The prognostic impact of comorbidity, nutritional and performance status on patients with diffuse large B cell lymphoma.

Background: The aim of the study was to investigate the impact of nutritional status, comorbidity, and performance status on patients with diffuse large B-cell lymphoma (DLBCL). Methods: A retrospective study was conducted on 112 DLBCL patients who were diagnosed at our center between 2009 and 2018. Demographic and disease characteristics and laboratory test results were recorded. Assessments were made using the age-adjusted Charlson comorbidity index (CCI-A) for comorbidity, albumin level for nutritional status, and Eastern Cooperative Oncology Group (ECOG) score for performance status. Results: The mean age of the patients was found to be 62.63 ± 15.16 years. The ECOG score of 65 patients (69.1%) was in the range of 0-1. The mean follow-up time of the patients was determined to be 25.24 ± 25.11 months, and at the end of the follow-up period, 64 patients (57.1%) were survivors. The progression-free survival (PFS), overall survival (OS), and 5-year OS rates of those with CCI-A > 4 were found to be significantly lower than those with CCI-A score ≤4 (P < 0.05). As a result of the Cox-Regression (Backward: LR method) analysis, ECOG and albumin levels were found to be independent risk factors for both OS and PFS (P < 0.05). Conclusion: This study demonstrated that CCI-A, ECOG, and nutritional status are independent prognostic markers for DLBCL patients. Initial evaluation of these patients should include all these parameters, which are easily available at the time of diagnosis.

The utility of CONUT score in indolent lymphoma patients.

Background and Aim: Similar to the uncertainties in the treatment criteria for indolent non-Hodgkin lymphoma (iNHL), the prognostic criteria have not been fully clarified. The Controlled Nutritional Status (CONUT) score is not only used as a predictor of malnutrition but also indicates prognosis in many chronic or malignant diseases. The aim of this study is to investigate the predictive and prognostic significance of the CONUT score in patients with iNHL. Patients and Methods: A retrospective evaluation was made of 109 patients with iNHL. The CONUT scores of the patients were compared between those with an indication for treatment and those followed without treatment. The same analysis was performed between patients who developed relapse after treatment. Survival analysis was performed on all patients, and associations between survival and the CONUT score were examined. Results: The median CONUT score was found to be higher in those who had treatment indications compared to those who did not (2 vs 1; P = 0.014). In the regression model, a CONUT absolute value above 5 was found as an independent risk factor predicting relapse. In the whole study population, a CONUT absolute value >2 predicted the risk of mortality with 53.9% sensitivity and 68.7% specificity (AUC ± SE = 0.639 ± 0.07; +PV = 35%; -PV = 82.6%; P = 0.034). Conclusion: CONUT score is a predictive and prognostic factor for patients with iNHL. The development of simple, low-budget prognostic and predictive biomarkers is critical not only for determining the course of the disease but also for follow-up and treatment management.

The prognostic significance of blood counts in patients with hodgkin lymphoma.

Background and Aim: The aim of the study was to examine the demographic, clinical features, treatment responses, and outcomes of Hodgkin lymphoma (HL) patients and to investigate the factors affecting their survival. Patients and Methods: A retrospective analysis was made of patients diagnosed with HL in our department between 2009 and 2019. Treatment regimen, treatment response, and follow-up times were recorded for all patients. Using these data, complete response (CR) rates, overall survival (OS), and progression-free survival (PFS) were calculated. The effects of parameters on survival were investigated with Cox regression analysis. Results: Evaluation was made of 60 patients with a median age of 33.5 years [18.0-80.0] and mean follow-up duration of 29.34 ± 23.64 months. Median OS and PFS could not be reached with a mean OS of 85.6 months, and PFS of 71.7 months at the final visit. Only initial leukocyte and neurophil count were determined to have a statistically significant impact on survival (OR = 1.004; P = 0.031 vs OR = 0.996; P = 0.036). Conclusion: In HL patients, in addition to the many prognostic scoring systems, leukocyte and neutrophil count can be used as an independent prognostic parameter. Patients with higher leukocyte and lower neutrophil counts at the time of diagnosis should be managed more carefully.

