The impact of plasma-rich platelet injection to perianal sphincters on incontinence and quality of life in patients with rectal cancer after low anterior or intersphincteric resection: a prospective cohort study.

BACKGROUND: Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery. METHODS: This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection. RESULTS: Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications. CONCLUSION: Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.

Knowledge and attitude changes of pregnant women regarding prenatal screening and diagnostic tests after counselling.

OBJECTIVES: This study aimed to reveal the knowledge level of pregnant women about prenatal diagnostic tests, Down syndrome (DS) and amniocentesis, their attitudes toward uptaking these tests, undergoing amniocentesis, and the termination of pregnancy. It also aimed to evaluate the effects of providing information, as well as a written information brochure about all the issues concerning women's knowledge and attitudes. MATERIALS AND METHODS: The gynecologists provided verbal and written information on prenatal screening tests (PSTs) and invasive prenatal diagnostic tests. Data were collected using an anonymous questionnaire, which was designed by the researchers on the basis of the literature. RESULTS: Knowledge of both DS and amniocentesis was found to be significantly higher after the education (p = 0.000 and p = 0.000, respectively). Attitudes toward amniocentesis changed significantly after the education. CONCLUSIONS: This study has shown that women had an inadequate knowledge about PSTs, DS, and amniocentesis. It has also revealed that education provided by gynecologists along with a written brochure of information tended to increase women's knowledge about PSTs.

Dental pulp stone formation during orthodontic treatment: A retrospective clinical follow-up study.

OBJECTIVE: The aim of this study was two-fold: (1) To assess the incidence of dental pulp stone formation during orthodontic treatment, and (2) to determine the correlations between the presence of dental pulp stones and age, gender, and dental arches. MATERIALS AND METHODS: A sample of 545 patients (334 girls and 211 boys, age range; 12-22 years) who had undergone nonextraction orthodontic treatment were included in this study. 8442 teeth (T1) and 8410 teeth (T2), including the first and second maxillary and mandibular premolars and molars were evaluated from the pre- (T1) and post-treatment (T2) panoramic radiographs of the patients. The Pearson Chi-square test was used to investigate the associations between the presence of dental pulp stone, gender, age, tooth type and arches. RESULTS: Dental pulp stones were detected in 3% of the teeth at pretreatment panoramic radiographs and 5.2% of the teeth at posttreatment panoramic radiographs. Pulp stone prevalence increased pointedly (2.2%) in the pre- and post-treatment radiographs (P < 0.001). Also, there was a significant difference between the age groups (P < 0.001). In the maxilla, dental pulp stones were found significantly more than that in the mandible at T1 and T2 panoramic radiographs. Maxillary first molars exhibited dental pulp stones the most frequently, followed by the maxillary second molars and mandibular first molars. CONCLUSION: Orthodontic treatment may trigger the formation of dental pulp stones. However, further studies are required to determine the relationship between the pulp stone formation and orthodontic treatment.

[Severe pain and livid discoloration in the left leg of a 32-year-old patient after intravascular heroin injection]. / Massive Schmerzen und livide Verfärbung des linken Beins nach intravaskulärer Heroininjektion bei einem 32-jährigen Patienten.

Acute leg ischemia after intra-arterial drug injection represents a critical vascular emergency scenario. Due to lack of evidence-based standards therapeutic strategies are oriented to the underlying pathomechanisms. For a sufficient therapy a close clinical monitoring and laboratory analyses as well as treatment with analgesics, anticoagulants, anti-inflammatory and spasmolytic agents are of utmost importance. This article reports on the diagnostic and therapeutic approaches in a 32-year-old patient with acute leg ischemia after intra-arterial administration of heroin and secondary infection with Peptostreptococcus and Peptoniphilus species.

Does base excess predict kidney injury in neonates with hypoxic-ischemic encephalopathy?

In neonates with hypoxic-ischemic encephalopathy (HIE), we studied the correlation between cord blood base excess (BE) and kidney function. Among 225 infants, 29 % had oliguria. BE levels differed significantly between oliguric and non-oliguric infants (p < 0.01), with a negative correlation to kidney injury (r = -0.544, p < 0.01). BE < -18 had 85 % specificity and 76 % sensitivity in predicting kidney injury (AUC = 0.88). These findings suggest BE as a valuable indicator of impending kidney injury in HIE infants, though underlying mechanisms may vary.

A full-custom fully implantable cochlear implant system validated in vivo with an animal model.

