Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

OBJECTIVE

The older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey.

METHODS

The data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire.

RESULTS

Of the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma.

CONCLUSIONS

Herein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.

Interaction between hypertension and periodontitis

OBJECTIVE

The possible association between hypertension and periodontitis and the effect of hypertension on periodontal treatment were investigated by evaluating salivary and gingival crevicular fluid (GCF) interleukin (IL)-6 and C reactive protein (CRP) levels.

METHODS

Forty-two healthy individuals without any previously diagnosed systemic disease [10 periodontally healthy (control) and 10 periodontitis (CP)] and subjects with hypertension [13 periodontally healthy (HP) and 9 with periodontitis (CP + HP)] participated in the study. GCF and saliva samples were obtained at baseline and 4 weeks after Phase I periodontal treatment. Biochemical parameters were analyzed using ELISA.

RESULTS

Before the periodontal treatment, significantly higher GCF IL-6 and CRP levels were detected in CP + HP and CP groups compared to HP and control groups (p < 0.01). Salivary CRP level in CP + HP group was found to be higher than the control group (p < 0.05). Statistically significant gingival and plaque index measurements (p < 0.01) might suggest a possible effect of hypertension on periodontal status. Periodontal treatment significantly improved the clinical indices; however, biochemical parameters did not change after the treatment.

CONCLUSION

The association of hypertension with periodontitis through local salivary and GCF inflammatory mediators might be possible in disease process.

Three-Dimensional Modeling and Quantitative Assessment of Mandibular Volume in Ectodermal Dysplasia: A Case Series

Background and Objectives: Ectodermal dysplasia (ED)-a genetic disorder-is characterized by severe tooth deficiency. We compared the mandibular volume and the sagittal and horizontal mandibular widths between patients with ED (ED group) and individuals without tooth deficiency (control group) using three-dimensional modeling. We hypothesized that the mandibular volume differs in ED cases owing to congenital tooth deficiency. Materials and Methods: We used previously obtained cone-beam computed tomography (CBCT) images of 13 patients with ED. The control group data comprised retrospective CBCT images of patients of similar age and sex with a skeletal relationship of class 1. Further, using the three-dimensional image analysis software, the tooth crowns were separated from the mandible, the mandible was reconstructed and the gonion-to-gonion distance in the mandible was marked, the distance to the menton point was measured, and the distance between the two condyles was measured and compared with the control group. Results: Overall, 46.2% and 53.8% of the participants were men and women, respectively. In the ED group, the mean age of the participants was 15.46 (range, 6-24) years, and the mean number of mandibular teeth was 4.62. Notably, the edentulous mandible volume of the ED group (27.020 mm3) was statistically significantly smaller than that of the control group (49.213 mm3) (p < 0.001). There was no difference between the two groups in terms of the marked points. For data analysis, the Shapiro-Wilk test, independent samples t-test, and Mann-Whitney U test were used. Conclusions: It has been considered that mandible volume does not develop in ED cases because of missing teeth. Modern practices, such as the CBCT technique and three-dimensional software, may be effective in identifying the true morphologic features, especially in patients with genetic syndromes affecting the maxillofacial structure.

Assessment of microcirculatory alteration by a vascular occlusion test using near-infrared spectroscopy in pediatric cardiac surgery: effect of cardiopulmonary bypass

OBJECTIVES

Cardiopulmonary bypass cause microcirculatory alterations. Near infrared spectroscopic measurement of tissue oxygen saturation and vascular occlusion test are novel technologies for assessing the microcirculatory function of peripheral tissue specifically in patients undergoing cardiac surgery with cardiopulmonary bypass.Our study aimed to evaluate dynamic microcirculatory function using the vascular occlusion testing during cardiac surgery in pediatric patients.

METHODS

120 pediatric patients were scheduled. Children had continuous regional oxygen saturation monitoring using near infrared spectroscopy and vascular occlusion test. Vascular occlusion test was performed five times; before induction (T1), after induction (T2), then during cardiopulmonary bypass with full flow (T3), after the termination of CPB (T4) and after sternum closure (T5).

RESULTS

Basal value was the lowest at T3 and this value was significantly different among measurements (p < 0,01).Values for maximum and minimum tissue oxygen saturation were the lowest at T3 (83,4 and 52,9%).The occlusion slope varied significantly among measurements (p < 0,01).Reperfusion slopes were significantly different among measurements (p < 0,01) with a further progressive decrease in reperfusion slope with duration of cardiopulmonary bypass.

CONCLUSION

Microcirculatory function can assessed using VOT with forearm Near-infrared spectroscopy derived variables during cardiopulmonary bypass in pediatric cardiac surgery. Noninvasive assessment of microcirculatory perfusion during cardiopulmonary bypass can further help evaluate and improve circulatory support techniques.

TRIAL REGISTRATION

The research Project was registered at ClinicalTrials.gov (NCT06191913).

Computed tomography-based assessment of sphenoid sinus and sella turcica pneumatization analysis: a retrospective study

Background

A preoperative three-dimensional examination of the sphenoid sinus anatomy, its pneumatization pattern, and its relevance to neighboring neurovascular constructions is crucial to preventing possible complications. In this study, the aim was to evaluate the relationship between sphenoid sinus pneumatization types and the sella turcica using computed tomography (CT).

Methods

CT data from 420 patients referred to the Department of Dentomaxillofacial Radiology were evaluated retrospectively. Sella pneumatization types were classified as conchal, presellar, incomplete sellar, and complete sellar, and they were evaluated. Obtained data were evaluated using the IBM SPSS 25.0 (Armonk, New York, USA) package program.

Results

CT images of 420 individuals, including 174 women and 246 men with a mean age of 43.87 ± 17.58 years, were included in the study. When the sella turcica morphologies were evaluated, the most widespread morphological type was irregularity in the posterior part of the dorsum sella, in 51.2% of cases. In addition, a statistically significant correlation was found between the pneumatization of the sphenoid sinus and the morphological types of sella (p < 0.05).

Conclusion

In this research endeavor, the predominant observation comprised the complete sellar sphenoid sinus pneumatization type, exhibiting irregularity in the posterior aspect of the dorsum sella, representing one of the sellar types. Notwithstanding, it is imperative to conduct additional investigations to establish the generalizability of the present study's findings.

Picturing asthma in Turkey: results from the Turkish adult asthma registry

INTRODUCTION

National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention.

METHODS

Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes.

RESULTS

The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions.

CONCLUSION

The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Relationship between pelvic incidence-adjusted relative spinopelvic parameters, global sagittal alignment and lower extremity compensations

PURPOSE

In response to sagittal malalignment, compensatory spinal and lower extremity mechanisms are recruited. Thoracolumbar realignment surgery has been shown to yield reciprocal changes in these compensations. Thus, whole-body radiographic assessment has come to the fore. This study aimed to evaluate the relationship between spinopelvic parameters and lower extremity compensation angles and to examine their coupled change with deformity correction.

METHODS

This was a multicenter retrospective analysis of patients who had ≥ 4 levels posterior fusion, whole-body radiographs, and ≥ 2 years follow-up. Relative Pelvic Version (RPV), Relative Lumbar Lordosis (RLL), Relative Spinopelvic Alignment (RSA), Femoral Obliquity Angle (FOA), Knee Flexion Angle (KFA) and Global Sagittal Axis (GSA) were measured preoperatively and 6 week postoperatively. Kruskal-Wallis tests were performed to assess the relation of relative spinopelvic parameters to global sagittal alignment and lower extremity compensation angles. Spearman's correlations were performed to assess correlations of pre-to-postoperative changes.

