Physical performance tests have excellent reliability in frail and non-frail patients with prostate cancer

PURPOSE

Our aim was to investigate the test-retest reliability of the 2-min walk test (2MWT), timed up and go test (TUG), and five times sit-to-stand test (FTSST) in prostate cancer (PC) patients.

METHODS

This study was conducted with 73 patients who were classified into two groups as frail and non-frail determined by the Geriatric-8 questionnaire. Patients performed the 2MWT, TUG, and FTSST tests for two times. The test-retest reliability of the 2MWT, TUG, and FTSST was assessed by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM95) and minimal detectable change (MDC95) values were calculated.

RESULTS

All tests showed excellent test-retest reliability for both groups (ICC(2.1) > 0.90). The SEM95 and MDC95 values of 2MWT were 3.09, 8.57, and 3.15 m, 8.73 m for frail and non-frail groups. The SEM95 and MDC95 values of TUG for the frail group were 0.6 and 1.66 and 0.43 and 1.19 for the non-frail group, respectively. The SEM95 and MDC95 values of FTST for the frail group were 0.68 and 1.88 and for the non-frail group 0.86 and 2.38.

CONCLUSIONS

The 2MWT, TUG, and FTSST showed excellent reliability in frail and non-frail older adults with PC which can be used to assess physical performance.

Is it possible that we can increase the lymph node number in cases with rectum tumor receiving neoadjuvant therapy?

Background

Though the recommended sampled lymph node number in colorectal carcinomas is at least 12, due to shrinkage after preoperative neoadjuvant chemoradiotherapy (NCRT), it can be difficult to attain that number.

Aim

Our aim is to increase the lymph node number by applying alcohol fixation on the formalin-fixed resection materials of the patients that received or not received neoadjuvant therapy and to evaluate the changes in staging due to obtained lymph nodes.

Settings and Design

Non-randomized controlled trial.

Materials and Methods

Lymph node dissection was performed in the resection materials with rectum tumor which were formalin- and afterwards, alcohol-fixed. The number of lymph nodes obtained by both of the methods and status of metastasis were evaluated statistically.

Results

Of the total 76 rectal tumors, 57 had and 19 had not received NCRT. The number of lymph node was adequate in 89.5% cases with no NCRT and in 63.2% cases with NCRT. While no change was observed after the alcohol fixation in the cases fulfilling adequacy criterion among those with no NCRT (p = 1.000), the adequacy rate increased from 63.2% to 87.7% in those with NCRT (p < 0.001). Although statistically insignificant, there was a change in pN stage in eight cases. In three of them, the stage varied from pN0 to pN1c, and in five cases, from pN1a to pN1b.

Conclusion

Using solutions as alcohol during fixation might facilitate the identification of metastatic lymph nodes, might change the stage of the disease and therefore, might affect the patient-based therapy.

Results of salvage treatment with CyberKnife® fractioned radiosurgery in recurrent large chordoma

AIM

Chordomas and chondrosarcomas are locally destructive tumors with high progression or recurrence rates after initial multimodality treatment. This report examined the role of radiosurgery in patients who were considered inoperable after the recurrence of large chordoma disease having undergone previous surgery and/or radiotherapy.

METHODS

All patients who were referred to Okmeydani Education and Research Hospital between 2012 and 2019 for treatment of recurrent or metastatic chordoma and considered not suitable for surgical treatment were included in the study. We included patients presenting with recurrent or metastatic chordoma, those who had undergone surgery and/or radiotherapy and were now considered to be surgically inoperable, patients whose tumors could lead to severe neurologic or organ dysfunction when resected, and those who underwent salvage treatments for definitive or palliative purposes with radiosurgery. After radiosurgical salvage therapy was performed on 13 patients using a CyberKnife® device, the effect of this treatment in terms of local control and survival and the factors that might affect it was investigated. Thirteen lesions were local (in-field) recurrence, and five lesions were closer to the primary tumor mass or seeding metastatic lesions. Tumor response was evaluated using the Response Evaluation Criteria for Solid Tumors (RECIST) system and volumetric analysis.

