The Role of Thrombocyte/Lymphocyte Ratio and Aspartate Transaminase/Alanine Transaminase (De Ritis) Ratio in Prediction of Recurrence and Progression in Non-muscle Invasive Bladder Cancer.

AIM: The purpose of the study was to determine the predictive value of platelet-to-lymphocyte ratio (PLR) and Aspartate transaminase (AST)/alanine transaminase (ALT) ratio (De Ritis ratio) for recurrence and progression in non-muscle-invasive bladder cancer (NMIBC). METHODS: A total of 231 patients who underwent transurethral tumor resection between 2016 and 2022 were retrospectively analyzed. Preoperative test results, including AST, ALT, platelet, and lymphocyte counts, were used to calculate the PLR and De Ritis ratio. Univariate and multivariate analyses were performed to identify the predictive factors associated with recurrence and progression. RESULTS: Based on the ROC curve, 1.19 and 1.21 were identified as the optimal cut-off values of the De Ritis ratio for recurrence and progression, respectively. Furthermore, PLR cut-off values for recurrence and progression were 114 and 118, respectively. There is a significant difference in recurrence-free survival (RFS) and progression-free survival (PFS) between the groups of patients with high and low De Ritis ratios (p = 0.028 and p = 0.021, respectively). In multivariate analysis, De Ritis ratio ≥ 1.19 and European Organization for Research and Treatment of Cancer (EORTC) high recurrence risk were determined to be significant predictors of tumor recurrence. Multivariate analysis also determined that T1 pathological stage, high tumor grade, European Organization for Research and Treatment of Cancer (EORTC) high progression risk, and De Ritis ratio ≥ 1.21 were risk factors for tumor progression. CONCLUSION: In our study, the preoperative De Ritis ratio represented an independent predictive factor for recurrence and progression in non-muscle invasive bladder cancer. The use of this biomarker in combination with other diagnostic/predictive tools might help urologists improve the clinical decision-making process in the future.

Controlling nutritional status score in predicting International Society of Urological Pathology score upgrading and biochemical recurrence after radical prostatectomy.

AIM: The aim of our study was to assess the predictive value of controlling nutritional status (CONUT) score for the prognosis of prostate cancer. METHODS: A total of 257 patients' characteristics, prostate-specific antigen (PSA) values, biopsy, and pathological specimen features were all recorded. The CONUT score was calculated for each patient from three blood parameters: total lymphocyte count (TLC), serum albumin, and cholesterol concentrations. Spearman's correlation coefficient was used to assess the correlation between the total CONUT score and the variables including age, body mass index, prostate volume, PSA, biopsy and pathological specimen features, and PSA-recurrence free survival (PSA-RFS) time. The Kaplan-Meier method and log-rank test were used for PSA-RFS analysis. Regression analyses were performed to assess the association between clinicopathological factors, the International Society of Urological Pathology (ISUP) upgrading, and biochemical recurrence (BCR). RESULTS: Statistically significant differences were determined in pathologic ISUP grade, and total tumor volume between low and high CONUT score groups. Additionally, the high CONUT score group had a significantly higher BCR rate and lower PSA-RFS when compared with the low CONUT score group. A strong positive correlation between total CONUT score and pathologic ISUP grade and a moderate negative correlation between total CONUT score and PSA-RFS was determined. In multivariate analysis, a total CONUT score ≥2 had a statistically significant association with ISUP upgrading (odds ratio [OR] = 3.05) and BCR (3.52). CONCLUSION: Preoperative CONUT score is an independent predictive factor for ISUP score upgrading and BCR in patients who undergo radical prostatectomy.

The effect of different management systems on milk yield and milk quality in Awassi sheep.

