The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study.

We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.

Breast self-examination among nurses and midwives in Odemis health district in Turkey.

BACKGROUND: The second leading cause of death due to cancer in Turkey is breast cancer, which accounts for 24% of female cancers. AIMS: To determine the practices of nurses and midwives and their attitude toward breast self-examination (BSE). SETTING AND DESIGN: The descriptive survey was conducted to determine the practices of nurses and midwives and their attitude toward BSE. It tried to cover the total population rather than sampling part of it. However, 15 nurses and midwives, where there were errors detected in their data coding papers, and who did not accept to join the study, were excluded from the study. A total of 80 nurses and midwives were included in the study group. MATERIALS AND METHODS: This survey was carried out at the State Hospital, all Public Health Cabins, and Family Health Centers, in the rural area of Izmir, a city located in the western region of Turkey. The data was collected between 15 March and 1 April 2004. STATISTICAL ANALYSIS: The analysis included descriptive statistics, to examine the association between BSE and medical history, knowledge of BSE, and attitude toward BSE. RESULTS: The results of the study indicated that 52% of the sample performed BSE. Approximately 35% of those who performed BSE reported that they acquired information regarding BSE during their work experience. A significant relationship was found between higher levels of work experience and BSE practice. Except for age, no significant relation was found between the sociodemographic factors and BSE practice. The sample showed a strong belief in the breast lump being the cause of breast cancer and it had a significant correlation with BSE practice. CONCLUSION: A positive correlation was found between nursing work experience and their practice alongside BSE medical professionals. Almost all the nurses and midwives knew how to conduct BSE, but did not prioritize practicing it.

The loneliness level of patients with gynecological cancer.

The purpose of this descriptive study was to determine the loneliness levels and the variables that have an effect on the loneliness of women with a gynecological cancer diagnosis. The main questions that the study addressed were as follows: (1) What is the loneliness level of patients with gynecological cancer? and (2) What kind of relationships are there between general demographic characteristics of patients with gynecological cancer and their loneliness? This descriptive study was conducted at Ege University, Faculty of Medicine, Application and Investigation Hospital, Maternity and Women Diseases Gynecology Clinic, from July to December 2002. Maternity and Women Diseases Clinic Oncology Service treated 161 patients during this time period. While all patients hospitalized between the specified dates constituted the universe of the investigation; the actual sample was 94 patients. As data collection tools, a questionnaire form, which aimed at identifying sociodemographic characteristics of patients and the features related to their diseases relevant to the literature and the UCLA-loneliness scale were used. The general loneliness mean score of women with gynecological cancer was 35.85 +/- 9.302. Women's mean scores of loneliness were affected by whether psychologic support was needed, genital organ diseases were treated, or a family member had a gynecological operation, and by the income situation. The disease of cancer, which creates the most fear and anxiety in the community, has adverse psychologic effects on both the patient and the family. In societies where men dominate, as is the case in our society, women's place in the society has been reduced to their reproductive capacity, and thus, the health of their genital organs is very important.

Therapy of acute hepatitis C with interferon-alpha2b plus ribavirin in a health care worker.

Hepatitis C virus can be transmitted to health care workers through needlestick accidents. In this report, the result of short-term therapy with interferon-alpha2b plus ribavirin combination of acute hepatitis C in a health care worker who infected through laboratory accident was presented. The patient received combination of interferon-alpha2b (5 MU three times a week) plus ribavirin (1000 mg daily) for three months. Aminotransferase levels were normalised and clearance of HCV RNA was obtained in the first month of the therapy. After 19 months of follow-up, he had undetectable levels of HCV RNA so sustained response (clearance of HCV RNA and normalisation of aminotransferases at least six months after cessation of therapy) was achieved. According to this result, short-term therapy of acute hepatitis C with interferon-alpha2b plus ribavirin may be an alternate to others.

An evaluation of nursing care in cancer patients.

The aim of the present study was to identify what hospitalized cancer patients expect from nurses in terms of the care they receive. The specific aims of this study were: (i) to identify those individuals to whom the patients felt closest in the hospital setting and (ii) to evaluate nurses' management of cancer patients during their stay in the hospital. The sample included patients hospitalized at Ege University Hospital and Suat Seren District Hospital, Izmir, Turkey. We found significant differences between the scores of satisfaction and dissatisfaction and gender age, education, occupation, type of cancer and the mode of treatment (p < 0.05). The majority of the cancer patients reported that nursing management was unsatisfactory. Some demographic factors such as cultural and social status affected patients' expectations.

