatoenteric syndrome: a report of eight patients from five unrelated families.

BACKGROUND: Trichohepatoenteric syndrome (THES) is characterized by neonatal-onset intractable diarrhea. It often requires long-term total parenteral nutrition (TPN). In addition, other characteristic findings of the syndrome include growth retardation, facial dysmorphism, hair abnormalities, various immunological problems and other rare system findings. Two genes and their associated pathogenic variants have been associated with this syndrome: SKIC3 and SKIC2. METHODS AND RESULTS: In this case series, the clinical findings and molecular analysis results of a total of 8 patients from 5 different families who presented with persistent diarrhea and were diagnosed with THES were shared. Pathogenic variants were detected in the SKIC3 gene in 6 of our patients and in the SKIC2 gene in 2 patients. It was planned to compare the clinical findings of our patients with other patients, together with literature data, and to present yet-undefined phenotypic features that may be related to THES. In our case series, in addition to our patients with a novel variant, patient number 2 had a dual phenotype (THES and Spondyloepimetaphyseal dysplasia, sponastrime type) that has not been reported yet. Delay in gross motor skills, mild cognitive impairment, radioulnar synostosis, osteoporosis, nephropathy and cystic lesions (renal and liver) were observed as unreported phenotypic findings. CONCLUSIONS: We are expanding the clinical and molecular repertoire of the syndrome regarding patients diagnosed with THES. We recommend that the NGS (next-generation sequencing) multigene panel should be used as a diagnostic tool in cases with persistent diarrhea.

[The Pan American Health Organization's Revolving Fund for access to vaccines: 43 years responding to the regional immunization programO Fundo Rotativo para Acesso a Vacinas da Organização Pan-Americana da Saúde: 43 anos respondendo ao Programa Regional de Imunizações]. / El Fondo Rotatorio para el acceso a las vacunas de la Organización Panamericana de la Salud: 43 años respondiendo al programa regional de inmunizaciones.

The Pan American Health Organization's Revolving Fund for Access to Vaccines (the Revolving Fund) is a shared pool of funds for the procurement of vaccines, syringes, and cold-chain equipment for the Member States of the Organization. With a view to evaluating the results obtained during the Revolving Fund's operation and analyzing its contributions to achievements in immunization, a review was conducted of historical documents and grey literature related to the Fund's history and current processes, as well as data from platforms fed by countries' annual reports, with reference to growth indicators, burden of vaccine-preventable diseases, introduction of new vaccines in the Region of the Americas, and lessons learned. In its 43 years of operation, the Revolving Fund has grown and contributed to the introduction of new vaccines, and the Region has made rapid progress in the field of immunization. However, several countries and territories in the Region have not yet introduced certain vaccines due to their high cost and the economic impact of sustainably administering them. The requirement to obtain the lowest possible price and to set a uniform price for all participating Member States has been instrumental in the Revolving Fund's contribution to the vaccination goals of national immunization programs, and for timely planning of demand, accompanied by technical advice. An interprogrammatic approach and the planning of auxiliary inputs are key to the success of the programs. Pandemic preparedness, regional vaccine production, and the protection of national budgets for sustainable procurement of high-cost vaccines are current and future challenges.

O Fundo Rotativo para Acesso a Vacinas (FR) da Organização Pan-Americana de Saúde é um fundo comum de capital e compra conjunta de vacinas, seringas e equipamento da cadeia de frio para os Estados Membros da Organização. Com o objetivo de avaliar os resultados obtidos durante sua operação e analisar sua contribuição para os êxitos da imunização, procedeu-se a uma revisão de documentos históricos e da literatura cinzenta relacionados à história do FR e revisaram-se os processos atuais, os dados de plataformas alimentadas pelos relatórios anuais dos países, os indicadores de crescimento, a carga de doenças imunopreveníveis, a introdução de novas vacinas na Região das Américas e as lições aprendidas. Constatou-se que, em seus 43 anos de operação, o FR cresceu e contribuiu para a introdução de novas vacinas e a região avançou com rapidez no campo da imunização. Entretanto, vários países e territórios da região ainda não introduziram determinadas vacinas em razão dos altos preços e do impacto econômico de manter sua administração. A cláusula do menor preço disponível e do preço uniforme para todos os Estados Membros participantes foi fundamental para a contribuição do FR para as metas de vacinação dos programas nacionais de imunização, bem como para o planejamento oportuno da demanda acompanhado pela assessoria técnica. A abordagem interprogramática e o planejamento de insumos auxiliares são necessários para o êxito dos programas. A preparação para pandemias, a produção regional de vacinas e a proteção dos orçamentos nacionais para a compra de vacinas de alto custo e sua sustentabilidade ainda constituem desafios atuais e futuros.