This study aimed to evaluate the effect of concentrate-based feeding (CF) and artificial pasture-based grazing (APG) management systems on milk yield, fatty acids, nutritional indices, and milk physicochemical characteristics of Awassi ewes. The research involved 300 heads of Awassi ewes, which were divided into two groups. Awassi sheep were managed in a CF and APG system to test the milk yield characteristics. The results showed a significant ( P < 0.01 ) difference in milk yield and lactation length between CF and APG management systems of ewes. The average daily milk yield showed a nonsignificant difference for both management systems, and no significant changes ( P > 0.05 ) in the chemical composition of CF and APG management systems were observed. Palmitic (C16:0), myristic (C14:0), stearic (C18:0) capric (C10:0), and lauric (C12:0) acids were the major saturated fatty acids found in milk from both management systems. The level of linoleic acid (C18:2 n-6) was significantly different in both treatments ( P < 0.05 ), but the linolenic (C18:3 n-3) acid level was nonsignificant in milk from the CF and APG management systems. The hypocholesterolemic / hypercholesterolemic (h / H) fatty acid and thrombogenicity (TI) ratios were significantly different ( P < 0.05 ); however, the atherogenicity (AI) had no significant difference between confined and grazing systems. In conclusion, it can be said that the lactation length and lactation milk yield were prolonged by the APG management system, though the milk composition and quality were not significantly affected.

Effect of hyperbaric exposure on pulmonary functions in hyperbaric chamber inside attendants.

Objective: The objective of the study was to compare pulmonary function tests results of hyperbaric chamber inside attendants (HCIAs) working in a hyperbaric chamber before and after sessions. Methods: A total of 68 health care personnel working as HCIAs in the hyperbaric oxygen therapy unit between June 2019 and September 2019 were included in the study. All participants experienced the pressure chamber for the first time. In spirometric evaluation, we measured forced vital capacity (FVC), forced expiratory volume at one second (FEV1), forced expiratory flow at 25%-75% of FVC (FEF25-75) and peak expiratory flow (PEF). In addition, FEV1/FVC ratio (FEV1%) was also calculated. Results: The mean FVC was found as 3.56 ± ± 0.66 (min-max: 2.17-5.63) before hyperbaric exposure and 3.44 ± 0.62 (min-max: 2.30-5.28) after the exposure (3.4%) (p≺0.05). The mean FEV1 was found as 3.37 ± 0.63 (2.13-5.39) before the session and 3.24 ± 0.59 (min-max: 2.3-5.28) after the session (3.9%) (p≺0.05). There was no statistically significant difference between the mean FEV1/FVC ratio, PEF and FEF25-75 measured before and after hyperbaric exposure. Conclusion: The results of this study indicated that among pulmonary function test parameters, decreases were found in FEV1, FVC, FEF25-75, PEF, but clinical significance has not been established.

Accuracy of emergency physicians' interpretation of computed tomography for urgent-emergent diagnoses in nontraumatic cases.

OBJECTIVE: The aim of this study is to evaluate the accuracy levels of the emergency physicians (EPs) managing the patient in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal computed tomography (CT) scans. METHODS: The EPs interpreted the CT scans of patients who visited the emergency department because of nontraumatic causes. Then, a radiology instructor made final assessments of these CT scans. Based on the interpretation of the radiology instructor, the false-positive rate, false-negative rate, sensitivity, specificity, positive predictive value, negative predictive value, and kappa coefficient (κ) of the EPs' interpretations of the CT scans were calculated. RESULTS: A total of 268 thoracics and 185 abdominal CT scans were assessed in our study. The overall sensitivity and specificity of the EPs' interpretation of the thoracic CT scans were 90% and 89%, respectively, whereas the abdominal CT interpretation was 88% and 86%, respectively. There was excellent concordance between the EPs and the radiology instructor with regard to the diagnoses of pneumothorax, pulmonary embolism, pleural effusion, parenchymal pathology, and masses (κ: 0.90, κ: 0.87, κ: 0.71, κ: 0.79, and κ: 0.91, respectively) and to the diagnoses of intraabdominal free fluid, intraabdominal free gas, aortic pathology, splenic pathology, gallbladder pathology, mesenteric artery embolism, appendicitis, gynecological pathology, and renal pathology (κ: 1, κ: 0.92, κ: 0.96, κ: 0.88, κ: 0.80, κ: 0.79, κ: 0.89, κ: 0.88, and κ: 0.82, respectively). CONCLUSION: The EPs are successful in the interpretation of the urgent-emergent pathological findings in thoracic and abdominal CT scans.

