Associating IDH and TERT Mutations in Glioma with Diffusion Anisotropy in Normal-Appearing White Matter.

BACKGROUND AND PURPOSE: IDH and TERT mutations might infiltratively manifest within normal-appearing white matter with specific phenotypes such as microstructural changes undetectable by standard MR imaging contrasts but potentially associable with DTI variables. The aim of this retrospective glioma study was to statistically investigate IDH and TERT associations and classifications with DTI reported microstructure in normal-appearing white matter. MATERIALS AND METHODS: Retrospective data from patients imaged between March 2012 and February 2016 were analyzed by grouping them as IDH-TERT subgroups and by IDH and TERT mutation status. DTI variables in the IDH-TERT subgroups were first identified by the Kruskal-Wallis test, followed by Dunn-Sidák multiple comparisons with Bonferroni correction. IDH and TERT mutations were compared with the Mann-Whitney U test. Classification by thresholding was tested using receiver operating characteristic analysis. RESULTS: Of 170 patients, 70 patients (mean age, 43.73 [SD, 15.32] years; 40 men) were included. Whole-brain normal-appearing white matter fractional anisotropy (FA) and relative anisotropy (RA) (P = .002) were significantly higher and the contralateral-ipsilateral hemispheric differences, ΔFA and ΔRA, (P < .001) were significantly lower in IDHonly patients compared with TERTonly, with a higher whole-brain normal-appearing white matter FA and RA (P = .01) and ΔFA and ΔRA (P = .002) compared to double positive patients. Whole-brain normal-appearing white matter ADC (P = .02), RD (P = .001), λ2 (P = .001), and λ3 (P = .001) were higher in IDH wild-type. Whole-brain normal-appearing white matter λ1 (AD) (P = .003), FA (P < .001), and RA (P = .003) were higher, but Δλ1 (P = .002), ΔFA, and ΔRA (P < .001) were lower in IDH mutant versus IDH wild-type. ΔFA (P = .01) and ΔRA (P = .02) were significantly higher in TERT mutant versus TERT wild-type. CONCLUSIONS: Axial and nonaxial diffusivities, anisotropy indices in the normal-appearing white matter and their interhemispheric differences demonstrated microstructural differences between IDH and TERT mutations, with the potential for classification methods.

Effectiveness of air purifiers in intensive care units: an intervention study.

BACKGROUND: Effective design and operation of intensive care unit (ICU) ventilation systems is important to prevent hospital-acquired infections. Air purifiers may contribute. AIMS: To detect the number and types of micro-organisms present in the air and on high-touch surfaces in ICUs, and to evaluate the effectiveness of air purifiers in reducing the microbial load and thus the rate of nosocomial infections in ICUs. METHOD: This intervention study was conducted in two similar ICUs between May to November 2020. Novaerus air purifiers were located in the intervention ICU for 2 months. Routine cleaning procedures and high-efficiency particulate air filtration continued in the control ICU as well as in the intervention ICU. After 2 months, the air purifiers were moved to the other ICU for the next 2 months to reduce any possible bias in the results. Air and surface samples were evaluated. FINDINGS: Evaluation of changes in the intervention ICU over time revealed a significantly lower colony concentration in the air and on surfaces on Day 60 compared with Day 1 (Pair<0.001 and Psurface<0.001). There was a significant positive correlation between the number of colonies detected and the rate of hospital-acquired infections in the intervention ICU (r=0.406, P=0.049) and in the control ICU (r=0.698, P=0.001). CONCLUSION: Using air purifiers in addition to heating, ventilation and air conditioning systems in hospitals may be an effective way to reduce the microbial load in the air and on surfaces, and thus hospital-acquired infections.

COULD COVID-19 TRIGGER TYPE 1 DIABETES? PRESENTATION OF COVID-19 CASE PRESENTED WITH DIABETIC KETOACIDOSIS.

COVID-19 is a viral disease that is recognized now as a pandemic by the World Health Organization. It is known that some viral infections may trigger autoimmune diseases. It has been revealed that COVID-19 may also lead to the pathogenesis of some autoimmune diseases, including Type 1 DM (T1DM) and autoimmune thyroid diseases. Here, we aimed to present a young female patient with COVID-19, who we followed up in our clinic, who presented with diabetic ketoacidosis (DKA), and developed Hashimoto's disease during the treatment process. In order to emphasize that COVID-19 may trigger the emergence of T1DM, that it may mask nonspecific DKA symptoms like nausea and vomiting, that it may cause delay in diagnosis of DKA, and also to emphasize the importance of evaluating other autoimmune diseases accompanying COVID-19, we found it appropriate to present this case.

