UK Haemoglobin Disorders Peer Review: A Quality Standards-based review programme for sickle cell disease and thalassaemia.

We evaluated the impact of peer reviews in driving improvement in healthcare quality for people with haemoglobinopathy in the United Kingdom. We analysed compliance to four Quality Standards (QS)-based peer reviews from 2010 to 2020 to evaluate its impact in driving healthcare quality. Seventeen paediatric and 29 adult haemoglobinopathy centres were reviewed in 2010/11 and 2012/13 respectively; 33 paediatric and 33 adult centres were reviewed in 2014/16, and 32 paediatric and 32 adult centres were reviewed in 2018/2020. Compliance with QS and participant feedback were analysed to assess the impact of peer review programmes to drive improvement in quality of care. We noted that haemoglobinopathy centres significantly improved their compliance to QS between the first two review programmes, but not in the final review programme. In comparison to other disease-group reviews, the haemoglobinopathy departments were less able to address critical peer review recommendations in their own institutions. The peer review programme was unable to drive sustained improvement in healthcare quality, underscoring the need for sustained development and support for haemoglobinopathy services in the National Health Service. Further work is needed to understand why disparities exist among peer review-driven improvement initiatives within different disease groups.

Antibacterial effect of silver nanoparticles mixed with calcium hydroxide or chlorhexidine on multispecies biofilms.

The purpose is to evaluate the antibacterial effects of the silver nanoparticles (AgNPs) (Nanografi, METU Teknokent, Ankara, Turkey) mixed with calcium hydroxide (Ca(OH)2) (Ultracal XS, Ultradent, St Louis, US) or chlorhexidine gel (CHX) (Gluco-Chex, Cerkamed, Stalowa Wola, Poland) against a multispecies biofilm, by confocal laser scanning microscopy (CLSM) and culture-based analysis. Dentine blocks were inoculated with Enterococcus faecalis, Streptococcus mutans, Lactobacillus acidophilus and Actinomyces naeslundii for 1 week. Infected dentine blocks were randomly divided into groups according to medication; saline solution (SS), Ca(OH)2, Ca(OH)2 + AgNP, 2%CHX gel and 2%CHX gel + AgNP and time of application: 1 and 7 days (all groups, n = 5). Bacterial samples were collected before and after medication to quantify the bacterial load. Biofilm elimination was quantitatively analyzed by Live/Dead BacLight Bacterial Viability staining and CLSM. The addition of AgNPs to Ca(OH)2 increased the effectiveness of medicament in terms of bacterial reduction in both application times (1 and 7 days) (p < 0.05: ANOVA, Tukey's test) according to culture-based analysis. The CLSM images revealed that mixture of AgNP with CHX killed significantly more bacteria when compared with all other medicaments at 1- and 7-day application times (p < 0.05 and p > 0.05, respectively: Kruskal-Wallis, Dunn post hoc tests). The efficacy of Ca(OH)2 mixed with AgNPs was superior to Ca(OH)2 used alone in both application times (p < 0.05) according to CLSM analysis. The present study put forth the potential use of AgNPs mixed with Ca(OH)2 or CHX on multispecies (Enterococcus faecalis, Streptococcus mutans, Lactobacillus acidophilus and Actinomyces naeslundii) biofilm in 1 and 7day application periods.

The Initial Cardiac Tissue Response to Cryopreserved Allogeneic Adipose Tissue-Derived Mesenchymal Stromal Cells in Rats with Chronic Ischemic Cardiomyopathy.

Mesenchymal stromal cells have proven capable of improving cardiac pump function in patients with chronic heart failure, yet little is known about their mode of action. The aim of the study was to investigate the short-term effect of cryopreserved allogeneic rat adipose tissue-derived stromal cells (ASC) on cardiac composition, cellular subpopulations, and gene transcription in a rat model of chronic ischemic cardiomyopathy (ICM). Myocardial infarction (MI) was induced by permanent ligation of the left anterior descending coronary artery. After 6 weeks, the rats were treated with ASCs, saline, or no injection, using echo-guided trans-thoracic intramyocardial injections. The cardiac tissue was subsequently collected for analysis of cellular subpopulations and gene transcription 3 and 7 days after treatment. At day 3, an upregulation of genes associated with angiogenesis were present in the ASC group. On day 7, increases in CCR2+ and CD38+ macrophages (p = 0.047 and p = 0.021), as well as in the CD4/CD8 lymphocyte ratio (p = 0.021), were found in the ASC group compared to the saline group. This was supported by an upregulation of genes associated with monocytes/macrophages. In conclusion, ASC treatment initiated an immune response involving monocytes/macrophages and T-cells and induced a gene expression pattern associated with angiogenesis and monocyte/macrophage differentiation.

