A cross-linguistic approach to children's reasoning: Turkish- and English-speaking children's use of metatalk.

When collaboratively solving problems, children discuss information reliability, for example, whether claims are based on direct or indirect observation, termed as "metatalk". Unlike English in which evidential marking is optional, languages with obligatory evidential marking such as Turkish, might provide children some advantages in communicating the reliability of their claims. The current preregistered online study investigated Turkish- and English-speaking 3- and 5-year-old children's (N = 144) use of metatalk. The child and the experimenter (E) were asked to decide in which of the two houses a toy was hiding. One house had the toy's footprints. When E left the Zoom meeting, an informant told the child that the toy was in the other house without the footprints in three within-subjects conditions. In the direct-observation condition, the child witnessed the informant move the toy. In the indirect-witness condition, the informant checked both houses and said that the toy was in the other house. In the indirect-hearsay condition, the informant simply said that the toy was in the other house. When E returned, the child had to convince E about how they knew the toy was in the other house using metatalk (e.g., "I saw it move"). Turkish-speaking children used metatalk more often than did English-speaking children, especially in the direct-observation condition. In the two indirect conditions, both groups of 5-year-olds were similar in their use of metatalk, but Turkish speaking 3-year-olds produced metatalk more often than did English-speaking 3-year-olds. Thus, languages with obligatory evidential marking might facilitate children's collaborative reasoning. RESEARCH HIGHLIGHTS: Children as young as 3 years of age can produce metatalk. Turkish-speaking children produce metatalk more often than English-speaking children. The difference between the two linguistic groups is more pronounced at age 3.

Health status, coronaphobia, quality of life, anxiety and depression in patients with lymphedema during COVID-19 pandemic.

Covid-19 has physical damage as well as serious impact on the mental health in the community. Symptoms such as anxiety, depression, fear, stress, and sleep problems were more commonly reported during Covid-19 pandemic. The aim of this study was to assess the health status, psychological conditions, quality of life, and possible risk factors of patients with lymphedema during the pandemic. The study included male and female patients aged ≥18 years with primary or secondary upper or lower extremity lymphedema (stage 1, 2, or 3) who were followed in our outpatient clinic. The patients were interviewed by phone. Health and social status were examined using a questionnaire, Covid-19 phobia was assessed using Covid-19 Phobia Scale (C19P-S), and quality of life was assessed using Lymphedema Quality of Life Questionnaire Arm or Leg (LYMQOL). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). The HADS scores showed that 35% of the patients had severe risk for depression and 10% had severe risk for anxiety. Factors with negative effect on HADS were lower education level, sedentary lifestyle, failure to perform lymphedema exercises, weight gain, and lymphedema duration. The C19P-S scores were higher indicating greater phobia in the overall score and subscores in patients with primary lymphedema and secondary lymphedema without malignancy, younger patients, those who are not able to walk regularly, and those who are not able to perform self manual lymphatic drainage (self-MLD). Factors with negative effects on LYMQOL were stage 3 lymphedema, female gender, younger age, and longer disease duration. Patients who performed regular self-MLD and lymphedema exercises demonstrated positive effects on LYMQOL. The results of this study suggest that patients with lymphedema affected by the COVID-19 pandemic are mostly younger patients, individuals with primary lymphedema, individuals with non-malignant etiology, individuals who unable to perform regular walking, and those unable to perform self- MLD.

[Endobronchial Ultrasound (EBUS) - an Update 2017]. / Endobronchialer Ultraschall (EBUS) ­ Update 2017.

Endobronchial Ultrasound (EBUS) with the two modalities curved and radial EBUS significantly improved the diagnostics in several pulmonary diseases. The examination and staging of mediastinal and hilar lymph nodes in patients with known or suspected lung malignancy as well as the evaluation of unknown pulmonary or mediastinal lesions can be achieved with minimal invasive means when using EBUS. More invasive surgical procedures for diagnostic purposes can be omitted. The diagnostic yield also increases when EBUS is applied in sarcoidosis or mediastinal lymph node tuberculosis but only to some extend in case of lymphoma. Samples obtained by EBUS-TBNA should be handled efficiently to allow molecular analysis in lung cancer. EBUS is a safe procedure, and complication rate is extremely low. Further advances of the EBUS technology focus on improving analysis of the information provided by the ultrasound image and a better tissue sampling by developing of new EBUS bronchoscopes and TBNA-needles.

