Carbon capture in polymer-based electrolytes

Nanoparticle organic hybrid materials (NOHMs) have been proposed as excellent electrolytes for combined CO2 capture and electrochemical conversion due to their conductive nature and chemical tunability. However, CO2 capture behavior and transport properties of these electrolytes after CO2 capture have not yet been studied. Here, we use a variety of nuclear magnetic resonance (NMR) techniques to explore the carbon speciation and transport properties of branched polyethylenimine (PEI) and PEI-grafted silica nanoparticles (denoted as NOHM-I-PEI) after CO2 capture. Quantitative 13C NMR spectra collected at variable temperatures reveal that absorbed CO2 exists as carbamates (RHNCOO- or RR'NCOO-) and carbonate/bicarbonate (CO32-/HCO3-). The transport properties of PEI and NOHM-I-PEI studied using 1H pulsed-field-gradient NMR, combined with molecular dynamics simulations, demonstrate that coulombic interactions between negatively and positively charged chains dominate in PEI, while the self-diffusion in NOHM-I-PEI is dominated by silica nanoparticles. These results provide strategies for selecting adsorbed forms of carbon for electrochemical reduction.

Association between body composition and mortality in patients requiring extracorporeal membrane oxygenation support

AIM

To ascertain the association between body composition, including muscle mass and adiposity, and patient mortality in those requiring extracorporeal membrane oxygenation (ECMO) for acute respiratory failure.

MATERIALS AND METHODS

A retrospective study was undertaken of all patients with acute respiratory failure requiring veno-venous (VV) ECMO between January 2015 and December 2019. Automated image segmentation software was used to quantify the cross-sectional area and average radiodensity (in Hounsfield units) of different muscle and fat compartments at the L3 level of whole-body computed tomography (CT) images taken within 48 h of initiation of ECMO support. The primary endpoint was 30-day post-ECMO initiation all-cause mortality. Logistic regression was used to analyse the correlation between CT measurements, co-morbidities, and 30-day survival.

RESULTS

The study included 189 patients (age = 43.8 ± 14.6, sex = 42.3% female). There was no significant association between 30-day survival status and cross-sectional area of muscle or fat. Muscle attenuation (psoas, long spine, and abdominal muscles respectively) at the L3 level were significantly lower in those who died within 30 days of ECMO cannulation (p<0.05). On multivariable analysis including age, sex, and pre-existing respiratory comorbidities, psoas muscle attenuation was an independent predictor of survival at 30 days (OR 0.97; 95% CI 0.94 to 1.00; p=0.047).

CONCLUSIONS

Reduced psoas muscle attenuation is associated with poorer survival outcomes at 30 days post-ECMO cannulation in patients who received VV ECMO support for respiratory failure. Cross-sectional areas of muscle and fat compartments did not correlate with survival outcomes at 30 days even when corrected for height and sex.

Nitrosative stress-based specific evaluation of creatine use in combination with aerobic running exercise at different speeds: a preclinical study in mice

OBJECTIVE

In acute and chronic aerobic exercise, skeletal muscle and liver are the main organs that adapt and regulate metabolic activity. The levels of nitrosative stress caused by exercise in these organs are extremely important in the continuity of exercise, its health-promoting benefits, and the evaluation of therapeutic efficacy. In this study, nitrosative stress levels were investigated in musculus quadriceps femoris tissue and liver tissue of mice that were given low and high-speed aerobic running exercise and also received Cr supplementation.

MATERIALS AND METHODS

In this study, nitrosative stress levels were investigated in the muscle/liver tissue of 42 BALB/c mice that were given low and high-speed aerobic running exercise and creatine monohydrate (Cr) (40 mg/kg of diet daily) supplementation with exercise. The study included six groups with and without Cr supplementation, low-speed aerobic running, high-speed aerobic running, and no exercise. The mice in groups with low-speed and high-speed aerobic exercise with and without Cr supplementation were run on the treadmill for 8 weeks. Then, nitric oxide (NO·), nitric oxide synthase (NOS), and peroxynitrite (ONOO-) levels in muscle/liver tissue were measured by spectrophotometric method.

RESULTS

It was found that the nitrosative stress level in the groups that did low and high-speed aerobic running exercises increased compared to the group that did not exercise. It was found that NO· decreased NOS activity and ONOO- level increased in muscle tissues of low and high-speed aerobic exercise groups that received Cr supplementation compared to those that did not. However, NO· and ONOO- levels in liver tissue decreased while NOS activity did not change. The lowest level of nitrosative stress in both muscle and liver tissue was found in the low-speed exercise group receiving Cr supplementation.

CONCLUSIONS

Although supplements in exercise are an important component, the simultaneously measured nitrosative stress level is critical in determining the optimal exercise.

Routine whole-body CT identifies clinically significant findings in patients supported with veno-venous extracorporeal membrane oxygenation

AIM

To determine the yield of routine whole-body computed tomography (CT) following extracorporeal membrane oxygenation (ECMO) initiation and to assess the association of these findings with prognosis.

MATERIALS AND METHODS

One hundred and ninety-eight consecutive patients with acute respiratory failure admitted for ECMO support between January 2015 and December 2019 who underwent whole-body CT performed within 48 h of ECMO initiation were examined in this single-institution retrospective study. CT findings were divided into three categories: clinically significant findings that may affect immediate management strategy or short-term outcomes; findings not related to hospital stay or outcome but require further workup; and benign findings that do not require further investigation. Logistic regression analysis was used to assess the association of CT findings with 7- and 30-day survival.

