Cenozoic migration of a desert plant lineage across the North Atlantic.

Previous paleobotanical work concluded that Paleogene elements of the sclerophyllous subhumid vegetation of western Eurasia and western North America were endemic to these disjunct regions, suggesting that the southern areas of the Holarctic flora were isolated at that time. Consequently, molecular studies invoked either parallel adaptation to dry climates from related ancestors, or long-distance dispersal in explaining disjunctions between the two regions, dismissing the contemporaneous migration of dry-adapted lineages via land bridges as unlikely. We report Vauquelinia (Rosaceae), currently endemic to western North America, in Cenozoic strata of western Eurasia. Revision of North American fossils previously assigned to Vauquelinia confirmed a single fossil-species of Vauquelinia and one of its close relative Kageneckia. We established taxonomic relationships of fossil-taxa using diagnostic character combinations shared with modern species and constructed a time-calibrated phylogeny. The fossil record suggests that Vauquelinia, currently endemic to arid and subdesert environments, originated under seasonally arid climates in the Eocene of western North America and subsequently crossed the Paleogene North Atlantic land bridge (NALB) to Europe. This pattern is replicated by other sclerophyllous, dry-adapted and warmth-loving plants, suggesting that several of these taxa potentially crossed the North Atlantic via the NALB during Eocene times.

Study for the Diagnostic Screening of Paroxysmal Nocturnal Hemoglobinuria in Older Patients with Unexplained Anemia and/or Cytopenia.

BACKGROUND: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematopoietic stem cell disease that may lead to weakness and death of patients, if unrecognized and untreated. Although consensus guidelines were reviewed recently for the diagnostic screening of PNH with multi-parameter flow cytometry (FCM), until now, no study has investigated the efficiency of such clinical indications in older patients. METHODS: Overall, 20 centers participated in the study and a total of 1,689 patients were included, 313 of whom were at geriatric age and 1,376 were aged 18 - 64 years. We evaluated the efficiency of consensus clinical indications for PNH testing using FCM in peripheral blood samples and compared the results of older patients and patients aged 18 - 64 years. RESULTS: PNH clones were detected positive in 7/313 (2.2%) of the older patients. Five (74.4%) of the patients with PNH clones had aplastic anemia, 1 had unexplained cytopenia, and 1 patient had myelodysplastic syndrome (MDS) with refractory anemia. PNH clones were not detected in any older patients who were screened for unexplained thrombosis, Coombs (-) hemolytic anemia, hemoglobinuria, and others (e.g., elevated lactate dehydrogenase (LDH), splenomegaly). We detected PNH clones in 55/1376 (4%) samples of the patients aged under 65 years. Forty-two (76.4%) patients with PNH clones had aplastic anemia, 2 patients had Coombs (-) hemolytic anemia, 3 patients had unexplained cytopenia, 1 patient had MDS with refractory anemia, 1 patient had hemoglobinuria, and 6 (10.9%) had others (e.g., elevated LDH, splenomegaly). PNH clones were not detected in any patients who were screened for unexplained thrombosis. There was no statistical difference between the geriatric population and patients aged 18 - 64 years in terms of clinical indications for PNH screening with FCM (p = 0.49). CONCLUSIONS: Our results showed that the current clinical indications for PNH screening with FCM were also efficient in older patients. We suggest that older patients with unexplained anemia, myelodysplastic syndrome with refractory anemia, and unexplained cytopenia should be screened for PNH with FCM to identify patients who would benefit from treatment.

Prevalence and types of cervical human papillomavirus among Turkish women and its relationship with demographic factors in a gynecology outpatient clinic.

PURPOSE OF INVESTIGATION: The purpose of this study was to determine the prevalence of various human papillomavirus (HPV) types and its relationship with some risk factors among Turkish women. MATERIALS AND METHODS: A total of 673 patients were included in the study. Cervical samples were taken from the patients for routine Pap smear and HPV DNA tests. HPV DNA was studied in the cervical smear by using the PCR method. RESULTS: The mean age of the patients was 40 ± 10.9 years. Of all patients, 13.5% had a positive HPV DNA test. In addition, 5.1% of the patients were HPV type 16 positive, 1.5% were HPV type 18 positive, 0.6% were HPV type 31 positive, and 0.9% were HPV type 53 positive. CONCLUSION: Findings show that awareness should be raised among Turkish women regarding HPV infection and vaccination.

Smilax (Smilacaceae) from the Miocene of western Eurasia with Caribbean biogeographic affinities.

