First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey.

AIM: To report, for the first time, the incidence and prevalence of childhood Type 1 diabetes in Turkey using a nationwide registry. METHODS: Information on birth date, city of birth, diagnosis date and gender of all patients with Type 1 diabetes aged < 18 years were obtained from the Turkish Social Security Institute for the period from January 2011 to December 2013. RESULTS: There were 17 175 prevalent cases of Type 1 diabetes over the 3-year period. The prevalence of Type 1 diabetes was 0.75/1 000 (95% CI 0.74-0.76) and was higher in girls than in boys (0.79 vs 0.72 /1 000; P < 0.01). There were 2465 incident cases in 2013. The incidence was slightly higher among girls (50.6%) than boys (49.4%); the girl:boy case ratio was 1.02. The incidence was 10.4/100 000 for boys and 11.3/100 000 for girls. The age-standardized incidence rate was 10.8 per 100 000 (95% CI 10.1-11.5) according to the WHO standard population, estimated using the direct method. The mean patient age at diagnosis was 10.6 ± 4.6 years. The highest proportion of cases (40.6%) was diagnosed in children aged 10-14 years. CONCLUSIONS: This is the first study to report the incidence and prevalence of Type 1 diabetes in children in Turkey. The incidence of Type 1 diabetes reflects the geographical location of Turkey, bridging Asia and Europe, with the incidence being higher than in Asia but lower than in Europe.

Depression Diagnosis Modeling With Advanced Computational Methods: Frequency-Domain eMVAR and Deep Learning.

Electroencephalogram (EEG)-based automated depression diagnosis systems have been suggested for early and accurate detection of mood disorders. EEG signals are highly irregular, nonlinear, and nonstationary in nature and are traditionally studied from a linear viewpoint by means of statistical and frequency features. Since, linear metrics present certain limitations and nonlinear methods have proven to be an efficient tool in understanding the complexities of the brain in the identification of underlying behavior of biological signals, such as electrocardiogram, EEG and magnetoencephalogram and thus, can be applied to all nonstationary signals. Various nonlinear algorithms can be used in the analysis of EEG signals. In this research paper, we aim to develop a novel methodology for EEG-based depression diagnosis utilizing 2 advanced computational techniques: frequency-domain extended multivariate autoregressive (eMVAR) and deep learning (DL). We proposed a hybrid method comprising a pretrained ResNet-50 and long-short term memory (LSTM) to capture depression-specific information and compared with a strong conventional machine learning (ML) framework having eMVAR connectivity features. The following 8 causality measures, which interpret the interaction mechanisms among spectrally decomposed oscillations, were used to extract features from multivariate EEG time series: directed coherence (DC), directed transfer function (DTF), partial DC (PDC), generalized PDC (gPDC), extended DC (eDC), delayed DC (dDC), extended PDC (ePDC), and delayed PDC (dPDC). The classification accuracies were 84% with DC, 85% with DTF, 95.3% with PDC, 95.1% with gPDC, 84.8% with eDC, 84.6% with dDC, 84.2% with ePDC, and 95.9% with dPDC for the eMVAR framework. Through a DL framework (ResNet-50 + LSTM), the classification accuracy was achieved as 90.22%. The results demonstrate that our DL methodology is a competitive alternative to the strong feature extraction-based ML methods in depression classification.

Current educational status of paediatric rheumatology in Europe: the results of PReS survey.

