Enthesitis in a European registry-based cohort of patients with psoriatic arthritis treated with tumour necrosis factor inhibitors: clinical burden, patient-reported outcomes, and treatment response.

OBJECTIVE: To explore the registration of enthesitis among biologic-naïve patients with psoriatic arthritis (PsA) initiating tumour necrosis factor inhibitor (TNFi) treatment across 12 European registries, compare the disease burden and patient-reported outcomes (PROs) between patients with and without enthesitis, and assess the enthesitis treatment response. METHOD: Demographics, clinical characteristics, and PROs at first TNFi (TNFi-1) initiation (baseline) were assessed in patients with PsA, diagnosed by a rheumatologist, with versus without assessment of entheses and between those with versus without enthesitis. Enthesitis scores and resolution frequency were identified at follow-up. RESULTS: Of 10 547 patients in the European Spondyloarthritis (EuroSpA) Research Collaboration Network initiating TNFi, 1357 underwent evaluation for enthesitis. Eight registries included a validated scoring system for enthesitis. At baseline, 874 patients underwent entheses assessment [Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) 485 patients, Spondyloarthritis Research Consortium of Canada (SPARCC) 389 patients]. Enthesitis was detected by MASES in 170/485 (35%, mean score ± sd 3.1 ± 2.4) and by SPARCC in 236/389 (61%, 4 ± 3.4). Achilles enthesitis was most frequent, by both MASES (unilateral/bilateral 28%/9%) and SPARCC (48%/18%). MASES/SPARCC baseline and follow-up scores for TNFi-1 were available for 100/105 patients. Of these, 63 patients (63%) (MASES) and 46 (43.8%) (SPARCC) achieved resolution of enthesitis. The site-specific enthesitis resolution was overall lower at SPARCC sites (peripheral; 63-80%) than at MASES sites (mainly axial; 82-100%) following TNFi-1. Disease activity and PROs were worse in patients with versus without enthesitis. CONCLUSION: Entheseal assessments are only registered in a minority of patients with PsA in routine care. When assessed, enthesitis was common, and a substantial proportion demonstrated resolution following treatment with TNFi-1.

Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey.

INTRODUCTION: Child abuse is a serious public problem. Signs of abuse are often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students' knowledge about and attitudes towards child abuse. MATERIAL AND METHODS: This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self-report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students' experience and requests made by students were evaluated by the students' response to questions put in the questionnaire. Descriptive statistics and chi-square tests were performed to analyse the questionnaire data. RESULTS: The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third-, fourth- and fifth-year students' answers. Fifth-year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic. CONCLUSION: Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse.

Quantum Transport Detected by Strong Proximity Interaction at a Graphene-WS2 van der Waals Interface.

Magnetotransport measurements demonstrate that graphene in a van der Waals heterostructure is a sensitive probe of quantum transport in an adjacent WS2 layer via strong Coulomb interactions. We observe a large low-field magnetoresistance (≫ e(2)/h) and a -ln T temperature dependence of the resistance. In-plane magnetic field resistance indicates the origin is orbital and nonclassical. We demonstrate a strong electron-hole asymmetry in the mobility and coherence length of graphene demonstrating the presence of localized Coulomb interactions with ionized donors in the WS2 substrate, which ultimately leads to screening as the Fermi level of graphene is tuned toward the conduction band of WS2. This leads us to conclude that graphene couples to quantum localization processes in WS2 via the Coulomb interaction and results in the observed signatures of quantum transport. Our results show that theoretical descriptions of the van der Waals interface should not ignore localized strong correlations.

The assessment of maternal and umbilical cord homocysteine levels in obese pregnant women.

PURPOSE: The aim of this study was to compare the maternal plasma and umbilical cord blood homocysteine levels in obese and non-obese pregnant women. MATERIALS AND METHODS: One hundred-ten term pregnant women, who completed their 3711, gestational weeks and were not in active labor, were enrolled in the study. While 41 out of them were obese (BMI ≥ 30 kg/m(2)), 69 were non-obese (BMI < 30 kg/m(2)). The maternal plasma and umbilical cord homocysteine levels and umbilical cord pH values were compared between the groups. The statistical analyses were performed using t-test, Mann Whitney test, and Chi-square test. Ap < 0.05 value was set as statistically significant. RESULTS: The mean of age was higher in obese group in borderline significance (26.8 ± 5.4 vs. 28.8 ± 5. l,p = 0.049). The mean of gestational weeks, birthweight, the mode of delivery, and umbilical cord pH values were similar between the groups (p > 0.05). The maternal plasma homocysteine levels [median (interquartile range); 7.6 (4.1) vs. 7.1 (4.9)] and umbilical cord homocysteine values were not statistically different [8.6 (4.2) vs. 8.8 (4.5)] between the groups (p > 0.05). CONCLUSION: The maternal and umbilical cord blood homocysteine levels are not different in obese and non-obese pregnant women.