Bilateral retinal vasculitis in a patient with lichen planus / Vasculite retiniana bilateral em um paciente com líquen plano

ABSTRACT Lichen planus (LP) is an autoimmune, inflammatory disease of unknown etiology that commonly affects the skin and mucous membranes. Retinal vasculitis is a group of vision-threatening disorders, in which autoimmunity is thought to play a role in pathogenesis. We present the case of a patient who was diagnosed with retinal vasculitis and who was followed up for mucosal LP. LP has not been reported as a cause of retinal vasculitis in the literature. We believe that the retinal vasculitis in this case was related to LP because cellular immunity plays a role in the pathogenesis of both entities.

RESUMO Líquen plano (LP) é uma doença auto-imune, inflamatória de etiologia desconhecida que normalmente afeta a pele e membranas mucosas. Vasculite retiniana engloba um grupo de doenças que ameaçam a visão em que a autoimunidade parece desempenhar um papel na sua patogênese. Apresentamos um caso que foi diagnosticado com vasculite da retina e que tinha sido acompanhado com LP de mucosa. LP não consta entre as causas de vasculite retiniana na literatura. Acreditamos que a vasculite da retina no nosso caso, foi relacionado com o LP considerando que a imunidade celular desempenha um papel na patogênese de ambas as entidades.

Ozone partially prevents diabetic neuropathy in rats.

Neuropathy is one of the most common complications of diabetes mellitus. Although the beneficial effects of good blood glucose control on diabetic neuropathy are known, this control cannot completely prevent the occurrence and progression of diabetic neuropathy. The aim of this study was to investigate whether ozone prevents diabetic neuropathy. 36 adult female Sprague-Dawley rats were randomly divided into 6 groups (n=6): control (C), ozone (O), diabetic (D), ozone-treated diabetic (DO), insulin-treated diabetic (DI), and ozone- and insulin-treated diabetic (DOI). Diabetes was induced by a single injection of streptozotocin (60 mg/kg, intraperitoneal [i.p.]), after which insulin was administered (3 IU, i.p.) to the DI and DOI groups for 28 days, and 1.1 mg/kg (50 µg/ml) ozone was given to the O, DO, and DOI groups for 15 days. 4 weeks after the induction of diabetes, the nerve conduction velocity (NCV), amplitude of the compound action potential (CAP), total oxidant status (TOS), and total antioxidant status (TAS) were measured, and the oxidative stress index (OSI) was calculated. The NCV, amplitude of CAP, and TAS of the DI and DOI groups were higher than those of the D group; the amplitudes of CAP and TAS of the DO group were higher than those of the D group; and the TOS and OSI of the DO, DI, and DOI groups were lower than those of the D group. These findings indicate that ozone partially prevents diabetic neuropathy in rats. It appears that the preventive effects of ozone are mediated through oxidant/antioxidant mechanisms.

Evaluation of whether the ACE gene I/D polymorphism constitutes a risk factor for chronic obstructive pulmonary disease in the Turkish population.

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow obstruction that occurs as a result of the normal inflammatory process to protect against harmful irritants and chemicals. Another physiological regulatory process, the renin angiotensin system (RAS), plays an important role in the pathology of many diseases. Angiotensin converting enzyme (ACE) is a key enzyme of RAS. We investigated the frequency of the ACE gene I/D polymorphism in patients with COPD in Turkey. This study was performed on 47 unrelated patients with COPD and 64 healthy subjects. DNA samples were isolated from peripheral blood, and ACE DNA was amplified by polymerase chain reaction. The frequencies of ACE genotypes were 27.7, 55.3, and 17% for DD, ID, and II in the COPD group, respectively, and 43.8, 43.8, and 12.4% in the control group. There was no statistically significant difference between groups (X(2) = 3.078; df = 2; P = 0.220). The distributions of ACE gene D alleles were 38.2% (N = 52) in the COPD group and 61.8% (N = 84) in the control group; and those of I alleles were 48.8% (N = 42) in the COPD group and 51.2% (N = 44) in the control group. There was no statistically significant difference between groups for allele frequency (X(2) = 2.419; df = 2; P = 0.120). We believe these results can be useful for large-scale population genetic research considering the frequency of the ACE gene variation in COPD patients in the Turkish population.

