Resazurin microplate test method for rapid determination of colistin resistance in carbapenem-resistant Acinetobacter baumanii isolates

BACKGROUND

Colistin-resistant Acinetobacter baumannii isolates are extremely important pathogens for hospital-acquired infections.

OBJECTIVE

To investigate the effectiveness of the resazurin microplate assay (REMA) for the rapid determination of colistin resistance.

METHODS

Susceptibility for colistin was investigated in vitro by the broth microdilution method (BMD) and the resazurin microplate assay (REMA) on 106 carbapenem-resistant Acinetobacter baumannii isolates.

RESULTS

The results of both test methods were compared, and the categorical agreement between them was found to be 100%. No minor, major, or very major discrepancy was observed between the 2 methods.

CONCLUSIONS

The most important advantages of REMA are that the results are obtained within 6 hours compared to the reference method, that it is easy to evaluate because it is colorimetric, and that the susceptibility result can be reported to the clinician on the same day as bacterial identification.

Nitrate Reductase Assay for Rapid Determination of Methicillin-Resistant Staphylococcus aureus Clinical Isolates

OBJECTIVE

To evaluate the performance of nitrate reductase assay (NRA), a rapid, colorimetric method for the determination of methicillin resistance in Staphylococcus aureus isolates obtained from the culture collection of the Akdeniz University Hospital Central Laboratory, Antalya, Türkiye.

MATERIALS AND METHODS

Identification for all 290 S aureus isolates at the species level was performed via matrix-assisted laser desorption/ionization-time of flight. Isolates were tested with NRA for methicillin resistance. The cefoxitin broth microdilution (BMD) method recommended by the Clinical and Laboratory Standards Institute was used as the reference method in the study. S aureus ATCC 29213 and S aureus ATCC 43300 strains were used for quality control.

RESULTS

According to Food and Drug Administration criteria, the category agreement between NRA and BMD was found to be 100%. The essential agreement between both methods was determined to be 96.20%. There is no minor, major, or extremely major discrepancy between both methods.

CONCLUSION

The results show that NRA is a rapid, practical, and reliable colorimetric method for detecting MRSA.

In vitro investigation of the effects of high-intensity therapeutic ultrasound (HITU) in glial tumor cell culture

OBJECTIVE

Amidst the evident challenges posed by brain tumors and the evident limitations of conventional treatment methodologies like surgery, radiotherapy, and chemotherapy, our primary objective was to probe the therapeutic potential of high-intensity therapeutic ultrasound (HITU). The aim was to introduce a safer, cost-effective, and efficient alternative to existing treatments, especially beneficial for inaccessible brain tumor sites and resource-constrained medical facilities.

MATERIALS AND METHODS

Leveraging post-1990s MR technology advancements, we employed the non-invasive HITU technique, akin to high-intensity focused ultrasound. This method directs acoustic energy to tissues, primarily inducing coagulation necrosis by absorbing energy and elevating tissue temperatures. Glial tumor cells were subjected to HITU to assess its effects.

RESULTS

Upon applying HITU to glial tumor cells, significant alterations in cellular structural integrity were evident. The main action of HITU was the absorption of acoustic energy, leading to a notable temperature rise and coagulation necrosis. Flow cytometry indicated significant cellular changes post-HITU. ANOVA and t-test analyses showed a significant relationship between HITU application and time (p<0.05). The Shapiro-Wilk test revealed non-normal data distribution (p<0.05), leading to the use of nonparametric methods. The t-test results after HITU displayed significant differences (p<0.05) in cell counts and fluorescence intensity between control and treated groups. This result was consistent across multiple tests, indicating the reliability of the method in causing cellular damage to the tumor cells.

CONCLUSIONS

Our laboratory analyses offer compelling evidence that HITU is not merely feasible but is also a promising non-invasive approach in the treatment paradigm of brain tumors. Standing distinctively apart from radiotherapy, HITU averts early, or late complications commonly associated with the former. While the path ahead mandates comprehensive research to ascertain its clinical utility, preliminary indications firmly posit HITU as a groundbreaking prospect in the management of brain tumors.

The Effect of Inoculum Size on Antimicrobial Susceptibility Testing of Mycobacterium tuberculosis