UNLABELLED: • PREMISE OF THE STUDY: Recent molecular studies provide a phylogenetic framework and some dated nodes for the monocot genus Smilax. The Caribbean Havanensis group of Smilax is part of a well-supported "New World clade" with a few disjunct taxa in the Old World. Although the fossil record of the genus is rich, it has been difficult to assign fossil taxa to extant groups based on their preserved morphological characters.• METHODS: Leaf fossils from Europe and Asia Minor were studied comparatively and put into a phylogenetic and biogeographic context using a molecular phylogeny of the genus.• KEY RESULTS: Fossils from the early Miocene of Anatolia represent a new species of Smilax with systematic affinities with the Havanensis group. The leaf type encountered in the fossil species is exclusively found in species of the Havanensis group among all modern Smilax. Scattered fossils of this type from the Miocene of Greece and Austria, previously referred to Quercus (Fagaceae), Ilex (Aquifoliaceae), and Mahonia (Berberidaceae) also belong to the new species.• CONCLUSIONS: The new Smilax provides first fossil evidence of the Havanensis group and proves that this group had a western Eurasian distribution during the Miocene. The age of the fossils is in good agreement with the (molecular-based) purported split between the Havanensis and Hispida groups within Smilax. The Miocene Smilax provides evidence that all four subclades within the "New World clade" had a disjunct intercontinental distribution during parts of the Neogene involving trans-Atlantic crossings (via floating islands or the North Atlantic land bridge) and the Beringia land bridge.

Is the BFM Regimen Feasible for the Treatment of Adult Acute Lymphoblastic Leukemia? A Retrospective Analysis of the Outcomes of BFM and Hyper-CVAD Chemotherapy in Two Centers.

Multiple induction regimens have been developed for adult patients with acute lymphoblastic leukemia (ALL). However, there have been no prospective randomized trials that directly compare these regimens. In this study, we wanted to evaluate the outcome of 50 adult ALL patients treated with BFM (i.e. Berlin-Frankfurt-Munster, n = 20) and hyper-CVAD (n = 30) protocols between March 2006 and October 2012. The median age was 25 years in the BFM group and 30.5 years in the hyper-CVAD group with a male/female ratio of 15:5 and 17:13, respectively. Forty-five percent of the patients in the BFM group and 30.3% in the hyper-CVAD group were <25 years old. The majority of cases were B cell in origin (80% in the BFM group and 70% in the hyper-CVAD group). Complete remission after induction therapy was achieved in 95 and 96% of the patients, respectively. The median follow-up time was 37 months. The 5-year survival rate was higher in the BFM group than in the hyper-CVAD group (59 vs. 34%). There were also no complications which could cause a delay during the hyper-CVAD regimen. Both chemotherapies were well tolerated. None of the patients died from drug-related toxicity. Only mild liver enzyme elevations were seen as toxicity in the BFM group; these did not cause any delay in therapy. The BFM regimen seems to be feasible for adult patients with ALL in terms of tolerability and efficacy, especially in young adults.

Maspin expression in endometrial hyperplasia and carcinoma, and its relation with angiogenesis.

AIM: The purpose of this study was to evaluate the maspin expression in endometrial hyperplasia and cancer, and also to investigate its relation with angiogenesis. MATERIALS AND METHODS: A total of 19 women with complex atypical hyperplasia, 44 patients with simple hyperplasia without atypia, and 67 patients with endometrial carcinoma were included. Maspin expression was assessed by immunohistochemistry (IHC), and tested for possible significant relation with age, FIGO stage, histologic type, grade, depth of myometrial invasion (MI), lymphovascular space involvement (LVSI), lymph node metastasis, and overall survival (OS). Angiogenesis was determined by vascular endothelial growth factor (VEGF) staining. RESULTS: Maspin expression was detected in only three patients with endometrial hyperplasia (5%). In patients with endometrial cancer, cytoplasmic and nuclear maspin expressions were detected in 36 (53.7%) and 18 (26.9%) patients, respectively. No significant relation was noted between staining localizations and prognostic variables. The five-year OS rate for patients with cytoplasmic staining was 91%, compared to 87% for patients without staining (p = 0.31). These values for nuclear expression were 100% and 87%, respectively (p = 0.16). The cytoplasmic and nuclear maspin expressions were found to be significantly correlated with VEGF (r = 0.278, p = 0.02 and r = 0.295, p = 0.01, respectively). DISCUSSION: This is the first study to demonstrate the relation between maspin expression and angiogenesis in endometrial cancer. Although no survival difference was noted for cytoplasmic or nuclear maspin expressions, a tendency was detected for nuclear staining. Further series will clarify the exact prognostic role of maspin expression in gynecological malignancies including endometrial cancer.

