Troponin-T value as a prognostic marker in neonates diagnosed with neonatal encephalopathy and receiving hypothermia treatment.

OBJECTIVE: The aim of this study was to investigate the effect of Troponin-T levels on the prognosis of neonatal encephalopathy (NE). PATIENTS AND METHODS: The study included one hundred and eleven newborns diagnosed with NE and receiving hypothermia treatment. The cases were separated into 2 groups according to the SARNAT classification as Stage 2 or Stage 3. The groups were compared in respect of anthropometric characteristics, APGAR scores, and biochemical parameters. The cases were also separated into 3 groups according to the Troponin-T levels and were compared with respect to the clinical course. RESULTS: The serum Troponin-T (p=0.012), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (p<0.0001), and lactate levels (p=0.04) in the Sarnat Stage 3 group were statistically significantly higher than in the Sarnat stage 2 group. A significant positive correlation was determined between the Troponin-T level and the total duration of respiratory support (r=0.20, p=0.03). A significant positive correlation was determined between the ALT/AST ratio and the length of stay in hospital (r=0.29, p=0.001), duration of intubation (r=0.32, p=0.01), and total duration of respiratory support (r=0.36, p<0.001). A statistically significant difference was determined in mortality rates between the 3 subgroups of Troponin-T levels; Group 1: 2.8%, Group 2:5.4%, and Group 3: 15.8%. (p=0.04, χ²=4.74). A cut-off value of 164 ng/L for Troponin-T was determined to predict mortality with 77% sensitivity and 67% specificity (AUC=0.73, p=0.023). When the groups were compared according to Troponin-T level, a statistically significant difference was determined in respect of length of stay in hospital (p=0.03, χ²=6.95) and total duration of oxygen support (p=0.01, χ²=9.12). CONCLUSIONS: The serum Troponin-T level can be evaluated as a prognostic marker in cases followed up with a diagnosis of NE and receiving hypothermia treatment. There is a need for further prospective studies with larger samples on this subject.

Cytokine release syndrome in Crimean-Congo hemorrhagic fever: can IL-1 receptor antagonist levels be a guide in its treatment?

OBJECTIVE: Crimean-Congo Hemorrhagic Fever (CCHF) is a potentially fatal zoonotic viral disease involving fever and hemorrhage. Our aim was to investigate the relationship between interleukin (IL)-1 and IL-1 receptor antagonist (RA) levels in patients with CCHF and the course of the disease and mortality, as well as to contribute to the literature at a time when new therapeutic protocols are being investigated. PATIENTS AND METHODS: Sixty-one patients with CCHF were admitted to our hospital's infectious diseases ward between March and September 2022, and 40 healthy people were included in the control group in our study. The patients were divided into mild/moderate (n=35) and severe (n=26) CCHF groups depending on the clinical course. The patients with CCHF were also divided into surviving and exitus groups. IL-1 and IL-1RA levels were measured from blood specimens using the ELISA method. RESULTS: Significant elevation in IL-1 and IL-1RA levels was observed in CCHF cases with a severe manifestation compared to those with moderate disease. Both patient groups' IL-1 and IL-1RA levels were also significantly higher than those of the control group. In addition, IL-1 and IL-1RA levels were significantly higher among the exitus patients compared to the surviving CCHF patients. The laboratory values of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine phosphokinase (CK), platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were also significantly higher among the patients with severe manifestations compared to the moderate severity patient group, and in the exitus patients compared to the survivors. However, platelet count and fibrinogen levels were lower in the patients with a severe manifestation compared to the moderate severity group and in the exitus patients compared to the survivors. White blood cells (WBC) were higher in exitus patients than in survivors. CONCLUSIONS: IL-1 and IL-1RA levels were elevated in all the CCHF patients, while the higher values in patients with a fatal course suggest that the inflammatory process is very severe and that IL-1 receptor antagonists may be needed in the treatment.

