Investigation of the protective effect of chitosan against arsenic-induced nephrotoxicity and oxidative damage in rat kidney tissue.

Arsenic is an important metalloid that can cause poisoning in humans and domestic animals. Exposure to arsenic causes cell damage, increasing the production of reactive oxygen species. Chitosan is a biopolymer obtained by deacetylation of chitin with antioxidant and metal ion chelating properties. In this study, the protective effect of chitosan on arsenic-induced nephrotoxicity and oxidative damage was investigated. 32 male Wistar-albino rats were divided into 4 groups of 8 rats each as control group (C), chitosan group (CS group), arsenic group (AS group), and arsenic+chitosan group (AS+CS group). The C group was given distilled water by oral gavage, the AS group was given 100 ppm/day Na-arsenite ad libitum with drinking water, the CS group was given 200 mg/kg/day chitosan dissolved in saline by oral gavage, the AS+CS group was given 100 ppm/day Na-arsenite ad libitum with drinking water and 200 mg/kg/day chitosan dissolved in saline by oral gavage for 30 days. At the end of the 30-day experimental period, 90 mg/kg ketamine was administered intraperitoneally to all rats, and blood samples and kidney tissues were collected. Urea, uric acid, creatinine, P, Mg, K, Ca, Na, Cystatin C (CYS-C), Neutrophil Gelatinase Associated Lipocalin (NGAL) and Kidney Injury Molecule 1 (KIM-1) levels were measured in serum samples. Malondialdehyde (MDA), Glutathione (GSH), Catalase (CAT) and Superoxide dismutase (SOD) levels in the supernatant obtained from kidney tissue were analyzed by ELISA method. Compared with AS group, uric acid and creatinine levels of the AS+CS group were significantly decreased (p<0.001), urea, KIM-1, CYS-C, NGAL, and MDA levels were numerically decreased and CAT, GSH, and SOD levels were numerically increased (p>0.05). In conclusion, based on both biochemical and histopathological-immunohistochemical- immunofluorescence findings, it can be concluded that chitosan attenuates kidney injury and protects the kidney.

Evaluation of Jaw Bone Change in Children and Adolescents with Rheumatic Heart Disease by Fractal Analysis.

BACKGROUND: Recognizing the oral needs of people living with rheumatic heart disease (RHD), particularly in relation to their jaws, is of paramount importance. AIMS: This study aimed to evaluate potential jaw bone changes in children and adolescents diagnosed with RHD and compare them with a group of healthy children and adolescents. METHODS AND MATERIAL: The dental panoramic radiographs (DPRs) of 32 children and adolescents diagnosed with RHD comprised the case group. In contrast, the control group consisted of DPRs from 32 children and adolescents without any known diseases. Two regions of interest (ROI1 and ROI2) of trabecular bone and a separate region of interest (ROI3) of cortical bone were selected for fractal analysis. The mandibular cortical index (MCI) was evaluated. RESULTS: The ROI1 fractal dimension (FD) value of the individuals in the case group was statistically higher in the right jaw than in the left jaw (P < 0.01). Significant differences were determined between the case and control groups regarding the left ROI1, and the left and the right ROI2 (P < 0.05). No significant difference was found between the patient and control groups regarding the MCI value (P > 0.05). CONCLUSIONS: The results of this study showed that bone metabolism was affected unilaterally in the condyle region and bilaterally in the gonial region of patients with RHD. It also revealed that the cortical layer was not affected.

MXene-based Ti2C/Ta2C lateral heterostructure: an intrinsic room temperature ferromagnetic material with large magnetic anisotropy.

Two-dimensional (2D) lateral heterostructures (LH) combining Ti2C and Ta2C MXenes were investigated by means of first-principles calculations. Our structural and elastic properties calculations show that the lateral Ti2C/Ta2C heterostructure results in a 2D material that is stronger than the original isolated MXenes and other 2D monolayers such as germanene or MoS2. The analysis of the evolution of the charge distribution with the size of the LH shows that, for small systems, it tends to distribute homogeneously between the two monolayers, whereas for larger systems electrons tend to accumulate in a region of ∼6 Šaround the interface. The work function of the heterostructure, one crucial parameter in the design of electronic nanodevices, is found to be lower than that of some conventional 2D LH. Remarkably, all the heterostructures studied show a very high Curie temperature (between 696 K and 1082 K), high magnetic moments and high magnetic anisotropy energies. These features make (Ti2C)/(Ta2C) lateral heterostructures very suitable candidates for spintronic, photocatalysis, and data storage applications based upon 2D magnetic materials.

