Comparison of Bedside Index for Severity in Acute Pancreatitis and Emergency Department SpO2, Age and Systemic Inflammatory Response Syndrome Scores in Predicting Severe Acute Pancreatitis in Patients with Acute Pancreatitis in the Emergency Department.

BACKGROUND: As the mortality of severe acute pancreatitis (SAP) is significantly higher than those with mild or moderate severity, it is of clinical significance to identify patients most likely to develop SAP at the time of emergency department (ED) presentation. OBJECTIVES: The aim of this study was to compare the performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Emergency Department SpO2, Age and SIRS (ED-SAS) scoring systems as early risk assessment tools for identifying patients at high-risk of developing SAP. METHODS: We retrospectively reviewed adult patients with AP presented to ED between January 2019-September 2022. We calculated the scores of each patient with the parameters of the initial data. The primary outcome was SAP. The secondary outcomes were 30-day mortality, intensive care admission, and identifying low-risk patients without complications. RESULTS: Of 415 patients, 34 (8.2%) developed SAP and 15 (3.6%) died. With regard to predicting SAP, BISAP and ED-SAS scores had similar discriminative ability with area under the curves (AUCs) of 0.84 (95% confidence interval [CI]:0.80-0.88) and 0.83 (95% CI:0.79-0.86), respectively (p = 0.642). At a cut-off score of ≥2 for SAP, sensitivity/specificity values were 73.5%/82.4% for BISAP, 76.5%/83.2% for ED-SAS. BISAP and ED-SAS scores of ≥3, yielded sensitivity/specificity values of 50%/95.8% and 35.3%/95.5%, respectively. BISAP and ED-SAS were also similar in predicting mortality (AUCs of 0.92 vs. 0.90, respectively) and intensive care unit admission (AUCs 0.91 vs. 0.91). CONCLUSION: The BISAP and ED-SAS scores performed similarly in predicting SAP, mortality, and intensive care unit admission. As an easily calculated tool early in the ED, ED-SAS may be helpful in disposition decisions for emergency physicians.

Effect of MELD-Na score on overall survival of periampullary cancer.

Periampullary cancers have a short overall survival (OS), and many prognostic factors have been studied for this purpose. They usually present with biliary obstruction, which negatively affects the liver, kidney, immune system, and cardiovascular system. This study aimed to investigate the effect of MELD-Na scores on OS in patients undergoing pancreaticoduodenectomy due to periampullary cancer. Patients who underwent pancreaticoduodenectomy due to periampullary cancer between January 2010 and January 2021 were included in the study. After applying the exclusion criteria, 80 of the 124 patients were included in the study. The demographic, laboratory, and pathologic data of the patients were analyzed retrospectively. Univariate analysis showed that MELD-Na score at admission, age-adjusted Charlson Comorbidity Index, adjuvant treatment, portal vein resection, lymphovascular invasion (LVI), T-stage, and tumor location were significantly associated with OS (p < 0.1). In multivariate analysis, MELD-Na score at admission (HR: 1.051, 95% CI [1.004-1.101]; p = 0.033), adjuvant treatment (HR: 4.717, 95% CI [2.371-9.383]; p < 0.001), LVI (HR: 2.473, 95% CI [1.355-4.515]; p = 0.003), and tumor location (HR: 2.380, 95% CI [1.274-4.445]; p = 0.007) were independent risk factors for OS. MELD-Na score, adjuvant treatment, LVI, and tumor location were independent risk factors for the OS of periampullary cancer. The MELD-Na score may be used to predict OS for patients undergoing pancreaticoduodenectomy due to periampullary cancer.

February 6th, Kahramanmaras earthquakes and the disaster management algorithm of adult emergency medicine in Turkey: An experience review.