A sterically stabilized immunolipoplex for systemic administration of a therapeutic gene.

A sterically stabilized immunolipoplex (TsPLP), containing an antitransferrin receptor single-chain antibody fragment (TfRscFv)-PEG molecule, has been developed to specifically and efficiently deliver a therapeutic gene to tumor cells. A postcoating preparation strategy was employed in which a DNA/lipid complex (lipoplex) was formed first and then sequentially conjugated with PEG and TfRscFv. The complex prepared by this method was shown to be superior in ability to deliver genes to tumor cells than when prepared by a common precoating strategy, in which DNA is mixed with TfRscFv-PEG conjugated liposome. Using prostate cancer cell line DU145, a comparison was made between the in vitro and in vivo gene delivery efficiencies of four complexes, Lipoplex (LP), PEG-Lipoplex (PLP), TfRscFv-PEG-Lipoplex (TsPLP) and our standard TfRscFv-Lipoplex (TsLP). In vitro, the order of transfection efficiency was TsLP>LP approximately TsPLP>PLP. However, in vivo the order of transfection efficiency, after systemic administration via the tail vein, was TsPLP>TsLP>LP or PLP with TsPLP-mediated exogenous gene expression in tumor being two-fold higher than when mediated by TsLP. This suggests that the in vitro transfection efficiency of TsPLP was not indicative of its in vivo efficiency. In addition, it was found that the level of exogenous gene expression in the tumor mediated by TsPLP was higher than that mediated by TsLP and did not decrease over the time. More importantly, high exogenous gene expression in tumor, but low expression in liver, was observed after an i.v. delivery of TsPLP carrying either the GFP reporter gene or the p53 gene, indicating that tumor preferential targeting was maintained by this complex in the presence of PEG. These findings show that incorporation of PEG into our targeted lipoplex results in a more efficient delivery of the complex to the tumor cells, possibly by inhibiting the first pass clearance observed with non-PEG containing liposomes. Therefore, these data demonstrate that TsPLP is a improvement over our previously established tumor targeted gene delivery complex for systemic gene therapy of cancer.

Sequence- and regio-selectivity in the montmorillonite-catalyzed synthesis of RNA.

The six binary montmorillonite clay-catalyzed reactions of the 5'-phosphorimidazolides of adenosine, cytidine, guanosine and uridine were performed and the eight dimers from each reaction were separated and analyzed by HPLC. A 16-51-fold higher yield of the 5'-purine-pyrimidine dimers over that of the 5'-pyrimidine-purines was observed. The total yield of the 5'-purine-pyrimidine dimers was in the 50-70% range while that of the 5'-pyrimidine-purine dimers was 1.3-7.0%. Less sequence selectivity was observed in the homodimers formed. Regioselectivity for the formation of 3', 5'-phosphodiester bonds over that found in the absence of clay was observed. The 5'-purine-pyrimidine, 5'-pyrimidine-pyrimidine and 5'-purine-purine dimers had 3', 5'-links in about half of their phosphodiester bonds. The percent phosphodiester links in the 5'-pyrimidine-pyrimidine dimers was 18%, a value close to that observed in the absence of the montmorillonite catalyst. The montmorillonite-catalyzed reaction of all four activated nucleotides was performed and the 24 products were separated and analyzed. The trends observed in the binary reactions were confirmed and the results also showed that the relative reactivity of the activated monomers was A > G > C > U in the ratio 8.2:4.8:1.3:1 respectively. No 5'-pyrimidine-purines with a 5'-U and pG3' pU, pC3' pA and pC3' pG were detected. These studies suggest that a limited population of RNAs would have formed in catalyzed prebiotic reactions.

Bridging the prebiotic and RNA worlds: prebiotic RNA synthesis on clay.

