The effectiveness of biofeedback therapy in children with monosymptomatic enuresis resistant to desmopressin treatment.

OBJECTIVE: To investigate the effect of biofeedback therapy on children with desmopressin- resistant primary monosymptomatic enuresis (MsE). MATERIAL AND METHODS: The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin- resistantprimary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment. RESULTS: The mean age of 29 patients included in the study was 9.14±3.07 (6-15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1±5.76 days/month, while after treatment this was calculated as 8.52±10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p<0.001). The TBV/NBC value before treatment was 0.66, while after treatment it was 0.77 (p<0.001). There was a statistically significant difference between the SBTG and USBTG groups in terms of presence of MsE in mother, and both parents (p=0.001, p=0.016, respectively). CONCLUSION: Biofeedback therapy is a safe, simple, and minimally invasive treatment modality in children with MsE resistant to desmopressin treatment. This treatment, which was found to increase total bladder capacity, may be recommended for children with MsE when conventional desmopressin treatment fails.

Left ventricle ejection fraction may predict mortality in renal transplant patients.

PURPOSE: Mortality is a major problem in renal transplant patients, and appropriate preoperative evaluation is very important. We retrospectively reviewed the left ventricle ejection fraction (LVEF) of renal transplant patients. MATERIAL AND METHODS: The clinical records of 1763 patients who had preoperative LVEF results and who underwent renal transplantation at Akdeniz University Faculty of Medicine during the years 2004-2014 were studied. The LVEF limit was set at 55%. LVEF, age, gender, diabetes mellitus, hypertension, type of dialysis were assessed by linear multiple regression analysis on survival. RESULTS: There were a total of 1763 renal transplant patients. Those with LVEF of <55% were identified as having left ventricular dysfunction. The mean LVEF was 59.4 ± 9.1 in the 43 patients who died after renal transplantation, while it was 62.6 ± 7.4 in the survivors (p = 0.02). The mortality rate in the LVEF < 55% group was 6.8% (11/162 patients), while mortality in the LVEF ≥ 55% group was 2% (32/1601 patients, p < 0.001). LVEF was found to be the most powerful variable on survival by the linear multiple regression analysis, R2 = 0.05, p < 0.001. CONCLUSION: LVEF may predict mortality in renal transplant patients. LVEF is known to be lower in patients with high cardiac mortality, who may require greater modifications of the postoperative risks.

Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system.

BACKGROUND/AIM: The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. MATERIALS AND METHODS: Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. RESULTS: The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. CONCLUSION: According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.

Mean platelet volume and platelet distribution as a diagnostic marker for penile vascular disease in patients with erectile dysfunction / Volumen medio de plaquetas y distribución de plaquetas como marcador diagnóstico para la enfermedad vascular peneana en pacientes con disfunción eréctil

Objective. To investigate the relationship between platelet activation parameters that are involved in the vascular response, the atherothrombotic process, and erectile function, in which epithelial dysfunction plays a significant role. Materials and methods. A study was performed on patients who had a color Doppler ultrasound (CDUS) of the penis due to erectile dysfunction. The patients were divided into two groups: those with normal CDUS findings, and those with vascular dysfunction on CDUS. Patients were also divided into two groups according to their scores using the International Index of Erectile Function (IIEF). The relationships between platelet activation factors, vascular parameters, and severity of the disorder were analyzed. Results. A total of 91 patients who fulfilled the inclusion criteria were included in the study. CDUS showed vascular dysfunction in 55 patients (Group I), while the findings were normal in 36 patients (Group II). Age, cholesterol level, disease duration, mean platelet volume (MPV), and platelet distribution width (PDW) were compared between Groups I and II, with Group I showing significantly higher values. The parameters that could affect Doppler ultrasound results were analyzed using multivariate regression analysis. This showed that PDW and disease duration were independent prognostic factors (p = .021 and p = .005, respectively). When the patients were divided into two groups according to their IIEF scores, in those with mild (Group A) and severe disease (Group B), it was found that there were significant differences between the groups with age, disease duration, and PDW, while two groups were found similar in terms of MPV, cholesterol levels, and hormone parameters. Conclusion. It is supposed that increased platelet activation parameters, and PDW in particular, give important information for disease progression and follow-up of vascular dysfunction in erectile dysfunction (AU)

