Prognostic value of Pleth Variability Index in patients followed up in the Intensive Care Unit.

OBJECTIVE: The Pleth Variability Index (PVI) can guide the approach to hypovolemia, which is sometimes the cause and sometimes the result of major diseases; further studies are needed on this index. Therefore, in the present study, we aimed to evaluate the prognostic value of PVI and its relationship with 28-day mortality. PATIENTS AND METHODS: A total of 158 patients were included. Patients were divided into two groups according to 28-day mortality. Patients who died within 28 days were assigned to Group M (Mortal), while those who survived were included in Group S (Survive). Patients' demographics, definitive diagnosis, arterial blood pressure, fingertip oxygen saturation, PVI, fingertip blood glucose, fever, pulse, shock index, and serum lactate level were recorded. RESULTS: Regarding demographics, no statistically significant difference was found between the two groups in terms of age, gender, and Body Mass Index (BMI) (p=0.356, p=0.966, and p=0.977, respectively). The rate of intubation, the use of vasopressors, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock index, and PVI values were statistically significantly higher in Group M compared to Group S (for all, p<0.001). Glasgow Coma Score (GCS), Perfusion Index (PI), and length of stay were statistically significantly lower in Group M than in Group S (p<0.001, p<0.001, and p=0.025, respectively). PVI predicted 28-day mortality with 83.8% sensitivity and 97.9% specificity. CONCLUSIONS: PVI, serum lactate level, PI, APACHE II, GCS, and need for vasopressors were independent risk factors for 28-day mortality in the Intensive Care Unit (ICU). PVI and serum lactate have a prognostic value in predicting mortality.

Obesity is not a descriptive factor for oxidative stress and viscosity in follicular fluid of in vitro fertilization patients.

BACKGROUND: Obesity's impact on micro-environmental oxidative stress and follicular fluid (FF) viscosity and whether or not it has any effect on in vitro fertilization (IVF) success is a matter of debate. AIMS: In this study, our aim was to evaluate the levels of oxidative stress markers and the FF viscosity in obese and non-obese patients. METHODS: Eighty norm-responder patients undergoing IVF were prospectively grouped according to their body mass indexes (BMI). Group 1 (n = 40) and group 2 (n = 40) had BMI values of ≤24.9 and ≥25.0, respectively. Total sulfhydryl (RSH) levels (nmol/m) and the formation of thiobarbituric acid-reactive substances (malondialdehyde, or MDA) (µmol/ml) in FFs were quantified. For the first time in our study, FF viscosity with changing BMI values was also determined. RESULTS: The mean levels of MDA (µmol/ml) and RSH (nmol/ml) were not significantly different between groups (1.37 ± 0.51; 1.51 ± 0.51; p > 0.05 for MDA and 0.42 ± 0.30; 0.41 ± 0.20; p > 0.05 for RSH, respectively). Similarly, the FF viscosity (centipoise) was not different between groups (1.28 ± 0.28; 1.30 ± 0.19; p < 0.05, respectively). Independent of BMI, no correlation was found between FF levels of oxidative markers and the number of oocytes retrieved or the fertilization rates. CONCLUSIONS: In our study, we found no difference in the levels of follicular oxidative and anti-oxidative markers or the follicular fluid viscosity with changing BMI values. We also demonstrated that the levels of oxidative stress markers and the viscosity of follicular fluid did not affect clinical outcomes.

The evaluation of hormonal and psychological parameters that affect bone mineral density in postmenopausal women.

OBJECTIVE: In this study we aimed to investigate the relationships between serum levels of DHEAS, reproductive hormones and low bone mineral density (BMD) in postmenopausal women. We also examined the relationship between psychological status of patients and their BMD results. PATIENTS AND METHODS: This study included postmenopausal female patients. BMD measurements were performed with dual-energy X-ray absorptiometry (DEXA). Psychological assessments of all cases were performed using the Hamilton Anxiety and Hamilton Depression scales. All patients provided fasting venous blood samples in order to determine serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and DHEAS. RESULTS: There were 33 cases (45.2%) with normal BMD levels and 40 cases (54.8%) with abnormal BMD levels (osteopenia and osteoporosis). DHEAS levels did not show any statistically significant difference according to BMD results (p = 0.431). The Hamilton Anxiety and Depression scores also did not show statistically significant differences in accordance with the BMD results (p = 0.889 and p = 0.706, respectively). CONCLUSIONS: According to our results, anxiety, depression and circulating DHEAS levels are not significantly associated with low levels of BMD, particularly at osteopenic levels. So these parameters are not useful for clinical practice in patients with low BMD in the middle-aged postmenopausal women.

