Effect of Remote Ischemic Preconditioning in Total Knee Arthroplasty on Thiol-Disulfi de Balance: a Randomized Controlled Study.

PURPOSE OF THE STUDY The purpose of this study was to minimize tourniquet-induced ischemia-reperfusion injury (IRI) in total knee arthroplasty (TKA) surgery using the remote ischemic preconditioning (RIPC) model, as well as to assess antioxidant balance with thioldisulfi de homeostasis (TDH). The secondary goal is to evaluate the impact of RIPC on TKA clinical outcomes. MATERIAL AND METHODS Patients in the ASA I-III group who underwent elective TKA were enrolled in this prospective, randomized, double-blind clinical research. TDH parameters were measured individually in groups with (Group I) and without (Group K) RIPC at the following times: preoperative (T0), right before the pneumatic tourniquet was opened (T1), 1 (T2), 6 (T3), and 24 (T4) hours after it was opened. In addition, at 3-hour intervals, the postoperative pain level was assessed using a visual analog scale (VAS). RESULTS This study included 60 cases (Group K; n=30, Group I; n=30). Both groups had equal native thiol, total thiol, disulfi de levels, disulfi de/native thiol, disulfi de/total thiol, and native thiol/total thiol ratios (p>0.05 for each). The change in native thiol, total thiol, and disulfi de values at T0 and T4 periods, however, was not statistically signifi cant for Group K (p=0.049, p=0.047, p=0.037, and p=0.217, p=0.191, p=0.220, respectively). At the 15th hour, VAS values in group I were considerably lower than in Group K (p=0.002). DISCUSSION This prospective, randomized, controlled trial examined how RIPC affected tourniquet-induced IRI-induced oxidative stress in TKA surgery. Lower native, total, and disulfi de levels at each postoperative time point were signifi cant. RIPC may reduce tourniquet-induced IRI-induced oxidative stress and TDH in TKA surgery. RIPC also reduced postoperative discomfort. CONCLUSIONS Our fi ndings suggest that RIPC may protect against the oxidative stress caused by IRI during limb surgery with a tourniquet and improve postoperative clinical outcomes. Key words: remote ischemic preconditioning, ischemia-reperfusion injury, thiol-disulfi de balance, oxidative stress, total knee arthroplasty.

Correlation between pre-radical prostatectomy standardized SUVmax ratios detected on 68Ga-PSMA-I&T PET/CT and final histopathology outcomes: an in-depth analysis.

OBJECTIVE: To evaluate the predictive potential of the maximum standardized uptake value(SUVmax) value of intraprostatic tumors derived from preoperative 68Ga-PSMA-I&T PET/CT (SUVT), and its ratios to SUVmax in the liver (SUVTLR) and parotid gland (SUVTPR) with respect to histopathological findings. MATERIALS AND METHODS: Data from patients who underwent radical prostatectomy (RP) for prostate cancer (PC) at our clinic between 2017 and 2020 were assessed. Patients with a secondary malignancy, a history of transurethral prostate resection, prior treatment for PC, or who received salvage RP were excluded. Whole-body images obtained using the same device, as per the guidelines, were reviewed by two nuclear medicine specialists with more than a decade of experience to reach a consensus for each lesion. The relationships between age, PSA, Prostate Volume, clinical T stage, biopsy International Society of Urological Pathology grade (ISUP), D'amico risk group, intraprostatic tumor volume (HPTV) identified in the final histopathological specimen review, HP-ISUP grade, seminal vesicle invasion (SVI), extracapsular invasion (ECI), positive surgical margine (PSM), SUVT, SUVTLR, and SUVTPR were analyzed. RESULTS: The mean age of the 64 included patients was 64.1 ±â€¯5.3. A statistically significant correlation was found between SUVT, SUVTLR, SUVTPR values, and histopathologic stage parameters, such as biopsy ISUP, D'amico Risk Classification, HP-ISUP, HPTV (p < 0.05). PSMATV, SUVT, and SUVTLR were statistically significant predictors of extracapsular invasion, while PSA, PSMATV, and SUVTLR were significant predictors of SVI (p < 0.05). CONCLUSION: The standardized SUVT, SUVTLR, and SUVTPR values could be employed as noninvasive markers to assist in predicting postoperative histopathological findings, particularly ECI, SVI, and PSM.