Objetivo. Investigar la relación entre los parámetros de activación de plaquetas involucrados en la respuesta vascular, el proceso aterotrombótico y la función eréctil, en la que la disfunción endotelial desempeña un papel importante. Material y métodos. Se analizaron los pacientes en los que se realizó una ecografía Doppler color (EDC) del pene por disfunción eréctil. Los pacientes fueron divididos en 2 grupos: con resultados normales en la EDC y con disfunción vascular en la EDC. Los pacientes fueron asimismo divididos en 2 grupos en función de las puntuaciones del Índice Internacional de Función Eréctil (IIFE). Se analizaron las relaciones entre los factores de activación plaquetaria, los parámetros vasculares y la gravedad del trastorno. Resultados. Un total de 91 pacientes que cumplieron los criterios de inclusión fueron incluidos en el estudio. La EDC mostró disfunción vascular en 55 pacientes (grupo i), mientras que los resultados fueron normales en 36 pacientes (grupo ii). La edad, el nivel de colesterol, la duración de la enfermedad, el volumen medio de plaquetas (VMP) y la anchura de distribución de las plaquetas (ADP) se compararon entre los grupos i y ii; además, los valores fueron expresivamente más altos en el grupo i. Los parámetros que podrían afectar los resultados de la EDC se valoraron con el análisis de regresión multivariante, lo que demostró que la ADP y la duración de la enfermedad fueron factores pronósticos independientes (p = 0,021 y p = 0,005, respectivamente). Cuando los pacientes fueron divididos en 2 grupos en función de las puntuaciones IIFE, en aquellos con enfermedad leve (grupo A) y enfermedad grave (grupo B) se encontraron diferencias significativas entre los grupos con la edad, la duración de la enfermedad y la ADP, mientras que ambos grupos fueron similares en términos de VMP, de niveles de colesterol y de parámetros hormonales. Conclusión. Al parecer, el aumento de los parámetros de activación plaquetar, y especialmente la ADP, proporcionan una importante información para la progresión de la enfermedad y el seguimiento de la disfunción vascular en la disfunción eréctil (AU)

The relationship between platelet-lymphocyte ratio and severity of erectile dysfunction.

The prognostic importance of platelet-lymphocyte ratio (PLR) is already known for various artery diseases. In this study, the relationship between PLR and severity of erectile dysfunction (ED) is examined in patients with impotence. The data from patients suffering from erection problems was screened retrospectively. Detailed medical history, age, International Index of Erectile Function-5 (IIEF-5) scores, fasting blood glucose, lipid, whole blood count, and hormone profile values were examined. Patients with no ED were selected as the control group. All men answered the IIEF-5 questions and were then classified according to their scores. Patients were determined to have severe ED (scores 5-7), moderate ED (scores 8-16), or mild ED (scores 17-21). An IIEF-5 score greater than 21 was accepted for the control group. The PLR values from both patient and control groups were evaluated. Demographic data were similar in both groups. Mean PLR value was 104 in control and 118 in the patient group (p < 0.001). PLR value increased depending on the severity of ED. Mean PLR values were 108 in mild, 116 in moderate, and 130 in severe ED groups. Compared with the control group, this value was statistically significant for patients with moderate and severe ED (p = 0.04 and p < 0.001). PLR showed weak negative but significant correlation with IIEF-5 scores (r = -0.27 and p < 0.001). The PLR value was found to be higher in patients with ED. PLR value may be related to ED and its severity in patients with impotence.

Protective effect of syringic acid on kidney ischemia-reperfusion injury.

The objective of the present study was to determine whether preischemic administration of syringic acid (SA) would attenuate renal ischemia-reperfusion injury (IRI). Rats were divided into three groups: Sham group; IR group; and IR + SA group. The effects of SA were examined using biochemical parameters including serum ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), tissue superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and malondialdehyde (MDA). The apoptosis status and histopathological changes were evaluated. After calculating the score for each histopathological change, the total score was obtained by summing all the scores. In the SA group, MDA, IMA, TOS, and OSI decreased significantly compared to the IR group. After SA administration, the increase in GPx activity was found to be significant. Apoptosis decreased significantly in the SA group compared with the IR group. The total score significantly decreased after administration of SA. Taken together, our findings suggest that SA preconditioning is effective in reducing tissue damage induced in kidney IRI. Renal histology also showed convincing evidence regarding the protective nature of SA.

Mannitol has a protective effect on testicular torsion: An experimental rat model.