Can extracorporeal magnetic innervation be a treatment modality for primary dysmenorrhea?

BACKGROUND/AIMS: To evaluate the efficacy of extracorporeal magnetic innervation (ExMI) as a treatment for primary dysmenorrhea compared with nonsteroidal anti-inflammatory drugs (NSAIDs) and combined oral contraceptives (COCs). METHODS: The cases were randomized into three groups (NSAID = 51, ExMI = 53, COC = 54). ExMI was applied for a total of 10 sessions. Women in the NSAID group used an oral NSAID at the start of each menstruation. Women in the COC group were given combined pills. Of the treatment options, ExMI was applied for only a single period, whereas NSAID and COC use continued for 12 months. RESULTS: At the first menstruation, visual analog scale (VAS) scores improved significantly in all groups (p < 0.001). NSAIDs and COCs continued to show efficacy over the entire study period (p < 0.05). However, in the ExMI group, VAS values increased from the first menstruation until 12 months. The VAS score at the 12th month was significantly higher in the ExMI group than in the other groups (p < 0.05), but markedly lower than the pretreatment value (49.9 ± 8.3 vs. 71.1 ± 10.1, p < 0.001). CONCLUSIONS: ExMI therapy might be a promising novel noninvasive option for primary dysmenorrhea. Efficacy began to decline after 3 months, but continued for 12 months.

Comparison of the effects of meloxicam and dexketoprofen on postoperative adhesion formation in a rat uterine horn surgical model.

STUDY OBJECTIVE: To compare the effects of 2 nonsteroidal antiinflammatory drugs of different chemical classes (meloxicam and dexketoprofen) on postoperative intraabdominal adhesion formation in a rat model. DESIGN: Experimental study (Canadian Task Force classification I). SETTING: Center for research and development. ANIMALS: Thirty female Wistar albino rats. INTERVENTIONS: The animals were randomly assigned to 1 of 3 groups (10 rats per group) and received intramuscular injections of 0.5 mg/kg dexketoprofen (group 1), 0.5 mg/kg meloxicam (group 2), or 1 mL sterile saline solution (control; group 3) daily for 2 days. Laparotomy was performed, and 1 of the uterine horns was damaged via monopolar electrocautery, whereas an incision was made in the other horn using a scalpel and was sutured to promote adhesion formation. The surgeons were blinded to the treatment method. Drug administration was continued for 5 days. The animals were euthanized at 14 days after surgery. MEASUREMENTS AND MAIN RESULTS: Intraperitoneal macroscopic and microscopic adhesions were assessed using standard adhesion scoring systems. Macroscopic adhesion scores were similar among the 3 groups in each horn (p > .50). The total histologic score was significantly lower in the meloxicam group than in the control group (8.0 vs 15.5; p = .006). Dexketoprofen did not significantly affect the total histologic score (11.0 vs 15.5; p = .09) or individual items (i.e., inflammation, fibroblastic activity, foreign body reaction, collagen formation, and vascular proliferation) compared with the control group (p > .02). Meloxicam significantly inhibited inflammation and collagen formation compared with the control group (p < .02). Meloxicam was also significantly superior to dexketoprofen in reducing inflammation (p = .006). CONCLUSION: Although meloxicam did not affect clinical adhesion formation, it significantly decreased histologic scores compared with those of the control group. Therefore, meloxicam may be suitable in reducing postoperative intraabdominal adhesion formation.

The effects of calcium hydroxide removal methods on bond strength of Epiphany SE with two irrigation protocols.

