Neuro-Ophthalmologic MRI Findings in the Detection of Rhinorrhoea Aetiology.

The purpose of this study is to evaluate the importance of neuro-ophthalmological magnetic resonance imaging (MRI) findings in the identification of the aetiology of rhinorrhoea, and the differentiation of spontaneous rhinorrhoea from non-spontaneous rhinorrhoea. MR images of 25 patients with spontaneous and 21 patients with non-spontaneous rhinorrhoea were evaluated for the presence of neuro-ophthalmological findings of intracranial hypertension (IHT). These include optic nerve vertical tortuosity, optic nerve sheath enlargement, flattening of the posterior sclera and optic nerve protrusion, as well as other MRI findings of ICH, such as partial empty sella, dilatation of Meckel's cave and the presence of arachnoid pits. IHT findings were more common in the spontaneous group. Six criteria (optic nerve distention, optic nerve vertical tortuosity, posterior flattening of the sclera, partial empty sella, Meckel's cave dilatation and presence of arachnoid pits) differentiate between patient and control groups. Patients with spontaneous cerebrospinal fluid (CSF) leaks should be evaluated for signs of IHT on MRI, as they are present in the majority of spontaneous CSF leaks and are representative of increased intracranial pressure.

Rasch analysis of the Neck Bournemouth Questionnaire: Turkish version, validity, and reliability study

Background/aim: The multidimensional evaluation of patients with chronic neck pain is important for planning the treatment program. The aim of this study was to investigate the validity and reliability of the Turkish version of the Neck Bournemouth Questionnaire (NBQ). Materials and methods: The internal construct validity of the NBQ was examined by the fit of the data to the Rasch measurement model. External validity of the NBQ was evaluated by testing for expected associations of Rasch transformed NBQ score with the corresponding variables through the process of convergent validity. The reliability of the NBQ in terms of both internal consistency and test-retest reliability was assessed by the person separation index (PSI) and differential item functioning (DIF) by time effect. Results: It was determined that the questionnaire has 2 factors. None of the items of Factor 1 (F1) and Factor 2 (F2) showed DIF. The reliability of F1 (Cronbach's alpha = 0.89, PSI = 0.87) and F2 (Cronbach's alpha = 0.77, PSI = 0.87) was good with Cronbach's alpha and PSI. There was a good correlation between NBQ/F1 and the Neck Disability Index (NDI) (r = 0.673) and Neck Pain and Disability Scale (NPDS) (r = 0.709). Also, there was a correlation between NBQ/F2 and the Beck Depression Inventory (BDI) (r = 0.552) and Beck Anxiety Inventory (BAI) (r = 0.410). Conclusion: The Turkish version of the Neck Bournemouth Questionnaire is valid and reliable.

High serum YKL-40 level is associated with poor prognosis in patients with lung cancer.

INTRODUCTION: YKL-40 is a glycoprotein that plays role in inflammation and malignant processes. High serum YKL-40 levels are associated with short survive in cancer and chronic obstructive pulmonary disease (COPD) is another reason to increase its' level. However, limited knowledges are known in YKL-40 along with lung cancer and COPD. MATERIALS AND METHODS: One hundred patients were involved to study with lung cancer (84 men, 16 women, and median age 62). Results were compared with 30 healthy volunteers. Thirteen patients were small cell lung cancer (SCLC), 87 patients were non-small cell lung cancer (NSCLC). 62% of patients were inoperable. RESULT: Median YKL-40 level was 222.7 ± 114.1 ng/mL in patients and was 144.5 ± 105.7 ng/mL in controls (p< 0.001). Stage, tumour size, lymph node involvement and distant metastasis weren't associated with serum YKL-40 level. Above all cut-off values (133.159 and 162 ng/mL) survival was shorter (p> 0.05). Patients with COPD had worse survive above all cut-off values (p< 0.05), especially according to 133 ng/mL (p= 0.01). CONCLUSIONS: YKL-40 level is useful in lung cancer however it's not related to cell type and prognosis. It is associated with poor prognosis in lung cancer patients with COPD.

Effects of Hysterectomy on Pelvic Floor Disorders: A Longitudinal Study.