Reliability of the Modified Ashworth Scale and Modified Tardieu Scale in patients with spinal cord injuries.

STUDY DESIGN: Psychometrics study. OBJECTIVES: To assess the reliability of the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) in patients with spinal cord injuries (SCIs). SETTING: Inpatient rehabilitation clinics at two state hospitals. METHODS: The study included 65 participants aged between 18 and 88 years with SCI with spasticity. All participants were at least 6 months after injury and had an American Spinal Injury Association Impairment Scale grade of A-D. The MAS and MTS scores were collected from the right hip adductor and hip extensor muscles, right knee extensor and knee flexor muscles and right plantar flexor muscles. Each participant was assessed twice by two experienced physiatrists 1 week apart. The raters were blinded to each other's scores. RESULTS: Inter-rater and test-retest agreement for the MAS scores (κ=0.531-0.774) was moderate to substantial. Inter-rater and test-retest agreement for the MTS X scores (κ=0.692-0.917) was substantial to almost perfect. Inter-rater reliability and test-retest reliability of the MTS R2-R1 was excellent (intra-class correlation coefficient (ICC) 0.874-0.973, confidence interval (CI): 0.79-0.98) for all muscles tested. Inter-rater reliability of the MTS R2 for the hip adductor and knee extensor muscles was poor (ICC 0.248, CI: -0.00 to 0.47 and ICC 0.094, CI: -0.16 to 0.34, respectively). The test-retest reliability of the MTS R2 was also poor for the knee extensor muscles (ICC 0.318, CI: -0.06 to 0.53). CONCLUSION: MAS has adequate reliability for determining lower-extremity spasticity in patients with SCI. The demonstration of excellent inter-rater reliability and test-retest reliability of the MTS R2-R1 suggests its utility as a complementary tool for informing treatment decisions in patients with SCI.

Effect of intravenous zoledronic acid infusion on electrocardiographic parameters in patients with osteoporosis.

We evaluated the effects of zoledronic acid (ZA) therapy on electrocardiographic (ECG) parameters for the first time in the literature. Measurements were performed on ECGs obtained before and after ZA infusion on the same day as well as 1 month after the infusion. ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias. INTRODUCTION: The aim of the present study was to evaluate the early and late effects of ZA therapy on ECG parameters which might be associated with the tendency for atrial and ventricular arrhythmias. METHODS: Consecutive patients with osteoporosis who were admitted to our clinic between December 2013 and December 2014 and who were scheduled to receive ZA infusion constituted our study population. Twelve-lead surface ECGs were obtained from all patients before and after ZA infusion on the same day as well as 1 month after the infusion. All ECG parameters were measured and compared with each other for each patient. RESULTS: Data of 100 patients were used in the analysis (9 male; 70.5 ± 11.6 years of age). There were no significant differences between repeated measurements regarding pmax, pmin, and p dispersion values. QT max and QT min values were significantly increased after infusion; however, there were no significant changes in QT dispersion, Tp-e interval, and Tp-e dispersion values. CONCLUSIONS: ZA infusion did not affect P wave dispersion both at the immediate post-infusion period and 1 month after infusion. QT values were significantly increased early after ZA infusion; however, there were no significant differences in parameters reflecting disparity of ventricular recovery times and transmural dispersion of ventricular repolarization. Based on these observations, it may be suggested that ZA infusion did not have any short- or long-term effect on any parameter that might be associated with the tendency for atrial fibrillation or ventricular arrhythmias.

The effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in the first SCID-mouse endometriosis-model developed in Turkey.