Phenotypic drug susceptibility testing (DST) requires a standardized amount of inoculum to produce reproducible susceptibility results. The most critical step in the application of DST in Mycobacterium tuberculosis isolates is the preparation of the bacterial inoculum. In this study, the effect of bacterial inoculum prepared in various McFarland turbidities on primary antituberculosis drug susceptibility of M. tuberculosis strains was investigated. Five standard ATCC strains (ATCC 27294 [H37Rv], ATCC 35822 [izoniazid-resistant], ATCC 35838 [rifampicin-resistant], ATCC 35820 [streptomycin-resistant], ATCC 35837 [ethambutol-resistant]) were tested. Inoculums of McFarland standard of 0.5, 1, 2, 3, and 1:100 dilutions of 1 McFarland standard of each strain were used. The effect of inoculum size on DST results was determined by the proportion method in Lowenstein-Jensen (LJ) medium and nitrate reductase assay (NRA) in the LJ medium. In both test methods, the increase in inoculum size did not affect the DST results of the strains. On the contrary, DST results were obtained more rapidly as a result of the use of dense inoculum. DST results obtained in all McFarland turbidities were found to be 100% compatible with the recommended amount of inoculum, 1:100 dilution of 1 McFarland standard (inoculum size of gold standard method). In conclusion, the use of a high amount of inoculum did not change the drug susceptibility profile of tuberculosis bacilli. Minimizing manipulations during the inoculum preparation phase of susceptibility testing, this outcome will decrease the need for equipment and make the test application easier, particularly in developing countries. IMPORTANCE During DST application, it can be challenging to evenly homogenize TB cell clumps with lipid-rich cell walls. These experiments must be carried out under Biosafety Level-3 (BSL-3) laboratory conditions with personal protective equipment and taking safety precautions because the procedures applied at this stage cause the formation of bacillus-laden aerosols and carry a serious risk of transmission. Considering this situation, this stage is important given that it is not possible to establish a BSL-3 laboratory in poor and developing countries. Reducing the manipulations to be applied during the preparation of bacterial turbidity will minimize the risk of aerosol formation. Perhaps there will be no need to do these steps for susceptibility tests in these countries or even in developed countries.

Perspectives on the use of digital health technologies in cardiology among specialists from an ESC member country: results from a survey

Background

Digital health technologies (DHTs) have the potential of facilitating both physicians' and patients' lives with regards to the diagnosis, treatment and follow-up of cardiovascular disease. A huge acceleration in relevant research has been noted particularly after the COVID-19 pandemic.

Purpose

The goal of this study was to determine the reasons for using DHTs in cardiology, as well as the perceived barriers to its use.

Methods

An electronic survey with 43 question multiple-choice questionnaire was conducted between January 10-March 3, 2022. National cardiac society member cardiology fellows in training and specialists were contacted via e-mail (n=2789).

Results

308/2789 (11.04%) subjects responded to the survey (72.40% males, 62.01% aged 30–44 years). 42.53% and 44.81% were affiliated with university hospitals and state hospitals, respectively. 88/297 (29.63%) stated having at least good understanding of DHTs in cardiology. 44.16% utilized smart devices to track their own health status. 117/290 (40.34%) and 193/299 (64.55%) used social media platforms to share medical information with their patients and other physicians, respectively. WhatsApp and Instagram were the most popular platforms for sharing with patients (92/117, 78.63% and 48/117, 41.03%), while WhatsApp and Twitter were the most popular platforms for sharing with other physicians (151/193, 78.24% and 91/193, 47.15%). Considerations and recommendation/utilization patterns of DHTs by physicians are summarized in Table 1. Perceived barriers to the use of DHTs in cardiology is shown on Figure 1 (A: physician-related, B: patient-related, C: technical).

Conclusion

Findings suggest that nearly half of the physicians use DHTs to collect their own health data and use social media to disseminate health information. The majority of physicians believe that DHT is beneficial to both themselves and their patients, and that DHT use in cardiology has increased as a result of the COVID-19 pandemic. To overcome the challenges to the use of DHTs in cardiology, a multilayered collaborative effort involving patient and professional organizations, as well as technical stakeholders and lawmakers, is required.

Funding Acknowledgement

Type of funding sources: None.

Electromechanical changes of the myocardium after anthracycline chemotherapy

Funding Acknowledgements

Type of funding sources: None.

Background and objectives

The most common side effects of chemotherapeutics in breast cancer is on the cardiovascular system. Global longitudinal strain (GLS) is the only parameter recommended for follow-up in current guidelines with limited evidence. Other strain imaging parameters and electrical changes after chemotherapy is not well studied. It is not known whether electrical or mechanical changes occur initially. The aim of this study is to evaluate repolarization parameters on ECG and mechanical changes together after chemotherapy in breast cancer patients.

Subjects and method

Consecutive patients who received chemotherapy due to breast cancer were included. Strain echocardiography and ECGs were performed pre-treatment (T0) and 3rd month after chemotherapy (T2). Additionally, just in three hours of first dose of chemotherapy (T1) another ECG was performed.  QT and QT correction for heart rate (QTc), QT dispersion (QT disp) and QTc dispersion (QTc disp), T wave peak to end time (Tpe) and Tpe corrected for QT-QTc measurements were performed (figüre 1 and 2). GLS, longitudinal strain for myocardial layers, circumferential strain (CS), radial strain (RS) and torsion measurements were performed. All mechanical and electrical parameters from different time intervals were compared.

Results

Thirty-five consecutive patients (35 females, mean age 48.9 ± 11.8 years) who received chemotherapy (mean doxorubicin cumulative dose 415 ± 32 mg/m2) due to breast cancer were included. There was no significant change in mean GLS values before and after treatment (T0 -%18.8 ± 6.82, T1 18.6 ± 3.5 p = 0,863 respectively). However, there was a significant decrease in CS, RS and torsion (T0 -%17,2 ± 3,5, T1-%13 ± 2,84 p &lt;0,001, T0 %45,1 ± 8,3, T1 %35,6 ±10 p &lt;0,001 and T0 %12,1 ± 3.5, T1 %7.7 ± 2.1 p &lt;0,001, respectively). QT, QTc, QTc disp and Tpe, Tpe/QTc parameters were prolonged just after chemotherapy and were still prolonged 3 months after ((QTc: T1 440.01 ± 27.63, T2 468.00 ± 38.98, T3 467.86 ± 35.09), (QTc disp T1 55.48 ± 20.22, T2 78.59 ± 16.15, T3 66.16 ± 14.62), (Tpe (QTc) T1 104 ± 18.52, T2 148.62 ± 19.16, T3 139.77 ± 21.63), (Tpe/QTc T1 0.213 ± 0.05, T2 0.281 ± 0.08, T3 0.258 ± 0.06).