Retrospective analysis of open preperitoneal mesh repair of complex inguinal hernias.

PURPOSE: The open posterior approach in the form of either a Stoppa or Wantz operation may be a good alternative technique particularly in the repair of complex inguinal hernias. The term "complex inguinal hernia" designates hernias with a combination of arduous features including large hernia defects, large to giant hernia sacs, multiple recurrences, and bilaterality. In this retrospective analysis, we investigated our results of open posterior repair in view of its feasibility in patients with complex inguinoscrotal hernias. METHODS: From a series of 845 inguinal hernia patients, we retrospectively reviewed the records of 60 patients with complex inguinal hernias whom were directed to open preperitoneal repair by either a Stoppa or Wantz procedure. RESULTS: More than 80% of cases were males with large to giant inguinoscrotal hernias. One half of patients had bilateral hernias, and one fourth had recurrent hernias. Early postoperative complications occurred in almost half of patients; however, most of them were minor. The most important early complication in this series was the full recurrences we encountered in the very next morning in two patients. Eighty-three percent of patients left hospital in the first 2 days averaging 1.8 days of hospital stay. The mesh:defect area ratio is < 7 in recurrent hernias while it is > 9 in nonrecurrent cases. CONCLUSION: The open posterior approach to complex inguinal hernias facilitated both handling and repair of difficult hernias. It was very well tolerated by the patients, and yielded favorable postoperative results. We think the open posterior repair may be a method of choice in the repair of complex inguinal hernias.

Effect of ripening time on peptide dynamics and bioactive peptide composition in Tulum cheese.

Skin bag Tulum cheeses traditionally produced in the Central Taurus region of Turkey were studied to identify peptide profiles by liquid chromatography-tandem mass spectrometry over 180 d of ripening. After mass spectrometry analysis, 203 peptides were identified: 59 from αS1-casein (CN), 11 from αS2-CN, 129 from ß-CN, and 4 from κ-CN. Numbers of αS1- and ß-CN-derived peptides increased with increasing number of ripening days due to the dependence of newly formed peptides on proteolysis. However, similar increases were not observed for αS2- and κ-CN-derived peptides. Most identified peptides consisted of ß-CN-derived peptides, followed by αS1-, αS2-, and κ-CN-derived peptides. Among these, bioactive peptides were found, including antihypertensive, antibacterial, antioxidant, dipeptidyl peptidase-4 inhibitory, metal chelating, skin regenerating, glucagon-like peptide-1 secretion enhancing, opioid, cathepsin B inhibitory, prolyl endopeptidase inhibitory, immunomodulatory, brain function improving, antiamnesic, antihypercholesterolemic, anti-inflammatory, and anticarcinogenic peptides.

The effect of ethical work climate on the organizational citizenship behavior of academic nurses.

AIM: This study demonstrates the effect of academic nurses' perceptions of ethical work climate on their organizational citizenship behaviour. BACKGROUND: Establishing healthy relationships in organizations and ensuring organizational effectiveness depend on workers' perception of organizational ethics and voluntary behaviours that improve their organizations. METHODS: This study was conducted with 644 academic nurses working in public institutions of higher education that offer nursing education at the undergraduate level in Turkey. The data were collected using a sociodemographic characteristics form, the Ethical Climate Scale and the Organizational Citizenship Behaviour Scale. The data were evaluated using statistical software. Approvals for the study were obtained from the institutions and their ethics committees, and the participants' consent was obtained. RESULTS: This study found there was a significant relationship between academic nurses' perception of ethical work climate and their organizational citizenship behaviour. Ethical work climate based on social responsibility had the most effect on organizational citizenship behaviour. CONCLUSIONS: Academic nurses' perceptions of ethical work climate affect their organizational citizenship behaviour. IMPLICATIONS FOR NURSING POLICY: Academic nurses should act in accordance with the laws and both professional and personal moral codes in the work environment, take into account team and institutional interests, be aware of their social responsibilities and be efficient. In this way, they can provide an ethical work environment and be a good organizational citizen based on volunteering and courtesy, thinking about team members, acting with advanced task awareness and supporting the development of the organization.

ASSOCIATIONS OF THYROID VOLUME AND FUNCTION WITH CHILDHOOD OBESITY.

