Evaluation of thiol-disulfide homeostasis in pseudoexfoliation glaucoma and primary open-angle glaucoma

Aims

This study aimed to compare the serum thiol-disulfide homeostasis, total antioxidant status (TAS), and total oxidant status (TOS) in patients with pseudoexfoliation glaucoma (PEG) patients, primary open-angle glaucoma (POAG) patients, and healthy individuals (control).

Methods

Ninety subjects were included in this study. Three groups were separated as PEG, POAG, and control. All groups were chosen to be similar in terms of age and gender. Blood samples were obtained following an overnight fasting state and were collected on the ice at 4°C. The serum samples were separated from the cells by centrifugation at 3000 rpm for 15 min and were stored at -80°C. Serum samples analyzed for TAS and TOS, native thiol, total thiol, disulfide, and native thiol/disulfide ratio.

Results

TAS and TOS levels of PEG patients were 1.2892 ± 0.0905 mmol/L; 5.0191 ± 2.7722 μmol/L, respectively. TAS and TOS levels of POAG patients were 1.2741 ± 0.1252 mmol/L; 4.1674 ± 1.7723 μmol/L, respectively. TAS and TOS levels of the control group were 2.3414 ± 0.1409 mmol/L; 4.0931 ± 0.1107 μmol/L, respectively. The TAS level was significantly lower in PEG and POAG groups compared to control. TOS level showed no significant differ ¬ ence between PEG, POAG, and control groups (P > 0.05). The mean serum total thiol and native thiol levels were significantly lower in patients with PEG compared to POAG and control group; there was no significant difference between the POAG and control group (P > 0.05). The mean serum disulfide level was significantly lower in patients with PEG compared to POAG (P = 0.018).

Conclusion

Low levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients. While total thiol and native thiol levels were higher in the PEG group, the disulfide level was higher in the POAG group. TAS and TOS levels showed no significant difference between POAG and PEG groups.

"How I whiten my teeth": YouTube™ as a patient information resource for teeth whitening

BACKGROUND

YouTube™ is the world's second most popular website after Google on the Internet. The aim of this study was to assess the quality and content of information YouTube™ videos for patients seeking information about teeth whitening.

METHODS

The keyword 'teeth whitening' was searched on YouTube™. YouTube™ was filtered by the relevance, and the first 100 videos that met the inclusion criteria were evaluated. The included videos were analyzed for views, duration, time since video upload, likes/dislikes, number of comments, source, material types (dental, natural, and other). Also, video purpose was analyzed under nine categories (definition, material preparation, the procedure of application, material comparison, before/after comparison, symptoms, post-op experience, commercial, educational). Each video was classified according to the quality of information content as 'good', 'moderate', or 'poor'. The Kruskal-Wallis test, Fischer's Exact test and Spearman correlation analyses were performed.

RESULTS

Most videos were uploaded by laypersons (60.0%). The definition of teeth whitening was the most commonly covered topic (74.0%), followed by the procedure of application (54.0%), and post-op experience (36.0%). Only 12% of videos were classified as having good information quality content, 53% moderate, and 35% were rated as poor information content. Poor-information content videos had a significantly higher number of viewing rates than the other groups (P = 0.002), besides the duration was significantly higher in poor-information content videos (P =0.002). There was a significant relationship between the quality of video information and material types (P <0.001).

CONCLUSIONS

YouTube™ should not be used as a thoroughly reliable and accurate source for patient information about teeth whitening. More informative and reliable content YouTube™ videos about teeth whitening should be uploaded by professionals.

YouTube™ as a source of information on oral habits

BACKGROUND

The aim of this study was to evaluate the content of oral habit videos on YouTube™.

MATERIALS AND METHODS

The four keywords "Oral Habits," "Thumb Sucking," "Tongue Thrust", and "Finger Sucking" relevant terms oral habits were searched on YouTube™. The videos sorted by view count were screened and evaluated. The following exclusion criteria were defined as; non-English videos, unrelated to a topic, poor audio-video quality, and duplication. A hundred videos were analyzed for general video characteristics (number of views, likes, dislikes, number of comments, and uploaded date) the purpose of the video, information content, audio-visual quality, and viewers' interaction index.

RESULTS

The top hundred videos have been viewed an average of 26,870.83 times. Most videos were uploaded by dentists (n = 29; 29.0%). Most of the videos (44.0%) were classified as having moderate general information content and 38.0% were rated as good, and 18.0% were rated as poor. Videos generally involved information about oral habits (82.0%), followed by personal experience (12.0%). The viewers' interaction index of all evaluated YouTube™ videos was 0.59. Good content videos had a significantly higher interaction index than the other groups (P = 0.011).

CONCLUSIONS

YouTube™ videos about the oral habits are generally inadequate and patients must be recommended to view them with caution. High quality and more informative videos about oral habits in dentistry should be uploaded to YouTube™ by professionals.

Analysis of corneal astigmatism with NIDEK axial length scan in caucasian cataract surgery candidates

Aims and Objectives

The aim of the study was to analyze and quantify the pattern of corneal astigmatism in Caucasian cataract surgery patients using a new optical biometer (axial length [AL] Scan, NIDEK Co., Gamagori, Japan).

Patients and Methods

The datasets of cataract surgery patients acquired between March 1, 2014, and April 15, 2016, were collected and analyzed. The corneal power (flat keratometry, steep keratometry, and mean keratometry), negative cylinder power, and axis of astigmatism were recorded. Keratometry values were optically measured by optical low coherence interferometry (AL-Scan, NIDEK Co., Ltd.,) before cataract extraction.

