Evaluation of visual field and ocular surface parameters by clinical comparison after blepharoplasty for dermatochalasis.

PURPOSE: To evaluate the effect of upper eyelid blepharoplasty surgery on corneal topography, visual field, ocular surface, meibography, corneal biomechanics and dry eye parameters. METHODS: This prospective study included a total 80 eyes of 40 patients. Following a detailed ophthalmological examination, standardized patient satisfaction questions were posed to patients before and after upper eyelid blepharoplasty surgery. Visual field test, non-invasive break up time (NIBUT), meibography, and corneal topography parameters were analyzed and evaluated. RESULTS: The mean (+) visible areas in the visual field were found to be 46.20±24.96 preoperatively, 56.73±21.98 at the 1st postoperative month and 65.96±18.5 at the 3rd month, which were statistically significant. NIBUT values preoperatively, at 1 month and at 3 months were 11.26±4.48, 11.16±4.5 and 10.14±4.0, respectively, which were statistically significant. Meibomian gland loss rates on meibography preoperatively and postoperatively at 1 and 3 months were found to be 30.24±8.3, 29.36±8.2 and 28.22±7.7 respectively and were statistically significant. With the scoring system after blepharoplasty, patients reported improvement in their symptoms. CONCLUSION: Upper eyelid blepharoplasty surgery is predicted to increase the quality of vision. It was observed that there was a functional and cosmetic improvement in the complaints of the patients after blepharoplasty. However, blepharoplasty may cause changes in eyelid dynamics and cause dry eye syndrome.

An effective approach for the treatment of severe punctal stenosis: Bicanalicular silicone tube intubation with pigtail probe.

PURPOSE: To evaluate the results of using a pigtail probe to open the inferior punctum followed by bicanalicular silicone tube intubation in patients with severe acquired punctal stenosis. METHODS: Forty-one eyes of 25 patients with severe inferior punctal stenosis admitted to our tertiary care center were included in the study. The degree of epiphora was determined using the Munk score and the fluorescein disappearance test. The inferior punctum was located and opened by entering the superior punctum with a pigtail probe. Then, bicanalicular silicone tube intubation was performed. The silicone tube was removed after six months. A Munk score of 0 or 1 and a fluorescein disappearance test score of 1 and 2 were considered a complete success. RESULTS: Ten (40%) patients were male, and 15 (60%) were female. The mean age was 60.4±15.5years. One year after the surgery, epiphora was absent in 18 eyes (43.9%) (Munk score grade 0) and rarely seen in 9 eyes (22%) (Munk score grade 1). At the one-year follow-up, the fluorescein disappearance test score was stage 1 (<3min) in 21 eyes (51.2%) and stage 2 (3-5min) in 13 eyes (31.7%). There was a statistically significant difference between the preoperative and one-year postoperative test results (P<0.001). CONCLUSION: In cases with severe punctal stenosis, a pigtail probe is an effective method for locating and opening the punctum, and punctal opening and prevention of restenosis were achieved by a bicanalicular stent.

Associating IDH and TERT Mutations in Glioma with Diffusion Anisotropy in Normal-Appearing White Matter.

