How does training given to pediatric nurses about artificial intelligence and robot nurses affect their opinions and attitude levels? A quasi-experimental study

PURPOSE

This study was conducted to investigate the effect of training provided to pediatric nurses on their knowledge and attitude levels about artificial intelligence and robot nurses.

DESIGN AND METHODS

In this study, a single-group pre- and post-test quasi-experimental design was used. Data were collected from pediatric nurses working in Training and Research Hospital located in western Turkey. Forty-three pediatric nurses participated in the study. The study data were collected using the "Pediatric Nurses' Descriptive Characteristics Form", "Artificial Intelligence Knowledge Form", and "Artificial Intelligence General Attitude Scale".

RESULTS

The mean scores of the participating pediatric nurses obtained from the Artificial Intelligence Knowledge Form before, right after and one month after the training were 41.16 ± 14.95, 68.25 ± 13.57 and 69.06 ± 13.19, respectively. The mean scores they obtained from the Positive Attitudes towards Artificial Intelligence subscale of the Artificial Intelligence General Attitude Scale before and after the training were 3.43 ± 0.54 and 3.59 ± 0.60, respectively whereas the mean scores they obtained from its Negative Attitudes towards Artificial Intelligence subscale were 2.68 ± 0.67 and 2.77 ± 0.75, respectively.

CONCLUSIONS

It was determined that the training given to the pediatric nurses about artificial intelligence and robot nurses increased the nurses' knowledge levels and their artificial intelligence attitude scores, but this increase in the artificial intelligence attitude scores was not significant.

PRACTICE IMPLICATIONS

The use of artificial intelligence and robotics or advanced technology in pediatric nursing care can be fostered.

Dosimetric comparison of free-breathing versus respiratory motion-managed radiotherapy via four-dimensional computed tomography-based volumetric-modulated arctherapy for lung cancer

PURPOSE

The aim of this study is to use respiratory motion-managed radiotherapy (RT) to reduce side effects and to compare dosimetric factors with free-breathing planning in patients with lung cancer.

MATERIALS AND METHODS

Simulation images were obtained in 10 respiratory phases with free breathing using four-dimensional computed tomography (4D-CT) scanner. Planning target volume (PTV) was created with 5mm margins in each direction of the internal target volume delineated using the maximum intensity projection. A volumetric arc treatment (VMAT) plan was created so that the prescribed dose would cover 98% of the PTV. Target volumes for the free-breathing VMAT plan were created according to ICRU Reports 62 and the same prescribed dose was used.

RESULTS

Patients were evaluated during January 2020. Median 63Gy (59.4-64) RT was administered. Median PTV volumes were 173.53 and 494.50cm3 (P=0.008) and dose covering 95% of PTV volume was 62.97 and 60.51Gy (P=0.13) in 4D-CT based and free-breathing VMAT plans, respectively. The mean and V50 heart dose was 6.03Gy (vs. 10.36Gy, P=0.043) and 8.2% (vs. 33.9%, P=0.007), and significantly lower in 4D-CT based VMAT plans and there was also found a non-significant reduction for other risky organ doses.

CONCLUSION

Ten patients treated with respiratory motion-managed RT with 4D-CT based VMAT technique. It was observed that PTV did not increase, the target was covered with 95% accuracy, and with statistical significance in heart doses, all risky organ doses were found to be less.

Assessment of quantitative zonal parameters of prostate gland in discrimination of normal, benign, and malignant conditions: are these the more reliable parameters in the diagnosis of prostate cancer?

OBJECTIVE

Prostate cancer diagnosis and treatment are increasing in current public healthcare programs. An improved resolution multiparametric magnetic resonance imaging (MRI) has shown the potential to enhance the detection and differentiation of this medical condition. In this study, MR perfusion parameters were investigated in different ages and diseases to differentiate clinically significant prostate cancer.

PATIENTS AND METHODS

From January 2017 to December 2022, 72 consecutive patients, who had undergone multiparametric MR imaging were enrolled in this study. Four different patient groups were formed: (1) those with prostate cancer, (2) those with prostatitis, (3) those with benign prostate hyperplasia (BPH), and (4) a control group. Quantitative dynamic contrast-enhanced (DCE)-MRI pharmacokinetic parameters included Ktrans, Kep, Ve, and iAUG. Different measurements were obtained from both the peripheral and transitional zones (PZ and TZ, respectively). Means values were compared between groups based on a univariate analysis.

RESULTS

Ktrans and Kep values in the PZ were found to be statistically significantly lower in the control group (p = 0. 003 and p = 0. 011, respectively). It was seen that Ktrans and Ve measurements obtained from PZ had a statistically significant determinant in detecting malignancy (p = 0. 013 and p = 0. 036, respectively). It was seen that Ktrans, Ve, and iAUG obtained from the TZ showed a statistically significant difference in prostate cancer (p = 0.025, p = 0.005, and p = 0. 011, respectively) in contrast to other cases. Peripheral Ve values were statistically significantly lower than those measured Ve values from the TZ in prostate cancer cases (p = 0.002) in contrast to the other cases.

CONCLUSIONS

Quantitative DCE-MRI parameters may vary according to age, disease, and zonal anatomy. These differences may contribute to the diagnosis of clinically relevant prostate cancer.