An improved reconstruction of May-June precipitation using tree-ring data from western Turkey and its links to volcanic eruptions.

We developed a high quality reconstruction of May-June precipitation for the interior region of southwestern Turkey using regional tree-ring data calibrated with meteorological data from Burdur. In this study, three new climate sensitive black pine chronologies were built. In addition to new chronologies, four previously published black pine chronologies were used for the reconstruction. Two separate reconstructions were developed. The first reconstruction used all site chronologies over the common interval AD 1813-2004. The second reconstruction used four of the chronologies with a common interval AD 1692-2004. R² values of the reconstructions were 0.64 and 0.51 with RE values of 0.63 and 0.51, respectively. During the period AD 1692-1938, 41 dry and 48 wet events were found. Very dry years occurred in AD 1725, 1814, 1851, 1887, 1916, and 1923, while very wet years occurred in AD 1736, 1780, 1788, 1803, and 1892. The longest dry period was 16 years long between 1860 and 1875. We then explored relationships between the reconstructed rainfall patterns and major volcanic eruptions, and discovered that wetter than normal years occurred during or immediately after the years with the largest volcanic eruptions.

Are neutrophil-to-lymphocyte ratios and large unstained cells different in hospitalized COVID-19 PCR-positive patients with and without diabetes mellitus?

OBJECTIVE: SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung alveoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the metabolic and immune systems. The hematological effects of COVID-19 and the relationship of lymphopenia with the severity of the disease have been reported previously. The parameter of percentage of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardiac diseases, solid tumors, and sepsis. The present study aimed to evaluate whether the parameters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Associations with disease severity were also sought. MATERIALS AND METHODS: In our retrospective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records. RESULTS: When diabetic patients were compared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs.  5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53±12.3 vs.  64.08±13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively). CONCLUSIONS: We determined that LUC counts and NLR values in COVID-19-positive patients with diabetes were statistically significantly higher compared to nondiabetic patients.

Comparison of diagnostic accuracy of saline infusion sonohysterography, transvaginal sonography and hysteroscopy.

We aimed to compare the accuracy of transvaginal sonography (TVS), saline infusion sonohysterography (SIS) and hysteroscopy (HS) for uterine pathologies among infertile women. A total of 346 patients were selected for operative hysteroscopy, following SIS after TVS. SIS was performed with a Cook Soft 500 IVF catheter. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated to compare the accuracy of TVS, SIS and hysteroscopy for uterine abnormalities. SIS showed a sensitivity of 87%, specificity of 100% and PPV of 100% for endometrial hyperplasia, and a sensitivity and NPV of 100% for polypoid lesions. For submucosal myoma SIS showed a sensitivity of 99% with PPV of 96%. Hysteroscopy had a sensitivity, specificity, PPV and NPV of 98%, 83%, 96% and 91%, respectively for overall uterine pathologies. Finally, SIS seems to be superior to TVS, for uterine pathologies, with respect to hysteroscopy as the gold standard.

[In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates to vancomycin, teicoplanin, linezolide and daptomycin]. / Metisiline dirençli staphylococcus aureus izolatlarinin vankomisin, teikoplanin, linezolid ve daptomisine in vitro duyarliliklari.

In this study, vancomycin, teicoplanin, linezolide and daptomycin susceptibility rates of 67 methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from various clinical samples between November 2006 and August 2010 in our laboratories, were investigated by E-test method and MIC values of the drugs were determined. Seventeen (25%) of the samples were from outpatient wards, 50 (75%) from inpatients of which 24 (48%) were from intensive care units. Distribution of MRSA isolated clinical samples were as follows: 16 (23.4%) blood, 28 (42.2%) wound swab, 15 (21.8%) tracheal aspirate, 2 (3.1%) urine, 2 (3.1%) urethral discharge, and one for each (1.6%) cerebrospinal fluid, joint fluid, catheter tip and nasal swab. Except one (1.5%) which was probably intermediate-resistant to vancomycin (since not confirmed by microdilution test or population analysis, this isolate was considered as "probable" intermediate-resistant), all of the isolates were found susceptible to all tested antibiotics. MIC(50) and MIC(90) values were determined as 0.75 and 1.5 µg/ml for vancomycin, 2 and 3 µg/ml for teicoplanin, 0.38 and 0.5 µg/ml for linezolide and 0.094 and 0.19 µg/ml for daptomycin, respectively. The MIC ranges were 0.25-3 µg/ml for vancomycin, 0.125-4 µg/ml for teicoplanin, 0.094-3 µg/ml for linezolide and 0.047-0.25 µg/ml for daptomycin. There was no statistically significant difference between MICs of outpatient, inpatient and intensive care unit isolates for any of the tested drugs (p> 0.05). Based on MIC90 values, daptomycin seems 4-16 times more effective than the other three drugs. It was concluded that considering their in-vitro antibacterial activity, these antibiotics can be used as alternatives to each other for the treatment of MRSA infections.

