Evaluación del valor predictivo negativo de la resonancia magnética multiparamétrica de próstata al combinar su puntuación con parámetros del antígeno prostático específico en pacientes con PSA en zona gris / The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients

Objetivo Calcular el valor predictivo negativo (VPN) de la resonancia magnética multiparamétrica (RMmp) de próstata negativa, definida como la ausencia de lesiones en las imágenes, cuando se combina con la densidad del PSA (DPSA) y el índice PSA libre/total (PSA l/t) en pacientes cuyo PSA se encuentra en la zona gris (4-10mg/ml). Métodos Se analizaron 191 pacientes con niveles de PSA entre 4 y 10mg/ml y RMmp negativa. El VPN de la RMmp negativa se calculó de acuerdo con un nivel de DPSA<0,15ng/ml/ml, un índice PSA l/t>0,15 y una combinación de ambos. Los pacientes se dividieron en 3 grupos de riesgo según estos dos parámetros, de la siguiente manera: • DPSA 0,01-0,07ng/ml/ml e índice PSA l/t≥25 en el grupo de bajo riesgo. • DPSA 0,08-0,15ng/ml/ml e índice PSA l/t 0,15-0,24 en el grupo de riesgo intermedio. • DPSA>0,15ng/ml/ml e índice PSA l/t<15 en el grupo de riesgo alto. Resultados El VPN de la RMmp negativa fue del 92,6% para el carcinoma de próstata clínicamente significativo (CPCS). El VPN aumentó al 97,5% en el grupo de riesgo bajo, y disminuyó al 33,3% en el de riesgo alto. El resultado al combinar la RMmp negativa con la DPSA<0,15ng/ml/ml fue muy similar al de su combinación con el PSA l/t>15. Conclusión el índice PSA l/t también podría utilizarse para aumentar el VPN de la RMmp, al igual que la DPSA. No recomendamos evitar la biopsia de próstata con una DPSA>0,15ng/ml/ml y un índice PSA l/t<0,15. Sin embargo, se requieren estudios controlados aleatorizados con más pacientes para confirmar los hallazgos de nuestro estudio. (AU)

Objective To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. Methods One hundred ninety-one patients with PSA levels between 4-10mg/ml and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/ml/ml, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters: • PSAD 0.01-0.07 ng/ml/ml and f/t PSA ratio ≥25 in a low-risk group. • PSAD 0.08-0.15 ng/ml/ml, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group. • PSAD>0.15 ng/ml/ml and f/t PSA ratio <15 in high-risk group, Results NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD <0.15 ng/ml/ml and f/t PSA>15. Conclusion f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/ml/ml and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study. (AU)

The effect of the combination of prostate-specific antigen derivatives with multiparametric prostate magnetic resonance imaging scores on the negative predictive value of it in grey zone patients.

OBJECTIVE: To calculate the negative predictive value (NPV) of negative multiparametric prostate magnetic resonance imaging (mpMRI), accepted as no lesions on images, when combined with prostate-specific antigen density (PSAD) and free/total prostate-specific antigen ratio (f/t PSA) in grey zone patients. METHODS: 191 patients with PSA levels between 4-10 mg/mL and negative mpMRI were analyzed. The NPV of negative mpMRI was calculated according to a PSAD level of <0.15 ng/mL/mL, f/t PSA ratio of >0.15, and a combination of both. Patients were divided into three risk groups according to these two parameters, which were PSAD 0.01-0.07 ng/mL/mL and f/t PSA ratio ≥25 in a low-risk group, PSAD 0.08-0.15 ng/mL/mL, and f/t PSA ratio 0.15-0.24 in an intermediate-risk group and high-risk group, in which PSAD > 0.15 ng/mL/mL and f/t PSA ratio <15. RESULTS: NPV of negative mpMRI was 92.6% for clinically significant prostate carcinoma (CSPCa). It increased to 97.5% in a low-risk group and decreased to 33.3% for CSPCa in a high-risk group. NPV of negative mpMRI results were so close when combined with PSAD < 0.15 ng/mL/mL and f/t PSA > 15. CONCLUSION: f/t PSA ratio might also be used to increase the NPV of mpMRI, like PSAD. We advise not to avoid prostate biopsy when PSAD is >0.15 ng/mL/mL and the f/t PSA ratio is <0.15. However, we need randomized controlled studies with more patients to confirm our study.