Tear function alterations in patients with polycystic ovary syndrome.

OBJECTIVE: Complaints of dry eye are prevalent worldwide and are known to be associated with insulin resistance (IR) and hyperandrogenism. However, dry eye is often overlooked in the context of polycystic ovary syndrome (PCOS). The aim of the present study was to evaluate whether or not there is any relation between tear functions and PCOS, which is a multifaceted disorder associated with IR or hyperandrogenism. PATIENTS AND METHODS: A total of 35 women with polycystic ovary syndrome (PCOS) were enrolled in this study, along with 27 healthy controls. Body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and free testosterone levels on the third day of menstruation were recorded, as well as hirsutism score (using the Ferriman Gallwey scoring system), insulin resistance (homeostasis model assessment), neutrophil-to- lymphocyte ratios (NLR), platelet-to-lymphocyte ratios (PLR), and mean platelet volumes (MPV). A complete ocular examination was followed by administration of the ocular surface disease index (OSDI) questionnaire and Schirmer and tear break-up time (TBUT) tests. RESULTS: Schirmer and OSDI results were similar between groups, but TBUT was significantly lower in the PCOS group (p = 0.002). There were negative correlations between FG score and TBUT test (r = -0.406, p = 0.001) and between NLR and Schirmer test (r = -0.294, p = 0.025). CONCLUSIONS: Although subjective dry eye symptoms do not present in all patients, these results confirm that tear reduction, which can cause further complications in patients with PCOS, can be detected by careful examination and sensitive tests.

The Investigation of Plasma Glucagon-like Peptide-1 Levels in Newly Diagnosed Type 1 Diabetic Children.

OBJECTIVE: To reveal the possible role of glucagon-like peptide-1 (GLP-1) in newly diagnosed Type 1 diabetic children. METHODS: Twenty-five newly diagnosed children and 22 healthy children were included in the study. RESULTS: In oral glucose tolerance tests, no correlation was observed between C-peptide and GLP-1 levels at 0 and 30 minutes, and plasma GLP-1 levels in both groups at 0 and 30 minutes were not statistically different. CONCLUSION: Consequently, fasting and postprandial GLP-1 levels in newly diagnosed Type 1 diabetic children are not different from healthy children. Glucagon-like peptide-1 levels in newly diagnosed Type 1 diabetic children suggest that plasma GLP-1 levels do not have any role in the pathogenesis of Type 1 diabetes mellitus.

Effects of intrathecal bupivacaine and bupivacaine plus sufentanil in elderly patients undergoing transurethral resection.

INTRODUCTION: The present study compared the effect of bupivacaine and bupivacaine + sufentanil on hemodynamic parameters and characteristics of spinal anesthesia in elderly patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia. TECHNICAL CONSIDERATIONS: The study included 40 American Society of Anesthesiologists (ASA) I-III patients scheduled to undergo TURP. Patients were blindly and randomly divided into two groups. Group B (n = 20) received 10 mg of intrathecal bupivacaine and group BS (n = 20) received 7.5 mg of bupivacaine + 5 µg of sufentanil. Sensory and motor block characteristics, hemodynamic changes, side effects, and time to first analgesic requirement were recorded. No differences in mean arterial pressure or heart rate, time for sensory blockade to reach the T10 level, and maximum sensory level were observed between the two groups. The time to first analgesic request was longer in group BS (P < 0.05). Motor block was significantly higher in group B (P < 0.05). In terms of side effects, no statistically significant differences occurred between the groups. CONCLUSIONS: Similar hemodynamic stability and sufficient level of sensory blockade were provided by bupivacaine and bupivacaine + sufentanil used for spinal anesthesia in patients undergoing TUR. Due to the fact that less motor block was observed and the time to first analgesic request was longer, the combination of bupivacaine + sufentanil might be appropriate for patients undergoing TUR.

A new surgical method of pilonidal sinus treatment: a bilaterally paralel elliptic fascio-cutaneous advancement flap technique.