OBJECTIVES: To understand the status of education and problems in paediatric rheumatology practice in Europe, through a survey. METHODS: A 26-item questionnaire was conducted during the 14th Congress of the Paediatric Rheumatology European Society in Istanbul, 2007. Physicians who were practicing or studying within the field of paediatric rheumatology for at least one year were included in the survey. RESULTS: One hundred and twenty eight physicians, 79 paediatric rheumatologists (including 5 paediatric immunologists and 10 paediatric nephrologists), 34 paediatric rheumatology fellows and 15 adult rheumatologists completed the survey. The physicians were from: Europe 95 (81.9%), South America 12 (10.4%), Middle East 5 (4.3%), Asia 2 (1.7%), Africa 2 (1.7%). The duration of training for paediatric rheumatology ranged between 1-5 years (mean: 3.12+/-1.11). Sixty physicians scored their education as unsatisfactory and among those, 48 physicians were from Europe. Physicians reported good skills in the following items; intraarticular injections (83.3%); soft tissue injections (47.6%); evaluation of radiographs (67.5%); whereas competence in the evaluation of computed tomography/magnetic resonance imaging (30.5%); and musculoskeletal sonography (16.7%) was much lower. A need for improved basic science and rotations among relevant fields were specifically expressed. CONCLUSION: Being a relatively new speciality in the realm of paediatrics, paediatric rheumatology education at the European level needs to be further discussed, revised and uniformed.

Effects of rapamycin treatment on pancreatic fibrosis, cellular apoptosis and oxidative stress in experimental chronic pancreatitis model.

PURPOSE: Rapamycin reduces hepatic fibrosis by inhibiting hepatic stellate cell activation. The present study investigated whether rapamycin treatment could modify the degree of fibrosis, cellular apoptosis and oxidative stress (OS) in an experimental model of CP. METHODS: Fifty-five male, Sprague-Dawley rats weighing 200-400g were randomized into four groups. CP was induced by intraductal trinitrobenzene sulfonic acid (TNBS) infusion in group A (n = 15) and group B (n = 15). Group C (n = 15) received intraductal TNBS and was killed for histologic confirmation at four weeks. Group D (n = 10) received intraductal saline instead of TNBS. Group A and group D received oral rapamycin (2 mg/kg/d) for two weeks after CP was induced while group B received oral tap water instead of rapamycin. Blood and pancreatic tissue specimens were collected and oxidative stress parameters, fibrosis and cellular apoptosis were determined. RESULTS: Tissue and blood malondialdehyde (MDA) levels were significantly lower in rapamycin treated group compared to controls (p < 0.001). Superoxide dismutase (SOD) and glutathion peroxidase (GSH-Px) activities were also significantly higher in the active treatment group (p < 0.001 for both). Tissue and blood MDA, SOD, GSH-Px measurements was similar in rapamycin group and pancreatic cannulation group (p > 0.05). Histopathologic fibrosis scores were similar in rapamycin and control groups. Apoptotic cell counts tended to be lower in rapamycin treated animals. CONCLUSIONS: Administration of rapamycin alleviated OS and, in part, prevented apoptotic cell death in experimental CP, but did not reduce fibrosis.

Muscular involvement in Behçet's disease: case report and review of the literature.

Acute necrotizing myositis is described in a 22-yr-old man with clinically diagnosed Behçet's disease. Light microscopic examination revealed a prominently granulocytic-monocytic infiltration of the muscle with severe necrosis. An infectious (bacterial, fungal or parasitic) etiology could be excluded by specific staining techniques and by immunohistochemistry. Vascular deposition of immune complexes was detected by direct immunofluorescence. Electron microscopy revealed severe structural damage and phagocytosis of muscle fibers. In the endomysium, leukocytes and occasional erythrocytes were found. Virus-like particles were not seen. The relevant literature on muscular involvement in Behçet's disease is reviewed. It is suggested that two different stages of inflammation occur in Behçet's disease. In the acute stage it presents as a granulocytic-monocytic necrotizing reaction developing from a neutrophil-mediated vasculitis. In the later phase lymphocytic infiltrations predominate. Despite the rare involvement of muscles the diagnosis of Behçet's disease should be considered particularly in younger patients presenting with muscular symptoms like pain and swelling pre-dominantly of the lower extremities.

High ethanol tolerance in young adults is associated with the low-activity variant of the promoter of the human serotonin transporter gene.