Fatty acid binding protein 4 is expressed in distinct endothelial and non-endothelial cell populations in glioblastoma.

AIMS: Glioblastoma (GBM) is the most common and aggressive primary brain tumour in adults. Angiogenesis and vasculogenesis play key roles in progression of GBMs. Fatty acid binding protein 4 (FABP4) is an intracellular chaperone for free fatty acids. FABP4 is detected in microvascular endothelial cells (ECs) in several normal tissues and promotes proliferation of ECs. The goal of this study was to characterize the tissue distribution pattern of FABP4 in GBMs. METHODS: Immunohistochemistry for FABP4 was performed on paraffin-embedded tumour sections and the intensity and distribution of FABP4 immunoreactivity were analysed. Double immunofluorescence was employed for detailed characterization of FABP4-positive cells. RESULTS: FABP4 immunoreactivity was absent in normal brain tissue sections. FABP4-positive cells were detected in 33%, 43%, 64% and 89% of Grade I, Grade II, Grade III and Grade IV glial tumours, respectively. Thus, the percentage of FABP4-positive cells in GBMs was significantly higher than lower-grade gliomas. In general, FABP4-expressing cells were distributed in a non-homogenous pattern, as 'hot spots' in glial tumours. FABP4 expression was detected in a subset of vascular ECs as well as some non-ECs. CONCLUSION: FABP4 is expressed in a significantly higher percentage of GBMs in comparison to both normal brain tissues and lower-grade glial tumours. FABP4 is expressed in some tumour ECs as well as non-ECs in glial tumours. As FABP4 promotes proliferation of ECs, detection of FABP4 in GBM-ECs, but not normal brain ECs suggests that FABP4 may play a role in the robust angiogenesis associated with GBMs.

Electronic transport in n- and p-type modulation doped Ga(x)In(1-x)N(y)As(1-y)/ GaAs quantum wells.

We present a comprehensive study of longitudinal transport of two-dimensional (2D) carriers in n- and p-type modulation doped Ga(x)In(1-x)N(y)As(1-y) /GaAs quantum well structures. The Hall mobility and carrier density of electrons in the n-modulation doped quantum wells (QWs) decreases with increasing nitrogen composition. However, the mobility of the 2D holes in p-modulation doped wells is not influenced by nitrogen and it is significantly higher than that of 2D electrons in n-modulation doped material. The observed behaviour is explained in terms of increasing electron effective mass as well as enhanced N-related alloying scattering with increasing nitrogen content. In order to determine the conduction band (CB) and valence band (VB) structures as well as electron and hole effective masses, the band anticrossing model with an eight-band [Formula: see text] approximation in the Lüttinger-Kohn approach is used. The effects of strain, quantum confinement and the strong coupling between the localized nitrogen states and the CB extended states of GaInAs are considered in the calculations. The results indicate that the nitrogen induces a strong perturbation to the CB of the matrix semiconductor whilst the VB remains unaffected. The temperature dependent mobility of 2D electron gas is discussed using an analytical model that accounts for the most important scattering mechanisms. The results indicate that the interface roughness and N-related alloy scattering are the dominant mechanisms at low temperatures, while polar optical phonon and N-related alloy scattering limit mobility at high temperatures.

Our clinical experience on calcaneal bone cysts: 36 cysts in 33 patients.

BACKGROUND: Solitary bone cysts are lesions of benign nature with fluid content. The frequent locations for these cysts are the proximal femur or humerus. Rarely, they may occur in locations such as the calcaneus, mostly in adults. We have reported the second largest case series of calcaneal bone cysts. MATERIALS AND METHODS: Thirty-six calcaneal cysts in 33 patients, 3 of which showed bilateral involvement, diagnosed, and followed between 1995 and 2008 in our clinic were retrospectively evaluated. RESULTS: The third most common location was the calcaneus, with cysts in 36 (14%) patients. The age range of the patients was 13-74 years (mean, 37.9 years). The complaints of the patients upon presentation to the hospital were heel pain in 16 patients (44.4%). Eighteen patients (50%) underwent surgical treatment, of these ten patients (27.7%) were treated with curettage and autogenous iliac wing grafting. CONCLUSIONS: Simple bone cysts with the location of calcaneus are not a rare entity. According to our series, simple bone cysts have been shown to be typically located in the calcaneus bone in middle-aged patients in particular. Furthermore, in such patients, heel pain is considerably severe, which is a symptom to be kept in mind in differential diagnosis. Curettage and autogenous grafting is the successful method of treatment and it provides good results.

