[Investigation of the Effect of Pasteurization on the Viability of Cryptosporidium parvum in Cow's Milk by Propidium Monoazide qPCR]. / Pastörizasyonun Inek Sütündeki Cryptosporidium parvum Canliligi Üzerine Etkisinin Propidium Monoazide qPCR ile Arastirilmasi.

Cow's milk, which is one of today's most important food sources, can be a reservoir for many pathogens that create a risk to public health. One of these pathogens is Cryptosporidium parvum. The oocysts of C.parvum, an obligate intracellular parasite, cause infection when ingested orally. The oocysts scattered around with the feces of infected cows or calves can contaminate raw milk and this is frequently seen in dairy farms. The aim of this study was to investigate the viability of C.parvum by propidium monoazide (PMA)-quantitative polymerase chain reaction (qPCR) method after heat treatment applied to contaminated raw cow's milk. For the study, 50 ml of unpasteurized cow's milk was contaminated with 5 X 105 C.parvum oocysts and portioned into 1.5 ml microcentrifuge tubes. Three groups, namely the control group, pasteurization group and boiling group were formed. No warming procedure was applied to the control group. In the pasteurization group, the milks in microcentrifuge tubes were poured into the wells of the dry block heater set to 71.7 °C and incubated for five seconds. At the end of the period, the milks were transferred to the wells of the cold metal tube, which was removed at -20 °C with the help of a micropipette, and incubated for five seconds. The milks in the boiling group were incubated for two minutes in a dry block heater set to 95 °C. After the heat treatment, the milks in microcentrifuge tubes were transferred to 10 ml centrifuge tubes, PBS was added to make the final volume 10 ml, and centrifuged at 4000 rpm for 20 minutes. After this process was repeated twice, 400 µl of PBS was added to the precipitate remaining at the bottom, and the precipitate was homogenized. One sample of each group was applied with PMA, while PMA was not applied to the other sample. PMA-applied samples were incubated for five minutes at room temperature and in the dark, and then exposed to UV light for five minutes in the device with cooling feature. The oocysts were collected by centrifugation at 5000 g for five minutes. After DNA isolation from oocysts, SYBR Green real time PCR (Rt-PCR) was performed using primers amplifying the COWP gene region. As a result of SYBR Green Rt-PCR, the mean Ct values of the control without PMA, pasteurization and boiling groups were determined as 25 ± 1.24, 23 ± 0.98 and 26 ± 1.03, respectively. While no peak was obtained in the boiling group after PMA application, the mean Ct values of the control and pasteurization groups were 28 ± 1.38 and 31 ± 1.46, respectively. As a result, it was concluded that live C.parvum cysts in milk could be detected by PMA-qPCR method and live oocysts could be found in pasteurized milk.

The background method: theory and computations.

The background method is a widely used technique to bound mean properties of turbulent flows rigorously. This work reviews recent advances in the theoretical formulation and numerical implementation of the method. First, we describe how the background method can be formulated systematically within a broader 'auxiliary function' framework for bounding mean quantities, and explain how symmetries of the flow and constraints such as maximum principles can be exploited. All ideas are presented in a general setting and are illustrated on Rayleigh-Bénard convection between stress-free isothermal plates. Second, we review a semidefinite programming approach and a timestepping approach to optimizing bounds computationally, revealing that they are related to each other through convex duality and low-rank matrix factorization. Open questions and promising directions for further numerical analysis of the background method are also outlined. This article is part of the theme issue 'Mathematical problems in physical fluid dynamics (part 1)'.

Detection of Partially Structural Collapse Using Long-Term Small Displacement Data from Satellite Images.