RESULTS

Clinically significant findings were present in 147 (74%) patients, findings requiring further workup were found in 82 (41%) patients, and benign findings were identified in 180 (90%) of the patients. Patients with clinically significant neurological findings had an elevated risk of death at 7 days (odds ratio [OR] 3.58; 95% confidence interval [CI] 1.29; 9.93; p=0.01), but not 30 days. Increasing numbers of clinically significant findings were associated with greater odds of mortality at 7 days (OR 1.70; 95% CI 1.08; 2.67; p=0.02) and 30 days (OR 1.41; 95% CI 1.02; 1.96; p=0.04).

CONCLUSIONS

Imaging patients at the point of admission for VV-ECMO with CT frequently identified clinically significant abnormalities with prognostic implications of these. These findings provide support for the use of more routine CT at the point of treatment escalation with prospective studies now required.

Decreasing e-waste through reliability enhancement encouraged by performance-based contracting

Purpose

In the last 20 years, e-waste has become a serious issue resulting from an overwhelming amount of electronics consumption. However, there has been limited research on how to decrease such waste in a structured manner. Toward study was to use a simulation methodology to investigate the dynamics of upfront investment in reliability enhancement promoted by performance-based contracting (PBC), based on the number of spare parts and duration of the contract.

Design/methodology/approach

The present research first details the relevant mathematical equations and uses game theory to demonstrate the utility for supplier and buyer relationships. Next, the effects of reliability enhancement, spare partsPBC are analyzed using a BlockSim simulation model.

Findings

The results indicate strong relationships among system design cost, reliability, availability and service cost. The authors found that investment in reliability increases system availability while reducing total service costs. Furthermore, increasing the spare parts inventory was determined to have less influence on the readiness of highly reliable systems. The findings support the notion that PBC reduces e-waste by increasing system availability, incentivizing upfront investment in reliability growth.

Research limitations/implications

Recognition of these findings in the context of buyer–supplier relationships will help managers better understand the value of upfront reliability investment, reducing maintenance, repair and overhaul requirements, avoiding the need to plan for extra spare parts and minimizing volume and the resulting e-waste.

Practical implications

This study also clarifies the uncertainty associated with upfront investment and provides potential incentives for suppliers.

Originality/value

The main contribution of this study is its use of PBC for e-waste reduction, highlighting the effects of upfront investment in reliability enhancement. The authors applied a game theory model to illustrate the relationship between incentives and upfront investment and demonstrate how increased levels of spare parts can be counterproductive to achieving readiness, reducing inventory and consequent e-waste.

The complex microbiome of caries-active and caries-free supragingival plaques in permanent dentition

Background and Aim

Dental caries is one of the most common diseases seen in the oral cavity in all periods of deciduous, mixed, and permanent dentition. A comprehensive study of the oral microbiome is required to understand its polymicrobial etiology. The aim of this study was to reveal the plaque microbiome of caries-active and caries-free adults.

Materials and Methods

A total of 52 samples were collected from 26 caries-active patients and 26 caries-free controls. Dental supragingival plaque samples were collected from each subject and the bacterial 16S rDNA, expanded V3-V4 region, was amplified using next generation sequencing.

Results

The core microbiome was defined with 235 shared bacteria in genus level, and among all microbiome 14.8% of all bacteria showed significant difference (P < 0.05). The bacteria responsible of caries may be listed as Anaeroglobus, Atopobium, Bifidobacterium, Centipeda, Cryptobacterium, Desulfobulbus, Filifactor, Howardella, Lactobacillus, Leptotrichiaceae (unclassified), Megasphaera, Mycoplasma, Olsenella, Phocaeicola, Propionibacterium, Pseudoramibacter, Scardovia, Schwartzia, Treponema, and Veillonellaceae (unclassified).

Conclusion

The present study provides comprehensive knowledge of the microbiological etiology of caries in permanent dentition.

Plate Positioning Affects the Pressure on the Axillary Nerve Following a Deltopectoral Approach

PURPOSE OF THE STUDY To investigate the pressure levels on the axillary nerve at different plate positions after plate fixation of a proximal humerus fracture. MATERIAL AND METHODS Eight fresh-frozen cadaveric specimens were used. The plates were applied on the lateral side of the humerus. A FlexiForce pressure sensor was placed between the nerve and the plate, and the pressure on the nerve was measured (Group 1). The plates were then placed in two different positions such that distal portion of the plates would have 30° anterior and 30° posterior angles to the anatomical axis of the humerus (Group 2 and 3). The anterior of the distal attachment of the deltoid muscle was then elevated and the plates were placed in the middle of the anatomical axis of the humerus (Group 4). The position of the plates were controlled by fluoroscopy and the pressure was measured for each configuration sequentially. RESULTS The mean age of the cadavers was 70.5 ± 6.8 years (range: 61-80 years). Mean pressure values of the groups were 2.65 ± 0.8, 2.52 ± 0.8, 5.65 ± 1.4, and 2.56 ± 0.9 N, respectively. Group 3 had statistically highest-pressure values than the other groups, while no difference was found among groups 1, 2, and 4. DISCUSSION Numbness and weakness of the shoulder muscles are other clinical findings. If numbness on the deltoid muscle is reported, then atrophy is noted in the deltoid muscle in later stages. Persistent pain may be seen even if fracture union occurs after PHF surgery. Axillary nerve entrapment may be considered after the removal of common complications such as avascular necrosis due to fracture, screw migration, infection, and biceps tendon and rotator cuff problems. The sensory branch of the axillary nerve provides the sensation of the anterior joint capsule and lateral part of the deltoid muscle. CONCLUSIONS Proximal humerus plates, which are angled posteriorly along, lead to an increased pressure on the axillary nerve. Anterior orientation of the plate or elevation of deltoid insertion may be used to prevent the possible complications related to axillary nerve. Level of evidence Level II. Key words: proximal humerus fracture, Philos, axillary nerve, nerve injury.