Sleep quality and glycemic control in children and adolescents with type 1 diabetes mellitus.

OBJECTIVE: This study aimed to investigate the frequency of sleep disorders, and the relationship between glycemic control and sleep characteristics in diabetic children and adolescents. PATIENTS AND METHODS: Sixty-one patients followed for at least one year for type 1 diabetes mellitus (T1DM) aged 6-16 years old, and eighty-three group-matched healthy controls were included in the study. Time in range (TIR) and hypoglycemia episode numbers were recorded using the freestyle libre sensor data. The sleep characteristics were evaluated using the Sleep Disturbance Scale for Children (SDSC) validated survey. The diabetic patients were trichotomized according to SDSC scores, as low, medium, and high score groups. RESULTS: Sleep duration, SDSC total score, and subgroup scores except for sleep hyperhidrosis (3.11±1.53 vs. 2.16±0.85, p<0.001, respectively) were similar (p>0.05) between the diabetic and control group. According to the survey, 1.6% of diabetic cases and 6.1% of the control group had clinically significant sleep disturbances (p>0.05). Duration of diabetes (DD) was lower (p=0.01), and the level of HbA1C was higher (p=0.02) in the high-score group than the others. Regression analysis revealed that TIR was the only independent determinant for the SDSC score (ß=-1.27, t=-1.90; p=0.012). CONCLUSIONS: Sleep habits and problems should be routinely evaluated in diabetic children and adolescents.

Machine learning models for estimating contamination across different curbside collection strategies.

Contaminated recyclables, which are frequently discarded as waste, pose a significant challenge to the implementation of a circular economy. These contaminated recyclables impede the circulation of resources, resulting in higher processing costs at material recovery facilities (MRFs). Over the past few decades, machine learning (ML) models such as linear regression (LR), support vector machine (SVM), and random forest (RF) have evolved to provide new methods for predicting inbound contamination rates in addition to traditional statistical models. In this study, we applied ML models to predict inbound contamination rates using demographic features from 15 counties in the U.S. with different curbside collection strategies. In general, we found that ML models outperformed linear mixed models. Specifically, SVM models had the highest performance (R2 = 0.75; mean absolute error (MAE) = 0.06), which may be due to their ability to model nonlinear relationships between features and inbound contamination rates. The key predictor was population, with poverty rate being positively correlated and median age negatively correlated with inbound contamination rates. To improve the management of contamination and enhance the implementation of a circular economy, better models are needed to understand and estimate inbound contamination rates as well as identify critical factors in the present and future.

Impact of body mass index and vitamin D on serum AMH levels and antral follicle count in PCOS.

OBJECTIVE: To investigate the effects of body mass index (BMI) values and 25(OH) vitamin D levels determined by Endocrine Society on serum Anti Mullerian Hormone (AMH) and antral follicle count (AFC) in women with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: Sixty infertile women with PCOS and 30 age-matched women with unexplained infertility (UEI), were included. Patients in PCOS and control groups were divided into three subgroups according to their BMI values as normal, overweight and obese. Each BMI group was divided into three subgroups according to vitamin D levels. While AMH and vitamin D levels were determined at first admission, AFC was measured on the third day of cycle. RESULTS: BMI, AFC, and AMH levels of women with PCOS were significantly higher than the UEI group. AMH values of women with PCOS with normal BMI were found to be significantly higher than UEI controls with normal BMI. AMH values of overweight and obese PCOS patients and controls were similar. As BMI values of the PCOS group increased, vitamin D levels decreased significantly. Vitamin D levels of the patients in the PCOS group were found to be significantly lower than the control group. When evaluated according to BMI, the vitamin D levels of normal, overweight and obese women with PCOS were significantly lower than the UEI. CONCLUSIONS: Rising BMI in PCOS leads to a significant decrease in vitamin D and AMH. Deficiency, insufficiency or normality of vitamin D do not affect the main markers of ovarian reserve.

