Multidisciplinary treatment and functional outcome evaluation of combined injuries of nerves, vessels, and flexor tendons: spaghetti wrist.

OBJECTIVE: In this study, we aimed to evaluate the effectiveness of the modified Kessler technique in managing spaghetti wrist lacerations by multidisciplinary treatment. PATIENTS AND METHODS: Patients who were operated and followed up with the diagnosis of spaghetti wrist tears in our clinic between January 2012 and December 2020 were included in the study. In the postoperative follow-ups, the parameters evaluating the functionality of the patients were examined. RESULTS: Patients were 105 male (86.7%) and 16 women (13.2%), with a mean age of 36.83 ± 16.38 years. At the final follow-up, functional outcomes were assessed. The most common injury mechanism was glass-related injuries (35.5%). The mean starting surgery time of the patients was 4.64±2.98 hours. The most frequently involved structures were the palmaris longus with a rate of 51% and the flexor digitorum superficialis with a rate of 45%. There were significant differences regarding intrinsic function and grip strength between male and female patients (p = 0.04, p = 0.21, respectively). There were significant differences regarding sensation and grip strength between smoker and nonsmoker patients (p = 0.03, p = 0.01, respectively). The number of the damaged structures was negatively correlated with postsurgical functional outcomes of four tests, including tendon function, opposition, intrinsic function, and grip strength. The physical therapy period was correlated to hand function tests (r = 0.756, p < 0.05). Nerve damage was negatively correlated with sensation (p = 0.011, r = -0.932). CONCLUSIONS: The modified Kessler technique is reliable with functional outcomes for spaghetti wrist injuries involving tendons, nerves, and arteries. Meticulous and early surgical treatment within the first 8 hours of spaghetti wrist injury and early initiation and long-term physical therapy are vital in patients' functional outcomes.

The relationship of preoperative hematologic parameters to invasion of anatomic structures and recurrence in tenosynovial giant-cell tumor of the digits.

Although the pathogenesis of Teno-Synovial Giant Cell Tumor (TSGCT) is not known, inflammation is thought to play a role in the etiology beside some other factors. Many researchers have found a close relationship between hematological parameters such as Mean Platelet Volume (MPV), Platelet/MPV Ratio (Plt/MPV), Monocyte/Neutrophil Ratio (MNR), Neutrophil/Lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR) and certain inflammatory, autoimmune and neoplastic diseases. The aim of the present study was to assess the relationship of hematological parameters (NLR, MNR and Plt/MPV) to tumor recurrence and spread after TSGCT surgery. Data from 102 patients who matched the inclusion criteria comprised preoperative hematological parameters, tumor size, anatomic region, side, presence of bone invasion, proximity to joints or neurovascular structures, and postoperative recurrence and complications. The mean follow-up was 54.2 months (±26.5). Recurrence was observed in 12 (11.8%) of the 102 cases. No significant correlation was found between recurrence and hematologic parameter, age, laterality (right-left) or zone (volar-dorsal). There were no significant differences in NLR, Plt/MPV or MNR between patients with and without bone, capsular, nerve or total involvement. The study thus showed that the various inflammatory parameters (NLR, Plt/MPV and MNR) calculated from blood count were not predictive of tumor invasion into anatomical structures or of digital TSGCT recurrence.

Comparison of the results of percutaneous and open screw fixation in the treatment of scaphoid nonunion fractures.

OBJECTIVE: Our study aims to compare the clinical results of percutaneous screw fixation and non-vascularized bone grafting with open screw fixation in patients who did not achieve union due to failure in diagnosis and treatment after a scaphoid fracture. PATIENTS AND METHODS: Forty-three patients with scaphoid nonunion fractures corresponding to the first three Slade and Dodds classification were divided into two groups. Non-vascularized bone grafting with open reduction and internal fixation (ORIF) was applied to 24 patients in the first group, and 19 patients in the second group were treated with a closed reduction and internal fixation (CRIF) (percutaneous screw fixation). The patients were followed up for preoperative and postoperative functional scores and time to union. RESULTS: Our study found that the scaphoid was most commonly fractured in the waist of the scaphoid. In our study, we found that distal scaphoid fractures had the highest union rate (100%), followed by the waist fractures (93.2%) and the weakest union (50%) in the proximal pole fractures. We observed that the fastest union had occurred in the fractures of the waist. We also observed that the union was completed earlier in patients who operated with ORIF than those with CRIF. We found union in 87.5% of patients who underwent ORIF, in 84.2% of patients who underwent CRIF. CRIF operation duration was shorter than expected from ORIF operation duration. CONCLUSIONS: We found that similar union rates could be achieved in the patient groups who underwent percutaneous and open screw fixation by selecting the appropriate patient in scaphoid nonunion fractures. Union was faster and functional results were more satisfactory in the ORIF group. The operation time was shorter in the CRIF group.