This compilation covers emergency medical management lessons from the February 6th Kahramanmaras earthquakes. The objective is to review relevant literature on emergency services patient management, focusing on Koenig's 1996 Simple Triage and Rapid Treatment (START) and Secondary Assessment of Victim Endpoint (SAVE) frameworks. Establishing a comprehensive seismic and mass casualty incident (MCI) protocol chain is the goal. The prehospital phase of seismic MCIs treats hypovolemia and gets patients to the nearest hospital. START-A plans to expedite emergency patient triage and pain management. The SAVE algorithm is crucial for the emergency patient secondary assessment. It advises using Glasgow Coma Scale, Mangled Extremity Severity Score, Burn Triage Score, and Safe Quake Score for admission, surgery, transfer, discharge, and outcomes. This compilation emphasizes the importance of using diagnostic tools like bedside blood gas analyzers and ultrasound devices during the assessment process, drawing from 6 February earthquake research. The findings create a solid framework for improving emergency medical response strategies, making them applicable in similar situations.

A Comparative Analysis of Deep Learning-Based Approaches for Classifying Dental Implants Decision Support System.

This study aims to provide an effective solution for the autonomous identification of dental implant brands through a deep learning-based computer diagnostic system. It also seeks to ascertain the system's potential in clinical practices and to offer a strategic framework for improving diagnosis and treatment processes in implantology. This study employed a total of 28 different deep learning models, including 18 convolutional neural network (CNN) models (VGG, ResNet, DenseNet, EfficientNet, RegNet, ConvNeXt) and 10 vision transformer models (Swin and Vision Transformer). The dataset comprises 1258 panoramic radiographs from patients who received implant treatments at Erciyes University Faculty of Dentistry between 2012 and 2023. It is utilized for the training and evaluation process of deep learning models and consists of prototypes from six different implant systems provided by six manufacturers. The deep learning-based dental implant system provided high classification accuracy for different dental implant brands using deep learning models. Furthermore, among all the architectures evaluated, the small model of the ConvNeXt architecture achieved an impressive accuracy rate of 94.2%, demonstrating a high level of classification success.This study emphasizes the effectiveness of deep learning-based systems in achieving high classification accuracy in dental implant types. These findings pave the way for integrating advanced deep learning tools into clinical practice, promising significant improvements in patient care and treatment outcomes.

A robust deep learning model for the classification of dental implant brands.

OBJECTIVE: In cases where the brands of implants are not known, treatment options can be significantly limited in potential complications arising from implant procedures. This research aims to explore the application of deep learning techniques for the classification of dental implant systems using panoramic radiographs. The primary objective is to assess the superiority of the proposed model in achieving accurate and efficient dental implant classification. MATERIAL AND METHODS: A comprehensive analysis was conducted using a diverse set of 25 convolutional neural network (CNN) models, including popular architectures such as VGG16, ResNet-50, EfficientNet, and ConvNeXt. The dataset of 1258 panoramic radiographs from patients who underwent implant treatment at faculty of dentistry was utilized for training and evaluation. Six different dental implant systems were employed as prototypes for the classification task. The precision, recall, F1 score, and support scores for each class have included in the classification accuracy report to ensure accurate and reliable results from the model. RESULTS: The experimental results demonstrate that the proposed model consistently outperformed the other evaluated CNN architectures in terms of accuracy, precision, recall, and F1-score. With an impressive accuracy of 95.74 % and high precision and recall rates, the ConvNeXt model showcased its superiority in accurately classifying dental implant systems. Notably, the model's performance was achieved with a relatively smaller number of parameters, indicating its efficiency and speed during inference. CONCLUSION: The findings highlight the effectiveness of deep learning techniques, particularly the proposed model, in accurately classifying dental implant systems from panoramic radiographs.

Prevalence of the hematopoietic rare genetic diseases in Türkiye: A retrospective study.