Bilateral capitellum humeri fracture; a case report.

This is the report of a 33-year-old female patient who was admitted to the Emergency Department with bilateral capitellum humerus fracture after a fall from a height. The patient was surgically treated with open reduction and internal fixation for both elbows, with 3 Kirschner wires on the right elbow and one mini-fragment screw on the left. Surgical intervention was carried out in emergency conditions. Following an early physical rehabilitation programme at the end of the 1st week, the roentgenograms in the 9th week showed acceptable bone union. However, in the 2nd year of follow-up the patient had consistent pain and 35 degrees of flexion loss in her right elbow due to degenerative change. The literature reveals only two reports of such cases. Thus, this rare case of bilateral capitellum humerus showed that early mobilisation after anatomic reduction and stable fixation with a mini-screw provided the optimal outcome.

Increased serum anti-carbonic anhydrase II antibodies in patients with Graves' disease.

Carbonic anhydrase II (CA II) has an important role in thyroid hormone synthesis via regulating iodide (I-) transport across thyroidal cell membranes and the existence of autoantibodies against CA I and/or CA II have been shown in sera from patient with various autoimmune diseases such as Sjögren's Syndrome, Systemic Lupus Erythmatosus, type 1 diabetes, primary biliary cirrhosis and ulcerative colitis. The aim of this study was to investigate the presence of anti-CA I and CA II antibodies in autoimmune thyroid disease and the relationships between the autoantibodies and other clinical parameters. We studied 40 autoimmune thyroid patients (20 Hashimoto's thyroiditis, HT and 20 Graves' disease, GD ) and 21 healthy control subjects. Serum anti-CA I and CA II antibodies were screened by ELISA. Positive rate of anti-CA II (25%) antibody was significantly higher in GD patients as compared to HT patients and control subjects (p<0.05). There were no significant changes in positive rate of anti-CA I antibody. In addition, a significant correlation between serum anti-CA antibodies titers and other studied clinical parameters was not found. The results suggest that anti-CA II antibodies may be involved in the pathogenesis of GD.

Factors associated with increased irisin levels in the type 1 diabetes mellitus.

OBJECTIVE: The aim of the present study was to determine the irisin levels in patients with the type 1 diabetes mellitus (T1DM) and to examine the relation of irisin levels with the inflammation and autoimmunity. METHODS: This study included 35 cases diagnosed with T1DM and 36 healthy volunteers. Antiglutamic acid decarboxylase (anti-GAD), islet cell antibody (ICA), and insulin autoantibody levels were measured in patients at the time when they were included into the study and recorded from the patient files. Serum irisin levels were measured by ELISA kit. RESULTS: The median irisin levels were determined higher in T1DM group compared to the control one (6.8 ng/ml vs. 4.8 ng/ml, p=0.022; respectively). Median irisin levels were higher in anti-GAD (p=0.022) and ICA (p=0.044) positive groups compared to negative groups. In T1DM group, irisin levels displayed positive correlation with glycosylated hemoglobin (HbA1c) (r=0.377, p<0.001) and anti-GAD (r=0.392, p=0.020) and negative correlation with creatinine (r=-0390, p=0.021). In multivariate regression model, HbA1c (B±SE: 2.76±17683, p<0.001), and anti-GAD (B±SE: 2.311±0.610, p=0.001) were determined as independent predictors for predicting the irisin levels. CONCLUSION: In patients with T1DM, which chronic inflammation and autoimmunity take part in their etiopathogenesis, anti-GAD levels were an independent risk factor for the irisin. Th is may suggest that factors such as inflammation and autoimmunity can be effective in the synthesis of irisin.

Ewing's sarcoma of the proximal phalanx of the foot: A rare case report.

