Evaluation of the demographic characteristics and general health status of earthquake survivors affected by the 2023 Kahramanmaras earthquake; a section from Gaziantep Nurdagi district.

BACKGROUND: An earthquake with a magnitude of 7.7 occurred in Pazarcik District of Turkey at 04.17 on February 6, 2023 and another earthquake of 7.6 occurred at 13.24 on the same day. This is the second largest earthquake to have occurred in Turkey. The aim of this study is to investigate the earthquake-related level of knowledge, attitudes and behaviours, general health and psychological status of survivors who were affected by the 2023 Kahramanmaras Earthquake and who were living in Nurdagi District of Gaziantep after the earthquake. METHODS: Data of 2317 individuals older than 18 years of age who were living in earthquake neighbourhoods, tents and containers in Nurdagi District of Gaziantep were examined. Variables were evaluated to find out the demographic characteristics and general health status of earthquake victims. General Health Questionnaire (GHQ-12) was used to find out psychological states of earthquake victims. RESULTS: The rate of injuries was 14.2% and leg and foot injuries were the most common with 44.2%. The relationship between injury status; and age, marital status, and being trapped under debris was revealed (p < 0.05). Mean GHQ-12 score of the survivors was 3.81 ± 2.81 and 51.9% experienced psychological distress. In the evaluation with logistic regression, it was found that female gender, being injured in the earthquake, loss of first degree and second degree relatives (with a higher rate in loss of first degree relative), having a severely damaged -to be demolished house and having a completely destroyed house were correlated with higher level of psychological distress (p < 0.05). CONCLUSION: General characteristics, injury prevalence and affecting factors of earthquake survivors were evaluated in the present study. Psychological distress was found in victims. For this reason, providing protective and assistive services to fight the destructive effects of earthquake is vital. Accordingly, increasing the awareness of people residing in earthquake zones regarding earthquakes is exceptionally important.

Tr-KIT/c-KIT ratio in renal cell carcinoma.

Truncated KIT (tr-KIT) is an alternative variant of c-KIT protein. Previous studies have clearly documented that c-KIT was associated with various oncogenic processes in RCC. However, the biological significance of tr-KIT in RCC development and progression remains unclear. So, it was aimed to investigate the possible association between RCC and tr-KIT which is thought to activate some oncogenic pathways. In this study, Kidney Cancer cDNA Array containing a total of 48 cDNA samples from the normal kidney tissues of 9 healthy subjects and kidney tumor tissues of 10 stage-1, 5 stage-2, 13 stage-3 and 11 stage-4 RCC patients was used for gene expression analysis. Real-Time PCR method was used to measure tr-KIT/c-KIT expression ratios. tr-KIT/c-KIT expression ratio was compared between tumor and normal samples, and statistically correlated with the clinical parameters of RCC patients. tr-KIT/c-KIT expression ratio was approximately 4-times higher in tumor samples than control ones (p = 0.001). Also, tr-KIT/c-KIT expression ratio was approximately two, three and six times higher in Fuhrman nuclear grades 2, 3 and 4 than normal, respectively (p = 0.009). Moreover, clear cell and papillary RCC has a significantly higher level of tr-KIT/c-KIT expression ratio than chromophobe RCC (p = 0.016). In the current study, it was stated for the first time that tr-KIT/c-KIT expression ratio was up-regulated in RCC tissues, and high tr-KIT/c-KIT expression ratio was correlated with more aggressive clinical features and poor patient prognosis. Our results suggest that increased tr-KIT/c-KIT expression ratio might be useful as a prognostic marker for RCC patients.

Multiparametric MRI in differentiating solitary brain metastasis from high-grade glioma: diagnostic value of the combined use of diffusion-weighted imaging, dynamic susceptibility contrast imaging, and magnetic resonance spectroscopy parameters.