Abstract Progress towards the laboratory demonstration of the steps in the prebiotic origin of the RNA world is reviewed. Montmorillonite clay catalyzes the formation of RNAs containing 6-14 monomer units from the activated mononucleotides of A, C, G, I and U. The RNAs formed have 3', 5'- and 2', 5'-links, pyrophosphate links and have both linear and cyclic chains. The purine oligonucleotides have more 3', 5'- links while the pyrimidine nucleotides have more 2', 5'-linkages. Template-directed synthesis on the heterogeneous oligo(C)s formed on mont- morillonite yields the corresponding oligo(G)s. The dimer fraction formed in the reaction of a binary mixture of a purine and pyrimidine nucleotide shows sequence selectivity with about a 20 fold excess of the 5'-purine-pyrimidine dimer over that of the 5'-pyrimidine-purine dimer. RNAs as long as 50 mers are formed by the elongation of a decamer bound to montmorillonite by the daily addition of activated monomer to it over a 14-day time period.

Formation of RNA oligomers on montmorillonite: site of catalysis.

Certain montmorillonites catalyze the self condensation of the 5'-phosphorimidazolide of nucleosides in pH 8 aqueous electrolyte solutions at ambient temperatures leading to formation of RNA oligomers. In order to establish the nature of the sites on montmorillonite responsible for this catalytic activity, oligomerization reactions were run with montmorillonites which had been selectively modified (I) at the edges by (a) fluoride treatment, (b) silylation, (c) metaphosphate treatment of the anion exchange sites (II) in the interlayer by (a) saturation with quaternary alkylammonium ions of increasing size, (b) aluminum polyoxo cations. High pressure liquid chromatography, HPLC, analysis of condensation products for their chain lengths and yields indicated that modification at the edges did not affect the catalytic activity to a significant extent, while blocking the interlayer strongly inhibited product formation.

Evaluation of signal-averaged electrocardiogram in healthy obese women: effects of subcutaneous adipose tissue.

OBJECTIVE: To determine the correlations between signal-averaged electrocardiography (SAECG) indices and various anthropometric parameters in obese women. SUBJECTS: Twenty-seven healthy obese women (mean age 29.7 +/- 9.6 y, mean body mass index 35.2 +/- 6.0 kg/m2). MEASUREMENTS: SAECG was performed using a Marquette, MAC 12/15 system. Bidirectional filtering, low-pass filtering 250 Hz and 25, 40 and 80 Hz high-pass filter settings were employed on the same averaged beats. At least 200 beats were averaged to achieve a noise level <1 microV. Body mass index, waist to hip circumference ratio, neck circumference, arm circumference and conicity index were determined for all subjects. Skinfold thicknesses were measured in triceps, biceps, subscapular, supra-iliac and para-umbilical regions. RESULTS: Significant correlations were observed between the root mean square (RMS) voltage of the terminal 40 ms of the filtered ORS complex at 25 and 40 Hz and skinfold thicknesses measured at different sites. Significant correlations were obtained between the noise level at 25 and 40 Hz and skinfold thicknesses measured at subscapular, biceps and triceps regions also. The only SAECG parameter correlated significantly with the noise level was the RMS voltage at 25 and 40 Hz high-pass filter settings. CONCLUSIONS: In obese women SAECG must be performed with 80 Hz high-pass filter setting which eliminates the random noise originating from the subcutaneous adipose tissue. In addition RMS voltage which shows positive linear correlations with the noise level of 25 and 40 Hz high-pass filter settings might be inappropriate for the definition of abnormal SAECG criteria in obese women.

Template-directed synthesis using the heterogeneous templates produced by montmorillonite catalysis. A possible bridge between the prebiotic and RNA worlds.

The synthesis of oligoguanylates [oligo(G)s] is catalyzed by a template of oligocytidylates [oligo(C)s] containing 2',5'- and 3',5'-linked phosphodiester bonds with and without incorporated C5'ppC groupings. An oligo(C) template containing exclusively 2',5'-phosphodiester bonds also serves as a template for the synthesis of complementary oligo(G)s. The oligo(C) template was prepared by the condensation of the 5'-phosphorimidazolide of cytidine on montmorillonite clay. These studies establish that RNA oligomers prepared by mineral catalysis, or other routes on the primitive earth, did not have to be exclusively 3',5'-linked to catalyze template-directed synthesis, since oligo(C)s containing a variety of linkage isomers serve as templates for the formation of complementary oligo(G)s. These findings support the postulate that origin of the RNA world was initiated by the RNA oligomers produced by polymerization of activated monomers formed by prebiotic processes.

Synthesis of RNA oligomers on heterogeneous templates.

