Assessment of the vegetation indices on Sentinel-2A images for predicting the soil productivity potential in Bursa, Turkey.

Although field surveys represent an essential method for determining soil productivity, the use of remote sensing techniques has become a popular option over recent years due to its economic and practical applications. The fundamental basis of this approach is the estimation of soil productivity by using the vegetation indices as an indicator, with reference to the yield. In this study, it is aimed to estimate the productivity potential of the agriculture areas from biomass density in case of limited pedological and parcel-based data. For this purpose, relationships between the FAO Soil Productivity Rating (SPR) and different vegetation indices were investigated. The indices NDVI, RE-OSAVI, and REMCARI were used with Sentinel-2A images. Wheat was selected as an indicator plant to estimate the yield because it is the most occupied (27.47%) cultigen in the field. The study was conducted at the Karacabey State Farm with an area of 87 km2 and is located in Bursa province, Turkey. The research showed a positive relationship between SPR and 2018 yield values (r2 = 0.616). During the tillering period, the r2 for RE-OSAVI was 0.629. In the heading stage, the r2 for NDVI was 0.577. The index REMCARI provided yield estimations with low accuracy coefficient (0.216 ≤ r2 ≤ 0.258) during all vegetation periods. These findings can be interpreted as the monitoring of the land quality with multispectral satellite images via NDVI and RE-OSAVI. In this way, we could decide the time to re-definition of soil properties with land surveys for determination of soil productivity when the detection of a decrease using the indices during some vegetation periods. However, further investigations are needed in controlled trial patterns with differential reference plants, although the findings obtained from the study are promising for the use of spectral vegetation indices to prediction and/or monitoring of soil productivity. Thus, the possibilities of using spectral indices in different ecologies and different plant species can be evaluated from a broad perspective. It was also suggested that Sentinel-2A images may be used for similar studies due to their spectral capabilities with the ESA-SNAP tool.

Tp-e Interval, Tp-e/QTc Ratio, and Fragmented QRS Are Correlated with the Severity of Liver Cirrhosis.

BACKGROUND: Arrhythmias and electrocardiographic changes are reported in several noncardiac diseases, including liver cirrhosis (LC). We intended to evaluate the interval from the peak to the end of the electrocardiographic T wave (Tp-e), Tp-e/QTc ratio, and fQRS as presumed markers of arrhythmias in LC. METHODS: In this cross-sectional study, a total of 88 consecutive patients with LC according to clinical, biological, ultrasonographic, or histological criteria and 73 control subjects were enrolled. The severity of cirrhosis was classified according to Pugh-Child's classification and Model for End-Stage Liver Disease (MELD) score. Tp-e interval, Tp-e/QTc ratio, and fQRS rates were measured from the 12-lead electrocardiogram. RESULTS: Tp-e interval, Tp-e/QTc ratio and fQRS rates were significantly increased in parallel to the severity of LC (P < 0.001, P < 0.001, and P = 0.003, respectively). In correlation analysis, Pugh-Child stage showed a significantly positive correlation with Tp-e interval (r = 0.462, P < 0.001), QTc interval (r = 0.373, P < 0.001), Tp-e/QTc ratio (r = 0.352, P < 0.001), and fQRS (r = 0.407, P < 0.001). Furthermore, Tp-e interval (r = 0.414, P < 0.001) and Tp-e/QTc ratio (r = 0.426, P< 0.001) had significant positive correlation with MELD score. CONCLUSIONS: Our study demonstrated that Tp-e interval, Tp-e/QTc ratios, and fQRS rates were significantly increased in parallel to the severity of LC. Thus, these findings may implicate that Tp-e interval, Tp-e/QTc ratio, and fQRS may be novel and useful indicators for prediction of arrhythmias in LC.

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis.

BACKGROUND: Serum C-reactive protein (CRP) increases and albumin decreases in patients with inflammation and infection. However, their role in patients with acute pancreatitis is not clear. The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients. METHODS: This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015. Ranson scores, Atlanta classification and CRP/albumin ratios of the patients were calculated. RESULTS: The CRP/albumin ratio was higher in deceased patients compared to survivors. The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time, CRP and erythrocyte sedimentation rate. In addition to the CRP/albumin ratio, necrotizing pancreatitis type, moderately severe and severe Atlanta classification, and total Ranson score were independent risk factors of mortality. It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk. A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity. It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28. Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death. CONCLUSION: The CRP/albumin ratio is a novel but promising, easy-to-measure, repeatable, non-invasive inflammation-based prognostic score in acute pancreatitis.

