Examination of Risk of Depression and Perception of Social Support in Pregnant Women Undergoing Intrauterine Intervention.

BACKGROUND: Interventions during pregnancy might increase the risk of depression becausethey may cause anxiety and stress in the mother. In these cases, it is important to provide social support to pregnant women. AIM: This study aimed to determine the relationship between the risk of depression and the perception of social support in pregnant women who had undergone intrauterine intervention (IUI). METHODS: The population of this descriptive study consisted of all pregnant women (n = 267) who attended a state hospital in Izmir between March and September 2022 and who had undergone IUI. Data were obtained using a sociodemographic data form, the Beck Depression Inventory (BDI), and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics and the Chi-square test were used in the study. RESULTS: In this study, of the women, 42.7% had ≥3 pregnancies; the gestational week of 93.6% of the pregnant women was between 13-24 weeks. The mean scores of the pregnant women were 11.12 ± 8.04 on the BDI and 61.06 ± 19.84 on the MSPSS. According to the results of the correlation analysis, there was a weak (<0.05) negative reverse correlation between the scales. CONCLUSIONS: In the results of this study, it has been determined that as perceived social support increases in pregnant women, symptoms of depression are less likely to occur. This result is important in terms of indicating the need for providing social support to pregnant women. Women should be able to identify depression risk factors during this process to receive appropriate care and support.

Assessment of Hospital Medical Emergency Team Operations in a Tertiary Care Center in Turkey.

BACKGROUND: Rapid Response Teams, strategically devised to mitigate mortality and morbidity stemming from unforeseen deteriorations and cardiac arrests within healthcare facilities, are ubiquitously implemented on a global scale. AIM: The aim of the study is to compare emergency physicians (EPs) and non-EPs on management protocols of Hospital Medical Emergency Teams (HoMET). METHODS: This was a retrospective cross-sectional study. The hospital archive underwent a retrospective scanning process, and patient records were meticulously examined. The assessment encompassed various facets, including demographic characteristics, activation locations, and response and intervention times of HoMET teams, composed of both EPs and other healthcare professionals. Data analysis was conducted using SPSS software version 20.0. RESULTS: A total of 1056 calls were included, with 52% (n = 549) involving male patients. The average age was 67.15 ± 19.45 years. EPs served as the team leader in 53% of the calls. Cardiac arrest was considered in 93.6% of the cases. The EPs group exhibited a higher average patient age, longer intervention times, and shorter arrival times (P < 0.001, P = 0.027, P < 0.001, respectively). A significant difference was observed in the locations of the calls and the groups of calls considering cardiac arrest (P < 0.001, P < 0.001, respectively). CONCLUSION: The optimization of intervention teams is imperative given the persistently high incidence and mortality rates associated with in-hospital cardiac arrests. Leveraging the expertise of EPs in the management of arrests and critical patients can potentially enhance the effectiveness of these teams. Nonetheless, further research is warranted to comprehensively explore and validate this aspect.

The protective effect of the proteasome inhibitor bortezomib on the uterus of ovariectomized rats.

Bortezomib (BORT) is an anti-tumour agent that inhibits proteasome, which is responsible for the degradation of many intracellular proteins. Although some side-effects and chemotherapeutic effects of BORT are known, there has not been enough research regarding its effects on different tissues of proteasome inhibition in the senile period (post-menopausal). The aim of this study was to investigate the safety of using BORT during the post-menopausal period. The post-menopausal effects of BORT were investigated on ovariectomized (OVX) Spraque-Dawley rats. The female rats were separated into three groups: control, ovariectomized (OVX), and OVX + BORT. OVX and OVX + BORT groups consisted of six rats in each. BORT was administered intraperitoneally in a dosage of 0.2 mg/kg two days a week for four weeks after OVX. The uteri of the rats were investigated using morphometrical, histopathological, and immunohistopathological methods. A striking atrophy in the endometrium and myometrium was observed due to an estrogen deficiency in the OVX group. The partial protective effect of BORT administration was observed morphometrically and histopathologically. In immunohistochemical research, cytoplasmic NF-KB activity was observed in the presence of proteasome inhibition in the endometrium. In light of these findings, the limited protective effects of post-menopausal BORT administration are worth mentioning.