RESULTS

The median age of the 13 patients was 59 years, and the median tumor volume of 18 lesions was 30.506 cc (R: 6884.06-150,418.519 mL). The median dose was 35 Gy (R: 17.5-47.5), the median fraction was 5 (R: 1-5), and the median biological effective dose BED_2.45 was 135 Gy (R: 63.82-231.68). The median time for radiosurgery was 30 months after the first radiotherapy and 45 months after the last surgery. The median follow-up time was 57 (R: 15-94) months. The progression-free survival was 24 months. The median survival was 33.9 months. Local control was achieved in 84.6% of patients after 1 year, and 76.9% after 2 years, with the mass shrinking or remaining stable. Survival after recurrence was 69.2% for the 1st year, 61.5% for the 2nd year, and 53.8% for the 5th year.

CONCLUSION

In patients with recurrent and surgically inoperable chordomas, stereotactic body radiation therapy (SBRT) is a reliable and effective treatment method. Promising result has been obtained with radiosurgery treatment under local control of patients.

LEVEL OF EVIDENCE

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

The efficacy and tolerability of ultra-hypofractionated radiotherapy in low-intermediate risk prostate cancer patients: single center experience

BACKGROUND

We aimed to investigate the efficacy and tolerability of ultra-hypofractionated radiotherapy (UHRT) in the treatment of low and intermediate-risk prostate cancer patients.

METHODS

This retrospective study was conducted using data derived from 44 patients who underwent UHRT, and toxicity assessment and clinical response were investigated. Treatment consisted of 35-36.25 Gy in 5 fractions using stereotactic ablative radiotherapy (SABR) with the Linac-based delivery system.

RESULTS

The median duration of follow-up was 52 months (8-68 months) and the median age was 71.5 years (54-85 years). Twenty-seven patients were assigned as intermediate-risk, whereas 17 patients had low-risk. The 5-year overall survival rate was 87.8%, while the 5-year biochemical recurrence-free survival (bRFS) rate was 97.4%. Acute grade 3 genitourinary (GU) side effect was not observed in any patient, whereas acute gastrointestinal (GI) system grade 3 side effect was seen in 6.8% of the patients. Late grade 3 GU and GI side effects were seen in 4.6% and 6.8% of the patients, respectively. In patients with planning target volume (PTV) ≥85 ml, acute grade ≥2 GU side effects were more common (p=.034).

CONCLUSION

Our data demonstrated that UHRT administered with volumetric arc therapy (VMAT) can be recommended for selected patients with low-intermediate risk prostate cancer. Further prospective, multicentric, controlled trials on larger series are warranted to reach more accurate conclusions.

Can we use neutrophil to lymphocyte ratio in the diagnosis and prediction of extracapsular extension in localized prostate cancer?

PURPOSE

We investigated role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of extracapsular extension (ECE) in clinically localized prostate cancer (PCa).

MATERIALS AND METHODS

A total of 396 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP), and 260 patients with benign prostatic hyperplasia (BPH) who underwent suprapubic prostatectomy were included in the study. Preoperative NLR, prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, prostate volume (PV), free/total PSA (f/t PSA) in both groups, and relation of NLR with PSA, Gleason Score (GS), and pathologic stage in PCa group were investigated. Records of patients were analyzed retrospectively.

RESULTS

NLR, free PSA, f/t PSA, and PV were statistically higher in BHP, and PSAD was higher in PCa group. In PCa group, NLR was found to be higher in patients with PSA >10 ng/ml compared to those with less than ⩽10 ng/ml. NLR increases as the preoperative GS increases, and it was higher in pT3 patients than pT2 patients. NLR was statistically higher in those patients with positive lymph nodes than those without after RRP (p = 0.029).

CONCLUSION

NLR is not a sufficient biomarker in differentiating clinically localized PCa from BPH. NLR increases as preoperative GS and pathologic stage increases. Lymph node involved patients after RRP have statistically higher NLR. NLR can be an indicator of ECE and lymph-node involvement in clinically localized PCa.

Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?

PURPOSE

Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement.

METHODS

Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)).

RESULTS

Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05).

CONCLUSION

Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery.

TRIAL REGISTRATION

This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433).