Conclusion

  Electrical and mechanical functions of the heart could be impaired together acutely even three months after doxorubicin chemotherapy. Cardio toxicity should be evaluated in terms of both electrically and mechanically.

Abstract Figure. ECG repolarization parameters

P174 Left atrial myxoma presenting in a cystic form

Background

Early diagnosis of atrial myxomas may be a challenge because of their synptoms are often nonspecific. Two-dimensional echocardiography is the diagnostic procedure of choice.

Case presentation

A 42-year-old woman presented with complaints of palpitation and fatigue. Physical examination revealed a diastolic murmur at the apex. Two-dimensional transthoracic echocardiography revealed an extremely mobile mass in the left atrium that consisted of multiple cystic and solid parts. Three-dimensional transesophageal echocardiography showed that the 4.3x3.3 cm mass was connected to the interatrial septum through a 0.7 cm pedincle, and it moved between the atrium and the ventricle through the mitral valve with each carciac cycle. Grade 1 mitral and aortic regurgitation and grade 3 tricuspid regurgitation was accompanied by a SPAP of 90 mmHG. The mass was surgically excised. Histopathologic diagnosis was myxoma.

Discussion

Types of cystic masses that can appear in the left atrium are myxomas, hydatid cysts and interatrial septal aneurysms. In our case report, echocardiographic findings of a mass that was connected to the IAS with a pedicle were supportive of cardiac myxoma. If not removed, myxomas may cause major complications like stroke, rupture, and hemodynamic problems. Surgery was indicated because the mass was cystic and highly mobile.

Abstract P174 Figure. mass

P650 A rare form of cardiac mass: primary cardiac lymphoma

Funding Acknowledgements

We declare no conflict of interest and no financial support

A rare form of cardiac mass

primary cardiac lymphoma

Introduction

Primary tumors of the heart are rare and constitute 5% of all cardiac masses. Primary cardiac lymphoma is a curable form of cancer that responds well to early diagnosis and chemotherapy.

Case report

56 year old male patient presented to our outpatient clinic with abdominal swelling. Echocardiography revealed a mass lesion that surrounded the right ventricle and restricted ventricular diastolic function. The mass lesion was poorly discernable from normal myocardial tissue. Magnetic resonance imaging (MRI) showed an infiltrative mass lesion that filled the right pericardial space, and that surrounded the junction between vena cava superior and the right atrium, as well as the root of the aorta. Subxyphoidal biopsy revealed diffuse large B cell lymphoma. Patient died on the 10th day of chemotherapy.

Discussion

Primary cardiac lymphoma constitutes only 2% of all primary cardiac tumors. Cardiac lymphomas are curable in early stages with chemotherapy without the need for surgical excision. Cardiac lymphoma should be kept in mind when faced with a cardiac mass lesion and imaging modalities such as MRI and PET scanning and tissue biopsy should be utilized before planning surgical interventions since these lesions respond well to chemotherapy

Abstract P650 Figure.

P256 Takotsubo syndrome early after treatment due to non cardiotoxic chemotheraphy agents

Case report

A 65 years old female attended emergency department with epigastric pain after chemotherapy. She had vinorelbine and gemcitabine treatment for malignant urotelial renal carcinoma. The patient was consulted with cardiology department, because of progressive high troponin T levels. She had no prior history except urotelial carsinoma for one year and hypertension for seven years. Her prior chemotherapy protocols included carboplatine and docetaxel. She did not describe typical angina pectoris or shortness of breath.

Electrocardiography (ECG) at admission had symmetrical T wave inversion on precordial derivations (figure 1). Echocardiography (echo) showed typical apical ballooning of the left ventricle (figure 2 and 3). We do not know the patient’s prior cardiac performance and acute coronary syndrome and Takotsubo syndrome were our preliminary diagnosis. Normal coronary arteries were seen on coronary angiography, ventriculography revealed apical ballooning movement of the left ventricle (Figure 4) and this supported our diagnosis as Takotsubo syndrome. She was already on valsartane 160 mg daily for hypertension and we included metoprolol 50 mg daily and enoxoparine 6000 IU s.c twice a day. For several days deep symmetrical T wave inversion persisted on ECG. After third day her ECG changings resolved (Figure 5) and echo images had recovered. The patient was discharged uneventfully and is followed.

Abstract P256 figures

P3140Burden and the clinical significance of the retained cardiac implantable electronic device components after heart transplantation

Background

Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Frequency and clinical significance of retained CIED components after HT is not well studied.