BACKGROUND AND PURPOSE: IDH and TERT mutations might infiltratively manifest within normal-appearing white matter with specific phenotypes such as microstructural changes undetectable by standard MR imaging contrasts but potentially associable with DTI variables. The aim of this retrospective glioma study was to statistically investigate IDH and TERT associations and classifications with DTI reported microstructure in normal-appearing white matter. MATERIALS AND METHODS: Retrospective data from patients imaged between March 2012 and February 2016 were analyzed by grouping them as IDH-TERT subgroups and by IDH and TERT mutation status. DTI variables in the IDH-TERT subgroups were first identified by the Kruskal-Wallis test, followed by Dunn-Sidák multiple comparisons with Bonferroni correction. IDH and TERT mutations were compared with the Mann-Whitney U test. Classification by thresholding was tested using receiver operating characteristic analysis. RESULTS: Of 170 patients, 70 patients (mean age, 43.73 [SD, 15.32] years; 40 men) were included. Whole-brain normal-appearing white matter fractional anisotropy (FA) and relative anisotropy (RA) (P = .002) were significantly higher and the contralateral-ipsilateral hemispheric differences, ΔFA and ΔRA, (P < .001) were significantly lower in IDHonly patients compared with TERTonly, with a higher whole-brain normal-appearing white matter FA and RA (P = .01) and ΔFA and ΔRA (P = .002) compared to double positive patients. Whole-brain normal-appearing white matter ADC (P = .02), RD (P = .001), λ2 (P = .001), and λ3 (P = .001) were higher in IDH wild-type. Whole-brain normal-appearing white matter λ1 (AD) (P = .003), FA (P < .001), and RA (P = .003) were higher, but Δλ1 (P = .002), ΔFA, and ΔRA (P < .001) were lower in IDH mutant versus IDH wild-type. ΔFA (P = .01) and ΔRA (P = .02) were significantly higher in TERT mutant versus TERT wild-type. CONCLUSIONS: Axial and nonaxial diffusivities, anisotropy indices in the normal-appearing white matter and their interhemispheric differences demonstrated microstructural differences between IDH and TERT mutations, with the potential for classification methods.

CCR7-guided neutrophil redirection to skin-draining lymph nodes regulates cutaneous inflammation and infection.

Neutrophils are the first nonresident effector immune cells that migrate to a site of infection or inflammation; however, improper control of neutrophil responses can cause considerable tissue damage. Here, we found that neutrophil responses in inflamed or infected skin were regulated by CCR7-dependent migration and phagocytosis of neutrophils in draining lymph nodes (dLNs). In mouse models of Toll-like receptor-induced skin inflammation and cutaneous Staphylococcus aureus infection, neutrophils migrated from the skin to the dLNs via lymphatic vessels in a CCR7-mediated manner. In the dLNs, these neutrophils were phagocytosed by lymph node-resident type 1 and type 2 conventional dendritic cells. CCR7 up-regulation on neutrophils was a conserved mechanism across different tissues and was induced by a broad range of microbial stimuli. In the context of cutaneous immune responses, disruption of CCR7 interactions by selective CCR7 deficiency of neutrophils resulted in increased antistaphylococcal immunity and aggravated skin inflammation. Thus, neutrophil homing to and clearance in skin-dLNs affects cutaneous immunity versus pathology.

Spatial and quantitative assessment of wind erosion from adjacent dunes with different surface cover ratios.

Direct measurements, models, and risk maps play significant roles in assessment and monitoring of wind erosion cases. Although active and passive traps allow researchers to measure point sediment transports directly, it is also possible to make geostatistical analysis of wind erosion with grid and random sampling at multiple points. Geostatistical models can be used in multi-sample eolian researches to improve model success and update model parameters. The present study was conducted for case-based geostatistical analysis of sediment transport rates (STRs) over two adjacent dunes (plot A and B) with different vegetation cover rates between 22 May and 15 June 2011. The plot A has a vegetative cover ratio of 30%, while the plot B has a vegetation cover ratio of 2% and sand content of the plots is 88%. Actual mass transports were measured with BEST sediment traps. A total of 19 BEST sediment trap assemblies were placed randomly over the plot A and 21 were placed over the plot B. A climate station was installed over the research site to record climate data throughout the experimental period. There were two wind erosion cases during the research period. U test indicated that differences in sediment transport rates of the plots for each case were significant (p < 0.00). Spatial analyses of STRs (kg m-1 h-1) also exhibited case-based differences. While nugget effect was observed in case 1 of the plot B, the other case in both plots were modeled with spherical model. Maximum likelihood distances in plot A and B were respectively identified as 61 m and 1 m in the first case and as 13 m and 30 m in the second case. Total mass transport was measured as 112 kg m-1 in plot A and as 2162 kg m-1 in plot B. Consequently, it was found that 30% vegetation cover reduced the total mass transport dramatically.