Is ischemia modified albumin a disease activity marker for inflammatory bowel diseases?

BACKGROUND AND AIM: We aimed to identify ischemia-modified albumin (IMA) levels in inflammatory bowel disease (IBD) and IBD subgroups, and to examine its relation with disease activity index. METHODS: Sixty-eight patients with IBD (35 ulcerative colitis [UC] and 33 crohn disease [CD]) and 65 healthy volunteers were included in the study. Rachmilewitz scoring system (endoscopic activity index [EAI]) was used to determine UC activity, and as for CD activity, CD activity index (CDAI) scoring was used. IMA measurement was performed with ELISA kit. RESULTS: Ischemia-modified albumin levels in IBD, UC, and CD groups were comparably higher than the control group (37.7 ng/mL vs 42.4 ng/mL vs 36.4 ng/mL vs 21.8 ng/mL, respectively; P < 0.05). In IBD group, a positive correlation was identified between IMA level and CRP (r = 0.325, P = 0.011), EAI(r = 0.302, P = 0.020), and CDAI (r = 0.311, P = 0.013). In stepwise regression model; it was identified that IMA(OR = 1.496; P = 0.016) and CRP(OR = 3.457; P = 0.015) are predictors of IBD in comparison with the control group. In linear regression model, it was identified that risk factors such as log(IMA) and log(CRP) were independent predictors of log(CDAI) and log(EAI) levels. CONCLUSION: This is the first study showing that IMA levels in IBD were determined higher in comparison with the control group. Moreover, IMA being a predictor for IBD and being positively correlated with disease activity indexes were determined for the first time in the study. In accordance with these results, it is possible to say that IMA in IBD might be related with the pathogenesis of disease and correlated with the severity of the disease.

Intragastric injection of botulinum toxin in the treatment of obesity: a single-center study.

Background: In recent years, various novel surgical and non-surgical therapeutic options have been developed for treating obesity. Due to its disputed success, intragastric botulinum toxin A (BTX-A) injection is still being debated. Objectives: We aim to contribute to this controversial issue in the literature by sharing our center's findings regarding intragastric BTX-A injections in the treatment of obesity. Design: Patients with a body mass index (BMI) of greater than 25 kg/m2 and at least one obesity-related complication, or a BMI of greater than 30 kg/m2 without complications, were eligible for the study if they were between the ages of 18 and 65. Methods: Following the same procedure, two endoscopists administered BTX-A to all patients. All patients were evaluated for obesity by measuring their lipid profile, hormone profile, and insulin resistance level before treatment. Results: In our study on 82 patients, we saw a significant mean weight loss (-9.2 kg, p < 0.001) in the second month, and there was no additional mean weight loss in the sixth month of follow-up. In addition, this result seems to be independent of the patient's insulin resistance. We did not see any serious side effects in any of the patients. Conclusion: Although the use of intragastric injection of BTX-A in the treatment of obesity is a controversial issue, we showed in our study that it causes significant weight loss. Further studies are needed on this subject, as it can be a safe method when the ideal dose and application site are combined with appropriate patient selection.

Re-Evaluation of Patient-Sourced Radiation Doses in PET/CT.