Comparison Of The Problem Solving Skills Levels Of Health Department Students Educed At Undergraduate And Associate Degree Level

@#Our study was conducted with the aim of comparing the parameters such as personal control, self-care level, academic achievement and family characteristics that affect the problem solving skill levels of undergraduate and associate degree students studying in health departments. Our research is cross-sectional; those who study at the same university in one year; It was carried out on 200 students, 100 of whom are at undergraduate level and 100 of whom are at associate degree level. In order to obtain the demographic information of the students; The personal data collection form created by the researchers was used and the "Problem Solving Inventory (PSI)" was used to determine problem solving skill levels.Data collection forms and questionnaires were applied with one-on-one interview technique. The voluntariness of the participants was taken as a basis in filling out the questionnaires. After the descriptive statistics (frequency, mean, standard deviation) of the socio-demographic data obtained and the scale scores and sub-dimension scores were made, two independent groups were compared by looking at their normal distribution conformity. The mean age of associate degree students participating in our study was 20.6 ± 1.26, and 20.8 ± 3.07 for undergraduate students. In comparisons made with PSI, which consists of three different sub-parameters, associate degree students are significantly more successful than undergraduate students in terms of "approach-avoidance", "personal control" and "problem solving questionnaire total score" (p>0.05). No difference was found in terms of "confidence in problem solving ability" sub-dimension. In the comparison of the Problem Solving Questionnaire by gender; no significant difference was found in sub-dimensions and total score(p>0.05). As a result; In all comparisons, problem solving abilities do not differ according to gender. The problem solving skill level was found to be moderate for both genders. As the education level increases; The psychological state, which has an effect on the quality of life, increases in the negative direction. In terms of problem solving abilities, a negative correlation was found with education level in all sub-categories.

Evaluation Of The Quality Of Life Levels Of Undergraduate And Associate Degree Students Studying In Health Departments

@#Quality of life is at the forefront of the goals that all societies aim to achieve today. This is the main reason why measuring quality of life is a routine procedure in many studies. This study was carried out by undergraduate and associate degree students of health sciences; the aim of this study was to evaluate and compare the quality of life. The research was carried out on a total of 200 undergraduate and associate degree students studying in the health sciences departments of the same university in a one-year period. In order to obtain the demographic information of the students; the personal data collection form created by the researchers and the World Health Organization Quality of Life Scale-Short Form (WHOQOL-Bref) were applied by one to one interview technique. The voluntariness of the participants was taken as a basis in filling out the questionnaires. SPSS-22 program was used to evaluate the data in our study. By making descriptive statistics, two independent groups were compared between the groups. The mean age of the associate degree students participating in our study was 20.6 ± 1.26, and the undergraduate students were 20.8 ± 3.07. When the last question, the 27th environmental question, is included in the WHOQOL-Bref scale, which consists of four sub-parameters, the name of the scale is named WHOQOL-Bref-TR. In our study, which we evaluated with WHOQOL-Bref-TR, the scores of undergraduate students in the "psychological field" sub-category were found to be significantly higher (p>0.05) than associate degree students in comparisons made based on education level. In the comparison made according to genders, the difference in general health, psychological, and environmental dimensions was not significant (p>0.05). In conclusion; in all comparisons, the level of quality of life and problem solving abilities do not differ depending on gender. As the education level increases; the psychological state, which has an effect on the quality of life, increases positively. With the data obtained, suggestions were made to curriculum arrangements and university administrations in order to increase the quality of life of young adults.

Successful Renal Transplantation, Bone Mineral Densitometry, and Affecting Factors.

