The diagnostic value of magnetic resonance imaging-based texture analysis in differentiating enchondroma and chondrosarcoma.

OBJECTIVE: To assess the diagnostic performance of MRI-based texture analysis for differentiating enchondromas and chondrosarcomas, especially on fat-suppressed proton density (FS-PD) images. MATERIALS AND METHODS: The whole tumor volumes of 23 chondrosarcomas and 24 enchondromas were manually segmented on both FS-PD and T1-weighted images. A total of 861 radiomic features were extracted. SelectKBest was used to select the features. The data were randomly split into training (n = 36) and test (n = 10) for T1-weighted and training (n = 37) and test (n = 10) for FS-PD datasets. Fivefold cross-validation was performed. Fifteen machine learning models were created using the training set. The best models for T1-weighted, FS-PD, and T1-weighted + FS-PD images were selected in terms of accuracy and area under the curve (AUC). RESULTS: There were 7 men and 16 women in the chondrosarcoma group (mean ± standard deviation age, 45.65 ± 11.24) and 7 men and 17 women in the enchondroma group (mean ± standard deviation age, 46.17 ± 11.79). Naive Bayes was the best model for accuracy and AUC for T1-weighted images (AUC = 0.76, accuracy = 80%, recall = 80%, precision = 80%, F1 score = 80%). The best model for FS-PD images was the K neighbors classifier for accuracy and AUC (AUC = 1.00, accuracy = 80%, recall = 80%, precision = 100%, F1 score = 89%). The best model for T1-weighted + FS-PD images was logistic regression for accuracy and AUC (AUC = 0.84, accuracy = 80%, recall = 60%, precision = 100%, F1 score = 75%). CONCLUSION: MRI-based machine learning models have promising results in the discrimination of enchondroma and chondrosarcoma based on radiomic features obtained from both FS-PD and T1-weighted images.

Effectiveness of Training: Airway Management of Tracheostomized Pediatric Patients by Pediatric Residents and Anesthesiology Residents.

To evaluate the effect of training on increasing baseline knowledge of pediatrics and anesthesia residents about airway management of pediatric patients with tracheostomy. It is a prospective, descriptive, before and after survey study. A questionnaire was conducted to measure the baseline knowledge of pediatrics and anesthesia residents about airway management in patients with pediatric tracheotomy. The same questionnaire was repeated after the education. Of the 63 participants, 42 were pediatric residents and 21 were anesthesiology residents. While the number of participants who answered the cuff part, inner cannula part, obturator part and balloon part of the tracheostomy tube correctly before the training was 27, 4, 10, and 12, respectively, these numbers increased to 53, 52, 57, and 55 after the training. There was a statistically significant improvement after the training in the correct response of the cuff, inner cannula, obturator, and balloon sections. A statistically significant improvement was observed in the answers received after the training for all 7 questions regarding the clinical scenario of accidental decannulation and tracheostomy bleeding compared to the pre-training. There was a statistical improvement in part where the participants rated themselves. In conclusion, training increases the ability of healthcare professionals to cope with life-threatening complications related to pediatric tracheotomy. A standardized education program on pediatric tracheostomy should be included in the routine programs of associated departments such as emergency medicine, anesthesia, and pediatrics residencies.

Effects of vitamin D receptor gene polymorphisms on the prognosis of COVID-19.

PURPOSE: Vitamin D deficiency has emerged as another potential risk factor for coronavirus disease (COVID-19) due to the immunomodulatory effects of 25 hydroxyvitamin D [25 (OH)D]. Vitamin D receptor (VDR) gene polymorphisms such as Fok I, Bsm I, Apa I, and Taq I are also associated with different courses of viral infections. This study aimed to evaluate the association between the VDR gene polymorphism at Fok I, Taq I, Bsm I, and Apa I genotypes and the prognosis of COVID-19 in respect to vitamin D deficiency. METHODS: Two-hundred ninety-seven patients with COVID-19 were enrolled. Serum 25 (OH)D levels were measured. Four variant regions of the VDR gene, FokI, BsmI, ApaI, and TaqI were determined. RESULTS: Eighty-three percent of subjects had vitamin D deficiency, and 40.7% of the whole group had severe deficiency. Median 25 (OH)D level was 11.97 ng/ml. Vitamin D levels were not related to inflammatory markers, disease severity, admission to intensive care unit (ICU), and mortality. While disease severity was related to Fok I Ff genotype, it was Taq TT genotype for ICU admission. Moreover, the ApaI aa genotype was common among the patients who were died. None of the deceased subjects had the Fok I FF genotype. CONCLUSION: 25 (OH)D levels were not related to the severity and mortality of COVID-19. VDR gene polymorphisms are independently associated with the severity of COVID-19 and the survival of patients.