Fertility protective effect of taxifolin in cisplatin-induced ovarian damage.

OBJECTIVE: The aim of our study was to investigate the protective effect of taxifolin on ovarian damage and reproductive dysfunction created by cisplatin administration. MATERIALS AND METHODS: A total of 36 albino Wistar female adult rats were equally divided into 3 groups as cisplatin administered only (CIS), taxifolin+cisplatin (T+C) and healthy control group (HG). Taxifolin 50 mg/kg was administered orally by gavage in the T+C (n=12) group. In the HG (n=12) and CIS (n=12) groups, the same volume of distilled water as a solvent was orally administered. One hour after administration of taxifolin or distilled water, animals in the T+C and CIS groups were injected with cisplatin at a dose of 2.5 mg/kg intraperitoneally. This procedure was repeated once a day for 14 days. Six animals from each group were sacrificed on day 15, and their ovaries were removed for histopathological and biochemical analysis. Ovarian tissue malondialdehyde (MDA), total Glutathione (tGSH), Nuclear Factor-Kappa B (NF-kB), Tumor Necrosis Factor-α (TNF-α), Interleukin 1 beta (IL-1ß), and Interleukin-6 (IL-6) levels were measured. The remaining animals (n=6 in each group) were kept in the laboratory with mature male rats for two months to breed. RESULTS: CIS administration led to an increase in inflammatory molecules and membrane lipid peroxidation products, and decreased the synthesis of antioxidant molecules. Compared to the CIS group, the ovarian tissue MDA, NF-kB, TNF-α, IL-1ß and IL-6 levels were found to be significantly decreased in the T+C group (p<0.001 for all comparisons). On the other hand, the tGSH levels of the T+C group were significantly higher than the CIS group (p<0.001). Milder ovarian necrosis, fibrosis and follicle damage were detected in animals which were given taxifolin. Four out of the six rats (67%) treated with taxifolin gave birth within 27 days. CONCLUSIONS: We demonstrated, for the first time, that taxifolin ameliorates cisplatin-induced ovarian injury by decreasing MDA and proinflammatory cytokines and increasing the antioxidant enzyme. The fact that more than half of the animals receiving taxifolin became pregnant suggests that the cytoprotective effect of taxifolin is strong enough to preserve fertility.

High serum AMH inhibits pathological growth of the low biomass endometrial microbiome.

OBJECTIVE: Although host microbiome play a role in both hormonal status and fertility, this issue has not yet been clarified. Since the endometrium is a sterile tissue, it is accepted that microbiota does not grow under normal conditions. The aim of the study was to reveal the characteristics of endometrial microbiota according to serum AMH levels in women with implantation failure. PATIENTS AND METHODS: Forty-five women aged 20-30 years with two or more implantation failures were included in the study. They were divided into 3 groups according to their serum AMH values: Group 1 -AMH <1.3 ng/ml; Group 2 - AMH between 1.3-2.6 ng/ml; Group 3 - AMH >2.6 ng/ml. Twenty-two healthy fertile women who were the same age as the infertile group and applied for cervical smear screening were accepted as the control group. Following the embryo transfer, the tip of the catheter was inserted into the transport medium under sterile conditions. Sowing was carried out by touching the tips of the catheter to the blood agar medium. After the evaluation of the petri dishes at the end of 48 hours of incubation, colonies were stained with Gram stain. Microorganisms in the colonies were identified with the Vitek-2 device according to their gram-staining characteristics and their antibiograms were made. RESULTS: A negative correlation was detected between low AMH values and the microbiome detection rates in endometrial cultures. In patients with low serum AMH levels, the chance of endometrial microbiota growth was higher in the endometrial culture medium. The most common bacteria were found to be MSSA, MRKNS and lactobacillus. Clinical pregnancy rates were found to be significantly higher in the group with high AMH levels. As AMH levels increased, positive flora detection rates decreased, while clinical pregnancy rates increased. CONCLUSIONS: Low serum AMH level increases the rate of positive endometrial microbiome in culture and decreases clinical pregnancy rates.

