The triglyceride-glucose index as a predictive marker for coronary slow flow phenomenon.

OBJECTIVE: The triglyceride-glucose index (TyG) has been proposed as a marker of insulin resistance (IR) and has shown associations with cardiovascular diseases. This study aimed to investigate the relationship between the TyG and the coronary slow flow phenomenon (CSFP) and explore the index's potential as a predictor of this condition. PATIENTS AND METHODS: A total of 187 patients who underwent coronary angiography were included; of these, 91 patients were diagnosed with CSFP, and 96 patients with normal coronary flow served as a control group. The TyG was calculated using fasting triglyceride and glucose levels. RESULTS: The results showed that the TyG was significantly higher in the CSFP group compared with the control group (p < 0.001). Additionally, the TyG exhibited a moderate positive correlation with the thrombolysis-in-myocardial-infarction frame count in coronary arteries (p < 0.001). A multivariate logistic regression analysis revealed that the TyG, along with gender, ejection fraction, and uric acid, remained significant predictors of CSFP (p < 0.05). CONCLUSIONS: This study's findings suggest that the TyG may serve as a useful marker for identifying individuals at risk of CSFP and provide insights into the potential role of IR in its pathophysiology.

Validación externa de los sistemas de puntuación actuales y desarrollo de un nuevo sistema de puntuación para la predicción de la tasa libre de cálculos tras la cirugía intrarrenal retrógrada en pacientes con un diámetro acumulado del cálculo de 2-4 cm / External validation of the current scoring systems and development of a novel scoring system to predict stone-free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm

Objetivo Nuestro objetivo principal es realizar la validación externa de los sistemas de puntuación actuales para predecir el estado libre de cálculos (ELC) después de la cirugía intrarrenal retrógrada (CRIR) para cálculos renales de 2-4 cm y desarrollar un nuevo sistema de puntuación reexaminando los posibles factores predictivos relacionados con el ELC. Métodos Se evaluaron retrospectivamente los pacientes que recibieron CRIR para el tratamiento de cálculos renales con diámetro acumulado de 2-4 cm, entre enero de 2017 y marzo de 2021. Los cálculos residuales ≤ 2 mm se definieron como clínicamente insignificantes, y estos casos se consideraron como ELC. Se examinaron los posibles factores predictivos relacionados con el ELC mediante el análisis de regresión logística multivariante. Se elaboró un nomograma y se creó un sistema de puntuación utilizando variables predictivas independientes. Mediante el análisis ROC se evaluó la capacidad de predicción de los sistemas de puntuación actuales y del recién desarrollado. Resultados Los sistemas de puntuación existentes resultaron insuficientes para predecir el ELC (AUC < 0,660 en todos los casos). Se identificaron como predictores independientes del ELC el área de superficie (OR: 0,991, p < 0,001), la densidad (OR: 0,998, p < 0,001), el número (OR: 0,365, p = 0,033) y la localización de los cálculos (p = 0,037). Utilizando estos marcadores predictivos, se desarrolló un nuevo sistema de puntuación cuyos resultados oscilan entre 4 y 15. El valor AUC de este sistema de puntuación fue de 0,802 (0,734-0,870). Conclusión Los sistemas de puntuación RUSS, S-ReSC y RIRS y el nomograma de Ito no lograron predecir el ELC en cálculos de > 2 cm. Nuestro nuevo sistema de puntuación tuvo una capacidad predictiva del ELC mayor en cálculos de > 2 cm, en comparación con los otros sistemas de puntuación (AU)

Objective Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS. Methods Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤ 2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis. Results The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870). Conclusion The RUSS, S-ReSC and RIRS scoring systems and Ito's nomogram failed to predict SFS in stones > 2 cm. The SFS predictive ability of our new scoring system was higher in > 2 cm stones compared to the other scoring systems (AU)

External validation of the current scoring systems and derivation of a novel scoring system to predict stone free rates after retrograde intrarenal surgery in patients with cumulative stone diameter of 2-4 cm.

OBJECTIVE: Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS. METHODS: Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis. RESULTS: The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870). CONCLUSION: The RUSS, S-ReSC and R.I.R.S. scoring systems and Ito's nomogram failed to predict SFS in stones >2 cm. The SFS predictive ability of our new scoring system was higher in >2 cm stones compared to the other scoring systems.

High resolution TCSPC imaging of diffuse light with a one-dimensional SPAD array scanning system.

