Investigation of Serum Interleukin 6, High-Sensitivity C-Reactive Protein and White Blood Cell Levels during the Diagnosis and Treatment of Paediatric Appendicitis Patients Before and during the COVID-19 Pandemic.

Introduction: In this study, we prospectively investigated changes in serum interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP) and full white blood cell (WBC) counts during the diagnosis and treatment of paediatric patients with appendicitis. We also investigated the effects of the COVID-19 pandemic on the diagnosis and treatment processes of paediatric appendicitis patients. Materials and Methods: A non-perforated appendicitis group (n = 110), a perforated appendicitis group (n = 35) and an appendicitis + COVID-19 group (n = 8) were formed. Blood samples were taken upon admission and every day until the three studied parameters returned to normal values. To investigate the effects of the COVID-19 pandemic on paediatric appendicitis patients, the perforated appendicitis rates and the times from the onset of the first symptoms to the operation before and during the pandemic were compared. Results: WBC, IL-6, and hsCRP dropped below the upper limits on the second postoperative day in the non-perforated appendicitis group, four to six days postoperatively in the perforated appendicitis group, and three to six days postoperatively in the appendicitis + COVID-19 group. These parameters were not within normal range in patients who developed complications during follow-up. The time from the onset of abdominal pain to the surgery was significantly longer during than before the pandemic in both the non-perforated appendicitis group and the perforated appendicitis group. Conclusions: Our results show that WBC, IL-6, and hsCRP are useful laboratory parameters that can complete clinical examinations in the diagnosis of appendicitis in paediatric patients and the identification of complications that may develop postoperatively.

In Vitro Antioxidant and Enzyme Inhibition Activity of Tanacetum argyrophyllum (K. Koch) Tzvelev var. argyrophyllum Extract.

Objectives: Tanacetum L. belongs to Asteraceae family and is represented by 46 species in Türkiye. Tanacetum genus is known for its insecticide and insect repellent effect. T. argyrophyllum contains sesquiterpene lactone derivatives. These compounds are responsible for its various activities, especially cytotoxic, antitumor, phytotoxic, antimicrobial, antiviral, and antifungal activity. There are not enough biological activity studies on the plant that are likely to have a wide variety of activities in terms of the compounds it contains. The aim of the present study is to evaluate various biological activities of 80% aqueous methanol extract prepared from aerial parts of T. argyrophyllum (K. Koch) Tzvelev var. argyrophyllum collected from Sivas province of Turkey. Materials and Methods: Antioxidant activity of the methanol extract was determined by 2,2'-diphenyl-1-picryl-hydrazyl and 2,2-azinobis (3-ethyl benzothiazoline-6-sulfonic acid) radical scavenging activity, total phenolic, and total flavonoid content tests. Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activities were investigated via Ellman's spectrometric method. Results: Total phenolic content was found as 71.67 mg/gallic acid equivalent g and total flavonoid content was 25.225 mg/quercetin equivalent g on a dry extract weight basis. In this work, AChE, BChE, and α-glycosidase enzymes were inhibited by the extract of T. argyrophyllum var. argyrophyllum. IC50 values for these enzymes were found as 266.79 µg/mL for AChE and 176.91 µg/mL for BChE. Also, the α-glycosidase activity exhibited a dose-dependent manner with increasing concentration. Conclusion: According to the results, T. argyrophyllum var. argyrophyllum can be used as an ingredient of functional foods as well as herbal products for diabetic and Alzheimer's disease patients.

Albumin haemoglobin index: A novel pre-operative marker for predicting mortality and hospital stay in patients under one-year undergoing gastrointestinal surgeries.

