Parent participation in early intervention/early childhood hearing impairment program.

BACKGROUND: It is a well-known fact that the parents play a key role in the early intervention program for their deaf and hard of hearing children. AIMS: This study aims to focus on issues related to the need for a collaborative, supportive and parent centred early intervention programs and (re)habilitation process for the children with hearing aids or cochlear implants for sustainable health. This study was a retrospective case control study. SUBJECT AND METHODS: Sixty parents (30 parent educated and 30 non- parent educated) were completed a Profile Questionnaire and a Family Awareness and Knowledge Questionnaire. The first questionnaire was designed to obtain the information related with the demographics of the family and their deaf or hard of hearing children. The latter was used to evaluate the knowledge of parents about their hearing handicapped children. All statistical analyses were performed with IBM SPSS Statistics, Version 22.0 software (Armonk, NY: IBM Corp). RESULTS: The parent awareness and knowledge of children with cochlear implants differed from those of control group who do not receive any family counselling, but not in clinically significant ways. CONCLUSIONS: Some of the variability in cochlear implantation outcomes that have protracted periods of development is related to family environment. Because the family environment can be modified and enhanced by therapy or counselling, these preliminary findings hold promise for future work in helping families for sustainability in health.

Difficulties encountered by hospitalized Syrian refugees and their expectations from nurses.

BACKGROUND: Treating patients with care and respecting their cultural values are key factors necessary to enhance the quality of nursing care. AIM: The objective of this study was to explore and describe the difficulties experienced by hospitalized Syrian refugees and their expectations from nurses and hospital administration. METHODS: We used a descriptive qualitative research approach to engage 30 Syrian refugees undergoing treatment in internal medicine who met the study criteria. Data were collected using a descriptive questionnaire and a semi-structured interview with open-ended interview questions. Interview transcripts were analysed using an inductive coding approach. Descriptive questions were analysed and presented via number and percentage. Other data were assessed using content analysis methods. RESULTS: Three major themes were developed following the analysis of the interviews. We determined that the refugees who participated in the study experienced difficulties in communicating, meeting their personal needs and correctly following treatment instructions. They also had certain expectations from the hospital administration and nurses, and they felt gratitude for both nurses and the nation of Turkey. CONCLUSIONS: The results of this study, shared with the executive administration of the hospital, may result in new policies which will help new Syrian refugee patients and patients with similar needs to have better experience related to patient care, communications and meeting personal needs. IMPLICATION FOR NURSING AND HEALTH POLICY: It is important that nurses and other healthcare provider consider the difficulties and expectations of refugees regarding healthcare services and include same in the development of provider training programmes. Development of public health welfare and employment law and policies help to lay the groundwork for successful integration of refugees in new cultures and countries.

Does visualisation during urethrocystoscopy provide pain relief? Results of an observational study.

BACKGROUND: To measure the effects of real-time visualisation during urethrocystoscopy on pain in patients who underwent ambulatory urethrocystoscopy. METHODS: An observational study was designed. From June 2012 to June 2013 patients who had ambulatory urethrocystoscopy participated in the study. In order to measure pain perception we used a numeric rating scale (NRS) 0 to 10. Additional data was collected including gender, reason for intervention, use of a rigid or a flexible instrument and whether the patient had had urethrocystoscopy before. RESULTS: 185 patients were evaluated. 125 patients preferred to watch their urethrocystoscopy on a real-time video screen, 60 patients did not. There was no statistically relevant difference in pain perception between those patients who watched their urethrocystoscopy on a real-time video screen and those who did not (p = 0.063). However, men who were allowed to watch their flexible urethrocystoscopy experienced significantly less pain, than those who did not (p = 0.007). No such effects could be measured for rigid urethrocystoscopy (p = 0.317). Furthermore, women experienced significantly higher levels of pain during the urethrocystoscopy than men (p = 0.032). CONCLUSIONS: Visualisation during urethrocystoscopy procedures in general does not significantly decrease pain in patients. Nevertheless, men who undergo flexible urethrocystoscopy should be offered to watch their procedure in real-time on a video screen. To make urethrocystoscopy less painful for both genders, especially for women, should be subject to further research.

[Gender-specific characteristics and survival of renal cell carcinoma]. / Geschlechtsspezifische Charakteristika und Prognose des Nierenzellkarzinoms.

