Microencapsulation of parathyroid cells via electric field and non-surgical transplantation approach.

PURPOSE: Hypoparathyroidism is a rare disease with low PTH, mostly seen as a consequence of neck surgery. Current management is the prescription of calcium and vitamin D, but the definitive treatment is parathyroid allotransplantation, which frequently triggers an immune response, thus cannot achieve the expected success. To overcome this problem, encapsulation of allogeneic cells is the most promising method. By optimizing the standard alginate cell encapsulation technique with parathyroid cells under high-voltage application, the authors reduced the size of parathyroid-encapsulated beads and evaluated these samples in vitro and in vivo. METHODS: Parathyroid cells were isolated, and standard-sized alginate macrobeads were prepared without any electrical field application, while microbeads in smaller sizes (< 500 µm), by the application of 13 kV. Bead morphologies, cell viability, and PTH secretion were evaluated in vitro for four weeks. For the in vivo part, beads were transplanted into Sprague-Dawley rats, and after retrieval, immunohistochemistry and PTH release were evaluated in addition to the assessment of cytokine/chemokine levels. RESULTS: The viability of parathyroid cells in micro- and macrobeads did not differ significantly. However, the amount of in vitro PTH secretion from microencapsulated cells was significantly lower than that from macroencapsulated cells, although it increased throughout the incubation period. Immunohistochemistry of PTH staining in both of the encapsulated cells identified as positive after retrieval. CONCLUSION: Contrary to the literature, a minimal in vivo immune response was developed for alginate-encapsulated parathyroid cells, regardless of bead size. Our findings suggest that injectable, micro-sized beads obtained using high-voltage may be a promising method for a non-surgical transplantation approach.

Vessel sealing system vs. conventional knot-tying for hilar dissection during living donor hepatectomy: a prospective, randomized, double-blinded study.

OBJECTIVE: LT has become the gold standard treatment for many liver diseases, especially chronic liver disease. A commonly seen problem, even in donors who do not develop any major complications after living donor hepatectomy (LDH), is the persistent drainage of lymphatic fluid from the hepatectomy site drain, which causes extensive hospitalization and consequent loss to the workforce. To our knowledge, no study has yet been published comparing LVSS and conventional knot-tying methods for hilar dissection, which is an important stage of the LDH procedure. We aimed to prospectively compare the outcomes of these two treatment methods. PATIENTS AND METHODS: Donor candidates were divided into two groups: conventional suture tying (conventional knot tying group; n=34) and Ligasure vessel sealing system (LVSS; n=34). A simple randomization method of drawing lots was used to assign the patients to each group. The following parameters were analyzed for all patients: age, gender, BMI, duration of surgery, postoperative drainage amounts, drain removal times and complications, length of hospital stay, morbidity, and mortality. RESULTS: There were no significant differences in terms of operative times, postoperative drainage levels, hospital stay or drain removal times. CONCLUSIONS: In this study, the use of LVSS in LDH was found to be safe, although it did not offer any advantage over conventional methods. Nevertheless, it seems probable that the use of LVSS could reduce operative time and amounts of lymphatic drainage, especially in centers with minimal experience with LDH, such as new LDH centers.

Evaluation of low-to-moderate arsenic exposure, metabolism and skin lesions in a Turkish rural population exposed through drinking water.