Success of custom total joint replacement simultaneous with orthognathic surgery in patients with idiopathic condylar resorption.

The aim of this study was to evaluate the aesthetic and functional outcomes of custom alloplastic total joint replacement combined with orthognathic surgery (cTJR + OS) in patients with idiopathic condylar resorption. Thirteen patients who underwent cTJR + OS between 2015 and 2022 were analysed retrospectively. Primary outcomes were maximum inter-incisal opening (MIO), scores for joint pain, jaw function, diet, sleep apnoea, and aesthetics. Secondary outcomes were cranial nerve VII deficits, infection, heterotopic ossification, prosthesis failure with need for reoperation, and bleeding. Clinical data were collected for a minimum 24 months post-surgery; postoperative data were compared with the preoperative data. Mean follow-up was 39.6 months. Significant improvements were observed in joint pain (P = 0.026), jaw function (P = 0.004), diet (P = 0.004), sleep apnoea (P = 0.001), and aesthetics (P = 0.001) scores, as well as in MIO (P = 0.006). The greatest improvements (preoperative to postoperative) were obtained for aesthetics and sleep apnoea, and the smallest for joint pain and MIO. Early and mid-term results were very satisfactory in terms of the patients' perceptions of the outcomes investigated. Optimization of the prosthesis design and increasing surgical experience may contribute to significant improvements in patient outcomes.

Is atrial fibrillation a risk factor for hearing loss?

OBJECTIVE: In the present study, we sought to evaluate the results of hearing loss in AF patients. PATIENTS AND METHODS: This study involved 50 patients with AF, as determined by means of electrocardiogram, and 50 patients without AF. The pure-tone audiometry (PTA) threshold values were measured at low, medium and high frequencies for both ears. The signal-to-noise ratio (SNR) DPOAEs and TEOAEs were also analyzed for both ears separately. RESULTS: Both the airway and bone conduction PTA thresholds at 3, 4 and 6 kHz (kilohertz) were significantly lower in the AF group than in the control group (p<0.05). The AF patients exhibited worse hearing and worse TEOAE results at 1, 2, 3 and 4 kHz. In fact, the TEOAE amplitudes of the AF group were significantly lower in both the right and left ears at 2, 3 and 4 kHz when compared with the control group (p<0.05). Moreover, the DPOAE amplitudes in the AF group were statistically significantly lower at 3.4 kHz in both ears when compared with the control group (p<0.05). CONCLUSIONS: In light of these findings, we believe that AF is a risk factor for hearing.

How advantageous is it to use computed tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

OBJECTIVE: Cholesteatoma (CHO) developing secondary to chronic otitis media (COM) can spread rapidly and cause important health problems such as hearing loss. Therefore, the presence of CHO should be diagnosed promptly with high accuracy and then treated surgically. The aim of this study was to investigate the effectiveness of artificial intelligence applications (AIA) in documenting the presence of CHO based on computed tomography (CT) images. PATIENTS AND METHODS: The study was performed on CT images of 100 CHO, 100 non-cholesteatoma (N-CHO) COM, and 100 control patients. Two AIA models including ResNet50 and MobileNetV2 were used for the classification of the images. RESULTS: Overall accuracy rate was 93.33% for the ResNet50 model and 86.67% for the MobilNetV2 model. Moreover, the diagnostic accuracy rates of these two models were 100% and 95% in the CHO group, 90% and 85% in the N-CHO group, and 90% and 80% in the control group, respectively. CONCLUSIONS: These results indicate that the use of AIA in the diagnosis of CHO will improve the diagnostic accuracy rates and will also help physicians in terms of reducing their workload and facilitating the selection of the correct treatment strategy.

Cognitive Science in a Nutshell.

We propose a novel characterization of the core of cognitive science as the study of how agents perform tasks, where agents and tasks are both broadly construed. We motivate the focus on agents and tasks through a discussion of their prevalence in cognitive science, their utility in identifying topics close to and distant from cognitive science, and their applicability to prominent issues in the field. We argue that our proposal clearly and succinctly highlights the distinctive characteristics of cognitive science and simultaneously motivates its interdisciplinary approach without losing sight of its roots in the study of information processing and cognitive representations.

