REliability of consensus-based segMentatIoN in raDiomic feature reproducibility (REMIND): A word of caution

OBJECTIVE

To evaluate the reliability of consensus-based segmentation in terms of reproducibility of radiomic features.

METHODS

In this retrospective study, three tumor data sets were investigated: breast cancer (n = 30), renal cell carcinoma (n = 30), and pituitary macroadenoma (n = 30). MRI was utilized for breast and pituitary data sets, while CT was used for renal data set. 12 readers participated in the segmentation process. Consensus segmentation was created by making corrections on a previous region or volume of interest. Four experiments were designed to evaluate the reproducibility of radiomic features. Reliability was assessed with intraclass correlation coefficient (ICC) with two cut-off values: 0.75 and 0.9.

RESULTS

Considering the lower bound of the 95% confidence interval and the ICC threshold of 0.90, at least 61% of the radiomic features were not reproducible in the inter-consensus analysis. In the susceptibility experiment, at least half (54%) became non-reproducible when the first reader is replaced with a different reader. In the intra-consensus analysis, at least about one-third (32%) were non-reproducible when the same second reader segmented the image over the same first reader two weeks later. Compared to inter-reader analysis based on independent single readers, the inter-consensus analysis did not statistically significantly improve the rates of reproducible features in all data sets and analyses.

CONCLUSIONS

Despite the positive connotation of the word "consensus", it is essential to REMIND that consensus-based segmentation has significant reproducibility issues. Therefore, the usage of consensus-based segmentation alone should be avoided unless a reliability analysis is performed, even if it is not practical in clinical settings.

Medical faculty students risk perception, attitudes, and behaviors regarding protection from COVID-19 infection

OBJECTIVE

This study aims to determine the risk perception, attitude, and behavior characteristics of Pamukkale University Faculty of Medicine students towards protection from COVID-19.

SUBJECTS AND METHODS

A total of 698 (48.2%) students of Pamukkale University Faculty of Medicine participated in this analytical cross-sectional study. Dependent variables were attitudes and behaviors related to protection from COVID-19, and independent variables were socio-demographic characteristics, sources of information about COVID-19, and health status. Data was collected through a survey using Google Forms. SPSS 17.0 (Inc., Chicago, IL, USA) software package was used for statistical analysis. Descriptive statistics were expressed as numbers and percentages for nominal data and mean and standard deviation for numerical data. Numerical data were compared with Mann Whitney U and Kruskal Wallis tests. Spearman correlation and backward linear regression analyses were used. A p-value of <0.05 was considered significant.

RESULTS

The mean age of 698 students participating in the study was 21.8±2.2, and 60% of them were female. The mean attitude score was 54.99±5.17 and the mean behavior score was 50.64±6.06. The information sources of the students about COVID-19 were TV news (69.3%). Linear regression analysis revealed that attitude scores of the female gender were higher than male gender (β=0.757±0.364 p=0.038, 95% CI: 0.440-1.471) and scores for using websites/social media accounts of professional organizations and professional associations as information sources were higher than not using (β=0.981 ± 0.388 p=0.011 95% CI: 0.230-1.732).

CONCLUSIONS

Medical students' attitude and behavior score towards protection against COVID-19 infection is slightly above the average level. Medical education should prepare students to manage epidemics.

P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

Purpose

To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts.

Methods

Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA.

Results

Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l.

Conclusion

Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

Response to parenteral iron therapy distinguish unexplained refractory iron deficiency anemia from iron-refractory iron deficiency anemia

INTRODUCTION

We evaluated that response to parenteral iron therapy could be helpful in distinguishing the types of iron deficiency anemia.

PATIENTS AND METHODS

This study analyzed responses to IV iron sucrose therapy of 15 children with unexplained refractory iron deficiency anemia (URIDA). We compared the results at diagnosis, 6 weeks and 6 months after the therapy. Results were compared with responses of 11 patients' results with iron-refractory iron deficiency anemia (IRIDA) from our previous study.