AIM: The aim of this study was to evaluate the mortality and morbidity of infants <1 year of age with intestinal obstruction requiring surgical intervention and to investigate the factors affecting mortality and hospital length of stay in paediatric surgery, including albumin-haemoglobin index. PATIENTS AND METHODS: The records of gastrointestinal paediatric surgeries in the past 10 years of patients who were <1-year-old at Baskent University Konya Hospital were obtained from the hospital and retrospectively studied. Patient characteristics, especially the relationship between albumin haemoglobin index (AHI) and hospital duration and mortality, were examined. According to the surgical areas, it also subjected this relationship to further analysed in subgroups. RESULTS: There were 144 cases who fulfilled the inclusion criteria. Pre-operative serum AHI was analysed using receiver operating characteristics (ROC) curve analyzes. In the ROC analysis, AHI had a diagnostic value in predicting case discharge rates (area under the curve: 0.755, P = 0.001). When the cut-off point was set at 46.18, the sensitivity of the test was 57.5% and the sensitivity for predicting survival was 84%. In the logistic regression model to estimate survival, the odds ratio of AHI was 1.063 (confidence interval: 1.020-1.108, P = 0.004). In subgroup analyzes, AHI positively predicted survival in the NEC group and in the other group. In a linear regression model analysing the effect of AHI on hospital stay of length, AHI explained 10% of the variance in the hospital stay of length variable and significantly and negatively influenced the hospital length variable (ß = -0.319, P = 0.05). In the linear regression model for subgroup analyzes, AHI significantly and negatively predicted hospital length of stay in the NEC and pyloric surgery groups, but positively predicted hospital length of stay in the perforation group. CONCLUSION: The AHI can be used as a valuable marker to predict the likelihood of discharge and length of hospital stay in paediatric surgical cases <1-year-old.

Phytochemical characterisation of Phlomis linearis Boiss. & Bal and screening for anticholinesterase, antiamylase, antimicrobial, and cytotoxic properties.

In the present work, essential oil and fatty acids and extracts obtained from aerial parts of Phlomis linearis Boiss. & Bal. were investigated for chemical composition and biological activities. The phytochemical analyses were conducted with gas chromatography-mass spectrometry/flame ionisation detector (GC-MS/FID) and liquid chromatography-mass spectromtetry (LC-MS/MS) techniques. The extracts and essential oil were studied for α-amylase and acetylcholinesterase activities with two different spectrophotometric methods. Antimicrobial activities of the extracts were investigated by microdilution. The extracts were evaluated in vitro for cytotoxic effects against cancer and normal cell lines by MTT assay. The essential oil (EO) contained α-pinene (12.5%) and ß-caryophyllene (10.7%) as main compounds. Palmitic (26.5%) and nonadecanoic acids (26.6%) were determined as fatty acids. Phytochemical analysis of the extracts found phenolic acids, phlinosides, verbascoside, and flavonoids. The extracts and essential oil demonstrated poor α-amylase inhibitory activity. The best acetylcholinesterase inhibitory activity was obtained for diethly ether extract of P. linearis (67.2 ± 3.4%) at 10 mg /mL concentration. Ethyl acetate extract found to be effective against Staphlococcus aureus at a minimum inhibitory concentration (MIC) of 156.26 µg/mL. Diethyl ether extract of P. linearis was active on A549 cell lines with an IC50 = 316 ± 4.16 µg/mL when compared with cisplatin IC50 = 24.43 ± 0.14 µg/mL. To the best of our knowledge, the present work is the first comprehensive report on anti-acetylcholinesterase, anti-α-amylase, and antimicrobial activities, as well as cytotoxic effects of P. linearis.

Identification of Durum Wheat Cultivars and Their Tetraploid Relatives with Low Cadmium Content.