Results

The study comprised 1233 eyes of 838 consecutive cataract candidates with a mean age of 66.8 ± 10.7 years (range 40-97 years). The mean keratometry value and corneal astigmatism were 43.69 ± 1.61 D and 0.84 ± 0.70 D, respectively. Corneal astigmatism of 1.00 D or greater was found in 344 eyes (27.9%), and 548 eyes (44.4%) had against-the-rule astigmatism. A trend toward decreasing J0 and J45 with age was found by linear regression models. The per-year increase in age was associated with a J0 and J45 decrease of 0.002 D and 0.001D, respectively.

Conclusion

This study provides the distribution of astigmatism axis and power for cataract patients in age subsets from Turkey.

Conservative surgical management of multiple myometrial abscesses; an unusual case with review of the literature

Myometrial abscess, especially with multiple foci, is quite rare and previous literature prevalently discusses unique locus of intramyometrial abscesses, usually treated with hysterectomy accompanied with or without bilateral salpingo-oophorectomy. The presented case, to the authors' knowledge, is the first multiple myometrial abscess case treated with conservative surgical approach.

Rapid Susceptibility Test for Mycobacterium tuberculosis to Isoniazid and Rifampin with Resazurin Method in Screw-Cap Tubes

Multi-drug resistant (MDR) Mycobacterium tuberculosis is still a serious public health problem all over the world. MDR tuberculosis (MDR-TB) caused by these strains has emerged within the last decade and rapid detection is critical for the effective treatment of patients. Recently, a resazurin microtiter assay plate for detecting MDR strains was developed. In this study, it was adapted to screw-cap tubes and the activity of isoniazid (INH) and rifampin (RIF) to 50 M. tuberculosis clinical isolates was tested by this method for the first time. Results were compared with the radiometric reference method for the susceptibility testing of M. tuberculosis complex. The results of both methods were in 100% and 96% agreement for RIF and INH, respectively. Specificity, sensitivity, positive predictive value and negative predictive value were 91.7%, 100%, 92.8% and 100% for INH, respectively. All of these values were 100% for RIF. Susceptibility testing results were obtained on the 8th day of incubation for 42 isolates and on the 9th day for the other eight strains. Our results indicate that this method is suitable for the early determination of INH and RIF resistance in developing countries because it is inexpensive, rapid and easy to perform.

[Investigation of plasmid-mediated quinolone resistance determinants in Enterobacteriaceae: a multicenter study]

Fluoroquinolones which are in use since 1986, are effective agents both against gram-positive and gram-negative bacteria. Quinolones show bactericidal effect as a result of inhibition of DNA gyrase and topoisomerase IV enzymes. Main quinolone resistance mechanisms are chromosomal mutations in these enzymes and decreased intracellular accumulation due to efflux pumps or decreased membrane uptake. Recently a new quinolone resistance mechanism mediated by plasmids has been defined. These plasmids carry genes called as qnr. Qnr genes do not cause quinolone resistance but they cause decreased quinolone susceptibility and lead to higher minimum inhibitory concentrations. Currently there are qnrA, qnrB, qnrC, qnrD and qnrS genes. This study was aimed to investigate the presence of plasmid-mediated quinolone resistance determinants in Enterobacteriaceae isolates collected from four different centers in Turkey. A total of 647 isolates (387 from Trabzon, Black Sea region; 82 from Canakkale, Trace region; 96 from Ankara, Central Anatolia region; 82 from Tokat, Black Sea region) belonging to the Enterobacteriaceae family collected between May-July 2009, were included in the study. Presence of qnrA, qnrB, qnrS and qnrC genes were investigated by multiplex polymerase chain reaction (PCR) method and confirmed by gene sequencing. The results of the PCR amplification revealed that 2 isolates were positive for qnrA, 12 isolates were positive for qnrB, 4 isolates were positive for qnrC and 10 isolates were positive for qnrS. However, the number of positive strains decreased with the use of gene sequencing, and this method led to the identification of qnrA1 in two isolates [Enterobacter cloacae (code. 796), Salmonella group B (code. 491)], qnrB1 in two isolates [Salmonella group B (code. 491), Citrobacter freundii (code. 768)], qnrB6 in one isolate [Escherichia coli (code. CC1800)], qnrB9 in one isolate [E.coli (code. CC1873)], qnrB24 in one isolate [Citrobacter koseri (code. MP5200)], qnrB27 in one isolate [C.freundii (code. 842)], qnrS1 in two isolates [E.coli (code. CC1705), E.coli (code.159)] and qnrB2 in one isolate [E.coli (code. 843)]. One of the isolates that carried the qnr gene was ciprofloxacin-resistant and two isolates were nalidixic-acid resistant. Transferable quinolone resistance due to the dissemination of qnr genes may have important impacts in terms of infection control and treatment problems. Survey of plasmid mediated quinolone resistance will help to determine the size of the issue and guide the measures that should be taken to avoid escalation of resistance and dissemination problem.

Results of tetanus vaccination in sarcoidosis

BACKGROUND AND OBJECTIVE

Cellular immunity abnormalities are associated with sarcoidosis. Normal cellular immunity is required for adequate humoral immunity; therefore, a decreased humoral immune response is possible in patients with sarcoidosis. We evaluated humoral immunity by vaccinating patients with sarcoidosis against tetanus.

