Depression, anxiety, hopelessness, and suicide in first-degree relatives of patients hospitalised in intensive care units in Türkiye.

OBJECTIVE: The purpose of this study was to investigate the prevalence of depression, anxiety disorder, hopelessness, and suicide among first-degree relatives of patients hospitalised in medical and anaesthesia intensive care units at an academic medical centre. METHODS: In this case-control study conducted in Türkiye, 32 first-degree relatives of 32 patients hospitalised for 14 days or more in intensive care units and 32 healthy volunteers were included for assessment. The Beck Depression Scale (BDS), Beck Anxiety Scale (BAS), Beck Hopelessness Scale (BHS), and Suicide Probability Scale (SPS) were administered to participants. Results: The mean age of patients' relatives was 42.1 ± 11.6 years and that of the controls was 43.0 ± 11.3 years. The median scores for the BDS, BHS, and SPS were significantly higher among the relatives of the patients than among controls (P = .008, P = .013, and P = .001, respectively). Based on cutoff scores for the BDS and BAS, depression was observed in 56.3% of the relatives of the patients and anxiety disorder was observed in 46.9%. In the group comprising patients' relatives, the median score for the BDS was significantly higher among female participants than among male participants (P = .038). CONCLUSIONS: First-degree relatives of patients hospitalised in intensive care units have a higher prevalence of depression, hopelessness, and suicidality. Female relatives are more depressed than male. Ensuring psychiatric evaluation of the relatives of patients hospitalised in intensive care units in Türkiye is important.

CHILDHOOD TRAUMAS, LOVE ATTITUDES, RELATIONSHIP SATISFACTION, AND SEXUAL FUNCTIONS IN EUTHYMIC DEPRESSIVE DISORDER PATIENTS.

BACKGROUND: It was aimed to compare childhood traumas, relationship satisfaction, sexual functions, and love attitudes in depressive disorder (DD) patients with healthy volunteers. SUBJECTS AND METHODS: The study included 100 DD patients, who were in remission and had no drug side effects, and 100 healthy volunteers. A sociodemographic data form, the Childhood Trauma Questionnaire (CTQ), the Love Attitudes Scale (LAS), the Relationship Assessment Scale (RAS), and the Arizona Sexual Experiences Scale (ASEX) were administered to all participants. In addition, the Hamilton Depression Rating Scale and the UKU Side Effect Rating Scale were applied to DD patients. RESULTS: CTQ physical abuse scores were higher in the DD group compared to the healthy volunteers (p<0.001). CTQ sexual abuse scores were higher in the DD group than those in healthy volunteers (p=0.020). CTQ emotional abuse scores were higher in the DD group than those in healthy volunteers (p<0.001). RAS scores were lower in the DD group compared to the healthy volunteers (p<0.001). ASEX scores in women were higher in the DD group compared to healthy volunteers (p=0.009). LAS passionate love scores were lower in the DD group than those in the healthy volunteers (p<.0.001). LAS friendship love scores were lower in the DD group than those in healthy volunteers (p=0.005). CONCLUSION: It can be said that DD patients have more history of abuse, less relationship satisfaction, and less passion for love. Female DD patients may experience more sexual problems.

The parental COVID-19 anxiety and emotional exhaustion in healthcare workers: exploring the roles of resilience, prosocialness, and optimism.

Healthcare workers (HCWs) also became the main protagonist of the tragic pandemic story. They have had a markedly higher risk of becoming infected with COVID-19. Outside work, healthcare workers with children have experienced mental health challenges, including the worry that they may carry COVID-19 home and infect their children. Based on these, the current study aimed to examine the effect of parental COVID-19 anxiety on emotional exhaustion and identify the roles of resilience, prosocialness, and optimism in this relationship. The findings demonstrated that prosocialness moderated the relationship between personal COVID-19 anxiety and emotional exhaustion by alleviating the depleting effects of personal COVID-19 anxiety. At the same time, prosocialness reinforced the negative effect of resilience on emotional exhaustion. On the other side, optimism moderated the relationship between parental COVID-19 anxiety and resilience by alleviating the adverse effect of parental COVID-19 anxiety. Moreover, it buffered the exacerbating effect of parental anxiety on personal anxiety. In conclusion, promoting personal resources (i.e., resilience, prosocialness, and optimism) seems an excellent way to mitigate the adverse consequences of the pandemic on mental health. Furthermore, the increment in parental mental health problems during COVID-19 pandemic may have long-term effects on children. Considering this perspective, we need to develop a proactive approach for parents' now and children's futures.

