The contribution of clinical assessments to the diagnostic algorithm of pulmonary embolism

BACKGROUND

Pulmonary thromboembolism (PE) is a major disease in respiratory emergencies. Thoracic CT angiography (CTA) is an important method of visualizing PE. Because of the high radiation and contrast exposure, the method should be performed selectively in patients in whom PE is suspected.

OBJECTIVES

The aim of the study was to identify the role of clinical scoring systems utilizing CTA results to diagnose PE.

MATERIAL AND METHODS

The study investigated 196 patients referred to the hospital emergency service in whom PE was suspected and CTA performed. They were evaluated by empirical, Wells, Geneva and Miniati assessments and classified as low, intermediate and high clinical probability. They were also classified according to serum D-dimer levels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated and evaluated according to CTA findings.

RESULTS

Empirical scoring was found to have the highest sensitivity, while the Wells system had the highest specificity. When low D-dimer levels and "low probabilty" were evaluated together for each scoring system, the sensitivity was found to be 100% for all methods. Wells scoring with a cut-off score of 4 had the highest specificity (56.1%).

CONCLUSIONS

Clinical scoring systems may be guides for patients in whom PE is suspected in the emergency department. The empirical and Wells scoring systems are effective methods for patient selection. Adding evaluation of D-dimer serum levels to the clinical scores could identify patients in whom CTA should be performed. Since CTA can only be used conservatively, the use of clinical scoring systems in conjunction with D-dimer levels can be a useful guide for patient selection.

Effects of microwave roasting on the yield and composition of cold pressed orange seed oils

The aim of this study was to valorize orange (Citrus sinensis) seeds, which are generated as waste. This study presents data about raw orange seed, the meal gained after cold pressing, and characterization data of the cold pressed seed oils. Furthermore, the effects of microwave roasting of the seds compared to regular roasting (control) were determined. The oil yield of orange seed cold pressing was around 52.93–62.99%. After cold pressing, 13.57–17.97% oil remained in the meal together with 20.68–25.61% protein. Hence, pressed meals could be valorized for different purposes. Except for turbidity, the color b* value, free acidity, the p-anisidine value and antioxidant capacity, there was no significant difference between the two oil samples for the measured physicochemical properties. Six different fatty acids were quantified and the major fatty acids were linoleic, palmitic and oleic acids. The fatty acid composition of the orange seed oil can be accepted as nutritionally balanced. Among the fifteen sterols quantified, ß-sitosterol was dominant (around 77–78%). Likewise, the α-tocopherol content of the samples was not significantly different. The thermal onset and peak temperatures, and enthalpies for crystallization and melting were also reported. This study showed that good quality orange seed oils can be produced by cold pressing, and the oils could be used in food and non-food applications.

Newborn Skin: Common Skin Problems

The newborn skin can be separated from adult's skin in several ways. In dermatologic examination it can be easily observed that it is thinner, less hairy and has less sweat and sebaceous gland secretions. These differentiations present especially in preterm newborns. Their skin is exposed to mechanical trauma, bacteria and weather, heat alterations. At birth, newborn skin is protected by the coverage of vernix caseosa, which has lubricating and antibacterial features and its pH ranges from 6.7 to 7.4. Beneath the vernix caseosa the skin has a pH of 5.5-6.0. In newborn dermatologic examination it is very important to distinguish transient benign dermatoses and severe diseases, make early diagnosis and treat congenital skin disorders. Although the benign cases are common in this life period, clinical presentations can be much more exaggerated, dramatic and cause a great deal of anxiety to parents. Therefore, as a doctor, knowing the dermatological, pathological and non-pathological common skin rashes guides the family in the right direction, offers advice to reduce uncertainty and time for the treatment of severe conditions and builds a confidential doctor-patient relationship. In this review, our aim is to provide a general overview to common skin rashes in newborn period.

MPV, NLR, and platelet count: new hematologic markers in diagnosis of malignant ovarian tumor

OBJECTIVE

Evaluation of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet count in the detection of malignant and benign ovarian tumors.