OBJECTIVE: The purpose of this study was to determine whether the combined use of diffusion weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and dynamic susceptibility contrast imaging (DSCI) parameters could provide a more accurate diagnosis in the differentiation of high-grade glioma (HGG) from solitary brain metastasis (SBM) in the enhancing tumour and in the peritumoural region. MATERIALS AND METHODS: Fifty-six patients who received DWI, DSCI, and MRS before surgery were assessed. In differentiating SBM from HGG, the cutoff values of the DWI-apparent diffusion coefficient (ADCmin, ADCmax, and ADCmean), DSCI-relative cerebral blood volume (rCBV), and MRS-Cho/Cr, Cho/NAA, and NAA/Cr parameters for the peritumoural region were determined with ROC. The combined ROC curve was used for the different combinations of the peritumoural region DWI, DSCI, and MRS parameters in differentiating between the two tumours, and the best model combination was formed. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. This study was approved by the Institutional Review Board at our institutes. RESULTS: In the enhancing tumour, all the parameters except NAA/Cr (P = 0.024) exhibited no statistical difference in differentiating between these two groups (P > 0.05). AUC values for ADCmin, ADCmax, ADCmean, rADCmin, rADCmax, rADCmean, rCBV, Cho/Cr, Cho/NAA, and NAA/Cr parameters in the peritumoural region in differentiating SBM from HGG were 0.860, 0.822, 0.848, 0.822, 0.801, 0.822, 0.906, 0.851, 0.903, and 0.784, respectively. In differentiating HGG from SBM, the best model consisted of the combination of peritumoural ADCmin, rCBV, and Cho/NAA parameters. AUC values were 0.970. CONCLUSIONS: The combination of peritumoural region ADCmin, rCBV, and Cho/NAA parameters can help in differentiating SBM from HGG, with a diagnostic accuracy of 97%.

Contribution of 3-T Susceptibility-Weighted MRI to Detection of Intraarticular Hemosiderin Accumulation in Patients With Hemophilia.

OBJECTIVE: The purpose of this study was to assess the feasibility of 3-T susceptibility-weighted imaging (SWI) for detecting intraarticular hemosiderin accumulation in patients with hemophilia. SUBJECTS AND METHODS: Forty-one joints in 24 patients with hemophilia were imaged with conventional MRI and SWI sequences. Two experienced musculoskeletal radiologists and one general radiologist (reader 3) interpreted the images for hemosiderin accumulation. The final decision was determined in consensus by readers 1 and 2 using both conventional MRI and SWI sequences. The diagnostic consistencies of each MRI sequence with the reference and pairwise agreements between interpreters were assessed. RESULTS: For conventional MRI sequences, the diagnostic consistencies of the two experienced musculoskeletal radiologists with the reference were substantial (κ = 0.63 and 0.62), whereas the consistency of the general radiologist with the reference was moderate (κ = 0.47). The SWI interpretations of all readers had almost perfect agreement with the reference (κ = 1, κ = 1, κ = 0.97). Interobserver agreement also improved at SWI interpretations. CONCLUSION: SWI contributes to more accurate grading of intraarticular hemosiderin accumulation than is achieved with conventional MRI sequences.

Magnetic Resonance Imaging of Intracranial Hypotension: Diagnostic Value of Combined Qualitative Signs and Quantitative Metrics.

OBJECTIVE: The aim of this study was to investigate whether the use of combination quantitative metrics (mamillopontine distance [MPD], pontomesencephalic angle, and mesencephalon anterior-posterior/medial-lateral diameter ratios) with qualitative signs (dural enhancement, subdural collections/hematoma, venous engorgement, pituitary gland enlargements, and tonsillar herniations) provides a more accurate diagnosis of intracranial hypotension (IH). METHODS: The quantitative metrics and qualitative signs of 34 patients and 34 control subjects were assessed by 2 independent observers. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of quantitative metrics and qualitative signs, and for the diagnosis of IH, optimum cutoff values of quantitative metrics were found with ROC analysis. Combined ROC curve was measured for the quantitative metrics, and qualitative signs combinations in determining diagnostic accuracy and sensitivity, specificity, and positive and negative predictive values were found, and the best model combination was formed. RESULTS: Whereas MPD and pontomesencephalic angle were significantly lower in patients with IH when compared with the control group (P < 0.001), mesencephalon anterior-posterior/medial-lateral diameter ratio was significantly higher (P < 0.001). For qualitative signs, the highest individual distinctive power was dural enhancement with area under the ROC curve (AUC) of 0.838. For quantitative metrics, the highest individual distinctive power was MPD with AUC of 0.947. The best accuracy in the diagnosis of IH was obtained by combination of dural enhancement, venous engorgement, and MPD with an AUC of 1.00. CONCLUSIONS: This study showed that the combined use of dural enhancement, venous engorgement, and MPD had diagnostic accuracy of 100 % for the diagnosis of IH. Therefore, a more accurate IH diagnosis can be provided with combination of quantitative metrics with qualitative signs.