In this study, 71 durum wheat cultivars (Triticum durum Desf.), 22 emmer wheat (Triticum dicoccum L.) and 11 wild emmer (Triticum dicoccoides L.) genotypes were genetically characterized to determine the alleles associated with high cadmium (Cd) content. After genotypic characterization, 14 cultivars selected among all genotypes with low and high Cd content were phenotyped by a pot experiment to verify the genotypic data. Identification of 32 durum wheat, one emmer wheat and four wild emmer genotypes showed that they have alleles associated with high Cd content, while 68 genotypes of which 39 durum wheat, 21 emmer wheat and 7 wild emmer cultivars had alleles associated with low Cd content, respectively. Moreover, phenotypic data obtained from pot experiment were similar to the molecular data. To sum up, the marker successfully classified durum wheat cultivars into either high or low accumulators and these results can be safely used in breeding programs to improve new durum wheat cultivars with alleles associated with low Cd content. Due to routine use of phosphorus fertilizers in agricultural areas and other anthropogenic factors related to Cd toxicity, new durum wheat cultivars with low Cd content should be urgently developed for safe production of macaroni or other types of wheat products for human and animal consumption.

Prophylactic intravenous paracetamol use in extremely premature infants for patent ductus arteriosus.

OBJECTIVES: Patency of ductus arteriosus (PDA) is a very common problem among extremely low birth weight infants (ELBW). Hemodynamic instability caused by PDA is associated with important morbidities. This study aims to evaluate the effects of prophylactic intravenous paracetamol on the hemodynamically significant patent ductus arteriosus (hsPDA). METHODS: A total of 75 infants of <28 week-gestational age were enrolled into the study which was retrospective. Prophylactic paracetamol as the experimental group and none-prophylaxis group as the control group were compared in the study. RESULTS: There were 35 subjects in the prophylactic paracetamol group (PPG), and 40 in the control group. Primary outcome measures were ductal closure, ductal diameter, grade 3-4 IVH, and repeated ibuprofen need for the treatment of hsPDA. At the time of the evaluation by echo, hsPDA, and the diameter of the ductus higher than 1 mm were found significantly lower in the PPG (p=0.004 and p=0.013). Additionally, the repeated course of ibuprofen was significantly lower in the PPG (p=0.025). Secondary outcomes were the other perinatal morbidities. According to the results of the study, the male gender is 6.6, and the paracetamol use is 5.5 times more likely to suffer from ROP. CONCLUSIONS: The results of the study indicated that prophylactic paracetamol use in ELBW infants decreases the likelihood of hsPDA. The repeated course of ibuprofen for the treatment of hsPDA can be reduced. Furthermore, it can be understood that while prophylactic use of paracetamol is preventive for intraventricular hemorrhage, it does not function in the same way for retinopathy of prematurity or bronchopulmonary dysplasia. It might even worse the retinopathy of prematurity. Further prospective randomized controlled and larger sample-sized studies are needed.

Concurrence of Two Rare Conditions: Simultaneous Bilateral Spontaneous Pneumothorax and Congenital Pulmonary Airway Malformation.

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare type of pneumothorax. Most reported cases are associated with underlying lung diseases. In a small number of pediatric studies, SBSP was found to be associated with human bocavirus bronchiolitis, Langerhans cell histiocytosis, and Mycoplasma pneumoniae infection. The present work examines an interesting case of type 2 congenital pulmonary airway malformation presenting with SBSP and bilateral multiple parenchymal cysts.

The effect of hyperlipidemia on bone graft regeneration of peri-implantal created defects in rabbits.

AIM: It is reported that hyperlipidemia affects quality and density of bone and adversely affects wound healing. The effect of hyperlipidemia on implant osseointegration and peri-implant defect regeneration has not been fully explained. The purpose of this study was to examine the effects of hyperlipidemia on the healing potential of the materials used for peri-implant bone regeneration and implant stability. MATERIALS AND METHODS: Twelve male, New Zealand rabbits were used in this study. Half of the rabbits were fed a 2% cholesterol diet for 8 weeks to induce hypercholesterolemia. Peri-implant defects (7 mm diameter) were created in the tibias of rabbits and placed implants (3.3 mm in diameter). This study was conducted as a split-mouth design. Animals were randomly divided into two groups: (1) hypercholesterol+autogenous graft group and hypercholesterol+xenograft group (n = 6), and (2) autogenous graft and xenograft groups as controls (n = 6). At 8 weeks after surgery, the rabbits were euthanized. During implant surgery and at 8 weeks, implant stability was measured with resonance frequency analysis (RFA values). Bone-to-implant contact (BIC) was analyzed via histomorphometric analysis. RESULTS: Hyperlipidemic groups showed significantly lower BIC values than those of the control groups at 8 weeks (p < 0.05). According to baseline RFA readings, there was no significant difference between control and hyperlipidemic groups (p Ëƒ 0.05). The hypercholesterol+autogenous graft group had significantly lower RFA readings and BIC values than the hypercholesterol+xenograft group at 8 weeks (p < 0.05). CONCLUSION: Within the limitations of this study, it was found that hyperlipidemia may negatively affect the implant stability especially in the autogenous group and also, may decrease peri-implant bone regeneration. However, further studies are necessary to confirm these results more.