Influence of resveratrol application with pulp-capping materials on the genetic expression levels of stem cells.

AIM: To evaluate in a laboratory setting the response of human mesenchymal stem cells (MSCs) to pulp-capping materials with and without resveratrol (RSV). METHODOLOGY: Five materials, Calcimol LC, Life, TheraCal LC, ProRoot MTA and Biodentine, were prepared according to the manufacturers' instructions. Human MSCs were then exposed to these materials, with and without RSV, for 24 h (n = 8). Cell viability was evaluated using the MTT assay, and total cell death was quantified by annexin V-FITC staining with flow cytometry. The expression levels of the IL-8, IL-10, HBD-2 and BCL-2 genes were investigated using real-time polymerase chain reaction (RT-PCR). Data obtained from MTT test were analysed using one-way anova, and Tukey's multiple-comparison test. The paired Student t test was employed to compare the effects of materials on gene expression (significance level of 5%). RESULTS: The group cell viabilities were Calcimol LC 53%, Life 43%, TheraCal LC 78%, ProRoot MTA 75% and Biodentine 78%. Calcimol LC and Life exhibited significant differences compared with the control groups (P < 0.05). The percentages of necrotic/late apoptotic cells associated with Calcimol LC and TheraCal LC were greater than in the other materials. However, when RSV was added to wells containing materials, cell viability increased to Calcimol LC 63%, Life 52%, TheraCal LC 82%, ProRoot MTA 91% and Biodentine 96%, and the percentages of early apoptotic and late apoptotic/necrotic cells decreased. Calcimol LC + RSV and Life + RSV differed significantly from the control group (P < 0.05). The expression of IL-8 gene was high for all materials, ProRoot MTA caused significant overexpression, and the addition of RSV reduced the expression of IL-8 in the Calcimol LC, TheraCal LC and ProRoot MTA groups and led to increased expression of IL-10 in the Calcimol LC, Life and Biodentine groups. HBD-2 and BCL-2 exhibited increased expression in ProRoot MTA with RSV (P < 0.05). CONCLUSIONS: The addition of RSV exerted a protective effect on MSCs and regulated the inflammatory process by altering the expression levels of pro- and anti-inflammatory genes.

Anatomo-radiological importance and the incidence of os odontoideum in Turkish subjects: a retrospective study.

PURPOSE: Os odontoideum is a rare anatomical and morphological variation of the odontoid process and associated with a range of symptoms such as spinal cord and vertebral artery injuries. This study aimed to evaluate the frequency of os odontoideum in Turkish cases by sagittal/coronal cervical magnetic resonance imaging (MRI) and computed tomography (CT) and analyze the relationship with age, gender and related symptoms. METHODS: The incidence of os odontoideum was retrospectively diagnosed by sagittal/coronal cervical CT and MRI out of 16,122 subjects aged 20-70 years (mean 46) in the period between 2014 and 2018. The relationship of os odontoideum with age, gender, and symptoms was recorded. RESULTS: The statistical analysis of the study was performed by the χ² test and two-way mixed ANOVA. Os odontoideum was detected in 18 (0.11%) (11 males; 7 females) out of 16,122 patients. The mean age was 47.5 ± 1.4 years in the females and 43.5 ± 2.5 years in the males (p < 0.05). 6 odontoideum were detected out of 6467 (3756 males, mean 48 ± 0.7, 2711 females, mean 46 ± 1.2) subjects by CT and 12 odontoideum were detected out of 9655 patients (5607 males and 4048 females) by MRI. CONCLUSION: Neck pain was the most frequent symptom. The prevalence of os odontoideum especially round type is more frequent in older male patients over 40 years old with head and neck pain or atlantoaxial instability, and is less common in Turkish subjects when compared to various ethnic groups.