Methods

Adult heart failure patients whom had heart transplantation in our institution from date June 2000 to December 2018 were retrospectively evaluated. Pre-post operative chest x-rays and recorded fluoroscopy images of the previous coronary angiograms or endomyocardial biopsies were reviewed by a single observer for retained CIED components. All patients clinical records were also reviewed for adverse outcomes of retained components such as deep venous thrombosis of upper extremity, infection and mortality.

Results

A total of 226 patients had bicaval orthotopic heart transplantation during study time. 73 (32%) of the patients had CIED before transplantation and 24 (32.8%) of the patients had retained lead components after HT. (Table 1) All of the components were part of a superior vena cava coil of the right ventricular ICD lead. Mean follow up time was 46.6±49.8 months and only 1 (1.3%) adverse event (right subclavian DVT) occurred in a patient with retained lead. There were not any statistical significance for mortality and infection between patients with and without lead fragments. Patients were also compared for history of any cardiac surgery before HT, especially ventricular assist device procedures and no differences were observed between groups.

For history of any cardiac surgery p=0.748, for assist device surgery, p=0.269). Patient's medical records reviewed for a history of magnetic resonance imaging (MRI). Two patients with retained lead fragments had non-thorocic (abdominal and cranial) MRI and any clinical pathology did not observed after MRI.

Table 1 All Patients With Retained CIED comp. Without Retained CIED comp. p (n=226) (n=24) (n=49) Age ± sd 42.91±12.2 44.88±12.6 41.59±13 0.290 Ischemic etiology 65 (28.8%) 8 (33.3%) 13 (26.5%) 0.546 CIED type   CRT-D 5 (20.8%) 5 (%10.2) 0.215   DR-ICD 5 (20.8%) 8 (16.3%) 0.636   VR-ICD 14 (58.3%) 35 (71.4%) 0.263 Dual coil ICD lead 24 (100%) 48 (97%) 1 Mortality (%) 96 (42.5) 7 (37%) 20 (40.8%) 0.463

Conclusion

Retained CIED components were seen 32.8% of the HT patients with CIED prior to transplantation. According to our data retained leads are not associated with severe adverse clinical outcomes. Also non cardiac MRI could be safe in patients with retained lead fragments.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer

OBJECTIVES

NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer.

METHODS

This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation.

RESULTS

There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels.

CONCLUSION

In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis.

EVALUATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN A PAEDIATRIC INTENSIVE CARE UNIT

Background

Relative adrenal insufficiency (RAI) is the inadequate production of cortisol due to dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis during a severe illness. We evaluated the HPA axis and RAI in a tertiary pediatric intensive care unit (PICU).

Methods

A total of 100 PICU patients were included in this prospective cohort study. Basal serum levels of adrenocorticotropic hormone (ACTH), cortisol values were compared with those in the control group. A low-dose ACTH stimulation test was performed in patients with basal cortisol levels below 18 µg/dL.

Results

The basal cortisol levels of the PICU patients were significantly higher than those of the control group (P < 0.05). All tested patients (n= 24) had delta cortisol levels > 9 µg/dL and a peak cortisol response > 18 µg/dL. Basal cortisol levels were positively correlated with Pediatric Risk of Mortality (PRISM) III scores (P < 0.05; r = 0.363). The basal or stimulated cortisol levels of the patients who received glucocorticoid treatment were higher than the cut-off levels.

Conclusions

High basal or stimulated cortisol levels are indicative of disease severity in the acute phase of stress. Patients with very high cortisol levels should be particularly carefully monitored because of the high mortality risk.

Low Density Polypropylene/Waste Cellulose Fiber Composites by High-Shear Thermo-Kinetic Mixer

Achieving an appreciable weight reduction in PP based composite materials, particularly the ones reinforced by glass fibers, is quite challenging while enhancing their mechanical properties and fullfilling other enviromental concerns. To address this issue, low density composites of Poly(propylene) (PP) and waste cellulose fibers (WCF) were produced by high-shear thermo-kinetic mixer. This technique facilitates the ease of processing for the mass production of such composite materials due to the availability of high shear rates and relatively short processing times during manufacturing. The structure-property behavior of the molded samples was investigated as a function of WCF content. Briefly, one-fold increase in elastic modulus, 18 % increase in tensile strength, 87 % increase in flexural modulus and 27 % increase in flexural strength of PP were achieved by the addition of 30 wt.% WCF. The significant enhancements in mechanical properties were mainly attributed to the homogeneous dispersion of intrinsically stiff WCF filler in the PP matrix as a direct result of the high-shear mixing. These results mainly suggest that waste cellulose fibers can be used as an effective reinforcing agent in PP matrix instead of highly dense, non-renewable and non-biodegradable fibers, such as glass fibers, that prevents further stresses on the environment. Along with this, the reuse of waste cellulose fiber in PP matrix, particularly at high concentrations like 30 wt.%, evenly corresponds to the reduction of total PP consumption for PP based composite production. The main conclusion of the study is that the extensive blending technology gives us the ability to produce high performance thermoplastic based composite materials as well as addressing the world-wide waste disposal problem by reusing of natural wastes, which is a great opportunity to ensure sustainability and reduce enviromental and economical costs for many industries.

Caspase-mediated Apoptotic Effects of Ebenus boissieri Barbey Extracts on Human Cervical Cancer Cell Line HeLa

Background:

Ebenus boissieri Barbey is an Antalya, Turkey-endemic plant belonging to Fabaceae family. The aerial parts and the roots of E. boissieri Barbey were used in this study.