RESULT

Six weeks after the start of treatment, ferritin, MCV, MCH and Hb values were in normal range in 10 patients. The increase in Hb, MCH, MCV, and ferritin values ranged 2.6-3.5 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. In five patients, Hb, MCH, and MCV mean (range) values [11.2 g/dL (11-12.2), 24.5 pg (24-25.6), and 67 fL (65-70)] were nearly normal but ferritin mean (range) values [9.8 ng/mL (8-11)] were below normal. Six weeks after the start of treatment, Hb, MCH, MCV and ferritin values of patients with IRIDA were increased. The increase in Hb, MCH, MCV, and ferritin values ranged 0.8-2.7 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. IRIDA is only partially responsive to parenteral iron supplementation. In conclusion, this study demonstrated that the response to intravenous iron therapy for the URIDA cases improved blood parameters more effectively than hereditary IRIDA. Response to parenteral iron therapy would be helpful to distinguish unexplained refractory IDA from hereditary IRIDA for clinicians who do not have access to hepcidin or TMPRS6 mutation analysis.

Shear bond strength of a self-adhering flowable composite when used for lingual retainer bonding

OBJECTIVE

The goal of this work was to assess the shear bond strength (SBS) and fracture mode of a self-adhering flowable composite when used after thermocycling for lingual retainer bonding.

MATERIALS AND METHODS

A total of 80 human mandibular incisor teeth were categorized into four equal groups: group 1: Vertise™ Flow (VF) without acid etching; group 2: VF with acid etching; group 3: VF with a self-etching bonding agent accompanied by an additional acid etching; group 4: Transbond LR control. Either VF or Transbond LR was applied to the lingual surface of the teeth by packing the material into cylindrical plastic matrices to simulate the lingual retainer bonding area. After all teeth were thermocycled (5000 cycles, 5 and 55 °C), fracture modes were examined under × 20 magnification. The SBS data were assessed via analysis of variance (ANOVA) and Tukey's tests. Fracture modes were analyzed by the χ(2) test at a significance level of 0.05.

RESULTS

Statistically significant differences in SBS values between groups (p < 0.001) were observed. Group 4 exhibited the highest (14.63 ± 1.36 MPa) and group 1 the lowest SBS (2.67 ± 1.35 MPa) values. Statistically significant differences were noted in fracture modes between groups 1, 3, and 4 (p < 0.001). In all the self-adhering flowable composite groups, the adhesive type (tooth-composite interface) fracture occurred more frequently than cohesive and mixed-type fractures.

CONCLUSION

When applied to bond lingual retainers to unetched enamel or with self-etching bonding agent accompanied by an additional acid etching, Vertise™ Flow resulted in a significant decrease in bond strength.

Feasibility of using thrombin generation assay (TGA) for monitoring of haemostasis during supplementation therapy in haemophilic patients without inhibitors

Monitoring factor replacement treatment and observing concordance with clinical haemostasis is crucial in vital haemorrhages and major surgeries in haemophilic patients. We aimed to investigate the value of the thrombin generation assay (TGA) and thromboelastography (TEG) for monitoring haemostasis in haemophilic patients during factor replacement treatment. The study group consisted of 29 patients (21 haemophilia A, 8 haemophilia B). All the patients FVIII-inhibitor were negative. A total of 35 bleeding episodes and/or surgical interventions were evaluated. aPTT, FVIII/FIX activity, TEG and TGA tests were conducted before and after factor therapy during the bleeding episode or surgical prophylaxis of haemophilic patients. Correlations among these tests were evaluated and compared with clinical responses. No correlation was found among aPTT, factor activities and clinical outcome. There were also no correlation found between TEG parameters and clinical outcome. The only significant correlation found between TGA parameters and clinical outcome was the correlation between peak thrombin. In conclusion, we found superiority of TGA-peak thrombin over other traditional tests for monitoring haemostasis in haemophilic patients in this study.