BACKGROUND: Ewing's sarcoma localized to foot is extremely rare. Local control is mandatory because of the aggressive nature of the tumor. Therapeutic options for these local tumors include neoadjuvant chemotherapy followed by surgery. DESCRIPTION OF THE CASE: A 17-year-old female patient presented with a 6-month history of progressive swelling and intermittent pain of the left great toe. Plain radiography and magnetic resonance imaging revealed an expansile mass that had originated from the proximal phalanx of the great toe and was destructing and surrounding the distal phalanx. Her erythrocyte sedimentation rate and serum lactate dehydrogenase levels were slightly elevated. Distant metastasis was not detected. The patient underwent an open biopsy, which confirmed the diagnosis of Ewing's sarcoma. She was treated with neoadjuvant chemotherapy and disarticulation above the metatarsophalangeal joint. She received adjuvant chemotherapy following the operation. The patient died 50 months after the operation as a result of disseminated disease. CONCLUSION: The distal phalanx of the foot is an extremely rare site for the development of Ewing's sarcoma. As local control is important to avoid dissemination of the disease, neoadjuvant chemotherapy followed by amputation or disarticulation of the affected digit and subsequently adjuvant chemotherapy may be favorable modality for increasing the patient's duration of survival. Hippokratia 2015, 19 (1): 82-84.

Comparison of propofol-remifentanil and propofol-ketamine combination for dilatation and currettage: a randomized double blind prospective trial.

OBJECTIVE: The purpose of this study was to compare the propofol-remifentanil combination and propofol-ketamine combination for Dilatation and Curettage (DC) procedure. PATIENTS AND METHODS: This prospective, double blind, and randomized study comprised 81 female patients undergoing diagnostic DC. Patients were randomly allocated to one of two groups; propofol-remifentanil (Group PR, n= 44) or propofol-ketamine (Group PK, n= 37). The level of sedation was assessed with the Ramsay Sedation Score (RSS). The patients' RSS scores were maintained at 4-5 with an additional 0.5 mg/kg bolus dose of propofol. Heart rate (HR), mean blood pressure (MBP), peripheral oxygen saturation (SpO2), and RSS were recorded. The Modify Aldrete Score (MAS) was used for postoperative recovery evaluation, and the time to reach MAS score of 10 was recorded. Total dose of propofol, procedure time, side effects, and satisfaction scores of patient and surgeon were also recorded. RESULTS: The mean HR and MBP values of Group PR were lower than those of Group PK, at all recording times. Sedation levels were significantly higher in Group PK. The total dose of propofol consumed was significantly higher in Group PR. The recovery time of Group PK was significantly longer than that of Group PF (p<0.05). Nausea-vomiting and bradycardia were more frequent in the Group PR. There was no difference in patient and surgeon satisfaction between the two groups. CONCLUSIONS: Ketamine-propofol combination provides better hemodynamic stability and better quality of sedation than propofol-remifentanil combination. Ketamine still seems as an advantageous and safe drug for such procedure.

The relationship between consumption of animal products and expenditure levels with Quality of Life Scores (SF-36) by veterinary students in Turkey / [A relação entre o consumo de produtos de origem animal e níveis de gasto com Scores de Qualidade de Vida (SF-36) por alunos de veterinária na Turquia]

The present study aimed to calculate the quality of life scores (Short Form-36) of veterinary students in Turkey and review their scores with regards to different socio-demographic characteristics. A total of 1211 students studying veterinary medicine in 26 different faculties in Turkey were selected by stratified sampling method and were asked questions concerning their consumption of and expenditures on foods of animal origin using the SF-36 questionnaire between October and December 2018. Significant differences were found between SF-36 components in terms of year level, gender, accommodation status, income level, and level of expenditures on foods and foods of animal origin (P<0.01). With the increase in the size of the budget set aside for animal products, the scores in the domains of physical functioning, vitality, mental health, pain, and general health perception also enhanced, and statistically significant differences were found (P<0.01). The low quality of life scores of the veterinary students can be improved by increasing their income level and consumption of foods of animal origin. This will ensure that they are energetic and have the desired level of mental and general health perceptions.(AU)

