The impact and future of artificial intelligence in medical genetics and molecular medicine: an ongoing revolution.

Artificial intelligence (AI) platforms have emerged as pivotal tools in genetics and molecular medicine, as in many other fields. The growth in patient data, identification of new diseases and phenotypes, discovery of new intracellular pathways, availability of greater sets of omics data, and the need to continuously analyse them have led to the development of new AI platforms. AI continues to weave its way into the fabric of genetics with the potential to unlock new discoveries and enhance patient care. This technology is setting the stage for breakthroughs across various domains, including dysmorphology, rare hereditary diseases, cancers, clinical microbiomics, the investigation of zoonotic diseases, omics studies in all medical disciplines. AI's role in facilitating a deeper understanding of these areas heralds a new era of personalised medicine, where treatments and diagnoses are tailored to the individual's molecular features, offering a more precise approach to combating genetic or acquired disorders. The significance of these AI platforms is growing as they assist healthcare professionals in the diagnostic and treatment processes, marking a pivotal shift towards more informed, efficient, and effective medical practice. In this review, we will explore the range of AI tools available and show how they have become vital in various sectors of genomic research supporting clinical decisions.

Association of Positive TwaVR/STaVR ECG Changes with Adverse Outcomes in Heart Failure Patients with Reduced Ejection Fraction Undergoing CABG in Turkey: A Retrospective Study.

BACKGROUND: Positive T-wave polarity in the augmented vector right lead (Tw-aVR) and ST-segment deviation in the augmented vector right lead (STaVR) have been identified as potential predictors of adverse outcomes in various cardiac conditions. AIM: The aim of the study was to examine the effect of positive Tw-aVR and STaVR on in-hospital mortality after coronary artery bypass grafting (CABG) surgery in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: A five-year retrospective study was conducted on 250 HFrEF patients who underwent CABG at a tertiary care hospital between January 2018 and December 2022. The primary outcome was in-hospital mortality, and the main exposures were positive Tw-aVR and STaVR on preoperative electrocardiograms. Logistic regression models were used to assess the factors associated with in-hospital mortality. RESULTS: Two hundred and fifty patients with a mean age of 67.4 ± 8.1 years were studied. Males constituted 68% of the participants. Among the participants, 60 (24%) had positive Tw-aVR, and 96 (38.4%) had STaVR. The overall in-hospital mortality rate was 7.6%, and patients with positive Tw-aVR and STaVR had significantly higher mortality rates than those without (odds ratio: 3.62 and 2.87, respectively, P < 0.01). These associations remained significant even after controlling for potential confounders such as age (adjusted odds ratio [AOR]: 1.11; 95% confidence interval [CI]: 1.03-1.20; P = 0.008), sex (AOR: 0.82; 95% CI: 0.31-2.18; P = 0.684), diabetes mellitus (AOR: 2.12; 95% CI: 0.88-5.12; P = 0.091), and chronic kidney disease (AOR: 1.79; 95% CI: 0.75-4.27; P = 0.194). CONCLUSION: Positive Tw-aVR and STaVR were found to be associated with in-hospital mortality in HFrEF patients after CABG. These findings suggest that identifying patients with positive Tw-aVR and STaVR may help identify those at higher risk of adverse outcomes and facilitate closer monitoring and more aggressive interventions.

Popliteal Fossa Sarcomas.

PURPOSE OF THE STUDY Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%-5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample. MATERIAL AND METHODS Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes. The minimum follow-up was 24 months. RESULTS The mean age of the patients was 48 ± 21.23 (range 3-72) years at the time of diagnosis. The mean follow-up was 41.79 ± 16.97 (range 24-120) months. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), unidentified fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (26%). At the latest followup, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease. CONCLUSIONS Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins. Key words: fossa poplitea, sarcoma.

Evaluation of the performance of simple laboratory parameters used in the diagnosis of acute appendicitis.