Smartphone-based clinical diagnostics: towards democratization of evidence-based health care.

Recent advancements in bioanalytical techniques have led to the development of novel and robust diagnostic approaches that hold promise for providing optimal patient treatment, guiding prevention programs and widening the scope of personalized medicine. However, these advanced diagnostic techniques are still complex, expensive and limited to centralized healthcare facilities or research laboratories. This significantly hinders the use of evidence-based diagnostics for resource-limited settings and the primary care, thus creating a gap between healthcare providers and patients, leaving these populations without access to precision and quality medicine. Smartphone-based imaging and sensing platforms are emerging as promising alternatives for bridging this gap and decentralizing diagnostic tests offering practical features such as portability, cost-effectiveness and connectivity. Moreover, towards simplifying and automating bioanalytical techniques, biosensors and lab-on-a-chip technologies have become essential to interface and integrate these assays, bringing together the high precision and sensitivity of diagnostic techniques with the connectivity and computational power of smartphones. Here, we provide an overview of the emerging field of clinical smartphone diagnostics and its contributing technologies, as well as their wide range of areas of application, which span from haematology to digital pathology and rapid infectious disease diagnostics.

Investigation of haptoglobin, serum amyloid A, and some biochemical parameters in calves with omphalitis.

AIM: In this study, it was aimed to determine the concentration of some important acute phase proteins (APPs) and some biochemical parameters pre-operative and post-operative in calves with omphalitis. MATERIALS AND METHODS: A total of 20 calves were used in the study and they consist of 10 clinically healthy calves that were used as a control and 10 calves with omphalitis were used as the treatment group. Blood samples were collected from Vena jugularis of animals to tubes with anticoagulant (sodium citrate) and without anticoagulants, pre-operative (day 0), and post-operative (day 7). Samples were used to determine the concentration of haptoglobin (Hp), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen, glucose, total protein, albumin, urea, total bilirubin, creatinine, calcium, phosphorus, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) concentrations. RESULTS: While the Hp, SAA, Cp, fibrinogen, urea, creatinine, total bilirubin, ALP, and GGT concentrations were statistically and significantly increasing rather than the control group during the pre-operative period for calves with omphalitis, they decreased to the post-operative period. Moreover, an insignificant increase in the glucose, total protein, and AST concentrations and an insignificant decrease in the albumin, calcium, and phosphorus concentrations were statistically determined. CONCLUSION: We have the opinion that the assessment of biochemical parameters and especially APP levels in calves with the omphalitis together with the clinical findings may be important in terms of the treatment and prognosis.

The effects of Desflurane and Sevoflurane on Nesfatin-1 levels in laparoscopic Cholecystectomy: a randomized controlled trial.

BACKGROUND: Nesfatin-1 is involved in cardiovascular regulation, stress-related responses. The objective of this study is to investigate the impact of volatile anesthetics on Nesfatin-1 levels. METHOD: Fourty-two patients aged 30-65 years with the American Society Anesthesiology (ASA) Class I-II who were scheduled for laparoscopic cholecystectomy were included in the study Patients were randomized into two group; desflurane administered group (Group I, n = 21) and sevoflurane administered group (Group II, n = 21). For anesthesia maintenance, the patients received 6% desflurane or 2% sevoflurane in 40% O2 and 60% air. The patient's heart rate (HR), mean, systolic and diastolic arterial pressures (MAP, SAP, DAP), peripheral O2 saturation (SpO2) were monitored and recorded before induction, after induction, after intubation, and during extubation. Blood samples were collected before induction (T1), and after extubation when aldrete score was 10 (T2). RESULTS: Demographic data were similar between the groups. The preoperative levels of nesfatin were similar in the two groups (p = 0.715). In desflurane group, post-operative nesfatin levels were similar compared to preoperative levels (p = 0.073). In sevoflurane group, post-operative nesfatin levels were similar (p = 0.131). The nesfatin levels (postoperative vs preoperative) were similar between the groups (p = 0.900). CONCLUSION: In conclusion, this study results suggest that nesfatin-1 levels are not affected by the use of sevoflurane or desflurane in patients undergoing laparoscopic cholecystectomy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617001023347 , retrospectively registered on 17 July 2017.

