Effect of rumen-protected choline on dairy cow metabolism, immunity, lactation performance, and vaginal discharge microbiome

Rumen-protected choline (RPC) promotes benefits in milk production, immunity, and health in dairy cows by optimizing lipid metabolism during transition period management and early lactation. However, the RPC success in dairy cows depends on choline bioavailability, which is affected by the type of protection used in rumen-protected choline. Therefore, our objectives were to determine the effects of a novel RPC on dry matter intake (DMI), identify markers of metabolism and immunity, and evaluate lactation performance. Dry Holstein (n = 48) cows at 245 ± 3 d of gestation were blocked by parity and assigned to control or RPC treatment within each block. Cows enrolled in the RPC treatment received 15 g/d of CholiGEM (Kemin Industries, Cavriago RE, Italy) from 21 d prepartum and 30 g/d of CholiGEM from calving to 21 d postpartum. During the transition period, DMI was measured daily, and blood was sampled weekly for energy-related metabolites such as β-hydroxybutyrate (BHB), glucose, and nonesterified fatty acids (NEFA), as well as immune function markers such as haptoglobin (Hp) and lipopolysaccharide-binding protein (LPB). Vaginal discharge samples were collected at the calving and 7 d postpartum and stored in microcentrifuge tubes at -80°C until 16S rRNA sequencing. The main responses of body condition score, body weight, DMI, milk yield, milk components, and immune function markers were analyzed using the GLIMMIX procedure of SAS with the effects of treatment, time, parity, and relevant covariates added to the models. The relative abundance of microbiome α-diversity was evaluated by 3 indexes (Chao1, Shannon, and Simpson) and β-diversity by principal coordinate analysis and permutational multivariate ANOVA. We found no differences in DMI in the pre- and postpartum periods. Cows fed RPC increased the yields of energy- and 3.5% fat-corrected milk and fat yield in primiparous and multiparous cows, with an interaction between treatment and parity for these lactation variables. However, we found no differences in milk protein and lactose up to 150 DIM between treatments. Glucose, NEFA, and BHB had no differences between the treatments. However, RPC decreased BHB numerically (control = 1.07 ± 0.13 vs. RPC = 0.63 ± 0.13) in multiparous on the third week postpartum and tended to reduce the incidence of subclinical ketosis (12.7% vs. 4.2%). No effects for Hp and LPB were found in cows fed RPC. Chao1, Shannon, and Simpson indexes were lower at calving in the RPC treatment than in the Control. However, no differences were found 7 d later for Chao1, Shannon, and Simpson indexes. The vaginal discharge microbiome was altered in cows fed RPC at 7 d postpartum. Fusobacterium, a common pathogen associated with metritis, was reduced in cows fed RPC. Rumen-protected choline enhanced lactation performance and health and altered the vaginal discharge microbiome which is a potential proxy for uterine healthy in dairy cows. The current study's findings corroborate that RPC is a tool to support adaptation to lactation and shed light on opportunities for further research in reproductive health.

Effect of 200 μg of gonadorelin hydrochloride at the first GnRH of a CIDR Synch program on ovulation rate and pregnancies per AI in Holstein heifers