Acoustic Radiation Force Impulse Quantification in the Evaluation of Thyroid Elasticity in Pediatric Patients With Hashimoto Thyroiditis.

OBJECTIVES: To evaluate the parenchymal elasticity of the thyroid gland with acoustic radiation force impulse imaging in pediatric patients with Hashimoto thyroiditis and to compare it with healthy volunteers. METHODS: Twenty-six patients with Hashimoto thyroiditis and 26 healthy volunteers between 6 and 17 years were included. The shear wave velocity (SWV) values of both thyroid lobes in both groups were evaluated. RESULTS: The age and sex characteristics of the controls and patients with Hashimoto thyroiditis were similar. The SWV of the thyroid gland in patients with Hashimoto thyroiditis (mean ± SD, 1.67 ± 0.63 m/s) was significantly higher than that in the control group (1.30 ± 0.13 m/s; P < .001). There was no significant difference between the thyroid lobes in both groups. A receiver operating characteristic curve analyses showed an optimal cutoff value of 1.41 m/s, with 73.1% sensitivity, 80.8% specificity, a 79.2 % positive predictive value, and a 75.0% negative predictive value (area under the curve, 0.806; P < .001). In patients with Hashimoto thyroiditis, there was a positive correlation between the SWV values versus anti-thyroperoxidase (Pearson r = 0.46; P = .038). There were no correlations between age, body mass index, thyroid function test results, and anti-thyroglobulin values and versus SWV values. Also, no significant differences were seen between the groups for gland size, gland vascularity, and l-thyroxine treatment. CONCLUSIONS: Acoustic radiation force impulse elastography showed a significant difference in the stiffness of the thyroid gland between children with Hashimoto thyroiditis and the healthy group. Using acoustic radiation force impulse elastography immediately after a standard ultrasound evaluation may predict chronic autoimmune thyroiditis.

Acoustic Radiation Force Impulse Quantification in the Evaluation of Renal Parenchyma Elasticity in Pediatric Patients With Chronic Kidney Disease: Preliminary Results.

OBJECTIVES: To evaluate renal parenchymal elasticity with acoustic radiation force impulse imaging in pediatric patients with chronic kidney disease (CKD) and compare with healthy volunteers. METHODS: Thirty-eight healthy volunteers and 30 pediatric CKD patients were enrolled in this prospective study. The shear wave velocity (SW) values of both kidneys in CKD patients and healthy volunteers were evaluated. RESULTS: The mean SW in healthy volunteers was 2.21 ± 0.34 m/s, whereas the same value was 1.81 ± 0.49, 1.72 ± 0.63, 1.66 ± 0.29, 1.48 ± 0.37, and 1.23 ± 0.27 for stages 1, 2, 3, 4, and 5 in CKD patients, respectively. The SW was significantly lower for each stage in the CKD patients compared with healthy volunteers. Acoustic radiation force impulse could not predict the different stages of CKD, with the exception of stage 5. The cut-off value for predicting CKD was 1.81 m/s; at this threshold, sensitivity was 76.5% and specificity was 92.1% (area under the curve = 0.870 [95% confidence interval: 0.750-0.990]; P < .001). Interobserver agreement expressed as intraclass coefficient correlation was 0.65 (95% confidence interval: 0.34 to 0.83; P < .001). CONCLUSIONS: Acoustic radiation force impulse may be a potentially useful tool in detecting CKD in pediatric patients.