Recovering value from single stream material recovery facilities - An outbound contamination analysis in Florida.

The single stream recycling (SSR) program is a process in which all recyclable materials are deposited into a single collection bin. SSR has gained popularity in the U.S. due to its inherent abilities in waste collection, and specifically, in Florida, more than twenty counties have recently switched their recycling program from dual stream recycling (DSR) to SSR. Despite a more efficient collection process, mixing all recyclable materials into a single bin can lead to cross contamination even before reaching material recovery facilities (MRFs). This study aims to provide a better understanding of the sorting process and equipment in MRFs, and the impact of the SSR program on contamination rates in outbound materials that were processed through Florida's recycling systems. First, we investigate the audit data obtained from a currently operating MRF in Florida using mass flow analysis to identify the most problematic recyclable streams and the processes with low efficiency and high false separation rates. According to our results, the sorting rates of mixed paper, glass and plastics are under the industry standards. Moreover, we investigate the outbound contamination rates of 35 old corrugated cardboard (OCC) and 266 old newsprints (ONP) samples obtained from four currently operating MRFs in Florida. Based on the results, only 31.4% of OCC samples and none of the ONP samples were within the accepted mills' standards for contamination rates. This study provides valuable insights for lowering contamination and raising the end-product quality by identifying the problematic contaminants and processes in sorting and separation in MRFs.

[Electronic vision aids : New options for rehabilitation of the visually impaired]. / Elektronische Hilfsmittel : Neue Möglichkeiten zur Rehabilitation Sehbehinderter.

Due to technical advances, there has been an enormous improvement of electronic vision aids in recent years. New developments are especially small portable devices which can be easily carried. The majority of electronic vision aids serve as a reading aid. Electronic magnifiers are a portable alternative to conventional screen readers. In addition, there are mobile reading devices and special computer tools. Color recognition devices and barcode scanners are helpful in everyday life. Ultrasonic orientation systems enable the recognition of obstacles also at head height. Mechanisms incorporated in shoes even comprise a navigation system. A brand new development is OrCam (OrCam Technologies Ltd., Israel), a small, inconspicuous camera system which is attached to the spectacles. It transmits vision information as a text. Smart phones and tablet personal computers have meanwhile been developed to such an extent that they replace more expensive special vision aids. Due to the immense technical progress, electronic vision aids provide visually impaired people with many elegant functions and new possibilities for ophthalmological rehabilitation. Besides the technical, mobile and financial aspects, the social acceptance of the devices, which should be as unobtrusive as possible, plays an essential role.

AFC vs. AMH: prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation.

OBJECTIVE: To assess the clinical value of antral follicle count (AFC) and anti-Mullerian hormone (AMH) for the prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation for IVF using GnRH antagonist treatment. PATIENTS AND METHODS: Fifty patients with endometrioma who underwent their first IVF/ICSI cycle with GnRH antagonist treatment were included in the study. The average AMH values were recorded as 1.5-2 ng/mL. Fifty infertile women are not suffering from endometrioma were selected from those with male factor infertility as control. They were matched according to both serum AMH levels and age. Serum samples have been collected before the IVF treatment for determining AMH levels in both groups of subjects. Likewise, each group of subject underwent ultrasound scan for AFC on day 3. Total number of oocytes retrieved during OPU, the number of transferred embryo, implantation and clinical pregnancy rates, live birth and abortion rates, total dose of rhFSH were noted in both groups of subjects. RESULTS: Day 3 AFC was significantly higher in the control group compared to women with endometrioma. Both the number of retrieved oocytes during oocyte pick-up, MII oocytes and 2 PN embryo were significantly lower in the endometrioma. Likewise, the fertilization, implantation, clinical pregnancy and live birth rates of endometrioma group were significantly lower than those in the control group. The total rFSH dose was higher in the endometrioma group than those in control. The percentage of abortion in the endometrioma group was found to higher compared to those with controls. CONCLUSIONS: AFC is more sensitive than the AMH in detecting ovarian response in women with ovarian endometrioma. The individualization of GnRH antagonist protocols in subjects having endometrioma might be improved by using an AFC-tailored approach instead of AMH.

