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Background: The increase in the intensity of livestock industries, by improving the technology of animal products manufacturing, largely depends on the correct organisation of herd reproduction and the intensity of using the biological capabilities of the animal organism. Various diseases, including such common diseases as mastitis, complicate the successful reproduction and growth of enterprise productivity. The widespread use of antibiotic-containing drugs for the treatment of mastitis creates a number of inevitable consequences for the body. The relevance of the study is due to the fact that the residual content of antibiotics in the collected milk after the course of treatment poses a serious danger to human health and reduces the quality of dairy products obtained from such milk. Aim: In this regard, the authors set the task of developing a new, antibiotic-free method of treating bovine mastitis. This paper is devoted to the problem of improving methods of treating the subclinical mastitis in dairy cattle by alternative methods during the interlactation period. Methods: The leading method for the study of this problem is an experimental method that allows to develop and test a veterinary homeopathic substance for the treatment of subclinical mastitis in cows during the interlactation period. Results: The paper presents materials on the typification of microflora in the milk of cows with subclinical mastitis and the effectiveness of a veterinary homeopathic substance developed by the authors. The use of the veterinary homeopathic substance provided a high therapeutic effect, did not cause side effects and complications in cows. Conclusion: The resulting veterinary substance was tested and introduced into the "Izhevskiy" natural complex of Akmola region as a new alternative method of treating subclinical mastitis in cows. Based on this substance, a drug for the treatment of mastitis will be developed and proposed for production. [Open Vet J 2023; 13(2.000): 193-201]

Mustafa Cakirca,1 Cumali Karatoprak,1 Mehmet Zorlu,1 Muharrem Kiskac,1 Mustafa Kanat,2 Mehmet Ali Cikrikcioglu,1 Pinar Soysal,3 Mehmet Hursitoglu,4 Ahmet Adil Camli,1 Reha Erkoc,1 Muhammad Abdul-Ghani5 1Internal Medicine Clinic, Faculty of Medicine, Bezmialem Vakif University, 2Department of Internal Medicine, Medical Faculty, Istanbul Medipol University, 3Department of Geriatric Medicine, Medical Faculty, Dokuz Eylül University, 4Department of Internal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey; 5Division of Medicine – Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA Aims: A close association has been demonstrated between increased cardiovascular risk and high asymmetric dimethylarginine (ADMA) levels in type 2 diabetes mellitus (DM) patients. We planned to measure serum ADMA levels in type 2 DM patients using vildagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor. Materials and methods: A total of 68 type 2 DM patients who were on metformin were enrolled in the study. Based on the glycemic levels of patients, vildagliptin was added on to treatment in 33 patients. Patients were followed for 6 months. Serum ADMA, C-reactive protein, and fibrinogen levels were compared in groups of patients using metformin or metformin + vildagliptin, after 6 months. Results: Serum ADMA levels were found to be significantly lower in the group using vildagliptin compared to the group using metformin + vildagliptin (P

Background: The increase in the intensity of livestock industries, by improving the technology of animal product manufacturing, largely depends on the correct organization of herd reproduction and the intensity of using the biological capabilities of the animal organism. Various diseases, including such common diseases as mastitis, complicate the successful reproduction and growth of enterprise productivity. The widespread use of antibiotic-containing drugs for the treatment of mastitis creates a number of inevitable consequences for the body. The relevance of the study is due to the fact that the residual content of antibiotics in the collected milk after the course of treatment poses a serious danger to human health and reduces the quality of dairy products obtained from such milk. Aim: The authors set the task of developing a new, antibiotic-free method of treating bovine mastitis. This paper is devoted to the problem of improving methods of treating the subclinical mastitis in dairy cattle by alternative methods during the interlactation period. Methods: The leading method for the study of this problem is an experimental method that allows to develop and test a veterinary homeopathic substance for the treatment of subclinical mastitis in cows during the interlactation period. Results: This paper presents materials on the typification of microflora in the milk of cows with subclinical mastitis and the effectiveness of a veterinary homeopathic substance developed by the authors. The use of the veterinary homeopathic substance provided a high therapeutic effect, and did not cause side effects and complications in cows. Conclusion: The resulting veterinary substance was tested and introduced into the "Izhevskiy" natural complex of Akmola region as a new alternative method of treating subclinical mastitis in cows. Based on this substance, a drug for the treatment of mastitis will be developed and proposed for production. [ABSTRACT FROM AUTHOR]

The dynamics of the consequences of the Proton-M carrier rocket crash on the soil and vegetation cover in the area where its parts fell were studied in 2007–2014. Analytical methods such as liquid chromatography with electrochemical and spectrophotometric detection were used. In 2007, four soil detoxifications were performed. A second study in 2009 showed a sharp increase in the area of contamination of plants by UDMH (unsymmetrical dimethylhydrazine) and NDMA (N-Nitrosodimethylamine). In 2010, the situation shifted in the opposite direction. Toxicants in plants were absent for three years (2010–2012) but reappeared in 2013 and 2014. The accidental crash of the Proton-M carrier rocket led to the destruction of the soil and vegetation cover, ignition of vegetation, and soil contamination. In the area where the rocket parts fell, the UDMH content in the soil was 1.4–5,200 times higher than the threshold limit value. The fall of the carrier rocket increased the area of soil contamination with UDMH to 3,600 m2, with NDMA to 917 m2, and with nitrate ions to 8,314 m2 . The reappearance of heptyl and nitrous compounds in plants and soil was detected four years after repeated detoxification of the soil. [ABSTRACT FROM AUTHOR]

Plastic mulch provides a range of benefits including helping modulate soil temperature, reduce soil erosion, evaporation, fertilizer leaching and weed problems and increasing the quality and yields of the product. But when the crops are harvested, plastic mulch needs to be removed from the ground for disposal. Otherwise, these wastes are mixed with the soil and have a negative impact on yields by reducing the access of nutrients and moisture in the soil. The purpose of the current study is, therefore, to propose a roller for plastic mulch retriever which is applicable when the crops are harvested, and the plastic mulch needs to be removed from the ground for disposal. The winding mechanism of the plastic mulch retriever performs the main function and must have the high-quality performance of the winding operation in the removal technology. Research based on requirements of tensile strength test method and changes of strength characteristics of plastic mulch from various factors under natural conditions. The coefficient of compaction of the used plastic mulch (Krel), was the ratio of the diameter of the standard plastic mulch which was wound in the factory to the diameter of the used plastic mulch during the winding. [ABSTRACT FROM AUTHOR]