Effects of human amniotic fluid on costal cartilage regeneration (an experimental study).

OBJECTIVE: After surgical correction of thoracic wall deformities, promoting neochondrogenesis in the perichondrial bed is very important for obtaining a flexible chest wall. In this experimental study, we aimed to investigate the effects of human amniotic fluid on cartilage regeneration in the costal perichondrial bed in a rabbit model. METHODS: Fifty-four adult New Zealand rabbits were divided into three groups, with 18 rabbits in each group. The third and fifth costal cartilages were excised totally on the right side and partially excised on the left side in all groups. Group 1 served as controls. All rabbits in group 1 underwent closure of the perichondrium of the third costal cartilage and closure of the perichondrium of the fifth costal cartilage with reimplantation of reshaped cartilage into the fifth costal perichondrial bed. Rabbits in group 2 underwent closure of the perichondrium of the third and fifth costal cartilages after the administration of human amniotic fluid into the perichondrial bed. Group 3 rabbits received both human amniotic fluid and underwent cartilage reimplantation. The third and fifth costal perichondriums in group 3 rabbits were closed after the administration of human amniotic fluid and the reimplantation of reshaped cartilages. Rabbits were sacrificed at two, eight and 12 weeks after operation. RESULTS: Numerical scores for the right perichondrial bed were significantly higher for group 2 compared to group 1 ( P < 0.05). But the difference was not significant for the left perichondrial bed ( P > 0.05). The diameter of chondrogenesis also did not differ significantly between left and right perichondrial bed for all groups. CONCLUSION: Our study shows that administration of human amniotic fluid into the perichondrial bed increases chondrogenesis in adult rabbits, an important finding which may contribute to improving chest wall flexibility after the surgical correction of pectus excavatum.

Surgical management of bronchiectasis: a collective review of 339 patients with long-term follow-up.

OBJECTIVE: The incidence of bronchiectasis has decreased significantly in developed countries due to successful control of childhood infections. However, the surgical treatment of this disease still plays an important role in thoracic surgical practice in underdeveloped and developing countries. The aim of this retrospective study was to present our surgical experience in patients with bronchiectasis, including our surgical treatment strategies and the results of long-term follow-up. METHODS: A retrospective chart review was conducted of 339 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2009. The patients' demographic features, the symptoms, etiologies and resection types, morbidity, mortality and outcomes after surgical management were analyzed. RESULTS: There were 301 (88.8 %) male and 38 (11.2 %) female patients; the average patient age was 22.4 years (range 15-50 years). The most common presenting symptoms were productive cough in 197 (58.1 %) patients. There were 21 (6.2 %) asymptomatic patients. Two hundred and thirty of the 339 patients (67.8 %) had had previous medical therapy before admission to our department. The most common etiology of bronchiectasis was childhood infections in 101 (29.8 %) patients. In most patients, bronchiectasis was found on the left side (n = 225, 66.4 %). Thirty-five patients underwent a second operation for bilateral disease. There were two (0.6 %) early postoperative mortalities including one myocardial infarction and one respiratory insufficiency. Complications occurred in 43 patients (12.7 %). The median follow-up was 13.6 months. Symptoms disappeared in 201 patients (71 %), and 66 patients (23.3 %) experienced an improvement, while 16 patients (5.7 %) continued to be symptomatic. CONCLUSION: Although improvements in medical treatment have resulted in a significant decrease in the number of patients with bronchiectasis, surgical management is still very important in developing countries. Surgical resection can be performed with acceptable morbidity and mortality rates. The aim should be the resection of all involved bronchiectatic sites, even in patients with bilateral disease, if the pulmonary reserve is adequate.

A 6.2-cm tracheal segment resection for tracheal post-intubation stenosis.

Post-intubation tracheal stenosis is a clinical problem caused by regional ischemic necrosis of the airway. The outcome of a long tracheal segment resection (6.2 cm) in a patient with post-intubation stenosis is presented.

Fracture resistance of thin-walled roots restored with different post systems.