Objective:

In the present study, we have examined the apoptotic effects of hydroalcoholic extracts of E. boissieri Barbey in human cervical cancer cell line HeLa.

Materials and Methods:

To determine the cytotoxic effect, cells were treated with various concentrations of extracts for 24, 48, and 72 h incubation periods. Cytotoxic effects were examined by Cell Titer 96 aqueous nonradioactive cell proliferation assay and the results were corrected by live/dead viability/cytotoxicity assay and trypan blue exclusion assay. Apoptotic effects were studied with multicaspase kit. Tumor necrosis factor-alpha (TNF-α) and interferon gamma (IFN-γ) release were also measured by enzyme-linked immunosorbent assay.

Results:

According to the results, E. boissieri Barbey extract caused significant increase in caspase levels. Thus, we suggest that the extract induces cells to undergo apoptosis. Especially, there was a sharp induction in caspase-3 activity. Levels of both TNF-α and IFN-γ in extract-treated groups were significantly and dose dependently exalted as compared to their relative controls.

Conclusion:

The effects of the extract on caspase-3, TNF-α, and IFN-γ levels mediate the plausible mechanism of apoptosis induction in HeLa. To the best of our knowledge, this is the first report indicating any pharmacological properties of E. Boissieri on HeLa cells.

SUMMARY

HeLa cell viability was reduced in dose-dependent manner for 72 h with an IC50 of approximate 28.03 μg/mL for aerial and 41.02 μg/mL for root

HeLa cells, exposure to the aerial extract led to 1.9, 3.8, 1.2, 2.4, and 3.45 fold induction of all caspases activities (-2, -3, -6, -8, and -9, respectively)

Both 30 μg/mL of aerial and 45 μg/mL of root extracts allowed the production of anticancer cytokines (TNFalpha; IFNgamma) in HeLa cell culture supernatants.

Abbreviations used: Tumor necrosis factor-alpha (TNF-α); Interferon gamma (IFN-γ); 3-(4, 5 dimethylthiazol-2-yl)-5-(3- carboxymethoxy-phenyl)-2-(4-sulfonyl)-2H-tetrazolium (MTS); Phosphate-Buffered Saline (PBS); Fetal Bovine Serum (FBS); para-Nitroanilin pNA; Enzyme-Linked ImmunoSorbent Assay (ELISA); Sodium Dodesyl sulphate –Polyacrilamide gel electrophoresis (SDS-PAGE); Tris-Buffered Saline (TBS); Hydocloric acid (HCl); Standart Error of Mean (SEM); National Cancer Institute (NCI); half maximal inhibitory concentration (IC₅₀)

Exciton Emission Intensity Modulation of Monolayer MoS2 via Au Plasmon Coupling

Modulation of photoluminescence of atomically thin transition metal dichalcogenide two-dimensional materials is critical for their integration in optoelectronic and photonic device applications. By coupling with different plasmonic array geometries, we have shown that the photoluminescence intensity can be enhanced and quenched in comparison with pristine monolayer MoS2. The enhanced exciton emission intensity can be further tuned by varying the angle of polarized incident excitation. Through controlled variation of the structural parameters of the plasmonic array in our experiment, we demonstrate modulation of the photoluminescence intensity from nearly fourfold quenching to approximately threefold enhancement. Our data indicates that the plasmonic resonance couples to optical fields at both, excitation and emission bands, and increases the spontaneous emission rate in a double spacing plasmonic array structure as compared with an equal spacing array structure. Furthermore our experimental results are supported by numerical as well as full electromagnetic wave simulations. This study can facilitate the incorporation of plasmon-enhanced transition metal dichalcogenide structures in photodetector, sensor and light emitter applications.

Elevated neutrophil-lymphocyte ratio in patients with euthyroid chronic autoimmune thyreotidis

OBJECTIVE

The neutrophil-lymphocyte ratio (NLR), determined from peripheral blood, is accepted as an available and practical indicator of the systemic inflammation. In this study, we aimed to determine whether the NLR was higher in euthyroid chronic autoimmune thyreotidis (CAT) patients compared to a healthy control group.

METHODS

A total of 112 patients were enrolled in this study, including 59 patients with euthyroid CAT on any form of therapy and 53 healthy controls. Th e CAT patients were similar in age to the healthy control group (mean 33.9±12.8 years versus 30.2±12.4 years, p=0.10). Measurements were available for the white blood cells (WBC), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), thyroid peroxidase immune antibody (anti-TPO), and anti-thyroglobulin immune antibody (anti-TG). The NLR and platelet-lymphocyte ratio (PLR) were calculated. Differences between the CAT and control groups were tested using the student's t-test and the correlations were determined using Pearson's correlation coefficients.

RESULTS

There were no differences between the CAT and control groups for WBCs (7.9±0.3 and 7.4±0.2, respectively; p=0.1) or neutrophils (5.5±0.3 and 5.4±1.1; p=0.9), but lymphocytes were higher in the CAT group (3.1±0.5 vs. 2.04±0.1; p=0.05) as was the NLR (4.0±0.7 vs. 2.0±0.1; p=0.01). Th e NLR was positively correlated with CRP (r=0.6, p<0.001), anti-TPO (r=0.3, p<0.001), anti-TG (r=0.3, p=0.006), WBCs (r=0.4, p<0.001), and the PLR (r=0.73, p<0.001). The PLR was also higher in the CAT than the control group (p=0.02).