BACKGROUND: Renal cell carcinoma (RCC) occurs twice as often in men as in women; however, the influence of gender on stage, grade, subtype and prognosis has not been studied in detail. METHODS: This study included 780 patients treated by (partial) nephrectomy at our institution in Marburg between 1990 and 2005. The mean follow-up was 5.44 years. RESULTS: Of the 780 patients, 486 (62%) were men and 294 (38%) were women. Women were significantly older (mean, 65.3 vs. 62.2 years; p<0.001, t-test), presented at lower T stages (p=0.046, chi(2)) and suffered metastasis less frequently at diagnosis (p=0.026, chi(2)). In addition, women more frequently had clear cell tumours (85.2% vs. 78.3%) and less frequently papillary tumours (11.0% vs. 18.8%) than men (p=0.026, chi(2)). In contrast, men had an increased risk of death from RCC (HR 1.23, CI 0.92-1.63); Kaplan-Meier curves revealed a significant difference in tumour-specific survival between men and women (p=0.033, log rank; 5-year survival 74% vs. 83%). However, unlike tumour stage and tumour grade, gender could not be retained as a significant independent prognostic marker in multivariate analysis. CONCLUSION: In general, RCC in men is characterized by higher tumour stages and more frequent metastasis at diagnosis along with inferior tumour-specific survival. However, as gender failed to qualify as an independent prognostic marker for tumour-specific survival, delayed diagnosis due to insufficient routine medical check-up and/or a more aggressive tumour biology might be be a concurrent cause. Thorough regular medical check-ups for men, also with regard to RCC, are thus mandatory.

[Transitional cell carcinoma of the bladder. Evaluation of plasma levels of cellular fibronectin as a stage-dependent marker]. / Das Transitionalzellkarzinom der Harnblase. Evaluation von zellulärem Fibronektin im Plasma als stadienabhängiger Marker.

Up to now markers for transitional cell carcinoma of the bladder (TCC) are missing. Fibronectin (FN) seems to play a key role in progression and invasion of malignant tumors. The aim of this study was to assess the value of cellular FN (cFN), a more specific subform of produced FN, in different stages of TCC.cFN was determined using a highly sensitive immunoassay which we developed. Blood samples were taken of 45 patients with the first diagnosis of TCC before undergoing TUR-B and 6 patients with metastatic TCC before chemotherapy; 70 patients with nonmalignant urological disorders served as a control group.Patients with TCC showed significantly elevated cFN plasma levels compared to controls (p<0.05). Patients with muscle-invasive disease (n=15) showed significantly higher cFN plasma levels compared to the group with superficial TCC. Patients with metastatic TCC showed the highest, but not significantly elevated cFN plasma levels compared to patients with muscle-invasive TCC.The elevated cFN plasma levels in TCC underline the important role of cFN for tumor progression and its potential role as a marker for TCC. Upcoming investigations are necessary to prove the value of the potential marker cFN during follow-up and its impact as a prognostic factor for recurrence and progression of TCC.

[Functional results of surgical treatment of bronchiectasis in a developing country]. / Resultados funcionales del tratamiento quirúrgico de las bronquiectasias en un país en vías de desarrollo.

BACKGROUND: The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. PATIENTS AND METHOD: From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall "social" or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the 6th postoperative month. RESULTS: The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). CONCLUSION: Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection.

The expression of angiopoietins and their receptor Tie-2 in human prostate carcinoma.

BACKGROUND: Angiopoietin-1 and angiopoietin-2 are antagonist angiogenic factors acting via the same receptor Tie-2. Their role in prostate carcinoma (PCa) is not known. MATERIAL AND METHODS: Using immunohistochemistry, localization of angiopoietin-1, angiopoietin-2 and their receptor Tie-2 was studied in normal human prostate and PCa. RESULTS: Few epithelial cells of normal prostate expressed angiopoietin-1 and Tie-2 but not angiopoietin-2. Normal prostate blood vessels were negative. In PCa, intraductal grown tumor cells showed angiopoietin-1 but not angiopoietin-2. Blood vessels close to the ducts and some apical tumor cells expressed angiopoietin-1 and Tie-2. In glandular PCa, most of the tumor and intraglandular stromal cells were positive for both angiopoietin-1 and angiopoietin-2. Angiopoietin-1 and angiopoietin-2 were also found in tumor capillaries. Additionally, angiopoietin-2 was expressed in smooth muscle cells of intratumoral blood vessels which also exhibited Tie-2. CONCLUSIONS: The results presented indicate a role of angiopoietin-Tie-2 system, particularly of angiopoietin-2 in the vascularization of PCa.