Comparison of naltrexone implant and oral buprenorphine-naloxone in the treatment of opiate use disorder.

OBJECTIVE: We aimed to compare the effectiveness of extended-release naltrexone (XR-NTX) implant and sublingual buprenorphine-naloxone (BUP-NX) in relapse prevention in opiate use disorder (OUD). METHODS: Medical records of 400 patients who were treated for OUD between 2016 and 2020 were retrospectively evaluated concerning sociodemographic and clinical characteristics and abstinence duration with either BUP-NX (192 patients) or XR-NTX (208 patients) as maintenance treatments. RESULTS: The median age of patients using BUP-NX was 25.00, and the median age of patients using XR-NTX was 25.50 (p = .785). The ratio of female patients in the BUP-NX group and the XR-NTX group was 7.3% (n = 14) and 6.7% (n = 14), respectively. A significantly higher abstinence time was observed in the BUP-NX group (median = 4 months) than in the XR-NTX group (median = 3 months) (p = .015). Liver function tests were within the normal ranges at the three time points, which were just before the beginning and in the first and third months of treatment. CONCLUSIONS: These findings suggest that BUP-NX might be more effective than XR-NTX in preventing relapse in OUD and both drugs are safe for the liver. Prospective randomized studies are needed to replicate our results.

Evaluation of Internet Gaming Disorder, Social Media Addiction, and Levels of Loneliness in Adolescents and Youth with Substance Use.

BACKGROUND AND OBJECTIVES: Substance use and addictive disorders are among the most significant public health concerns, particularly during adolescence. The current study aims to investigate internet gaming disorder, social media addiction, and loneliness levels in adolescents and youths with substance use. Methods: The study group consisted of 93 adolescents and youths aged 15-24 who presented to the Alcohol and Substance Addiction Research and Application Center or the Child and Adolescent Mental Health and Diseases outpatient clinic for substance use. Ninety-one healthy volunteers who did not use substances during any period of their lives participated as a control group. The participants fulfilled the Social Media Addiction Scale (SMAS), Internet Gaming Disorder Scale - Short-Form (IGDS9-SF), UCLA Loneliness Scale (UCLA-LS), and Drug Use Disorders Identification Test - Extended (DUDIT-E). Results: The symptoms of internet gaming disorder were significantly lower in the patient group compared with the control group. Although it was not significant, social media addiction was higher in the patient group than in the control group. The experience of loneliness was significantly higher in the patient group than in the control group. A significant negative correlation was found between treatment motivation and loneliness. Conclusions: School guidance teachers should monitor children who do not have friends or are lonely and be aware of the potential for substance use because it can emerge as a method of coping with the feeling of loneliness among adolescents. In future studies, investigating comprehensive factors contributing to different addictive behaviors may help to clarify the co-occurrence.

[Distribution of Hepatitis C Virus (HCV) Genotypes Among Intravenous Drug and Non-Drug User Patients]. / Damar Içi Madde Bagimliligi Olan ve Madde Bagimlisi Olmayan Hastalar Arasinda Hepatit C Virus (HCV) Genotiplerinin Dagilimi.