The development of satellite sensors and interferometry synthetic aperture radar (InSAR) technology has enabled the exploitation of their benefits for long-term structural health monitoring (SHM). However, some restrictions cause this process to provide a small number of images leading to the problem of small data for SAR-based SHM. Conversely, the major challenge of the long-term monitoring of civil structures pertains to variations in their inherent properties by environmental and/or operational variability. This article aims to propose new hybrid unsupervised learning methods for addressing these challenges. The methods in this work contain three main parts: (i) data augmentation by the Markov Chain Monte Carlo algorithm, (ii) feature normalization, and (iii) decision making via Mahalanobis-squared distance. The first method presented in this work develops an artificial neural network-based feature normalization by proposing an iterative hyperparameter selection of hidden neurons of the network. The second method is a novel unsupervised teacher-student learning by combining an undercomplete deep neural network and an overcomplete single-layer neural network. A small set of long-term displacement samples extracted from a few SAR images of TerraSAR-X is applied to validate the proposed methods. The results show that the methods can effectively deal with the major challenges in the SAR-based SHM applications.

Bowel perforation of ventriculoperitoneal shunt catheter: endoscopically treated two cases.

PURPOSE: Many techniques were used for the treatment of hydrocephalus, and ventriculoperitoneal shunt surgery is a widely used procedure. Ventriculoperitoneal shunt surgery has been associated with several complications like obstruction of the tube, infection, cerebrospinal fluid loculation, intestinal obstruction, migration of the shunt, and perforation of the intestinal organs. Perforation of the bowel owing to protrusion of ventriculoperitoneal shunt catheter from the anus is an extremely rare complication. Mini or exploratory laparotomy and revision of peritoneal part of shunt and repair of bowel perforation, or pulling out the ventriculoperitoneal shunt catheter and using external ventricular drainage and antibiotics, or colonoscopic removal of ventriculoperitoneal shunt catheter and repair of the bowel can be performed. Retrograde contamination of cerebrospinal fluid and meningitis is a very important part of the treatment in these cases. We aimed to present two cases with bowel perforation who treated with endoscopically. METHODS: We report the cases of 2 patients with transanal protrusion of VPS catheter and the management via endoscopic therapeutic options. RESULTS: Successful treatment of the patients was achieved by endoscopic removal of the catheter and endoscopic repair of the bowel perforation. CONCLUSION: If peritonitis, bowel obstruction, or abscess does not occur, endoscopic removal of shunt and bowel repairing with endoclips may be enough.

Shunt timing in meningomyelocele and clinical results: analysis of 80 cases.

PURPOSE: Meningomyelocele is a serious pathology that requires immediate surgical treatment. Its management is difficult due to accompanying other pathologies and hydrocephalus. Shunt timing is still controversial. Therefore, this study retrospectively assessed 80 patients in order to improve the shunt timing and management of patients with meningomyelocele. METHODS: A total of 80 patients were followed up for 18-48 (average, 23) months. Patients were analyzed for the following variables: delivery method and time, head circumference monitoring, shunt timing, complication rates of patients who underwent shunting, during the early or follow-up period, accompanying pathologies, size, and localization of lesion. RESULTS: Patients including 46 males and 34 females have been operated. In 40% of patients, the accompanying pathology was determined. Approximately 85% of patients had hydrocephalus, and a ventriculoperitoneal shunt was placed on 36 symptomatic and 22 patients with hydrocephalus that developed during the follow-up. Differences in shunt-related and general complications were not significant between patients who underwent shunt placement during the same session and patients who underwent shunt placement during the follow-up. However, the incidence of cerebrospinal fluid fistula formation from the wound in patients who underwent shunt placement during the same session was significantly lower than those who underwent shunt placement during follow-up. CONCLUSIONS: Immediate surgery (within the first 48 h) provides positive results, which is consistent with the existing literature. According to the logistic regression analysis, the placement of the meningomyelocele sac in the lumbosacral region is decisive in shunt insertion. Placing the shunt in the same session for patients with hydrocephalus and later for patients who developed hydrocephalus during the follow-up is recommended as a favorable treatment.

Refining the role of phenology in regulating gross ecosystem productivity across European peatlands.