Background: Acute appendicitis (AA) is one of the most common emergency surgery. Aim: To evaluate the performance of laboratory parameters used in the diagnosis of AA. Subjects and Methods: There were two groups. In both groups, leukocyte (WBC), neutrophil, lymphocyte count, neutrophil/lymphocyte ratio (NLR), mean platelet volume (MPV), red cell distribution width (RDW), and platelet distribution width (PDW) values were examined in complete blood count (CBC). In addition, serum bilirubin (total bilirubin and direct bilirubin) values were examined. All laboratory parameters studied were compared to evaluate their diagnostic performance. Results: A total of 128 people were in the AA group and 122 people were in the healthy group (control). WBC count, neutrophil count, NLR, total bilirubin, direct bilirubin, and PDW values were significantly higher in the AA group than in the control group (P value <0.05). Lymphocyte counts and MPV values in the AA group were significantly lower than in the control group (P value <0.05). The sensitivity and selectivity of the WBC and neutrophil counts in AA were 95.13%, 89.34%, 94.53%, and 93.44%, respectively. The sensitivity and selectivity of the total bilirubin values were 59.38% and 73.77%, respectively. Area under the ROC curve (AUC) values within 95% confidence interval were over 0.900 for neutrophil count, WBC count, direct bilirubin, NLR, and PDW values. AUC values for total bilirubin, lymphocyte count, RDW, and MPV values were below 0.700. Conclusions: Diagnostic performances of the laboratory parameters were determined as follows: neutrophil count > WBC count > direct bilirubin = NLR = PDW > total bilirubin = lymphocyte count = RDW = MPV.

EPISODE OF ACUTE HEMOLYSIS DUE TO UNDIAGNOSED GLUCOSE-6-PHOSPHATE DEHIDROGENASE DEFICIENCY IN AN ADOLESCENT WITH NEWLY DIAGNOSED TYPE 1 DIABETES MELLITUS: CASE REPORT AND REVIEW OF LITERATURE.

Glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency is common in the community. The most important clinical manifestation of G6PD deficiency is acute hemolytic anemia due to oxidative stressors. Diabetes Mellitus (DM) can precipitate hemolysis in patients with G6PD deficiency. Here, we described a 15-year-old male with newly diagnosed type 1 DM (T1DM) and unknown G6PD deficiency who suffered from hemolytic anemia during normalization of blood glucose. On admission, the patient did not have ketoacidosis. After the patient's blood sugars were regulated with insulin therapy, he presented five days later with hemolytic anemia. The cause of hemolytic anemia was G6PD deficiency. The patient had no previous episodes of hemolysis and had no relevant family history. Hypoglycemia did not occur during blood glucose regulation. The return of blood sugar to normal after a long period of hyperglycemia was thought to be the possible cause of hemolysis. In conclusion, G6PD deficiency should be considered when there is an episode of hemolysis in newly diagnosed children and adolescents with T1DM, especially in the absence of ketoacidosis and hypoglycemia.

Giant Cell Tumor of the Proximal Phalanx: Report of two Cases Treated by Two Different Methods and Review of the Literature.

The hand is an extremely rare site for giant cell tumor (GCT). There are only a few reported cases of GCT including the hand, and even fewer reporting involvement of phalanges. GCTs in small bones are typically more aggressive and have higher local recurrence and rate of metastasis in younger patients compared to long bone involvement, so the treatment is more clinically challenging in the hand. In this study, we present the management of giant cell tumors of the proximal phalanxin two patients treated with two different method; ray resection and arthrodesis using an iliac crest graft. Key words: giant cell tumor, phalanx, hand, recurrence.

Alterations in the immunoreactivity of laminin, type IV collagen and α3ß1 integrin in diabetic rat ovarian follicles.