CONTEXT: The links between obesity and thyroid function or thyroid volume in children are still controversial with limited available data. OBJECTIVE: This study aimed to examine thyroid function and volume in obese Turkish school-age children in comparison to normal-weight children. DESIGN: Cross-sectional study. SUBJECTS AND METHODS: One hundred obese children (47 boys, 53 girls; mean age 10.34±2.79 years) with a body mass index (BMI) above 95th percentile, and 100 normal-weight children (42 boys, 58 girls; 10.34±2.79 years) were included. The study parameters were BMI z score (Z-BMI), body surface area (BSA), thyroid volume, free thyroxine (fT4) and thyroid stimulating hormone (TSH) levels. RESULTS: The mean TSH and fT4 levels did not show a significant difference between obese and normal-weight children (p>0.05). The mean thyroid volume was higher in obese children (6.46±5.84 and 4.64±1.44, respectively; p=0.043). fT4 correlated negatively with Z-BMI in both normal-weight and obese children (r=-0.285, p=0.004 and r=-0.289, p=0.004, respectively). Thyroid volume, on the other hand, correlated positively with Z-BMI, again in both normal-weight and obese children (r=0.657, p<0.001 and r=0.444, p<0.001, respectively). Similar associations were found for BSA. CONCLUSIONS: Thyroid volume correlated positively and fT4 correlated negatively with Z-BMI and BSA, in both obese and normal-weight school-age children, whereas TSH appears to be independent of these parameters.

Protective effect of oxymatrine against renal ischemia/reperfusion injury in rats.

BACKGROUND: Renal ischemia/reperfusion (I/R) injury is a common cause of acute kidney injury. The pathologic mechanisms underlying renal I/R injury are complicated, involving reactive oxygen species, necrosis, cell apoptosis, and inflammation, but the exact mechanisms remain unclear. OBJECTIVES: This study aimed to investigate the effect of oxymatrine (OMT) on renal I/R injury and its underlying mechanism. METHODS: Thirty male Sprague-Dawley rats were randomly allocated to three groups (n = 10): the sham-control group, the renal I/R-untreated (I/R-untreated) group, and the I/R-OMT group. Renal I/R injury were induced by clamping the left renal artery for 45 min followed by 24 h of reperfusion. At 10 min before reperfusion, the rats in the I/R-OMT-treated group rats received an intravenous injection of 40 mg/kg OMT. Renal function and histological changes were compared and the relevant parameters of oxidative stress and inflammation were detected. RESULTS: Oxymatrine pretreatment significantly decreased the level of renal dysfunction, attenuated the renal histological changes, the levels of reactive oxygen species production in renal tissue upon I/R. Additionally, OMT pretreatment could further activate the serum antioxidant enzyme activities. CONCLUSION: The beneficial effects of OMT were likely mediated by the inhibition of lipid peroxidation and the increase in endogenous antioxidant activity. The results of this study indicate that oxymatrine may represent a potent anti-oxidant drug to protect the kidney against I/R injury (Fig. 5, Ref. 29).

High cholesterol diet leads to oxidant load and peroxidation in the rabbit kidney tissue.

OBJECTIVES: The aim of this study was to investigate possible effects of high cholesterol diet on oxidant/antioxidant status in rabbit kidney tissues. BACKGROUND: Although a number of experimental animal models have suggested that hyperlipidemia is associated with progressive kidney failure data remain sparse on the role of dietary cholesterol intake on kidney disease. METHODS: Twelve male New Zealand albino rabbits were randomly divided into two groups (control and cholesterol). Both groups were fed on a standard laboratory diet. Animals in the cholesterol group additionally received cholesterol (1 g/kg/day), orally. The study period was 12 weeks. Activities of catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), nitric oxide synthase (NOS), xanthine oxidase (XO), paraoxonase (PON), adenosine deaminase (ADA) enzymes and levels of malondialdehyde (MDA) and nitric oxide (NO) were measured in kidney tissue samples. Histological examination of the kidney tissue samples was also done. RESULTS: SOD, GSH-Px and XO enzyme activities were found to be decreased and NOS and PON activities increased significantly in cholesterol group compared to controls. As an indication of oxidation, MDA levels were found to be increased in cholesterol group. Histological examination revealed some derangements in the kidney tissue. CONCLUSION: High cholesterol diet creates oxidant load and causes peroxidation, which in turn, leads derangements in the rabbit kidney tissue (Tab. 2, Fig. 2, Ref. 69).