The effect of luteolin in prevention of periodontal disease in Wistar rats.

BACKGROUND: Periodontal disease is the chronic infectious disease of the periodontium. Because of irreversibility, prevention of disease is one of the most important goals of periodontal treatment. The aim of this study was to evaluate the effect of luteolin, a powerful anti-inflammatory agent, on the prevention of experimental periodontitis by determining morphological and histological tissue alterations. METHODS: This study consisted of 28 rats and four experimental groups: healthy control group (C, n = 6); periodontitis group (P, n = 6); periodontitis and 50 mg/kg luteolin administered group (L-50, n = 8); and periodontitis and 100 mg/kg luteolin administered group (L-100, n = 8). Experimental periodontitis was induced via ligature method around lower right first molar teeth. All rats were euthanized 11 days after. The severity of periodontal destruction was determined by measuring alveolar bone loss under a stereomicroscope. Osteoblast and inflammatory cell counts were counted on hematoxylin-eosin-stained slides and osteoclasts were counted on tartrate-resistant acid phosphatase-stained slides. The levels of inducible nitric oxide synthase (iNOS), bone morphogenetic protein (BMP)-2, matrix metalloproteinase (MMP)-8, tissue inhibitor of MMP (TIMP)-1, receptor activator of nuclear factor κB ligand (RANKL), and osteoprotegerin (OPG) were determined by immunohistochemistry. RESULTS: The highest alveolar bone loss was observed in the periodontitis group and the luteolin administration decreased bone loss in both groups. Osteoblast cell number was higher and osteoclast and inflammatory cell numbers were lower in the P group compared to C, L-50, and L-100 groups. Luteolin, dose-dependently increased osteoblast cell counts. Luteolin attenuated periodontal inflammation in both L-50 and L-100 groups. Like osteoblast cell numbers, BMP-2 expressions were also elevated in luteolin groups. Both doses of luteolin significantly increased TIMP-1 and BMP-2 expressions and decreased MMP-8 levels. iNOS expressions increased in P group and L-100 significantly decreased iNOS levels. RANKL increased and OPG decreased in P group and 100 mg/kg luteolin increased OPG and decreased RANKL levels significantly. CONCLUSIONS: Within the limits of present experimental study, luteolin successfully improved periodontal health in a ligature-induced experimental periodontitis model in Wistar rats. The decrease in inflammation, osteoclastic and collagenase activity and increase in osteoblastic activity are possibly involved in this process.