The role of plant phenology as a regulator for gross ecosystem productivity (GEP) in peatlands is empirically not well constrained. This is because proxies to track vegetation development with daily coverage at the ecosystem scale have only recently become available and the lack of such data has hampered the disentangling of biotic and abiotic effects. This study aimed at unraveling the mechanisms that regulate the seasonal variation in GEP across a network of eight European peatlands. Therefore, we described phenology with canopy greenness derived from digital repeat photography and disentangled the effects of radiation, temperature and phenology on GEP with commonality analysis and structural equation modeling. The resulting relational network could not only delineate direct effects but also accounted for possible effect combinations such as interdependencies (mediation) and interactions (moderation). We found that peatland GEP was controlled by the same mechanisms across all sites: phenology constituted a key predictor for the seasonal variation in GEP and further acted as a distinct mediator for temperature and radiation effects on GEP. In particular, the effect of air temperature on GEP was fully mediated through phenology, implying that direct temperature effects representing the thermoregulation of photosynthesis were negligible. The tight coupling between temperature, phenology and GEP applied especially to high latitude and high altitude peatlands and during phenological transition phases. Our study highlights the importance of phenological effects when evaluating the future response of peatland GEP to climate change. Climate change will affect peatland GEP especially through changing temperature patterns during plant phenologically sensitive phases in high latitude and high altitude regions.

Paediatric High-Grade Intracranial Mesenchymal Chondrosarcoma: A Case Report with 6 Years of Follow-Up without Recurrence.

INTRODUCTION: Intracranial mesenchymal chondrosarcoma (MSC) is an extremely rare tumour that constitutes only 0.015% of all central nervous system tumours. These tumours usually originate from skull base synchondrosis and are often observed in young adults during their second and third decades of life. Despite the absence of a consensus regarding adjuvant radiotherapy, radical excision remains crucial for the prognosis of MSC. CASE PRESENTATION: We herein present the case of a young male patient with intracranial MSC, a malignant tumour, for which no consensus regarding its treatment has yet been established. The patient underwent radical excision followed by adjuvant radiotherapy. Histological analysis revealed a poorly differentiated tumour containing necrotic areas. Notably, no signs of recurrence had been observed after 6 years. CONCLUSION: The absence of recurrence over a long follow-up duration suggests the importance of radical excision and adjuvant radiotherapy.

Tumor necrosis factor alpha and interleukin-1 beta levels in cerebrospinal fluid examination for the diagnosis of ventriculoperitoneal shunt-related ventriculitis.

PURPOSE: Ventriculitis is known to develop after chronic inflammation and bacterial invasion of the ventricular surface with a recurrence of shunt infections. The aim of this study is to evaluate the diagnostic value of elevation in cerebrospinal fluid (CSF) interleukin-1 beta (IL-1ß) and tumor necrosis factor alpha (TNF-α) together with CSF culture and laboratory test results in the diagnosis of ventriculoperitoneal (VP) shunt-related ventriculitis, which is known to be more problematic than conventional shunt infection. METHODS: The study included a total of 34 patients with a VP shunt due to hydrocephalus, who presented with a headache, fever, and shunt infection at the Emergency Department and had a pre-diagnosis of ventriculitis. Nineteen patients were diagnosed with shunt-related infection or ventriculitis using the CSF obtained from the shunt pump. The IL-1ß and TNF-α levels from the CSF samples of all patients were measured using the Micro ELISA immunoassay method. RESULTS: CSF direct microscopic observation revealed that the mean cell count, IL-1ß level, CRP level, and blood leukocyte level were higher in patients with ventriculitis compared to those diagnosed with shunt infection (p = 0.02, p = 0.009, p = 0.004, and p = 0.009, respectively). The probability of predicting positive culture outcome was 92.7% with 90.9% sensitivity and 82.6% specificity when IL-1ß values exceeded 4.0 pg/ml. TNF-α values did not show a significant, reliable pattern compared to IL-1ß. CONCLUSIONS: IL-1ß is a reliable parameter which shall be used in the diagnosis of ventriculitis by predicting positive culture outcome with high sensitivity and specificity.

Pediatric Giant Cerebral Candida Abscess: A Case Report.

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.

Pediatric Traumatic Pneumorrhachis: Case Report.

