Single-scan ultrafast laser inscription of waveguides in IG2 for type-I and type-II operation in the mid-infrared

We demonstrate, for the first time to our knowledge, single-scan ultrafast laser inscription and performance of mid-infrared waveguiding in IG2 chalcogenide glass in the type-I and type-II configurations. The waveguiding properties at 4550 nm are studied as a function of pulse energy, repetition rate, and additionally separation between the two inscribed tracks for type-II waveguides. Propagation losses of ∼1.2 dB/cm in a type-II waveguide and ∼2.1 dB/cm in a type-I waveguide have been demonstrated. For the latter type, there is an inverse relation between the refractive index contrast and the deposited surface energy density. Notably, type-I and type-II waveguiding have been observed at 4550 nm within and between the tracks of two-track structures. In addition, although type-II waveguiding has been observed in the near infrared (1064 nm) and mid infrared (4550 nm) in two-track structures, type-I waveguiding within each track has only been observed in the mid infrared.

Evaluation of peripheral inflammatory markers, serum B12, folate, ferritin levels and clinical correlations in children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD)

AIM

The aim of the current study is to compare serum B12, folate, and ferritin levels and peripheral inflammatory indicators between children with Autism Spectrum Disorders (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and healthy controls (HC) and to evaluate the correlation of those with symptoms.

MATERIALS AND METHODS

A total of 203 children were evaluated (ASD = 72; ADHD = 61; HC = 70). Diagnoses of ASD and ADHD were ascertained according to Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). Control group was chosen among the healthy children who applied to general pediatrics outpatient clinic. Gilliam Autism Rating Scale-2 is used to assess autistic symptoms and Atilla Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale is used for ADHD symptoms.

RESULTS

Neutrophil levels (p = 0.014) and neutrophil/lymphocyte ratio (NLR) (p = 0.016) were higher in the ADHD and ASD groups compared to HC. Neutrophil values explained 70.1% of the variance across groups while NLR explained a further 29.9% of the variance. NLR significantly correlated with social interaction problems in ASD (r = 0.26, p = 0.04). There were no significant differences between groups in terms of vitamin B12, folate and ferritin levels.

CONCLUSION

Our results may support involvement of inflammation in the underlying pathophysiology of neurodevelopmental disorders. However, these parameters should be analyzed in a wider population to clarify the effect on the etiology and symptomatology of neurodevelopmental disorders.

Relationship Between Osteoporosis and Serum Sclerostin Levels in Kidney Transplant Recipients

OBJECTIVES

Sclerostin, a peptide secreted primarily by osteocytes, suppresses osteoblast maturation, thus reducing bone formation. Here, we evaluated the relationship between sclerostin levels and osteoporosis in kidney transplant recipients.

MATERIALS AND METHODS

This cross-sectional study included 78 kidney transplantrecipients > 18 years old and at least 6 months posttransplant. In our center, unrelated living-donor kidney transplants are not performed. Patients with parathyroid adenoma or parathyroidectomy history were excluded. Lumbar and femoral neck bone mineral densities andT and Z scores were obtained by dual-energy X-ray absorptiometry; results were used to divide patients into osteoporotic and nonosteoporotic groups. Serum sclerostin was measured by enzyme-linked immunosorbent assay.

RESULTS

: Of total patients, 43% had osteoporosis, mean age was 40.8 years, and 70% were male. Groups had similar ages, male-female distribution, time posttransplant, cumulative corticosteroid dose, estimated glomerular filtration rates, and 25-hydroxyvitamin D2 levels (P > .05). The osteoporotic group had lower sclerostin (405.9 ± 234.9 vs 521.7 ± 233.5 ng/dL; P = .035) and higherintact parathyroid hormone levels (110.9 ± 68.0 vs 84.8 ± 41.4 pg/mL; P = .04) than the nonosteoporotic group. Sclerostin levels were not correlated with cumulative corticosteroid dose, intact parathyroid hormone, bone mineral density, and T scores at any site but were weakly negatively correlated with age (P = .04, r = -0.25). In multiple regression analyses, only intact parathyroid hormone had negative effects on lumbar bone mineral density (P = .02) andT scores (P = .036). Serum sclerostin levels, age, and cumulative corticosteroid dose did not affect lumbar or hip bone mineral density and T scores (P > .05).

CONCLUSIONS

Sclerostin levels were low in our osteoporotic patients;therefore, sclerostin may not be a contributing factor to osteoporosis development. Because sclerostin is an osteocyte-derived peptide, its serum levels only reflect total osteocyte number and bone mass.

Sugammadex Improves Neuromuscular Function in Patients Receiving Perioperative Steroids

Context

Sugammadex has steroid-encapsulating effect.

Aim

This study was undertaken to assess whether the clinical efficacy of sugammadex was altered by the administration of steroids.

Setting and Design

Sixty patients between 18 and 60 years of age with the American Society of Anesthesiologists I-IV and undergoing elective direct laryngoscopy/biopsy were included in this study.

Materials and Methods

Patients were assigned to two groups based on the intraoperative steroid use: those who received steroid (Group S) and who did not (Group C). After standard general anesthesia, patients were monitored with the train of four (TOF) monitoring. The preferred steroid and its dose, timing of steroid administration, and TOF value before and after sugammadex as well as the time to recovery (TOF of 0.9) were recorded.

Statistical Analysis Used

SPSS software version 17.0 was used for statistical analysis.

