Spreading depolarization: A phenomenon in the brain.

In 1944, the physiologist Leão while studying epilepsy in the rabbit noticed a sudden temporary cessation of electrocorticographic (ECoG) activity accompanied with a large negative slow potential change recorded by extracellular electrodes, that is later known as spreading depolarizations (SDs). The depression of the brain electrical activity was slowly propagating through the cerebral cortex. The mechanism of propagation is still controversial. SDs and seizures are following each other interchangeably, yet the puzzle needs more investigation to be clarified. SDs have an obvious effect on blood-brain barrier integrity mainly through transcellular and paracellular routs, but not much known about that especially following traumatic brain injury (TBI). The cortical spreading depolarization (CSD) and the depression of brain activity have been recognized following a variety of neurological diseases and brain injuries. CSD has been studied in animal models and recently in humans, and it has been recognized and described as a massive neuronal depolarization accompanied with high level of disturbances in transmembrane ion gradients and significant changes in cerebral blood flow (1-3). Although there is a considerable amount of literatures on SD have been done since 1944, but the biophysical mechanism of SD, the long term effect on the brain structures and functions, and it is role in different disorders are still incompletely understood.Here, we summarize the history of spreading depolarization and the most accepted hypothesis for mechanism of initiation and propagation of that phenomenon. Most importantly, we present the most updated research on the relationship and interaction between spreading depolarization and traumatic brain injuries, seizure, blood-brain barrier, neurovascular coupling, and other neurological conditions. Learning more about the spreading depolarization will increase our understanding about that phenomenon and may explain its association with different clinical presentations.

Role of mandibular anatomical structures in sexual dimorphism in Turkish population: a radiomorphometric CBCT study.

Sex determination is one of the primary concerns of forensic science. The cranial bones, pelvis, and mandible have been used for determining the sex of specimens. Because the mandible is robust and sexually dimorphic, studies have evaluated its metric and morphological traits. This study was designed as a retrospective study involving cone beam computed tomography (CBCT) images to assess sexual dimorphism of the mandible in the Turkish population. Total sample group consisted of 176 bimaxillary CBCT scans (71 males and 102 females; ages 19-67 years). Sixteen mandibular parameters were measured using two different software programmes. Measurements were recorded in various planes of three-dimensional (3D) reconstructions of the scans. All parameters aside from SIMaCD were found to be statistically significant. The highest diagnostic accuracy rate was associated with IMaF, and the overall accuracy rate of the fourteen parameters was found to be 80%.

Audiological evaluation of the cochlear nerve with brainstem evoked response audiometry in patients with COVID-19.

PURPOSE: In this clinical study, it was aimed to prospectively evaluate the cochlear nerve with brainstem evoked response audiometry (BERA) in terms of audiological ailments in patients with COVID-19. Although the relationship of COVID-19 with tinnitus and hearing loss has been investigated since the day this infectious respiratory disease emerged, its relationship with BERA has not been fully demonstrated from a neurological perspective. METHODS: It was carried out on a group of patients who had COVID-19 in the last 6 months between February and August 2021 in Diyarbakir Gazi Yasargil Training and Research Hospital. Patients between the ages of 18-50, who applied to the otorhinolaryngology and neurology clinic and had COVID-19 in the last 6 months, were selected. The COVID-19 group of our study consisted of 30 patients, 18 males and 12 females, who had had COVID-19 disease in the last 6 months, and 30 healthy individuals, 16 males and 14 females, as the control group. RESULTS: In patients with COVID-19, the evaluation of the destruction of the cochlear nerve with BERA showed that there was a statistically significant prolongation in I-III and I-V interpeaks at 70, 80 and 90 db nhl. CONCLUSIONS: Statistically significant prolongation of especially I-III and I-V Interpeaks in BERA showed that COVID-19 has the potential to cause neuropathy. We believe that the BERA test should be considered in the neurological evaluation of cochlear nerve damage in patients with COVID-19 as a differential diagnosis.

Comparison of Molecular Markers and Classical Histopathological Diagnostic Methods in Grade II and III Glial Tumors and Their Prognostic Outcomes.