Evaluation of Renal Parenchyma Elasticity With Acoustic Radiation Force Impulse Quantification in Nutcracker Syndrome and Comparisons With Grayscale Doppler Sonography and Laboratory Findings.

OBJECTIVES: We sought to evaluate renal parenchymal elasticity with Virtual Touch quantification of acoustic radiation force impulse imaging in nutcracker syndrome and to compare shear-wave velocity (SWV) values with grayscale Doppler sonography and laboratory findings. METHODS: Thirty-eight healthy volunteers and forty-three nutcracker syndrome patients were enrolled in this prospective study. SWV values for both kidneys in nutcracker syndrome patients and healthy volunteers were evaluated. Grayscale Doppler ultrasound and laboratory findings were obtained and compared with SWV values in both nutcracker syndrome patients and healthy volunteers. RESULTS: In nutcracker syndrome patients, SWV values for the left kidney were significantly lower than those for the right kidney (n = 43; 1.93 ± 0.43 m/s vs 2.53 ± 0.45 m/s [P < .001]). Healthy volunteers' SWV values for both kidneys had no statistically significant differences. There was a statistically significant difference between nutcracker syndrome patients and healthy volunteers for the SWV values and body mass index values. There was no statistically significant correlation between SWV values of nutcracker syndrome patients and age, gender, glomerular filtration rate, body mass index, vein diameter ratio, peak velocity ratio, or resistive indices. CONCLUSIONS: Acoustic radiation force impulse imaging offers new, additional information on the affected left kidney parenchymal changes in nutcracker syndrome patients.

Effect of arteriovenous fistula and usage of arm with fistula on bone mineral density in hemodialysis patients.

We aimed to determine the incidence of osteoporosis in hemodialysis patients, to evaluate the differences due to arteriovenous fistula on bone mineral density (BMD) and to investigate whether usage of arm with fistula has an effect on BMD. In this cross-sectional study, 96 patients with chronic renal disease undergone to dialysis were included. Place of fistula (radial and brachial) and dominant hand were recorded. All patients were asked to complete Likert's scale in order to determine the frequency of their usage of arm with fistula. Patients were assigned in two groups: age >51 and < 50 years. Age-matched control group included 60 subjects. BMD measurements were done on lumbar vertebra, femur and both forearms. BMD measurement of proximal femur and total radius were significantly lower in patients >50 years compared to healthy controls and bone density measurement of lumbar vertebra, proximal femur, 1/3 distal and total radius were significantly lower in patients < 50 years compared to healthy controls (p < 0.05). BMD measurement was significantly lower in arms with fistula, especially with radial fistula, compared to both arms without fistula and healthy controls (p < 0.05). When all patients were evaluated, BMD scores were lowering by increasing age, duration of dialysis and fistula and decreasing usage of arm with fistula. BMD in hemodialysis patients is lower than normal population. BMD of arm with fistula is lower than arm without fistula and healthy controls. Both radial and brachial fistula affect negatively ipsilateral BMD. Movement of arm with fistula has positive effects on BMD.

Diagnostic Performance of Thyroid Nodule Risk Stratification Systems: Comparison of ACR-TIRADS, EU-TIRADS, K-TIRADS, and ATA Guidelines.