Eye Tracking for Deep Learning Segmentation Using Convolutional Neural Networks

Deep learning with convolutional neural networks (CNNs) has experienced tremendous growth in multiple healthcare applications and has been shown to have high accuracy in semantic segmentation of medical (e.g., radiology and pathology) images. However, a key barrier in the required training of CNNs is obtaining large-scale and precisely annotated imaging data. We sought to address the lack of annotated data with eye tracking technology. As a proof of principle, our hypothesis was that segmentation masks generated with the help of eye tracking (ET) would be very similar to those rendered by hand annotation (HA). Additionally, our goal was to show that a CNN trained on ET masks would be equivalent to one trained on HA masks, the latter being the current standard approach. Step 1: Screen captures of 19 publicly available radiologic images of assorted structures within various modalities were analyzed. ET and HA masks for all regions of interest (ROIs) were generated from these image datasets. Step 2: Utilizing a similar approach, ET and HA masks for 356 publicly available T1-weighted postcontrast meningioma images were generated. Three hundred six of these image + mask pairs were used to train a CNN with U-net-based architecture. The remaining 50 images were used as the independent test set. Step 1: ET and HA masks for the nonneurological images had an average Dice similarity coefficient (DSC) of 0.86 between each other. Step 2: Meningioma ET and HA masks had an average DSC of 0.85 between each other. After separate training using both approaches, the ET approach performed virtually identically to HA on the test set of 50 images. The former had an area under the curve (AUC) of 0.88, while the latter had AUC of 0.87. ET and HA predictions had trimmed mean DSCs compared to the original HA maps of 0.73 and 0.74, respectively. These trimmed DSCs between ET and HA were found to be statistically equivalent with a p value of 0.015. We have demonstrated that ET can create segmentation masks suitable for deep learning semantic segmentation. Future work will integrate ET to produce masks in a faster, more natural manner that distracts less from typical radiology clinical workflow.

Simvastatin in an experimental spinal cord injury model: a histopathological and biochemical evidence based study

AIM

In this study we tried to determine the possible neuroprotective effects of simvastatin in a rat model of Spinal Cord Injury (SCI) with the help of biochemical and histopathological tests.

METHODS

Rats were divided into 5 groups:1) SCI control, 2) Sham operated, 3) SCI with 10 mg/kg intraperitoneal simvastatin, 4) SCI with 10 mg/kg oral simvastatin, 5) SCI with 10 mg/kg subcutaneous simvastatin. After the treatment period, all rats were sacrificed; their blood and spinal cord samples were taken for biochemical and histopathological assessment.

RESULTS

When the groups were compared in terms of oedema and inflammation status, the scores of groups receiving simvastatin were better than the control and sham groups (p = 0.001 and p = 0.038 respectively). When the 3 treatment groups (oral, intraperitoneal and subcutaneous simvastatin groups) were compared with each other in terms of inflammation, haemorrhage and oedema, there were no significant differences between groups (p = 0.112, p = 0.797 and p = 0.188, respectively). NSE and S100B levels were significantly lower in the treatment groups compared to the sham group (p = 0.039 and p = 0.004 respectively).

CONCLUSION

According to our biochemical and histopathological findings, simvastatin 10 mg/kg has a positive impact in the spinal cord injury model in rats, regardless of route of application (Tab. 1, Fig. 5, Ref. 26).

Improved Functional Outcomes with Reverse Shoulder Arthroplasty Compared to Hemiarthroplasty after Proximal Humeral Fractures in the Elderly

PURPOSE OF THE STUDY Unsatisfactory functional results following hemiarthroplasty (HA) are seen in the treatment of 3- and 4-part proximal humeral fractures due to tuberosity healing problems and rotator cuff tears. Reverse shoulder arthroplasty (RSA) has been popular for improving functional outcomes. This study compares the results of HA and RSA in the treatment of comminuted proximal humeral fractures in the elderly. MATERIAL AND METHODS Patients over 60 years of age with three- or four-part proximal humeral fractures were included in the study. Twenty-five patients were treated with HA and 33 patients with RSA. The patients were evaluated with/using the American Shoulder and Elbow Surgeons (ASES) and Constant scores, active and passive ranges of motions of the shoulders and muscle strength measurements of HA and RSA patients were compared. RESULTS The mean age of the patients was 66 (60-85) years in the HA group and 73 (60-83) years in the RSA group. The mean ASES and Constant scores were 44.6 and 70 (p=0.06), 24 and 49 (p=0.022), respectively. The mean active abduction was measured as 50° and 90° (p=0.001), flexions as 70° and 120° (p=0.02), and external rotation as 30° and 50° (p=0.210), respectively. CONCLUSIONS In the treatment of three- or four-part proximal humeral fractures of the elderly, RSA gives significantly better functional results compared to HA. Key words: proximal humeral fractures, hemiarthroplasty, reverse shoulder arthroplasty.

