European Biological Variation Study (EuBIVAS): within- and between-subject biological variation estimates of ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX), N-terminal propeptide of type I collagen (PINP), osteocalcin, intact fibroblast growth factor 23 and uncarboxylated-unphosphorylated matrix-Gla protein-a cooperation between the EFLM Working Group on Biological Variation and the International Osteoporosis Foundation-International Federation of Clinical Chemistry Committee on Bone Metabolism.

We have calculated the biological variation (BV) of different bone metabolism biomarkers on a large, well-described cohort of subjects. BV is important to calculate reference change value (or least significant change) which allows evaluating if the difference observed between two consecutive measurements in a patient is biologically significant or not. INTRODUCTION: Within-subject (CVI) and between-subject (CVG) biological variation (BV) estimates are essential in determining both analytical performance specifications (APS) and reference change values (RCV). Previously published estimates of BV for bone metabolism biomarkers are generally not compliant with the most up-to-date quality criteria for BV studies. We calculated the BV and RCV for different bone metabolism markers, namely ß-isomerized C-terminal telopeptide of type I collagen (ß-CTX), N-terminal propeptide of type I collagen (PINP), osteocalcin (OC), intact fibroblast growth factor 23 (iFGF-23), and uncarboxylated-unphosphorylated Matrix-Gla Protein (uCuP-MGP) using samples from the European Biological Variation Study (EuBIVAS). METHODS: In the EuBIVAS, 91 subjects were recruited from six European laboratories. Fasting blood samples were obtained weekly for ten consecutive weeks. The samples were run in duplicate on IDS iSYS or DiaSorin Liaison instruments. The results were subjected to outlier and variance homogeneity analysis before CV-ANOVA was used to obtain the BV estimates. RESULTS: We found no effect of gender upon the CVI estimates. The following CVI estimates with 95% confidence intervals (95% CI) were obtained: ß-CTX 15.1% (14.4-16.0%), PINP 8.8% (8.4-9.3%), OC 8.9% (8.5-9.4%), iFGF23 13.9% (13.2-14.7%), and uCuP-MGP 6.9% (6.1-7.3%). CONCLUSIONS: The EuBIVAS has provided updated BV estimates for bone markers, including iFGF23, which have not been previously published, facilitating the improved follow-up of patients being treated for metabolic bone disease.

Age-related changes of nasal cavity and conchae volumes and volume fractions in children: a stereological study.

BACKGROUND: The anatomy of the human nasal cavity (NC) is complex and its structures are closely related to the functions of the NC. Studies which assessing the mean volumes of NC and conchae are very infrequent. The purpose of current study is to investigate development of NC and conchae according to age and sex by using stereological method. MATERIALS AND METHODS: This retrospective volumetric study was carried out on 342 individuals (166 females and 176 males) between 0 and 18 years old with no pathological conditions or medical procedures that affected the skeletal morphology of the NC. Volumetric estimations were determined on computed tomography (CT) images using point-counting approach of stereological methods. RESULTS: NC, inferior nasal conchae (INC) and middle nasal conchae (MNC) volume measurements that obtained using point-counting method were increased with age in both sexes until 15 years old. Regardless of gender; no significant difference was determined between the left and right values for NC, conchae volumes and choanae measurements. Generally, significant differences were determined in NC and INC volumes according to gender after they reached maximum growth period. According to age the volume ratios of INC to NC and MNC to NC were ranged from 18% to 32% and 9% to15%, respectively. CONCLUSIONS: The current study demonstrated that the point-counting method is effective in determining volume estimation of NC and is well suited for CT studies. Our results could provide volumetric indexes for the NC and conchae, which could help the physician for both patient selections for surgery, and for the assessment of any surgical technique used to treatment of nasal obstruction. (.

Serum human epididymis protein 4 can be a useful tumor marker in the differential diagnosis of adnexal masses during pregnancy: a pilot study.