In Vitro evaluation of the bond strength of metal brackets adhered to different dental restorative materials using different orthodontic adhesives.

Background: During orthodontic treatment, teeth with brackets may sometimes be restored with different restorative materials. In this case, the content of the orthodontic adhesive selected for bracket bonding may also be important. Aim: This study compared the bond strength of metal orthodontic brackets adhered to different resin composite and glass ionomer cement (GIC) restoration surfaces with glass ionomer-based and resin-based orthodontic adhesives to determine the best orthodontic adhesive for use in restored teeth. Material and Methods: This study prepared 80 discs. Four material groups of 20 discs were created: reinforced high-viscosity GIC, high-viscosity GIC, flowable bulk-fill resin composite, and nanohybrid resin composite. Specimens in each material group were divided into two subgroups that differed in the orthodontic adhesive used to bond the brackets to the prepared specimens. After 24 hours, the specimens were shear bond strength (SBS) tested at 1 mm/min using a universal tester. Results: The SBS of glass ionomer-based orthodontic adhesive differed significantly between metal brackets adhered to different bases (P < 0.001). The highest SBSs were observed between metal brackets and high-viscosity glass ionomer restorations (6.79 ± 2.38). The highest SBSs observed with a resin-based orthodontic adhesive were between metal brackets adhered to nanohybrid resin composite restorations (8.84 ± 2.10; P = 0.030). Conclusions: Glass ionomer-based orthodontic adhesive provided safer bond strength and demineralization prevention when applying metal brackets to teeth with glass ionomer restorations.

Correlation between the serum lumican level and the severity of coronary artery disease.

OBJECTIVE: Several studies have previously shown that some small leucine-rich proteoglycans (SLRPs) are associated with atherosclerotic plaque. We aim to investigate the relationship between circulating lumican levels and the severity of coronary artery disease (CAD). PATIENTS AND METHODS: This study included 255 consecutive patients who underwent coronary angiography for stable angina pectoris. All demographic and clinical data were collected prospectively. The severity of CAD was assessed based on the Gensini score and a value >40 was defined as advanced CAD. RESULTS: Eighty-eight patients were in the advanced CAD group; these are older and the frequency of diabetes mellitus, cerebrovascular accidents, reduced ejection fraction (EF), left atrium diameter was higher. Serum lumican levels were found as higher in advanced CAD group (0.4 ng/ml vs. 0.6 ng/ml, respectively, p<0.001). When the Gensini score increased, a statistically significant increase was observed in lumican levels with a good correlation (r=0.556 and p<0.001). In multivariate analysis, diabetes mellitus, EF and lumican were predictive for advanced CAD. Lumican level predicts CAD seriousness with a sensitivity rate of 64%, specificity rate of 65%. CONCLUSIONS: In this study, we reveal a relationship between serum lumican levels and CAD severity. More research is warranted to determine the mechanism and prognostic values of lumican in the atherosclerosis.

Comparative proteomics analysis of transforming growth factor-beta1-overexpressed human dental pulp stem cell-derived secretome on CD44-mediated fibroblast activation via canonical smad signal pathway.