Anti-inflammatory and antiresorptive functions of melatonin on experimentally induced periapical lesions.

AIM: To investigate the effects of systemically administered melatonin on inflammation and alveolar bone resorption in rats with experimentally induced periapical lesions. METHODOLOGY: Thirty adult Sprague Dawley rats were divided equally into negative, positive control and melatonin groups. The pulp chambers of their mandibular first molars were exposed to the oral environment to induce experimental periapical lesions in the positive control and melatonin groups. The melatonin group received daily intraperitoneal injections of melatonin at a dose of 10 mg kg-1 . After 21 days, the animals were euthanized; the hemi-mandible parts were prepared for radiological, histopathological, immunohistochemical (IL-1ß, RANK, RANKL, OPG and tartrate-resistant acid phosphatase (TRAP) and Brown-Brenn (bacteria) evaluations. Data were analysed by Kruskal-Wallis (for non-parametric data) and one-way anova tests (for parametric data) (P < 0.05). RESULTS: The area of radiographic periapical bone loss was significantly smaller in rats that were given daily intraperitoneal injections of melatonin (P < 0.01). The histopathological scores of the melatonin group were significantly lower than those of positive control group (P < 0.01). Histomorphometrically, the area of periapical bone loss in the melatonin group was significantly smaller than the positive control group (P < 0.01). The expression of IL1-ß, RANK and RANKL was significantly higher in the positive control group, whereas OPG was significantly higher in the melatonin group (P < 0.01). The number of osteoclasts was significantly greater in the positive control group by TRAP staining analyses (P < 0.01). The scores for bacteria localization using Brown-Brenn staining in the melatonin group was significantly lower than that of the positive control group (P < 0.01). CONCLUSIONS: Melatonin demonstrated antiresorptive effects on bone associated with experimentally induced periapical lesions in rats via its anti-inflammatory activity. Further studies are necessary to evaluate its possible effects on the healing of periapical lesions.

Mechanical reduction in intracanal Enterococcus faecalis when using three different single-file systems: an ex vivo comparative study.

AIM: To evaluate the bacterial reduction achieved by WaveOne Gold (Dentsply Sirona Endodontics, Ballaigues, Switzerland), Hyflex EDM (Coltene-Whaledent, Altstätten, Switzerland), and XP-endo Shaper (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) in canals infected with Enterococcus faecalis. The null hypothesis (H0 ) was that there would be no difference amongst the NiTi systems in reducing the root canal bacterial load. METHODOLOGY: Seventy-four mandibular premolar teeth with straight and round root canals were selected. Sixty-two root canals were contaminated with E. faecalis for 4 weeks and subjected to mechanical preparation with one of three single-file NiTi rotary systems (WaveOne Gold, Hyflex EDM, and XP Endo Shaper). Twelve non-contaminated root canals were used as negative controls. Bacterial samples were collected with sterile paper points (Dentsply Sirona Endodontics) before and after rotary instrumentation to quantify the bacterial load. Five roots from each instrumentation group were evaluated topographically from the coronal, middle and apical thirds by SEM. The bacterial reduction was calculated and analysed statistically by the Kruskal-Wallis and Dunn post hoc tests, all at 5% significance. RESULTS: The samples taken before instrumentation showed approximately 9.64 log CFU bacterial load. Instrumentation with the Hyflex EDM and XP-endo Shaper resulted in significantly greater bacterial reduction than those with WaveOne Gold (P = 0.00). All specimens had bacterial growth. SEM images supported the CFU/mL data. Thick and dense debris was observed in WaveOne Gold samples. Instrumentation resulted in the disruption of the biofilm-like structure, and both areas of clean and open dentinal tubules and areas with thick debris were observed in Hyflex EDM and XP-endo Shaper samples. CONCLUSIONS: Instrumentation in straight and round canals of premolar teeth with the Hyflex EDM and XP-endo Shaper resulted in significantly greater bacterial reduction than WaveOne Gold. No instrumentation system rendered root canals completely free from bacteria.