The effect of colchicine on alveolar bone loss in ligature-induced periodontitis

Abstract Colchicine is widely used in the treatment of several inflammatory diseases due to its anti-inflammatory effect, but effects on bone metabolism are unclear. The aim of this study was to evaluate the effects of systemically-administered colchicine on healthy periodontium and experimentally-induced periodontitis. In total, 42 male Wistar rats were included in this study. A non-ligated group constituting the negative control group (Control, C, n = 6) and a ligature-only group forming the positive control group (LO, n = 12) were created separately. Twelve rats were treated with 0.4 mg/kg colchicine and another 12 with 1 mg/kg colchicine. In the colchicine-administered groups, right mandibles constituted the ligated groups (1 mgC-L or 0.4 mgC-L) and left mandibles formed the corresponding non-ligated controls (1mgC or 0.4mgC). Silk ligatures were placed at the gingival margin of the lower first molars. The animals were euthanized at different time-points of healing (11 or 30 days). Alveolar bone loss was clinically measured and TRAP+ osteoclasts, osteoblastic activity, and MMP-1 expression were examined histologically. There was no increase in alveolar bone loss with either colchicine dose in healthy periodontium (p > 0.05) and the highest level of alveolar bone loss, TRAP+ osteoclast number, and MMP-1 expression were measured in the LO group (p < 0.05). The 0.4 mgC-L group showed less alveolar bone loss at 11 days (p < 0.05), but greater loss at 30 days. The 1 mgC-L group showed higher osteoblast number than the other ligated groups (p < 0.05) at both time-points. In summary, colchicine did not increase alveolar bone loss in healthy periodontium and also may tend to reduce periodontitis progression. However, further extensive study is necessary to understand the mechanism of colchicine action on alveolar bone loss in periodontitis.

Antidiabetic activity evaluation of Onobrychis species on alloxan-induced diabetic mice

In the current study, four Onobrychis species, O. albiflora Hub.-Mor., O. argyrea Boiss. subsp. argyrea Boiss., O. galegifolia Boiss., and O. tournefortii (Willd.) Desv. were collected from Anatolia to be evaluated for their antidiabetic activities. Methanol water extracts of the aerial parts were used for experiments. An alloxan-induced diabetic mice test model was used. Phytochemical analysis of the tested extracts was investigated using the HPLC method. The highest activity was observed with treatment of O. albiflora aerial part extract. Significant decrements were detected in the blood glucose levels as follows: 180.83±47.48 and 252.83±50.47mg/dL at 100 mg/kg and 200 mg/kg doses of O. albiflora, respectively, when compared to the isotonic saline solution control group, eliciting a blood glucose level of 494.20±27.32. Among the tested standard compounds, rutin and isoquercetin were detected in the examined species. The highest amount of rutin (1.1981±0.0017%) and isoquercetin (0.7318±0.0197%) were found in O. albiflora and O. argyrea subsp. argyrea, respectively. Antidiabetic activities of the tested Onobrychis species seem to indicate a possible correlation with their rutin and isoquercetin contents. Therefore, rutin and isoquercetin may be the antidiabetic compounds that contribute to the antidiabetic activity of the tested Onobrychis species.

Anti-inflammatory and antibacterial evaluation of Thymus sipyleus Boiss. subsp. sipyleus var. sipyleus essential oil against rhinosinusitis pathogens.

Thymus sipyleus Boiss. subsp. sipyleus var. sipyleus of the Lamiaceae, locally known as thyme scented lemon, which is an endemic taxon collected from Sivas in Anatolia, was investigated in this study due to its folk medicine use against rhinosinusitis. The aromatic characteristics of the plant material gave the idea for the detailed evaluation of the volatiles and essential oil thereof. Consequently, the oil was obtained by Clevenger type hydrodistillation followed by gas chromatography-flame ionization detector (GC-FID) and gas chromatography/mass spectrometry (GC/MS) analyses for phytochemical characterization. To confirm the folk medicinal use against sinusitis, in vitro antimicrobial activities of the essential oil was evaluated by agar diffusion, microdilution and vapour diffusion methods against selected rhinosinusitis associated strains such as Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, Streptococcus pyogenes, S. pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae and Moraxella catarrhalis. Additionally, the in vitro anti-inflammatory activity was evaluated by 5-lipoxygenase (5-LOX) inhibitory effect of the essential oil spectrophotometrically. Furthermore, the composition of the volatiles of the vapour phase of the oil was determined by headspace-solid phase microextraction (HS-SPME-GC/MS) after 15 min and 24 h in accordance with antimicrobial vapour diffusion method conditions, respectively. According to the analytical results, the main component was determined as thymol (66.2%). Whereas in the HS-SPME method p-cymene (26.1%) and γ-terpinene (26%) were identified as the main volatile components within the 15. min., and thymol (75.3%) after 24 h, respectively. The antibacterial activity against rhinosinusitis pathogens varied between 160 and 1250 µg/mL minimum inhibitory concentrations, with the best inhibitory effects observed against the S. aureus, S. pyogenes and M. catarrhalis. The anti-inflammatory activity of the oil was determined as 12.1 ±â€¯1.8% in 100 µg/mL. The results showed the in vitro antimicrobial and anti-inflammatory potential of the oil also in vapour phase against sinusitis supporting the traditional use.

