Evaluation of an Updated Gene Panel as a Diagnostic Tool for Both Male and Female Infertility.

In recent years, an increasing number of genes associated with male and female infertility have been identified. The genetics of infertility is no longer limited to the analysis of karyotypes or specific genes, and it is now possible to analyse several dozen infertility genes simultaneously. Here, we present the diagnostic activity over the past two years including 140 patients (63 women and 77 men). Targeted sequencing revealed causative variants in 17 patients, representing an overall diagnostic rate of 12.1%, with prevalence rates in females and males of 11% and 13%, respectively. The gene-disease relationship (GDR) was re-evaluated for genes due to the addition of new patients and/or variants in the actual study. Five genes changed categories: two female genes (MEIOB and TBPL2) moved from limited to moderate; two male genes (SOHLH1 and GALNTL5) moved from no evidence to strong and from limited to moderate; and SEPTIN12, which was unable to classify male infertility, was reclassified as limited. Many infertility genes have yet to be identified. With the increasing integration of genetics in reproductive medicine, the scope of intervention extends to include other family members, in addition to individual patients or couples. Genetic counselling consultations and appropriate staffing will need to be established in fertility centres. Trial registration number: Not applicable.

Investigation of the effect of virtual reality distraction in patients undergoing mandibular periodontal surgery: A randomized controlled study.

OBJECTIVE: This clinical study aimed to evaluate the effect of virtual reality (VR) technology on anxiety and pain levels in patients undergoing gingivectomy and gingivoplasty procedures. MATERIALS AND METHODS: The patients were randomized into test (surgery with VR glasses) and control (surgery without VR glasses) groups. Before the surgery, the anxiety level was measured using the modified dental anxiety scale (MDAS), and anticipated pain (AP) was measured by a visual analog scale (VAS). Immediately after the surgery, the pain and discomfort associated with the surgery (VASP), procedure time (T), and time perception (TP) were evaluated. The patients in the test group were requested to assess the immersion (VASI), satisfaction (VASS), perception of reduced anxiety (VASA), and perceived control (VASC). One week after surgery, MDAS was applied to all patients. RESULTS: This trial was conducted with 41 female and 17 male subjects with a mean age of 29.69 ± 12.32. There were no significant differences between the groups in terms of age, sex, preoperative MDAS, or AP. After surgery, MDAS, VASP, T, and TP failed to differ significantly between the groups. The subject age was positively correlated with VASI, VASS, VASA, and VASC (r = 0.60, p = 0.00; r = 0.44, p = 0.02; r = 0.46, p = 0.02; r = 0.50, p = 0.01, respectively) and negatively correlated with VASP (r = 0.47, p = 0.04). CONCLUSIONS: VR application did not affect anxiety and pain levels in patients undergoing periodontal surgery. More studies are needed to evaluate VR distraction in periodontal surgeries with diverse age samples and video options. CLINICAL SIGNIFICANCE: VR does not affect anxiety and pain levels during gingivectomy and gingivoplasty surgeries in the young adult population. It should be evaluated in older age groups. Trial registration ClinicalTrials.gov Identifier: NCT06092177.

Cartoid Near Occlusion: Time to Re-think Endarectomy?

OBJECTIVES: Carotid near occlusion (CNO) treatment is still controversial. In the discussion of surgical revascularization of these patients, periprocedural complications and technical failure should be considered in addition to the long-term results. We examined the efficacy and safety of surgical treatment in CNO and non-CNO patients undergoing carotid endarterectomy (CEA). METHODS: Data from 152 patients (118 male and 34 female) who underwent isolated CEA between January 2018 and June 2020 without critical contralateral lesions were retrospectively analyzed. Patients were divided into 2 groups: CNO (n = 52) and non-CNO (n = 100). The groups were compared regarding postoperative transient ischemic attack (TIA), ipsilateral ischemic stroke, and mortality. RESULTS: The success rate of the procedure was 100% in the CNO group and 99% in the Non-CNO group. In the Non-CNO group, 1 patient had ipsilateral ischemic stroke on postoperative day 0, and this patient was treated with carotid artery stenting. While the number of patients who died in the non-CNO group was 3 (3%) overall, the exitus rate was 1 (1.9%) in the CNO group (P >.05). In the CNO group, retinal TIA was observed in 1 patient (1.9%), ischemic stroke in 2 patients (3.8%), and TIA in 1 patient (1.9%). In the non-CNO group; Retinal TIA was observed in 1 patient (1.0%), ischemic stroke in 2 patients (2.0%), and TIA in 2 patients (2.0%). There was no statistically significant difference between the groups in terms of postoperative neurologic complications and primary endpoints at 12-month follow-up (P >.05). CONCLUSIONS: Carotid endarterectomy is a safe, feasible, and advantageous procedure in selected CNO patients, as in non-CNO carotid artery patients. Therefore, we recommend a surgical approach to prevent neurological events in CNO patients.