AIM: To demonstrate the changes in Grade II and III glial tumors after WHO 2016 Brain Tumors Classification. MATERIAL AND METHODS: The previous diagnoses and postoperative treatment of the 83 patients were recorded. We used real-time PCR (mutation assay) for the analysis of IDH1 and IDH2, while we used FISH test to determine 1p/19q codeletion. The integrated diagnosis was compared with classical histopathological diagnoses. RESULTS: We studied 13 oligodendendrogliomas, 41 astrocytomas and 29 oligoastrocytomas patients with classical histopathological diagnosis group. IDH mutation was detected in 51 of the patients after genetic analysis, whereas 1p/19q codeletion was detected in 20 patients. We found that grade II IDH-mut astrocytoma patients had significantly better survival outcomes compared to grade III IDH-mut astrocytoma patients. CONCLUSION: Grade II and III gliomas are separated into more homogeneous diagnostic groups for survival after molecular marker analyses. Compared to histopathological diagnosis, the WHO 2016 glioma classification with molecular markers provides new perspectives in patient prognosis and treatment. However, due to the costs of using molecular markers, the extent to which it can be used remains questionable.

Surgical management of sporadic hemangioblastomas located in the posterior fossa of brain.

PURPOSE: Hemangioblastomas (HBs) are highly vascular tumors, constituting 2%-3% of central nervous system (CNS) tumors. Surgery is a treatment option for HBs. The purpose of this study was to evaluate the demographic, clinical, and radiological findings of patients with HBs who were operated on via microsurgical technique at our clinic and to determine the findings specific to HBs and evaluate their pathological findings and confirmation. METHODS: We evaluated age, gender, initial complaints and duration of 100 patients (50 female and 50 male patients), presence of cranial nerve deficits, magnetic resonance imaging, data (localization, presence of hydrocephalus, tumor size, enhancement pattern, and cystic and solid component features), resection rates, pathological findings (grade, Ki-67 ratio, and staining results), recurrence, special conditions of patients, and the final status of patients in this study. RESULTS: Mean age was 39.08 ± 14.77 years and 66.7% of the patients presented with cerebellar findings. Five of the cases were located in the brainstem, five were located in the cerebellopontine angle, and two were in the cerebellar cortex. In all patients, gross total resection was performed using arteriovenous malformation repair. CONCLUSIONS: Surgical intervention of small and cystic tumors can be performed safely with en bloc resection along with preoperative detailed imaging, improved microsurgical techniques, and an extensive understanding of anatomical and vascular structures. On the contrary, patients with a brainstem invasion and solid structure present surgical difficulties due to arteriovenous malformation-like vascularizations; therefore, gross total resection is the optimal treatment in HBs.

Comparison of local rosmarinic acid and topical dexpanthenol applications on wound healing in a rat experimental wound model.

BACKGROUND: The aim of the study was to compare the effects of rosmarinic acid and dexpanthenol in a rat experimental wound model. MATERIALS AND METHODS: Twenty-four Wistar albino rats weighing 200-250 g were randomly divided into three groups. After 2-cm full-thickness skin defects were created, the wounds were washed with sterile 0.9% NaCl solution. After washing, the control group was left untreated, the second group received 5% dexpanthenol cream, and the third group received 10% rosmarinic acid cream. Before excision, the skin was evaluated macroscopically by measuring the reduction in wound size; after excision, histological examination (epithelisation, inflammation, fibrosis, granulation) was performed. RESULTS: Macroscopic comparison of the wound sizes showed that group 3 showed a statistically significant difference in wound size reduction compared to the other two groups. Histopathological examination showed that there was no statistically significant difference between the groups. We found that the rosmarinic acid group had greater wound size reduction than the other two groups. However, epithelialisation was detected in fewer cases. CONCLUSIONS: We believe that rosmarinic acid can be used as a topical cream for wound healing, as it leads to significant reduction in wound size, resulting in fewer scars.

Calvarial bone defects in ovariectomised rats treated with mesenchymal stem cells and demineralised freeze-dried bone allografts.