BACKGROUND: Hysterectomy might adversely affect pelvic floor functions and result in many different symptoms, such as urinary and anal incontinence, obstructed defecation, and constipation. OBJECTIVE: The aim of this prospective study was to evaluate the influence of hysterectomy on pelvic floor disorders. DESIGN: This was a prospective and longitudinal study. SETTINGS: The study was conducted at the Ankara University Department of Surgery and the Dr Zekai Tahir Burak Women's Health Research and Education Hospital between September 2008 and March 2011. PATIENTS: The study was performed on patients who underwent hysterectomy for benign pathologies. MAIN OUTCOME MEASURES: A questionnaire about urinary incontinence (International Continence Society scoring), anal incontinence, constipation, and obstructed defecation (Rome criteria and constipation severity score), along with an extensive obstetric history, was administered preoperatively and postoperatively annually for 4 years. RESULTS: Patients (N = 327) who had completed each of the 4 annual postoperative follow-ups were included in this study. Compared with the preoperative observations, the occurrence of each symptom was significantly increased at each of the follow-up years (p < 0.001). Over the 4 postoperative years, the frequencies for constipation (n = 245) were 7.8%, 8.2%, 8.6%, and 5.3%; those for obstructed defecation (n = 269) were 4.5%, 5.2%, 4.1%, and 3.0%; those for anal incontinence (n = 252) were 4.8%, 6.3%, 6.0%, and 5.2%, and those for urinary incontinence (n = 99) were 12.1%, 12.1%, 11.1%, and 13.1%. In addition, patients who had no preoperative symptom (n = 70) from any of the selected symptoms showed a postoperative occurrence of at least 1 of these symptoms of 15.8%, 14.3%, 11.4%, and 8.6% for the postoperative years 1, 2, 3, and 4. LIMITATIONS: Although the study had several limitations, no comparison with a control population was the most important one. CONCLUSIONS: Hysterectomy for benign gynecologic pathologies had a significant negative impact on pelvic floor functions in patients who had no previous symptoms.

Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial.

BACKGROUND: Minimally invasive procedures may be an alternative to surgical excisions for pilonidal disease. OBJECTIVE: The aim of the study was to compare phenol injection versus excision with open healing technique. DESIGN: This is a prospective randomized study (ACTRN12612000868886). SETTINGS: This study was conducted at the Ankara University and Ufuk University Departments of Surgery. PATIENTS: One hundred forty patients were randomly assigned to phenol injection (n = 70) or excision with open healing (n = 70). MAIN OUTCOME MEASURES: The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale pain score, painkiller intake, time to resume daily activities, recurrence rate, Short Form 36 Health Survey, and Nottingham Health Profile at 3 weeks after surgery. RESULTS: Time to complete wound healing (16.2 ± 8.7 versus 40.1 ± 9.7 days) was significantly in favor of the phenol injection group (p < 0.001). The median operation time was 14.0 ± 3.8 minutes in the phenol group versus 49.0 ± 24.2 minutes in the excision with open healing group (p < 0.001). The time to resume daily activities (pain-free mobilization and defecation) was 0.8 ± 2.8 and 16.2 ± 12.6 hours after phenol injection and 9.3 ± 10.0 and 22.5 ± 15.1 hours after the excision with open healing treatment (p < 0.001, p = 0.008). Visual analog pain score at 48 hours and painkiller intake within 48 hours were significantly in favor of the phenol injection group. At the mean follow-up of 39.2 ± 9.0 months after surgery, no differences were seen in the recurrence rate between the treatment arms (13 recurrences in phenol vs 9 in excision with open healing; p = not significant). Short Form 36 and Nottingham Health Profile scores at 3 weeks after surgery were also in favor of phenol injection. LIMITATIONS: The present study was not double blinded, and a history of abscess drainage was significantly higher in the surgery group. CONCLUSIONS: Based on the results, we conclude that phenol injection is as effective as the excision with open healing technique.

Immunologic alterations and efficacy of subcutaneous immunotherapy with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients.