Knowledge graph analytics platform with LINCS and IDG for Parkinson's disease target illumination.

BACKGROUND: LINCS, "Library of Integrated Network-based Cellular Signatures", and IDG, "Illuminating the Druggable Genome", are both NIH projects and consortia that have generated rich datasets for the study of the molecular basis of human health and disease. LINCS L1000 expression signatures provide unbiased systems/omics experimental evidence. IDG provides compiled and curated knowledge for illumination and prioritization of novel drug target hypotheses. Together, these resources can support a powerful new approach to identifying novel drug targets for complex diseases, such as Parkinson's disease (PD), which continues to inflict severe harm on human health, and resist traditional research approaches. RESULTS: Integrating LINCS and IDG, we built the Knowledge Graph Analytics Platform (KGAP) to support an important use case: identification and prioritization of drug target hypotheses for associated diseases. The KGAP approach includes strong semantics interpretable by domain scientists and a robust, high performance implementation of a graph database and related analytical methods. Illustrating the value of our approach, we investigated results from queries relevant to PD. Approved PD drug indications from IDG's resource DrugCentral were used as starting points for evidence paths exploring chemogenomic space via LINCS expression signatures for associated genes, evaluated as target hypotheses by integration with IDG. The KG-analytic scoring function was validated against a gold standard dataset of genes associated with PD as elucidated, published mechanism-of-action drug targets, also from DrugCentral. IDG's resource TIN-X was used to rank and filter KGAP results for novel PD targets, and one, SYNGR3 (Synaptogyrin-3), was manually investigated further as a case study and plausible new drug target for PD. CONCLUSIONS: The synergy of LINCS and IDG, via KG methods, empowers graph analytics methods for the investigation of the molecular basis of complex diseases, and specifically for identification and prioritization of novel drug targets. The KGAP approach enables downstream applications via integration with resources similarly aligned with modern KG methodology. The generality of the approach indicates that KGAP is applicable to many disease areas, in addition to PD, the focus of this paper.

Altered expression of pulmonary epithelial cell markers in fetal and adult mice generated by in vitro embryo culture and embryo transfer.

Lung development is impaired in mice generated through transfer of in vitro-derived blastocysts. The main objective of the current study was to determine if the composition of epithelial cells in the fetal and adult lung tissue is altered in mice generated through transfer of in vitro-derived blastocysts. The study comprised of two experimental (EGs) and two control (CGs) groups. Fetuses (18.5 d.p.c.) and adult mice (8-week-old) of the EGs (EGfetus , n=18, EGadult, n=15) were produced by the transfer of day-5 F2 blastocysts to pseudo-pregnant females. F2 fetuses and adult mice derived from naturally-ovulating females served as the CGs (CGfetus, n=18, CGadult n=15). The expression of Tuba-1a (a marker of ciliated cells), Foxj-1 (a marker of motile ciliated cells), Uch-L1 (a marker of neuroendocrine cells), Cldn-10 (a marker of Club cells), Aqp-5 (a marker of Type I alveolar cells), and Sp-C (a marker of Type II alveolar cells) was determined using western blot, immunohistochemistry/immunofluorescence and qRT-PCR analyses. Weight of fetuses as well as adult mice is decreased in mice comprising the EGs. Impaired lung development observed in EGfetus was associated with altered expression of Tuba-1a, Foxj-1, Cldn10, Uch-L1, Sp-C and Aqp-5. Morphology of the adult lung tissue was similar between the groups except for a significant increase in the thickness of the epithelia in EGadult. The expression of Cldn-10 and Sp-C was also altered in EGadult. It remains to be determined whether altered expression of these genes has any long-term impact on epithelial cell functions in the adult lung tissue.