Prognostic Performance of Shock Index, Diastolic Shock Index, Age Shock Index, and Modified Shock Index in COVID-19 Pneumonia.

OBJECTIVE: We aimed to compare the prognostic accuracy of shock indexes in terms of mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. METHODS: Hospitalized patients whose COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) test results were positive, had thoracic computed tomography (CT) scan performed, and had typical thoracic CT findings for COVID-19 were included in the study. RESULTS: Eight hundred one patients were included in the study. Chronic obstructive pulmonary disease, congestive heart failure, chronic neurological diseases, chronic renal failure, and a history of malignancy were found to be chronic diseases that were significantly associated with mortality in patients with COVID-19 pneumonia. White blood cell, neutrophil, lymphocyte, C reactive protein, creatinine, sodium, aspartate aminotransferase, alanine aminotransferase, total bilirubin, high sensitive troponin, d-dimer, hemoglobin, and platelet had a statistically significant relationship with in-hospital mortality in patients with COVID-19 pneumonia. The area under the curve (AUC) values of shock index (SI), age shock index (aSI), diastolic shock index (dSI), and modified shock index (mSI) calculated to predict mortality were 0.772, 0.745, 0.737, 0.755, and Youden Index J (YJI) values were 0.523, 0.396, 0.436, 0.452, respectively. CONCLUSIONS: The results of this study show that SI, dSI, mSI, and aSI are effective in predicting in-hospital mortality.

The role of Ga68 PSMA PET/CT imaging in Lu177 PSMA treatment planning in metastatic castration-resistant prostate cancer.

OBJECTIVE: Lutetium-177 (Lu177) prostate-specific membrane antigen (Lu177 PSMA) is a novel targeted treatment for patients with metastatic castration-resistant prostate cancer (CRPC). The purpose of the study was to determine the molecular volumetric Gallium-68 (Ga68) PSMA PET/CT parameters that can predict patients who will respond to treatment. METHODS: These single-center retrospective data were obtained from metastatic CRPC patients receiving intravenous 6.0-8.5 GBq Lu177 PSMA treatment every 6-8 weeks for a maximum of 3-8 cycles, with baseline Ga68 PSMA PET/CT scan, clinical data, and information on treatment responses. All lesions were divided into two groups according to the increase and decrease in PSMA expression levels of 600 bone lesions and 85 lymph nodes that were compatible with metastasis of 23 patients after the treatment. The primary endpoint of our study was the evaluation of the relation between the baseline SUVmax, PSMA TV, TL PSMA values, and the treatment response of the two groups. The threshold values were determined for the parameters that had significant relations. In the present study, the prostate-specific antigen (PSA) response and treatment-induced toxicities were also evaluated as the secondary endpoint. RESULTS: It was found that SUVmax, PSMA TV, and TL PSMA values in bone metastases showed significant differences between the groups with decreased and increased PSMA expression levels after the treatment. The AUC value for SUVmax was significant (AUC = 0.677; p < 0.001). The cutoff value was > 10.50 (sensitivity = 91.8%, Specificity = 41.5%) for SUVmax, > 1.50 cm3 (sensitivity = 49.1%, specificity = 70%) for PSMA TV and > 8.50 g (sensitivity = %60.9, specificity = %72.2) for TL PSMA. The median SUVmax value before the treatment in all metastatic lymph nodes was found to be 7.1 (5.4-12.4), and the median SUVmax after the treatment was 2.5 (1.6-12.1) (p < 0.001). CONCLUSION: It was shown in the present study that Lu177 PSMA treatment response may be higher in CRPC patients with metastatic bone lesion with high baseline PSMA expression level, and better treatment response may be achieved in patients with lymph node metastases than in bone metastases.

Comparison of diagnostic accuracy of point-of-care ultrasonography and X-ray of bony injuries of the knee.