RESULTS

193 patients (156F, 37 M) were included. The mean age was 57.2 ± 16.6 years. The mean follow-up duration was 50.6 (24-90) months. On average, 10.3 ± 3.8 levels were fused. Among the cohort, 124 (64.2%) had a sacral or sacroiliac fixation, and 43 (22.3%) had 3-column osteotomies. Preoperative FOA, KFA and GSA significantly differed between RPV, RLL and RSA categories. Significant weak-to-strong correlations were observed between spinopelvic parameters, global sagittal alignment and lower extremity compensation angles (rho range: - 0.351 to 0.767).

CONCLUSIONS

PI-adjusted relative spinopelvic parameters significantly correlated with measurements of the lower extremity compensation. Postoperative changes in RPV, RLL and RSA reflected changes in FOA, KFA and GSA. These measurements may serve as a valuable proxy for surgical planning when whole-body imaging is not available.

Evaluation of Clinical and Oral Findings in Patients with Epidermolysis bullosa

Introduction: Epidermolysis bullosa (EB) is a genetically inherited disease characterized by recurrent bullae and erosions on the skin with numerous signs of dental caries and poor oral hygiene. The aim of this study was to investigate the general clinical and oral findings of patients with EB. Materials and Methods: In this prospective study, the clinical and oral findings and family history of 26 cases with EB were evaluated. The type of EB, gender, age, parental consanguinity, dental caries, oral findings, distribution of lesions and presence of associated anomalies, clinical and oral findings correlated with gender were recorded. Results: All 26 patients with EB had a history of consanguinity and siblings with EB to varying degrees. In our study, malnutrition, anemia and growth retardation, gastrointestinal system complications, hair thinning, hand and nail deformity, ocular problems and renal disease (in one case) were observed with variable frequencies. When the intraoral findings of the patients were investigated, extensive dental caries in all EB types, enamel hypoplasia in junctional EB (JEB) and the presence of tooth-root to be extracted in dystrophic EB (DEB), intraoral bullae and lesions, ankyloglossia, vestibular sulcus insufficiency, microstomia and maxillary atrophy were observed. Three cases had restorative treatment and one case had prosthetic rehabilitation. Conclusions: Oral involvement can be seen with varying frequencies depending on the type of EB and the severity of the disease. It may result from delayed oral and dental rehabilitation due to physical disabilities, limitations and more pressing medical problems. Microstomy, pain from mucosal lesions, and restricted access to the mouth can be caused by poor oral hygiene. Oral complications and caloric needs of individuals with EB should be determined, and individual prophylaxis should be applied to prevent caries formation and protect teeth.

Long-term opioid medication profile of European adult spinal deformity patients: minimum five years follow-up study

BACKGROUND CONTEXT

There remains significant variability in the use of postoperative opioids. On one end, it is proven that appropriate pain control is a critical aspect of patient management; on the other end, past few decades have been associated with major increases in opioid-related overdoses and addiction treatment. We hypothesized that several pre- and postoperative risk factors affecting long-term opioid use could be identified.

PURPOSE

Evaluation of factors associated with minimum 5-year postoperative opioid use following adult spinal deformity surgery.

STUDY DESIGN/SETTING

Prospectively followed study group database.

PATIENT SAMPLE

Adult spinal deformity patients who underwent elective spine surgery between 2009 and 2016 were included.

OUTCOME MEASURES

Opioid usage or otherwise at minimum 5 years follow-up. Use of nonopioid analgesics, weak and strong opioids METHODS: Retrospective analysis of patients undergoing elective spinal deformity surgery. A total of 37 factors comprising patient characteristics, radiographic measurements, operative details, preoperative and early postoperative opioid use, and mechanical complications and revisions were analyzed. Details on identified factors were provided.

RESULTS

A total of 265 patients (215F, 50M) from five sites were included. The mean follow-up duration was 68.4±11.7 (60-102) months. On average, 10.6±3.5 levels were fused. Preoperatively, 64 (24.2%) patients were using opioids. The rate of opioid users increased to 33.6% at 6 weeks and decreased to 21.5% at 6 months. During follow-up, there were patients who discontinued opioids, while others have started and/or restarted using opioids. As a result, 59 (22.3%) patients were still on opioids at the latest follow-up. Multivariate analyses showed that factors independently affecting opioid use at an average of 68 months postoperatively, in order of significance, were opioid use at sixth weeks, preoperative opioid use and opioid use at sixth months with the odds ratios of 2.88, 2.51, and 2.38 respectively. At these time points, factors such as age, number of comorbidities, tobacco use, the time of the last prior spine surgery and postoperative sagittal plane alignment affected opioid usage rates.

CONCLUSIONS

Opioid usage at 6 weeks was found to be more predictive of long-term opioid use compared to preoperative use. Patients should be well informed to have realistic expectations regarding opioid use when considering adult spinal deformity surgery.

Evaluation of Radiation Exposure Due to Dental Radiographs Taken during Endodontic Treatment Sessions in Young Permanent Teeth

Background and Objectives: The aim of this study was to retrospectively analyze the duration of treatment and the number of dental radiographs taken during endodontic treatment (endo-t) of young permanent teeth (YPT). Materials and Methods: Age, gender, affected tooth number, apex status, duration of treatment and dental radiographs taken during this period were retrospectively evaluated in pediatric patients aged 6−15 years who presented to the pedodontic department for endo-t of anterior YPT. Data were analyzed with Kruskal Wallis H, Dunn and Pearson chi-square tests. p < 0.05 was accepted as statistically significant in all analyses. Results: Anterior endo-t was initiated in 471 of 9,200 pedodontic patients between the ages of 6 and 15 years who applied to our university. The reason for seeking treatment was caries (8.1%) and trauma (91.9%). It was observed that 59% of the teeth had an open apex and 45.7% had a closed apex. A total of 1893 periapical radiographs (Per-R) and 245 panoramic radiographs (Pan-R) were taken from 471 pediatric patients during the treatment period. Total number of dental radiographs was 2138 with 4.5 per patient. Number of Per-R was lower in patients whose treatment was completed in a single session (p < 0.001). There was no difference in the number of Pan-R with respect to duration of treatment (p = 0.560). Conclusions: In children, the number of Per-R significantly increased with prolonged duration of treatment encompassing multiple sessions for endo-t procedures of anterior YPT, decided based on the apex and lesion status of the affected tooth. Especially in long-term traditional apexification treatments, treatment should be carried out in children with the ALADAIP (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific) principle in mind.

