Ultrasonographic assessment of knee joint in patients with diabetes mellitus: comparison of sonographic changes in distal femoral cartilage and tendon structures with non-diabetics patients.

OBJECTIVE: The aim of this study was to evaluate the adverse effects of diabetes mellitus on the knee joint by using ultrasonography. PATIENTS AND METHODS: One hundred and two subjects with diabetes for 5 years and more were compared prospectively with 93 age and sex-matched healthy subjects. Individuals in both groups were aged between 40-55, had a body mass index below 30 kg/m2, and had no knee joint complaints. Femoral cartilage thickness, cartilage surface, quadriceps and patellar tendon thickness in both knees were assessed by ultrasonography using a 5-12 mHz linear transducer. RESULTS: According to ultrasonographic findings, thin and irregular femoral cartilage was more common in diabetic patients than in healthy controls (p<0.05). Diabetic patients had thinner quadriceps tendons compared to the control group (p<0.001). No statistically significant difference was recorded in patellar tendon thickness (right knee p=0.697, left knee p=0.639). The presence of effusion in the suprapatellar recess of the right knee was more common in diabetics than non-diabetics (p=0.006). CONCLUSIONS: Irregularity and thinning of the distal femoral cartilage in diabetics may indicate cartilage degeneration. In addition, the decrease in the thickness of the quadriceps tendon may lead to instability and adversely affect the knee joint. These sonographic findings may indicate early knee joint degeneration, so ultrasonography may help determine the possible risk of osteoarthritis in diabetic patients.

Antimicrobial effectiveness of different irrigation activation techniques on teeth with artificial internal root resorption and contaminated with Enterococcus faecalis: a confocal laser scanning,icroscopy analysis.

This study aimed to compare the antibacterial efficacy of standard needle irrigation (SNI), EDDY, passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shock wave enhanced emission photoacoustic streaming (SWEEPS) activation on the teeth with simulated internal root resorption (IRR) and contaminated with Enterococcus faecalis (E. faecalis) using confocal laser scanning microscopy (CLSM) analyses. A total of 79 human maxillary central incisors with a single canal were selected. The canals were accessed, and then, the roots were split in the bucco-lingual direction. Artificial IRR cavities (depth of 0.8 mm and a diameter of 1.6 mm) were prepared using round burs and 20% nitric acid in the middle region of the root halves. The root halves were reconstructed with cyanoacrylate glue, and the canals were contaminated with a culture of E. faecalis for 30 days. Root canal preparation was performed using the ProTaper Next rotary files up to X5 and 2.5% NaOCl irrigation. Teeth were randomly assigned to five groups according to the irrigation activation method (n = 15): SNI, EDDY, PUI, PIPS, and SWEEPS. The final irrigation procedures were performed using a total of 6 mL of 2.5% NaOCl for each tooth with an activation time of 3 × 30 s. The canals were stained with LIVE/DEAD BacLight dye and analyzed with CLSM to determine the percentages of dead bacteria in the biofilm. Two-way ANOVA and post hoc Tukey tests were used for statistical analysis (P < .05). None of the irrigation activation methods tested provided 100% bacterial elimination. There was no significant difference between the irrigation activation methods tested in terms of the percentage of dead bacteria (P > 0.05). In irrigation activation methods other than PIPS, there was no significant difference in the percentage of dead bacteria between the coronal, middle, and apical regions of the roots (P > 0.05). A higher percentage of dead bacteria was found in the middle region compared to the apical region in the PIPS (P < 0.05). Within the limitations of this study, SII, EDDY, PUI, PIPS, and SWEEPS have a similar antimicrobial effect on the teeth with IRR and contaminated with E. faecalis.

Antibacterial efficacy of copper-added chitosan nanoparticles: a confocal laser scanning microscopy analysis.

The aim of this study was to evaluate the antibacterial efficacy of copper added chitosan nanoparticles (CU-CNPs) as an irrigation solution with different irrigants in terms of eliminating Enterococcus Faecalis (E. faecalis) from the root canals. Fifty mandibular premolar teeth were prepared and infected with E. faecalis for 21 days. After the incubation period, samples were randomly divided into a control group irrigated with distilled water and 4 experimental groups (n = 10) irrigated with as follows, %6 NaOCl, %6 NaOCl + %9 editronate (HEBP), Chitosan nanoparticles (CNPs), and CU-CNPs. To calculate the proportion of dead E. faecalis cell volume, stained using LIVE/DEAD BacLight Bacterial Viability Kit and were scanned using confocal laser scanning microscope (CLSM). All the irrigation solutions significantly (P < .05) killed the bacteria in the canal, except for the control group. CU-CNPs solution killed the highest (P < .05) number of bacteria compared with the other experimental groups. No significant difference was found between CNPs, NaOCl + HEBP, and NaOCl in terms of antibacterial activity. CU-CNPs solution was exhibited higher antibacterial efficacy against E. faecalis.