BACKGROUND: Successful renal transplantation corrects many disorders of bone and mineral metabolism owing to the normalization of serum levels of calcium and phosphorus and restoration of calcitriol production. However, successful transplantation does not guarantee complete resolution of the pre-transplantation osteopathy. METHODS: This study evaluated 100 patients who underwent successful renal transplantation. We determined the possible risk factors for osteoporosis among 72 male and 28 female renal transplant patients of mean age 32.3 ± 10.0 years with 81% of them recipients of living-related grafts. Bone mineral densitometry (BMD) was performed in all patients before and ≥ 1 year after transplantation. Routine test results and demographic data were recorded. RESULTS: At the time of transplantation 76% of the patients had osteoporosis or osteopeni and only 24% of them had normal BMD in 4 regions (femur neck, lumber, radius, and ultradistal). After transplantation, 70% of them had osteopororosis or osteopeni and 30% were normal. After renal transplantation, BMD scores increased (P > .05) although the diagnosis of the bone disease did not change (P < .05). Only preexisting osteodystrophy and smoking were found to be important risk factors for post-transplantation osteoporosis. CONCLUSIONS: After renal transplantation, BMD scores increased whereas the diagnosis of bone disease did not change statistically. We found that medical management of osteopenia/osteoporosis before transplantation and smoking habit are the main factors to prevent post-transplantation osteoporosis. Further long-term studies may be more helpful for evaluating the risk factors of post-transplantation osteoporosis.

Sagittal abdominal diameter as an anthropometric measure of cardiovascular and graft loss risk in renal transplant recipients.

BACKGROUND: Sagittal abdominal diameter (SAD) has been presented as a stronger prognostic factor for all-cause and cardiovascular mortality in the general population. The aim of this study was to evaluate the relationship between SAD and its associated parameters in renal transplant recipients. METHODS: One hundred eighty-one renal transplant recipients were enrolled in the study. All patients were evaluated according to standard clinical and biochemical parameters. Anthropometric measurements were performed for all patients. Pulse-wave velocity (PWV) was determined from pressure tracing over carotid and femoral arteries with the use of the Sphygmocor system. RESULTS: Patients were divided into 2 groups according to SAD measurements. Group 1 (n = 127) was defined as SAD <24.3 cm, and group 2 (n = 54) was defined as SAD ≥ 24.3 cm. Patients in group 2 had significantly higher triglycerides, C-reactive protein (CRP), uric acid, systolic blood pressure, PWV, and body mass index measurements compared with group 1 (P < .05 for all). In group 2, estimated glomerular filtration rate (eGFR) was significantly lower than group 1 (P = .022). SAD had positive correlation with PWV, systolic and diastolic blood pressure, body mass index, triglycerides, fasting glucose, CRP, and uric acid (P < .05 for all). On stepwise linear regression analyses, proteinuria (P = .005), SAD (P = .001), and CRP (P = .015) independently predicted the degree of percentage change of eGFR. CONCLUSIONS: Considering the significant association of visceral fat with inflammation and cardiovascular disease, estimating visceral fat by means of SAD could be a useful tool to stratify cardiovascular risk as well as graft function in renal transplant recipients.

Post-transplant C-reactive protein predicts arterial stiffness and graft function in renal transplant recipients.

BACKGROUND: The aim of this study was to evaluate the renal and cardiovascular outcomes of post-transplant c-reactive protein (CRP) levels. METHODS: One hundred fifty renal transplant recipients (113 men; median age, 38.9 ± 10.8 years) were cross-sectionally analyzed. Mean pre-transplant and post-transplant CRP levels were analyzed by the 1(st), 3(rd), 6(th), 12(th), and 24(th) months of transplantation. Patients were divided into 3 groups according to mean post-transplantation CRP levels: group 1 (CRP >20 mg/L and fluctuating levels; n = 34), group 2 (CRP, 6-20 mg/L; n = 40), and group 3 (CRP <6 mg/L; n = 76). Arterial stiffness was measured by means of carotid femoral pulse-wave velocity (PWv) by use of the SphygmoCor system. RESULTS: Patients in group 1 had significantly lower estimated glomerular filtration rate (eGFR) (P = .000) and left ventricular systolic function and higher duration of dialysis before transplantation, pulse-wave velocity (PWv), proteinuria, and left ventricular mass index when compared with the other two groups. In regression analysis, eGFR and PWv were detected as the predictors of post-transplantation CRP levels. CONCLUSIONS: Fluctuating and high stable (>20 mg/L) post-transplant CRP levels predict eGFR, proteinuria, left ventricular mass index, and PWv after transplantation. Thus, CRP levels may be a useful marker to anticipate graft survival and cardiovascular morbidity in renal transplant recipients.