Accurate interpretation of thyroid dysfunction during pregnancy: should we continue to use published guidelines instead of population-based gestation-specific reference intervals for the thyroid-stimulating hormone (TSH)?

BACKGROUND: Considering the changes in thyroid physiology associated with pregnancy and poor outcomes related to abnormal maternal thyroid function, international guidelines recommend using population-based trimester-specific reference intervals (RIs) for thyroid testing. If these RIs are not available in the laboratory, implementing recommended fixed cut-off values globally is still controversial. To address this issue, we aimed to establish appropriate RI of thyroid-stimulating hormone (TSH) in pregnant Turkish women for our laboratory and compare the prevalence of thyroid dysfunction based on the established and recommended criteria. METHODS: Of 2638 pregnant women, 1777 women followed in the obstetric outpatient were enrolled in the reference interval study after applying exclusion criteria related to medical and prenatal history. A retrospective study was conducted by collecting data from July 2016 to March 2019. Serum TSH was measured by UniCel DxI 800 Immunoassay System (Beckman Coulter Inc., Brea, CA, USA). The study design relied on two approaches in order to classify pregnant women: trimester-specific and subgroup-specific; the latter involved dividing each trimester into two subgroups: T1a, T1b, T2a, T2b, T3a, T3b. The lower and upper limits of the RIs were derived by the parametric method after normalizing the data distribution using the modified Box-Cox power transformation method. RESULTS: The lowest TSH value was detected at 8-12 weeks in early pregnancy, and the median value of TSH in the T1b subgroup was significantly lower than the T1a subgroup (P < 0.05). TSH levels showed a gradual trend of increase along with the pregnancy and increased significantly in the T2a, T2b, and T3b subgroups compared to the preceding subgroups (P < 0.05). Compared to the diagnostic criteria recommended by American Thyroid Association (ATA), the prevalence of thyroid dysfunction was significantly different from the established trimester- and subgroup-specific RIs throughout the pregnancy (P < 0.001). CONCLUSIONS: We conclude that establishing gestation- and laboratory-specific RIs, especially for TSH, is essential for diagnosing thyroid disorders in pregnancy, and the recommended universal cut-off values, which may contribute to the risk of a misdiagnosis or a missed diagnosis, should be taken with caution in the clinical setting. However, regarding the fluctuation of thyroid function tests throughout pregnancy, trimester-specific RIs are insufficient, and implementing split phases is required.

Serum progesterone level above 0.85 ng/mL and progesterone/estradiol ratio may be useful predictors for replacing cleavage-stage with blastocyst-stage embryo transfer in fresh IVF/ICSI cycles without premature progesterone elevation.