Improvement in desulfurization of dibenzothiophene and dibenzothiophene sulfone by Paenibacillus strains using immobilization or nanoparticle coating.

AIMS: Biodesulfurization of fossil fuels is a promising technology for deep desulfurization. Previously, we have shown that Paenibacillus strains 32O-W and 32O-Y can desulfurize dibenzothiophene (DBT) and DBT sulfone (DBTS) effectively. In this work, improvements in DBT and DBTS desulfurization by these strains were investigated through immobilization and nanoparticle coating of cells. METHODS AND RESULTS: Paenibacillus strains 32O-W and 32O-Y immobilized in alginate gel beads or coated with Fe3 O4 magnetite nanoparticles were grown at various concentrations (0.1-2 mmol l-1 ) of DBT or DBTS for 96 h. The production of 2-hydroxybiphenyl (2-HBP) from the 4S pathway biotransformation of DBT or DBTS was measured. The highest amounts of 2-HBP production occurred at concentrations of 0.1 and 0.5 mmol l-1 . Compared to planktonic cultures maximum 2-HBP production increased by 54% for DBT and 90% for DBTS desulfurization with immobilized strains, and 44% for DBT and 66% for DBTS desulfurization by nanoparticle-coated strains. CONCLUSIONS: Nanoparticle-coated and immobilized cells may be of use in efforts to increase the efficiency of biodesulfurization. SIGNIFICANCE AND IMPACT OF THE STUDY: Alginate immobilization or nanoparticle coating of bacterial cells may be useful approaches for the enhancement of biodesulfurization for eventual use on an industrial scale.

Evaluation of inflammatory parameters in patients with cutaneous leishmaniasis.

Cutaneous leishmaniasis (CL) is a vector-borne parasitic disease characterized by various skin lesions that can cause deformities when healed. Our aim in this study is to show the utility of parameters such as neutrophil/lymphocyte ratio (NLR), thrombocyte/lymphocyte ratio (TLR), and mean thrombocyte volume (MTV) as auxiliary laboratory methods in CL patients. About 107 patients who were admitted to our dermatological and venereal diseases outpatient clinic between January 2018 and January 2019 and were diagnosed with CL by microscopic examination and 74 healthy individuals were included in the study. There were no significant differences between the patient and control group in terms of neutrophil counts, leukocyte counts, platelet counts, and NLR values (P values: .271, .053, .263, and .459, respectively). When the TLR and MTV values of patients with CL and those of the healthy controls were compared, it was found that TLR and MTV values were statistically higher in patients with CL (P values of .010 and .044, respectively). Based on these data, NLR was not considered to be a suitable parameter for demonstrating inflammation in CL patients, but TLR and MTV were held to be an appropriate parameter for demonstrating inflammation in CL patients. In addition, we think that the increase in MTV and TLR, can be used as an auxiliary laboratory test in the diagnosis of CL disease.

The effect of secukinumab treatment on inflammatory parameters in patients with psoriasis: A multicentre restrospective study.

AIM: Psoriasis is a common chronic inflammatory disease of the skin with remission and relapses. The aim of this study was to investigate the change in inflammatory parameters such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) in patients receiving secukinumab treatment for psoriasis vulgaris (PV). MATERIALS AND METHODS: In this retrospective study, we evaluated the laboratory results of 40 patients who were followed up with a diagnosis of PV and received secukinumab treatment in three different dermatology clinics between July 2018 and September 2019. RESULTS: Neutrophil count and leukocyte count were significantly decreased after secukinumab treatment. (P < .001) There was no statistically significant difference between lymphocyte count, platelet count, MPV, NLR and PLR values before treatment and at the 4th month of treatment (P values .230, .065, .110, .915 and .365, respectively). CONCLUSION: In conclusion, it can be concluded that parameters such as NLR, PLR and MPV are not suitable parameters for monitoring the effects of secukinumab treatment on inflammation.

Atypical and unusual morphological variants of cutaneous leishmaniasis.