Clinicopathologic characteristics of recurrent endometrioid endometrial cancer patients and analysis of methods used durıing surveillance

OBJECTIVE

To determine cilinicopathologic characteristics of recurrent endometrioid type endometrial cancer patients and analyze the methods applied in detection of recurrent disease during follow-up period.

METHODS

We have retrospectively reviewed the file records of the 226 patients who had endometrioid type carcinoma. Bimanual pelvic examination, speculum examination, carcinogenic antigen-125 (CA125) testing, vaginal cuff cytologic screening, transabdominal ultrasound (TAUS) and transvaginal ultrasound(TVUS) imagings were performed within the context of routine follow-up control examinations in the post-treatment period in every 3 months within the first 2 years and in every 6 months in the following 2 years and with annual control in the consecutive years.

RESULTS

Mean follow-up durations was 25.7±18.9 months while recurrence rate was 3.1%. The study patient group underwent totally 1116 times TVUS and 1084 times whole TA-US evaluations, 973 times vaginal cuff cytological screening, 1125 times pelvic and general physical examinations beside 1060 times CA-125 testings were performed in accordance with our routinely performed follow-up protocol. The asymptomatic recurrent cases ; one of those was dignosed with pelvic examination while diagnosis was established using TA-USG evaluation in the other asymptomatic patient. The other 5 cases were symptomatic. Pelvic examination, Computed Tomograhy and Magnetic Resonance Imaging were utilized in diagnosing 1, 3 and 1 of those patients, respectively.

CONCLUSION

The presence of symptoms and pelvic examination seem to be the most effective modalities in detecting recurrence in follow-up of endometrial cancer. It would be reasonable to optimize intervals between follow-up visits and to determine the appropriate evaluations by considering risk levels of the patients.

Stabilization of T2 relaxation and magnetization transfer in cartilage explants by immersion in perfluorocarbon liquid

PURPOSE

Magnetic resonance imaging of ex vivo cartilage measures parameters such as T₂ and magnetization transfer ratio (MTR), which reflect structural changes associated with osteoarthritis. Samples are often immersed in aqueous solutions to prevent dehydration and to to improve susceptibility matching. This study sought to determine the extent to which T₂ and MTR changes are attributable to immersion alone and to identify immersion conditions to minimize this confounding factor.

METHODS

T₂ and MTR were measured before and after immersion for up to 24 hours at 4°C. Bovine nasal and articular cartilage and human articular cartilage were studied. Experimental groups included undisturbed immersion in Fluorinert FC-770, a susceptibility-matched, hydrophobic liquid with minimal tissue penetration, and immersion in Fluorinert, Dulbecco's phosphate-buffered saline (DPBS), or saline, with removal from the magnet between scans. ¹⁹ F and ¹ H-MRI were used to detect cartilage penetration by Fluorinert and swelling, respectively.

RESULTS

Saline and DPBS immersion rapidly increased T₂ , wet weight and cartilage volume and decreased MTR, suggesting increased water content for all cartilage types. Fluorinert-immersed samples exhibited minimal changes in T₂ or MTR. No ingress of Fluorinert was detected after 2 weeks of continuous immersion at 4°C.

CONCLUSION

Ex vivo quantitative MR studies of cartilage may be confounded by the effects of immersion in aqueous solution, which may be comparable to or larger than effects attributed to pathology. These effects may be mitigated by immersion in perfluorocarbon liquids such as Fluorinert FC-770.

Prediction of the Mortality with Comorbidity - Polypharmacy Score in the Osteoporotic Hip Fractures

PURPOSE OF THE STUDY Osteoporotic hip fractures commonly associated with comorbid diseases and use of multiple drugs. Polypharmacy status and the comorbidity-polypharmacy score (CPS) are the most common two grading system to predict mortality risk for the trauma patients older than 45 years. The purpose of the study was to determine whether the CPS or polypharmacy can predict the mortality risk in the older patients had a surgery due to an osteoporotic hip fracture. MATERIAL AND METHODS Consecutive patients aged > 65 years had an osteoporotic hip fracture due to a simple trauma were enrolled in the study. Detailed data were collected included comorbid conditions, medications, T-scores and additional fractures. Patients were divided into four groups according to CPS classification and polypharmacy status was indicated in case of using five or more drugs before admission. Overall mortality was assessed using Kaplan-Meier survival testing. Factors influencing 1-year, 2-year and 5-year mortality were evaluated using a multivariate logistic regression model with adjusted odds ratios (AORs) and a threshold significance at p < 0.05. RESULTS A total of 109 patients (65% women) with a mean age 80 ± 8.06 were included in the study. The mean time to death from the surgery was 42.06 ± 34.9 months. The Kaplan-Meier survival curves showed a significant difference in mortality among CPS groups. (Log-Rank test < 0.001). CPS presented a significant prediction in 1-year (AOR: 4.2; p < 0.05) and 2-year mortality (AOR: 2.9; p < 0.05) after adjustment for several covariates (including age, gender, surgical procedure) whereas 5-year mortality did not reveal a significant prediction (p = 0.46) Polypharmacy existence did not independently predict both overall or year-based mortality (p > 0.05) . CONCLUSIONS CPS is a better predictor for mortality risk than polypharmacy existence in the first two years in the patients underwent surgery for an osteoporotic hip fracture. Key words:osteoporotic hip fracture, mortality, polypharmacy, comorbidity.