PURPOSE: The aim of this study investigates whether the secretome collected from human dental pulp stem cells (hDPSCs) transfected with transforming growth factor-beta1 (TGF-ß1) is related to CD44 expression of fibroblasts and canonical smad signaling pathway via proteomic analyzes. MATERIALS AND METHODS: In order to obtain secretome, hDPSCs were conditioned with serum-free alpha-MEM in an incubator containing 37°C, 5% CO2, and humidity for 18-24 h. Proteins in control and TGF-ß1 secretome were analyzed by tandem mass spectrometry-based shotgun proteomic method. Bioinformatic evaluations were completed via Ingenuity Pathway Analysis (IPA, QIAGEN) software. CD44 expressions in fibroblasts were evaluated by real time-PCR, western blot, and immunofluorescent staining. The relationship of canonical smad pathway and CD44 was analyzed by western blot and LC-MS/MS. Cell cycle, proliferation and wound healing tests were performed in the secretome groups. RESULTS: Venn diagram was showed 174 common proteins were identified from each group. In the control secretome 140 unique proteins were identified and 66 entries were exclusive for TGF-ß1 secretome. CD44 gene and protein expressions were increased in fibroblasts treated with TGF-ß1 secretome. Relationship between targeted protein data showed that activation of the canonical TGF-ß1/Smad pathway was up-regulated CD44 expression in fibroblasts. The canonical smad pathway-mediated upregulation of CD44 may increase the mitotic activity, proliferation, and wound healing potential in fibroblasts. CONCLUSION: While TGF-ß1-transfected hDPSC secretome may be a potential therapeutic candidate in regenerative connective tissue therapies as it induces fibroblast activation, anti-TGF-ß1-based therapies would be considered in histopathological conditions such as pulmonary fibrosis or hepatic fibrosis.

Exploring a novel class of Janus MXenes by first principles calculations: structural, electronic and magnetic properties of Sc2CXT, X = O, F, OH; T = C, S, N.

The already intriguing electronic and optical properties of the MXene Sc2C family can be further tuned through a wide range of possible functionalizations. Here, by means of density functional theory, we show that the 36 possible elements of the Janus MXT (M: Sc2C, X: O, F, OH, T: C, N, S) family, built by considering the four possible structural models (i) FCC, (ii) HCP, (iii) FCC + HCP, and (iv) HCP + FCC, are all potentially stable. The analysis of their mechanical properties shows the excellent mechanical flexibility of functionalized MXenes (f-MXenes) under large strain, making them more suitable for applications where stress could be an issue. Interestingly, while Sc2C presents a metallic character, Sc2COS, Sc2CFN and Sc2COHN are found to be semiconductors with bandgaps of 2.5 eV (indirect), 1.67 eV (indirect) and 1.1 eV (direct), respectively, which presents promising applications for nano- and optoelectronics. Moreover, Sc2CFC presents a ferromagnetic ground state with the 2 × 2 × 1 supercell magnetic moment of 3.99 µB, while the ground state of Sc2COHC might be antiferromagnetic with a magnetic moment of 3.98 µB, depending on the environment. Remarkably, the band structures of Sc2CFC and Sc2COHC present a half-metallic character with an HSE06 fundamental band gap of 0.60 eV and 0.48 eV, respectively. Our results confirm the extraordinary potential of the Janus MXT (M: Sc2C, X: O, F, OH, T: C, N, S) family for novel applications in 2D nano-,opto- and spintronics.

Remineralization activities of toothpastes with and without aloe vera with different ratios of fluoride on demineralized enamel: An In-vitro study.

AIM and Background: The aim of this in-vitro study was to evaluate and compare the efficacy of both pure aloe vera and commercially available toothpastes with different fluoride compounds and different fluoride amounts on artificial initial enamel lesions by Vicker's microhardness values. In the study, 72 extracted human molar teeth were divided into mesiodistal and 144 specimens were prepared using the vestibule and palatal/lingual surfaces of the teeth. After the surface treatments and initial microhardness measurements, all the specimens were placed in a demineralizing solution (pH: 4.5) for 7 days, resulting in artificial initial enamel lesion, and were randomly assigned to eight groups (n = 18). After the teeth were subjected to pH cycle for 14 days, microhardness measurements were repeated and the data were recorded. Materials and Methods: Statistical analyzes were performed using MedCalc Statistical Software version 12.7.7. The significance level was determined to be 0.05. Results: In the statistical results, when the microhardness values after demineralization and post-cycle were compared, Groups B1 and A2 showed the lowest values, while Groups A3 and B3 did not show a significant difference in terms of microhardness values after demineralization and post-cycle, and only Group B4 showed statistically significantly higher values. Conclusions: This study emphasized the remineralization effects of fluoride on initial enamel lesions. It can be said that toothpaste containing 1450 ppm fluoride and aloe vera provides an effective remineralization and sodium monofluorophosphate formulation may have a synergistic effect with aloe vera.