Elastohydrodynamic propulsion of a filament magnetically driven at both ends.

The elastohydrodynamic interaction between an elastic filament and its surrounding fluid was exploited to develop the first microswimmers. These flexible microswimmers are typically actuated magnetically at one end and their propulsion behavior is relatively well understood. In this work, we move beyond the traditional single-end actuation setup and explore the propulsion characteristics of an elastic filament driven by magnetic torques at both ends. We report the emergence of new modes of propulsion behaviors in different physical regimes, depending on the balance of elastic and viscous forces as well as the arrangement of the magnetic moments at the filament ends. In particular, under the same magnetic actuation, a filament driven at both ends can propel either forward or backward depending on its relative stiffness. Moreover, this new backward propulsion mode can generate a magnitude of propulsion that is unattainable by the traditional single-end actuation setup. We characterize these new propulsion behaviors and provide some physical insights into how they emerge from the complex interplay between viscous and elastic forces and magnetic actuation in various configurations. Taken together, these findings could guide the development of soft microrobots with enhanced propulsion performance and maneuverability for future biomedical applications.

Comparison of Bretschneider HTK cardioplegia solution and blood cardioplegia in terms of postoperative results in patients who underwent isolated supracoronary ascending aortic replacement.

INTRODUCTION: Cardiac arrest with cardioplegia is the most common and reliable method of myocardial protection in cardiac surgery, but there is no definite consensus on the use of different types of cardioplegia. Two of the commonly used types of cardioplegia are Bretschneider histidine-tryptophan-ketoglutarate solution (Custodiol) and conventional blood cardioplegia. In this study, Custodiol solution and conventional blood cardioplegia used in patients with type A aortic dissection who underwent supracoronary ascending aortic replacement were aimed to be compared in terms of postoperative results. METHODS: 70 patients with type A aortic dissection who underwent supracoronary ascending aortic replacement in our clinic between January 2011 - October 2020 were included. Patients were divided into two groups, blood cardioplegia group (n = 48) and Custodiol group (n = 22) and they were compared regarding preoperative, perioperative and postoperative variables. RESULTS: There was no significant difference between cardiopulmonary bypass time and cross-clamp time (p = 0.17 and p = 0.16, respectively). Mechanical ventilator weaning time, intensive care unit stay and hospital stay were shorter in Custodiol group (p = 0.04,p = 0.03 and p = 0.05, respectively). While inotropic support need was higher in the blood cardioplegia group (p = 0.001), there was no significant difference in terms of mortality, arrhythmia, neurological complications and renal complications. CONCLUSIONS: Our results show that Custodiol cardioplegia solution may be superior to blood cardioplegia in reducing mechanical ventilation weaning period, intensive care and hospital stay, and reducing the use of inotropic agents in patients with type A aortic dissection undergoing supracoronary ascending aorta replacement.

Effects of membrane viscoelasticity on the red blood cell dynamics in a microcapillary.