AIM: In order to determine the possible effects of diabetes, we aimed to investigate the expression of extracellular matrix proteins in the theca and granulosa layers in different follicular stages. METHODS: Thirty-two adult Wistar albino male rats were divided into 4 groups as control and sampled groups. Four, eight and twelve weeks after inducing diabetes with an intraperitoneal injection of streptozotocin (40 mg/kg), the expressions of laminin, type IV collagen and α3ß1 integrin in ovarian tissues were evaluated by immunohistochemical method. RESULTS: In our study, in the first month of diabetes, a significant increase was observed in laminin, type IV collagen and α3ß1 integrin expressions in all follicle types compared to the control group in both the theca and granulosa layers. Laminin and type IV collagen immunoreactivity tended to increase in D2 and D3 groups also. Integrin expression did not change in the newly formed follicles in the D2 and D3 groups, however, it tended to change and increase in the developing follicles. CONCLUSIONS: The changes in the expression of laminin, type IV collagen and α3ß1 integrin, which are the extracellular matrix proteins in the follicle, along with diabetes, show that diabetes plays a role in the regulation of follicular development (Tab. 4, Fig. 36, Ref. 29).

The level of collaboration amongst nurses in Turkey.

AIM: This study was conducted to determine the level of collaboration amongst nurses in Turkey. BACKGROUND: Collaboration amongst nurses is thought to increase nurse-physician collaboration and decrease medical mistakes. It has been connected with positive patient outcomes and increased job satisfaction for nurses. There are some studies on nurse-physician collaboration in Turkey, but nurse-nurse collaboration has not been measured before in this context. There are limited studies in the literature on nurse-nurse collaboration. METHODS: The sample of this study consisted of 859 nurses who work at one public hospital, one university hospital and four private hospitals in Turkey. The study was designed as descriptive and cross-sectional research. The data were collected using the nurse-nurse collaboration scale and a socio-demographic questionnaire. The nurse-nurse collaboration scale comprises five subdimensions: problem-solving, shared process, communication, coordination and professionalism. The cut-off value of the scale for minimum expected collaboration degree was determined as 2.5. RESULTS: It was found that the total nurse-nurse collaboration level in the sample was 3.09, which is above minimum expected degree of collaboration (2.5). In regard to the subdimensions of the scale, the lowest mean score (2.97) was for problem-solving and the highest (3.20) was for professionalism. Graduate nurses' problem-solving, coordination, professionalism and cooperation skills were found to be higher than those of undergraduate nurses. Nurses employed under continuous employment contracts presented higher collaboration scores than those employed with annual, temporary contracts. CONCLUSIONS: Regarding the results obtained in the study, although the Turkish nurses were collaborating at the minimum expected level, they can collaborate more. Improved collaboration between nurses will increase patient satisfaction and thus will have a favourable impact on patient safety. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Nurses who have a bachelor's or higher level degree should be hired, and nurses should be provided with job security in the form of a continuous employment contract to enhance nurse-nurse collaboration.

The attitudes of Turkish nurses towards the employment of internationally educated nurses.

AIM: To define the attitudes of nurses working in public hospitals towards the employment of internationally educated nurses. BACKGROUND: The employment of internationally educated nurses is expected to be an important strategy for solving the nursing shortage in Turkey and many other countries. METHODS: This descriptive and cross-sectional study was conducted with nurses working in seven public university hospitals in different geographical regions of Turkey in September 2015. The data were collected from 1061 nurses in these hospitals using a self-report questionnaire. Data analysis was performed using descriptive statistics, t-test and the Mann-Whitney U test. RESULTS: The participants generally did not have positive attitudes towards the employment of internationally educated nurses citing the possibility of experiencing cultural and professional difficulties. They also indicated that the employment of internationally educated nurses is not a real solution for the nursing shortage unless working conditions for nurses are improved. However, younger nurses have more positive attitudes towards employment of internationally educated nurses than older ones. IMPLICATIONS FOR NURSING POLICY: Defining the attitudes of the nurses working in clinical fields towards the employment of internationally educated nurses is an important issue, because it provides data for reviewing the existing policies and evaluating the possible issues that require attention during implementation of these policies. Policymakers may focus on both creating better working environment conditions and helping both the native and internationally educated nurses during the recruiting process.

Utilizing ethnic-specific differences in minor allele frequency to recategorize reported pathogenic deafness variants.