Validity and reliability of the baby Eating behaviour Questionnaire in a Turkey sample

The research was centered on developing a Turkish version of the Baby Eating Behaviour Questionnaire (BEBQ), ensuring cultural and linguistic adaptation while upholding its reliability and validity. Employing a methodological approach, the study encompassed 202 mothers whose infants were aged between 0 and 6 months. Data collection took place from December 2022 to January 2023, utilizing the Parent Demographic Questionnaire and BEBQ. Statistical analysis incorporated descriptive statistics, assessing reliability through Cronbach's alpha, test-retest, and item-total score analysis. Explanatory and confirmatory factor analyses were conducted, revealing 18 items across 4 sub-dimensions, explaining 58.3% of total variance. The scale demonstrated high reliability with a Cronbach's alpha of 0.81, while Confirmatory Factor Analysis validated the model with a Root Mean Square Error of Approximation at 0.074. Test-retest results exhibited a strong correlation (Pearson Correlation of 0.97, p < 0.001). The adapted BEBQ serves as a valid, reliable tool for evaluating infant feeding behavior in the Turkish context.

Effect of therapeutic play using a toy nebulizer and toy mask on a child's fear and anxiety levels

PURPOSE

This study aimed to examine the effect of therapeutic play using a toy nebulizer and mask before inhaler treatment on children's fear and anxiety levels in a pediatric emergency department.

DESIGN AND METHOD

This randomized controlled clinical trial included 84 children aged 3-8 years who were admitted to the pediatric emergency department with respiratory system disease. This study was registered in the Clinical Trials database.Therapeutic play was applied to the children in the therapeutic play group with a toy nebulizer, toy mask, and amigurumi doll, after which the children received treatment with these devices. The children in the control group received nebular treatment using a standard nebulizer and a mask. The children were required to answer the 'Children's Fear Scale' (CFS) and 'Children's Anxiety Metre-State' (CAMS) before and after treatment.

RESULTS

Fear and anxiety levels were significantly lower in the therapeutic play group than in the control group (p = 0.001). A statistically significant difference was found between the two groups regarding acceptance of the mask used during treatment and adaptation to the treatment (p = 0.001).

CONCLUSIONS

Therapeutic play with a toy nebulizer and mask effectively reduced fear of hospitals and related anxiety in children.

PRACTICE IMPLICATIONS

Playing therapeutic play with a toy nebulizer and toy mask during nebulization is a promising strategy to reduce children's fear and anxiety.

Endometrial carcinoma detection with 3.0 Tesla imaging: which sequence is more useful

OBJECTIVE

Detection of endometrial cancer (EC) is crucial in pre-operative EC management. The study aimed at determining the most reliable sequence in magnetic resonance imaging (MRI) evaluation at the EC. Different sequences were compared using histopathological results as the gold standard.

PATIENTS AND METHODS

In this retrospective study, 62 women diagnosed with EC were examined using 3 Tesla MR and post-hysterectomy histopathological examination. The MRI protocol included diffusion-weighted imaging (DWI), T2 weighted images, Dynamic Contrast T1 weighted images, and ZOOMit DWI. Apparent diffusion coefficient (ADC) maps were also obtained. ADC maps were calculated for both DWI and ZOOMit DWI. All serial images were analyzed by endometrial distance to account for myometrial invasion and tumor size. All sequences and histopathological results were compared using the paired sample t-test.

RESULTS

In all 32 women, post-hysterectomy histopathological confirmation was obtained. Mean myometrial invasion values were not significantly different after comparing DWI, ZOOM it DWI, and Dynamic contrast enhancement (DCE)-T1WI (p=0.054, p=0.039). The first strong correlation was found between DWI and ZOOMit DWI (0.943). The second was between ZOOMit DWI and DCE-T1 WI (0.949). Comparing each set of sequences, no statistically significant differences in tumor size (p > 0.05) were found. Also, no statistically significant differences between images and histopathological size were found. The ADC values of ZOOMit DWI indicated that this method detected significant differences between EC histological subtypes.

CONCLUSIONS

Each sequence is essential and valuable, whereas priorities may vary depending on the desired information. The most valuable sequences for the myometrial invasion were ZOOMit and conventional DWI. T2WI and DCE T1 WI were more valuable sequences the size of EC.

An Experimental Methodology to Determine Components of Power Losses of a Gearbox

In this study, an experimental methodology is presented to separate various components of the power loss of a gearbox. The methodology relies on two separate measurements. One is designed to measure total power loss of a gearbox housing a single spur gear pair under both loaded and unloaded conditions such that load-independent (spin) and load-dependent (mechanical) components can be separated. With the assumption that gear pair and rolling element bearings constitute the bulk of the gearbox power loss, a second measurement system designed to quantify rolling element bearing losses is proposed. With this setup, spin and mechanical power losses of rolling element bearings used in the gearbox experiments are measured. Combining the sets of gearbox and bearing data, power loss components attributable to the gear pair and rolling element bearings are quantified as a function of speed and torque. The results indicate that all gear and bearing related components are significant and a methodology such as the one proposed in this study is warranted.

Psychometric Properties of the Turkish Version of the Developmental Support Competency Scale for Nurses (DSCS-N)

PURPOSE

Developmental care is considered an important component of development and health promotion of premature infants, however, studies regarding assessment of nurses' competency of developmental care are inadequate. This study is designed to determine the psychometric properties of the Turkish version of the Developmental Support Competency Scale for Nurses (DSCS-N).

DESIGN AND METHODS

This methodological study includes 140 nurses working at a tertiary level neonatal intensive care unit (NICU). Data were collected using the Nurse Introductory Form and Developmental Support Competency Scale for Nurses. The scale was assessed in terms of language and content validity, construct validity, internal consistency and time invariance.

RESULTS

The scale consisted of 19 items and six subscales. In the confirmatory analysis, which is a validity analysis, it was found that the scale's factor loadings ranged between 0.27 and 0.92, and the ratio of chi-square to degrees of freedom was 1.64. Other fit indices (CFI = 0.96, NFI = 0.92, NNFI = 0.95) were at desirable levels. Cronbach's alpha coefficient was found to be 0.90. According to item analysis results, item-total correlations ranged between 0.26 and 0.66. It was found that nurses' responses to the scale items at two different times were consistent and did not change over time (p > 0.05).

