Effectiveness of osteopathic manipulative applications on hypothalamic-pituitary-adrenal (HPA) axis in youth with major depressive disorder: a randomized double-blind, placebo-controlled trial.

CONTEXT: Osteopathic treatments regulate the neurovegetative system through joint mobilizations and manipulations, and myofascial and craniosacral techniques. Despite the growing body of research, the precise impact of osteopathic medicine on the autonomic nervous system (ANS) is not yet fully elucidated. As to Kuchera's techniques, the stimulation of the sympathetic trunk and prevertebral ganglia contributed to harmonization of the sympathetic activity. However, potential relationships between the harmonization of the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis largely remain uncertain and warrant further exploration. OBJECTIVES: This study was designed to evaluate the effectiveness of the osteopathic sympathetic harmonization (OSH) on the SNS and the HPA axis in youth with major depressive disorder (MDD). METHODS: The study included 39 youths aged 15-21 years and diagnosed with MDD. The participants were randomly assigned into either the OSH or the placebo group. Stimulation was performed on the sympathetic truncus and prevertebral ganglia in the OSH group. The stimulation of the placebo group was performed with a lighter touch and a shorter duration in similar areas. Each participant completed the Beck Depression Inventory (BDI) and the State and Trait Anxiety Inventory (SAI and TAI) before the application. Blood pressure (BP) and pulse measurements were made, and saliva samples were taken before, immediately after, and 20 min after application. RESULTS: The baseline BDI (p=0.617) and TAI (p=0.322) scores were similar in both groups. Although the SAI scores decreased in both groups postintervention, no statistically significant difference was found between the two groups. Subjects who received OSH had a decrease in α-amylase level (p=0.028) and an increase in cortisol level (p=0.009) 20 min after the procedure. CONCLUSIONS: Following OSH application in depressed youth, SNS activity may decrease, whereas HPA axis activity may increase. Future studies may examine the therapeutic efficacy of repeated OSH applications in depressed individuals.

The examination of stress symptoms and posttraumatic growth in the patients diagnosed with Covid-19.

OBJECTIVE: COVID-19 infection can profoundly affect patients' lives. Coping with difficult life crises can also lead to increased stress or positive psychological change called post-traumatic growth. This research was conducted to examine the symptoms of stress and post-traumatic growth symptoms in the patients diagnosed with COVID-19 (Coronavirus). METHOD: The present study, which is in a descriptive design, was conducted with 175 patients who were discharged after being treated in the intensive care units with the diagnosis of COVID-19. The personal information form, the Posttraumatic Diagnostic Scale (PTDS), and the Posttraumatic Growth Inventory (PTGI) were used to collect data. RESULTS: The mean score for Posttraumatic Stress Symptoms of the participants was 19.18 ± 9.53, and the mean score for Posttraumatic Growth Inventory was 0.86 ± 0.47. In addition, a significant positive correlation was found between PTDS and PTGI mean scores (p < 0.001). As the degree of being affected by covid 19 increases, posttraumatic growth and traumatic stress symptom levels increase (p < 0.05). The posttraumatic growth levels increase as the time elapsed after the treatment of COVID-19 increases (p < 0.001). CONCLUSION: It was determined that after the traumatic experience (COVID-19), the participants had moderate traumatic stress symptoms, and they overcame this situation by experiencing growth. It is recommended to take preventive measures against the symptoms of stress and support the patients in terms of overcoming this process by getting stronger.

Comprehensive anatomy of the superior hypogastric plexus and its relationship with pelvic surgery landmarks: defining the safe zone around the promontory.