OBJECTIVE: The purpose of this study was to compare the effects of five calcium hydroxide removal methods on the bond strength of Epiphany SE sealer after canal irrigation with NaOCl+EDTA or NaOCl+MTAD. MATERIALS AND METHODS: The 120 roots were instrumented by using the ProTaper rotary system under irrigation with 2.5% sodium hypochlorite and randomly divided into two major groups according to the final irrigation: 1.3% NaOCl + MTAD and 5% NaOCl + 17% EDTA. For controls, 10 roots from each of the final irrigations with NaOCl + MTAD and NaOCl + EDTA (20 roots) were not filled with Ca(OH)2. The intra-canal paste, Ca(OH)2 was applied to each of the 100 remaining roots and stored at 37°C for 7 days. Each group was sub-divided into five sub-groups (n = 10) according to the removal technique for the intra-canal dressing: Group-1: recapitulation with size 30 K file + 3 ml of saline solution, Group-2: recapitulation with size 30 K file + 3 ml of 5% NaOCl, Group-3: using 5% NaOCl + 17% EDTA, Group-4: using 5%NaOCl + 15% citric acid, and Group-5: using 1.3% NaOCl + 5 ml MTAD. The root canals were filled with Resilon and Epiphany SE sealer. The bond strength was measured. RESULTS: The mean bond strength of Epiphany SE to root dentine irrigated with NaOCl + MTAD was lower than that of NaOCl + EDTA. The highest bond strengths were 3.31 ± 0.057 and 2.60 ± 0.054 in the NaOCl + citric acid group when Ca(OH)2 was applied to roots treated with NaOCl + EDTA and NaOCl + MTAD, respectively (p < 0.05). CONCLUSION: For root canals treated with NaOCl + EDTA or NaOCl + MTAD, the use of NaOCl + chelating agent for Ca(OH)2 removal does not adversely affect the bond strength of Epiphany SE to dentin.

Association of passive smoking with dental development in young children.

AIM: To assess dental development in young children who have been exposed to passive smoking by comparing dental ages with the corresponding features in a healthy control group. MATERIALS AND METHODS: A total of 90 passive smokers (PS) with a mean age of 5.49 years and 90 healthy age-matched controls were included in this study. The children were investigated for stimulated salivary cotinine level. Three categories were formed with respect to the number of cigarettes smoked. Dental development was analysed using panoramic radiographs. RESULTS: The dose-response relationship between the cotinine levels of the PS subjects and the number of cigarettes smoked per day was found to be significantly different for the three exposure categories. A significant difference was found between the chronological and dental ages of PS subjects when compared with those of the control group, but there were no significant differences in dental ages related to gender in both groups. CONCLUSION: We could clearly conclude that young children who were PS subjects had delayed dental development.

Increased frequency of MEFV gene mutations in patients with primary dysmenorrhea.

OBJECTIVES: Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever and polyserositis and an autosomal recessive inheritance mode. Up to 15 % of FMF patients are reported to experience perimenstrual attacks. Primary dysmenorrhea could be an incomplete abdominal attack, or patients with dysmenorrhea may have increased frequency of MEFV gene mutation carriage. Therefore, we aimed to evaluate the frequency of MEFV gene mutations in patients with dysmenorrhea. METHODS: Eighty-four patients with primary dysmenorrhea attending consecutively to our gynecology department and 73 healthy female controls selected from hospital staff were included in the study, and MEFV gene mutations were analyzed. RESULTS: The prevalence of total allelic variants was significantly increased in dysmenorrhea patients (p = 0.015); analysis of individual variant rates revealed a significant increase in the frequency of MEFV gene mutations in dysmenorrhea patients compared with the control group (p = 0.036). CONCLUSION: Gynecologists and primary care physicians must be aware of FMF in the differential diagnosis of dysmenorrhea.

Observation of long spin-relaxation times in bilayer graphene at room temperature.

We report on the first systematic study of spin transport in bilayer graphene (BLG) as a function of mobility, minimum conductivity, charge density, and temperature. The spin-relaxation time τ(s) scales inversely with the mobility µ of BLG samples both at room temperature (RT) and at low temperature (LT). This indicates the importance of D'yakonov-Perel' spin scattering in BLG. Spin-relaxation times of up to 2 ns at RT are observed in samples with the lowest mobility. These times are an order of magnitude longer than any values previously reported for single-layer graphene (SLG). We discuss the role of intrinsic and extrinsic factors that could lead to the dominance of D'yakonov-Perel' spin scattering in BLG. In comparison to SLG, significant changes in the carrier density dependence of τ(s) are observed as a function of temperature.

Effectiveness of screening for gestational diabetes during the late gestational period among pregnant Turkish women.

AIM: To assess the incidence of gestational diabetes mellitus (GDM) beyond 30 gestational weeks (GW) in pregnant Turkish women and to determine the criteria for repeating the test during the late period of gestation when the results were normal after the initial screen. MATERIALS AND METHODS: Two hundred pregnant women were enrolled. Maternal age, gravidity, parity and presence of other risk factors (family history of diabetes mellitus, habitual abortions, prior fetal macrosomia, obesity, gestational hypertension history) were collected. First, GDM was evaluated between the 24th and 28th GW by screening (50-g glucose challenge test) and diagnostic tests. This protocol was repeated again at least 1 month from the first screen at the 30th-34th GW in all patients, except those diagnosed with GDM due to an abnormal 3-h test. The results were compared with the clinical risk factors. RESULTS: In total, 19.5% of the cases had positive results in the first screening test. Six patients were diagnosed with GDM. Among the remaining 194 pregnancies, another 10 cases were diagnosed as having GDM with repeated tests, and the incidence of newly diagnosed GDM was 5.2%. Only the mean age (34.2 years) (P = 0.010) and a history of delivering a macrosomic infant (P < 0.010) were significantly high in the late-gestation GDM-positive cases. CONCLUSIONS: Even when early screening tests are negative, pregnancies with advanced maternal ages and those with a history of delivering a macrosomic infant should be re-evaluated for GDM during the late gestational period with screening and diagnostic tests.