CONCLUSIONS

In this study, we found that NLR values were higher in euthyroid CAT patients than in a healthy control group and that NLR correlated with autoantibodies used to diagnose the disease.

Cytotoxic and immunomodulatory effects of Ebenus boissieri Barbey on breast cancer cells

We aimed to determine the cytotoxic and immunomodulatory effects of hydroalcoholic extracts of the roots and aerial parts of Ebenus boissieri (EB) on breast cancer MDA-MB231 cells and the non-cancerous human embryonic kidney cell line, 293T. Cell viability was determined by MTT assay, trypan blue exclusion, and Live/Dead Viability/Cytotoxicity assay. Apoptosis was evaluated by measuring the activity of caspase-2, 3, 6, 8, and 9. Tumor necrosis factor (TNF)-α and interferon (IFN)-g release was assayed by ELISA, and protein expression of caspase-3, TNF-a, and IFN-g was determined by western blot. The results of this study revealed that MDA-MB231 cell viability was reduced in a dose-dependent manner by the aerial and root extract of EB at 72 h with a half-maximal inhibitory concentration (IC50) of 41.1 ± 2.76 and 65 ± 1.09 μg/mL, respectively. In contrast, neither the aerial nor the root extracts of this plant inhibited the proliferation of 293T cells at doses up to 1000 μg/mL. There was a time-dependent increase in caspase activity, especially caspase-3 and caspase-9. The levels of TNF-aand IFN-g significantly increased in MDA-MB231 cells treated with aerial extract. In conclusion, the extracts of EB induced apoptosis in breast cancer cells by altering the levels of caspases, TNF-a, and IFN-g. The components and precise modes of action of EB have not yet been determined. However, potential antitumor and immunomodulatory activity was observed along with selectivity against cancer cells in vitro, suggesting that hydroalcoholic extracts of this plant are worthy of additional study.

Cytotoxic and apoptotic effects of Ebenus boissieri Barbey on human lung cancer cell line A549

Background:

Fabaceae family members are known to possess preventive and therapeutic potentials against various types of cancers.

Objective:

The aim of this study was to investigate the cytotoxic and apoptotic effects of hydroalcoholic extracts from the aerial parts and roots of an endemic Ebenus species; Ebenus boissieri Barbey in human lung cancer cell line.

Materials and Methods:

After treatment with hydroalcoholic extracts cytotoxic activities of both extracts were measured by 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide assay, whereas caspase-3 activity, tumor necrosis factor-a lpha (TNF-α) and interferon gamma (IFN-γ) releasewere measured by enzyme linked immunosorbent assay.

Results:

According to in vitro assay results, the increase in all caspases activity suggested that extracts induce cells to undergo apoptosis. Especially, induction in caspase-3 activity was the most remarkable result of this study. Both aerial part and root extracts induced apoptosis by increasing caspase-3 activity, TNF-α and IFN-γ release. When compared to their relative controls, the concentrations of both TNF-α and IFN-γ in extract-treated groups were significantly and dose dependently exalted.

Conclusion:

Taken together, our results indicate that the hydroalcoholic extracts of E. boissieri can be considered as a source of new anti-apoptotic and therefore anti-carcinogenic agent.

Idiopathic scrotal calcinosis in a case who presented 20 years after the initiation of symptoms: a review of the literature

Idiopathic scrotal calcinosis (ISC) is characterised by the presence of multiple firm scrotal nodules of unknown or controversial etiology. It is a rare, yet benign, entity of the scrotal skin. However, it affects the quality of life of the patients. Here, we describe a case report of ISC in a 50 year-old male patient with a 20 year-history of symptoms. Despite the delayed diagnosis, patient was treated with surgical excision succesfully. No recurrence has been seen by the end of the 3 years of follow-up. We also reviewed the literature.

Operative hysteroscopy preserving virginity: a new technique

OBJECTIVE

To present a new technique of virginity-preserving operative hysteroscopy in the treatment of intrauterine pathologies.

MATERIALS AND METHODS

The details of operative hysteroscopy in which the hymenal orifice was left intact to preserve virginity are presented. The technique briefly involved the following steps: holding the cervix with a tenaculum and its traction to the immediate posterior hymenal opening with use of office hysteroscopy, which was then followed by operative conventional hysteroscopy.

RESULTS

The technique was performed successfully in all patients with an annular hymenal morphology. The technique enabled complete resection of intrauterine pathologies in all cases. There was no case of inadvertent hymenal injury during the procedure.

CONCLUSION

The presented technique, makes it possible to easily treat intrauterine pathologies while preserving the hymen. It can be preferred in groups of patients in whom it is necessary to preserve virginity.

Association between family history and clinicopathologic characteristics in 1987 breast cancer patients: single institution experience from Turkey

PURPOSE

To evaluate the clinicopathologic characteristics and survival of patients with family history of breast/ ovarian cancer (FHBOC).