Turkish pediatric residents' knowledge, perceptions, and practices of blood culture sampling.

INTRODUCTION: Pediatrics is one of the medical specialties in which blood cultures for bloodstream infections are performed very frequently. This study aimed to evaluate pediatric residents' knowledge and perceptions of blood culture sampling. MATERIAL AND METHODS: Between June 2019 and September 2019, a questionnaire comprising 20 questions about blood culture sampling was sent via email to participants who were pediatric residents at five different hospitals in Turkey. There were 11 true/false and nine multiple-choice questions that assessed three aspects of culture sampling: indications, sampling practice and knowledge, and contamination. The percentage of correct answers was used to calculate an overall score and subsection scores. RESULTS: A total of 132 pediatric residents [102 (77%) female] with a mean age of 28.3±2.8 years completed the questionnaire. Forty-five (35%) were in their 1st year of residency. Sixty (46%) participants reported that they had not performed blood culture sampling in the last week. There was a negative relationship between years in training and the number of cultures performed (Kendal's tau-b=-0.297, p<0.001). The overall median score was 65 (range, 35-90) and it seemed to increase with years of training. The lowest median score was in the contamination subscale and only one (0.76%) participant correctly answered all questions concerning contamination. CONCLUSION: Residents who obtained the majority of blood cultures had the lowest knowledge levels. Therefore, it is evident that the knowledge levels of pediatric residents must be increased in order to improve blood culture sampling practices in centers where they perform blood culture sampling.

Evaluation of pediatric high-energy trauma patients with whole-body computed tomography.

OBJECTIVES: We aimed to evaluate the findings of whole-body computed tomography (WBCT) in pediatric high-energy trauma patients and to determine the distribution of injuries. MATERIALS AND METHODS: The WBCT images of 1132 pediatric patients who were admitted to emergency department between 2013 and 2018 for high-energy trauma were evaluated retrospectively. Six hundred and twenty patients with abdominal, chest, head, and skeletal injuries were included. RESULTS: Using the WBCT images, we detected skeletal injuries in 557 pediatric patients; spinal, rib, extremity, and pelvic fractures were detected in 113, 57, 51, and 37 patients, respectively. Craniofacial fractures were viewed in 299 patients. We detected intracranial hemorrhage, pulmonary contusion, pneumothorax, and solid organ injuries in 102, 115, 45, and 55 pediatric patients, respectively. CONCLUSION: The frequency and distribution of injuries in trauma cases vary between adults and children. While there are many studies about whole-body CT findings of adult trauma, there are only a few studies about pediatric high-energy trauma patients. The traumatic injury types also differ in pediatric age groups. WBCT scan (with pediatric radiation dose) is the fast and accurate diagnostic tool in high-energy trauma cases and therefore is associated with low mortality rates.

The effect of type 2 diabetes mellitus on changes in the fractal dimension of periapical lesion in teeth after root canal treatment: a fractal analysis study.

AIM: This single-centre retrospective case-control study evaluated fractal dimension (FD) changes in radiographs of periapical lesions using a fractal analysis in healthy individuals and type 2 diabetes mellitus (DM) patients following root canal treatment. METHODOLOGY: The study data consisted of two groups: the DM group which contained a total of 46 mandibular molar teeth in 37 patients with no systemic disease other than type 2 DM, and the control group which contained a total of 52 mandibular molar teeth in 41 patients without systemic disease. Periapical radiographs were obtained prior to root canal treatment and 1 year post-treatment. Fractal analysis was performed by selecting a region of interest on the periapical radiographs. For both groups, the FD changes in lesion area were calculated and compared. In addition, periapical status was evaluated using the periapical index (PAI) scores on periapical radiographs for both groups. Data were analysed using dependent-sample t-test, independent-sample t-test, Wilcoxon signed-rank test and Mann-Whitney U-test. RESULTS: In both groups, FD values were increased significantly 1 year post-treatment as compared with those prior to treatment (P < 0.05). The time-dependent increase in FD was significantly greater in the control group (P < 0.05). Time-dependent increases in FD did not differ between genders (P > 0.05). There was a significant decrease in PAI scores in both type 2 DM and control groups depending on time (P < 0.05). No significant difference was found between the groups in terms of time-related decreases in PAI scores (P > 0.05). CONCLUSION: An increase in the FD of the periapical lesion area was observed 1 year after root canal treatment. DM had a negative effect on FD increase.