Reliability and Validity of the Modified Dental Anxiety Scale in Turkish Patients

We aimed to determine dental anxiety among Turkish patients and assess the sensitivity, specificity, positive/negative predictive values and reliability of the Modified Dental Anxiety Scale (MDAS) and Corah's Dental Anxiety Scale (DAS). Patients referred to our clinic for dental treatment who had a history of dental anxiety were included in the study. 294 randomly selected patients (mean age 38.8 years) completed a questionnaire combining Corah's DAS and MDAS. They were retested 15 days later. The prevalence of dental anxiety was found to be 9.9% (29/294) for Corah's DAS at the cut-off point ≥ 15 and 8.8% (26/294) for the MDAS at the cut-off point ≥ 19. Both dental anxiety scales gave acceptable sensitivity, specificity, positive and negative predictive values at these cut-off points.

Gene delivery: intelligent but just at the beginning

Gene therapy is used to treat genetic disorders, which may be achieved both ex vivo and in vivo. Gene-delivery systems usually include a carrier system which both protects the gene expression plasmid and allows its extracellular and intracellular trafficking. Viruses are used in most of the clinical trials today; however, they do have important drawbacks. Non-viral vectors based on lipids, water-soluble polycations, other non-condensing polymers and nano- or microparticles/capsules have been proposed. Cationic polymers, especially carrying novel targeting ligands. are receiving increasing attention. Intelligent polymers with temperature, pH, and light sensitivities for a controllable and effective non-viral transfection have recently been introduced but are just at the beginning. Our preliminary studies showed that block copolymers of N-isopropylacrylamide-acrylic acid with poly(ethylene imine) could be one example of these novel non-viral vectors.

Growth inhibition of SK-MEL-30 human melanoma cells by antisense c-myc oligonucleotides delivered by poly(N-isopropylacrylamide)/ poly(ethyleneimine) copolymer

The c-myc oncogene has been shown to be overexpressed in a number of malignancies and plays a key role in the abnormal growth regulation of melanoma cells. This study aimed to provide an efficient system for the in vitro manipulation of c-myc expression by antisense oligonucleotides. Therefore, we used poly(NIPA)/PEI2B copolymer as vector in order to improve the intracellular availability and stability of AS ODNs. We targeted oligonucleotide sequences within the human c-myc mRNA as free AS ODNs or conjugated with a thermosensitive copolymer, in an effort to inhibit the growth of human melanoma cells. The conjugates adopted more positive charge and smaller size at 37 degrees C and they had no toxic effects on human fibroblast cells. The conjugated AS ODNs showed increased antiproliferative effect on melanoma cells as compared to free AS ODNs. At a concentration of 100 ng, AS ODNs inhibited SK-MEL 30 human melanoma cell line proliferation maximally by 18.6%, whereas the same amount of conjugated AS ODN provided 52% inhibition. The greatest inhibition was obtained by conjugates having a polymer:AS ODN ratio of 9. Greatest inhibition was detected at 48 h and decreased after 96 h, which may be due to the depletion of AS ODNs. The results confirm the enhanced antiproliferative effects of poly(NIPA)/PEI2B-conjugated AS ODNs, which may provide improved intracellular availability for c-myc-directed antisense strategies.

Patterns of care for lung cancer in radiation oncology departments of Turkey

PURPOSE

To determine the patterns of care for lung cancer in Turkish radiation oncology centers.

METHODS AND MATERIALS

Questionnaire forms from 21 of 24 (87.5%) centers that responded were evaluated.

RESULTS

The most frequent histology was non-small cell lung cancer (NSCLC) (81%). The most common postoperative radiotherapy (RT) indications were close/(+) surgical margins (95%) and presence of pN2 disease (91%). The most common indications for postoperative chemotherapy (CHT) were ">/= IB" disease (19%) and the presence of pN2 disease (19%). In Stage IIIA potentially resectable NSCLC, the most frequent treatment approach was neoadjuvant concomitant chemoradiotherapy (CHRT) (57%). In Stage IIIA unresectable and Stage IIIB disease, the most frequent approach was definitive concomitant CHRT (91%). In limited SCLC, the most common treatment approach was concomitant CHRT with cisplatin+etoposide for cycles 1-3, completion of CHT to cycles 4-6, and finally prophylactic cranial irradiation in patients with complete response (71%). Six cycles of cisplatin + etoposide CHT and palliative thoracic RT, when required, was the most commonly used treatment (81%) in extensive SCLC. Sixty-two percent of centers did not have endobronchial brachytherapy (EBB) facilities.

CONCLUSION

There is great variation in diagnostic testing, treatment strategies, indications for postoperative RT and CHT, RT features, and EBB availability for LC cases. To establish standards, national guidelines should be prepared using a multidisciplinary approach.