ABSTRACT: The purpose of this study was to compare the diagnostic performance of 4 different ultrasound-based risk scoring systems for thyroid nodules (TNs). This study consecutively included 256 patients (mean age: 43.98 ± 12.94 years, min-max: 18-89 years; 225 females, 31 males) with 266 TNs. Each nodule was evaluated and classified according to the American Thyroid Association (ATA), American College of Radiology (ACR), European Thyroid Association, and Korean Thyroid Imaging Reporting and Data System (ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively) before performing ultrasound-guided fine-needle aspiration biopsy. Pathological results were reported according to the Bethesda system. Outcomes of the 4 classification systems were compared with respect to Bethesda results. Twenty-eight (10.5%) nodules had malignant cytology results. Diagnostic performances of the scoring systems were comparable with similar area under the curve values according to the reference standards of category 5 of each scoring system. The sensitivity and specificity values of these guidelines were as follows: ACR-TIRADS, 60.7% and 95.4%; EU-TIRADS, 71.4% and 93.3%; ATA-2015, 71.4% and 93.3%; and K-TIRADS, 67.9% and 93.3%. The biopsy rate of malignant nodules was 57.1% for K-TIRADS and ATA, whereas this value was 46.4% for ACR and EU-TIRADS. ACR-TIRADS had the lowest unnecessary biopsy rate (141 of 238 benign nodules, 46%). The diagnostic performance of 4 risk stratification systems appears to be comparable, as shown by similar sensitivity, specificity, and area under the curve values. However, the ACR-TIRADS had slightly higher accuracy and necessitated fewer unnecessary biopsies for benign nodules.

Evaluation of the relationship between Ki67 expression level and neoadjuvant treatment response and prognosis in breast cancer based on the Neo-Bioscore staging system.

BACKGROUND: Neoadjuvant chemotherapy (NAC) is widely used in the treatment of primary breast cancer. Different staging systems have been developed to evaluate the residual tumor after NAC and classify patients into different prognostic groups. Ki67, a proliferation marker, has been shown to be useful in predicting treatment response and prognosis. We aimed to investigate the prognostic importance Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels in breast cancer patients who received NAC and correlations between Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels. METHODS: A total of 176 invasive breast carcinoma patients who underwent NAC were included in the study. Ki67 levels were evaluated by immunohistochemical methods in Trucut biopsy and surgical excision specimens. Patients were classified into prognostic groups using the Neo-Bioscore staging system. RESULTS: Patients with high pretreatment Ki67 score were more likely to be in the higher Neo-Bioscore risk group (p < 0.001). Patients with a high posttreatment Ki67 score were more likely to be in the higher Neo-Bioscore prognostic risk group (p < 0.001). Overall survival (OS) and disease-free survival (DFS) were shorter in patients with high posttreatment Ki67 scores and in patients in the higher Neo-Bioscore risk group. We also determined a cutoff 37% for pathological complete response. CONCLUSION: Neo-Bioscore staging system is found to be important in predicting survival. The posttreatment Ki67 level is more important than pretreatment Ki67 level in predicting survival.

Frequency of complications and risk factors associated with computed tomography guided core needle lung biopsies.

BACKGROUND: Although transthoracic needle biopsy (TTNB) is an effective method for diagnosis of lung tumors, it has some complications. It is crucial to know the frequency and severity of the complications of TTNB and its risk factors in order to avoid them. OBJECTIVES: Evaluate the complications and risk factors of computed tomography guided core needle lung biopsies (CT-CNLB). DESIGN: Prospective evaluation of complications. SETTING: Single center in Turkey. PATIENTS AND METHODS: For CT-CNLBs performed between October 2017 and March 2018, the complications of biopsies were noted and classified as major and minor based on guidelines of the Society of Interventional Radiology. MAIN OUTCOME MEASURES: The complications and risk factors for complications were evaluated. SAMPLE SIZE: 123 adult patients. RESULTS: The most common complications were pulmonary hemorrhage (30.9%) and pneumothorax (22%). Increased overall pulmonary hemorrhage was observed with underlying emphysema (P=.022), non-peripheral location of the lesion (P<.001), increased needle pathway (P<.001), fissure penetration (P=.011), increased number of pleura penetrations (P=.024), prolonged needle time across pleura (P=.037), and decreased lesion size (P=.033). The pneumothorax rate increased with non-peripheral location of the lesion (P<.007), fissure penetration (P=.021), prolonged needle time across the pleura (P=.013), and decreased lesion size (P=.002). In the logistic regression analyses for he two most common complications, the only risk factor for both alveolar hemorrhage and pneumothorax was a non-peripheral location of the lesion (P<.001, OR=14.7, 95% CI=3.9-55.4 for alveolar hemorrhage) and (P=.001, OR=156.2, 95% CI =7.34-3324.7 for pneumothorax). CONCLUSION: Most common complications of CT-CNLB were pneumothorax and pulmonary alveolar hemorrhage with a 5.7% major complication rate. Choosing the shortest possible trans-pulmonary needle pathway minimizes the risk of complications. LIMITATIONS: Limited number of patients, absence of rare complications as death, air embolism, and needle tract seeding. CONFLICT OF INTEREST: None.