BACKGROUND: The aim of the study was to investigate the ability of a combination of bone marrow mesenchymal stem cells (BM-MSCs) with and without demineralised freeze-dried bone allografts (DFDBAs) to induce bone regeneration in calvarial defects in ovariectomised rats. MATERIALS AND METHODS: Critical size defects were filled with a combination of DFDBAs and BM-MSCs or BM-MSCs alone. Eight weeks after calvarial surgery, the rats were sacrificed. The samples were analysed histologically and immunohistochemically. RESULTS: No difference was observed in vascularisation between groups C1 (animals with cranial defect only, control group) and O1 (animals with cranial defect only, ovariectomy group). Intramembranous ossification was observed at a limited level in groups C2 (animals with cranial defect with MSCs, control group) and O2 (animals with cranial defect with MSCs, ovariectomy group) compared to C1 and O1. In group C3 (animals with DFDBAs with MSCs, control group), the fibrous structures of the matrix became compact as a result of a bone graft having been placed in the cavity, but in group O3 (animals with DFDBAs with MSCs, ovariectomy group), the fibrous tissue was poorly distributed between the bone grafts for the most parts. CONCLUSIONS: We conclude that the insertion of BM-MSCs enhances bone healing; however, the DFDBA/BM-MSC combination has little effect on overcoming impaired bone formation in ovariectomised rats.

Splenic artery angiography: clinical classification of origin and branching variations of splenic artery by multi-detector computed tomography angiography method.

BACKGROUND: The splenic artery (SA) variations are rarely reported in the literature. Knowledge of the range of the SA and other arterial anomalies and their specific frequencies is very important ever for every visceral surgeon as well as for treatment of gastrointestinal bleeding, organ transplantation, transarterial chemoembolisation of neoplasm, infusion therapy, therapeutic arterial ligation, iatrogenic injuries. At the literature, there are more studies on the coeliac trunk, superior mesenteric artery and hepatic artery variations, but studies on the SA variations are uncommon. The studies on the SA variations are mostly in the form of case reports, but there are not many studies with large population on this issue. The purpose of this study was to evaluate the SA alone and to determine the variations determined separately from the other arteries. Accurate awareness of all the possible anatomic variations is crucial in the upper abdomen surgery. MATERIALS AND METHODS: Seven hundred fifty patients undergoing multi-detector computed tomography angiography between 2015 and 2017 were retrospectively evaluated for the SA variations. We created a new classification system to determine anatomic variations of the SA. RESULTS: Twenty-three different types were identified related to anatomic variations in the origin and branching pattern of the SA. While 596 (79.47%) patients had standard SA anatomy, 154 (20.53%) patients had variant SA anatomy. CONCLUSIONS: The SA has quite different variation types and the practical context of the issue is of primary importance in surgery, gastroenterology, oncology and radiology. Liver and pancreas transplantation, splenectomy, embolisation of tumours of the abdominal organs, as well as other numerous diagnostic and therapeutic procedures, require detailed anatomical knowledge.

Investigation of antioxidant effects of rosmarinic acid on liver, lung and kidney in rats: a biochemical and histopathological study.

BACKGROUND: The aim of the study was to investigate the protective effects of rosmarinic acid in rats exposed to hepatic ischaemia/reperfusion (I/R) injury. MATERIALS AND METHODS: Thirty-two rats were randomly classified into four groups of 8 rats each: laparotomy without medication, rosmarinic acid (dose of 50 mg/kg via oral gavage) followed by laparotomy, laparotomy followed by hepatic I/R, and hepatic I/R with rosmarinic acid. Serum aspartate aminotransferase, alanine aminotransferase, and malondialdehyde levels and total oxidant activity and total antioxidant capacity levels of the liver, lung, and kidney were assessed. The histopathologic assessment was also performed. RESULTS: Rosmarinic acid significantly reduced liver function test parameters and decreased oxidative stress and abnormal histopathologic findings in the liver. The oxidative stress in the lung significantly increased in the I/R group but significantly decreased in the I/R + rosmarinic acid group due to the addition of rosmarinic acid. Rosmarinic acid led to no reduction in oxidative stress in kidney following hepatic I/R injury. There were no statistically significant differences among the groups regarding histopathologic changes in kidney and lung sections. CONCLUSIONS: Rosmarinic acid has antioxidant properties and is an effective hepatoprotective agent. However, although rosmarinic acid provides useful effects in the lung by increasing antioxidant capacity and reducing oxidative stress after I/R injury, it does not ameliorate histopathologic changes. These findings suggest that rosmarinic acid is likely to provide favourable outcomes in the treatment of hepatic I/R injury.