Intelligent polymers as nonviral vectors

The successful gene therapy largely depends on the vector type that allows a selective and efficient gene delivery to target cells with minimal toxicity. Nonviral vectors are much safer and cheaper, can be produced easily in large quantities, and have higher genetic material carrying capacity. However, they are generally less efficient in delivering DNA and initiating gene expression as compared to viral vectors, particularly when used in vivo. As nonviral vectors, polycations may work well for efficient cell uptake and endosomal escape, because they do form compact and smaller complexes with plasmid DNA and carry amine groups, which give positive charge and buffering ability that allows safe escape from endosome/lysosome. However, this is a disadvantage in the following step, which is releasing the plasmid DNA within the cytosol. In order to initiate transcription and enhance gene expression, the polymer/plasmid complex should dissociate after releasing from endosome safely and effectively. There are also other limitations with some of the polycationic carriers, for example, aggregation, toxicity, etc. Intelligent polymers, also called as 'stimuli responsive polymers', have a great potential as nonviral vectors to obtain site-, timing-, and duration period-specific gene expression, which is already exhibited in recent studies that are briefly summarized here.

Survey of dental radiological practice in Turkey

OBJECTIVES

The aim of this study was to determine the dentist's knowledge about dose reduction techniques, radiographic equipment and quality of dental radiographic service in general dental practice in Turkey.

METHODS

The survey was performed on 636 dentists who attended the 11th International Congress organized by the Turkish Dental Association. Information on the demographic characteristics of the dentists, radiographic equipment, techniques and processing they used and radiation protection was obtained with a 32 point questionnaire.

RESULTS

The respondents' knowledge concerning the technical details of their equipment was limited, with 512 (86.9%) not knowing the kilovoltage peak (kVp) of their machine. Only 34 (5.5%) respondents reported having rectangular collimators. The dentists had little knowledge about the speed of film they used. D-speed film was the most preferred one with 21.6%. Fifty-eight (10.2%) dentists used E-speed film and the F-speed film was used only by 13 (2.3%) dentists. The most preferred technique (62%) for periapical radiography was the bisecting angle technique. Four hundred and eighty five (82.5%) of the dentists reported that they took the radiographs by themselves.

CONCLUSIONS

In the present study, the results indicate that for minimizing any unnecessary radiation, attempts should be made to improve dentists' knowledge about radiation dose reduction techniques.

The effect of EGF application in gel form on histamine content of experimentally induced wound in mice

The factors participating to the wound healing are complex and still obscure. Among these factors, epidermal growth factor (EGF) and histamine by increasing reepithelization and reparation tissue strength via enhancing collagen deposition to the wound site have a beneficial effect. This study was performed to investigate the effect of EGF dosage forms on the histamine content of the experimentally induced wound and some wound healing criters in the mice. Histological investigation of reepithelization, wound tensile strength for healing and collagen maturation, and histamine levels were assessed in the present study. Thirty two mice were divided into control, and EGF treated groups. Controls included three subgroups; untreated (n=5), 0.9% NaCl applied (n=5), and gel applied (n=5). Experimental groups were treated with two forms of EGF; EGF, solution form in 0.9% NaCl (n=5) and the gel form in 0.2% w/w in carbopol 940 (n=7). The discrepancy between these forms were evaluated. This evaluation was done by the application of two forms of EGF for 15 days on experimentally induced wound healing. Gel form of EGF by sustained release from bioadhesive polymer is found to be more effective than the soluble form, on the healing of the wound, by acceleration of reepithelization and increment of wound tensile strength. The tensile strength of the wound indicates the rate of repair and collagen maturation. It has been observed that when physiological saline and carbopol 940 exposed to incision without EGF causes a significant increase in tissue histamine content. According to the results of the present investigation; the histamine content is found to be decreased by EGF gel dosage form treatment, therefore preventing abnormal collagen formation has a beneficial effect on wound healing.

