COMPARISON OF LAPAROSCOPIC AND OPEN PYELOPLASTY IMPACT ON COMFORT AND SUCCESS: A RETROSPECTIVE, SINGLE CENTER STUDY.

Ureteropelvic junction obstruction causes hydronephrosis and may lead to renal parenchymal damage unless timely diagnosed and treated. Although open pyeloplasty is still the gold standard, it needs to be compared with new techniques. In this study, we compared laparoscopic and open pyeloplasty. Data on 113 patients who had undergone surgery between 2008 and 2014 were evaluated retrospectively. Thirty-nine patients had undergone laparoscopic pyeloplasty, and 74 had undergone open pyeloplasty. Ultrasonography was performed at 3 months and scintigraphy at 6 months postoperatively. Parameters such as the length of surgery, need for analgesics, length of hospital stay, complications, and success rates were compared. When compared to open pyeloplasty (mean 9.8 dexketoprofen 50 mg IV dose), the need for an analgesic was significantly lower in the laparoscopic pyeloplasty (mean 4.5, paracetamol 15 mg/kg IV dose) group (p<0.05). The length of hospital stay was also shorter in the laparoscopic pyeloplasty group (mean 4.0 days) than in the open pyeloplasty group (mean 7.3 days) (p<0.05). This study demonstrated that laparoscopic pyeloplasty could be safely used in the treatment of ureteropelvic junction obstruction with a lower need for analgesics and a shorter length of hospital stay than with open pyeloplasty.

Metabolic risk factors and the role of prophylaxis in pediatric urolithiasis.

Suppose that the recurrence in pediatric urolithiasis has a close relationship with metabolic abnormalities and is affected by residual burden and prophylaxis. If so, the recurrence rates could be reduced with effective surgery and appropriate prophylaxis. Here we retrospectively evaluate the metabolic risk factors data of 148 children who were operated on between January 2005 and March 2013 due to kidney stones. All patients underwent percutaneous nephrolithotomy (PCNL), and all were children. Thirteen children had a history of surgery performed to treat urological anomalies. Twenty-four-hour urine analysis, the residual status of surgery, BMI levels, and the number of metabolic abnormalities were noted. Only 18 (15%) of 122 patients without residual stones after PCNL had recurrence at follow-up whereas; nine (26%) of 26 patients with residual stones developed recurrence (p = 0.017). Recurrence was observed in 14 (16%) of 89 patients with a metabolic abnormality, and 13 (30%) of 44 patients with two or more metabolic abnormalities had recurrence at follow-up (p = 0.024). Those patients with no metabolic abnormalities did not develop recurrence. Stone recurrence was seen in six (8%) of 78 children who were given metabolic prophylaxis, compared to 21 (30%) of 70 patients who did not receive metabolic prophylaxis (p = 0.02). No stone recurrence was seen in nine children who were given Shohl's, whereas four (67%) of six patients who did not take Shohl's had recurrence (p = 0.022). Complete removal of stones by a suitable surgical method is essential to avoid recurrences. Detailed clinical and laboratory evaluations should be performed in children with urolithiasis. Appropriate specific prophylactic treatment (e.g., potassium citrate and Shohl's) and non-specific prophylactic treatment (e.g., avoiding animal proteins, salt, simple sugars, and increased water intake) should be given to prevent reformation of stones in patients with pediatric urolithiasis.

Production of Bovine Colostrum for Human Consumption to Improve Health.

Colostrum contains all essential nutrients for the neonate during the first days of life, with impacts that continue far beyond these first days. Bovine colostrum has been used for human consumption due to the high concentrations of bioactive proteins, vitamins, minerals, growth factors, as well as free and conjugated oligosaccharides. Processes involved in the preparation of bovine colostrum for human consumption play a pivotal role in preserving and maintaining the activity of the bioactive molecules. As bovine colostrum is a multifunctional food that offers a myriad of benefits for human health, assessing the main processes used in preparing it with both advantages and disadvantages is a crucial point to discuss. We discuss major processes effects for colostrum production on the nutritional value, some advanced technologies to preserve processed bovine colostrum and the end-product forms consumed by humans whether as dairy products or dietary supplements.

Additional VCUG-related parameters for predicting the success of endoscopic injection in children with primary vesicoureteral reflux.

