Potential modifications of the PLASMIC scoring system for predicting thrombotic thrombocytopenic purpura: Sometimes, less is more.

INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening occlusive disease of the microcirculation characterized by systemic platelet plugs, organ ischemia, deep thrombocytopenia, and fragmentation of erythrocytes. One of the widely used scoring system to determine the clinical probability of TTP is the PLASMIC scoring system. This study aimed to evaluate the contribution of PLASMIC score modifications to sensitivity and specificity in patients with microangiopathic hemolytic anemia (MAHA) undergoing plasma exchange with a prediagnosis of TTP at our center. MATERIALS AND METHODS: The data of patients who were hospitalized with a previous diagnosis of MAHA and TTP and underwent plasma exchange at Bursa Uludag University, Faculty of Medicine, Department of Hematology between January 2000 and January 2022 were retrospectively analyzed. RESULTS: Overall, 33 patients (including 15 and 18 with and without TTP, respectively) were included in this study. Receiver operating characteristic (ROC) analysis revealed that the area under the curve (AUC) for the original PLASMIC score was 0.985 (95% confidence interval [95% CI]: 0.955-1.000), and AUC for the PLASMIC score without mean corpuscular volume (MCV) was 0.967 (95% CI: 0.910-1.000), which is close to the original AUC. With the removal of MCV from the scoring system, the sensitivity decreased from 100% to 93%, whereas the specificity increased from 33% to 78%. CONCLUSIONS: Based on the results of this validation study, removing MCV from the PLASMIC score led to the categorization of eight non-TTP cases in the low-risk category, and this could avoid unnecessary plasma exchange. However, in our study increasing the specificity was at the expense of the sensitivity by missing one patient with this new scoring system without MCV. Further multicenter studies with large sample sizes are required owing to the fact that different parameters may be effective in TTP prediction among different populations.

Serum and Milk Levels of Antibodies to Bovine Viral Diarrhoea Virus, Bovine Herpesvirus-1 and -4, and Circulation of Different Bovine Herpesvirus-4 Genotypes in Dairy Cattle with Clinical Mastitis.

Introduction: Bovine viral diarrhoea virus (BVDV) and bovine herpesvirus (BoHV)-1 and -4 are important causes of respiratory diseases and reproductive disorders of dairy cattle worldwide. Material and Methods: Investigation of BVDV and BoHV-1 and -4 antibody levels in the serum and milk of dairy cattle in a group with clinical mastitis and a healthy group was undertaken using an indirect ELISA, and identification of the BoHV-4 genotypes in clinical mastitis cases was attempted by PCR and sequencing. Results: Antibodies specific to BVDV, BoHV-1 and BoHV-4 were detected in the serum and milk of all dairy cattle with clinical mastitis. The cut-off values for BVDV and BoHV-1 in the sera and milk were extremely high in both healthy and mastitic animals. However, BoHV-4 antibodies were detected only in the clinically mastitic cattle, and BoHV-4 levels were higher in milk than in sera among these animals. Genotypes I and II of BoHV-4 were detected in the milk samples of four seropositive cows with clinical mastitis from the same herd. Conclusion: The results of this investigation demonstrate that clinical mastitis cases in the same herd may have aetiology in different BoHV-4 genotypes.

Does Food Safety Knowledge Affect Attitudes and Practices? A Preliminary Study of Turkish Veterinary Students.

This study aimed to evaluate effects of the food safety courses that veterinary medicine students take during their education at Kirikkale University, Turkey, on the students' food safety knowledge, attitudes, and practices. A questionnaire comprising demographic, knowledge, attitudes, and practices sections was developed, and eight experts performed the clarity test. The questionnaire was pilot-tested by 35 students. The final questionnaire was conducted among Kirikkale University first-year (freshmen) and fifth-year (senior) veterinary medicine students (n = 224). According to logistic regression analysis results, seniors were 2.8 times more likely than freshmen to have high-level knowledge. However, regardless of students' grades, knowledge level was not observed to correlate with students' behaviors. Additionally, no significant relation was found between knowledge level and gender, food safety career plan, or food poisoning experience (p > .05). Conspicuously, students who lived in a village before entering university were 5.3 times more likely to have high-level knowledge than those who lived in a city center. Overall, this study shows that food safety courses in the curriculum lead to an increase in students' level of food safety knowledge. However, although an increase in knowledge level positively influenced food safety attitudes, students had problems putting their knowledge and attitudes into practice. This may be overcome by focusing on practical courses that teach students how to apply learned knowledge in daily life.