BACKGROUND: There is a continuing debate about whether monoallergen subcutaneous immunotherapy (SCIT) is able to modulate immune and clinical responses toward main causal allergen in polysensitized patients. OBJECTIVE: To investigate short-term immunologic changes and clinical effectiveness of SCIT with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients who have rhinitis with or without asthma. METHODS: Nineteen monosensitized and 24 polysensitized patients participated in this prospective, self-placebo-controlled, interventional study. Cluster immunotherapy with D pteronyssinus was administered after 2 months of placebo in both groups. Immunologic parameters, including CD203c expression on basophils after allergen stimulation, total IgE, specific IgE, and specific IgG4, were evaluated at baseline, after placebo, and after immunotherapy. Clinical effectiveness was assessed using monthly symptom-medication scores, visual analog scale, quality-of-life questionnaire, and nasal allergen provocation test. RESULTS: At baseline, polysensitized patients had higher CD203c expression on basophils than monosensitized patients (P = .007). Activated basophils expressing CD203c, total IgE, and specific IgG4 were significantly increased after immunotherapy compared with baseline and placebo in the polysensitized group (P < .025). After immunotherapy, specific IgE and D pteronyssinus-induced CD203c expression were significantly higher in polysensitized than monosensitized patients (P < .05). The total symptom scores and the Mini Rhinoconjunctivitis Quality of Life Questionnaire scores in polysensitized patients and the visual analog scale scores in both groups were lower after immunotherapy compared with baseline and placebo (P < .025). Titrated nasal allergen provocation test with D pteronyssinus increased after immunotherapy in the monosensitized group (P < .05). CONCLUSION: This study indicates that monosensitized and polysensitized patients have distinct humoral response and basophil behavior to SCIT. However, a single-allergen immunotherapy corresponding to the most clinically troublesome allergy in polysensitized patients can lead to early clinical efficacy comparable to that seen in monosensitized patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01795846.

The airway device preference may affect the overlapping of the common carotid artery by the internal jugular vein.

BACKGROUND: Anatomical variation in the internal jugular vein (IJV), as well as its small size, tendency to collapse, and proximity to the common carotid artery (CCA) makes central venous cannulation via the IJV a technically challenging procedure, especially in pediatric patients. AIM: We evaluated the effects of laryngeal mask airway insertion and endotracheal intubation (ETT) on the anatomical relationship between the IJV and the CCA in neutral and 40° head away positions. METHOD: After parental consent 92 patients with ASA physical status I-II, aged 0-17, undergoing elective urological surgery were enrolled and divided into two groups according to the airway management device used for anesthesia: Group laryngeal mask airway (n = 63) and Group ETT (n = 29). An ultrasonographic evaluation was performed before and after airway instrumentation at neutral and 40° head rotation. The IJV position in relation to the CCA was noted, and the overlap percentage of the CCA was calculated as the ratio of the CCA length covering by the internal jugular vein to the transverse diameter of the CCA. RESULTS: With no airway device insertion, the position of the IJV was found to be anterolateral to the CCA in the majority of patients (48.8% vs 35.3%, right vs left IJV) in the neutral head position. While there was no significant change in the overlap percentages of the CCA after laryngeal mask airway insertion in the neutral head position [48.71% vs 57.30% for the right IJV (difference in median: -21.20; 95% confidence interval (CI) of difference: -56.92 to 14.52; P = 0.133); 52.54% vs 60.36% for the left IJV (difference in median: -10.3; 95% CI of difference: -41.49 to 20.89; P = 0.128)], it increased significantly in the 40° head away position on both sides [50.11% vs 64.83% for the right IJV (difference in median: -55; 95% CI of difference: -84 to -25.24; P = 0.01); 53.82% vs 71.20% for the left IJV (difference in median: -46; 95% CI of difference: -86.85 to -5.15; P = 0.004)]. However, the overlap percentages of CCA decreased significantly on the right side with patients in a neutral head position (31.23% vs 6.27%, difference in median: 19; 95% CI of difference: -5.68 to 43.68; P = 0.002) and on both sides in the 40° head away position [29.50% vs 16.19%, difference in median: 26; 95% CI of difference: 2.84 to 49.16; P = 0.03 and 47% vs 31.94%, difference in median: 9.50; 95% CI of difference: -40.87 to 59.87; P = 0.03 for the right and left sides, respectively] after ETT insertion. CONCLUSIONS: Laryngeal mask airway with 40° head rotation increases, whereas ETT decreases, the overlap percentage of CCA by IJV. Both head position and airway management methods have an influence on the overlap of the CCA by the IJV in pediatric patients.