PURPOSE: The purpose of this study was to evaluate serum concentrations of human epididymis protein 4 (HE4) and cancer antigen 125 (CA 125) in healthy women and their pregnant counterparts to determine the influence of pregnancy on these biomarkers. MATERIALS AND METHODS: Serum concentrations of CA 125 and HE4 were measured in 27 healthy non-pregnant women and 26 healthy pregnant women in the first and second trimesters. RESULTS: Higher concentration of CA 125 was found in pregnants than in non-pregnant women (p = 0.002). There was no difference in CA 125 concentrations between first and second trimesters (p = 0.13). Serum HE4 concentration was not different in pregnant group compared to non-pregnant women (p = 0.510). Likewise, no difference was found in HE4 levels between the trimesters (p = 0.485). There was a positive correlation between increasing parity and CA 125 (p = 0.023), but not HE4 (p = 1.0). CONCLUSION: HE4 serum biomarker is unaffected by pregnancy status and may be useful for evaluation of doubtful pelvic masses in pregnancy. Contrarily, increased serum levels of CA 125 could yield increased number of false-positive results.

Estimation of spleen volume and surface area of the newborns' cadaveric spleen using stereological methods.

BACKGROUND: The purpose of this study was to compare different techniques for the estimation of spleen volume and surface area using magnetic resonance imaging (MRI) images, ultrasonography (USG) images and cadaveric specimen, and to evaluate errors associated with volume estimation techniques based onfluid displacement. MATERIALS AND METHODS: Five new born cadavers, aged 39.7 ± 1.5 weeks, weighted 2.220 ± 1.056 g, were included in the present study. Three different methods were used to assess the spleen volume. The vertical section technique was applied using cycloid test probes for estimation of spleen surface area in MRI. RESULTS: The mean ± standard deviation of spleen volumes by fluid displacement was 4.82 ± 3.85 cm³. Volumes determined by the Cavalieri's principle using physical section and point-counting techniques were 4.45 ± 3.47 cm³ and 4.65 ± 3.75 cm³, respectively; volumes measured by USG and cadaver using ellipsoid formula were 4.70 ± 3.02 cm3 and 5.98 ± 4.58 cm³, respectively. No significant differences were found among all methods (p > 0.05). The spleen surface area was calculated as a 32.3 ± 20.6 cm² by physical sections using cadaver and also it was determined on axial, sagittal and coronal MR planes as 24.9 ± 15.2 cm², 18.5 ± 5.92 cm² and 24.3 ± 12.7 cm², respectively. CONCLUSIONS: As a result, MR images allow an easy, reliable and reproducible volume and surface area estimation of normal and abnormal spleen using Cavalieri'sprinciple. We consider that our study may serve as a reference for similar studies to be conducted in future. :

The effect of ovariectomy on the skin flap viability and myeloperoxidase levels.

OBJECTIVES: Estrogen could affect the rate and quality of wound healing in skin. We aimed to investigate the effects of ovariectomy on skin flap viability and myeloperoxidase (MPO) levels in a rat model. BACKGROUND: Estrogens have many important beneficial and protective roles in skin that they improve collagen content and quality, maintain skin thickness and enhance vascularization. It has been shown that estrogen supplementation accelerates cutaneous wound healing in elderly patients. METHODS: Forty-eight cycling female Wistar albino rats were randomly divided into three groups (n = 16); ovariectomy (Group 1), sham (Group 2), and control (Group 3). Rats were subjected to bilateral ovariectomy in the Group 1, and only laparotomy in the Group 2. Twenty-one days later in the Group 1 and 2, a dorsal caudally based skin flap elevation was done. In the Group 3, the rats had a dorsal skin flap without any surgical intervention. Ten days later, the flaps were harvested for histopathologic examination and biochemical analyses. RESULTS: The rats in the Group 1 had significantly larger necrotic area and lower flap viability than in the Group 2 and 3 (p<0.05). Histopathologic examination showed that necrotic flap regions contained muscle necrosis with an abundant neutrophil infiltration, and severe edema in the Group 1. The MPO activity in the distal of skin flaps was significantly higher in the Group 1 compared to the Group 2 and 3 (p<0.05). CONCLUSION: This study shows that ovariectomy has deleterious effects on skin flap viability in a rat model (Tab. 1, Fig. 6, Ref. 44).