The existence of air in the spinal canal is referred to as pneumorrhachis. It is classified as extradural (epidural) or intradural (subdural or subarachnoid) according to the location where it is found. Nontraumatic, traumatic, and iatrogenic causes have been attributed to its occurrence. Traumatic pneumorrhachis is very rare and rarely seen in children. In our article, a 16-year-old male child in which air formation within the spinal canal was detected after an injury by a penetrating and cutting (knife) tool is discussed. Observing air within the spinal canal due to traumatic causes is an important situation rarely seen in the pediatric age group. In general, this situation, which can be seen after multiple trauma, may be encountered following a minor trauma. The correct assessment of the radiologic imaging methods ensures not to miss the manifestation of the disease.

Surgical approaches to upper thoracic Pott's disease with spinal instability during childhood: two cases.

PURPOSE: Tuberculosis is a common disease worldwide that is caused by Mycobacterium tuberculosis. Tuberculosis is primarily a pulmonary disease, but extrapulmonary manifestations are not uncommon, especially in children and adolescents. METHODS: We present two pediatric patients who underwent surgery in our clinic for Pott's disease in the upper thoracic region. The patients were investigated to describe their age, complaints, neurological examination results, disease location, surgical procedure, and complications. RESULTS: The patients were 2 and 14 years old and exhibited disease located in the upper thoracic region (T2-T3 and T1-T2). Both patients displayed severe neurological deficits (Frankel B and C). The kyphotic angles were 82.2° and 43.2°. The patients were stabilized by applying fusion using transpedicular screws via a posterior approach. They also underwent anti-tuberculosis treatment for approximately 1 year. One year later, neither patient exhibited any neurological deficit, and their kyphotic angles were measured as 11° and 1°, respectively. CONCLUSIONS: The recommended treatment approach for unstable cases of Pott's disease located in the upper thoracic region who exhibit neurological deficit and severe kyphotic angling or the development of kyphosis on the thoracic vertebrae is surgical. Decompression, stabilization, and fusion and kyphotic correction can be safely performed via a posterior approach. One of the present cases is the youngest patient described in the literature to undergo transpedicular surgery as a result of Pott's disease. Our other case is the first described in the literature who developed ptosis as a result of tuberculosis and underwent a procedure via posterior transpedicular screw.

European In-Situ Snow Measurements: Practices and Purposes.

In-situ snow measurements conducted by European institutions for operational, research, and energy business applications were surveyed in the framework of the European Cooperation in Science and Technology (COST) Action ES1404, called "A European network for a harmonised monitoring of snow for the benefit of climate change scenarios, hydrology, and numerical weather prediction". Here we present the results of this survey, which was answered by 125 participants from 99 operational and research institutions, belonging to 38 European countries. The typologies of environments where the snow measurements are performed range from mountain to low elevated plains, including forests, bogs, tundra, urban areas, glaciers, lake ice, and sea ice. Of the respondents, 93% measure snow macrophysical parameters, such as snow presence, snow depth (HS), snow water equivalent (SWE), and snow density. These describe the bulk characteristics of the whole snowpack or of a snow layer, and they are the primary snow properties that are needed for most operational applications (such as hydrological monitoring, avalanche forecast, and weather forecast). In most cases, these measurements are done with manual methods, although for snow presence, HS, and SWE, automatized methods are also applied by some respondents. Parameters characterizing precipitating and suspended snow (such as the height of new snow, precipitation intensity, flux of drifting/blowing snow, and particle size distribution), some of which are crucial for the operational services, are measured by 74% of the respondents. Parameters characterizing the snow microstructural properties (such as the snow grain size and shape, and specific surface area), the snow electromagnetic properties (such as albedo, brightness temperature, and backscatter), and the snow composition (such as impurities and isotopes) are measured by 41%, 26%, and 13% of the respondents, respectively, mostly for research applications. The results of this survey are discussed from the perspective of the need of enhancing the efficiency and coverage of the in-situ observational network applying automatic and cheap measurement methods. Moreover, recommendations for the enhancement and harmonization of the observational network and measurement practices are provided.

Cognitive and anatomical correlates of anosognosia in amnestic mild cognitive impairment and early-stage Alzheimer's disease.