Calcium fructoborate regulate colon cancer (Caco-2) cytotoxicity through modulation of apoptosis.

Sugar-borate esters have recently been reported to have anti-cancer potential. Among the sugar-borate esters, calcium fructoborate (CaFB) possesses beneficial effects on human health. Despite the beneficial effects of CaFB, there is a lack of knowledge about their mode of action in cancer. The potential cytotoxic effects of CaFB were investigated on colon cancer cells (Caco-2). The mode of action was determined through the evaluation of Fyn and Hck expression levels together with Bcl-2, Bax, and PI3K/Akt pathway proteins. CaFB treatment was found to be most effective on Caco-2 cells at 10 mM concentration for 24 h. Decreased Bcl-2 levels and increased Bax levels at 10 mM were evaluated as an indicator of apoptotic effects of CaFB. Akt, p70S6K, and 4EBP1 levels, in general, tend to decrease following CaFB, while PTEN and TSC2 levels have been found to increase. Furthermore, CaFB upregulated Hck expression and downregulated Fyn expression. In conclusion, our results indicated that CaFB treatment at 10 mM concentration, the IC50 dose found in our study, might prevent colon cancer cell proliferation both by inducing apoptosis and presumably by activating autophagy.

BVDV, BHV-1 and BLV antibodies in dromedary camels of Turkey kept without and with ruminants.

Camels are the only animals bred to sustain the tradition of wrestling in Turkey and are reared within a limited set of geographic areas. Farmers of such animals may also be engaged in ruminant breeding. The current research was aimed at documenting bovine viral diarrhoea virus (BVDV), bovine herpesvirus-1 (BHV-1), and bovine leukaemia virus (BLV) infections in sera collected from dromedary camels in four different geographical regions of Turkey during the years 2019-2021. All samples were tested for BVDV, BHV-1 and BLV antibodies as well as BVDV antigen by ELISA. Antibodies against BVDV were found in 16.8% of the camel sera tested. However, none of the camels sampled were positive in terms of BHV-1 and BLV antibodies as well as BVDV antigen. The prevalence was observed higher in the herds in which ruminants were raised in addition to camels (OR = 4.583, 95% CI, 1.298-16.182), (p = 0.018), while the prevalence was observed lower in the herds in which only camels were raised. This study showed that BVDV infection was more prevalent than BHV-1 and BLV infections in Turkish dromedary camels. Herewith, the camels, being a susceptible species to numerous viral ruminant diseases, may also serve as an important source of BVDV infection for other ruminant animals in the same flock.

Investigation of Factors Influencing Thoroughbred Horses' Racing Career Length in Turkey.

The aim of this research was to determine the average length of a Thoroughbred horse's racing career in Turkey using survival functions of Thoroughbred horses with various characteristics. In addition, the aim was to identify risk factors that could influence the duration of a Thoroughbred horse's racing career and develop a survival model that took these factors into account. A total of 11,721 Thoroughbred horses born in 2007 and later were included in the study population. The horses involved in the study were followed for a minimum of 1 year. Kaplan-Meier analysis was used to calculate the average length of racing career for each factor studied. Extended Cox regression analysis was used to determine the risk factors upon time of career ending and to create a survival model. Results showed that, the mean career length of Thoroughbred horses was 17.79 months (95% CI: 17.41-18.13). Also, "starting age of the race," "number of starts," "type of track where the race started," "racing on a single type racetrack" and "earning status" were found risk factors that affect the length of the racing career. Earnings was the top relative contributor to the established model, and its sole adjusted effect showed that being in the lowest earning group increased the hazard of career ending 2.28 times (95% CI:1.98-2.61) compared to horses with highest earning group. In conclusion, clear differences upon the length of racing career was observed for each investigated factor. Future studies should be considerate of these differences when analyzing population data.

Do reporting guidelines have an impact? Empirical assessment of changes in reporting before and after the PRISMA extension statement for network meta-analysis.