3 Tesla MRI in diagnosis and follow up of children with pneumonia.

PURPOSE: To investigate the utilization of 3-Tesla (3 T) magnetic resonance imaging (MRI) in detection of pulmonary abnormalities in children with pneumonia. MATERIALS AND METHODS: Forty-seven children with pneumonia prospectively underwent 3 T thoracic MRI and posteroanterior (PA) chest radiography (CR). Of these, 15 patients also underwent contrast-enhanced thorax computed tomography (CT) or high-resolution CT (HRCT). The MRI protocol included axial and coronal T2-weighted spectral presaturation with inversion recovery (SPIR) Multivane-XD and axial echo-planar diffusion-weighted imaging (EPI DWI) with respiratory gating. Kappa statistics, Cochran Q, and McNemar tests were used to investigate the results. RESULTS: Agreement between CR and MRI was substantial in detecting consolidation/infiltration (k = 0.64), peribronchial thickening (k = 0.64), and bronchiectasis (k = 1); moderate in detecting cavity (k = 0.54) and pleural effusion (k = 0.44); and fair in detecting empyema (0.32) and bilateral involvement of lungs (k = 0.23). MRI was superior to CR in detecting bilateral involvement (p < 0.001), lymph node (p < 0.001), pleural effusion (p < 0.001), and empyema (p = 0.003). MRI detected all the consolidation/infiltration also detected on CT imaging. A kappa test showed moderate agreement between MRI and CT in detecting pleural effusion and ground-glass opacity (GGO), and substantial or almost perfect agreement for all other pathologies. No statistically significant difference was observed between MRI and CT for detecting pneumonia-associated pathologies by the McNemar test. CONCLUSION: Thoracic 3 T MRI is an accurate and effective technique for evaluating children with pneumonia. MRI detected more pathologies than CR and had similar results to those of thorax CT.

Using predictive analytics to identify drug-resistant epilepsy patients.

Epilepsy is one of the most common brain disorders that greatly affects patients' quality of life and poses serious risks to their health. While the majority of the patients positively respond to the existing anti-epilepsy drugs, others who developed the refractory type of epilepsy show resistance against drug therapy and need to undergo advance treatments such as surgery. Given that identifying such patients is not a straightforward process and requires long courses of trial and error with anti-epilepsy drugs, this study aims at predicting those at-risk patients using clinical and demographic data obtained from electronic medical records. Specifically, the study employs several predictive analytics machine-learning methods, equipped with a novel approach for data balancing, to identify drug-resistant patients using their comorbidities and demographic information along with the initial epilepsy-related diagnosis made by their physician. The promising results we obtained highlight the potential use of machine-learning techniques in facilitating medical decisions and suggest the possibility of extending the proposed approach for developing a clinical decision support system for medical professionals.

Anaesthetic Management of Patients Undergoing Bariatric Surgery.

