Investigation of typhlitis in bone marrow transplant patients in a stem cell transplant unit.

Typhlitis is a special type of enterocolitis that specifically develops in immunosuppressive patients with hematological malignancies. Typhlitis is a common consideration after bone marrow transplantation due to high-dose chemotherapy that is used in conditioning regimens those contain high-dose cytotoxic chemotherapeutic agents. Although there are several studies about typhlitis during chemotherapy or in leukemia patients, there is not enough data evaluating its relationship between stem cell transplant in adults. Therefore, the current study aimed to analyze the possible causes that may lead to the development of typhlitis in hematopoietic stem cell recipient patients. This retrospective study included 210 adult patients who underwent bone marrow transplantation between January 2017 and December 2019. Pediatric patients (patients younger than 18 years of age) were excluded. Patients' data were evaluated to determine their effects on typhlitis and the mortality risk of the patients with typhlitis. The analysis of the variables was performed using the IBM SPSS Statistics for Windows version 26 (IBM Corp., Armonk, NY).Variables were analyzed at a 95% confidence level and a P value <0.05 was considered significant. Typhlitis developed in 23 (10.9%) transplant patients. Male sex, length of hospital stay, presence of febrile neutropenia, antibiotic and antifungal use, need for switching antibiotics, duration of neutropenia, diarrhea and antibiotic use in days were risk factors for development of typhlitis. It was observed that 100-days mortality was higher in typhlitis group reaching to a statistical significance (P < .05). In multiple logistic regression analysis, presence of mucositis and additional source of infection were determined as independent risk factors for the development of typhlitis in bone marrow transplant patients. This study provides valuable information for bone marrow transplant patients through an analysis of risk factors for the development of typhlitis. According to our results, mucositis and additional bacterial infections were found as risk factors for typhlitis therefore it would be beneficial for clinicians to consider these factors in patient follow-up. However, due to the retrospective nature of our study, prospective studies are needed to investigate risk factors and optimum treatment methods for typhlitis.

The effect of rheumatoid arthritis on upper extremity functions: A kinematic perspective.

AIM: To examine the global upper extremity kinematics in 3D while performing "jar opening motion" in Rheumatoid Arthritis (RA) and to compare these with healthy individuals. METHOD: Twenty-four women (12 healthy, 12 RA) were included. Evaluations were made with a JAMAR dynamometer, Health Assessment Questionnaire, and 3D kinematic analysis of global upper extremity during "jar opening motion." The time taken during "jar opening motion" was analyzed in 2 parts (Part 1, Part 2), with total time: part 1 + part 2. In addition, shoulder-to-table distance; elbow flexion angle; wrist extension angle; the area scanned and angular rotation by arm, forearm and hand were used in the analysis. RESULTS: Between groups, there was a statistical difference in: bilateral hand grip strength; part 1, part 2, total time; shoulder-to-table distance; elbow flexion angle; the area scanned by hand; angular rotation of arm and hand in favor of the healthy group (P < .05). In stepwise multiple regression analysis, the most predictive variable for disability was elbow flexion, explaining 53.9% of disability. CONCLUSION: Compared to healthy individuals, individuals with RA have slower motion, more elbow flexion, less hand grip strength, circular pattern in hand, rotation in arm and hand. Increased disability may result in greater load on elbow flexion.

The Future of Burn Care From a Complexity Science Perspective.

Health care is undergoing a profound technological and digital transformation and has become increasingly complex. It is important for burns professionals and researchers to adapt to these developments which may require new ways of thinking and subsequent new strategies. As Einstein has put it: "We must learn to see the world anew." The relatively new scientific discipline "Complexity science" can give more direction to this and is the metaphorical open door that should not go unnoticed in view of the burn care of the future. Complexity science studies "why the whole is more than the sum of the parts." It studies how multiple separate components interact with each other and their environment and how these interactions lead to "behavior of the system." Biological systems are always part of smaller and larger systems and exhibit the behavior of adaptivity, hence the name complex adaptive systems. From the perspective of complexity science, a severe burn injury is an extreme disruption of the "human body system." But this disruption also applies to the systems at the organ and cellular levels. All these systems follow the principles of complex systems. Awareness of the scaling process at multilevel helps to understand and manage the complex situation when dealing with severe burn cases. This paper aims to create awareness of the concept of complexity and to demonstrate the value and possibilities of complexity science methods and tools for the future of burn care through examples from preclinical, clinical, and organizational perspectives in burn care.