Surgery in patients with haemophilia and high responding inhibitors: Izmir experience

  This report evaluates the haemostatic efficacy of recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrate (APCC) in patients with haemophilia and high responding inhibitors who underwent major and minor surgery. Data pertaining to surgeries from 2001 to 2009 at a single centre were retrospectively analysed. During this period, 53 surgical procedures were performed in 30 haemophiliacs with high responding inhibitors. Mean age was 16.2±9.4 years. Eleven major surgeries in 4 patients, 41 radioisotope synovectomies (RS) and one circumcision classified as minor surgery in 28 patients were performed. Among the major surgery procedures, four were treated with rFVIIa, five with APCC and two with sequential use of APCC and rFVIIa. We used rFVIIa at the dosage of 80-120 μg kg(-1) every 2 h and APCC 100 IU kg(-1) every 12 h for the major surgery. When performing RS, we used rFVIIa in 18 patients with 26 target joints and APCC in 9 patients with 15 target joints. Three consecutive doses of rFVIIa (90 μg kg(-1) ) were used at 2-h intervals followed by additional three doses at 6-h intervals. The initial dose of APCC was 75 IU kg(-1) followed by a second and third dose of 50 IU kg(-1) at 12-h intervals. APCC and rFVIIa demonstrated excellent efficacy in our major and minor surgical interventions [100% (22/22) and 94% (31/33), respectively]. We had only two bleeding complications with rFVIIa. There were no thromboembolic complications. APCC and rFVIIa provide an effective and safe first line haemostatic therapy for inhibitor-positive haemophiliacs, allowing both major and minor surgery to be successfully performed.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients

OBJECTIVE

To investigate the results of rhomboid excision and the Limberg flap procedure to treat pilonidal sinus disease.

METHOD

The records of 411 patients with pilonidal sinus disease, who underwent rhomboid excision and Limberg flap procedure, were analysed. All sinus tracks were resected en bloc, and a Limberg flap was prepared from left or right gluteal region. A suction drain was routinely used.

RESULTS

The mean follow-up period was 109.2 +/- 4.5 months (range: 12-183 months). Recurrence occurred in 12 (2.91%) patients who were all male. In 42 (10.21%) patients, anaesthesia or hypoaesthesia of the upper portion of the flap occurred; this was temporary in 25 patients. Twelve (2.91%) patients developed a seroma and 15 (3.64%) a wound infection. The average hospital stay was 3.2 days (range: 1-10 days), and the average time of return to work was 12.4 days (range: 7-18 days). The average time to walk without pain was 13.4 days (range: 10-28 days) and the average time to sitting on the toilet without pain was 16.1 days (range: 12-28 days).

CONCLUSION

The Limberg flap procedure is effective and has a low complication rate, short time for returning to normal activity and short hospitalization.

Comparison of free jejunal graft with gastric pull-up reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma

The purpose of this study is to evaluate the operative outcomes of a gastric pull-up and free jejunal graft reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma. Records of all patients who underwent esophageal resection for carcinoma of the hypopharynx and cervical esophagus were reviewed. Reconstruction after esophagectomy was performed using the gastric pull-up (n = 38) or free jejunal graft (n = 14) techniques. The hypopharynx was the most common primary tumor site for the free jejunal graft group, whereas the gastric pull-up group had lesions more frequently in the cervical esophagus (P < 0.05). Both operative time and blood loss in the gastric pull-up group were significantly longer and excessive than those of the free jejunal graft group (P < 0.05). The graft survival rate was 95% (32/34) in the gastric pull-up group and 93% (13/14) for the free jejunal transfer group. The overall leakage rate was 1.9% (1/52). Three patients died (6%) in the postoperative period. There was no significant difference with regard to operative morbidity and mortality between the gastric pull-up group and free jejunal graft group. In conclusion, both free jejunal graft and gastric pull-up are safe and effective methods for the immediate restoration of alimentary continuity.

Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

OBJECTIVES

Levosimendan is a novel positive inotropic calcium sensitiser agent used in acute left heart failure. In this study, the effect of levosimendan on the right ventricular systolic and diastolic functions was evaluated by tissue Doppler comparing them with dobutamine in patients with ischaemic heart failure.