The role of pegaptanib sodium in the suppression of epidural fibrosis in a postlaminectomy rat model

OBJECTIVE

Spinal epidural fibrosis is a clinical condition that develops after laminectomy and can compress the spine. Many agents have been tried for the treatment, but none has entered clinical use at present. Pegaptanib sodium is an antiangiogenetic drug that prevents the development of new vessels and thus adhesion by inhibiting the effect of VEGF.

MATERIAL AND METHOD

20 Wistar rats were used in this study. The rats were divided into 2 different groups as the control and pegaptanib sodium group. Three levels of laminectomy were performed. Only laminectomy was performed in the control group. A cotton ball soaked with 3 mg/kg Pegaptanib sodium diluted 1: 10 with 0.9 % NaCl was topically applied to the dura in the surgical field for 5 minutes in the pegaptanib sodium group. The rats were sacrificed 3 weeks later and histopathologically examined. The epidural fibrosis was graded.

RESULTS

The epidural fibrosis grade in the pegaptanib sodium was significantly lower than in the control group c2 = 11,65; (p = 0.004)CONCLUSION: Pegaptanib sodium blocked the VEGF through its anti-VEGF effect and decreased spinal epidural fibrosis in rats that had undergone laminectomy (Tab. 2, Fig. 3, Ref. 53).

A RARE CLINICAL PRESENTATION: A PATIENT WITH CHRONIC RENAL FAILURE, SECONDARY HYPERPARATHYROIDISM AND CALCIPHYLAXIS

Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is usually observed in women and it is a serious complication of hyperparathyroidism secondary to chronic renal failure. CUA is characterized by ischemic tissue loss secondary to progressive vascular degeneration. Although it is rare, it may end up with sepsis and organ failure and can be fatal. Its pathogenesis is not fully understood, but it is thought that it occurs secondary to increased calcification activators such as oxidized LDL, TNF- α, calcitriol, fibronectin, collagen-I, and TGF-1α. The most effective treatment is managing underlying pathology and decreasing serum calcium and phosphorus levels. In this report, we aimed to present an end stage renal failure case with coexisting hyperparathyroidism, hyperthyroidism and calciphylaxis in whom cutaneous manifestations were healed 6 months after parathyroidectomy.

Role and Clinical Significance of Plasma N-Terminal Brain Natriuretic Peptide Measurement in Children with Brain Edema

OBJECTIVE

Brain natriuretic peptide (BNP) is a potent natriuretic and vasodilator factor. BNP plasma concentrations were found to be elevated in patients with brain edema. The purpose of the present study is to evaluate the relationship between plasma NT-proBNP concentration and the presence of brain edema in patients with intracranial pathology.

MATERIALS AND METHODS

The plasma NT-proBNP levels of 50 patients and 25 healthy subjects were measured. The NT-proBNP levels of the patient group were measured during admission and after 7 days of treatment.

RESULTS

NT-proBNP plasma concentrations were found to be significantly higher in the patient group with brain edema than in the control group (p < 0.005). There were no significant differences in the NT-proBNP plasma concentrations between patients with intracranial pathology without brain edema and the control group (p > 0.005). NT-proBNP plasma concentrations were found to be significantly higher in patients with brain edema as compared with patients without brain edema before treatment (p < 0.005).

CONCLUSION

These results suggest that excessive secretion of plasma NT-proBNP is related to brain edema. Plasma NT-proBNP levels may serve as a marker to guide the early-diagnostic and therapeutic management in children with brain edema. Further studies are required to evaluate the role of BNP in brain edema pathophysiology.

Undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation of the ovary

PURPOSE OF INVESTIGATION

Primary sarcomas account for of 2-3% of all female genital tract cancers and ovaries are unusual sites for sarcomas. The authors aimed to report a case of primary ovarian sarcoma.

MATERIALS AND METHODS

A 46-year-old woman presented with abdominal pain and distention. Abdominal MRI revealed a 20-cm-sized complex mass in the right adnexa and ascites. Preoperative CA-125 was 289 U/ml. She underwent optimal debulking surgery and diagnosed with undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation.

RESULTS

The patient presented with severe abdominal pain and distention 32 days after the operation and recurrent disease was diagnosed. First cure of adjuvant chemotherapy was administered, but she died 15 days later.

CONCLUSION

Coexistence of undifferentiated pleomorphic sarcoma and rhabdomyosarcoma shows highly aggressive behavior and its prognosis is extremely poor. To the best of the authors' knowledge, this is the second case report of the coexistence of these type tumors in the literature.

IODINE DEFICIENCY IN PREGNANT WOMEN LIVING IN WESTERN TURKEY (EDIRNE)

Objective

Data about iodine status in pregnant women in Turkey is not sufficient. We aimed to determine the iodine status, goiter prevalence, iodized salt consumption among first trimester pregnant women living in Edirne.

Design and setting

Cross-sectional study was performed on pregnant women living in Edirne.