OBJECTIVE: Cutaneous leishmaniasis (CL) is a skin disease characterised by prolonged nodulo-ulcerative lesions of the skin that heals with atrophic scar. Clinical features of CL vary depending on the type of parasite and host immune resistance. The aim of this study was to investigate the clinical features of atypical and unusual morphological variants of CL patients diagnosed in our clinic. MATERIALS AND METHODS: In this prospective study, 27 CL patients with atypical clinical features among 486 patients admitted to our clinic between July 2018 and September 2019 and diagnosed as CL by slit-skin smear examination or histopathological examination were included. RESULTS: Of 27 patients, 15 (55.5%) were male and 12 (44.5%) were female. The mean age of the patients was 25.8 ± 7.62 years. Seven (25.9%) patients had lupoid lesions, five (18.6%) patients had eczematoid lesions, four (14.8%) patients had lip lesions, three (11.1%) patients had erysipelas-like lesions, two (7.4%) patients had eyelid lesions, two (7.4%) patients had sporotrichoid lesions, two (7.4%) patients had verrucous lesions, one (3.7%) patient had psoriasiform lesion and one (3.7%) patient had paronychial lesion. CONCLUSION: In conclusion, rare clinical forms of CL are presented in this study. It should be kept in mind that CL may have very different clinical features and should be considered in the differential diagnosis of eczema, psoriasis, erysipelas, sporotrichosis, paronychia and verrucous lesions.

Evaluation of hirsutism and hormonal parameters in acne vulgaris patients treated with isotretinoin.

BACKGROUND: Although the effect of isotretinoin use on hormonal changes in acne pathogenesis is not fully known, there are limited studies on its effects on the development of hirsutism. In this study, it was aimed to evaluate the effect of isotretinoin use on hirsutism and hormonal parameters in patients with acne vulgaris. METHODS: In this study, 30 female acne patients and 30 healthy females were evaluated prospectively. Menstrual irregularity, LH, FSH, prolactin, progesterone, 17-OH progesterone, oestradiol, total testosterone, DHEA-S, insulin, glucose, TSH levels, Ferriman-Gallwey (FG) score and ultrasonography (USG) findings of control group and patient group were recorded. RESULTS: Pre-treatment progesterone (P = .007) and oestradiol (P = .001) levels of the patients were statistically lower than the control group. In the patient group, menstrual irregularity (P < 001) and FG hirsutism score at the third month of treatment were significantly higher than before treatment. In 10% of the patients, there were abnormal findings on pelvic USG in the third month of treatment. CONCLUSION: In our study, it could not be revealed that isotretinoin has a significant effect on pituitary, adrenal hormones and insulin resistance. We found that 3 months of isotretinoin treatment caused an increase in menstrual irregularity and FG hirsutism score.

Do SARS-CoV-2 Infection (COVID-19) and the Medications Administered for Its Treatment Impair Testicular Functions?

PURPOSE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted primarily via respiratory droplets and enters host cells through angiotensin-converting enzyme 2 (ACE-2) receptors. ACE-2 receptors have been identified in many tissues including testes. The aim of the study has been to investigate the long-term effects of SARS-CoV-2 infection (COVID-19) and its relative treatment on male reproductive health. METHODS: Cross-sectional analysis has been performed on 49 recovered COVID-19 patients who had semen analysis prior to the COVID-19 pandemic. Those who had a recovery time lag of at least 3 months have been re-examined, and 29 eligible patients with no andrological problems have been enrolled in the study. Following a detailed physical examination and retrieval of medical history, the values of semen analysis and serum sex hormone parameters have been collected and compared before and after COVID-19 infection. The p value of <0.05 has been considered significant. RESULTS: The average age of the 29 patients has been 31.21 ± 5.48 (range: 18-41) years. Favipiravir has been co-administered with hydroxychloroquine in 17 patients, while the remaining 12 received favipiravir treatment without hydroxychloroquine. The average time between clinical recovery from COVID-19 and collection of semen has been 4.52 ± 1.36 (range: 3-8) months. Before and after COVID-19, serum follicle-stimulating hormone, luteinizing hormone, total testosterone, and prolactin levels, as well as all semen parameters, have been comparable. CONCLUSION: Our study demonstrated that COVID-19 and its treatment with favipiravir and hydroxychloroquine did not affect spermatogenesis and serum androgen levels in the long-term period. Further clinical studies with larger sample size are needed to confirm and support our findings.