Central serotonergic neurotransmission has been implicated in the aetiology of ethanol tolerance and dependence. Cellular expression of the serotonin transporter and serotonin reuptake is modulated via a polymorphic, repetitive element in the 5'-flanking regulatory region of the serotonin transporter gene (5-HTTLPR). We report the association of the low-activity, short variant of the 5-HTTLPR with high ethanol tolerance among young adults in a case-control association study (n = 713). The low-activity 5-HTTLPR showed a significantly increased allele frequency (chi2 = 7.30; df = 2; P = 0.007) and genotype frequency among young adults (< or =26 years) with high ethanol tolerance homozygous for the short allele (chi2 = 7.58; df = 1; P = 0.02). The estimated odds ratio for the homozygous short variant compared to the homozygous long variant was 2.82 (95% CI 1.30-6.11). This indicates that the low-activity 5-HTTLPR may be involved in the neuronal mechanisms responsible for ethanol tolerance and dependence.

Comparison of short- and long-term cyclosporine A therapy in chronic idiopathic urticaria.

BACKGROUND: Chronic idiopathic urticaria is sometimes difficult to treat, with little response to antihistamine therapy. OBJECTIVE: In a limited number of severe chronic idiopathic urticaria patients, cyclosporine A (CsA) therapy was found to be effective. In this study, we compared the clinical efficacy and safety of short- and long-term CsA applications. METHODS: Twenty patients with severe disease, unresponsive to antihistamines and showing a positive autologous serum skin test (ASST) were randomized to 4 mg/kg per day of CsA for 4 or 12 weeks. The clinical efficacy was measured with a daily activity score of weal numbers and itch (UAS). The two groups were compared in terms of mean reduction in UAS and ASST response to pre-and post-treatment sera. RESULTS: The clinical improvement was dramatic in the first month of treatment in both groups. There was no significant difference in the frequency of responses, side effects and the reduction of UAS in either group. CONCLUSION: The preliminary results of our study suggest that CsA is clinically effective for chronic urticaria. The prolonged use of this therapy for more than 1 month provides little benefit in the clinical improvement.

[Discrepancies between police breath alcohol measurements in a field trial and blood alcohol concentration according to BGA guidelines and possible consequences for citizens]. / Diskrepanzen zwischen polizeilichen AAK-Messungen im Feldversuch und BAK-Bestimmungen nach BGA-Richtlinien sowie mögliche Konsequenzen für Betroffene.

Divergences between breath-alcohol values measured on the occasion of police field experiments and precise blood-alcohol determinations according to guidelines of the German National Institute of Health (BGA) are reported. In 169 selected cases the difference of time between breath analysis and drawing the blood sample was less than 15 minutes. The consequences regarding forensic relevant cut-off values (0.8, 1.1, and 1.6/1000 resp.) are discussed.

Acute hand ischemia after radial artery cannulation resulting in amputation.

Although radial artery cannulation is a common procedure, in rare cases, it can cause thrombosis leading to severe ischemia of the hand and potentially subsequent gangrene resulting in tissue loss. In this case report, a patient who developed a severely ischemic left hand subsequent to radial artery cannulation is presented. Doppler ultrasound studies showed adequate flow in the patient's hand, however complete thrombosis of the radial artery and significant low flow of the ulnar artery were found using arterial angiogram. The ischemia progressed and surgical intervention to revascularize the hand was unsuccessful, which led to the ultimate amputation of the patient's hand. In cases such as these, where Doppler ultrasound findings show flow but the hand ischemia continues to progress, further diagnostic studies and surgical intervention should be performed as soon as possible to minimize the amount of tissue loss.

Evaluation of treatment outcomes of early-stage endometrial cancer radiotherapy: a single center experience.