PURPOSE: To assess the impact of serum progesterone level and the progesterone/estradiol ratio on determining the appropriate day of embryo transfer in fresh IVF/ICSI cycles without premature progesterone elevation. METHODS: This was a retrospective cohort study in a university teaching hospital. Only fresh embryo transfer cycles in the GnRH-antagonist protocol without elevated trigger-day progesterone levels (n = 508) were analyzed after taking into consideration the exclusion criteria. The main outcome measure was to determine the association between below and above of the cut-off values of serum progesterone level and P/E2 ratio regarding clinical pregnancy, ongoing pregnancy and live birth rates. These rates were assessed with the use of percentile and logistic regression analyses according to the threshold levels of serum progesterone levels < 0.85 ng/mL versus ≥ 0.85 ng/mL on the day of hCG administration. RESULTS: The clinical pregnancy rates were significantly lower in fresh cycles with P levels ≥ 0.85 ng/mL on the day of hCG administration than in cycles with P levels < 0.85 ng/mL for the cleavage-stage embryo transfers (26.7% vs. 47.5%, p = 0.001). Blastocyst-stage embryo transfer improved pregnancy results although the P levels were ≥ 0.85 ng/mL (53.8% vs. 51.4%, p > 0.05). The adjusted odds ratio of P levels < 0.85 ng/mL revealed significant differences in only cleavage-stage embryo transfer cycles (aOR = 0.424, p = 0.016). CONCLUSION: Although serum progesterone levels are below the accepted cut-off level of 1.5 ng/mL, there may be reduced pregnancy outcomes in fresh embryo transfer cycles. A threshold level such as 0.85 ng/mL may ensure the decision to replace the cleavage stage with the blastocyst-stage embryo transfer in fresh cycles without premature progesterone elevation.

The Most Frequently Cited References in the Articles Published in the Journal of Craniofacial Surgery Between 1995 and 2020.

ABSTRACT: The aim of this study is to examine the cited-references in the articles published in the Journal of Craniofacial Surgery between 1995 and 2020. On February 20, 2021, all articles published before January 1, 2021, in the Journal of Craniofacial Surgery were listed using advanced search in the Web of Science database. The journal's ISSN and e-ISSN numbers were used to perform this search. All information about these articles has been marked and exported to Tab-delimited (Win) format. It was then analyzed with the VOSviewer software. In the Web of Science database, it was investigated that a total of 11,888 articles were published in the Journal of Craniofacial Surgery between 1995 and 2020. A total of 137,829 different cited-references were used in these 11,888 articles. The top 15 most cited-references were identified. It was found that the first 3 most cited journals were Plastic and Reconstructive Surgery (n: 21,700; 15.74%), Journal of Craniofacial Surgery (n: 12,199; 8.85%), and Journal of Oral and Maxillofacial Surgery (n: 9383, 6.81%), respectively. As far as we know, the present study is the first study to analyze the cited-references in the field of craniofacial surgery. The authors think that the publications determined in this study are fundamental building blocks for both the field of craniofacial surgery and the Journal of Craniofacial Surgery.

Endoscopic Endonasal Removal of Stray Bullets in the Fossa Pterygopalatine in Innocent Young Bystanders of Conflicts in Somalia in a Period of Six Months.

ABSTRACT: In Somalia, which is located in the horn of Africa, a fragile and insecure state structure allowed the strengthening of terrorist groups provoking armed conflicts. Stray bullet injuries can be defined as an accidental bullet wound caused by an anonymous attacker and are usually associated with celebratory gunfire or urban violence. The anatomy of the pterygopalatine fossa (PPF) is complex and penetrating foreign body injuries pose even a greater challenge for the surgeon to operate in this area. Endoscopic approaches facilitate the removal of foreign bodies from the paranasal sinuses, orbital cavity, and aerodigestive system, minimizing potential risks. This study presents a series of removal of stray bullets found in the PPF, as a result of urban violence in Somalia in a period of 6 months. Patient demographics, foreign body origin, treatment modalities, and surgery details were evaluated and assessed. All patients were male and aged 16, 2, and 24 years, respectively. The surgeries were quite straightforward with surgery times recorded as 25, 44, and 22 minutes, respectively. The endoscopic endonasal approach proved to provide safe and sufficient access for removal. Surprisingly, even the foreign body in the PPF of a 2-year-old patient could be removed with an endoscopic endonasal approach and did not require an external approach. The management of foreign body removal in the PPF is challenging due to the potential risks of iatrogenic vascular and nervous tissue injury. The endoscopic endonasal approach for removal proved efficient in 3 cases regardless of age and anatomical dimensions.

A New Pathogenic Variant in the TRIOBP Associated with Profound Deafness Is Remediable with Cochlear Implantation.