Association between COVID-19 and increased incidence of overactive bladder symptoms in female patients: A retrospective analysis.

INTRODUCTION AND OBJECTIVES: To investigate female patients' post-COVID-19 voiding symptoms and to research how they relate to overactive bladder (OAB). PATIENTS: One hundred and forty patients aged 20-50 years who were hospitalised and discharged due to COVID-19 at Kartal Dr. Lütfi Kirdar City Hospital between 2021 and 2022 and 50 patients with a history of COVID-19 among two hundred female patients who presented to the urology outpatient clinic with symptoms related to OAB were retrospectively analysed. Bladder diary, overactive bladder symptom score (OABSS), uroflowmetry values and time of onset of symptoms of symptomatic patients were recorded for all patients. Disease-free individuals for control purposes were not included in the study. RESULTS: It was observed that 38% of 140 hospitalized patients had a symptomatic change related to OAB, and there was a significant difference in voiding diary, OABSS, and uroflowmetry Qmax values between symptomatic and non-symptomatic patients after COVID-19. (p:0.001) There was a significant difference between the pre-COVID-19 (estimated) and post-COVID-19 (current) voiding diary and OABSS values of all symptomatic patients (with and without a history of hospitalization). (p:0.001) When these two groups were compared with each other, there was a significant difference between the post-COVID-19 voiding diary, OABSS values, and the meantime to the onset of symptoms in inpatients and outpatients (p:0.001) CONCLUSION: COVID-19 may be associated with urgency/urge incontinence and overactive bladder in female patients.

Salmonella carriage and change in serovar distribution in broiler giblets at slaughterhouse level in Turkiye: first report using ISO 6579-1:2017 and ISO 6579-3:2014.

This study aimed to determine the prevalence and serovar distribution of salmonellae in liver, heart, and spleen (LHS) and gizzard (G) of slaughtered broilers. For this, a total of 60 sample units, comprised of 30 LHS and 30 G collected from 3 slaughterhouses, were analysed by reference methods for detection and serotyping as revised ISO 6579-1:2017 and ISO 6579-3:2014, respectively. Also, Salmonella-specific real-time PCR (Salm-PCR) was used for species confirmation, while Salmonella Enteritidis (S. Enteritidis) and Salmonella Typhimurium (S. Typhimurium) specific real-time PCR (SE/ST-PCR) was evaluated to determine its efficiency for rapid detection of the serovars mandated in current legal regulations compared to standard serotyping. All LHS (100%-30/30) and 90% (27/30) of G samples harbored Salmonella with an overall prevalence of 95% (57/60) in samples examined, where all isolates were confirmed as Salmonella by Salm-PCR. The most prevalent serovar in broiler giblets was S. Virchow (80.70%-46/57) followed by S. Enteritidis (19.30%-11/57). SE/ST-PCR (%17.54-10/57) could not detect one G isolate, which was serotyped as S. Enteritidis by standard serotyping. High relative accuracy (98.25%), sensitivity (100%) and specificity (100%), and agreement between methods (κ: 0.94) verified SE/ST-PCR's potential to be used as an alternative in rapid detection of S. Enteritidis and S. Typhimurium. Data on high Salmonella prevalence in broiler giblets of slaughterhouse origin, and detection of the pathogen by the implementation of all requirements indicated in the revised ISO 6579-1:2017 standard method, enabling the determination of actual prevalence in the samples with high sensitivity and specificity is of significance for public health. Additionally, identification of S. Virchow as the dominant serovar followed by S. Enteritidis with a relatively lower prevalence, and absence of S. Typhimurium in broiler giblets are important findings for Turkiye. This up to date data, obtained by strict application of ISO 6579-3:2014 procedures, indicated a shift in circulating serovars in the broiler industry. The objective findings in this study would bring awareness to national/international literature, and may be of use in future improvements in legal regulations.