OBJECTIVE: Pilonidal sinus disease (PSD) is a common chronic disease in young people, It is often associated with considerable discomfort and morbidity. BACKGROUND: We aimed to describe our new bilateral parallel elliptic fascio-cutaneous advancement flap technique in PSD treatment and we assessed the technique's results in 57 patients. METHOD: This procedure consists of a bilateral parallel elliptical excision, mobilization of the fascio-cutaneous flap from the median line of the wound, fixation of the base of the flap to the sacrococcygeal fascia by method of overlapping, and suturing its edge to the lateral side. Finally, we closed the wound without tension in accord with the anatomical plane. RESULT: The mean age of the patients was 25.3 ± 4 years. Complications such as infection, wound dehiscence, and seroma were detected in 2 (3.5 %), 2 (3.5 %), and 3 (5.2 %) patients, respectively. The mean durations of hospitalization and absence from work were 2.4 ± 3 and 12.6 ± 3 days, respectively. The mean length of defects after operations was 14.4 ± 1 cm and the mean width was 7.2 ± 1 cm). Follow up period averaged 21.4 ± 1.2 (range, 12 to 72) months. Recurrence occurred in one (1.7 %) patient. included in this study. We detected a mild-degree wound dehiscence in patients with wound infection (n=2, 3.5 %). CONCLUSION: Our novel technique provided the patients with minimum postoperative morbidity, short hospital stay and reduced absence from work. In addition, the technique has a satisfying aesthetic outcome and a decreased recurrence rate. Moreover, the flap could be prepared easily. In the light of our results, we suggest that our novel surgical technique seems to be a reasonable method in treatment of PSD (Fig. 2, Ref. 24).

Expression characteristics of ARF1 and SAR1 during development and the de-etiolation process.

ARF1 (ADP-ribosylation factor 1) and SAR1 (secretion-associated RAS super family) are involved in the formation and budding of vesicles throughout plant endomembrane systems. The molecular mechanisms of this transport have been studied extensively in mammalian and yeast cells. However, very little is known about the mechanisms of coat protein complex (COP) formation and recruitment of COP-vesicle cargoes in plants. To provide insights into vesicular trafficking in Pisum sativum L., we investigated mRNA and protein expression patterns of ARF1 and SAR1 in roots and shoots at early growth stages and in the de-etiolation process. We showed that ARF1 was concentrated mostly in the crude Golgi fractions, and SAR1 was concentrated predominantly in the crude ER fractions of de-etiolated shoots. ARF1 and SAR1 proteins were several times more abundant in shoots relative to roots. In total protein homogenates, the expression level of SAR1 and ARF1 was higher in shoots of dark-grown pea plants than light-grown plants. In contrast, ARF1 was higher in roots of light-grown pea relative to roots of dark-grown pea. With ageing, the ARF1 mRNA in roots was reduced, while SAR1 expression increased. Unlike ARF1 transcripts, ARF1 protein levels did not fluctuate significantly in root and shoot tissue during early development. The relative abundance of SAR1 protein in root tissues may suggest a high level of vesicular transport from the ER to the Golgi. Experimental results suggested that white light probably affects the regulation of ARF1 and SAR1 protein levels. On the other hand, short-term white light affects SAR1 but not ARF1.

Optimizing the P300-based brain-computer interface: current status, limitations and future directions.

This paper summarizes the presentations and discussions at a workshop held during the Fourth International BCI Meeting charged with reviewing and evaluating the current state, limitations and future development of P300-based brain-computer interface (P300-BCI) systems. We reviewed such issues as potential users, recording methods, stimulus presentation paradigms, feature extraction and classification algorithms, and applications. A summary of the discussions and the panel's recommendations for each of these aspects are presented.

Neurokinin B signalling in human puberty.

Recent identification of TAC3 or TACR3 (encoding neurokinin B and its receptor, NK3R, respectively) mutations as the causes of normosmic idiopathic hypogonadotrophic hypogonadism has provided compelling evidence for the involvement of neurokinin B (NKB) signalling in puberty. A surge of subsequent studies pointing towards an understanding of the exact mechanism through which NKB signalling exerts its effects in puberty led to a postulated sketch of the GnRH pulse generator, in which kisspeptin, NKB and dynorphin work in concert to elicit pulsatile gonadotrophin-releasing hormone release in the median eminence.

The effects of L-NG-nitroarginine in a zymosan-induced multiple organ dysfunction syndrome model.

BACKGROUND: The aim of this study was to investigate the role of nitric oxide in mesenteric ischemia, organ injury and survival in zymosan-induced multiple organ dysfunction syndrome (MODS) by using the nonselective nitric oxide synthase inhibitor L-N(G)-nitroarginine (L-NNA). METHODS: Swiss albino mice (20-40 g) were used in the study. The animals were randomly divided into four groups. The first group was treated intraperitoneally with saline and served as the sham group for L-NNA. The second group was treated with zymosan (500 mg/kg). The mice in the third and fourth group received L-NNA (20 mg/kg), 1 and 6 h after saline or zymosan administration. Six hours after the administration of zymosan, animals were used for mesenteric arterial blood flow (MABF) measurements and then sacrificed for biochemical and histopathological analyses at the 18th hour. RESULTS: In zymosan-treated animals, MABF was significantly lower than that of solvent saline-treated controls (controls: 4.7 +/- 0.8 ml.min(-1); zymosan: 1.7 +/- 0.7 ml.min(-1), p < 0.05). L-NNA did not prevent zymosan-induced MABF decrease (controls: 4.5 +/- 0.8 ml.min(-1); zymosan: 2.5 +/- 1.4 ml.min(-1), p <0.05). Also treatment with L-NNA has no beneficial effect on survival and organ injury in zymosan-induced MODS. CONCLUSION: In this study, inhibition of both inducible and constitutive nitric oxide synthase by L-NNA did not abolish the harmful effects of zymosan. L-NNA remains an agent without any therapeutic potential in this acute experimental model of MODS.