[Efficiency, risks, and advantages of using robotic support systems in interventional medicine]. / Leistungsfähigkeit, Risiken und Vorteile des Einsatzes der Robotik in medizinisch-operativen Disziplinen.

During the past decade, robotic systems were evaluated for the first time in practically all surgical disciplines. With only a few exceptions (radical prostatectomy), mechatronic systems did not achieve a breakthrough in any field of application. Second generation robotic devices with better integration of complementary technologies (preoperative therapy planning, intraoperative diagnostic work-up, navigation, etc.) and augmented functionality are now ready to be introduced into clinical practice. It is hoped that the specific advantages of robotics will result in increased use compared to previous systems. Robotics is a key technology if new surgical strategies ("scarless surgery") are to succeed.

Evaluation of mist production and tissue dissection efficiency using different types of ultrasound shears.

BACKGROUND: Ultrasound shears often are applied in minimally invasive surgery because they facilitate fast and secure tissue dissection, thereby reducing operative time. Although the technical principle underlying all the shears is almost identical, considerable differences exist between specific instruments. However, production of disturbing mist should be avoided. METHODS: To obtain quantitative measurements regarding mist production, a novel hermetically sealed test system was developed. Tissue dissection efficiency was evaluated by means of a standardized cutting test. The dissection time and the numbers of cuttings were recorded. In this study, four different ultrasound dissectors from three manufacturers were assessed. One manufacturer provided two instruments: a conventional instrument and an improved version, which was designed particularly to reduce mist emission. RESULTS: The fastest ultrasound dissector emitted the highest quantity of disturbing mist. However, improved dissection efficiency does not linearly correlate with mist production. This clearly could be shown for the improved "less mist production instrument," which turned out to work faster than the comparable standard dissector but produced significantly less mist. CONCLUSION: Ultrasonic shears are effective for bloodless tissue dissection but may impede surgical proceeding by mist production. The findings of this study demonstrate that emission of mist can be reduced not only by lowering the dissection power, resulting in a prolonged dissection time, but also by modifying the technical design of an instrument. Further development of ultrasonic cutting devices therefore should account for the desired results.

Instrumentation and surgical technique for an innovative safe sigmoid approach for NOTES.

A set of new instruments was designed to establish an access to the abdominal cavity for NOTES via the rectosigmoid. It comprehends a metal overtube which is positioned using a modified TEM device. The entry point is targeted by transrectal ultrasound and secured by a purse-string suture. Closure is achieved by means of a linear stapler application. The applicability of the system could already be confirmed in animal survival studies.

An innovative, safe and sterile sigmoid access (ISSA) for NOTES.

BACKGROUND AND STUDY AIMS: The use of a transcolonic approach for natural orifice transluminal endoscopic surgery (NOTES) offers relevant advantages compared with a transgastric procedure. However both techniques are still limited by specific shortcomings that need to be resolved before the transluminal approach can be translated to human applications. In this article we describe an innovative method for a transcolonic procedure, which might represent the next step forward in NOTES. PATIENTS AND METHODS: In three acute and five survival porcine models we evaluated a specially designed guide tube, which is inserted via a transcolonic approach into the abdominal cavity after intraperitoneal instillation of a decontamination solution. After endoscopic evaluation of the abdomen the closure of the entry site was performed surgically. Main parameters obtained in the study were the feasibility and safety of the approach, the bacterial contamination due to the transcolonic procedure, and the safe closure of the entry site. Animals in the survival model were euthanized 10 days after the procedure. RESULTS: The transcolonic approach took place without complications. There was no bleeding or laceration of adjacent organs. The surgical closure guaranteed a leak-proof closure of the entry site. All pigs in the survival model showed an excellent postinterventional course. At necropsy, the colonic incision sites were completely closed and appeared well healed. No abscesses or any sign of inflammation could be identified. CONCLUSIONS: The transcolonic approach using an innovative guide tube is feasible and safe. The technique described offers mentionable advantages and therefore reduces the known shortcomings of NOTES. However, further studies are needed to approve our results of an initial evaluation.

Interfacial behavior of common food contact polymer additives.