NLPC sin catéter versus NLPC estándar en la población geriátrica / Tubeless versus standard PCNL in geriatric population

Introducción y objetivo: La nefrolitotomía percutánea (NLPC) es un procedimiento estándar, seguro y eficaz para los cálculos renales de gran tamaño en todos los grupos de edad. La sonda de nefrostomía constituye una parte muy valiosa de la nefrolitotomía. Sin embargo, recientemente se ha modificado la sonda de nefrostomía al ser reemplazada por el catéter ureteral o la sonda doble J, gracias a los avances en urotecnología y en las herramientas quirúrgicas. El objetivo del presente artículo es evaluar la seguridad y la fiabilidad de la nefrolitotomía percutánea sin catéter en la población geriátrica. Métodos: Entre enero de 2009 y septiembre de 2013 un total 52 pacientes de 65 o más años con cálculos renales mayores de 2 cm fueron sometidos a NLPC. El primer grupo de 25 pacientes (48%), con una edad media de 70,0 años (des: +3,8) fueron sometidos a NLPC sin catéter, mientras que el segundo grupo formado por 27 (52%) pacientes con una edad media de 71,3 años (des: +4,0) fueron sometidos a NLPC estándar. Se compararon aleatoriamente y de forma retrospectiva los pacientes en términos de carga litiásica, necesidad de antibióticos, valores de creatinina, espesor del parénquima renal, índice de masa corporal (IMC), grado de Clavien, tiempo de hospitalización y estado libre de litiasis. Resultados: Se apreció que los grupos eran similares en cuanto a edad, IMC y sexo (p > 0,05). La carga litiásica, la duración del procedimiento quirúrgico y la tasa de empleo de analgésicos narcóticos fueron significativamente mayores desde el punto de vista estadístico en el grupo de NLPC estándar que en el grupo de NLPC sin catéter (p < 0,05). El tiempo de hospitalización fue de 1,7 días en el grupo de NLPC sin catéter y de 2,6 en el de NLPC estándar (p < 0,05). No se halló ninguna diferencia significativa entre los grupos en cuanto a una disminución en los niveles de hemoglobina, creatinina, los niveles de espesor del parénquima y el grado de Clavien, transfusiones preoperatorias de sangre, LEC previa, localización del cálculo, número de accesos y la tasa de éxito (p > 0,05). La carga litiásica fue de 900 mm2 (304-4.232) en el grupo de NLPC estándar y de 600 mm2 (220-2.660) en el grupo de NLPC sin catéter, siendo esta diferencia estadísticamente significativa (p = 0,014). Se alcanzó éxito global en el 96,0 y 96,3% de los pacientes sometidos a NLPC sin catéter y NLPC estándar, respectivamente, tras una sesión de NLPC. Conclusiones: Se determinó que la nefrolitotomía percutánea sin catéter es tan segura y eficaz como la NLPC estándar en la población geriátrica. Está especialmente recomendada en este grupo de pacientes dadas sus ventajas, como son un período de hospitalización más corto, una menor necesidad de analgésicos y una recuperación de la movilidad más rápida