The concept of an RNA world in the chemical origin of life is appealing, as nucleic acids are capable of both information storage and acting as templates that catalyse the synthesis of complementary molecules. Template-directed synthesis has been demonstrated for homogeneous oligonucleotides that, like natural nucleic acids, have 3',5' linkages between the nucleotide monomers. But it seems likely that prebiotic routes to RNA-like molecules would have produced heterogeneous molecules with various kinds of phosphodiester linkages and both linear and cyclic nucleotide chains. Here we show that such heterogeneity need be no obstacle to the templating of complementary molecules. Specifically, we show that heterogeneous oligocytidylates, formed by the montmorillonite clay-catalysed condensation of actuated monomers, can serve as templates for the synthesis of oligoguanylates. Furthermore, we show that oligocytidylates that are exclusively 2',5'-linked can also direct synthesis of oligoguanylates. Such heterogeneous templating reactions could have increased the diversity of the pool of protonucleic acids from which life ultimately emerged.

Influence of global system of mobile telephones on permanent pacemakers

To investigate the influence of Global System of Mobile (GSM) telephones on permanent pacemakers, four brands of GSM telephones: Panasonic, Motorola, Nokia, Ericsson, and 24 permanent pacemaker, 17 models of five major brands, were tested in their original sterile packages. Pacemaker brands tested were Pacessetter, Cardiac Pacemakers Inc. (CPI), Vitatron, Medtronic and Intermedics. The effects of switching on and off, ringing and transmission were tested and marker channel recordings were made connuously. Tests were carried out for each model of GSM telephone wile the telephone was immediately on or up to 15 cm above the pacemaker box. No program chagne was noted in any of the pacemakers. All CPI models tested, Synchrony II of Pacesetter, Unity of Intermedics, and Thera SR of Medtronic were unaffected. However all remaining models showed intermittent and/or continuous inhibition of 2-13 seconds and inappropriate triggering of impulse when the telephones were placed on the package. Interference dsppeared beyond 15 cm in all pacemaker models. O ne pacemaker, AFP of Pacesetter implanted 8 years ago, induced VT as long as the patient tried to keep the telephone active over either ear. In conclusion, patients with permanent pacemakers shoud be advised not to use GSM telephones until further tests prove their safety.

Importance of serum anticardiolipin antibody levels in coronary heart disease.

During the past 10 years it has been shown that some patients with antibodies to phospholipids develop recurrent venous and arterial thromboses, repeated fetal loss, and thrombocytopenia. The aim of this study is to determine the importance of levels of serum anticardiolipin antibodies (ACA) in patients with coronary heart disease (CHD). The study population consisted of 76 CHD patients (Group 1) and 22 healthy subjects (Group 2). Group 1 comprised three subgroups: (1a) 32 patients with acute myocardial infarction (MI), (1b) 22 patients with chronic CHD and a history of MI, and (1c) 22 patients with CHD but without previous MI. Immunoglobulin G anticardiolipin antibodies (IgG ACA) and immunoglobulin M anticardiolipin antibodies (IgM ACA) were detected by ELISA. High IgG ACA levels were found in 36 patients (47%) in Group 1, but no high levels were found in the control group. IgM ACA levels showed no significant difference between the two groups. The ACA (IgG and IgM) levels showed no correlation with age, gender, risk factor profiles, platelet counts, coronary artery lesions, left ventricular function, and morbidity and mortality rates during the follow-up period of 22 months. As a result, measurement of ACA in CHD patients is unlikely to yield information that is diagnostically or prognostically important. The importance of serum anticardiolipin antibody levels in the natural history and prognosis of CHD is still undetermined and remains to be clarified.

The binding and reactions of nucleotides and polynucleotides on iron oxide hydroxide polymorphs.

The iron oxide hydroxide minerals goethite and akaganéite were likely constituents of the sediments present in, for instance, geothermal regions of the primitive earth. They may have adsorbed organics and catalyzed the condensation processes which led to the origins of life. The binding to and reactions of nucleotides and oligonucleotides with these minerals was investigated. The adsorption of adenosine, 5'-AMP, 3'-AMP, 5'-UMP, and 5'-CMP to these minerals was studied. Adenosine did not bind to goethite and akaganéite. The adsorption isotherms for the binding of the nucleotides revealed that they all had close to the same affinity for the mineral. Binding to goethite was about four times stronger than to akaganéite. There was little difference in the adsorption of each nucleotide suggesting the binding was between the negative charge on the phosphate group and the positive charges on the mineral surface. The absence of binding of adenosine is consistent with this explanation. Binding decreases as the pH increases due to the titration of the positive (acidic) centers on the minerals. Two times as many moles of polynucleotides were bound to these minerals as compared to the mononucleotides. Watson-Crick hydrogen bonding of adenosine and 5'-AMP to poly(U) complexes with goethite and akaganéite was observed. There was no interaction of uridine with the poly(U)-goethite complex as expected if Watson-Crick hydrogen bonding is taking place. Neither goethite nor akaganéite catalyzed the oligomerization of the phosphorimidazolide of adenosine (ImpA). The template directed synthesis of oligomers of 5'-GMP on the poly(C) bound to goethite was observed. Higher molecular weight oligomers were observed when the poly(C) was bound to goethite than was found in the absence of the mineral.