The preventive effects of atorvastatin and N-acetyl cysteine in experimentally induced ischemia-reperfusion injury in rats.

AIM: We investigated the effects of atorvastatin and N-acetyl cysteine in decreasing ischemia-reperfusion damage after detorsion of a volvulus of the cecum and ascending colon. METHODS: Wistar albino rats (250-300 g) were divided into four groups. A cecal-ascending colon volvulus was created by the intestinal clockwise 720° rotation. At the end of one hour, the bowel was detorsioned. Group I (n = 7) was the sham (laparotomy) group, Group II (n = 7) the control (no treatment, volvulus or detorsion), Group III (n = 7) (N-acetyl cysteine administered ) , and Group IV (n = 7) (atorvastatin administered ) group. Blood samples were collected from each group via peripheral veins and centrifuged one hour after detorsion. The parameters of ischemia including malondialdehyde, glutathione peroxidase, catalase, and superoxide dismutase were then observed in the serous fluid. RESULTS: Malondialdehyde and superoxide dismutase increased in the control group, whereas they were reduced in the Group III and Group IV (p = 0.005; p = 0.008, respectively). The glutathione peroxidase levels revealed no significant differences (p > 0.05), whereas the catalase levels of the group III was higher than in each of the other three groups (p < 0.001). Histopathological evaluation detected reduced lesioning of the organ in the groups which were given atorvastatin and N-acetyl cysteine. CONCLUSION: Atorvastatin and of N-acetyl cysteine have a similar preventive effect in experimental ischemia-reperfusion injury (Tab. 8, Fig. 6, Ref. 24).

Determinants of felt stigma in epilepsy.

The present study aimed to determine the level of felt stigma, overprotection, concealment, and concerns related to epilepsy in different life domains by using culturally-specific scales for Turkish individuals with epilepsy. Also, it aimed to detect relations among the study variables and to determine the variables which predict felt stigma. For this purpose, felt stigma scale, overprotection scale, concealment of epilepsy scale, and concerns of epilepsy scale were administered to two hundred adult persons with epilepsy (PWE). The results showed that almost half of the participants reported felt stigma, overprotection, concealment of epilepsy, concerns related to future occupation, and concerns related to social life. Almost all the study variables show correlations with each other. Concealment of epilepsy, concerns related to social life, and concerns related to future occupation were found as the predictors of felt stigma.

The impact of occlusal plane cant along with gingival display on smile attractiveness.

OBJECTIVES: To evaluate the influence of occlusal plane cant in conjunction with maxillary gingival display on perception of smile attractiveness by orthodontists, dentists, and laypersons. SETTING AND SAMPLE POPULATION: Faculty of Dentistry at Baskent University. A total of 204 raters for smile attractiveness. MATERIALS AND METHODS: A frontal intra-oral photograph of aligned teeth was modified using image processing software. Six different occlusal lines representing 0° to 5° cants were obtained by tilting the photographs. Each occlusal cant was adjusted in five manners resulting in five different gingival display amounts. Attractiveness of the 30 different smiles was evaluated by 204 raters divided into three groups (n = 68 in each group). RESULTS: Both occlusal cant (p < 0.001) and gingival display amount (p < 0.001) had a statistically significant influence on smile attractiveness. Smile attractiveness scores with reference to amount of gingival display showed a significant difference between rater groups (p < 0.001). Orthodontists preferred 1-mm coverage of upper central incisors by the upper lip, whereas dentists and laypersons preferred 2 mm. Significant (p < 0.001) interaction was observed between occlusal cant and gingival display amount, which influenced smile attractiveness. CONCLUSION: Increase in both occlusal plane cant and gingival display negatively influences smile attractiveness. The influence of occlusal plane cant becomes less when gingival display increases, whereas the influence of gingival display decreases when occlusal cant increases. Dentists are more generous than orthodontists, while laypersons are the most generous regarding smile attractiveness scores.