Cardiovascular risk factors: The effects of ageing and smoking on the immune system, an observational clinical study

Currently immunomodulatory compounds are under investigation for use in patients with cardiovascular disease, caused by atherosclerosis. These trials, using recurrent cardiovascular events as endpoint, require enrollment of large patient groups. We investigated the effect of key risk factors for atherosclerosis development, ageing and smoking, on the immune system, with the objective to identify biomarkers differentiating between human populations, and potentially serving as endpoints for future phase 1B trials with immunomodulatory compounds. Blood was collected from young healthy volunteers (aged 18-25 years, n=30), young smokers (18-25 years, n=20), elderly healthy volunteers (>60 years, n=20), heavy smokers (>45 years, 15 packyears, n=11) and patients with stable coronary artery disease (CAD) (>60 years, n=27). Circulating immune cell subsets were characterized by flow cytometry, and collected plasma was evaluated by proteomics (Olink). Clear ageing effects were observed, mostly illustrated by a lower level in CD8⁺ and naïve CD4⁺ and CD8⁺ T cells, with an increase in CD4⁺ and CD8⁺ effector memory T cells in elderly healthy volunteers compared to young healthy volunteers. Heavy smokers showed a more inflammatory cellular phenotype, especially a shift in Th1/Th2 ratio: higher Th1 and lower Th2 percentages compared to young healthy volunteers. A significant decrease in circulating atheroprotective oxLDL-specific IgM was found in patients with CAD compared to young healthy volunteers. Elevated pro-inflammatory and chemotactic proteins TREM1 and CCL11 were observed in elderly volunteers compared to young volunteers. In addition, heavy smokers had an increase in pro-inflammatory cytokine IL-6 and lysosomal protein LAMP3. These data show that ageing and smoking are associated with an inflammatory immunophenotype, and that heavy smokers or aged individuals may serve as potential populations for future clinical trials investigating immunomodulatory drugs targeted for cardiovascular disease.

Can the Density of Mineralized Dental Tissues (Dentin and Enamel) Be Measured and Compared with 3D Cone Beam Computed Tomography in Cases of Ectodermal Dysplasia?

BACKGROUND Since 3-dimensional cone beam computed tomography (CBCT) started to be used in dentistry, mineral density can now be examined with computer software from the data on the images obtained. Detailed and clear images at different slice intervals can be obtained with CBCT, and mineral density can be measured from the image data on a computer with a Hounsfield unit (HU) scale. In addition to the broad opportunities presented by CBCT, this feature has presented a wider perspective to researchers. MATERIAL AND METHODS In this study, the CBCT images obtained from patients with the genetic disorder of ectodermal dysplasia were compared with the images of a control group to determine differences in mineralization of the teeth and to show that these could be compared by measuring the mineral density of dentin and enamel tissues using the HU scale on data from CBCT images. This opens new opportunities for cognitive and implementation research. RESULTS In the study, CBCT images of 14 ectodermal dysplasia and 14 control group cases previously obtained for various reasons were used. Mineral density measurements were made from 4 different regions of the teeth of the ectodermal dysplasia and control groups (incisor edge of the crown, the center buccal, cervicale line, and apex of the teeth), and the groups were compared. CONCLUSIONS The aim of this study was to provide a new overview of the feasibility and suitability of mineralization measurement of dentin and enamel dental tissues with CBCT in ectodermal dysplasia and control groups.

Comparison of early-stage stenosis and regurgitation results among patients who underwent aortic valve repair

INTRODUCTION

This study aimed to analyse the results of paediatric aortic valve repairs in our institution.

METHOD

The data of 57 patients under 18 years of age who underwent aortic valve repair between 2014 and 2019 were retrospectively analysed. Early postoperative reoperation and hospital mortality rates were evaluated based on the ages of the patients, their preoperative diagnoses, and the surgical techniques used. Survival curves for groups of patients were calculated by Kaplan-Meier analysis.

RESULTS

The rate of reoperation was 14% (n = 8), and there were no significant differences regarding valve pathologies and preoperative diagnoses (p > 0.05). Among the repair techniques, tricuspidisation was considered to be a risk factor for reoperation (p < 0.05). Augmentation, the material used (0.1 PTFE or pericardium), and the number of cusps were not found to have significant effects on reoperation or mortality. The mean follow-up period was 29.86 ± 21.30 months. The survival rates of the patients were 88%, 100%, and 88.2% for those with aortic stenosis, aortic insufficiency, and mixed disease, respectively, and no significant difference was found when these rates were evaluated with the log-rank test (p > 0.05). The mortality rate was 8.8% (n = 5), and undergoing surgery before the age of 1 year was found to be significant in terms of mortality (p = 0.032, p < 0.05). The bicuspid aortic valve group had the lowest mortality risk, while the Shone complex group had the highest.

CONCLUSION

With its acceptable reoperation and mortality rates, aortic valve repair should be the first choice of treatment in the paediatric age group. Early results were satisfactory in all groups.

The role of neutrophil-to-lymphocyte ratio in predicting mortality after bidirectional Glenn procedure

This study aimed to address the role of various inflammation-related blood indices for the assessment of in-hospital outcomes in subjects undergoing Glenn procedure. Subjects who underwent the Glenn procedure for hypoplastic left heart syndrome were analysed retrospectively. Subjects were divided into two groups: Group 1 consisted of 78 patients who were discharged, and Group 2 included 12 patients who died after surgery. Post-operative third-day neutrophil count and neutrophil-to-lymphocyte ratio value were significantly higher in the exitus group compared to the discharged group (p = 0.006 and p = 0.003, respectively). Third-day neutrophil-to-lymphocyte ratio was positively correlated with duration of intubation (r = 0.253, p = 0.018), length of stay in ICU (r = 0.296, p = 0.006) and length of hospital stay (r = 0.297, p = 0.005). Multiple logistic regression analysis revealed that patients with high third-day neutrophil-to-lymphocyte ratio (≥6) had 14.227-fold higher risk of death compared to those with lower values. In addition, higher pulmonary arterial pressure was associated with increased risk of death. Receiver operating characteristics analysis revealed that neutrophil-to-lymphocyte ratio had 66.67% sensitivity, 84% specificity, 81.61% accuracy, 40.00% positive predictive value and 94.03% negative predictive value with a cut-off point of ≥6 to predict mortality. Third-day neutrophil-to-lymphocyte ratio and increased post-operative pulmonary arterial pressure are significant predictors for in-hospital mortality in Glenn procedure recipients. A cut-off value of ≥6 for third-day neutrophil-to-lymphocyte ratio predicts mortality with 66.67% sensitivity and 84% specificity. Given its simplicity and availability, post-operative neutrophil-to-lymphocyte ratio should be monitored on a daily basis to identify patients with high risk for mortality after Glenn procedure.

Effect of intraoperative theophylline use on acute kidney injury in paediatric cardiac surgery

BACKGROUND

This study aimed to examine the effects of theophylline use in preventing renal dysfunction in patients undergoing CHD surgery.

METHODS

A total of 94 patients aged 1-60 months were included in the study. Patients in the theophylline group were enrolled according to a pre-defined protocol for treatment administration, while controls were selected retrospectively from patients without theophylline treatment during the same period - who were matched according to critical baseline characteristics.

RESULTS

The incidence of acute kidney injury was similar between the two groups (p = 1.000). Higher urinary output and lower fluid balance were found intraoperatively and also postoperatively in the theophylline group (all, p < 0.050). Postoperative decrease in urinary output and estimated glomerular filtration rate were higher in the theophylline group (p < 0.050). Lower postoperative urea and creatinine levels were shown in theophylline recipients (p < 0.050). Urea levels increased significantly in the non-theophylline group during surgery (p < 0.001), and no significant change was observed in theophylline group (p = 0.136). Postoperative increase in creatinine and lactate levels was demonstrated in theophylline group (p < 0.050), and lactate levels were higher in the non-theophylline group during and after cardiopulmonary bypass (p = 0.010). Multiple linear regression analysis revealed less reduction in estimated glomerular filtration rate with higher age and in the presence of theophylline use (p < 0.050).