Montmorillonite catalysis of RNA oligomer formation in aqueous solution. A model for the prebiotic formation of RNA.

Oligomers of adenylic acid of up to the 11-mer in length are formed by the reaction of the phosphorimidazolide of adenosine (ImpA) in pH 8 aqueous solution at room temperature in the presence of Na(+)-montmorillonite. These oligomers are joined by phosphodiester bonds in which the 3',5'-linkage predominates over the 2',5'-linkage by a 2:1 ratio. Reaction of a 9:1 mixture of ImpA, A5'ppA results in the formation of oligomers with a 3:1 ratio of 3',5'- to 2',5'-linked phosphodiester bonds. A high proportion of these oligomers contain the A5'ppA grouping. A5'ppA reacts much more rapidly with ImpA than does 5'-ADP (ppA) or 5'-ATP (pppA). The exchangeable cation associated with the montmorillonite effects the observed catalysis with Li+, Na+, NH4+, and Ca2+ being the more effective while Mg2+ and Al3+ are almost ineffective catalysts. 2',5'-Linked oligomers, up to the tetramer in length, are formed using UO2(2+)-montmorillonite. The structure analysis of individual oligomer fractions was performed by selective enzymatic and KOH hydrolytic studies followed by HPLC analysis of the reaction products. It is concluded from the composition of the oligomers that the rate of addition ImpA to a 3'-terminus containing a 2',5'-linkage is slower than the addition to a nucleoside joined by a 3',5'-linked phosphodiester bond. The potential importance of mineral catalysis of the formation of RNA and other oligomers on primitive Earth is discussed.

Oligomerization of ribonucleotides on montmorillonite: reaction of the 5'-phosphorimidazolide of adenosine.

The regiospecific formation of oligomers from unblocked monomers in aqueous solution is one of the central tenets in research on the origins of life on earth. Direct experimental support for this hypothesis has been obtained in studies of the condensation of the 5'-phosphorimidazolide of adenosine (ImpA) with itself and with P1,P2-diadenosine-5',5'-pyrophosphate (AppA) in water in the presence of a montmorillonite clay. Oligomers of up to ten nucleotides in length are formed. Analysis of the trimers, tetramers, and pentamers formed from a 9:1 ImpA:AppA mixture has shown that 85% of the bonds formed are 3',5'-linked and that any 2',5'-linkages present are at the phosphodiester bond next to the 3'-terminus of the oligomers.

Oligomerization reactions of ribonucleotides: the reaction of the 5'-phosphorimidazolide of nucleosides on montmorillonite and other minerals.

The reaction of ImpA in the presence of Na+ -montmorillonite 22A or Na+ -Volclay in aqueous, pH 8 solution gives a 50-60% yield of dimers and trimers (pA)2 and (pA)3. The ratio of 3',5'-phosphodiester bond formation is twice as great as 2',5'-bond formation. The reaction requires the presence of Mg2+ and is inhibited by 0.4 M imidazole. N-methylimidazole enhances the rate of the reaction but does not cause major changes in yield or product composition. Higher yields were obtained when Li+ -or Ca2+ -montmorillonites were used in place of Na+ -montmorillonite. Little or no phosphodiester bond formation was observed with Mg2+ - or Al3+ -montmorillonite. Montmorillonites other than 22A and Volclay exhibited little or no catalysis. In addition, little or no catalysis was exhibited in ferrugenous smectite, nontronite, allophane, imogolite or sepiolite. Oligomers were also formed by the reaction of ImpG, 2-methylImpG, ImpC and ImpU in the presence of Na+ -montmorillonite. The pyrimidine nucleotides gave significantly lower yields of oligomers.