Realizations of fully implantable cochlear implants (FICIs) for providing adequate solution to esthetic concerns and frequent battery replacement have lacked of addressing system level criteria as a complete device. Here, we present a full-custom FICI that considers design of both an implantable sensor for wide range sound sensing and a signal conditioning circuit for electrical stimulation of the auditory nerve. The microelectromechanical system (MEMS)-based acoustic sensor utilizes multiple cantilever beam structures to sense and filter the mechanical vibrations on the ossicular chain. The area optimized bilayer design of the piezoelectric sensor met with the volume limitation in the middle ear while achieving high signal-to-noise-ratio. The sensor outputs are processed by a current mode low-power signal conditioning circuit that stimulates the auditory neurons through intracochlear electrodes. The FICI is validated with an in vivo model where the electrical auditory brainstem response (eABR) of the animal was observed while applying sound excitation. The eABR results demonstrate that the system is able to evoke responses in the auditory nerves of a guinea pig for sound range of 45-100 dB SPL within the selected frequency bands.

Observations on shock induced chemistry of cyclohexane.

We use double pass absorption spectroscopy to examine shock induced reactions in situ in cyclohexane and benzene at pressures up to 33.1 GPa. Reactions in cyclohexane begin by 27 GPa and complete by 33.1 GPa. Reactions in benzene are observed to begin by 12 GPa and are complete by 18 GPa. Absorption spectra indicate that the first reaction in cyclohexane occurs within or near the shock front, and that a metastable local equilibrium is reached in the post-shock state. A second process may be observed upon reshock at the lower pressures, suggesting a new equilibrium is reached post-reshock as well. Absorption bands are consistent with the formation of short radicals or fragments upon decomposition; however, spectral resolution is too low to confirm this mechanism.

Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy.

OBJECTIVES: The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fissures using the endoanal ultrasonography. BACKGROUND: Lateral internal sphincterotomy is an effective method in treatment of chronic anal fissures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the efficiency of the treatment. METHODS: Totally, 40 patients with unhealed anal fissures after the lateral internal sphincterotomy were enrolled consecutively. The fissures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography. RESULTS: There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superficial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be sufficient, a localized abscess formation of less than 1 cm was detected at the anal crypts level. CONCLUSION: The use of endoanal ultrasonography in patients with unhealed or recurrent anal fissure is a beneficial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31).

Medical faculty students risk perception, attitudes, and behaviors regarding protection from COVID-19 infection.

OBJECTIVE: This study aims to determine the risk perception, attitude, and behavior characteristics of Pamukkale University Faculty of Medicine students towards protection from COVID-19. SUBJECTS AND METHODS: A total of 698 (48.2%) students of Pamukkale University Faculty of Medicine participated in this analytical cross-sectional study. Dependent variables were attitudes and behaviors related to protection from COVID-19, and independent variables were socio-demographic characteristics, sources of information about COVID-19, and health status. Data was collected through a survey using Google Forms. SPSS 17.0 (Inc., Chicago, IL, USA) software package was used for statistical analysis. Descriptive statistics were expressed as numbers and percentages for nominal data and mean and standard deviation for numerical data. Numerical data were compared with Mann Whitney U and Kruskal Wallis tests. Spearman correlation and backward linear regression analyses were used. A p-value of <0.05 was considered significant. RESULTS: The mean age of 698 students participating in the study was 21.8±2.2, and 60% of them were female. The mean attitude score was 54.99±5.17 and the mean behavior score was 50.64±6.06. The information sources of the students about COVID-19 were TV news (69.3%). Linear regression analysis revealed that attitude scores of the female gender were higher than male gender (ß=0.757±0.364 p=0.038, 95% CI: 0.440-1.471) and scores for using websites/social media accounts of professional organizations and professional associations as information sources were higher than not using (ß=0.981 ± 0.388 p=0.011 95% CI: 0.230-1.732). CONCLUSIONS: Medical students' attitude and behavior score towards protection against COVID-19 infection is slightly above the average level. Medical education should prepare students to manage epidemics.

Feasibility of using thrombin generation assay (TGA) for monitoring of haemostasis during supplementation therapy in haemophilic patients without inhibitors.

