Age Estimation Using Machine Learning Algorithms with Parameters Obtained from X-ray Images of the Calcaneus.

BACKGROUND: Determination of bone age is a critical issue for forensics, surgery, and basic sciences. AIM: This study aims to estimate age with high accuracy and precision using Machine Learning (ML) algorithms with parameters obtained from calcaneus x-ray images of healthy individuals. METHOD: The study was carried out by retrospectively examining the foot X-ray images of 341 people aged 18-65 years. Maximum width of the calcaneus (MW), body width (BW), maximum length (MAXL), minimum length (MINL), facies articularis cuboidea height (FACH), maximum height (MAXH), and tuber calcanei width (TKW) parameters were measured from the images. The measurements were then grouped as 20-45 years of age, 46-64 years of age, 65 and older, and age estimation was made by using these at the input of ML models. RESULTS: As a result of the ML input of the measurements obtained, a 0.85 Accuracy (Acc) rate was obtained with the Extra Tree Classifier algorithm. The accuracy rate of other algorithms was found to vary between 0.78 and 0.82. The contribution of parameters to the overall result was evaluated by using the shapley additive explanations (SHAP) analyzer of Random Forest algorithm and the MAXH parameter was found to have the highest contribution in age estimation. CONCLUSIONS: As a result of our study, calcaneus bone was found to have high accuracy and precision in age estimations.

Sex prediction with morphometric measurements of first and fifth metatarsal and phalanx obtained from X-ray images by using machine learning algorithms.

BACKGROUND: The aim of this study is to predict sex with machine learning (ML) algorithms by making morphometric measurements on radiological images of the first and fifth metatarsal and phalanx bones. MATERIALS AND METHODS: In this study, radiologic images of 263 individuals (135 female, 128 male) between the ages of 27 and 60 were analysed retrospectively. The images in digital imaging and communications in medicine (DICOM) format were transferred to personal workstation Radiant DICOM Viewer programme. Length and width measurements of the first and fifth metatarsal and foot phalanx bones were performed on the transferred images. In addition, the ratios of the total length of the first proximal and distal phalanx and length of the first metatarsal and total length of fifth proximal, middle, and distal phalanx and maximum length of fifth metatarsal were calculated. RESULTS: As a result of machine learning algorithms, highest accuracy, specificity, sensitivity, and Matthews correlation coefficient values were found as 0.85, 0.86, 0.85, and 0.71, respectively with decision tree algorithm. It was found that accuracy rates of other algorithms varied between 0.74 and 0.83. CONCLUSIONS: As a result of our study, it was found that sex estimation was made with high accuracy rate by using machine learning algorithms on X-ray images of the first and fifth metatarsal and foot phalanx. We think that in cases when pelvis, cranium and long bones are harmed and examination is difficult, bones of the first and fifth metatarsal and foot phalanx can be used for sex estimation.

Outcome-based reimbursement in Central-Eastern Europe and Middle-East.

Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels.

The protective and therapeutic effects of linalool against doxorubicin-induced cardiotoxicity in Wistar albino rats.

The aim of the present study was to determine the protective and therapeutic effects of linalool (LIN) against doxorubicin (DOX)-induced cardiotoxicity in rats histologically and biochemically. In experiments, 64 male Wistar albino rats were randomly divided into eight groups ( n = 8). These groups were control (C) (0.9% saline solution), DOX (20 mg/kg DOX), LIN50 (50 mg/kg LIN), LIN100 (100 mg/kg LIN), DOX + LIN50 (20 mg/kg DOX and 50 mg/kg LIN), DOX + LIN100 (20 mg/kg DOX and 100 mg/kg LIN), LIN50 + DOX (50 mg/kg LIN and 20 mg/kg DOX), and LIN100 + DOX (100 mg/kg LIN and 20 mg/kg DOX). It was determined that necrosis and extensive inflammatory cell infiltration were observed in the DOX group. It was determined that histopathological changes significantly decreased in groups treated with LIN after DOX administration. While the caspase-3 immunostaining was highly evident in DOX group apoptotic cells ( p < 0.001, for all), the intensity of caspase-3 immunostaining in the treatment groups decreased ( p < 0.05). While DOX administration resulted in a significant increase in malondialdehyde (MDA) levels and plasma Creatine kinase (CK) and lactate dehydrogenase (LDH) levels in cardiac tissue when compared to the C groups, it was observed that DOX + LIN administration led to a significant decrease in MDA, plasma CK and LDH levels and a significant increase in glutathione (GSH), superoxide dismutase, and catalase enzyme levels. Finally, it was concluded that DOX led to heavy cardiotoxicity and DOX + LIN administration could remove cardiomyopathy symptoms.