The mechanical properties of red blood cells (RBCs) play key roles in their biological functions in microcirculation. In particular, RBCs must deform significantly to travel through microcapillaries with sizes comparable with or even smaller than their own. Although the dynamics of RBCs in microcapillaries have received considerable attention, the effect of membrane viscoelasticity has been largely overlooked. In this work, we present a computational study based on the boundary integral method and thin-shell mechanics to examine how membrane viscoelasticity influences the dynamics of RBCs flowing through straight and constricted microcapillaries. Our results reveal that the cell with a viscoelastic membrane undergoes substantially different motion and deformation compared with results based on a purely elastic membrane model. Comparisons with experimental data also suggest the importance of accounting for membrane viscoelasticity to properly capture the transient dynamics of an RBC flowing through a microcapillary. Taken together, these findings demonstrate the significant effects of membrane viscoelasticity on RBC dynamics in different microcapillary environments. The computational framework also lays the groundwork for more accurate quantitative modeling of the mechanical response of RBCs in their mechanotransduction process in subsequent investigations.

The effect of bovine serum albumin-glutaraldehyde and polyethylene glycol polymer on local tissue reaction and inflammation in rabbit carotid artery anastomosis.

OBJECTIVES: In addition to the hemostatic properties of hemostatic agents, the investigation of their immunogenic properties, their local effects on application area has been the subject of many experimental studies. There are limited data on the inflammatory effects of Bovine serum albumin-glutaraldehyde and Polyethylene glycol polymer. Therefore, we investigated the effects of these agents on tissue reactions and inflammation in rabbit carotid artery anastomosis in our experimental study. METHODS: Twenty-one New Zealand male rabbits were randomly divided into three groups. The right carotid artery anastomosis was performed on the control group after transection. Hemostatic agents were applied locally to other two groups separately after transection and anastomosis. At the end of 28 days, the type of inflammation, inflammatory cell infiltration, degree of inflammation, and amount of residual adhesives were examined and compared statistically. RESULTS: Cell infiltrations associated with inflammation on the anastomosis site (eosinophils, epithelioid/giant cells, lymphocytes, and plasma cells) and inflammation grade in the groups of hemostatic agents were significantly lower compared to the control group (p < .05). There was no difference between the hemostatic agents. While mild inflammation (61.9%) was dominant in the groups of hemostatic agents, moderate inflammation (85.7%) was more common in the control group. No severe inflammation was observed in any of the three groups. Residual sealant grade between hemostatic agents did not differ significantly. CONCLUSIONS: When inflammation and tissue reactions of the 4th week were evaluated, it was determined that both hemostatic agents did not cause severe inflammation. However, comparative results at multiple time intervals are needed due to the dynamic process of inflammation.

Closing the Wearable Gap: Foot-ankle kinematic modeling via deep learning models based on a smart sock wearable.

The development of wearable technology, which enables motion tracking analysis for human movement outside the laboratory, can improve awareness of personal health and performance. This study used a wearable smart sock prototype to track foot-ankle kinematics during gait movement. Multivariable linear regression and two deep learning models, including long short-term memory (LSTM) and convolutional neural networks, were trained to estimate the joint angles in sagittal and frontal planes measured by an optical motion capture system. Participant-specific models were established for ten healthy subjects walking on a treadmill. The prototype was tested at various walking speeds to assess its ability to track movements for multiple speeds and generalize models for estimating joint angles in sagittal and frontal planes. LSTM outperformed other models with lower mean absolute error (MAE), lower root mean squared error, and higher R-squared values. The average MAE score was less than 1.138° and 0.939° in sagittal and frontal planes, respectively, when training models for each speed and 2.15° and 1.14° when trained and evaluated for all speeds. These results indicate wearable smart socks to generalize foot-ankle kinematics over various walking speeds with relatively low error and could consequently be used to measure gait parameters without the need for a lab-constricted motion capture system.

Ten-year outcomes of patients who developed persistent azoospermia following chemotherapy associated with different oncological diagnoses: A retrospective cohort study from a different perspective.