OBJECTIVE: Testicular torsion is an emergency condition that causes testicular injury. Any treatment opportunity reducing the destructive effect of testicular torsion is important for the future life of patients. In this experimental study we investigated the protective effect of mannitol on ischemia-reperfusion (I/R) injury in a rat testes torsion model. METHOD: In total, 32 male Sprague Dawley rats were included. Four experimental groups included eight rats each. Group A was a sham group in which the right testis was brought out through a scrotal incision and then replaced in the scrotum without torsion. In Group B, the right testis was torsioned, by rotating 720° clockwise and fixed to the scrotum with no treatment. In Group C, the same testicular torsion process was performed with saline infusion just after testicular torsion. In group D, mannitol infusion was used just after testicular torsion. Testicles were detorsioned after 3 h and left inside for more than 2 h before orchiectomy. Histopathological, immunohistochemical, and biochemical analyses were performed. RESULTS: Testicular architecture was disturbed significantly in the torsion groups without mannitol infusion. However, testicular tissue structure was significantly better in the mannitol-treated group, demonstrating a protective effect. Similar findings were also shown for the proliferating cell nuclear antigen (PCNA) index and antioxidant activity; both were higher in the mannitol group than in the no-treatment and saline groups (p < 0.01). The apoptotic index was also significantly lower in the mannitol-treated group compared with the no treatment and saline groups (p < 0.01). CONCLUSIONS: The seminiferous tubule structure in testicular torsion without mannitol treatment was significantly disturbed, whereas the structural disruption was considerably less in the mannitol group. Mannitol treatment also decreased reactive oxygen radical levels significantly and was able to decrease apoptosis. These results were consistent with other organ model studies that evaluated the protective effects of mannitol treatment in I/R injury. Mannitol infusion had a protective effect against I/R injury in testicular torsion in rats. This experimental study may guide clinicians to evaluate the effectiveness of mannitol in human testicular torsion.

Risk stratification using gated stress myocardial perfusion imaging: comparison between patients with and without sexual dysfunction.

Sexuality is an indispensable part of life. When a problem is encountered related to this topic, the quality of life is negatively affected. Therefore, every problem related to sexuality is extremely private and important to an individual. This study aims to investigate the use of myocardial perfusion scintigraphy (MPS) for advanced assessment of patients with known or suspected coronary artery disease, cardiovascular disease, and in the intermediate risk group for SD. The study included 250 patients (150 male, 100 female, mean age 54±12.10) sent by the Cardiology Clinic to the Nuclear Medicine Clinic for MPS due to suspected cardiovascular disease (CVD). The questionnaire study was applied by two methods as face-to-face interviews or online. Data on sociodemographic characteristics and cardiovascular diseases together with risk factors for sexual activity were collected using a general information form. Patients were divided into three categories of risk depending on major risk factors for cardiovascular diseases: low, intermediate, and high risk. On comparing the risk scores between the groups, it was seen that there was a statistically clear reduction in the intermediate risk group of patients with SD according to MPS scoring. MPS is a cost-effective, reliable, and accurate non-invasive diagnostic method necessary for routine use to assess cardiovascular disease and in the intermediate risk group for SD.

Female sexual dysfunction in androgenetic alopecia: Case-control study.

INTRODUCTION: We sought to evaluate the association of female sexual dysfunction (FSD) with androgenetic alopecia (AGA) and metabolic syndrome (MetS) in premenopausal women. METHODS: From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausal women who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwig's classification. The MetS assessment was made according to the NCEP-ATP III criteria. RESULTS: In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13-1.30; p<0.001), AGA (OR 3.42, 95% CI 1.31-8.94; p=0.017), MetS (OR 5.39, 95% CI 1.34-21.62; p=0.012), and free testosterone (OR 0.18, 95% CI 0.09-0.37; p<0.001) were independently associated with FSD. CONCLUSIONS: Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception.

OBJECTIVES: To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction. PATIENTS AND METHODS: The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed. RESULTS: There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater. CONCLUSION: Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

The association of urolithiasis and androgenetic alopecia.