High Salmonella load with serovar virchow dominance pose major public safety risk in postchill broiler carcasses.

The objective of this study was to determine Salmonella contamination levels, presence and serovar distribution in broiler carcasses before and after chilling, as well as to evaluate the effectiveness of chilling process. A total of 96 pooled neck skin samples (PNSS) of 48 prechill (PreC) and 48 postchill (PosC) carcasses, representing 480 broilers collected in 6 mo' period were analyzed using ISO 6579-2:2012 Miniaturized Most Probable Number (ISO-mMPN) technique. Species confirmation and serovar identification was performed by Salmonella-specific real-time PCR (Salm-PCR) and conventional serotyping, respectively. Mean Salmonella count was 1.84 log10 MPN/g in PreC, and 1.48 log10 MPN/g in PosC samples, indicating a statistically significant reduction of 0.36 log10 MPN/g (p < 0.05) in the counts by plant's air chill system. Salmonella positivity reduced from 97.9% (47/48) in PreC to 85.42% (41/48) in PosC samples, confirmed by Salm-PCR with identified serovars as S. Virchow (89.77 %) followed by S. Schwarzengrund (9.09%) and S. Bredeney (1.14%). Persistence of high load and prevalence of Salmonella with serovar Virchow dominance (other than the ones mandated in current guidelines) in the final product contributes significant and up to date data to relevant literature, and provides unbiased epidemiological reference to legal authorities for future relevant revisions.

A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate.

OBJECTIVES: To evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer. MATERIALS AND METHODS: The study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values. RESULTS: PSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515-0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations. CONCLUSION: PSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

Evaluation of three instruments for laparoscopic cholecystectomy: harmonic scalpel, bipolar vessel sealer, and conventional technique.

AIM: Laparoscopy is the gold standard procedure in the surgery of gall bladder. Harmonic scalpel and bipolar vessel sealer are the other instruments for laparoscopic cholecystectomy. The aim of this study is to compare the effectiveness and safety of the three instruments for laparoscopic cholecystectomy. METHODS: A total of 60 patients were included into the study. Patients were divided into three groups. In Group A, cystic duct and artery were sealed using laparoscopic clips and gall bladder was dissected from the hepatic bed using electrocautery. In Group B, cystic duct and artery were sealed using Harmonic scalpel and gall bladder was dissected from the hepatic bed using Harmonic scalpel. In Group C, cystic duct and artery were sealed using Bipolar vessel sealer and gall bladder was dissected from the hepatic bed using Bipolar vessel sealer. Groups were compared for the following parameters: duration of surgery, amount of drainage, cystic duct opening pressure and cost. RESULTS: The duration of surgery was 31.5 ± 11.1 minutes in Group B, 33.1 ± 10 minutes in Group A, and 36.5 ± 9.9 in Group C; and the difference between Group B and Group C was statistically significant (P<0.04). Cystic duct opening pressure was highest in Group A which was 324.0 ± 23.4 mmHg. For all of these 3 groups total cost was found to be 900$, 2900$, 1800$ for groups A, B, and C; respectively. CONCLUSION: In laparoscopic cholecystectomy different energy source instruments may be safe to use with a cautious dissection and sealing of the cystic duct.

A new scoring system to predict mortality in community-acquired pneumonia: CURB (S)-65.