BACKGROUND: This study evaluated the treatment procedures for chemotherapy (CT)-induced persistent azoospermia and their outcomes from a different perspective. METHODS: In 63 patients (mean age: 30.16 ± 4.91 years) who had undergone CT 11 ± 5 years earlier, the semen volume, gonadotropins level, FSH level, genetics, micro-testicular sperm extraction (m-TESE) result, sperm DNA fragmentation index (SDFI), semen reactive oxidative stress (ROS) rate, duration of embryonic development, and pregnancy and baby take-home rates were examined. The correlations between the ROS rates and the SDFIs, m-TESE results, sperm motility, pathology scores, time-lapses, and baby take-home rates were evaluated. RESULTS: The semen volumes were 3.5 ± 1.1/ml. The FSH level following CT was 17.87 ± 5.80 mIU/ml. A sperm rate of 34.9% was found from the m-TESE result. The mean SDFI and ROS rate were 4 (<15-30>) and 1.29 ± 0.51, respectively. The time-lapse was calculated as 5h. Pregnancy and live birth were achieved at 20.63% and 12.7%, respectively. In the patients with a low ROS (≤1.42) and SDFI (≤15), the m-TESE success rate was high, the FSH value was low, the pathological score and fertilization rate were elevated, the embryonic cleavage period was normal, and the pregnancy and baby take-home rates were high. DISCUSSION: The sperms may be detected using m-TESE in patients who develop persistent azoospermia associated with CT due to different oncological diagnoses. Our study revealed that a low FSH value and normal ejaculatory ROS rates are positive predictive factors of sperm detection before m-TESE. The motility of the sperms detected after m-TESE and normal SDFI rates were found to be positive predictive criteria of high fertilization, good embryonic cleavage, pregnancy, and live birth.

A Case Series of Problems That Can Occur During Open Heart Surgery in Patients With COVID-19 Infection.

The utilization of open cardiac surgery on patients infected with coronavirus disease 2019 (COVID-19) has resulted in a very challenging perioperative management method. High rates of morbidity and mortality have been documented in the literature for patients who have undergone open heart surgery while infected with COVID-19; however, data on complications that may occur during and after surgery in patients with COVID-19 infection are limited. In this article, we aimed to present the clinical course and perioperative consequences of three patients with preoperative COVID-19 infection.

Hypoxia-inducible factor-1α and ischemia-modified albumin levels in intensive care COVID-19 Patients.

OBJECTIVES: In this study, it was aimed to evaluate the hypoxia-inducible factor-1α (HIF-1α) and ischemia-modified albumin (IMA) levels of patients diagnosed with COVID-19 in the intensive care unit (ICU) and healthy controls. To our knowledge, this is the first study investigate HIF-1α and IMA levels in COVID-19 patients in ICUs and comparing them with a healthy control group. For this reason, our study is original and will contribute to the literature. METHODS: A total of 70 intensive care patients diagnosed with COVID-19, and 72 healthy controls were included in the study. RESULTS: When we compared the patient and healthy control group; there were no statistically significant differences between the groups in terms of age and gender (p>0.05). No exitus was observed in the patient group. We found weak correlation between HIF-1α and IMA (r: 0.320). However, there were statistically significant differences in HIF-1α and IMA levels in the patient group. The receiver operating characteristic (ROC) curve demonstrated an area under curve (AUC) value of 0.651 for HIF-1α and 0.937 for IMA. CONCLUSIONS: The HIF-1α and IMA levels were significantly higher among COVID-19 patients in ICU compared with healthy controls. HIF-1α and IMA levels can be used as reliable markers for the prognosis of COVID-19.

Impact of Preoperative Embolization on Carotid Body Tumor Surgery.

BACKGROUND: The aim of this study is to investigate the effect of preoperative carotid body tumor embolization (CBTE) on the amount of bleeding, and vascular and neurological complications in carotid body tumors. METHODS: Fifty patients treated for 51 carotid body tumors in 2 clinics, between 2005 and 2020, were evaluated. Polyvinyl alcohol embolization of the carotid body tumor was performed in 23 patients before the surgical excision. The results were compared with the remaining 28 patients, in whom CBTE was not performed, in terms of neurological complications, requirement of additional vascular interventions, bleeding amount, and length of hospital stay. RESULTS: Mean bleeding amount was significantly lower in the CBTE group (406-217 mL, P < 0.05). Median erythrocyte suspension transfusion was significantly lower in the CBTE group (0.3 units vs. 1.1 units, P < 0.05). Neurological deficits developed in a total of 13 patients: 6 in the CBTE group and 7 in the non-CBTE group, in the early postoperative period (P = 0.90). No significant difference was observed between the groups in terms of additional vascular interventions and length of hospital stay (P = 0.79 and P = 0.61). CONCLUSIONS: Carotid body tumors are rarely encountered tumors. However, their surgical excision is challenging for surgeons regarding intraoperative and postoperative bleeding. This study demonstrates that preoperative CBTE significantly reduces the amount of bleeding, especially in Shamblin type II/III tumors.