Introduction and objectives: Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for large-volume renal calculi for all age groups. Nephrostomy tube constitutes an invaluable part of the nephrolithotomy operation. However, the nephrostomy tube has been recently replaced with ureteral catheter or double J-stent thanks to advances in urotechnology and operation equipment. The aim of the current article was to evaluate the safety and reliability of tubeless percutaneous nephrolithotomy in the geriatric population. Methods: Between January 2009 and September 2013, a total of 52 patients aged 65 years or elder with renal calculi bigger than 2 cm underwent PCNL operation. The first group of 25 patients (48%) with a mean age of 70.0 years (std: ±3,8) underwent tubeless PCNL whereas the second group consisting of 27 (52%) patients with a mean age of 71.3 years (std: ±4,0) underwent standard PCNL. The patients were randomly compared retrospectively in terms of burden of calculus, analgesic requirement, creatinine value, renal parenchymal thickness, Body-mass index (BMI), clavien score, length of hospitalization, and being calculus-free. Results: The groups were found to be similar in age, BMI, and gender (P > .05). Burden of calculus, duration of operation, and rate of narcotic analgesic use were found to be statistically significantly higher in the group of Standard PCNL group than in the Tubeless PCNL group (P < .05). Length of hospital stay was 1.7 days in the group of tubeless PCNL and 2.6 days in the standard PCNL group (P < .05). No significant difference was found between the groups in terms of fall in hemoglobin, creatinine, values of parenchymal thickness, and clavien score, preoperative blood transfusion, previous SWL, location of calculi, number of access, and rate of success (P > .05). Burden of calculus was 900 mm2 (304-4232) in the standard PCNL group and 600 mm2 (220-2660) in the tubeless PCNL group with the difference being statistically significant (P = .014). Overall success was achieved in 96.0 and 96.3% of tubeless PCNL and standard PCNL patients after one session of PCNL, respectively. Conclusions: Tubeless percutaneous nephrolithotomy was found to be as safe and effective as standard PCNL in the geriatric population. It is recommended especially in this group of patients because of its advantages such as shorter length of hospitalization, less analgesic requirement, and earlier mobilization

Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial.

OBJECTIVE: Patellofemoral joint osteoarthritis (PFJ OA) contributes considerably to knee OA symptoms. This study aimed to determine the efficacy of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA. METHODS: A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged ≥40 years with symptomatic and radiographic PFJ OA participated. Physiotherapists delivered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm); and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: 81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference: -15.2 mm, 95% CI -27.0 to -3.4). No significant effects on ADL were observed (5.8; 95% CI -0.6 to 12.1). At 9 months there were no significant effects for self-report of improvement, pain (-10.5 mm, 95% CI -22.7 to 1.8) or ADL (3.0, 95% CI -3.7 to 9.7). CONCLUSION: Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. However over 9-months, both options were equivalent. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12608000288325): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82878.

Tubeless versus standard PCNL in geriatric population.

INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for large-volume renal calculi for all age groups. Nephrostomy tube constitutes an invaluable part of the nephrolithotomy operation. However, the nephrostomy tube has been recently replaced with ureteral catheter or double J-stent thanks to advances in urotechnology and operation equipment. The aim of the current article was to evaluate the safety and reliability of tubeless percutaneous nephrolithotomy in the geriatric population. METHODS: Between January 2009 and September 2013, a total of 52 patients aged 65 years or elder with renal calculi bigger than 2cm underwent PCNL operation. The first group of 25 patients (48%) with a mean age of 70.0 years (std:±3,8) underwent tubeless PCNL whereas the second group consisting of 27 (52%) patients with a mean age of 71.3 years (std: ±4,0) underwent standard PCNL. The patients were randomly compared retrospectively in terms of burden of calculus, analgesic requirement, creatinine value, renal parenchymal thickness, Body-mass index (BMI), clavien score, length of hospitalization, and being calculus-free. RESULTS: The groups were found to be similar in age, BMI, and gender (P>.05). Burden of calculus, duration of operation, and rate of narcotic analgesic use were found to be statistically significantly higher in the group of Standard PCNL group than in the Tubeless PCNL group (P<.05). Length of hospital stay was 1.7 days in the group of tubeless PCNL and 2.6 days in the standard PCNL group (P<.05). No significant difference was found between the groups in terms of fall in hemoglobin, creatinine, values of parenchymal thickness, and clavien score, preoperative blood transfusion, previous SWL, location of calculi, number of access, and rate of success (P>.05). Burden of calculus was 900 mm2 (304-4232) in the standard PCNL group and 600mm(2) (220-2660) in the tubeless PCNL group with the difference being statistically significant (P=.014). Overall success was achieved in 96.0 and 96.3% of tubeless PCNL and standard PCNL patients after one session of PCNL, respectively. CONCLUSIONS: Tubeless percutaneous nephrolithotomy was found to be as safe and effective as standard PCNL in the geriatric population. It is recommended especially in this group of patients because of its advantages such as shorter length of hospitalization, less analgesic requirement, and earlier mobilization.