Results

There is no statistically significant difference between groups in terms of age, gender, preoperative medication use, and TOF ratio just before administering sugammadex. The reached time to TOF 0.9 after sugammadex administration was significantly shorter in Group S than Group C (P < 0.05). A within-group comparison in Group S showed no difference in TOF ratio immediately before sugammadex as well as the dose of sugammadex in those who received prednisolone; time to TOF 0.9 was higher in prednisolone receivers as compared to dexamethasone receivers (P < 0.05).

Conclusion

In patients receiving steroids, and particularly dexamethasone, an earlier reversal of neuromuscular block by sugammadex was found, in contrast with what one expect. Further studies are required to determine the cause of this effect which is probably due to a potential interaction between sugammadex and steroids.

Evaluation of Serum Selenium and Erythrocyte Glutathione Peroxidase Levels in Patients with Recurrent Tonsillitis

The aim of this study is to investigate serum selenium (Se) and glutathione peroxidase (GSH-Px) levels in patients with recurrent tonsillitis. The study included 53 patients with recurrent tonsillitis and 51 healthy children. The measurement of serum Se levels were done in graphite furnace atomic absorption spectrophotometer using Zeeman background correction. Erythrocyte GSH-Px levels were indirectly measured by using the spectrophotometry. The ages of children in both groups ranged between 3 and 13 years, with a mean age of 7.60 years for patient group and 7.22 years for control group. Mean serum Se levels in patient and control groups were 60.4 and 78.7 µg/dL respectively. Mean erythrocyte GSH-Px levels in patient and control groups were 7.0 and 23.1 U/g hb, respectively. The mean blood Se and GSH-Px levels in patients with recurrent tonsillitis were significantly (P < 0.001) lower than control group. In our study, we found that serum Se and erythrocyte GSH-Px levels of cases with recurrent tonsillitis were significantly lower than healthy controls. The decline in serum Se and erythrocyte GSH-Px enzyme levels may predispose a chronic disease state but this issue needs further investigation.

Lead, selenium and nickel concentrations in epithelial ovarian cancer, borderline ovarian tumor and healthy ovarian tissues

OBJECTIVE

Wide variation exists in ovarian cancer incidence rates suggesting the importance of environmental factors. Due to increasing environmental pollution, trace elements and heavy metals have drawn attention in studies defining the etiology of cancer, but scant data is available for ovarian cancer. Our aim was to compare the tissue concentrations of lead, selenium and nickel in epithelial ovarian cancer, borderline tumor and healthy ovarian tissues.

METHODS

The levels of lead, selenium and nickel were estimated using atomic absorption spectrophotometry in formalin-fixed paraffin-embedded tissue samples. Tests were carried out in 20 malignant epithelial ovarian cancer, 15 epithelial borderline tumor and 20 non-neoplastic healthy ovaries. Two samples were collected for borderline tumors, one from papillary projection and one from the smooth surface of cyst wall.

RESULTS

Pb and Ni concentrations were found to be higher both in malignant and borderline tissues than those in healthy ovaries. Concentrations of Pb and Ni in malignant tissues, borderline papillary projections and capsular tissue samples were not different. Comparison of Se concentrations of malignant, borderline and healthy ovarian tissues did not reveal statistical difference. Studied metal levels were not found to be different in either papillary projection or in cyst wall of the borderline tumors.

CONCLUSIONS

This study revealed the accumulation of lead and nickel in ovarian tissue is associated with borderline and malignant proliferation of the surface epithelium. Accumulation of these metals in epithelial ovarian cancer and borderline ovarian tumor has not been demonstrated before.

Serum prolidase activity in systemic sclerosis

Systemic sclerosis, also known as scleroderma, is a complex systemic inflammatory autoimmune disease that targets the vasculature and connective tissue-producing cells and components of the innate and adaptive immune systems. The disease is characterized by a hardening of the skin and an increased synthesis of collagen . Prolidase is a specific imidodipeptidase involved in collagen degradation. The aim of this study was to search the serum prolidase activity (SPA) in the two subtypes of systemic sclerosis: diffuse and limited cutaneous systemic sclerosis. For this purpose, 35 patients diagnosed with systemic sclerosis (24 diffuse and 11 limited) and 41 healthy control subjects were included in the study. SPA was determined using Myara's method, which is a modification of Chinard's method. SPA did not differ between the scleroderma patients and controls (p = 0.467). However, SPA was significantly lower in diffuse form than in both limited form and control subjects (p = 0.021 and p = 0.024, respectively). SPA also did not differ between the limited form and control subjects (p = 0.145). Scleroderma is characterized by excessive deposition of collagen and tissue fibrosis due to the reduced collagen degradation. SPA is reduced in scleroderma patients, especially in diffuse form. Circulating autoantibodies, oxidative stress, and decreased physical activity may contribute to this process.

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism

AIM

This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism.

METHODS

The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations.

RESULTS

Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P < 0.001) and significantly higher mitral late diastolic A-wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P < 0.001), whereas Am velocity was higher in hypothyroidism patients (P = 0.018). LV lateral Em velocity and Em /Am ratio were significantly lower in patients with hypothyroidism compared with the control group (P < 0.001). With regard to atrial electromechanical conduction, atrial electromechanical delay (PA) lateral, PA septum, PA tricuspid, and each of interatrial and intraatrial conduction delay were significantly prolonged in hypothyroidism patients as compared with the control group (P < 0.001, P < 0.001, P = 0.023, P = 0.002, and P = 0.003, respectively). P-wave dispersion was significantly different in the pediatric patients with hypothyroidism (P < 0.001).

CONCLUSION

This study demonstrated atrial electromechanical conduction delay, abnormal P-wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism.