MATERIAL AND METHODS

Sixty-six patients admitted to the present clinic over three years were in- cluded in the study. Patients diagnosed with ovarian cancer were grouped into the areas of epithelial and granulosa cell tumor diagno- sis. The values were compared to patients with benign cystic structure. Patients' preoperative hematologic parameters and their values four weeks postoperatively were analyzed. Statistical analyses were performed with SPSS software.

RESULTS

MPV, NLR, and platelet count were observed at a higher rate as statistically significant in patients diagnosed with malignant ovarian cancer, compared to those with benign adnexal mass.

CONCLUSION

The hemnatological parameters such as MPV, NLR, and platelet count in the detection of malignant ovarian tumors have been evaluated as useful new markers.

[The acetabulum nonunion: reconstruction and reosteosynthesis : A long-term outcome]

Acetabular nonunions are rare, especially after operative treatment of an acetabular fracture. There are only single reports of the reconstruction and therapy of acetabular nonunion. Furthermore, there are fewer reports for treatment of acetabular nonunion with a long follow-up. We report a successful revision of an acetabular nonunion after transversal fracture and previous operative intervention, as well as the long-term follow-up after revision surgery.

Differentiation of phyllodes tumors versus fibroadenomas: Mammographic and sonographic features

Purpose: To determine if mammographic and sonographic findings allow discrimination between phyllodes tumor and large sized fibroadenoma, which mimic each other in the clinical, radiologic and histopathologic appearances.

Material and Methods: Thirty-one histopathologically proven masses including 12 phyllodes tumors and 19 fibroadenomas 3 cm or greater in diameter were compared. In total 28 women were retrospectively evaluated by mammography and pre-operative sonography.

Results: Mammography revealed a high-density mass compared with surrounding fibroglandular breast tissue to be present in 9 of the 12 (75%) phyllodes tumors and 7 of the 19 (37%) fibroadenomas. At sonography a mass, which had a round or lobulated shape, marked posterior acoustic enhancement and intramural cystic areas, were statistically significantly more likely to be phyllodes tumors than fibroadenomas. None of the other mammographic or sonographic characteristics proved to be useful in differentiating phyllodes tumors and fibroadenomas.

Conclusion: Although masses of high density at mammography, circumscribed border associated with posterior acoustic enhancement and internal cystic areas at sonography should suggest the diagnosis of phyllodes tumors rather than large sized fibroadenomas, there was a substantial overlap in the mammographic and sonographic characteristics of these two tumors. Therefore, an excisional biopsy would be necessary for equivocal masses.

Bovine serum albumin-Cu(II) hybrid nanoflowers: An effective adsorbent for solid phase extraction and slurry sampling flame atomic absorption spectrometric analysis of cadmium and lead in water, hair, food and cigarette samples

Herein, the synthesis of bovine serum albumin-Cu(II) hybrid nanoflowers (BSA-NFs) through the building blocks of bovine serum albumin (BSA) and copper(II) ions in phosphate buffered saline (PBS) and their use as adsorbent for cadmium and lead ions are reported. The BSA-NFs, for the first time, were efficiently utilized as novel adsorbent for solid phase extraction (SPE) of cadmium and lead ions in water, food, cigarette and hair samples. The method is based on the separation and pre-concentration of Cd(II) and Pb(II) by BSA-NFs prior to determination by slurry analysis via flame atomic absorption spectrometry (FAAS). The analytes were adsorbed on BSA-NFs under the vortex mixing and then the ion-loaded slurry was separated and directly introduced into the flame AAS nebulizer by using a hand-made micro sample introduction system to eliminate a number of drawbacks. The effects of analytical key parameters, such as pH, amount of BSA-NFs, vortexing time, sample volume, and matrix effect of foreign ions on adsorbing of Cd(II) and Pb(II) were systematically investigated and optimized. The limits of detection (LODs) for Cd(II) and Pb(II) were calculated as 0.37 μg L(-)(1) and 8.8 μg L(-)(1), respectively. The relative standard deviation percentages (RSDs) (N = 5) for Cd(II) and Pb(II) were 7.2%, and 5.0%, respectively. The accuracy of the developed procedure was validated by the analysis of certified reference materials (TMDA-53.3 Fortified Water, TMDA-70 Fortified Water, SPS-WW2 Waste Water, NCSDC-73349 Bush Branches and Leaves) and by addition/recovery analysis. The quantitative recoveries were obtained for the analysis of certified reference materials and addition/recovery tests. The method was successfully applied to the analysis of cadmium and lead in water, food, cigarette and hair samples.