Irganox 1076 (IN1076) and Irganox 1010 (IN1010), phenol containing species often used as antioxidant additives in food packaging polymers have both hydrophilic and hydrophobic functional groups. Consequently these additives are likely to absorb to surfaces where their free energy is minimized. Experiments described in this work examine the two-dimensional phase behavior and vibrational structure of IN1076 and IN1010 films adsorbed to the air/water interface. Surface pressure isotherms show that repeated compression of these films leads to continued irreversible loss of molecules and that on a per molecule basis, this loss is more pronounced for IN1076 than for IN1010. Differences in the surface properties of these two antioxidant additives are interpreted based on differences in molecular structure. Surface specific vibrational measurements of these organic films show very little conformational order, implying that even when closely packed, both antioxidant species have little affinity for forming highly organized domains. These findings have important ramifications for mechanisms that reduce antioxidant activity in polymers as well as descriptions of antioxidant blooming on polymer surfaces.

Minimally invasive anterior contralateral approach for the treatment of cervical disc herniation.

BACKGROUND: During the practice of ipsilateral approach to the offending lesion in anterior simple discectomy, the authors realized that it achieves better surgical exposure of the opposite foraminal area. In addition, it was also realized that routine procedures for better visualization of the foraminal area, such as stripping longus colli muscles, further excising of the anterior longitudinal ligament, or using a spreader, which cause more invasive surgery during the standard anterior approach, are not necessary because the contralateral approach already achieves sufficient exposure of the target foraminal area. OBJECTIVE: Evaluation of the results and effectiveness of this minimal invasive technique in patients with either soft or hard disc herniations. METHODS: Between January 1994 and April 2002, 216 patients underwent anterior contralateral microdiscectomy without fusion for cervical disc herniation at 1 or 2 adjacent levels. Anterior contralateral microdiscectomy is a less invasive technique than standard anterior simple discectomy in which longus colli muscles are not stripped, and the lateral part of annulus fibrosis at the side of intervention and ventrolateral part of it at the opposite side are not removed. In addition, a mini Zenker handheld retractor is used for retraction of paravertebral soft tissues and a spreader is not used during the discectomy procedure. There were 182 patients diagnosed with radiculopathy and 34 patients with myelopathy. Assessments of the neurological status of patients with radiculopathy were done by physical examinations, and of those with myelopathy according to the modified Japanese Orthopaedic Association cervical spine functional assessment scale. These neurological assessments were repeated in the 18th month after surgery. In the follow-up period, the outcomes of surgery were also assessed for all patients in 4 categories, from failure to excellent. RESULTS: Surgery outcomes generally have been good to excellent and none of the patients were made worse by the procedure. The outcomes were significantly better in the radiculopathy and soft disc herniation groups. Other positive outcome factors were short duration and sudden onset of symptoms, normal cervical curvature, and single-level disease. Follow-up radiological studies revealed fibrous healing with normal or slight loss of disc height in 199 (92.1%) patients and total obliteration of the involved disc space representing radiological fusion signs in 13 (6%) patients. The overall complications observed in this study were 2 spontaneous and 2 postinfection collapses of disc level, 1 excessive fibrosis of disc level, and 2 adjacent-level diseases. CONCLUSION: Anterior contralateral microdiscectomy without fusion achieves better exposure for resection of the offending foraminal or far lateral lesions, ventral osteophytes, or a disc fragment under direct microscopic visualization. Collapse and instability of the involved disc level can also be avoided via this less invasive technique.

Response to growth hormone with respect to pubertal status on increased dose in idiopathic growth hormone deficiency: an analysis of Turkish children in the KIGS database (Pfizer International Growth Study).