Graft function and arterial stiffness: can bioimpedance analysis be useful in renal transplant recipients?

OBJECTIVE: We aimed to determine the total body water (TBW) by means of bioimpedance analysis (BIA) and to analyze the association of TBW, graft function, and arterial stiffness by means of pulse-wave velocity (PWV) and echocardiographic measurements in renal transplant (RT) recipients. METHODS: Eighty-two RT recipients (mean age, 38.7 ± 11.5 y; 58 male) who were using ≥1 antihypertensive treatment were enrolled in the study. Biochemical parameters, 24-hour urinary protein loss, estimated glomerular filtration rate (eGFR), transthoracic echocardiography, bioimpedance analysis according to systolic blood pressure, TBW, lean tissue index (LTI), extracellular water (ECW), intracellular water (ICW), lean tissue mass (LTM), phase angle (Phi50) levels, and renal resistive index (RRI) were evaluated. RESULTS: TBW and ECW were significantly correlated with systolic blood pressure. Urinary protein loss, pulmonary artery pressure, frequency of overhydration, systolic blood pressure, TBW, LTI, ECW, ICW, LTM, and Phi50 values were significantly higher in patients with estimated glomerular filtration rate (eGFR) 15-49 mL/min but similar in patients with eGFR 50-70 mL/min. CONCLUSIONS: Hypertensive RT recipients have increased TBW, LTI, ICW, FTI, LTM, and Phi50 values. Graft function is positively correlated with systolic blood pressure and BIA parameters. Therefore, hypertensive RT recipients should be closely followed with the use of BIA for an early diagnosis of loss of graft function.

Relationship between inflammation and sex hormone profile in female patients receiving different types of renal replacement therapy.

BACKGROUND: Patients with end-stage renal disease (ESRD) experience female sexual dysfunction (FSD). The purpose of this study was to compare FSD in different types of renal replacement therapy and control patients. METHODS: The study was consisted of 47 renal transplantation (RT), 46 hemodialysis (HD), and 28 continuous ambulatory peritoneal dialysis (CAPD) patients and 36 healthy control subjects. All groups were evaluated with the following scales: Female Sexual Function Index (FSFI) questionnaire, Short Form (SF)-36 questionnaires, and Beck Depression Inventory (BDI). Demographic data, laboratory values, and hormone levels were obtained. The patients with FSFI score <26.55 were accepted as experiencing sexual dysfunction. RESULTS: Overall, total FSFI scores in RT, HD, CAPD, and control were 22 (range, 2-35), 22.4 (4-34), 18.35 (2-34), and 29.6 (2-35), respectively. The mean total FSFI score was not different in patients receiving different kinds of renal replacement therapy (P > .05) although they were significantly worse then the control group (P < .001). On regression analysis, age was significantly associated with FSD (ß = -0.14; P = .001). In addition, the physiologic health domain of SF-36 was significantly better in control groups (P < .001). The difference in terms of mean of BDI score did not reach statistical significance among patient groups (P > .05). Female sexual dysfunction score was negatively correlated with BDI (r = -0.371; P < .001) and positively correlated with the mental-physical components score of SF-36 (r = 0.423 [P < .001] and r = 0.494 [P < .001], respectively) in all patients groups. Regarding the hormones of the patients, there was a significant difference between RT and the HD and CAPD groups in dihydroepiandrosterone sulfate (DHEAS; P < .001), RT and HD in prolactin (P < .001), and RT and CAPD in free testesterone (P < .001). CONCLUSIONS: Renal transplantation, hemodialysis, and peritoneal dialysis patients were at more risk of developing sexual dysfunction and lower quality of life scores than healthy subjects. Notably, the mode of renal replacement therapy had no impact on female sexual function.

Cytomegalovirus infection in renal transplant recipients: one center's experience.