The initial ovulatory response during synchronization programs is often low in dairy heifers, largely due to follicular dynamics and hormonal dynamics. Specifically, the progesterone concentration (P4) at the time of the first GnRH treatment in a breeding program can influence the LH response, often resulting in a suboptimal ovulatory response. The objective of this study was to determine the effect of the highest label dose 200 μg (100 μg vs. 200 μg) of GnRH (50 μg gonadorelin hydrochloride per mL; Factrel®; Zoetis Inc. Madison, NJ) at the first GnRH of a 6-d CoSynch plus P4 device program on ovulatory response and pregnancy per AI (P/AI) in first service in Holstein heifers. A total of 1308 Holstein heifers were randomly allocated at the beginning of a 6-d CIDR-Synch program, Day 0, to receive either i.m. treatment of 100 μg (2CC, n = 655) or 200 μg (4CC, n = 653) of GnRH. Also, at Day 0, heifers received an intravaginal insert with 1.38 g of P4 (Eazi-Breed CIDR® Cattle Insert; Zoetis Inc., Madison, NJ). On Day 6, the insert was removed, and i.m. treatment of 25 mg of PGF2α (12.5 mg dinoprost tromethamine/mL; Lutalyse® HighCon Injection Zoetis) was administered. On Day 7, a second i.m. treatment of 25 mg of PGF2α was given, followed on Day 9 by concurrent i.m. treatment of 100 μg of GnRH and timed AI (TAI). A subset of 396 heifers had their ovaries scanned to evaluate ovulatory response, and blood samples were collected to measure the serum concentration of P4 at Day 0 and Day 6 of the study. The P4 concentrations at Day 0 were categorized as Low (≤3ng/mL) or High (>3ng/mL). The ovulatory response was greater for heifers receiving 4CC than 2CC at Day 0 (54.7% vs. 42.8%). The ovulatory response was greater for Low P4 than High P4 at Day 0 (54.3% vs. 37.8%). However, there was not an interaction between treatment and P4 concentrations (Low P4 2CC = 48.6% vs. High P4 2CC = 30.0%; Low P4 4CC = 60.0% vs. High P4 4CC = 45.5%). The ROC curve analysis indicates that P4 concentrations at Day 0 treatment could predict the ovulatory response, although the area under the curve was only 0.6. As expected, heifers that ovulated had increased P/AI (No = 55.6% vs. Yes = 67.7%); however, there was no effect of treatment on P/AI (2CC = 63.3% vs. 4CC = 59.6%), nor interactions between treatment and ovulation and treatment and P4 (HIGH vs LOW) for pregnancy outcomes. In summary, P4 concentration and increasing the dose of GnRH at Day 0 positively impacted ovulatory response in Holstein heifers. However, there was no interaction between treatment and P4 on ovulation and no subsequent impact of GnRH dose on P/AI.

Safety and efficacy of the combination of cryotherapy and photodynamic modalities with imiquimod in patients with actinic keratosis: a systematic review and meta-analysis

INTRODUCTION

Actinic keratosis (AK) is an intraepithelial tumor that, in most cases, arises in chronically sun-exposed areas. The combination of cryotherapy and photodynamic modalities with imiquimod has been proven to be a potential therapeutic option for AKs. However, there is no comprehensive systematic study that discussed this concept in literature taking into consideration both efficacy and safety.

EVIDENCE ACQUISITION

We performed a comprehensive search of the literature for studies assessing the efficacy and toxicity of the combinatorial tripartite regimen, consisting of cryotherapy and photodynamic modalities with imiquimod in AK. Metanalysis was performed using comprehensive meta-analysis version 3.0.

EVIDENCE SYNTHESIS

After the screening of 1031 studies, five studies were included. Two trials compared the effect of imiquimod/cryotherapy versus cryotherapy alone or versus cryotherapy/vehicle. Our meta-analysis indicated that imiquimod/cryotherapy effectively induces complete clinical clearance in patients with AKs (OR: 6.26; 95%CI: 1.56-24.1; P=0.01). Moreover, another two studies, which were not meta-analyzed, indicated a substantial clinical clearance in the number of AK lesions in the imiquimod plus photodynamic therapy arm as compared to 5% imiquimod or PDT alone. No serious systemic adverse events were reported in all the treatment arms.

CONCLUSIONS

Combined PDT or cryotherapy with imiquimod is more effective in the complete recovery of AK than treatment with imiquimod alone.

Dupilumab therapy in Atopic Dermatitis is safe during COVID-19 infection era: A systematic review and meta-analysis of 1611 patients

The aim of this meta‐analysis is to evaluate the safety of dupilumab use in the management of atopic dermatitis (AD) during the current pandemic regarding the risk and the hazards of COVID‐19 infection. Seven databases (Google Scholar, Web of Science, Scopus, Virtual Health Library, PubMed, System for Information on Gray Literature in Europe, and The New York Academy of Medicine) were searched for eligible studies from inception until November 24, 2021. The quality of evidence was rated using the National Institute of Health and the Joanna Briggs Institute Critical Appraisal tool. Meta‐analysis was performed when the outcome is presented ≥2 studies. A total of 12 papers including 1611 AD patients were included in the study. The prevalence of COVID‐19 in AD treated with dupilumab was 3.2% (95% confidence interval [CI]: 1.7–5.8). COVID‐19 symptoms were reported by five patients who were presented with one or more of the following symptoms (fatigue, loss of taste and smell, runny nose, conjunctivitis, gastrointestinal symptoms, fever, cough, and dyspnea). Only three cases of COVID‐19 were hospitalized with a prevalence of 4.5%, while no patients with COVID‐19 died. Dupilumab is safe regarding the risk and the hazards of COVID‐19 in AD patients. Thus, based on these results continuation of dupilumab in AD patients is recommended, since dupilumab seems to be safe and crucial for a better disease outcome.