Effect of tempol, a membrane-permeable radical scavenger, on mesenteric blood flow and organ injury in a murine cecal ligation and puncture model of septic shock.

BACKGROUND: Interventions that reduce the generation or the effects of reactive oxygen species exert beneficial effects in a variety of models of septic shock. We investigated the effect of tempol, a low-molecular-weight membrane-permeable radical scavenger, on mesenteric blood flow and organ injury in a murine cecal ligation and puncture (CLP) model of septic shock. MATERIALS AND METHODS: Forty-four Swiss albino mice were anesthetized with chloral hydrate (400 mg/kg, i.p.) and subjected to CLP (except for the sham-operated animals). The animals were divided randomly into 4 groups: the 1st group was sham operated (sham-operated group, n = 10); the 2nd group underwent CLP and was injected with saline (CLP + saline group, n = 12); the 3rd group was sham operated and treated with tempol (10 mg/kg, i.p., sham-treated + tempol group, n = 10); the 4th group underwent CLP and was treated with tempol (10 mg/kg, i.p., CLP + tempol group, n = 12). Mesenteric arterial blood flow (MABF) was measured by Doppler ultrasound. Poly(adenosine 5'-diphosphate-ribose) polymerase (PARP) activity was examined in the liver, lung, and kidneys. RESULTS: In the CLP + saline group, the MABF was significantly lower than in the sham-operated group (p < 0.001). After tempol administration, MABF values significantly increased (p < 0.05). We observed significantly stronger PARP-positive staining in the lungs and kidney glomeruli in the CLP + saline group than in those of the sham-operated group (p(lung) = 0.0148, p(glomeruli) = 0.0025). A marked reduction in PARP activity was found in the lung and kidney glomeruli of the CLP + tempol group (p(lung) = 0.0026, p(glomeruli) = 0.0085). There was no significant effect of CLP on PARP activity in the liver and kidney tubuli (p(liver) > 0.05, p(tubuli) > 0.05). CONCLUSION: Tempol improved MABF in a CLP-induced septic shock model. Although tempol could not prevent the activation of PARP in the liver and kidney tubuli, it did attenuate PARP activation in the lung and kidney glomeruli.

IL-18 and IL-18 binding protein concentrations in serum and ovarian follicular fluid do not affect in vitro fertilization outcomes in obese, overweight, and non-obese patients.

Obesity causes the specific upregulation of proinflammatory cytokines and chemokines. One of these cytokines, IL-18, has a well-known association with obesity. Our aim in this study was to test the effect of serum and intrafollicular IL-18 and IL-18 binding protein (BP) levels on in vitro fertilization outcomes in obese, overweight, and non-obese patients. Serum and pooled follicular fluid levels of IL-18, IL-18BP, and the IL-18/IL-18BP ratios were evaluated in 21 non-obese (body mass index [BMI] <25), 37 overweight (25or=30) patients undergoing in vitro fertilization. IL-18 and IL-18BP levels in serum and follicular fluid did not change with obesity. There was no correlation among serum intrafollicular IL-18, IL-18BP levels, and the number of oocytes retrieved and transferred, embryo grades or pregnancy ratios. The levels of serum and intrafollicular IL-18, IL-18BP, and the IL-18/IL-18BP ratios do not seem to be related to in vitro fertilization outcomes in obese, overweight, and non-obese patients.

What should the management of incest pregnancies be? An ethical view presented via three cases.

Incest is a taboo and a neglected social problem. Especially in the adolescent population, which is a very sensitive period of development, it becomes harder for the patients to share their secret with either legal or health authorities. Sometimes pregnancy becomes the only vehicle to uncover this secret. There is a contradiction whether their pregnancies should continue or not. Some authors believe abortion is the best choice for the victim to pull herself together, whereas others advocate that it is just another trauma that will not solve the problem but merely hide it. In this report, three paternal incest cases and their pregnancies will be presented. The aim is not only to discuss the different points of view regarding the management of these pregnancies but also to make the clinicians think about the different choices before making a decision.