BACKGROUND: There is no human data regarding the exposure, metabolism and potential health effects of arsenic (As) contamination in drinking water in the Central Anatolian region of Turkey. METHODS: Residents in ten villages with drinking water of total As (T-As) level >50 µg L-1 and 10-50 µg L-1 were selected as an exposed group (n = 420) and <10 µg L-1 as an unexposed group (n = 185). Time-weighted average-As (TWA-As) intake was calculated from T-As analysis of drinking water samples. Concentrations of T-As in urine and hair samples, urinary As species [i.e., As(III), As(V), MMA(V) and DMA(V], and some micronutrients in serum samples of residents of the study area were determined. Primary and secondary methylation indices (PMI and SMI, respectively) were assessed from urinary As species concentrations and the presence of skin lesion was examined. RESULTS: TWA-As intake was found as 75 µg L-1 in the exposed group. Urinary and hair T-As and urinary As species concentrations were significantly higher in the exposed group (P < 0.05). The PMI and SMI values revealed that methylation capacities of the residents were efficient and that there was no saturation in As metabolism. No significant increase was observed in the frequency of skin lesions (hyperpigmentation, hypopigmentation, keratosis) of the exposed group (P > 0.05). Only frequency of keratosis either at the hand or foot was higher in individuals with hair As concentration >1 µg g-1 (P < 0.05). CONCLUSIONS: Individuals living in the study area were chronically exposed to low-to-moderate As due to geological contamination in drinking water. No significant increase was observed in the frequency of skin lesions. Because of the controversy surrounding the health risks of low-to-moderate As exposure, it is critical to initiate long-term follow-up studies on health effects in this region.

Medical and Surgical Care of Patients With Mesothelioma and Their Relatives Carrying Germline BAP1 Mutations.

The most common malignancies that develop in carriers of BAP1 germline mutations include diffuse malignant mesothelioma, uveal and cutaneous melanoma, renal cell carcinoma, and less frequently, breast cancer, several types of skin carcinomas, and other tumor types. Mesotheliomas in these patients are significantly less aggressive, and patients require a multidisciplinary approach that involves genetic counseling, medical genetics, pathology, surgical, medical, and radiation oncology expertise. Some BAP1 carriers have asymptomatic mesothelioma that can be followed by close clinical observation without apparent adverse outcomes: they may survive many years without therapy. Others may grow aggressively but very often respond to therapy. Detecting BAP1 germline mutations has, therefore, substantial medical, social, and economic impact. Close monitoring of these patients and their relatives is expected to result in prolonged life expectancy, improved quality of life, and being cost-effective. The co-authors of this paper are those who have published the vast majority of cases of mesothelioma occurring in patients carrying inactivating germline BAP1 mutations and who have studied the families affected by the BAP1 cancer syndrome for many years. This paper reports our experience. It is intended to be a source of information for all physicians who care for patients carrying germline BAP1 mutations. We discuss the clinical presentation, diagnostic and treatment challenges, and our recommendations of how to best care for these patients and their family members, including the potential economic and psychosocial impact.

Comparison of factors affecting patients with a myofascial temporomandibular disorder with and without sleep bruxism.

Aims and Background: The aim of the present study was to evaluate the relationship between jaw function, neck disability, sleep quality, fatigue, and headache in patients with myofascial temporomandibular disorder (TMD) with sleep Bruxism (SB) and without it (non-SB). Subjects and Methods: This case-control study was conducted with a total of 200 myofascial TMD patients, comprising 91 identified as SB and 109 as non-SB. The Jaw Function Limitations Scale (JFLS), Neck Disability Index (NDI), Pittsburgh Sleep Quality Index (PSQI), Fatigue Severity Scale (FSS), and Headache Impact Test-6 (HIT-6) scales and indexes were used. Results: In the group with SB compared to the non-SB group, JFLS, NDI, PUKI, and FSS scores were statistically significantly higher (P < 0.001). No statistically significant difference was found between the groups in terms of visual analog scale (VAS) (P = 0.127) and HIT-6 scores (P = 0.365). The probability of having JFLS in patients with SB compared to those without was folded 3.551 times (P = 0.002), and the probability of having NDI increased 3.473 times (P = 0.002). In addition, SB was observed to trigger poor sleep quality (P < 0.001). There was no statistically significant determinant of bruxism on FSS (P = 0.196), and on HIT-6 (P = 0.488). Conclusion: It can be concluded that SB causes limitation of the jaw's functional activities, neck problems, and decreased sleep quality in myofascial TMD. These findings emphasize the importance of considering SB when evaluating and treating patients with myofascial TMD problems.

Spontaneous space closure following the extraction of the first permanent mandibular molar.