BACKGROUND AND OBJECTIVES: A rare type of nonsyndromic autosomal recessive hereditary hearing loss is caused by pathogenic mutations in the TRIOBP gene mostly involving exons 6 and 7. These mutations cause hearing loss originating from dysfunction of sensory inner ear hair cells. Of all the affected siblings, 2 brothers and 1 sister, part of an Afghan family, were referred to our clinic for diagnostic workup and candidacy selection for cochlear implantation (CI). METHODS: Molecular analysis showed a homozygous c.1342C > T p. (Arg448*) pathogenic variant in exon 7 of the TRIOBP gene (reference sequence NM_001039141.2) in all 3 affected siblings. Clinical audiometry demonstrated profound sensorineural hearing loss in all 3 affected siblings (2 males and 1 female), and they were implanted unilaterally. RESULTS: One month after activation, the pure-tone averages with the CI processor were between 30 and 23 dBHL. Ten months after the first activation of the implant, open-set speech audiometry test could be performed for the first time in the 2 younger CI recipients (S5 and S9), and they could identify up to a maximum 77% phonemes correctly. The oldest brother (S12) could not yet perform open-set speech audiometry at that moment. CONCLUSIONS: Implant outcomes are better with normal inner ear anatomy in general. The earlier congenital patients are implanted, the better their outcomes. Here, we demonstrate both statements are true in a homozygous c.1342C > T p. (Arg448*) pathogenic variant in the TRIOBP gene in all 3 affected siblings.

The efficiency of progesterone/estradiol and progesterone/follicle ratio without elevated trigger-day progesterone levels on the reproductive outcomes of GnRH antagonist IVF/ICSI cycles.

AIM: To assess the predictive value of serum progesterone/estradiol (P/E2) and serum progesterone/follicle (P/F) ratios on the reproductive outcomes of women without elevated trigger-day progesterone levels undergoing GnRH-antagonist IVF (in vitro fertilization)/ICSI (intracytoplasmic sperm injection) cycles. MATERIALS AND METHODS: This was a retrospective cohort study in a university teaching hospital conducted between January 2017 and December 2019. Couples who underwent assisted reproduction cycles were evaluated. Initially, 978 cycles were evaluated and only GnRH antagonist cycles (n = 505) without elevated trigger-day progesterone levels were analyzed after respecting exclusion criteria. RESULTS: A total of 505 cycles were analyzed after the exclusion criteria were met. The clinical pregnancy rate, ongoing pregnancy rate, and live birth rate were 45.5%, 30.9%, and 27.8%, respectively. Cutoff values of P/E2 and P/F ratios that were discriminative for achieving or not achieving clinical pregnancy were 0.36 and 0.17, respectively. The clinical pregnancy rates were found to be significantly different between below and above P/E2 cutoff values (49.8% vs. 40.1%, respectively, p = .031), while there were no significant differences between below and above P/F cutoff values regarding the pregnancy outcomes. CONCLUSION: The P/E2 and P/F ratios were found to be more efficient and reliable markers than serum progesterone level alone in predicting the reproductive outcomes of assisted reproduction cycles without a premature rise in serum progesterone levels. A P/E2 ratio ≤0.36 and a P/F ratio ≤0.17 significantly improved the cycle outcomes.

Global Research on Maxillofacial Fracture Over the Last 40 Years: A Bibliometric Study.

ABSTRACT: Maxillofacial injuries are widely investigated worldwide as it consists a significant portion of trauma patients. Many researchers from various regions have reported the clinical and statistical analyses of maxillofacial fractures (MFFs) as the statistical data of MMFs are of great importance for both effective control and prevention of these cases. The number of studies concerning the diagnosis and treatment modalities of MFFs has significantly increased over the years. The bibliometric method was used to analyze publication outputs, countries, journals, most citations, and trends. In this study, the bibliometric analysis method was used in the publications related to MFFs published between 1980 and 2019, which were Science Citation Index Expanded indexed in the Web of Science database. Bibliometric analysis is applied to evaluate existing data in an evidence-based manner. The highest number of scientific articles on MFFs came from the USA, which was also the most cited country among others. When the distribution of the words in abstracts and titles by years was examined, it was seen that there was a significant change in the words "navigation," "computer," and "technology" between 2009 and 2012. The authors predict that our study would provide a novel perspective to the studies about MFFs and contribute to the researchers about the limits of the topic, and being aware of the active journals that publish the papers on this issue would facilitate the work of the researchers.