BACKGROUND: Anosognosia is a common feature in Alzheimer's disease (AD). The brain substrates of anosognosia are not fully understood, and less is known about the cognitive substrates of anosognosia in prodromal and early stages of AD. METHODS: Fourty-seven patients with amnestic-type mild cognitive impairment (aMCI) (n = 26) and early-stage AD (n = 21) were included, and Clinical Insight Rating Scale and Anosognosia Questionnaire for Dementia (AQ-D) were used to assess anosognosia. A detailed neuropsychological battery was administered; each patient underwent a structural magnetic resonance imaging (MRI). Correlation between anosognosia and performance in individual cognitive domains as well as correlation between anosognosia and cortical thickness values in regions of interest were assessed. RESULTS: Performance of the anosognosic patients in Digit Ordering Test (DOT), Digit Span Backwards, and Clock Drawing Test (CDT) was significantly worse compared to non-anosognosic patients in the total study population and in the aMCI subgroup but not in AD group. AQ-D scores negatively correlated with Mini-Mental State Examination (MMSE), California Verbal Learning Test (CVLT), Digit Span Backwards and CDT scores in total group and MMSE, CVLT, DOT, and Digit Span Backwards scores in the aMCI group. No significant correlations were found between cortical thickness measurements and AQ-D scores in any of the patient populations. CONCLUSIONS: Anosognosia was associated with episodic memory, working memory, and executive functions in the total population and aMCI group, but no association was found in early-stage AD patients. Anosognosia in the early stages of AD may be related with non-structural changes such as hypoconnectivity rather than structural changes.

Volumetric differences suggest involvement of cerebellum and brainstem in chronic migraine.

BACKGROUND: Chronic migraine (CM) is a disabling neurologic condition that often evolves from episodic migraine. There has been mounting evidence on the volumetric changes detected by magnetic resonance imaging (MRI) technique in migraineurs. These studies mainly focused on episodic migraine patients and less is known about the differences in CM patients. METHOD: A total of 24 CM patients and 24 healthy control individuals (all females) were included in this study. All participants underwent neurological examination and MRI. High-resolution anatomical MRI images were processed with an automated segmentation method (FreeSurfer). White-matter abnormalities of the brain were also evaluated with the Age-Related White-Matter-Changes Scale. RESULTS: The volumes of the cerebellum and brainstem were found to be smaller in CM patients compared to healthy controls. White-matter abnormalities were also found in CM patients, specifically in the bilateral parieto-occipital areas. There was no correlation between the clinical variables and volume decrease in these regions. CONCLUSION: CM patients showed significant volume differences in infratentorial areas and white-matter abnormalities in the posterior part of the brain. It is currently unclear whether the structural brain changes seen in migraine patients are the cause or the result of headaches. Longitudinal volumetric neuroimaging studies with larger groups, especially on the chronification of migraine, are needed to shed light on this topic.

Immediate Outcomes of Aortic Valve Replacement with Sutureless versus Stentless Bioprosthesis.

BACKGROUND: Aortic valve replacement (AVR) with a sutureless valve is an innovative therapy in high-risk elderly patients. The study aim was to compare the early results of AVR using sutureless aortic valves or stentless aortic bioprostheses. METHODS: A retrospective analysis was conducted of 55 patients who underwent AVR with either a sutureless valve (Perceval S; n = 24 or Edwards Intuity; n = 9) or a stentless valve (Sorin Freedom SOLO™; n = 22). RESULTS: Baseline patient characteristics were similar in both groups, except for NYHA class. Concomitant procedures were performed in 17 patients (51.5%) of the sutureless group and in nine patients (40.9%) of the stentless group (p = 0.44). The aortic cross-clamp time was 55 ± 23 min in the sutureless group and 102 ± 36 min in the stentless group (p <0.0001), while the postoperative peak aortic gradient was 19.5 ± 5.0 mmHg and 29.3 ± 15.4 mmHg for the sutureless group and stentless group, respectively (p = 0.037). The postoperative mean gradient was 9.3 ± 3.4 mmHg for the sutureless group and 15.1 ± 10.5 mmHg for the stentless group (p = 0.06). Blood product transfusion was required less frequently by the sutureless group, but drainage and bleeding was similar in both groups. The intensive care unit and hospital stays were significantly shorter in favor of the sutureless group. One sutureless patient (3.0%) and two stentless patients (9.1%) died in hospital (p = 0.557). CONCLUSIONS: Early results of the present study suggested that surgical AVR with a sutureless valve is associated with a good hemodynamic performance and an improved early outcome.