AIM: To compare the growth response to growth hormone (GH) treatment in patients with idiopathic GH deficiency (IGHD) who were prepubertal with the response of those who were pubertal at the onset of GH therapy on an increased GH dose. PATIENTS AND METHODS: Among the Turkish patients enrolled in the Pfizer International Growth Study (KIGS) database with the diagnosis of IGHD, the growth data over 2 years of GH therapy were analyzed longitudinally of 113 (79 M) prepubertal (Group 1) and 44 (33 M) pubertal (Group 2) patients. Pubertal signs were reported to be present initially or to have appeared within 6 months of GH therapy in Group 2. Mean +/- SD age at onset of therapy was 8.7 +/- 3.5 and 13.5 +/- 1.8 years; height SDS -4.2 +/- 1.4 and -3.2 +/- 1.1 (p < 0.05) in Groups 1 and 2, respectively. Mid-parental height (MPH) SDS did not show a significant difference between the two groups (-1.5 +/- 1.1 vs -1.7 +/- 1.1). RESULTS: Delta height SDS over 2 years of therapy was significantly higher in Group 1 (1.1 +/- 1.0) than in Group 2 (0.7 +/- 0.6) (p <0.05) in spite of a significantly lower dose of GH (14.6 +/- 3.3 in Group 1 vs 17.0 +/- 3.1 IU/m2/week in Group 2, p < 0.05). Ht--MPH SDS showed an increase from -2.4 +/- 1.7 to -1.4 +/- 1.5 in Group 1 and from -1.5 +/- 1.5 to -0.8 +/- 1.3 in Group 2. Overall delta height SDS showed negative correlations with age (r = -0.32), height SDS (r = -0.41) and height--MPH SDS (r = -0.40) at onset of therapy (p < 0.001). CONCLUSIONS: These data show that in IGHD the slight increase (15-20%) in the dose of GH during puberty was not adequate to maintain height velocity at the same magnitude as in prepuberty, and thus was not cost effective.

Is there a correlation between the pineal gland calcification and migraine?

OBJECTIVE: The pineal gland calcifications have been associated with some diseases such as cerebral infarction, Alzheimer's disease and intracerebral hemorrhage while most cases are considered idiopathic and physiologic. However, there are limited data in the current literature about the association of pineal calcification and migraine. Our aim was to evaluate this association between migraine and pineal calcification by computed tomography of the brain. PATIENTS AND METHODS: In our study, we assessed the computed tomography images of patients, who referred to the neurology outpatient clinic with the complaint of headache and were diagnosed with migraine without aura based according to 2004 criteria of the International Headache Society. 503 migraine patients and 500 control subjects without migraine diagnosis were included in this study. RESULTS: When migraine and control groups were compared by pineal calcification, the rates were determined as 80, 6% and 55% in migraine and control group, respectively. The difference was statistically significant (p < 0.001). In addition, it was seen that pineal calcifications, detected in migraine patients, did not show age-related increase. CONCLUSIONS: According to our data, we can point that pineal calcification may be associated with migraine.

Investigation of Heschl's gyrus and planum temporale in patients with schizophrenia and bipolar disorder: a proton magnetic resonance spectroscopy study.

BACKGROUND: Superior temporal cortices include brain regions dedicated to auditory processing and several lines of evidence suggest structural and functional abnormalities in both schizophrenia and bipolar disorder within this brain region. However, possible glutamatergic dysfunction within this region has not been investigated in adult patients. METHODS: Thirty patients with schizophrenia (38.67±12.46years of age), 28 euthymic patients with bipolar I disorder (35.32±9.12years of age), and 30 age-, gender- and education-matched healthy controls were enrolled. Proton magnetic resonance spectroscopy data were acquired using a 3.0T Siemens MAGNETOM TIM Trio MR system and single voxel Point REsolved Spectroscopy Sequence (PRESS) in order to quantify brain metabolites within the left and right Heschl's gyrus and planum temporale of superior temporal cortices. RESULTS: There were significant abnormalities in glutamate (Glu) (F(2,78)=8.52, p<0.0001), N-acetyl aspartate (tNAA) (F(2,81)=5.73, p=0.005), creatine (tCr) (F(2,83)=5.91, p=0.004) and inositol (Ins) (F(2,82)=8.49, p<0.0001) concentrations in the left superior temporal cortex. In general, metabolite levels were lower for bipolar disorder patients when compared to healthy participants. Moreover, patients with bipolar disorder exhibited significantly lower tCr and Ins concentrations when compared to schizophrenia patients. In addition, we have found significant correlations between the superior temporal cortex metabolites and clinical measures. CONCLUSION: As the left auditory cortices are associated with language and speech, left hemisphere specific abnormalities may have clinical significance. Our findings are suggestive of shared glutamatergic abnormalities in schizophrenia and bipolar disorder.

The identification of 5 alpha-reductase-2 and 17 beta-hydroxysteroid dehydrogenase-3 gene defects in male pseudohermaphrodites from a Turkish kindred.