Transcatheter closure of patent ductus arteriosus in under 6 kg and premature infants

BACKGROUND

Transcatheter closure of a patent ductus arteriosus (PDA) has always been considered risky for infants weighing <6 kg and preterms. We present our findings regarding transcatheter closures of PDA.

METHODS

The inclusion criteria were a weight of <6 kg and the presence of PDA symptoms. The study subjects were divided into two groups: <6 kg and premature infants.

RESULTS

A total of 69 infants were included. The mean ages and weights of the <6 kg and the preterms were 5.4 ± 2.7 months and 30.3 ± 19.9 days, and 4.6 ± 0.8 and 1.7 ± 0.3 kg, respectively. Type C PDAs were most frequently observed in the premature group, and type A was in <6 kg. Sixteen of the patients were premature infants, and 81.2% of them had an extremely low birth weight. All of the premature infants had comorbidities, and had been receiving respiratory support therapy. Transcatheter closure was successfully completed in 81.2% of the premature infants and 94.3% of the <6-kg infants. Major complications occurred in 4 patients (one death and three device embolizations). The patient's age was found to be the main risk factor. The most frequently used device was the Amplatzer duct occluder II in additional sizes (84.6%) in the preterms and the Amplatzer duct occluder I (34%) and II (34%) in the <6-kg group.

CONCLUSION

The transcatheter closure of PDA is relatively safe and effective in preterms and in infants <6 kg. The selection of a suitable device based on the type of PDA is critical to the success of the procedure.

Serum human epididymis protein 4 can be a useful tumor marker in the differential diagnosis of adnexal masses during pregnancy: a pilot study

PURPOSE

The purpose of this study was to evaluate serum concentrations of human epididymis protein 4 (HE4) and cancer antigen 125 (CA 125) in healthy women and their pregnant counterparts to determine the influence of pregnancy on these biomarkers.

MATERIALS AND METHODS

Serum concentrations of CA 125 and HE4 were measured in 27 healthy non-pregnant women and 26 healthy pregnant women in the first and second trimesters.

RESULTS

Higher concentration of CA 125 was found in pregnants than in non-pregnant women (p = 0.002). There was no difference in CA 125 concentrations between first and second trimesters (p = 0.13). Serum HE4 concentration was not different in pregnant group compared to non-pregnant women (p = 0.510). Likewise, no difference was found in HE4 levels between the trimesters (p = 0.485). There was a positive correlation between increasing parity and CA 125 (p = 0.023), but not HE4 (p = 1.0).

CONCLUSION

HE4 serum biomarker is unaffected by pregnancy status and may be useful for evaluation of doubtful pelvic masses in pregnancy. Contrarily, increased serum levels of CA 125 could yield increased number of false-positive results.

The effect of ovariectomy on the skin flap viability and myeloperoxidase levels

OBJECTIVES

Estrogen could affect the rate and quality of wound healing in skin. We aimed to investigate the effects of ovariectomy on skin flap viability and myeloperoxidase (MPO) levels in a rat model.

BACKGROUND

Estrogens have many important beneficial and protective roles in skin that they improve collagen content and quality, maintain skin thickness and enhance vascularization. It has been shown that estrogen supplementation accelerates cutaneous wound healing in elderly patients.

METHODS

Forty-eight cycling female Wistar albino rats were randomly divided into three groups (n = 16); ovariectomy (Group 1), sham (Group 2), and control (Group 3). Rats were subjected to bilateral ovariectomy in the Group 1, and only laparotomy in the Group 2. Twenty-one days later in the Group 1 and 2, a dorsal caudally based skin flap elevation was done. In the Group 3, the rats had a dorsal skin flap without any surgical intervention. Ten days later, the flaps were harvested for histopathologic examination and biochemical analyses.

RESULTS

The rats in the Group 1 had significantly larger necrotic area and lower flap viability than in the Group 2 and 3 (p<0.05). Histopathologic examination showed that necrotic flap regions contained muscle necrosis with an abundant neutrophil infiltration, and severe edema in the Group 1. The MPO activity in the distal of skin flaps was significantly higher in the Group 1 compared to the Group 2 and 3 (p<0.05).

CONCLUSION

This study shows that ovariectomy has deleterious effects on skin flap viability in a rat model (Tab. 1, Fig. 6, Ref. 44).

Comparison of anaesthetic cost in open and laparoscopic appendectomy

CONTEXT

Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia.

AIMS

This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopic appendectomy under general anesthesia.

SETTINGS AND DESIGN

The design is retrospective and records of 379 patients who underwent open or laparoscopic appendectomy under general anesthesia, falling under the category of I-III risk group according to the American Society of Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77.

SUBJECTS AND METHODS

Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesia were evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluated the anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar $) of anesthetic agents used (induction, maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspiration probe), and intravenously administered fluids were evaluated.

STATISTICAL ANALYSIS USED

We used Statistical Package for the Social Sciences software (SPSS version 17.0) for statistical analysis.

RESULTS

Of the patients, 237 were males (62.53%) and 142 were females (37.47%). Anesthesia time limits were established as 70.30 ± 30.23 minute in Group I and 74.92 ± 31.83 minute in Group II. Mean anesthesia administration cost per patient was found to be 78.79 ± 30.01₺ (39.16 ± 14.15$) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34$) in Group II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158).

CONCLUSIONS

Although a statistical difference was not established in this study in terms of time and costs in appendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditions of drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update and revise cost analyses from time to time.

Follow-up of P dispersion after transcatheter closure of an atrial septal defect in children

OBJECTIVES

To determine in paediatric patients with atrial septal defects whether differences in P wave dispersion occurred with transcatheter closures using the Amplatzer septal occluder.