Studies on the epidemiology of tropical theileriosis (Theileria annulata infection) in cattle in Central Anatolia, Turkey

An epidemiological survey for Theileria annulata infection was conducted in 12 selected villages around Ankara in Central Anatolia, Turkey, during the period April 1990 to January 1993. During the survey, 198 cattle of 30 local breeds, 84 Holstein-Friesian x local breeds and 84 Holstein-Friesian breed were examined for antibodies to T. annulata and the presence of the vector ticks. Four species of Hyalomma ticks were identified: Hyalomma anatolicum anatolicum, Hyalomma anatolicum excavtum, Hyalomma detritum and Hyalomma marginatum marginatum. Salivary gland staining indicated that infected adult ticks of all four species were present and, therefore, were implicated in the transmission of tropical theileriosis in the field. Generally, the Hyalomma infestation rate was low, with the heaviest infestations occurring on the older animals. Young adults and calves had very low infestation rates. Most ticks seen on cattle were adults, very few nymphs were found. The blood smear and serological examination of the 198 cattle conducted in March, before the start of the first disease season, showed that the prevalence of piroplasmosis was 11.1% (22 out of 198) and the seroprevalence of T. annulata was 10.6% (21 out of 198). Forty-three animals were then excluded from the study because they were seropositive and/or harboured piroplasms. Ninety-two seronegative animals showed piroplasmosis (92 out of 155) and 34 seronegative animals became seropositive for T. annulata (34 out of 155) during the three disease seasons. One animal became clinically ill with tropical theileriosis and required treatment. The incidence of cattle showing piroplasmosis and disease in the total study sample was 50.7% and 0.5% per disease season, respectively. The seroconversion rate of new infection with T. annulata in the total study was 14.3% per animal season. The number of cattle showing piroplasmosis was much greater than the number of seropositive cattle, which may indicate the presence of another species of Theileria. The two different management systems encountered in the study were considered to have influenced the tick infestation levels.

The effect of taurine administration on vitamin C levels of several tissues in mice

Taurine (2-aminoethane sulphonic acid), a sulphur-containing beta amino acid, is the most prevalent free intracellular amino acid in many human and animal tissues. Vitamin C metabolism is also fluenced by sulphur-containing amino acids. The aim of this study is to investigate the effect of taurine administration on the vitamin C levels of plasma and several tissues (brain, liver, kidneys) in mice with incisional skin wounds. Animals were divided into two as control and taurine groups. Taurine was freshly dissolved in sterile saline and administered daily (60 microl, ip) for five days in the taurine group. At the end of the fifth day, the animals were killed by decapitation. The brain, liver and kidneys were immediately removed. Vitamin C levels were measured in plasma and several tissues. The administration of taurine had no effect on the plasma vitamin C levels (P>0.05) but significantly increased in liver and kidneys (P<0.001). In conclusion, taurine may affect the vitamin C metabolism in tissues by different mechanisms.

Comparison of different treatment combinations for chronic hepatitis B infection

Chronic hepatitis B virus (HBV) infection is a leading cause of cirrhosis and hepatocellular carcinoma worldwide. Its prevalence approaches 10% in hyper endemic areas. The aim of treating chronic HBV infection is to halt progression of liver injury by suppressing viral replication or eliminating infection. This study was planned to evaluate the advantages of combination therapy with interferon-alpha plus second-generation nucleoside analogues (lamivudine or famciclovir), or vaccination with a pre-S2 and S proteins containing vaccine in chronic HBV infection. 29 patients were divided into three groups and were treated with the following combinations: (1) IFN-alpha2a 9 million units 3x week for 6 months with HBV vaccine 20 microg given on 0, 1 and 2 months; (2) IFN-alpha2a 6 million units 3x week plus famciclovir 250 mg 3x day for 6 months; (3) IFN-alpha2a 6 million units 3x week plus lamivudine 100 mg/day for 6 months. Complete response was suspected in 3 patients in group 1, in 4 patients in group 2, and in 7 patients in group 3. Partial response was suspected in 4, 1 and 2 patients in groups 1, 2 and 3, respectively. The results of the present study suggest that the combination of IFN-alpha with lamivudine is more effective than the combination of IFN-alpha with HBV vaccination or famciclovir.