PATIENTS AND METHOD

We screened 60 patients with sarcoidosis (42 females, average age 39 +/- 11 years) and 40 healthy subjects as a control (23 females, average age 38 +/- 9 years). Of the 51 sarcoidosis patients and 33 controls that did not have sufficient tetanus antibody titers, 48 patients and 31 controls agreed to be vaccinated and were included in the vaccination program. Blood serum samples were collected from the subjects before and after vaccination and evaluated for tetanus toxoid IgG antibodies with an enzyme-linked immunosorbent assay (ELISA).

RESULTS

As a result of the vaccination, 24 of the sarcoidosis patients (50%) and 7 of the controls (23%) had insufficient antibody responses (p = 0.019). No relationship was found in sarcoidosis patients between the rate of having sufficient antibody levels and disease duration, activation state, and radiographic staging of the disease. Conversely, mean lymphocyte numbers were significantly lower in patients with insufficient tetanus antibody levels (p = 0.013).

CONCLUSION

Tetanus vaccinations in sarcoidosis patients are less effective than in healthy controls, suggesting that patients with sarcoidosis have a hyporesponsive humoral immune system.

Submillimetric target-registration error using a novel, non-invasive fiducial system for image-guided otologic surgery

OBJECTIVE

Otologic surgery is undertaken to treat ailments of the ear, including persistent infections, hearing loss, vertigo, and cancer. Typically performed on otherwise-healthy patients in outpatient facilities, the application of image-guided surgery (IGS) has been limited because accurate (<1 mm), non-invasive fiducial systems for otologic surgery have not been available. We now present such a fiducial system.

METHODS

A dental bite-block was fitted with a custom-designed rigid frame with 7 fiducial markers surrounding each external ear. The bones containing the ear (i.e., the temporal bones) of 3 cadaveric skulls were removed and replaced with discs containing 13 surgical targets arranged in a cross-hair pattern about the centroid of each ear. The surgical targets (26/skull) and fiducial markers (14/skull) were identified both within CT scans using a published algorithm and in physical space using an infrared optical tracking system. Fiducial registration error (FRE), fiducial localization error (FLE), and target registration error (TRE) were calculated.

RESULTS

For all trials, root mean square FRE = 0.66, FLE = 0.72, and TRE = 0.77 mm. The mean TRE for n = 234 independent targets was 0.73 with a standard deviation of 0.25 mm.

CONCLUSIONS

Using a novel, non-invasive fiducial system (the EarMark), submillimetric accuracy was repeatably achieved. This system will facilitate image-guided otologic surgery.

[Investigation of the effect of efflux pump inhibitors to MIC values of ciprofloxacin in clinical isolates of Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus]

The aim of this study was to investigate the effects of efflux pump inhibitors on the minimal inhibitory concentration (MIC) values of ciprofloxacin (CIP) in fluoroquinolone-resistant 42 Pseudomonas aeruginosa (n= 42), Escherichia coil (n= 97), Acinetobacter baumannii (n= 58) and Staphylococcus aureus (n= 80) strains isolated from clinical specimens. For this purpose phenylalanyl-arginyl-beta-naphthylamide (PA beta N) was used for P. aeruginosa, E. coli, A. baumannii and reserpine for S. aureus isolates as pump inhibitors. Fluoroquinolone resistance of the clinical isolates were determined by VITEK2 Compact (BioMerieux, France) automated system and confirmed with standard broth microdilution method. For the investigation of the effects of inhibitor agents, the MIC values were also determined in the presence of 25 microg/ml and 100 microg/ml PA beta N and 20 microg/ml reserpine. In the presence of 25 mg/l PA beta N, 61.9% of CIP resistant P. aeruginosa strains converted to susceptible ones, while this rate was 73.8% in the presence of 100 mg/l PA beta N. In A. baumannii clinical isolates, 8.6% and 15.5% of CIP-resistant strains have become susceptible in the presence of 25 mg/l and 100 mg/l PA beta N, respectively. Similarly the MIC values for CIP have decreased > or = 4 folds in 42.2%, and > or = 2 folds in 30.9% of E. coli isolates, in the presence of 25 mg/l PA beta N, however, there was no change in MICs of 26.9% of E. coli strains. The MIC values have also been lowered for > or = 4 folds in 83.6%, and two folds in 13.4% of E. coli strains by the use of 100 mg/l PA beta N concentration, however, no decrease in MIC values was detected in 3% of the isolates. 20 mg/l of reserpine have caused a decrease of > or = 4 folds in 8.75%, and two folds in 33.75% of S. aureus isolates, while there was no change in MIC values of 57.5% of S. aureus strains. Our results showed that PA beta N causes significant reduction in MIC values for CIP in the clinical isolates of P. aeruginosa, E. coli and A. baumannii and this effect may be attributed to efflux pump inhibition. In contrast, it was concluded that reserpine does not have a considerable effect on the MIC values of S. aureus against ciprofloxacin.

Identification of frequency and distribution of the nine most frequent mutations among patients with 21-hydroxylase deficiency in Turkey

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders mainly due to defects in the steroid 21-hydroxylase (CYP21A2) gene.

METHODS

To determine the mutational spectrum in the Turkish population, the CYP21A2 active gene was analyzed in 100 unrelated patients with the classical form of 21-hydroxylase deficiency using PCR and RFLP.

RESULTS

Mutations were detected in 78 patients: 64 patients were homozygous for one mutation, seven patients were compound heterozygous with different mutations on each chromosome, two patients were homozygous for two different mutations, five patients were heterozygous, and 22 patients harbored none of the tested mutations. The most frequent mutation was IVS2-13A/C (28.5%), followed by large gene deletion (17%), Q318X (11.5%), I172N (4%), V281L (3.5%), R356W (3.5%), 8-bp (3%), complex alleles (2%), P30L (1%) and E6 cluster (1%).