Evaluation of the sexual function and quality of life in raloxifene treated postmenopausal women.

OBJECTIVE: To evaluate the net effect of raloxifene on overall quality of life and sexual function in postmenopausal women. METHODS: The study was performed in the Gynecology and Obstetrics outpatient clinic of Gazi University Faculty of Medicine between January 2002 and February 2005. Fifty postmenopausal women, in whom raloxifene was indicated for prevention and treatment of osteoporosis, were considered the study group. Fifty postmenopausal women who were not osteoporotic were enrolled as the control group. Participants completed a questionnaire composed of several parts (GRISS, BDI and ISI), at the beginning and end of the 12-month treatment period. RESULTS: Two groups were similar to each other with respect to total GRISS scores at the beginning and at the end of the study (P=0.929 and P=0.508; respectively). Raloxifene was associated with a significant improvement from baseline in the total scores of BDI (P=0.0001), whereas this improvement was not significantly different from the control group (P=0.216). With regard to ISI scores, there were no differences between groups in total scores. Raloxifene use did not seem to affect subscores of ISI either. CONCLUSIONS: This study failed to prove any deleterious effect of raloxifene on quality of life and sexual functions.

The role of frozen section evaluation in the diagnosis of adnexal mass.

The purpose of this study was to evaluate the accuracy of frozen section diagnosis in patients who were subjected to the exploratory laparotomy for pelvic mass. Overall, 207 patients were included in this study and the mean age of the patients was 50.9 +/- 14.9 years (range, 18-84 years). Of these patients, 98 (47%) had benign, 16 (8%) had borderline, and 93 (45%) had malignant histologies at permanent section. The diagnosis at frozen section was deferred for three patients (1.4%) and these patients were excluded from the further analyses. The overall discordance rate was 5.3%. To calculate the sensitivity and specificity values, 2 x 2 contingency tables were constructed in two ways. In the first calculation, borderline histology was considered malignant, and the sensitivity and specificity rates were 97% and 92%, respectively. In the second analysis, it was accepted as benign, and these values were 100% and 98%, respectively. To determine the possible factors related with discordant diagnoses, age, menopausal status, tumoral size, laterality of tumors, and histologic diagnoses were analyzed. Significant association was noted for size and borderline and mucinous histologies. In patients with borderline histology, the discordance rate was 40%. This value for the remaining patients was 3.2% (P < 0.001). The rate of misdiagnosis was 17.4% for mucinous tumors, whereas it was 4.8% for the remaining epithelial tumors (P = 0.03). Frozen section evaluation revealed high sensitivity and specificity values in this study. To increase the accuracy of diagnosis, further diagnostic markers are needed especially for patients with large lesions, borderline tumors, and mucinous histologies.

Assessment of human papilloma viral load of archival cervical intraepithelial neoplasia by real-time polymerase chain reaction in a Turkish population.

The purpose of this study was to determine the existence, and viral load of human papilloma virus (HPV) subtypes 16 and 18 in paraffinized cervical intraepithelial neoplasia (CIN) samples by real-time polymerase chain reaction (RT-PCR). Overall 94 women were included. Of these patients 47 (50%) had CIN I, 27 (28.8%) had CIN II, and 20 (21.2%) had CIN III. HPV positivity for these three groups were 4.2%, 14.8% and 45%, respectively. HPV positivity in CIN III patients was significantly higher than CIN I (OR = 18.41, 95% CI 3.00-145.73; p < 0.001), and CIN II patients (OR = 4.70, 95% CI 1.00-23.76; p = 0.05). The difference between CIN I and II was not significant (p = 0.18). Viral loads were 10(2), and 10(4) copy/ml for two CIN I patients; 10(2), 10(3), and 10(5) for three CIN II patients; and 10(2), 10(3), 10(4), 10(4), 10(5), 10(5), and 10(6) copy/ml for eight patients with CIN III. Viral load of the remaining one patient could not be assessed. No significant variance was noted among the groups with respect to viral load (p = 0.73). RT-PCR had important advantages of detecting, typing, and quantifying at the same time. Although HPV positivity was increased significantly by the degree of lesions, this relation was not observed for viral load.

Effects of a monthly injectable steroidal contraceptive, Mesigyna, on menstrual pattern, lipoproteins, and coagulation parameters.