OBJECTIVES: The objective of this study is to investigate whether patients with androgenetic alopecia were at risk in terms of urinary system stone disease. PATIENTS AND METHODS: Patients with no baldness (Hamilton-Norwood Scala [HNS] stage I) were categorized as Group I, those with hair loss in the frontal region (HNS stages II, III, IIIa, and IVa) as Group II, those with hair loss in the vertex region (HNS stage III-vertex, V) as Group III and those with hair loss in both vertex and frontal regions (HNS stages IV, Va, VI, and VII) as Group IV. Patients in all groups were compared in terms of presence of stone, and the presence of any association between alopecia and urolithiasis, with common etiological risk factors, was investigated. RESULTS: Three hundred and two male patients were included in the study. The presence of urolithiasis was detected in 28.9% of patients in Group I; 26.5% of Group II; 36.9% of Group III; and 44.4% of Group IV (p = 0.085). Among patients aged under 60, urinary stone disease was detected in 30.8% of patients in Group I; 26.4% of Group II; 41.2% of Group III; and 53.8% of Group IV (p = 0.001). In patients aged over 60, urolithiasis was detected in 12.5% of patients in Group I; 26.9% of Group II; 32.2% of Group III; and 37.8% of Group IV (p = 0.371). CONCLUSIONS: We determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old.

Major Ozonated Autohemotherapy Preconditioning Ameliorates Kidney Ischemia-Reperfusion Injury.

Medical ozone has therapeutic properties as an antimicrobial, anti-inflammatory, modulator of antioxidant defense system. Major ozonated autohemotherapy (MOA) is a new therapeutic approach that is widely used in the treatment of many diseases. The objective of the present study was to determine whether preischemic application of MOA would attenuate renal ischemia-reperfusion injury (IRI) in rabbits. Twenty-four male New Zealand white rabbits were divided into four groups, each including six animals: (1) Sham-operated group, (2) Ozone group (the MOA group without IRI), (3) IR group (60 min ischemia followed by 24 h reperfusion), and (4) IR + MOA group (MOA group). The effects of MOA were examined by use of hematologic and biochemical parameters consisting of neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). In addition, the histopathological changes including the tubular brush border loss (TBBL), tubular cast (TC), tubular necrosis (TN), intertubular hemorrhage and congestion (IHC), dilatation of bowman space (DBS), and interstitial inflammatory cells infiltration (IECI) were evaluated. In the IR group, compared to the Sham group, biochemical parameters indicating oxidative stress, NLR, IL-6, TNF-α, IMA, TOS, and OSI have increased. MOA reduced inflammation and oxidative stress parameters. Although TAS values have decreased in the IR group and increased in the MOA-pretreated group, no significant changes in TAS values were detected between the IR and MOA groups. The total score was obtained by summing all the scores from morphological kidney damage markers. The total score has increased with IR damage when compared with the Sham group (13.83 ± 4.30 vs 1.51 ± 1.71; p = 0.002). But, the total score has decreased significantly after application of MOA (5.01 ± 1.49; p = 0.002; compared with the IR group). MOA preconditioning is effective in reducing tissue damage induced in kidney ischemia-reperfusion injury. The protective effect of MOA is mediated via reducing inflammatory response and regulating of reactive oxygen species (ROS). Renal histology also showed convincing evidence regarding MOA's protective nature against kidney injury induced renal ischemia-reperfusion. Consequently, MOA might be helpful in protecting the kidneys from IR-induced damage in humans, probably through the anti-inflammatory effect and reducing the total oxidant status.

Fournier's gangrene current approaches.

Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients.

Comparison of transperitoneal laparoscopic nephrectomy outcomes in atrophic and hydronephrotic kidneys.

OBJECTIVE: To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. MATERIAL AND METHODS: Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre-and post-operative hemoglobin and creatinine values, transfusion rates and length of hospital stays. RESULTS: Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. CONCLUSION: Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.

Do Hypertension, diabetes mellitus and obesity increase the risk of severity of nephrolithiasis?

OBJECTIVE: In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). METHODS: A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. RESULTS: Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 ± 4.93 kg/m(2) and 25.29 ± 4.12 kg/m(2), respectively (p<0.001). Twenty-five (20.6%) of the patients with stones diagnosed by ultrasound had DM, while 49 (10.8%) of those without stones had DM (p=0.004). When comparing patients with and without kidney stones, logistic regression analysis revealed that DM (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.17 to 3.63, p=0.013) and BMI (OR 1.08, CI 1.03 to 1.13, p=0.003) were independently associated with presence of stones. No significant relationship was found between the same variables and cumulative stone diameter (CSD) and stone surface area (SA) evaluated for stone burden. CONCLUSIONS: While diabetes mellitus, Hypertension and increased Body Mass Index may add to the possibility of stone formation, they did not affect stone burden.