METHOD

A total of 31 children who had undergone transcatheter closures were evaluated. P maximum, P minimum, and P dispersion were measured with 12-lead surface electrocardiography, before the procedure and one week, one month, three months, six months and one year following the procedure. SPSS 10 was used for statistical analysis.

RESULTS

There were 23 (74.2%) females and 8 (25.8%) males with an overall mean age of 7.5 +/- 4.1 years and mean weight of 26.2 +/- 16.9 kg. The P maximum and P minimum measurements differed between patients during the follow-up period. Both measurements decreased with time. However, P dispersion was not significantly different throughout the follow-up period (before the procedure P maximum 95.4 +/- 15.6 ms, P minimum 64.5 +/- 15.4 ms, and P dispersion 30.8 +/- 11.4 ms; one year later, P maximum 76.1 +/- 14.6 ms, P minimum 47.1 +/- 12.1 ms, and P dispersion 29.1 +/- 9.1 ms).

CONCLUSION

Over time, there are no P dispersion differences in transcatheter closures using the Amplatzer septal occluder.

Effect of Ramadan fasting on serum concentration of apelin-13 and new obesity indices in healthy adult men

Background

The aim of this study was to determine how Ramadan fasting (RF) affected the recently described new obesity indices [visceral adiposity index (VAI), waist circumference to height ratio (WHtR), body adiposity index (BAI)], and serum concentration of apelin-13 (RF) in healthy adult men.

Material/Methods

For this purpose, 42 healthy adult men were selected. Anthropometric parameters were measured and a sample of venous blood was obtained for biochemical assays on the first and last days of Ramadan.

When all subjects were evaluated, all anthropometric parameters changed except VAI. Serum apelin-13, triglyceride (TG), HDL-cholesterol (HDL-C), and insulin levels did not change. When patients were divided into 3 groups according to body mass index (BMI), BAI decreased in normal-weight subjects and WHtR decreased in other groups, but VAI and apelin-13 did not change in any groups.

Results

We demonstrate for the first time that while some anthropometric parameters changed, VAI and serum apelin-13 levels did not change with RF. BMI, waist circumference (WC), TG, and HDL-C were evaluated together in calculation of VAI. TG, VAI, and HDL-C remained unchanged by RF. Even if body weight (BW) and BMI decreased, apelin-13 was not affected by RF. The data on serum apelin-13 may have been influenced by the small-percentage decrease in BW, as well as insignificant improvements in metabolic parameters such as lipid profiles, glucose, and insulin.

Conclusions

We found that Ramadan fasting in healthy adult men was associated with significant decreases in BW, BMI, WHtR, and BAI, but we found no significant changes in VAI and serum apelin-13 concentrations.

Elevated red blood cell distribution width and inflammation in printing workers

BACKGROUND

The aim of this study was to estimate the effects of exposure to chemical compounds on systemic biochemical inflammatory markers in printing industry workers.

MATERIAL/METHODS

Fifty-eight printing workers from 19 different small- and medium-sized enterprises in the printing sector were investigated. For comparison, 80 healthy workers not subjected to workplace chemicals served as control subjects.

RESULTS

No significant differences were observed between the printing workers and control subjects with respect to age, BMI, waist circumference/hip circumference ratio, smoking, and alcohol consumption. Printing workers had significantly higher serum TNF-alpha levels (11.02 ± 5.34 vs. 9.26 ± 3.87 pg/ml, p=0.039), plasma fibrinogen levels (1.74 ± 0.49 vs. 1.38 ± 0.5 mg/dl, p=0.012), and red blood cell distribution width (RDW-SD) (49.77 ± 3.09 vs. 47.3 ± 2.88 p<0.01) compared to control subjects.

CONCLUSIONS

Elevation of RDW, serum TNF-alpha, and plasma fibrinogen levels in printing workers may be due to systemic toxic effects of chemical compounds used in this sector. TNF-alpha is an inflammatory cytokine that has a wide spectrum of biological activities, and fibrinogen plays an important role in pathological processes. Some compounds may be carcinogenic or mutagenic. Better designed workplaces and working conditions will help to reduce the hazardous effects of chemical compounds.

Plasma selenium levels in Turkish women with polycystic ovary syndrome

OBJECTIVE(S)

To evaluate selenium (Se) levels in serum and their relation with hyperandrogenism and insulin resistance (IR) in women with polycystic ovary syndrome (PCOS) and in control subjects.

STUDY DESIGN

Women with any gynecological problem who presented to the Kahramanmaras Sutcuimam University Medical Faculty Gynecology and Obstetric Outpatient Clinic were invited to participate. Group 1 consisted of 36 cases with a diagnosis of PCOS according to the 2003 Rotterdam Consensus Criteria, and Group 2 (control group) consisted of 33 age- and BMI-matched healthy women. In all cases, serum total testosterone (tT), dihydroepiandrostenedione-sulfate (DHEAS), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), insulin, glucose (mg/dL), total cholesterol (TC) (mg/dL), high density lipoprotein-cholesterol (HDL-C) (mg/dL), low density lipoprotein-cholesterol (LDL-C) (mg/dL), triglyceride (TG) (mg/dL) and Se levels were measured.

RESULTS

The level of FSH was significantly lower, and the levels of LH, E2, tT, and DHEAS were significantly higher in group 1 than in group 2 (p<0.05). The hirsutism score was significantly higher among PCOS women compared to the control group (p<0.05). Although insulin levels and HOMA-IR were markedly increased in the PCOS group compared to the control group, the differences were not significant (p>0.05). The plasma Se level was significantly lower in PCOS women compared to the control group (p<0.05). When we combined the all women in two groups, regarding them as one group (combined group, n=69), a negative correlation between Se and LH and tT was present (p<0.05).