A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children

Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children. This pilot, single-centre, open-label, randomised clinical study assessed the taste tolerability and comparative population pharmacokinetics of the novel tramadol chewable tablet against a compounded tramadol hydrochloride oral liquid, at a dose of 1 mg.kg^-1 . A 5-point facial hedonic scale was used by the children, parents and nurses to assess tolerability. One hundred and forty-one children aged 3-16 years were given tramadol 30 min before general anaesthesia. Blood samples were taken following the induction of anaesthesia and for up to 5 h following tramadol administration. Tramadol and its active metabolite O-desmethyltramadol were analysed using reversed-phase high-performance liquid chromatography. A population pharmacokinetic model was built using non-linear mixed effects modelling. The relative bioavailability for the tablet was 1.25 times higher (95%CI 1.16-1.35) than for tramadol hydrochloride oral liquid, while the absorption rate constant for the tablet was significantly lower (1.97 h^-1 vs. 3.34 h^-1 , p < 0.001). Larger inter-individual variability in absorption rates were observed with the liquid tramadol. The tramadol chewable tablet was more acceptable in taste to children when assessed by the children, parents and nurses (all p < 0.001). We conclude that the novel tramadol chewable tablet has favourable acceptability and more reliable relative bioavailability in children compared with tramadol hydrochloride oral liquid.

No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study

This study was performed to evaluate whether the use of drugs in the treatment of osteoporosis in women is associated with COVID-19 outcomes. The results showed that the risk of hospitalization, intensive care unit admission, and mortality was not altered in individuals taking anti-osteoporosis drugs, suggesting no safety issues during a COVID-19 infection.

INTRODUCTION

Whether patients with COVID-19 receiving anti-osteoporosis drugs have lower risk of worse outcomes has not been reported yet. The aim of this study was to evaluate the association of anti-osteoporosis drug use with COVID-19 outcomes in women.

METHODS

Data obtained from a nationwide, multicenter, retrospective cohort of patients diagnosed with COVID-19 from March 11th to May 30th, 2020 was retrieved from the Turkish Ministry of Health Database. Women 50 years or older with confirmed COVID-19 who were receiving anti-osteoporosis drugs were compared with a 1:1 propensity score-matched COVID-19 positive women who were not receiving these drugs. The primary outcomes were hospitalization, ICU (intensive care unit) admission, and mortality.

RESULTS

A total of 1997 women on anti-osteoporosis drugs and 1997 control patients were analyzed. In the treatment group, 1787 (89.5%) women were receiving bisphosphonates, 197 (9.9%) denosumab, and 17 (0.9%) teriparatide for the last 12 months. Hospitalization and mortality rates were similar between the treatment and control groups. ICU admission rate was lower in the treatment group (23.0% vs 27.0%, p = 0.013). However, multivariate analysis showed that anti-osteoporosis drug use was not an independent associate of any outcome. Hospitalization, ICU admission, and mortality rates were similar among bisphosphonate, denosumab, or teriparatide users.

CONCLUSION

Results of this nationwide study showed that preexisting use of anti-osteoporosis drugs in women did not alter the COVID-19-related risk of hospitalization, ICU admission, and mortality. These results do not suggest discontinuation of these drugs during a COVID-19 infection.

HPLC-UV assay of tramadol and O-desmethyltramadol in human plasma containing other drugs potentially co-administered to participants in a paediatric population pharmacokinetic study

Multimodal analgesia is employed in paediatric pain management to maximise analgesia and minimise side effects. Tramadol is dosed at 1-1.5 mg/kg to treat severe pain in children but the assay for tramadol in plasma samples for pharmacokinetic and toxicology studies does not often consider concurrently administered medications. In this study we developed and validated an HPLC-UV method to quantify tramadol and its main metabolite (O-desmethyltramadol) in human plasma in the presence of seven potentially interfering drugs. Sample preparation method was developed by combining liquid-liquid extraction and protein precipitation. Chromatographic separation was achieved on a BDS-Hypersil-C18 column (5 µm, 250 × 4.6 mm) using a double gradient method. The limit of quantification was 6.7 ng/ml for both tramadol and ODT. The precision and accuracy were in compliance with ICH guidelines. This method was successfully employed to analyse the blood samples of 137 paediatric participants in a tramadol pharmacokinetic trial.