The protective effect of taurine pretreatment on carbon tetrachloride-induced hepatic damage--a light and electron microscopic study

The results regarding taurine pretreatment on CCl(4)-induced hepatic injury are controversial. To assess the therapeutic efficacy of taurine on rat liver injury, hepatic malondialdehyde, glutathione, and hydroxyproline levels together with morphologic alterations in the liver following CCl(4) administration were investigated. The rats were divided into three groups. Taurine-treated animals received 15 ml/kg/day of a 5% taurine solution by a gastric tube for 5 days before administering CCl(4) (2 ml/kg, intraperitoneally, in a single dose). CCl(4)-treated rats received the same amount of saline solution. Control animals received no treatment. The increase of hepatic malondialdehyde formation in the CCl(4)-treated group was partially prevented by taurine pretreatment, but taurine had no significant effect on the glutathione and hydroxyproline content in the CCl(4)-treated rats. Taurine pretreatment induced a marked beneficial effect regarding the prevention of hepatocellular necrosis and atrophy as demonstrated morphologically. In conclusion, these results suggest that taurine pretreatment might not significantly change the biochemical parameters, but prevents the morphologic damage caused by CCl(4) in the early stages.

Increased nitric oxide in exhaled air in patients with rheumatic heart disease

BACKGROUND

Endogenous production of nitric oxide and its presence in exhaled air was observed in humans. Prior studies have yielded contrasting information about the production of nitric oxide in patients with heart failure.

AIMS

The aim of this study was to measure nitric oxide in the exhaled air of patients with chronic rheumatic heart disease with and without pulmonary hypertension.

METHODS

Seventy-four patients (6 patients had isolated mitral stenosis; 13 patients had combined mitral stenosis and mitral regurgitation; 1 patient had isolated mitral regurgitation; 54 patients had combined mitral and aortic valve disease) and 27 healthy subjects were entered in the study. The nitric oxide concentration in exhaled air was determined with a chemiluminescence analyser. Echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure.

RESULTS

The level of exhaled nitric oxide was significantly greater in patients with rheumatic heart disease than in controls. The value of nitric oxide concentration in exhaled air was significantly increased in patients with pulmonary hypertension, as compared with patients who had normal pulmonary artery systolic pressure.

CONCLUSION

We found increased nitric oxide in the exhaled air in patients with rheumatic heart disease, especially in those with pulmonary hypertension, compared with healthy patients.

Factors of patient satisfaction/dissatisfaction in a dental faculty outpatient clinic in Turkey

OBJECTIVES

Being service providers, dental professionals should satisfy their consumers/dental patients. This study investigates satisfaction with dental care among the patients of a dental faculty outpatient clinic of a major university in Izmir, Turkey.

METHOD

The study was performed on 1001 patients of whom 674 filled out the questionnaire containing sociodemographic items and open-ended questions to determine the factors of (dis)satisfaction. The open-ended questions were content analyzed, and each patient was scored according to his comments: "complaining: (0)", "both praising and complaining: (1)", "no comment: (2)", and "praising: (3)". Each factor that has an impact on the decision of the study sample was determined by statistical analyses of data, using student t-test, chi-square test, and multiple regression analysis.

RESULTS

Most of the patients were highly educated (74.7%), had a high income (48.7%), and were young to middle-aged (73.1%). There was a well-balanced gender representation. The patient sample had sought care mostly for dental caries, periodontal diseases, problems with old restorations, and prosthetic rehabilitation. Of 1,001 patients, 38.6% were satisfied with the dental care they received, 23.8% were both satisfied and dissatisfied, 5% were dissatisfied, and 32.7% failed to comment. No significant differences were observed between the satisfaction/dissatisfaction scores and sociodemographic variables of the patients in the groups (P>0.05). The most important components of satisfaction were found to be "relationship between dentists and patients" (P<0.001), "organized service system" (P<0.001), and "scientific ability of dental personnel" (P<0.001). The most prominent complaints were "long treatment span" (P<0.001), "disorganized service system" (P<0.001), and "slowness of radiographical examination procedures" (P<0.001).

CONCLUSIONS

Despite the significant variations among the cultural and ethnic structures of different societies, personal interactions have priority in establishing satisfying dental service.

Role of the nitric oxide pathway on ischemia-reperfusion injury in an isolated perfused guinea pig heart

We examined the role of the nitric oxide (NO) pathway on ischemia-reperfusion injury with the use of isolated perfused guinea pig hearts. We administered to the heart either L-arginine or N-nitro-L-arginine methyl ester (L-NAME) before or after 20 min of ischemia, and we observed the heart rate, aortic pressure, and contractile force, as well as the levels of malondialdehyde (MDA) and glutathione (GSH). We observed that L-NAME increased the tissue MDA levels and aortic pressure. On the other hand, L-arginine before the onset of reperfusion decreased aortic pressure and tissue MDA levels but increased the tissue GSH levels. We concluded that L-arginine administration before the onset of reperfusion improves myocardial recovery from ischemic injury.