CONCLUSION

The distribution of mutation frequencies in our study was slightly different from those previously reported in Turkey and in other parts of the world.

Vascular endothelial growth factor gene polymorphisms in Turkish patients with sarcoidosis

Polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is considered to decrease predisposition to sarcoidosis. Our study aimed to investigate the roles of this polymorphism in the development and extent of sarcoidosis. We examined polymorphisms of the VEGF gene in 90 cases with histopathological diagnosis of sarcoidosis and in 110 healthy subjects. VEGF +813 gene polymorphisms were determined using a polymerase chain reaction-based method after DNA isolation. A significant increase in the frequency of the T allele was found in healthy subjects (odds ratio 0.55; 95% confidence interval 0.32-0.97, P<0.05). Our results suggest that increase in rarer T allele at + 813 locus of VEGF gene may diminish susceptibility to sarcoidosis in Turkish population.

Dry eye syndrome in diabetic children

PURPOSE

To compare the symptoms, signs, and results of objective tests for dry eye syndrome (DES) in type 1 diabetes mellitus (T1DM) patients and controls.

METHODS

A total of 104 children with T1DM and 104 age- and sex-matched controls were compared in terms of the symptoms, signs, and results of objective tests for DES. Duration of T1DM, presence of diabetic retinopathy, mean hemoglobin A1c level, pubertal status, and a history of accompanying autoimmune disease were noted in T1DM group. Analysis of variance, multivariate regression analysis, Student t, Mann-Whitney U, and chi-square tests were used for statistical analysis.

RESULTS

A total of 15.4% of diabetic children complained of dry eye symptoms, versus 1.9% of the controls (p=0.029). Dry eye signs were detected in 7.7% of diabetic children, versus 0.96% of controls (p=0.034). Tear break-up time (TBUT) and Schirmer test results were significantly lower in T1DM group than controls (p=0.018, p=0.024, respectively). A total of 7.7% of diabetic children had definite and 0.96% had probable diagnosis of DES, versus none of the controls (p=0.03). TBUT and Schirmer test results were significantly lower in patients with more than 10 years duration of T1DM (p<0.001 for both).

CONCLUSIONS

The prevalence of symptoms, signs, and definite diagnosis of DES are higher and basal tear secretion and tear film stability are lower in diabetic children than controls. Duration of T1DM is the only disease-related variable which is associated with basal tear secretion and tear film stability.

Goldenhar syndrome associated with growth hormone deficiency

Goldenhar syndrome is a rare disorder of unknown etiology. The most frequent findings are vertebral defects, hemifacial microsomia and ear abnormalities. We present an 8-year-old boy with oculo-auriculo-vertebral (Goldenhar) syndrome. He also had a parachute mitral valve and growth hormone deficiency. Parachute mitral valve is a previously unreported finding while growth hormone deficiency was reported just in one case in the literature.

Cerebrospinal fluid total tau protein levels in patients with multiple sclerosis

BACKGROUND

Tau protein is present in the microtubules of axons. Markers of various types have been used to demonstrate multiple sclerosis (MS) activity and axonal damage. This study aimed to demonstrate the association between cerebrospinal fluid (CSF) tau protein concentrations and clinical prognosis in MS patients.

METHODS

We included 45 patients that were diagnosed according to the McDonald's criteria. The control group was made up of 38 patients that had no signs or symptoms related to the primary central nervous system lesion correlated with the patient group. CSF total tau protein was measured using the ELISA method based on the sandwich method with Innogenetics Innotest hTau antigen kit in pg/ml type.

RESULTS

In the patient group, the mean CSF total tau protein level was 238.66 +/- 237.44, whereas it was 93.65 +/- 82.14 in the control group. The mean total tau protein was higher in the three clinical forms when compared with the control group and it was statistically significant (P<0.05).

CONCLUSIONS

High tau protein level may be an early marker of axonal damage and this marker may be used for monitoring axon preventing therapies in the follow-up.

Relationship between embryo quality and aneuploidies

Many high-grade embryos selected for transfer according to their morphological evaluation were detected to have chromosomal abnormalities after aneuploidy screening for infertility by preimplantation genetic diagnosis (PGD). The aim of this study was to detect if there is any correlation between embryo quality and genetic status. The chromosomal status of the day three embryos was studied by multicolour fluorescence in-situ hybridization for chromosomes 13, 18, 21, X and Y. PGD was performed on 132 patients for 1107 embryos. The correlation between embryo quality and aneuploidy was analysed. The analysis showed that a large proportion of normal embryos (50.7%, n = 280) were grade I. In addition, a considerably high proportion of aneuploid embryos (36.1%, n = 83) were evaluated as grade I. There was a significant relationship between PGD results and embryo grades (P = 0.001). Of the 69 polyploid embryos, 21.7% were grade I and 37.8% were grade II. Of the 83 haploid embryos, 27.8% were grade I and 34.9% were grade II. Euploidy was positively related to morphological grade of embryo (P = 0.001). It was also possible for chromosomally abnormal embryos to have a good developmental potential, and they could be selected for embryo transfer unless the PGD procedure was applied.

Two new colorimetric methods for early detection of vancomycin and oxacillin resistance in Staphylococcus aureus

We developed two colorimetric methods for the detection of vancomycin- and oxacillin-resistant Staphylococcus aureus in </=6 h: (i) a nitrate reductase assay and (ii) a resazurin microplate method. MICs agreed with results obtained by CLSI methods for oxacillin. However, detection of vancomycin resistance required a larger inoculum. These methods may be recommended for the detection of vancomycin- and oxacillin-resistant S. aureus.