Genotype distribution of hepatitis C virus (HCV) can vary over the years between different patient groups and regions. The prevalence of intravenous drug users (IVDU) is known to increase in our country, yet there are a limited number of studies investigating the distribution of HCV genotypes in this group. These data are essential for monitorization of the changes in HCV epidemiology. The present study aimed to evaluate the five-year results of HCV genotyping among patients infected with HCV related to IVDU and unrelated to drug use. Plasma samples of 720 patients (HCV antibody, HCV RNA positive), which were sent to our laboratory for HCV genotyping between January 2014-March 2019 were analyzed. HCV RNA extraction from plasma samples was performed in the automated-extraction system of EZ1 advanced (Qiagen, Germany) using the EZ1 virus mini kit v2.0 (Qiagen, Germany). Amplicons were obtained by amplifying the 5'NCR and core gene region in the Rotorgene 6000 real-time PCR (Qiagen, Germany) device with the HCV RNA real-time quantitative 2.0 (NLM, Italy) kit. For the genotyping, a commercial line probe assay (LIPA) based on in vitro reverse hybridization GEN-C2.0 kit (NLM, Italy) which can distinguish 1, 2, 3, 4, 6 genotypes and 1a, 1b, 2a/c, 2b, 3a, 3b, 3c, 3k, 4a, 4b, 4c/d, 4e, 4f, 4h, 5a, 6a/b, 6g, 6f/q, 6m, 7a subtypes of HCV, based on variations in the 5'-NCR and core regions was used. HCV genotype distribution of 266 IVDU (93.2%: male; median age: 25 ± 6.82) and 454 non-drug users (51.3%: male; median age: 56.5 ± 16.06) were examined. In order of frequency in the group with IVDU; genotype 1a, 3a, 1b, 4c/d, 2b, 4, 3 were observed and genotype 1, 2a/c and mixed genotype (1+3a) were detected in one patient. In the group without IVDU, in order of frequency; genotype 1b, 1a, 3a, 1, 2a/c, 4 were observed and genotype 2b, 4c/d, 5a, 6a/b, 6 and mixed genotype (3+4) were detected in one patient. Genotypes 1a and 3a were significantly higher in the IVDU group (p< 0.00001, p< 0.00001), while 1b was significantly higher in patients without IVDU (p< 0.00001). Genotypes 1a and 3a were more common in young men (p< 0.00001, p= 0.000163), while 1b was higher in middleaged women (p< 0.00001). The incidence of genotypes 1b (p= 0.021) and 3a (p= 0.012) was higher in foreign nationals than the Turkish patients. When the HCV genotype distribution was examined by years, it was observed that the percentages of genotype 1b and 1a were decreasing, while the percentage of genotype 3a was increasing. As a result, in this study, HCV genotype distribution among IVDU was observed to be different from the general population without IVDU. It was found that genotypes 1a and 3a were more common in the IVDU group. As in the other regions of our country, genotype 1b was found most frequently in the general population. Genotype 3a increases significantly compared to years. In our study, the determination of genotypes existing in different parts of the world may be due to the foreign nationals living in our city and our region is a tourism center. It is also necessary to investigate whether there is an increase in IVDU over the years.

Fear, Anxiety, Burnout, and Insomnia Levels of Healthcare Workers during COVID-19 Pandemic in Turkey.

BACKGROUND: This study aims to assess fear, anxiety, anxiety sensitivity, burnout, and insomnia of healthcare workers (HCWs) during novel coronavirus-2019 (COVID-19) outbreak and to identify their relation to sociodemographic and clinical characteristics. SUBJECTS AND METHODS: Totally 600 HCWs were included in this cross-sectional study. A Sociodemographic Data Form, Coronavirus Anxiety Scale (CAS), Fear of COVID-19 Scale (FCV-19S), Anxiety Sensitivity Index-3 (ASI-3), Maslach Burnout Inventory (MBI), and Insomnia Severity Index (ISI) were used. RESULTS: Of participants, 364 were females and 236 were males with a mean age of 33.49±7.29 years. About 95.3% of HCWs had a fear of infecting their loved ones. Mean MBI and ISI scores were significantly higher among HCWs working in COVID-19 clinics and intensive care units (p=0.000; p=0.039). Mean CAS, FCV-19S, MBI, and ISI scores were significantly higher in women than men (p=0.000; p=0.000; p=0.027; p=0.005). Mean CAS and ISI scores were significantly higher among nurses (p=0.008; p=0.004), while mean ASI-3 of the other HCWs and MBI scores of physicians were significantly higher (p=0.009; p=0.000). CONCLUSION: The COVID-19 pandemic is a major health issue associated with psychiatric illnesses in HCW subgroups with distinct sociodemographic characteristics. It is of utmost importance to develop individualized preventive and therapeutic psychiatric services for HCWs.