C1 Inhibitor Administration Reduces Local Inflammation and Capillary Leakage, Without Affecting Long-term Wound Healing Parameters, in a Pig Burn Wound Model.

BACKGROUND: Burns induce a boost in local and systemic complement levels as well as immune cell infiltration in the burn wound, which may negatively affect wound healing. OBJECTIVE: In this study, the effects of long-term treatment with complement inhibitor C1 esterase inhibitor (C1inh) on post-burn inflammation and wound healing parameters were analyzed in time up to 60 days post-burn. METHODS: Burned pigs were treated either with or without C1inh up to 15 days post-burn. Burn wound biopsies and blood were collected at different time points up to 60 days post-burn. Thereafter, complement in blood as well as complement and immune cells in the wound, capillary leakage, necrosis, reepithelialization and wound contraction were quantified. RESULTS: No significant differences in complement C3 blood levels were observed at any time point between C1inh-treated and control pigs. In the wound, complement C4 levels were significantly lower in the C1inh group than in controls at day 3-6 and 21-30 post-burn. Similarly, C3 levels, neutrophil and macrophage infiltration in the wound were, although not statistically significant, reduced in C1inh-treated pigs at day 9-14 post-burn. No differences in lymphocyte infiltration in the wound were found between C1inh and control pigs. C1inh-treated pigs also showed reduced capillary leakage. Despite these effects, no significant differences in the long-term wound healing parameters necrosis, reepithelialization and wound contraction were observed between C1inh and control pigs. CONCLUSION: In pigs, 15 days of C1inh treatment after burn, leads to a reduction in local inflammation and capillary leakage in the burn wound without affecting long-term wound healing parameters.

Hemorheological alterations following an acute bout of nordic hamstring exercise in active male participants1.

BACKGROUND: The Nordic hamstring exercise (NHE) has been proven to be an effective preventive technique for hamstring injuries. Hemorheological parameters (erythrocyte deformability and aggregation) play a critical role in exercise influencing oxygenation. Although previous studies presented hemorheological alterations induced by different types of exercise, changes in red blood cell (RBC) deformability and aggregation following NHE remain unknown. Present study was designed to explore possible alterations in hemorheological and oxidative parameters after an acute bout of NHE. METHODS: 10 healthy, male, active students (mean age 19.9±0.23, BMI: 21.56±0.54) participated to the study. They performed a single session of seven-repetitions of NHE followed by a familiarisation period. Blood samples were obtained before and immediately after the exercise from the antecubital vein. Hemorheological parameters were measured by an ektacytometer. RESULTS: NHE did not change deformability, hematocrit and oxidative stress but, increased RBC aggregation index (AI, p = 0.011) and decreased RBC aggregation half time (t½, p = 0.009). CONCLUSIONS: Our results suggest that, increased RBC aggregation following an acute bout of NHE may result in increased plasma skimming and thus ease the flow of blood.

Increased erythrocyte aggregation following an acute bout of eccentric isokinetic exercise does not exceed two days.

