Chronology of PAH and PCB pollution using sediment core in the Golden Horn estuary (Sea of Marmara).

The sources and depositional history of 16 polycyclic aromatic hydrocarbons (PAHs) and 18 polychlorinated biphenyl (PCBs) congeners in the Golden Horn estuary (Istanbul) were investigated using a dated sediment core for the period between 1880 and 2012. The concentrations of PAHs and PCBs were calculated for every 4 cm slices of the sediment core and ranged from 1203.5 to 3441.4 ng/g and 5.4 to 41.4 ng/g, respectively. The diagnostic ratios indicated that the maximum PAH values correspondence to combustion after a crude oil-carrying Romanian tanker (Independenta) accident in the Istanbul Strait in 1979. The historical deposition of PAHs and PCBs in the Golden Horn was influenced by municipal effluent and heavy industrial dischargers approximately 50 years. When the Silahtaraga thermal power plant (TPP) was operating, PCB pollution rose; however, after a thorough rehabilitation effort and the outlawing of PCB use in the 1990s, pollution levels significantly tended to decrease.

Osteoarthritic changes in the knees of recently retired male professional footballers: a pilot study.

Background: Knee osteoarthritis (OA) is common amongst retired male professional footballers. There is limited understanding with respect to the interplay between imaging findings, clinical presentation and patient-reported outcome measures (PROMs) in retired professional footballers with knee OA. Objectives: This pilot study aimed to evaluate the extent of radiological and clinical knee OA in a cohort of retired male professional footballers, and to explore the relationship between these findings and knee-related PROMs. Methods: Fifteen retired male professional footballers underwent knee radiographs and were surveyed on their history of clinical OA, severe knee injury and previous knee surgery. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess health outcomes, such as level of function and pain. Results: Radiological knee OA was diagnosed in six out of 15 participants. Seven of the participants had a clinical diagnosis of knee OA. Evidence of clinical and radiological OA was present amongst four participants. Radiological knee OA and clinical OA was significantly associated with a history of severe knee injury and previous knee surgery. Low correlations (ρ<-0.40) were found between knee OA severity and knee-related PROMs. Moderate correlation (ρ=-0.65) was found between clinical knee OA and KOOS-SP. Conclusion: Clinical knee OA correlates with PROMs amongst retired professional footballers but radiological OA does not. Further studies are required to understand the relationship between imaging findings, clinical presentation and PROMs amongst retired professional footballers with knee OA.

Anxiety disorders comorbidity in pediatric bipolar disorder: a meta-analysis and meta-regression study.

OBJECTIVE: Anxiety disorders (AD) are known for its comorbidity and negative impact on the course of adult bipolar disorder (BD). However, there is limited research on AD comorbidity in pediatric BD (PBD). Here, we aimed to conduct a meta-analysis and meta-regression study about the comorbidity and covariates of AD and PBD. METHOD: We systematically searched relevant articles published until May 2019, as defined in PRISMA guidelines. Variables for associated features and prevalence of AD were extracted. RESULTS: Thirty-seven articles represented data for the analysis. Lifetime any AD comorbidity was 44.7%; panic disorder (PD) was 12.7%; generalized anxiety disorder (GAD) was 27.4%; social phobia was 20.1%; separation anxiety disorder (SAD) was 26.1%; and obsessive-compulsive disorder (OCD) was 16.7%. Childhood-onset studies reported higher GAD and SAD comorbidity, while adolescent-onset studies reported higher PD, OCD, and social phobia. Age of onset, gender, comorbidity of ADHD, substance use, oppositional defiant disorder and conduct disorder affected each anxiety disorders' comorbidity with PBD differently. CONCLUSION: Anxiety disorders are highly comorbid with PBD. Early-onset PBD increases the risk of AD. Biopsychosocial aspects of this comorbidity and its course needs to be evaluated further.

What opportunities do European early career psychiatrists have?

In the past century, biological, psychological and social sciences have brought significant progresses to psychiatry, building it is a broad medical specialty, closely linked to somatic medicine, psychology and society. Many psychiatrists early in their career have understood that it is easier to face these challenges in a collaborative way, and therefore there has been in the last decades a growth of local and national associations of psychiatric trainees and early career psychiatrists across Europe. In 2007, the European Psychiatric Association (EPA) has integrated in its program the "Young Psychiatrists Committee", an informal network of young psychiatrists. This Committee since 2010 has been known as the Early Career Psychiatrists Committee (ECPC). EPA has been making remarkable efforts towards supporting early career psychiatrists' education and participation in scientific congresses, promoting their professional growth and integration into the international professional community. Likewise, early career psychiatrists contribute to EPA with their motivation, enthusiasm and creative ideas, proving this initiative as an effective win-win cooperation.

Prognosis of hospitalized patients with community-acquired pneumonia.