Authorized Generic Drugs: an Overview.

In the United States (U.S.), an authorized generic (AG) drug is essentially the approved brand-name drug (i.e., innovator drug), but marketed with a different name. Like independent generics, authorized generics (AGs) generally tend to cost less than their brand name counterpart, even though AGs are essentially identical to the brand. Most patients and health professionals are unaware of the availability of AGs even though they are commonplace. The launch of an AG has a financial impact on patients and on the competitive landscape of the pharmaceutical industry. Information regarding AGs is limited. The purpose of this study is to familiarize the reader with AGs. A review of the government documents and literature was conducted. The marketing of AGs has resulted, but not always, in benefits to the patient. AGs have been used as a tool in agreements between brand and generic companies. Countries have differing allowance and approval policies for AGs. AGs have played an important role in the healthcare system.

Equivalence and regulatory approaches of nonbiological complex drug products across the United States, the European Union, and Turkey.

Regulatory agencies around the world may have different standards and approaches to evaluate and approve drug products and biological products. We describe the U.S. Food and Drug Administration's (FDA) Generic Drug User Fee Act program, as well as their approach to complex products. We discuss regulatory approaches for the development of nonbiological complex drug follow-ons and approval pathways in the United States. We compare FDA policies with other regulatory agencies (i.e., the European Medicines Agency and the Turkish Medicines and Medical Devices Agency). In particular, we describe the policies/pathways across these three agencies to assess equivalence of glatiramer acetate, enoxaparin sodium, and sodium ferric gluconate complex products. We also examine the Turkish market for these selected nonbiological complex drugs.

Saffron (its active constituent, crocin) supplementation attenuates lipid peroxidation and protects against tissue injury.

The aim of the current study was to investigate the outcomes in a rat model of an acute swimming exercise induced oxidative stress in brain, kidney, liver, skeletal and cardiac muscles using supplementation with crocin. Rats were divided into the eight groups; Normal Control (NC: Untreated and did not swim), Crocin Control (CC: Received crocin and did not swim), Exercise-1 (E-1: Untreated and swam), Exercise-24 (E-24: Untreated and swam), Exercise-48 (E-48: Untreated and swam), Exercise+Crocin-1 (EC-1: Received crocin and swam), Exercise+Crocin-24 (EC-24: Received crocin and swam), Exercise+Crocin-48 (EC-48: Received crocin and swam). The malondialdehyde (MDA) and xanthine oxidase (XO) enzymes levels increased after swimming in untreated and crocin treated groups, but there was a lower increase in crocin treated groups. The highest MDA levels in all tissues were observed in E-1 compared to all other groups. There were significant differences between control and exercise groups in MDA levels of tissues (p < 0.001). In contrast, there were significant differences between control and exercise groups in glutathione (GSH) levels of tissues.In addition, the crocin supplementation significantly increased GSH levels and decreased MDA and XO enzyme levels when compared to untreated exercise groups. Crocin can protect the tissues against exercise induced oxidative stress by enhancing antioxidant activity (Tab. 3, Fig. 1, Ref. 37).

Gastrointestinal Injuries in Blunt Abdominal Traumas.

AIM: To discuss the efficiency of RTS (Revised TraumaScore), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.Method and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. FINDINGS: Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intraabdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference.However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) CONCLUSION: Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both morbidity and mortality while low RTS is significantly related only to the mortality risk.

Protective effects of saffron (its active constituent, crocin) on nephropathy in streptozotocin-induced diabetic rats.