Subjects and methods

A total of 275 pregnant women in their first trimester were examined regarding iodized salt use, median urinary iodine concentration (UIC), presence or absence of goitre and thyroid function. Goitre status was determined by palpation. Participants filled out a questionnaire, which included questions regarding sociodemographic features, iodized salt consumption, knowledge, and behavior regarding iodine deficiency. UIC was measured using colorimetric method based on Sandell-Kolthoff reaction. Thyroid hormones and TSH were measured by chemiluminescence immunoassays.

Results

While the proportion of iodized salt use was 96.6%, UIC was below 150 μg/L in 88.4 % of the women. The median UIC was 77 μg/L, indicating insufficient iodine intake. Total goitre rate was 19.3%.

Conclusions

Our study shows that iodine deficiency is a serious problem among pregnant women in Edirne. We suggest that pregnant women living in Edirne should be supplemented by iodine-containing preparations in addition to iodized salt.

CLINICALLY UNDETECTABLE OCCULT THYROID PAPILLARY CARCINOMA PRESENTING WITH CERVICAL LYMPH NODE METASTASIS

Background

Occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy without clinical and radiologic findings has been rarely reported.

Case report

A 47 years old female patient admitted to otorhinolaryngology clinic with 4X3 cm sized cervical mass. Physical examination of the patient was noted as a nontender, firm, mobile lymph node at right lateral cervical region. There was no inflammatory or infection disease in the history of patients anamnesis and no abnormal value on laboratory tests. Ultrasound screening of the neck detected a lymph node with suspicious features for malignancy. Head and neck examination was normal and there is no evidence of a tumoral mass or nodule in the thyroid gland. Whole body scan of MRI showed no pathologic sign both in the neck and body. Excisional biopsy was performed and revealed a carcinoma with papillary morphology. Immunohistochemical staining features of the tumor confirmed a papillary carcinoma derived from the thyroid gland. Second look USG of the neck and thyroid was performed but it revealed no tumoral mass. The patient underwent total thyroidectomy with right functional and central lymph node dissection. Histological examination of the thyroid gland showed multicentric 2 mm sized, three foci of papillary carcinoma located in bilateral thyroid lobes and metastatic lymph nodes in the right side of the neck.

Conclusion

A metastatic cervical lymph node can be evidence of a clinically undetected occult papillary thyroid carcinoma. Specific immunohistochemistry staining of specimen may lead to appropriate surgery and progression of carcinoma may be hindered by application of additional RAI therapy.

Combination therapy with lenalidomide and nanoceria ameliorates CNS autoimmunity

OBJECTIVE

Multiple sclerosis (MS) is a debilitating neurological disorder involving an autoimmune reaction to oligodendrocytes and degeneration of the axons they ensheath in the CNS. Because the damage to oligodendrocytes and axons involves local inflammation and associated oxidative stress, we tested the therapeutic efficacy of combined treatment with a potent anti-inflammatory thalidomide analog (lenalidomide) and novel synthetic anti-oxidant cerium oxide nanoparticles (nanoceria) in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS.

METHODS

C57BL/6 mice were randomly assigned to a control (no EAE) group, or one of the four myelin oligodendrocyte glycoprotein-induced EAE groups: vehicle, lenalidomide, nanoceria, or lenalidomide plus nanoceria. During a 23 day period, clinical EAE symptoms were evaluated daily, and MRI brain scans were performed at 11-13 days and 20-22 days. Histological and biochemical analyses of brain tissue samples were performed to quantify myelin loss and local inflammation.

RESULTS

Lenalidomide treatment alone delayed symptom onset, while nanoceria treatment had no effect on symptom onset or severity, but did promote recovery; lenalidomide and nanoceria each significantly attenuated white matter pathology and associated inflammation. Combined treatment with lenalidomide and nanoceria resulted in a near elimination of EAE symptoms, and reduced white matter pathology and inflammatory cell responses to a much greater extent than either treatment alone.

INTERPRETATION

By suppressing inflammation and oxidative stress, combined treatment with lenalidomide and nanoceria can reduce demyelination and associated neurological symptoms in EAE mice. Our preclinical data suggest a potential application of this combination therapy in MS.

Analysis of mcDESPOT- and CPMG-derived parameter estimates for two-component nonexchanging systems

PURPOSE

To compare the reliability and stability of the multicomponent-driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) and Carl-Purcell-Meiboom-Gill (CPMG) approaches to parameter estimation.

METHODS

The stability and reliability of mcDESPOT and CPMG-derived parameter estimates were compared through examination of energy surfaces, evaluation of model sloppiness, and Monte Carlo simulations. Comparisons were performed on an equal time basis and assuming a two-component system. Parameter estimation bias, reflecting accuracy, and dispersion, reflecting precision, were derived for a range of signal-to-noise ratios (SNRs) and relaxation parameters.

RESULTS

The energy surfaces for parameters incorporated into the mcDESPOT signal model exhibit flatness, a complex structure of local minima, and instability to noise to a much greater extent than the corresponding surfaces for CPMG. Although both mcDESPOT and CPMG performed well at high SNR, the CPMG approach yielded parameter estimates of considerably greater accuracy and precision at lower SNR.