The aim of the article is to examine one of the neglected areas in the spatiality of religion, the spatial distribution of religious institutions and the changes that have taken place in this relation over time in the case of Debrecen, a specific city in Hungary, which has hosted several religions both in the past and present. The main findings are discussed in five subsections concentrating on five consecutive periods. During the period under study, the number of institutions run by churches increased steadily until the Second World War. This process was interrupted after the Second World War, and partly as a consequence of the world war (with the deportation of Jews to concentration camps) and partly due to the anti-religious nature of the socialist regime, there was a significant decline followed by a resumption of expansion after 1990. Regarding the location of the institutions within the city and its changes, there were significant differences between the various types of institutions (e.g., churches, administrative centres, kindergartens, elementary and grammar schools). Research primarily relied on document analysis and fieldwork.

Exploring the main cooperation schemes between the member-states of the Eurasian Economic Union (EAEU) within a broader context of the geopolitical processes in the Post-Soviet space, the article intends to discuss the feasibility of integration among Former Soviet countries. The article intends to present the formally announced integration initiatives in the Post-Soviet space (such as the CIS, EurAsEC and EAEU) as part of a de-facto ongoing process of disintegration that started right after the collapse of the Soviet Union. Within this scheme, Russia consistently acts as a generator of a centripetal integration force by proposing different institutional frameworks for integration. However, it is not sufficiently powerful to overcome the centrifugal inertia acquired by the rest of the Post-Soviet states. The article concludes that, in spite of its formal integration purposes, the EAEU is indeed another stage of the ongoing disintegration process in the Post-Soviet space.

The rapid and significant expansion of urban areas is observed worldwide; however, considerable differences are detected within the characteristics of the process. The rural–urban fringe is changing most dynamically from the aspect of land use and this tends to be relevant in the case of post-socialist cities in Central Europe even with a stagnating or decreasing population. Debrecen (Hungary) and its hinterland adequately represent the migration trends of Hungarian cities and the great administrative area provided wide intra-urban suburbanization processes. The current study put the emphasis on the analysis of the spatial pattern of built-up areas and the distribution of residents. In order to discover the processes of the post-socialist transition period, detailed point layers were created to illustrate every built-up parcel in the rural–urban fringe of Debrecen (for the years 1980, 2000, and 2020). The most important characteristics were discovered with the help of GIS methods—Kernel-density, grid pattern analysis of the object density, and analysis of land cover/land use changes using Corine Land Cover Change (CLCC) databases. The dynamic and extended expansion of built-up areas was seen until 2000, in which the outskirts (including hobby gardens) densified spectacularly. The urban sprawl has been less intensive since the millennium and the increase in built-up areas has become more concentrated. As a consequence of the transition period, extended territories—primarily the least dense parts of the rural–urban fringe—are faced with the disappearance of buildings due to agricultural cultivation reasons.

In the modern context, the problems of science and art sometimes cannot be timely addressed and evaluated due to their comprehensive and rapid development. Every now and then, one should form new thoughts and opinions in order to determine the main goal and direction of contemporary art, avoiding theoretical stereotyped studies. Taking into account that modern art researchers have a great opportunity to conduct analysis in a special and simple way, we will carry out an expedient psychoanalytic study on cinema characters.

The study describes the experimental complex of the station located in the Tien Shan mountains at an elevation of 3340 m above sea level. The complex consists of detectors of different types scattered across the station area, such as scintillation particles detectors, Cherenkov detectors, radio emission detectors for the measurement of the electron component of extensive air showers (EAS) created by the (1–1000) PeV cosmic ray particles, an ionization calorimeter and neutron detectors for the study of the nuclear-active component of EAS cores, and the underground particle detectors for the detection of cosmic ray muons. The data acquisition system allows the simultaneous recording of parameters from various stand-alone detectors registering an EAS, and storage of the acquired data in the database. As an illustration of research capability, the results of the EAS study are presented here which were obtained during the last few years at the different experimental set-ups constituting the Tien Shan complex.

To characterize the defects in β-cell function in subjects with impaired fasting glucose (IFG) and compare the results to impaired glucose tolerance (IGT) and normal glucose tolerance (NGT) subjects, β-cell glucose sensitivity and rate sensitivity during the oral glucose tolerance test were measured with the model by Mari in 172 Mexican Americans. A subgroup (n=70) received a 2-h hyperglycemic clamp (+125 mg/dL), and first- and second-phase insulin secretion were quantitated. Compared with NGT, subjects with IFG and IGT manifested a decrease in β-cell glucose sensitivity; IFG subjects, but not IGT subjects, had decreased β-cell rate sensitivity. In IFG subjects, the defect in β-cell glucose sensitivity was time dependent, began to improve after 60 min, and was comparable to NGT after 90 min. The incremental area under the plasma C-peptide concentration curve during the first 12 min of the hyperglycemic clamp (ΔC-pep[AUC]0-12) was inversely related with the increase in FPG concentration (r=-36, r=0.001), whereas ΔC-pep[AUC]15-120 positively correlated with FPG concentration (r=0.29, r<0.05). When adjusted for the prevailing level of insulin resistance, first-phase insulin secretion was markedly decreased in both IFG and IGT, whereas second-phase insulin secretion was decreased only in IGT. These results demonstrate distinct defects in β-cell function in IFG and IGT. [ABSTRACT FROM AUTHOR]