Spatial distribution and insecticide susceptibility status of Aedes aegypti and Aedes albopictus in dengue affected urban areas of Rawalpindi, Pakistan.

BACKGROUND & OBJECTIVES: Dengue is one of the most common arthropod-borne viral diseases which is transmitted mainly by two vector species, Aedes aegypti (Linnaeus 1762) and Ae. albopictus (Skuse, 1894) worldwide. As there is no effective medicine and vaccine available, vector control remains the most effective measure to prevent its transmission and outbreak. The aim of the study was to confirm the co-occurrence of Aedes aegypti and Ae. albopictus populations in the different localities of Rawalpindi, Pakistan and examine their susceptibility status against different groups of insecticides. METHODS: Ovitraps were randomly placed in the study localities. The number of eggs from all the ovitraps were counted and incubated for hatching in Medical Entomology and Disease Vector Control (MEDVC) insectarium for rearing up to adult stage. The adults were then identified by using the pictorial keys. Spatial distribution and aggregation of both Ae. aegypti and Ae. albopictus populations was determined by using Index of dispersion or variance to mean ratio and k values of the negative binomial distribution. The susceptibility status of both the species against different insecticides was assessed by using the World Health Organization (WHO) standard bioassay tests. RESULTS: The results showed that there was coexistence among Ae. aegypti and Ae. albopictus populations and the aggregation of their eggs was also observed in all the localities studied in Rawalpindi. Larval bioassays of both the populations exhibited incipient resistance against temephos while adult susceptibility testing results showed that both the species were resistant to DDT, malathion, bendiocarb and permethrin. INTERPRETATION & CONCLUSION: The results suggested that all the field populations of Ae. aegypti and Ae. albopictus existed together and showed qualitative changes in their susceptibility status. Resistance against deltamethrin and lambdacyhalothrin was not confirmed and further investigation was recommended to confirm the change in their susceptibility status. This study could help public health authorities to apply simultaneous control activities on both species due to their coexistence and also resistance management strategies should be formulated to slow down the process of development of resistance.

Determining online consumer's luxury purchase intention: The influence of antecedent factors and the moderating role of brand awareness, perceived risk, and web atmospherics.

The Internet has become the fastest-growing way to sell luxury products. Purchase intention for luxury products in online stores has taken attention in the last few years since the sector has proliferated. The primary objective of this study is to examine the impact of various factors such as Product knowledge, Price consciousness, Perceived enjoyment, Perceived ease of usage, and usefulness on online luxury purchase intention in developing countries like Pakistan. Data was collected from 267 luxury fashion customers in Pakistan through an online questionnaire, and the results were analyzed using Smart PLS-SEM. In addition, the paper investigates the moderating effect of Perceived risk, Brand awareness and Web Atmospheric on the link between the Attitude and Online Luxury Purchase Intentions of the consumer to buy luxury fashion products online. The framework of this study is validated by structural equation modelling (SEM). The findings of this study show that perceived enjoyment, price consciousness, and Perceived ease of use significantly and positively impact online luxury purchase intention. Additionally, the findings indicated that brand awareness, perceived risk, and web atmospherics each intervened as moderators in the relationship between attitudes toward purchasing luxury products and online luxury purchase intentions. Product knowledge is not directly related to online purchase intention, but Attitude plays a mediating role in the relationship between product knowledge and online luxury buying purpose. In the context of luxury product intention, this study is one of the first to investigate the moderating effect that brand awareness, perceived risk, and web atmospherics play. It will help luxury brands develop the right tactics for selling luxury goods online in developing countries like Pakistan.

Acute kidney injury after surgical treatment of failed endovascular aneurysm repair.