BACKGROUND: Cytomegalovirus (CMV) is the most common opportunistic viral infection that causes morbidity, graft loss, and mortality among renal transplant recipients (RTRs). The aim of this study was to evaluate the impact of CMV infection on allograft function, graft/patient survival, and the possible asssociations between CMV infection and HLA typing. METHOD: This retrospective study included 162 RTRs who had at least 1 year regular post-transplantatioin follow-up between January 2007 and December 2011. Recipients who had positive quantative CMV-polymerase chain reaction (PCR) were assigned to the study group (n = 17) and PCR-negative patients were assigned to the control group (n = 145). To determine whether CMV infection was related to HLA specificities, the incidence of CMV infection was analyzed in relation to HLA-A, -B, and -DR typing. RESULTS: Study groups were similar in terms of demographic, clinical, and basal laboratory findings. Duration of dialysis before transplantation was significantly longer in this study group (P = .018). Although the total HLA mismatches of both groups were similar, we found that HLA-B51-positive recipients had a lower risk for CMV infection (P = .018). CMV infection was more frequent in patients with a double-J stent (P = .001). Although basal creatinine levels of the two groups were similar, the study group patients' creatinine levels were significantly increased during the 1-year post-transplantation period compared to controls (P = .0001). Frequency of acute rejection was significantly higher in the study group (41.2% vs 11%, P = .001). Graft loss due to any cause was also significantly higher in the study group (29.4% vs 6.9%, P = .01). Patients who had preoperative induction therapy and post-transplantatioin tacrolimus-based regimens were prone to CMV infection (P = .0001, .006). CONCLUSIONS: Despite recent advances in prophylaxis, CMV infection is still a risk factor for RTRs. According to our data, long pretransplantation dialysis duration, being HLA-B51-negative, having a double-J stent, preoperative induction therapy, and post-transplantation tacrolimus-based regimens might induce development of CMV infection by 1-year post-transplantation follow-up.

Investigation of prevalence and characteristics of mesiodens in a non-syndromic 11256 dental outpatients.

AIM: To investigate the prevalence of mesiodens in a sample of Turkish dental patients and their distribution among genders. PATIENTS AND METHODS: A retrospective study was performed using panoramic radiography of 11256 patients, who ranged in age from 15 to 55 years old. All data (age, sex and or syndrome) were obtained from the patient files and analyzed for mesiodens. Statistical evaluation of the presence of mesiodens related to gender was performed by the Pearson chi-squared test. RESULTS: Mesiodens was detected in 15 subjects (0.13%). The prevalence of mesiodens for females and males was 0.20% and 0.057%, respectively (p = 0.037). The most commonly observed mesiodens was maxillary canine-like type (60%). Most of the mesiodens (67%) were found in the vertical position, followed by horizontal position (33%). The age and sex distribution, number of mesiodens per patient, shape, direction, size, and effect on permanent maxillary incisors are also presented in this study. The most common complication caused by mesiodens was midline of the permanent incisors. CONCLUSIONS: Mesiodens is an uncommon developmental anomaly in Turkish dental patients. Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications.

Low graft function and ongoing hyperparathyroidism are closely related to post-transplantation osteoporosis.

INTRODUCTION: Renal transplantation (RT) is the gold standard therapy for chronic renal failure. Immunosuppressive drug choice, malnutrition, adynamic bone disease and hyperparathyroidism are important factors impacting the development of posttransplant osteoporosis. Body composition analysis with bioimpedance devices (BIA) is a useful noninvasive tool to detect malnutrition among the RT population. We investigated the effects of graft function, immunosuppressive drug regimens and biochemical characteristics on bone mineral density of RT patients as well as the reliability of BIA measurements to diagnose osteoporosis. METHODS: One hundred three recipients with a minimum of 12 months post-RT follow-up underwent body composition analysis using the Tanita Analyzer. The last 6 months of monthly biochemical parameters and glomerular filtration rates (GFR) as well as drug regimens were collected retrospectively from patient charts. Patients were divided into 2 groups, according to their femoral neck and lumbal T scores, as osteoporosis (n = 42) and control groups (n = 61). RESULTS: The mean GFR of osteoporotic patients was significantly lower (P = .04) and parathyroid hormone (PTH) levels significantly higher (P = .002). According to BIA, osteoporotic patients showed lower bone mass, fat mass, visceral fat ratio, muscle mass, waist-hip ratios, and body mass index values (P < .05). Correlation analysis revealed GFR to negatively correlate with PTH (r = -0.231, P = .010) and positively with femur t scores (r = 0.389, P = .0001) as well as with BIA findings (P = .0001). In contrast, PTH levels in negatively correlated with lumbar and femoral neck t scores (r = -0.22, -0.4 and P = .026, .0001, respectively) but not with BIA findings including bone mass. CONCLUSION: Changes in bone density after RT were affected by graft function. The rapid loss of bone mineral density emphasizes the need for prevention started in the early posttransplant period. BMD measurements provided a guide for treatment and for subsequent evaluation.