The effects of different environmental pH on healing of tympanic membrane: an experimental study.

In this study, we investigated the effect of environmental pH on healing of acute rat tympanic membrane perforations. Twenty Wistar albino rats were divided into four groups and used in the study. A large myringotomy was performed in the posteroinferior quadrants of both tympanic membranes. In left ears, topical pH 4 standard calibration solution was used in groups 1 and 3, and pH 7 standard calibration solution was used in groups 2 and 4. Right ears served as controls, and allowed for spontaneous healing. The solutions were applied for 2 days in groups 1 and 2, and for 7 days in groups 3 and 4. Healing was assessed by macroscopic closure of the tympanic membrane perforation, and histopathological analysis of lamina propria edema, neovascularization, inflammatory cells, and fibroblastic reaction in the temporal bones. pH 7 and pH 4 groups were similar for macroscopic closure of perforation on day 2; however difference was significant on day 7. The fibroblastic activity was significantly less on days 2 and 7 in pH 4 group. On day 7, there were significant differences between pH 4 and pH 7, and pH 7 and control groups for inflammatory cell infiltration. In conclusion, clinical and histopathological results of this study indicated that acidic environmental pH speeded up and shortened wound-healing process. By building up optimum environmental pH, a healthy healing may be achieved in acute tympanic membrane perforations.

Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical Study.

PURPOSE: We investigated possible predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein and white blood count in patients with 4 to 10 mm distal ureteral stones. MATERIALS AND METHODS: A total of 251 patients who presented with renal colic secondary to distal ureteral stone were included in study. Patients were grouped according to spontaneous stone passage. Serum C-reactive protein, white blood count and other possible factors were investigated for their potential predictive value for spontaneous stone passage at a followup of 5 weeks. Potential predictive factors for spontaneous stone passage were evaluated with univariate and multivariate analyses. ROC curve analysis was performed to find an optimal cutoff value for serum C-reactive protein according to spontaneous stone passage. Statistical significance was considered at p <0.05. RESULTS: Spontaneous stone passage was observed in 135 patients (53.8%) in group 1 while 116 (46.2%) in group 2 did not expel the stone spontaneously. Median stone size was 5.7 mm. Stone size, serum C-reactive protein and white blood count were significantly higher in group 2 than in group 1. The number of patients with hydronephrosis and the number with spontaneous stone passage history were significantly lower in group 2 compared to group 1. The cutoff value of serum C-reactive protein provided by ROC analysis was 0.506 mg/l. Time to spontaneous stone passage was significantly higher in patients with serum C-reactive protein above the threshold and in patients with ureteral stones greater than 6 mm. CONCLUSIONS: Stone size, previous spontaneous passage, hydronephrosis, serum C-reactive protein and white blood count can be used to predict spontaneous stone passage in patients with 4 to 10 mm distal ureteral stones. A serum C-reactive protein level of 0.506 mg/l can serve as a cutoff value to predict spontaneous stone passage.

Adaptation and validation of the Ankylosing Spondylitis Work Instability Scale (AS-WIS) for use in Turkey.

The Ankylosing Spondylitis Work Instability Scale (AS-WIS) is a recently developed 20-item measure to assess work instability in AS. This study aimed to adapt the AS-WIS to Turkish and to test its reliability and validity. After the translation process, 132 AS patients were assessed by the AS-WIS, Bath AS Disease Activity Index, Bath AS Functional Index and the AS Quality of Life Questionnaire. Reliability was tested by internal consistency, person separation index (PSI) and intra-class correlation coefficient (ICC); internal construct validity by Rasch analysis; external construct validity by associations with comparator scales and cross-cultural validity by comparison with the original UK data. Reliability of the Turkish AS-WIS was good with Cronbach's α and PSI of 0.88 and test-retest ICC of 0.91. Data showed good fit to Rasch model [mean item fit: -0.477 (SD 1.047), Chi-square interaction: 60.9 (df = 40, p = 0.018)]. There was no differential item functioning by age, gender, disease duration or work type. The scale was strictly unidimensional. 51 % of the patients were at moderate risk, and 9 % were at high risk of having to give up their work. External construct validity was confirmed by expected correlations with comparator scales, and a clear gradient of disease activity and functional status across increasing levels of risk. Cross-cultural validity showed some differences in item locations, but this cancelled out at the test level. Turkish version of the AS-WIS is reliable, valid and available for use in routine clinical setting to identify patients who are at risk of having to give up their current job.