Comparison of GTR, T-PRF and open-flap debridement in the treatment of intrabony defects with endo-perio lesions: a randomized controlled trial.

BACKGROUND: Titanium- prepared platelet rich fibrin (T-PRF) is an autologous hemo-component with a high concentration of platelets that also incorporates leukocytes, and growth factors into the dense fibrin matrix and can be used as a healing biomaterial. This study assesses the adjunctive use of T-PRF in intrabony defects (IBDs) with open flap debridement (OFD) in comparison with guided tissue regeneration (GTR) as a gold standard and OFD alone as a control. MATERIAL AND METHODS: A total of 45 patients (15 per group) were randomized as either T-PRF (test group), GTR (test group), or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and IBD were recorded. The radiographic depth of IBD was also measured. Primary outcomes assessed were changes in PD, CAL, and radiographic IBD that were assessed at the beginning and nine months later.  Results: The PRF and GTR group showed significant improvement in clinical parameters compared with the OFD alone (control group) at nine months. While there were no significant differences in PD and CAL between test groups (T-PRF and GTR groups), the significant difference was found in radiographic IBD depth. CONCLUSION: T-PRF may give similar successful results as GTR in the treatment of IBDs with endo-perio lesions.

The Birth of a New Branch of Medicine: Psychiatry.

Psychiatric treatment prior to 1955 seemed to be at a standstill. All kinds of treatments, including surgical ones, were used ineffectively. Then suddenly, out of nowhere, a new treatment -chlorpromazine - created a worldwide revolution. Here is what we saw in Delaware. It was not much different in the rest of the world. Patients improved and were rapidly dischargedfrom mental institutions causing workforce reductions. I was sitting on a state employee job application evaluation committee and witnessed these events. It was also exciting to see rapid changes in administration at the state hospital. Since what happened in Delaware also happened nationally, this was a national event and should be recognized as such. The following few pages are to remember the details. Major changes made psychiatry more of an accepted medical specialty. Psychiatrists are no longer "outsiders." I would be glad to answer any questions about the information presented here.

The role of fetuin-A in cardiac functions and metabolism in peritoneal dialysis patients.

AIM: Fetuin-A is a member of protease inhibitors that act as an inhibitor of vascular calcification. In our study, the relationship of fetuin-A with metabolic and echocardiographic parameters in peritoneal dialysis (PD) patients has been investigated. METHODS: Besides demographic, clinical and laboratory data, fetuin-A level was recorded. Echocardiographic examinations were performed by the same operator. RESULTS: Fifty-two chronic PD patients (mean age: 52.7 ± 15.4 years) and 31 healthy volunteers (mean age: 41.3 ± 10.7 years) were included. Fetuin-A levels were significantly lower in the patient group (57.5 ± 31.5 ng/mL vs. 72.5 ± 34.0 ng/mL, P = 0.002). There was a significant relation between age and fetuin-A levels (P = 0.025). Four patients with chronic heart failure had significantly lower fetuin-A levels compared with those without. There was no relation between fetuin-A levels and the presence of diabetes mellitus, left ventricular hypertrophy and ischemic heart disease. No relationship was detected between fetuin-A level and any echocardiographic parameter. Age and hematocrite were correlated negatively, and serum albumin positively with fetuin-A levels. On linear regression analysis, fetuin-A level was related with age, hematocrite and presence of heart failure. CONCLUSION: PD patients with heart failure have significantly lower fetuin-A levels. Age is a main determinant of fetuin-A level and fetuin-A may act as a negative acute phase reactant in PD patients.

Ptotic gall bladder with hepatic masses: a case report.