INTRODUCTION: The long-term prognosis of patients with community-acquired pneumonia (CAP) has attracted increasing interest in recent years. The objective of the present study is to investigate the short and long-term outcomes in hospitalized patients with CAP and to identify the predictive factors associated with mortality. PATIENTS AND METHODS: The study was designed as a retrospective, multicenter, observational study. Hospitalized patients with CAP, as recorded in the pneumonia database of the Turkish Thoracic Society between 2011 and 2013, were included. Short-term mortality was defined as 30-day mortality and long-term mortality was assessed from those who survived 30 days. Predictive factors for short- and long-term mortality were analyzed. RESULTS: The study included 785 patients, 68% of whom were male and the mean age was 67±16 (18-92). The median duration of follow-up was 61.2±11.8 (37-90) months. Thirty-day mortality was 9.2% and the median survival of patients surviving 30 days was 62.8±4.4 months. Multivariate analysis revealed that advanced age, the absence of fever, a higher Charlson comorbidity score, higher blood urea nitrogen (BUN)/albumin ratios and lower alanine aminotransferase (ALT) levels were all predictors of long-term mortality. CONCLUSION: Long-term mortality following hospitalization for CAP is high. Charlson score and lack of fever are potential indicators for decreased long-term survival. As novel parameters, baseline BUN/albumin ratios and ALT levels are significantly associated with late mortality. Further interventions and closer monitoring are necessary for such subgroups of patients.

Severe musculoskeletal time-loss injuries and symptoms of common mental disorders in professional soccer: a longitudinal analysis of 12-month follow-up data.

PURPOSE: Psychological factors have shown to be predictors of injury in professional football. However, it seems that this is a two-way relationship, as severe musculoskeletal time-loss injuries have shown to be associated with the onset of symptoms of common mental disorders (CMD). There is no longitudinal study performed exploring this interaction between symptoms of CMD and injuries. The purpose of this study was to explore the interaction between severe musculoskeletal time-loss injuries and symptoms of CMD in professional football players over a 12-month period. METHODS: Players were recruited by their national players' unions in five European countries. Symptoms of CMD included in the study were related to distress, anxiety/depression, sleep disturbance and adverse alcohol use. RESULTS: A total of 384 professional football players were enrolled in the study, of whom 262 (68%) completed the 12-month follow-up period. The mean age of the participants at baseline was 27 ± 5 years, and they had played professional football for 8 ± 5 years on average. Symptoms of CMD at baseline were not associated with the onset of severe musculoskeletal time-loss injuries during the follow-up period with relative risks (and 95% CI) ranging from 0.6 (0.3-1.0) to 1.0 (0.5-2.2). In contrast, severe musculoskeletal time-loss injuries reported at baseline were associated with the onset of symptoms of CMD during the follow-up period with relative risks ranging from 1.8 (0.8-3.7) to 6.9 (4.0-11.9). CONCLUSION: No relationship was found between symptoms of CMD and the onset of severe musculoskeletal time-loss injuries. However, professional football players who suffered from severe musculoskeletal time-loss injuries are likely to develop subsequent symptoms of CMD. This study emphasizes the need for an interdisciplinary medical approach, which not only focuses on the physical but also on the mental health of professional football players. An early identification of players at risk of symptoms of CMD, such as those suffering from severe musculoskeletal injuries, creates the opportunity for an interdisciplinary clinical medical team to treat the players timely and adequately. LEVEL OF EVIDENCE: Prospective cohort study, Level II.

To which countries do European psychiatric trainees want to move to and why?

BACKGROUND: There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country. METHODS: Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration. RESULTS: A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have 'ever' considered to move to a different country in their future, 53.5% were considering it 'now', at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%). CONCLUSIONS: A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.

Incidence, aetiology and prevention of musculoskeletal injuries in volleyball: A systematic review of the literature.

Currently, there is no overview of the incidence and (volleyball-specific) risk factors of musculoskeletal injuries among volleyball players, nor any insight into the effect of preventive measures on the incidence of injuries in volleyball. This study aimed to review systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures of volleyball injuries. To this end, a highly sensitive search strategy was built based on two groups of keywords (and their synonyms). Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports and sports medicine literature) via EBSCOhost. The results showed that ankle, knee and shoulder injuries are the most common injuries sustained while playing volleyball. Results are presented separately for acute and overuse injuries, as well as for contact and non-contact injuries. Measures to prevent musculoskeletal injuries, anterior knee injuries and ankle injuries were identified in the scientific literature. These preventive measures were found to have a significant effect on decreasing the occurrence of volleyball injuries (for instance on ankle injuries with a reduction from 0.9 to 0.5 injuries per 1000 player hours). Our systematic review showed that musculoskeletal injuries are common among volleyball players, while effective preventive measures remain scarce. Further epidemiological studies should focus on other specific injuries besides knee and ankle injuries, and should also report their prevalence and not only the incidence. Additionally, high-quality studies on the aetiology and prevention of shoulder injuries are lacking and should be a focus of future studies.