Objective: The study objective was to assess the relationship between β-cell function and HbA(1c).Research Design and Methods: A total of 522 Mexican American subjects participated in this study. Each subject received a 75-g oral glucose tolerance test (OGTT) after a 10- to 12-h overnight fast. Insulin sensitivity was assessed with the Matsuda index. Insulin secretory rate was quantitated from deconvolution of the plasma C-peptide concentration. β-Cell function was assessed with the insulin secretion/insulin resistance (IS/IR) (disposition) index and was related to the level of HbA(1c).Results: At HbA(1c) levels <5.5%, both the Matsuda index of insulin sensitivity and IS/IR index were constant. However, as the HbA(1c) increased >5.5%, there was a precipitous decrease in both the Matsuda index and the IS/IR index. Subjects with HbA(1c) = 6.0-6.4% had a 44 and 74% decrease in the Matsuda index and the IS/IR index, respectively, compared with subjects with HbA(1c) <5.5% (P < 0.01 for both indices). Subjects with normal glucose tolerance and HbA(1c) <5.7% had β-cell function comparable to that of subjects with normal glucose tolerance with HbA(1c) = 5.7-6.4%. However, subjects with impaired fasting glucose or impaired glucose tolerance had a marked decrease in β-cell function independent of their HbA(1c) level.Conclusions: The results of the current study demonstrate that in Mexican Americans, as HbA(1c) increases >6.0%, both insulin sensitivity and β-cell function decrease markedly. Performing an OGTT is pivotal for accurate identification of subjects with impaired β-cell function. [ABSTRACT FROM AUTHOR]

Objective: Statin therapy is well known to reduce inflammatory markers such as tumor necrosis factor-a (TNF-a), interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP). However, whether this relationship is maintained in the setting of targeting very low levels of LDL (<70 mg dl) in patients with type 2 diabetes has not been clearly established. Materials and Methods: We measured hsCRP, IL-6, and TNF-a in 43 subject enrolled into the multicenter, open-label, crossover prospective study evaluating the effects of lipid-lowering treatment on steroid synthesis in patients with type 2 diabetes (MODEST study). Subjects with diabetes and coronary artery disease were treated with 80 mg of atorvastatin for 12 weeks. The effect of treatment on pro-inflammatory markers was assessed after 12 weeks. Results: High-dose atorvastatin treatment significantly reduced the plasma levels of IL-6 and hsCRP (p<0.05, p<0.001, respectively), but not of TNF-a (p=0.051). Conclusion: Atorvastatin treatment targeting very low LDL-cholesterol level reduced the levels of several important inflammatory markers in patients with type 2 diabetes and coronary heart disease. (ClinicalTrials.gov number, NCT00433823). [ABSTRACT FROM AUTHOR]

Objective: In this study it is aimed to investigate the oxygen-dependent bactericidal activity of leukocytes in patients with diabetes mellitus type 2. Materials and Methods: All the data obtained from 28 patients with diabetes mellitus were compared with 31 demographically matched control individuals. Leukocytes of patients with diabetes mellitus and healthy control group were separated from blood samples for determination of oxygen-dependent antimicrobial activity enzymes including superoxide dismutase (SOD), glutathione reductase (GSH-R), gluthatione peroxidase (GSH-Px) and catalase. As lipid peroxidation products, thiobarbituric acid reactive substances (TBARS) were measured. Results: SOD, GSH-R, and catalase activities of patients with type 2 diabetes were not significantly different from control group (p>0.05). GSH-Px levels of patients with diabetes mellitus were significantly lower than control group (0.012±0.08 U/mg.pr versus 0.057±0.046 U/mg.pr, p<0.05). Measurements of TBARS were not different between patients with diabetes mellitus and control group (5.49±1.31 mmol/l versus 5.53±1.45 mmol/l, p=0.905). Conclusions: It is difficult to suggest that in patients with diabetes mellitus the tendency to some known infections is due to alteration in oxygen-dependent bactericidal activity of leukocytes. [ABSTRACT FROM AUTHOR]

The essential oils from rosemary ( Rosmarinus officinalis L.) and laurel ( Laurus nobilis L.) obtained from Mersin Province in Turkey, were tested for their fumigant toxicity against all life stages of confused flour beetle ( Tribolium confusum du Val.). GC-MS analysis showed that 1,8-cineole was found to be the major component of both rosemary and laurel essential oils. Vapors of rosemary and laurel essential oils were toxic to all life stages of T. confusum. Only 65% mortality of the eggs was achieved when exposed to a dose of 172.6 mg l −1 air of rosemary essential oil at the longest exposure period (144 h); at the same dose, the pupae were the most resistant stage, with LT90 (lethal time) value of 120.2 h. The adults were the most resistant stage to laurel essential oil, with LT90 value of 77.2 h. On the basis of LT90 values, tolerance of the life stages of T. confusum to rosemary and laurel essential oils was, in descending order: pupa < larva < adult, and larva < adult < egg < pupa, respectively. Based on the concentration × time (Ct) products (g h l −1), rosemary essential oil was more toxic than laurel to the adults and larvae of T. confusum. However, laurel essential oil was more toxic than rosemary to the eggs and pupae. Since these essential oils need such high Ct products to obtain complete mortality of T. confusum compared with the most commonly used commercial fumigants, it would be impossible to use them on their own as a commercial fumigant against stored-product insects. [ABSTRACT FROM AUTHOR]

Research results of delayed fluorescence decay kinetics in solid chrysene films deposited on quartz substrates in vacuum are presented. It is found that at the temperatures which are close to the temperature of liquid nitrogen, phosphorescence and annihilation delayed fluorescence decay kinetics are described by non-exponential function. The data obtained were discussed from the point of formal kinetics and percolation T-T annihilation models. [ABSTRACT FROM AUTHOR]

This awareness study aimed to determine the ultrasound (US) examination rates in relation to US-confirmed metabolic dysfunction-associated fatty liver disease (MAFLD) diagnosis in internal medicine outpatients with type 2 diabetes (T2D) across Türkiye. A total of 6283 T2D patients were included in this multicenter retrospective cohort study conducted at 17 internal medicine clinics across Türkiye. The presence and indications for US performed within the last 3 years were recorded along with US-confirmed MAFLD rates, laboratory findings on the day of US, and referral rates. Fibrosis-4 (FIB-4) index was calculated to estimate the risk of advanced liver fibrosis (FIB-4 index ≥ 1.3). Overall, 1731 (27.6%) of 6283 patients had US examination, which revealed MAFLD diagnosis in 69.9% of cases. In addition, 24.4% of patients with US-confirmed MAFLD were at risk of advanced fibrosis (FIB-4 index ≥ 1.3), and the referral rate was 15.5%. In conclusion, our findings emphasize an insufficient MAFLD awareness among clinicians and the likelihood of most of T2D patients to be at risk of living with an unknown status regarding their MAFLD and advanced fibrosis risk.