The neuropsychological and neurophysiological profile of women with pseudoseizure.

OBJECTIVE: Our aim in this study was to compare the assessments of neuropsychological tests and the p50 neurophysiological test of patients with seizure diagnosed as conversion disorder and healthy control subjects, and to investigate the neurological status in conversion disorder with pseudoseizure. METHODS: A total of 22 female conversion disorder patients with convulsions diagnosed according to SCID-I/CV and 22 healthy women were included in the assessment. The participants were administered WMS-R, the cancellation test, and the Stroop test as neuropsychological tests and p50 was assessed as a neurophysiological test. RESULTS: The patient's results for the neuropsychological tests were found to be significantly low compared to the control group. The p50 sensory gating ratios of the patient group were statistically significantly lower than the controls. There was no significant correlation between the neuropsychological test scores and gating ratios of the patient and control groups. CONCLUSIONS: This study is the first to check sensory gating in conversion disorder patients with pseudoseizure and its most important result is finding reduced p50 sensory gating in patients. Our results suggest that these patients have a neurological tendency to this disease due to functional neurophysiological features.

Protective effect of omega-3 fatty acids on diethylnitrosamine toxicity in rats.

OBJECTIVES: In this study, it was aimed to investigate the effect of n-3 fatty acids (n-3 FA) on diethylnitrosamine (DEN) toxicity with respect to alterations including nitric oxide (NO) formation, uric acid level as well as some liver related enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities in rats. MATERIALS AND METHODS: Forty male Wistar albino rats were used as animal materials. Animals were divided into 4 groups and treated as follows: Rats in group 1 (control) were intraperitoneally (i.p) injected with single dose of saline; rats in group 2 were i.p. injected with DEN at a dose of 150 mg/kg/body weight; rats in group 3 were treated with DEN (via single i.p. injection at 150 mg/kg/body weight) plus n-3 FA (at a dose of 0.4 g /kg/day via subcutaneous route in fish oil) for 7 days, and group 4 received n-3 FA via s.c. route at a dose of 0.4 g/kg/day in fish oil for 7 days. The plasma samples were analyzed for NO, uric acid levels as well as for activities of AST, ALT and ALP. RESULTS: Uric acid level was lower in DEN group than in control. In addition, NO level and AST, ALT, ALP activities in DEN group were significantly higher than in control. Nitric oxide concentration, ALT and ALP activities in DEN + n-3 FA treated rats were lower than in DEN alone. Uric acid level in DEN + n-3 FA group was higher than in DEN group. CONCLUSIONS: These results suggest that n-3 fatty acids could ameliorate the toxic effects of DEN in part by means of its free radical scavenging activity and may be of therapeutic value in the protection of liver against toxic effects of DEN.  

Aortobifemoral bypass via paramedian incision and retroperitoneal approach for aortoiliac occlusive disease.