METHODS

Patients having an acute decompensated heart failure with ischaemic cardiomyopathy and left ventricular ejection fraction <40% were included in the study. Before and 24-h after treatment, peak systolic (Sa), peak early (Ea), peak late (Aa) diastolic annular velocities and Ea/Aa ratio from tricuspid lateral annulus by tissue Doppler and systolic pulmonary artery pressure (SPAP) were measured.

RESULTS

Sa, Ea and the Ea/Aa ratio were significantly increased in the levosimendan group whereas SPAP was significantly reduced. In the dobutamine group, no significant differences were observed in the Sa, Ea, Aa and Ea/Aa ratio in spite of a significant reduction in SPAP. Decrease in SPAP was greater in the levosimendan group (p=0.002).

CONCLUSION

Levosimendan improves right ventricular systolic and diastolic functions.

Intradermal methylene blue injection for the treatment of intractable idiopathic pruritus ani: results of 30 cases

Some cases of idiopathic pruritus anu may be refractory to treatment with dietary and hygienic instructions and short-term topical medications. In this study, we documented our technique and results with methylene blue injection in a large series of patients with intractable idiopathic pruritus ani. The results of 30 adult patients with well-documented intractable idiopathic pruritus ani who were treated with intradermal methylene blue injection are reported. No antibiotic prophylaxis, anesthesia or sedation was used. A total of 15 ml of a 1% methylene blue solution was injected intracutaneously and subcutaneously in the affected perianal area. A second injection (rescue treatment) was offered one month later to patients who declared partial response, and follow-up was restarted. One month after injection, 24 patients (80%) were symptom-free, 5 declared partial remissions, and one patient still had the same degree of pruritus ani. Five patients with partial remission underwent a second methylene blue injection, which provided complete relief in four. Therefore, the early response rate was 80% with single injection and 93.3% (28 of 30) with the rescue treatment. At six months, three recurrences were noted, indicating to a success rate of 83.3% (25 of 30). At 12 months after treatment, 23 patients (76.7%) were symptom free. This study has shown that intradermal methylene blue injection is a safe, simple, fast and efficient method of treating intractable idiopathic pruritus ani.

Postpartum maternal levels of hemoglobin A1c and cord C-peptide in macrosomic infants of non-diabetic mothers

OBJECTIVE

This study was designed to test the hypothesis that macrosomia in infants born to non-diabetic mothers is associated with an increased incidence of hyperinsulinemia and normal maternal glucose regulation in late pregnancy.

METHODS

Twenty mothers and their macrosomic infants were chosen as the study group, and 20 mothers with their appropriate-for-gestational-age infants were chosen as the control group.

RESULTS

No difference in postpartum mean hemoglobin A1c levels was observed between the mothers of macrosomic infants and those of control infants. Cord plasma C-peptide levels were significantly higher in macrosomic than in control infants.

CONCLUSIONS

This study revealed that macrosomic infants of non-diabetic mothers were significantly more likely to have hyperinsulinemia than were normal-sized infants, and this hyperinsulinemia was not caused by dysregulation in glucose metabolism.

Comparison of wavelet transform and FFT methods in the analysis of EEG signals

In this study, whether the wavelet transform method is better for spectral analysis of the brain signals is investigated. For this purpose, as a spectral analysis tool, wavelet transform is compared with fast Fourier transform (FFT) applied to the electroencephalograms (EEG), which have been used in the previous studies. In addition, the time-domain characteristics of the wavelet transform are also detected. The comparison results show that the wavelet transform method is better in detecting brain diseases.

Acute infantile haemorrhagic oedema associated with hepatitis A

Acute infantile haemorrhagic oedema (AIHO) is characterised by purpura, ecchymosis and inflammatory oedema of the face and extremities. It is seen in children aged 4-24 months. The atiology is not known. We report a case of AIHO diagnosed by skin biopsy demonstrating leukocyte-elastic vasculitis. Laboratory studies showed positive hepatitis A IgM and IgG antibodies. The liver function tests were normal, indicating subclinical hepatitis. Cryoglobulinaemia was detected, suggesting that the disease was related to hepatitis A.

Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy

BACKGROUND

There is an ongoing need, from both the medical and the economic perspective, for a more accurate definition of the influence of symptomatic or asymptomatic gallstone disease on gastrointestinal symptomatology, as well as on the health of the individual in general.

METHODS

Using the Gastrointestinal Quality of Life Index (GIQLI), 37 symptomatic and 30 asymptomatic gallstone patients were evaluated at admission to the hospital and again 4 months after undergoing an uneventful laparoscopic cholecystectomy (LC).

RESULTS

Postoperatively, significant increases in the total GIQLI score were noted in both the symptomatic group (113.42 +/- 21.9 vs 80.32 +/- 19.1 preoperatively; p < 0.05) and the asymptomatic group (96.37 +/- 14.26 vs 113.30 +/- 15.22; p < 0.05). For the subgroups of items, the core symptoms and the physical, psychological, and disease-specific items improved significantly in both groups in the postoperative period (p < 0.05 for all comparisons), but only the symptomatic group achieved a significant improvement in the subgroup of social items (p < 0.05). Negative correlations were found in both the symptomatic and asymptomatic groups between the preoperative GIQLI scores and the improvement seen after LC (r = -0.70 and r = -0.49, respectively).

CONCLUSION

Gallstone disease has a profoundly negative impact on quality of life, especially in symptomatic patients with a history of biliary colic attacks and/or the complications of the disease. Although the condition is not equally distressing for the asymptomatic group of patients without such a history, uncomplicated LC improves the quality of life significantly in both groups. Gallstone patients with lower GIQLI scores are more likely to benefit from LC.

AR spectral analysis of EEG signals by using maximum likelihood estimation

In this study, EEG signals were analyzed using autoregressive (AR) method. Parameters in AR method were realized by using maximum likelihood estimation (MLE). Results were compared with fast Fourier transform (FFT) method. It is observed that AR method gives better results in the analysis of EEG signals. On the other hand, the results have also showed that AR method can also be used for some other researches and diagnosis of diseases.

Primary spontaneous coronary artery dissections in atherosclerotic patients. Report of nine cases with review of the pertinent literature

Primary spontaneous coronary artery dissection is one of the rare causes of acute myocardial infarction. Previous studies reports that it is mostly seen in middle aged women in the last trimester of pregnancy and early postpartum period. Clinical presentation of the disease is variable in pattern and severity related to extent and development rate of dissection. In the last 2 years, nine non-pregnant primary spontaneous coronary artery dissection cases were found in coronary angiography among 3750 patients prediagnosed as coronary artery disease. The cases were presented and discussed with review of the pertinent literature.

Investigation of the relationship between low Apgar scores and early neonatal thyroid function

BACKGROUND

The aim of the present study was to assess the effects of low Apgar scores on perinatal thyroid function.

METHODS

Forty full-term infants delivered by the normal spontaneous vaginal route were enrolled into the study. All babies had 1 and 5 min Apgar scores below 4. The control group consisted of 26 full-term healthy neonates. Cord blood and serum tri-iodothyronine (T3), thyroxine (T4), reverse tri-iodothyronine (rT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH) and thyroid-binding globulin (TBG) determinations were performed by an enzyme immunoassay method.

RESULTS

The mean values of FT4 and T4 observed in the cord blood of the study group were significantly lower compared with matched controls, whereas the mean TSH values were significantly higher. There were no differences in concentrations of T3, rT3 and TBG between the two groups.

CONCLUSIONS

These results demonstrate the existence of transient hypothyroidism at birth in babies with Apgar scores below 4 delivered by the spontaneous vaginal route.

Application of periodogram and AR spectral analysis to EEG signals

In this study, in order to analyze the EEG signal, the conventional and modern spectral methods were investigated. Interpretation and performance of these methods were detected for clinical applications. For this purpose EEG data obtained from different persons were processed by PC computer using periodogram and AR model algorithms. Periodogram and AR modeling approaches were compared for their resolution and interpretation performance. It was determined that the AR approach is better for the use in clinical and research areas, because of the clear spectra that are obtained by it.