Brief in vitro IL-12 conditioning of CD8 + T Cells for anticancer adoptive T cell therapy

Cancer immunotherapy represents a potential treatment approach through non-specific and specific enhancement of the immune responses. Adoptive cell therapy (ACT) is a potential modality of immunotherapy that depends on harvesting T cells from the tumor-bearing host, activating them in vitro and infusing them back to the same host. Several cytokines, in particular IL-2, IL-7 and IL-15, have been used to enhance survival T cells in vitro. Although effective, conditioning of T cells in vitro with these cytokines requires long-term culture which results in the loss of expression of their trafficking receptors mainly CD62L. It also results in exhaustion of the activated T cells and reduction in their functions upon adoptive transfer in vivo. Our recent studies and those of other groups showed that brief (3 days) conditioning of CD8⁺ T cells by IL-12 in vitro can result in enhancing function of tumor-reactive CD8⁺ T cells. Adoptive transfer of these IL-12-conditioned CD8⁺ T cells into tumor-bearing mice, preconditioned with cyclophosphamide, 1 day before ACT, induced tumor eradication that was associated with generation of tumor-specific memory response. In this review, we summarize studies that indicated to the superiority of IL-12 as a potential cytokine for conditioning T cells for ACT. In addition, we discuss some of the cellular and molecular mechanisms that govern how IL-12 programs CD8⁺ T cells to enhance their functionality especially in vitro and its implication in combination with other ACT modalities, opening a avenue for the clinical application of this cytokine.

Melanoma and hypertension, is there an association? A U.S. population based study

BACKGROUND

Melanoma is one of the three major types of skin cancer. In this study we aimed to investigate the association between melanoma and hypertension comorbidity.

METHODS

We performed a population based study using NHANES database during the period 1999-2004. Data were analyzed using SPSS version 24.

RESULTS

Data for 12446 individuals of which 146 had a diagnosis for melanoma were extracted. Melanoma group were older than the no melanoma group as 51% of the melanoma group were 60 years or elder; however 53.6% of the no melanoma group falls below 30 years old. Melanoma group had higher frequency of hypertension (37%) compared to the no melanoma group (22.5%). Logistic regression revealed that melanoma patients had higher odds of hypertension prevalence using the unadjusted model (odds ratio (OR): 2.03, 95% confidence interval (CI): 1.45-2.84, p <0.001). However, after controlling of all potential confounding factors the significance was lost (OR: 0.89, 95% CI: 0.61-1.3, p = 0.54).

CONCLUSIONS

There may be a possible association of melanoma with hypertension comorbidity. With the limitations we faced, we encourage further research to confirm the association of melanoma and hypertension comorbidity.

Efficacy of retinoids alone or in combination with other remedies in the management of warts: A systematic review and network meta-analysis

The use of combined systemic retinoids and intralesional immunotherapy in the management of warts is still debatable without straightforward evidence. Through network meta-analysis, the current study evaluated the efficacy and safety of systemic retinoids alone or combined with other remedies in the treatment of warts. We searched six literature databases for clinical trials that compared systemic retinoids to local treatments or placebo in wart management. Outcomes were calculated as odds ratios (OR) with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses (with a frequentist approach). Network meta-analysis of eight trials showed that oral acitretin plus intralesional Candida Ag (OR = 367.71), INF-α plus oral isotretinoin (OR = 223.77), oral acitretin (OR = 117), Candida Ag (OR = 91.93), oral isotretinoin (OR = 62.26) and topical isotretinoin (OR = 17.69) had higher complete recovery rates than placebo. Regarding the P-score, oral acitretin plus intralesional Candida Ag had the highest efficacy in achieving complete response (P-score = 0.88), followed by INF-α plus oral isotretinoin (P-score = 0.79), then oral acitretin (P-score = 0.60). Variable baseline characteristics and lack of data on some outcomes. The current study shows the efficacy for systemic retinoids in the treatment of warts, especially reluctant or recurrent types. Moreover, combinations of systemic retinoids with intralesional immunotherapy yield higher rates of complete clearance with lower recurrence.