Objective: Patient-centredness (PC) is central to the health care of older adults with multimorbidity, but knowledge about the psychometric quality of instruments measuring it in this group is scarce. Based on an integrative model of PC, we aimed to identify assessment instruments of PC for this particular group and evaluate their psychometric properties., Methods: We systematically searched six electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science and PSYNDEX), initially covering research published up to 2018 and updated later to include work up to July 2022. In evaluating the psychometric properties of identified instruments, we followed the COSMIN methodology., Results: We identified 12 studies reporting on 10 instruments measuring PC in the health care of older adults with multimorbidity. For these instruments, structural validity and internal consistency were the psychometric properties reported most often. Based on the COSMIN criteria, eight instruments received favourable ratings for internal consistency with respect to methodological quality ('very good'), measurement property ('sufficient') and overall quality of evidence ('moderate'). Ratings of structural validity varied more largely, with three to seven instruments showing at least adequate methodological quality, sufficient structural validity or moderate quality of evidence., Conclusions: Similar to comparable previous reviews, evidence on the psychometric properties of instruments assessing PC in the health care of older adults with multimorbidity was rather limited. Informed by comprehensive models of PC, further research should aim at developing measures of PC that stand out on a broader range of psychometric properties., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

A 7-year-old nulliparous Chinchilla queen was admitted to a veterinary clinic for routine ovariohysterectomy. Examination of the uterus, greater omentum and varicose ovarian veins revealed multiple thin-walled cysts filled with a transparent fluid over the serosal surfaces of these organs. Histologically, the cysts were of variable size, filled with a small amount of mucinous fluid, and had thin walls that contained hypocellular collagen and a few small calibre vessels. The inner and outer epithelium of the cyst walls and the cells that lined the uterine serosa were immunopositive for cytokeratin and vimentin, suggesting a mesothelial origin. Alpha-smooth muscle actin immunolabelling was patchy or continuous in smooth muscle in the wall of many of the cysts., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Patient-centeredness (PC) aims to adapt health care to the individual needs and preferences of patients. An existing integrative model of PC comprises several dimensions of PC which have not yet been investigated from the patients' perspective. Older patients with multimorbidity represent a target group for patient-centered care, as their care needs are particularly complex and should be addressed individually. We aimed to assess the perspective that older patients with multimorbidity have of patient-centered care and to examine the transferability of the integrative model of PC to this specific population., Method: We performed 4 guided focus group interviews with a total of 20 older individuals with multimorbidity. The focus group interviews were audio-recorded and transcribed verbatim. Patients' statements were content-analyzed applying an a priori designed system of categories that included the dimensions of PC from the integrative model and the additional category 'prognosis and life expectancy', which had emerged from an initial literature search on aspects of PC specific to the multimorbid elderly., Results: The new category 'prognosis and life expectancy' was confirmed and expanded to 'individual care needs related to aging and chronic disesase'. All dimensions of our integrative PC model were confirmed for older patients with multimorbidity. Among these, we found that eight dimensions (individual care needs related to aging and chronic disease, biopsychosocial perspective, clinician-patient communication, essential characteristics of the clinician, clinician-patient-relationship, involvement of family and friends, coordination and continuity of care, access to care) were complemented by aspects specific to this target population., Conclusions: The integrative PC model is applicable to the population of older patients with multimorbidity. For a population-specific adaptation, it might be complemented by the dimension 'individual care needs in aging and chronic disease', in conjunction with age-specific aspects within existing dimensions. Together with corresponding results from a Delphi survey, our adapted PC model will serve as the basis for a subsequent systematic review of instruments measuring PC in older patients with multimorbidity., Trial Registration: PROSPERO ( https://www.crd.york.ac.uk/prospero; CRD42018084057; 2018/02/01), German Clinical Trials Register ( www.drks.de ; DRKS00013309; 2018/01/23)., (© 2021. The Author(s).)

Background and Objectives: Older adults suffering from multimorbidity represent a priority target group for patient-centeredness (PC). We aimed to investigate the transferability of an existing integrated model of PC comprising 15 dimensions on the care of older adults with multimorbidity from an expert perspective., Research Design and Methods: A total of 242 experts were invited to participate in a 2-round online Delphi study. In round 1, they were asked to (a) individually rate relevance and clarity of the dimensions, (b) add missing dimensions, and (c) prioritize the dimensions. In round 2, experts received results of round 1 and were asked to rerate their ratings., Results: Forty-eight experts participated in round 1 and 39 in round 2. Ten dimensions were rated as sufficiently relevant and clear, including one new dimension ("prognosis and life expectancy, burden of treatment"). Four dimensions were rated as relevant but insufficiently clear. One dimension failed to reach our validation threshold on both criteria. The 5 dimensions rated as most important were: "patient as a unique person," "clinician-patient communication," "patient involvement in care," "physical, cognitive, and emotional support," and "involvement of family and friends.", Discussion and Implications: The experts' ratings were higher regarding relevance than regarding clarity, which emphasizes the still existing conceptual uncertainty of PC. Our results give further directions regarding the operationalization of PC in older adults with multimorbidity, which is essential for its implementation in routine care. Further refined using focus groups with geriatric patients, our adapted model serves as a basis for a systematic review of assessment instruments., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This study aims to determine the validity and reliability of the Turkish translation of brief diabetic foot ulceration risk checklist (BDURC)., Methods: This methodological study was conducted at the diabetes clinic of a state hospital in Istanbul, Turkey. The data were collected with the BDURC developed by Zhou et al. in 2018. A study was conducted with 430 patients with Type 2 diabetes. The scale was retested after 4 weeks by 60 participants. Language equivalence of the scale was provided. Experts' opinions were taken about the content validity of the scale. Reliability of the scale was determined with the test-retest reliability, item-total correlation, and internal consistency analysis., Results: Confirmatory factor analysis revealed a two-factor structure with good model suitability. Cronbach's alpha coefficient for the scale and its subscales was 0.79. Test-retest scores showed no statistically significant difference between the items (p>0.05). The reliability index was higher than 0.80., Conclusion: The BDURC-TR is a valid and reliable tool that can be used in clinics to identify the risk factors for diabetic foot ulcers in patients with Type 2 diabetes in Turkey., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (Copyright: © 2021 by Istanbul Northern Anatolian Association of Public Hospitals.)