BACKGROUND: Rare genetic diseases are an important global public health problem. At present there are defined approximately 8120 genetic diseases in 15,465 epidemiological datasets and 70% of them start in childhood. Hematopoiesis is the production of all cellular components of blood and continues throughout life. OBJECTIVE: This study aims to present prevalence of hematopoietic rare genetic diseases recorden in Turkey. METHODS: The population of study consist of 84.680.273 people who received healthcare from the Turkish National Health Service (49.9% female, 50.1% male). TNHS collects and records electronic data which relates with illness or health information of Turkish population since 2018. All healthcare facilities utilize the Personal Electronic Health Record System (PHR), aligning with standards outlined in the Turkish National Health Data Dictionary and the Health Coding Reference Server (HCRS) established by the Ministry of Health in 2007. The data dictionary comprises essential packages such as patient application and examination records. RESULTS: Diagnosed female population (53.04%) were higher than male (46.96%). Data shows that most of the people with rare genetic diseases were diagnosed in Marmara Region. The overall prevalence of Hematopoietic Rare Genetic Diseases higher in the years of 2021 and 2022. CONCLUSION: The prevalence increased gradually from 2018 to 2022. The consanguinity marriage seems to be the main problem which resulted higher rate of rare genetic diseases in Türkiye.

Prognostic value of early warning scores in patients presenting to the emergency department with exacerbation of COPD.

OBJECTIVE: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a condition that frequently presents to the emergency department (ED) and its prognosis is not very well understood. Risk tools that can be used rapidly in the ED are needed to predict the prognosis of these patients. METHODS: This study comprised a retrospective cohort of AECOPD patients presenting to a single center between 2015 and 2022. The prognostic accuracy of several clinical early warning scoring systems, Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), NEWS­2, Systemic Inflammatory Response Syndrome (SIRS) and the quick Sepsis-related Organ Failure Assessment (qSOFA), were compared. The outcome variable was determined as one-month mortality. RESULTS: Of the 598 patients, 63 (10.5%) had died within 1 month after presenting to the ED. Patients who died had more often congestive heart failure, altered mental status, and admission to intensive care, and they were older. Although the MEWS, NEWS, NEWS­2, and qSOFA scores of those who died were higher than those who survived, there was no difference between the SIRS scores of these two groups. The score with the highest positive likelihood ratio for mortality estimation was qSOFA (8.5, 95% confidence interval [CI] 3.7-19.6). The negative likelihood ratios of the scores were similar, the NEWS score had a negative likelihood ratio of 0.4 (95% CI 0.2-0.8) with the highest negative predictive value of 96.0%. CONCLUSION: In AECOPD patients, most of the early warning scores that are frequently used in the ED were found to have a moderate ability to exclude mortality and a low ability to predict mortality.

Attitudes of parents of children with ADHD towards genetic testing: Data from a Turkish sample.

This study aimed to examine the opinions of parents with children diagnosed with attention deficit/hyperactivity disorder about genetic tests. A total of 540 parents living in Turkey participated in the study face-to-face and online. A questionnaire form prepared by the researchers was used as the data collection instrument. Face-to-face data were collected in different institutions in the cities of Izmir, Bursa and Antalya, while online data were collected through Google Forms. The results revealed that parents' views on genetic testing differed according to the sex and age of the child, as well as the parents' level of education and income, and whether the parents had genetic testing during pregnancy (p < 0.05). In the analysis, it was determined that parents' knowledge and awareness levels about genetic tests were generally low, while parents who reported that they would consider having genetic tests had concerns about the storage of their DNA materials, family conflicts that could be caused by genetic tests, and the compatibility of genetic tests with their religious beliefs.

Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants.