N-3 vs. n-6 fatty acids differentially influence calcium signalling and adhesion of inflammatory activated monocytes: impact of lipid rafts.

BACKGROUND: Anti-inflammatory n-3 fatty acids (FA) like docosahexaenoic acid (DHA) opposed to the pro-inflammatory n-6 FA arachidonic acid (AA) might modulate lipid rafts within the cell membrane by differential incorporation. In inflammation, monocyte adhesion to endothelial cells is a crucial step mediated by intracellular calcium changes. We investigated whether lipid rafts mediate FA-induced modulation of adhesion and intracellular calcium. METHODS: In isolated human monocytes and monocytic U937 cells we measured adhesion to human umbilical vein endothelial cells (HUVEC) using a parallel flow chamber and a static assay, adhesion molecules by FACScan, and intracellular calcium by fluorescence. Monocyte lipid rafts were isolated by ultracentrifugation and submitted to gas chromatography for FA analysis. RESULTS: Pre-incubation with AA or DHA resulted in a predominant incorporation of the respective FA into raft compared to non-raft fraction. DHA as compared to AA significantly reduced monocyte adhesion and calcium release after stimulation with TNF-α while expression of adhesion molecules remained unchanged. Pre-treatment with a calcium chelator abolished the effect of FA on calcium and adhesion. Disruption of lipid rafts prevented FA-induced modulations. CONCLUSION: Incorporation of FA into lipid rafts seem to be crucial for modulation of adhesion under inflammatory conditions.

Association of circulating factor seven activating protease (FSAP) and of oral Omega-3 fatty acids supplements with clinical outcome in patients with atrial fibrillation: the OMEGA-AF study.

Factor VII Activating Protease (FSAP) activates factor VII (FVII) as well as pro-urokinase (uPA). Our goal was to evaluate the relation between plasma levels of FSAP and clinical instability in atrial fibrillation (AF) and possible effects of oral omega-3 fatty acids (FA) supplements. 101 patients with persistent AF were analyzed in the OMEGA-AF Study. Plasma FSAP levels were measured at baseline and after 12 weeks of treatment with omega-3 FA. The median FSAP antigen concentration, in contrast to FSAP activity, was higher in patients with persistent AF. The maintenance of SR after successful cardioversion (CV) did not lead to a normalization of FSAP concentration. Supplementation with omega-3 FA but not placebo significantly reduced elevated FSAP concentration. Furthermore, elevated FSAP levels did not indicate a significantly increased risk of recurrence of AF after electrical CV or cardiovascular clinical events during 1 year of follow-up. Plasma FSAP concentration was increased in patients with AF and may be involved in the pathogenesis of this condition. The possible effects of omega-3 FA on clinical AF potential could be linked with modulation of circulating FSAP levels.

Exploring stigmatization in digital newspaper coverage of substance use disorder.

Substance use disorder is a global health issue that profoundly affects both individuals and societies. Social stigma acts as a significant barrier to treatment motivation. Mass media plays a substantial role in shaping societal perceptions. This study aims to identify stigmatizing attitudes in news narratives concerning substance use disorder as portrayed in digital newspapers. We examined news articles from the top eight national digital newspapers published during 2022 by using quantitative and retrospective content analysis. Following the review, we collected 1.233 news articles, removed 480 articles which were irrelevant or duplicate, and analyzed the remaining 753 articles using quantitative content analysis methods on SPSS 26.0. The majority of news articles depict substance use disorder in a negative consideration. The analysis revealed that nearly all news sources were news agencies and only 11% of the articles offered potential solutions. Alarmingly, 69.7% of the articles contained stigmatizing content, while 53.1% directly impacted the social lives of individuals with substance use disorder. Furthermore, 44.1% of the articles reinforced a dangerous perception associated with individuals with substance use disorder. To address these issues, we recommend a more empathetic portrayal of substance use disorder, support for help-seeking behavior, and advocacy for effective solutions in news coverage.

Acute left main coronary artery occlusion.

The treatment of an acute left main coronary artery occlusion still poses a challenge. In this case report we present a 50-year-old patient with an acute occlusion of the left main artery. After a successful angioplasty without "stenting" due to the complexity of the stenosis the patient underwent a successful bypass surgery. We discuss the therapeutic options of acute left main occlusion regarding medical, interventional and surgical options.