Can we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study.

PURPOSE: The aim of this study was to compare the combined ultrasound-guided supraclavicular brachial plexus block (SCB) and distal median, radial, and ulnar nerve blocks, with the supraclavicular block alone. METHOD: Sixty-two patients undergoing upper extremity surgery were randomized to supraclavicular only (Group S, n = 31) or supraclavicular + distal (Group SD, n = 31) group. Patients in Group S received 32 mL of 1.5 % lidocaine + epinephrine 5 µg/mL, while those in Group SD received 20 mL of 1.5 % lidocaine + epinephrine 5 µg/mL followed by distal median, radial, and ulnar nerve blocks using equal volumes of 2 % lidocaine + 0.5 % levobupivacaine (4 mL/nerve). Sensory and motor blocks of the ulnar, median, radial and musculocutaneous nerves were assessed every 5 min starting at the 10th minute. The imaging, needling and performance times were recorded. Also, the onset and anesthesia-related times, need for analgesic and first analgesic times, were noted. RESULTS: In Group SD, the anesthesia onset [15 (10-25) vs. 20 (15-30) min, p < 0.001] and anesthesia related times [16.6 (10.7-28.2) vs. 22 (15.9-33.7) min, p < 0.001] were significantly shorter than those of Group S. Additionally, the analgesic requirement was lower in Group SD (56.7 vs. 88.5 %, p = 0.009), while among the patients who required analgesic, the first analgesic time was longer in Group SD in comparison to Group S [625 (347-1764) vs. 315 (233-746) min p < 0.001]. CONCLUSIONS: The addition of distal median, radial, and ulnar nerve blocks to SCB shortens anesthesia-related time and anesthesia onset time when compared with a SCB alone.

Psychometric properties of the Turkish version of the Fagerström test for nicotine dependence.

INTRODUCTION: The Fagerström Test for Nicotine Dependence (FTND), modified from Fagerström Tolerance Questionnairre (FTQ), is used to determine whether a smoker trying to quit will need nicotine replacement therapy to treat with drawal symptoms. The FTND has been translated into many languages and has been referred to in the smoking literature worldwide. However, only a few studies have examined the psychometric propertiesof the non-English FTND versions. This study aimed to assess the psychometric properties of the Turkish version of the FTND. MATERIALS AND METHODS: Confirmatory factor analysis (CFA) was used to test the factor structure of the Turkish version of the questionnaire using a large sample from two smoking cessation clinics in Istanbul, Turkey. Our study comprised 502 smokers who entered one of these smoking cessation clinics between October 1 and December 31, 2011. All subjects gave informed consent to the study. We assessed the validity of the FTND using CFA, and we calculated Cronbach's alpha coefficients to determine reliability. RESULT: One-factor CFA included all of the items on the FTND. All items loaded on this factor with a score of 0.40 or higher. The goodness of fit statistics were adequate, with a Comparative Fit Index (CFI) of 0.922, a Tucker-Lewis Index (TLI) of 0.902, and a root-mean-square error of approximation (RMSEA) of 0.081. Two-factor CFA comprised the three "morning smoking" items, and the three "smoking pattern" items. The factor loadings and the goodness-of-fit statistics confirmed that the FTND has a two-factor structure. CONCLUSIONS: Analyses confirmed that the Turkish version of the FTND has a two-factor structure with moderate reliability. This study found that using a total score as an estimate of nicotine dependence may limit the assessment of specific smoking dependency and tailoring intervention approaches. We suggest that a two-factor FTND in clinical practice would more accurately determine the nicotine dependence of patients.