The Epidemiology and Management of Maxillofacial Fractures at a Tertiary Care Hospital in a Conflict-Torn Region in Somalia.

ABSTRACT: The etiology of maxillofacial fractures (MFFs) varies according to the geographical location and density of the population. This study aimed to analyze the etiology, pattern, and treatment of MFFs. Epidemiological characteristics and treatment modalities of MFFs have never been evaluated in Somalia. The study included 45 patients who were operated on for MFFs at a tertiary care hospital in Somalia (2018-2019). Patient demographics, fracture causes, types, associated non-facial injuries, treatment modalities, and hospitalization-time were evaluated. The most common etiological factors of the MFFs were explosion (24.4%) and assault (24.4%), followed by gunshot (22.2%), sports accident (15.6%), motor vehicle accident (11.1%), and fall from height (2.2%) patients, respectively. The main site of injury was the mandible bone (64.4%) followed by nasal bone, maxilla, zygomatic, and orbital region. The most common non-facial injuries of the MFFs were soft tissue laceration (37.8%) followed by femoral fracture (6.7%), clavicle fracture (4.4%), and femoral fracture with chest injuries (2.2%). The most applied treatment was open reduction microplate +/- intermaxillary fixation (77.8%). Due to the size of the mandible fractures, an iliac autograft (6.7%) was performed. The mean length of the hospital stay was 11.8 ±â€Š8.4 days (range, 1-45 days), and some patients (15.6%) needed intensive care due to severe injuries. This will be the first study aiming to analyze the etiology, pattern, and treatment of MFFs in Somalia. This study deals with the social aspects of Somalia, and it shows that MFFs develop as a result of highly interpersonal violence in a young man.

A Novel Three-Dimensional Robot Arm Steered Camera for Ear Surgery.

ABSTRACT: Ear surgery requires magnified imaging of anatomical structures from its beginning to achieve safe and successful surgical outcomes. The historical evolution of magnification in otology has developed from monocular to binocular, and to three-dimensional and even to digital in modern times. Current technological advancements pursue high-quality visualization for the best surgical outcomes but also ergonomic for surgeons. Here, we evaluated the usability of such new technology in common otological surgeries like cochlear implantation and stapedectomy for the first time in patients. A three-dimensional camera mounted to a robot arm has hands-free control by goggles worn by the surgeon on a head mount. The camera at a distance of the patients but can also be draped in a sterile way that it forms a barrier tent between patient and surgical personnel in the theatre. The main reason to evaluate the feasibility of this new exoscope was driven by COVID-19 obligate measures for elective surgery such as hearing restoration. This new technology can be considered an important advantage for the surgeons working in microsurgery to perform their elective operations without aerosolization of the drill rinsing water possibly containing contaminated tissue. From a subjective point of view, the image quality is equivalent to conventional microscopes to provide safe otologic surgery.

A Bibliometric Keyword and Term Analysis of the Articles Published in the Journal of Craniofacial Surgery Between 1995 and 2020.