CONCLUSIONS

DSCS-N is a valid and reliable scale for measuring Turkish nurses' competency of developmental support.

PRACTICE IMPLICATIONS

DSCS-N can be used as a tool contributing to the implementation of developmental care. The scale can help nurses working in neonatal intensive care units to determine their competency of developmental care.

The effects of auditory interventions on pain and comfort in premature newborns in the neonatal intensive care unit; a randomised controlled trial

OBJECTIVE

This study investigated the effects of three auditory interventions; white noise, recorded mother's voice, and MiniMuffs, applied during a heel lance on pain and comfort in premature infants in the neonatal intensive care units.

DESIGN AND METHODS

This experimental, parallel, randomised controlled research was conducted in a state hospital tertiary-level neonatal intensive care unit. The sample comprised sixty-four premature infants with gestational ages of 31-36 weeks. The infants were randomly assigned to four groups: i) white noise, ii) recorded mother's voice, iii) MiniMuffs, and iv) control. Pain and comfort of newborns were evaluated according to the Neonatal Infant Pain Scale (NIPS) and the COMFORTneo scale. Oxygen saturation, heart rate, and crying time were also measured.

RESULTS

The mean of oxygen saturation levels in the white noise, recorded mother's voice, and MiniMuffs group were higher than the control group. The heart rate, crying time, mean NIPS score, COMFORTneo score of the premature neonates in the white noise, recorded mother's voice, and MiniMuffs groups were significantly lower than the control group (p < .001).

CONCLUSION

Auditory interventions used during heel lance reduce the pain and increase the comfort of the premature infants. White noise is extremely effective in preventing infants's pain.

The effect of simulation-based education on childhood epileptic seizure management knowledge, skills, and attitudes of nursing students

BACKGROUND

Lack of knowledge about epileptic seizure management and negative attitudes toward children with epilepsy among nursing students may negatively affect the quality of healthcare services they deliver.

AIM

This study aimed to examine the effect of training given to nursing students using simulation and standard child mannequins on their childhood epileptic seizure management knowledge, skills, and attitudes.

METHODS

Participants (n = 72) were recruited from a Nursing Faculty in Izmir, Turkey. Students were randomly assigned to the intervention and control groups (n = 36 in each). The intervention group received simulation-based training on epilepsy while the control group received standard child mannequin training on epilepsy. One week after the training, the students were asked to demonstrate their epileptic seizure management knowledge and skills on a simulation model or a standard child mannequin. During this process, they were observed and assessed by two independent observers on the basis of a list of epileptic seizure management skills. All participants completed the personal information form, the Epilepsy and Epileptic Seizure Management Knowledge Test, and the Epilepsy Knowledge and Attitude Scale before, and after the training, McNemar's test, repeated measure ANOVA (intravenous), dependent t-test, chi-square test, Fisher's exact test, independent t-test, Pearson's correlation analysis, and Pearson's chi-square test were used to compare the groups. Intraclass correlation coefficient (ICC) was used to evaluate the consistency between observers.

RESULTS

The epilepsy knowledge scale mean scores of both groups significantly increased after their respective trainings (p < 0.001), but the difference between the groups was not statistically significant (p = 0.829). There was no statistically significant difference between the pre- and posttraining epilepsy attitude scale mean scores of the control group (p = 0.630), however, a statistically significant increase was observed in the epilepsy attitude scale mean score of the intervention group (p = 0.008). In addition, both groups' self-confidence in epileptic seizure management significantly increased after the training (p = 0.000).

CONCLUSIONS

Simulation-based training was beneficial for students insofar as it helped them to develop positive attitudes toward epilepsy.

Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years.

DESIGN

This study is a randomized controlled trial.

METHODS

The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy.

FINDINGS

A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group.

CONCLUSIONS

The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.

The effect of nesting positions on pain, stress and comfort during heel lance in premature infants

BACKGROUND

Nesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU.

METHODS

Experimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31-35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit.

RESULTS

The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p < 0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 min after the heel lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions.

CONCLUSIONS

Nesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants.

Effects of Virtual Reality and External Cold and Vibration on Pain in 7- to 12-Year-Old Children During Phlebotomy: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the effects of the virtual reality (VR) and external cold and vibration methods on pain scores in children aged 7 to 12 years during phlebotomy.

DESIGN

A randomized controlled study.

METHODS

The sample of children (n = 121) was allocated to the groups (group 1, VR; group 2, external cold and vibration; group 3, control) by blocked randomization. Pain scores were assessed after the phlebotomy using self-report, parent's reports, report from the nurse who attempted the phlebotomy, and researchers' report with the Wong-Baker FACES scale.

FINDINGS

Pain scores were determined to be lower in groups 1 and 2. Although there was no difference between the groups 1 and 2, a statistically significant difference was found between groups 1 or 2 and group 3 based on all pain scores.

CONCLUSIONS

Results suggest that VR and external cold and vibration are effective in reducing the pain in 7- to 12-year-old children during phlebotomy. VR can be used safely for the pain management of children who are growing up in the age of technology.

Infiltration and extravasation in pediatric patients: A prevalence study in a children’s hospital

Purpose:

The aim of this study is to determine the prevalence of infiltration and extravasation among children staying in a children’s hospital and the interventions carried out when infiltration or extravasation occurred.