BACKGROUND: Postoperative adjuvant radiotherapy (RT) in the management of early stage endometrial cancer (EC) is still controversial. Here we report our institutional experience with patients who received postoperative RT for stage I-II EC over a period of 35 years and assess potential predictors of local recurrence (LR), distant metastasis (DM), and overall survival (OS). MATERIALS AND METHODS: A total of 188 patients undergoing postoperative RT for stage IA-II EC between 1977 and 2012 were evaluated. Some 96 received median 46 Gy whole pelvic radiotherapy (WPRT) (range: 40-60 Gy), 37 were given WPRT with vaginal cuff therapy (VCT), and 55 received only VCT either with brachytherapy (BT) or stereotactic body radiotherapy (SBRT). Chemotherapy was given to 5 patients with uterine papillary serous carcinoma (UPSC). Logistic regression analysis was used to assess the effect of clinicopathological factors on LR, DM, and OS. RESULTS: Median follow-up time was 11 years (range: 1-35 years). At the time of analysis, 34 patients were not alive. Of the 15 patients with LR, 7 (46.7%) recurred in the vaginal stump, 5 (33.3%) in the pelvic region, and 3 (20%) in the paraaortic nodal region, while 12 had distant metastasis. UPSC histology (p=0.027), sole VCT (p=0.041), high histologic grade (p=0.034), and age≥71 (p=0.04) were poor prognostic factors on univariate analysis. CONCLUSIONS: In our patients receiving radiotherapy for early-stage EC, grade III disease and age≥71 were associated with shorter OS whereas UPSC histology was an independent predictor for both LR and DM.

Update on treatment options for spinal brucellosis.

We evaluated the efficacy and tolerability of antibiotic regimens and optimal duration of therapy in complicated and uncomplicated forms of spinal brucellosis. This is a multicentre, retrospective and comparative study involving a total of 293 patients with spinal brucellosis from 19 health institutions. Comparison of complicated and uncomplicated spinal brucellosis was statistically analysed. Complicated spinal brucellosis was diagnosed in 78 (26.6%) of our patients. Clinical presentation was found to be significantly more acute, with fever and weight loss, in patients in the complicated group. They had significantly higher leukocyte and platelet counts, erythrocyte sedimentation rates and C-reactive protein levels, and lower haemoglobulin levels. The involvement of the thoracic spine was significantly more frequent in complicated cases. Spondylodiscitis was complicated, with paravertebral abscess in 38 (13.0%), prevertebral abscess in 13 (4.4%), epidural abscess in 30 (10.2%), psoas abscess in 10 (3.4%) and radiculitis in 8 (2.7%) patients. The five major combination regimens were: doxycycline 200 mg/day, rifampicin 600 mg/day and streptomycin 1 g/day; doxycycline 200 mg/day, rifampicin 600 mg/day and gentamicin 5 mg/kg; doxycycline 200 mg/day and rifampicin 600 mg/day; doxycycline 200 mg/day and streptomycin 1 g/day; and doxycycline 200 mg/day, rifampicin 600 mg/day and ciprofloxacin 1 g/day. There were no significant therapeutic differences between these antibiotic groups; the results were similar regarding the complicated and uncomplicated groups. Patients were mostly treated with doxycycline and rifampicin with or without an aminoglycoside. In the former subgroup, complicated cases received antibiotics for a longer duration than uncomplicated cases. Early recognition of complicated cases is critical in preventing devastating complications. Antimicrobial treatment should be prolonged in complicated spinal brucellosis in particular.

Morphology of non-vascular intracerebral fluid spaces.

In the electron microscope the value for the extracellular space (ECS) in the mammalian CNS was suggested of several percent to about one third dependent on the method how it was evaluated. Since von Harreveld introduced 1965 cryofixation to estimate the extension of the ECS, the method has been never applied in brain edema research. We carried out improved low temperature methods to measure the extracellular space of the mammalian CNS in physiological conditions. Small samples of brain tissue were cryofixed by slam freezing on a precooled metal mirror and substituted with ethanol at -95 degrees C over 17 hours. The embedding procedure was carried out at -22 degrees C with LR-White under UV-irradiation. ECS was measured computer assisted with Bioquant Software. The values for the ECS of the cryofixed normal rat brain were more than twice compared to the usual transmission electron microscopy (16.3% to 7.4%, p < 0.01) and close to those estimated by von Harreveld (18.1-25.5%, 1965). It was interesting that the data obtained in cryofixed normal rat brain correspond to the extension measured in rat brain with irradiation edema, which was conventionally treated for EM. Greater variance of ECS in cryofixed brain (16.3% +/- 3.4) demonstrate that it is far more variable than expected. This data correspond closely to the in vivo ECS. The morphological evaluation of brain edema should be revised under this premise.