OBJECTIVE: To evaluate the effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in SCID mice. MATERIALS AND METHODS: Prospective, randomized, controlled, experimental study. Experimental Research Center of Yeditepe University (YUDETAM). Thirty female, non-pregnant, nulligravid severe combined immunodeficient (SCID) mice. Endometriotic cells collected from patients with endometriosis were implanted subcutaneously in 30 SCID mice. These mice were randomized into two study groups: in the first group, mice were administered melatonin (20 mg/kg/day) following induction of endometriosis for four weeks; in the second group, nothing was administered. All the mice were given a high dose of exogenous estradiol (50 µg/kg/d, twice weekly). Four weeks after inoculation, necropsies were performed and endometriotic lesions were collected. All the lesions were evaluated histopathologically and the levels of SOD and MDA were assessed in the lesions. RESULTS: Successful implantation was observed in the 28 mice that survived. Mean MDA level was 5.0 ± 1.7 and 8.8 ± 2.6 in the melatonin and control groups, respectively (p = 0.01); mean SOD level was 1.1 ± 0.1 and 1.0 ± 0.1 in the melatonin and control groups, respectively (p = 0.49). Mean histopathological score was lower in the melatonin group (p = 0.04). CONCLUSIONS: Melatonin was effective in the treatment of experimental endometriosis induced in SCID mice.

Idiopathic Hypoparathyroidism Mimicking Ankylosing Spondylitis: A Case Report.

Idiopathic hypoparathyroidism, inadequate secretion of parathyroid hormone of unknown etiology, may mimic ankylosing spondylitis both clinically and radiologically. Spinal complaints may be the first sign of any endocrinological disorder.

Effects of aloe vera gel on the induction of endometriosis and regression of endometrial explants in a rat model.

PURPOSE OF INVESTIGATION: To evaluate the preventive and reducing effect of aloe vera gel on surgically-induced endometrial foci in rats. MATERIALS AND METHODS: Twenty-four reproductive aged female non-pregnant, nulligravid Sprague-Dawley albino rats were used. The rats were randomly divided to three groups (Group 1: control, Group 2: aloe vera endometriosis formation, and Group 3: aloe vera endometriosis treatment). A peritoneal lavage using one-ml saline was taken at all the operations for determination of superoxide dismutase (SOD), malondialdehyde (MDA), and catalase (CAT). Forty-eight horns were implanted in 24 rats. RESULTS: All the implants were properly formed after implantation. In Group 3, before aloe vera application, the sum of the volumes was 87.2 ± 20.4 mm³ and after treatment the volumes dropped to 28.9 ± 14.9 mm3 (p = 0.01). As evaluation of aloe vera on the formation of endometriosis in the second operation in Group 2, the sum of the volumes was 2.9±1.4 mm³ and in Group 1, 118.9 ± 20.0 mm3 (p = 0.001). Likewise, similar changes were observed in the histopatological scores. CONCLUSION: The application of aloe vera was seen to raise antioxidant levels in the peritoneal fluid and to reduce oxidative stress markers. Aloe vera is effective in the inhibition of formation and regression of endometriotic lesions.

Sacroiliitis or insufficiency fracture?

Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.

Comparison of low-dose spinal anesthesia and single-shot femoral block combination with conventional dose spinal anesthesia in outpatient arthroscopic meniscus repair.

OBJECTIVE: In the current prospective, randomized study, we aimed to compare the effects of low dose selective spinal anesthesia with 5 mg of hyperbaric bupivacaine and single-shot femoral nerve block combination with conventional dose selective spinal anesthesia in terms of intraoperative anesthesia characteristics, block recovery characteristics, and postoperative analgesic consumption. PATIENTS AND METHODS: After obtaining institutional Ethics Committee approval, 52 ASA I-II patients aged 25-65, undergoing arthroscopic meniscus repair were randomly assigned to Group S (conventional dose selective spinal anesthesia with 10 mg bupivacaine) and Group FS (low-dose selective spinal anesthesia with 5mg bupivacaine +single-shot femoral block with 0.25% bupivacaine). Primary endpoints were time to reach T12 sensory block level, L2 regression, and complete motor block regression. Secondary endpoints were maximum sensory block level (MSBL); time to reach MSBL, time to first urination, time to first analgesic consumption and pain severity at the time of first mobilization. RESULTS: Demographic characteristics were similar in both groups (p > 0.05). MSBL and time to reach T12 sensory level were similar in both groups (p > 0.05). Time to reach L2 regression, complete motor block regression, and time to first micturition were significantly shorter; time to first analgesic consumption was significantly longer; and total analgesic consumption and severity of pain at time of first mobilization were significantly lower in Group FS (p < 0.05). CONCLUSIONS: The findings of the current study suggest that addition of single-shot femoral block to low dose spinal anesthesia could be an alternative to conventional dose spinal anesthesia in outpatient arthroscopic meniscus repair. CLINICAL TRIALS REGISTRATION NUMBER: NCT02322372.