CONCLUSION

Although we demonstrated a similar incidence of acute kidney injury in the both groups, we revealed an important decrease in serum creatinine, urea and lactate levels, accompanied by improved estimated glomerular filtration rate, increased urine output and decreased fluid overload, with theophylline treatment, suggesting that renal functions significantly improved with the use of theophylline.

Clinical Characteristics and Outcome of COVID-19 in Turkish Hematological Malignancy Patients

Objective:

Patients with solid malignancies are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection than the healthy population. The outcome of SARS-CoV-2 infection in highly immunosuppressed populations, such as in patients with hematological malignancies, is a point of interest. We aimed to analyze the symptoms, complications, intensive care unit admissions, and mortality rates of patients with hematological malignancies infected with SARS-CoV-2 in Turkey.

Materials and Methods:

In this multicenter study, we included 340 adult and pediatric patients diagnosed with SARS-CoV-2 from March to November 2020. Diagnosis and status of primary disease, treatment schedules for hematological malignancies, time from last treatment, life expectancy related to the hematological disease, and comorbidities were recorded, together with data regarding symptoms, treatment, and outcome of SARS-CoV-2 infection.

Results:

Forty four patients were asymptomatic at diagnosis of SARS-CoV- 2 infection. Among symptomatic patients, fever, cough, and dyspnea were observed in 62.6%, 48.8%, and 41.8%, respectively. Sixty-nine (20%) patients had mild SARS-CoV-2 disease, whereas moderate, severe, and critical disease was reported in 101 (29%), 71 (20%), and 55 (16%) patients, respectively. Of the entire cohort, 251 (73.8%) patients were hospitalized for SARS-CoV-2. Mortality related to SARS-CoV-2 infection was 26.5% in the entire cohort; this comprised 4.4% of those patients with mild disease, 12.4% of those with moderate disease, and 83% of those with severe or critical disease. Active hematological disease, lower life expectancy related to primary hematological disease, neutropenia at diagnosis of SARS-CoV-2, ICU admission, and first-line therapy used for coronavirus disease-2019 treatment were found to be related to higher mortality rates. Treatments with hydroxychloroquine alone or in combination with azithromycin were associated with a higher rate of mortality in comparison to favipiravir use.

Conclusion:

Patients with hematological malignancy infected with SARS-CoV-2 have an increased risk of severe disease and mortality.

Comparison of Del Nido and Blood Cardioplegia in Pediatric Patients Undergoing Surgical Repair for Congenital Heart Disease

The aim of the study is to investigate the impact of two different cardioplegia solutions, the del Nido (dN) and blood cardioplegia (BC), on postoperative troponin concentrations, vasoactive-inotrope score, and length of hospital stay in pediatric patients undergoing cardiovascular surgery for CHD. 80 subjects aged between 1 and 120 months who were scheduled for surgical repair for a CHD were prospectively enrolled in this study. Study subjects were allocated to one of the study groups using simple randomization technique as follows: The del Nido cardioplegia group (n = 40, median age 8.5 [5.5-14] months) and conventional blood cardioplegia group (n = 40, median age 11 [5-36] months). Aortic cross-clamp time and cardiopulmonary bypass time were recorded in all subjects. Troponin I and vasoactive-inotropic score, which indicates the amount of cardiovascular support by various inotropes or vasopressors, were recorded following the repair. The difference in troponin I, vasoactive-inotropic score (VIS), length of ICU stay, and length of hospital stay between the two groups was the primary outcome measure of this study. The volume of cardioplegia was significantly lower in dN group than that of the BC group (p < 0.001). Cardiopulmonary bypass time and aortic cross-clamp time were significantly shorter in subjects receiving dN cardioplegia than those receiving BC (p = 0.006, and p = 0.001, respectively). Subjects assigned to BC had higher Troponin I concentrations at postoperative 24th hour compared to subjects receiving dN cardioplegia [1.60 (0.92-2.49) ng/mL vs. 1.03 (0.55-1.83) ng/mL, p = 0.045]. VIS was also significantly higher in BC group at 24th [10 (10-13) vs. 10 (5-10), p = 0.032] and 48th hours [10 (1.5-10) vs. 0 (0-10), p = 0.005] compared to that of the dN cardioplegia group. The median extubation time was 7.5 (3.5-20.5) hours in dN cardioplegia group and 5 (4-10) hours in the BC group (p = 0.384). There were no significant differences between the groups with respect to the length of ICU stay and length of hospital stay. No mortality and no significant arrhythmias requiring medical or electrical cardioversion were noted in any of the groups. In conclusion, dN cardioplegia provides shorter aortic cross-clamp time and cardiopulmonary bypass time, and lower postoperative troponin I concentration and vasoactive-inotrope scores compared to BC in pediatric subjects undergoing surgical repair for CHD. However, lengths of ICU and hospital stay are similar in dN cardioplegia and BC groups.

Prediction of new prescription requirements for diabetes patients using big data technologies

Purpose

The study aimed to evaluate the effectiveness of using large data sets for new diabetes patient prescriptions.

Design/methodology/approach

This study consisted of 101,766 individuals, who had applied to the hospital with a diabetes diagnosis and were hospitalized for 1–14 days and subjected to laboratory tests and medication.

Findings

With the help of Mahout and Scala, data mining methods of random forest and multilayer perceptron were used. Accuracy rates of these methods were found to be 0.879 and 0.849 for Mahout and 0.849 and 0.870 for Scala.

Originality/value

The mahout random forest method provided a better prediction of new prescription requirements than the other methods according to accuracy criteria.

Towards remote monitoring in pediatric care and clinical trials-Tolerability, repeatability and reference values of candidate digital endpoints derived from physical activity, heart rate and sleep in healthy children

Background

Digital devices and wearables allow for the measurement of a wide range of health-related parameters in a non-invasive manner, which may be particularly valuable in pediatrics. Incorporation of such parameters in clinical trials or care as digital endpoint could reduce the burden for children and their parents but requires clinical validation in the target population. This study aims to determine the tolerability, repeatability, and reference values of novel digital endpoints in healthy children.

Methods

Apparently healthy children (n = 175, 46% male) aged 2–16 were included. Subjects were monitored for 21 days using a home-monitoring platform with several devices (smartwatch, spirometer, thermometer, blood pressure monitor, scales). Endpoints were analyzed with a mixed effects model, assessing variables that explained within- and between-subject variability. Endpoints based on physical activity, heart rate, and sleep-related parameters were included in the analysis. For physical-activity-related endpoints, a sample size needed to detect a 15% increase was calculated.

Findings

Median compliance was 94%. Variability in each physical activity-related candidate endpoint was explained by age, sex, watch wear time, rain duration per day, average ambient temperature, and population density of the city of residence. Estimated sample sizes for candidate endpoints ranged from 33–110 per group. Daytime heart rate, nocturnal heart rate and sleep duration decreased as a function of age and were comparable to reference values published in the literature.