CONCLUSION(S)

Our results show decreased plasma concentrations of Se and a negative correlation between Se and LH, tT in women with PCOS. These results indicate that Se may play a role in the pathogenesis of PCOS related with hyperandrogenism.

Off-label use of Amplatzer devices in congenital heart disorders during childhood

BACKGROUND

Certain medical devices used to treat congenital cardiac lesions in the cardiac catheterization laboratory are used on an off-label and non-routine basis. This article discusses the non-routine use of Amplatzer medical devices.

METHODS

In a retrospective study, from November 2006 to December 2011, Amplatzer devices used in our paediatric cardiology ward were reviewed.

RESULTS

Children (n = 436) were catheterized to close their defects (438 defects) using Amplatzer devices. The mean age and body weight of the patients were 5.87 +/- 4.2 years and 20.8 +/- 13.6 kg. On-label devices were used for 421 patients (96.1%) and off-label devices for 17 patients (3.9%). The off-label use indications and used devices were the Amplatzer septal occluder (aortopulmonary window closure), the muscular ventricular septal occluder (perimembranous ventricular septal defect occlusion, patent ductus arteriosus occlusion, and right pulmonary artery to left atrium fistulous connection closure), the vascular plug (coronary fistula occlusion, left ventricle pseudoaneurysm occlusion, atypical patent ductus arteriosus occlusion, and anomalous pulmonary venous drainage occlusion), and the ductal occluder (ventricular septal defect occlusion). These devices were successfully implanted in exclusively extraordinary, difficult, or extreme cases.

CONCLUSIONS

The use of a medical device outside of its approved purpose is commonly referred to as "off-label use". This study showed that the issue of off-label, non-routine use of devices exists in paediatric cardiology. Furthermore, the percutaneous closure of defects with non-routine Amplatzer devices is safe and effective, with a high success rate and a high follow-up term outcome.

Comparison of the efficacy of different-sized Amplatzer duct occluders (I, II, and II AS) in children weighing less than 10 kg

The transcatheter closure of patent ductus arteriosus (PDA) may cause more complications in small children. Amplatzer (St. Jude Medical, Plymouth, MN) has produces three types of devices for ductal occlusion: the Amplatzer duct occluder I (ADO I) and II (ADO II) and the recently introduced ADO II additional sizes (ADO II AS). We performed this study to determine the efficacy and complication rates in children who weigh <10 kg for the three types of devices used in our clinic. Between February 2007 and March 2012, 77 patients weighing <10 kg had their PDAs occluded with ADOs. The mean age of the patients was 0.76 ± 0.44 years (range 17 days-2 years), and their mean weight was 6.73 ± 2.05 (range 1.2-9.9) kg. In total, 54 girls (70.1 %) and 23 boys (29.9 %) with a mean pulmonary ductus diameter of 2.55 ± 1.0 (1.08-5.94) mm were included in the study. The ADO I was used in 26 patients (33.8 %); the ADO II was used in 43 patients (55.8 %); and the ADO II AS was used in 8 patients (10.4 %). The mean ages of patients with the ADO I, ADO II, and ADO II AS were 1.07 ± 0.48, 0.66 ± 0.31, and 0.28 ± 0.17 years (p < 0.05), respectively. Their mean weights were 7.86 ± 1.45, 6.50 ± 1.85, and 4.36 ± 2.49 kg (p < 0.05), respectively. Their mean narrowest ductal diameters were 3.11 ± 0.96, 2.25 ± 1.06, and 2.33 ± 1.01 mm (p < 0.05), respectively. The use of the ADO II and ADO II AS was found to be more common in type C defects. One patient with the ADO I and 5 patients with the ADO II (7.8 %) developed varying degrees of left pulmonary artery stenosis or iatrogenic aortic coarctation. In 1 patient, the ADO II AS was replaced with the ADO II due to a significant residual shunt observed during the procedure. Each of the ADOs has its own advantages and disadvantages. Although the ADO I is convenient for medium- and large-sized defects, the ADO II and ADO II AS can be used both anterogradely and retrogradely. The ADO II AS is safe and efficient to use in small infants.

Malondialdehyde level and adenosine deaminase activity in adenoid tissue of patients with OME and obstructive adenoid hypertrophy

OBJECTIVE

The aim of our study was to determine and compare adenosine deaminase (ADA) activity and malondialdehyde (MDA) level in adenoid tissue of patients with or without otitis media with effusion (OME).

METHODS

The study included 30 patients undergoing adenoidectomy due to obstructive adenoid hypertrophy (OAH) or OME. Tissue MDA level was measured by the method of Okawa with modification and tissue ADA activity by the method of Giusti. We measured, superoxide dismutase (SOD) and catalase (CAT) activities as well.

RESULTS

In patients with OAH, mean tissue MDA level and ADA activity were 4.13 ± 0.90 nmol/mg Pr and 0.39 ± 0.04 U/mg Pr, respectively, which were significantly higher than those of OME group (1.43 ± 0.41 nmol/mg Protein and 0.22 ± 0.04 U/mg Pr, respectively) (P<0.05). SOD and CAT activities were found to be increased in patients with OAH when compared to the OME group but they did not reach statistically significant level (P=0.06 and 0.05 respectively).

CONCLUSIONS

The present study showed the presence of measurable ADA activity in adenoid tissue, and also significant increases in both tissue MDA level and ADA activity in OAH tissue when compared to adenoid tissue of the patient with OME. However, the significance of changes in MDA and ADA activation in the pathogenesis of OAH requires further study.