Prevalence and distribution of the fabella: a radiographic study in Turkish subjects.

BACKGROUND: The purpose of this study is to examine the plain knee radiographs in Turkish subjects in order to determine the prevalence of the fabella and analyse the differences between age, gender, laterality and its symmetry pattern. MATERIALS AND METHODS: Bilateral antero-posterior and lateral knee radiographs of 500 patients (250 male and 250 female subjects, 1000 knee radiographs) were randomly selected from the clinical database and retrospectively evaluated. Data on patient age, gender, and knee laterality (right-left) were evaluated from hospital records. The differences between the sesamoid bones at a particular location and the side, sex and age groups were analysed. RESULTS: The overall prevalence of the fabella (unilateral or bilateral) was 22.8% (114 subjects). The fabella was present unilaterally in 38 (7.6%) subjects, while it was present bilaterally in 76 (15.2%) subjects. The prevalence of the fabella was similar between the body sides. The prevalence of the fabella was also similar between genders (unilateral or bilateral cases) and age groups. CONCLUSIONS: We examined the prevalence, symmetry pattern, age and gender differences in Turkish population. It is the first study performed on Turkish population with the largest sample in current literature. Prevalence of fabella is found to be 22.8% which is quite similar with other Caucasian ethnic populations.

Disulfiram, as a candidate NF-κB and proteasome inhibitor, prevents endometriotic implant growing in a rat model of endometriosis.

OBJECTIVE: Disulfiram (DSF) exerts its therapeutic effects through oxidative, proteasome, and nuclear factor kappa beta (NF-κB) pathways. The study was planned to test the impact of DSF on growing of endometriotic implants in rats with experimentally induced endometriosis. PATIENTS AND METHODS: Thirty rats were labeled as the control (n = 8), sham (n = 6), GnRH-agonist (n = 8) and the DSF (n = 8) groups. The rats in the group 3 exposed to single dose leuprolide acetate. The rats in group 4 were treated with DSF for 21 days. The serum activity of oxidant and antioxidant markers, total oxidant status (TOS), total antioxidant status (TAS), interleukin-1ß, and tumor necrosis factor-α (TNF-α) were determined. Implants were processed for NF-κB, PCNA, and CD34 immunostaining. RESULTS: The serum concentration of malondialdehyde in the DSF group was significantly higher than those in other groups. The concentration of TAS, TNF-α, and interleukin-1ß in the DSF group considerably decreased compared to control group. Following treatment with DSF while the percentage of Grade 1 and 2 implants increased the percentage of Grade 3 and 4 implants decreased. The implants disappeared totally in two cases in the DSF group and one case in the GnRH-agonist group. The mean H-Scores of implant NF-κB and PCNA in DSF treated animals were found to significantly lower than those of the control group. CONCLUSIONS: By decreasing NF-κB expression, angiogenesis, and cell proliferation DSF prevents the growth of endometriotic implants.

Serum and follicular fluid irisin levels in poor and high responder women undergoing IVF/ICSI.