BACKGROUND: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for network meta-analysis (NMA) published in 2015 promotes comprehensive reporting in published systematic reviews with NMA. PRISMA-NMA includes 32 items: 27 core items as indicated in the 2009 PRISMA Statement and five items specific to the reporting of NMAs. Although NMA reporting is improving, it is unclear whether PRISMA-NMA has accelerated this improvement. We aimed to investigate the impact of PRISMA-NMA and highlight key items that require attention and improvement. METHODS: We updated our previous collection of NMAs with articles published between April 2015 and July 2018. We assessed the completeness of reporting for each NMA, including main manuscript and online supplements, using the PRISMA-NMA checklist. The PRISMA-NMA checklist originally includes 32 total items (i.e. a 32-point scale original PRISMA-NMA score). We also prepared a modified version of the PRISMA-NMA checklist with 49 items to evaluate separately at a more granular level all multiple-content items (i.e. a 49-point scale modified PRISMA-NMA score). We compared average reporting scores of articles published until and after 2015. RESULTS: In the 1144 included NMAs the mean modified PRISMA-NMA score was 32.1 (95% CI 31.8-32.4) of a possible 49-excellence-score. For 1-year increase, the mean modified score increased by 0.96 (95% CI 0.32 to 1.59) for 389 NMAs published until 2015 and by 0.53 (95% CI 0.02 to 1.04) for 755 NMAs published after 2015. The mean modified PRISMA-NMA score for NMAs published after 2015 was higher by 0.81 (95% CI 0.23 to 1.39) compared to before 2015 when adjusting for journal impact factor, type of review, funding, and treatment category. Description of summary effect sizes to be used, presentation of individual study data, sources of funding for the systematic review, and role of funders dropped in frequency after 2015 by 6-16%. CONCLUSIONS: NMAs published after 2015 more frequently reported the five items associated with NMA compared to those published until 2015. However, improvement in reporting after 2015 is compatible with that observed on a yearly basis until 2015, and hence, it could not be attributed solely to the publication of the PRISMA-NMA.

Seasonal and Age-Associated Pathogen Distribution in Newborn Calves with Diarrhea Admitted to ICU.

Calf mortality constitutes a substantial loss for agriculture economy-based countries and is also a significant herd problem in developed countries. However, the occurrence and frequency of responsible gastro-intestinal (GI) pathogens in severe newborn diarrhea is still not well known. We aimed to determine the seasonal and age-associated pathogen distribution of severe diarrhea in newborn calves admitted to the intensive care unit (ICU) of Erciyes University animal hospital over a year. Fecal samples were collected during the ICU admissions, and specimens were subjected to a diarrheal pathogen screening panel that included bovine coronavirus (BCoV), Cryptosporidium spp., ETEC K99+, and bovine rotavirus, using RT-PCR and conventional PCR methods. Further isolation experiments were performed with permissive cell cultures and bacterial enrichment methods to identify the clinical importance of infectious pathogen shedding in the ICU. Among the hospitalized calves aged less than 45 days old, the majority of calves originated from small farms (85.9%). The pathogen that most frequently occurred was Cryptosporidium spp. (61.5%) followed by rotavirus (56.4%). The frequency of animal admission to ICU and GI pathogen identification was higher during the winter season (44.9%) when compared to other seasons. Most calves included in the study were 1-6 days old (44.9%). Lastly, co-infection with rotavirus and Cryptosporidium spp. occurred more frequently than other dual or multi-infection events. This study was the first to define severe diarrhea-causing GI pathogens from ICU admitted newborn calves in Turkey.

Volumetric regression ratio of the primary tumor and metastatic lymph nodes after induction chemotherapy predicts overall survival in head and neck squamous cell carcinoma: a retrospective analysis.