OBJECTIVE: The first decision to be made in the case of community-acquired pneumonia (CAP) is whether hospitalization of the patient is mandatory. In this study, we aimed to investigate whether the addition of oxygenation parameters to CURB-65 has diagnostic value in predicting mortality in CAP. PATIENTS AND METHODS: A total of 903 CAP patients were included in the study. Patients with a CURB-65 score of 0 and 1 were classified as Group 1 and patients with a CURB-65 score of 2 or more were classified as Group 2. The prediction of mortality through Pneumonia Severity Index (PSI), CURB-65 and CURBS-65/CURBP-65 with the addition of SaO2 and PaO2 values; hence the four different models, was compared among all patient groups. RESULTS: As a result, 3.3% of the cases in Group 1 and 12.7% of the cases in Group 2 died. In both CURB-65 groups, it was noted that the frequency of patients with SaO2 <90% was significantly higher in the dead group than in the alive patient group (p=0.009 and p=0.001, respectively). In the univariate analysis, PaO2<60, and SaO2<90 were significantly associated with mortality. Model 2 (CURBS-65) and Model 3 (CURBP- 65) were examined, SaO2<90 (OR 2.08) was found to have an effect on death. In predicting mortality by the receiver operating characteristics (ROC) analysis, it was understood that the CURBS-65 score had a slightly higher area under the curve (AUC) value than CURB-65. CONCLUSIONS: As a result, it has been shown that the use of CURBS-65 scoring instead of CURB-65 clinical scoring may be more useful in predicting mortality.

Knowledge and attitudes of emergency medicine physicians and nurses regarding emergency management of dentofacial trauma in pediatric patients.

OBJECTIVES: Considering that the first visit for dentofacial trauma is generally in emergency departments, the awareness and knowledge of the emergency medicine staff regarding the treatment of dentofacial injuries is very important for the prognosis. The aim of this study was to investigate the knowledge, education, and self-confidence levels of emergency medicine physicians and nurses concerning the diagnosis and treatment of dentofacial traumatic injuries in pediatric patients. METHODS: This questionnaire-based, cross-sectional study included emergency medicine physicians and emergency medicine nurses. The survey contained questions and three sections on participants' general data, attitudes, basic knowledge, and confidence levels in managing dentofacial trauma. RESULTS: A total of 407 participants (250 emergency medicine physicians and 157 emergency medicine nurses) were included in this study. There was a significant difference between the groups regarding the correct answers to the questions about trauma management and emergency management of crown fractures and avulsed permanent teeth (p <0.05). CONCLUSION: Our findings show that there is a lack of information on dentofacial trauma for emergency medicine physicians and nurses. In order to increase knowledge in this area and to improve the diagnosis and management of dentofacial trauma, interdisciplinary seminars, case discussions, and continuing education programs should be held for emergency medicine staff.

Serum amyloid A and haptoglobin concentrations and liver fat percentage in lactating dairy cows with abomasal displacement.

BACKGROUND: There has been increased interest in measuring the serum concentration of acute phase reactants such as serum amyloid A [SAA] and haptoglobin [haptoglobin] in periparturient cattle in order to provide a method for detecting the presence of inflammation or bacterial infection. OBJECTIVES: To determine whether [SAA] and [haptoglobin] are increased in cows with displaced abomasum as compared with healthy dairy cows. ANIMALS: Fifty-four adult dairy cows in early lactation that had left displaced abomasum (LDA, n = 34), right displaced abomasum or abomasal volvulus (RDA/AV, n = 11), or were healthy on physical examination (control, n = 9). MATERIALS AND METHODS: Inflammatory diseases or bacterial infections such as mastitis, metritis, or pneumonia were not clinically apparent in any animal. Jugular venous blood was obtained from all cows and analyzed. Liver samples were obtained by biopsy in cattle with abomasal displacement. RESULTS: [SAA] and [haptoglobin] concentrations were increased in cows with LDA or RDA/AV as compared with healthy controls. Cows with displaced abomasum had mild to moderate hepatic lipidosis, based on liver fat percentages of 9.3 +/- 5.3% (mean +/- SD, LDA) and 10.8 +/- 7.7% (RDA/AV). [SAA] and [haptoglobin] were most strongly associated with liver fat percentage, r(s) = +0.55 (P < .0001) and r(s) = +0.42 (P = .0041), respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: An increase in [SAA] or [haptoglobin] in postparturient dairy cows with LDA or RDA/AV is not specific for inflammation or bacterial infection. An increase in [SAA] or [haptoglobin] may indicate the presence of hepatic lipidosis in cattle with abomasal displacement.