Pharmacobotanical study of Hypericum thymopsis

ABSTRACT Hypericum thymopsis Boiss., Hypericaceae, is an endemic herb which generally grows at the calcareous steppe regions of Central Turkey. In flowering stage, the aerial parts of this species are used for wound-healing and sedation, and its infusions are used against stomach diseases and throat infections by local people. The aim of this study, to examine and to reveal of the morphology, anatomy and histology of the aerial vegetative and reproductive organs of the H. thymopsis, which are used in popular medicine and thus contributing to the pharmacognostic evaluation of the species. In comparison with previous published morphological description of the species, some different findings about plant height and leaf length were found. In addition, some morphological characteristics such as dimensions of sepals and ovaries, length of filaments, anthers, pistils and pedicels were examined here for the first time. The anatomical characteristics of stem, leaf, sepal, filament and pistil were studied using light microscopy and additionally for stem and leaf using scanning electron microscopy. The stem has the secondary growth, and circular shape. The leaves are amphistomatic and the mesophyll is dorsiventral. Stomata are anisocytic and sunken. The glandiferous emergences are present on stem and translucent glands exist in leaf mesophyll. Type A secretory canals are present in stem, leaf, sepal and petal cross section. While type B secretory canals are observed in sepal and petal, type C secretory canals are observed solely in ovary cross section. All the structural features herein found can assist the diagnosis of H. thymopsis.

Evaluation of Choroidal Thickness in Children With Iron Deficiency Anemia.

PURPOSE: The purpose of this study was to determine whether there are differences in choroidal thickness in children with iron deficiency anemia (IDA). METHODS: Fifty-two patients with IDA and 54 healthy children between 3 and 16 years of age were enrolled in this study. After complete eye examinations were conducted for each participant, the choroidal thickness was measured using optical coherence tomography. Correlations between the choroidal thickness and clinical and laboratory parameters were also evaluated. RESULTS: There were no statistically significant differences between the two groups in terms of visual acuity, intraocular pressure, central corneal thickness, or axial length (P > 0.05). The choroidal thicknesses at the foveal center were 303.13 ± 27.14 µm in the IDA patients and 333.67 ± 39.77 µm in the healthy control children (P < 0.001); additionally, the choroidal thicknesses at each point within the horizontal nasal and temporal quadrants were thinner in the IDA group. There were positive correlations between the choroidal thickness and hemoglobin (r = 0.337; P < 0.001), mean corpuscular volume (r = 0.305; P = 0.001), iron (r = 0.264; P = 0.006), and ferritin (r = 0.287; P = 0.003) levels; however, there were no correlations between the clinical or ocular characteristics and the choroidal thickness. CONCLUSIONS: The patients with IDA had significantly thinner choroidal thicknesses than those of the healthy children. Choroidal thinning in childhood may be an early sign of deterioration in the ocular blood circulation, without any risk of atherosclerosis in advanced age in the patients with IDA.