Conclusions

Wearable- and portable devices are tolerable for pediatric subjects. The raw data, models and reference values presented here can be used to guide further validation and, in the future, clinical trial designs involving the included measures.

A nomogram for decision-making of completion surgery in endometrial cancer diagnosed after hysterectomy

OBJECTIVE

Extrauterine tumor spread is one of the essential determinants of disease outcome in endometrial cancer. However; more than 30% of patients still undergo incomplete surgery at the initial attempt. Strategies regarding the management of patients with incompletely staged early-stage disease or patients with undebulked advanced-stage disease remain controversial. Depending on postoperative uterine features and findings on imaging, patients may be put on observation or receive adjuvant therapy or undergo re-staging or debulking surgery followed by adjuvant therapy. To identify patients who would most benefit from a completion surgery, either for restaging or for cytoreduction, we developed a nomogram for estimation of extrauterine disease based on findings of final hysterectomy specimen.

METHODS

Data of 336 patients whose extrauterine disease status was known were analyzed. A nomogram was constructed using patient characteristics including age, grade, myometrial invasion, lymphovascular space involvement, cervical involvement, and peritoneal cytology. The nomogram was internally validated in terms of discrimination, calibration and overall performance.

RESULTS

The nomogram showed good performance accuracy with an area under the receiver operating characteristic curve of 0.870, a specificity of 95.5%, and a positive predictive value of 73.9%. Decision curve analysis revealed that the use of the nomogram in decision-making for completion surgery leads to the equivalent of a net 18 true-positive results per 100 patients without an increase in the number of false-positive results.

CONCLUSIONS

Estimation of extrauterine disease from final hysterectomy specimen is possible with high predictive performance using the nomogram developed. The nomogram may help clinicians in decision-making for management of incomplete surgeries.

Comparison of mandibular index values determined from standard panoramic versus cone beam computed tomography reconstructed images

OBJECTIVE

The aim of this study was to compare mandibular index values, including the mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI), determined on the basis of cone beam computed tomography (CBCT) and panoramic reconstructed (PR) images.

STUDY DESIGN

PR and CBCT images of 182 patients were retrospectively analyzed. Cross-sectional (CS) and PR images were obtained from CBCT data. The MCI, MI, and PMI were assessed on CS, PR, and panoramic images and evaluated for intra- and interobserver agreements by κ-value or intraclass correlation coefficient (ICC) analysis. Agreement among measurement methods was assessed by using the Bland-Altman method, with CS images as the gold standard for linear measurements.

RESULTS

Measurements from PR and CS images agreed with those from panoramic images in 66.7% and 53.8% of C3 classifications of MCI (porous cortices forming many endosteal residues), respectively. Panoramic and CBCT images exhibited good agreement in MI findings (ICC 0.91) and moderate (PR and panoramic images: ICC 0.79) to good (CS and panoramic images: ICC 0.87) agreement in PMI findings.

CONCLUSIONS

Because of the overlapping of buccal and lingual cortices, panoramic images are especially inadequate for determining the C3 category of MCI. However, CS images obtained from available CBCT data provide better visibility compared with panoramic images and, therefore, can be used for evaluating mandibular indices.

Relative pelvic version: an individualized pelvic incidence-based proportional parameter that quantifies pelvic version more precisely than pelvic tilt

BACKGROUND CONTEXT

Pelvic tilt (PT) is used as an indicator of pelvic version with increased values indicating retroversion and disability. The concept of using PT solely as an absolute numerical value can be misleading, especially for the patients with pelvic incidence (PI) values near the upper and lower normal limits. Relative pelvic version (RPV) is a PI-based individualized measure of the pelvic version. Relative pelvic version indicates the individualized spatial orientation of the pelvis relative to the ideal sacral slope as defined by the magnitude of PI.

PURPOSE

The aim of this study was to compare RPV and PT for their ability to predict mechanical complications and their correlations with health-related quality of Life (HRQoL) scores.

STUDY DESIGN

A retrospective analysis of a prospectively collected data of adult spinal deformity patients was carried out. Mechanical complications (proximal junctional kyphosis or proximal junctional failure, distal junctional kyphosis or distal junctional failure, rod breakage, and implant-related complications) and HRQoL scores (Oswestry Disability Index [ODI], Core Outcome Measures Index [COMI], Short Form-36 Physical Component Summary [SF-36 PCS], and Scoliosis Research Society 22 Spinal Deformity Questionnaire [SRS-22]) were used as outcome measures.

METHODS

Inclusion criteria were ≥4 levels fusion, and ≥2-year follow-up. Correlations between PT, RPV, PI, and HRQoL were analyzed using Pearson correlation coefficient. Pelvic incidence values and mechanical complication rates in RPV subgroups for each PT category were compared using one-way analysis of variance, Student t test, and chi-squared tests. Predictive models for mechanical complications with RPV and PT were analyzed using binomial logistic regressions.

RESULTS

A total of 222 patients (168 women, 54 men) met the inclusion criteria. Mean age was 52.2±19.3 (18-84) years. Mean follow-up was 28.8±8.2 (24-62) months. There was a significant correlation between PT and PI (r=0.613, p<.001), threatening the use of PT to quantify pelvic version for different PI values. Relative pelvic version was not correlated with PI (r=-0.108, p>.05), being able to quantify pelvic version for all PI values. Compared with PT, RPV had stronger partial correlations with ODI, COMI, SF-36 PCS, and SRS-22 scores (p<.05). Discrimination performance assessed by area under the curve, percentage accuracy in classification, true positive rate, true negative rate, and positive and negative predictive values was better for the model with RPV than for PT. For average PI sizes, the agreement between RPV and PT were moderate (0.609, p<.001), whereas the agreement in small and large PI sizes were poor (0.189, p>.05; -0.098, p>.496, respectively). When analyzed by RPV, each PT "0," "+," and "++" category was further divided into two or three distinct subgroups of patients having different PI values (p=.000, p=.000, and p=.029, respectively). Relative pelvic version subgroups within the same PT category displayed different mechanical complication rates (p=.000, p=.020, and p=.019, respectively).

CONCLUSIONS

Pelvic tilt may be insufficient or misleading in quantifying normoversion for the whole spectrum of PI values when used as an absolute numeric value in conjunction with previously reported population-based average thresholds of 20 and 30 degrees. Relative pelvic version offers an individualized quantification of ante-, normo-, and retroversion for all PI sizes. Schwab PT groups were found to constitute inhomogeneous subgroup of patients with different mean PI values and mechanical complication rates. Compared with PT, RPV showed a greater association with both mechanical complications and HRQoL.

Treatment of industrial estate wastewater by the application of electrocoagulation process using iron electrodes

In this study electrocoagulation (EC) of industrial estate wastewater taken from the inlet of wastewater treatment plant was investigated using sacrificial iron electrodes. Employing a pole changer to homogenous consumption of electrodes, studies on the parameters such as current density, supporting electrolyte concentration and initial pH, which have significant effects on COD removal and hence the energy consumption, were performed. Hydrogen peroxide was used in different concentrations to observe its effects on COD removal efficiency and the energy consumption. Sludge productions were also calculated for all experiments. COD removal efficiency of ∼92% was obtained at the best experimental conditions (i = 30 mA/cm², SE = 3 mM Na₂SO₄, pH = original pH (∼6) of the wastewater, 1500 mg/L H₂O₂) with an energy cost of €3.41/m³ wastewater treated and the sludge production of 5.45 g per g COD removed.