Adolescent pregnancies and obstetric outcomes in southeast Turkey: data from two regional centers.

PURPOSE OF INVESTIGATION: To evaluate adolescent pregnancy and obstetric outcomes. METHODS: This retrospective cohort study was performed by analysis of patient files and birth records of pregnant women who delivered in two cities in Southeast Anatolia, Turkey. Pregnant women aged 19 years old and younger were included in the study group. Women between 20 and 35 years of age constituted the control group. RESULTS: The incidence of adolescent pregnancy during the study period was 11%. Birth weight and hemoglobin level were significantly higher in the control group (p < 0.05). The majority of the women in the study group delivered vaginally (p < 0.05). The incidence of preterm labor, intrauterine growth retardation, and stillbirth was significantly higher in the study group (p < 0.05). Adolescent mothers were most likely to have low birth weight and very low birth weight babies (p < 0.05). CONCLUSION: Adolescent pregnancies were associated with adverse pregnancy outcomes in our study population. Possible grounds for such increase warrant further evaluation and discussion.

Computed tomography depiction of normal inguinal lymph nodes in children.

BACKGROUND: The aim of the study was to establish computed tomography (CT) characteristics, distribution and provide normative data about size of normal inguinal lymph nodes in a paediatric population. MATERIALS AND METHODS: Four hundred eighty-one otherwise healthy children (147 girls, mean age: 8.87, range 0-17 years) underwent pelvic CT in the setting of high-energy trauma were included in the study. Both axial and coronal 1.25-mm reconstructions were evaluated for the presence, location (deep or superficial), number, presence of fat attenuation, and shape of the lymph nodes, short-axis diameter of the biggest lymph node for each of right and left inguinal regions. RESULTS: A total of 7556 lymph nodes were detected in 481 subjects (the mean count of superficial and deep inguinal lymph nodes was 13.35 [range 6-23] and 2.36 [range 0-7] per subject, respectively): 15% (1135/7556) deep located, 85% (6421/7556) superficially located, 86.6% (6547/7556) with fat attenuation, 99.2% (7496/7556) oval in shape, 0.8% (60/7556) spherical. The short-axis diameter of the lymph nodes increased with age. Pearson's correlation coefficient for superficial and deep lymph nodes in boys and girls, respectively: 0.538 (p < 0.001), 0.504 (p < 0.001), 0.452 (p < 0.001) and 0.268 (p < 0.001). The mean maximum short-axis diameters in different age groups and gender varied between 6.33 ± 0.85 mm and 8.68 ± 1.33 mm for superficial, 3.62 ± 1.16 mm and 5.83 ± 1.05 mm for deep inguinal lymph nodes. CONCLUSIONS: Inguinal lymph nodes were multiple, commonly contained fat, and were oval in shape. The data determined about inguinal lymph node size in different paediatric age groups may be applicable as normative data in daily clinical CT evaluation practice.

Prenatal diagnosis of a case with anencephaly-omphalocele-unilateral absent radial ray.

We report here a female fetus with anencephaly, omphalocele and unilateral radial aplasia. The combination of two of these three malformations were reported in a number of patients diagnosed as Gershoni-Barush syndrome, ORR phenotype, VATER association, Schisis association, OEIS complex, Schinzel phocomelia syndrome and Acalvaria but they have not been reported all together in the same patient up to date. We hypothesize that, some or all these syndromes given above may be related etiologically.

Prenatal diagnosis of a case probably with Oral-Facial-Digital Syndrome--Gabrielli type.

We report here a case with microcephaly, preauricular pits, cleft lip-palate, hypertelorism, multiple frenula and preaxial polydactyly. The clinical picture overlaps with many syndromes, but it is mostly consistent with oral-facial-digital syndrome, Gabrielli type. There are no previously reported cases of this syndrome presenting also with microcephaly. On the other hand, it is hard to differentiate this clinical picture from Goldenhar syndrome (Oculo-auriculo-vertebral spectrum), and oculo-auriculo-fronto-nasal syndrome because of many overlapping features.