Bioabsorbable atrial septal occluder for percutaneous closure of atrial septal defect in children

The BioSTAR bioabsorbable septal repair implant is a new transcatheter secundum atrial septal defect occlusion device that is absorbed and replaced by healthy native tissue. This retrospective analysis was designed to determine the most significant factors for its successful use in children. From October 2009 through December 2010, 33 children underwent catheterization to close secundum atrial septal defects by means of the BioSTAR. The mean age of the patients was 6.8 ± 3.4 years (range, 2.5-13 yr), and the mean body weight was 22.6 ± 11 kg (range, 11-55 kg). The device was successfully implanted in 91% of patients (30/33). In 2 patients, the attempt had to be abandoned because of deficient aortic rim. A 3rd patient had to be converted to surgery because the device embolized to the pulmonary artery. In 1 patient, 2 BioSTAR devices were used to occlude 2 separate holes. The mean maximum stretched diameter of the single-hole defects was 13.5 ± 2.5 mm (range, 8.5-18 mm). Twenty-five patients (76%) had a single-hole defect. The mean follow-up time was 7.7 ± 4.1 months (range, 0.8-15.6 mo). The occlusion rates were 77% after 24 hours and 97% at the end of follow-up. The BioSTAR septal occluder is best suited for small-to-moderate defects. Percutaneous closure of secundum atrial septal defects with the BioSTAR is safe and effective, yielding a high success rate at midterm outcome.

Transcatheter closure of a residual patent ductus arteriosus after surgical ligation in children

BACKGROUND AND OBJECTIVES

To assess the safety and efficacy of transcatheter closure of residual ductal flow after initial surgical ligation of the arterial duct.

SUBJECTS AND METHODS

Between June 2005 and December 2009, transcatheter occlusion of residual postsurgical ductus arteriosus was performed in six children.

RESULTS

The mean patient age was 10±5.5 years; mean post-procedural time since the initial surgical closure was 6.3±4.5 years. The mean diameter of the patent ductus arteriosus on angiography was 1.3±0.5 mm (range, 0.8 to 2.4 mm). Three different types of coils were used successfully without any complications.

CONCLUSION

Transcatheter occlusion of residual postsurgical arterial duct is a safe and successful procedure. However, attention should be paid due to the distorting shape of the arterial duct.

Plasma selenium, zinc, copper and lipid levels in postmenopausal Turkish women and their relation with osteoporosis

It has been shown that the trace elements and lipids play role in the growth, development and maintenance of bones. We aimed to investigate serum selenium (Se), zinc (Zn), copper (Cu) and lipid (total cholesterol, triglyceride (TG), high density lipoprotein-cholesterol, low-density lipoprotein-cholesterol) levels in postmenopausal women with osteoporosis, osteopenia and in healthy controls, and to determine the relationship between Se, Zn, Cu and lipid parameters and bone mineral density (BMD). The study included 107 postmenopausal women; 35 healthy (group 1), 37 osteopenic (group 2) and 35 osteoporotic (group 3). The women in all three groups were carefully matched for body mass index (BMI). Serum concentrations of Se, Zn and Cu were measured by atomic absorption spectrophotometry. Plasma Se, Cu, Zn and lipid levels were similar in all groups (p > 0.05). When we combined the women in each of the three groups, and considered them as one group (n = 107) we found a positive correlation between BMI and lumbar vertebra BMD, femur neck BMD, femur total BMD; a positive correlation between TG and femur neck BMD, femur total BMD; a positive correlation between Zn and lumbar vertebra BMD (total T score) (p < 0.05). There was no correlation between Se, Cu, Zn, P and lipid parameters (p > 0.05). Although BMI has a positive effect on BMD, trace elements and lipids, except Zn and TG, did not directly and correlatively influence BMD. Further studies are needed to clarify the role and relationship of trace elements and lipid parameters in postmenopausal osteoporosis.

Nitric oxide: a new biomarker of Doxorubicin toxicity in children?

Doxorubicin (DOX) has been used in the treatment of childhood cancers, but its usage is limited because of cardiotoxicity. There are many studies on the role of nitric oxide (NO) in several cardiac diseases. However, to the authors' knowledge, no studies have investigated the plasma levels of total nitrite, a stable product of NO, in children that received DOX. The authors determined plasma total nitrite levels in 29 children who received DOX and investigated the correlations between these and other clinical and laboratory findings. All patients were in remission during the study period. Plasma total nitrite levels and cardiac functions were determined prospectively. The mean cumulative DOX dose was 310.0 ± 90.9 mg/m(2). In echocardiographic evaluation, 3 patients (10.3%) had a pathological value for ejection fraction (EF) and/or fractional shortening (FS), whereas 11 patients (37.9%) had a threshold value. Total nitrite levels were higher in patients than in matched controls (75.24 ± 39.4 vs 43.14 ± 10.58 μmol/L, respectively, P < .001). It was also found to be higher in patients who had a pathological/threshold value of EF and FS than in patients who had a physiological value of EF and FS (92.35 ± 50.36 vs 59.26 ± 13.56 μmol/L, respectively, P = .038). A negative correlation was found between FS and plasma total nitrite level (r = -.42, P = .023). The authors speculate that increased NO may be a sign of subclinical cardiotoxicity of DOX.

Serum reference levels of selenium, zinc and copper in healthy pregnant women at a prenatal screening program in southeastern Mediterranean region of Turkey

PROJECT

The aim of the study was to investigate the serum reference range for Selenium (Se), Zinc (Zn) and Copper (Cu) levels in women of 10-14 (group I) and 16-20 (group II) weeks of gestation and compare them with those in non-pregnant healthy women and healthy men.