INTRODUCTION: Aorto-bifemoral graft bypass operation is performed in the surgical treatment of aortoiliac occlusive occlusive disease. The conventional standard technique used is the median laparotomy and transperitoneal approach. In this study we evaluated the outcome of aortobifemoral bypass operation via paramedian and retroperitoneal approach. METHODS: 17 patients were operated upon for aortobiiliac occlusive disease from January 2008 through December 2011. Mean age of the patients was 61.8 +/- 8.9 (47-78 years). All patients except for one were operated via left paramedian vertical 8 to 10 cm incision approximately 6 cm to the left or right of midline, extending from a few centimeters above the umbilicus to just above the symphysis pubis. The aortas were reached retroperitoneally through this incision. RESULTS: There was one postoperative death secondary to pulmonary complications. No intraoperative or postoperative surgical complication had occured. All patients were discharged from the hospital on antiplatelet therapy. Graft patency was evaluated by means of physical examination on discharge. Upon the patients' hospital discharge, primary graft patency was 100%. The ankle-brachial indices measured from both the right and left sides were 0.51 +/- 0.10 preoperatively and 0.99 +/- 0.14 postoperatively (p <0.001). DISCUSSION: A lot of complications can be observed due to median laparotomy such as evisceration, incisional hernia, peritonitis, bride ileus. We believe that retroperitoneal approach for aorto-bifemoral graft bypass operation in the patients with bilateral iliac arterial occlusive disease is a well tolerated minimally invasive operation when compared to the conventional median laparotomy approach.

The effect of agoraphobia on oxidative stress in panic disorder.

We aimed to investigate whether agoraphobia (A) in panic disorder (PD) has any effects on oxidative and anti-oxidative parameters. We measured total antioxidant capacity (TAC), paraoxonase (PON), arylesterase (ARE) antioxidant and malondialdehyde (MDA) oxidant levels using blood samples from a total of 31 PD patients with A, 22 PD patients without A and 53 control group subjects. There was a significant difference between the TAC, PON, ARE and MDA levels of the three groups consisting of PD with A, PD without A and the control group. The two-way comparison to clarify the group creating the difference showed that the TAC, PON, and ARE antioxidants were significantly lower in the PD with A group compared to the control group while the MDA oxidant was significantly higher. There was no significant difference between the PD without A and control groups for TAC, PON, ARE and MDA levels. We clearly demonstrated that the oxidative stress and damage to the anti-oxidative mechanism are significantly higher in the PD group with A. These findings suggest that oxidative/anti-oxidative mechanisms may play a more important role on the pathogenesis of PB with A.

Characterization of Punica granatum L. peels and quantitatively determination of its biosorption behavior towards lead(II) ions and Acid Blue 40.

In this study, a waste biomass of Punica granatum L. (P. granatum L.) peels was firstly characterized by means of Brunauer-Emmett-Teller (BET) surface area, elemental analysis, FT-IR, thermogravimetric (TG) analysis and zeta potential measurement techniques. FT-IR results indicated that the mechanism involved in the biosorption of lead(II) ions and AB40 onto biosorbent was mainly attributed to lead(II) ions and dye binding of amino, carboxylic, hydroxyl and carbonyl groups. The biosorption abilities of P. granatum L. peels for lead(II) ions and Acid Blue 40 (AB40) were then investigated. Biosorption equilibrium and kinetic data fit well by the Langmuir isotherm and the pseudo-second-order kinetic models, respectively. The maximum biosorption capacities were 193.9 mg g(-1) for lead(II) ions and 138.1 mg g(-1) for AB40. Biosorption processes were spontaneous and endothermic in nature according to the thermodynamic results and the equilibrium was attained within 50 min. The validity of used kinetic models in this study can be quantitatively checked by using a normalized standard deviation Δq(%). Finally, the biosorption procedure was adopted to treat the real and simulated wastewaters including several metal salts and dyes. The wastewater applications have shown that the biosorbent indicated a reasonable biosorption capability to remove lead(II) ions (98.07%) and AB40 (94.76%) from industrial wastewaters.

Assesment of correlation between bispectral index and four common sedation scales used in mechanically ventilated patients in ICU.