The assessment of maternal and umbilical cord homocysteine levels in obese pregnant women.

PURPOSE: The aim of this study was to compare the maternal plasma and umbilical cord blood homocysteine levels in obese and non-obese pregnant women. MATERIALS AND METHODS: One hundred-ten term pregnant women, who completed their 3711, gestational weeks and were not in active labor, were enrolled in the study. While 41 out of them were obese (BMI ≥ 30 kg/m(2)), 69 were non-obese (BMI < 30 kg/m(2)). The maternal plasma and umbilical cord homocysteine levels and umbilical cord pH values were compared between the groups. The statistical analyses were performed using t-test, Mann Whitney test, and Chi-square test. Ap < 0.05 value was set as statistically significant. RESULTS: The mean of age was higher in obese group in borderline significance (26.8 ± 5.4 vs. 28.8 ± 5. l,p = 0.049). The mean of gestational weeks, birthweight, the mode of delivery, and umbilical cord pH values were similar between the groups (p > 0.05). The maternal plasma homocysteine levels [median (interquartile range); 7.6 (4.1) vs. 7.1 (4.9)] and umbilical cord homocysteine values were not statistically different [8.6 (4.2) vs. 8.8 (4.5)] between the groups (p > 0.05). CONCLUSION: The maternal and umbilical cord blood homocysteine levels are not different in obese and non-obese pregnant women.

Alterations of the thioredoxin system during subarachnoid hemorrhage-induced cerebral vasospasm.

BACKGROUND: The exact underlying pathogenic mechanisms and effective preventive or therapeutic interventions for cerebral vasospasm remain obscure. The thioredoxin (Trx) system performs important functions in the central nervous system including neurotrophic and neuroprotective actions. There is no study directly investigating the effects of subarachnoid hemorrhage (SAH) induced cerebral vasospasm on the Trx system in the literature. METHODS: Sixteen male New Zealand rabbits were randomly divided into two groups of eight rabbits each: a control group and a SAH group. The control group, (n = 8) was a sham surgery group in which SAH was not induced. In the SAH group, (n = 8), the SAH protocol was used to induce cerebral vasospasm. The brain and brainstem were removed and each brainstem was cut coronally into two pieces: an anterior part that contains basilar artery and a dorsal part that contains brainstem tissue. The brainstem tissue thioredoxin-1(Trx1), thioredoxin-2 (Trx2), thioredoxin reductase (TrxR), thioredoxin reductase-1 (TrxR1), thioredoxin-interacting protein (TXNIP) levels were investigated. Total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde levels (MDA) and tumor necrosis factor alpha (TNF-alpha) levels were investigated for determining the oxidative-antioxidative status of the related brain tissues. Basilar artery segments were investigated for cross-sectional area and wall thickness measurements. RESULTS: SAH statistically significantly reduced the tissue levels of Trx1 (p < 0.01) and TrxR (p < 0.01). Trx2 levels were not significantly altered after SAH (p > 0.05). SAH significantly reduced the expression of TrxR1 (p < 0.01) and significantly increased the expression of TXNIP (p < 0.01) when compared with controls. TOS levels and MDA levels significantly increased after SAH (p < 0.01) and TAS levels significantly reduced after SAH (p < 0.01). TNF-alpha levels significantly increased after SAH (p < 0.01). SAH-induced cerebral vasospasm significantly (p < 0.05) increased the wall thickness and reduced the mean cross-sectional area of the basilar artery (p < 0.05). CONCLUSIONS: The Trx system seems to be negatively affected by the simultaneously interrelated enzymatic alterations during cerebral vasospasm.

Efficacy of endodontic applications of ozone and low-temperature atmospheric pressure plasma on root canals infected with Enterococcus faecalis.