The structural studies on the medicinal plant Haplophyllum telephioides

ABSTRACT Haplophyllum telephioides Boiss., Rutaceae, is an endemic herb which generally grows at the steppe region in Central Turkey. Its aerial parts in flowering stage are used by local people against influenza virus due to its antimicrobial effect. The main purpose of this study was to examine the morphology, anatomy and histology of the vegetative and reproductive organs of the H. telephioides, which are used in popular medicine, thereby, contributing to the pharmacognostic evaluation of the species. The species was studied morphologically in detail. New morphological features were described for them, such as the dimension of leaf, sepal and fruit, size of filament, anther and pistil, and diameter of the ovary. In addition, some deviating features were found in relation to previous published descriptions for the species, such as plant height and petal length. The anatomy of plant parts such as stem, leaf, sepal, petal, filament and pistil, were studied using light microscopy and scanning electron microscopy. Stem has incipient secondary growth. The leaf is amphistomatic and the mesophyll is equifacial. Stomata are anomocytic and sunken. In micromorphological studies, it is determined that the leaf is coated by a thick cuticle and above epicuticular wax. Schizogenous glands were found in all vegetative and reproductive organs. The structural features herein found can assist the diagnosis of H. telephioides.

Phytochemical analyses and effects of Alchemilla mollis (Buser) Rothm. and Alchemilla persica Rothm. in rat endometriosis model.

PURPOSE: The aim of the present study is to evaluate the treatment potential of Alchemilla mollis (Buser) Rothm. and Alchemilla persica Rothm. in the experimentally induced endometriosis model in rats. METHODS: Endometriosis was surgically induced in rats by autotransplanting endometrial tissue to abdominal wall. Thirty-six rats were randomly divided into six groups. The groups were orally treated with the methanol:water (80:20) extracts of aerial parts and roots of A. mollis and A. persica. Buserelin acetate (20 mg) was used as the reference drug. The phytochemical contents of the most active extracts were determined by high performance liquid chromatography. RESULTS: The cystic formation was determined to be significantly decreased with the aerial part extract of A. mollis. A reduction in the endometrioma was also determined for the aerial part extract of A. persica group. However, significant reduction on the levels of cytokine were recorded for the A. mollis aerial part extract group. Therefore, the phytochemical contents of the aerial part extracts of A. mollis. and A. persica were analyzed. CONCLUSION: The results of the present study revealed that the aerial part extracts of A. mollis and A. persica could be beneficial in the treatment of endometriosis.

Time to stone clearance for ureteral stones treated with extracorporeal shock wave lithotripsy.

OBJECTIVE: To evaluate the time to stone-free status after shock wave lithotripsy (SWL) for ureteral stones. METHODS: Medical records of 387 patients with ureteral stones who have been treated were retrospectively reviewed. Exclusion criteria for this analysis included nonopaque stones, prior ureteric surgery, multiple ureteral stones, anomalous kidneys or ureters, hydroureteronephrosis, infravesical obstruction, nonfunctioning kidney, inadequate follow-up, and treatment with calcium-channel blockers and alpha blockers. Ninety or 120 shocks per minute at suggested maximum energy for safety were applied. Patients were revisited periodically and stone-free status was accepted as success. The data were analyzed according to stone localizations; size (5-10 mm [group 1], 11-15 mm [group 2], and ≥16 mm [group 3]); and number of SWL sessions. RESULTS: The initial stone locations were: upper ureter in 23%, middle ureter in 17.9%, and distal ureter in 59% of the patients. The average stone diameter was 10.1 mm (range, 5-23). The SWL sessions varied between 1 and 4 (mean, 1.3). Of the 117 patients 109 (93.1%) were stone free 20 days after the first session of SWL. The mean time to achieve stone-free status was 4.6 days. Group 1 had the quickest stone clearance time as expected (mean, 2.2 days [range, 1-3]). Groups 2 and 3 had longer times at 7.7 days (range, 3-18) and 12.2 days (range, 11-37), respectively. CONCLUSIONS: SWL appears as a quick and effective treatment modality for ureteral stones. However, high-burden ureteral stones (>16 mm) have considerably long periods of clearance and therefore appear to be unsuitable for SWL treatment.

Which factors may effect urinary leakage following percutaneous nephrolithotomy?