Atypically located pericardial cysts.

Pericardial cysts are generally recognized when they present in a cardiophrenic angle, but may not be suspected when they occur elsewhere in the thorax. To highlight the unusual localisations of pericardial cysts, we represent two patients with cysts of which one was adjacent to the left pulmonary hilum and the other was located in the subpulmonary region. The clinicians should take into consideration this entity in the differential diagnosis of cystic lesions of the mediastinum.

Is impaired sleep quality responsible for a nondipping pattern even in normotensive individuals?

OBJECTIVE: We aimed to evaluate the relationship between sleep quality and a dipping-nondipping pattern in normotensive individuals. MATERIALS AND METHODS: Our study was carried out on 100 normotensive individuals; 50 of these individuals had a dipping pattern and 50 had a nondipping pattern, and were chosen from among patients in whom ambulatory blood pressure monitoring was applied before for any reason. All study participants underwent the Pittsburgh Sleep Quality Index survey to evaluate sleep disturbances. RESULTS: The overall scores and all the components of the Pittsburgh Sleep Quality Index scores were significantly higher in the nondipper normotensive group compared with the dipper normotensive group. CONCLUSION: In conclusion, the nondipping blood pressure pattern appears to be associated with poor sleep quality not only in hypertensive patients but also in normotensive healthy individuals. When evaluating patients with poor sleep quality, the possibility that they may have a nondipping pattern even if they are normotensive should be kept in mind.

Mean platelet volume as an inflammatory marker in acute exacerbation of chronic obstructive pulmonary disease.

INTRODUCTION:  Mean platelet volume (MPV) is inversely correlated with inflammation in inflammatory bowel diseases, rheumatoid arthritis, and ankylosing spondylitis as shown in the previous studies. It has been reported that elevated values of MPV are associated with cardiovascular diseases and stable chronic obstructive pulmonary disease (COPD). However, MPV values in acute exacerbation of COPD have not been investigated so far. OBJECTIVES:  This retrospective study was conducted to investigate the relationships between MPV and acute phase reactants and functional parameters during COPD exacerbation. PATIENTS AND METHODS:  The study included 47 patients with COPD with mild to very severe airway obstruction and 40 age­matched healthy subjects. C­reactive protein levels and complete blood count were analyzed and compared in patients during the stable period and during exacerbation of COPD. RESULTS:  MPV values were 9.3 ±1.4 and 8.6 ±1.0 fl during stable period and during acute exacerbation, respectively. Mean MPV values in the control group were 9.3 ±0.8 fl. MPV values were significantly lower in patients during acute exacerbation than in those during the stable period of COPD and in control subjects (both, P <0.001). CONCLUSIONS:  The results suggest that assessment of MPV in COPD exacerbation may indicate systemic inflammation. Thus, MPV may be used as a negative acute­phase reactant in COPD exacerbation.

[Pelvic lymphadenitis after total hip arthroplasty : Mimicking of lymph node metastases in a patient with prostate cancer]. / Pelvine Lymphadenitis nach Implantation einer Hüft-TEP : Imitation von Lymphknotenmetastasen im Rahmen einer radikalen Prostatektomie.

This report describes the case of a 65-year-old patient who underwent radical prostatectomy in our department. Intraoperatively we detected suspicious lymph nodes on the left side. The histopathological examination revealed histiocytosis and foreign body giant cells but no sign of tumor. The enlarged lymph nodes were ascribed to an ipsilateral total hip arthroplasty performed 14 years previously because of progressive coxarthrosis. Lymphadenitis after total hip arthroplasty is frequently observed. Histopathologically and with the use of polarized light microscopy, histiocytosis and wear particles such as titanium, polyethylene, and polyethylene-methylacrylate may be detected. When operating on patients with arthroplasty of a lower limb, particularly those with a total endoprosthesis, the surgeon should bear in mind that changes in lymph node consistency and size do not necessarily indicate tumor involvement or metastases.

Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility.

AIM: The objective of this study was to determine whether regular combined exercise program, which consists strength, stretching and aerobic exercises and additional jumping training, improve balance, fall risk, quality of life and depression status of older people living in a residential care. METHODS: A total of 168 residents who live in a long term care facility were screened. The trial began with 78 eligible participants and they were randomly grouped as combined exercises program (COM) group that includes stretching, strength and aerobic exercises, and COM plus jumping (COMpJ) group. 66 of the participants finished the trial. The groups were convened three times a week for six weeks. Each group had a warm-up, effective training and a cooling down periods. The total exercising time was no longer than 45 minutes in each group. Berg balance test and Biodex Balance System for the assessment of the dynamic balance and fall risk, short form 36 (SF 36) for the health related quality of life and Geriatric Depression Scale (GDS) for evaluation of the depression status were used. RESULTS: The balance improvement and fall risk reduction were observed in both of the groups at the end of the trial; however, the improvements were statistically better in jumping combined group. Also health related quality of life improved in both groups. CONCLUSION: Regular group exercise in a long term care facility have several beneficial effects on the elderly residents in regard to balance improvement, fall risk reduction and quality of life. The addition of jumping to strength, stretching and aerobic exercises provides important contributions to balance improvement and fall risk reduction.

A multidisciplinary approach to the management of individuals with fragile X syndrome.

BACKGROUND: Fragile X syndrome (FXS) is the most common inherited form of intellectual disability. Since the identification of the responsible gene (FMR1) and its protein (FMRP), there has been enormous progress in both clinical and pathogenetic research on the neurobehavioural aspects of the condition. However, studies regarding other medical problems anticipated in individuals with FXS are limited. A multidisciplinary study evaluating various causes of morbidity in the same group has not been published yet. METHODS: Twenty-four boys with FXS full mutation were recruited out of a larger group of 103 diagnosed in one centre over the past 10 years. Ear nose and throat, eye and cardiac examinations were performed in addition to routine cognitive, behavioural, neurological and speech and language assessments. RESULTS: The average IQ score was 49.8 +/- 20 (range 25-90). There were four patients (18%) with IQ above 70. Using DSM-IV, attention deficit hyperactivity disorder was diagnosed in five boys out of 22 examined (23%), while 32% were diagnosed with pervasive developmental disorder. The seizure frequency was 17%. A psychiatric disorder was diagnosed in six out of eight boys with electroencephalogram abnormalities (75%). Minimal conductive hearing loss was found in five (5/22) patients. There was significant delay in both expressive and receptive language skills. Ocular findings were refractive errors (13%) and strabismus (4.4%). Mitral valve prolapsus (MVP) was observed in 3/22 (13.7%) patients and aortic annulus dilatation was present in 2/22 (9%) patients. CONCLUSIONS: Frequency of psychiatric diagnoses made with DSM-IV were in parallel to those reported in the literature. Comorbidity of seizures and psychiatric disorders was noteworthy. The percentage of 'high-functioning' full mutation males supports the previous observations. Ear nose and throat and eye examination revealed remarkably lower prevalence of abnormal findings than reported. MVP was slightly less frequent compared with the single study in the literature. Age at the time of examination had an effect on the outcome of cardiac evaluation. These findings will guide us in future management of the group of patients followed in our institution. The protocol applied provides an applicable outline for multidisciplinary institutional settings dealing with individuals with FXS.

[Tracheobronchial injuries due to blunt thoracic trauma: 10 years experience]. / Künt gögüs travmasina bagli trakeobronsiyal yaralanmalar: 10 yillik deneyim.

The tracheobronchial injuries are seldom, but life threatening. Their successful diagnosis and treatment require a high level of suspicion. In this report, we reviewed our experience with seven patients with tracheobronchial injuries due to blunt thoracic trauma, treated over the past 10 years. Definitive diagnosis was recognized with bronchoscopy after clinical suspicion. Most injuries were located in the right bronchial tree (five patients), whereas only one patient had an injury located in the left bronchial tree and one in trachea. The majority of the injuries were repaired primarily (five patients) and two required lobectomy. There were no postoperative mortality; but three postoperative complications were noted; one empyema and two partial stenoses on the repair line.