The reactive oxygen species take role in pathogenesis of many diseases including hypoxia, hypercholesterolemia, atherosclerosis, nephropathy, hypertension, ischemia-reperfusion damage, and heart defects. The aim of this study was to evaluate whether crocin administration could protect kidney injury from oxidative stress in streptozotocin-induced diabetic rats. The rats were randomly divided into 3 groups each containing 10 animals as follows: group 1, control group; group 2, diabetes mellitus (DM) group; and group 3, DM + crocin group. At the end of the study, trunk blood was collected to determine the plasma levels of blood urea nitrogen (BUN) and creatinine (Cr). The kidney tissue was removed, and biochemical and histological changes were examined. Diabetes caused a significant increase in malondialdehyde (MDA) and xanthine oxidase (XO) activities and a decrease in glutathione (GSH) contents (p < 0.01) when compared with control group in the rat kidneys. Crocin given to DM rats significantly decreased MDA (p < 0.01) and XO (p < 0.05) activities and elevated GSH (p < 0.05) contents when compared with DM group. Plasma levels of BUN and Cr were significantly higher in the DM group when compared with the control group (p < 0.01). Pretreatment of the DM animals with crocin decreased the high level of serum Cr and BUN. Control group was normal in histological appearance, but congestion, severe inflammation, tubular desquamation, tubular necrosis, and hydropic degeneration in tubular cells were observed in the DM group. Histopathological changes markedly reduced, and appearance of kidney was nearly similar to control group in DM + crocin group. Our results show that crocin could be beneficial in reducing diabetes-induced renal injury.

Determination of antioxidant activity of bioactive peptide fractions obtained from yogurt.

In this study, physicochemical and microbiological properties of traditional and commercial yogurt samples were determined during 4 wk of storage. Proteolytic activity, which occurs during the storage period of yogurt samples, was also determined. Peptide fractions obtained from yogurts were investigated and the effect of proteolysis on peptide release during storage was determined. The antioxidant activities of peptides released from yogurt water-soluble extracts (WSE) and from HPLC fractions were determined by 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) methods. The antioxidant activity of WSE from traditional yogurt was greater than that of WSE from commercial yogurts. In analysis by the ABTS method, mean values increased from 7.697 to 8.739 mM Trolox/g in commercial yogurts, and from 10.115 to 13.182 mM Trolox/g in traditional yogurts during storage. Antioxidant activities of peptides released from HPLC fractions of selected yogurt samples increased 10 to 200 times. In all yogurt samples, the greatest antioxidant activity was shown in the F2 fraction. After further fractionation of yogurt samples, the fractions coded as F2.2, F2.3, F4.3, and F4.4 had the highest antioxidant activity values. Total antioxidant activity of yogurts was low but after purification of peptides by fractionation in HPLC, peptide fractions with high antioxidant activity were obtained.

Genotypic identification of some lactic acid bacteria by amplified fragment length polymorphism analysis and investigation of their potential usage as starter culture combinations in Beyaz cheese manufacture.

In this study, 2 different starter culture combinations were prepared for cheesemaking. Starter culture combinations were formed from 8 strains of lactic acid bacteria. They were identified as Lactococcus lactis ssp. lactis (2 strains), Lactobacillus plantarum (5 strains), and Lactobacillus paraplantarum (1 strain) by amplified fragment length polymorphism analysis. The effects of these combinations on the physicochemical and microbiological properties of Beyaz cheeses were investigated. These cheeses were compared with Beyaz cheeses that were produced with a commercial starter culture containing Lc. lactis ssp. lactis and Lc. lactis ssp. cremoris as control. All cheeses were ripened in brine at 4 degrees C for 90 d. Dry matter, fat in dry matter, titratable acidity, pH, salt in dry matter, total N, water-soluble N, and ripening index were determined. Sodium dodecyl sulfate-PAGE patterns of cheeses showed that alpha(S)-casein and beta-casein degraded slightly during the ripening period. Lactic acid bacteria, total mesophilic aerobic bacteria, yeast, molds, and coliforms were also counted. All analyses were repeated twice during d 7, 30, 60, and 90. The starter culture combinations were found to be significantly different from the control group in pH, salt content, and lactobacilli, lactococci, and total mesophilic aerobic bacteria counts, whereas the cheeses were similar in fat, dry matter content, and coliform, yeast, and mold counts. The sensory analysis of cheeses indicated that textural properties of control cheeses presented somewhat lower scores than those of the test groups. The panelists preferred the tastes of treatment cheeses, whereas cheeses with starter culture combinations and control cheeses had similar scores for appearance and flavor. These results indicated that both starter culture combinations are suitable for Beyaz cheese production.