Transforming growth factor ß1-enriched secretome up-regulate osteogenic differentiation of dental pulp stem cells, and a potential therapeutic for gingival wound healing: A comparative proteomics study.

OBJECTIVES: Current study aimed at comparing the human dental pulp-derived stem cell (hDPSC) secretome (Control secretome) and transforming growth factor beta1 (TGF-ß1)-transfected hDPSC secretome (TGF-ß1 Secretome), which have the potential to be therapeutic in terms of regenerative dentistry, in terms of osteogenesis, adipogenesis and gingival wound healing with proteomic analyses. MATERIALS AND METHODS: pCMV-TGF-ß1 plasmid was transfected into hDPSCs by electroporation. hDPSC and TGF-ß1 transfected hDPSC secretomes were collected for LC-MS/MS. Protein contents in control secretome and TGF-ß1 secretome were analyzed by tandem mass spectrometry-based shotgun proteomic method. Bioinformatic evaluations for canonical pathways, upstream regulators and networks were completed via Ingenuity Pathway Analysis (IPA, QIAGEN) software. Surface marker expressions between groups, treated secretome were measured by flow cytometry. To support the proteomic data morphologically, we performed osteogenic-adipogenic differentiation in hDPSCs treated with control secretome and TGF-ß1 secretome, and scratch wound healing assay in gingival fibroblasts. Statistical analyses were performed by GraphPad Prism 8.02. RESULTS: Venn diagram classification showed us 174 common proteins were identified from each group. In the control secretome 140 unique proteins were identified and 66 entries were exclusive for TGF-ß1 secretome. TGF-ß1 secretome was found to have therapeutic effect on MSC-specific immunophenotypes. TGF-ß1 secretome was determined to up-regulate osteogenesis-related molecules and pathways while down-regulating adipogenesis-related pathways. Analysis of canonical pathways showed that TGF-ß1 secretome is associated with the wound healing pathway. CONCLUSION: Our study provided the first evidence that proteins identified in TGF-ß1-transfected hDPSC secretomes are potential regulators of osteogenic/adipogenic differentiation and fibroblast wound healing. CLINICAL SIGNIFICANCE: Based on these results, TGF-ß1 secretome may have a therapeutic effect in repairing osteoporosis-related bone injuries, wound healing of oral mucosa and gingival tissue. TGF-ß1 secretome may be a potential cell-free therapeutic in orthopedics and regenerative dentistry.

The dark side of technology: cyberloafing, a Turkish study of nursing behaviour.

AIM: This study aimed to explore the frequency of both serious and minor cyberloafing behaviours of nurses and the factors which affect these behaviours. BACKGROUND: Cyberloafing is using the internet or an internet connected device at work for personal use. Cyberloafing is a behaviour that negatively affects the personal performance of healthcare staff. METHODS: A total of 375 nurses in three large hospitals in Eastern Turkey participated in this descriptive research. A personal information form and the Cyberloafing Scale were used to collect the data. RESULTS: The data analyses showed moderate levels of minor cyberloafing scores and low levels of serious cyberloafing scores. The more serious level of cyberloafing behaviour was found among nurses who had social networking accounts and spent more than four hours on the internet each day. Minor cyberloafing behaviours occurred more frequently than the serious level. CONCLUSIONS: The frequency of cyberloafing behaviours is influenced by time spent on the internet, having social networking accounts, age, marital status, education and professional experience. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings support the development of policies that are designed to have nurses focus on patient care during work hours; use their working hours more effectively; and prevent cyberloafing.

Impact of acute myocardial injury on prognosis in patients with COVID-19.