Turkish validation of the Jefferson scale of empathy for nurses seeking kidney donations in intensive care units.

AIM: To find the answer to the question: is a high level of empathy of intensive care nurses effective in increasing organ donation? MATERIALS AND METHODS: This study was performed with nurses who had been working in intensive care units for at least 1 year in 17 hospitals in 8 provinces in Turkey. Jefferson Scale of Empathy and the other questionnaire forms were sent to the nurses by email, and completed forms from those who accepted to participate in the study were also received by email. RESULTS: There was a positive significant relationship between donor declaration and empathy score. An increase was observed in empathy score as donor declaration increased. Cronbach's alpha coefficient of Jefferson Scale of Empathy (JSE) in general was α = 0.71. JSE is an acceptable tool of measurement in terms of internal consistency. Turkish validation of JSE was provided. DISCUSSION: There was a direct relationship between empathy levels of intensive care nurses and donor declarations and organ finding. Therefore, it can be assumed that a preference for nurses with a high level of empathy to work in intensive care units would be effective in increasing organ donations. Alternatively, empathy increasing trainings during in-service trainings and seminars for intensive care nurses may increase organ donation and thus provide hope for patients awaiting organ donations.

Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review.

BACKGROUND: Kiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken. METHODS: Inpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010-December 2013 (pre-rotavirus vaccine) and January 2016-September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre- and post-rotavirus vaccine introduction. RESULTS: The incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12·8% vs. 7·2%, p < 0·001) and all-cause under-five mortality (15·9% vs. 5·7%, p = 0·006) pre- and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction. CONCLUSIONS: AGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.

Can monocyte/HDL show inflammatory activity of isotretinoin treatment in acne patients?

Aim: There are reports that isotretinoin causes some important diseases such as teratogenicity, inflammatory bowel disease and sacroiliitis by triggering inflammation. (Monocyte/HDL (high density lipoprotein) ratio) MHR is closely related to inflammation and is thought to be an indicator of atherosclerotic development. We aimed to investigate how isotretinoin (ISO) affects the immunoinflammatory response in acne patients.Materials and Methods: In this study, 116 nodulocystic acne patients who received ISO treatment for at least three months were evaluated retrospectively. ISO treatment was given to patients at a dose of 0.5-1 mg/kg. Pre-treatment and post-treatment white blood cell (WBC), neutrophil, lymphocyte, monocyte, platelet, mean platelet volume (MPV), platelet, plateletcrit, platelet distribution width (PDW), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), total cholesterol, LDL cholesterol, triglyceride, HDL cholesterol and MHR were evaluated.Results: MPV and MHR values were significantly increased after 3 month treatment (p < 0.05). There was no significant change in NLR and PLR values (p > 0.05). There was a significant decrease in neutrophil count (p < 0.05). There were no significant changes in WBC, lymphocyte, monocyte, platelet, plateletcrit values (p > 0.05). Total cholesterol, LDL cholesterol and triglyceride levels were significantly increased after three months of treatment (p < 0.05). HDL cholesterol levels decreased significantly after three months of treatment (p < 0.05).Conclusion: We concluded that ISO treatment may trigger inflammation due to the increase in MPV and MHR value. MHR can show inflammation after ISO treatment.

Comment on ''how does omalizumab affect the immunoinflammatory response in patients with chronic spontaneous urticaria?'': reply from author.

We read Cosansu's commentary entitled ''Hematological parameters in patients with chronic spontaneous urticaria'' to our study with a great interest. The author noted that monocytes increased in inflammatory diseases such as urticaria but decreased after treatment. She argued that NMR was not used as an inflammatory marker in previous studies, so that NMR should not be used to evaluate the response to omalizumab treatment in urticaria and decreased by chance. We thank the author for her interest in our article.

How does omalizumab affect the immunoinflammatory response in patients with chronic spontaneous urticaria?