Introduction: Elderly, multimorbid patients are a primary target group for patient-centred care, and fostering patient-centredness (PC) in this group has been associated with different healthcare aims such as safety and quality of healthcare. However, evidence on effects of patient-centred interventions is still limited and mixed. In part, the lack of consistent evidence has its roots in a conceptual uncertainty of the term 'PC', which also hampers the development of assessment tools for PC. Consequently, reviews on assessment instruments of PC reveal problems regarding the quality of identified assessment instruments and regarding their comparability. Some of these reviews focus on the elderly. However, while the concept of multimorbidity is partly inherent, this focus is not explicit in any of the reviews.The aim of this systematic review is to identify assessment instruments of PC in the multimorbid elderly, using a subgroup-specific definition of PC ('subgroup-specific integrative model of PC') as the conceptual underpinning, and to provide a critical quality appraisal of their psychometric properties., Methods and Analysis: A comprehensive systematic literature search for assessment tools on PC will be conducted in the MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science and PSYNDEX electronic databases. The search strategy will be informed by the subgroup-specific integrative model of PC. The electronic literature search will be complemented by a hand-search combining citation tracking, search in project databases, and contacting authors from relevant studies/reviews. The literature search (systematic and hand-search) will cover the period from November, 2018 to December 2019.The retrieval of relevant studies will be conducted via title screening, abstract screening, and full-text eligibility assessment applying defined inclusion criteria. Full texts will be independently assessed by two team members. Data from the included articles will be extracted using a standardised extraction form and evaluated based on the COSMIN methodology for systematic reviews of patient-reported outcome measures, which focuses on the methodological quality of included studies as well as on the measurement properties of the assessment instruments. Data extraction and quality assessment will be conducted by two independent reviewers., Ethics and Dissemination: The study has received approval from the Ethics Committee of the University of Freiburg (reference number 587/17). The results of the project will be disseminated via scientific oral presentations at national and international conferences and will be published in scientific journals., Trial Registration Numbers: CRD42018084057; DRKS00013309., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Adult attention-deficit/hyperactivity disorder (ADHD) is a serious mental disorder associated with impaired neurocognitive performance related to working memory function. Recent clinical trials have suggested that mindfulness is a promising intervention in adults with ADHD. We performed a randomised controlled clinical trial to investigate working memory (WM) with an n-back task in adults with ADHD during fMRI before and after an 8-week mindfulness intervention (MAP) compared with psychoeducation (PE). ADHD symptoms were assessed using the self- and observer-rated Conners Adult ADHD Rating Scales (CAARS). The complete pre-post data of 21 MAP and 19 PE participants were analysed. We found no group difference in ADHD symptoms or task performance at the pre-measurement, but there was a significant decrease in ADHD symptoms and significant improvement in task performance in both groups at the post-measurement. Furthermore, we found a significant increase in task-related activation in the right parietal lobe, with no difference between groups. Exploratory two-sample paired t-tests revealed significant increased brain activation after MAP in the bilateral inferior parietal lobule, right posterior insula and right precuneus. A decrease in self-rated 'Inattention/Memory Problems' after MAP compared to baseline was associated with stronger activation in parts of the left putamen, globus pallidus and thalamus., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Attention-deficit/hyperactivity disorder (ADHD) in adulthood is a serious and frequent psychiatric disorder with the core symptoms inattention, impulsivity, and hyperactivity. The principal aim of this study was to investigate associations between brain morphology, i.e., cortical thickness and volumes of subcortical gray matter, and individual symptom severity in adult ADHD., Methods: Surface-based brain morphometry was performed in 35 women and 29 men with ADHD using FreeSurfer. Linear regressions were calculated between cortical thickness and the volumes of subcortical gray matter and the inattention, hyperactivity, and impulsivity subscales of the Conners Adult ADHD Rating Scales (CAARS). Two separate analyses were performed. For the first analysis, age was included as additional regressor. For the second analysis, both age and severity of depression were included as additional regressors. Study participants were recruited between June 2012 and January 2014., Results: Linear regression identified an area in the left occipital cortex of men, covering parts of the middle occipital sulcus and gyrus, in which the score on the CAARS inattention subscale predicted increased mean cortical thickness [ F (1,27) = 26.27, p  < 0.001, adjusted R 2  = 0.4744]. No significant associations were found between cortical thickness and the scores on CAARS subscales in women. No significant associations were found between the volumes of subcortical gray matter and the scores on CAARS subscales, neither in men nor in women. These results remained stable when severity of depression was included as additional regressor, together with age., Conclusion: Increased cortical thickness in the left occipital cortex may represent a mechanism to compensate for dysfunctional attentional networks in male adult ADHD patients.

Reduced attentional preference for faces and symptoms of social anxiety are common in autism spectrum disorders (ASDs). The neuropeptide oxytocin triggers anxiolytic functions and enhances eye gaze, facial emotion recognition and neural correlates of face processing in ASD. Here we investigated whether a single dose of oxytocin increases attention to faces in ASD. As a secondary question, we explored the influence of social anxiety on these effects. We tested for oxytocin's effects on attention to neutral faces as compared to houses in a sample of 29 autistic individuals and 30 control participants using a dot-probe paradigm with two different presentation times (100 or 500 ms). A single dose of 24 IU oxytocin was administered in a randomized, double-blind placebo-controlled, cross-over design. Under placebo, ASD individuals paid less attention to faces presented for 500 ms than did controls. Oxytocin administration increased the allocation of attention toward faces in ASD to a level observed in controls. Secondary analyses revealed that these oxytocin effects primarily occurred in ASD individuals with high levels of social anxiety who were characterized by attentional avoidance of faces under placebo. Our results confirm a positive influence of intranasal oxytocin on social attention processes in ASD. Further, they suggest that oxytocin may in particular restore the attentional preference for facial information in ASD individuals with high social anxiety. We conclude that oxytocin's anxiolytic properties may partially account for its positive effects on socio-cognitive functioning in ASD, such as enhanced eye gaze and facial emotion recognition.