[Role of pretherapeutic biomarkers in lung cancer with special regards to bronchoscopic procedures]. / Prätherapeutische Biomarker des Lungenkarzinoms unter besonderer Berücksichtigung der Bronchoskopie.

Molecular biomarkers are becoming increasingly significant in the workup of lung carcinoma patients. They assist in diagnosis, selecting the most adequate therapy and determining prognosis. Obtaining blood based biomarkers or volatile markers in exhaled breath may provide a less invasive method in the future. For the time being, bronchoscopy is still the method of choice to obtain specimen and assess tissue based biomarkers. The techniques how specimen are collected and processed for analysis are of paramount importance.

Pneumoconiosis in dental technicians: HRCT and pulmonary function findings.

BACKGROUND: Pneumoconiosis is a form of diffuse interstitial lung disease, often resulting from occupational exposures. As dental prosthetic technicians (DPTs) build prostheses, they are exposed to many chemical materials that increase their risk of developing pneumoconiosis. AIMS: To document pulmonary function and prevalence of pneumoconiosis in DPTs. METHODS: A cross-sectional study of DPTs working in prosthetic laboratories who underwent pulmonary function test and high-resolution chest computed tomography (HRCT) scanning. RESULTS: There were 76 participants and pneumoconiosis was diagnosed in 46%. The most commonly seen radiological finding was round opacities, present in 38%. Agreement among HRCT readers was moderate to good. As defined by HRCT, emphysema was diagnosed more often in those with a longer occupational history or a history of smoking, and low carbon monoxide diffusion capacity (DLCO), but not in those with pneumoconiosis. Forced expiratory rate and DLCO were significantly lower in those who had worked 16 years or more (all P < 0.05). DLCO values were significantly lower in technicians with emphysema and in current smokers (all P < 0.01). Round opacities were also present in a substantial proportion of DPTs who had 15 years or less exposure. Because HRCT is able to detect radiological changes of occupational lung disease very early, the prevalence of pneumoconiosis in our participants was quite high. CONCLUSIONS: Pneumoconiosis identified by HRCT was present in almost half of DPTs surveyed. Appropriate education and workplace protection should be given to DPTs in order to prevent exposure to hazardous materials in dental prosthetics laboratories.

A case of toxic epidermal necrolysis-like skin lesions with systemic lupus erythematosus and review of the literature.

OBJECTIVE: Subepidermal bullous lesions and toxic epidermal necrolysis-like (TEN-like) lesions can occur in patients with systemic lupus erythematosus (SLE). In this report, we describe a case of a patient previously diagnosed with SLE who experienced TEN-like skin lesions with unusual subacute progression in the context of the current literature. METHODS: We present a recent case of TEN-like lupus erythematosus and review of studies published in English identifying SLE cases mimicking TEN, accessed via PubMed and Google Scholar databases. The keywords used in the search were: TEN, SLE, TEN-like SLE, and TEN-like lesions. The search covered all articles from January 1980 to November 2011. RESULTS: A 52-year-old male presented with fatigue, weakness, and weight loss (23 kg in two months). Skin redness started across nose and cheeks six months before admission. Bilateral pleural effusions were observed in a thorax tomography taken in the referral hospital two months prior to admission. Because of articular involvement, antinuclear antibody (ANA), and anti-dsDNA positivity, the patient was diagnosed with SLE. We initiated a punch skin biopsy, and the findings were consistent with Stevens-Johnson syndrome. There was marked basal layer necrosis in the epidermis, and there was predominantly lymphohistiocytic infiltrate in the dermis. A total of 22 cases, including our case, with TEN-like lupus erythematosus were reported in the literature. In addition, cutaneous lupus had positive ANAs in 18 of 22 patients (81.8%). The patients were aged 12 to 76 years; 21 cases were women and only one patient was male. DISCUSSION: Skin involvement, including the rare variant of TEN-like acute cutaneous SLE, is very common among SLE patients. The acute syndrome of pan-epidermolysis or apoptotic pan-epidermolysis may become a useful designation when considering a clinical diagnosis of drug-induced TEN or SLE. Further studies are required to verify our findings.