N-acetylcysteine versus Dopamine to Prevent Acute Kidney Injury after Cardiac Surgery in Patients with Preexisting Moderate Renal Insufficiency

Objective

Acute kidney injury after cardiac surgery is associated with mortality and morbidity. Therefore, strategies to prevent acute kidney injury are very important. The aim of this placebo-controlled randomized double-blind study was to compare the prophylactic efficacy of N-Acetylcysteine and dopamine administration in patients with pre-existing moderate renal insufficiency who were undergoing cardiopulmonary bypass.

Methods

This study included 135 patients with pre-existing moderate renal insufficiency who were scheduled for coronary artery bypass grafting surgery. Serum creatinine and GFR were recorded preoperatively and on the first and second postoperative days.

Results

On the first and second postoperative days, the drugs used showed statistically significant differences among the creatinine groups (P<0.001). According to Tukey's HSD, on the first and second PO, the creatinine of Group N, D and P were significantly different (P<0.001). On the first and second PO, the used drugs showed statistically significant differences among the effects of eGFR (P<0.001). According to Tukey's HSD on the first postoperative day, the average eGFR score of Group N compared to D and P were significantly difference (P<0.001). On the second postoperative day, the eGFR of Group N and D showed no difference (P=0.37), but P showed a difference (P<0.001).

Conclusion

We found that the prophylactic use of intravenous N-Acetylcysteine had a protective effect on renal function, whereas the application of renal dose dopamine did not have a protective effect in patients with pre-existing moderate renal failure.

Relative lumbar lordosis and lordosis distribution index: individualized pelvic incidence–based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis

OBJECTIVE

The subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value. Relative LL (RLL) and the lordosis distribution index (LDI) are PI-based individualized measures. RLL quantifies the magnitude of lordosis relative to the ideal lordosis as defined by the magnitude of PI. LDI defines the magnitude of lower arc lordosis in proportion to total lordosis. The aim of this study was to compare RLL and PI − LL for their ability to predict postoperative complications and their correlations with health-related quality of life (HRQOL) scores.

METHODS

Inclusion criteria were ≥ 4 levels of fusion and ≥ 2 years of follow-up. Mechanical complications were proximal junctional kyphosis/proximal junctional failure, distal junctional kyphosis/distal junctional failure, rod breakage, and implant-related complications. Correlations between PI − LL, RLL, PI, and HRQOL were analyzed using the Pearson correlation coefficient. Mechanical complication rates in PI − LL, RLL, LDI, RLL, and LDI interpreted together, and RLL subgroups for each PI − LL category were compared using chi-square tests and the exact test. Predictive models for mechanical complications with RLL and PI − LL were analyzed using binomial logistic regressions.

RESULTS

Two hundred twenty-two patients (168 women, 54 men) were included. The mean age was 52.2 ± 19.3 years (range 18–84 years). The mean follow-up was 28.8 ± 8.2 months (range 24–62 months). There was a significant correlation between PI − LL and PI (r = 0.441, p < 0.001), threatening the use of PI − LL to quantify spinopelvic mismatch for different PI values. RLL was not correlated with PI (r = −0.093, p > 0.05); therefore, it was able to quantify divergence from ideal lordosis for all PI values. Compared with PI − LL, RLL had stronger correlations with HRQOL scores (p < 0.05). Discrimination performance was better for the model with RLL than for PI − LL. The agreement between RLL and PI − LL was high (κ = 0.943, p < 0.001), moderate (κ = 0.455, p < 0.001), and poor (κ = −0.154, p = 0.343), respectively, for large, average, and small PI sizes. When analyzed by RLL, each PI − LL category was further divided into distinct groups of patients who had different mechanical complication rates (p < 0.001).

CONCLUSIONS

Using the formula of PI − LL may be insufficient to quantify normolordosis for the whole spectrum of PI values when applied as an absolute numeric value in conjunction with previously reported population-based average thresholds of 10° and 20°. Schwab PI − LL groups were found to constitute an inhomogeneous group of patients. RLL offers an individualized quantification of LL for all PI sizes. Compared with PI − LL, RLL showed a greater association with both mechanical complications and HRQOL. The use of RLL and LDI together, instead of PI − LL, for surgical planning may result in lower mechanical complication rates and better long-term HRQOL.

Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery

BACKGROUND

The restoration of normal sagittal alignment is a critical goal in adult spinal deformity surgery to achieve favorable outcomes and prevent mechanical complications. Schwab sagittal modifiers have been accepted as targets for appropriate alignment, but addressing these targets does not always prevent high mechanical complication or revision rates. This may be because the linear absolute numerical parameters do not cover the whole pelvic incidence spectrum and the distribution of lordosis, pelvic anteversion, and negative malalignment are not considered as potential causes of failure. The aim of the present study was to develop and validate a score based on pelvic-incidence-based proportional parameters to better predict mechanical complications.

METHODS

Two hundred and twenty-two patients (168 women and 54 men) followed for ≥2 years after posterior fusion at ≥4 levels were included in the study. The mean age (and standard deviation) was 52.2 ± 19.3 years (range, 18 to 84 years), and the mean duration of follow-up was 28.8 ± 8.2 months (range, 24 to 62 months). The global alignment and proportion (GAP) score was developed and validated in groups of patients randomly assigned to derivation (n = 148, 66.7%) and validation (n = 74, 33.3%) cohorts. GAP score parameters were relative pelvic version (the measured minus the ideal sacral slope), relative lumbar lordosis (the measured minus the ideal lumbar lordosis), lordosis distribution index (the L4-S1 lordosis divided by the L1-S1 lordosis multiplied by 100), relative spinopelvic alignment (the measured minus the ideal global tilt), and an age factor. Proximal and distal junctional kyphosis and/or failure, rod breakage, and other implant-related complications were considered mechanical complications. The predictive accuracy of the GAP score was analyzed using receiver operating characteristic (ROC) analyses. Associations between GAP categories and mechanical complications and revisions were analyzed using Cochran-Armitage tests.

RESULTS

In the validation cohort, 32 patients (43%) experienced mechanical complications and 17 (23%) underwent mechanical revision. The area under curve for the GAP score predicting mechanical complications was 0.92 (standard error [SE] = 0.034, p < 0.001, 95% [confidence interval [CI] = 0.85 to 0.98). Postoperatively, patients with a proportioned spinopelvic state according to the GAP score had a mechanical complication rate of 6% while those with a moderately or severely disproportioned spinopelvic state had rates of 47% and 95%, respectively.

CONCLUSIONS

The GAP score is a new pelvic-incidence-based proportional method of analyzing the sagittal plane that predicts mechanical complications in patients undergoing surgery for adult spinal deformity. Setting surgical goals according to the GAP score may decrease the prevalence of mechanical complications.