The amygdala reveals enhanced reactivity to fearful eye whites, even when they are backwardly masked by a neutral face and therefore processed with limited visual awareness. In our fMRI study, we investigated whether this effect is indeed associated with fear detection within the eyes of the neutral face mask, or more generally, with reactivity to any salient increase in eye white area. In addition, we examined whether a single dose of intranasal oxytocin would modulate amygdala responses to masked fearful eye whites via a double-blind, placebo-controlled pharmacological protocol. We found that increased amygdala responses to salient changes within a face's eye region occurred specifically for masked fearful eyes but not for similar increases in white area as induced by nonsocial control stimuli. Administration of oxytocin attenuated amygdala responses to masked fearful eye whites. Our results suggest that the amygdala is particularly tuned to potential threat signals from the eye region. The dampening effects of oxytocin on early amygdala reactivity may reflect reduced vigilance for facial threat cues at a preconscious level. Future studies may investigate whether this early modulation accounts for the beneficial effects of oxytocin on social cognition in anxiety-related disorders, as suggested by previous studies.

Progression of normal glucose tolerance (NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance (IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diabetes mellitus (type 2 DM) and even normoglycemic IGT patients manifest these defects. Beta cell dysfunction and insulin resistance also contribute to the progression of IGT to type 2 DM. Improving insulin sensitivity and/or preserving functions of beta-cells can be a rational way to normalize the GT and to control transition of IGT to type 2 DM. Loosing weight, for example, improves whole body insulin sensitivity and preserves beta-cell function and its inhibitory effect on progression of IGT to type 2 DM had been proven. But interventions aiming weight loss usually not applicable in real life. Pharmacotherapy is another option to gain better insulin sensitivity and to maintain beta-cell function. In this review, two potential treatment options (lifestyle modification and pharmacologic agents) that limits the IGT-type 2 DM conversion in prediabetic subjects are discussed.

The neuropeptide oxytocin has recently been shown to modulate covert attention shifts to emotional face cues and to improve discrimination of masked facial emotions. These results suggest that oxytocin modulates facial emotion processing at early perceptual stages prior to full evaluation of the emotional expression. Here, we used functional magnetic resonance imaging to examine whether oxytocin alters neural responses to backwardly masked angry and happy faces while controlling for attention to the eye vs the mouth region. Intranasal oxytocin administration reduced amygdala reactivity to masked emotions when attending to salient facial features, ie, the eyes of angry faces and the mouth of happy faces. In addition, oxytocin decreased neural responses within the fusiform gyrus and brain stem areas, as well as functional coupling between the amygdala and the fusiform gyrus specifically for threat cues from the eyes. Effects of oxytocin on brain activity were not attributable to differences in behavioral performance, as oxytocin had no impact on mere emotion detection. Our results suggest that oxytocin attenuates neural correlates of early arousal by threat signals from the eye region. As reduced threat sensitivity may increase the likelihood of engaging in social interactions, our findings may have important implications for clinical states of social anxiety.

The present paper summarizes functional imaging studies investigating the effects of intranasal oxytocin (OT) on brain responses to social stimuli. We aim to integrate previous research, point to unresolved issues and highlight perspectives for future studies. The studies so far have focused on identifying neural circuits underlying social information processing which are particularly sensitive to modulations by exogenous OT. Most consistently, stimulus-related responses of the amygdala and associated areas within the prefrontal and temporal cortices have been found to be modulated by OT administration. However, there are a number of unresolved issues related to the possible role of sex differences and hormonal status, genetic variability, and individual differences in socio-cognitive functioning. Future studies focusing on these open questions are expected to contribute to a more nuanced understanding of the role of the central OT system in humans and may provide the basis for novel treatment approaches for mental disorders characterized by social deficits. This article is part of a Special Issue entitled Oxytocin and Social Behav., (© 2013 Published by Elsevier B.V.)

Aim: The aim of this study was to examine the relationship between whole-body insulin-mediated glucose disposal and the fasting plasma glucose concentration in nondiabetic individuals., Research Design and Methods: Two hundred fifty-three nondiabetic subjects with normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance, and combined glucose intolerance received a 75-g oral glucose tolerance test and euglycemic hyperinsulinemic clamp. Total glucose disposal (TGD) during the insulin clamp was compared in IFG and NGT individuals and was related to fasting and 2-hour plasma glucose concentrations in each group., Results: TGD varied considerably between NGT and IFG individuals and displayed a strong inverse relationship with the 2-hour plasma glucose (PG; r = 0.40, P < .0001) but not with the fasting PG. When IFG and NGT individuals were stratified based on their 2-hour PG concentration, the increase in 2-hour PG was associated with a progressive decrease in TGD in both groups, and the TGD was comparable among NGT and IFG individuals., Conclusion: The present results indicate the following: 1) as in NGT, insulin-stimulated TGD varies considerably in IFG individuals; 2) the large variability in TGD in IFG and NGT individuals is related to the 2-hour PG concentration; and 3) after adjustment for the 2-hour proglucagon concentration, IFG subjects have comparable TGD with NGT individuals.

Objective: To assess the relation between fetal and maternal blood type (ABO, Rh) incompatibility and development of gestational diabetes mellitus (GDM)., Materials and Methods: A total of 500 pregnant women underwent diagnostic test for GDM by a 100-g oral glucose tolerance test (OGTT) after an 8 to 12-h overnight fast participated in this study. OGTT was performed between the 24-28 weeks of gestation, but participants who were at high risk for GDM were tested after the first prenatal visit. In the postpartum period, maternal and infant blood types were determined. Presence of GDM was evaluated in terms of matched and unmatched fetal and maternal ABO and Rh blood types separately., Results: GDM was detected in 235 participants. Unmatched ABO blood types between the mother-infant pairs were present in 44.7% (n=105) of GDM (+) and 35.8 % (n=95) of GDM (-) patients. Incompatible feto-maternal ABO blood type was positively correlated with development of GDM which was marginally significant. (p=0.045; R=1.2;95% CL; 1.004-1.48). However, Rh feto-maternal blood type incompatibility was not related with development of GDM., Conclusions: Feto-maternal ABO blood type incompatibility may be a weak risk factor for the development of GDM.