Protective effects of udenafil citrate, piracetam and dexmedetomidine treatment on testicular torsion/detorsion-induced ischaemia/reperfusion injury in rats

The aim of this study was to investigate the antioxidant properties of udenafil citrate (1.4 mg kg(-1) -2.8 mg kg(-1) ), dexmedetomidine 25 μg kg(-1) and piracetam 200 mg kg(-1) administered on ipsilateral/contralateral testes after ischaemia in a rat model of testicular torsion/detorsion (T/D) and define its protective effect histologically. Fifty-six Wistar albino rats were included and randomly assigned into 6 groups. No intervention was performed in control group (Group 1, n = 8) and in torsion/detorsion group, (Group 2, n = 8). Udenafil 1.4 mg kg(-1) was given to torsion/detorsion group (Group 3, n = 10), udenafil 2.8 mg kg(-1) was given to torsion/detorsion group (Group 4, n = 10), piracetam 200 mg kg(-1) was given to torsion/detorsion group (Group 5, n = 10) and dexmedetomidine 25 μg kg(-1) was given to torsion/detorsion group (Group 6, n = 10) intraperitoneally after 60 mins of testicular torsion. Biochemical and histopathological testicular injury were evaluated. When the tissue was examined by TOS values, Group 3, Group 4 and Group 5 were significantly lower than Group 2. In contrary Group 6 values were significantly higher than Group 2. The increasing doses of udenafil demonstrated antioxidant properties on the testis tissue and histopathological that protects the testicles.

Sensory neuron subpopulation-specific dysregulation of intracellular calcium in a rat model of chemotherapy-induced peripheral neuropathy

The purpose of the present study was to test the prediction that the unique manifestation of chemotherapeutic-induced peripheral neuropathy (CIPN) would be reflected in a specific pattern of changes in the regulation of the intracellular Ca(2+) concentration ([Ca(2+)]i) in subpopulations of cutaneous neurons. To test this prediction, we characterized the pattern of changes in mechanical nociceptive threshold associated with paclitaxel administration (2mg/kg, iv, every other day for four days), as well as the impact of target of innervation and paclitaxel treatment on the regulation of [Ca(2+)]i in subpopulations of putative nociceptive and non-nociceptive neurons. Neurons innervating the glabrous and hairy skin of the hindpaw as well as the thigh were identified with retrograde tracers, and fura-2 was used to assess changes in [Ca(2+)]i. Paclitaxel was associated with a persistent decrease in mechanical nociceptive threshold in response to stimuli applied to the glabrous skin of the hindpaw, but not the hairy skin of the hindpaw or the thigh. However, in both putative nociceptive and non-nociceptive neurons, resting [Ca(2+)]i was significantly lower in neurons innervating the thigh after treatment. The magnitude of the depolarization-evoked Ca(2+) transient was also lower in putative non-nociceptive thigh neurons. More interestingly, while paclitaxel had no detectable influence on either resting or depolarization-evoked Ca(2+) transients in putative non-nociceptive neurons, in putative nociceptive neurons there was a subpopulation-specific decrease in the duration of the evoked Ca(2+) transient that was largely restricted to neurons innervating the glabrous skin. These results suggest that peripheral nerve length alone, does not account for the selective distribution of CIPN symptoms. Rather, they suggest the symptoms of CIPN reflect an interaction between the toxic actions of the therapeutic and unique properties of the neurons deleteriously impacted.