BACKGROUND: Pelvic surgery carries an inherent risk of autonomic nerve injury leading to genitourinary and bowel dysfunction due to the close proximity of the superior hypogastric plexus (SHP). The aim of this study was to define the detailed anatomy of SHP and identify its relationship with the vascular landmarks and ureters for pelvic autonomic nerve-preserving surgery. METHODS: A cadaveric study on the detailed anatomy of the SHP was conducted in our surgical anatomy research unit. Between 02/2019 and 10/2019, macroscopic anatomical dissections were performed on 45 fresh adult cadavers (39 male, 6 female). Distances between the SHP, major vascular structures, and other anatomical landmarks were measured. RESULTS: Three types of SHP morphology were observed: mesh (64.8%), single nerve (24.4%), and fiber (10.8%). SHP bifurcation was located inferior to the aortic bifurcation in all cases; however, it was observed cranial to the promontory in 80% of the cases, whereas 18% were caudally and 2% were over the promontory. The closest vessels to the left and right of the SHP bifurcation were the left common iliac vein (LCIV) (86.2%, the mean distance was 8.49 ± 7.97 mm) and the right internal iliac artery (RIIA) (48.2%, mean distance was 13.4 ± 9.79 mm), respectively. At SHP bifurcation level, the lateral edge of the SHP was detected on the LCIV in 22 cases and on the RIIA in 10 cases for the left and right side of the plexus, respectively. The distance between the SHP bifurcation and the ureter was 27.9 mm on the right and 24.2 mm on the left. The width of the left (LHN) and right hypogastric nerves (RHN) were 4.35 mm and 4.62 mm at 2 cm below the SHP bifurcation, respectively. LHN was on the vascular structures in 13 cases, whereas RHN in only 1 case, 2 cm below the SHP bifurcation. CONCLUSIONS: Understanding the location of the SHP, including its relationship with important anatomical landmarks, might prevent iatrogenic injury and reduce postoperative morbidity in the pelvic surgery setting.

Do Fair and Just Systems Require Compensation for the Disadvantages of the Natural Lottery? A Discussion on Society's Duties on the Provision of Gene Therapy.

Genetic diseases have been thought to be acquired as a result of sheer bad luck. However, recent advances in medical science have demonstrated the mechanisms of genetic disorders, which enable us to intervene with their occurrence and treatment. Today, gene therapy, once considered too risky, has become safer and can save the lives of patients with previously untreatable and lethal genetic diseases. However, the positive expectations from gene therapy are overshadowed by their extremely high prices. Thus, the duty of society in the provision of gene therapies has been frequently discussed. The discussions mainly focus on how to meet the genetic treatment needs of patients without violating the notion of justice and fairness in society. This study discusses the theoretical grounds for society's duty to compensate for genetic disease patients' disadvantages by providing them with appropriate genetic treatment. The main question is whether a fair and just system requires society to provide available lifesaving gene therapy to patients in need. The discussion is constructed on the crucial notion of the fair equal opportunity principle in a just system and the plausibility of including disadvantages emerging from bad luck in the natural lottery in the domain of justice.

Inconsistencies in institutional review board decisions: A proposal to regulate the decision-making process.

Medical sciences and medical technologies are developing in an enormous pace. The number of multi-site and multi- cultural clinical trials is increasing in line with this development. Yet, the increase in number brought about a problem, namely that of inconsistencies in institutional review board (IRB) decisions. The efforts to develop a comprehensive and systematic framework for the decision-making procedure of IRB members were ineffective and ended up in form of lists containing general principles of research ethics. The increase in multi-site, multi-cultural clinical research together with the initiation of new institutional review boards in countries involved in these researches emphasize the importance of defining the sine qua non criteria for considering a proposed research study to be ethical, as well as for avoiding inconsistencies in institutional review board decisions. The aim of this study is to prepare a toolkit for IRB members to regulate the ethical decision-making process while minimizing inconsistencies in institutional review board decisions. The objective is to minimize the effect of subjective factors and to ensure that all issues in key international documents and guidelines are covered prior to the point of reaching a conclusion for the proposed research protocol. By providing a comprehensive review of the Declaration of Helsinki, Council For International Organizations of Medical Sciences Guidelines, International Conference on Harmonization Guidelines, Standards and Operational Guidance for Ethics Review of Health-related Research with Human Participants of World Health Organization, and Medical Ethics Manual of the World Medical Association, this study aims at developing a standard evaluation sheet for institutional review board members to evaluate the ethical appropriateness of proposed trial protocols (Tab. 1, Ref. 35). Keywords: clinical research, ethics review committee, human subjects, informed consent, institutional review board, research ethics.