The objective of this study was to determine the effects of a once-monthly injectable contraceptive (Mesigyna) on menstrual pattern, lipoproteins, and coagulation parameters. Thirty-six women aged 18-35 years requesting monthly injectable contraception were included. Before injecting estradiol valerate 5 mg and norethisterone enanthate 50 mg, coagulation, lipoprotein, and liver function parameters were determined. After the 3- and 6-month injections, the same coagulation and serum lipid measurements and liver function tests were repeated, and women were questioned about their menstrual patterns and side effects. Thirty women who completed 6 months were evaluated. At the end of 3 months, two-thirds of the 30 women had normal menstrual patterns; at the end of 6 months, 80% of the women had normal menses. Serum LDL, total cholesterol, and triglyceride levels did not change significantly, while HDL and VLDL decreased significantly (p = 0.032 and p = 0.039, respectively) at 6 months. PT and aPTT measures did not change at the end of 6 months, while fibrinogen levels were significantly lower (p = 0.013). Serum total bilirubin levels increased (p = 0.022) and albumin levels decreased (p = 0.022) at the end of 6 months. Mesigyna was well tolerated and side effects and menstrual abnormalities were acceptable. There were no clinically significant changes in lipoprotein, coagulation, or hepatic parameters.

The changes in ovarian hormone levels and ovarian artery blood flow rate after laparoscopic tubal sterilization.

OBJECTIVE: To investigate the changes in serum ovarian hormone levels and ovarian artery blood flow rate by Doppler ultrasonography following laparoscopic tubal sterilization. METHODS: Laparoscopic tubal sterilization have been performed on 13 voluntary subjects between the sixth and eighth days of the menstrual cycle. Serum ovarian hormone levels and ovarian artery blood flow rate, by Doppler ultrasonography, were determined 3 days before the operation, on the post-operative third day and on the post-operative third month. The results of 10 participants who finished the follow-up period were analyzed. RESULTS: There were no statistically significant changes in serum levels of ovarian hormones after laparoscopic tubal ligation. The end-diastolic blood flow in ovarian artery was found to be decreased following tubal sterilization (8.7+/-2.8 and 7.4+/-1.8m/sec, respectively, P>0.05), while resistivity index (RI) increased after the operation (0.7+/-0.1 and 0.8+/-0.03, respectively, P>0.05). CONCLUSION: There was no change in ovarian hormone levels after laparoscopic tubal sterilization. There is slight but statistically non-significant decrease in ovarian artery blood flow rate following tubal sterilization, signifying a local increase in vascular resistance.

The axial bilobed flap for burn contractures of the axilla.

The axial bilobed flap, based on the transverse and descending branches of the circumflex scapular artery, was used to successfully reconstruct burn contractures of the axilla. The main advantages of this flap are that the donor site is closed primarily, it provides an adequate amount of healthy and pliable skin with an excellent blood supply and no chance of contraction, and it is an easy technique. In this paper, two cases are presented.

Seroprevalence of rubella virus in Turkish pregnant women.

OBJECTIVES: To assess the immune status of a group of Turkish pregnant women who had never been immunized. METHODS: Between June 1990 and April 1993, the seroprevelance of rubella was determined in the study group of 1351 women. RESULTS: A total of 242 (17.9%) pregnant women were found to be susceptible to rubella infection and the seropositivity rate related to prior infection was 82.1%. CONCLUSIONS: The importance of Rubella IgG determination in Turkish pregnant women is discussed and recommendations for prevention and control of congenital rubella syndrome (CRS) are suggested.

HIV antibody screening in a gynecology and obstetrics clinic Ankara, Turkey.

In 416 pregnant women, admitted to our outpatient obstetric clinic for antenatal care between December 1987 and August 1988, HIV antibody assessments were performed by ELISA technique. No seropositive case was reported.

Surgical treatment alternatives in stress incontinence.

OBJECTIVES: This study was performed to evaluate the different surgical treatment alternatives for urinary stress incontinence and their clinical results. METHODS: Of the patients who visited our clinic between January 1989 and June 1994 complaining of urinary stress incontinence, 408 were found to have genuine stress incontinence (GSI) after undergoing clinical and laboratory investigations. These 408 patients were treated with different surgical techniques. Their postoperative results are discussed. RESULTS: After postoperative follow-up, the success rates of the different surgical techniques were as follows: anterior colporrhaphy (Kelly plication) 66.2%, Marshall-Marchetti-Krantz 88.7%, Burch procedure 94.1%, and sling urethropexy 97.5%. CONCLUSIONS: Patients with a clear-cut diagnosis of GSI must be surgically treated. There are several different techniques, all of which have advantages and disadvantages. If the right technique is used for the right patient then the success rate is high.