O presente estudo teve como objetivo calcular os escores de qualidade de vida (SF-36) de estudantes de veterinária na Turquia e revisar seus escores no que diz respeito a diferentes características sociodemográficas. Um total de 1211 estudantes de medicina veterinária em 26 faculdades diferentes na Turquia foram selecionados pelo método de amostragem estratificada e foram questionadas sobre o consumo e as despesas com alimentos de origem animal usando o questionário SF-36 entre outubro e dezembro de 2018. Diferenças significativas foram encontradas entre os participantes do SF-36 em termos de nível do ano, gênero, status de acomodação, nível de renda e nível de gastos com alimentos e alimentos de origem animal (P <0,01). Com o aumento do orçamento reservado para produtos de origem animal, as pontuações nos domínios de funcionamento físico, vitalidade, saúde mental, dor e percepção geral de saúde também aumentaram e foram encontradas diferenças estatisticamente significativas (P <0,01). Os baixos índices de qualidade de vida dos veterinários podem ser melhorados, aumentando o nível de renda e o consumo de alimentos de origem animal. Isso garantirá mais energia e que tenham o nível desejado de percepção mental e geral de saúde.(AU)

Prevalence of coronary artery anomalies in patients undergoing coronary artery angiography: a review of 16768 patients. A retrospective, single-center study.

AIM: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this study was to report the prevalence of CAAs by investigating coronary artery angiography (CAG) images of patients admitted to the authors' hospital, a tertiary healthcare provider. METHODS: Images of 16,768 patients who underwent CAG in our hospital were evaluated regarding CAAs. RESULTS: CAAs were detected in 120 (0.7%) cases. Anomalous origin and course of arteries were observed in 86 (0.51%) cases. Seven of these cases were diagnosed with acute coronary syndrome and 5 of them were treated with angioplasty without any complication. Absence of LMCA was revealed as the most frequent anomaly in the subgroup analysis of origin and course anomalies by being spotted in 59 (49.9 %) cases of total 120. Myocardial bridge, which constituted all intrinsic coronary anomalies in our study, was determined in 18 (0.1%) patients. All of the anomalies of coronary termination were coronary artery fistulas which were seen in 16 (0.09%) of patients and 2 of them were occluded with coil. CONCLUSION: Absence of LMCA was the most frequently encountered anomaly. Although CAAs are rare cases, they can cause difficulties in CAG interventions and surgical operations. This study presents CAA frequencies of patients who performed CAG.

Music effects on event-related potentials of humans on the basis of cultural environment.

Auditory oddball responses were recorded from Turkish subjects in a silent environment or superimposed on white noise, or music played with violoncello or a similar music played with ney, a reed flute frequently listened by the Turkish population. P3 amplitudes with ney music in the background were significantly larger than both the white noise and violoncello backgrounds. The topography of the P3 response changed significantly between the ney and silent background conditions, indicating a relatively higher participation of frontal areas during hearing ney. Our results showed that hearing music of a familiar style increases the allocation of attentional resources during memory updating processes which is supposed to determine the P3 amplitude, and therefore showed the effects of cultural environment on the cognitive processes.

Contrast sonography for inconclusive findings on routine sonography.

OBJECTIVES: We conducted a pilot study in 20 women with sonographically suspect endometria, to assess the value of contrast sonography and patient acceptance of this procedure. METHODS: Saline solution 4-20 ml was injected into the uterine cavity using an embryo transfer catheter, followed by hysteroscopy in 19 cases and hysterectomy in one case. RESULTS: A polyp was diagnosed in 12 patients, a submucous myoma in one patient, a proliferated endometrium in five patients and a placental polyp in one patient. A sonographic irregular structure was diagnosed in one patient which turned out to be coagula on hysteroscopy and histology. The procedure was well accepted by all patients. The diagnosis found by contrast sonography agreed in all cases with that found by hysteroscopy. CONCLUSION: Our results show that contrast sonography is an easy, quick and inexpensive procedure which increases the diagnostic value of vaginal sonography. The indications for contrast sonography are based on inconclusive sonographic findings, especially if polyps or submucous myoma are suspected.

Malignancy arising in extraovarian endometriosis during estrogen stimulation.

OBJECTIVE: Endometriosis can undergo estrogen-dependent changes similar to endometrium and may carry a risk of developing hyperplasia and carcinoma during unopposed estrogen stimulation. MATERIAL-METHOD: We reviewed the existing literature to analyze the potential of a malignancy arising from extraovarian endometriosis by estrogen stimulation. RESULTS: To our knowledge, there are 20 published cases so far, with a malign transformed endometriosis during estrogen stimulation at an extraovarian site. The most common site of malignancy arising from endometriosis was the vagina (n = 5). The most common histological finding was adenocarcinoma (n = 13). The incidence of malignant transformation in extraovarian endometriosis during unopposed estrogen replacement can not be estimated based upon these case reports. CONCLUSION: Unopposed estrogen stimulation may lead to premalignant or malignant transformation in the residual foci of endometriosis. Therefore, the addition of progestins to estrogen replacement therapy should be considered in women who have undergone hysterectomy with oophorectomy because of endometriosis, especially if they are known to have residual endometriosis.