OBJECTIVES: The aim of this study was to assess adherence to the European Society of Cardiology 2020 non-ST elevation acute coronary syndrome (NST-ACS) guidelines, identify factors affecting this compliance, and explore the link between adherence and adverse cardiac outcomes. METHODS: This prospective cohort study was conducted in a tertiary-level academic hospital between January 2022 and January 2023. Patients diagnosed with NST-ACS in the emergency department (ED) were included. The primary outcome measured was the rate of adherence to the guidelines, and secondary outcomes were factors affecting this adherence in the ED and its association with 28-day adverse cardiac outcomes. RESULTS: Of the 298 patients included, guideline adherence was achieved in 32.2% in the ED. The highest compliance was observed in performing a 12-lead electrocardiogram (ECG) within 10 minutes (99.7%), while the lowest was found for obtaining additional right and posterior ECG leads when ongoing ischemia was suspected (42.3%). Factors associated with better adherence included the experience level of the treating physician, the presence of cardiac-quality chest pain, initial ischemic ECG findings, higher initial troponin levels, and advanced history, electrocardiogram, age, risk factors, and troponin score and Charlson comorbidity index. Complete guideline adherence over 28 days was achieved in 19.1% of patients and was found to be significantly associated with lower rates of adverse cardiac outcomes. CONCLUSIONS: Adherence to NST-ACS guidelines was generally low but was associated with improved patient outcomes. This study highlighted the importance of various factors associated with guideline adherence. Future research should explore further barriers to guideline adherence and develop targeted interventions.

The effects of technical factors on the fractal dimension in different dental radiographic images.

Purpose: The aim of this study was to assess the impact of exposure parameters and image formats on fractal dimension (FD) values in periapical, panoramic, and CBCT images. Materials and methods: Seven dry male mandibles were selected, and a Gutta-Percha was used to identify identical regions of interest. A periapical radiograph was taken with 60 kVp/7 mA and exported in DICOM, JPEG, TIFF, and PNG formats. Nine periapical radiographs (60, 65, 70 kVp; 4, 5, 6 mA) were taken from seven dry human mandibles. Additionally, 12 panoramic radiographs (60, 70, 81, 90 kVp; 5, 8, 13 mA) and 10 CBCT images (with different scanning options and FOVs) were taken from each mandible. FDs were measured from a standard area. Results: The intra-class correlation coefficient demonstrated a high degree of agreement between observers. No significant difference was found between TIFF and PNG formats (p > 0.05). The highest FD mean was found in TIFF format, while the lowest FD mean was found in JPEG format (p<0.001). There was no significant difference between kVp and mA settings in periapical images. In panoramic images, a significant difference was found at 90 kVp (p = 0.001) and 13 mA (p<0.001), with lower FD values observed at these settings. There was no significant difference between FOV and resolution in CBCT images (p > 0.05). Conclusion: The format of the image can influence FD. For periapical and panoramic radiographs, kVp and mA settings do not have a significant impact on FD. However, fractal analysis may not be an ideal method for evaluating three-dimensional images, such as those obtained with CBCT.

The prognostic effect of the systemic immune-inflammation index on overall survival of periampullary cancer.

OBJECTIVE: The systemic immune-inflammation index (SII) is used to assess survival in many cancers. SII has been examined separately in pancreatic head, ampulla, and distal choledochus cancers, and different cut-off values were found. Detecting the location of periampullary cancer before surgery may be difficult or misleading. This study aimed to investigate the use of SII in predicting overall survival (OS) with periampullary cancers regardless of tumor location. METHODS: Between January 2010 and January 2020, 163 patients who underwent pancreaticoduodenectomy for periampullary tumors were assessed. After applying the exclusion criteria, data from 116 patients with cancer who underwent pancreaticoduodenectomy were included in the study. RESULTS: OS was compared using Kaplan-Meier curves. The prognostic significance of baseline SII and other factors were assessed in univariate and multivariate analyses using the Cox proportional hazard regression model. Univariate analysis demonstrated that age ≥60.5 years (hazard ratio [HR]: 2.042, 95% CI: [1.355-3.078]; p = 0.001), male sex (HR: 1.863, 95% CI: [1.231-2.821]; p = 0.003), tumor in the pancreatic head vs. ampulla (HR: 2.150, 95% CI: [1.364-3.389]; p = 0.001), tumor in the pancreatic head vs. distal choledochus (HR: 1.945, 95% CI: [1.091-3.472]; p = 0.024), N (+) stage (HR: 1.868, 95% CI: [1.223-2.854]; p = 0.004), total bilirubin level >0.35 (HR: 2.131, 95% CI: [1.245-3.649]; p = 0.006), NLR >2.13 (HR: 1.911, 95% CI: [1.248-2.925]; p = 0.003), and SII >704 (HR: 1.966, 95% CI: [1.310-2.950]; p = 0.001) were significantly associated with OS. Multivariate analysis revealed that SII >704 (HR: 2.375; p < 0.001), age ≥ 60.5 years (HR: 2.728; p < 0.001), N-stage positivity (HR: 3.431; p < 0.001), and tumor in the pancreatic head vs. ampulla (HR: 2.801; p < 0.001) were independently associated with poor survival. There was no difference between tumor locations in terms of SII (p = 0.206). CONCLUSIONS: SII is an independent prognostic risk factor and may be a marker for predicting OS in patients with periampullary cancer. There was no statistical difference between the tumor locations in terms of SII. A single cut-off value of SII may be used for periampullary cancer survival without the need for a pathology specimen.