ABSTRACT: The aim of this study is to analyze the terms in the abstract section and keywords of articles published in the Journal of Craniofacial Surgery (J Craniofac Surg) bibliometrically. Using the advanced search section in the Web of Science database on February 26, 2021, all articles published in the J Craniofac Surg from 1995 to 2020 were listed. All records of the detected 11,888 articles were exported and both terms in the abstract and keywords used in the articles were determined through the VOSviewer (version 1.6.16) software. It was found that the 10 most common terms in the abstract were patient (n: 6820), study (n: 4729), surgery (n: 3422), case (n: 3230), year (n: 2585), treatment (n: 2430), author (n: 2303) complication (n: 2150), month (n: 2061), and technique (n: 2002), respectively. It was found that the 10 most common keywords were craniosynostosis (n: 408), distraction osteogenesis (n: 257), orthognathic surgery (n: 243), mandible (n: 225), cleft palate (n: 214), reconstruction (n: 206), surgery (n: 157), cranioplasty (n: 150), cleft lip (n: 133), and computed tomography (n: 132), respectively. To the best of our knowledge, the current study is the first bibliometric keyword and term analysis in the field of craniofacial surgery. This study will enable us to have an idea about the past and current trends and the visibility of the articles published in the J Craniofac Surg.

The 25 Most Cited Articles in The Journal of Craniofacial Surgery: A Study Based on the Web of Science From 1995 to 2020.

ABSTRACT: The aim of this study was to identified and analyzed the top 25 most cited articles among the articles published in The Journal of Craniofacial Surgery (J Craniofac Surg) from 1995 to 2020 in the Web of Science database. Using the advanced search section in the Web of Science, all articles published in the J Craniofac Surg were listed. The distribution of the numbers of publications by years was determined. It was determined that a total of 11,888 articles were published in the J Craniofac Surg between 1995 and 2020. A total of 84,218 citations were made to these articles, and the h-index of these articles was 73. The top 25 most cited articles were determined. The top three countries that made the most cited to these 25 articles were the USA (n: 1112), China (n: 292), and Germany (n: 251), respectively. The top three journals that made the most cited to these 25 articles were the J Craniofac Surg (n: 378), Plast Reconstr Surg (n: 179), and J Oral Maxillofac Surg (n: 120), respectively. The authors think that this study may benefit researchers in this field by identifying the most cited articles in the J Craniofac Surg.

Integrating Telepsychiatric Services into the Conventional Systems for Psychiatric Support to Health Care Workers and Their Children During COVID-19 Pandemics: Results from A National Experience.

Background:A system presented here was established to provide psychiatric help for health care workers (HCWs) that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions.Introduction:The aim of this study was to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams.Materials and Methods:A mobile application-based approach supported by the conventional local units was used. A three-step approach including contacting live operators followed by video calls from psychiatrists or child and adolescent psychiatrists and if necessary local unit support was used to provide support.Results:In addition to system records covering sociodemographic variables and initial complaints, a telephone survey, questioning the effectiveness and satisfaction of the system, was used as the main outcome. The number of individuals who asked for a psychiatrist appointment from operators after downloading the application was 1,076 (n = 879 [81.6%] support for self) (n = 197 [18.4%] support for child). Four hundred forty-nine (n = 449) HCWs (41.7%) replied video calls and received psychiatric help from psychiatrists on the time of appointment (n = 351 [78.1%] support for self) (n = 98 [21.8%] support for child). The overall satisfaction level of HCWs for the service they received was 8.1/10 (8.1/10 for support for self, 8.4/10 for support for the child. 86.6% (n = 389).Discussion:The findings of this study suggest that although telepsychiatry may be useful in public health emergencies such as COVID-19 pandemics should not be consisted of only telephone lines or video calls.Conclusions:Systems combining telehealth applications and local intervention teams may be more effective and establishing such organizations is possible in short intervals.

Regulatory consideration on preparation and clinical use of COVID-19 convalescent plasma.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease (COVID-19), spreading from Wuhan to worldwide has been emerged since December 2019. Although scientists and researchers have been racing to develop specific therapeutic agents or vaccines against SARS-CoV-2 since the identification of the agent, either a drug or a vaccine has not been approved to treat or to prevent COVID-19 up to date. On the base of historical experiences, Convalescent Plasma (CP), a passive antibody therapy, has been evaluated as a hopeful and potential therapeutic option since the beginning of the COVID-19 outbreak. Immune plasma had been used previously for the treatment of H1N1 influenza virus, SARS-CoV-1 and MERS-CoV epidemics successfully. In this scope competent authorities are responsible to set up certain principles and criteria for the collection and clinical use of COVID-19 Convalescent Plasma (CCP). This document has been prepared to aid both for the convalescent plasma suppliers and the clinicians. The first part encompasses the supply of CCP and the second part lead the clinical use of CCP for the treatment of patients with severe COVID-19 infection. Turkish Ministry of Health developed a guide on collection and clinical use of CCP and created a web-based monitoring system to follow-up the patients treated with convalescent plasma in universal. This follow-up process is thought to be crucial for the creation and development of current and future treatment modalities. This guide would be a pathfinder for clinicians and/or institutions those eager to conduct CCP treatment more effectively.

Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14-16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

Effect of Piezoelectric Technique on Auditory Function on Postoperative Day One in Septorhinoplasty Surgery.

AIM: To examine the effect of the piezoelectric application used increasingly for osteotomy and correction of nasal dorsum in septorhinoplasty surgeries on early auditory functions. METHODS: Our study was conducted after the decision of 10840098-604.01.01-E.9057 taken from Istanbul Medipol University Clinical Research Local Ethics Committee. This study was designed to be prospective, randomized and controlled. Twenty patients between 18 and 50 years of age that piezoelectric technique was used in the study group and 10 patients in the same age range who underwent nasal surgery (endoscopic sinus surgery, septoplasty, lower concha radiofrequency and nasal valve surgery) for any reason in the control group were included in the study. Audiologic functions of the patients in both the groups were assessed by pure audio audiometry, tympanometry and distortion product otoacoustic emission test before the surgery and 24 hours after the surgery. The data obtained were statistically compared using the SPSS 22.0 program and P < 0.05 was considered significant. RESULTS: Twenty patients (5 males, 15 females) that piezoelectric (ultrasonics) technique was used during septorhinoplasty in the study group and 10 patients (5 males, 5 females) in the control group were included in the study. In the study and the control groups, preoperative and postoperative air/bone path thresholds at the right and left ears did not differ significantly (P > 0.05) at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz. The results of distortion product otoacoustic emission results (signal/noise ratio) obtained postoperatively were not statistically significant (P > 0.05) with the results obtained preoperatively. CONCLUSION: The results of the study show that the piezoelectric technique used in septorhinoplasty does not cause a negative effect on auditory functions. This study is the first comparative study to investigate the effect of piezoelectric technique used in septorhinoplasty surgery on auditory functions. After further clinical studies performed with well-selected and large patient population, the piezoelectric techniques can be a preferred technique during septorhinoplasty operations.

Effects of Rhinoplasty on Labyrinthine Function.

BACKGROUND: Rhinoplasty is a common surgical procedure that is requested and accepted by patients for cosmetic and functional reasons. Osteotomies are performed on nasal bone, maxillary crest, or vomer to fix the deviations of the nasal dorsum or septum. During the percussion of the osteotomes with the surgical mallet, the vibration energy diffuses to the cranium. Auditory and vestibular systems may be affected by these vibrations. OBJECTIVES: To assess the effects of rhinoplasty, in which osteotomies were performed using a hammer, on the audiovestibular system. METHODS: Thirty adults who underwent rhinoplasty were included in the study group. Ten age and gender matched adults who had nasal surgery without surgical mallet or osteotome served as the control group. The patients in both groups were assessed using pure tone audiometry, tympanometry, distortion product otoacoustic emission testing, and vestibular-evoked myogenic potential, as well as video head impulse tests (vHIT) before the operation and 1 week after the operation. RESULTS: On auditory assessment, there was no significant difference between the study and control groups regarding pure tone thresholds at frequencies of 250 Hz to 8 kHz (P > 0.05) as well as otoacoustic emissions. The vestibular assessment performed by using vestibular-evoked myogenic potential and vHIT did not reveal a statistically significant difference between the groups, before surgery or after surgery (P > 0.05). CONCLUSIONS: Rhinoplasty appears to be a safe operation in terms of audiovestibular functions, and osteotomy, in which a hammer is usually used, does not have an impact on hearing or balance functions of the ear.

Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.