PURPOSE: We aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and X-ray (XR) in the diagnosis of knee bone fractures and fracture characteristics in cases of injuries to the knee. METHODS: The study was conducted in the emergency department (ED) of a tertiary hospital between March 2017 and March 2019. It included patients who presented to the ED with isolated knee injuries, were suspected to have a bony lesion based on clinical examinations, and were ultimately referred for XR. Five emergency physicians (EPs) who had at least three years of ED experience participated in the study. Before the study, these EPs received training on knee examination and radiographic investigation of the knee joint. They were also trained on how to assess the knee joint using POCUS. The knee bones, patella, femur, tibia, and fibula were evaluated. A POCUS examination of the knee bones was carried out according to the eight-step Kozaci Protocol. RESULTS: This study included 92 patients with knee trauma. The mean age of the patients was 34 ± 16 years (6-55 years). Using POCUS and XR, fractures were detected in 40 (43%) and 32 patients (35%), respectively. Relative to XR, for detecting fractures, POCUS showed sensitivity, specificity, positive predictive value, and negative predictive value of 97%, 85%, 78%, 98%, respectively, and the kappa value was 0.774. POCUS examination revealed hematoma and edema in the soft tissue in 34 (37%) patients and hemarthrosis in 33 patients (36%). CONCLUSION: XR is the first and most widely used imaging modality to identify fractures of the knee bone trauma. However, POCUS examination can successfully diagnose bony lesions of the knee in patients with stable vital signs and without life-threatening injuries. It can also easily diagnose hematoma and hemarthrosis. Therefore, POCUS can be used as a diagnostic tool in emergency situations where XR is not available.

Predators of the giant pine scale, Marchalina hellenica (Gennadius 1883; Hemiptera: Marchalinidae), out of its natural range in Turkey.

Marchalina hellenica is a sap sucking scale insect endemic to the Aegean basin and it has been introduced to several regions in Greece and Turkey to increase pine honey production. It is also considered as a pest since heavy infestation may leave the host trees vulnerable to secondary pests. An understanding of its natural predators would facilitate planning biocontrol programs. Although there are several studies reporting the predators of M. hellenica in its native range, there is no study identifying those in its introduced range. We aimed to determine predators of M. hellenica in Burdur, one of its introduced sites in Turkey. We carried out sampling through regular visits in an M. hellenica-infested locality nearby Burdur Lake. Through field and laboratory observations, we identified 19 species predating upon M. hellenica. Comparing predators reported in previous studies in its native range and those we found in the present study showed that 12 of the species that we found are new reports for the species predating upon M. hellenica. The highest number of predator individuals belonged to the monophagous Neoleucopis kartliana. Myrrha octodecimguttata, Chilocorus bipustulatus and Harmonia quadripunctata were also the most frequently observed predators.

The Role of Metabolic Volumetric Parameters in Predicting Malignancy in Incidental Thyroid Nodules Detected in 18F-FDG PET/CT Scans

Objectives: The metabolic activities of tumors can be calculated volumetrically during positron emission tomography/computed tomography (PET/CT) imaging using metabolic tumor volume (MTV) and total lesion glycolysis (TLG). This study aimed to evaluate the roles of MTV and TLG in predicting the malignancy risk of incidental thyroid nodules detected by PET/CT imaging. Methods: Active metabolic areas of each section were manually drawn by region of interest to calculate the MTV of nodules, and all obtained values were then summed. TLG, the product of mean standardized uptake value and MTV, was calculated by multiplying two values. All participants underwent thyroid ultrasonography imaging. All nodules were divided into risk classes according to the European Thyroid Image Reporting and Data System (EU-TIRADS) that was developed by the European Thyroid Association. The American Thyroid Association Guidelines were used to determine which thyroid nodules would undergo thyroid fine-needle biopsy (FNAB). Results were classified according to the Bethesda scoring system. Results: TLG levels were significantly higher in malignant or malignant-suspicious nodules than in benign nodules (p=0.013). Although MTV levels were high in malignant or malignant-suspicious nodules than in benign and non-diagnostic nodules, it was statistically insignificant at limit values (p=0.079). Areas under curve (AUC) were 0.726 (p=0.005) and AUC: 0.668 (p=0.039) for TLG and MTV, respectively. The 2.3 g cut-off value of TLG has a sensitivity of 85.7% and specificity of 59.0%. The 1.7 mL cut-off value of MTV has a sensitivity of 78.6% and specificity of 60.4%. Conclusion: We believe that TLG evaluation will be useful in predicting high-risk malignancy or malignancy suspicion based on EU-TIRADS risk classification of incidental thyroid nodules detected in PET/CT images. We believe that unnecessary thyroid FNABs can be avoided for thyroid incidental nodules if such relation and cut-off values are determined and that it will be useful in hastening the operation of the necessary patients.