The comparison of del nido cardioplegia and crystalloid-based blood cardioplegia in adult isolated coronary bypass surgery: A randomized controlled trial.

Background and Aim: In our study, patients who underwent isolated coronary artery bypass surgery (CABG) using Del Nido cardioplegia (DNC) and crystalloid-based cold blood cardioplegia (CBC) were compared. Subject and Methods: In this study, two groups of patients who underwent isolated CABG using DNC (n = 106) and CBC (n = 107) were prospectively randomized. Groups were compared in terms of many results such as troponin T, returning spontaneous rhythm, and cardioplegia volume. Results and Conclusions: Median troponin T levels of the DNC and CBC groups were compared for the 0th hour (baseline), 12th, 36th, and 60th hours. There was no statistical difference between groups in troponin T levels of the baseline 0th hour (18[33] vs. 22[27] pg/ml; P = 0.724). Troponin T levels at the 12th hour were less in the DNC group than the CBC group but no statistical difference between the groups (790[735] vs. 826[820] pg/ml; P = 0.068), respectively. Troponin T levels at 36th and 60th hours were higher in the CBC group compared to the DNC group, and a statistical difference was observed (580[546] vs. 650[550] pg/ml; P = 0.030) and (359[395] vs. 421[400] pg/ml; P = 0.020), respectively. After X-clamping, the spontaneous rhythm rate was statistically higher in the DNC group than the CBC group (72.60% vs. 37.40%; P < 0.001). There was no statistical difference between the groups in terms of postoperative arrhythmia, hospital stay, and mortality rates (P > 0.05). Based on data we acquired from the study, we think that DNC is at least as safe and effective as CBC in adult CABG cases.

Are calculated ratios and red blood cell and platelet distribution width really important for the laryngeal cancer and precancerous larynx lesions.

INTRODUCTION: In this research, it is planned to investigate the differences in neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, reticulocyte distribution width, and platelet distribution width values of groups of benign laryngeal lesion, precancerous laryngeal lesion, and laryngeal squamous cell carcinoma and among patients with different stages of tumors in laryngeal carcinoma and precancerous laryngeal lesion groups, and whether these values carry a prognostic features. MATERIALS AND METHODS: The investigated parameters determined from preoperative blood samples of patients have been compared among the groups and in the subgroups according to severity of illness in laryngeal carcinoma and precancerous laryngeal lesion groups. Also, the laryngeal carcinoma and precancerous laryngeal lesion groups were divided into two subgroups as good and poor prognosis and were compared with patients having good prognosis requiring no additional treatment during the follow-up, and the statistical significance of the differences was examined. RESULTS: On comparison, statistically significant differences were only observed between the gross larynx carcinoma group and other lesions. Apart from that, when the values were evaluated in terms of prognosis, no significant statistical results were found in any of the values. CONCLUSION: Despite the significant statistical results seen in the gross tumors, it is known that there are more objective methods for identifying those lesions in clinical use. We conclude that caution should be exercised when using these new hematological parameters, which can be affected by many factors.

Comparison of clinical outcomes of three different packing materials in the treatment of severe acute otitis externa.

OBJECTIVE: To analyse the clinical outcomes of biodegradable synthetic polyurethane foam versus ribbon gauze and ear wick in the treatment of severe acute otitis externa. METHODS: Ninety-two adults with severe acute otitis externa were randomly assigned to groups receiving ear wick (n = 28), ribbon gauze (n = 34) or biodegradable synthetic polyurethane foam (n = 30). Clinical efficacy, in terms of otalgia, oedema, erythema and tenderness of the external auditory canal, was assessed before packing was applied and at follow up on the 3rd and 7th days of presentation. RESULTS: All packing materials were associated with improved otalgia and oedema on the 3rd day; however, there were significant differences between biodegradable synthetic polyurethane foam and the other packing materials, and there was no significant reduction in tenderness in the biodegradable synthetic polyurethane foam group on the 3rd day. In the ribbon gauze and ear wick groups, improvements in all clinical efficacy scores were statistically significant for all pairwise comparisons. CONCLUSION: The three packing materials were all quite effective in treating severe acute otitis externa, but ear wick and ribbon gauze were superior to biodegradable synthetic polyurethane foam for relieving signs and symptoms, especially on the 3rd day.