Effect of electromagnetic fields and antioxidants on the trace element content of rat teeth

The purpose of this study was to examine the possible effect of extremely low-frequency electromagnetic fields (ELF-EMFs), from a high-voltage source, on rat teeth in terms of changes in trace elements (TEs) and the effect of antioxidants (melatonin [MLT] and Ganoderma lucidum [GL]) in counteracting these effects. We used adult male Wistar albino rats with a mean weight of 250–300 g and divided the rats into eight groups. The groups were subjected to an ELF-EMF that was applied with a high-voltage line for 8 hours/day for 26 days (Groups I, II, and III) or 52 days (Groups V, VI, and VII). Groups IV and VIII were the 26- and 52-day control/sham groups, respectively. Groups II and VI were treated with GL, and Groups III and VII were treated with MLT. MLT and GL were administered daily based on the weight of the animals and appropriate standards. At the end of the study, the rats were euthanized, and their anterior teeth were extracted. The teeth were preserved in pure water before evaluating the major TEs. At the end of the study, TE concentrations (in mg/kg) were assessed in the control and test groups. Compared with Group V, statistically significant differences in the concentrations of zinc (Zn) and strontium (Sr) were found for Group VII (ELF-EMF + MLT) (P<0.05). Therefore, ELF-EMF exposure can change the content of certain TEs in teeth and, after administering MLT and GL, the values of some of the TEs return to normal.

Decision analysis to identify the ideal treatment for adult spinal deformity: What is the impact of complications on treatment outcomes?

Objective

The aim of this study was to analyze the impact of treatment complications on outcomes in adult spinal deformity (ASD) using a decision analysis (DA) model.

Methods

The study included 535 ASD patients (371 with non-surgical (NS) and 164 with surgical (S) treatment) from an international multicentre database of ASD patients. DA was structured in two main steps; 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference -utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and nonlife threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement, no change and deterioration. Death/complete paralysis was considered as a separate category.

Results

All 535 patients were analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment offered significantly higher chances of clinical improvement but also was significantly more prone to complications (31.7% vs. 11.1%, p < 0.001).

Conclusion

Surgical treatment of ASD is more likely to cause complications compared to NS treatment. On the other hand, surgery has been shown to provide a higher likelihood of improvement in HRQoL scores. So, the decision on the type of treatment in ASD needs to take both chances of improvement and burden associated with S or NS treatments and better be arrived by the active participation of patients and physicians equipped with the present information.

Level of evidence

Level II, Decision analysis.

Great migration: epigenetic reprogramming and germ cell-oocyte metamorphosis determine individual ovarian reserve

Emigration is defined as a synchronized movement of germ cells between the yolk sack and genital ridges. The miraculous migration of germ cells resembles the remigration of salmon traveling from one habitat to other. This migration of germ cells is indispensible for the development of new generations. It is not, however, clear why germ cells differentiate during migration but not at the place of origin. In order to escape harmful somatic signals which might disturb the proper establishment of germ cells forced germ cell migration may be necessary. Another reason may be to benefit from the opportunities of new habitats. Therefore, emigration may have powerful effects on the population dynamics of the immigrant germ cells. While some of these cells do reach their target, some others die or reach to wrong targets. Only germ cell precursors with genetically, and structurally powerful can reach their target. Likewise, epigenetic reprogramming in both migratory and post-migratory germ cells is essential for the establishment of totipotency. During this journey some germ cells may sacrifice themselves for the goodness of the others. The number and quality of germ cells reaching the genital ridge may vary depending on the problems encountered during migration. If the aim in germ cell specification is to provide an optimal ovarian reserve for the continuity of the generation, then this cascade of events cannot be only accomplished at the same level for every one but also are manifested by several outcomes. This is significant evidence supporting the possibility of unique individual ovarian reserve.

Disturbed endometrial NF-κB expression in women with recurrent implantation failure

OBJECTIVE

This study was planned to investigate whether expression levels of endometrial NF-κB1 and NFκB p65 changes in women with recurrent implantation failure (RIF).

PATIENTS AND METHODS

The study group consists of 30 RIF patients having at least three previous failed IVF cycles. The control group comprises of 30 patients having one or no previous failed attempt. Endometrial samples were obtained from all participants during hysteroscopy at the late follicular phase. Samples underwent ELISA analysis and immunohistochemical staining. The semi-quantitative H-Score method was used for analyzing the intensity of endometrial NF-κB p65 expression.

RESULTS

The concentrations of endometrial NF-κB1 were found to be significantly increased when compared to control subjects. Likewise, significantly increased NF-κB p65 immunoreactivity was detected in the cytoplasm of luminal and glandular epithelial cells. The H-Score of NF-κB p65 in RIF women was found to be significantly increased when compared to control group.

CONCLUSIONS

Increased levels of NF-κB1 and NF-κB p65 in the endometrium of RIF women can disturb physiological inflammation which is known to be positive modulator of endometrial receptivity.

Diagnostic accuracy of different display types in detection of recurrent caries under restorations by using CBCT

OBJECTIVES

To assess the in vitro diagnostic ability of CBCT images using seven different display types in the detection of recurrent caries.

METHODS

Our study comprised 128 extracted human premolar and molar teeth. 8 groups each containing 16 teeth were obtained as follows: (1) Black Class I (Occlusal) amalgam filling without caries; (2) Black Class I (Occlusal) composite filling without caries; (3) Black Class II (Proximal) amalgam filling without caries; (4) Black Class II (Proximal) composite filling without caries; (5) Black Class I (Occlusal) amalgam filling with caries; (6) Black Class I (Occlusal) composite filling with caries; (7) Black Class II (Proximal) amalgam filling with caries; and (8) Black Class II (Proximal) composite filling with caries. Teeth were imaged using 100 × 90 mm field of view at three different voxel sizes of a CBCT unit (Planmeca ProMax(®) 3D ProFace™; Planmeca, Helsinki, Finland). CBCT TIFF images were opened and viewed using custom-designed software for computers on different display types. Intra- and interobserver agreements were calculated. The highest area under the receiver operating characteristic curve (Az) values for each image type, observer, reading and restoration were compared using z-tests against Az = 0.5. The significance level was set at p = 0.05.

RESULTS

We found poor and moderate agreements. In general, Az values were found when software and medical diagnostic monitor were utilized. For Observer 2, Az values were statistically significantly higher when software was used on medical monitor [p = 0.036, p = 0.015 and p = 0.002, for normal-resolution mode (0.200 mm(3) voxel size), high-resolution mode (0.150 mm(3) voxel size) and low-resolution mode (0.400 mm(3) voxel size), respectively]. No statistically significant differences were found among other display types for all modes (p > 0.05). In general, no difference was found among 3 different voxel sizes (p > 0.05). In general, higher Az values were obtained for composite restorations than for amalgam restorations for all observers. For Observer 1, Az values for composite restorations were statistically significantly higher than those of amalgam restorations for MacBook and iPhone (Apple Inc., Cupertino, CA) assessments (p = 0.002 and p = 0.048, respectively).

CONCLUSIONS

Higher Az values were observed with medical monitors when used with dedicated software compared to other display types which performed similarly in the diagnosis of recurrent caries under restorations. In addition, observers performed better in detection of recurrent caries when assessing composite restorations than amalgams.

A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden?

BACKGROUND

Adult spinal deformity (ASD) is a major public health problem. There are pros and cons of the available treatment alternatives (surgical or non-surgical) and it had been difficult to identify the best treatment modality.

AIM

To construct a statistical DA model to identify the optimum overall treatment in ASD.

METHODS

From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical-NS, 164 surgical-S), constitute the population of this study. DA was structured in two main steps of: (1) baseline analysis (assessing the probabilities of outcomes, assessing the values of preference-utilities-, combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and (2) sensitivity analysis.