CONCLUSION

mcDESPOT and CPMG both permit high-quality parameter estimates under SNR that are clinically achievable under many circumstances, depending upon available hardware and resolution and acquisition time constraints. At moderate to high SNR, the mcDESPOT approach incorporating two-step phase increments can yield accurate parameter estimates while providing values for longitudinal relaxation times that are not available through CPMG. However, at low SNR, the CPMG approach is more stable and provides superior parameter estimates. Magn Reson Med 75:2406-2420, 2016. © 2015 Wiley Periodicals, Inc.

Effects of vitamin C and exercise on lipid profile, platelet and erythrocyte indices in young soccer players

AIM

Exercise may increase production of reactive oxygen species (ROS) enhancing oxidative stress. Antioxidants can efficiently scavenge ROS before they initiate oxidative damage of biomolecules such as enzymes, nucleic acids, lipids and lipoproteins in the body. Vitamin C, an important antioxidant, may affect oxidative stress in living organism. Therefore, this study was carried out to investigate the effects of exercise and vitamin C on thiobarbituric acid-reactive substance (TBARS), lipid profile, erythrocyte and platelet indices in young soccer players.

METHODS

This investigation was carried out on twenty two male volunteer players in three groups. The first group was examined as a control. The second group was only exposed to exercise. The third group was exposed to exercise plus vitamin C (500 mg/day) administered per oral. The players were 23.50±0.59 year-old, 67.66±1.52 kg body weight and 1.74±0.03 m height. Blood samples were collected in vacutainer tubes for analysis of biochemical and hematological parameters.

RESULTS

While the levels of high density lipoprotein-cholesterol (HDL-C) were significantly increased (P<0.05) with only exercise, the cholesterol and low density lipoprotein-cholesterol (LDL-C) were decreased (P<0.05 to P<0.01) with exercise and exercise plus vitamin C treatment. While TBARS levels were increased (P<0.05) with exercise training, it was decreased (P<0.05) with exercise plus vitamin C treatment. The platelet counts (PLT), mean platelet volume (MPV), plateletcrit (PCT) and red blood cell distribution width (RDW) were significantly decreased (P<0.05) with exercise plus vitamin C. There were significantly correlations (P<0.05 to P<0.01) between lipid values and erythrocyte and platelet indices.

CONCLUSION

In light of these results, exercise may play a role in decreasing of LDL-C and in increasing of HDL-C. In addition, exercise plus vitamin C may diminish TBARS-levels and may affect the values of PLT, MPV, PCT and RDW in young soccer players.

Vascular endothelial growth factor and endothelin-1 levels in normal pregnant women and pregnant women with pre-eclampsia

The aim of the study was to estimate the levels of vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1) in maternal serum from normal pregnant women and women with pre-eclampsia. Serum concentrations of VEGF and ET-1 were measured in maternal blood in control group (n = 40) and in pregnancies complicated by pre-eclampsia (n = 40). Results showed that maternal VEGF levels were significantly raised in women with pre-eclampsia (p < 0.001). ET-1 concentration was not significantly different among women with pre-eclampsia compared with that in the control group. It was concluded that an increase in serum VEGF level was demonstrated in pre-eclampsia, suggesting that VEGF is involved in pathogenesis of pre-eclampsia. Further studies are needed to determine the serum concentrations of VEGF in pregnant women before the development of pre-eclampsia.

Comparison of connective tissue components in the uterine ligaments between women with and without pelvic organ prolapse

AIM

Aim of the study was the comparison of the connective tissue components in the uterine ligaments between the women with and without pelvic organ prolapse.

METHODS

This study included 15 postmenopausal women without pelvic organ prolapse who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign pathologies (control group) and 15 postmenopausal women who underwent vaginal hysterectomy because of pelvic organ prolapse (POP group). During the operation, samples for histological examination were taken from the cardinal and sacrouterine ligaments. The contents of collagen type I, collagen type III and elastin, and number and mitotic activity of fibroblasts in uterine ligaments were histopatholocially determined.

RESULTS

The collagen type I content for the POP group was significantly higher than that of the control group. Collagen type III content, elastin content, and number and mitotic activity of fibroblasts were not significantly different between the control and POP groups.

CONCLUSION

Collagen type I was found to be increased in the uterine ligaments of the POP group. The other connective tissue components did not differ between the two groups.

Incorporation of Rician noise in the analysis of biexponential transverse relaxation in cartilage using a multiple gradient echo sequence at 3 and 7 Tesla

PURPOSE

Previous work has evaluated the quality of different analytic methods for extracting relaxation times from magnitude imaging data exhibiting Rician noise. However, biexponential analysis of relaxation in tissue, including cartilage, and materials is of increasing interest. We, therefore, analyzed biexponential transverse relaxation decay in the presence of Rician noise and assessed the accuracy and precision of several approaches to determining component fractions and apparent transverse relaxation times.

THEORY AND METHODS

Comparisons of four different voxel-by-voxel fitting methods were performed using Monte Carlo simulations, and phantom and ex vivo bovine nasal cartilage (BNC) experiments. In each case, preclinical and clinical imaging field strengths of 7 Tesla (T) and 3T, respectively, and parameters, were investigated across a range of signal-to-noise ratios (SNR). Results were compared with Cramér-Rao lower bound calculations.

RESULTS

As expected, at high SNR, all methods performed well. At lower SNR, fits explicitly incorporating the analytic form of the Rician noise maintained performance. The much more efficient correction scheme of Gudbjartsson and Patz performed almost as well in many cases. Ex vivo experiments on phantoms and BNC were consistent with simulation results.