OBJECTIVE: To describe perioperative anaesthetic management with laparoscopic sleeve gastrectomy (LSG). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Anesthesiology, Ondokuz Mayis University, Turkey, between January 2012 and December 2017. METHODOLOGY: Patients who underwent LSG at the study centre were considered. Hospital records were retrospectively reviewed. Information was collected on demographic characteristics, comorbidities, haemodynamic parameters, airway and anaesthetic management and complications. RESULTS: The study included 95 patients (mean age, 37.4±12.1 years; mean body mass index, 46 Kg/m2). Despite high airway assessment scores in some patients, 93 patients (98%) were conventionally intubated using our modified ramp position. Anaesthesia induction involved propofol, and anaesthesia maintenance involved inhalation anaesthetics (remifentanil supplementation). Additionally, rocuronium and sugammadex were used. Postoperative pain was managed with multimodal analgesia. Dose calculations were mostly based on lean/ideal body weight. Significant differences were found in the mean arterial pressure, heart rate and arterial oxygen saturation before induction and 5 min after induction. Intraoperatively, 3 patients (3.2%) developed bronchospasm and 1 (1.1%) developed bradycardia. There were no postoperative complications. CONCLUSION: Inhalational anaesthesia with remifentanil and rocuronium-sugammadex is a safe option in bariatric surgery. Although conventional techniques are sufficient to establish the airway in most cases, preparations for difficult intubation should be made. Furthermore, careful patient selection, preoperative anaesthetic management planning and appropriate postoperative monitoring are necessary.

The prevalence of Burnout Syndrome among Turkish Urologists: Results of a Nationwide Survey.

OBJECTIVE: To investigate the prevalence of Burnout syndrome (BS) with its emotional exhausting (EE), depersonalization (DP), and personal accomplishment (PA) dimensions among Turkish urologists. MATERIAL AND METHODS: A total of 2,259 certified Turkish urologists were invited by e-mail to participate in this cross-sectional survey-based study. An online survey was conducted to evaluate three dimensions of BS ie: -EE, DP and PA-and their association with socio-demographic variables of Turkish urologists using the Maslach Burnout Inventory (MBI). RESULTS: Of the 2259 urologists contacted, 362 (with a mean age of 44±9.9 years) completed the survey. The mean EE, DP and PA scores were 16.8±8.7, 6.6±4.6 and 8.2±5.6, respectively. Cronbach's α reliability co-efficiencies were 0.920 for EE, 0.819 for DP and 0.803 for PA. Antidepressant drug usage was quite prevalent among participants (21.9%), and the most common comorbidity was hypertension (13%). The academic title, age, smoking status, monthly income and relationships between colleagues and employers were associated with BS (p<0.05). CONCLUSION: The prevalence of BS among Turkish urologists is quite prevalent in terms of EE and DP subscales and may negatively affect the psychosocial status and well-being of the urologists. In this study, a high prevalence of BS has been reported among Turkish urologists. In conclusion the BS could become an important occupational and health problem, if it is not properly managed.

Bedside ultrasonography for the confirmation of gastric tube placement in the neonate.

BACKGROUND: Naso/Orogastric tube (NOGT) misplacement can lead to significant complications. Therefore, the assessment of tube position is essential to ensure patient safety. Although radiography is considered the gold standard for determining NOGT location, new methods may be helpful in reducing repetitive radiation exposure, especially for neonates. In this study, we sought to investigate if bedside ultrasonography (BUSG) can be used to verify NOGT placement in neonatal intensive care patients. MATERIALS AND METHODS: Infants requiring NOGT placement were enrolled. After insertion of the NOGT, the location was first identified using BUSG and then confirmed using abdominal radiography for comparison. RESULTS: The study cohort included 51 infants with an average gestational age of 34 ± 4.9 weeks. BUSG determined the NOGT location correctly with a sensitivity of 92.2%. The location of the NOGT could not be determined by BUSG in four neonates (7.8%). In one infant, the NOGT was positioned in the esophagus, as determined both by BUSG and radiography. CONCLUSION: BUSG is a promising diagnostic tool for determining NOGT location in neonates, thereby eliminating the need for abdominal radiography.

Subtrochanteric derotation osteotomy using a bent dynamic compression plate in children with medial femoral torsion.

Subtrochanteric osteotomy of the femur using a bent dynamic compression plate is a simple, safe, and stable technique for correction of severe medial femoral torsion.