INTRODUCTION AND OBJECTIVE: Prediction of vesicoureteral reflux (VUR) prognosis and decision for treatment are usually made according to the reflux grading classification. But the management of VUR is still controversial since there are difficulties in distinguishing reflux grade due to inter- and intra-observer variations. Previous studies have demonstrated that the distal ureteral diameter ratio (UDR) on voiding cystourethrography (VCUG) may be more predictive for clinical prognosis than reflux grade. We aimed to predict the success of endoscopic injection in primary VUR by creating new models that include other additional parameters (timing of reflux, delayed post-voiding contrast drainage of the upper urinary tract) as well as UDR. STUDY DESIGN: A total of 200 patients aged 2-15 years with primary VUR undergoing endoscopic injection were retrospectively evaluated. Demographic and clinical data for a total of 248 renal units were recorded. Besides reflux grade and laterality, distal ureteral diameter, UDR, timing of reflux [early filling, late filling or voiding] and presence of contrast delay in upper tract drainage were also assessed on VCUG. According to the complete resolution of VUR on the control VCUG at the postoperative 3rd month, the renal units were divided into two main groups: successful (n = 171, 68.9%) and unresolved (n = 77, 31.1%) RESULTS: The failure rate of endoscopic injection was found to be 4.068 times greater with early filling reflux on VCUG, 3.076 times greater with UDR>0.24, 2.745 times greater with delayed contrast drainage of the upper urinary tract, 2.666 times greater with the presence of scar in DMSA, 2.493 times greater with bladder-bowel dysfunction and 2.341 times greater with febrile urinary tract infection. We also observed that a model in which all VCUG-related parameters were combined provided a better estimation of endoscopic injection outcomes compared to only the reflux grade (AUC: 0.903 vs. 0.604, respectively). DISCUSSION: Distal ureteral dilatation is considered to be a more decisive factor for clinical outcomes of primary VUR rather than upper urinary tract dilatation since ureterovesical junction anatomy plays a more important role in primary VUR pathophysiology. Studies investigating new prediction models on this topic have recently become more popular. However, a consensus has not yet been achieved. CONCLUSION: We consider that UDR level, the timing of reflux and delayed upper tract drainage on VCUG may be more predictive parameters of endoscopic injection success compared with reflux grade, and could facilitate selecting the best candidates for surgery.

Effectiveness and complications of mini-percutaneous nephrolithotomy in children: one center experience with 232 kidney units.

OBJECTIVE: To evaluate the efficacy and complications of mini-percutaneous nephrolithotomy (PCNL) surgery using 14-20 Fr access sheaths in pediatric patients, as well as the results of postoperative stone analysis and metabolic urine analysis. MATERIAL AND METHODS: We retrospectively evaluated the records of 206 pediatric patients (232 kidney units) who underwent mini-PCNL for kidney stones in our clinic between February 2011 and December 2018. We evaluated the demographic characteristics, complications, stone-free rates, and the results of chemical analysis and urinary metabolic analysis. RESULTS: The age ranged from 9 months to 16 years. The mean age was 5.1±3.9 years, and the median age was 3.5 years. The median stone burden was 200 mm2 (min: 100; max: 1600). Kidney stones were most commonly located in the pelvis in 118 (50.9%) patients, followed by lower calyceal stones in 42 (18.1%) and multiple calyceal stones in 38 (16.4%) patients, respectively. While the success of mini-PCNL was 80.6% after the first session, this rate increased to 87.9% after auxiliary treatments. The total complication rate was 12.9% according to modified Clavien classification. A postoperative stone analysis showed that calcium oxalate had the highest frequency with 61.1% of patients, followed by cystine stone with 21.3% of patients. Metabolic urine analysis revealed no abnormalities in 42.8% of patients. The most common metabolic abnormality was hyperoxaluria (32%), followed by hypercalcuria (19.6%). CONCLUSION: Mini-PCNL is a safe and effective procedure with reasonable complications for the treatment of pediatric kidney stones. All kinds of multidisciplinary efforts are required to remove kidney stones completely in pediatric patients.

Can the expression level of PIWIL 2 gene be a serum marker for prostate cancer? A single-center prospective study.