Outcome of pregnancies after non-amniocentesis-induced premature rupture of membranes at 14 to 23 weeks' gestation.

OBJECTIVE: To evaluate the outcome of singleton pregnancies after non-amniocentesis-induced premature rupture of membranes (PROM) at 14 to 23 weeks' gestation. STUDY DESIGN: We reviewed the hospital records of 53 consecutive pregnant women with PROM at 14 to 23 weeks' gestation at our institution from 1991 to 1996; the pregnancies were not associated with amniocentesis or multiple gestation. RESULTS: The median interval between PROM and delivery was 1 day (range 0-90; mean 5.2 days). Fifty-two (98%) of the 53 neonates were stillborn or died within 4 days. One neonate (2%), a 720-gram male delivered vaginally at 23 weeks' gestation, survived. The infant had Apgar scores of 6 at 1 minute and 2 at 5 minutes, and showed normal physical and neurological development at age 5 months. CONCLUSION: The outcome of pregnancies with non-amniocentesis-induced PROM at 14 to 23 weeks' gestation is almost uniformly poor.

Spontaneous vaginal delivery in the birth-chair versus in the conventional dorsal position: a matched controlled comparison.

AIM: The aim of the study was to assess the effect of a birth-chair on obstetric outcome. PATIENTS AND METHODS: We reviewed the hospital records of 220 consecutive pregnant women who gave birth on a birth-chair at our institution. The control group consisted of 440 pregnant women who preceded and followed the index cases and who had spontaneous vaginal deliveries in the conventional dorsal supine position. The controls were matched for parity and for the attending mid-wife. RESULTS: Patients who delivered in the birth-chair had significantly lower rates of episiotomy and manual separation of the placenta. The umbilical blood cord pH was significantly higher in neonates of the birth-chair group. The duration of labour, rate of perineal and vaginal injury, Apgar scores and rate of admission to a neonatal intermediate care unit were not influenced by the mode of delivery. CONCLUSION: Our data support previous studies that a birth-chair delivery may be a safe alternative to conventional delivery in the supine position.

A study on enzyme activities of some sphingolipidoses.

Enzyme activities were determined in fibroblast cell cultures of eight patients suspected of having a type of sphingolipidosis. The patients were 0 to 4 years of age; four were female and four were male. Thirteen age-matched controls were also included in the study. In one of the cases, hexosaminidase A activity was found to be 0% (43-82%), while in two other cases beta-galactosidase activity was found to be 5 nmol/h/mg protein (100-1035 nmol/h/mg protein) and arylsulfatase activity was found to be 12 nmol/h/mg protein (106-990 nmol/h/mg protein), respectively. Two more enzymes, alpha-galactosidase (11-39 nmol/h/mg protein) and cerebroside beta-galactosidase (3.7-6.9 nmol/h/mg protein), were also evaluated but were found to be in the normal ranges in these patients. Therefore, these patients were considered to have Tay-Sachs disease, GM1 gangliosidosis and metachromatic leukodystrophy, respectively. The remaining five patients were normal in respect to the five enzyme activities determined. For the prenatal diagnosis of metachromatic leukodystrophy, arylsulfatase A activity was determined in one amniotic cell culture. The activity found in this case was lower than normal (34 nmol/h/mg protein versus 387 nmol/h/mg protein found in three control amniotic cell cultures.

Pregnancies in patients with premature ovarian failure.

We present 5 women with premature ovarian failure (POF) who were treated with different regimes and conceived. Three patients conceived spontaneously while on cyclic estrogen/progestagen replacement therapy. One patient conceived after high-dose gonadotrophin treatment. Embryo transfer with oocytes donated from a third party donor was performed in one patient abroad. Due to legal reasons the heterogeneous oocyte donation for patients with POF cannot be performed in some countries such as Austria. Therefore, many patients who desire pregnancy cannot receive optimal treatment for their condition.