Comparison of the diagnostic accuracy of X-ray and computed tomography in patients with wrist injury.

BACKGROUND: This study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis of fractures. METHODS: Patients; who admitted to ED with injuries due to wrist trauma and who underwent XR imaging and CT scans in the period from 1 January 2017 to 1 January 2018, were included in the study. CT scan image interpretation reports recorded in the hospital automation system were considered eligible to be included in the study. XR images were interpreted by an orthopedics and traumatology specialist. The sensitivity (Sn), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Kappa (κ) coefficient of XR were calculated according to CT. Inter-rater agreement was graded according to κ values. RESULTS: A total of 274 patients were included in the study. Fractures were identified in the XR images in 180 (66%) patients and in the CT images in 196 (72%) patients. Compared to CT, the Sn, Sp, PPV, NPV and κ coefficient of XR were 89%, 92%, 97%, 77% and 0.764 respectively. Compared to CT, the highest sensitivity of XR was measured to detecting radius (Sn: 95%, κ: 0.896) and 5th metacarpal fractures (Sn: 77%, κ: 0.859), the lowest sensitivity of XR was calculated in detecting scaphoid, capitate, pisiform, trapezium hamate, and triquetrum fractures (Sn: 59-14%, κ: 0.619-0.240). The sensitivity and κ coefficient of XR were calculated 54% and 0.530 in the adjacent bone fracture, 83% and 0.830 in joint dislocation, 75% and 0.661 in the fractures extending to the joint space. CONCLUSIONS: XR is the first-choice imaging modality in the evaluation of wrist injuries, but CT imaging should be preferred when fractures extending to the joint space, adjacent bone fracture and carpal bone fracture are being considered.

Ingested Foreign Body Imaging Using Point-of-Care Ultrasonography: A Case Series.

The ingestion of foreign bodies is a common problem in the pediatric population. Emergent treatment of ingested foreign bodies is dependent on the type of foreign body ingested, patient symptoms, timing of ingestion, and the location of the foreign body. Although X-ray and computed tomography are the imaging techniques used most often to assess for foreign bodies, ultrasonography, which lacks ionizing radiation, may also be useful. This case series describes 8 cases of gastrointestinal tract foreign bodies and the utility of point-of-care ultrasonography for their real-time evaluation.

Comparison of X-Ray Imaging and Computed Tomography Scan in the Evaluation of Knee Trauma.

Background and objectives: The aim of the study was to compare the accuracy of X-ray (XR) imaging according to computed tomography (CT) scanning in the diagnosis of knee bone fractures, and in the determination of fracture characteristics, and to identify CT scan indications in patients with knee trauma. Materials and methods: The patients who presented to the emergency department (ED) due to knee trauma between January 2017 and December 2018 and who underwent XR imaging and CT scans were included in the study. XR images were reinterpreted by an emergency physician. The official reports, which had been interpreted by a radiologist in the hospital automation system for CT images, were considered valid. Results: Five hundred and forty-eight patients were included in the study. Of the patients, 200 (36.5%) had fractures in XR imaging and 208 (38.0%) had fractures in CT scans. Compared to CT scanning, XR imaging was found to have 89% sensitivity, 95% specificity, 92% positive predictive value, and 92% negative predictive value in identifying the fracture. The sensitivity of XR imaging in identifying growth plate fracture, angulation, stepping off, and extension of the fracture into the joint space was determined as 78% and less. According to the kappa value, there was determined a perfect concordance between the XR imaging and CT scans in angulation, stepping off, and extension of the fracture into the joint space. This concordance was moderate in growth plate fractures. Conclusions: XR imaging has a low sensitivity in identifying knee fractures. There is a moderate concordance between XR imaging and CT scanning in identifying growth plate fractures. Therefore, CT scanning should be performed in patients whose fracture type and fracture characteristics are not able to be determined exactly with XR imaging in knee injury.