OBJECTIVE: To evaluate the factors that may effect urinary leakage following percutaneous nephrolithotomy (PCNL). METHODS: Four hundred and thirty-three patients who underwent PCNL were reviewed retrospectively. The factors that may lead to leakage after surgery were analyzed as categorized into four groups according to individual variables (age, sex, body mass index); renal factors (previous surgery, extracorporeal shock wave lithotripsy history, presence of hydronephrosis); stone burden; and surgical features (access number, type of dilatation, presence of nephrostomy catheter). These data were compared for the presence and duration of urinary leakage. RESULTS: There was no statistically significant correlation between individual factors and both the presence of leak (POL) and the duration of leak (DOL) (P > 0.05). Among renal factors, only presence and degree of hydronephrosis was significantly correlated with POL (P < 0.001) and DOL (P < 0.001). The mean cumulative stone burden neither had impact on POL nor correlated with DOL (P > 0.05). Among surgical factors, dilatation with a Nephromax dilator significantly increased incidence of POL when compared with an Amplatz dilator (P < 0.001), yet did not change DOL. Using an internal ureteral stent significantly decreased incidence of POL and DOL (P < 0.001). DOL increased with catheter diameter and stay time (P < 0.05). CONCLUSION: Several yet simple factors appear to be effective in postoperative urine leakage from the access sites after percutaneous stone surgery. Precautions may also be simple if these factors are considered preoperatively.

Do changes in a high serum prostate-specific antigen level and the free/total prostate-specific antigen ratio after antibiotic treatment rule out biopsy and the suspicion of cancer?

OBJECTIVES: To evaluate the impact of antibiotic treatment in patients with higher-than-normal prostate-specific antigen (PSA) levels in terms of changes both in total PSA and free/total (f/t) PSA ratios. MATERIALS AND METHODS: Serum PSA and f/t PSA changes after antibiotic treatment in 85 patients with normal digital rectal examination but elevated age-adjusted serum PSA levels were evaluated with relevance to biopsy results. RESULTS: Serum PSA levels decreased after antibiotic treatment in 47 of 85 patients. The f/t PSA ratio decreased or remained unchanged in 21 and increased in 26 of these 47 cases. Cancer detection rate in the former group was 52.4% (11/21), while it was 7.7% (2/26) in the latter (p = 0.002). There were 38 patients with increased PSA levels after antibiotics. The f/t PSA ratios decreased or remained unchanged in 20 and increased in 18 of these 38 cases. Cancer detection rates were 55% (11/20) in the former and 16.7% (3/18) in the latter group (p = 0.003). CONCLUSIONS: The PSA and f/t PSA levels may change with long-term antibiotic treatment in patients with elevated PSA values. The f/t PSA ratio rather than total PSA appears to be more helpful in suggesting prostate cancer in these cases.

VEGF, COX-2, and PCNA expression in renal cell carcinoma subtypes and their prognostic value.

OBJECTIVE: To evaluate the prognostic value of new markers such as VEGF (vascular endothelial growth factor), COX-2 (cyclooxygenase-2), and PCNA (proliferating cell nuclear antigen) and review their differences in expression by histological subtype in patients with renal cell carcinoma (RCC). METHODS: About 99 patients who underwent radical (n = 79) or partial nephrectomy (n = 20) were included in this study. Histopathological specimens from the subjects were retrospectively analyzed immunohistochemically for the presence of VEGF, COX-2, or PCNA. RESULTS: Mean staining ratios for VEGF, COX-2, and PCNA were 16.5, 16.8, and 31%, respectively. Correlations were evaluated among these three prognostic factors. There was no correlation between PCNA and VEGF (P = .068), but there were significant correlations between COX-2 and both PCNA and VEGF (P = .005 and P = .000, respectively). A significant correlation was found between the expression of VEGF and both pathologic stage and vascular invasion (P = .018 and P = .025, respectively). In addition, patients with conventional RCC had significantly lower VEGF and COX-2 levels than those with papillary RCC (P < .012). CONCLUSIONS: It is obvious that prognostic factors such as VEGF, COX-2, and PCNA may vary depending on histological subtype. The level of expression of these factors together with histological subtype may provide valuable predictive information about the outcome of treatment.