Background and Objectives: The aim of the present study was to evaluate left ventricle systolic and diastolic function, using tissue Doppler echocardiography (TDE), in relation to blood glucose status in prediabetic patients who had no evidence of heart disease by conventional echocardiography (CE)., Subjects and Methods: We included 60 patients (30 female, 30 male) and 20 healthy controls (10 male, 10 female). All participants were randomised into four groups according to their oral glucose tolerance test. Group-I consisted of those patients who had only impaired fasting glucose (IFG). group-II consisted of patients who had only impaired glucose tolerance (IGT) and group-III consisted of patients who had both IFG and IGT, that is so-called combined glucose intolerance. Group-IV included the healthy controls. All subjects underwent both CE and TDE., Results: No significant differences were found among the four groups in terms of CE. There was no significant difference between group-IV and group-I with respect to the early peak diastolic velocity (Ea) of medial mitral annulus (11.65±0.66 vs. 9.72±1.58, p>0.05), whereas a statistically significant difference was found between group-IV and group-II (11.65±0.66 vs. 9.06±1.07, p<0.001) and between group-IV and group-III (11.65±0.66 vs. 9.74±1.09, p<0.05)., Conclusion: Diastolic myocardial dysfunction in prediabetic patients may be identified by quantitative TDE before the appearance of CE indices of myocardial dysfunction.

Subjects with impaired fasting glucose (IFG) are at increased risk for type 2 diabetes. We recently demonstrated that IFG subjects have increased hepatic insulin resistance with normal insulin sensitivity in skeletal muscle. In this study, we quantitated the insulin secretion rate from deconvolution analysis of the plasma C-peptide concentration during an oral glucose tolerance test (OGTT) and compared the results in IFG subjects with those in subjects with impaired glucose tolerance (IGT) and normal glucose tolerance (NGT). One hundred and one NGT subjects, 64 subjects with isolated IGT, 24 subjects with isolated IFG, and 48 subjects with combined (IFG + IGT) glucose intolerance (CGI) received an OGTT. Plasma glucose, insulin, and C-peptide concentrations were measured before and every 15 min after glucose ingestion. Insulin secretion rate (ISR) was determined by deconvolution of plasma C-peptide concentration. Inverse of the Matsuda index of whole body insulin sensitivity was used as a measure of insulin resistance; 56 subjects also received a euglycemic hyperinsulinemic clamp. The insulin secretion/insulin resistance (disposition) index was calculated as the ratio between incremental area under the ISR curve (∆ISR[AUC]) to incremental area under the glucose curve (∆G[AUC]) factored by the severity of insulin resistance (measured by Matsuda index during OGTT or glucose disposal during insulin clamp). Compared to NGT, the insulin secretion/insulin resistance index during first 30 min of OGTT was reduced by 47, 49, and 74% in IFG, IGT, and CGI, respectively (all < 0.0001). The insulin secretion/insulin resistance index during the second hour (60-120 min) of the OGTT in subjects with IFG was similar to that in NGT (0.79 ± 0.6 vs. 0.72 ± 0.5, respectively, P = NS), but was profoundly reduced in subjects with IGT and CGI (0.31 ± 0.2 and 0.19 ± 0.11, respectively; P < 0.0001 vs. both NGT and IFG). Early-phase insulin secretion is impaired in both IFG and IGT, while the late-phase insulin secretion is impaired only in subjects with IGT.

Background: In chronic obstructive pulmonary disease (COPD) patients, functional and structural changes of the respiratory system greatly influence cardiovascular autonomic functions. Determining autonomic balance may be important in understanding the pathophysiology of COPD and useful clinically in the treatment of COPD patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are useful tools in assessing the autonomic neurovegetative function. Our aim in this study was to evaluate the HRV and HRT variables in COPD patients. Twenty five moderate to severe COPD patients and 25 healthy subjects were included in this study., Methods: Pulmonary function tests and echocardiographic examination, arterial blood gases analysis were performed, HRV and HRT analysis were assessed from a 24-hour Holter recording., Results: When HRV and HRT parameters were compared, COPD patients had significantly decreased sNN50 total, pNN50, SDANN, SDNN, SDNNI, rMSDD in time domain HRV parameters, and the values of the HRT onset was significantly less negative in COPD patients. Although the values of the HRT slope were lower in COPD patients, there was no significant difference between the two groups. We also found a correlation between HRT and HRV parameters., Conclusions: In addition to HRV parameters, HRT onset was significantly different in COPD patients. In our opinion, the combination of HRV variables and HRT onset may be simple and elegant ways of evaluating cardiac autonomic functions. New investigations of HRT and HRV in COPD patients have a potential importance for improving risk stratification and therapeutic approaches, and understanding the autonomic outcomes of the disease process.

Today atherosclerotic diseases are among the most important causes of death in the world. Epidemiological, clinical, genetic, experimental and pathological studies have clearly shown the role of lipoproteins in atherosclerosis. LDL is the major atherogenic lipoprotein and has been defined as the primary target of lipid lowering treatment by NCEP. Although the level of LDL, the primary target in the treatment of dyslipidemia, has been set as below 100 mg/dl in coronary heart diseases (CHD) and CHD risk equivalents, this level has been pulled down to below 70 mg/dl for the group defined as very high risk group by the ATP (Adult Treatment Panel) guide that has been updated following the new clinical studies. As we already know, cholesterol is the precursor of glucocorticoids, mineralocorticoids and sex steroids, besides being a structural component of the cell membrane. Both adrenal and non-adrenal (ovarian+testicular) all steroid hormones are primarily synthesized using the LDL-cholesterol in the circulation. In addition to this, there is 'de novo' cholesterol synthesis in both the adrenals and gonads controlled by the HMG-CoA reductase enzyme. A third pathway, which under normal circumstances has little contribution as compared to the first two, is the use of circulatory HDL-cholesterol by the adrenal and gonadal tissues for the synthesis of steroids. Our knowledge on extremely lowered LDL levels is quite limited. However, since statins both decrease circulatory LDL and inhibit de novo cholesterol synthesis, they are likely to affect the synthesis of steroid hormones.