Histopathologic and immunohistochemical investigations of dental abscess formed in maxillofacial area.

BACKGROUND: An abscess is a pocket of pus that forms around the root of an infected tooth. In this study, we aimed to investigate the extracellular matrix proteases ADAMTS1, ADAMTS4, osteonectin, and osteopontin expressions in abscess fluid cells in jaws after implantation and prosthesis operation. MATERIALS AND METHODS: In this clinical study, abscess fluids belonging to 17 patients who applied to the Department of Oral and Maxillofacial Surgery were examined histopathologically and immunohistochemically. In the histopathological examination of the abscess fluid, separation of chromatin bridges in the nuclei of neutrophil cells, pyknosis and apoptotic changes in the nucleus, degenerative change in the cytoplasm, and occasional vacuolar structures were observed. RESULTS: The positive reaction of ADAMTS1 was observed in fibroblast cells, plasma cells, and macrophage cells. The positive reaction of ADAMTS4 was observed in fibroblast cells, osteoclast cells, and some apoptotic leukocyte cells. Osteopontin expression in osteoclastic cells and polymorphonuclear cells was defined as positive. Osteonectin expression was positive in polymorphonuclear leukocytes and hypertrophic fibroblast cells. CONCLUSIONS: ADAMTS1 and ADAMTS4 may induce bone destruction with its distinctive property in alveolar bone resorption, which promotes the activation of osteoclasts, which can accelerate the destruction of the extracellular matrix in the acute phase. Furthermore, osteoclastic activity increased with the increase of osteonectin and osteopontin protein expression due to inflammation in the abscess cases.

Neuroprotective effects of Potentilla fulgens on spinal cord injury in rats: an immunohistochemical analysis.

BACKGROUND: This examination was performed to research the advantage of the antioxidant impact of Potentilla fulgens on spinal cord injury (SCI) in rats. MATERIALS AND METHODS: In the SCI model of this examination, the tolerably serious lesion was performed at the L1-L2 spinal segmental level. SCI animals were given P. fulgens 400 mg/kg/day, intraperitoneally. At 7 days post-lesion, exploratory rats were executed after intraperitoneal administration 7 ketamine HCL (0.15 mL/100 g body weight). Spinal cord specimens were taken for histological examination or assurance of malondialdehyde (MDA) and glutathione (GSH) levels and myelope- roxidase (MPO) action. SCI caused a remarkable decline in spinal cord GSH content, trailed by noteworthy increments in MDA levels and MPO action. RESULTS: Degenerative changes in some multipolar and bipolar nerve cells and pyknotic changes in the nuclei of glial cells were likewise noticed. Remarkable development was seen in cells and vascular structures of P. fulgens treated groups when contrasted with untreated groups. CONCLUSIONS: Potentilla fulgens application may influence angiogenetic impro- vement in vein endothelial cells, reduce inflammatory cell aggregation by influ- encing cytokine system and may make apoptotic nerve cells and neuroprotective component in glial cells.

Effects of formaldehyde on vascular endothelial growth factor, matrix metallopeptidase 2 and osteonectin levels in periodontal membrane and alveolar bone in rats.