Treatment options for autoimmune bullous dermatoses other than systemic steroids: A systematic review and network meta-analysis

Autoimmune blistering diseases can eventually cause life-threatening complications if left untreated. Although there is no cure for these bullous diseases; their therapy is based on suppressing the immune system to cease the de novo formation of the generated antibodies. The current study aimed to assess the safety and efficacy of using standing alone alternative therapies beyond systemic steroids for management of autoimmune bullous diseases. We searched six literature databases for both randomized and quasi-randomized clinical trials that assessed the efficacy of drugs other than systemic steroids in autoimmune bullous diseases. Outcomes were calculated as odds ratios with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses with a frequentist approach. The network ranking order for 629 bullous pemphigoid patients, from the best to the worst was, clobetasol propionate cream (40 mg; (P-score = .87), clobetasol propionate cream (10-30 mg; P-score = .77), nicotinamide plus tetracycline (P-score = .56), steroids (P-score = .29) and doxycycline (P-score = .01). Limitations of this study are the small sample of the included studies except for blister trial and lack of randomization in most trials. To conclude, Combined doxycycline and nicotinamides are safer and more effective option for extensive bullous pemphigoid patients than the usual use of systemic steroids. For limited disease, topical corticosteroid (40 mg/d) use provides a safer and better response modality than the other proposed treatments.

WITHDRAWN: The effect of anti IL-2/IL-2 complex versus stand-alone low dose of IL-2 on imiquimod induced psoriasis like skin inflammation model

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Correlation between COVID-19 case fatality rate and percentage of BCG vaccination: is it true the vaccine is protective?

Background

The observations of some recent epidemiological studies offer hope for a reduced impact of COVID-19 for countries which practice universal BCG vaccination policy.

Main body

This report provides a correlation between the case fatality rates of COVID-19 and the percentage of BCG vaccination coverage in 183 most affected countries. The main objective of this observational ecologic report is to evaluate possible effects of the previous BCG vaccination in different populations and the epidemic outcomes specially the rates of severe/critical cases and case fatalities. The analysis is preliminary since it is based on constantly rolling data while the COVID-19 pandemic is still unfolding.

Conclusion

Our findings seem to support the fact that an older BCG vaccine may have a protective role in avoiding severe/critical SARS-CoV2 pneumonia and relatively decrease its fatalities.

Telemedicine approach for psoriasis management, time for application? A systematic review of published studies

Psoriasis is a common chronic inflammatory skin condition. It has a chronic course with multiple evolving relapses and patients require long-term treatment and follow-up. Teledermatology was introduced for diagnosis, treatment and follow-up of chronic diseases. Thus, we performed a systematic review for collecting the evidence regarding the efficacy of telemedicine in psoriasis management. Out of 287 records, we included seven studies (four of which were randomized controlled trials). We found that telemedicine alone or combined with usual care had the same or higher efficacy of psoriasis management compared to usual care or control group. We recommend further studies for assessing the pros and cons of this intervention which can replace conventional strategies especially in pandemic times.

90 Establishment and characterization of Day 30 equine chorionic girdle and allantochorion cell lines

Establishing cell lines is a good model for experimental applications to study molecular mechanisms and cell-specific gene expression. Equids have a diffuse epitheliochorial placenta, where the invasive trophoblast is represented by the chorionic girdle (CG) and the noninvasive trophoblast by the allantochorion (AC). Embryonic CG cells are unique to horses and have a crucial role in equine chorionic gonadotropin (eCG) production and maintenance of pregnancy during the first trimester. This study had three objectives: (1) establishing a stable cell line from Day 30 CG cells and AC using lentivirus encoding hTERT; (2) characterisation of Day 30 CG cells and AC cell morphology and expression of eCG α (eCGA) and β (eCGB) subunits, major histocompatibility complex class II (MHCII), and Kisspeptin receptor (KISS1R) in CG and AC cells; (3) investigating eCG protein production invitro from Day 30 CG and AC cells. Three mares (n=3) were used to collect Day 30 conceptuses by non-surgical uterine lavage on Day 30 of pregnancy. All 3 conceptuses were dissected for CG and AC cells then cultured invitro to confluency in cell culture plates. Second-generation lentiviral particles were generated using a three-vector system including transfer vector pLV-hTERT-IRES-hygro, and human telomerase reverse transcriptase (hTERT) lentivirus was utilised to establish stable hygromycin-resistant equine embryonic cell lines. Reverse-transcription PCR (RT-PCR) was used to study gene expression in cells and radioimmunoassay was used to investigate protein presence in the media. We established a hygromycin-resistant Day 30 CG and AC cell lines that express eCGA, eCGB, and hTERT and confirmed using RT-PCR yielding the predicted bands. The cell lines were maintained for 16 passages (7±2 days/passage), 10 of which were cultured after the lentiviral infection steps. Also, we characterised CG cells as fast-growing, large, binucleated, and epithelioid, and AC cells as rapid-growing showing smaller, squamous, mononucleate, epithelioid, and elongated fibroblastic cells. The RT-PCR results showed eCGA and eCGB subunits are expressed by both Day 30 CG and AC cells, but MHCII and KISS1R genes were not expressed in either of cells. Moreover, radioimmunoassay results showed that Day 30 CG cells did produce eCG protein (35.42ngmL−1) invitro earlier than what previous literature has shown. However, Day 30 AC cells did not produce eCG protein (0.042ngmL−1) invitro, and both CG and AC cell lines stopped secreting eCG in the media after the lentiviral infection. To conclude, establishing stable and hygromycin-resistant cell lines from Day 30 equine CG and AC cells using lentivirus encoding pLV-hTERT-IRES-hygro is attainable. Also, equine chorionic gonadotropin eCG protein is produced invitro as early as Day 30 from CG cells.