Prognostic significance of serum vascular endothelial growth factor and Angiopoietin-2 in patients with lung cancer.

INTRODUCTION: Vascular endothelial growth factor (VEGF) and Angiopoietin-2 (Ang-2) are major angiogenic mediators in neovascularization process. In current literature both biomarkers are discussed separately and only for non-small cell lung cancer (NSCLC). So in this study we aimed to examine them together for both cell types NSCLC and small cell lung cancer (SCLC). PATIENTS AND METHODS: 100 patients with lung cancer were enrolled to this single center study. 87 of patients were diagnosed with NSCLC including 28 adenocarcinomas and 59 squamous cell cancers and 13 were SCLC. Results were compared with 30 healthy volunteers. Pre-treatment serum VEGF and Ang-2 levels were measured by using ELISA method. RESULTS: While serum Ang-2 levels were higher in patients than healthy controls (23395 pg/mL vs. 4025 pg/mL, p< 0.001), VEGF levels didn't differ (2308 pg/mL vs. 2433 pg/mL, p> 0.05). There was no difference between cases with SCLC and NSCLC in terms of Ang-2. But serum VEGF values were significantly lower in SCLC than NSCLC and control groups. None of these mediators were correlated with cell type, tumor size, TNM staging, performance status and operability. VEGF levels were higher in patients with chronic obstructive pulmonary disease (COPD), but it was not significant. Three cut of values were determined according to sensitivity and specificity by using youden index. They were 8515.73 pg/mL (sensitivity 78%, specificity 76%), 7097 pg/mL (sensitivity 80%, specificity 70%) and 11063.48 pg/mL (sensitivity 76%, specificity 70%). Patients with SCLC had shorter survival time above cut-off values (p> 0.05). VEGF and Ang-2 showed a weak positive correlation (p= 0.1 and r= 0.638). CONCLUSION: In conclusion, serum VEGF wasn't useful to predict lung cancer, prognosis or cell type. Albeit Ang-2 was higher in patients with lung cancer without any effect on survival. Due to the heterogeneity of the studies done with serum measurement Ang-2 on tumor tissue should be more meaningful.

Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome?

[Purpose] The hypothalamic-pituitary-adrenal (HPA) axis in the etiopathogenesis of fibromyalgia is not clear. This study aimed to analyze the effects of a 6-week aerobic exercise program on the HPA axis in patients with fibromyalgia and to investigate the effects of this program on the disease symptoms, patients' fitness, disability, and quality of life. [Subjects and Methods] Fifty fibromyalgia patients were randomized to Group 1 (stretching and flexibility exercises at home for 6 weeks) and Group 2 (aerobic exercise three times a week and the same at-home exercises as Group 1 for 6 weeks). Serum levels of cortisol, adrenocorticotropic hormone, insulin-like growth factor-1, and growth hormone were analyzed at baseline and at the end of, and 1 hr after an exercise stress test. [Results] Group 2 showed better improvement in morning stiffness duration and pain. Growth hormone levels significantly increased after intervention and cortisol levels significantly decreased at time-time interaction in both groups. No significant differences in adrenocorticotropic hormone and insulin-like growth factor-1 were found. [Conclusion] The results of this study seem to support the hypothesis that there is a dysregulation of the HPA axis in patients with FM, and that a six-week exercise program can influence symptoms and affect the HPA axis hormones.

Association of serum estradiol levels on the day of hCG administration with pregnancy rates and embryo scores in fresh ICSI/ET cycles down regulated with either GnRH agonists or GnRH antagonists.