Bilateral Tibial Stress Fractures and Osteoporosis in a Young Patient.

Stress fractures result from microscopic bone injury due to repetitive submaximal stress and include fatigue and insufficiency fracture components. Fatigue fractures generally occur in runners and athletes and are caused by abnormal physical load on the bone. On the other hand, insufficiency fractures are generally seen in the elderly secondary to osteoporosis, typically involving the pelvis and surrounding bones. Insufficiency fracture occurs as a result of normal loading in the abnormal bone. In this case report, we describe a young patient with bilateral tibial stress fractures with both fatigue and insufficiency components.

Does rotation during catheter withdrawal in embryo transfer increase pregnancy rates?

BACKGROUND: The aim of this study was to determine whether there is a difference in pregnancy rates between groups that we removed directly and removed by rotating the embryo transfer catheter 360°. METHODS: The study group consisted of 552 patients who were withdrawn by 360° rotation and 797 patients who were withdrawn without catheter rotation. All patients underwent one or two fresh ETs on day 3 or 5. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. RESULTS: There were no significant differences in demographic and clinical characteristics of both groups, such as age, body mass index (BMI), duration of infertility, causes of infertility, and basal hormone levels. Clinicals pregnancy rate, in the study group, 48% (265/552) and in the control group, 50.8% (405/797) were similar in both groups. When the implantation rate and miscarriage rate were examined, both groups were found to be similar. CONCLUSION: It was found that 360° rotation while pulling catheter during embryo transfer had no effect on pregnancy and clinical pregnancy.

Histopathologic Evaluation of COVID-19 Patients With Peripheral Arterial Thromboembolism: Does Clot Composition Make Any Sense?

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes thromboembolic complications during or post-infection period despite a lack of conventional risk factors. The study aims to learn fundamental changes in COVID-19 patients who underwent embolectomy in terms of clinical characteristics and clot composition. METHODS: In a retrospective cohort study design, we evaluated 21 patients who underwent embolectomy in our clinic between March 12, 2020, and December 31, 2020. Demographics, characteristics, and laboratory values were abstracted and analyzed. Histopathological assessment was held in the pathology department. RESULTS: Of these 21 patients, 11 (52.3%) were SARS-CoV-2 positive and 10 (47.6%) were SARS-CoV-2 negative. There is no statistical difference in terms of anatomic distribution, diagnostic method, length of hospital stay, amputation or mortality levels. Thromboembolic material of COVID-19 patients include significantly less red blood cell (RBC) (21.2-32.6%; P= 0.01), more lymphocyte (14.1-2.6%; P< 0.001), and more leukocyte (27.1-22.1%; P= 0.05). There was no statistical difference between the fibrin ratio. CONCLUSIONS: Inflammatory cells are prominent in arterial thromboembolic material of COVID-19 patients. A combination of hyperinflammation and prothrombotic status may be responsible for this phenomenon.

Direct kidney injury or lower extremity ischemia induced indirect kidney injury: Which one is more harmful for kidneys?