BACKGROUND: Isokinetic exercise is used to reduce strength imbalance and to enhance performance. OBJECTIVE: The aim of this study was to investigate the acute effects of a single bout of eccentric isokinetic exercise on hemorheology (erythrocyte deformability and aggregation), total oxidant/antioxidant status (TOS/TAS) and oxidative stress index (OSI) in active individuals. METHODS: The study comprises 11 active, healthy, male subjects (mean age of 19.45 ± 0.31 years, BMI 22.05 ± 0.51 kg/m2). They performed single, unilateral eccentric contractions of knee flexors and extensors with dominant leg on a dynamometer. Isokinetic hamstring, quadriceps strength were recorded at eccentric (30, 120° s-1) angular velocities. Eight active age-matched healthy male subjects were included as a control group, who did not receive exercise. Blood samples were obtained before, immediately after and two days after the exercise session. Hemorheological parameters were measured by an ektacytometer. TOS/TAS were determined using a commercial kit. RESULTS: A session of eccentric isokinetic exercise did not affect erythrocyte deformability and oxidative stress indices, whereas red blood cell (RBC) aggregation was increased initially and returned to pre-exercise levels after two days following exercise. CONCLUSION: Our results suggest that, increased RBC aggregation following an acute bout of isokinetic exercise may result in increased plasma skimming that augments tissue perfusion and clearance of metabolites within a period of two days following exercise.

Ultrasound-guided single-injection femoral nerve block provides effective analgesia after total knee arthroplasty up to 48 hours.

OBJECTIVES: The purpose of this study is to evaluate the effects of ultrasound (US) guided single-injection femoral nerve block (FNB) spinal anesthesia on pain control, morphine consumption, adverse effects, and patient satisfaction during the postoperative 48-hour period in patients undergoing total knee arthroplasty (TKA). METHODS: One hundred four ASA physical status I-III patients undergoing single TKA for degenerative joint disease were enrolled in this clinical study. Patients were randomly distributed into two groups: US-guided single-injection FNB with 40 ml of 0.5% bupivacaine and 1:200,000 epinephrine was administered to Group F (n=51) patients. Preservative-free saline was injected in Group P (n=53) patients using the same method as Group F. Pain scores, morphine consumption, incidences of adverse events, and patient satisfaction were assessed over the course of 48 hours. RESULTS: Group F used significantly less morphine compared with Group P (18.7 mg vs. 39.6 mg) during the first 48 hours after surgery (p<0.001). When compared with group P, the VRS scores both at rest and during movement were significantly lower in Group F at 4, 8, 12, 24, and 48 hours after TKA (for all comparisons p<0.001). In addition, patient satisfaction was better in Group F than Group P. CONCLUSION: This study suggests that a US-guided single-injection femoral nerve block following TKA improves patient satisfaction and reduces consumption of morphine during the first 48 hours.

Isolation, characterization, spectroscopic properties and quantum chemical computations of an important phytoalexin resveratrol as antioxidant component from Vitis labrusca L. and their chemical compositions.

In this study, isolation and characterization of trans-resveratrol (RES) as an antioxidant compound were carried out from VLE, VLG and VLS. Furthermore, antioxidant activities were evaluated by using six different methods. Finally, total phenolic, flavonoid, ascorbic acid, anthocyanin, lycopene, ß-carotene and vitamin E contents were carried out. In addition, the FT-IR, (13)C and (1)H NMR chemical shifts and UV-vis. spectra of trans-resveratrol were experimentally recorded. Quantum chemical computations such as the molecular geometry, vibrational frequencies, UV-vis. spectroscopic parameters, HOMOs-LUMOs energies, molecular electrostatic potential (MEP), natural bond orbitals (NBO) and nonlinear optics (NLO) properties of title molecule have been calculated by using DFT/B3PW91 method with 6-311++G(d,p) basis set in ground state for the first time. The obtained results show that the calculated spectroscopic data are in a good agreement with experimental data.

Evaluation of in-vitro Antioxidant Properties of Hydroalcoholic Solution Extracts Urtica dioica L., Malva neglecta Wallr. and Their Mixture.