Gall bladder (GB) may be found in a variety of abnormal positions. Most of them are due to arrested development of embryonic growth at different stages. A 63-year-old female patient was admitted to our radiology unit for magnetic resonance imaging (MRI) of the liver for the lesions identified in abdominal ultrasonography (US) and computed tomography (CT). MRI showed that there was a lobulated heterogenous mass in the left lobe of the liver and a smaller one in the right lobe of the liver with the same appearance. The inferior pole of the liver was located in the pelvic space, and the GB, which contained sludges and stones, was lying down to the upper pelvic space. Hepatic masses were considered to be hemangiomas, and GB was diagnosed as ptotic GB with luminal sludge and stones. In this case, especially, MR imaging helped the surgeon to plan a proper approach to the GB in abnormal localization.

Boric acid increases the expression levels of human anion exchanger genes SLC4A2 and SLC4A3.

Boron is an important micronutrient in plants and animals. The role of boron in living systems includes coordinated regulation of gene expression, growth and proliferation of higher plants and animals. There are several well-defined genes associated with boron transportation and tolerance in plants and these genes show close homology with human anion exchanger genes. Mutation of these genes also characterizes some genetic disorders. We investigated the toxic effects of boric acid on HEK293 cells and mRNA expression of anion exchanger (SLC4A1, SLC4A2 and SLC4A3) genes. Cytotoxicity of boric acid at different concentrations was tested by using the methylthiazolyldiphenyl-tetrazolium bromide assay. Gene expression profiles were examined using quantitative real-time PCR. In the HEK293 cells, the nontoxic upper concentration of boric acid was 250 µM; more than 500 µM caused cytotoxicity. The 250 µM boric acid concentration increased gene expression level of SLC4A2 up to 8.6-fold and SLC4A3 up to 2.6-fold, after 36-h incubation. There was no significant effect of boric acid on SLC4A1 mRNA expression levels.

Randomized trial of short-course high-dose erythropoietin in donation after cardiac death kidney transplant recipients.

Eryhropoiesis-stimulating agents have demonstrated tissue-protective effects in experimental models of ischemia-reperfusion injury. PROTECT was a 12-month, randomized, double-blind, placebo-controlled, single center study with high-dose recombinant human erythropoietin-ß (Epoetin) in 92 donation after cardiac death (DCD) kidney transplant recipients. Patients were randomized to receive an intravenous bolus of Epoetin (3.3 × 10(4) international unit (IU); n = 45) or placebo (saline 0.9% solution; n = 47) on 3 consecutive days, starting 3-4 h before the transplantation and 24 h and 48 h after reperfusion. The immunosuppressive regimen included an anti-CD25 antibody, steroids, mycophenolate mofetil and delayed introduction of cyclosporine. Primary end point was a composite of the incidence of primary nonfunction and delayed graft function, either defined by spontaneous functional recovery or need for dialysis in the first week. Secondary objectives included duration of delayed function, renal function and proteinuria up to 1 year and thrombotic adverse events. Results showed no differences in the incidence or duration of delayed graft function and/or primary nonfunction (Epoetin 77.8 vs. placebo 78.7%, p = 1.00). Epoetin treatment significantly increased the risk of thrombotic events at 1 month and 1 year (Epoetin 24.4% vs. placebo 6.4%, p = 0.02).

Erythropoietin, progenitors, and repair.

The erythropoietin-erythropoietin-receptor (EPO-EPO-R) system has recently been identified as an important cellular survival pathway. Its presence has also been demonstrated in the kidney and identified as a therapeutic target to prevent loss of renal function. Part of the protective effects may be related to the action of erythropoietin on endothelial function and expansion of endothelial progenitor cells. This paper reviews current evidence for involvement of these mechanisms in EPO-mediated renoprotection.

Sun exposure and age at natural menopause: a cross-sectional study in Turkish women.