Haemorrhoids during pregnancy.

Haemorrhoids are varicose veins of the rectum covered by mucosa at or near the anal canal. They are normally asymptomatic, can occur at any age and affect both males and females. In this review, we address the issue of the approach of the obstetrician to haemorrhoids and their management. Haemorrhoids are common in young women and commoner during pregnancy and the puerperium. Obstetricians and gynaecologists should be familiar with haemorrhoids, a proctological disease, diagnosis and their treatment, but they have little experience regarding the impact of pregnancy on haemorrhoids. The obstetrician must be able to relieve symptoms in patients who are pregnant, or who have just delivered.

Vaginitis in Turkish women: symptoms, epidemiologic - microbiologic association.

OBJECTIVE: To determine the relationship between clinical-epidemiologic findings and microbiologic results in vaginitis. METHODS: A prospective study of 212 women with vaginal symptoms was undertaken. Each patient underwent an evaluation that included standardized history, interview after pelvic examination and vaginal culture. RESULTS: Only 45% of patients received diagnosis. Only two symptoms were more frequently noted with diagnosis. Itching was more frequent in vulvovaginal candidiasis (VCC) whereas odor was more frequent in Bacterial vaginosis (BV). BV was associated with a history of spontaneous and induced abortion, increased number of pregnancy, vaginal douching practice and intrauterine contraceptive device usage. VVC was found to be associated with no contraceptive usage and previous vaginitis history. CONCLUSION: Presenting symptoms alone or with microbiologic studies has limited value, and that of the women with vaginal symptoms may lack a microbiologic diagnosis. Evidence-based approaches that produce highly accurate diagnostic and effective treatment regimens would be expected in the future.

Dynamic thiol-disulfide homeostasis in hyperemesis gravidarum.

OBJECTIVE: To determine serum thiol-disulfide homeostasis in hyperemesis gravidarum. STUDY DESIGN: Twenty-six pregnant women with hyperemesis gravidarum and 37 healthy pregnant women were included in the study. Native thiol, disulfide and total thiol concentrations were measured with a novel automated method. RESULTS: Serum disulfide levels were 15.68±4.41 µmol l(-1) in the hyperemesis gravidarum group and 13.49±2.81 µmol l(-1) in the healthy group (P=0.031). Native thiol levels were 213.86±26.29 µmol l(-1) in the hyperemesis gravidarum group and 232.18±19.21 µmol l(-1) in healthy group (P=0.004), and total thiol levels were 245.23±28.58 µmol l(-1) in the hyperemesis gravidarum group and 259.17±19.94 µmol l(-1) in the healthy group (P=0.038). CONCLUSION: Native and total thiol were deficient in the hyperemesis gravidarum group and this deficiency was correlated with the severity of the disease. The thiol-disulfide balance has shifted to the oxidative side. This metabolic disturbance may have a role in the pathogenesis of hyperemesis gravidarum.

Effects of diphenhydramine HCl and methylprednisolone in the prevention of abdominal adhesions.

OBJECTIVE: The purpose of this study was to determine the effects of diphenhydramine hydrochloride and methylprednisolone in peritoneal adhesions. MATERIALS AND METHODS: Forty-eight male rats were used in the study. The rats were anesthetized by 5 mg/kg ketamine hydrochloride. After opening the abdomen, 10 longitudinal incisions of 2 to 3 cm in length were made on the right parietal peritoneum, and a 2 cm(2) peritoneal layer was excised from the left abdominal wall. The abdomen was closed with 3/0 silk suture. Group I was the control group, group II was given 10 mg/kg diphenhydramine intravenously, group III was given 20 mg/kg methylprednisolone intravenously, and group IV was administered both of the drugs in the above doses. A blood sample of 2 mL was taken from the rats on the 14th day after the operation. The animals were then sacrificed. The abdomen was opened and abdominal adhesions were examined. A tissue sample of 1 g was taken from the abdominal incision line. Albumin, zinc, and hemoglobin levels and leucocyte counts in the blood were determined as well as hydroxyproline levels in the tissue. RESULTS: Numbers of adhesions were as follows: 9 in group I, 3 in group II, and 2 in group III. No adhesion was observed in group IV. Albumin, zinc, and hemoglobin levels and leucocyte counts were found to be similar in all groups. Hydroxyproline levels in the tissue were significantly lower in groups III and IV than in groups I and II (P <0.05). CONCLUSIONS: Diphenhydramine and methylprednisolone reduced postoperative adhesions significantly in rats. Further investigations are needed in order to use these drugs as antiadhesive agents in humans.