OBJECTIVE: The primary objective of this study was to evaluate the frequency and impact of acute myocardial injury on prognosis in hospitalized COVID-19 patients. PATIENTS AND METHODS: This was a retrospective study that included consecutive hospitalized patients with COVID-19. Clinic-demographic characteristics, laboratory values, and high-sensitivity troponin I were extracted from the electronic database. Mortality and other clinical complications, including respiratory failure requiring invasive mechanical ventilation and acute kidney injury were recorded. Myocardial injury was defined as having a serum troponin I value >19.8 ng/mL. We performed Kaplan-Meier survival analysis and Cox regression to determine survival times and independent predictors of mortality. RESULTS: A total of 324 patients were included. Seventy-seven patients (23.8%) had acute myocardial injury. The primary outcome measure, namely death, occurred in 54.5% and 3.2% of the patients with and without myocardial injury, respectively. Notably, 75.3% of the patients with myocardial injury and 6.5% of the patients without myocardial injury developed ARDS. Overall, 50 out of 324 patients (15.4%) died during the study period. The mortality rate was 54.5% in patients with myocardial injury and 3.2% in patients without myocardial injury. Mean survival times were significantly different between the groups (15.1±0.9 days in patients with myocardial injury and 24.4±0.7 days in patients without myocardial injury, log-rank test p-value <0.001). CONCLUSIONS: The presence of chronic kidney disease and application of invasive mechanical ventilation were found to be independent predictors of in-hospital mortality. The presence of acute myocardial injury was common but not independently associated with mortality among hospitalized COVID-19 patients.

Gene expression profiles of transient receptor potential (TRP) channels in the peripheral blood mononuclear cells of psoriasis patients.

Psoriasis is a chronic autoimmune disease in which peripheral blood mononuclear cells (PBMCs) are involved in the pathological process. Transient receptor potential (TRP) channels expressed in immune cells have been shown to be associated with inflammatory diseases. We aimed to evaluate mRNA expression levels of TRP channels in PBMCs of patients with psoriasis. 30 patients with plaque psoriasis and 30 healthy age- and gender-matched control subjects were included in this study. mRNA expression levels of TRP channels in psoriasis patients were determined by Real-time polymerase chain reaction. A decreased TRPM4, TRPM7, TRPV3, TRPV4, and TRPC6 genes expression levels were found in the patient group compared to controls, respectively (p = 0.045, p = 0.000, p = 0.000, p = 0.045, p = 0.009), whereas, an increased expression level was found in TRPM2 and TRPV1 genes in the patient group compared to controls (p = 0.001 and p = 0.028). This is the first study showing the TRP channel mRNA expressions in PBMCs of psoriasis patients. Different expression patterns of TRP channels may have a role in pathogenesis of psoriasis.

Three-dimensional volumetric analysis of the maxillary sinus: a cone-beam computed tomography study.

BACKGROUND: This study aimed to determine the volumetric size of the maxillary sinus and investigate the effect of gender and age on maxillary sinus volume (MSV) using cone-beam computed tomography (CBCT) images in a Turkish subpopulation. MATERIALS AND METHODS: This retrospective volumetric CBCT study was carried out on 133 individuals (84 females, 49 males) between 8 and 51 years old. MSV was measured using the MIMICS 21.0 software (Materialise HQ Technologielaan, Leuven, Belgium). All statistical analyses were performed using the SPSS 21.0 (SPSS, Chicago, IL, USA) software. Mean and standard deviation of both maxillary sinuses measurements were calculated and compared to gender and age. P values < 0.05 were considered to indicate statistical significance. RESULTS: Mean volume of the right maxillary sinus was 13.173 cm3, while for the left was 13.194 cm3. There was no significant difference between right and left maxillary sinus volumes (p > 0.05). There was no significant correlation between MSV and age (p > 0.05). It was found that MSV did not change according to gender (p > 0.05). CONCLUSIONS: Right and left maxillary sinus volumes were not different from each other. Gender and age were not found to be related to maxillary sinus volume.

The effect of intraurethral dexpanthenol in hypospadias repair: experimental rabbit study.

INTRODUCTION: In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity. OBJECTIVE: The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis. STUDY DESIGN: In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000 g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500 mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500 mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment. RESULTS: The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P = 0.018 and P = 0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P = 0.019 and P = 0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P > 0.05). DISCUSSION: This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed. CONCLUSIONS: Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.