CONCLUSION

Explicit incorporation of Rician noise greatly improves accuracy and precision in the analysis of biexponential transverse decay data.

Clinical analysis of emergency peripartum hysterectomies in a tertiary center

OBJECTIVE

To investigate the incidence, indications, complications, and risk factors associated with increased mortality and morbidity of emergency peripartum hysterectomy (EPH).

MATERIALS AND METHODS

The authors retrospectively analyzed 48 cases of EPH performed within six-year interval at Ondokuz Mayis University Hospital. EPH was defined as the operation performed for life-threatening hemorrhage which could not be controlled with conservative treatment modalities within 24 hours of a delivery.

RESULTS

The incidence of EPH was 5.03 per 1,000 deliveries. The most common indication for EPH was abnormal placental adherence (n = 22, 45.8%), followed by uter- ine atony (n = 19, 39.6%). All the patients with placenta accreta had a history of repeat cesarian section (CS) and placenta previa.Total hysterectomy was performed in almost all of the patients (n = 47, 97.9%). All women required blood transfusions. Maternal morbidity was significant, with bladder injury (31.3%) and disseminated intravascular coagulation (18.7%) among the most common complications. There were one maternal (2.1%) and five neonatal deaths (10.4%).

CONCLUSION

Since most of the EPH cases are associated with prior cesarean delivery, decision of the first CS should be made for true obstetrical indications.If conservative treatments fail to control massive obstetrical bleeding, blood products and an experienced obstetrician should be ready to perform EPH to decrease the maternal mor- bidity and mortality.

Stabilization of the inverse Laplace transform of multiexponential decay through introduction of a second dimension

We propose a new approach to stabilizing the inverse Laplace transform of a multiexponential decay signal, a classically ill-posed problem, in the context of nuclear magnetic resonance relaxometry. The method is based on extension to a second, indirectly detected, dimension, that is, use of the established framework of two-dimensional relaxometry, followed by projection onto the desired axis. Numerical results for signals comprised of discrete T1 and T2 relaxation components and experiments performed on agarose gel phantoms are presented. We find markedly improved accuracy, and stability with respect to noise, as well as insensitivity to regularization in quantifying underlying relaxation components through use of the two-dimensional as compared to the one-dimensional inverse Laplace transform. This improvement is demonstrated separately for two different inversion algorithms, non-negative least squares and non-linear least squares, to indicate the generalizability of this approach. These results may have wide applicability in approaches to the Fredholm integral equation of the first kind.

[Where are we in the treatment of chronic osteomyelitis?]

Chronic osteomyelitis is a multifaceted bacterial infection with common features, which requires surgery for remission. The duration and modality of concomitant administration of antibiotic agents for adult patients is still based on expert opinions. The traditional recommendation of 6 to 12 weeks of antibiotic therapy with intravenous administration for at least the first 2 weeks is more and more challenged in favor of an oral antibiotic treatment with selected agents from the start. There is no evidence that the total duration of antibiotic therapy for more than 6-12 weeks improves outcome, when compared with shorter regimens. External advice from an expert team with combined surgeons and infectious disease physicians may help to reduce antibiotic consumption in a cost-effective way.

Endometrial stromal sarcoma with coexistent endometrioid adenocarcinoma in a woman with previous breast cancer: a preliminary case report

Endometrial stromal sarcoma (ESS) is a rare neoplasm of the uterus. The authors report a case of low-grade ESS coexistent with endometrioid adenocarcinoma of the uterus in a woman with a previous history of breast cancer. To the best of their knowledge, such a case has not been reported to date.

Association of paraoxonase activity and atherosclerosis in patients with chronic hepatitis B

BACKGROUND

The hepatitis B virus is a significant pathogen that causes cirrhosis, and hepatocellular cancer as a result of the damage it causes to liver cells. Its infection affects more than 400 million people globally. Although there is an effective vaccine and treatment methods, almost 1, 000, 000 people die every year.

OBJECTIVE

To investigate paraoxonase and arylesterase activities along with oxidative status parameters and serum lipid levels, and to find out if there is any increased susceptibility to atherogenesis.

METHODS

Thirty-four subjects with chronic hepatitis B and 39 healthy subjects as control were enrolled in the study. Age, body mass index and gender, Serum Triglycerides (TG), High-density Lipoprotein (HDL) and Low-Density lipoprotein (LDL) levels, serum paraoxonase-1 and arylesterase activities were determined. Oxidative and antioxidative statuses were evaluated by measuring serum-free sulfhydryl groups, lipid hydroperoxide levels, total antioxidant capacity, total oxidant status, and oxidative stress index.

RESULTS

Serum TG and LDL levels were higher while serum HDL levels were lower in patients with chronic hepatitis B than in controls but the differences did not reach statistical significance. Serum paraoxonase-1 and arylesterase activities, plasma free sulfhydryl groups, and total antioxidant capacity were significantly lower in patients than in controls (p=0.018, p=0.005, p<0.001, p=0.037 respectively), while lipid hydroperoxide, total oxidant status, and oxidative stress index were significantly higher (for all p<0.001).

CONCLUSION

The diminution in the paraoxonase-1 and arylesterase activities could contribute to the accelerated development of atherosclerosis in patients with chronic hepatitis B.