OBJECTIVES: The aim of this study was to investigate and compare the severity of kidney damage following lower limb ischemia-reperfusion and direct kidney ischemia-reperfusion. METHODS: Thirty Sprague Dawley male rats were randomly divided into three groups; lower extremity ischemia-reperfusion group (Group 2), renal ischemia-reperfusion group (Group 3) and control (anesthesia and median laparotomy only) (Group 1). In group 3, 1-h ischemia was performed on the kidney and in group 2, 1-h ischemia was performed on the left lower extremity. This procedure was followed by reperfusion for 24 h. Renal tissues were removed after the reperfusion period and the groups were evaluated for glutathioneperoxidase activity, malondialdehyde and GSH levels, and furthermore, their histolopathological scores were calculated. RESULTS: Renal malondialdehyde levels were significantly higher in Group 2 and Group 3 than they were in the Control group. There was no significant difference in renal malondialdehyde levels between Group 2 and Group 3. Kidney glutathione (GSH) levels were statistically lower in Group 2 and Group 3 than in the Control group. No statistically significant difference was found between Group 2 and Group 3 regarding their GSH levels. In histological evaluation, there was no statistically significant difference between Group 2 and Group 3 in terms of kidney damage score. CONCLUSIONS: This study has identified that lower extremity ischemia induces remote kidney damage with similar features to kidney injury, occurring after direct kidney ischemia-reperfusion.

The effect of bovine serum albumin-glutaraldehyde and polyethylene glycol polymer on neointimal hyperplasia in rabbit carotid artery anastomosis.

OBJECTIVE: Since the systemic drugs have been used to reduce the hyperplasic response in the tunica intima, the periadventitial local drug applications to the vascular wall have gained more popularity. In this study, we investigated the effect of bovine serum albumin-glutaraldehyde and polyethylene glycol polymer on neointimal hyperplasia in rabbit carotid artery anastomosis to explore the effects of these two different agents. METHODS: 21 New Zealand male rabbits were randomly divided into three groups. The carotid artery transection and anastomosis was performed onthe control group. The bovine serum albumin-glutaraldehyde and the polyethylene glycol polymer were applied locally on the other two groups seperatley after transection and anastomosis of the carotid arteries. At the end of 28-day follow-up, the histological and the immunohistochemical results related to neointimal hyperplasia were compared. RESULTS: The glue residues were detected in the BSA-glutaraldehyde group, but in the PEG polymer group there was no glue residue. The intima thickness and the intima/media thickness ratio in the control group was significantly higher (p<0.05) than the other groups. These values did not differ significantly between the BSA-glutaraldehyde group and the PEG polymer group (p>0.05). The lumen diameter and the area in the control group were significantly higher (p < 0.05) than the BSA-glutaraldehyde group. These values between the control group and the PEG polymer group did not differ significantly (p>0.05). aSMA-positive staining score in the Control group was found to be significantly lower (p < 0.05) than the BSA-glutaraldehyde and PEG polymer group and the VEGF-positive staining score in the control group was found to be significantly higher (p < 0.05) than the BSA-glutaraldehyde and the PEG polymer group. CONCLUSIONS: Although the both agents have positive results on neointimal hyperplasia, it would be favorable to use polyethylene glycol polymer, since it does not seem to affect the lumen area and the lumen diameter of the vessel.

Severe ovarian hyperstimulation syndrome and gonadotropin-releasing hormone agonist trigger in patients with hypogonadotropic hypogonadism: A report of two cases.

Ovarian Hyperstimulation syndrome (OHSS) is a rare condition in patients with hypogonadotropic hypogonadism. Two patients with hypogonadotropic hypogonadism are reported, a rare case of severe OHSS and a case of prevented OHSS via gonadotropin-releasing hormone (GnRH) agonist trigger, respectively. The first case was a 31-year-old patient. In vitro fertilization (IVF) treatment was performed three times but the patient never developed OHSS. The first patient was diagnosed as having severe OHSS on the ninth day after the fresh embryo transfer. She stayed 66 days in hospital and 50.5 litres of fluid were aspirated from her abdomen. The second case was a 26-year-old and primary infertile patient. She had never undergone IVF treatment. The GnRH agonist stimulation test was performed before IVF treatment. After the ovarian stimulation, GnRH agonist trigger was given. Thirty-two oocytes were retrieved from the ovaries and OHSS did not occur. Although severe OHSS is rare, it can develop in patients hypogonadotropic hypogonadism. If a GnRH stimulation test is performed before ovarian stimulation, OHSS can be prevented because the test allows agonist triggering instead of hCG in hypogonadotropic hypogonadism.