We report a time-correlated single-photon counting (TCSPC) imaging system based on a line-scanning architecture. The system benefits from the high fill-factor, active area, and large dimension of an advanced CMOS single-photon avalanche diode (SPAD) array line-sensor. A two-dimensional image is constructed using a moving mirror to scan the line-sensor field-of-view (FOV) across the target, to enable the efficient acquisition of a two-dimensional 0.26 Mpixel TCSPC image. We demonstrate the capabilities of the system for TCSPC imaging and locating objects obscured in scattering media - specifically to locate a series of discrete point sources of light along an optical fibre submerged in a highly scattering solution. We demonstrate that by selectively imaging using early arriving photons which have undergone less scattering than later arriving photons, our TCSPC imaging system is able to locate the position of discrete point sources of light than a non-time-resolved imaging system.

Development and validation of a nomogram for predicting the likelihood of metastasis in prostate cancer patients undergoing Ga-68 PSMA PET/CT due to biochemical recurrence.

OBJECTIVE: To develop a nomogram based on commonly used clinical data for predicting the likelihood of metastasis in gallium-68 prostate-specific membrane antigen PET/computed tomography (Ga-68 PSMA PET/CT) scans of prostate cancer patients with confirmed biochemical recurrence (BCR). METHODS: One-hundred thirty-five ( n = 135) patients who underwent Ga-68 PSMA PET/CT due to BCR were included in the study. Predictors of metastasis in Ga-68 PSMA PET/CT were determined with multivariable logistic regression analysis. Coefficients derived from the regression model were used to develop a prediction nomogram. The performance of the prediction model was evaluated with receiver operating characteristic analysis. Internal validation was performed with 50 bootstrap resamples, and the nomogram's clinical benefit was assessed with decision curve analysis. RESULTS: Multivariable logistic regression analysis revealed that ISUP group, prostate-specific antigen (PSA) before PET and PSA doubling time were independent predictors of metastasis in Ga-68 PSMA PET/CT. A prediction nomogram was developed according to this model [the area under curve: 0.866; 95% confidence interval (CI), 0.788-0.944]. The best cutoff value of the nomogram-derived likelihood for predicting metastasis was 60%, with a bootstrap-corrected accuracy of 78.8%. An online version of the nomogram was implemented on pro-gram.nzm.co ( https://pro-gram.nzm.co ). CONCLUSION: The proposed nomogram provides a practical approach for predicting the likelihood of imaging-based metastasis according to Ga-68 PSMA PET/CT in patients with BCR, with results ≥60% being the most accurate cutoff for referring patients to Ga-68 PSMA PET/CT. If validated in a larger cohort, this tool can serve as a guide for the appropriate use of Ga-68 PSMA PET/CT.

Metastatic Pancreatic Cancer Second-Line Treatment Options: Is the Difference Only in Cost?

INTRODUCTION: Although pancreatic cancer ranks seventh in cancer-related deaths, it is an extremely fatal disease, and more than 330,000 people die from this disease worldwide. Although there are many first-line treatment studies in the literature, there are almost no prospective studies regarding second-line therapy. Therefore, there is no standard approach in the second-line treatment of pancreatic cancer. We decided to conduct this study to investigate second-line treatments with problems such as cost, treatment efficacy, and toxicity. METHODS: Patients older than 18 years old who applied to Ege University Hospital medical oncology department with a diagnosis of metastatic pancreatic cancer, who received first-line chemotherapy due to their illness, and who had progressed afterwards were included in the study. The files of the patients who applied between 2013 and 2017 were examined. RESULTS: Our study's primary endpoint was progression-free survival, and it was found that the median progression-free survival was 3.2 months in the Xelox patients, 3.7 months in the gemcitabine-nab paclitaxel patients, and 3.5 months in the other regimens. When the secondary endpoint was evaluated, overall survival, the median overall survival was 5.9 months in the Xelox patients, 5.3 months in the gemcitabine-nab paclitaxel patients, and 4.8 months in the other regimens. CONCLUSION: As a result, second-line treatments were compared, and no statistically significant difference was found between them. For this reason, the side effects of previously used drugs and the side effects of new drugs to be used, as well as their costs, should be evaluated when choosing a treatment.

Tc-99m pyrophosphate scintigraphy for cardiac amyloidosis: concordance between planar and SPECT/CT imaging.