Blood agar for susceptibility testing of Mycobacterium tuberculosis against first-line drugs

OBJECTIVE

To evaluate the performance of blood agar for the susceptibility testing of 50 Mycobacterium tuberculosis clinical isolates against isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB).

DESIGN

The activity of the drugs was determined by the proportion method on blood agar instead of Middlebrook 7H10 agar according to Clinical Laboratory Standard Institute recommendations. The final concentrations of INH, RMP, SM and EMB were 0.2 microg/ml, 1 microg/ ml, 2 microg/ml and 5 microg/ml, respectively.

RESULTS

The results were compared with the radiometric proportion method as the reference, and the agreements were determined as 100% for INH and RMP, 92% for SM and 96% for EMB. The specificity, sensitivity, positive predictive value and negative predictive value were 90.4% and 97.5%, 100% and 90%, 66.6% and 90% and 100% and 97.5% for SM and EMB, respectively, while these values were 100% for INH and RMP. The results of susceptibility testing were obtained on the 14th day of incubation.

CONCLUSION

According to this preliminary study, our results suggest that blood agar can be used as an alternative medium for the susceptibility testing of M. tuberculosis strains against INH, RMP, SM and EMB in resource-limited countries. However, further studies are needed before implementating the method in diagnostic laboratories.

Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance

In current practice, optimal placement of deep-brain stimulators (DBSs) used to treat movement disorders in patients with Parkinson's disease and essential tremor is an iterative procedure. A target is chosen preoperatively based on anatomical landmarks identified on magnetic resonance images. This point is used as an initial position that is refined intraoperatively using both microelectrode recordings and macrostimulation. In this paper, we report on our current progress toward developing a system for the computer-assisted preoperative selection of target points and for the intraoperative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the preoperative target, of an electrophysiological atlas, and of an intraoperative interface. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information could be used to resolve structures not visible in anatomic images, thus improving both preoperative and intraoperative guidance. Our intraoperative system has reached the stage of a working prototype and we compare targeting accuracy as well as the number of paths needed to reach the targets with our system and with the method in current clinical use.

Minimally invasive, image-guided, facial-recess approach to the middle ear: demonstration of the concept of percutaneous cochlear access in vitro

HYPOTHESIS

Image-guided surgery will permit accurate access to the middle ear via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex.

BACKGROUND

The widespread use of image-guided methods in otologic surgery has been limited by the need for a system that achieves the necessary level of accuracy with an easy-to-use, noninvasive fiducial marker system. We have developed and recently reported such a system (accuracy within the temporal bone = 0.76 +/- 0.23 mm; n = 234 measurements). With this system, image-guided otologic surgery is feasible.

METHODS

Skulls (n = 2) were fitted with a dental bite-block affixed fiducial frame and scanned by computed tomography using standard temporal-bone algorithms. The frame was removed and replaced with an infrared emitter used to track the skull during dissection. Tracking was accomplished using an infrared tracker and commercially available software. Using this system in conjunction with a tracked otologic drill, the middle ear was approached via the facial recess using a single drill hole from the lateral aspect of the mastoid cortex. The path of the drill was verified by subsequently performing a traditional temporal bone dissection, preserving the tunnel of bone through which the drill pass had been made.

RESULTS

An accurate approach to the middle ear via the facial recess was achieved without violating the canal of the facial nerve, the horizontal semicircular canal, or the external auditory canal.

CONCLUSIONS

Image-guided otologic surgery provides access to the cochlea via the facial recess in a minimally invasive, percutaneous fashion. While the present study was confined to in vitro demonstration, these exciting results warrant in vivo testing, which may lead to clinically applicable access.

In vitro assessment of image-guided otologic surgery: submillimeter accuracy within the region of the temporal bone

OBJECTIVES

Application of image-guided surgery to otology has been limited by the need for submillimeter accuracy via a fiducial system that is easily usable (noninvasive and nonobstructive).

METHODS

A dental bite-block was fitted with a rigid frame with 7 fiducial markers surrounding each external ear. The temporal bones of 3 cadaveric skulls were removed and replaced with surgical targets arranged in a bull's-eye pattern about the centroid of each temporal bone. The surgical targets were identified both within CT scans and in physical space using an infrared optical tracking system. The difference between positions in CT space versus physical space was calculated as target registration error.

RESULTS

A total of 234 independent target registration errors were calculated. Mean +/- standard deviation = 0.73 mm +/- 0.25 mm.

CONCLUSIONS

These findings show that image-guided otologic surgery with submillimeter accuracy is achievable with a minimally invasive fiducial frame. Significance In vivo validation of the system is ongoing. With such validation, this system may facilitate clinically applicable image-guided otologic surgery.

EBM RATING

A.

Accuracy of customized miniature stereotactic platforms

In this study, a new system was evaluated for implanting deep-brain stimulators based on a one-piece platform for each trajectory customized from a preoperative planning image. During surgery, the platform is attached to skull-implanted posts that extend through the scalp. The platform acts as a miniature stereotactic frame to provide guidance for parallel cannulas as they are advanced through a burr hole to the target. Accuracy is determined from a postoperative CT. For each implantation, the distance between the position observed in the postoperative image and the position calculated relative to the platform from the preoperative image is our measure of error. Because this measure incorporates the surgical error of electrode anchoring, brain shift between preoperative and postoperative scanning, and error in the measurement of the position of the electrode in CT, it will tend to overestimate the true error. The mean error was 2.8 mm for 20 implantations. These data reflect favorably the accuracy of this system when compared with others.