Male pseudohermaphroditism (MPH) is characterized by incomplete differentiation of male genitalia in the presence of testicular tissue. Enzymatic defects involving androgen synthesis or action are causes of MPH. We studied the molecular genetics of a large isolated inbred Turkish kindred with MPH due to either 5 alpha-reductase-2 (SRD5A2) or 17 beta-hydroxysteroid dehydrogenase-3 (17 beta HSD3) gene defects. Using single strand DNA conformational polymorphism analysis and DNA sequencing, a new mutation in exon 5 of SRD5A2 gene was detected in certain male pseudohermaphrodites from this kindred. This single base deletion (adenine) resulted in a frame shift at amino acid position 251 resulting in the addition of 23 amino acids at the carboxyl-terminal of this 254-amino acid isozyme. Transfection expression of the mutant isozyme in CV1 cells showed a complete loss of enzymatic activity in the conversion of [14C]testosterone to dihydrotestosterone, without a change in the messenger ribonucleic acid level compared to that of the wild-type isozyme. Analysis of the 17 beta HSD3 gene in other male pseudohermaphrodites from this kindred revealed a single point mutation (G-->A) at the boundary between intron 8 and exon 9, disrupting the splice acceptor site of exon 9. In this kindred, in addition to the identification of male pseudohermaphrodites with either a homozygous SRD5A2 or 17 beta HSD3 gene defect, other male pseudohermaphrodites were found to be genetically more complex: e.g. homozygous for the SRD5A2 defect and heterozygous for the 17 beta HSD3 defect, or homozygous for the 17 beta HSD3 defect and heterozygous for the SRD5A2 defect. Also, phenotypically normal carriers were identified with either one or both gene defects. Homozygous male pseudohermaphrodites with SRD5A2 or 17 beta HSD3 gene defects were phenotypically distinguishable by the presence of mild gynecomastia in the latter. Hormone data were consistent with the particular homozygous gene defect. In summary, we show 1) the novel existence of two gene defects, SRD5A2 and 17 beta HSD3, each causing MPH within a large isolated Turkish kindred; 2) that the two defects segregate independently and may be inherited from two different progenitors; and 3) analysis of a new mutation in exon 5 of SRD5A2 gene, supporting the functional importance of the carboxyl-terminal of 5 alpha-reductase-2 isozyme.

Disseminated Strongyloides stercoralis in human immunodeficiency virus-infected patients. Treatment failure and a review of the literature.

We describe a North American human immunodeficiency virus (HIV)-positive patient with Strongyloides stercoralis infection of the gastrointestinal tract, who required repeated "standard" courses of thiabendazole. Pulmonary infection with numerous roundworms developed, as suspected by bronchoalveolar lavage, and while he was receiving therapy, dissemination occurred. On autopsy, S stercoralis was recovered in the gastrointestinal tract, liver, lung, and heart. After a literature review, we conclude that HIV-positive patients have a higher risk of dissemination and "standard" treatment failure. This may occur without elevation of IgE or eosinophilia. Those patients may require prolonged courses of thiabendazole or alternatively ivermectin therapy.

Testicular dysfunction in human immunodeficiency virus-infected men.

This review pertains to gonadal function in men with human immunodeficiency virus (HIV) infection, who often exhibit clinical and biochemical evidence of hypogonadism. Hypogonadotropic hypogonadism appears to be the most commonly encountered abnormality, although complete anterior pituitary insufficiency and primary gonadal failure have been reported. Levels of sex hormone-binding globulin (SHBG) are either unchanged or increased. Plasma levels of estrogens, progesterone, androstenedione, dehydroepiandrosterone sulfate (DHEA-S), and prolactin vary. Pathologically, except for involvement by opportunistic infections, no significant abnormality in the hypothalamic-pituitary area has been described, but evidence of orchitis is commonly present. The cause(s) of these abnormalities remains unclear. The possible factors leading to hypogonadism in HIV-infected men include HIV infection itself, opportunistic infections, chronic debilitating illness, and effects of cytokines on the hypothalamic-pituitary-gonadal axis. Further studies are needed to clarify the cause(s) of testicular dysfunction in HIV-infected men and its clinical significance, treatment, relevance to the progression of HIV infection, and influence on the immune system.