UNLABELLED: This study aimed to compare the antimicrobial efficacy of low-temperature atmospheric pressure plasma (LTAPP) design and gaseous ozone delivery system with 2.5% NaOCl on Enterococcus faecalis in root canal walls and dentine tubules. The samples were divided into LTAPP (n = 12), ozone (n = 12), NaOCl (positive control, n = 12) and saline (negative control, n = 6) groups. Microbial samples were collected using paper points and dentin chips from root canals. Antimicrobial efficacy was assessed by counting the colony-forming units of Ent. faecalis before and after each irrigation protocol. Data were analysed using Kruskal-Wallis, Wilcoxon signed-rank, Friedman and Bonferroni t (Dunn's test)-tests (P = 0.05). The microbial sampling with paper points showed antibacterial efficacy of NaOCl, LTAPP, ozone and saline in descending order, respectively (P < 0.05). The microbial sampling with dentin chips demonstrated a superior efficacy of LTAPP compared with NaOCl in the middle third (P < 0.05), while both had similar effects in coronal and apical thirds (P > 0.05). NaOCl and LTAPP were better than ozone at the coronal and middle parts of the root canals (P < 0.05). These findings led us to suggest that LTAPP, which has no thermal and chemical effects, may be of great aid in endodontic treatment. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study handles different perspectives on chemomechanical preparation of root canals. Ozone and low-temperature atmospheric pressure plasma (LTAPP) were investigated to determine whether they could be an alternative for NaOCl. Up to now, chemical solutions (NaOCl, chlorhexidine digluconate, etc...) have been used to disinfect the root canals. When the reported effects of LTAPP on biological and chemical decontamination were taken into consideration, a question rose whether it has antimicrobial efficacy in root canals infected with E. faecalis. According to the findings of the present study, LTAPP may constitute a promising aid in endodontics in disinfection of root canals.

Diffuse soft tissue and vascular calcification in systemic lupus erythematosus with chronic kidney disease.

The systemic disorder of mineral and bone metabolism which is related to chronic kidney disease (CKD) is called mineral and bone disorder (MBD). Calcifications related to CKD-MBD may occur in ophthalmic tissue, arterial walls, subcutaneous and periarticular soft tissues and organs. The vascular calcifications are the most important causes of mortality and morbidity in CKD. Here, we present a case of systemic lupus erythematosus with early and disseminated calcifications of vascular and periarticular soft tissues related to CKD-MBD.

Accuracy of Color Determination by Intraoral Scanners in Bleached and Unbleached Teeth: A Clinical Study.

PURPOSE: This clinical study aimed to evaluate the color measurement ability of intraoral scanners (Trios 3, (3Shape, Copenhagen, Denmark) and Cerec Omnicam, (Dentsply Sirona, Charlotte, NC, USA) in comparison to VITA Classical and VITA 3D-Master shades obtained by a spectrophotometer (Easyshade V, VITA, Zahnfabrik, Bad Säckingen, Germany). METHODS: Four hundred eighty teeth from thirty patients were included in the study. Fifteen patients had never undergone bleaching, and the other fifteen had undergone professional bleaching within the last 6 months. VITA Classical and VITA 3D Master shades were determined using Trios 3 (T3), Cerec Omnicam (CO), and EasyShade V from cervical, middle, and incisal/occlusal areas of maxillary and mandibular central and lateral incisors, canines, and first premolars. Color accuracy rates (cAR) were assessed by categorizing the color data according to the Munsell color system for bleached and unbleached teeth, maxillary and mandibular, and teeth arranged from anterior to posterior in each quadrant. McNemar, Mann-Whitney U, and Wilcoxon tests and Point Biserial Correlation Analysis were used for statistical analysis (significance level α=0.050). RESULTS: The bleached teeth had a significantly higher cAR for T3 in VITA 3D Master and VITA Classical guides (p<0.05). The cAR of the incisal area in VITA 3D Master was significantly lower in both scanners (p<0.05) except for the lightness/hue/chroma of bleached teeth. T3 cAR increased statistically significantly from anterior to posterior (p<0.001); however, no significant difference was found for CO (p=0.482). CONCLUSION: The color accuracy rates of both scanners for shade guides that included all color components in this study were below 30%, which was not clinically satisfactory for color measurement. Confirming the measurements with a spectrophotometer is recommended.

Is aortic knob width a novel predictor of mortality in hemodialysis patients?