OBJECTIVE: The aim of the present study was to evaluate the predictive value of the serum expression level of Piwi-like 2 (PIWIL2), a stem cell protein, for prostate cancer (PCa). MATERIALS AND METHOD: This randomized and prospective study included a total of 60 volunteers between 50 and 75 years old. Cases were assigned to three groups according to prostate-specific antigen (PSA) elevations and pathology reports, with 20 participants in each group. The first group included patients with a PSA level of >4 ng/dL and with PCa, the second group included patients with a PSA level of >4 ng/dL and with benign prostate hyperplasia, and the third group included patients with a PSA level of ≤4 ng/dL and with benign prostate hyperplasia. The levels of serum PSA and PIWIL2 expressions were compared between the groups. RESULTS: The median serum PSA levels were 28.5 (4.6-98.1) ng/mL, 8.89 (4.3-24.1) ng/mL, and 2.4 (0.3-3.8) ng/mL for groups 1, 2, and 3, respectively. The PSA levels were significantly different between the groups (p<0.001). The median PIWIL2 gene expression levels were 2.54 (0.28-9.27), 2.27 (0.6-9.38), and 1.17 (0.26-3.07) for groups 1, 2, and 3, respectively. The PIWIL2 gene expression level was found to be lower in patients with a PSA level of <4 (p=0.02). No significant difference was observed between patients with and without cancer among those with a PSA level of ≥4 (p>0.05). Patients diagnosed with cancer were grouped according to the criteria of the International Society of Urological Pathology (ISUP), and PIWIL2 gene expression was observed to be significantly higher among patients with ISUP of >3 than among those with ISUP of ≤3 (p=0.04). CONCLUSION: In our study, it was observed that the serum level of PIWIL2 gene expression could not be a diagnostic indicator of PCa; however, it could be a beneficial prognostic indicator particularly for progressed disease.

The Incidence and Related Risk Factors of Chronic Thromboembolic Pulmonary Hypertension after Acute Pulmonary Embolism.

OBJECTIVES: More than half of (> 50%) the patients with choronic thromboembolic pulmonary hypertension (CTEPH) have no acute pulmonary embolism history with clinical signs, so determining the actual incidence and prevalence of CTEPH is difficult. This study aimed to investigate the incidence of CTEPH and the risk factors that may be associated with CTEPH in patients with acute pulmonary thromboembolism (PTE). MATERIAL AND METHODS: Three hundred and eighteen patients with acute pulmonary embolism diagnosed by thorax CT or ventilation/perfussion scintigraphy in our clinic were included into this study. Patients with risk factors for pulmonary hypertension other than thromboembolic disease were excluded from the study. Patients with pulmonary hypertension (PHT) (systolic PAB > 35 mmHg) determined by echocardiography performed in the 6th month were enrolled into the study. RESULTS: Fifty-seven of the 112 patients were female, and the mean age was 57.09 ± 17.30 (16-86) years. Presence of PHT was determined in the 6th month in 45 of the 112 patients (8 of them were symptomatic) and CTEPH incidence (symptomatic + asymptomatic) was identified as 40.16%. Symptomatic CTEPH incidence was calculated as 7.14%. When we searched about the risk factors that may have a role in the development of CTEPH; we determined that CTEPH risk was increased 4.59 times by only being male (95% CI 1.071-19.683, p= 0.040), 218 times by previous history of DVT (95% CI 1.235-38543.073, p= 0.041), and 56.903 times by PaO2 < 80 mmHg (95% CI 2.656-1219.228, p= 0.010). CONCLUSION: CTEPH development after PTE is a situation that can occur in many patients. If probable risk factors are known, patients can be closely monitorized for CTEPH development.

Aflatoxin M1 in Tarhana chips.

Tarhana chips are a popular traditional fermented food consumed widely in the Kahramanmaras region of Turkey. Tarhana chips are different from many other types of fermented food in that they are produced in the form of tortilla chips. Cereal and yoghurt are the main ingredients in Tarhana chips. Aflatoxin M1 (AFM1) levels in dairy and dairy-based products are of concern for human health. To investigate AFM1 contamination, a total of 40 samples were collected from Kahramanmaras region and AFM1 levels were determined by competitive enzyme-linked immunosorbent assay (ELISA). Furthermore, physicochemical characteristics of Tarhana chips were investigated and compared with classic fried chips in terms of nutritional value. Based on data obtained from enzyme-linked immunosorbent assay, 21 (52.5%) out of 40 samples contained AFM1 in the range 0.5-36.6 ng/kg, so AFM1 levels of all samples were below the legal limit.