Does septoplasty change the dimensions of compensatory hypertrophy of the middle turbinate?

OBJECTIVE: To measure the dimensions of compensatory hypertrophy of the middle turbinate in patients with nasal septal deviation, before and after septoplasty. METHODS: The mucosal and bony structures of the middle turbinate and the angle of the septum were measured using radiological analysis before septoplasty and at least one year after septoplasty. All pre- and post-operative measurements of the middle turbinate were compared using the paired sample t-test and Wilcoxon rank sum test. RESULTS: The dimensions of bony and mucosal components of the middle turbinate on concave and convex sides of the septum were not significantly changed by septoplasty. There was a significant negative correlation after septoplasty between the angle of the septum and the middle turbinate total area on the deviated side (p = 0.033). CONCLUSION: The present study findings suggest that compensatory hypertrophy of the middle turbinate is not affected by septoplasty, even after one year.

Successful desensitization to vitamin D in a patient with vitamin D deficiency

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An unusual cause of generalised seizure following cardiac surgery: with bolus cefazolin administration.

Although some of the aetiological factors of seizure, such as cerebral microemboli, cerebral oedema, hypoperfusion, cerebral hypoxia and metabolic encephalopathy cannot be completely controlled during cardiac surgery, cautious management of all steps in the procedure may prevent the administrative causes of seizure. Cefazolin, which is known to be a proconvulsant agent, may be a suspected agent of seizure complications in patients with renal insufficiency. Surprisingly, intravenous bolus administration of cefazolin may also trigger seizure in patients with normal renal function. In this case report, a complication of generalised seizure after cardiac surgery with intravenous bolus administration of cefazolin is described, along with a brief review of the literature.

Complications of arteriovenous fistula with polytetraflouroethylen grafts in hemodialysis patients.

PURPOSE: Vessels with high venous flow rate are needed for the application of hemodialysis in patients needing chronic hemodialysis. The increase in the number of chronic hemodialysis patients has led to an increase in the number of vascular surgical operations. The aim of this study was to evaluate the results of polytetraflouroethylen (PTFE) graft arteriovenous fistula (AVF) applications. MATERIALS AND METHODS: Files of 596 patients who received hemodialysis treatment at the Nephrology Unit of the Sanliurfa Mehmet Akif Inan State Hospital between September 2009 and 2013 were retrospectively analyzed. PTFE grafts and autogenous AVFs applied in 22 patients were analyzed, and demographic data and PTFE graft associated complications of these patients were evaluated. RESULTS: We found that the graft patency duration (months ± standard deviation) and the patency after graft revision were 16 ± 13 and 83.3%. Complications were detected in 14 patients (63%). One patient developed hematoma in early stages. CONCLUSIONS: We conclude that even if PFTE graft AVF applications cause significant complications, the procedure has a high patency rate after graft revision.

Chemical effect on the K shell x-ray fluorescence parameters of some Ce compounds.

Chemical effects on the Kß/Kα x-ray intensity ratios, fluorescence yields wK and vacancy transfer probabilities ηKL for some Ce compounds were investigated. In this study, the samples were excited by 59.54 keV γ-rays from a 5Ci (241)Am annular radioactive source. K x-rays emitted by samples were counted by an HPGe detector with a resolution of 182 eV at 5.9 keV. The experimental values were compared with the theoretical and other experimental values. The aim of these measurements was to characterize the dependence of the line position and line width with the chemical environment changes.

Prevalence and some psychosocial characteristics of social anxiety disorder in an urban population of Turkish children and adolescents.