OBJECTIVE: Identifying reliable predictors of mortality in end-stage renal disease patients is crucial for patient outcomes. Aortic knob width is a radiographic parameter used to assess cardiovascular diseases and atherosclerosis. This study investigated the association between aortic knob width and mortality in hemodialysis patients. PATIENTS AND METHODS: The study included data collected between 2007 and 2022 from 103 patients aged between 18 and 85 who had been undergoing hemodialysis treatment for at least one year. Patients were divided into two groups: survivors and deceased. The aortic knob width was measured using a posterior-anterior chest radiograph after midweek hemodialysis. The relationship between aortic knob width and mortality was investigated. RESULTS: Deceased patients had significantly larger aortic knob widths compared with survivors. The deceased group's hemodialysis (HD) duration was shorter, median age was older, Kt/V, hemoglobin, and albumin levels were lower, and the frequency of patients with hypertension, diabetes, and aortic wall calcification was higher. Aortic knob width greater than 37.98 mm was identified as a predictor of mortality in hemodialysis patients. Survival rates for aortic knob width <37.98 mm are 98.1% for 1 year and 64.9% for 15 years. For aortic knob width larger than 37.98 mm, survival rates are 88% for three years, 68% for five years, 45.2% for ten years, and 25% for fifteen years. The most important risk factors for increased aortic knob width were age, male sex, aortic calcification, and hypertension. CONCLUSIONS: Age, male gender, aortic calcification, and hypertension are the primary risk factors for increased aortic knob width in hemodialysis patients. Aortic knob width greater than 37.98 mm, which can be measured simply and rapidly using posterior-anterior chest radiography, may be a predictor of mortality. Graphical Abstract: https://www.europeanreview.org/wp/wp-content/uploads/Graphical-Abstract-10.jpg.

A retrospective radiographic study of coronal-periapical status and root canal filling quality in a selected adult Turkish population.

OBJECTIVE: To investigate the oral health (with regard to the periapical status, quality of root fillings and coronal restorations) in an urban adult Turkish subpopulation using digital panoramic radiographs. MATERIALS AND METHODS: One thousand digital panoramic radiographs involving 28,000 teeth were selected from the archive of the Public Oral and Dental Health Center of Isparta. Coronal status (the type of restoration, signs of marginal leakage or decay), root filling quality (length and lateral seal) and periapical status (according to Periapical Index, PAI) were evaluated. Correlations between apical periodontitis (AP) and the quality of root fillings or coronal restorations were statistically analyzed using the χ(2) test. RESULTS: Of the 28,000 teeth evaluated, 22,380 (80.0%) were sound, 4,732 (16.9%) were missing, 753 (2.6%) were filled and 135 (0.5%) were decayed. Of the 753 coronal restorations, 400 (53.1%) were radiographically acceptable. Of the 23,268 teeth, 601 (2.6%) were root filled and 247 root fillings were adequate. Ninety-five (15.8%) root-filled teeth had AP (PAI 3-5). Out of the total, the AP prevalence was 0.4% in root-filled teeth and 0.8% in teeth without root fillings. The presence of AP was significantly correlated with inadequate coronal restorations and root canal fillings (p = 0.000). CONCLUSION: Tooth type, quality and type of coronal restorations, and length and homogeneity of root fillings significantly affected periapical status.

Modified Limberg transposition flap in the treatment of pilonidal sinus disease.

BACKGROUND: Pilonidal sinus disease (PSD) is a common problem in surgical practice. Different non-surgical and surgical methods have been used for treating PSD. Flap techniques including the Limberg flap have become more popular in recent years. A modified Limberg flap was used to reduce the problems of skin maceration and recurrence associated with the conventional Limberg flap technique. The aim of this retrospective study was to assess the effectiveness of the modified Limberg flap technique for PSD. METHODS: Medical records of 94 patients with PSD who had been treated with a modified Limberg flap between December 2006 and 2009 were evaluated. The patients' age, sex, duration of preoperative symptoms, operative time, mean hospital stay, postoperative complications, wound infection rate, maceration rate and recurrence rate, time until return to work, time until sitting on the toilet without pain, hypoesthesia in the gluteal region, and satisfaction score were recorded during follow-up or at the last interview. Clinical data were obtained at the end of the 5th postoperative day and at 1, 3, 6, and 12 months following surgery. RESULTS: There were 83 male and 11 female patients. The mean operative time was 38.95 ± 6.77 min (range 30-67 min). All patients were followed up longer than 12 months, and the mean follow-up period was 30.97 ± 12.7 months (range 12-54 months). While wound dehiscence was observed in only one patient, we did not detect any case of flap necrosis. Two cases of seroma were observed. Wound infection was detected in 5 patients (5.3%). Surgical drainage was performed in 2 cases. Another 3 patients were treated with oral antibiotics. Maceration of the surgical incision site was detected in 8 patients (8.5%) who were all successfully treated with conservative measures. There were 4 patients (4.2%) with recurrence in this series. CONCLUSIONS: When compared with the available data on use of the conventional Limberg flap for PSD, our results suggest that use of the modified Limberg flap is associated with a lower maceration and recurrence rate, and greater patient satisfaction.