AIM: The aim of this study was to determine the prognostic factors, such as the developmental stage of second permanent molar (SPM), the angulation of SPM, and presence/absence of the third molar associated with the spontaneous space closure after the mandibular first permanent molars (FPM) extraction. MATERIAL AND METHODS: A total of 177 mandibular SPMs were evaluated in this cross-sectional study. The prognostic factors determining successful space closure such as SPM developmental stage, SPM angulation, and presence/absence of the third molar were evaluated. RESULTS: The mean age of the patients at the time of extraction of SPM was 9.4 years and post-extraction assessment at the time of the study was 12.7 years. Of the total 177 mandibular SPMs, 36 SPMs (20.3%) were at Demirjian stage D, 63 (35.6%) at stage E, 60 (34%) at stage F, 18 (10.1%) at stage G. 18 SPMs (10.1%) had distal angulation, 23 SPMs (13.0%) had mesial angulation and 136 SPMs (76.9%) had upright angulation. At the time of radiographic assessment, 79.1% of the mandibular quadrants showed evidence of third molar formation. Of the 177 mandibular SPMs, 93 (52.5%) exhibited successful space closure in the mandibular arch. CONCLUSIONS: There is no statistical significance between the chronological age and the developmental stage of the mandibular SPM with regard to the successful spontaneous space closure at the time of the dental extraction of FPMs. The presence of the mandibular third molar may be a consideration for spontaneous space closure in the mandibular arch.

The outcome of a national MS-Covid-19 study: What the Turkish MS cohort reveals?

BACKGROUND: The pandemic of the new type of corona virus infection 2019 [Covid-19] also affect people with Multiple Sclerosis (pwMS). Currently, the accumulating information on the effects of the infection regarding the demographic and clinical characteristics of the disease, as well as outcomes within different DMTs¸ enable us to have better practices on the management of the Covid-19 infection in pwMS. OBJECTIVE: To investigate the incidence of coronavirus disease 2019 (Covid-19) and to reveal the relationship between the demographic-clinical and therapeutic features and the outcome of Covid-19 infection in a multi-center national cohort of pwMS. METHODS: The Turkish Neurological Society-MS Study Group in association with the Italian MuSC-19 Study Group initiated this study. A web-based electronic Case Report Form (eCRF) of Study-MuSC-19 were used to collect the data. The demographic data and MS histories of the patients were obtained from the file tracking forms of the relevant clinics. RESULTS: 309 MS patients with confirmed Covid-19 infection were included in this study. Two hundred nineteen (219) were females (70.9%). The mean age was 36.9, ranging from 18 to 66, 194 of them (62.8%) were under 40. The clinical phenotype was relapsing-remitting in 277 (89.6%) and progressive in 32 (10.4%). Disease duration ranged from 0.2 years to 31.4 years. The median EDSS was 1.5, ranging from 0 to 8.5. The EDSS score was<= 1 in 134 (43%) of the patients. 91.6% of the patients were on a DMT, Fingolimod was the most frequently used drug (22.0%), followed by Interferon (20.1%). The comorbidity rate is 11.7%. We were not able to detect any significant association of DMTs with Covid-19 severity. CONCLUSION: The Turkish MS-Covid-19 cohort had confirmed that pwMS are not at risk of having a more severe COVID-19 outcome irrespective of the DMT that they are treated. In addition, due to being a younger population with less comorbidities most had a mild disease further highlight that the only associated risk factors for having a moderate to severe COVID-19 course are similar with the general population such as having comorbid conditions and being older.

The effects of breathing exercises in mothers of children with special health care needs:A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Caring for a child with a disability affects musculoskeletal system pain, fatigue, sleep quality, and anxiety of the mothers. The purpose of the study was to determine the effectiveness of breathing exercises in mothers with chronic non-specific low back pain (NLBP). METHODS: Forty-three mothers with chronic NLBP were randomly assigned to the experimental group (n= 23) and the control group (n= 20). The experimental group received breathing exercises with core stabilization exercises (BSET) for three sessions a week for 8 weeks, and the control group performed stabilization exercises (SET) only, for the same period. Pain severity, fatigue, anxiety, and sleep quality were evaluated before and after the treatment programs. RESULTS: After the treatment programs, significant differences were observed in pain, fatigue, and sleep quality in both groups (p< 0.05). However, the BSET group showed a significantly better improvement in anxiety levels and sleep quality than the SET group (p< 0.05). CONCLUSIONS: The improvements in pain, fatigue and sleep quality were seen in both groups after treatment programs. It is recommended breathing exercises are added to core stabilization programs to provide greater improvements in anxiety level and sleep quality for mothers of children with disabilities, who have NLBP.