BACKGROUND: New generation PET/CT devices provide quality images using low radiopharmaceutical activities. Dose monitoring is carried out for nuclear medicine personnel, other health personnel, and companions by determining the radiation dose emitted from low-activity patients to the environment. In particular, it is necessary to revise the working conditions of the personnel according to the radiation dose exposed. AIM: It was aimed to reevaluate the radiation dose rate transmitted to the environment from patients injected with 18F-FDG. MATERIALS AND METHODS: A total of 31 patients (14F, 17M) who underwent 18F-FDG PET/CT imaging were included. The mean 18F-FDG activity of 7.26 ± 1.29 mCi was used for injection. After injection, radiation dose rates (mR/h) were measured at distances of 25, 50, 100, 150, and 200cm for 3 different periods from the level of the head, thorax, abdomen, and pelvis by using a GM counter. Additionally, biological samples such as urine and sweat were taken during 3 different periods. The activity amounts (µCi) in the samples were measured with a well-type counter. RESULTS: Strong correlations were calculated between normalized dose rates obtained by all regions and time. Considering the nuclear medicine staff handling time with a PET/CT patient, the average dose received by staff was calculated between a range of 0.002-0.004 mSv/pt. The radiation dose exposed to the porter and nurse was calculated as 0.049 mSv/pt for the 2nd hour and 0.001-0.007 mSv/pt for the 4th hour, respectively. The companion was exposed to a dose between 0.073-0.147 mSv and 0.024-0.048 mSv for public transport and private car transportation after 4-6 hours of injection (for 30-60 min of travel duration), respectively. For inpatients, the received dose for porters, serving 20min from a distance of 30cm for the 2nd and 4th hours after the PET/CT scan, was 0.049 mSv/pt and 0.048 mSv/pt, respectively. And for nurses serving from a 50cm distance between 1-5 minutes, these values were found to be 0.001-0.007mSv/pt, 0.001-0.007mSv/pt, and 0.001-0.006mSv/pt, respectively. CONCLUSION: The radiation dose of nuclear medicine staff, porters, nurses, and companions are found to be below the recommended dose limit by the ICRP. According to our results, there is no need for any restrictions for patients, companions, or healthcare personnel in PET/CT units.

Reassessment of Radiation Exposure From Bone Scintigraphy.

AIM: This study was aimed to re-determine the radiation dose rate emitted from the patients who underwent bone scintigraphy. MATERIAL AND METHODS: A mean of 20.87±2.54 mCi 99mTc-MDP was injected into patients. A GM counter was used to measure dose rates in 3 different periods, at intervals of 25, 50, 100, 150, and 200 cm from the patient's anterior for head, thorax, abdomen, and pelvis levels. Measurements were used to determine patient-induced environmental doses and radiation doses to personnel/patient relatives. RESULTS AND DISCUSSION: There were strong correlations between mean dose rate (mRh-1mCi-1) and time at all regions and distances. The received dose for staff was calculated between a range of 0.01-0.02 mSv/mCi per patient. The total dose to be received by the companion was estimated to be between 0.019-0.039 and 0.011-0.022 mSv for public and personal vehicle transportation, respectively. The radiation dose exposed by nurses (4th, 6th, and 8th hours after injection) was found to be 0.012-0.064, 0.006-0.038, and 0.002-0.018 mSv/- patient, respectively. CONCLUSION: The fact that the doses of personnel and patient relatives in the study were below the legal limits shows that the study was carried out within a safe range. However, in terms of radiation protection, it is necessary to limit the time spent with the patient as much as possible and increase the distance. Since the dangers of low radiation dosages are unknown, there is a need to inform the patient's relatives and staff about the potential risks.

Evaluation of non-gastric upper gastrointestinal system polyps: an epidemiological assessment.

Non-gastric upper gastrointestinal system polyps are detected rarely and mostly incidentally during upper gastrointestinal endoscopy. While the majority of lesions are asymptomatic and benign, some lesions have the potential to become malignant, and may be associated with other malignancies. Between May 2010 and June 2022, a total of 127,493 patients who underwent upper gastrointestinal endoscopy were retrospectively screened. Among these patients, those who had polyps in the esophagus and duodenum and biopsied were included in the study. A total of 248 patients with non-gastric polyps were included in this study. The esophageal polyp detection rate was 80.00/100,000, while the duodenal polyp detection rate was 114.52/100,000. In 102 patients (41.1%) with esophageal polyps, the mean age was 50.6 ± 15.1, and 44.1% (n = 45) were male. The most common type of polyps was squamous papilloma (n = 61, 59.8%), followed by inflammatory papilloma (n = 18, 17.6%). In 146 patients (58.9%) with duodenal polyps, the mean age of patients was 58.3 ± 16.5, and 69.8% (n = 102) were male. Brunner's gland hyperplasia, inflammatory polyp, ectopic gastric mucosa, and adenomatous polyp were reported to be the most prevalent types of polyps in the duodenum overall (28.1%, 27.4%, 14.4%, and 13.7%, respectively). It is crucial to identify rare non-gastric polyps and create an effective follow-up and treatment plan in the era of frequently performed upper gastrointestinal endoscopies. The epidemiological assessment of non-gastric polyps, as well as a follow-up and treatment strategy, are presented in this study.

Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation?

Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic tool for many biliary diseases. Selective biliary cannulation is the first step of the treatment process. Needle knife fistulotomy (NKF) and conventional precut sphincterotomy (CPS) are widely used in difficult biliary cannulation. However, there are different results in their effectiveness and safety. This study aimed to compare both methods regarding cannulation success and adverse event profile. MATERIALS AND METHODS: All eligible consecutive patients with naive papillae who underwent biliary ERCP by a single experienced endoscopist over a 3-year period were included retrospectively. The standard cannulation method with a guidewire-loaded sphincterotome was initially used for biliary cannulation in all patients. Cannulation was accepted as difficult in the case of failure of standard cannulation within 5 minutes or despite 5 attempts or insertion of the guidewire to the pancreatic duct 5 times. Three modalities in patients with difficult biliary cannulation were employed according to the structure and configuration of the papillae in addition to unintentional pancreatic cannulation: (1) NKF, (2) CPS, (3) Double guidewire technique or guidewire orientation/precut following pancreatic stenting. Latter was excluded to enable direct comparison between NKF and CPS groups. RESULTS: A total of 644 patients were recruited. Analyses were performed with 541 patients after the exclusion of 103 patients. Mean (SD) age was 60.4 (18.2) years, and 257 (47.5%) patients were male. While standard cannulation was successful in 366 (67.6%), difficult biliary cannulation was observed in 175 (32.4%) patients. NKF was performed in 101 (57.7%) patients, and cannulation success was 100% in the first ERCP session. In contrast, CPS was performed in 74 (42.3%) patients with a lower cannulation success rate (79.7%) than NKF ( P <0.001). Post-ERCP pancreatitis rate was higher in CPS (9.5%) than NKF group (3.0%, P =0.063). Bleeding and cholangitis were similar in both groups. CONCLUSIONS: In patients with difficult biliary cannulation with appropriate papillary structure and configuration, NKF should be used as the first choice in experienced hands because of high biliary cannulation success and low Post-ERCP pancreatitis risk.

Use of Vedolizumab in Inflammatory Bowel Disease: A Single-Center Experience.

BACKGROUND: Vedolizumab, which is a monoclonal antibody that selectively binds to α4ß7 integrin in the gastrointestinal system, may be an effective and safe treatment alternative in those with anti-tumor necrosis factor-resistant inflammatory bowel disease. METHODS: Patients administered vedolizumab due to anti-tumor necrosis factor resistant or anti-tumor necrosis factor side effects between August 2017 and November 2020 were included in the study. Crohn's patients were evaluated using the Harvey-Bradshaw index and Simple Endoscopic Score for Crohn's Disease, whereas ulcerative colitis patients were evaluated with the Partial Mayo Score Index and Rachmilewitz score. All patients were followed up for 3 months and their blood samples were taken every 3 months. Hemoglobin, white blood cell, leukocyte, lymphocyte, and platelet counts of the patients were performed. Albumin, C-reactive protein, and erythrocye sedimentation rate values were recorded. The side effect profile for vedolizumab was evaluated for all patients. Among the side effects, arthralgia and flu-like symptoms were observed. RESULTS: A total of 48 patients (18 ulcerative colitis and 30 Crohn's disease) were included in the study. Vedolizumab therapy was initi- ated in the patients due to anti-tumor necrosis factor resistance (17 ulcerative colitis and 26 Crohn's disease) or anti-tumor necrosis factor side effects (1 ulcerative colitis and 4 Crohn's disease). A total of 30 (63%) patients, including 15 (83%) ulcerative colitis and 15 (50%) Crohn's disease, responded to treatment (both response and remission). The mean duration of response to treatment was 4.5 ± 1.5 months. A total of 20 (42%) patients in the vedolizumab therapy subgroup (10/10, ulcerative colitis/Crohn's disease) went into remission. The mean Harvey-Bradshaw Index value was 9.8 ± 2.8 in the Crohn's disease patients at the time of initial treatment. The mean Simple Endoscopic Score for Crohn's disease value was 11.2 ± 3.1 at the time of initial treatment. The mean Harvey-Bradshaw Index value was 6.5 ± 3.0 and the mean Simple Endoscopic Score for Crohn's disease value was 4.9 ± 3.6 at 6 months post-treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 9.3 ± 1.2 at the time of initial treatment. In addition, the mean Partial Mayo Scoring Index was 6.4 ± 1.5 at the time of initial treatment. The mean Ulcerative Colitis Endoscopic Index (Rachmilewitz) value was 0 (0-6.0), and the mean Partial Mayo Scoring Index was 1.5 (0.3-4.0) at 6 months post-treatment. CONCLUSION: Vedolizumab therapy is effective in both induction and maintenance of remission in inflammatory bowel disease patients who are resistant to anti-tumor necrosis factor or who can not receive anti-tumor necrosis factor therapy due to side effects. No signifi- cant side effect was observed in the patients during follow-up.