BACKGROUND: The objective of this study was to investigate whether long term formaldehyde inhalation may affect periodontal membrane and alveolar bone loss leading to periodontitis. The negative effects of formaldehyde were described using vascular endothelial growth factor (VEGF), matrix metallopeptidase 2 (MMP-2) and osteonectin antibodies involved in the extracellular matrix and angiogenetic development. MATERIALS AND METHODS: Thirty adult Wistar albino rats were used in this study. Rats were divided into two groups: a control group (n = 15) and formaldehyde administered group (n = 15). Formaldehyde group was exposed to inhalation of 10 ppm formaldehyde 8 hours a day, 5 days a week for 5 weeks. Maxillary bone regions were dissected under anaesthesia. After fixation in 10% formaldehyde solution, tissues were passed through graded ethanol series to obtain paraffin blocks. Five-micrometre histological sections were cut with RM2265 rotary microtome stained with Masson trichrome and VEGF, MMP-2 and osteonectin antibodies for examination under Olympus BH-2 light microscopy. RESULTS: The present study revealed that congestion in blood vessels, degeneration of collagen fibres and alveolar matrix around alveolar bone were observed to be more significant in formaldehyde group than the control group (p ≤ 0.001). Interestingly, VEGF expression in the formaldehyde group was the most significant finding between the two groups (p < 0.001). When compared inflammation, MMP-2 and osteonectin expressions were significant (p < 0.01) in the formaldehyde group. CONCLUSIONS: It was suggested that formaldehyde toxicity decreased the expression of MMP-2 and in osteoblasts as well as affecting the retention of MMP levels in tooth cavity, which is very low in collagen fibres. But, vice versa for the expression of VEGF in dilated vascular endothelial cells and osteocytes in alveolar bone. As a conclusion, formaldehyde disrupts the periodontal membrane and may cause collagen fibres degeneration by affecting the alveolar bone matrix.

Histopathological changes in the choroid plexus after traumatic brain injury in the rats: a histologic and immunohistochemical study.

BACKGROUND: Traumatic brain injury (TBI) is in part associated with the disruption of the blood-brain barrier. In this study, we analysed the histopathological changes in E-cadherin and vascular endothelial growth factor (VEGF) expression after TBI in rats. MATERIALS AND METHODS: The rats were divided into two groups as the control and the trauma groups. Sprague-Dawley rats were subjected to TBI with a weight-drop device using 300 g/1 m weight-height impact. After 5 days of TBI, blood samples were taken under ketamine hydroxide anaesthesia and biochemical analyses were performed. The control and trauma groups were compared in terms of biochemical values. RESULTS: There was no change in glutathione (GSH) levels and blood-brain barier permeability. However, malondialdehyde (MDA) and myeloperoxidase (MPO) activity levels increased in the trauma group. In the histopathological examination, choroid plexus in the lateral ventricle, near the pia mater membrane, was removed. In the traumatic group, some of epithelial cells were hyperplasic. Some of them were peeled off the apical surface and had local degeneration. CONCLUSIONS: In addition, we observed congestion in capillary vessels and mononuclear cell infiltration around the vessels. After TBI, the increase in VEGF levels, vascular permeability, and interaction with VEGF receptors in endothelial cells lead to oedema of the vessel wall. On the other hand, E-cadherin expression decreased in the tight-junction structures between epithelial cells and basal membrane, resulting in an increase in cerebrospinal fluid in the intervillous area.

Effects of nicotine administration in rats on MMP2 and VEGF levels in periodontal membrane.

BACKGROUND: Nicotine is associated with increased incidence of periodontal disease and poor response to therapy. This article aimed at identifying the expression of matrix metalloproteinases 2 (MMPs2) and vascular endothelial growth factor (VEGF) proteins on extracellular matrix, fibrous distribution and angiogenetic development in periodontitis caused by nicotine effects on periodontal membrane. MATERIALS AND METHODS: In this experimental study, rats were divided into nicotine and control groups. While the rats in the nicotine group (n = 6) were administered 2 mg/kg nicotine sulphate for 28 days, the animals in the control group (n = 6) were only administered 1.5 mL physiologic saline solution subcutaneously for 28 days. RESULTS: Histological sections were prepared and immunohistochemically stained for MMP2 and VEGF. The sections stained with Trichrome-Masson were observed under light microscope. VEGF and MMP2 immunoreactivity of periodontal gingiva and dentin was assessed by immunohistochemical staining. CONCLUSIONS: Nicotine reduces MMP production, disrupts collagen synthesis and causes periodontitis. We observed that nicotine increases periodontitis by disrupting periodontal membrane and prevents tooth to anchor in dental alveoli by disrupting epithelial structure.

Recurrence of atretic parietal cephalocele in adult: a case report and review of literature.