[Adjuvant therapy of primary malignant melanoma with natural human interferon-beta. Significant survival advantage in 96 treated patients in comparison with 288 untreated symptomatic controls]. / Adjuvante Therapie des primären malignen Melanoms mit natürlichem humanen Interferon-beta. Signifikanter Uberlebensvorteil bei 96 behandelten Patienten im Vergleich zu 288 unbehandelten Symptomenzwillingen.

In the dermatological department of Dortmund's Municipal Medical Centre, between May 1986 and April 1991 a total of 105 patients with primary malignant melanoma (stage I) underwent adjuvant treatment with 5 million IU natural interferon beta as a 30-min i.v. infusion three times weekly for 6 months. During follow-up the patients were examined at short intervals and all recurrences and disease-related cases of death were documented up to September 1992. We evaluated the outcome of patients treated with interferon beta (n = 96 with valid notes of tumour thickness) compared with untreated historical controls (n = 288) matched for tumour thickness, localization, and sex, taken from the Central Malignant Melanoma Registry (CMMR) of the German Dermatological Society. Therefore, the main prognostic factors were identical between cases and controls. A computerized randomization was used to fit three control patients to each treated patient. Survival rate and recurrence-free survival were estimated in both groups for a period of 5 years. During the follow-up 3 patients died in the interferon beta group and the 5-year survival rate was 95%, as against 89% in the control group (P < 0.05 for difference between survival curves). Recurrence-free survival curves were also more favourable for interferon-treated patients than for the control group (P = 0.06). A detailed analysis of high-risk patients with tumour thickness of over 1.5 mm also demonstrated obviously better survival (5 years: 95% vs 77%; P = 0.012) and recurrence-free survival rates (5 years: 75% vs 53%; P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Navigation for ankle arthroscopy: anatomical study of the anterolateral portal with reference to the superficial peroneal nerve.

We aimed to navigate the surgeon regarding the localization of the main anatomical structures at the anterior part of the ankle joint, in order to find easily the safest anatomical points with reference to the superficial peroneal nerve (SPN), in particular for anterolateral portal placement in ankle arthroscopy. Sixty-three ankles in 36 fresh cadavers were dissected. In all specimens we examined (1) the distance between the SPN bifurcation and the most distal point of the lateral malleolus; and at the level of ankle joint, (2) the number of SPN, (3) the distance between the medial and intermediate dorsal cutaneous nerves, which are branches of the SPN, (4) the localization of the peroneus tertius (PT) tendon in relation to the lateral malleolus, (5) the width of the extensor digitorum longus (EDL) tendon, (6) the relationship of the PT tendon and (7) the relationship of the extensor hallucis longus (EHL) tendon with the SPN. The results were as follows: (1) In 41 ankles with bifurcation (65%) the average distance was 71.8+/-35.3 mm. (2) There were two SPN branches in 39 (62%), three branches in seven (11%) and one branch in 17 (27%) cases. (3) In 39 ankles with two branches of the SPN, the mean distance was 15.2+/-7.1 mm. (4) The lateral border of the PT tendon was positioned a mean distance of 20.8+/-3.3 mm proximal and 25.2+/-5.8 mm medial to the reference points. (5) The mean width was 10.1+/-2.9 mm. (6) In 42 ankles (67%) the distance between the lateral border of the PT tendon and the SPN was a mean of 6.2+/-6.6 mm, median of 3 mm (range 0-22 mm lateral to the tendon). (7) In 56 cases (89%) a branch of the SPN was found a mean of 6.6+/-4 mm and a median of 6 mm lateral to the EHL tendon, and in seven cases (11%) on the tendon. According to our study, in ankle arthroscopy the risk of the SPN injury is maximal in the 0-3 mm lateral to the PT tendon. To avoid injury to the SPN, the safest placement of the anterolateral portal is 4 mm lateral to the PT tendon.