Geographic Genetic Structure of Alectoris chukar in Türkiye: Post-LGM-Induced Hybridization and Human-Mediated Contaminations.

Türkiye is considered an important evolutionary area for Chukar partridge (Alectoris chukar), since it is both a potential ancestral area and a diversification center for the species. Using 2 mitochondrial (Cty-b and D-loop) and 13 polymorphic microsatellite markers, we investigated the geographic genetic structure of A. chukar populations to determine how past climatic fluctuations and human activities have shaped the gene pool of this species in Türkiye. Our results indicate, firstly, that only A. chukar of the genus Alectoris is present in Türkiye (Anatolia and Thrace), with no natural or artificial gene flow from congenerics. Secondly, the geographic genetic structure of the species in Türkiye has been shaped by topographic heterogeneity, Pleistocene climatic fluctuations, and artificial transport by humans. Third, there appears to be three genetic clusters: Thracian, Eastern, and Western. Fourth, the post-LGM demographic expansion of the Eastern and Western populations has formed a hybrid zone in Central Anatolia (~8 kyBP). Fifth, the rate of China clade-B contamination in Türkiye is about 8% in mtDNA and about 12% in nuDNA, with the Southeastern Anatolian population having the highest contamination. Sixth, the Thracian population was the most genetically distinct, with the lowest genetic diversity and highest level of inbreeding and no China clad-B contamination. These results can contribute to the conservation regarding A. chukar populations, especially the Thracian population.

Circulating factor VII activating protease (FSAP) is associated with clinical outcome in acute coronary syndrome.

BACKGROUND: Factor VII activating protease (FSAP) is a circulating serine protease strongly expressed in unstable plaques and may serve as a marker of plaque destabilization. The aim of this study was to examine the relation between plasma concentrations of FSAP and clinical instability and outcome in coronary artery disease (CAD). METHODS AND RESULTS: Circulating FSAP concentration and activity, as well as FSAP mRNA expression in monocytes, were measured in 231 sequential patients who underwent coronary angiography because of stable angina pectoris (n=50), unstable angina pectoris (n=43), or acute myocardial infarction (n=87). FSAP activity, but not FSAP antigen concentration, was elevated in patients with CAD compared with a control group. Elevated FSAP activity (≥1.035 plasma equivalent units [PEU]/ml) indicated a significantly increased risk of death or non-fatal myocardial infarction during 1 year of follow-up as compared with patients with low activity of FSAP (odds ratio 1.895 [95% confidence interval 1.093-3.283]; P=0.023). Furthermore, there were no significant changes in the FSAP expression in monocytes from CAD and control subjects in the basal state but there were differences after stimulation with proinflammatory factors. CONCLUSIONS: Plasma FSAP activity was significantly increased in patients with acute coronary syndrome and may be involved in the pathogenesis of these conditions. High levels of FSAP activity were predictive of adverse events during follow-up, suggesting its potential role in risk stratification and clinical management of CAD patients.

Influence of time between last myocardial infarction and prophylactic implantable defibrillator implant on device detections and therapies. "Routine Practice" data from the SEARCH MI registry.

BACKGROUND: A multicenter European Registry, SEARCH-MI, was instituted in the year 2002 in order to assess patients' outcomes and ICD interventions in patients with a previous MI and depressed LV function, treated with an ICD according to MADIT II results. In this analysis, we evaluate the influence of the time elapsed between last myocardial infarction (MI) and prophylactic cardioverter defibrillator (ICD) implant on device activations. METHODS: 643 patients with left ventricular dysfunction (mean LVEF 26 ± 5%) and NYHA class I-III were prospectively followed for 1.8 ± 1.2 years in a multicenter registry. The population was divided into 3 groups according to the time between last MI and ICD implant: [1] from 40 days to less than 1.5 years; [2] from 1.5 to less than 7 years and [3] at least 7 years. RESULTS: The cumulative incidence of ventricular tachyarrhymias and appropriate device therapy (ATP or shock) were higher in patients implanted longer time from last MI (Gray's Test p=0.002 and p=0.013 respectively). No significant differences were seen in all cause mortality (Gray's Test p=0.618) or sudden cardiac death across the MI stratification groups (Gray's Test p=0.663). CONCLUSIONS: Patients implanted with an ICD longer after the MI have a higher chance of presenting ventricular tachyarrhythmias and appropriate ICD therapy, while no differences were seen in overall mortality. These observations may be important for improving patient targeting in sudden death prevention.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in the evaluation of the biliary obstruction.