A novel Fryns "Anophthalmia-plus" syndrome associated with primary hypothyroidism

A novel Fryns "anophthalmla-plus" syndrome associated with primary hypothyroidism: Here, we report a newborn male with "anophthalmia-plus" syndrome and primary congenital hypothyroidism. To our knowledge this is the first case of 'anophthalmia-plus' syndrome associated with congenital hypothyroidism in the literature up to date.

Alterations in serum growth hormone (GH)/GH dependent ternary complex components (IGF-I, IGFBP-3, ALS, IGF-I/IGFBP-3 molar ratio) and the influence of these alterations on growth pattern in female rhythmic gymnasts

BACKGROUND AND AIM

Normal growth in children is regulated to a great extent through the actions of the GH/IGF-I axis, a system consisting of GH and its mediators (ternary complex) that modulate growth in many tissues. The ternary complex (IGF-I/IGFBP-3/ALS) provides an acute regulatory mechanism in which IGF-I may be mobilized from the circulating reservoir of 150 kDa complexes to the tissues. Acute exercise is known to be a stimulus for GH secretion. The beneficial effects of scheduled exercise on body composition are also well established. However, the impact of strenuous exercise on the pubertal development of child athletes is still not well understood. The first goal of this study was to assess the acute effects of high intensity exercise training on GH-dependent ternary complex components in female rhythmic gymnasts compared to age-matched healthy female controls with normal physical activity. The second goal was to explore the influence of these exercise-induced changes on skeletal and pubertal growth in the same group prospectively over a period of 4 years.

SUBJECTS AND METHODS

Seventeen female rhythmic gymnasts, aged 11.4 +/- 0.9 years, who had 10 h per week intense exercise for at least 4 months volunteered to participate in this study. Anthropometric measurement of height (Height SDS for chronological age [HtSDS(CA)], parentally adjusted height, predicted adult height), bone age and weight (BMI) were made using standard techniques in gymnasts and controls (aged 12.5 +/- 3.0 years, n = 12). Gymnasts were followed up to 4 years to observe growth velocity and pubertal progression. In order to determine the acute impact of exercise on levels of GH and GH-dependent ternary complex component (IGF-I, IGFBP-3, ALS, IGF-I/IGFBP-3 molar ratio), blood samples were obtained from gymnasts after a routine 2-h high-intensity training program and then after a 2-day rest period. These results were compared with age-matched controls with no scheduled sports activity.

RESULTS

Despite the significant increment in serum GH and GH-dependent components immediately following the exercise, serum GH/IGF-I levels showed a significant decrement (p < 0.01) after a 2-day rest in gymnasts, to a nadir as low as those of the control subjects' baseline levels (p < 0.01). There was no difference in anthropometric characteristics of gymnasts and controls except BMI; gymnasts were leaner than controls. During a 4-year follow up, there were no differences between the gymnasts and controls in regard to skeletal growth and reaching their predicted height. However, in gymnasts there was a delay in pubertal tempo but not in growth.

CONCLUSION

Intense exercise induces an acute rise in GH levels, but this acute elevation rapidly normalizes after a 2-day rest in female rhythmic gymnasts. These fluctuations in serum GH and GH-dependent ternary complex components had no reflection on the skeletal growth patterns in gymnasts over the 4-year follow up but there was a delay in their pubertal progression.

Remarkable substituent effects on antimicrobial activities of 1,3-diorganylimidazolidinium salts

In vitro antibacterial and antifungal activities of a series of 25 diazolidinium salts, 1,3-diorganylimidazolidinium (1), together with 1,3-dialkylpyrimidinium (2), were evaluated against standard strains: Escherichia coli (ATCC 25922), Staphylococcus epidermidis (ATCC 12228), Staphylococcus aureus (ATCC 29213), Enterococcus faecalis (ATCC 29212), Enterobacter cloacae (ATCC 13047), Pseudomonas aeruginosa (ATCC 27853) and Candida albicans (ATCC 10239). Selective and effective antibacterial activity against one gram-negative (P. aeruginosa) and two gram-positive (E. faecalis and S. aureus) bacteria were found in salts 1a, 1i and 1j, in contrast to modest to poor activity observed in the rest of the salts. The enhanced antibacterial activity is clearly linked to the introduction of two bulky mesityl or mesitylbenzyl substituents on the nitrogen atoms of the imidazoline skeleton, while the side chain of the backbone of the molecule has no influence.

Mutations of the 5alpha-steroid reductase type 2 gene in six Turkish patients from unrelated families and a large pedigree of an isolated Turkish village

We describe six Turkish patients with 5alpha-steroid reductase type 2 deficiency from unrelated Turkish families and a large pedigree of one of these patients who reside north-west of Anatolia. Patients NA, KS, BD and SY presented for evaluation of bilateral inguinal masses with female phenotypes. Patient ABE had penoscrotal hypospadias with male phenotype. Homozygous mutation of the 5alphaSR2 gene was identified in five of these patients by genomic DNA analysis. These mutations were Leu55Gln in exon 1 (in patients FG, BD and ABE), deltaMet157 in exon 3 (in patient NA), and splice junction abnormality in intron 1 (in patient SY). One individual (patient KS) was found to be a compound heterozygous carrier of two different mutations, Leu55Gln in exon 1 and Arg171Ser in exon 3. Patient FG had a large pedigree with the Leu55Gln mutation in exon 1. The pedigree of this family with marital consanguinity is remarkable, and possibly due to the isolation of this family because of economic and social problems. A further 85 individuals belonging to this family were analyzed for exon 1 Leu55Gln mutations in the 5alphaSR2 gene. Forty-two of these 85 individuals (49.41%) had this alteration; 11 were homozygous (8 genetic male, 3 genetic female) and 31 heterozygous (18 genetic male, genetic female) for this mutation. It was interesting to see asymptomatic homozygous female carriers. In conclusion, according to our results and those of other Turkish patients reported by different investigators, 5aSR2 gene mutation analysis, especially for Leu55Gln in exon 1 and deltaMet157 in exon 3, must be carried out in Turkish patients with male pseudohermaphroditism. Homozygous asymptomatic female carriers must be taken into consideration in this clinical entity, especially in a closed population, because of the risk of transmitting the disease to their offspring.