Noncompliance to smoke-free law: which hospitality premises are more prone?

OBJECTIVES: In Turkey, smoking has been banned in hospitality establishments since July 2009. The objective of this study was to determine noncompliance to the smoke-free law and its change in 2 consecutive years in enclosed spaces of hospitality venues and also to evaluate the factors associated with noncompliance. STUDY DESIGN: This is an observational study. METHODS: Hospitality venues in Istanbul were visited, and data were collected through direct observation and interviews. Observation of smoking, cigarette butts or existence of ashtrays were defined as noncompliance. The survey was repeated in 2 consecutive years; the venues were visited both in 2013 and 2014. Logistic regression was used to evaluate factors associated with noncompliance. RESULTS: In 2013, 450 establishments were visited, and in the next year, 367 (81.6%) were revisited. Noncompliance for 2013 and 2014 were 49.0% and 29.7%, respectively. The highest violation was observed in bars and traditional coffeehouses. There was a significant decrease in noncompliance from 2013 to 2014 among restaurants and cafés, while such a change was not observed among bars and traditional coffeehouses. In the multivariate analysis, venues other than restaurants, venues that did not have no-smoking signs and venues which had been issued fines previously had increased probability of noncompliance. CONCLUSIONS: While compliance to smoke-free law had increased significantly within 1 year, almost one third of the venues were still violating the law in 2014. The venues which were issued fines continued to violate the law. There is a need to strengthen enforcement efforts and revise the methods of enforcement and penalties in hospitality establishments.

Survival evaluation of the patients with diabetic major lower-extremity amputations.

PURPOSE: The purpose of this study was to evaluate the survival after major lower-limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients. METHODS: A total of 140 diabetic patients who underwent major lower-limb amputation during the period of 2001-2011 were enrolled in the study. The patients were grouped as below-knee and above-knee amputations. The differences in survival by age, gender, amputation level and revision surgery were investigated. The clinical follow-up periods and the results of the patients with major lower-limb amputation were retrospectively assessed. RESULTS: The mean follow-up period was 24.87 months (range 0.06-120 months). The mortality rate of series was 32.8 % for 1 year and 70 % for 5 years. One-year mortality rate was 24.6 % and 5-year mortality rate was 66.3 % in below-knee group, 1-year mortality rate was 43.3 % and 5-year mortality rate was 83.3 % in above-knee group. The difference between mortality rates of these groups was significant (p: 0.019). There was no statistically significant difference according to age and gender (p: 0.543 and 0.568). The previous minor amputations were found to have no effect on mortality (p: 0.471). CONCLUSION: Routine utilization of diabetes follow-up, screening and treatment programs with a multidisciplinary approach might be mandatory to handle early multisystem involvement-prevent major amputation, and increase survival rate in diabetic patients. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Effect of the interval between organ donor brain death and organ harvesting on kidney graft function after transplantation.

We hypothesized that providing a longer resuscitation period (>12 hours) for a brain-dead organ donor (BDOD) to attenuate the detrimental effects of sympathetic discharge that occur during this event would improve graft function. We reviewed the medical records of patients who had received a kidney transplant from a BDOD between November 2001 and June 2006. The patients were divided into two groups according to whether the interval between the brain death of the organ donor and organ harvest was >12 hours (group 1 n=12) or .05). When compared with patients in group 2, those in group 1 demonstrated a significant trend toward improved renal graft function in terms of serum creatinine levels, BUN levels, and urine output. Five patients in group 2 and two patients in group 1 required hemodialysis during the early posttransplantation period (P>.05). Our results indicate that longer in situ resuscitation of the graft kidney in BDODs may improve posttransplant function.