Background: This study aims to report the incidence of acute kidney injury following surgical reconstruction after a failed endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms. Methods: This retrospective study included 44 patients (39 males, 5 females; mean age: 70±11.3 years; range, 35 to 84 years) who underwent emergency or elective surgical reconstruction after failed EVAR between February 2015 and January 2019. Patients were divided into two groups: acute kidney injury group and no acute kidney injury group. The primary end-point of the study was to evaluate the development of acute kidney injury following surgery. The secondary end-points included the 30-day and one-year mortality rates. Results: Surgical reconstruction of the abdominal aorta was performed electively in 29 (65.9%) patients and urgently in 15 (34.1%) patients. Acute kidney injury occurred in 12 (27.3%) patients. The interval from endovascular aneurysm repair to surgical reconstruction was statistically significantly higher in the no acute kidney injury group than in the acute kidney injury group (24.6±11.5 and 18.1±13.3 months, respectively; p=0.145). The mean abdominal aortic aneurysm diameter, neck angulation, and neck diameter were statistically significantly higher in the acute kidney injury group than in the no acute kidney injury group (p=0.001, p=0.009, and p<0.001, respectively). No statistically significant difference was observed between the acute kidney injury and no acute kidney injury groups for the overall 30-day mortality (p=0.185) and oneyear mortality (p=0.999). Conclusion: Acute kidney injury is not uncommon after the surgical reconstruction of a failed EVAR. Aneurysm-related anatomical factors may have an impact on the development of postoperative acute kidney injury. Comprehensive surgical planning should be performed for open abdominal aortic surgery after a failed EVAR.

Silent neurological involvement in biopsy-defined coeliac patients.

Coeliac disease (CD) is an autoimmune disease of small intestine associated with sensitivity to gluten. The clinical manifestations are often of gastrointestinal nature, although the disease may be present asymptomatically as well. It is a chronic disease and in the absence of overt neurological involvement, extended gluten exposure may give rise to silent or subtle morphological and white-matter changes in central nervous system. The present study investigates such changes using brain volumetry and the assessment of white-matter tissue in CD patients without neurological symptoms. Seventeen CD patients without any neurological involvement were included in the study and went under neurological evaluation and anatomical MRI. Individual gray- and white-matter, and subcortical structure volumes were acquired for using automated volumetric analyses. The observed white-matter hyperintensities (WMH) evaluated using Age-Related White-Matter Changes scale. Findings show a bilateral decrease in cortical gray-matter and caudate nuclei volumes in CD compared to controls. Negative correlations were found between the duration of the disease and the volumes of the affected regions. Cerebellum was seemingly unaffected. In addition, significantly higher proportion of WMH was found in CD patients, specifically in bilateral frontal and occipitoparietal cortices. We observed a significant gray-matter and caudate nucleus atrophy in the CD patients in the absence of marked neurological symptoms. Present findings point out to a need for histopathological investigations potentially focusing on anti-TG2 antibodies, and serial volumetric analyses on the CD-related cortical and subcortical changes.

Otosclerosis and vitamin D receptor gene polymorphism.

OBJECTIVE: The possible genetic relationship between otosclerosis and Vitamin D Receptor (VDR) gene polymorphism is uncertain. The aim of this study is to assess association between otosclerosis and VDR gene polymorphisms. STUDY DESIGN: Case-control Studies. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Clinical diagnosis of stapes fixation was based on otoscopic, audiometric, tympanometric and surgical findings. We identified 25 eligible patient and 60 controls to investigate the association of the VDR gene polymorphisms FokI, BsmI, ApaI, and Taq I with otosclerosis. The patient and control DNA was genotyped for; VDR Bsm I (rs1544410), VDR Apa I (rs7975232), VDR Taq I (rs731236) and VDR Fok I (rs2228570) gene. Primer, simple probe sequences was genotyped by RT-PCR restriction fragment length polymorphism. RESULTS: There was a statistically significant association between VDR gene and otosclerosis in polymorphism Taq I, Apa I and Bsm I. There was no significant association between VDR gene and otosclerosis in polymorphism Foq I. CONCLUSION: Three polymorphisms (Taq I, Apa I and Bsm I) in the VDR gene appear to be associated to susceptibility to otosclerosis disorder with otosclerosis patients.