Long-term outcomes of conventional core decompression for osteonecrosis of the femoral head in systemic lupus erythematosus: a single-center retrospective study.

OBJECTIVE: Although the therapeutic efficacy of conventional core decompression (CD) for the early-stage osteonecrosis (ON) has been widely investigated in the literature, no study to date has specifically focused on its therapeutic effect on the long-term outcome of ON of the femoral head (ONFH) in systemic lupus erythematosus (SLE). This study aimed to provide a long-term survival analysis of all hips that underwent conventional CD for the management of ONFH in a consecutive case series of patients with SLE. PATIENTS AND METHODS: Sixteen hips of 10 consecutive SLE patients that underwent conventional CD for the management of ONFH in a single tertiary referral center were retrospectively identified and included in the study. After a retrospective chart review, several clinical and radiological data were recorded. RESULTS: All the hips treated with CD were stage I or IIA sclerotic and/or cystic based on the classification system of Ficat. Only the 2 hips of 1 patient (12.5%) survived both clinically and radiographically. The median overall survival for all hips after CD was 80 months (95% CI, 60-100). The 5-, 10-, and 15- year survival rates of hip joints following CD were 63%, 31%, and 12.5%, respectively (CI 95% 63.567 to 133.058 months). CONCLUSIONS: Conventional CD may not be effective in preventing the progression of pre-collapse ONFH to collapse and eventually end-stage osteoarthritis requiring arthroplasty in patients with SLE.

Influence of visual information on consent for invasive procedures in intensive care unit.

OBJECTIVE: Patients hospitalized in Intensive Care Units (ICU) are critically ill. Sometimes informed consent for invasive procedures cannot be obtained from patients or relatives due to insufficient information. METHODOLOGY: Relatives of the patients who were being hospitalized in ICUs of state hospitals in 3 provinces in Eastern part of Turkey during year 2015, who were planned to undergo central venous catheter insertion, tracheostomy, and percutaneous gastroenterostomy (PGE) were asked to sign consent forms and these relatives were included in the study. The study groups were allocated as verbal (VeIG) and verbal-visual information groups (ViIG). The next of kin who had the right for signing was included in the study. RESULTS: Relatives of patients were interviewed for 512 invasive procedures. For the central venous catheterization, 91.6% of the VeIG (n = 166) and 97.6% of the ViIG (n = 166) accepted the central venous catheterization interventions (n = 332), for the tracheostomy, 65.3% of the VeIG (n = 49), 85.4% of the ViIG (n = 48) accepted the tracheostomy interventions (n = 97), and for the PGE, 23.8% of the VeIG (n = 42) and 48.8% of the ViIG (n = 41) accepted the PGE interventions (n = 83). A statistically significant difference was detected between VeIG and ViIG with regard to approval and refusal rates for different interventions. When approval-refusal rates were compared with regard to education level, statistically significant difference was not detected between VeIG and ViIG with regard to approval and refusal rates. CONCLUSIONS: Using visual materials such as video in addition to verbal information provided an improvement in consent ratios regardless of education levels.

Cloning and Overexpression of the als, pflA, and adhB Genes in Streptococcus thermophilus and Their Effects on Metabolite Formation.

Streptococcus thermophilus is a lactic acid bacterium and used as starter culture in the dairy industry, mainly in the manufacture of yoghurt, with Lactobacillus delbrueckii subsp. bulgaricus. It produces lactic acid as a major fermentation end product and some carbonyl compounds through sugar metabolism. The level of metabolites could be improved using molecular biotechnology. The genes of als, encoding α-acetolactate synthase (Als), the pflA, encoding pyruvate-formate lyase activating enzyme (PflA), and the adhB which encodes alcohol dehydrogenase (AdhB) of S. thermophilus NCFB2393 strain were amplified by polymerase chain reaction and separately cloned into the overexpression vector pNZ276 under the control of the lacA promoter. The strains were transformed individually with the constructed plasmids. Their abilities to generate important metabolites such as pyruvate, lactate, formate, acetaldehyde, acetoin, ethanol, and 2,3-butanediol in LM17 medium were analyzed using high-performance liquid chromatography. High level of 2,3-butanediol was obtained by overexpressing the als gene. The level of formate increased slightly by overexpressing the pflA gene. The overexpression of the adhB gene, on the other hand, resulted in a significant increase in the ethanol level.

Polysaccharidase and glycosidase production of avicel grown rumen fungus Orpinomyces sp. GMLF5.

Extracellular and cell-associated enzyme preparations were obtained from ruminal anaerobic fungi Orpinomyces sp. GMLF5 grown in culture containing microcrystalline cellulose (avicel) as sole energy source and degradation capacities of the preparations towards several polysaccharides and glycosides were studied. Fungus showed substantial increases in xylanase, carboxymethyl cellulase (CMCase), lichenase, amylase, beta-xylosidase, beta-glucosidase and alpha-L-arabinofuranosidase activities between 72 and 168 hours. High amounts of cell associated beta-xylosidase were noted in 4 and 5 days old cultures. Optimum temperature and pH of the polysaccharidases were found at 50 degrees C and 6.0-6.5, respectively. Xylanase was found to be virtually stable at 50 degrees C, CMCase and lichenase were stable at 40 degrees C for 200 min, however amylase was found more sensitive to heat treatment. The fibrolytic enzymes of the isolate GMLF5 were observed to be capable of hydrolyze the avicel.