Fluoxetine, not donepezil, reverses anhedonia, cognitive dysfunctions and hippocampal proteome changes during repeated social defeat exposure.

While anhedonia is considered a core symptom of major depressive disorder (MDD), less attention has been paid to cognitive dysfunctions. We evaluated the behavioural and molecular effects of a selective serotonin re-uptake inhibitor (SSRI, fluoxetine) and an acetylcholinesterase inhibitor (AChEI, donepezil) on emotional-cognitive endophenotypes of depression and the hippocampal proteome. A chronic social defeat (SD) procedure was followed up by "reminder" sessions of direct and indirect SD. Anhedonia-related behaviour was assessed longitudinally by intracranial self-stimulation (ICSS). Cognitive dysfunction was analysed by an object recognition test (ORT) and extinction of fear memory. Tandem mass spectrometry (MSE) and protein-protein-interaction (PPI) network modelling were used to characterise the underlying biological processes of SD and SSRI/AChEI treatment. Independent selected reaction monitoring (SRM) was conducted for molecular validation. Repeated SD resulted in a stable increase of anhedonia-like behaviour as measured by ICSS. Fluoxetine treatment reversed this phenotype, whereas donepezil showed no effect. Fluoxetine improved recognition memory and inhibitory learning in a stressor-related context, whereas donepezil only improved fear extinction. MSE and PPI network analysis highlighted functional SD stress-related hippocampal proteome changes including reduced glutamatergic neurotransmission and learning processes, which were reversed by fluoxetine, but not by donepezil. SRM validation of molecular key players involved in these pathways confirmed the hypothesis that fluoxetine acts via increased AMPA receptor signalling and Ca2+-mediated neuroplasticity in the amelioration of stress-impaired reward processing and memory consolidation. Our study highlights molecular mediators of SD stress reversed by SSRI treatment, identifying potential viable future targets to improve cognitive dysfunctions in MDD patients.

Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro-immuno-endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, can affect these reactions. OBJECTIVE: The aim of this study was to evaluate the effect of the combination of general anesthesia and thoracic epidural analgesia (TEA) on cytokine reaction in laparoscopic cholecystectomy. STUDY DESIGN: Prospective, randomized clinical comparative study. MATERIALS AND METHODS: Sixty adult patients scheduled for elective laparoscopic cholecystectomy were divided into four groups. Group saline (Group S), group fentanyl (Group F), group bupivacaine (Group B), and group levobupivacaine (Group L) were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively, via epidural catheter before surgical incision. RESULTS: There were no differences among groups in the demographic features, heart rate, mean arterial pressure, and peripheral oxygen saturation values. Group L had lower visual analogue scale value compared to the other postoperative groups (P < 0.01). In all groups, interleukin-6 (IL-6), IL-8, and IL-10 levels started to increase at 2 h and returned to the basal level at 24 h. IL levels increased in most of the epidural saline-administered group compared to other groups (P < 0.05). CONCLUSION: Combined general anesthesia and TEA provided pain control and hemodynamic stability more efficiently during the first 24 h of the intraoperative and postoperative period by suppressing cytokine levels. However, we determined that this effect was more obvious with the local anesthetic and opioid combination.

Seasonal preponderance in testicular torsión: is it a myth / Preponderancia estacional de la torsión testicular: ¿Es un mito?