Intralesional immunotherapy for the treatment of warts: A network meta-analysis

BACKGROUND

Without clear evidence, selecting among the existing immunotherapeutic options for warts remains challenging.

OBJECTIVE

Through network meta-analyses, we aimed to evaluate the comparative efficacy of different intralesional immunotherapeutic modalities.

METHODS

We included randomized controlled trials comparing intralesional immunotherapeutic modalities to cryotherapy, placebo, or imiquimod. All outcomes were presented as odds ratios (ORs) with 95% confidence intervals. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software. The P-score was used to rank different treatments.

RESULTS

Network meta-analysis of 17 randomized controlled trials (1676 patients) showed that PPD (purified protein derivative vaccine, OR 39.56), MMR (measles, mumps, rubella vaccine, OR 17.46) and interferon β (OR 15.55) had the highest efficacy in terms of complete recovery at the primary site compared with placebo. Regarding complete recovery at the distant site, autoinoculation (OR 79.95), PPD (OR 42.95), and MMR (OR 15.39) were all statistically superior to placebo. According to the P-score, MMR was more effective than other modalities in reducing the recurrence rate at the same site.

LIMITATIONS

Relatively small sample size in some comparisons and variability in baseline characteristics.

CONCLUSION

PPD and MMR were the most effective in achieving complete primary and distant recovery (along with autoinoculation for distant recovery) and reducing the recurrence rate at the same site compared with cryotherapy and other immunotherapeutic modalities.

Ginsenoside Rk1 bioactivity: a systematic review

Ginsenoside Rk1 (G-Rk1) is a unique component created by processing the ginseng plant (mainly Sung Ginseng (SG)) at high temperatures. The aim of our study was to systematically review the pharmacological effects of G-Rk1. We utilized and manually searched eight databases to select in vivo and in vitro original studies that provided information about biological, pharmaceutical effects of G-Rk1 and were published up to July 2017 with no restriction on language or study design. Out of the 156 papers identified, we retrieved 28 eligible papers in the first skimming phase of research. Several articles largely described the G-Rk1 anti-cancer activity investigating "cell viability", "cell proliferation inhibition", "apoptotic activity", and "effects of G-Rk1 on G1 phase and autophagy in tumor cells" either alone or in combination with G-Rg5. Others proved that it has antiplatelet aggregation activities, anti-inflammatory effects, anti-insulin resistance, nephroprotective effect, antimicrobial effect, cognitive function enhancement, lipid accumulation reduction and prevents osteoporosis. In conclusion, G-Rk1 has a significant anti-tumor effect on liver cancer, melanoma, lung cancer, cervical cancer, colon cancer, pancreatic cancer, gastric cancer, and breast adenocarcinoma against in vitro cell lines. In vivo experiments are further warranted to confirm these effects.

Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography

The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001). This study used an objective measure to demonstrate the long-standing belief that hypotensive anesthesia is efficacious in reducing tissue perfusion in the surgical field. The data suggest that pharmacologically depressing the level of mean arterial pressure by 18% may result in a 41-52% decrease in facial soft tissue perfusion. This study reports a novel method of quantitative analysis.

Augmentation of the infraorbital rim in orthognathic surgery

Mid-face augmentation via a Le Fort I osteotomy is a commonly performed operation. Advancement of the upper jaw and associated structures (nose, lower cheek areas) can certainly improve function as well as facial aesthetics and harmony. Often, in patients with severe mid-face deficiency, hypoplasia of the maxilla extends all the way up to the infraorbital rims. The receding infraorbital rim contributes to the negative vector of the globes. In patients with this level of mid-face hypoplasia, while advancing the maxilla at the Le Fort I level satisfies all of the requirements for orthognathic surgery, the deficient infraorbital rim remains unchanged and can actually accentuate the negative vector of the globes. This article explains our approach in augmentation of the deficient infraorbital rim using alloplastic silicone implants at the time of a Le Fort I osteotomy.