Monitoring factor replacement treatment and observing concordance with clinical haemostasis is crucial in vital haemorrhages and major surgeries in haemophilic patients. We aimed to investigate the value of the thrombin generation assay (TGA) and thromboelastography (TEG) for monitoring haemostasis in haemophilic patients during factor replacement treatment. The study group consisted of 29 patients (21 haemophilia A, 8 haemophilia B). All the patients FVIII-inhibitor were negative. A total of 35 bleeding episodes and/or surgical interventions were evaluated. aPTT, FVIII/FIX activity, TEG and TGA tests were conducted before and after factor therapy during the bleeding episode or surgical prophylaxis of haemophilic patients. Correlations among these tests were evaluated and compared with clinical responses. No correlation was found among aPTT, factor activities and clinical outcome. There were also no correlation found between TEG parameters and clinical outcome. The only significant correlation found between TGA parameters and clinical outcome was the correlation between peak thrombin. In conclusion, we found superiority of TGA-peak thrombin over other traditional tests for monitoring haemostasis in haemophilic patients in this study.

The efficacy of dinoprostone vaginal insert for active management of premature rupture of membranes at term: a randomized controlled trial.

PURPOSE: To evaluate the efficacy and safety of the vaginal insertion of dinoprostone in terms of achieving cervical ripening, shortening the length of labor, and lowering the cesarean delivery rate for term pregnancies complicated with premature rupture of membranes. METHODS: A prospective, randomized, controlled trial enrolled 100 women with term pregnancies complicated with premature rupture of membranes. Each had a normal non stress test, unscarred uterus, a singleton pregnancy with cephalic presentation, and a Bishop score of less than 4. Patients were randomized to receive a 10 mg dinoprostone vaginal insert single dose or no medication. After cervical ripening, oxytocin induction was performed during labor for both the study and control group. Cervical ripening in the 12th hour, total delivery time and delivery mode were compared between the two groups. RESULTS: More often cervical ripening was obtained in the study group women who used dinoprostone vaginal inserts compared to the control group (p: 0.001). Latent phase of labor and total delivery time was shorter in the study group women than the control group (p: 0.022 and p: 0.026). There was no difference in terms of delivery mode and indication of section between study and control groups. CONCLUSION: The use of dinoprostone vaginal inserts in patients with term pregnancy of premature rupture of membranes reduced both the latent phase of labor and total delivery time without increasing the rate of cesarean section.

Spontaneous cholecystocutaneous fistula as a rare complication of gallstones.

Spontaneous perforation of gallbladder as a complication of biliary stones may lead to a cholecystocutaneous abscess or fistula. The pathophysiology of this condition has been associated with increased pressure in the gallbladder, secondary to biliary obstruction. Ultrasonography and Computed Tomography (CT) can be used for diagnosis of cholecystocutaneous abscess or fistula. The treatment of fistula requires adequate drainage, antibiotics, followed by elective cholecystectomy with excision of the fistula. We report a case of spontaneous cholecystocutaneous fistula in an 89-year-old female patient who presented with obstructive jaundice and subcutaneous abscess in the right subcostal area. Abdominal CT scan showed gallstones and communication between the abscess and the gallbladder. First abdominal wall abscess was drained externally then cholecystectomy and exploration of common bile duct was performed (Fig. 3, Ref. 8).

Associations of coronary plaque characteristics and coronary calcification with bone mineral density in postmenopausal women.

OBJECTIVE: We aimed at investigating the association of postmenopausal osteoporosis in different measurement locations, with the coronary plaque burden and morphology detected by coronary computed tomography angiography (CCTA). PATIENTS AND METHODS: We analyzed a total of 223 postmenopausal women who had undergone both dual-energy X-ray absorptiometry (DXA) and CCTA. Coronary plaque characteristics were analyzed using CCTA. RESULTS: The number of burdens was higher in the osteoporosis/osteopenia group of patients than in the normal group. Agatston score and BMI were not significantly different between the two groups. T-score femur and bone mineral density (BMD) femur were higher in patients with severe coronary artery disease (CAD as compared to those with mild CAD (p=0.036 and p=0.049, respectively), whereas T-score lumbar and BMD lumbar were not significantly different. Non-calcified/mixed plaque burden was an independent predictor of osteopenia/osteoporosis (OR: 1.396, 95% CI 1.007-1.934; p=0.045) together with age (OR: 1.053, 95% CI 1.015-1.093; p=0.006). CONCLUSIONS: Non-calcified/mixed plaque burden was significantly and independently associated with osteoporosis/osteopenia at femoral neck but not at lumbar spine. Osteopenia/osteoporosis was not significantly associated with CAC.

Acute effects of postural changes and lower body positive and negative pressure on the eye.