Renoprotective Effect of Humic Acid on Renal Ischemia-Reperfusion Injury: An Experimental Study in Rats.

Humic acid is an antioxidant molecule used in agriculture and livestock breeding, as well as in medicine. Our aim was to investigate the potential renoprotective effects of humic acid in a renal ischemia reperfusion model. Twenty-one rats were randomly divided into three equal groups. Intraperitoneal serum or humic acid was injected at 1, 12, and 24 h. Non-ischemic group I was evaluated as sham. The left renal artery was clamped in serum (group II) and intraperitoneal humic acid (group III) to subject to left renal ischemic reperfusion procedure. Ischemia and reperfusion time was 60 min for each. Total antioxidant status, total oxidative status, oxidative stress index, and ischemia-modified albumin levels were analyzed biochemically from the serum samples. Kidneys were evaluated histopatologically and immunohistochemically. Biochemical results showed that total oxidative status, ischemia-modified albumin, and oxidative stress index levels were significantly decreased, but total antioxidant status was increased in the humic acid group (III) compared with the ischemia group (II) On histopathological examination, renal tubular dilatation, tubular cell damage and necrosis, dilatation of Bowman's capsule, hyaline casts, and tubular cell spillage were decreased in the humic acid group (III) compared with the ischemia group (II). Immunohistochemical results showed that apoptosis was deteriorated in group III. Renal ischemia reperfusion injury was attenuated by humic acid administration. These observations indicate that humic acid may have a potential therapeutic effect on renal ischemia reperfusion injury by preventing oxidative stress.

Predictive role of hematologic parameters in testicular torsion.

PURPOSE: To evaluate the predictive role of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet count (PLT) in the diagnosis of testicular torsion (TT) and testicular viability following TT. MATERIALS AND METHODS: We analyzed two study groups in this retrospective study: 75 patients with a diagnosis of TT (group 1) and 56 age-matched healthy subjects (group 2). We performed a complete blood count as a part of the diagnostic procedure, and NLR, PLR, MPV, and PLT values were recorded. We compared the patient and control groups in terms of these parameters. Then, TT patients were divided into two subgroups according to the time elapsed since the onset of symptoms. Subsequently, we evaluated the relationship between the duration of symptoms and these parameters. RESULTS: There were significant differences between groups 1 and 2 in NLR, PLR, and PLT (p<0.001 for all). There was no predictive role of MPV in the diagnosis of TT (p=0.328). We determined significantly high sensitivity and specificity levels for NLR in the prediction of TT diagnosis (84% and 92%, respectively). Furthermore, NLR was significantly related to the duration of symptoms in TT patients (p=0.01). CONCLUSIONS: NLR may be a useful parameter in the diagnosis of TT. Furthermore, NLR may be used as a predictive factor for testicular viability following TT.

The accuracy of urinary ultrasound in the diagnosis of urinary stone disease in patients with acute flank pain: is it influenced by the time of ultrasound performance during the day or week?

BACKGROUND: The aim of this article is to investigate the possible impact of timing of ultrasound (US) during the day or week on its diagnostic accuracy. METHODS: We analyzed the records of 500 patients who underwent an initial urinary US, followed by a noncontrast computed tomography (NCCT) for the assessment of urinary stone disease. The sensitivity, specificity, negative and positive predictive values, negative and positive likelihood ratio, and overall diagnostic accuracy rates of US and were analyzed at different times of the day or week. RESULTS: The specificity and diagnostic accuracy of urinary US showed a decline toward the middle of the week followed by a steady rise by the end of the week, higher sensitivity for urinary US was noticed around mid-week. On the other hand, when urinary US results are subgrouped according to the time of the day they are performed, the specificity remained generally stable but the sensitivity and diagnostic accuracy showed lowest levels between 11:00 a.m. and 02:00 p.m. and between 04:00 p.m. and 05:00 p.m. Although some observational differences between sensitivity, specificity, and diagnostic accuracy of urinary US performed at different times of the day or week are seen, these differences were not statistically significant. CONCLUSIONS: Our study showed no significant influence of US timing on its diagnostic accuracy. A larger randomized prospective series is necessary to evaluate the impact of different factors on "precision" and "accuracy" in US reporting and, hence, the diagnostic accuracy of urinary US in identifying urinary stone disease.