Progressive cutaneous Cryptococcosis complicated with meningitis in a myasthenia gravis patient on long-term immunosuppressive therapy - a case report

BACKGROUND

Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans and most remarkably manifests in HIV-infected individuals, especially in the settings of very low CD4 count. Development of cryptococcosis in HIV-uninfected individuals is exceedingly rare and usually signifies a marked immunodeficiency. Cryptococcosis in association with myasthenia gravis or thymoma has been previously documented in only very few cases in the literature.

CASE PRESENTATION

We reported a complicated case of severe cutaneous cryptococcosis in a 39-year-old Vietnamese male patient with myasthenia gravis on long-term immunosuppressive therapy. The patient presented with a five month history of recurrent and progressive skin lesions that later on progressed into cryptococcal meningitis.

CONCLUSION

Through this case, we aimed to emphasize the importance of including cutaneous cryptococcosis in the differential diagnosis of cutaneous lesions in patients on chronic immunosuppressive therapy. The cutaneous manifestations of cryptococcosis can be the first clue for a disseminated disease, which makes early recognition crucial and life-saving.

Comparison of GnRH antagonist and agonist mini-dose long protocols in infertile cases undergoing controlled ovarian hyperstimulation

AIM

The purpose of the present study was to determine if there is a difference between multi-dose gonadotropin releasing hormone (GnRH) antagonist protocol and long GnRH agonist protocol.

MATERIALS AND METHODS

This retrospective study compared the data pertaining to patients chosen as per predetermined acceptance criteria, 113 of whom were administered multi-dose antagonist protocol for controlled ovarian hyperstimulation (COH) while 133 were administered long agonist protocol for COH at Suleymaniye Teaching Hospital of Obstetrics and Gynecology.

RESULTS

While cancellation rate was found to be significantly higher in antagonist group (17.7% vs 11.28%), the number of follicles > 14 mm and > 16 mm, E2 level, and the number of retrieved oocytes on the day of hCG trigger were significantly lower in the same group. However, there was no difference between fertilization rates and embryonic development rates. The pregnancy rates per transfer and per cycle were found to be 40.9% and 31.7%, respectively; in the antagonist group they were lower, though not significantly, when compared to agonist group (44.1% and 39.1%, respectively). Ongoing pregnancy rates were found to be similar between the groups.

CONCLUSION

GnRH antagonist treatment protocol has a level of efficacy similar to agonist treatment protocol in terms of pregnancy results for all groups.

Alexithymia in Diabetes Mellitus

Background

Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation.

Objective

To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes.

Method

In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean±SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. P<0.05 was considered statistically significant.

Results

The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2±14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243±110 mg/dl, HbA1c 7.3±3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3±3.7 vs. 10.6±3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.

Heart Rate Variability in Diabetes Patients

Diabetes mellitus can cause cardiovascular autonomic neuropathy and is associated with increased cardiovascular deaths. We investigated cardiovascular autonomic neuropathy in diabetics and healthy controls by analysis of heart rate variability. Thirty-one diabetics and 30 age- and sex-matched controls were included. In the time domain we measured the mean R-R interval (NN), the standard deviation of the R-R interval index (SDNN), the standard deviation of the 5-min R - R interval mean (SDANN), the root mean square of successive R - R interval differences (RMSSD) and the percentage of beats with a consecutive R - R interval difference > 50 ms (pNN50). In the frequency domain we measured high-frequency power (HF), low-frequency power (LF) and the LF/HF ratio. Diabetes patients had lower values for time-domain and frequency-domain parameters than controls. Most heart rate variability parameters were lower in diabetes patients with chronic complications than in those without chronic complications.

An aesthetic approach in the repair of anterior frontal sinus fractures

The management of upper facial trauma is a common responsibility of surgeons taking care of maxillofacial injuries. Historically, the most commonly used surgical approach has been the bi-temporal (coronal) incision. As is well known, the coronal incision carries some inherent complications such as hair loss, long scars, and increased length of hospital stay. The purpose of this article is to describe an aesthetic approach, similar to an endoscopic brow lift, for the repair of anterior wall fractures of the frontal sinus without the need for long incisions or fixation devices.

Assessment of perioperative, early, and late postoperative complications of the inside-out transobturator tape procedure in the treatment of stress urinary incontinence

OBJECTIVE

To evaluate the complications of urinary incontinence surgery with transobturator tape (TVT-O) system and to describe its diagnosis and management.