METHODS

In this study with 1987 breast cancer patients, we analyzed their tumor characteristics and outcomes, as well as the total number, degree and age of affected relatives, and their type of cancer. Results were assessed using Pearson chi-square test, Kaplan-Meier method and Cox regression analysis.

RESULTS

24.1% (n=479) of the patients had FHBOC. Patients with FHBOC were younger (47.7 vs. 49.1 years; p=0.03) and tended to have node-negative breast cancer (45.4 vs. 39.8%; p=0.006). The median overall survival (OS) was shorter in patients with FHBOC with a borderline p-value (p=0.063), compared to patients with no family history. The median OS was shorter in patients who had ≥ 2 relatives with breast cancer (p=0.014), in those having first degree relatives with breast cancer, presenting with metastatic disease (p= 0.020). FHBOC patients with triple negative breast cancer had the highest risk of death (p<0.0001) and recurrence (p<0.0001). Patients who had at least one relative with breast cancer aged ≤ 50 years were also at increased risk of recurrence (p7equals;0.006).

CONCLUSION

Our results suggest that patients with FH7horbar;BOC are younger, tend to have small tumor size, node-negative disease and their survival is shorter compared to patients without family history. This is the first study evaluating the clinicopathologic differences of patients with and without FHBOC in Turkish population.

Utility of ApoB/ApoA1 ratio for the prediction of cardiovascular risk in children with metabolic syndrome

OBJECTIVE

To assess whether apoB/apoA1 ratio is associated or not with metabolic syndrome in obese children.

METHODS

A 198 obese children and 41 healthy control subjects were enrolled in a cross-sectional study. The apoB/apoA1 ratio and other metabolic syndrome components in obese children with/without metabolic syndrome were compared to healthy controls.

RESULTS

The apoA1 level did not show significant difference (p = 0.664) but apoB level (p = 0.000) and apoB/apoA1 ratio (p = 0.001) were significantly higher in obese group than in control group. Also, the apoB/apoA1 ratio was significantly higher in obese children with metabolic syndrome when compared to obese children without metabolic syndrome (p = 0.007) and showed positive correlation with triglyceride (r = 0.404, p = 0.000) and negative correlation with high-density lipoprotein cholesterol (r = -0.593, p = 0.000).

CONCLUSIONS

The apoB/apoA1 ratio is associated with metabolic syndrome in obese children. An elevated apoB/apoA1 ratio may constitute an important feature of the metabolic syndrome. There is a need for long term follow-up studies concerning cardiovascular risk in obese children with metabolic syndrome and high apoB/apoA1 ratio.

The prevalence of overweight and obese children aged 6-17 years in the West Black Sea region of Turkey

OBJECTIVE

To assess the prevalence of overweight and obese Turkish children.

DESIGN

Cross-sectional study in school children.

SUBJECTS

A total of 6924 children (3281 boys and 3643 girls) aged 6-17 years from the West Black Sea region of Turkey.

MEASUREMENTS

Overweight and obese were defined using international age- and sex-specific cutoff points for body mass index. The data were analysed by age, sex, residence and socioeconomic level.

RESULTS

The overall prevalence of overweight and obesity was 10.3% and 6.1% respectively. The overall prevalence of obesity in boys and girls was 7.0% and 5.4%, respectively, and the difference was significant (chi(2) = 8, p = 0.004). The prevalence of obesity in urban and rural areas was 7.7% and 3.9%, respectively, and the difference was significant (chi(2) = 40, p < 0.001). The prevalence of overweight boys and girls in urban areas was 11.6% and 13.2%, respectively, but the difference was not significant (chi(2) = 2, p > 0.05). However, the prevalence of overweight boys and girls in rural areas was 4.8% and 9.4%, respectively, and the difference was significant (chi(2) = 25, p < 0.001). Although the prevalence of obesity differed significantly between boys and girls in urban children (chi(2) = 13, p < 0.001), no significant difference was detected in the prevalence between boys and girls from rural areas (chi(2) = 0.4, p > 0.5). The prevalence of obesity was significantly higher in private schools than in public schools (chi(2) = 48, p < 0.0001). The prevalence of overweight and obese Turkish children aged 6-17 years is considerably lower than in most European countries. The children in urban settings and higher socioeconomic groups had a higher prevalence of overweight and obesity. The Westernisation of the behaviour patterns of children and living in an urban setting in a developing country are risk factors for obesity.

Experimental measurement of the dispersion relations of the surface plasmon modes of metal nanoparticle chains

The dispersion relations of the surface plasmon modes of metal nanoparticle chains are measured, and compared with theory. The theoretical model includes the effects of retardation, radiative damping and dynamic depolarization due to the finite size of the nanoparticles. The results reveal that, in addition to one longitudinal and one transverse mode, there is a third mode, which has not been previously reported.

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus

OBJECTIVE

Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM).

METHODS

Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups.

RESULTS

The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT.

CONCLUSION

Women with GDM have increased CIMT compared with unaffected women.