Parenteral Methotrexate Is Efficient in the Treatment of Azathioprine Refractory Crohn's Disease.

BACKGROUND: There is limited data in the literature analyzing the efficacy of methotrexate in Crohn's disease used after thiopurine analogs. We aimed in our study to show the efficacy of methotrexate in Crohn's disease patients who failed to respond to thiopurine treatment. METHODS: The study included 29 azathioprine refractory patients with Crohn's disease. Intramuscular methotrexate (25 mg/week) in the induction of remission and intramuscular methotrexate (15 mg/week) in 29 CD patients with a median follow-up time of 13 months was performed. In 15 (51.7%) patients, methotrexate was used in combination with anti-Tumour necrosis factor (TNF) (combination group), while it was used in 14 (48.3%) patients in monotherapy (monotherapy group). RESULTS: The mean Harvey-Bradshaw index score significantly decreased in the follow-up period (Wk0 = 7.6, last visit = 4.5, P < .001). Remission and response rates at week 12 were 75.9% and 79.3%, respectively. Maintenance of remission (77.8% vs 37.5%, respectively, P = .1) and response rates (77.8% vs 50%, respectively, P = .3) due to last visit examination were numerically higher in combination group but they were not statistically significant. The cumulative probability of remission maintenance in patients with methotrexate therapy was 72.7%, 33.1%, and 22.0% at 1, 2 ,and 4 years after starting methotrexate, respectively. CONCLUSION: Our results show that parenteral use of methotrexate is efficacious in inducing and maintaining remission as a step-up agent in azathioprine refractory Crohn's disease patients.

Similarities and Differences Between Gerontal and Young Patients with Acute Pancreatitis: Evaluation of Clinical Characteristics and Outcomes.

BACKGROUND: Acute pancreatitis is an abrupt inflammatory disease of the exocrine pancreas and it can occur in different severities. It is becoming more common and more mortal in the gerontal population. The aim of our study was to explore the similarities and differences between young and gerontal patients with acute pancreatitis, with a special emphasis on patients over 80 years of age. METHODS: Medical records of patients (n = 1150) with acute pancreatitis were analyzed retrospectively. Several scoring systems including Bedside index for severity in acute pancreatitis, Ranson's score, Harmless acute pancreatitis score, Acute Physiology and Chronic Health Evaluation, Balthazar Grade, Glasgow score, and Japanese severity score were applied at admission. Patients were divided into 3 groups; group I, young group (n = 706), if they were aged <65 years; group II, older group (n = 338), if they were aged ≥65 years to <80 years; group III, octogenarian group (n = 106), if they were aged ≥ 0 years. RESULTS: In total, 1150 patients with acute pancreatitis were analyzed. Octogenarian group (n = 42, 39.6%) showed a more severe acute pancreatitis compared to patients in group I (n = 15, 2.1%) and II (n = 50, 14.8%, P < .001). Complications were more common in patients in group III (P < .001). Mortality rate was higher in patients in group III (n = 53, 50%) compared to group I (n = 8, 1.1%) and group II (n = 53, 15.7%) (P < .001). CONCLUSION: Gerontal patients with acute pancreatitis tend to have more severe disease and systemic and local complications. Mortality rates were higher in older patients compared to younger patients.

Decreased mismatch negativity and elevated frontal-lateral connectivity in first-episode psychosis.