The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults.

BACKGROUND: Caudal epidural block (CEB) is a reliable and effective technique commonly used in pain practice. Having accurate knowledge of sacral anatomy and its anatomical variations is very important for avoiding complications, especially as may occur during dural puncture. This study was undertaken to delineate the anatomical features of the sacrococcygeal region relevant to dural sac (DS) puncture. METHODS: We reviewed magnetic resonance (MRI) images of 1,000 adult patients to determine of the level of termination of the DS, the distance between the upper margin of the sacrococcygeal membrane and the DS, and the presence of incidental dural cystic lesions. Each sacral vertebra was divided into three equal portions (upper, middle, and lower thirds), was defined as a separate region. RESULTS: The level (26.7% of all patients) of termination of the DS was most commonly the upper one-third of S2. The DS terminated below the 3rd sacral vertebra in 0.1% of all patients. No posterior sacral meningocele was seen, but 13 (1.3% of all patients) had a sacral Tarlov cyst. In three of 13 patients (23%), the Tarlov cysts terminated below 3rd sacral vertebra level (0.3% of all patients). CONCLUSION: Knowledge of the level of termination of the DS, the distance between the upper margin of the sacrococcygeal membrane and the DS, and the presence of Tarlov cysts on MRI images of before CEB is very important and might decrease the risk of dural puncture.

Radiological aspect of fungus ball within a mucocele of the sphenoid sinus.

Paranasal sinus fungus ball is within the non-invasive forms and is characterized by the presence of aggregated hyphae that do not invade the sinus mucosa. Mucoceles are benign, expansile, cyst-like lesions of the paranasal sinuses. The mucoid secretions of mucoceles are usually sterile. However, secondary infections, mostly bacterial, may lead to the development of pyocoeles. Although an association between a fungus ball and a mucocele is rare in the paranasal sinuses, this disease entity should be considered in the differential diagnosis of expansile, cystic sinus lesions. In this article, clinical and radiological findings of a 61-year-old male patient with isolated sphenoid sinus fungus ball within a mucocele presented with headache and periorbital pain were discussed with recent literature.

Aeration efficiency of free-surface conduit flow systems.

Dissolved oxygen is a measure of the quantity of oxygen present in water and is one of the best indicators of the health of a water ecosystem. Dissolved oxygen levels in water can be increased by creating turbulent conditions where fine air bubbles are carried into the bulk of the flow. This is achieved by hydraulic structures. A free-surface conduit is a particular instance of this. In the present work, a series of experiments were conducted to investigate the aeration efficiency of free-surface conduit flow systems. The results indicate that free-surface conduit flow systems are very effective for oxygen transfer. At Froude numbers greater than 15, almost full oxygen transfer up to the saturation value was reached. Moreover, from experimental data, a regression equation was obtained with a very high correlation coefficient, showing the effect of various parameters on the aeration efficiency.

Anterior cruciate ligament reconstruction by using otogenous [correction of otogeneous] hamstring tendons with home-based rehabilitation.

We investigated patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction using otogenous hamstring tendons with a cross-pin technique to compare a post-operative home-based rehabilitation programme with a clinic-based programme. ACL reconstruction was performed on 104 patients (103 male) by the same surgeon. The mean age of the patients was 31.5 years (range 18 - 43 years) and the mean time interval between injury and operation was 34.3 months. Patients were randomly allocated to either a home-based (n = 52) or clinic-based rehabilitation programme (n = 52). Mean follow-up was 31.1 months (range 12 - 66 months). Patients underwent a series of examinations before and after surgery in order to evaluate functional recovery of their injured knee. The results demonstrated that using otogeneous hamstring tendons for ACL reconstruction was safe and produced satisfactory results. The study also demonstrated that a home-based rehabilitation programme was as effective as a clinic-based programme.