Solid-phase extraction of iridium from soil and water samples by using activated carbon cloth prior to its spectrophotometric determination

A solid-phase extraction method for separation and preconcentration of Ir(IV) ion by using activated carbon cloth (ACC) has been presented. Ir(IV) as their 1-(2-pyridylazo) 2-naphtol (PAN) chelate was adsorbed on ACC at pH 2.0 and was eluted from ACC with acidic dimethylformamide (DMF). The Ir(IV) concentration was determined at 536 nm as Ir(IV)-PAN complex by using UV-vis spectrophotometer. The analytical parameters including pH, sample and eluent flow rates, amount of PAN, eluent type, concentration, and sample volume were optimized. The effects of foreign ions on the recoveries of iridium were also investigated. The preconcentration factor was calculated as 60. The limit of detection (LOD) and the limit of quantification (LOQ) of the method were found as 0.039 and 0.129 μg L(-1), respectively. The method was applied to soil and water samples for iridium determination.

Anterior Sacral Meningocele Masquerading as an Ovarian Cyst: A Rare Clinical Presentation Associated with Marfan Syndrome

Anterior sacral meningocele is a very rare clinical entity characterized by herniation of a meningeal sac through a sacrococcygeal defect. We report a case of a 20-year old female with Marfan syndrome who presented with abdominal distention that was misdiagnosed as an ovarian cyst on pelvic ultrasound. Pelvic magnetic resonance (MR) imaging showed large, well-defined multiloculated intrasacral and presacral cysts communicating via two separate broad necks and extending through defects in anterior aspect of sacral vertebrae. This case emphasizes that anterior sacral meningocele should be considered in the differential diagnosis of cases with pelvic cysts particularly in patients with underlying connective tissue disorders. Because severe neurologic complications or even death may occur without proper preoperative planning in such cases, MR imaging should always be performed for evaluation and characterization of pelvis cystic lesions.

Resveratrol successfully treats experimental endometriosis through modulation of oxidative stress and lipid peroxidation

BACKGROUND AND AIMS

The purpose of this study was to investigate the potential therapeutic efficiency of resveratrol in the treatment of experimental endometriosis in rats.

SETTINGS AND DESIGN

Experimental study was carried out in a University hospital.

MATERIALS AND METHODS

Endometriosis was surgically induced in 24 female rats. Four weeks after this procedure, the viability and dimensions of the endometriosis foci were recorded. Rats were then randomly divided into three groups: (1) Control group (n = 8); (2) low dose (10 mg/kg) resveratrol group (n = 8); (3) high dose (100 mg/kg) resveratrol group (n = 8). At the end of the 7-day treatment, blood samples were taken and laparotomy was performed. The endometrial implants were processed for biochemical, histological and immunohistochemical studies.

STATISTICAL ANALYSIS USED

The Kruskal-Wallis H test and one-way ANOVA test were used.

RESULTS

Resveratrol-treated rats showed significantly reduced endometriotic implant volumes (P = 0.004). After treatment, a significant and dose-dependent increase in activities of superoxide dismutase and glutathione peroxidase in serum and tissue of the rats in Group 2 and Group 3 was detected. Similarly, serum and tissue malonyl dialdehyde levels and tissue catalase levels were significantly higher in Group 3 than that of control animals. Histological scores and proliferating cell nuclear antigen expression levels were also significantly reduced in Group 2 and Group 3 than that of control group.

CONCLUSION

In a rat endometriosis model, resveratrol showed potential ameliorative effects on endometriotic implants probably due to its potent antioxidative properties.

Damage modeling of small-scale experiments on dental enamel with hierarchical microstructure

Dental enamel is a highly anisotropic and heterogeneous material, which exhibits an optimal reliability with respect to the various loads occurring over years. In this work, enamel's microstructure of parallel aligned rods of mineral fibers is modeled and mechanical properties are evaluated in terms of strength and toughness with the help of a multiscale modeling method. The established model is validated by comparing it with the stress-strain curves identified by microcantilever beam experiments extracted from these rods. Moreover, in order to gain further insight in the damage-tolerant behavior of enamel, the size of crystallites below which the structure becomes insensitive to flaws is studied by a microstructural finite element model. The assumption regarding the fiber strength is verified by a numerical study leading to accordance of fiber size and flaw tolerance size, and the debonding strength is estimated by optimizing the failure behavior of the microstructure on the hierarchical level above the individual fibers. Based on these well-grounded properties, the material behavior is predicted well by homogenization of a representative unit cell including damage, taking imperfections (like microcracks in the present case) into account.