The imaging protocol and the optimal cut-off points for quantitative assessment of technetium-99m pyrophosphate (Tc-99m PYP) cardiac amyloidosis scintigraphy remain controversial. The aim of this study was to evaluate the concordance between planar and SPECT images, and to investigate the contribution of SPECT/CT to diagnostic precision. All patients referred to our department for Tc-99m PYP cardiac imaging between April 2019 and April 2022 were included in the study. Heart-to-contralateral lung (H/CL) ratios were calculated from anterior planar images at both 1- and 3 h, and visual grading was done in SPECT/CT images at both time points. A total of 141 patients were included in the study (median age 59 years, 54% female). There was a strong positive correlation between H/CL ratios calculated at 1- and 3 h (Pearson's ρ = 0.842, p < 0.001). The highest level of concordance between planar and SPECT/CT images was achieved at a H/CL cut-off point of 1.5 for 1-h images, and 1.4 for 3-h images. SPECT/CT imaging contributed to diagnostic precision in both 1- and 3-h images by reducing the rate of equivocal results from 83% (n = 117) to 25% (n = 35), and from 77% (n = 108) to 27% (n = 38), respectively. Our findings have three implications: (1) planar imaging at both 1- and 3 h could be redundant, (2) a lower H/CL cut-off point for 3-h planar images could improve concordance between planar and SPECT imaging, and (3) SPECT/CT in both 1- and 3 h could improve the diagnostic precision by offering markedly reduced equivocal results.

Demonstration of the protective effect of ghrelin in the livers of rats with cisplatin toxicity.

Despite the various and newly developed chemotherapeutic agents in recent years, cisplatin is still used very frequently as a chemotherapeutic agent, even though cisplatin has toxic effects on many organs. The aim of our study is to show whether ghrelin reduces the liver toxicity of cisplatin in the rat model. Twenty-eight male Sprague Dawley albino mature rats were chosen to be utilized in the study. Group 1 rats (n = 7) were taken as the control group, and no medication was given to them. Group 2 rats (n = 7) received 5 mg/kg/day cisplatin and 1 ml/kg/day of 0.9% NaCl, Group 3 rats (n = 7) received 5 mg/kg/day cisplatin and 10 ng/kg/day ghrelin, Group 4 rats (n = 7) received 5 mg/kg/day cisplatin and 20 ng/kg/day ghrelin for 3 days. Glutathione, malondialdehyde (MDA), superoxide dismutase (SOD), plasma alanine aminotransferase (ALT) levels, and liver biopsy results were measured in rats. It was determined that, especially in the high-dose group, the MDA, plasma ALT, and SOD levels increased less in the ghrelin group as compared to the cisplatin group, and the glutathione level decreased slightly with a low dose of ghrelin, while it increased with a higher dose. In histopathological examination, it was determined that the toxic effect of cisplatin on the liver was reduced with a low dose of ghrelin, and its histopathological appearance was similar to normal liver tissue when given a high dose of ghrelin. These findings show that ghrelin, especially in high doses, can be used to reduce the toxic effect of cisplatin.

Time-resolved spectral-domain optical coherence tomography with CMOS SPAD sensors.

We present a first spectral-domain optical coherence tomography (SD-OCT) system deploying a complementary metal-oxide-semiconductor (CMOS) single-photon avalanche diode (SPAD) based, time-resolved line sensor. The sensor with 1024 pixels achieves a sensitivity of 87 dB at an A-scan rate of 1 kHz using a supercontinuum laser source with a repetition rate of 20 MHz, 38 nm bandwidth, and 2 mW power at 850 nm centre wavelength. In the time-resolved mode of the sensor, the system combines low-coherence interferometry (LCI) and massively parallel time-resolved single-photon counting to control the detection of interference spectra on the single-photon level based on the time-of-arrival of photons. For proof of concept demonstration of the combined detection scheme we show the acquisition of time-resolved interference spectra and the reconstruction of OCT images from selected time bins. Then, we exemplify the temporal discrimination feature with 50 ps time resolution and 249 ps timing uncertainty by removing unwanted reflections from along the optical path at a 30 mm distance from the sample. The current limitations of the proposed technique in terms of sensor parameters are analysed and potential improvements are identified for advanced photonic applications.

Effect of fluid resuscitation on acute lung injury in a rat model of sepsis.