AIM: To compare the fracture resistance of thin-walled roots after restoration with different types of post systems. METHODOLOGY: One hundred and sixty-five decoronated maxillary central incisors were root filled and randomly assigned to three groups with respect to the remaining dentine thickness of root (1.0 mm, 1.5 mm, 2.0 mm). Each group was randomly divided into five equal subgroups. The subgroups were restored with one of the following post systems: polyethylene woven fibre (R), composite resin cured by light-transmitting post + glass fibre post (L), electrical glass fibre post (E), composite corono-radicular restoration (C) and cast metal post (M). Standard cores were constructed using composite resin in the first four groups. The samples were subjected to a gradually increasing force (1 mm min(-1)). The force required to fracture was recorded. The data was analysed with anova and Tukey test (P = 0.05). RESULTS: The cast metal post group had the highest fracture strength (P < 0.001). There was no significant difference in fracture resistance between the other four groups. Fracture resistance was affected largely by the remaining dentine thickness in fibre post groups; however, the difference was not significant. On the contrary in the cast metal post group load failure was inversely influenced by axio-proximal dimension of dentine walls. CONCLUSION: The cast post group had a higher fracture strength than resin groups. The force required to fracture the roots was similar for all fibre post systems and for all dentine thicknesses.

Primary pulmonary paraganglioma with Hodgkin's lymphoma.

Extra-adrenal paragangliomas are uncommon tumors arising from neuroectodermal-derived paraganglionic tissue. There are very few case reports on primary pulmonary paraganglioma in the literature. We present the case of a 21-year-old man who was treated with chemotherapy for Hodgkin's lymphoma. Only a partial response was noted so he underwent additional chemotherapy and involved field radiotherapy. PET-CT showed pathological activity in the lung parenchyma. Subsequent bronchoscopic biopsy showed paraganglioma and the patient underwent a left lower lobectomy.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Spinal reflexes in normal and sulfite oxidase deficient rats: effect of sulfite exposure.

Sulfites, which are commonly used as food preservatives, are continuously formed in the body during metabolism of sulfur-containing amino acids. Sulfite is oxidized to sulfate ion by sulfite oxidase (SOX, EC. 1.8.3.1). Although sulfite treatment has been reported to increase the excitability of some neurons in vitro, the possible effects of sulfite on neuronal excitability in vivo remain unclear. The aim of this study was to investigate the possible effects of sulfite treatment on spinal reflexes in anesthetized SOX competent and deficient rats. For this purpose, male albino rats used in this study were divided into four groups such as control group (C), sulfite group (CS), SOX deficient group (D), and SOX deficient + sulfite group (DS). Rats in SOX deficient groups were made deficient in SOX by the administration of low molybdenum (Mo) diet (AIN 76, Research Dyets Inc., USA) with concurrent addition of 200-ppm tungsten (W) to their drinking water in the form of sodium tungstate (NaWO4). Sulfite in the form of sodium metabisulfite (Na2O5S2, 70 mg/kg) was given orally by adding to drinking water to the S and DS groups. Monosynaptic reflex potentials were recorded from the ipsilateral L5 ventral root. SOX deficient rats had an approximately 15-fold decrease in hepatic SOX activity compared with normal rats. This makes SOX activity of SOXD rats in the range of human SOX activity. The results of this study show that sulfite treatment significantly increases the amplitude of the monosynaptic reflex response in both S and DS groups with respect to their respective control groups (C and D). SOX deficient rats also had enhanced spinal reflexes when compared with control rats. In conclusion, sulfite has increasing effects on the excitability of spinal reflexes and we speculate that this compound may exhibit its effects on nervous system by affecting sodium channels.

Diagnosis and surgical treatment of pulmonary sequestration.

BACKGROUND: Pulmonary sequestration is the term used to describe a rare embryonic mass of lung tissue which has no bronchial communication with the normal tracheobronchial tree. METHODS: In this study, we reviewed the medical records of 14 patients who underwent surgical resection for pulmonary sequestration between January 1992 and December 2006. RESULTS: Nine patients were symptomatic with recurrent respiratory tract infections and five patients were asymptomatic with a suspected lesion revealed incidentally during imaging investigations for other indications. Pulmonary sequestration was diagnosed with preoperative diagnostic procedures in eight patients and the other six cases were diagnosed after histopathological examination of the resected specimen. All patients were treated surgically. No postoperative complications were observed. CONCLUSIONS: We conclude that the optimal treatment of pulmonary sequestration is surgical resection to avoid infection and destruction of the normal pulmonary parenchyma, even in asymptomatic cases. Moreover, in the case of pulmonary infection and the destruction of normal tissue, major resection such as lobectomy or pneumonectomy may be considered, instead of limited resection.

Surgical repair of congenital sternal cleft in an adult to prevent traumatic pericardial rupture.