Methods:

A prospective and descriptive research design was used in the study, conducted between September 2015 and February 2016, and determined the prevalence of infiltration and extravasation and their characteristics. The study sample consisted of 297 peripheral catheters in 173 pediatric patients.

Results:

Of 297 peripheral catheters, 50.8% were located on the right and 30.6% were inserted in the dorsal metacarpal vein. Infiltration and extravasation occurred in 2.9% and 2.3% of the patients, respectively. The prevalence of infiltration and extravasation was 5.5 and 4.4 per 1000 patient-days, respectively. The applied interventions after infiltration or extravasation included covering with a gauze dressing or alcohol-soaked cotton, cold application, irrigation with physiological saline, and elevation.

Conclusion:

The infiltration and extravasation prevalence were found to be high, but the interventions to address them were inadequate. Training and implementation strategies should be planned for pediatric nurses to prevent infiltration and extravasation.

Investigation of RadFET response to X-ray and electron beams

The irradiation response of Radiation Sensing Field Effect Transistor (RadFET), also known as MOSFET/pMOS dosimeter, to high energy X-rays and electron beams was investigated. The threshold voltages before and after irradiation were measured and the trap densities in the gate oxide and oxide/silicon interface of the RadFETs are evaluated. The RadFETs were irradiated with 6MV X-rays, and 10 and 18MeV electron beams emitted from a Linear accelerator (LINAC). Linear and non-linear fits to experimental results showed that after an initial linear response up to several Gy, deviation from the linearity occurred due to electric field screening by the radiation induced oxide trapped charges. The radiation-induced fixed traps (FTs) and switching traps (STs) were analysed and the FT density was found to be higher than the ST density for all beam types and doses. The radiation response, fading characteristics, and variation of the trapped charges of the RadFETs showed similar behaviour in tests.

Primary mucinous carcinoma of the vulva with signet ring cells deriving from the cloaca

Vulvar neoplasias are rarely encountered lesions at female genital tract, regardless if they are primary or metastatic. Presence of signet ring cells in a tumour at female genito-urinary tract is highly suggestive of a metastatic lesion particularly from a gastrointestinal tumour. Here the authors present a case of vulvar carcinoma with signet ring cells with an undetermined primary site possibly originating from embryonic cloaca.

Evaluation of aqueductal CSF flow dynamics with phase contrast cine MR imaging in idiopathic intracranial hypertension patients: preliminary results

OBJECTIVE

We aimed to evaluate dynamic cerebrospinal fluid (CSF) flow in idiopathic intracranial hypertension (IIH) patients with new MRI technology phase contrast cine (PCC) MRI.

PATIENTS AND METHODS

Nineteen patients diagnosed with idiopathic intracranial hypertension and 11 healthy volunteers were included in this study. Nine of the IIH cases had been previously diagnosed and had been on drug treatment and 10 cases were diagnosed with IIH recently and had not been put on drug treatment yet. All CSF flow datas were evaluated by phase contrast-MRI using a 1,5 T MRI. The CSF flow was calculated in the equidistant MRI sequence which was taken through a cardiac cycle.

RESULTS

Mean aqueduct area in the IIH group was 3.04 ± 1.14 mm², mean peak rate was 3.29 ± 1.77 cm/sec, mean average rate was 0.35 ± 0.33 cm/sec and mean flow was 0.67 ± 0.95 ml/min. In the control group mean aqueduct area was 2.87 ± 1.01 mm², mean peak rate was 4.20 ± 1.40 cm/sec, mean average rate was 0.37 ± 0.18 cm/sec and mean flow was 0.64 ± 0.40 ml/min. A statistically significant difference was found for the PCC MRI parameter of mean rate value (p: 0.007) between the control group and IIH patients. A statistically insignificant (p: 0.058) but marked difference was found for mean flow value.

CONCLUSIONS

To our knowledge this study is the first CSF flow study in the idiopathic intracranial hypertension patients. We found a difference between the IIH groups and controls in mean rate and flow parameters. It was interesting that the mean rate and flow values of the untreated group that were higher than the controls. CSF flow analysis may be a marker to follow up IIH patients.

Nutritional style of parents and examination of the effective factors

AIM

This study was performed to determine the nutritional style in parents who had children aged between 3 and 6 years and the effective factors.

MATERIAL AND METHODS

The sample number of this descriptive study was calculated with the sample formula for unknown population and the parents of 300 children aged between 3 and 6 years who attended a nursery school in the province of İzmir constituted the sample. The sample was reached in two periods. "The Sociodemographic Data Form" and "the Parent Nutritional Style Scale" were used as data collection tools. Written approval was obtained from the scientific ethics committee of the Ege University, Faculty of Nursery (B.30.2.EGE.0.82.00.00/29-288). The heights and weights of the children were measured by the investigators with certain measurement tools. The body mass index standard deviation score (BMI SDS) was calculated for each child. The children whose body mass index standard deviations were between +2 and -2 standard deviation were considered to have normal weight. The Auxology program was used to obtain these data. The body mass indexes of the parents were calculated according to the height and weight values stated by themselves. In analyses of the data, student's t-test and Mann-Whitney U test were used for comparison of two groups. Variance analysis and Kruskal-Wallis variance were used for multiple comparisons; Bonferrroni corrected Mann-Whitney U test and Shefee test were used for advanced analysis.

RESULTS

It was found that the variables including the age, education level, number of children, working status of the mothers and the perception of the child's weight by the mother affected the nutritional style of the parents. The mean "emotional" and "instrumental" nutrition subdimension scores of the mothers who were young, who had an education of primary school and who were housewifes, the mean "encouraging nutrition" subdimension scores of the mothers who had small for gestational age babies and the mean "emotional" nutrition sub-dimension scores of the mothers who perceived their babies' weights as lower than normal were found to be higher (p<0.05). No significant difference was found in the nutritional style in relation with the child's BMI SDS and the mother's own BMI.