Investigation of the effect of oral and internal bisphosphonate use on bone density in the jaws in patients with osteoporosis in panoramic radiography.

OBJECTIVES: This study aims to quantitatively evaluate the effects of bisphosphonate use duration and route of administration on mandibular cortical and trabecular bone in postmenopausal women. STUDY DESIGN: Ninety postmenopausal women over the age of 50 were included in this study. Trabecular bone density was specified numerically by fractal dimension (FD) in the region of interest selected on the panoramic radiograph. The width of the mandibular cortical (MCW) bone under the mental foramen of the mandible was measured. Mann-Whitney U test was used for parameters that did not show a normal distribution. Spearman rho correlation test was used to determine the relationship between continuous measurement parameters. RESULTS: It was observed that FD and MCW of dentate and edentate individuals using bisphosphonate were statistically significantly lower than those of healthy individuals (P < .05). There was no significant correlation was found between the duration of use of bisphosphonates and the fractal values obtained from the relevant regions of the mandible (P > .05). CONCLUSION: Fractal dimension was found to be lower in oral bisphosphonate use than in intravenous bisphosphonate use. The width of the mandibular cortical bone values was found to be lower in individuals using bisphosphonate than in healthy individuals. Fractal dimension and MCW may benefit clinicians as quantitative parameters in panoramic radiography in the diagnosis of osteoporosis.

Developing deep learning methods for classification of teeth in dental panoramic radiography.

OBJECTIVES: We aimed to develop an artificial intelligence-based clinical dental decision-support system using deep-learning methods to reduce diagnostic interpretation error and time and increase the effectiveness of dental treatment and classification. STUDY DESIGN: We compared the performance of 2 deep-learning methods, Faster Regions With the Convolutional Neural Networks (R-CNN) and You Only Look Once V4 (YOLO-V4), for tooth classification in dental panoramic radiography to determine which is more successful in terms of accuracy, time, and detection ability. Using a method based on deep-learning models trained on a semantic segmentation task, we analyzed 1200 panoramic radiographs selected retrospectively. In the classification process, our model identified 36 classes, including 32 teeth and 4 impacted teeth. RESULTS: The YOLO-V4 method achieved a mean 99.90% precision, 99.18% recall, and 99.54% F1 score. The Faster R-CNN method achieved a mean 93.67% precision, 90.79% recall, and 92.21% F1 score. Experimental evaluations showed that the YOLO-V4 method outperformed the Faster R-CNN method in terms of accuracy of predicted teeth in the tooth classification process, speed of tooth classification, and ability to detect impacted and erupted third molars. CONCLUSIONS: The YOLO-V4 method outperforms the Faster R-CNN method in terms of accuracy of tooth prediction, speed of detection, and ability to detect impacted third molars and erupted third molars. The proposed deep learning based methods can assist dentists in clinical decision making, save time, and reduce the negative effects of stress and fatigue in daily practice.