AIM: Sepsis is a systemic infection reaction and intravascular volume therapy plays a crucial role in it's treatment. Acute respiratory distress syndrome (ARDS) occurs in the lungs, the most affected organ. This study aimed to investigate the different effects of fluid therapy on ARDS caused by sepsis. METHOD: To form a sepsis model, cecal ligation and puncture (CLP) procedure were performed on 44 adult rats. Divided into six groups; normal, CLP group, those treated with 40 ml/kg 0.9 % NaCl, 3 % NaCl (hypertonic saline), Ringer Lactate and Hydroxyethyl starch. After 24 hours treatments, histopathological examination of the lungs were done, and the plasma levels of CRP, TNF-α and IL-6 and paO2 were measured. RESULTS: The scores of all histological parameters of the group treated with hypertonic saline were significantly lower than of the other groups (p < 0.001). Likewise, according to the arterial blood gas results, paO2 was significantly higher (p < 0.01) in the hypertonic saline group compared to the other groups, and paCO2 was significantly lower (p < 0.01). CRP, TNF-α and IL-6 levels of inflammatory markers were also significantly lower in hypertonic saline groups compared to other groups (p < 0.001). CONCLUSIONS: Our study shows that treatment with hypertonic saline reduces the progression of ARDS in sepsis (Tab. 3, Fig. 4, Ref. 49).

Gender and age differences in absolute and relative handgrip strength of the Turkish population aged 8-27 years.

We aimed to investigate the impact of anthropometric variables on absolute and relative hand grip strength (HGS) and associations among them in gender-specific age groups and also to evaluate normative HGS values adjusted to body mass index (BMI), fat free mass (FFM) and fat free mass index (FFMI) in healthy subjects as a function of age group and gender. A total of 567 volunteers (n=271 boys, 10.89±1.16 years, and n=296 girls, 10.86±1.07 years) participated in this study. Three consecutive trials for both hands were performed; the highest value was used as the HGS. There were no significant differences between genders in both anthropometric and strength values except FFM, FFMI and left-side grip strength (LSGS) in the 8-12 age group even though HGS values were normalized. FFM (r=0.80, r=0.86, p<0.01) and FFMI (r=0.57, r=0.76, p<0.01) had strong relationship with HGS in both females and males, respectively. The results of this study show that both age-dependent increases in HGS and gender differences are strongly associated with changes in FFM and FFMI. For this purpose, we suggest using FFM or FFMI-corrected HGS values to compare or constitute standard data as a guide for practitioners when interpreting grip strength measurements.

Time-resolved spectroscopy at 19,000 lines per second using a CMOS SPAD line array enables advanced biophotonics applications.

A SPAD-based line sensor fabricated in 130 nm CMOS technology capable of acquiring time-resolved fluorescence spectra (TRFS) in 8.3 milliseconds is presented. To the best of our knowledge, this is the fastest time correlated single photon counting (TCSPC) TRFS acquisition reported to date. The line sensor is an upgrade to our prior work and incorporates: i) parallelized interface from sensor to surrounding circuitry enabling high line rate to the PC (19,000 lines/s) and ii) novel time-gating architecture where detected photons in the OFF region are rejected digitally after the output stage of the SPAD. The time-gating architecture was chosen to avoid electrical transients on the SPAD high voltage supplies when gating is achieved by excess bias modulation. The time-gate has an adjustable location and time window width allowing the user to focus on time-events of interest. On-chip integrated center-of-mass (CMM) calculations provide efficient acquisition of photon arrivals and direct lifetime estimation of fluorescence decays. Furthermore, any of the SPC, TCSPC and on-chip CMM modes can be used in conjunction with the time-gating. The higher readout rate and versatile architecture greatly empower the user and will allow widespread applications across many techniques and disciplines. Here we focused on 3 examples of TRFS and time-gated Raman spectroscopy: i) kinetics of chlorophyll A fluorescence from an intact leaf; ii) kinetics of a thrombin biosensor FRET probe from quenched to fluorescence states; iii) ex vivo mouse lung tissue autofluorescence TRFS; iv) time-gated Raman spectroscopy of toluene at 3056 cm-1 peak. To the best of our knowledge, we detect spectrally for the first time the fast rise in fluorescence lifetime of chlorophyll A in a measurement over single fluorescent transient.

Retrospective analysis of patients with relapsed or refractory testicular nonseminous germ cell tumors treated with autologous stem cell transplantation.