CONCLUSIONS

The nutritional styles of parents are affected by some sociodemographic and anthropometric properties, but the relation with the child's weight should be demonstrated by observational studies.

Hepatocyte apoptotic index and p53 expression in obstructive jaundice rats

OBJECTIVE

Obstructive jaundice is a serious disease. It can deteriorate critical functions in the liver.

MATERIAL AND METHOD

A total of 20 male Wistar-Albino rats were randomly allocated into two groups consisting of ten in each as follows: Group I (Control) was subjected to a sham operation isolating the bile duct. Group II(Study) was subjected to acute cholestasis induced by bile duct ligation with 4/0 silk suture from two different places and full fold cut between ligatures. On the 7th day, group II rats were re-operated for liver sampling and sacrification-aimed histological analysis through the old incision with anaesthesia. Hepatic tissues were histologically and immunohistochemically processed. The number of apoptotic and p53(+) cells were measured.

RESULTS

On the 7th day, the averages of direct and indirect bilirubin values in Group II rats were found to be 6.99 and 11.70 mg/dl, respectively. They were observed to be statistically significant. In the immunohistochemical evaluation p53 expression in hepatocytes was assessed, p53-positive hepatocytes were determined to exist quite widely in the tissue samples taken from the livers of rats in the study group. Nevertheless, no cells exhibiting p53 expression were found in the tissue samples of the control group.

CONCLUSION

Apoptosis is a closed box and it might make it possible to stop the many disease processes or accelerate the healing. If the principal effective mechanism in the liver under a certain stress factor is apoptosis, it is definite that it will make a difference in the treatment approach. Consequently, we can say that both apoptotic index and p53 expression increase in the rats' liver with biliary obstruction (Fig. 4, Ref. 51).

[Comparison of extracorporeal liver assist devices - albumin dialysis versus plasma exchange - in acute-on-chronic liver failure]

BACKGROUND AND AIM

Extracorporeal liver assist devices are besides causal and symptomatic approaches important therapeutic options in acute-on-chronic (AOC) liver failure. In this retrospective analysis, albumin dialysis was compared to therapeutic plasma exchange (TPA) under various aspects.

PATIENTS AND METHODS

Data from 20 patients per group (10 women, 10 men in each group, mean age 51 ± 12,6 years and 48,2 ± 15,2 years, respectively) treated over a period of 3 months were analyzed. During the first treatment, 5 sessions of dialysis were performed (week 1) for both procedures, 3 more sessions were completed in the second and in the third week each. Data were acquired on days 1, 8, 13, 20, 28 and 90.

RESULTS

After 28 days, 13 out of 20 patients following albumin dialysis and 7 out of 20 patients following plasma exchange had survived (p = 0,11). After 90 days, 10 patients following albumin dialysis and 5 patients following plasma exchange were alive (p = 0,19). Degree of hepatic encephalopathy (HE) had not improved significantly. Rates of complication (infections, bleeding or system clotting) were similar under both procedures.

CONCLUSION

Extracorporeal liver assist devices can be considered equally well as a therapeutic option in acute-on-chronic liver failure. Differences in 90-day survival were not observed in our study.

Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants

Although the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox® FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.

Tacrolimus as a reasonable alternative in a patient with steroid-dependent and thiopurine-refractory autoimmune pancreatitis with IgG4-associated cholangitis

BACKGROUND

More recently, autoimmune pancreatitis (AIP) in association with IgG4-positive cholangitis (IAC) has been recognised as a new and challenging entity. Currently, initiation of high dose steroids (e.g., prednisolone 0.5 - 1 mg/kg/day) followed by a steroid dose taper in combination with purine antagonists (e.g., azathioprine or 6-mercaptopurine) after resolution has been recommended as standard therapy.

CASE REPORT

A 68-year-old male patient was referred to our institution in February 2012 for therapy evaluation of a steroid-dependent course of autoimmune pancreatitis type 1 with IgG4-associated cholangitis. Since the first diagnosis in March 2011, the patient was treated with high-dose steroids with good response. Whenever steroids were tapered down to a daily dose <20 mg, cholestatic liver enzymes increased dramatically despite concurrent immunosuppressive therapy primarily with azathioprine and 6-MP thereafter. Therefore, we restarted steroid therapy (1 mg/kg/day) in combination with tacrolimus achieving a target level of 5 - 7 ng/mL. During the down-tapering phase, follow-up examinations presented a patient in good general condition without jaundice. Moreover, liver and pancreatic enzymes and also immunoglobulins returned to normal values without any evidence of relapse up today (66 weeks).

CONCLUSION

In this case, the combination of steroids with tacrolimus seems to be a reasonable alternative in a patient with steroid-dependent and thiopurine-refractory autoimmune pancreatitis with IgG4-associated cholangitis. To date, this is the first description of such a therapeutic approach for this entity.

Non-alcoholic steatohepatitis occurs in celiac disease and is associated with cellular stress

BACKGROUND AND AIMS

Liver and gut not only share alimentary but also immunological features. Major histocompatibility complex class I-related chains A and B (MIC A/B) function as indicators for cellular stress. These so called stress-induced ligands are suggested to play an important role in the progression of non-alcoholic fatty liver disease (NAFLD) and are a prominent feature of celiac disease (CD).

PATIENTS AND METHODS

In the present study, 24 patients with celiac disease and 20 patients with non-alcoholic steatohepatitis (NASH) were included. Liver enzymes, serum cell death markers (M30, M65), MIC B and expression of adiponectin were determined.