Ochratoxin A in grape pekmez (grape molasses) consumed in Turkey.

In this study, ochratoxin A (OTA) in 55 home-made, 20 commercial and 7 organic grape pekmez (grape molasses) produced in Turkey was investigated. OTA was detected in 73% of home-made pekmez samples, in 35% of commercial pekmez samples and in 71% of organic pekmez samples. Eleven per cent of the samples had OTA levels higher than 10 µg/l. The highest OTA level (31 µg/l) was detected in organic pekmez. The maximum OTA levels were 15 µg/l and 12 µg/l in home-made and commercial pekmez samples, respectively. Mean OTA levels were 3.5 µg/l, 1.4 µg/l and 9.2 µg/l in home-made, commercial and organic pekmez samples, respectively. Organic pekmez samples and home-made pekmez samples had higher OTA contamination than commercial pekmez samples. Results confirm OTA contamination in grape pekmez samples, indicating that the OTA level in grape pekmez could be a potential risk for consumers.

Determination of aflatoxin B1 levels in organic spices and herbs.

Organically produced spices and herbs were analyzed for determination of aflatoxin B1 (AFB1) by ELISA using immunoaffinity column. For this purpose 93 organic spices and 37 organic herbs were randomly selected from organic markets and organic shops in Turkey. AFB1 was detected in 58 organic spice and 32 organic herb samples. Among organic spice samples, the maximum value was detected in cinnamon sample (53 µg/kg). AFB1 was not detected in thyme samples. AFB1 levels of 41 organic spice samples were above the EU regulatory limit (5 µg/kg). Among organic herb samples the highest concentration of AFB1 (52.5 µg/kg) was detected in a rosehip sample. AFB1 levels of 21 organic herb samples were above the regulatory limits of the European Union. These results showed that more stringent measures must be taken for the prevention of mold contamination in the production of organic spices and herbs.

Several quality attributes of beef and turkey meat doner kebabs produced by traditional or continuous process.

The chemical, microbiological and sensory properties of doners produced by traditional or continuous processes were investigated. The production method (traditional or continuous) did not affect microbiological quality (p < 0.05). Doners produced by traditional process had generally better sensory properties than those produced by continuous process. Continuous process produced turkey meat doners with lesser fat content (p < 0.05), higher moisture content (p < 0.05). Even though, doners produced by the traditional process were given higher ratings by the sensory panel than those produced by the continuous process, the difference might not have any practical importance. Given the higher production capacity, continuous process is expected to replace traditional process in the years to come.

The effect of acid adaptation conditions on heat resistance of Escherichia coli O157: H7.

The objective of this study was to determine the effect of acid adaptation conditions on heat resistance of E. coli O157: H7 932. E. coli O157: H7 was adapted to acid by exposing the cells to pH 4.5 (2h), pH 5.0 (1 h), and pH 5.5 (1 h) in tryptic soy broth. D and z values of the acid adapted and control cultures at 54 degrees C, 56 degrees C, and 58 degrees C were determined in E buffer. The heat resistance of E. coli O157: H7 increased significantly (p<0.05) after acid adaptation at pH 4.5 or pH 5.0. E. coli O157: H7 adapted to acid at pH 4.5 for 2 h had the highest D values at all temperatures tested (20.3-10.7-3.3 min) while D values of culture adapted to acid at pH 5.0 for 1 h were 18.2, 7.9, and 2.6 min at 54 degrees C, 56 degrees C and 58 degrees C, respectively. Heat resistance of culture adapted to acid at pH 5.5 for 1 h and the control culture was not significantly different (P<0.05). Culture adapted to acid at pH 4.5 had the highest z value (5.10 degrees C), whereas control culture had the lowest z value (4.33 degrees C). This study showed that the magnitude of heat tolerance changed with the adaptation pH and at low adaptation pH, E. coli O157: H7 showed maximum heat resistance. Acid adaptation at pH 4.5 or 5.0 provides E. coli O157: H7 with cross-protection against heat treatments, and that this factor must be considered to estimate this pathogen's thermal tolerance accurately.