Left ventricular mass index and its relationship to ambulatory blood pressure and renal resistivity index in renal transplant recipients.

INTRODUCTION AND AIMS: Left ventricular hypertrophy (LVH) is frequently observed in patients with end-stage renal disease and renal allograft recipients. It is an independent, strong predictor of morbidity and mortality. Renal resistive index (RRI) is an important determinant of graft function in transplant recipients. In essential hypertension, increased RRI is associated with reduced renal function and tubulointerstitial damage. In this present study, we investigated the association of ambulatory blood pressure monitoring parameters and RRI on left ventricular mass index among renal transplant recipients. METHODS: Charts of 98 renal transplant recipients with echocardiography, ambulatory blood pressure monitoring, and renal Doppler ultrasonography as well as laboratory tests including serum creatinine, glomerular filtration rate, and C-reactive protein (CRP) level at the end of post-transplantation year 1 were analyzed in this study. LVMI was calculated using the Devereux formula with echocardiographic findings. RESULTS: Left ventricular mass index (LVMI) positively correlated with mean systolic blood pressure (SBP) (r = 0.512; P = .0001), mean nighttime SBP (r = 0.312; P = .007), mean nighttime diastolic blood pressure (DBP) (r = 0.427; P = .005), renal resistive index (RRI; r = 0.290; P = .004), and age (r = 0.371; P = .001). Multiple logistic regression analysis revealed that mean and maximum nighttime SBP and RRI were independent risk factors for LVMI (P = .001, .035, and .05, respectively). CONCLUSION: High RRI is one of the main indicators of cardiovascular disease in renal transplant recipients. Additionally, older age, high blood pressure, and nondipper pattern are important risk factors of LVH.

Prevalence of root dilacerations in Central Anatolian Turkish dental patients / Prevalencia de las dilaceraciones radiculares en pacientes dentales turcos de la región de Anatolia Central

OBJECTIVE: The aim of this study was to determine, retrospectively, the prevalence and distribution of the dilaceration of the root for each tooth-type in a sample of Central Anatolian Turkish population by using panoramic radiographs. METHOD: Panoramic radiograhs of 6912 patients (3860 women and 3052 men, mean age 29.04 years, range, 15 to 50 years) were examined for the presence of root dilacerations. Chi-square test was also used to compare the prevalence of dilacerations between male and female subjects and upper and lower jaws. RESULTS: Data showed that 1108 (16.0%) of these subjects had one or more teeth that were dilacerated and these were detected in 466 (15.2%) males and 642 (16.6%) females. Statistical analysis (χ² test) showed a significant difference in the prevalence of dilaceration among male and female patients. Mandibular third molars were dilacerated most often (3.76%), followed by mandibular second molars (1.81%). Dilaceration was found in 1.23% of maxillary second premolars and 1.23% of mandibular second molars. CONCLUSION: Root dilacerations are not uncommon among Turkish dental patients, and their early detection could be important in treatment problems associated with it. However, further larger scale studies are required to assess its prevalence in the general population in order to compare it with other ethnic groups.

OBJETIVO: El objetivo de este estudio fue determinar retrospectivamente la prevalencia y distribución de la dilaceración radicular para cada tipo de diente en una muestra poblacional turca de Anatolia Central, usando radiografías panorámicas. MÉTODO: Se examinaron las radiografías panorámicas de 6912 pacientes (3860 mujeres y 3052 hombres, edad promedio 29.04 años, rango 15 a 50 años) en busca de presencia de dilaceraciones de la raíz. También se usó la prueba de Chi-cuadrado para comparar la prevalencia de dilaceraciones entre los sujetos varones y hembras, y la mandíbula inferior y superior. RESULTADOS: Los datos mostraron que 1108 (16.0%) de estos sujetos tenían uno o más dientes dilacerados, detectados en 466 (15.2%) varones y 642 (16.6%) hembras. El análisis estadístico (prueba χ²) mostró una diferencia significativa en la prevalencia de dilaceración entre los pacientes varones y las hembras. Los terceros molares mandibulares se hallaban dilacerados con mayor frecuencia (3.76%), seguidos por los segundos molares mandibulares (1.81%). Se halló dilaceración en 1.23% de los segundos premolares maxilares y 1.23% de los segundos molares mandibulares. CONCLUSIÓN: Las dilaceraciones radiculares no son poco comunes entre los pacientes dentales turcos, y su detección temprana podría ser importante en el tratamiento de problemas asociados con ellas.