Ethnic-specific differences in minor allele frequency impact variant categorization for genetic screening of nonsyndromic hearing loss (NSHL) and other genetic disorders. We sought to evaluate all previously reported pathogenic NSHL variants in the context of a large number of controls from ethnically distinct populations sequenced with orthogonal massively parallel sequencing methods. We used HGMD, ClinVar, and dbSNP to generate a comprehensive list of reported pathogenic NSHL variants and re-evaluated these variants in the context of 8,595 individuals from 12 populations and 6 ethnically distinct major human evolutionary phylogenetic groups from three sources (Exome Variant Server, 1000 Genomes project, and a control set of individuals created for this study, the OtoDB). Of the 2,197 reported pathogenic deafness variants, 325 (14.8%) were present in at least one of the 8,595 controls, indicating a minor allele frequency (MAF) > 0.00006. MAFs ranged as high as 0.72, a level incompatible with pathogenicity for a fully penetrant disease like NSHL. Based on these data, we established MAF thresholds of 0.005 for autosomal-recessive variants (excluding specific variants in GJB2) and 0.0005 for autosomal-dominant variants. Using these thresholds, we recategorized 93 (4.2%) of reported pathogenic variants as benign. Our data show that evaluation of reported pathogenic deafness variants using variant MAFs from multiple distinct ethnicities and sequenced by orthogonal methods provides a powerful filter for determining pathogenicity. The proposed MAF thresholds will facilitate clinical interpretation of variants identified in genetic testing for NSHL. All data are publicly available to facilitate interpretation of genetic variants causing deafness.

Microbiological quality of pastrami and associated surfaces at the point of sale in Kayseri, Turkey.

OBJECTIVE: The aim of this study is to trace the possible relations between the hygienic status of slicing utensils and the microbiological quality of pastrami. STUDY DESIGN: A total of 75 pastrami retail markets were visited in Kayseri, Turkey, where the pastrami (a ready-to-eat meat product) is commonly produced and consumed. Sliced pastrami, the cutting board and knife surface swabs were collected from each pastrami retail point to trace possible sources of contamination. METHODS: Samples were analysed for the presence of total viable counts (TVC), total coliforms, Escherichia coli, members of Enterobacteriaceae, Staphylococcus aureus and Listeria spp. In addition, pastrami samples were analysed for sulphite-reducing Clostridium spp. and Toxoplasma gondii. RESULTS: When compared with the target values of related literatures, a total of 6 (8%) pastrami samples were found unsatisfactory as a result of TVC (5.3%), Enterobacteriaceae (5.3%), E. coli (2.6%), S. aureus (2.6%), Listeria spp. (2.6%) and Listeria monocytogenes (1.3%) contaminations. No T. gondii positivity was observed among the pastrami samples. None of the cutting board and knife surface swabs were found to harbour TVC level >103 cfu/cm2, E. coli and L. monocytogenes. For the total coliforms, 7 (9.3%) and 5 (6.6%) of cutting board and knife surface swabs were found to exceed the target value (<2.5 cfu/cm2), respectively. No statistically significant correlation was detected between the organisms on pastrami and slicing utensils indicating that pastrami were not cross-contaminated by the contact surfaces. CONCLUSION: More emphasis needs to be placed for training of food handlers and to apply good hygienic practices at the point of pastrami sale. The conditions at retail points must be monitored and inspections should be tightened to protect public health.

Complete upper urinary tract obstruction caused by penetrating pellet injury of the ureterintroduction.

Ureteral injuries due to gunshots are tend to be misdiagnosed because of concomitant vascular and intraabdominal organ wounds. Our case is a 23-year-old man who was admitted to the hospital with multiple abdominal gunshot wounds. Laboratory findings showed worsening anemia, and the computed tomography (CT) scan showed multiple lead bullets inside the abdomen and retroperitoneum. Patient was then taken to the operation room for laparatomy. There were many intestinal injuries and also a stable retroperitoneal hematoma. There was no ureteral injury mentioned in the operation note or the initial CT report. Two weeks after this operation, the patient developed significant urine leakage from the abdominal wounds. Ureteral J stent placement was our first choice of treatment. This was complicated with a late ureteral obstruction. The final treatment was an ureteroureterostomy. Diagnosing ureteral injuries due to traumatic causes can be hard in most of the cases. Physicians should consider early evaluation of the patient for ureteral leakage if there is suspicion about ureteral injury.