RESULTS

Four hundred and thirty-two patients (309 NS, 123 S) had baseline and 1 year follow-up ODI measurements. Overall, 104 (24.1 %) were found to be improved (a decrease in ODI > 8 points), 225 (52.1 %) unchanged (-8 > ODI > 8) and 65 deteriorated. Surgery presented with a higher chance of improvement (54.2 %) versus NS (9.7 %). The overall QALE ranged from 56 to 69 (of 100 years) and demonstrated better final QALE in the NS group (60 vs. 65, P = 0.0038), this group having started with higher QALE as well (56 vs. 65 years, P < 0.0001). There were improvements in overall QALE in both groups but this was significant only in the surgical group (S from 56 to 60 years, P < 0.0001; NS from 65 to 65 years, P = 0.27). In addition, in the subgroup of patients with significant baseline disability (ODI > 25) surgery appeared to yield marginally better final QALE (58 vs. 56 years, P = 0.1) despite very a similar baseline (54 vs. 54 years, P = 0.93).

DISCUSSION AND CONCLUSIONS

This study demonstrated that a single best treatment modality for ASD may not exist. Conservative treatment appears to yield higher (up to 6 %) QALE compared to surgery, most probably secondary to a higher baseline QALE. On the other hand, surgery provides a significantly higher increase in QALE. Especially in patients with significant disability at baseline, the final QALE tended higher in the S group (although not significant). Finally, chances of a relevant improvement at first year turned out to be significantly lower with NS treatment.

Evaluating Left-Censored Data Through Substitution, Parametric, Semi-parametric, and Nonparametric Methods: A Simulation Study

In this study, an attempt was made to determine the degrees of bias in particular sampling sizes and methods. The aim of the study was to determine deviations from the median, the mean, and the standard deviation (SD) in different sample sizes and at different censoring rates for log-normal, exponential, and Weibull distributions in the case of full and censored data sampling. Thus, the concept of "censoring" and censoring types was handled in the first place. Then substitution, parametric (MLE), nonparametric (KM), and semi-parametric (ROS) methods were introduced for the evaluation of left-censored observations. Within the scope of the present study, the data were produced uncensored based on the different parameters of each distribution. Then the datasets were left-censored at the ratios of 5, 25, 45, and 65 %. The censored data were estimated through substitution (LOD and LOD/[Formula: see text]), parametric (MLE), semi-parametric (ROS), and nonparametric (KM) methods. In addition, evaluation was made by increasing the sample size from 20 to 300 by tens. Performance comparison was made between the uncensored dataset and the censored dataset on the basis of deviations from the median, the mean, and the SD. The results of simulation studies show that LOD/[Formula: see text] and ROS methods give better results than other methods in deviation from the mean in different sample sizes and at different censoring rates, while ROS gives better results than other methods in deviation from the median in almost all sample sizes and at almost all censoring rates.

Multiple Regression Analysis of Factors Affecting Health-Related Quality of Life in Adult Spinal Deformity

BACKGROUND

Previous studies demonstrated the adult spinal deformity (ASD) population is heterogeneous. Multiple parameters may affect health-related quality of life (HRQL).

AIM

To understand the ranking of parameters affecting HRQL in ASD using multiple regression analysis.

PATIENTS AND METHODS

A total of 483 patients enrolled in a prospective multicenter ASD database from the population. Multiple regression analysis was performed for Scoliosis Research Society-22 (SRS-22) and Oswestry Disability Index (ODI) separately. Initially proposed primary variables of diagnosis (highest correlation), age, lordosis gap (L gap), and coronal curve location were regressed for each response variable (SRS-22 and ODI) univariately. Age and L gap could not be used together because of high colinearity. Coronal curve location was removed owing to an insignificant correlation. Two initial models were considered per response, consisting of diagnosis and age in one and diagnosis and L gap in the other. The rest of the potentially predictive variables were introduced in these models one at a time. Final models were evaluated using stepwise automatic model selection.

RESULTS

For ODI, body mass index (BMI), gender, and sagittal and spinopelvic parameters were in the basic model but only BMI and gender in the model with L gap and only gender in the model with age were highly predictive. For SRS-22, a large number of parameters were in the basic model but BMI, gender, coronal balance, lordosis curve, and sagittal vertical axis in the model with L gap and only gender in the model with age were highly predictive. Coronal curve location was not significantly predictive in any model.

CONCLUSIONS

These findings reiterate the importance of patient diagnosis, age, and/or the amount of lordosis as the most important factors affecting HRQL in ASD. Gender, BMI, and sagittal vertical axis appear to be consistently important co-variables whereas coronal balance and magnitude of L curves may also be important in SRS-22. These may aid in better understanding the problem in ASD and may be useful in future classifications.

Additional Diagnostic Value of Inversion Recovery Single-Shot Fast-Spin Echo Sequence in Differentiation Between Hepatic Hemangiomas and Cysts

OBJECTIVE

The aim of this study was to evaluate the additional diagnostic value of "inversion recovery" single-shot fast-spin echo (IR-SSFSE) sequence using the inversion time at the null point for hepatic hemangiomas as a supplement to standard T2-weighted (T2W) magnetic resonance imaging for the distinction of hemangiomas and cysts.

METHODS

A total of 228 lesions in 56 patients were evaluated in this retrospective study. In addition to routine hepatic magnetic resonance imaging, IR-SSFSE imaging using inversion time value of 600 milliseconds (null point for hepatic hemangiomas) was obtained. Two radiologists independently reviewed T2W images at first and T2W images plus IR-SSFSE sequence 4 weeks afterward and used a 5-point scale to indicate the possibility of detected hyperintense lesion is a cyst or a hemangioma. A receiver operating characteristic analysis and κ statistics were used to evaluate the diagnostic additive value of IR-SSFSE sequence for differentiation of hepatic hemangiomas and cysts, and to determine interobserver agreement, respectively.

RESULTS

Among 228 lesions, diameters of which ranges from 2 to 125 mm (mean, 13.84 ± 16.24 mm), 56.14% of them (n = 128) were hemangiomas, and 43.86% of them were cysts (n = 100). In the receiver operating characteristic analysis for the differentiation of hepatic hemangiomas from cysts, the calculated area under the curve (AUC) for standard T2W images alone was 0.889 (95% confidence interval [CI], 0.825-0.953) for the first observer and 0.913 (95% CI, 0.861-0.965) for the second observer. When IR-SSFSE sequence was combined to T2W images, AUC was calculated as 0.958 (95% CI, 0.920-0.996) for the first observer and 0.980 (95% CI, 0.956-1.0) for the second observer. The AUC values obtained from standard T2W images and standard T2W plus IR-SSFSE images were significantly different for both observers (P < 0.01). Both observers demonstrate better performance in differentiating hemangiomas and cysts with a combination of IR-SSFSE sequence and T2W imaging than with T2W imaging alone. Adding IR-SSFSE sequence as a supplement to standard T2W images improved the sensitivity and the κ values.

CONCLUSIONS

Inversion recovery single-shot fast-spin echo sequence using the inversion time to null signal from the hepatic hemangiomas as a supplement to standard T2W images is useful for distinguishing hemangiomas from hepatic cysts without the need for intravenous gadolinium chelate administration.