PURPOSE: We looked for any predictive value of change in primary tumor and metastatic lymph node volumes after induction chemotherapy (IC) on oncologic outcome in head and neck squamous cell carcinoma (HNSCC). METHODS: Nineteen patients with stage IVA/B HNSCC treated between 2004 and 2010 with at least one cycle of IC (docetaxel, cisplatin and 5-fluorouracil/TPF) and concomitant chemoradiotherapy (CRT) with cisplatin were retrospectively analyzed. Volumes were calculated separately for primary tumor (Vtm), lymph node metastases (Vln) and their sum (Vsum) on computed tomography (CT) images before and after IC. The effect of volumetric changes on locoregional failure (LRF), distant metastasis (DM) and overall survival (OS) was assessed. P values <0.05 were considered as statistically significant. RESULTS: The median follow-up of surviving patients was 25 months (range: 10.7-83.3). The median number of cycles and duration of TPF was 3 (range: 1-4) and 44 days (range: 4-116), respectively. Empirical area under the curve (AUC) analyses for death, LRF and DM revealed optimal cut-off values of Vtm diminution (30.54%, AUC: 87%) and Vsum decrease (35.45%, AUC: 64.55%) only for OS (p <0.05). Among those, a reduction in Vsum more than 35.4% between pre- and post-IC was significantly correlated with better OS (100 vs 43% at 2 years, p <0.05). CONCLUSION: Volumetric shrinkage of the tumor load after IC assessed with CT seems to predict OS. The assessment of volumetric shrinkage upon IC might be used to decide whether to offer patients alternative strategies like palliative/de-intensified treatments or more aggressive combined modalities after IC.

Fistula tract curettage and the use of biological dermal plugs improve high transsphincteric fistula healing in an animal model.

PURPOSE: The treatment of high transsphincteric fistula is a complex procedure, which may be associated with the risk of recurrence and fecal incontinence. In this study, we used an animal model to compare different types of sphincter-preserving treatments for transsphincteric fistula. METHODS: Sixteen female New Zealand rabbits, weighing 2.8-4.8 kg underwent a surgical creation of high transsphincteric fistula. After 6 weeks, magnetic resonance imaging (MRI) was performed in order to confirm fistula formation and measure the fistula diameter. The rabbits were divided into three groups. Group 1 received no plug treatment (control). Autologous dermal graft and acellular dermal matrix were used as a plug in groups 2 and 3, respectively. Five weeks after treatment, fistula tract healing was determined by measuring the largest fistula diameter with MRI. All rabbits were euthanized and the anorectum excised en bloc for histopathological examination. RESULTS: According to the MRI findings, all groups showed significant healing after the treatment (p < 0.05). The healing rate of fistula diameters after treatment was 40, 66, and 29% in the control, dermal graft, and acellular dermal matrix groups, respectively. In terms of negative healing parameters such as neutrophil, eosinophil, lymphocyte, and plasmocyte accumulation, dermal graft and acellular dermal matrix groups showed significantly lower results than those in the control group (p < 0.05). CONCLUSION: According to MRI and histopathological results, fistula tract curettage and fistula orifice closure improved transsphincteric anal fistula healing. Additionally, in this study, plug treatment favoring autologous dermal graft resulted in better healing.

Dosimetric evaluation of nasopharyngeal carcinomas irradiated with different IMRT techniques.

PURPOSE: To evaluate the performance of volumetric arc therapy (VMAT), dynamic intensity modulated radiotherapy (IMRT) and step-and-shoot IMRT techniques in nasopharyngeal cancer (NPC) patients. METHODS: IMRT plans of 48 NPC patients treated between May 2010 and December 2012, were evaluated. Twenty two patients were planned with VMAT, 18 with dynamic IMRT and 8 with step-and-shoot IMRT. Conformity index (CI) and homogeneity index (HI), the dosimetry of the planning target volumes (PTVs) and organs at risk (OARs) and the monitor units (MU) were evaluated for each IMRT modality. RESULTS: The conformity indices of VMAT and dynamic IMRT were better than step-and-shoot IMRT plans (p<0.05). Step-and-shoot IMRT plans provided better homogeneity than VMAT (p=0.01). MUs for dynamic IMRT were much higher compared to VMAT (p<0.01) and step and- shoot IMRT (p<0.01). There was no significant difference between the 3 techniques in terms of PTV70 mean doses. When compared with step-and-shoot IMRT, VMAT and dynamic IMRT had a better sparing effect on optic nerves, eyes and optic chiasm (p<0.05). VMAT plans performed better sparing for brain stem than dynamic IMRT (p=0.01). There was a remarkable decrease in the maximum doses of VMAT to the eye. CONCLUSIONS: VMAT outperforms dynamic IMRT by effectively reducing the MU and the dose to some OARs, with adequate PTV coverage. Also, VMAT provides better sparing of normal tissue and conformity than step-and-shoot IMRT. Differences between step-and-shoot IMRT and dynamic IMRT are thought to be due to technical differences of linear accelerator devices like fiber size, variable fiber, dose rate and gantry.