Clinical Performance of Nanofilled and Microhybrid Direct Composite Restorations on Endodontically Treated Teeth.

This study evaluated the clinical performance of direct restorations made of nanofilled and microhybrid resin composites in endodontically treated teeth. Twenty patients (11 males, 9 females; mean age: 34.2±10) that met the inclusion criteria received a total of 48 restorations. After employing etch-and-rinse adhesive system, one dentist placed all restorations using either a nanofilled (Filtek Ultimate) or microhybrid (Filtek Z250) resin composite. The restorations were clinically reviewed at baseline, 6 months, and up to 2 years using the modified United States Public Health Service (USPHS) criteria. The changes were analyzed using the McNemar test and marginal homogeneity tests (p⟨0.05). The mean observation period was 17.4 months. With respect to color match, marginal adaptation, secondary caries, and surface texture, no significant differences were found between the two restorative materials (p⟩0.05). Most restorations yielded alpha or bravo scores with respect to the evaluation criteria. Five restorations failed due to chipping up to 2 years (1 microhybrid at 6 m, and 3 at 2 years; 1 nanofilled at 2 y) and were repaired. One complete replacement and one extraction due to endodontic complications were needed for 2 microhybrid resin group at 2 years.

Clinical Evaluation of Silorane and Nano-hybrid Resin Composite Restorations in Class II Cavities up to 3 Years.

In this study, the clinical performance of a silorane-based resin composite (SC) vs a nano-hybrid resin composite (NHC) was evaluated in Class II cavities. From January 2012 to February 2013, a total of 29 patients (eight men, 21 women; mean age, 24 ± 5 years) received 29 pairs of restorations using both SC (Filtek Silorane, 3M ESPE) and NHC (Filtek Z550, 3M ESPE) materials. Patients were followed until February 2015. One operator performed all restorations using the corresponding adhesive resins according to the manufacturers' instructions. Two calibrated independent examiners evaluated the restorations at one week, six months, and then annually using the modified United States Public Health Service (USPHS) criteria for anatomic form, marginal adaptation, color match, surface roughness, marginal discoloration, secondary caries, and postoperative sensitivity. Changes in the USPHS parameters were analyzed with the McNemar test (α=0.05). The mean observation period was 31.2 months. Marginal adaptation was the only parameter that showed a significant difference and was worse for SC than NHC (p=0.012). At the final recall, 17 restorations from the SC group and five from the NHC group received a score of 1 (explorer catches). These scores were significantly different between baseline and final recall for SC (p<0.001) but not for NHC (p>0.05). Both NHC and SC performed similarly in Class II restorations up to three years except for marginal adaptation, for which the latter demonstrated significant deterioration at the final recall compared with baseline.

Actual drug allergy during childhood: Five years’ experience at a tertiary referral centre