INTRODUCTION: Isolated congenital sternal cleft in an adult is a very rare anomaly and few cases have been reported so far. Here we report on a successful repair of a sternal cleft associated with an anterior pericardial defect in an adult. MATERIAL AND METHOD: A 20-year-old man presented with a bony defect in the inferior part of his sternum. Physical examination revealed an ovoid gap with a diameter of 5 cm in the distal part of the sternum. Pulsations of the heart could be easily seen through the defect. There were no associated anomalies. The patient underwent surgery for repair of the sternal cleft. RESULTS: A computed tomography scan of the chest confirmed the physical findings of an inferior sternal cleft involving approximately 50 % of the sternum. The result of echocardiography was normal. The postoperative period was uneventful. Direct complete closure without compromising cardiac function was achieved in this patient. At one-year follow-up, his sternal appearance was normal. DISCUSSION: According to the literature, the use of autogenous tissue is better than prosthetic material for reconstruction, with respect to both the risk of infection and the inability of prosthetic material to grow with the patient.

Inhibition of spinal reflexes by acetylsalicylate and metamizol (dipyrone) in rats.

The effects of acetylsalicylate and metamizol on spinal monosynaptic reflexes were tested in spinal rats. Adult rats were anesthetized with ketamine, artificially ventilated, and spinalized at the C1 level. A laminectomy was performed in the lumbosacral region. Following electrical stimulation of the sciatic nerve by single pulses, the reflex potentials were recorded from the ipsilateral L5 ventral root. Acetylsalicylate was administered orally via nasogastric tube and metamizol intramuscularly. Acetylsalicylate (50 and 100 mg/kg) and metamizol (15 mg/kg) significantly decreased the amplitude of the reflex response (p < 0.05). But the 10-mg/kg metamizol dose did not significantly decrease the amplitude of the reflex response. The cyclooxygenase products of arachidonic acid may play an important role in regulating the reflex potential.

Comparative biosorption of mercuric ions from aquatic systems by immobilized live and heat-inactivated Trametes versicolor and Pleurotus sajur-caju.

Trametes versicolor and Pleurotus sajur-caju mycelia immobilized in Ca-alginate beads were used for the removal of mercuric ions from aqueous solutions. The sorption of Hg(II) ions by alginate beads and both immobilized live and heat-killed fungal mycelia of T. versicolor and P. sajur-caju was studied in the concentration range of 0.150-3.00 mmol dm(-3). The biosorption of Hg(II) increased as the initial concentration of Hg(II) ions increased in the medium. Maximum biosorption capacities for plain alginate beads were 0.144+/-0.005 mmol Hg(II)/g; for immobilized live and heat-killed fungal mycelia of T. versicolor were 0.171+/-0.007 mmol Hg(II)/g and 0.383+/-0.012 mmol Hg(II)/g respectively; whereas for live and heat-killed P. sajur-caju, the values were 0.450+/-0.014 mmol Hg(II)/g and 0.660+/-0.019 mmol Hg(II)/g respectively. Biosorption equilibrium was established in about 1 h and the equilibrium adsorption was well described by Langmuir and Freundlich adsorption isotherms. Between 15 and 45 degrees C the biosorption capacity was not affected and maximum adsorption was observed between pH 4.0 and 6.0. The alginate-fungus beads could be regenerated using 10 mmol dm(-3) HCl solution, with up to 97% recovery. The biosorbents were reused in five biosorption-desorption cycles without a significant loss in biosorption capacity. Heat-killed T. versicolor and P. sajur-caju removed 73% and 81% of the Hg(II) ions, respectively, from synthetic wastewater samples.

Effects of acute exercise on the levels of iron, magnesium, and uric acid in liver and spleen tissues.

In this study, we investigated the effects of acute exercise on tissue levels of iron, magnesium, and uric acid of rats. Twenty adult Wistar albino rats were used for the study. They were divided into two groups: controls (n=10) and the study group (n=10). The study group was left into a small water pool and allowed to do swimming exercise for 30 min while controls rested. All of the animals were sacrificed, and their livers and spleens removed and homogenized immediately. The iron, magnesium, and uric acid levels of the homogenates were measured by an autoanalyzer (ILAB 900, Italy) with commercial kits from the same company. Results were evaluated by the Mann-Whitney U-test. According to our results, the liver iron levels increased significantly with exercise, whereas spleen iron levels decreased significantly (p<0.05) compared to controls. We found no significant differences in the levels of the other two parameters with exercise. These results show that the iron distribution in organs changes with exercise.