Early renal transplantation after donor renal angiography affects initial graft function.

BACKGROUND: Renal angiography of a living donor is a common radiologic examination before transplantation. However, the contrast agent used during this procedure can cause contrast nephropathy. There are insufficient data regarding whether this radiocontrast exposure detoriates renal function and survival after transplantation. In this study, we analyzed the effects of radiocontrast exposure to donors before transplant surgery on the incidence of delayed graft function (DGF) and on the outcomes of recipients at 1 year posttransplantation. METHODS: We divided 80 living donor transplantations according to the duration between the renal angiography and the transplantation procedure: Group 1 as early transplantation at ≤ 20 days (n = 42) versus group 2 of late transplantation at ≥ 20 days (n = 38). We retrospectively collected acute rejection episodes and graft survival at 1 year, monthly serum creatinine values of, DGF, proteinuria at 1 month, GFR at posttransplant day 3 month 1, and 1 year. RESULTS: There were 10 group 1 recipients (23.8%) and 2 group 2 (5.3%) subjects who experienced ≥ 1 acute rejection episode in the 1st posttransplant year (P = .02); 1 patient in each group experienced graft loss at 1 year (P = .941). DGF was observed in 9 (22%) versus 1 patient (2.6%) in group 2 (P = .009). Posttransplant day 3 creatinine values were significantly higher (P = .005) with significantly lower GFR values (P = .043) in group 1. However, creatinine and GFR levels were similar at 1 month and 1 year. Month 1 proteinuria levels were significantly higher in group 1 (P = .014). There was a significant negative correlation between renal angiography time and month 1 proteinuria (P = .014). CONCLUSIONS: Early renal transplantation (within 2 weeks after renal angiography) in living kidney donors can detoriate initial graft function and cause DGF.

Microarray-based gene expression analysis of an animal model for closed head injury.

OBJECTIVE: Traumatic brain injury (TBI) is a major cause of death and disability in both children and the elderly. Mortality from TBI is said account for 1-2% of all deaths. One-third to one-half of all traumatic deaths is due to head injury. Of those who survive, the majority is left with significant disabilities, including 3% who remain in a vegetative state and only approximately 30% who make a good recovery. Microarray studies and other genomic techniques facilitate the discovery of new targets for the treatment of diseases, which aids in drug development, immunotherapeutics and gene therapy. Gene expression profiling or microarray analysis enables the measurement of thousands of genes in a single RNA sample. METHODS: In this study, adult Wistar-albino rats underwent TBI using a trauma device. Brain tissues and blood samples were taken for gene expression at 1, 12 and 48 h post-trauma and were then analysed via microarray. Total RNA was isolated using an RNeasy Mini Kit (QIAGEN-Sample & Assay Technologies, Hilden, Germany) and tested using a 2100 Bioanalyzer (Agilent Technologies, Palo Alto, CA). Overall changes in gene expression were evaluated using Agilent Whole Rat Genome 4 × 44 K oligonucleotide arrays and analysed with GeneSpring (GeneSpring 6.1, Silicon Genetics, Redwood City, CA) software. Only genes with a signal-to-noise ratio of above 2 in the experiments were included in the statistical analysis. RESULTS: ANOVA (p<0.05) was performed to identify differentially expressed probe sets. Additional filtering (minimum 2-fold change) was applied to extract the most differentially expressed genes based on the study groups (Control vs. 1st hour, Control vs. 12th hour, Control vs. 48th hour). Differentially expressed genes were detected via microarray analysis. A gene interaction-based network investigation of the genes that were identified via traditional microarray data analysis describes a significantly relevant gene network that includes the C1ql2, Cbnl, Sdc1, Bdnf, MMP9, and Cd47 genes, which were differentially expressed compared with the controls. CONCLUSIONS: In this study, we will review the current understanding of the genetic susceptibility of TBI with microarrays. Our results highlight the importance of genes that control the response of the brain to injury as well as the suitability of microarrays for identifying specific targets for further study.

Prevalence of root dilacerations in Central Anatolian Turkish dental patients.