The study was aimed at evaluating the antioxidant activity of hydroalcoholic solution extracts of Urtica dioica L. (UD), Malva neglecta Wallr. (MN) plants and their mixture. In this study, flower (UDF), root (UDR), seed (UDS) and leaf (UDL) parts of UD and flower (MNF) and leaf (MNL) parts of MN were used. The antioxidant properties of hydroalcoholic extracts and their mixture were evaluated using different antioxidant tests such as total antioxidant activity, reducing power, superoxide anion radical scavenging, hydrogen peroxide scavenging, free radical scavenging, and metal chelating activity for comparison. In addition, total phenolic compounds in the extracts of both plants were determined as catechin equivalent. The various antioxidant activities were compared to natural and synthetic standard antioxidants such as BHA, BHT and α-tocopherol. According to FTC method, the both extracts exhibited strong total antioxidant activity. At the concentration of 100 µg/mL, Hydroalcoholic extracts of UDS, UDR, UDF, UDL, MNF, MNL, and UD-MN showed 81.7%, 79.8%, 78.3%, 76.4%, 77.3%, 74.1%, and 80.7%, respectively. Comparable, 100 µg/mL of standard antioxidants BHA, BHT and α-tocopherol exhibited 66.2%, 70.6%, and 50.1% inhibition on peroxidation of linoleic acid emulsion, respectively. In addition, UD-MN showed strong superoxide anion radical scavenging activity comparable with UDR, UDF, UDL, MNF, and MNL. Based on the findings, plants mixture was commonly found to have synergistically higher antioxidant activity.

Antioxidant properties of Urtica pilulifera root, seed, flower, and leaf extract.

This study was conducted to evaluate the antioxidative properties of hydroalcoholic (80%) extracts from different parts of Urtica pilulifera L. (Family Urticaceae), including leaf (UPL), flower (UPF), seed (UPS), and root (UPR). Antioxidative activity of the extracts was measured using the ferric thiocyanate method, thiobarbituric acid method, reductive potential, metal chelating, free radical, superoxide anion radical, and hydrogen peroxide scavenging activity. In addition, the results were compared with antioxidants such as tert-butylated hydroxyanisole (BHA), tert-butylated hydroxytoluene (BHT), and α-tocopherol. Total antioxidant activities of UPS, UPF, UPL, UPR, BHA, BHT, and α-tocopherol were 88.79%, 85.13%, 86.72%, 78.46%, 81.31%, 76.12%, and 46.28%, respectively. Like the antioxidant activity, the reducing power and the superoxide anion radical and free radical scavenging activities of UPL, UPF, UPS, and UPR are concentration dependent. A correlation between higher antioxidant activity and the amount of total phenolics was found in the extracts.

Desflurane anaesthesia in a patient with multiple sclerosis in total hip replacement.

Multiple sclerosis (MS) is a progressive demyelinating disease presenting with a relapsing-remitting course and affects large areas of the brain and the spinal cord. Surgical stress often induces exacerbation of MS symptoms. It is mandatory to prepare the MS patient very carefully for the surgery and anaesthesia with an effective premedication and an effective postoperative analgesia following a safe and minimal-risk anaesthesia management. In recent reports, results of general and regional anaesthesia in MS patients have been discussed. To our knowledge this is the first case report of the use of desflurane anaesthesia in a patient with MS. In conclusion, desflurane anaesthesia is a safe and useful method for MS patients.

The effects of Urtica dioica L. leaf extract on aniline 4-hydroxylase in mice.

The effects of hydroalcoholic (80% ethanol-20% water) extract of Urtica dioica L. on microsomal aniline 4-hydroxylase (A4H) were investigated in the liver of Swiss albino mice (8- 10-weeks-old) treated with two doses (50 and 100 mg/kg body weight, given orally for 14 days ). The activities of A4H showed a significant increase in the liver at both dose levels of extract treatment. The hydroalcoholic extract of Urtica dioica induced the activities of A4H that had been increased by treatment of metal ions (Mg2+ and Ca2+) and the mixture of cofactors (NADH and NADPH). At saturated concentration of cofactor, microsomal A4H exhibited significantly even higher activities in the presence of the mixture of cofactors than NADPH and NADH. Mg2+ and Ca2+ ions acted as stimulants in vitro. The present results suggest that the hydroalcoholic extract of Urtica dioica may have modalatory effect on aniline hydroxylase at least in part and enhance the activity of A4H adding metals ions and cofactors.