OBJECTIVE: We examined the follicular fluid (FF) and serum levels of irisin in high and poor responders undergoing IVF/ICSI to test whether irisin has a role in the metabolic regulation of energy homeostasis in growing follicle. PATIENTS AND METHODS: Twenty infertile women with PCOS and 20 poor responder participants undergoing controlled ovarian stimulation (COS) with GnRH antagonist protocol for IVF/ICSI treatment were allocated. Blood was obtained at the time of oocyte retrieval. The follicular fluid content of mature follicles was collected from both high and poor responder women. Irisin levels were measured by using EIA. RESULTS: There was no significant difference between serum and FF-irisin levels in women with PCOS. (11.18 ± 5.14 µg/mL vs. 11.06 ± 4.93 µg/mL, p < 0.96). In contrast, serum levels of irisin in poor responders were significantly higher than in the FF-irisin levels (13.13 ± 4.27 µg/mL vs. 10.09 ± 4.14 µg/mL, p < 0.01). FF-irisin levels of PCOS subjects were positively and significantly correlated with serum levels of irisin (r: 0.81, p < 0.00). Serum irisin was positively associated with serum levels of total testosterone but was negatively associated with HOMA-IR in the overall patient population. FF-irisin levels were also noted to be negatively correlated with HOMA-IR. Although there is no correlation between serum irisin and AMH levels, FF irisin levels were negatively correlated with serum AMH levels in PCOS subjects. Contrary to PCOS group there were no significant correlation between serum and FF-irisin levels in poor responder group (r: 0.21; p < 0.35). CONCLUSIONS: The present study is the first attempt to explore the role of irisin in oocyte development by measuring FF and serum levels of this molecules in patients with poor and high responders undergoing IVF/ICSI.

The Use of ShotBlocker for Reducing the Pain and Anxiety Associated With Intramuscular Injection: A Randomized, Placebo Controlled Study.

There are few studies evaluating the effect of ShotBlocker on pain acquired from intramuscular injection, and these are mostly in children. We hypothesized that the use of ShotBlocker, while administering an intramuscular injection, would reduce the pain and anxiety due to intramuscular injection in adults. A randomized, placebo controlled trial was carried out for more than 20 months in 2010-2011 on 180 adults aged 18 to 80 years who received intramuscular injections of diclofenac sodium (75 mg/3 mL) at the outpatient clinic of a hospital. The patients were grouped into 3 groups: control, placebo control, and experimental. The experimental group was given an intramuscular injection of diclofenac sodium with ShotBlocker. Pain intensity was measured through a visual analog scale after the injection and anxiety was measured using Spielberger's State-Trait Anxiety Inventory. Pulse rate was counted and state and trait anxiety was measured before and after the injection. The Mann-Whitney U test and Wilcoxon and Kruskall-Wallis tests were used to evaluate the data. Patients in the ShotBlocker group had significantly lower pain intensity than those in the placebo and control groups. State anxiety level increased after the injection in the experimental group but did not change in the other 2 groups. ShotBlocker did not affect the pulse rate. Our results suggest that using ShotBlocker during intramuscular injection reduced patients' pain intensity because of injection but did not reduce anxiety levels. Thus, ShotBlocker is recommended as a pain-relieving tool during intramuscular injection in adults.

[Full depth imaging: a new imaging technique using optical coherence tomography (OCT)]. / Full Depth Imaging: neue Aufnahmetechnik mittels optischer Kohärenztomografie (OCT).

PURPOSE: The aim of this study was to evaluate the full depth imaging (FDI) mode as a new acquisition technique with spectral domain (SD) optical coherence tomography (OCT) from Heidelberg Engineering for illustrating vitreoretinal and choroidal structures with high contrast. METHODS: Patients with different diseases such as age-related macular degeneration, chorioretinopathia centralis serosa, diabetic retinopathy and epiretinal gliosis were examined with the FDI mode. For comparison, we also examined healthy probands with conventional OCT and the enhanced depth imaging (EDI) mode. FDI images were obtained with a manual acquisition technique. First, 100 conventional OCT scans of the vitreoretinal interface were averaged. After manual switching to the EDI mode the previous averaged image was overlayed with EDI images until vitreous, retina and choroid were projected in one comparably sharp image. RESULTS: The FDI mode enables SD-OCT images showing the vitreoretinal interface and deep choroid structures with a high contrast. The new acquisition mode has a few limitations: it is only possible to perform a single linear scan, a raster scan is not possible. The FDI mode is a manual acquisition technique and not automated yet. CONCLUSION: By a combination of averaged images of the vitreoretinal interface with the help of conventional SD-OCT scans with EDI OCT scans the FDI mode exhibits a simultaneous contrast image of the posterior vitreous, the retina and the choroid. Whereas the application of OCT was focused to evaluate the retina-retinal pigment epithel complex, the routine reinforcement of FDI scans could additionally show potential vitreous and choroidal pathologies. As the FDI mode is not an automated application yet it may be too complex to use for routine diagnostics at the moment.