The Visualization of a Foreign Body in a Patient's Subglottic Region Using Point-of-Care Ultrasonography.

Point-of-care ultrasonography is a real-time dynamic examination that is useful for evaluating the location of foreign bodies in a patient's gastrointestinal tract and soft tissue. In particular, it is useful for identifying radiolucent foreign bodies that are difficult to visualize using routine x-ray examinations. This case study describes the visualization of a radiolucent foreign body in a patient's subglottic region using point-of-care ultrasonography.

The Measurement of Elderly Volunteers' Optic Nerve Sheath Diameters by Ocular Ultrasonography.

BACKGROUND AND OBJECTIVES: The optic nerve is a component of the central nervous system, and the optic nerve sheath is connected to the subarachnoid space. For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research. In this study, we aimed to determine the standard ONSD value in healthy adultsaged65 years of age or older who had not previously been diagnosed with a disease that could increase the ICP. MATERIALS AND METHODS: The right and left ONSD values and ONSD differences were compared, according to the gender of the patients. The patients were divided into 3 groups, according to their age. The age groups were assigned as follows: Group 1: 65-74 years of age; Group 2: 75-84 years of age; and Group 3: 85 years of age or older. The ONSDs and the ONSD difference between the left and right eyes of Group 1, Group 2 and Group 3 were compared. RESULTS: The study included 195 volunteers. The mean ONSD of both eyes was 4.16±0.69 mm, and the difference between the ONSD of the left and right eyes was 0.16±0.18 mm. There was no difference between genders in terms of right ONSD, left ONSD, mean ONSD and ONSD difference between the left and right eyes. There was no correlation between age and ONSD and ONSD difference. When the age groups and ONSD were compared, no difference was found between the groups. CONCLUSIONS: In conclusion, the ONSDs of both eyes do not vary with age in healthy adults aged65 years or older. ONSD does not vary between genders. The calculation of ONSD difference can be used to determine ICP increase.

Comparison of Point-of-Care Ultrasonography and Radiography in the Diagnosis of Long-Bone Fractures.

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855). Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.

Outcomes of intravesical chondroitin-sulfate and combined hyaluronic-acid/chondroitin-sulfate therapy on female sexual function in bladder pain syndrome.

INTRODUCTION AND HYPOTHESIS: Our aim was to determine the efficacy of intravesical chondroitin sulfate (CS) and combined hyaluronic acid/chondroitin sufate (HA/CS) treatment and their effects on sexual function of females with interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: A total of 68 female patients with IC/BPS between 2012 and 2018 were reviewed. Thirty-three patients were treated with combined HA/CS and 28 patients were treated with CS. Instillations were performed weekly for the first month, biweekly for the second month, and monthly in the third and fourth months. Before and after the sixth month of the treatment, all patients were evaluated with the Female Sexual Function Index (FSFI), visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), and voiding diary, and changes were recorded. RESULTS: A statistically significant improvement was determined for FSFI, VAS, ICSI, and ICPI scores after treatment in both groups. Among baseline characteristics, a weak but significant negative correlation was determined only between the ICSI score improvement and age (rho: -0.38; p = 0.03) on statistical analysis. Compared with CS, combined HA/CS treatment was superior in terms of ICSI, ICPI, and daytime and nighttime frequency improvement (0.042, 0.038, 0.039, and 0.045; respectively). All domains of the sexual function index were significantly improved at the sixth month of intravesical therapy in both groups. A statistical difference was not found between the two groups. CONCLUSIONS: Although it seems that intravesical HA/CS combination is superior to CS alone in terms of symptom reduction, both of them have beneficial effects on sexual function.

Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries.