MATERIALS AND METHODS

A total of 156 patients who were diagnosed as having stress incontinence and mixed incontinence with stress predominance underwent a TOT operation under spinal anesthesia by one surgeon or two surgeons (MB, AEY) from the team. TVT-obturator inside out material was used in the operation. Urodynamic tests and pad tests were done on all the patients. This is a prospective and retrospective study of the complications of TVT-O. The operation was performed under regional anesthesia, as described by Deval et al. Patients were excluded from the study if they had been operated under general or local anesthesia, had undergone any vaginal operations except for anterior repair (cystocele), wanted to have a baby, had severe systemic diseases or had been diagnosed as having urge incontinence in urodynamic tests. These situations may affect the rate of complications, the authors also excluded slings that had materials other than monofilament polypropylene, and patients who were suspected of having neurologic bladder conditions. The bladder and urethra were evaluated using cystoscopy. The durations of the TOT procedure, cystoscopy, and if performed, the cystocele operation, were recorded. Perioperative, early, and late postoperative complications were analyzed by follow-up visits (after two months to four years).

RESULTS

Of the 156 patients included in the study, 100 (64.1%) had pure stress urinary incontinence and 56 (35.9%) had mixed incontinence, 20 (12.8%) had previous incontinence surgery. The mean duration of follow up was 30.3 ± 7.4 (range 17-42) months. The mean age of the patients was found to be 48.43 ± 6.24 years (range 42-68). The mean parity of the patients was 5.24 ± 2.86 (range 2-13), and mean body mass index was found to be 23.7 ± 4.8. Mean maximum detrusor pressure was 10.30 ± 4.08 and the mean ALP value was 80.80 ± 25.57. Mean operative time was found to be 13.8 ± 5.16 min in patients who underwent only TOT and TOT-anterior repair. Vaginal injury including to the lateral fornix (4.4%), hemorrhaging of more than 200 ml (3.2%), vascular damage (1.9%), hematoma on the leg (1.9%), hemorrhaging of more than 500 ml (0.064%), and bladder perforation (1.2%) were detected as perioperative complications. Urethral injury and perioperative nerve and intestinal injury did not occur. The most common complication in early postoperative period was inguinal pain extending the legs (30.7%), followed by headaches (23.7%), fever (12.8%), urinary tract infection (5.7%), and urinary retention (3.2%), respectively. Late postoperative complications included vaginal erosion (4.4%), de novo urge incontinence (8.9%), de novo dyspareunia (7.1%), perineal pain (4.4%), and worsening urgency (8.9%).

CONCLUSION

Although the TVT-O technique is a minimal invasive surgery method applied to treat the urinary incontinence surgically, it does not imply that it is a complication-free surgical procedure. Despite the low incidence of intraoperative complications, there is a mild risk of early and late postoperative complications. Fortunately these complications can be taken under control by either conservative and simple medical treatments or surgical procedures.

Troponin I and D-Dimer levels in preeclampsia and eclampsia: prospective study

OBJECTIVE

The aim of this study was to evaluate serum cardiac troponin I and D-Dimer (D-Di) levels in preeclampsia (PE), eclampsia (E), and normotensive healthy pregnant women in third trimester in order to define their diagnostic value.

MATERIALS AND METHODS

The study group consisted of 42 preeclamptic patients and 16 eclamptic patient; 108 healthy normotensive pregnant women in third trimester who were chosen from outpatients clinic and examined regularly used as a control group. Serum cardiac troponin I and D-Di levels were measured using an immunoassay.

RESULTS

The average levels of troponin I were 0.0134 ± 0.0091, 0.017 ± 0.0085, 0.180 ± 0.136 in control group, preeclamptic, and eclamptic patients, respectively. The levels of troponin in eclamptic patients were statistically higher than the normotensive and preeclamptic group (p = 0.016, p = 0.014). There were no differences in terms of troponin I level between preeclamptic group and normotensive pregnant women in third trimester (p = 0.089). The average D-Di levels were 634 ± 228 ng/ml, 1426 ± 430 ng/ml, 2067 ± 580 ng/ml in control group, preeclamptic, and eclamptic patients, respectively. The levels of D-Di in preeclamptic and eclamptic patients were found significantly higher than the control groups (p = 0.034, p = 0.020).

CONCLUSION

Serum troponin I levels increased in eclamptic patient because of myocardial damage. An increased level of troponin was not detected in preeclamptic patients. However; D-Di level increased in preeclamptic and eclamptic patients.