OBJECTIVE: In this study, we aimed to investigate the relation of testicular torsion and weather conditions, and to report results from Turkey, a country located between temperate and sub-tropical climate zones. METHODS: A total of 56 patients that had surgery with the diagnosis of testicular torsion in Ankara Education and Research Hospital Urology Clinic between 2005 and 2014 were included in the study. Age of the patient, side of torsion, date and time at onset of pain, scrotal exploration time, ischemia duration, degree Arch. Esp. Urol. 2015; 68 (10): 750-754 of cord torsion, the surgical procedure performed, and scrotal Doppler ultrasound (USG) findings at the time of diagnosis and 1 month after surgery were retrospectively analyzed. The web archives of Turkish Republic Meteorology General Directorate was used to determine the seasonal and mean temperatures at the time of diagnosis. The data were analyzed with SPSS V. 16 statistical package program using Chi-square, Mann-Whitney U and Wilcoxon tests. RESULTS: The mean age of 56 males included in the study was 18.88 ± 0.73 years. Right testicular torsion was seen in 23, and left testicular torsion was seen in 33 patients. Testicular arterial flow was absent in 37, arterial flow was moderately decreased in 12, and significantly decreased in 7 patients on Doppler USG. Detorsion procedure was performed in 46 patients while 10 patients had orchiectomy. Nine patients were admitted in summer, 14 in fall, 15 in winter, and 18 in spring. The mean air temperature at the time of admittance was 9.31 ± 1.05ºC. The prevalence of testicular torsion was not found different among the seasons (p = 0.39). The analysis of air temperature at the time of admittance of the patients revealed that it was below 15ºC in 40 patients while it was above 15ºC in 16 patients, with a significant difference in between (p = 0.002). CONCLUSIONS: The prevalence of testicular torsion did not change in relation with the seasons. However, it was determined that its prevalence was directly proportional to the air temperature, and increased particularly below 15ºC

OBJETIVO: En este estudio buscamos investigar la relación entre la torsión testicular y las condiciones meteorológicas, y comunicar los resultados de Turquía, un país localizado entre las zonas climáticas templada y subtropical. Metodos: Se incluyeron en el estudio 56 pacientes que fueron intervenidos con el diagnostico de torsión testicular en la consulta de Urología del Hospital Ankara Education and Research Hospital entre 2005 y 2014. La edad del paciente, el lado de la torsión, la fecha y hora del inicio del dolor, la hora de la exploración escrotal, el tiempo de isquemia, el grado de torsión del cordón, la intervención quirúrgica realizada y los hallazgos de la ecografía Doppler en el momento del diagnostico y al mes de la cirugía fueron analizados retrospectivamente. Se utilizaron los archivos web de la Dirección General de Meteorología de la República Turca para determinar las temperaturas estacionales y medias en el momento del diagnóstico. Los datos se analizaron con el programa SPSS V. 16 statistical package utilizando las pruebas de Chi-cuadrado, U de Mann-Whitney y Wilcoxon. RESULTADOS: La edad media de los 56 varones incluidos en el estudio fue de 18,88 ± 0.73 años. La torsión fue derecha en 23 pacientes e izquierda en 33. No había flujo arterial testicular en la ecografía Doppler en 37 pacientes, estaba moderadamente disminuido en 12 y significativamente disminuido en 7. Se realizó detorsión en 46 pacientes y orquiectomía en 10. Nueve pacientes ingresaron en verano, 14 en otoño, 15 en invierno y 18 en primavera. La temperatura media del aire en el momento del ingreso era de 9,31 ± 1,05ºC. No se encontró una prevalencia diferente de torsión testicular entre las estaciones (p = 0,39). El análisis de la temperatura del aire en el momento del ingreso reveló que era menor de 15ºC en 40 pacientes y mayor de 15ºC en 16 pacientes, con una diferencia significativa (p = 0,002). CONCLUSION: La prevalencia de torsión testicular no cambia en relación con las estaciones. Sin embargo, se determinó que su prevalencia era directamente proporcional a la temperatura del aire, y aumentaba particularmente por debajo de 15ºC

Multiple repeat cesarean delivery is associated with increased maternal morbidity irrespective of placenta accreata.

OBJECTIVE: The present study aimed to investigate the perinatal morbidity associated with multiple repeat cesarean deliveries (CD) and, thus, to achieve a body of evidence for the current practice of discouraging pregnancy after undergoing three CDs. PATIENTS AND METHODS: This study prospectively reviewed a total of 500 women who consecutively underwent CD between January 1, 2009 and April 1, 2009. The patients were allocated into four groups based on the number of CDs they had undergone (Group 1: first CD, Group 2: second CD, Group 3: third CD, Group 4: fourth CD). Data related with their demographic and clinical characteristics were recorded as well as their perioperative characteristics and clinical characteristics of the neonates born to them. Cochran-Armitage test for trends and Spearman rank correlation analysis test was used to evaluate the trend of perioperative complications and neonatal outcome with the increasing number of CDs. RESULTS: The mean age, gravidity and parity were significantly higher in groups 2-4 than those of the women who had their first CD (Group 1). The average operation time and mean delivery time as well as severe adhesions, bowel injury increased significantly with the number of CD. Neonatal characteristics were similar among groups except for a trend towards a decrease in the rate of meconium stained and a trend towards increase in the rate of neonatal sepsis with the increasing number of CD. CONCLUSIONS: We have found positive correlation between the maternal morbidity and the number of CDs. The occurrence of adhesions emerges as the most significant indicator of maternal morbidity, eventually leading to the neighboring organ injury and prolonged operation time.