Purpose: The aim of this study was to evaluate the effect of omalizumab on immunoinflammatory cells in patients with chronic spontaneous urticaria (CSU).Material and methods: The study was designed retrospectively. Seventy-four patients diagnosed with CSU and taking omalizumab between 2016 and 2019 were included in this study. Hematological parameters of the patients before treatment and after 12 weeks of treatment were recorded. Lymphocyte/monocyte ratio (LMR), neutrophil/monocyte ratio (NMR), neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were examined and the effects of omalizumab treatment on inflammatory parameters were evaluated. Angioedema status of patients, total IgE levels and the relationship between these variables were investigated. The results were evaluated statistically.Results: The neutrophil count, the neutrophil/lymphocyte ratio and neutrophil/monocyte ratio showed a statistically significant reduction after 12 weeks of omalizumab treatment. There was no significant change in other data.Conclusion: In our study, omalizumab treatment significantly reduced neutrophil/lymphocyte ratio and neutrophil/monocyte ratio. Further studies are needed to assess the correlation between treatment response and these parameters to determine the likelihood of a decrease in these values by the antiinflammatory effect of omalizumab.

The effect of biological agent treatment on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume, and C-reactive protein in psoriasis patients.

INTRODUCTION: In recent years, the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) and C reactive protein (CRP) have been shown to be important indicators of systemic inflammation. Studies have shown that NLR, PLR, MPV and CRP are higher in psoriasis patients than in the control group. AIM: To investigate the NLR, PLR, MPV and serum CRP levels in patients who were treated with biological agents for psoriasis. MATERIAL AND METHODS: In our study, 75 patients who were followed up and had a diagnosis of psoriasis vulgaris and took a biological agent therapy between January 2014 and December 2017 in the Dermatology Clinic of the Dicle University Medical Faculty Hospital were evaluated before treatment, and 3 and 6 months after treatment. RESULTS: Neutrophil count, lymphocyte count, thrombocyte count, NLR, PLR, MPV and CRP values before the biological agent treatment were statistically higher than the values at 3 and 6 months of treatment. There was no statistically significant difference between pre-treatment neutrophil, lymphocyte, leukocyte, platelet, NLR, PLR, MPV, CRP values and values at 3 and 6 months after treatment when we compared four different biological agents. CONCLUSIONS: It was seen that NLR, PLR, MPV and CRP values decreased independently of the type of the biological agent used in our study. Therefore, we think that these parameters can be used to evaluate the effects of biological agent treatment on systemic inflammation in psoriasis patients and to monitor the course of the disease.

Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment.

BACKGROUND/AIMS: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. METHODS: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. RESULTS: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. CONCLUSION: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

Saccular Aneurysm of the Internal Jugular Vein in an Adult Patient and Its Surgical Treatment.

OBJECTIVES: Congenital jugular vein aneurysm in an adult patient is a rare condition. CLINICAL REPORT: A 17-year-old patient presented to the authors' clinic with left neck swelling. The clinical and radiological findings were appropriate with the internal jugular vein aneurysm. The authors detailed their experience in the surgical treatment of this true saccular aneurysm. CONCLUSION: Jugular venous aneurysm is a rare benign venous pathology and it can be easily confused with other neck pathologies. Its surgical excision can be sometimes difficult and troublesome than expected.

Comparative Analysis of the Healing Effects of the Transplanted Cell Sheets to the Experimentally Injured Maxillary Sinuses.

BACKGROUND: In our study, the authors aimed to obtain a live and functional sinus epithelium with mesenchymal stem cells and nasal mucosa epithelial cells from rabbits which are cultured in temperature-responsive culture plates to get a single-layer. METHODOLOGY/PRINCIPAL: Twenty-two female New Zealand rabbits were included in the study. Two of them were used to obtain mesenchymal stem cells. A total of 40 maxillary sinuses were randomly divided into 5 groups: 1) control group which is used to investigate normal rabbit maxillary mucosa, 2) secondary healing group, 3) mesenchymal stem cell graft group, 4) differentiated mesenchymal stem cell group, and 5) nasal mucosal graft group. The animals were sacrificed at the 28th day after the surgery.Scanning electron microscopy, transmission electron microscopy, and immunohistochemical investigations were performed. RESULTS: With these investigations, it was shown that; all graft groups were histologically better than secondary healing group and when the authors compared the graft groups, differentiated mesenchymal stem cell group were the best. CONCLUSION: Our study results showed that endoscopic sinus surgery and treatment with cell sheets, which were generated in temperature-responsive culture dishes, had more functional respiratory epithelium.