OBJECTIVE: The aim of this study was to determine, retrospectively, the prevalence and distribution of the dilaceration of the root for each tooth-type in a sample of Central Anatolian Turkish population by using panoramic radiographs. METHOD: Panoramic radiograhs of 6912 patients (3860 women and 3052 men, mean age 29.04 years, range, 15 to 50 years) were examined for the presence of root dilacerations. Chi-square test was also used to compare the prevalence of dilacerations between male and female subjects and upper and lower jaws. RESULTS: Data showed that 1108 (16.0%) of these subjects had one or more teeth that were dilacerated and these were detected in 466 (15.2%) males and 642 (16.6%) females. Statistical analysis (chi2 test) showed a significant difference in the prevalence of dilaceration among male and female patients. Mandibular third molars were dilacerated most often (3.76%), followed by mandibular second molars (1.81%). Dilaceration was found in 1.23% of maxillary second premolars and 1.23% of mandibular second molars. CONCLUSION: Root dilacerations are not uncommon among Turkish dental patients, and their early detection could be important in treatment problems associated with it. However further larger scale studies are required to assess its prevalence in the general population in order to compare it with other ethnic groups.

Comparison of basiliximab and daclizumab with triple immunosuppression in renal transplantation.

PURPOSE: Graft rejection is a serious problem despite immunosuppressive agents. Immunosuppression has been achieved with monoclonal antibodies (mAb) that bind specifically to the α subunit of the interleukin (IL)-2 receptor present on activated T lymphocytes. We explored the effects of two of the mAbs-daclizumab and basiliximab-on graft function. MATERIALS AND METHODS: Our 1543 renal transplant recipients received baseline therapy with cyclosporine or tacrolimus plus corticosteroids and mycophenolate mofetil. In addition standard dosages intravenously of daclizumab (n=156) or basiliximab (n=45) in were administered intravenously to 201 renal transplant patients who included 122 men and 79 women of overall mean age of 30±13.7 years. RESULTS: Patient and donor characteristics including age, sex, causes of renal failure, presence of comorbidities, panel-reactive antibodies, and numbers of human leukocyte antigen-mismatched were similar between the groups. During a mean follow-up of 27±20 months, biopsy-proven acute rejection was observed in three patients in the basiliximab group and 23 in the daclizumab group. Cytomegalovirus infection occurred in 13 patients. There was no case of posttransplant lymphoproliferative disorder. Three polyoma BK nephropathies were detected in the daclizumab group. No hypersensitivity reaction occurred in either group. One-year patient survival was 100% in the basiliximab group and 99% in the daclizumab group, with graft survivals of 95% versus 94%, respectively. The mean creatinine levels at discharge were 2 mg/dL versus 2.3 mg/dL and at 12 months, 1.3 mg/dL versus 1.2 mg/dL, respectively. CONCLUSIONS: Acute rejection episodes remain a significant risk factor for the development of graft dysfunction and poor long-term graft survival. IL-2R antagonists were effective antibody therapies. There was no apparent difference between basiliximab and daclizumab treatment.

Influence of 1,25-dihydroxyvitamin D3 on human leukocyte antigen-DR expression, macrophage infiltration, and graft survival in renal allografts.

Vitamin D plays an important role in the regulation of cellular growth and cell proliferation as well as exerting immunoregulatory activities. We sought to show the influence of vitamin D on renal graft survival. Among 102 patients, 40 were treated with vitamin D (group D) and the remaining 62 cases were not, forming a control group (group C). We studied human leukocyte antigen (HLA)-DR expression on tubules, interstitial cells, peritubular capillaries (PTCs), and evaluated macrophage infiltration of the interstitium and the PTCs. Compared to group C, group D patients showed fewer acute rejection episodes. Compared to group C patients group D patients showed significantly lower degrees of tubular and interstitial HLA-DR expression as well as interstitial and PTC macrophage infiltration. In addition in the PTC, HLA-DR expression was greater and therefore PTC destruction less in group D patients (P<.001). Twenty-seven (43.5%) of 62 group C patients lost their grafts at 29.2±15 months, whereas only 7/40 (17.5%) group D patients lost their grafts at 43.2±13 months. A significant difference was noted between the two groups in regard to the time of graft loss (P<.01). Testing vitamin D therapy along with several other covariates showed an independent effect on 5-year graft survival (P<.001). These data confirmed that vitamin D therapy shows an independent positive impact on long-term graft survival, which may be explained by its immunosuppressive effects of to reduce renal HLA-DR expression and renal macrophage infiltration and in turn mitigate PTC destruction. In conclusion, these results highlighted the potential use of vitamin D in renal allograft patients.