Effects of iloprost and piracetam in spinal cord ischemia-reperfusion injury in the rabbit.

STUDY DESIGN: Experimental Study. OBJECTIVES: The aim of this study was to investigate the neuroprotective effects of iloprost and piracetam on spinal cord ischemia/reperfusion (I/R) injury in the rabbit. SETTINGS: The Experimental Research Center of Selcuk University, Konya, Turkey. METHODS: A total of 24 rabbits were divided into four groups of six rabbits each, as follows: group 1 (n = 6) sham, laparotomy only; group 2 (n = 6) I/R; group 3 (n = 6) I/R+iloprost; and group 4 (n = 6) I/R+piracetam. I/R was established in groups 2, 3 and 4. Subsequently, they were followed up neurologically for 24 h until the rabbits were killed; biochemical and histopathological examinations of samples from the spinal cord were carried out. RESULTS: Neurological examination results were significantly better in the iloprost and piracetam groups compared with the I/R group (P < 0.05). Neuroprotection was achieved with iloprost and piracetam by suppressing malondialdehyde (P < 0.05), increasing glutathione peroxidase activity (P < 0.05) and decreasing the xanthine oxidase level. In histopathological assessment, iloprost and piracetam groups were statistically different from the I/R group in terms of the number of apoptotic neurons in gray matter and white matter, as well as in terms of degenerated neurons and glial cells (P < 0.05). No statistical difference was determined between the four groups in the number of degenerated glial cells (P > 0.05). CONCLUSION: This study has shown that iloprost and piracetam have neuroprotective effects in I/R injury both neurologically and histopathologically because of inhibition of lipid peroxidation.

Epidemiological findings on Hepatitis C infection in a tertiary level hospital in mid-northern Anatolia in Turkey: A four-year analysis.

The hepatitis C virus (HCV) is a blood-borne pathogen that causes acute or chronic infection of the liver, sometimes leading to serious liver damage and fatality. The objective of this study was to evaluate HCV prevalence in patients attending the Regional Training and Research Hospital for Medical Examination and Surgery in Samsun Province of Turkey between 2014 and 2017. Blood specimens taken from 152 596 patients were screened for HCV infection by using the anti-HCV assay. Seropositive samples were subjected to polymerase chain reaction (PCR) testing in order to determine whether the HCV infection was active. Genotyping was then performed. Overall, HCV seropositivity and active HCV infection were 2.76% and 2.05%, respectively. Foreign nationals accounted for 5.61% of the seropositive samples and 1.37% of active HCV infective samples. We further report that 2017 was the year with the highest seroprevalence which was 3.64%. HCV genotype 1 was the most common genotype detected in residents of Samsun Province at 89.86%, followed by Genotype 3 at 4.54%. This study provides important information on the levels of HCV infection in the Samsun region of Turkey. The data indicate that there was a rising trend of HCV infection between 2014 and 2017.

Hyperprolactinemia and possibly related development of prolactinoma during amisulpride treatment; three cases.

Schizophrenia is a chronic and debilitating psychotic mental disorder that affects about 1% of the world's population. Antipsychotic drugs are the mainstay of treatment in schizophrenia. Hyperprolactinemia, which is a common side effect of typical antipsychotics, is also associated with the use of some of the newer atypical agents. Antipsychotics may enhance prolactinoma growth as manifested by an increase in serum prolactin concentration. Prolactin-secreting pituitary adenomas possibly related with antipsychotics have been described in the literature. To our knowledge, this is the first series of cases showing a possible relation between pituitary adenomas and amisulpride treatment in patients with schizophrenia.