RESULTS

Mean patient age was 42 years (18 - 69) for CD and 49 years (33 - 68) for the NASH group. ALT and AST values were lower in CD compared to NASH patients. While serum cell death markers were higher in NASH, the predominant type of cell death in CD was apoptosis. Also, expression of MIC B was significantly up-regulated in CD patients as compared to NASH patients. Adiponectin values were significantly lower in NASH compared to CD patients.

CONCLUSION

Stress-induced ligands and apoptosis are induced in CD. Prospective studies need to determine the exact role of cellular stress and apoptosis in the gut-liver axis and the clinical implications to screen for NAFLD in CD patients.

The investigation of radionuclide distributions in soil samples collected from Bursa, Turkey

The distributions of (226)Ra, (232)Th, (40)K and (137)Cs activity concentrations were determined using a high-purity germanium detector in uncultivated surface soil samples collected from Bursa. The range of (226)Ra, (232)Th, (40)K and (137)Cs activity concentrations varied from 10±1 to 61±3 Bq kg(-1) (mean value 25±3 Bq kg(-1)), from 12±1 to 50±2 Bq kg(-1) (mean value 26±3 Bq kg(-1)), from 257±5 to 1010±11 Bq kg(-1) (mean value 435±44 Bq kg(-1)) and from 1.01±0.07 to 48.97±0.54 Bq kg(-1) (mean value 8.52±2.59 Bq kg(-1)), respectively. In addition, the mean outdoor absorbed dose rates in air, annual effective dose equivalent, radium equivalent activity and external hazard index were found to be 45 nGy h(-1), 56 μSv y(-1), 96 Bq kg(-1) and 0.26, respectively. The gross beta activity concentrations were determined using a Tennelec LB 1000-PW detector. The range of gross beta activity concentrations varied from 46±9 to 1199±113 Bq kg(-1) with a mean value of 541±19 Bq kg(-1).

Smoothing factor and voice perturbation measurements

OBJECTIVE

Although gradual frequency and amplitude variations originating from intonation or vocal instability are not related to voice quality, jitter and shimmer are sensitive to such variations. These parameters are therefore calculated by subtracting the average of a group of successive periods from the middle period; the period number that is averaged is called the smoothing factor. The aim of this study was to investigate the effect of smoothing factor size on frequency and amplitude perturbation measurements.

METHODOLOGY

A prospective study was designed, incorporating recorded voice samples from ten male and ten female healthy adult volunteers; samples were analyzed with the Multi Dimensional Voice Program for Multi-Speech. We used all low smoothing factor sizes up to 21, and then skipped smoothing factor sizes in steps of ten, resulting in 28 different levels.

RESULTS

Smoothed pitch perturbation quotient and smoothed amplitude perturbation quotient values increased as the smoothing factor size increased. Smoothing factor size was correlated with smoothed pitch perturbation quotient and smoothed amplitude perturbation quotient values in males (r = 0.589 and r = 0.698, respectively) and females (r = 0.736 and r = 0.847, respectively).

CONCLUSION

Our study revealed an exact relationship between smoothing factor values and perturbation measures. At low smoothing factor values, perturbation measures are sensitive to short-term variations, whereas at high smoothing factor values, they are less sensitive to short-term but more sensitive to long-term variations.

Impact of immunosuppressive therapy on hepatitis C infection after renal transplantation

BACKGROUND

Among patients after renal transplantation (NTx), hepatitis C virus (HCV) infection is a risk factor for graft loss and patient death caused by hepatic decompensation. Also, HCV has been implicated in the pathogenesis of glomerular diseases in native and transplanted kidneys. Therefore, the aim of this retrospective cohort study was to determine the effects of the widely used calcineurin inhibitors (CNI) cyclosporine A (CsA) and tacrolimus (Tac) on hepatitis C virus replication, inflammatory activity, development of liver fibrosis, and long-term renal graft function.

SUBJECTS AND METHODS

A cohort of 71 patients with HCV infection after kidney transplantation under immunosuppression with either CsA or Tac were analyzed for viral kinetics and serum transaminases. In addition, presence of liver fibrosis was detected by non-invasive measurements using the FibroScan. Graft function was determined biochemically. Patients with interferon therapy prior to transplantation were excluded from the study in order to avoid any impact of the antiviral therapy on outcomes.

RESULTS

In the early period after transplantation, hepatitis C viral load was lower in patients treated with Tac as compared to CsA. This effect became negligible 3 months after transplantation. However, hepatic inflammatory activity was reduced in the CsA-treated group. Extent of liver fibrosis was similar in both groups of HCV-infected patients as well as in a control group of non-HCV-infected patients after renal transplantation (NTx), respectively. Renal function and glomerular filtration rate, as calculated by the modification of diet in renal disease (MDRD) formula, were significantly better in patients treated with Tac.

CONCLUSIONS

During long-term immunosuppression, the CNIs cyclosporine A versus tacrolimus showed no significant differences in HCV-infected patients after renal transplantation with respect to viral replication and development of liver fibrosis. However, function of the renal graft is significantly better preserved in patients receiving tacrolimus.

Evaluation of quantitative liver function tests in HIV-positive patients under anti-retroviral therapy

Background and aims

Quantitative tests of liver function (QTLF) which are based on the hepatic metabolism or clearance of test substances have been successfully used to predict prognosis of a variety of different liver diseases. Still sufficient data in HIV-patients under anti-retroviral therapy (ART) are lacking. Therefore, the aim of this prospective study was to investigate if and to what extent ART influences a broad panel of quantitative tests of liver function in patients with HIV-infection.