Investigation of zoonotic infections in risk groups in Ordu University Hospital, Turkey.

AIMS: Zoonotic diseases, which are a major public health problem in our city, have a negative impact on public health and also cause economic losses due to yield losses of animals and deaths. This study was carried out to determine the seroprevalence of tularemia, bartonellosis, brucellosis, Q fever, and cystic echinococcosis in the risk groups for zoonotic infection. SUBJECTS AND METHODS: Ninety serum samples were taken from people in the risk groups in covering veterinarian, butchers, farmers and examined with the following tests: Microagglutination test for tularemia, indirect fluorescent antibody test (IFAT) for bartonellosis, standard tube agglutination test for brucellosis, IFAT IgG for Q fever, and enzyme-linked immunosorbent assay IgG test for cystic hydatid. STATISTICAL ANALYSIS USED: The Chi-square analysis was used to assess, and the logistic regression analysis was used to identify the risk factors. RESULTS: The analyzed all serum samples were found to be seronegative for tularemia, bartonellosis, and hydatid cyst antibodies. When analyzed for Coxiella burnetii with IgG antibody titers, it was determined that 23 samples (25.6%) were seropositivity. When brucellosis was analyzed with serological tests for Brucella, it was positive in seven samples (7.8%). CONCLUSIONS: In this study, examined in the risk groups in which it is located along black sea coast of Turkey for tularemia, bartonellosis, and hydatid cysts, seropositivity was not found. When Brucella was tested, 7.8% was found to be positive, and when analyzed in terms of Q fever, 25.6% of people were determined to be seropositive. In conclusion, in our region, Q fever seropositivity was found to be higher in the risk groups. Therefore, most of the zoonotic disease look like not so common in the region, out of tularemia.

THE EFFECTS OF MATERNAL HYPOTHYROIDISM ON THE IMMUNOREACTIVITY OF CYTOCHROME P450 AROMATASE IN THE POSTNATAL RAT TESTICLES.

INTRODUCTION: Abnormal thyroid function affect spermato-genesis and male infertility. For men, the aromatase deficiency can cause infertility. In this study, the aim is to investigate the effect of maternal hypothyroidism on offspring testicular morphology and cytochrome-P450-aromatase (P450arom) immunoreactivity. MATERIALS AND METHODS: Eighteen Wistar albino pregnant rats were divided into three groups, namely A, B and K groups. Hypothyroidism was induced by adding 0.01% of propyl thiouracil (PTU) in drinking water. Hypothyroid mothers, group A: given PTU for 21 days during pregnancy, group B: given PTU for 21 days prior to pregnancy; control mothers, group K, given only water. Hypothyroid and control group mothers' pups at postnatal day (PND) 15 and 60 were sacrificed. We determined immunoreactivity intensity of P450arom and mRNA levels by RT-PCR performed in the testis tissues. ELISA method was used for thyroid function tests for T3, T4 and TSH. Structure of seminiferous tubule was evaluated by hematoxylin-eosin staining. RESULTS: It was seen that the aromatase expression in 15-day-old maternal hypothyroid groups was similar to the one in the control group while there was a decline in the aromatase expression of 60-day-old groups. As for mRNA, it was determined that it had a tendency to increase over time in all groups but this increase was not significant. The tubule diameter and Johnsen's Testicular Biopsy Score diminished in all hypothyroid groups in comparison to the control group. CONCLUSION: The changes that occur in the early period of testis development due to maternal hypothyroidism negatively affect testis development in the next stages of life. This situation leads to a decline in aromatase expression in the following years.