BACKGROUND AND AIM: About 20-25% of the testicular germ cell tumors (TGCT) are relapsed or refractory after first line therapy and optimal treatment for this group is poorly defined. We aimed to analyze the efficacy and safety of autologous stem cell transplantation (ASCT) in this patient group.Material and. METHODS: 19 patients with 28 ASCT were retrospectively analyzed. All the patients were treated with BEP (Bleomycin, etoposide, cisplatin) as first line therapy and TIP(paclitexalifosfamide, cisplatin) was given as salvage chemotherapy. Stem cell collection was performed with TIP and granulocyte stimulating factor. ASCT was performed with carboplatin(700mg/m2) and etoposite(750mg /m 2). The results were provided as median(min-max). P<0.05 was accepted as statistical significant level. RESULTS: After ASCT, complete(CR) and partial remission (PR) rates were 47.3% and 31 .5% respectively. The median overall survival(OS) and progression free survival (PFS) were 18(0-37.4 months) and 7(0-15months) months respectively. Estimated 2-year OS was 47.4% and PFS was 35.3%. Grade 3/4 toxicities including diarrhea, mucositis, and toxic hepatitis were observed in 5 patients. Only one patient died due to complication of transplantation. CONCLUSION: Although the number of the patients in this study is limited, ASCT seems to be a safe and effective treatment modality in relapsed refractory non-seminomatousTGCT with an acceptable OS, PFS and mortality rates.

Prognostic scores in acute pancreatitis : A review.

Predicting the course of an attack of acute pancreatitis still represents a challenge for the physicians.Some early interventions such as endoscopic retrograde cholangiopancreatography and sphincterotomy, admission to the intensive care unit, enteral feeding, and prophylactic antibiotics have been proven to decrease morbidity and mortality in patients of high-risk groups. However, acute pancreatitis has a potential of morbidity and mortality, and therefore early diagnosis and objective assessment of severity of the disease is fundamental. To date, many different prognostic scores have been applied to the initial management of acute pancreatitis for the evaluation of the severity of disease. However, each of the scoring systems has advantages and disadvantages. In this paper, we tried to summarize the prognostic scoring systems and their performances in assessing severity and prognosis of acute pancreatitis. (Acta gastro-enterol. belg., 2016, 79, 337-347).

Assessment of periapical health, quality of root canal filling, and coronal restoration by using cone-beam computed tomography.

AIM: The purpose of this study is to use cone-beam computed tomography (CBCT) to describe the prevalence of apical health, the quality of root canal filling, and coronal restorations of endodontically treated teeth in the east Anatolian subpopulation of Turkey. MATERIALS AND METHODS: CBCT scans were taken from 748 patients attending for the 1st time to the clinic at the Oral Diagnosis and Radiology Department at Ataturk University's Faculty of Dentistry in Erzurum, Turkey. All images were analyzed by two research assistants who were trained using examples of CBCT images with and without the presence of periapical radiolucency. The two examiners assessed images from the experiment independently, and the readings were then compared. All data were entered on an MS Excel 2007 spreadsheet and SPSS software 15.0 which was used for statistical analysis. The Chi-square test was used to determine if a patient's periapical status was associated with the technical quality of root filling, coronal status, and to evaluate differences between tooth subgroups. RESULTS: In total, 147 teeth from 748 patients were found to have been treated endodontically. Sixty three teeth were found to have short root canal fillings, whereas 74 teeth had adequate root canal fillings, and the remaining 10 teeth had over extended root canal filling. A significant correlation was observed between the length of root filling and apical periodontitis (P = 0,023). Inadequately dense root canal filling was observed in 141 teeth, whereas adequately dense filling was found in only six teeth. There was a significant correlation between the density of root filling and apical periodontitis (P = 0.044). Coronal restoration was found in 90 teeth, but was not observed in all the three teeth. A crown was present in 54 teeth. There was a significant correlation between coronal restoration and apical periodontitis (P = 0.028). CONCLUSION: The results indicate that the quality of both the root filling and restoration were found to have impact on the periapical health of root-filled teeth.

Vitamin C suppresses lipopolysaccharide-induced procoagulant response of human monocyte-derived macrophages.