Expression of fungal cellulase gene in Lactococcus lactis to construct novel recombinant silage inoculants.

The facultative anaerobic bacterium Lactococcus lactis has been used as a host for expression of a gene isolated from the anaerobic rumen fungus Neocallimastix sp. The coding region of the cellulase gene was obtained from the fungus with the aid of polymerase chain reaction amplification. The gene was then transformed into pCT vector system and the constructed recombinant plasmid was introduced into two L. lactis strains (IL403 and MG1363) by electroporation. The gene encoding the fungal originated cellulase was expressed in both strains successfully although the expression level was relatively lower in comparison with the original enzyme activity. Genetically modified L. lactis strains were used as silage inoculants for pre-biodegradation of the plant biomass during ensiling. That treatment resulted in a notable reduction of the acid detergent fiber (ADF) and neutral detergent fiber (NDF) contents of the plant biomass used as silage material. Inoculation with recombinant strain IL1043 resulted in 4.8 and 9.7 % decrease in NDF and ADF contents, respectively while the inoculation of silage with strain MG1363 decreased the ADF content by >5 %.

Extracorporeal magnetic innervation for the treatment of stress urinary incontinence: results of two-year follow-up.

INTRODUCTION: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up. RESULTS: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 +/- 10.7 to 6.5 +/- 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy. CONCLUSION: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

Acute bacterial meningitis after transrectal needle biopsy of the prostate: a case report.

Transrectal biopsy of the prostate (TBP) is the most accurate method of diagnosing prostate cancer. Although debate remains, prophylactic antibiotic therapy is most frequently used to prevent infectious complications after TBP. Here, we present a case of Escherichia coli meningitis after TBP despite quinolone prophylaxis.

Effect of long-term sitting on serum prostate-specific antigen levels.

OBJECTIVE: The aim of this study was to evaluate the effect of long-term sitting on serum prostate-specific antigen (PSA) levels. METHOD: The serum PSA levels of 50 bus drivers under the age of 45 (mean 37.7) years who worked at least 8 h a day for more than 3 weeks were compared with those of 50 healthy surgeons in similar age groups (mean 37.7 years) who spent most of their working time standing. RESULTS: There was no statistically significant difference between the mean PSA level of the study group (1.211 +/- 0.96 ng/ml) and that of the control group (1.214 +/- 0.74 ng/ml; p > 0.05). The PSA levels returned to normal after a 5-day resting period in cases who had higher values than the anticipated 2.5 ng/ml for this age group at the initial determination. CONCLUSIONS: These results suggest that there is no relationship between long-term sitting and serum PSA levels. A second PSA determination after a 5-day resting period may be helpful in cases with higher than normal initial values.

Isolation and overexpression of a gene encoding an extracellular beta-(1,3-1,4)-glucanase from Streptococcus bovis JB1.

Streptococcus bovis JB1 was found to produce a 25-kDa extracellular enzyme active against beta-(1,3-1,4)-glucans. A gene was isolated encoding a specific beta-(1,3-1,4)-glucanase that corresponds to this size and belongs to glycoside hydrolase family 16. A 4- to 10-fold increase in supernatant beta-glucanase activity was obtained when the cloned beta-glucanase gene was reintroduced into S. bovis JB1 by use of constructs based on the plasmid vector pTRW10 or pIL253. The beta-(1,3-1,4)-glucanase gene was also expressed upon introduction of the pTRW10 construct pTRWL1R into Lactococcus lactis IL2661 and Enterococcus faecalis JH2-SS, although extracellular activity was 8- to 50-fold lower than that in S. bovis JB1. The beta-(1,3-1,4)-glucanase purified from the culture supernatant of S. bovis JB1 carrying pTRWL1R showed a K(m) of 2.8 mg per ml and a Vmax of 338 mumol of glucose equivalents per min per mg of protein with barley beta-glucan as the substrate. The S. bovis beta-(1,3-1,4)-glucanase may contribute to the ability of this bacterium to utilize starch by degrading structural polysaccharides present in endosperm cell walls.

Penile fractures and our treatment policy.

To evaluate our diagnosis and treatment policy of penile fractures, we reviewed 13 cases treated between August 1992 and August 1995. In ten patients early surgical correction, in one patient an elective surgical intervention was carried out. Two patients with minimal haematoma were suggested to undergo conservative treatment, but only one of them came to the control examination and he complained of fixed induration, pain and mild deviation in erection. In the group of early surgical repair there was no complication. In a patient who had had a delayed procedure small induration and minimal deviation were found. In the light of these findings we think that in penile fractures early surgical repair produces the best results.