The relation between monocyte to HDL ratio and no-reflow phenomenon in the patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: No-reflow phenomenon is a prognostic value in ST-segment elevation myocardial infarction (STEMI). Monocyte to high density lipoprotein ratio (MHR) has recently emerged as a marker of inflammation and oxidative stress in the cardiovascular disease. PURPOSE: In this study, we aimed to investigate the relation between MHR and no-reflow phenomenon in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI). MATERIAL AND METHODS: A total of 600 patients with STEMI (470 men; mean age, 62 ± 12 years) admitted within 12 hours from symptom onset were included into this study. Patients were classified into 2 groups based on postintervention Thrombolysis in Myocardial Infarction (TIMI) flow grade: no-reflow-TIMI flow grade 0, 1, or 2 (group 1); angiographic success-TIMI flow grade 3 (group 2). RESULTS: According to admission whole-blood cell count results, the patients in the no-reflow group had significantly higher monocyte count and MHR values when compared with those of the reflow patients. After multivariate backward logistic regression, MHR remained independent predictors of no reflow after pPCI. Adjusted odds ratios were calculated as 1.09 for MHR (P< .001; confidence interval [CI], 1.07-1.12). Receiver operating characteristic curve analysis suggested that the optimum MHR level cutoff point for patients with no-reflow was 22.5, with a sensitivity and specificity of 70.2% and 73.3%, respectively (area under curve, 0.768; 95% CI, 0.725-0.811). CONCLUSION: In conclusion, MHR levels are one of the independent predictors of no reflow in patients with STEMI after pPCI.

Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing.

PURPOSE: The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. METHODS: The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15) years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. RESULTS: The quadriceps muscle cross-sectional diameter had a mean of 157.2 mm(2) (115.6/319.5) in the operated extremity, and it was 193 mm(2) (77.6/282.2) in the non-operated normal side (p = 0.001). For the Gracilis muscle, the mean was 84.4 mm(2) (19.7/171) at the operated extremity and 75.7 mm(2) (26.9/238.2) on the normal side (p = 0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p < 0.05). While DP-TT distance was 11.4 mm (9.4/20.4) in the operated extremity, it was 14.1 mm (7.3/17.1) in the non-operated extremity (p = 0.001). The correlation analyses revealed that the quadriceps hypotrophy negatively correlated (r = -0.4, p = 0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r = 0.4, p = 0.03). CONCLUSION: This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing and treating the hypotrophy of the quadriceps muscle following the surgical treatment of tibial fracture, which may help to overcome this quite common pathology.

Distal airways are protected from goblet cell metaplasia by diminished expression of IL-13 signalling components.

BACKGROUND: Increased mucus production is a critical factor impairing lung function in patients suffering from bronchial asthma, the most common chronic inflammatory lung disease worldwide. OBJECTIVE: This study aimed at investigating whether goblet cell (GC) metaplasia and mucus production are differentially regulated in proximal and distal airways. METHODS: Female Balb/c mice were sensitized to ovalbumin (OVA) and challenged with an OVA-aerosol on two consecutive days for 1 week (acute) or 12 weeks (chronic). Real-time RT-PCR analysis was applied on microdissected airways. RESULTS: In acutely and chronically OVA-challenged mice, GC metaplasia and mucus production were observed in proximal but not in distal airways. In contrast, inflammation reflected by the infiltration of eosinophils and expression of the TH2-type cytokines IL-4 and IL-13 was increased in both proximal and distal airways. Abundance of IL-13Rα1 was lower in distal airways of healthy control mice. Under acute and chronic OVA-exposure, activation of IL-13Rα1-dependent signalling cascade, reflected by Spdef and Foxo3A transcription factors, was attenuated in distal compared to proximal airways. CONCLUSION AND CLINICAL RELEVANCE: These data indicate that distal airways might be less sensitive to IL-13-induced GC metaplasia and mucus production through lower expression of IL-13Rα1 and attenuated activation of downstream signalling. This might represent a protective strategy to prevent mucus plugging of distal airways and thus impaired ventilation of attached alveoli.

Evaluation of orange-brown precipitate formed in root canals after irrigation with chlorhexidine and QMix and spectroscopic analysis of precipitates produced by a mixture of chlorhexidine/NaOCl and QMix/NaOCl.