The protective effect of Ginkgo biloba extract on CCl4-induced hepatic damage

The aim of this study was to evaluate the protective effect of Ginkgo biloba extract on CCl4-induced hepatic damage in rats. Hepatic malondialdehyde, glutathione and hydroxyproline levels and histopathologic alterations in liver specimens were assessed. 200 mg/kg/day Ginkgo biloba extract were given orally to the animals for 10 days, then a single dose of 2 ml/kg b.w. carbon tetrachloride was, administered intraperitoneally. Ginkgo biloba extract treatment reduced hepatic malondialdehyde levels significantly (p < 0.05), but did not alter glutathione (p > 0.05) and hydroxyproline levels (p > 0.05). The light and electron microscopic findings showed that Ginkgo biloba extract limited the CCl4-induced hepatocyte necrosis and atrophy. These results suggest that this extract may protect the hepatocytes from carbon tetrachloride-induced liver injury.

Beneficial effect of Iloprost on impaired colonic anastomotic healing induced by intraperitoneal 5-fluorouracil infusion

PURPOSE

5-Fluorouracil is the most effective chemotherapeutic agent in the management of patients with systemic colorectal cancer. Studies in recent years discussed the gradually increasing benefits of 5-fluorouracil within adjuvant chemotherapy protocols after complete surgical resections. However, many studies also have demonstrated that 5-fluorouracil impairs wound-healing on colonic anastomoses.

METHODS

In our experimental study, we examined the influence of intraperitoneal 5-fluorouracil on healing of colonic anastomoses and, also, attempted to discover whether Iloprost (PGI2 analog, a potent vasodilator with confirmed cytoprotectivity and inhibitor of thrombocyte aggregation) counteracts impaired wound-healing induced by 5-fluorouracil. A total of 80 Wistar-Albino male rats were separated into four groups. From the day of the operation, Group A received intraperitoneal saline solution, Group B received 20 mg/kg 5-fluorouracil intraperitoneally, Group C received 20 mg/kg 5-fluorouracil plus 2 microg/kg Iloprost intraperitoneally, and Group D received 2 microg/kg Iloprost intraperitoneally. Each group was divided into two subgroups, and both subgroups were killed on the third and seventh postoperative days, respectively. The subjects were measured for anastomose bursting pressures and tissue hydroxyproline levels, and wound-healing was evaluated histopathologically. Statistical evaluations among each group were made with Student's t-test and Pearson's chi-squared tests.

RESULTS

Iloprost had an accelerating effect on normal colonic anastomose wound-healing histopathologically, had no significant difference on bursting pressures and hydroxyproline levels, and significantly improved the impaired healing effect of 5-fluorouracil.

CONCLUSIONS

Our study showed a positive effect of Iloprost on the healing of colon anastomosis and, more importantly, if wound-healing is impaired by a chemotherapeutic agent, Iloprost counteracts and reverses the effect. [Key words: 5-Fluorouracil; Healing of colon anastomoses; Iloprost

Consanguineous marriages among parents of Down patients

In order to reveal if there is an effect on the genesis of meiotic- or early zygotic non-disjunctions, data related to 1598 Down syndrome patients from 1578 families studied in five different genetic centers in Turkey are reported. Parental consanguinity and the inbreeding coefficient were found to be lower among patients of 21-trisomics than in parents without Down offspring. It was concluded that available information does not support the presence of a "non-disjunction gene" in man.

Mathematical model for enteric film coating of tablets

The enteric film coating of placebo tablets, using a methacrylic acid-methyl methacrylate copolymer as the film former in the coating solution, was studied by statistical techniques. The effects of four independent formulation and process variables on the disintegration time of the coated film in simulated intestinal fluid and on the resistance to disintegration of the coated film in simulated gastric fluid were studied. The results of a statistically designed set of experiments were used as the input data. Regression analysis of these data resulted in two first-order polynomial equations. The linear model obtained for the disintegration time of the coating in the simulated intestinal fluid was analyzed by the steepest descent method to determine the most suitable combination of the independent variables.