PURPOSE: In this study, our purpose was to investigate the diagnostic efficacy of the dynamic contrast-enhanced magnetic resonance imaging (MRI) method in the patients with bile duct obstruction. MATERIALS AND METHODS: 108 consecutive patients (53 men, 55 women, mean age; 55.77 ± 14.62, range 18-86 years) were included in this study. All the patients underwent conventional upper abdomen MRI using intravenous contrast material (Gd-DTPA) and MRCP in 1.5 Tesla MRI scanner. MRCP images were evaluated together with the T1 and T2w images, and both biliary ducts and surrounding tissues were examined for possible pathologies that may cause obstruction. RESULTS: MRI/MRCP findings compared with final diagnoses, MRI/MRCP in the demonstration of bile duct obstruction sensitivity 96%, the specificity 100%, and accuracy 96.3%, in the detection of presence and level of obstruction, the sensitivity 96.7%, specificity 100%, and accuracy 97.2%, in the diagnosis of choledocholithiasis, the sensitivity 82.3%, specificity 96%, and accuracy 91.7%, and in the determination of the character of the stenosis, sensitivity 95.6%, specificity 91.3%, and accuracy 94.5% were found. CONCLUSION: The combination of dynamic contrast-enhanced MRI and MRCP techniques in patients with suspected biliary obstruction gives the detailed information about the presence of obstruction, location, and causes and is a highly specific and sensitive method.

Interplay between Ca2+ cycling and mitochondrial permeability transition pores promotes reperfusion-induced injury of cardiac myocytes.

Uncontrolled release of Ca(2+) from the sarcoplasmic reticulum (SR) contributes to the reperfusion-induced cardiomyocyte injury, e.g. hypercontracture and necrosis. To find out the underlying cellular mechanisms of this phenomenon, we investigated whether the opening of mitochondrial permeability transition pores (MPTP), resulting in ATP depletion and reactive oxygen species (ROS) formation, may be involved. For this purpose, isolated cardiac myocytes from adult rats were subjected to simulated ischemia and reperfusion. MPTP opening was detected by calcein release and by monitoring the ΔΨ(m). Fura-2 was used to monitor cytosolic [Ca(2+)](i) or mitochondrial calcium [Ca(2+)](m), after quenching the cytosolic compartment with MnCl(2). Mitochondrial ROS [ROS](m) production was detected with MitoSOX Red and mag-fura-2 was used to monitor Mg(2+) concentration, which reflects changes in cellular ATP. Necrosis was determined by propidium iodide staining. Reperfusion led to a calcein release from mitochondria, ΔΨ(m) collapse and disturbance of ATP recovery. Simultaneously, Ca(2+) oscillations occurred, [Ca(2+)](m) and [ROS](m) increased, cells developed hypercontracture and underwent necrosis. Inhibition of the SR-driven Ca(2+) cycling with thapsigargine or ryanodine prevented mitochondrial dysfunction, ROS formation and MPTP opening. Suppression of the mitochondrial Ca(2+) uptake (Ru360) or MPTP (cyclosporine A) significantly attenuated Ca(2+) cycling, hypercontracture and necrosis. ROS scavengers (2-mercaptopropionyl glycine or N-acetylcysteine) had no effect on these parameters, but reduced [ROS](m). In conclusion, MPTP opening occurs early during reperfusion and is due to the Ca(2+) oscillations originating primarily from the SR and supported by MPTP. The interplay between Ca(2+) cycling and MPTP promotes the reperfusion-induced cardiomyocyte hypercontracture and necrosis. Mitochondrial ROS formation is a result rather than a cause of MPTP opening.