PURPOSE: The aim of this study was to compare the correlation between bispectral index (BIS) monitor and four commonly used subjective clinical scales (Ramsay Sedation Scale (RSS), Richmond Agitation Sedation Scale (RASS), Sedation Agitation Scale, Adaptation to Intensive Care Environment scale) in mechanically ventilated patients in intensive care unit (ICU). In addition, comparison of responsiveness of the clinical scales in respect to BIS changes is another goal of this study. MATERIALS AND METHODS: Mechanically ventilated thirty patients who required sedation for any reason were enrolled to study. Patients who needed neuromuscular blockade, patients with known hearing and visual problems, neurological diseases, anoxic encephalopathy, mental retardation and who developed hemodynamic instability (mean arterial pressure below 60 mmHg) and hypoxemia (sPO2 below 90%) during follow-up were excluded. Starting before the initiation of sedation, first BIS scores then clinical sedation scales were evaluated. This procedure is repeated every 2 hours for 24 hours. RESULTS: All of the four clinical scales were significantly correlated with BIS. BIS and clinical scale values, except Adaptation to Intensive Care Environment scale, showed significant changes compared to baseline after the initiation of sedation. Ramsay and Richmond scales showed the highest correlation with BIS (respectively, r = 0.758, r = 0.750). Adaptation to Intensive Care Environment revealed the lowest correlation (r = 0.565). CONCLUSIONS: All of the scales were significantly correlated with BIS. RSS and RASS showed higher correlation than other scales. As a conclusion: RSS and RASS can be used for monitoring the depth of sedation in mechanically ventilated patients in ICU.

5/6 nephrectomy as a validated rat model mimicking human warfarin-related nephropathy.

BACKGROUND/AIMS: We previously reported that patients with chronic kidney disease (CKD) receiving warfarin therapy and whose international normalized ratio increases to >3.0 may develop acute kidney injury (AKI) as a result of glomerular hemorrhage and formation of obstructive red blood cell (RBC) casts. We named this condition warfarin-related nephropathy (WRN). We also previously reported that acute excessive anticoagulation with brodifacoum (superwarfarin) induces AKI in 5/6 nephrectomy (5/6NE) rats. Limitations of the brodifacoum model precluded a careful assessment of dose-response relationships. METHODS: Warfarin treatment was used in 5/6NE. RESULTS: Herein we report that warfarin treatment of 5/6NE rats resulted in a dose-dependent increase in serum creatinine (SC). The increase in SC following warfarin treatment was greater at 3 and 19 weeks after the ablative surgery, than that observed 8 weeks after the ablative surgery. The SC increase was correlated with the prothrombin time increase. Morphologically, 5/6NE, but not control rats, had acute tubular injury with RBC and RBC casts in the tubules. Treatment with vitamin K prevented SC increase and morphologic changes in the kidney associated with warfarin treatment. A single episode of WRN did not affect the progression of CKD in 5/6NE. CONCLUSION: (1) The 5/6NE model of CKD is an appropriate animal model to study the pathogenesis of WRN. (2) The pharmacokinetics of warfarin is better suited to the study of WRN than that of brodifacoum. (3) The more advanced stages of 5/6NE are more susceptible to WRN than the earlier stages. (4) Vitamin K treatment prevents WRN.

Determination of tetracycline residues in chicken meat by liquid chromatography-tandem mass spectrometry.

Analysis of residual levels of tetracyclines (TCs) in chicken meat was performed using a validated liquid chromatography coupled with a tandem mass spectrometry (LC-MS/MS) technique. Overall, the recoveries for TCs ranged from 56.9% to 101.2%, with standard deviations of 4.5-13.2%. Detection limits ranged from 7.9 to 14.6 µg kg⁻¹. In four of 60 samples, doxycycline (DXC) was determined in a range from 19.9 to 35.6 µg kg⁻¹; and in one sample tetracycline was detected at 17.2 µg kg⁻¹. Chlortetracycline (CTC) and oxytetracycline (OTC) were not detected in any of the tested samples. This study indicates that chicken meat sold in Bursa, Turkey, contained some residues of TCs. Therefore, stricter regulations for the use of antibiotics in the poultry industry and the monitoring of drug residues in chicken meat prior to marketing are needed. Finally, this method has been applied successfully for the confirmation of TCs in chicken meat.