Patients and methods

Nineteen patients (14 males, 5 females, mean age 40 years) with HIV-infection underwent QTLF including lidocaine half-life test (LHT), galactose elimination capacity (GEC), and indocyanine green clearance (IGC). These tests were performed before and 3 to 6 months after initiation of anti-retroviral therapy. Twenty age-matched healthy, medication-and virus-free adults served as controls.

Results

Lidocaine half-life was significantly lower in HIV-patients without ART. Combining anti-retroviral therapies shifted cytochrome p450 activity back into standard ranges. Galactose elimination capacity as a parameter of cytosolic liver function and indocyanine green clearance as a parameter of liver perfusion were not affected by ART.

Conclusions

QTLF may be a tool to predict prognosis or hepatic complications in HIV-infected patients with liver disease. Early determination of lidocaine half-life seems to be useful - this should be considered during the treatment of HIV-positive individuals.

Calculation of angular distribution of 662 keV gamma rays by Monte Carlo method in copper medium

This paper presents results on the angular distribution of Compton scattering of 662 keV gamma photons in both forward and backward hemispheres in copper medium. The number of scattered events graph has been determined for scattered gamma photons in both the forward and backward hemispheres and theoretical saturation thicknesses have been obtained using these results. Furthermore, response function of a 51 x 51 mm NaI(Tl) detector at 60 degrees angle with incoming photons scattered from a 10mm thick copper layer has been determined using Monte Carlo method.

Horner's syndrome from giant schwannoma of the cervical sympathetic chain: case report

OBJECTIVES

Nerve sheath tumours are uncommon lesions in adults. Schwannomas originating from the cervical sympathetic chain are a rare subgroup of nerve sheath tumours. Moreover, the existence of Horner's Syndrome before surgery is uncommon, with only five cases reported in the literature. Here we review the presentation, imaging characteristics, and operative considerations of a patient with a large cervical sympathetic chain schwannoma, presenting with Horner's Syndrome. A 60-year-old woman with a left upper eyelid ptosis presented to our outpatient department complaining of a painless left-sided neck mass.

RESULTS

Histopathologic examination of excised mass, which was nearly 9.0 cm x 7.0 cm x 6.0 cm, revealed a benign schwannoma.

CONCLUSION

When dealing with cervical masses, schwannoma should be considered in the differential diagnosis, especially when some neurological symptoms exist.

A combination of zinc and pyridoxine supplementation to the diet of laying hens improves performance and egg quality

The objective of this study was to investigate whether zinc, along with pyridoxine, is effective in improving performance and egg quality of laying hens. One hundred and twenty, 28-week-old Hy-Line laying hens were assigned to four treatment groups, 30 hens each. The birds were fed a basal diet or the basal diet supplemented with either 30 mg of zinc/kg of diet, 8 mg of pyridoxine/kg of diet, or 30 mg of zinc plus 8 mg of pyridoxine/kg of diet. Feed conversion (P < 0.01) and egg production (P < 0.01) improved most when both zinc and pyridoxine were supplemented to the diet. Eggshell weights were also greatest (P < 0.01) when the diet was supplemented with both pyridoxine and zinc. Egg-shape index was, however, greatest with zinc-supplemented diet (P < 0.004). Haugh unit was greatest in eggs of hens fed a diet supplemented with both zinc and pyridoxine (P < 0.01). Dietary zinc and pyridoxine supplementations together increased plasma calcium and phosphorous concentrations (P < 0.002). The results of the present study suggested that zinc (30 ppm) and pyridoxine (8 ppm) supplements, when used together, are recommended in terms of a better performance and egg quality in laying hens.

Epidermal growth factor increases tissue antioxidant enzyme activities in ethanol-induced gastric injury in rat

The aim of the present study is to investigate whether the antioxidant mechanisms are involved in epidermal growth factor (EGF)-mediated protection from ethanol-induced gastric damage. Twenty four female Sprague-Dawley rats were assigned into 3 groups; control (C) group (n=8) was given physiologic saline by gavage; ethanol (E) group (n=8) was given 1 ml of 80% ethanol (v/v) in distilled water by gavage and EGF group (n=8) was given EGF (100 mg/kg-body wt.) intraperitonealy half an hour before the administration of ethanol. The protein carbonyl content was significantly higher in the E group than the C group (p<0.01). On the other hand, EGF decreased the protein carbonyl content in the EGF group (p<0.01). Gastric myeloperoxidase activity increased significantly after the administration of ethanol (p<0.01). The administration of EGF decreased significantly the myeloperoxidase activity (p<0.01). Although ethanol caused a slight decrease in the catalase activity, no statistical significance was observed between groups E and C. The catalase activity increased significantly after EGF treatment (p<0.01). The superoxide dismutase activity decreased significantly in the E group when compared to the C group (p<0.05) while it was found to be increased significantly in the EGF group in comparison with the E group (p<0.01). In summary, the present results indicate that the gastroprotective effect of EGF in the experimental lesions induced by ethanol could be attributed to its property such as to augment the antioxidant enzyme activities.