Osteopetrosis, renal tubular acidosis without urinary concentration abnormality, cerebral calcification and severe mental retardation in three Turkish brothers

Deficiency of carbonic anhydrase II (CA II) isoenzyme produces metabolic disorders of bone, kidney and brain. In this report we describe the clinical, radiological, pathological and genetic findings in three brothers who were affected with the autosomal recessive syndrome of osteopetrosis, renal tubular acidosis (RTA) and cerebral calcification. The RTA was hybrid type, but urinary concentration ability was intact. Additional features were severe mental retardation, stunted growth, microcephaly, dental malocclusion, high-arched palate, and broad thumbs. Previous reported patients with this syndrome were predominantly from the Middle East and Mediterranean region. This is the first report with CA II deficiency from the Turkish population. The presence of mental retardation and relative infrequency of skeletal fractures in our patients resembles the clinical course of patients with the Arabic mutation of the CA II gene, but this mutation was not found in our patients.

Hypospadias in a patient with Kabuki make-up (Niikawa-Kuroki) syndrome

A patient showing the typical facies and other signs of Kabuki make-up syndrome (KMS) was also found to have hypospadias, a finding previously reported only once in a patient with KMS.

Association of partial gonadal dysgenesis, nephropathy and WT1 gene mutation without Wilms' tumor: incomplete Denys-Drash syndrome

The concurrence of ambiguous genitalia, nephropathy and predisposition to Wilms' tumor are characteristics of Denys-Drash syndrome. Some of the reported patients do not express the full spectrum of the syndrome, while the occurrence of nephropathy has become a generally accepted common feature of this syndrome. We report an infant with male pseudohermaphroditism due to partial gonadal dysgenesis and nephropathy without Wilms' tumor but with a Wilms' tumor suppressor gene (WT1) mutation. The high risk of Wilms' tumor mandates regular surveillance and the use of prophylactic bilateral nephrectomy as a treatment is not yet clear.

Recombinant human growth hormone treatment in children with thalassemia major

BACKGROUND

To evaluate the growth hormone reserve and the growth hormone response to recombinant human growth hormone (GH) in prepubertal thalassemic children with growth retardation.

METHODS

Twenty thalassemic patients with short stature and delayed bone age were studied. Patients were randomized into GH-treated (n = 10) and non-GH treated (control; n = 10) groups. The GH-treated group received recombinant human (rh)-GH (Genotropin) at the dose of 0.7 IU/kg per week for 12 months.

RESULTS

There was a significant discordance between GH response to pharmacologic stimuli and physiological secretion of GH/GHRH testing. Following the administration of rhGH, growth velocity increased from 2.47 +/- 0.48 cm/year to 6.27 +/- 0.76 cm/year (P = 0.005), whereas there was not a similar change in the non-GH-treated group. The height velocities of the two groups during the 1 year follow-up period were significantly different (6.27 +/- 0.76 vs 3.99 +/- 0.34 cm/year; P = 0.025). There were significant differences between the height velocity improvements and height velocity standard deviation scores of the two groups as well.

CONCLUSION

The present study has demonstrated that rhGH is a safe and efficacious mode of treatment in thalassemic children.

Evaluation of the pancreas reserve in siblings of type I diabetic children

INTRODUCTION

The purpose of this study was to determine the pancreas reserve in siblings of diabetic patients by screening islet cell antibodies (ICA), insulin auto antibodies (IAA), reduced C-peptide levels, first-phase insulin release and the derangement of cellular immunity (reduction of natural killer cells, abnormality of the T cell subpopulations).

METHODS AND RESULTS

Twelve siblings (aged 9.3 +/- 2.8 years) of diabetic children were evaluated and results were compared with the control group (12.1 +/- 3.5 years). For siblings of the diabetic children, fasting, post-prandial and glucagon response C-peptide mean values were 2.2 +/- 1.2, 7.2 +/- 7.1 and 5.3 +/- 3.6 ng/mL, respectively, while in the control group they were 1.5 +/- 0.8, 3.6 +/- 2.0 and 5.1 +/- 2.9 ng/mL, respectively. There were no differences between the two groups. In 33%, postprandial C-peptide, and in 11% of the siblings, glucagon response C-peptide values were exaggerated. In siblings the first phase insulin release (FPIR) during an intravenous glucose tolerance test was 128.5 +/- 96.6 (above the 50th percentile) and stimulated insulin release (SIR) was 103.8 +/- 92.5 (above 25th percentile). Sibling values were significantly lower than the control group (FPIR 152.4 +/- 42.5, P = 0.01; SIR 134.9 +/- 38.2, P = 0.01). Values for FPIR (in two children) and SIR (three cases) were below the 5th percentile. In one, FPIR and SIR levels were both below the 1st percentile. Islet cell antibodies and IAA were also present in this subject. Treatment with nicotinamide was started in the cases with FPIR and SIR below the 5th percentile. We did not observe overt diabetic symptoms during the follow-up period of more than 3 years.