The question is whether bedtime insulin, one of the standard therapy regimens of type 2 diabetes, can be more atherogenic than daytime insulin. There is no study to answer this question. However, pharmacokinetics of drugs and physiopathology of type 2 diabetes are considered, we can assume that daytime OAD plus bedtime insulin therapy might be more atherogenic than daytime insulin plus bedtime OAD therapy. The rationale for combination therapy is based on the assumption that, if evening insulin lowers the fasting glucose concentration to normal, then daytime oral agents will be more effective in controlling postprandial hyperglycemia. However, exogenous insulin administration is not a convenient way to inhibit hepatic glucose production which determines fasting plasma glucose because in post absorptive period, hepatic glucose production is determined by high glucagon and low insulin levels. In postprandial period, beta cell-originated insulin inhibits glucagon synthesis by paracrine effect and also inhibits hepatic glucose production by using half of its concentration that administered to portal system. Since half of insulin that found in portal system is exposed to hepatic clearance to inhibit hepatic glucose production, portal insulin concentration is 2-4-folds higher than peripheral insulin concentration. But, exogenous insulin neither inhibits glucagon synthesis via paracrine effect, nor reaches desired portal concentrations because it has a short half-life and in opposition to physiologic states it is not administered to the portal system. On the contrary, its peripheral concentration is higher than portal one. Thus, exogenous insulin that is used to inhibit hepatic glucose production requires higher concentrations than physiologic values. Eventually, peripheral hyperinsulinemic state which is a risk factor of CVD is created iatrogenically. Bearing in mind that PI3K pathway, working synchronously with the diurnal rhythm of other metabolic hormones, is more active during daytime especially in postprandial period when aminoacids and glucose exist in the environment, and that decreased insulin response in PI3K pathway in diabetics, we may propose iatrogenically created hyperinsulinemia can cause more atherogenic effects via MAPK pathway. For that reason, using OAD instead of bedtime insulin may be a more convenient way to inhibit hepatic glucose production. Thus, glucagon synthesis inhibition can be achieved via paracrine effect of OAD-induced insulin secretion, as well as required portal insulin concentration can be reached by the direct secretion of insulin to the portal system. Moreover, lower peripheral hyperinsulinemia state can be provided.

Hypothyroid patients have increased concentrations of creatinine kinase that is mostly due to increased CK-MM. However, CK-MB has also been reported to increase above reference values in hypothyroid patients without apparent myocardial damage. This may create confusion during the evaluation of myocardial injury in a hypothyroid patient presenting with chest pain. Troponin I is considered as a superior marker for the diagnosis of myocardial infarction in hypothyroid patients. However, there are some reports showing an increase in the level of troponin I without any myocardial damage in hypothyroid patients as in our case. In this report, we present a 47 years old male hypothyroid patient who had chest pain, abnormal electrocardiographic findings and increased cardiac enzymes suggesting acute coronary syndrome although he had normal coronary arteriogram.

Objective: Subclinical hypothyroidism (SH) is a mild form of thyroid failure, associated with initial signs of cardiovascular hypothyroidism. Tissue Doppler echocardiography (TDE) is a new and powerful method in evaluation of both regional and global systolic or diastolic ventricular function. We aimed to investigate the use of TDE in evaluation of cardiac effects of SH and affect of thyroid hormone replacement therapy (TRT) on tissue Doppler parameters of SH patients., Methods: Twenty-two patients who were diagnosed as SH and 22 healthy, age and sex-matched cases were included in the study. Conventional echocardiography and TDE were performed in all individuals. TRT was started in SH group. On the achievement of euthyroid state echocardiography were repeated., Results: Septal annulus relaxation time was significantly higher in SH group (82+/-21, 98+/-11 ms, p=0.024). Lateral annulus and myocardial relaxation times, precontraction/contraction ratios and precontraction times were also slightly higher. Septal lateral annulus and lateral myocardial relaxation times were decreased after TRT (98+/-11 vs. 81+/-12, p<0.001, 89+/-14 vs. 78+/-11, p=0.022, 90+/-16 vs. 80+/-14 ms, p=0.008, respectively). Precontraction times and precontraction/contraction ratios decreased after TRT but did not reach the significance level. There was a positive correlation between TSH and TDE relaxation times., Conclusions: TDE is a powerful tool in diagnosis and follow-up of SH patients and TRT inhibits adverse affects of SH on myocardium. Septal myocardium is the most affected region of left ventricle in SH. The relaxation time is the best criteria of cardiac involvement and monitoring the effect of TRT.

Objective: To determine the rate of distal symmetrical polyneuropathy (DSP) in patients with type 2 diabetes mellitus, to evaluate the role of history, neurological examination and the electrodiagnostic methods in the diagnosis of DSP, and to determine the association between electromyography-supported neuropathy (ESN), neuropathic complaints (NCs) and risk factors., Subjects and Methods: A total of 191 type 2 DM patients (109 female, 82 male; mean age 58.7 +/- 10 years) were recruited. The NCs were recorded. All patients had electromyographic (EMG) examinations. The relationship between ESN, NCs and risk factors were evaluated., Results: Of the 191 patients, 83 (43.5%) had DSP on EMG examinations and 92 (48.2%) patients suffered from NCs. Among the ESN patients, a significant relationship existed with HbA1(c) level, illness duration, smoking, male gender or insulin usage (p < 0.05) but not with age, hypertension, hypercholesterolemia or hypertriglyceridemia. The frequency of NCs was higher in patients with ESN. There was also a significant association between NCs and ESN (p < 0.05). The presence of NCs was not related to age, gender, smoking, hypertension, hypercholesterolemia and hypertriglyceridemia (p > 0.05) but NCs were correlated to HbA1(c) level, illness duration and insulin usage (p < 0.05)., Conclusion: Our data show that a strong association exists between the presence of DSP and illness duration, HbA1(c), smoking, thereby indicating that cessation of smoking and near normal glycemic control would be additional precautions to delay the beginning or progression of polyneuropathy., (Copyright 2006 S. Karger AG, Basel.)