EFFECTS OF SOME BIOINSECTICIDES AND ENTOMOPATHOGENIC FUNGI ON COLORADO POTATO BEETLE (LEPTINOTARSA DECEMLINEATA L.).

In this study, biological activity of entomopathogenic fungi (4 strains) isolated from the Colorado potato beetle and the commercial biopesticides containing entomopathogenic fungi; Priority® (Paecilomyces fumosoroseus), Nibortem® (Verticillium lecanii), Nostalgist® (Beauveria bassiana), Bio-Magic* (Metarhizium anisopliae), Bio-Nematon* (Paeciliomyces sp.) and plant extracts; Nimbedicine EC* (Azadiractin) were determined against Leptinotarsa decemlineata under laboratory conditions. An Imidacloprid active ingredient commercial insecticide was also used to compare the insecticidal activity and distilled water was used as control. The biological control agents were applied to 2nd-3rd larval instars, 4th larval instars and adults with spray and leaf dipping methods. Single concentration (108 conidia/mL⁻¹) of entomopathogenic fungi and recommended dose of bioinsecticides were prepared for application. The number of dead insects were determined at 3, 5, and 7 days after applications. Experiments were conducted at 25 ±1° C and 60% ± 5 relative humidity with 16:8 h light: dark conditions. Entomopathogenic fungi and bioinsecticides were found to be more effective on larval stage than 4th larval instars and adults. In spray methods, Bio-Magic®, Nibortem®, and Nostalgist® caused 96.4%, 92.9% and 82.1% mortality on 2nd larval instars and 20%, 36.7% and 33.3% mortality on adults, respectively. All local fungal isolates (B. bassiana) applied on 2nd and 4th larval instars caused 100% mortality. Adults showed 58.6-86.2% mortality.

Healthcare information technology infrastructures in Turkey.

OBJECTIVES: The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Saglik-Net (Turkish for "Health-Net"), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Saglik-Net are also briefly summarized. METHODS: The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey. RESULTS: Saglik-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients' Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Saglik-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments. CONCLUSION: With the introduction of the "Health Transformation Program" in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality.

The role of preoperative B-mode and Doppler ultrasonography in predicting technical challenges for laparoscopic cholecystectomy.

PURPOSE: The aim of this study was to predict probable technical challenges before laparoscopic cholecystectomy and to operate the proper patient at the right time and by the right technique. METHODS: The study was performed in a tertiary reference hospital in six months. B-mod grey scale, colour, and power Doppler ultrasonographies were obtained for fifty consecutive patients for whom elective laparoscopic holecystectomies were planned. The technical difficulties were noted by a single surgeon observer while the teams were performing the operations. Neither the observer nor the members of the surgical team were aware of the preoperative test results. These two groups of parameters were compared. RESULTS: There were significant correlations between the technical challenges encountered during the operations and preoperative ultrasonographic measurements: the mean of gallbladder wall thickness, increasing power Doppler signal of the gallbladder wall, stone size and the gallbladder's stone loading pattern. CONCLUSION: B-mod grey scale and Doppler ultrasonography are the best tests at hand for predicting intraoperative challenges before laparoscopic surgery. It is important that the radiologist and surgeon reach consensus.

N-acetylcysteine prevents doxorubucine-induced cardiotoxicity in rats.

This study is designed to observe the effects of N-acetylcysteine (NAC) on doxorubucine-induced cardiac toxicity in rats both histologically and biochemically. Totally 32 rats divided equally into four groups were studied. The first group received only 200 mg/kg NAC intraperitoneal (i.p.) once every 24 h for 5 days (group 1); the second group received 20 mg/kg doxorubucine (DOX) i.p. single dose plus NAC 200 mg/kg i.p. once every 24 h for 5 days (group 2); the third group received DOX 20 mg/kg DOX i.p. single dose (group 3) and the fourth group, which is also the control group, received saline (group 4). Following 24 h of the final dose, blood samples were drawn from a portal vein and heart tissue were obtained. Tissue thiobarbituric acid reactive substance (TBARS) and nitric oxide (NO) levels were highest in the DOX group. In the DOX-treated rats, serum TBARS, NO, aspartate transaminase, lactate dehydrogenase and creatine kinase levels were highest when compared with other groups. Except for serum superoxide dismutase levels, all other parameters differed significantly between the DOX plus NAC group and the DOX group. In the DOX plus NAC group, general architecture was preserved better than the DOX group and myofibril loss was minimal compared with the DOX group. NAC demonstrated, both biochemically and histologically, to be effective in the prevention of DOX-induced cardiotoxicity in rat models. Evaluation of NAC's effect on DOX toxicity warrants further clinical trials on cancer patients.