OBJECTIVE: Although vitamin C is a strong antioxidant, the epidemiologic evidence to support its role in lowering risk of cardiovascular disease is inconsistent. In order to define the role of vitamin C in vascular pathophysiology, we have investigated the effect of vitamin C on the tissue factor (TF) and Factor VII Activating Protease (FSAP) expression induced by lipopolysaccharide (LPS) in human monocyte-derived macrophages. MATERIALS AND METHODS: Vitamin C at clinically relevant doses was tested to its ability to influence the LPS- and reactive oxygen species (ROS) - generating system of xanthine/xanthine oxidase (X/XO) NF-kB activity in human monocyte-derived macrophages. RESULTS: Vitamin C-treatment prevents LPS- and ROS-induced DNA-binding activity of NF-kB in a concentration-dependent fashion. Vitamin C also inhibited the phosphorylation and proteolytic degradation of the inhibitor protein IkBa. In parallel to regulate NF-kB activity, vitamin C reduced the expression of TF and FSAP, genes known to be induced by bacterial LPS and triggered the extrinsic coagulation cascade and linked thrombosis with inflammation. CONCLUSIONS: Vitamin C alters pro-inflammatory and pro-coagulatory processes via inhibition of NF-kB activation and exerts beneficial antiatherogenic effects on human monocyte-derived macrophages in addition to its anti-oxidant properties.

Factors effecting influenza vaccination uptake among health care workers: a multi-center cross-sectional study.

BACKGROUND: The present study aimed to identify factors affecting vaccination against influenza among health professionals. METHODS: We used a multi-centre cross-sectional design to conduct an online self-administered questionnaire with physicians and nurses at state and foundation university hospitals in the south-east of Turkey, between 1 January 2015 and 1 February 2015. The five participating hospitals provided staff email address lists filtered for physicians and nurses. The questionnaire comprised multiple choice questions covering demographic data, knowledge sources, and Likert-type items on factors affecting vaccination against influenza. The target response rate was 20 %. RESULTS: In total, 642 (22 %) of 2870 health professionals (1220 physicians and 1650 nurses) responded to the questionnaire. Participants' mean age was 29.6 ± 9.2 years (range 17-62 years); 177 (28.2 %) were physicians and 448 (71.3 %) were nurses. The rate of regular vaccination was 9.2 % (15.2 % for physicians and 8.2 % for nurses). Increasing age, longer work duration in health services, being male, being a physician, working in an internal medicine department, having a chronic disease, and living with a person over 65 years old significantly increased vaccination compliance (p < 0.05). We found differences between vaccine compliant and non-compliant groups for expected benefit from vaccination, social influences, and personal efficacy (p < 0.05). Univariate analysis showed differences between the groups in perceptions of personal risks, side effects, and efficacy of the vaccine (p < 0.05). Multivariate analysis found that important factors influencing vaccination behavior were work place, colleagues' opinions, having a chronic disease, belief that vaccination was effective, and belief that flu can be prevented by natural ways. CONCLUSION: Numerous factors influence health professionals' decisions about influenza vaccination. Strategies to increase the ratio of vaccination among physicians and nurses should consider all of these factors to increase the likelihood of success.

Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation.

BACKGROUND: Fibre supplements are useful, but whether a plum-derived mixed fibre that contains both soluble and insoluble fibre improves constipation is unknown. AIM: To investigate the efficacy and tolerability of mixed soluble/insoluble fibre vs. psyllium in a randomized double-blind controlled trial. METHODS: Constipated patients (Rome III) received mixed fibre or psyllium, 5 g b.d., for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement/week above baseline for ≥2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and quality of life (QoL). RESULTS: Seventy-two subjects (mixed fibre = 40; psyllium = 32) were enrolled and two from psyllium group withdrew. The mean complete spontaneous bowel movement/week increased with both mixed fibre (P < 0.0001) and psyllium (P = 0.0002) without group difference. There were 30 (75%) responders with mixed fibre and 24 (75%) with psyllium (P = 0.9). Stool consistency increased (P = 0.04), straining (P = 0.006) and bloating scores decreased (P = 0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, P = 0.01) and felt that mixed fibre dissolved better (P = 0.02) compared to psyllium. QoL improved (P = 0.0125) with both treatments without group differences. CONCLUSIONS: Mixed fibre and psyllium were equally efficacious in improving constipation and QoL. Mixed fibre was more effective in relieving flatulence, bloating and dissolved better. Mixed fibre is effective and well tolerated.