Missed malignancies during laparoscopic cholecystectomy.

BACKGROUND/AIMS: Laparoscopic cholecystectomy is now the treatment of choice for symptomatic gallstone diseases. However, besides its great benefits, perhaps the most disappointing complication of this operation is missed malignancies. In this study, patients who had missed malignancies that were diagnosed shortly after laparoscopic cholecystectomy were studied. We aim to find out the cause of missed and delayed diagnosis. METHODOLOGY: Between 1991 and June 1997, 9 patients undergoing laparoscopic cholecystectomy, which had been performed elsewhere 2-9 months earlier, and having had missed malignancy were included in this study. A diagnostic survey was collected from the medical records, questionnaires, and a semiological analysis. All laboratory data and physical findings, before and after laparoscopic cholecystectomy, were recorded. Follow-up data were obtained through a telephone questionnaire. RESULTS: Of these 9 patients, 6 had colorectal carcinoma and 3 had pancreas carcinoma. All patients complained of recent atypical pain at the time of laparoscopic cholecystectomy, except for 1 patient who had no symptomatic regression. CONCLUSIONS: It is necessary to make a careful semiological, physical and laboratory analysis of patients with cholelithiasis before especially laparoscopic cholecystectomy. Elderly patients, atypical biliary pain and associated symptoms must draw attention to the possibility malignancy.

Visceral injuries, wound infection and sepsis following electrical injuries.

Visceral injuries, wound infection and sepsis were investigated in 226 inpatients who sustained electrical burns over a period of 15 years. Four patients who sustained thoracic and abdominal organ injuries were noted in this series. The patients had injuries of the small intestine, stomach, colon and the lung. All the patients received operative treatment. Two of them died of sepsis. Injuries to the internal organs should always be considered following high-voltage injuries, and they should be managed as early as possible. The data concerning wound infection and sepsis following electrical injuries were evaluated in three consecutive 5-year periods. Over this period of 15 years, different antibiotic regimens were used for prophylaxis and treatment. Most patients in the current series had been contaminated or infected by various pathogens prior to admission. Long-lasting administration of prophylactic antibiotics in these patients showed no improvement in controlling the sepsis. After 1987, most of the microorganisms were eliminated following more effective antimicrobial therapy. The progressive decrease in infection frequency of species such as Pseudomonas aeruginosa, Proteus mirabilis and Enterobacter cloacae, appeared to be causally related to the changes in the general therapeutic protocol which included new antibiotics. The infections caused by E. coli and Staphylococcus aureus showed a rather steady state. A marked increase in frequency of negative wound cultures was also noted between the years 1989 and 1993. A gradual decrease in mortality rates was observed from the first to the last 5-year period, whereas mortality rates due to sepsis showed a gradual but slower decline. Sepsis (142 patients comprising 62.8 per cent of the total mortality rate) was the most frequent complication resulting in death.

Diffuse cavernous rectal hemangioma--clinical appearance, diagnostic modalities and sphincter saving approach to therapy: report of 2 and a collective review of 79 cases.

Two cases of diffuse cavernous haemangioma of the rectum are reported and a thorough review of the world literature with a sum of 79 patients is done. We advocate low anterior resections for the treatment of this disease; sleeve resections are not necessary, since the recurrent bleeding and complication rates are not statistically different from the low anterior resections without mucosal stripping.

Living unrelated donor kidney transplantation between spouses.