Craniorachischisis totalis: a case report and review of the literature.

OBJECTIVE: To discuss a fetus with craniorachischisis diagnosed antenatally and to review the literature. METHOD: Case report. RESULTS: Craniorachischisis was detected on ultrasound scan in a fetus at gestational week 13. Pregnancy was terminated and diagnosis was verified postnatally. CONCLUSION: Craniorachischisis is a rare and severe form of neural tube defects (NTDs). The majority of currently known cases of mouse craniorachischisis have been found to result from disturbance of a single molecular signaling cascade, called planar cell polarity pathway (PCP). The mutant genes that have been causative in disturbance of PCP in mouse models have been examined in human malformations but none of them have so far been implicated in human craniorachischisis. To date, no other genes except the gene encoding 5,10-methylenetetrahydrofolate reductase have been specifically implicated in predisposition to NTDs. We suggest that other PCP genes should be considered as candidates for a role in the etiology of human NTDs. Further investigations are therefore necessary.

Comparison of serum CA 19.9, CA 125 and CEA levels with severity of chronic obstructive pulmonary disease.

OBJECTIVE: To investigate serum levels of CA 19.9, CA 125 and carcinoembryonic antigen (CEA) in patients with different stages of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: Fifty-three consecutive patients (50 males, 3 females, mean age 67.6 +/- 10.1 years) with COPD were included in this study. Serum levels of CA 19.9, CA 25 and CEA were determined by the chemiluminescent immunometric method. Based on values obtained from pulmonary function tests, the patients were divided into 3 groups: moderate (21), severe (18) and very severe (14). Data were analyzed with a Kruskal-Wallis one-way analysis of variance test and Mann-Whitney U test. RESULTS: The mean serum levels of CA 125 and CA 19.9 were significantly higher in patients with very severe COPD (p = 0.013 and p = 0.017, respectively) than in patients with severe and moderate COPD (p < 0.05). Patients with cor pulmonale had significantly high mean serum levels of CEA, CA 19.9 and CA 125 (p < 0.05). Patients using a long-acting beta-agonist and theophylline showed significantly higher mean serum levels of CA 125 than patients who were not (p < 0.05). CONCLUSION: Data showed that the increased serum tumor markers in patients with COPD might be due to the severity of COPD, medication and cor pulmonale.

Systematic review of the biological variation data for diabetes related analytes.

BACKGROUND: Objective interpretation of laboratory test results used to diagnose and monitor diabetes mellitus in part requires the application of biological variation data (BVD). The quality of published BVD has been questioned. The aim of this study was to quality assess publications reporting BVD for diabetes-related analytes using the Biological Variation Data Critical Appraisal Checklist (BIVAC); to assess whether published BVD are fit for purpose and whether the study design and population attributes influence BVD estimates and to undertake a meta-analysis of the BVD from BIVAC-assessed publications. METHODS: Publications reporting data for glucose, HbA1c, adiponectin, C-peptide, fructosamine, insulin like growth factor 1 (IGF-1), insulin like growth factor binding protein 3 (IGFBP-3), insulin, lactate and pyruvate were identified using a systematic literature search. These publications were assessed using the BIVAC, receiving grades A, B, C or D, where A is of highest quality. A meta-analysis of the BVD from the assessed studies utilised weightings based upon BIVAC grades and the width of the data confidence intervals to generate global BVD estimates. RESULTS: BIVAC assessment of 47 publications delivered 1 A, 3 B, 39C and 4 D gradings. Publications relating to adiponectin, C-peptide, IGF-1, IGFBP-3, lactate and pyruvate were all assessed as grade C. Meta-analysis enabled global BV estimates for all analytes except pyruvate, lactate and fructosamine. CONCLUSIONS: This study delivers updated and evidence-based BV estimates for diabetes-related analytes. There remains a need for delivery of new high-quality BV studies for several clinically important analytes.