PURPOSE: To define the prevalence and some of the psychosocial characteristics of social anxiety disorder (SAD) in an urban population of Turkish children and adolescents. SUBJECTS AND METHODS: This was a two-stage cross-sectional urban-based study conducted in Fatih, Istanbul, Turkey. The initial sample included 1,482 students between the 4th and 8th grades. The first stage involved screening using the Social Anxiety Scale for Children-Revised (SASC-R) and the Capa Social Phobia Scale for Children and Adolescents (CSPSCA). According to the test results, 324 children were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) in the second stage. RESULTS: The SAD prevalence rate was 3.9%. According to the multiple regression analysis, low paternal education and trait anxiety were associated with SASC-R scores, whereas female gender and trait anxiety were associated with CSPSCA scores. According to logistic regression analysis, the anxiety subscale of the self-concept scale and trait anxiety were associated with SAD. CONCLUSION: SAD is a relatively common disorder that is associated with lower self-concept in children and adolescents. Low paternal education, trait anxiety, and low self-concept may be the intervention targets for SAD prevention and treatment.

Psychological consequences of bullying for hospital and aged care nurses.

AIM: This study examines the psychological consequences of workplace bullying by negative affectivity (NA) and demographics for hospital and aged care nurses. INTRODUCTION/BACKGROUND: Nurses are particularly vulnerable to workplace bullying, with suggestions that oppressed group behaviours may play a role. Bullying is a potent stressor that can negatively impact psychological well-being, which, with NA and demographics, may be important in understanding the consequences of nurse bullying. Such factors are yet to be examined together across different nursing contexts. METHODS: A cross-sectional survey was conducted across hospital and aged care nurses working within a medium to large Australian healthcare organization in October 2009. The sample comprised 233 (29.1%) hospital and 208 (43.8%) aged care nurses. Analyses of covariance were used to evaluate the data. RESULTS: For hospital nurses, psychological distress was noted as an impact of bullying, while depression was the impact for aged care nurses. Full-time aged care nurses reporting bullying had higher psychological distress scores, compared with part-time workers in the same area. NA was a significant covariate across both outcomes in both contexts. DISCUSSION/CONCLUSION: This study demonstrates that bullying has detrimental consequences for the mental health of nurses in both hospital and aged care contexts. The results support the suggestion that nurses are an oppressed group at high risk of bullying, confirm the intrinsic nature of NA to the bullying process, and highlight the importance of employment type for aged care nurses. Given the shortage of nurses, managers need to give higher priority to addressing workplace bullying and implementing zero tolerance policies.

Determination of K-L total vacancy transfer probabilities using a weak gamma source in 2π geometrical configuration.

The K shell intensity ratios K(ß)/K(α) for 9 elements in the atomic range 40 ≤ Z ≤ 50 have been determined using a weak (133)Ba gamma source at excitation energy of 80.997 keV. The K-L total vacancy transfer probabilities (η(KL)) for these elements have been determined. K x-rays emitted by samples were detected using a CdTe semiconductor detector (resolution <1.2 keV for the (57)Co gamma ray at 122 keV) with a 2π solid angle. The measured values were compared with the theoretical values calculated using Scofield's tables based on the Hartree-Slater and Hartree-Fock theories and available experimental values.

Studies on mass attenuation coefficient, effective atomic number and electron density of some vitamins.

Mass attenuation coefficient, µm, atomic cross-section, σi, electronic cross-section, σe, effective atomic number, Zeff and effective electron density, Nel, were determined experimentally and theoretically for some vitamins (retinol, beta-carotene, thiamine, riboflavin, niacinamide, pantothenic acid, pyridoxine, biotin, folic acid, cyanocobalamin, ascorbic acid, cholecalciferol, alpha-tocopherol, ketamine, hesperidin) at 30.82, 59.54, 80.99, 356.61, 661.66 and 1,408.01 keV photon energies using a NaI(Tl) scintillation detector. The theoretical mass attenuation coefficients were estimated using mixture rules. The calculated values were compared with the experimental values for all vitamins.

A new concept in the treatment of extravasation injury: controlled drug delivery systems.