The diagnostic value of using combined MR diffusion tensor imaging parameters to differentiate between low- and high-grade meningioma.

OBJECTIVE: The purpose of this study was to examine whether the combined use of MR diffusion tensor imaging (DTI) parameters [DTI-apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)] could provide a more accurate diagnosis in differentiating between low-grade and atypical/anaplastic (high-grade) meningioma. METHODS: Pathologically proven 45 meningioma patients [32 low-grade, 13 high-grade (11 atypical and 2 anaplastic)] who had received DTI before surgery were assessed retrospectively by 2 independent observers. For each lesion, MR DTI parameters (ADCmin, ADCmax, ADCmean, FA, AD, and RD) and ratios (rADCmin, rADCmax, rADCmean, rFA, rAD, and rRD) were calculated. When differentiating between low- and high-grade meningioma, the optimum cutoff values of all MR DTI parameters were determined by using receiver operating characteristic (ROC) analysis. Area under the curve (AUC) was measured with combined ROC analysis for different combinations of MR DTI parameters in order to identify the model combination with the best diagnostic accuracy in differentiation between low and high-grade meningioma. RESULTS: Although the ADCmin, ADCmax, ADCmean, AD, RD, rADCmin, rADCmax, rADCmean, rAD, and rRD values of high-grade meningioma were significantly low (p = 0.007, p = 0.045, p = 0.035, p = 0.045, p = 0.003, p = 0.02, p = 0.03, p = 0.03, p = 0.045, and p = 0.01, respectively), when compared with low-grade meningioma, their FA and rFA values were significantly high (p = 0.007 and p = 0.01, respectively). For all MR DTI parameters, the highest individual distinctive power was RD with AUC of 0.778. The best diagnostic accuracy in differentiating between low- and high-grade meningioma was obtained by combining the ADCmin, RD, and FA parameters with 0.962 AUC. CONCLUSION: This study shows that combined MR DTI parameters consisting of ADCmin, RD, and FA can differentiate high-grade from low-grade meningioma with a diagnostic accuracy of 96.2%. Advances in knowledge: To the best of our knowledge, this is the first study reporting that a combined use of all MR DTI parameters provides higher diagnostic accuracy for the differentiation of low- from high-grade meningioma. Our study shows that any of the model combinations was superior to use of any individual MR DTI parameters for differentiation between low and high-grade meningioma. A combination of ADCmin, RD, and FA was found to be the best model for differentiating low-grade from high-grade meningioma and sensitivity, specificity, and AUC values were found to be 92.3%, 100%, and 0.96, respectively. Thus, a combination of MR DTI parameters can provide more accurate diagnostic information when differentiation between low and high-grade meningioma.

Shear wave velocity of the healthy thyroid gland in children with acoustic radiation force impulse elastography.

PURPOSE: Acoustic radiation force impulse imaging is a kind of shear wave elastography that can be used in children for differentiating thyroid pathologies. Possible changes in the healthy thyroid gland in children may create difficulties in the use of shear wave velocities (SWV) in thyroid pathologies. The aim of this study was to define the normal values of SWV for the healthy thyroid gland in children, elucidate the correlation of the SWV values with potential influencing factors, and evaluate intra-operator reproducibility of the SWV. METHODS: Between January 2015 and December 2015, a total of 145 healthy children (81 girls, 64 boys; mean age, 10.5 ± 3.14 years; range 6-17 years) were enrolled in the study. The SWV and volume of the thyroid gland were determined. RESULTS: The mean shear wave velocity of the thyroid gland was 1.22 ± 0.20 m/s. There was no correlation between age and the mean SWV of the thyroid gland (Spearman Rho = 0.049, p = 0.556). There was also no correlation between the thyroid gland volume or BSA and the mean SWV. The only correlation detected was between BSA and total thyroid gland volume (p < 0.001). CONCLUSION: In the present study, the SWV of the healthy thyroid gland in children was determined. There was no correlation between the SWV of the thyroid gland and age, BSA, or thyroid gland volume.