Common presentation of atretic parietal cephalocele is mostly seen in infants and young children. It is a palpable midline parietal soft tissue mass which is thought to represent involuted true cephalocele (meningocele or encephalocele) connected to dura mater via a fibrous stalk. Atretic parietal cephalocele is associated with increased incidence of intracranial anomalies.. Parietal cephaloceles comprise about 1% of all cerebrospinal congenital malformations and 10% of cephaloceles. We report here the case of an atretic parietal cephalocele with no associated brain malformations in adult.

The perinatal effects of maternal caffeine intake on fetal and neonatal brain levels of testosterone, estradiol, and dihydrotestosterone in rats.

Testosterone, estradiol, and dihydrotestosterone are the main sex steroid hormones responsible for the organization and sexual differentiation of brain structures during early development. The hypothalamo-pituitary-adrenocortical axis, adrenal cells, and gonads play a key role in the production of sex steroids and express adenosine receptors. Caffeine is a non-selective adenosine antagonist; therefore, it can modulate metabolic pathways in these tissues. Besides, the proportion of pregnant women that consume caffeine is ∼60%. That is why the relationship between maternal caffeine consumption and fetal development is important. Therefore, we aimed to investigate this modulatory effect of maternal caffeine consumption on sex steroids in the fetal and neonatal brain tissues. Pregnant rats were treated with a low (0.3 g/L) or high (0.8 g/L) dose of caffeine in their drinking water during pregnancy and lactation. The testosterone, estradiol, and dihydrotestosterone levels in the frontal cortex and hypothalamus were measured using radioimmunoassay at embryonic day 19 (E19), birth (PN0), and postnatal day 4 (PN4). The administration of low-dose caffeine increased the body weight in PN4 male and female rats and anogenital index in PN4 males. The administration of high-dose caffeine decreased the adrenal weight in E19 male rats and increased testosterone levels in the frontal cortex of E19 female rats and the hypothalamus of PN0 male rats. Maternal caffeine intake during pregnancy affects sex steroid levels in the frontal cortex and hypothalamus of the offspring. This concentration changes of the sex steroids in the brain may influence behavioral and neuroendocrine functions at some point in adult life.

LONGER CECUM INSERTION TIME AND MORE INADEQUATE COLONIC PREPARATION IN PATIENTS WITH ACROMEGALY: IS A DIFFERENT COLONOSCOPY PREPARATION NEEDED?

PURPOSE: To investigate whether there is a difference between acromegalic and non-acromegalic cases in terms of bowel preparation and colonoscopic intervention. METHODS: Patients with controlled and uncontrolled acromegaly and as a control group (CG) patients without acromegaly between January 2010 and March 2014 were included. Groups were compared regarding adequacy of bowel preparation, cecal insertion time (CIT) and colonoscopy results. RESULTS: Fifty-nine patients with acromegaly (controlled n=30, uncontrolled n=29) and 73 age and gender matched volunteers without acromegaly were evaluated. CIT in cases with controlled, uncontrolled acromegaly cases and in CG was 5.33 [4.00-6.00], 7.00 [4.91-11.31], and 3.10 [2.35-4.65] minutes, respectively (p<0.001). Cases in CG had shorter CIT compared to controlled and uncontrolled acromegaly cases ( p=0.014 and p<0.001, respectively). There was no significant difference regarding CIT between controlled and uncontrolled acromegaly cases (p=0.247). Six (20%) of controlled acromegaly patients, 10 (35%) of uncontrolled acromegaly patients and three (4%) of CG had inadequate bowel cleansing (p<0.001). Although statistically insignificant, cases with inadequate bowel cleansing had tendency towards having prolonged CIT in comparison to cases with adequate bowel cleansing (6.00 [3.87-9.00] and 4.16 [2.95-5.70] minutes, respectively, p=0.07). CONCLUSION: Inadequate bowel cleansing is one of the main problems encountered during colonoscopic investigation/surveillance in acromegalic patients. Therefore, a different protocol for colonoscopy preparation may be needed for these cases.

Effects of lowered dialysate sodium on left ventricle function and brain natriuretic peptide in maintenance of hemodialysis patients.