Introduction: Entry into weightlessness results in a fluid shift and a loss of hydrostatic gradients. These factors are believed to affect the eye and contribute to the ocular changes that occur in space. We measured eye parameters during fluid shifts produced by lower body negative pressure (LBNP) and lower body positive pressure (LBPP) and changes in hydrostatic gradient direction (supine-prone) in normal subjects to assess the relative effects of fluid shifts and hydrostatic gradient changes on the eye. Methods: Ocular parameters (intraocular pressure (IOP), ocular geometry, and optical coherence tomography measures) were measured in the seated, supine, and prone positions. To create a fluid shift in the supine and prone positions, the lower body chamber pressure ranged from -40 mmHg to +40 mmHg. Subjects maintained each posture and LBNP/LBPP combination for 15 min prior to data collection. A linear mixed-effects model was used to determine the effects of fluid shifts (as reflected by LBNP/LBPP) and hydrostatic gradient changes (as reflected by the change from seated to supine and from seated to prone) on eye parameters. Results: Chamber pressure was positively correlated with both increased choroidal thickness (ß = 0.11 , p = 0.01) and IOP (ß = 0.06 p < 0.001). The change in posture increased IOP compared to seated IOP (supine ß = 2.1, p = 0.01, prone ß = 9.5, p < 0.001 prone) but not choroidal thickness. IOP changes correlated with axial length (R = 0.72, p < 0.001). Discussion: The effects of hydrostatic gradients and fluids shifts on the eye were investigated by inducing a fluid shift in both the supine and prone postures. Both hydrostatic gradients (posture) and fluid shifts (chamber pressure) affected IOP, but only hydrostatic gradients affected axial length and aqueous depth. Changes in choroidal thickness were only significant for the fluid shifts. Changes in hydrostatic gradients can produce significant changes in both IOP and axial length. Fluid shifts are often cited as important factors in the pathophysiology of SANS, but the local loss of hydrostatic gradients in the head may also play an important role in these ocular findings.

Evaluation of a novel mid-infrared pyrometer for dynamic material experiments.

Temperature is a complicated thermodynamic parameter to measure in dynamic compression experiments. Optical pyrometry is a general-purpose "work-horse" technique for measuring temperature from a radiant surface on these experimental platforms. The optical pyrometry channels are commonly held to the visible or Near-Infrared spectrum, which provides high fidelity temperature measurement for shock temperature above ∼1200-1500 K. However, low temperature (T < 1200 K) dynamic material experiments, including low pressure or quasi-isentropic studies, as well as experiments with complex thermodynamic paths, require Mid-Infrared (Mid-IR) for high fidelity measurements. This article outlines the design, testing, and characterization of a novel Mid-IR pyrometer system that can be configured between 2.5 and 5.0 µm, suitable for lower temperature measurements and for increasing the fidelity and precision of higher temperature measurements. Experimental validation was done on two separate gas gun platforms, with two separate impact velocities, achieving temperatures between 450 and 1100 K.

The effect of halofuginone and pirfenidone on wound healing in experimental glaucoma filtration surgery.

PURPOSE: To investigate the effects of halofuginone and pirfenidone on wound healing in experimental glaucoma filtration surgery (GFS). STUDY DESIGN: Animal experimentation. METHODS: A total of 42 male New Zealand albino rabbits were separated into 6 equal groups. A limbal-based trabeculectomy was performed on 5 groups, and Group I (control group) underwent no surgery and received no postoperative medication. For Group II (sham group), 1 drop 0.9% NaCl was instilled qid for 14 days. For Group III, 1% topical corticosteroid (prednisolone acetate) was instilled 1 drop qid for 14 days. For Group IV, 0.4mg/mL mitomycin-C (MMC) was applied intraoperatively to the region of the scleral flap. For Group V, 0.5% pirfenidone was instilled 1 drop qid for 14 days postoperatively. For Group VI, a sponge soaked in 10ng/mL halofuginone was applied to the surgical region for 3 mins. In addition, 1% topical corticosteroid was instilled ×1 drop qid for 14 days postoperatively for Groups IV, V and VI. After 14 days, sections prepared from the bleb regions of the enucleated eyes were evaluated histopathologically and immunohistochemically. Statistical analyses of the study were performed with Kruskal-Wallis variance analysis and the Mann-Whitney U test. RESULTS: With regard to fibroblasts, suppression of the number of mononuclear cells and immunohistochemical staining intensity of transforming growth factor-b (TGF-ß), fibroblast growth factor-b (FGF-ß) and platelet derived growth factor (PDGF), the corticosteroid, MMC, pirfenidone and halofuginone groups were seen to exhibit more effect than the sham group (P<0.05). Compared to the pirfenidone and fuginone groups, inhibition of fibroblast and monocyte proliferation was determined to be lower in the MMC group (P<0.05). The intensity of TGF-ß and FGF-ß staining was seen to be lower in these two treatment groups than in the MMC group (P<0.05). CONCLUSIONS: Halofuginone and pirfenidone may be used as effective alternative agents in delaying wound healing in glaucoma filtration surgery.