PROCEDURE

This cross-sectional study was performed in 351 pregnant women [group I (n: 177) and group II (n: 174)], 30 non-pregnant women and 30 men as controls. The levels of Se, Zn and Cu levels were determined on flame and furnace atomic absorption spectrophotometer using Zeeman background correction.

RESULTS

In the 10-14 weeks of gestation Se, Zn and Cu serum levels were 44.85+/-9.23, 81.30+/-31.94 and 132.33+/-38.24 microg/dl, in 16-20 weeks of gestation were 47.18+/-10.92, 74.25+/-22.47 and 164.86+/-39.69 microg/dl, in non-pregnant women were 55.38+/-8.81, 121.41+/-29.22 and 104.75+/-39.14 microg/dl also in men 72.24+/-9.28, 134.85+/-15.95 and 78.29+/-20.90 microg/dl, respectively.

CONCLUSION

A significant low level of serum Se, Zn and a high level of Cu in the pregnant women in the 10-14 and 16-20 weeks of gestation were detected when compared with that of non-pregnant women and men.

Visfatin plasma concentrations in patients with hyperthyroidism and hypothyroidism before and after control of thyroid function

Alterations in thyroid function are associated with changes in body weight, metabolism, and low-grade inflammation. In several studies, plasma levels of visfatin were found to be associated with body mass index, diabetes, and metabolic syndrome. In our study we aimed to evaluate visfatin levels according to thyroid dysfunction. The study cohort comprised 56 Hashimoto thyroiditis patients with hypothyroidism (43.94+/-14.27 yr), 56 Graves patients with hyperthyroidism (45.87+/-13.28 yr), and 56 euthyroid healthy subjects (45.23+/-7.11 yr) as a control group. In addition, we evaluated the effect of therapy on plasma visfatin levels in 16 hypothyroid and in 25 hyperthyroid patients. Markedly low visfatin levels were found in hyperthyroid patients [9.44 (8.07- 10.8) ng/ml] compared with the hypothyroid [49.93 (40.72- 59.1) ng/ml] and control groups [38.6 (30.6-46.6) ng/ml] (p<0.001, p<0.001). Plasma visfatin levels in patients with hypothyroidism decreased significantly following treatment [58.58 (10.21-190.7) ng/ml vs 40.00 (10.01-102.6) ng/ml; p=0.001]. Plasma visfatin levels increased significantly after antithyroid therapy in patients with hyperthyroidism [7.86 (1.02-19.23) ng/ml vs 12.63 (3.48-110.9) ng/ml; p<0.001]. There were negative correlations between visfatin levels with free T3 (r=-0.719, p<0.001), and free T4 (r=-0.716, p<0.001) levels. There was a positive correlation between visfatin and TSH levels (r=0.701, p<0.001). There was a negative correlation between delta visfatin levels with delta free T3, delta free T4 (r=-0.686, p<0.001; r=-0.624, p<0.001). Visfatin thus seems to be regulated by thyroid hormones. While the influence of thyroid dysfunction on adipocytokine production and release is still poorly understood, the results of our study suggest that the effects of hyper- and hypothyroidism on various metabolic parameters may be partly mediated by visfatin.

Effects of early administration of dexamethasone, N-acetylcysteine and aprotinin on inflammatory and oxidant-antioxidant status after lung contusion in rats

INTRODUCTION

This experimental setting was undertaken to elucidate and confirm the role of inflammatory and oxidant-antioxidant mechanisms on blunt injury induced moderate pulmonary contusion (PC). We intended to determine the effects of dexamethasone (DXM), N-acetylcysteine (NAC) and aprotinin (APR) in terms of their ability to diminish the consequences of acute lung injury due to PC.

METHODS

Rats were allocated to five subgroups. Except for the control, all subgroups had a moderate pulmonary contusion. Following 45 min of observation, animals in groups I and II received intraperitoneal saline, group III 10 mg/kg DXM, group IV 500 mg/kg NAC and group V 30,000 kIU/ml APR. After the procedure, 6 h after contusion, blood gas analysis, lung tissue nitric oxide (NO) and malondialdehyde (MDA) levels, superoxide dismutase (SOD) and catalase (CAT) activity, bronchoalveolar lavage (BAL) fluid and histopathological examination were performed.

RESULTS

All PaO(2) values decreased significantly in contused rats as compared with the control group (p<0.05). DXM, NAC and APR resulted in a slight increase in PaO(2) values compared with group II (p<0.05). Lung tissue levels of MDA and NO were higher in the contusion group than in the control (p<0.05). DXM, NAC and APR all decreased the levels of MDA and NO (p<0.05), however the decrease in NO was not found to be significant with APR (p>0.05). SOD and CAT activities increased significantly after contusion compared to control group (p<0.05). There was no significant difference even though SOD levels were elevated in groups III, IV and V compared with contused animals (p>0.05). Neutrophils in BAL fluid significantly increased in contused animals (p<0.05). Only DXM significantly decreased neutrophil population in BAL fluid (p<0.05). Scores for alveolar haemorrhage/oedema were higher in all contusion-performed rats than those in the control (p<0.05). Compared with the other drugs, only APR significantly improved the haemorrhage/oedema scores compared to sham animals (p=0.024).

CONCLUSIONS

Our findings demonstrate that moderate bilateral PC induced by blunt chest trauma leads to an early inflammatory process which is clearly associated with activation of the oxidant-antioxidant cascade. On this basis, early supportive treatment with DXM, NAC and APR may yield favourable results on pulmonary pathophysiological parameters which are adversely affected due to PC.