Emergency Medicine Association of Turkey Disaster Committee Summary of Field Observations of February 6th Kahramanmaras Earthquakes.

An earthquake measuring 7.7 magnitude on the Richter scale occurred at 04:17am on February 6, 2023 in the Pazarcik district of Kahramanmaras province Turkey. In the hours following the 7.7 magnitude event in Kahramanmaras, a second 7.6 magnitude earthquake struck the region and a third 6.4 magnitude earthquake struck Gaziantep, causing extensive damage and death. A total of ten provinces directly experienced the earthquake, including Kahramanmaras, Hatay, Gaziantep, Osmaniye, Malatya, Adana, Diyarbakir, Sanliurfa, Adiyaman, and Kilis. The official figures indicate 31,643 people were killed, 80,278 were injured, and 6,444 buildings were destroyed within seven days of the earthquakes (as of 12:00pm/noon on Monday, February 13th). The area affected by the earthquake has been officially declared to be 500km in diameter. This report primarily relies on observations made by pioneer Emergency Physicians (EPs) who went to the disaster areas shortly after the first earthquake (in the early stages of the disaster). According to their observations: (1) Due to winter conditions, there were transportation problems and a shortage of personnel reaching disaster areas on the first day after the disaster; (2) On the second day of the disaster, health equipment was in short supply; (3) As of the third day, health workers were unprepared in terms of knowledge and experience for the disaster; and (4) The subsequent deployment of health personnel to the disaster area was uncoordinated and unplanned on the following days, which resulted in the health personnel working there not being able to meet even their basic needs (such as food, heating, and shelter). During the first week, coordination was most frequently reported as the most significant problem.

Comparative evaluation of trabecular bone structures of bruxist and non-bruxist individuals with bone apposition in the mandible angle region by fractal analysis.

OBJECTIVE: This study aimed to compare the trabecular internal structure of different regions of the mandible according to the grades of appositional classification in the mandible angle region in probable bruxist individuals and non-bruxist G0(Convex course of the basal cortex, no directional change, no bone apposition) individuals by measuring fractal dimension (FD) on panoramic radiographs. METHODS: 200 sample jaws, bilaterally, of 80 probable bruxists and 20 non-bruxist G0 individuals were included in the study. According to the classification in the literature, each mandible angle apposition severity was classified as G0-G1-G2-G3. FD was calculated by selecting the region of interest (ROI) area of 7 regions from each sample. Gender differences in changes between ROIs in radiographs and independent samples t-test were evaluated. Relation between categorical variables was determined by chi-square test (p < .05). RESULTS: In the comparison of the probable bruxist and non-bruxist G0 groups, FD was found to be statistically significantly higher in the mandible angle (p = 0.013) and cortical bone (p = 0.000) regions in the probable bruxist group than in the non-bruxist G0 group. There is a statistically significant difference between probable bruxist G0 and non-bruxist G0 grades in terms of FD averages in cortical bone (p < 0.001). A statistically significant difference was found in the relationship of ROIs with gender in canine apex (p = 0.021) and canine distal (p = 0.041) regions. CONCLUSION: FD was found to be higher in the mandibular angle region and cortical bone in probable bruxist individuals than in non-bruxist G0 individuals. Morphological changes seen in the mandible angulus region may be a finding that may raise suspicion for bruxism for clinicians.