First Report of Ascochyta rabiei Causing Ascochyta Blight of Cicer pinnatifidum

In July 2005, small (2 to 5 mm), elongated, dark brown spots on the stems of Cicer pinnatifidum Jaub. & Spach. were observed on plants grown in the rocky hills of the Kahramanmaras Province. To understand this phenomenon, field trips to Kahramanmaras, Adiyaman, and Sanliurfa provinces were conducted in the summer of 2006. C. pinnatifidum plants exhibiting symptoms similar to Ascochyta rabiei (Pass.) Lab. were collected during May and June. The plants had flowers and pods with seeds at the time of collection. Ascochyta blight symptoms on stems were not extensive. None of the plants had leaf symptoms, but one plant had lesions on its pods. Twelve plants exhibiting Ascochyta blight symptoms were taken to the laboratory, and necrotic parts were used for isolation of the fungi on potato dextrose agar (PDA). After 3 to 5 days of culturing on PDA, characteristic beige-to-dark brown colony development of A. rabiei from explants was observed and five isolates from different locations were recovered. The fungal colony growth was slow and limited conidia formed on PDA. The isolates were also cultured on chickpea meal agar (CMA) and Czapek Dox Agar (CDA) media. Abundant conidia formation occurred only on CMA, 10 to 12 days after culturing. Conidia were one-celled similar to that of A. rabiei of chickpea and single-spore isolations were done. C. pinnatifidum and chickpea cv. Gokce (C. arietinum L.) were inoculated with spore suspensions of 5 × 10⁵ spores per ml (2). Ten- to twelve-day-old seedlings were used for inoculation in the experiments. Brown-black lesions at the crown region on C. pinnatifidum seedlings were observed 9 to 10 days after inoculation, and characteristic Ascochyta blight symptoms on stems developed on chickpea cv. Gokce. The fungus was reisolated from the infected seedlings. For molecular characterization, mating type of the isolates was determined by PCR using A. rabiei specific Tail1, Com1, and Sp21 primers (1). A single band of Mat 1.2 specific 500- bp product was amplified by PCR from five of the A. rabiei isolates of C. pinnatifidum. This confirmed that the isolates from C. pinnatifidum are A. rabiei. References: (1) M. P. Barve et al. Fungal Genet. Biol. 39:151, 2003. (2) M. S. A. Khan et al. Plant Pathol. 48:230, 1999.

The effects of desferrioxamine and quercetin on liver injury induced by hepatic ischaemia-reperfusion in rats

BACKGROUND

This study was designed to examine the effects of desferrioxamine and quercetin on hepatic ischaemia-reperfusion injury in rat.

METHODOLOGY

Thirty Wistar albino rats were randomized into five groups. Group I was the control group. Group II received no treatment. Group III and group IV received intramuscular injections of desferrioxamine (100 mg/kg per day) and quercetin (50 mg/kg per day) respectively. Group V was administered desferrioxamine and quercetin in combination. After treatment for 3 days, groups II, III, IV, and V were exposed to total hepatic ischaemia for 45 minutes. Plasma alanine aminotransferase levels, malondialdehyde and reduced glutathione activities were measured after reperfusion for 1 hour. Histopathological analysis of liver tissues was carried out.

RESULTS

Our results indicated that tissue malondialdehyde levels and histopathological liver damage scores were significantly higher in the ischaemia-reperfusion group than in the control group. Administration of desferrioxamine, quercetin, and desferrioxamine+quercetin significantly decreased these parameters. Plasma alanine aminotransferase levels were also increased after ischaemia-reperfusion. Quercetin and desferrioxamine + quercetin significantly decreased the activity of this enzyme when compared to ischaemia-reperfusion group.

CONCLUSIONS

The present data suggest that both desferrioxamine and quercetin may be useful to protect against ischaemia-reperfusion induced liver damage.

Effect of leptin on renal ischemia-reperfusion damage in rats

Tumor necrosis factor-alpha (TNF-alpha) has been established as an important mediator in renal ischemia-reperfusion (I/R) injury. Leptin, a product of the ob gene, has been known to exhibit cytoprotective effects on renal tissue, but its effect on renal tissue TNF-alpha level after renal I/R injury in rats remains unknown. The purpose of the study was to evaluate the effects of leptin on renal tissue TNF-alpha, malondialdehyde (MDA), protein carbonyls (PCs) and total sulfydryl group (SH) levels, and plasma nitrite levels after renal I/R injury in rats. The animals were divided into three groups: control, I/R and I/R+leptin. Rats were subjected to renal ischemia by clamping the left pedicle for 45 min, and then reperfused for 1 h. The I/R+leptin group was pretreated intraperitoneally with leptin (10 microg/kg) 30 min before the induction of ischemia. Our results indicate that MDA, TNF-alpha levels, and PCs were significantly higher in the I/R group than those in the control group (p < 0.05). The administration of leptin decreased these parameters (p < 0.05) significantly. The SH level was observed to significantly decrease after I/R injury when compared to the control group (p < 0.05). Leptin treatment significantly increased tissue SH and plasma nitrite levels when compared to the I/R group (p < 0.05). Plasma nitrite levels did not change significantly in I/R when compared to the control. These results suggest that leptin could exert a protective effect on I/R induced renal damage by decreasing TNF-alpha levels and increasing nitrite level.

The effect of different intraabdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy

BACKGROUND

This prospective, randomized, and controlled study was designed to investigate the effects of different intraabdominal pressures (IAPs) on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy (LC).

METHODS

Twenty-four patients (12 men, 12 women) who underwent LC at either 10 or 15 mmHg of IAP were randomized into two groups. Repeated blood samples were collected to measure thiobarbituric acid reactive substances (TBARS) levels to assess lipid peroxidation and protein carbonyl content and protein sulfhydryl groups to assess protein oxidation status.

RESULTS

Serum protein carbonyls and TBARS levels were found to be increased immediately after desufflation in both study groups when compared to the preoperative levels. On the other hand, protein sulfhydryl levels were found to be decreased in both study groups. Although increases in protein carbonyls and TBARS levels were more prominent in patients who underwent LC at 15 mmHg of IAP, this difference was not statistically significant between both groups.

CONCLUSIONS

The results suggest that both 15 and 10 mmHg of LAP could lead to an increased oxidative stress response during LC, but no difference was found between the groups.