From November 3, 1975 to November 3, 1990, 874 kidney transplants were performed at out centers. Of these, 675 (77.2%) were from living donors and 199 (22.8%) were from cadaver donors. Five hundred eighty (66.4%) of the living donors were first degree related while 99 (11.3%) were unrelated or second degree related donors, 29 of which were spouses. All donor recipient pairs were ABO-compatible, with the exception of one pair. Donor recipient relations were wife to husband in 25 cases and husband to wife in 4 cases. All were first grafts and started functioning during surgery. In this series, the follow-up for the recipients was 4 to 64 months (mean 33.5 +/- 4.5 months). One-year patient survival and graft survival rates were 92.4% and 81.9%, respectively. Two-year patient survival and graft survival rates were 92.4% and 78.2%, respectively. The single ABO-incompatible case is also doing well, 21 months postoperatively. This study demonstrates that the interspouse kidney transplantation may be used when cadaver organ shortage is a problem. While providing the couple with a better quality of life, interspouse kidney transplantation also enables the couple to share the joy of giving and receiving the "gift of life" from one another.

Severe electrical injury.

From January 1979 to January 1987, 125 patients were treated in our Centre for various electrical injuries. Among them, 85 patients were over 15 years of age (89.4 per cent were males and 10.6 per cent females) and 40 patients were below 15 years of age (92.5 per cent were males and 7.5 per cent females). Electricians were the most frequently injured in the over 15-year-old age-group, whereas most patients under 15 years old were students. We focused our study on five patients with multiple and severe electrical injury. Two of these patients were injured while erecting TV aerials, two were injured at work and the other one was working on a house roof. Despite all our efforts extensive limb amputations were required. Following complete healing, we fitted prostheses to the amputation stumps. All the patients have now returned to society as capable individuals, two of them to their previous occupations and the other three with new occupations. Our experience with five patients showed that patients with severe electrical injury and multiple amputations have a reasonable chance of recovery. Rehabilitation therapy must be given as early as possible after the electrical injury so that the patients may return to their normal place in society.

Epidemiology of adults' and childrens' burns in a Turkish burn center.

From 1 January 1979 to 1 January 1985, 4094 patients were treated for burn injury in our centre. Of these, 84.9 per cent were treated as outpatients and 617 (15.1 per cent) were hospitalized. Of the 617 patients, 56.7 per cent were under 15 years of age (birth to 6 years: 67.7 per cent; 7-15 years, 32.3 per cent) and 43.3 per cent were over 15 years. The causes of burns in the over 15 years group were: flame, 36.3 per cent; electrical, 28.0 per cent; scalding, 18.4 per cent; liquefied petroleum (LP) gas explosion, 11.0 per cent; and others, 6.3 per cent. The burn cases in the under 15 years group were: scalding, 58.0 per cent; flame, 24.6 per cent; electrical, 10.0 per cent; hot meals, 5.2 per cent; and others, 2.0 per cent. After being resuscitated, these patients were treated with systemic antibiotics, local chemotherapy and silver-nitrate-incorporated amniotic membrane. Despite all medical efforts, 217 (35.7 per cent) of the hospitalized patients died as a result of various complications. At the same time, 3477 patients were treated as outpatients: 72.0 per cent of these were under 15 years old (birth to 6 years, 82.9 per cent, 7-15 years, 18.8 per cent) and 28.0 per cent patients were over 15 years of age. The causes of burn injury in these patients were: hot liquids, 61.7 per cent; flame, 17.0 per cent; hot meals, 8.4 per cent; hot metal, 5.8 per cent; electrical, 3.6 per cent; and chemical, 1.7 per cent.

The use of silver nitrate-incorporated amniotic membrane as a temporary dressing.

Human amniotic membrane is one of the most effective biological dressings used in burn treatment. Since 1978, we have been using human amniotic membrane incorporating 0.5 per cent silver nitrate. Studies in 96 patients using this method showed that the silver-incorporated membranes gave a better therapeutic effect than plain amniotic membranes. It was noted that 0.5 per cent silver nitrate incorporated into the membranes increased their manageability, provided easier application to the burned area and created a bactericidal effect, therefore reducing the risk of contamination and infection. One of the main advantages of wound coverage with amniotic membrane is that it does not appear to discourage re-epithelization, reduces fluid, protein, heat and energy loss, increases mobility and most important this may be the ideal wound cover next to the patient's own skin. Therefore, we highly recommend the use of 0.5 per cent silver nitrate-incorporated amniotic membrane, since it is readily available and freely obtainable, has low preparation and storage costs that make it an ideal dressing to use, especially in countries where economic factors prevent the purchase of other types of dressings.