Evaluation of body composition parameters in patients with psoriasis.

BACKGROUND: Body composition parameters, such as weight, body mass index (BMI), and visceral fat rating, have been found to be associated with psoriasis. However, the associations of these parameters with psoriasis have not been demonstrated clearly. OBJECTIVES: This study aimed to evaluate body composition parameters in patients with psoriasis. METHODS: The relationships between the various body composition parameters and psoriasis were retrospectively examined in 242 patients with plaque psoriasis (119 women, 123 men) over a 2-year period during 2010-2012. In addition, the correlations between body composition parameters and Psoriasis Area and Severity Index (PASI) score were evaluated in treated and untreated patients with psoriasis. Patients were divided into two groups according to whether or not they had received systemic therapy within the previous three months. Body composition values were measured using the Tanita SC-330 Body Composition Analyzer(®). RESULTS: Statistically significant differences were recorded in terms of weight (kg), body fat percentage, fat mass (kg), total body water (TBW) percentage, metabolic age, visceral fat rating, BMI, and degree of obesity among treated and untreated patients and control subjects. Differences in fat-free mass (FFM) (kg), muscle mass (kg), TBW (kg), and bone mass (kg) were found to be close to the limit for significance. The treated and untreated groups showed no significant differences in any of the parameters evaluated. The correlations between PASI score and the various parameters provided some evidence for such relationships. CONCLUSIONS: The present study provides evidence of a relationship between some body composition parameters and the occurrence of psoriasis. We suggest that body composition parameters should be analyzed not only in obese psoriasis patients but in all psoriasis patients upon their first diagnosis. Systemic therapy does not appear to cause any changes in body composition parameters.

Does rectum and bladder dose vary during the course of image-guided radiotherapy in the postprostatectomy setting?

AIMS AND BACKGROUND: To assess the variations in actual doses delivered to the rectum and bladder in the course of postprostatectomy radiotherapy using kilovoltage-cone-beam computed tomography datasets acquired during image-guided radiotherapy. METHODS AND STUDY DESIGN: Twenty consecutive patients treated with intensity-modulated or intensity-modulated arc therapy to the prostate bed were retrospectively evaluated. Both the planning tomography and kilovoltage-cone-beam computed tomography were acquired with an empty rectum and a half-full bladder. Target localization was performed on the basis of soft tissue matching using cone-beam computed tomography scans before each treatment fraction. A total of 16 cone-beam computed tomography scans per patient (acquired at the first 5 fractions and twice weekly thereafter) were used for the assessments. The bladder and rectum were re-contoured offline on each cone-beam computed tomography scan by a single physician, and the delivered doses were recalculated. The variations in certain dose-volume parameters for the rectum and bladder (BD2cc, RD 2cc, V40%, V50%, V60%, V65%) were analyzed using the paired t test. RESULTS: Most of the dose volume variations for rectum and bladder were significantly higher than predicted (P <0.05) for the 320 kilovoltage-cone-beam computed tomography sets, except for the doses received by 2 cc of the bladder and V50 and V60 of the rectum. The dose-volume parameters of the bladder did not meet our criteria of V65 ≤25% and V40 ≤50% in 10% and 20% of the patients, respectively. None of the dose-volume histograms showed rectal V65 ≥17%; however, the rectal V40 ≤35% dose constraint was not met in 11 patients. For all patients, the ANOVA test revealed no significant difference between the variations. CONCLUSION: Actual doses delivered during treatment were found to be higher than predicted, but the majority of calculated bladder and rectal doses remained in the limits of our plan acceptance criteria. Interfraction variability of the rectum and bladder is a major concern in the postprostatectomy radiotherapy setting, even when patients are instructed about rectal and bladder preparation before the radiotherapy course. Image guidance with cone-beam computed tomography at each treatment fraction may offer a viable tool to account for interfraction variations of the rectum and bladder throughout the treatment course.