Decreased mismatch negativity (MMN) is a proposed biomarker for psychotic disorders. However, the magnitude of the effect appears to be attenuated in first-episode populations. Furthermore, how mismatch negativity amplitudes are related to brain connectivity in this population is unclear. In this study, we used high-density EEG to record duration-deviant MMN from 22 patients with first-episode psychosis (FEP) and 23 age-matched controls (HC). Consistent with past work, we found decreased MMN amplitude in FEP over a large area of the frontal scalp. We also found decreased latency over the occipital scalp. MMN amplitude was negatively correlated with antipsychotic dose. We used Granger causality to investigate directional connectivity between frontal, midline, left, and right scalp during MMN and found reduced connectivity in FEP compared to HC and following deviant stimuli compared to standard stimuli. FEP participants with smaller decreases in connectivity from standard to deviant stimuli had worse disorganization symptoms. On the other hand, connectivity from the front of the scalp following deviant stimuli was relatively preserved in FEP compared to controls. Our results suggest that a relative imbalance of bottom-up and top-down perceptual processing is present in the early stages of psychotic disorders.

IgG4 producing POEMS syndrome: A rarely recognized subtype.

Serum IgG4 is typically measured for Immunoglobulin G4-related Disease (IgG4-RD), a fibroinflammatory condition associated with polyclonal increase in serum IgG4. Yet, increased IgG4 may still be monoclonal, and little is known about IgG4 POEMS syndrome. We present a case of 40-year-old male with a mass lesion in the left sacral ala. The mass was composed of non-neoplastic fibrous tissue and dense infiltrate of mature plasmacytes with dense eosinophilic cytoplasm and eccentrically placed nuclei that express monoclonal Lambda free light chains and show diffuse positivity for IgG and IgG4. We discuss clinical manifestations and challenges encountered in the diagnosis and treatment of this rare coexistence.

The Efficacy of Biofeedback Treatment in Patients with Fecal Incontinence.

BACKGROUND: The initial treatment for fecal incontinence (FI) includes supportive treatment and medical treatment. If the initial treatment fails, biofeedback therapy (BFT) is recommended. However, there are limited and conflicting results in the literature supporting the beneficial effect of BFT for FI. The aim of the study is to analyze the efficacy of BFT in 126 patients who have FI due to several causes. METHODS: The data of 126 patients (88 females (69.8%) and 38 males (30.2%)) were collected retrospectively. Colonoscopy, anorectal manometry (ARM), and 3D-Endoanal ultrasonography (EAUS) were performed for all patients before applying BFT. In addition, all patients received toilet training instruction and training in Kegel and other pelvic floor strengthening exercises from an experienced nurse, before BFT. RESULTS: The median age of participants was 54 years (range 18-75 years). While 80 patients (63.5%) had clinical and manometric benefit from BFT, 46 patients (36.5%) did not respond to BFT. According to the EAUS and ARM findings, BFT was beneficial in patients who had partial external sphincter failure, and was unsuccessful in patients who had both internal and external sphincter failure, both internal and external sphincter tears, and external sphincter tear rates of more than 25%. After BFT, significant increases in squeeze pressures were observed, with this increase being higher in the positive-response group. CONCLUSION: The results suggest that BFT is effective in the treatment of FI for specific patient populations.

Incidence of anti-heparin/platelet factor 4 antibodies and heparin-induced thrombocytopenia in medical patients.

OBJECTIVE: Heparin-induced thrombocytopenia (HIT) is a life threatening complication of heparin therapy, causing thrombosis. The aim of our study was to find out the frequencies of HIT antibody seroconversion and clinical HIT in Turkish medical patients on different forms of heparins. METHODS: Our study included 61 patients who were on unfractionated heparin (UFH) (n: 37) and low molecular weight heparin (LMWH) (n: 24) therapies. The frequency of HIT antibody formation was determined by means of antigenic (ELISA), and functional assays (serotonin release assay-SRA). RESULTS: The seroconversion rates in UFH and LMWH groups were found to be 18.9% and 4.1% (ELISA), and 8.1% and 4.1% (SRA), respectively. One patient (2.1%) on UFH therapy developed deep vein thrombosis. No thromboembolic event was observed in patients taking LMWH. CONCLUSION: Seroconversion rates by means of antigenic and functional assays and clinical HIT were more common in patients on UFH than patients on LMWH therapy.