Predictors of immediate tracheal extubation in the operating room after liver transplantation.

Immediate postoperative extubation may reduce the incidence of postoperative respiratory complications after orthotopic liver transplantation (OLT). We evaluated the predictors of immediate tracheal extubation in the operating room (OR) in our patients by retrospectively reviewing data from all patients who underwent OLT between January 2004 and June 2006. The patients were divided into two groups according to whether they had undergone extubation in the OR (group 1 n=52) or in the intensive care unit (ICU; group 2 n=48). When compared with the patients in group 2, those in group 1 had lower mean preoperative serum creatinine levels (0.9 +/- 1 vs 0.6 +/- 0.3 mg/dL, P=.04) and intraoperative transfusion requirements (packed red blood cells, 35.5 +/- 29.8 vs 25.6 +/- 19.0 mL/kg; P=.05, and fresh frozen plasma, 33.1 +/- 15.6 vs 25.7 +/- 14.3 mL/kg; P=.01). The incidence of intraoperative hypotension and emergent OLT was significantly greater in group 2 than group 1 (33.3% vs 13.5%, P=.01 and 45.8% vs 21.2%, respectively, P=.009). On logistic regression analysis, only emergent OLT (P=.009, odds ratio = 3.5) and intraoperative hypotension (P=.018, odds ratio = 3.7) were significantly associated with a lower probability of immediate postoperative extubation in the OR. Our results suggested that hemodynamic stability and elective OLT were predictors of successful immediate tracheal extubation in the OR.

Prostaglandin E1 infusion therapy in dry age-related macular degeneration.

OBJECTIVE: The pilot study is intended to show whether prostaglandin E1 (PGE1) infusions are able to stop the gradual vision loss in dry age-related macular degeneration (AMD) and, further, to stabilize or improve visual acuity. METHODS: With PGE1 infusions 11 patients with different forms of dry AMD were treated and compared with a control group of 10 untreated patients with dry AMD. The target parameter was the visual acuity, as determined with the ETDRS logMAR charts. Other examinations performed during the study were tests of contrast vision, colour vision and central visual fields, as well as autofluorescence and fluorescein angiography and multifocal electroretinography. RESULTS: On termination of the infusions, six patients showed an increase in visual acuity by at least one line, an improvement that was seen in eight patients 2 months after the end of the infusion therapy. After 6 months, one patient exhibited an improvement of visual acuity by three lines and three patients an improvement by one line. Five patients were found to show no change of their baseline acuity values after 6 months, while two patients exhibited an impairment by one line. The visual acuity in the dry AMD control group without PGE1 treatment had decreased by 0.8 lines on the average after 6 months. Contrast vision, central visual fields and the multifocal electroretinogram showed improvements on the termination of infusions and up to 2 months later; no substantial change of these parameters, as compared with the baseline findings, was seen 6 months after the termination of infusions. SUMMARY: This pilot study suggests that PGE1 infusions have a stabilizing or improving effect on the visual acuity of patients with dry AMD. Owing to the limitations of a pilot study, these results should, however, be validated in a larger, randomized and blinded study.

Delayed traumatic intracerebral hematoma.

Although delayed traumatic intracerebral hematomas (DTICHs) have been frequently reported since 1970, the time interval from trauma to hemorrhage and diagnosis has not been well defined. Eight patients with DITCH were found among 1,320 head-injured patients admitted to the neurosurgical service through the emergency department from March 1989 to March 1990. The mean time interval between initial and follow-up CT scan was 22 h. The mean time interval between initial trauma and diagnosis of DITCH was 24 h. One patient was diagnosed incidentally by magnetic resonance imaging. Three patients underwent operation and five patients were managed conservatively. Three patients died, resulting in a case mortality rate of 37.5%. The time interval for DTICHs' development and pitfalls in its diagnosis were discussed.