PURPOSE: To investigate the interrelation between serum E2 level on hCG day, score of transferred embryos and pregnancy achievement. METHODS: Records of 350 women aged 18-40 years who underwent ovarian hyperstimulation in fresh cycles down regulated either with GnRH agonist (n = 70) or GnRH antagonist (n = 280) followed by oocyte pick-up, ICSI and embryo transfer are retrospectively analyzed. RESULTS: Median E2 levels on hCG day of cycles ending with and without pregnancy were similar (p = 0.308). ROC curve for AUC of E2 on hCG day with dependent variable pregnancy rate also demonstrated that the E2 level on hCG day cannot be used to predict pregnancy in IVF/ICSI cycles (AUC 0.532, 95 % confidence interval: 0.471-0.593). Grouping cycles according to their E2 levels on hCG day also did not demonstrate any detrimental effect of either low or high E2 levels on hCG day both in agonist and antagonist cycles. Pregnancy rates are strongly correlated with mean and total score of transferred embryos. Interrelation of E2 on hCG day and pregnancy rate is independent from score of transferred embryos. CONCLUSIONS: E2 on hCG day is not correlated with pregnancy rates and cannot be used to predict pregnancy in neither agonist nor antagonist cycles, no matter its level or percentile is used.

[Latent tuberculosis treatment results in patients that taken TNF-alpha blockers at Ankara Numune Training and Research Hospital Chest Diseases Clinic for last 8 years (2006-2013)]. / Ankara Numune Egitim Arastirma Hastanesi Gögüs Hastaliklari Kliniginde son 8 yilda (2006-2013) TNF-alfa blokeri kullanan hastalara verilen latent tüberküloz tedavisi sonuçlari

INTRODUCTION: Tuberculosis occurrence was evaluated in patients that applied tuberculosis chemoprophylaxis and currently receiving tumor necrosis factor-alpha (TNF-α) blocker. MATERIALS AND METHODS: Incidence of tuberculosis were retrospectively evaluated in patients that currently receiving TNF-α-blocking therapy and received tuberculosis chemoprophylaxis at Ankara Numune Education and Research Hospital, Lung Disease Department, between 2006-2013 years. 134 patients that were diagnosed with rheumatologic and dermatologic diseases, were evaluated. Patients were in the age range 18-80 years. Age, gender, smoking status, BCG vaccination, chest radiography, diagnose of disease, presence of concomitant disease, tuberculosis story, PPD value, chemoprophylaxis acquisition, which anti-tuberculosis agents received, duration of chemoprophylaxis, duration of TNF-α blocker, other immunosuppressive using were measured. RESULTS: Rheumatologic diseases were often. Prophylaxis has given at 73.9% of patients. Patients with received anti-TNF-α therapy (n= 134) have not developed pulmonary or extra-pulmonary tuberculosis disease. CONCLUSION: Patients with received anti-TNF-α therapy, are scanned with TST or Quantiferon. If latent tuberculosis infection are diagnosed, tuberculosis prophylaxis should be started pre-anti-TNF-α therapy at least one month and INH chemoprophylaxis should be completed on 9 months or RIF should be completed on 4 months. Serum liver enzymes and bilirubin measurements monthly; follow-up physical examination and chest radiography should be performed for 3 months.

Effects of onabotulinum toxin-A injection on sexual function in women with refractory interstitial cystitis/bladder pain syndrome: A prospective study.

OBJECTIVES: To determine the effect of intravesical onabotulinum toxin-A (BoNT-A) treatment on sexual functions in female patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS). METHODS: Female patients with IC/BPS refractory to previous treatments were included in the study between January 2020 and April 2022. Patients were treated with the trigone-sparing injection (Group 1) or trigone-included injection (Group 2) techniques. 100 Units of BoNT-A was applied submucosally on 20 different points. The patients were evaluated with visual analog scale (VAS), O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Female Sexual Function Index (FSFI) questionnaires, 3-day voiding diary, uroflowmetry, and post-voiding residual volume analysis in the preoperative period, as well as on the 30th and 90th days postoperatively. For the repeated measurements, analysis of variance was used to assess the time-dependent variation across groups. RESULTS: The baseline FSFI score of the patients was 15.96 ± 3.82. Following the treatment, the FSFI scores were 22.43 ± 4.93 and 24.41 ± 5.94 on the 30th and 90th days, respectively (p < .001). We observed statistically significant improvement in all FSFI subdomains (p < .05). Statistically significant improvements with treatment on ICSI, ICPI, and VAS scores were achieved (p < .05). Preoperative FSFI scores were similar in Group 1 and Group 2 (p = .147). While the preoperative FSFI scores were 17.00 ± 3.73 and 14.84 ± 3.72 for Group 1 and Group 2, respectively, the scores after the treatment were 22.85 ± 5.01 and 21.98 ± 5.01 on the 30th day, and 24.62 ± 6.06 and 24.19 ± 6.05 on the 90th day postoperatively. Significant improvement was observed in FSFI scores with treatment, and no difference was observed between the two groups in terms of treatment response (p = .706). CONCLUSIONS: Intravesical BoNT-A injection in the treatment of women with refractory IC/BPS improves sexual functions. It also significantly improves pain and symptom scores. Both trigone-sparing and trigone-including injections are similarly safe and effective.