Toxic, Genotoxic and Teratogenic Effects of Ibuprofen and its Derivatives.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are extensively used pharmaceuticals and tons of kilos are produced annually. Ibuprofen is one of the core medicines of non-steroidal anti-inflammatory drug and is primarily used for reduced pain, fever and tissue inflammation. It is also available for the treatment of osteoarthritis, rheumatoid arthritis, tendonitis, etc. It is still one of the most prescribed non-steroidal anti-inflammatory drugs in contemporary times. Although ibuprofen is a drug that has been used for years, it is also known to have various serious toxic effects. OBJECTIVE: In this review, we aimed to clarify toxic and genotoxic effects of Ibuprofen by analyzing major journal indexes. METHODS: The search was concentrated on the Web of Science, PubMed, Science Direct, Scopus, EBSCO Host, and Google Scholar databases, including the keyword combinations "genotoxicity", "toxicity", "teratogenicity", "side effects", "Ibuprofen". RESULTS: In the search procedure, a total number of 11738 studies about the topic were reviewed. Consequently, 42 studies were classified as appropriate according to the inclusion criteria and were therefore included in the review. The results presented and discussed in this review indicate that Ibuprofen might represent a toxic, genotoxic and teratogenic risk for non-target, freshwater invertebrates, vertebrates and toxic for human especially in overdose or misuse situation. CONCLUSION: Ibuprofen generally was found to be toxic, mutagenic, teratogenic and genotoxic agent in various organisms. In human cases mostly overdose or misuse was found to be toxic. However acute toxicity was also reported in some human clinical studies. More detailed genotoxicity, teratogenicity and especially carcinogenic potential should be investigated to reach full decision of its safety.

Evaluation of the Relationship between Aromatase/Sirtuin1 Interaction and miRNA Expression in Human Neuroblastoma Cells.

BACKGROUND: Changes in activation/inhibition of Sirtuin-1 (SIRT1) and aromatase play an important role in a plethora of diseases. MicroRNAs (miRNAs) modulate multiple molecular pathways and affect a substantial number of physiological and pathological processes. OBJECTIVE: The aim of this study was to investigate any possible interaction between aromatase and SIRT1 in SH-SY5Y cells and to see how there is a connection between this interaction and miRNA expression, if there is an interaction. METHODS: In this study, cells were incubated in serum-deprived media for 6, 12, and 24 h. Aromatase and SIRT1 expressions were evaluated by Western blot. The IC50 concentration of SIRT1 activator (SRT1720), SIRT1 inhibitor (EX527), and aromatase inhibitors (letrozole and fadrozole) was determined by the XTT method. Then, CYP19A1 and SIRT1 levels were evaluated in the presence of SIRT1 siRNA or IC50 values for each activator/inhibitor. Finally, CYP19A1, SIRT1 expression and miRNA target gene were assessed with bioinformatic approaches. RESULTS: Aromatase and SIRT1 protein levels were significantly elevated in the cells incubated at 24 h in serum-deprived media (p ≤ 0.05). SIRT1 also positively regulated CYP19A1 in SH-SY5Y cells in media with/without FBS. Serum deprivation depending on time course caused changes in the oxidant/ antioxidant system. While oxidative stress index tended to decrease in the absence of FBS at 24 h compared to the control, it showed a significant decrease at 48 h in a serum-deprived manner (p ≤ 0.001). As a result of bioinformatics analysis, we determined 3 miRNAs that could potentially regulate SIRT1 and CYP19A1. hsa-miR-27a-3p and hsa-miR-181a-5p correlated in terms of their expressions at 24 h compared to 12 h, and there was a significant decrease in the expression of these miRNAs. On the contrary, the expression of hsa-miR-30c-5p significantly increased at 24 h compared to 12 h. CONCLUSION: Considering the results, a direct link between aromatase and SIRT1 was observed in human neuroblastoma cells. The identification of key miRNAs, hsa-miR-27a-3p, hsa-miR-30c-5p, and hsa-miR-181a-5p targeting both aromatase and SIRT1, provides an approach with novel insights on neurology-associated diseases.

Toxicity, Genotoxicity, and Carcinogenicity of Isotretinoin.