OBJECTIVE: In this study, the accuracy of bedside thoracic ultrasonography (TUSG) performed by emergency physicians with patients in the supine position was compared with that of thoracic computed tomography (TCT) for the determination of thoracic injuries due to trauma. METHODS: Patients who suffered the multiple traumas, whose thoracic trauma was identified on physical examination or TCT imaging were included in the study. TUSG was performed following a physical examination by the emergency physician who managed the trauma patient. Subcutaneous emphysema, pneumothorax, pulmonary contusions (PCs), hemothorax, pericardial effusion and tamponade, sternal and clavicular fractures and rib fractures were identified by TUSG. TCT imaging was performed after the ultrasonography examination was completed. RESULTS: Eighty-one patients were included in the study. TCT scans showed subcutaneous emphysema in 16 (19.8%) patients, pneumothorax in 21 (25.9%), PCs in 27 (33.3%), hemothorax in 20 (24.7%), sternum and clavicular fractures in 6 (7.4%) and rib fractures in 21 (25.9%). The sensitivity and specificity of ultrasonography varied for detecting the following pathologies: subcutaneous emphysema (56% and 95%), pneumothorax (86% and 97%), hemothorax (45% and 98%), PCs (63% and 91%), sternal fractures (83% and 97%), clavicular fractures (83% and 100%) and rib fractures (67% and 98%), respectively. CONCLUSION: In conclusion, ultrasound was found to be highly specific but only moderately sensitive for the identification of thoracic injuries.

Evaluation of ABO blood groups and blood-based biomarkers as a predictor of growth kinetics of renal angiomyolipoma.

PURPOSE: The aim of our study was to investigate the impact of the ABO blood groups and blood-based biomarkers on the growth kinetics of renal angiomyolipoma (AML). METHODS: A total of 124 patients with AML who were followed-up between 2010 and 2018 were retrospectively reviewed. The patients' characteristics were recorded, including age, body mass index (BMI), blood pressure, smoking history, and ABO blood group. Baseline laboratory test results, including serum creatinine, AST, ALT, platelet, neutrophil and lymphocyte count, were used to calculate the estimated glomerular filtration rate (eGFR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and De Ritis ratio. The Cox regression analysis was used to evaluate the relationship between variables and tumor growth. RESULTS: The study population comprised 71 women and 44 men with a median age of 47.3 (28-65) years. Among patients classified according to the blood groups, no significant differences were observed regarding age, BMI, smoking history, co-morbidities, NLR, PLR, De Ritis ratio, eGFR, or tumor size and localisation. The mean growth rate from baseline to the last scan was 0.36 ± 0.27 cm, 0.21 ± 0.21 cm, 0.14 ± 0.11 cm, and 0.19 ± 0.17 cm for blood type O, A, B, and AB, respectively. In multivariate analysis, eGFR < 60 (p = 0.044), central tumor localisation (p = 0.030), presence of blood group-0 (p = 0.038), and De Ritis ratio ≥ 1.24 (p = 0.047) were statistically associated with tumor growth. CONCLUSION: Our study demonstrates that both the ABO blood groups and the De Ritis ratio might represent independent predictors of tumor growth rate in patients with renal AML.

The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures.

OBJECTIVE: We aimed to compare the efficacy of Point-of-care ultrasonography (POCUS) with radiography in the diagnosis of tibia fracture (TF) and fibula fracture (FF), and determation of fracture characteristics. METHODS: Patients aged 5-55 years who were admitted to ED due to low-energy, simple extremity trauma, who had a suspected TF and FF on physical examination were included in this prospective study. One physician performed POCUS examination. Other physician evaluated the radiography images. The obtained results were compared. RESULTS: A total of 62 patients were included in the study. TF was detected in 21 patients by radiography and in 24 patients by POCUS. FF was detected in 24 patients by radiography and in 25 patients by POCUS. Ten of the patients had both TF and FF. Compared with radiography, sensitivity, specificity, PPV and NPV of POCUS in the detection of TF were 100%, 93%, 88% and 100% (95% CI, 91-100%), respectively. Compared with direct X-ray imaging, sensitivity, specificity, PPV and NPV of POCUS in the detection of FF were 100%, 97%, 96% and 100% (95% CI, 96-100%), respectively. We determined that POCUS is also successful in detection of fracture features such as angulation, step-off, extension into the joint space that can determine the treatment decision. CONCLUSION: This study demonstrated that POCUS was found to be as successful as direct X-ray imaging in the diagnosis of TF and FF.