Effect of polyacrylic acid on dentin protease activities.

OBJECTIVE: This study tested whether treatment of demineralized dentin with polyacrylic acid (PAA) has any activatory or inhibitory activity on dentin matrix metalloproteinases (MMP)s or cathepsin K (CAT-K). METHODS: Dentin beams (1mm×2mm×6mm; n=10) were completely demineralized with EDTA. After initial dry mass assessment, the beams were dipped into 37% phosphoric acid (PA), PA+2% benzalkonium chloride (BAC), PA+2% chlorhexidine digluconate (CHX), 10% PAA, PAA+BAC or PAA+CHX for 20s. Demineralized beams without treatment served as control. All beams were incubated in simulated body fluid (SBF) for 1 week and the dry mass loss was evaluated. Aliquots of SBF were used to analyze solubilized telopeptide fragments using ICTP as indicator of MMP-mediated collagen degradation and CTX for CAT-K-mediated degradation. Additional demineralized beams (n=10) were used to measure the influence of different chemical treatments on total MMP activity of EDTA-demineralized dentin using generic MMP assay. Data were analyzed by ANOVA (α=0.05). RESULTS: Dry mass loss ranged from 6% (PA) to 2% for (PA-BAC) or (PAA-BAC) (p<0.05). ICTP release of PAA-treated group was significantly higher (p<0.05) than the control, and not significantly different from the PA group (p>0.05). PA+CHX or PAA+CHX and PAA+BAC showed significantly lower ICTP than PA or PAA groups (p<0.05). CAT-K activity increased significantly after 10% PAA treatment compared to control (p<0.05) or to PA postreatment. SIGNIFICANCE: Demineralized dentin treated with 10% polyacrylic acid activated CAT-K more than 37% phosphoric acid; 2% chlorhexidine digluconate seems to be a better inhibitor of MMPs and CAT-K than 2% benzalkonium chloride.

Serum estradiol/free testosterone ratio can be important predictor for varicose vein recurrence in men.

AIM: Recurrent varicose veins are a frustration for both the patient and the surgeon. More investigation of the exact diagnosis, proper practice, and causes for the recurrence of varicose veins is needed. METHODS: We investigated a total number of 187 patients in a five year period with an estradiol-2/free testosterone (E2/fT) ratio relationship on recurrent varicose veins in men between the ages of 20-50. Fifity years was the maximum age due to the age dependent sex steroid hormone regression that occurs after this age, which may interefere with the assessment. Fifty three men with an elevated E2/fT ratio (group A), and 143 men with no endocrinologic problems (group B) were enrolled in the study and had surgery for varicose veins. After 5 years follow up (mean 3 years), Group A (N.=29) and group B (N.=43) had recurrent varicose veins by clinical and radiologic findings. Venous blood samples were driven from all patients of both groups in the morning to detect the levels of serum E2 and fT levels. Patient history of surgery for varicose veins, physical examination, color duplex ultrasound of both limbs, and classification of CEAP were performed in both groups. RESULTS: The serum E2/fT ratio was significantly higher in Group A (5.21 ± 0.56) compared to group B (2.54±0.27) in the recurrent varicose vein groups (p ≤ 0.05). Moreover, there was a high correlation between serum E2/fT ratio and the CEAP clinical classification in group A (5) compared to group B (2) (P≤0.05). Also, recurrence rate was higher in group A (54%) compared to group B (32%)(P≤0.05). CONCLUSION: Elevated serum E2/fT ratio is a precipitating factor for recurrent varicose veins in male patients.