[Adjuvant stereotactic low energy radiation therapy of exudative age-dependent macular degeneration (Oraya system)]. / Adjuvante stereotaktische niederenergetische Strahlentherapie bei exsudativer altersabhängiger Makuladegeneration (Oraya System).

With respect to the increasing number of patients and the risk and burden for patients caused by injections, a reduction in the number and frequency of injections with vascular endothelial growth factor (VEGF) inhibitors in exudative age-related macular degeneration (ARMD) is desirable. Stereotactic low-voltage x-ray irradiation seems to be a promising approach. For this purpose the Oraya system is available and has shown positive results in initial studies. Pending presentation of phase II and III study data this adjuvant irradiation should only be used in clinical trials.

Adrenomedullin: possible predictor of insulin resistance in women with polycystic ovary syndrome.

The aim of the study was to investigate adrenomedullin (ADM) levels and its relation with insulin resistance in women with polycystic ovary syndrome (PCOS). Twenty-nine women with PCOS and 29 age- and body mass index (BMI)- matched control subjects were included in the study. PCOS was defined according to criteria by the Rotterdam European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine (ESHRE/ASRM)-sponsored PCOS consensus workshop group. A full clinical and biochemical examination including basal hormones and metabolic profile was performed. Insulin resistance was calculated by using the homeostasis model assessment of insulin resistance index (HOMA-IR). Plasma ADM levels were measured by high performance liquid chromatographic (HPLC) method. Plasma ADM, fasting insulin levels and HOMA-IR were significantly higher in patients with PCOS than the control group. ADM levels were positively correlated with insulin levels and HOMA-IR index. The best cut-off value of ADM levels to identify the presence of insulin resistance (HOMA-IR≥2.7) was 30.44 ng/ml. Calculated odds ratio of insulin resistance by using logistic regression analysis, as predicted by ADM, was 0.15 (95% confidence interval, 0.037-0.628; p=0.009). In multiple regression analysis, ADM level was an independent predictor of HOMA-IR index. Our finding indicated that ADM levels increased in women with PCOS in accordance with HOMA-IR. ADM could be a significant independent determinant of insulin resistance in women with PCOS.

Fatty liver disease in an autopsy series of children and adolescents.

BACKGROUND AND AIMS: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adolescents. Obesity is a major risk factor for NAFLD; however, it has been shown that NAFLD is not rare in non-obese adults. The aim of this study was to determine the prevalence of NAFLD in obese and non-obese children and adolescents. METHODS: The medical records of 340 subjects (aged 2-20 years) in whom autopsy was performed were retrospectively reviewed. Of those, 10 subjects were excluded due to insufficient data. The remaining 330 subjects were included in the study, of whom 264 were normal weight and 66 were obese. All liver biopsy sections were evaluated by two pathologists in a blinded fashion. RESULTS: The prevalence of fatty liver was 6% among all the subjects and was higher in the overweight group than in the normal-weight group (10.6% vs 4.9%; p<0.001). The prevalence of NAFLD increased concomitant with age. There was no significant difference between sexes in cases with NAFLD. Simple steatosis was detected in 7 subjects. Steatohepatitis was determined as type 1 in 5 subjects, type 2 in 7 subjects, and as overlap in 1 subject. CONCLUSIONS: This study demonstrated that NAFLD is an important public health problem not only in obese but also in non-obese children and adolescents. This suggests that whereas obesity may be a risk factor, other pathogenic factors may exist that could contribute to the NAFLD.