[Thoracic trauma: analysis of 987 cases]. / Gögüs travmalari: 987 olgunun analizi.

In Izmir Chest Diseases and Thoracic Surgery Training Hospital, Department of 1st Thoracic Surgery, between 1988 and 1998, 987 patients who were treated for their chest trauma were retrospectively reviewed in regard to their age, sex, cause of trauma, associated organ injuries, treatment modality, complication rate and mortality. In 710 (72%) cases of chest injuries were related to blunt trauma and 277 (28%) patients sustained penetrating trauma. 402 (41%) patients underwent tube thoracostomy only. While majority of patients (553 pts, 56%) were managed conservatively, only 32 (3%) underwent thoracotomy. Complication rate in our series was 4.6% and the most frequently atelectasis was seen. 13 patients died due to trauma related causes (mortality: 1.3%). There was no difference between blunt and penetrating trauma patients in view of morbidity and mortality rates (p = 0.29 and p = 0.10, respectively). Mean hospital stay among all patients was 9.6 +/- 8.6 days. This period was 10.0 +/- 8.5 days in blunt trauma group, and 8.4 +/- 8.6 days in penetrating trauma group. However this difference has reached statistical significance at a p value of 0.0068.

Alternative splicing, expression, and genomic structure of the 3' region of the gene encoding the sarcolemmal-associated proteins (SLAPs) defines a novel class of coiled-coil tail-anchored membrane proteins.

The sarcolemmal associated proteins (SLAPs) are encoded by multiple mRNAs that are presumably generated by alternative splicing mechanisms. The amino acid sequence of the SLAP1 isoform exhibited 76% identity with TOP(AP), a topographically graded antigen of the chick visual system. The regions of coiled-coil structure including an 11-heptad acidic amphipathic alpha-helical segment was conserved with a major divergence in sequence noted in the hydrophobic C termini predicted to be transmembrane domains in the two polypeptides. The genomic organization of the 3' region of the SLAP gene indicated that SLAP1 and TOP(AP) are generated by alternative splicing mechanisms, which are conserved among mammalian and avian species. SLAP1/TOP(AP) were encoded by 11 exons distributed over a minimum of 35 kilobase pairs of continuous DNA; 9 of the exons were constitutively expressed, and 2 were alternatively spliced. The exons range in size from 60 to 321 base pairs, and the predicted functional domains within the polypeptides were encompassed by single exons. The introns vary from 0.2 to 10 kilobase pairs and conform to consensus dinucleotide splicing signals. Reverse transcriptase-polymerase chain reaction studies demonstrated that alternative exons (IV and X) of SLAP were expressed in a tissue-specific fashion and developmentally regulated. The alternatively spliced exon X, which encodes the putative transmembrane anchor in TOP(AP), and a constitutively expressed exon XI, which encodes the putative transmembrane domain in SLAP, were found to target these polypeptides to membrane structures. The presence and conservation of termination codons in exons X and XI render expression of the two SLAP1/TOP(AP) transmembrane domains mutually exclusive. These data reveal that TOP(AP) and SLAP are alternatively spliced products of a single gene that encodes a unique class of tail-anchored membrane proteins.

Endostatin inhibits angiogenesis by stabilization of newly formed endothelial tubes.

Endostatin decreased vascular endothelial growth factor (VEGF)-induced formation of endothelial tubes and microvessels sprouting from aortic rings and blocked their network. After cessation of treatment, the survival time of endostatin plus VEGF-treated tubes was approximately doubled in comparison to VEGF alone. Endostatin antibody blocked VEGF-induced endothelial tube formation and disrupted existing tubes. Endostatin immunostaining was localized between endothelium and basement membrane and in inter-endothelial junctions of new, but not of quiescent, blood vessels. In tumors grown in SCID mice, endostatin immunostaining was stronger accompanying blood vessel maturation and was significantly prominent in vessels of tumor marginal zone where angiogenesis is highly active. These data indicate a new antiangiogenic action of endostatin stabilizing and maturating endothelial tubes of newly formed blood vessels. Thus, strategies accelerating vascular stabilization and maturation could be promising in tumor therapy.