BACKGROUND: Acne is a chronic inflammatory disease mainly observed in adolescence, but it can also be seen during the neonatal, infantile, pre-pubertal, and adult periods. Isotretinoin (13-cis-retinoic acid) is a first-generation retinoid and is the most effective treatment for acne vulgaris. OBJECTIVE: The present study has been systematically designed to figure out the toxic, genotoxic, and carcinogenic activities of isotretinoin. METHODS: In this study, a systematic approach was followed by focusing on the possible links between these topics. The search of the databases was carried out author in accordance with the guidelines of the Centre for Reviews and Dissemination (2009) developed by York University National Institute of Health Research. The search was concentrated on the Web of Science, PubMed, Science Direct, Scopus, EBSCO Host, and Google Scholar databases. RESULTS: Isotretinoin was found as a toxic agent in all studies. All researchers proposed that apoptosis is the only pathway of adverse effects of isotretinoin. However, genotoxicity, teratogenicity, and carcinogenicity information of isotretinoin is very limited and controversial. CONCLUSION: More detailed studies need to clarify the genotoxic and carcinogenic potential of isotretinoin. Patients should be informed correctly, the risks of treatment should be explained, and awareness should be raised.

Relationship between clinical anxiety and patient outcomes in patients with chronic obstructive lung disease exacerbation in the emergency department.

PURPOSE: Anxiety is a comorbidity that is not routinely addressed in patients with chronic obstructive lung disease (COPD) exacerbation in the emergency department (ED). Anxiety in patients with COPD exacerbation can be related with negative outcomes. The Generalized Anxiety Disorder 7 (GAD-7) score is an easy-to-use tool to determine anxiety. This study aimed to investigate the relationship between GAD­7 score and patient outcomes in patients with COPD exacerbation in the ED. METHODS: A prospective, cross-sectional study was conducted in a tertiary academic ED between July 2019 and January 2021. Patients admitted to the ED with COPD exacerbation were included. A GAD­7 score of ≥ 10 was defined as clinically significant anxiety. Negative outcomes were defined as a composite outcome that included recurrent ED visits, intensive care unit admission, and mortality. The relationship between clinically significant anxiety and negative outcomes within 30 days was determined. RESULTS: A total of 92 patients were assessed for eligibility and 80 were included in the study. Thirty-seven patients (46.3%) experienced negative outcomes. Although no significant difference was detected in median GAD­7 scores between patients with positive and negative outcomes, negative outcomes were significantly higher in patients who had a GAD­7 score of ≥ 10 (n = 25, p = 0.03). A sensitivity of 43.2%, specificity of 79.1%, positive likelihood ratio of 2.1 and negative likelihood ratio of 0.7 were determined for GAD­7 score in predicting negative outcome. CONCLUSION: In patients with COPD exacerbation in the ED, a GAD­7 score of ≥ 10 was associated with 30-day negative outcomes.

A new perspective for radiologic findings of bruxism on dental panoramic radiography.

OBJECTIVE: This study aims to evaluate whether there is a relationship between the appositional classification in the mandible angle region and the mandibular cortical index (MCI) seen in bruxist individuals and to differentiate between the bruxist group without mandibular apposition and the non-bruxist group on panoramic radiographs. METHODS: The mandible angle region of 209 individuals, 170 bruxists and 39 non-bruxists, were included in the study. Each mandible angle apposition was classified as G0 (No directional change, no bone apposition)-G1 (Directional change on the basal cortex. No bone apposition)-G2 (Directional change plus generalized bone apposition with inhomogeneous surface)-G3 (Directional change plus localized bone apposition at one or more sites). The MCI of each individual was recorded according to their classified apposition. RESULTS: No statistically significant difference was found in the relationship between MCI and apposition severity in mandible angle grades in bruxist individuals (p = 0.063). A statistically significant difference was found between MCI and the bruxist G0/non-bruxist G0 groups (p < 0.001). While the MCI-C1 was higher in non-bruxist G0 individuals, the MCI-C2 was higher in bruxist G0 individuals. A statistically significant correlation was found between gender and severity of grades (p < 0.001). CONCLUSION: Although it is known that appositional changes are seen in the mandible angle region in bruxism, MCI can be used as a valuable radiologic diagnostic criterion during the evaluation of bruxist and healthy individuals in the G0 grade who have not yet radiologically demonstrated bone apposition in the mandible angle.