Effect of lomeguatrib-temozolomide combination on MGMT promoter methylation and expression in primary glioblastoma tumor cells.

Temozolomide (TMZ) is commonly used in the treatment of glioblastoma (GBM). The MGMT repair enzyme (O (6)-methylguanine-DNA methyltransferase) is an important factor causing chemotherapeutic resistance. MGMT prevents the formation of toxic effects of alkyl adducts by removing them from the DNA. Therefore, MGMT inhibition is an interesting therapeutic approach to circumvent TMZ resistance. The aim of the study was to investigate the effect of the combination of lomeguatrib (an MGMT inactivator) with TMZ, on MGMT expression and methylation. Primary cell cultures were obtained from GBM tumor tissues. The sensitivity of primary GBM cell cultures and GBM cell lines to TMZ, and to the combination of TMZ and lomeguatrib, was determined by a cytotoxicity assay (MTT). MGMT and p53 expression, and MGMT methylation were investigated after drug application. In addition, the proportion of apoptotic cells and DNA fragmentation was analyzed. The combination of TMZ and lomeguatrib in primary GBM cell cultures and glioma cell lines decreased MGMT expression, increased p53 expression, and did not change MGMT methylation. Moreover, apoptosis was induced and DNA fragmentation was increased in cells. In addition, we also showed that lomeguatrib-TMZ combination did not have any effect on the cell cycle. Finally, we determined that the sensitivity of each primary GBM cells and glioma cell lines to the lomeguatrib-TMZ combination was different and significantly associated with the structure of MGMT methylation. Our study suggests that lomeguatrib can be used with TMZ for GBM treatment, although further clinical studies will be needed so as to determine the feasibility of this therapeutic approach.

Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones.

OBJECTIVES: To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10-20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications. PATIENTS AND METHODS: A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments <3 mm. The success rates, auxiliary procedures, and complications were compared in each group. RESULTS: Success rates were 66.5, 91.4, and 87% for SWL, PNL, and RIRS (p < 0.001). The need for auxiliary procedures was more common after SWL than PNL and RIRS (21.9 vs 5.7 vs 8.7%, respectively; p < 0.001). The overall complication rates for the SWL, PNL, and RIRS were 7.6, 22.1, and 10.9%, respectively (p < 0.001). Thirteen patients in PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p < 0.001). Fluoroscopy and operation time were significantly longer in the PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively). CONCLUSIONS: For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.

Cervical stromal involvement can predict survival in advanced endometrial carcinoma: a review of 67 patients.

PURPOSE: To assess clinical, surgical and pathologic variables in survival of advanced endometrial cancer. METHODS: Sixty-seven advanced-stage (stages III and IV according to FIGO 2009) endometrial cancer cases were evaluated retrospectively. The effects on survival of age, histologic subtype, stage, grade, myometrial invasion, optimal cytoreduction, parity and cervical involvement were analyzed. RESULTS: Cervical involvement (P = 0.033) and nulliparity (P = 0.042) were worsening features in terms of survival. In 56 cases (83.5%) optimal cytoreduction could be achieved and survival was significantly longer in this group than the group who were not optimally cytoreduced (mean 30.4 vs. 9.6 months) (P < 0.01). Depth of myometrial invasion, histologic type of tumor, stage, grade, and age younger or older than 60 years were not found to be related to survival. Neither adjuvant therapy type nor their combination were superior to each other for improving survival. CONCLUSIONS: Cervical stromal involvement is a poor prognostic factor in cases of advanced endometrial carcinoma. Further studies are required to describe the effect of different surgical approaches such as radical hysterectomy on survival in the presence of cervical stromal invasion.