OBJECTIVES: In a cross-sectional study of 157 Turkish women attending outpatient clinics of a university hospital during April-May 2003, association between various subject characteristics and menopause timing was investigated. METHODS: Characteristics were self-reported by women aged 45-60. Of the lifestyle factors, sun exposure, physical activity, food intake and dressing with headscarf were obtained as recalled average lifelong practices up to time of menopause. Cox proportional hazard modeling was used, censoring for hysterectomy, oopherectomy and HRT use. RESULTS: Median age at natural menopause was 52 years. In multivariate analysis, earlier natural menopause was associated with low level of lifelong sun exposure (HR=6.381, 95% CI: 2.996-13.588, p< or =0.0001), heavy physical activity (HR=2.335, 95% CI: 1.305-4.177, p=0.0043), current calcium supplement use (HR=3.191, 95% CI: 1.361-7.485, p=0.0076), diagnosis of hypertension (HR=2.002, 95% CI: 1.186-3.378, p=0.0093), not owning a house (HR=3.002, 95% CI: 1.148-7.852, p=0.0250) and longer years on oral contraceptives (HR=1.085, 95% CI: 1.000-1.176, p=0.0487). Engagement in farming (HR=2.043, 95% CI: 1.056-3.952, p=0.0339), height (cm) (HR=0.953, 95% CI: 0.907-0.994, p=0.0279) and fish consumption (servings/week) (HR=0.600, 95% CI: 0.375-0.960, p=0.0331) were associated with age at menopause in univariate analysis only. For n=109 women who recalled whether maternal menopausal age was <50 or > or =50, sun exposure (HR=7.221, 95% CI: 2.971-17.547, p<0.0001) was a stronger predictor of age at natural menopause than maternal menopausal age (HR=2.882, 95% CI: 1.477-5.621, p=0.0019). CONCLUSIONS: We identify some previously unrecognized correlates of age at natural menopause, namely self-reported lifelong sun exposure, lifelong physical activity, house-ownership, current use of calcium supplements, and lifelong fish consumption. These findings should be confirmed in larger studies.

Effects of octreotide and morphine on the clearance rate of indium-111-pentetreotide from the epidural space.

In this study we aimed to evaluate the possible mechanisms by which somatostatin acts when given epidurally. Twenty male New Zealand rabbits were randomly separated into four groups and various drugs were administered via a caudal epidural catheter. Group 1 received a bolus of 3.7 MBq indium-111 ((111)In)-pentetreotide, group 2 received 200 microg octreotide and after 15 min a bolus of 3.7 MBq (111)In-pentetreotide, group 3 received 0.1 mg morphine and after 15 min a bolus of 3.7 MBq (111)In-pentetreotide, and group 4 received a bolus of 3.7 MBq technetium-99m (99Tc(m))-diethylene triamine pentaacetic acid (DTPA). Dynamic images of 60 min' duration were obtained from the posterior projection. T(1/2), fast and T(1/2) total clearance half-times were calculated. When unlabelled octreotide was given to block somatostatin receptors, clearance of (111)In-pentetreotide was found to be faster. Epidural morphine administration did not change the clearance rate of (111)In-pentetreotide. All these findings are in favour of octreotide binding to its probable own specific receptors present in the epidural space.

Gastric lymphomas in Turkey. Analysis of prognostic factors with special emphasis on flow cytometric DNA content.

BACKGROUND: In contrast to DNA ploidy, to the authors' knowledge the prognostic significance of S-phase fraction (SPF) in gastric lymphomas has not been determined. In the current study, the prognostic significance of various parameters including SPF and DNA aneuploidy were analyzed and some distinct epidemiologic and biologic features of gastric lymphomas in Turkey were found. METHODS: A series of 78 gastric lymphoma patients followed at Hacettepe University is reported. DNA flow cytometry was performed for 34 patients. The influence of various parameters on survival was investigated with the log rank test. The Cox proportional hazards model was fitted to identify independent prognostic factors. RESULTS: The median age of the patients was 50 years. There was no correlation between patient age and tumor grade. DNA content analysis revealed 4 of the 34 cases to be aneuploid with DNA index values < 1.0. The mean SPF was 33.5%. In the univariate analysis, surgical resection of the tumor, modified Ann Arbor stage, performance status, response to first-line chemotherapy, lactate dehydrogenase (LDH) level, and SPF were important prognostic factors for disease free survival (DFS). The same parameters, excluding LDH level, were important for determining overall survival (OS). In the multivariate analysis, surgical resection of the tumor, disease stage, performance status, and age were found to be important prognostic factors for OS. CONCLUSIONS: To the authors' knowledge the current study is the first to demonstrate the prognostic significance of SPF in gastric lymphomas. The distinguishing features of Turkish gastric lymphoma patients are 1) DNA indices of aneuploid cases that all are < 1.0, which is a unique feature; 2) a lower percentage of aneuploid cases; 3) a higher SPF; 4) a younger age distribution; and 5) lack of an age-grade correlation. The authors conclude that gastric lymphomas in Turkey have distinct biologic and epidemiologic characteristics.