The acute effect of orlistat on endothelial function in young obese women.

Recent studies indicate that abdominal fat accumulation is related to impaired endothelial function in young healthy volunteers. The aim of this study was to determine the acute effect of gastrointestinal lipase inhibitor on brachial flow-mediated vasodilatation and hemodynamic parameters in young obese women. The study population was composed of 42 female obese patients (mean age 29 +/- 4 years, age range between 18 and 34 years). Flow-mediated endothelial-dependent vasodilatation was assessed in the brachial artery in response to reactive hyperemia using high-resolution ultrasound. Brachial artery diameter (3.46 +/- 0.72 mm to 3.82 +/- 0.84 mm) and flow-mediated vasodilation (7.6 +/- 0.8% to 9.8 +/- 1.6%) changed significantly after 12 weeks of therapy (p < 0.001). Brachial artery flow was not changed (124 +/- 92 ml/min to 148 +/- 14 ml/min, p > 0.05). The results of this study demonstrate that orlistat improved endothelial function, weight, body mass index and systolic and diastolic blood pressure in young women.

Maternal serum levels of dehydroepiandrosterone sulfate and labor induction in postterm pregnancies.

OBJECTIVES: To study the relationship between maternal endogenous dehydroepiandrosterone sulfate (DHEAS) levels, success of labor induction, and Bishop scores in postterm pregnancies. METHODS: There were 65 postterm pregnancies. Group 1 consisted of women spontaneously in the active phase of labor, and group 2 of women with hypotonic uterine contractions whose labor was inducted by oxytocin. Levels of DHEAS were studied from venous blood samples. Demographic data and Bishop scores were recorded. RESULTS: The demographic characteristics of patients were similar, but DHEAS levels were higher in group 1 than in group 2 (P<0.001). Linear regression analysis showed a significant relationship between DHEAS and Bishop scores. DHEAS levels in women delivered vaginally were significantly higher than in women delivered by cesarean section. From the receiver operating characteristics (ROC) curve, DHEAS levels might determine the mode of delivery and success of labor induction; however, Bishop scores do not. CONCLUSIONS: DHEAS levels may be an important factor influencing the efficiency of labor and the success of labor induction in postterm pregnancies.

Pethidine versus tramadol for pain relief during labor.

OBJECTIVE: To evaluate and compare the analgesic efficacy and adverse effects of tramadol and pethidine in labor. METHOD: Fifty-nine full term parturients were randomly assigned to one of two groups in active labor. Group 1 received 100 mg pethidine; group 2, 100 mg tramadol, intramuscularly. Analgesic efficacy, maternal side effects, changes in the blood pressure, heart rate, and duration of labor were assessed. RESULT: At 30 and 60 min after drug administration, pain relief was greater in the pethidine group than in tramadol group. The incidence of nausea and fatigue was higher in the tramadol group. Following drug administration the decrease in systolic and diastolic blood pressure and the increase in heart rate were statistically significant in both groups. No significant difference was found between the groups when compared for duration of labor and Apgar scores. None of the neonates developed respiratory depression. CONCLUSION: Pethidine seems to be a better alternative than tramadol in obstetric analgesia because of its superiority in analgesic efficacy and low incidence of maternal side effects.

Spin-orbit proximity effect in graphene.

The development of spintronics devices relies on efficient generation of spin-polarized currents and their electric-field-controlled manipulation. While observation of exceptionally long spin relaxation lengths makes graphene an intriguing material for spintronics studies, electric field modulation of spin currents is almost impossible due to negligible intrinsic spin-orbit coupling of graphene. In this work, we create an artificial interface between monolayer graphene and few-layer semiconducting tungsten disulphide. In these devices, we observe that graphene acquires spin-orbit coupling up to 17 meV, three orders of magnitude higher than its intrinsic value, without modifying the structure of the graphene. The proximity spin-orbit coupling leads to the spin Hall effect even at room temperature, and opens the door to spin field effect transistors. We show that intrinsic defects in tungsten disulphide play an important role in this proximity effect and that graphene can act as a probe to detect defects in semiconducting surfaces.