PURPOSE: To investigate the effectiveness of the intralesionally injected controlled granulocyte-monocyte colony stimulating factor (GM-CSF) releasing system in widening refractory extravasation wounds. METHODS: The determination of in vitro GM-CSF release from chitosan gel was the first, and in vivo effect of the molecule was the second step of the study. Thirty-five Wistar-Albino rats were randomly divided into 5 groups: 1) control group (adriamycin group) (n=7); 2) adriamycin+normal saline group (n=7); 3) adriamycin+chitosan group (n=7); 4) adriamycin+1 µg/mL GM-CSF-loaded chitosan group (n=7); and 5) adriamycin+10 µg/mL GM-CSF loaded chitosan group (n=7). The wound area was measured macroscopically and histological examination was carried out for wound healing and tissue response to the polymer. RESULTS: The best healing process was observed with the controlled released GM-CSF groups (groups 4 and 5). The 1 µg/mL GM-CSF loaded group showed superior wound healing than that of 10 µg/mL GM-CSF loaded gels. This result was correlated with the in vitro study which also showed increased drug release in the 1 µg/mL GM-CSF loaded group than the 10 µg/mL GMC-SF loaded gels. CONCLUSION: This study suggests that GM-CSF, applied with controlled drug delivery system, can supply dynamic treatment options with long-lasting activity in single-dose administration.

Determination of photon attenuation coefficient, porosity and field capacity of soil by gamma-ray transmission for 60, 356 and 662 keV gamma rays.

Gamma-ray transmission methods have been used accurately for the study of the properties of soil in the agricultural purposes. In this study, photon attenuation coefficient, porosity and field capacity of soil are determined by using gamma-ray transmission method. To this end, the soil sample was collected from Erzurum and a 2 x 2 in NaI (Tl) scintillation detector measured the attenuation of strongly collimated monoenergetic gamma beam through soil sample. The radioactive sources used in the experiment were (241)Am, (133)Ba and (137)Cs. The mass attenuation coefficients of dry soil samples were calculated from the transmission measurements. The soil samples were irrigated by adding known quantities of water and the soil-water properties were examined. It was observed that gamma-ray transmission method for determination of the soil parameters has advantages such as practical, inexpensive, non-destructive and fast analysis.

Nm23 expression in node-positive and node-negative endometrial cancer.

OBJECTIVE: To examine the relationships between the expression of protein Nm23 and surgical stage, histologic grade, histopathologic findings, and survival in women with endometrial carcinoma. METHODS: 19 patients with lymph node involvement were matched with 24 patients without lymph node involvement and the best paraffin-embedded blocks were selected for Nm23 immunohistochemical staining. The slides were evaluated semiquantitatively according to their degree of cytoplasmic staining. Statistical analysis was performed to determine whether there was a relationship between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, lymph node metastasis, and/or lymphovascular space involvement. Survival analysis was also performed. RESULTS: Slides from 15 patients (79%) with lymph node involvement and 22 patients (88%) without lymph node involvement were found to be positive for Nm23 (P=0.01). No significant relations were observed between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, or lymphovascular space involvement. Nm23 expression was found to be significantly related to lower rates of lymph node metastasis and longer survival (P=0.02). CONCLUSION: Elevated Nm23 expression is related to lower rates of lymph node metastasis and longer survival.

Microsatellite instability and methylation of the DNA mismatch repair genes in head and neck cancer.

BACKGROUND: Methylation in the promoter region of the DNA mismatch repair genes hMLH1 and hMSH2 and microsatellite instability at three loci were analyzed in the tumor tissue from patients with head and neck cancer. METHODS: Microsatellite instability and promoter methylation were investigated by PCR, denaturing-polyacrylamide gel electrophoresis and digestion with methylation-specific restriction enzymes. RESULTS: Microsatellite instability was observed in 41% of the patients. hMLH1 and hMSH2 genes were methylated in 47% and 30% of the patients, respectively. BAT25 and BAT26 instability were associated with age and histopathology, respectively. Methylation frequency of the hMLH1 gene promoter was significantly higher in patients displaying a high level of microsatellite instability. Instability at the BAT 26 and D2S123 loci were associated with the MSI-high status. CONCLUSIONS: Our results indicate that microsatellite instability and modifications in the hMLH1 and hMSH2 genes are implicated in a significant proportion of the patients with head and neck cancer.