Selenium levels in first-degree relatives of diabetic patients

The present study was conducted to evaluate the serum selenium levels in first-degree relatives of diabetic patients (FDR) according to controls. Insulin resistance, serum lipid levels, inflammation markers, and blood pressure were also studied in these patients. Serum levels of selenium in FDR were significantly lower than control group (74.65 +/- 5.9 vs 88.7 +/- 8.7 microg/dl, p < 0.0001). HsCRP, HOMA-IR, insulin, homocysteine levels were significantly higher in FDR according to the control group (1.32 +/- 0.9 vs 0.63 +/- 0.4 mg/dL, p < 0.0001; 2.07 +/- 0.84 vs 1.51 +/- 0.69, p < 0.0001; 9.26 +/- 3.8 vs 6.8 +/- 2.98 microU/MI, p < 0.0001; 15.7 +/- 7.4 vs 11.5 +/- 5.1 micromol/L, p < 0.0001, respectively). There was significant correlation between selenium levels and hsCRP (r = - 0.450, p < 0.0001). There was also weak significant correlation also between HOMA-IR and selenium levels (r = -0.227, p = 0.003). There was a correlation between systolic blood pressure and BMI (r = 0.365, p < 0.0001). But there was no correlation between selenium levels and blood pressure or other parameters. HsCRP, HOMA-IR, homocysteine levels in individuals with selenium levels < 80 microg/L (n = 78) was significantly higher than hsCRP HOMA-IR, homocysteine levels in individuals with selenium levels >or= 80 (n = 91; 1.23 +/- 0.98 vs 0.81 +/- 0.76 mg/dL, p < 0.003; 1.99 +/- 0.88 vs 1.64 +/- 0.74, p < 0.005; 15.0 +/- 7.6 vs 12.9 +/- 5.7 micromol/L, p < 0.049, respectively). Selenium deficiency may contribute to cardiovascular disease risk in FDR.

Visfatin plasma concentrations in patients with hyperthyroidism and hypothyroidism before and after control of thyroid function

Alterations in thyroid function are associated with changes in body weight, metabolism, and low-grade inflammation. In several studies, plasma levels of visfatin were found to be associated with body mass index, diabetes, and metabolic syndrome. In our study we aimed to evaluate visfatin levels according to thyroid dysfunction. The study cohort comprised 56 Hashimoto thyroiditis patients with hypothyroidism (43.94+/-14.27 yr), 56 Graves patients with hyperthyroidism (45.87+/-13.28 yr), and 56 euthyroid healthy subjects (45.23+/-7.11 yr) as a control group. In addition, we evaluated the effect of therapy on plasma visfatin levels in 16 hypothyroid and in 25 hyperthyroid patients. Markedly low visfatin levels were found in hyperthyroid patients [9.44 (8.07- 10.8) ng/ml] compared with the hypothyroid [49.93 (40.72- 59.1) ng/ml] and control groups [38.6 (30.6-46.6) ng/ml] (p<0.001, p<0.001). Plasma visfatin levels in patients with hypothyroidism decreased significantly following treatment [58.58 (10.21-190.7) ng/ml vs 40.00 (10.01-102.6) ng/ml; p=0.001]. Plasma visfatin levels increased significantly after antithyroid therapy in patients with hyperthyroidism [7.86 (1.02-19.23) ng/ml vs 12.63 (3.48-110.9) ng/ml; p<0.001]. There were negative correlations between visfatin levels with free T3 (r=-0.719, p<0.001), and free T4 (r=-0.716, p<0.001) levels. There was a positive correlation between visfatin and TSH levels (r=0.701, p<0.001). There was a negative correlation between delta visfatin levels with delta free T3, delta free T4 (r=-0.686, p<0.001; r=-0.624, p<0.001). Visfatin thus seems to be regulated by thyroid hormones. While the influence of thyroid dysfunction on adipocytokine production and release is still poorly understood, the results of our study suggest that the effects of hyper- and hypothyroidism on various metabolic parameters may be partly mediated by visfatin.

Plasma visfatin concentrations in childhood obesity: relationships with insulin resistance and anthropometric indices

BACKGROUND

The aim of this study was to investigate the relationships between plasma visfatin, insulin resistance, lipid profile and anthropometric measurements in obese children.

SUBJECTS AND METHODS

Plasma levels of visfatin, insulin, glucose, lipid profile and anthropometric indices were determined in 30 obese children and compared with those in 30 age- and gender-matched non-obese children. Visfatin was measured with enzyme-linked immunosorbent assay and logarithmically transformed to log visfatin for parametric comparisons.

RESULTS

The obese group had significantly elevated plasma visfatin, fasting glucose and insulin and homeostasis model assessment (HOMA) values, as well as elevated lipid concentrations, compared with non-obese children. In the obese group log visfatin correlated positively with weight (p = 0.007), waist circumference (p = 0.007), hip circumference (p = 0.034), BMI (p = 0.005), insulin (p = 0.041) and HOMA (p = 0.044). No correlation was found between visfatin and lipid profile in obese children (p >0.05). Linear regression analysis revealed significant positive relationships between log visfatin and BMI (p = 0.005), insulin and BMI (p <0.001), and between HOMA and BMI (p <0.001) in the obese group but not in the control group. Multivariate regression analysis with log visfatin as a dependent variable showed that only BMI (p = 0.005) and bodyweight (p = 0.014) correlated positively with log visfatin in obese children.

CONCLUSIONS

An increased visfatin concentration may be associated with BMI and insulin resistance in obese children. Although these findings may lay a foundation for further hypotheses, the limited sample size in the present study means that longitudinal studies with more patients are needed.