Antimicrobial activity of amniotic fluid obtained vaginally.

Twenty-nine amniotic fluid samples were aspirated from pregnant women at term (38-40 weeks' gestation) by tapping the bulging membrane vaginally, and their effects on Escherichia coli, Staphylococcus aureus and Candida albicans were studied. Inhibition rates were 72.41% for E coli, 68.96% for S aureus and 79.31% for C albicans. Two samples (6.90%) affected only a single organism, 18 (62.07%) affected two organisms and eight (27.59%) affected all three. Only one sample (3.45%) had no inhibitory effect on the microorganisms studied. Thus, 28 of 29 samples (96.55%) inhibited the growth of at least one of the microorganisms tested. These results are also significant because there is a high risk of contamination of amniotic fluid samples obtained through the vaginal route, although they can be obtained easier that way than through amniocentesis.

Effects of dexamethasone and betamethasone on in vitro cultures from human astrocytoma.

Cultures of human astrocytoma have been derived by collagenase digestion and are presumed, from their aneuploid karyotypes, to be predominantly neoplastic. Early passage cultures in proliferative phase have been cloned in the presence of dexamethasone and betamethasone, both commonly used in management of patients with brain tumours. These steroids raise both the cloning efficiency and the proliferative capacity of cells within each clone. Inhibition was detected only in very high steroid concentrations (25-50 microng/ml). Since these concentrations are unlikely to be attained in vivo it is concluded that anticipated physiological levels of these steroids enhance cell survival at low densities in culture. The significance of this in vivo is discussed.

[Diagnostic value of determining hemoglobin in cerebrospinal fluid in acute cerebral circulatory disorders]. / Diagnosticheskoe znachenie opredeleniia gemoglobina v spinnomozgovoi zhidkosti pri ostrykh narusheniiakh mozgovogo krovoobrashcheniia.

The results of hemoglobin determination in the CSF by the method of fluorescence microscopy in 195 patients speaks in favor of relative diagnostical importance of hemoglobin in the supra fall-out CSF for establishing the character of the stroke. The following circumstances testify to this fact: 1) in an artificial admixture of blood in the CSF in some cases there may be hemolysis of "passing" erythrocytes; 2) in a genuine admixture of blood, tests of hemoglobin in the centrifugate of the CSF may be negative since in some cases the transition of hemoglobin into bilirubin in the subarachmoid space occurs more rapidly than the hemolysis of erythrocytes. Thus, the hemoglobin does not accumulate in the liquid in quantities, sufficient enough to be measured by the existing methods; 3) in a large amount of artificial blood admixture, even without a hemolysis of "passing" erythrocytes the hemoglobin tests in the centrifugate of the CSF may be positive at the expense of hemoglobin of the blood plasma.

[Bilirubin and the blood-brain barrier]. / Bilirubin i gemato-éntsefalicheskii bar'er.

The report contains some results of a parallel determination of bilirubin in the blood serum and CSF in 321 patients with different diseases. The bilirubin in the blood serum was studied according to Jendrassik and Cleghorn (1936), in the CSF according to Jendrassik and the spectrophotometrically according to Fleming's and Woolf's (1965) formula. It was demonstrated that bilirubin appears in the CSF only in jaundice of different etiology, cerebral hemorrhages and in blocking the liquor paths. In the absence of such syndromes the haematoencephalic barrier is impassable for bilirubin.

Computed tomography in the diagnosis of colloid cyst.

The diagnosis of colloid cyst of the third ventricle is notoriously difficult and contributes significantly to the high mortality. Three cases are presented in which computed tomography has contributed to the diagnosis by showing (1) the dilatation of the lateral ventricles without dilatation of the midline ventricular system, and (2) the lesion as an area of increased density within the third ventricle. Computed tomography may reduce the overall mortality in this condition by reducing the number of patients who succumb undiagnosed during an acute phase of raised intracranial pressure.