Clinico-epidemiological study of caustic substance ingestion accidents in children in Anatolia: the DROOL score as a new prognostic tool.

BACKGROUND: To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study. METHODS: We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10-14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10-14 days) and late (> or = 21 days) dilatation patients who were referred for OBD by other hospitals. RESULTS: In total, 144 (71%) incidents occurred within the parents' home and 44 (22%) occurred at another individual's home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients' parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10-14 days. Timely endoscopy was performed within 10-14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS < or = 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients. CONCLUSIONS: Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10-14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (> or = 21 days). OBD can then also be started earlier in these patients.

Altered hip muscle forces during gait in people with patellofemoral osteoarthritis.

OBJECTIVES: The study aimed to (1) assess whether higher vasti (VASTI), gluteus medius (GMED), gluteus maximus (GMAX) and gluteus minimus (GMIN) forces are associated with participant characteristics (lower age, male gender) and clinical characteristics (lower radiographic disease severity, lower symptom severity and higher walking speed); and (2) determine whether hip and knee muscle forces are lower in people with patellofemoral joint (PFJ) osteoarthritis (OA) compared to those without PFJ OA. DESIGN: Sixty participants with PFJ OA and 18 (asymptomatic, no radiographic OA) controls ≥40 years were recruited from the community or via referrals. A three-dimensional musculoskeletal model was used in conjunction with optimisation theory to calculate lower-limb muscle forces during walking. Associations of peak muscle forces with participant and clinical characteristics were conducted using Pearson's r or independent t-tests and between-group comparisons of mean peak muscle forces performed with walking speed as a covariate. RESULTS: Peak muscle forces were not significantly associated with participant, symptomatic or radiographic-specific characteristics. Faster walking speed was associated with higher VASTI muscle force in the PFJ OA (r = 0.495; P < 0.001) and control groups (r = 0.727; P = 0.001) and higher GMAX muscle force (r = 0.593; P = 0.009) in the control group only. Individuals with PFJ OA (N = 60) walked with lower GMED and GMIN muscle forces than controls (N = 18): GMED, mean difference 0.15 [95% confidence interval (CI): 0.01 to 0.29] body weight (BW); GMIN, 0.03 [0.01 to 0.06] BW. No between-group differences were observed in VASTI or GMAX muscle force: VASTI, 0.10 [-0.11 to 0.31] BW; GMAX, 0.01 [-0.11 to 0.09] BW. CONCLUSION: Individuals with PFJ OA ambulate with lower peak hip abductor muscle forces than their healthy counterparts.

Investigation of ABCB1 gene polymorphism with colchicine response in Behçet's disease.

Colchicine is commonly used in the treatment of Behçet's disease. However, some patients are unresponsive to colchicine treatment. Adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1) transports colchicine out of cells. We investigated a possible association of C3435T polymorphism of the ABCB1 (MDR1) gene with colchicine response in patients with Behçet's disease. We randomly selected 97 patients with Behçet's disease, examined ABCB1 (MDR1) gene C3435T polymorphisms, and evaluated patient responses to colchicine. Forty-three patients were colchicine responsive, while the remaining 54 patients were unresponsive. No significant difference was found between genotypic and allelic frequencies of the ABCB1 C3435T polymorphisms in patients with Behçet's disease and healthy volunteers. Also, there was no significant difference among responsive and nonresponsive patients. We concluded that ABCB1 C3435T polymorphism is not associated with a colchicine response in patients with Behçet's disease.