Gastrointestinal stromal tumors presenting as pelvic masses: report of two cases

We present two cases of gastrointestinal stromal tumors (GISTs) that presented as pelvic masses. These tumors can present diagnostic problems and they may be difficult to discover preoperatively. GISTs are neoplasms that can be diagnosed utilizing immunohistochemistry, especially detecting CD117 (c-kit) reactivity along with associated histological features. GISTs, should be considered in the differential diagnosis of ovarian tumors especially when imaging studies and rectovaginal examination findings are inconclusive and vague. Histologic diagnosis of these tumors are important considering the efficacy of tyrosine kinase inhibitor therapy after surgery in such cases.

Neonatal screening for congenital hypothyroidism in West Black Sea area, Turkey

The aim of this study was to investigate the incidence of congenital hypothyroidism (CH) in the West Black Sea Area, a mild-to-moderate iodine deficient area in Turkey. Neonatal screening for CH was performed using blood specimens collected onto filter paper. Thyrotropin [thyroid-stimulating hormone (TSH)] was measured by radioimmunoassay, and a value >20 microU/ml was considered as cut-off point for re-examining. Venous serum was obtained to measure TSH, thyroxin (T4), free T4 (FT4) and thyroglobulin (TG). To determine the iodine status of the study area, median urinary iodine was measured in 212 randomly selected neonates and their mothers. A total of 18606 neonates were screened from three cities (Bolu, Düzce, and Zonguldak) between 2000 and 2002. With a cut-off point of TSH value >20 microU/ml, the recall rate was found 1.6%. Eight cases of CH were diagnosed (incidence 1/2326). There were three cases of transient hypothyroidism, with an incidence of 1/6202. Twenty-six percent of the TSH values was greater than 5 microU/ml. Median urinary iodine concentrations in neonates and their mothers were 85 microg/l and 40 microg/l, respectively. The incidences of CH, transient hypothyroidism and the recall rate were higher in our study area than many countries in Europe. The study area has been affected by mild-to-moderate iodine deficiency. Neonatal screening for CH should be introduced in Turkey without delay. A national comprehensive infantile hypothyroidism and iodine prophylaxis policies should be developed.

Wolfram (DIDMOAD) syndrome: a multidisciplinary clinical study in nine Turkish patients and review of the literature

AIM

To study Wolfram syndrome (WFS) with multidisciplinary consultations and compare the results with the literature.

METHODS

Nine patients fulfilled the ascertainment criteria of WFS (insulin-dependent diabetes mellitus and optic atrophy). All patients were evaluated by the departments of paediatrics, ophthalmology, audiology, urology and medical biology.

RESULTS

The earliest manifestation of WFS was insulin-dependent diabetes mellitus (at a median age of 6.9 y), followed by optic atrophy (8.9 y), diabetes insipidus (10.2 y) and deafness (10.5 y). Short stature was found in five cases, delayed puberty in two cases and hypergonadotropic hypogonadism in one case. Audiography disclosed hearing loss at high frequency in all patients (100%), but only five patients had clinical subjective hearing problems. Intravenous pyelography revealed hydroureteronephrosis in eight patients. Urodynamics revealed a normal bladder in only one patient. Three patients had a low-capacity, low-compliance bladder, detrusor external sphincteric dyssynergia and emptying problem, while five had an atonic bladder. Ocular findings were optic atrophy, low visual acuity and colour vision defects. Visual field tests revealed concentric and/or peripheral diminution in five patients. Visual evoked potentials were abnormal (reduced amplitude to both flash and pattern stimulation) in seven patients. Cranial magnetic resonance imaging showed mild or moderate atrophy of the optic nerves, chiasm, cerebellum, basal ganglia and brainstem in six patients; there was a partially empty sella in one case. There was no evidence of mitochondrial tRNA(Leu) (UUR) A to G (nucleotide 3243) mutation.

CONCLUSION

Wolfram syndrome should be evaluated in a multidisciplinary manner. Some specific and dynamic tests are necessary to make a more precise estimate of the prevalence and median age of the components of WFS. Short stature is a common feature in WFS. Hypogonadism may be hypogonadotropic or hypergonadotropic. Bladder dysfunction does not always present as a large atonic bladder in WFS. A low-capacity, high-pressure bladder with sphincteric dyssynergia is also common.

Prognostic significance of apoptotic index and bcl-2 and p53 expression in epithelial ovarian carcinoma

PURPOSE OF THE STUDY

To determine if bcl-2 and p53 expression, and apoptotic index (AI) were associated with patient outcome in epithelial carcinomas of the ovary (EOC) and therefore useful as prognostic factors to predict survival.

METHODS

A total of 50 women with epithelial carcinomas of the ovary were retrospectively analyzed. The archival paraffin-embedded material of of these cases were evaluated for expression of p53 and bcl-2 by immunohistochemical techniques. Apoptotic cells were detected with an in situ hybridisation method.

RESULTS

A total of 33 (66%) of 50 cases showed positive immunoreactivity for the p53 antibody. Twenty-four of the 50 cases showed positive bcl-2 protein expression. Median value for AI was found to be 2.48. No statistically significant association was found between bcl-2 and p53 expression and clinicopathologic features. Univariate survival analysis of AI failed to reveal any effect on prognosis in the study population.

CONCLUSION

We found neither p53 nor bcl-2 immunoreactivity to be of prognostic significance in patients with EOC. In addition, AI was not found to be an independent prognostic factor.