Insulin stabilizes microvascular endothelial barrier function via phosphatidylinositol 3-kinase/Akt-mediated Rac1 activation.

OBJECTIVE: Insulin is a key regulator of metabolism, but it also confers protective effects on the cardiovascular system. Here, we analyze the mechanism by which insulin stabilizes endothelial barrier function. METHODS AND RESULTS: Insulin reduced basal and antagonized tumor necrosis factor-alpha-induced macromolecule permeability of rat coronary microvascular endothelial monolayers. It also abolished reperfusion-induced vascular leakage in isolated-perfused rat hearts. Insulin induced dephosphorylation of the regulatory myosin light chains, as well as translocation of actin and vascular endothelial (VE)-cadherin to cell borders, indicating a reduction in contractile activation and stabilization of cell adhesion structures. These protective effects were blocked by genistein or Hydroxy-2-naphthalenylmethylphosphonic acid tris acetoxymethyl ester (HNMPA-[AM](3)), a pan-tyrosine-kinase or specific insulin-receptor-kinase inhibitor, respectively. Insulin stimulated the phosphatidylinositol 3-kinase (PI3K)/Akt pathway and NO production, and it activated Rac1. Inhibition of PI3K/Akt abrogated Rac1 activation and insulin-induced barrier protection, whereas inhibition of the endothelial nitric oxide synthase/soluble guanylyl cyclase pathway partially inhibited them. Inhibition of Rac1 abrogated the assembly of actin at cell borders. Accordingly, it abolished the protective effect of insulin on barrier function of the cultured endothelial monolayer, as well as the intact coronary system of ischemic-reperfused hearts. CONCLUSIONS: Insulin stabilizes endothelial barrier via inactivation of the endothelial contractile machinery and enhancement of cell-cell adhesions. These effects are mediated via PI3K/Akt- and NO/cGMP-induced Rac1 activation.

Validity and Reliability Study of the Childbirth Trauma Index.

OBJECTIVE: The aim of this study is to seek evidence for the validity and reliability of the Childbirth Trauma Index Scale, originally developed by Anderson for adolescents, among women in 18-45 age group. METHOD: Two hundred twenty women who were in the postpartum period until 72 hours after birth were included in the study. In the study, the Impact of Events Scale was used to test the criterion validity of the Childbirth Trauma Index Scale, being adapted to Turkish. RESULTS: The goodness of fit values obtained by the first level CFA (x2 (19, N = 220) 91.75; p < .01; x2/SD = 4.82; CMIN: 91,75; RMSEA = 0.132; CFI = .90; GFI = .90) shows that the proposed two-factor model is acceptable in accordance with the data. CONCLUSION: Birth Trauma Index is recommended to be used as a data collection tool in postpartum clinics and primary health care services by health personnel in order to detect postpartum birth trauma.

The Relationship of Serum Leptin and Ghrelin Levels with Craving and Withdrawal in Opioid Use Disorder.

Objective: This study aims to investigate plasma levels of leptin, acyl ghrelin, and unacylated ghrelin during heroin withdrawal in patients with opioid use disorder (OUD) with regard to the relationship of these levels with craving and their changes over time. Methods: This study included 28 male patients diagnosed with OUD according to DSM-5 diagnostic criteria who received inpatient rehabilitation. The control group included 28 healthy male volunteers with characteristics similar to the patient group. Plasma leptin, acyl ghrelin, and unacylated ghrelin levels of the patients were measured 3 times throughout the study by collecting blood on the first day, the seventh day at the end of the detox, and the twenty-first day. Blood was collected only once from the control group to determine their plasma leptin, acyl ghrelin, and unacylated ghrelin levels. Results: Our study did not determine any statistically significant differences between patients with OUD and healthy controls with regard to plasma leptin, acyl ghrelin, and unacylated ghrelin levels on the first, seventh, and twenty-first days of withdrawal. Plasma levels of leptin, acyl ghrelin, and unacylated ghrelin did not significantly correlate with craving scores. Conclusion: This study does not support the hypothesis that plasma leptin, acyl ghrelin, and unacylated ghrelin levels are markers in those with OUD. Further research, particularly in humans, is recommended to replicate and expand on the findings of the current literature.