BACKGROUND: Drug hypersensitivity reactions (DHR) are common in the paediatric population, representing a public health problem. Recent studies have confirmed that the frequency of drug allergy is overestimated by both parents and physicians. The aim of this study is to determine the prevalence and risk factors of actual drug allergies in children admitted to a tertiary referral allergy centre. METHODS: Medical records covering the period of 2005-2010 of children with a history of DHR were reviewed. Demographic features of the patients and results of skin and drug provocation tests were noted. The European Network for Drug Allergy (ENDA) questionnaire was filled by using medical records and making phone calls with parents. RESULTS: Ninety-six patients with 140 DHRs were evaluated. Seventeen children had confirmed drug allergy by positive skin tests (n = 11) and drug provocation tests (n = 5). One patient underwent severe anaphylaxis and subsequent cardiac arrest during infusion of the drug, and therefore diagnostic tests were not performed. Actual drug allergy was more frequent in children with chronic diseases (58.8% vs. 26.5%,p = 0.018) and histories of anaphylaxis during DHR (58.8% vs. 24%, p = 0.001). The patients' history of anaphylaxis [OR: 5.789, 95%CI: 1.880-17.554, p = 0.002], sweating [OR: 7.8, 95%CI: 1.041-58.443,p = 0.046] and dyspnoea [OR: 5.230, 95%CI: 1.836-14.894, p = 0.002] during suspicious DHRs increased the risk for actual drug allergy. CONCLUSION: Actual drug allergy was determined in 17.7% of the patients with a suspicious DHR. Having a history of anaphylaxis during suspected drug reactions as well as symptoms of sweating and dyspnoea increased the risk for actual drug allergy

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Actual drug allergy during childhood: Five years' experience at a tertiary referral centre.

BACKGROUND: Drug hypersensitivity reactions (DHR) are common in the paediatric population, representing a public health problem. Recent studies have confirmed that the frequency of drug allergy is overestimated by both parents and physicians. The aim of this study is to determine the prevalence and risk factors of actual drug allergies in children admitted to a tertiary referral allergy centre. METHODS: Medical records covering the period of 2005-2010 of children with a history of DHR were reviewed. Demographic features of the patients and results of skin and drug provocation tests were noted. The European Network for Drug Allergy (ENDA) questionnaire was filled by using medical records and making phone calls with parents. RESULTS: Ninety-six patients with 140 DHRs were evaluated. Seventeen children had confirmed drug allergy by positive skin tests (n=11) and drug provocation tests (n=5). One patient underwent severe anaphylaxis and subsequent cardiac arrest during infusion of the drug, and therefore diagnostic tests were not performed. Actual drug allergy was more frequent in children with chronic diseases (58.8% vs. 26.5%, p=0.018) and histories of anaphylaxis during DHR (58.8% vs. 24%, p=0.001). The patients' history of anaphylaxis [OR: 5.789, 95%CI: 1.880-17.554, p=0.002], sweating [OR: 7.8, 95%CI: 1.041-58.443, p=0.046] and dyspnoea [OR: 5.230, 95%CI: 1.836-14.894, p=0.002] during suspicious DHRs increased the risk for actual drug allergy. CONCLUSION: Actual drug allergy was determined in 17.7% of the patients with a suspicious DHR. Having a history of anaphylaxis during suspected drug reactions as well as symptoms of sweating and dyspnoea increased the risk for actual drug allergy.

Effect of QMix irrigant on the microhardness of root canal dentine.

BACKGROUND: The aim of this study was to evaluate the effects of QMix, EDTA + CHX, EDTA + NaOCl and maleic acid on the microhardness of root canal dentine. METHODS: Forty recently extracted human maxillary canine teeth were longitudinally sectioned into 80 segments and then embedded in an autopolymerizing acrylic resin. The microhardness of the dentine in the specimen was measured with a Vickers diamond indenter at the coronal, middle and apical thirds of the roots. Finally, the specimens were divided randomly into four groups: 17% EDTA + 2.5% NaOCl; 17% EDTA + 2% CHX; QMix; and 7% maleic acid. Post-treatment microhardness values were obtained and the decrease in microhardness was calculated as a percentage. Microhardness values were statistically analysed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Maleic acid significantly decreased microhardness in all regions, compared to the other groups. In the coronal and middle regions, there was no significant difference among the other groups. In the apical region, there was no significant difference between QMix and 17% EDTA + 2% CHX but these groups presented significant dentine microhardness reduction compared to the 17% EDTA + 2.5% NaOCl group. CONCLUSIONS: While maleic acid showed the greatest reduction in dentine microhardness, it was found that QMix, 17% EDTA + 2% CHX and 17% EDTA + 2.5% NaOCl cause the same reduction in the microhardness of root canal dentine in the coronal and middle regions.

Serum basal tryptase may be a good marker for predicting the risk of anaphylaxis in children with food allergy.