A single centre experience in circumcision of haemophilia patients: Izmir protocol.

Haemophiliacs and their families consider that circumcision is a very important step to become a member of society and it is a social obligation for men in Turkey. Although bleeding risk is high, almost all haemophiliacs would like to be circumcised in Turkish society. The aim of this study was to evaluate our experience in circumcision of haemophilia patients and define efficacy, safety and complication rates of our protocol, called 'Izmir protocol'. In this study, we retrospectively reviewed medical records of 50 patients with haemophilia who underwent circumcision at our hospital according to Izmir protocol between 1996 and 2009. Oral tranexamic acid and fibrin glue were used in all children. One hour before the operation, first dose of factor concentrate was given. After reaching a plasma factor level of around 90-100%, the prepuce was incised circumferentially and excised using Gomco clamp or open technique under general anaesthesia. Intermittent injections of factor concentrate were given every 12 for 48 h. While the first two doses were given at higher amount to achieve or continue plasma factor level at 90-100%, in the last three doses, the aim was to maintain the plasma factor level at 50-60%. Forty-eight hours after the circumcision, patients were discharged. Three patients (6%) showed bleeding complication and all were resolved easily. All had at least one excuse from the protocol (Lower doses of factor concentrates was used in 2, tranexamic acid was not used in 2). Izmir protocol is safe, cheap and easy to carry out.

Surgery in patients with haemophilia and high responding inhibitors: Izmir experience.

This report evaluates the haemostatic efficacy of recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrate (APCC) in patients with haemophilia and high responding inhibitors who underwent major and minor surgery. Data pertaining to surgeries from 2001 to 2009 at a single centre were retrospectively analysed. During this period, 53 surgical procedures were performed in 30 haemophiliacs with high responding inhibitors. Mean age was 16.2±9.4 years. Eleven major surgeries in 4 patients, 41 radioisotope synovectomies (RS) and one circumcision classified as minor surgery in 28 patients were performed. Among the major surgery procedures, four were treated with rFVIIa, five with APCC and two with sequential use of APCC and rFVIIa. We used rFVIIa at the dosage of 80-120 µg kg(-1) every 2 h and APCC 100 IU kg(-1) every 12 h for the major surgery. When performing RS, we used rFVIIa in 18 patients with 26 target joints and APCC in 9 patients with 15 target joints. Three consecutive doses of rFVIIa (90 µg kg(-1) ) were used at 2-h intervals followed by additional three doses at 6-h intervals. The initial dose of APCC was 75 IU kg(-1) followed by a second and third dose of 50 IU kg(-1) at 12-h intervals. APCC and rFVIIa demonstrated excellent efficacy in our major and minor surgical interventions [100% (22/22) and 94% (31/33), respectively]. We had only two bleeding complications with rFVIIa. There were no thromboembolic complications. APCC and rFVIIa provide an effective and safe first line haemostatic therapy for inhibitor-positive haemophiliacs, allowing both major and minor surgery to be successfully performed.

The survival effect of E-cadherin and catenins in colorectal carcinomas.

AIM: The E-cadherin/catenin complex plays an important role in epithelial tissue architecture. Decreased expression of cell adhesion molecules (E-cadherin, α-, ß- and γ-catenin) have been reported to correlate with invasive behaviour. The aim of this study was to investigate the relation between the expression of adhesion molecules and clinicopathological characteristics and survival in colorectal carcinoma. METHOD: The expression of adhesion molecules were studied by immunohistochemistry in 138 colorectal carcinomas. RESULTS: The mean age of the patients was 65 years (range: 21-89 years). In primary carcinomas, a reduction in membranous expression of E-cadherin, α-catenin, ß-catenin, γ-catenin was demonstrated (70%, 68%, 73%, 77%, respectively). Nuclear expression of ß-catenin was found in eight (5%) patients. Decreased membranous ß- and γ-catenin expression significantly correlated with tumour differentiation (P = 0.013, P = 0.03, respectively). There was a significant association between advanced stage of the tumour and decreased membranous α-catenin expression (P = 0.012). Decreased E-cadherin and ß-catenin membranous expression correlated with short survival following curative resection of the primary tumour (P = 0.04, P = 0.03, respectively). CONCLUSION: The decreased membranous expression of E-cadherin and ß-catenin and increased cytoplasmic expression of ß-catenin might be used as a prognostic marker to monitor patients with colorectal cancer.