AIMS: (i) To compare chlorhexidine and QMix(TM) in terms of orange-brown precipitate generation in root canals and (ii) to analyse the precipitate produced by mixing chlorhexidine and QMix(™) with NaOCl to determine whether para-chloroaniline was produced. METHODOLOGY: The root canals of 57 single-rooted anterior teeth were prepared using ProTaper Universal rotary instruments up to size F4. Two millilitres of 2.5% NaOCl was used between each instrument change. The specimens were then divided randomly into three groups (n = 19) and irrigated as follows: group 1, 5 mL of distilled water (control group) for 60 s; group 2, 5 mL of 2% chlorhexidine for 60 s; and group 3, 5 mL of QMix for 60 s. The roots were split longitudinally, and one of the halves was photographed using a stereomicroscope. The amount of orange-brown precipitate was evaluated using a four-grade scoring system. The data were analysed statistically using the Kruskal-Wallis and Mann-Whitney U-tests (P = 0.05). To evaluate whether the precipitates included para-chloroaniline, 5 mL of 2% chlorhexidine and 5 mL QMix were separately mixed with 5 mL of 2.5% NaOCl in two flasks. After centrifugation, precipitates were obtained and analysed using (1) H NMR spectra. The data were subjected to statistical analysis using the Kruskal-Wallis and Mann-Whitney tests at a 95% confidence level (P = 0.05). RESULTS: Chlorhexidine had significantly higher scores than QMix(™) in terms of orange-brown precipitate formed in the root canals (P < 0.001). According to the 1H NMR spectra, para-chloroaniline was present in the mixture of chlorhexidine and NaOCl. However, the mixture of QMix(™) and NaOCl did not result in para-chloroaniline formation. CONCLUSION: QMix(™) does not form para-chloroaniline when associated with NaOCl.

Effects of polylactic acid film on middle ear mucosa and cochlear function in Guinea pigs.

Our aim was to assess the effects of polylactic acid (PLA) on middle ear mucosa and cochlea, to be used as a film barrier for postoperative adhesion prevention in the middle ear. Twenty-one albino Guinea pigs were included in the study. A window was opened on both tympanic bulla and on one side PLA material was placed in the middle ear and on the other side only fenestration was performed and used as a control. All Guinea pigs underwent evaluation of tympanic membranes microscopically; functional hearing was analyzed by auditory brainstem responses preoperatively, in the first and the sixth month. All Guinea pigs were killed on the sixth month for histopathologic evaluation of their temporal bones. There was no statistical difference between both groups regarding hearing thresholds, interpeak wave latencies preoperatively and on first and the sixth months postoperatively. Histopathological evaluation revealed no specific changes. There was a mild local inflammation both in the PLA implanted and control ears. PLA film barrier most likely has no toxic effects on Guinea pig middle ear and does not show any ototoxic side effects.

Preliminary results of a novel quorum sensing inhibitor against pneumococcal infection and biofilm formation with special interest to otitis media and cochlear implantation.

The purpose of the study is to assess the effect of a novel quorum sensing inhibitor (QSI), coded as 'yd 47', against otitis media and biofilm formation on Cochlear implants (CIs). Small pieces cut from cochlear implant were implanted under the skin in the retroauricular area on both sides of four guinea pigs. The implant pieces in the study and control sides were implanted in Streptococcus pneumoniae strain solution and saline, respectively. The right and left middle ears were also instilled with a solution containing pneumococci and saline, respectively. The animals were only given an intraperitoneal 'yd 47' twice daily for three months to be assessed later with electron microscopy. Clinical examination with palpation, inspection and otoscopy did not reveal any sign of implant infection or otitis media. In the study and control implant materials, soft tissues around the implant and tympanic membranes, there was no biofilm formation by pneumococci. Contamination by various cells and some rod-shaped bacteria (not diplococcic) were seen in some of the materials. In conclusion, the novel QSI seems promising in the prevention of otitis media and biofilm formation on CIs by pneumococci.