Serum paraoxonase and arylesterase values as antioxidants in healthy premature infants at fasting and posprandial times.

OBJECTIVE: Newborn infants, particularly preterm infants, are at greater risk of oxidative stress because of an imbalance between high oxidant loads and immature antioxidant defenses. In several studies, the activities of serum paraoxonase (PON) and arylesterase (ARE) have been found to decline in patients under increased oxidative stress. We investigated the relationships between PON-1 and ARE with fasting and postprandial in premature newborns in this study. PATIENTS AND METHODS: Serum paraoxonase-1 and arylesterase levels were investigated in premature infants less than 37 weeks, after birth while they were fasting and postprandial. RESULTS: The paraoxonase-1 and arylesterase values of infants in fasting were significantly lower than the values in postprandial (for paraoxonase-1, p = 0.034, 0.002, and 0.002, respectively; for arylesterase, p < 0.001, 0.002, and p < 0.001, respectively). CONCLUSIONS: In premature infants, paraoxonase-1 and arylesterase values are increased in postprandial and reduced in fasting, showing that these neonates are subjected to oxidative stress. Thus, starting feeding as soon as possible in premature newborns is vital to protect them from oxidative damage.

Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra- and extrathoracic airways in patients with or without chronic obstructive pulmonary disease.

BACKGROUND: The use of the steep Trendelenburg position and abdominal CO2-insufflation during surgery can lead to significant reduction in pulmonary compliance and upper airway oedema. The postoperative time course of these effects and their influence on postoperative lung function is unknown. Therefore, we assessed intra- and extrathoracic airway resistance and nasal air flow in patients with or without chronic obstructive pulmonary disease (COPD) during robotic-assisted prostatectomy. METHODS: In 55 patients without and 20 patients with COPD spirometric measurements and nasal resistance were obtained before operation, 40 and 120 min, and 1 and 5 days after operation. We measured vital capacity (VC), forced expiratory volume in 1 s (FEV1), maximal mid-expiratory and inspiratory flow (MEF50, MIF50), arterial oxygen saturation, and nasal flow. The occurrence of postoperative conjunctival oedema (chemosis) was also assessed. RESULTS: In patients without COPD, MEF50/MIF50 increased and nasal flow decreased significantly after surgery (P<0.0001) and normalized within 24 h. VC and FEV1 decreased after operation with a nadir at 24 h and recovered to normal until the fifth day (P<0.0001). In patients with COPD, changes in MEF50/MIF50 and nasal flow were similar, while changes in VC and FEV1 lasted beyond the fifth day (P<0.0001). CONCLUSIONS: Robotic-assisted prostatectomy in the steep Trendelenburg position led to an increase in upper airway resistance directly after surgery that normalized within 24 h. The development of chemosis can be indicative of increased upper airway resistance. In patients without COPD, VC and FEV1 were reduced after surgery and recovered within 5 days, while in patients with COPD, the alteration lasted beyond 5 days.

Pharmaceutical industry interactions of psychiatric trainees from 20 European countries.

BACKGROUND: Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees. METHODS: One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire. RESULTS: The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean)=0.92, SD=1.44, range=0-12) and most in Portugal (M=19.06, SD=17.44, range=0-100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M=3.30, SD=1.26 vs. M=2.39, SD=1.06 on a 5-point Likert scale: 1 "completely disagree" to 5 "completely agree"). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio)=1.21, 95%CI=1.12-1.30 and OR=1.18, 95%CI=1.02-1.37). CONCLUSIONS: There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.

Electrokinetic dewatering of Turkish glass sand plant tailings.

In this study, the dewatering of glass sand plant tailings from Mersin, Turkey was investigated using an electrokinetic technique. The particle size (d(80)) of the solid waste material tested was less than 0.020 mm and consisted mainly of silica, orthoclase, alumina, potassium and iron oxides. In current plant practice, Larox high-pressure filters are used to produce a filter cake containing 22-25% moisture. As an alternative, a laboratory-scale dewatering pond using an electrokinetic technique was designed and a final product (cake) containing 34% moisture was obtained after 24h treatment using 14.6 V direct current applied for 40 min. When the treatment continued up to 48 h, a firm-to-hard cake was produced.

Angiomyolipoma of the kidney with lymph node involvement in a 17-year old female mimicking renal cell carcinoma: a case report.

Angiomyolipoma with extrarenal involvement is very uncommon. Herein we report a case of angiomyolipoma with lymph node involvement in a 17-year-old female. The diagnosis and treatment of the case is discussed.