CONCLUSION

We recommend that borderline insulin secretion be tested annually in siblings who show insufficient FPIR.

Investigation of serum minimal inhibitory concentrations of some benzimidazole, imidazole and benzothiazole derivatives and their effects on liver and renal functions

In previous studies many benzimidazole, imidazole and benzothiazole derivatives had been synthesized and their antimicrobial activities were tested in vitro conditions. Four of these compounds showed minimal inhibitory concentrations (MIC) of 5-25 micrograms/ml against standard strains and clinical isolates. In order to determine whether these four compounds can be used for therapeutic purpose, their serum MIC values and side effects on hepatic and renal functions were determined. Different concentrations of the compounds were tested on Wistar rats. Compound 1 was administered orally, intramuscularly and intravenously; compounds 2, 3 and 4 were given orally and intramuscularly. Blood samples were taken 4 and 24 h after administration of the compounds. Serum MIC values were investigated by bioassay and serum levels of biochemical parameters by autoanalyzer. None of the tested compounds showed antimicrobial activity at their serum concentrations. Although creatinine activity was found at normal levels in all experiments, compounds 1 and 2 caused a significant increase in blood urea nitrogen (BUN) level. The values of aspartate aminotransferase and/or alanine aminotransferase and/or alkaline phosphatase which are characteristic for liver function were generally found at high levels. According to these results, it can be concluded that the tested compounds caused damage in liver and biliary tracts without antimicrobial activity by their serum concentrations.

Cardiac involvement in childhood polyarteritis nodosa

In this report, we evaluated the cardiac findings of 15 children with polyarteritis nodosa. The age range of the patients was 4-14 years; with a mean of 10 years. All have had systemic involvement of the disease. The most common findings in cardiac evaluation were diminished left ventricular systolic functions and mild mitral and/or tricuspid valve regurgitation. One patient had pericardial thickening with no effusion. One had sinus tachycardia. There were no signs of myocardial infarction or ischemia clinically or electro-cardiographically. In conclusion, we did not find cardiac complications, such as pericarditis or myocardial infarction, to be as frequent as in previous reports. However, even in asymptomatic patients, systolic dysfunction or valvular involvement were common findings in patients with polyarteritis nodosa, which were not reported previously. These findings may be due to the histological changes of the myocardium or atrioventricular valves. Although these were not severe and fatal lesions, long-term follow-up of these patients with echocardiography may help to determine the course of cardiac involvement.

Synthesis and antimicrobial activity of electron rich olefin derived cyclic ureas

Seventeen cyclic ureas containing imidazolidine and benzimidazoline nuclei were synthesised by the reaction of electron-rich olefins with appropriate group 16 elements. (O, S, Se, Te). The compounds synthesised were identified by 1H, 13C-NMR, FT-IR and mass spectroscopic techniques and micro analysis. All compounds studied in this work were screened for their in vitro antimicrobial activity against standard strains: Enterococcus faecalis (ATCC 29212), Staphylococcus aureus (ATCC 29213), Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 27853). Eight of the compounds were found effective to inhibit the growth of Gram-positive bacteria (Enterococcus faecalis and Staphylococcus aureus) at MIC values between 25-400 micrograms/ml. None of the compounds exhibit antimicrobial activity against gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) at the concentrations studied (6.25-800 micrograms/ml).

Antimicrobial activity of carbene complexes of rhodium(I) and ruthenium(II)

Twenty-four carbene-rhodium(I), carbene-ruthenium(II) complexes and related compounds were evaluated for their in vitro antimicrobial activity against the Gram-positive bacteria Enterococcus faecalis (ATCC 29212) and Staphylococcus aureus (ATCC 29213) and Gram-negative bacteria Escherichia coli (ATCC 25922), Pseudmonas aeruginosa (ATCC 27853). The compounds 1, 2, 3, 5, 7, 8, 9, 16, 18 and 19 were found very effective to inhibit the growth of Enterococcus faecalis and Staphylococcus aureus at the minimum inhibitory concentrations (MICs) of 5, 25, 5, 50, 25, 24, 24, 24, 6.25and 12.5 micrograms/ml, respectively. The compounds 6, 10, 12, 14, 15 and 17 were significantly effective against Enterococcus faecalis and Staphylococcus aureus with MIC values of 100-200 micrograms/ml. The compounds 2, 6 and 11 were also significantly effective against Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa with MIC values of 200-400 micrograms/ml.

Synthesis and antimicrobial activity of substituted benzimidazole, benzothiazole and imidazole derivatives

New benzimidazole, benzothiazole and imidazole derivatives were synthesized by reacting electron-rich olefins (5, 23 and 29) with appropriate reagents. The compounds synthesized were identified by 1H, 13C-NMR, FT-IR and mass spectroscopic techniques and micro analysis. All new and related compounds were evaluated for their in vitro antimicrobial activity against different bacteria. The compounds 17, 18, 19, 20, 21, 22 and 24 were found very effective to inhibit the growth of Enterococcus faecalis (ATCC 29212) and Staphylococcus aureus (ATCC 29213) at minimum inhibitory concentrations (MICs) of 25, 25, 12.5, 50, 25, 50 and 50 micrograms/ml, respectively. The compounds 4, 10a, 10c, 16, 25, 26 and 31 were significantly effective against Enterococcus faecalis (ATCC 29212) and Staphylococcus aureus (ATCC 29213) with MIC values of 100-200 micrograms/ml. None of the compounds proved to be effective against Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 27853) in the concentrations studied.