INTRODUCTION: Impaired diastolic flow is characterized by decreased left ventricular (LV) filling diastole, abnormal LV distensibility, or delayed relaxation. B-Type natriuretic peptide (BNP) is an indicator of various cardiovascular diseases and body volume status. The aim of this study was to determine whether the lowering of dialysate sodium (Na) levels is effective on LV systolic and diastolic parameters and BNP in the maintenance of hemodialysis patients. MATERIALS AND METHODS: The study included 49 chronic hemodialysis patients. Left atrium (LA) diameter and LV ejection fraction, LV systolic and diastolic diameter, deceleration time (DT), pulmonary artery pressure (PAP), inferior vena cava diameter (IVCD), early diastolic transmitral flow ( E) and late diastolic transmitral flow ( A) velocities, E/ A ratio, isovolumic relaxation time, peak early diastolic velocity ( E'), late diastolic velocity ( A') of tissue Doppler mitral annulus, and flow propagation velocity of mitral inflow ( Vp) were measured before and 6 months after hemodialysis with low Na dialysate. RESULTS: Six months after low Na hemodialysis, a decrease was observed in echocardiographic parameters such as PAP and IVCD ( p < 0.05, p < 0.001, and p < 0.001, respectively). However, a significant difference was not observed in LA diameter. In LV diastolic measurement of E and A waves, E/ A ratio, DT, Vp, septal E' and A', and lateral E' and A' exhibited significant improvement by low Na HD. BNP level was significantly reduced ( p < 0.001). CONCLUSIONS: Lowered dialysate Na concentration improves PAP, IVCD, and LV diastolic properties assessed by mitral inflow filling, tissue Doppler velocity, and mitral inflow velocity propagation.

An Investigation of Post-Traumatic Growth Experiences Among Living Kidney Donors.

More than 1 million patients are estimated to have undergone transplantation in the past years. In recent years, living-donor kidney transplantation accounted for more than 50% of all transplantations. Kidney transplantation from living donors is regarded as a contradictory case to the "do no harm" principle as a major surgical intervention is performed on a normal and healthy person at the expense of recovery of the organ recipient. The purpose of this study was to investigate positive psychological experiences, specifically post-traumatic growth (PTG), among living kidney donors. The sample consisted of a total of 184 kidney donors. The age of donors ranged between 21-76 (mean, 50.76; SD, 10.93). In this study 67.9% of donors were female. The recipients on dialysis group had higher scores than the recipients who did not have dialysis; the mean difference was significant on the subscales of change in life philosophy, change in relationships, change in self-perception, and in the PTGI score. The donors with higher education levels received higher scores on the subscale of change in relationships in comparison with donors with low education. The donors who were married and older than 51 years had higher scores than donors who were not married or younger on the subscale of change in self-perception. This is a single-center study; this center performs more than 500 kidney transplantations per year. There is a good system and experience at each step before and after transplantation for donor and recipient and relatives. It is a really big potential trauma to donate a kidney to your relative; you can change this negative effect to a positive effect with a good system. The present study also showed that when compared with the scale's absolute midpoint, kidney donors in the study sample experienced moderate-to-high levels of PTG.

First International Paired Exchange Kidney Transplantations of Turkey.

OBJECTIVE: We estimated that many patients on the waiting list for kidney transplantation in Turkey have immunologicaly incompatible suitable living donors. Paired exchange kidney transplantation (PETx) is superior to desensitization for patients with incompatible donors. Recently we decided to begin an international PETx program. METHODS: We report three international living related paired kidney transplantations which occurred between May 14,2013, and March 7, 2014. The international donor and recipient operations were performed at Medical Park Hospital, Antalya, Turkey. All pairs were living related and written proofs were obtained according to Turkish laws. As with the donor procedures, the transplantation procedures were performed at the same time. RESULTS: The uniqueness of these transplantations was that they are the first international exchange kidney transplantations between Turkey and Kirghizia. Currently all recipients are alive with wel-functioning grafts. CONCLUSION: In our institute, a 5% increase was obtained in living-related kidney transplantations by the help of PETx on a national basis. We believe that international PETx may also have the potential to expand the donor pool.