A relationship between serum basal tryptase (sBT) levels, anaphylactic reactions, and clonal mast cell diseases was shown recently in adults with venom allergy, but the relationship between sBT levels and IgE-mediated food allergy and anaphylaxis is not known. In this study, children with food allergy (FA; n = 167) were analyzed in two groups according to the presence (FA+/A+; n = 79) or absence of anaphylaxis (FA+/A-; n = 88) and were compared with a control group (n = 113). Median sBT values in FA+/A+, FA+/A-, and control groups were 4.0 ng/ml (2.8-5.8), 3.6 (2.3-4.5), and 3.3 (2.4-4.4), respectively (P = 0.022). sBT measurements higher than the cutoff values of 5.7 and 14.5 were associated with 50% and 90% predicted probabilities, respectively, of moderate to severe anaphylaxis. Children with tree nuts/peanut allergies had significantly higher levels of sBT than children with milk and egg allergy (P = 0.022). Results suggest that sBT levels may predict moderate to severe anaphylaxis in children with food allergy, which may follow a particular pattern according to the food allergy phenotype.

Importance of serum basal tryptase levels in children with insect venom allergy.

BACKGROUND: The importance of serum basal tryptase (sBT) levels on patients with venom allergy is highlighted in recent adulthood studies. The aim of this study was to evaluate the sBT levels of venom-allergic children with varying severity of clinical reactions. We also aimed to document the association between sBT levels and severe systemic reactions (SR). METHODS: Serum basal tryptase levels were estimated by UniCAP (Pharmacia & Upjohn, Uppsala, Sweden). Children who suffered from large local reaction (LLR) or SR after insect stings were included along with healthy control subjects without a history of any local or SR after insect stings. RESULTS: A total of 128 children (55 with SR, 18 with LLR, and 55 age and sex-matched control subjects) with a median age of 8.9 years (range 3.2-17.4) were enrolled. Severe SR was encountered in 24 (44%) patients with SRs. The median level of sBT in children with SRs (median, interquartile range) [4.2 µg/l (3.6-4.9)] was significantly higher than in children with LLRs [3.1 µg/l (2.5-4.0)] and healthy control subjects [2.9 µg/l (2.3-3.4)] (P < 0.001). Logistic regression analysis revealed sBT ≥ 4.8 µg/l as a significant risk factor for severe SR (5.7 [1.5-21.4]; P = 0.01) in children with venom allergy. CONCLUSIONS: Our results indicate that sBT levels are associated with a higher risk of severe SR in children with insect venom hypersensitivity. Determination of sBT levels may help clinicians to identify patients under risk of severe SRs and optimal and timely use of therapeutic interventions in children with venom allergy.

Turkish community-based palliative care model: a unique design.

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Accumulation of heavy metals with water quality parameters in Kizilirmak River Basin (Delice River) in Turkey.

Kizilirmak River has been used as Ankara's drinking water source for approximately 1.5 years. Therefore, this region's water, sediment, and fish samples are measured for detecting the heavy metals. This is important for the current situation as well as the future in terms of potential impact. The amount of heavy metals in drinking water should be within the limited values; otherwise, the accumulation of heavy metals will cause many problems to living organisms. Especially high levels of arsenic, cadmium, nickel, mercury, etc. are very dangerous to freshwater ecosystems as for human if the water is being use as drinking water. In this study, water, sediment samples, muscle, and gills of three fish species (Capoeta tinca, Capoeta capoeta, Leuciscus cephalus) were analyzed for the presence of heavy metals such as (Al, Fe, As, Cd, Ni, Mn, Se, Si) to determine present accumulation levels and possible toxic effect. The accumulation pattern of heavy metals in the water, sediment, and fish tissue follows the sequence: Si>Fe>Al>Mn>As>Ni>Se>Cd, Fe>Al>Mn>Ni>As>Se>Cd, and Fe>Al>Mn>As>Ni>Si>Cd. In addition, the detected concentrations of heavy metals in the Kizilirmak and Delice Rivers are compared with other heavy metal studies in the other main rivers and lakes in Turkey.