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Objective: To explore the possible relationship between vitamin D and coronavirus disease-2019 in an urban population known to have relatively low vitamin D levels. Method: The retrospective study was conducted in Bursa, Turkey, and comprised data of 30 family health centers from March 1 to December 15, 2020, related to diagnosed inpatients of coronovairus disease-2019. The diagnosis was based on polymerase chain reaction test for severe acute respiratory syndrome coronavirus-2 infection. Vitamin D levels of these patients were obtained from previous records and compared with those without polymerase chain reaction positivity. Vitamin D levels of positive patients who survived were compared with those who died of coronavirus disease-2019. Data was analysed using SPSS 21. Result: Of the 2,105 patients whose data was retrived, 212(10%) were positive for coronavirus disease-2019, while 1,893(90%) were negative. Among the positive patients, 89(42%) were men and 123(58%) were women. The overall median age was 45 years (Q1-Q3(Q1: first quartile, Q3: third quartile): 35-56 years). Vitamin D level was not significantly different between the positive and negative patients (p>0.05). Among the positive patients, 2(0.9%) patients did not have new admissions to the designated centers and their data was excluded, 206(97.2%) survived and 4(1.9%) died. There was no significant difference in vitamin D levels between those who survived and those who died (p>0.05). Conclusion: There was no significant relationship found between vitamin D levels and coronavirus disease-2019 infection and related deaths. Key Words: COVID-19, PCR positivity, SARS-CoV-2 infection, Vitamin D.

Multiple gestations are high-risk pregnancies with increased obstetric and perinatal risks. Preterm labor occurs in about half of twin pregnancies. Thus, prediction of the time of delivery and prevention of premature birth are very important in multiple gestations. Anterior uterocervical angle is a successful tool that has been used in the prediction of preterm labor in recent years. However there is only limited data about this issue for twin pregnancies in the literature. Here, we aimed to demonstrate the relationship between uterocervical angle and preterm labor in twin pregnancies more clearly and reliably with this meta-analysis. In this context, "twin gestation, uterocervical angle, cervical angle, angle, cervix, cervical, preterm and preterm labor" keywords were used and PubMed, Medline, ClinicalKey, Scopus, Science Direct, Web of Science, and Google Scholar database were searched between 1 January 2010 and 27 December 2020. Finally, a total of three studies were included in the analysis. Here, we found that uterocervical angle was associated with a higher risk of preterm delivery in the overall effect.

Objective To investigate the shape differences in the putamen of early-onset Parkinson’s patients compared with healthy controls and to assess and to assess sub-regional brain abnormalities. Methods This study was conducted using the 3-T MRI scans of 23 early-onset Parkinson’s patients and age and gender matched control subjects. Landmark coordinate data obtained and Procrustes analysis was used to compare mean shapes. The relationships between the centroid sizes of the left and right putamen, and the durations of disease examined using growth curve models. Results While there was a significant difference between the right putamen shape of control and patient groups, there was not found a significant difference in terms of left putamen. Sub-regional analyses showed that for the right putamen, the most prominent deformations were localized in the middle-posterior putamen and minimal deformations were seen in the anterior putamen. Conclusion Although they were not as pronounced as those in the right putamen, the deformations in the left putamen mimic the deformations in the right putamen which are found mainly in the middle-posterior putamen and at a lesser extend in the anterior putamen.

Background/aim: The goal of this study was to compare differences in hand and wrist shapes and to evaluate these according to growth and allometry in children on radiographs related to bone age. Materials and methods: The study included 263 males and 189 females. A total of 452 left hand and wrist radiographs were retrospectively collected. Standard anatomical landmarks marked on radiographs. Results: There were seen to be significant differences in comparisons of hand and wrist shapes according to sex (P = 0.009). The most suitable model in the growth models was seen as the Gompertz growth model for both females and males (model P < 0.001). For the relationship between shape and size to evaluate allometry, significant models were obtained in females (model P = 0.017, MSE = 0.0002) and in males (model P < 0.001, MSE = 0.0002). In our study, the difference between the sexes was found mostly in the radiocarpal region. It was observed that the deformation of the carpal bones started in the distal row carpal bones. Conclusion: Significant differences were found in hand and wrist shapes according to sex. Models for growth and allometry of hand and wrist shapes were found to be significant in children.

Objective Obesity in childhood and adolescence is one of the most serious public health problems due to a remarkable increase in prevalence in recent years and its close relationship with non-communicable diseases, such as diabetes and hypertension, resulting in increased adult morbidity and mortality. This study aims to quantify the secular trend in different regions of Turkey from 1990 to 2015 by performing a meta-analysis of childhood and adolescent obesity prevalence studies conducted. Methods Uludag University Library Database was searched for relevant articles published prior to March 2017. The heterogeneity of the studies in the meta-analysis was tested by the I2 statistic and Cochran's Q test. The obesity trend analyses were examined by chi-square trend analysis with respect to five year periods. The statistical significance level was taken as α=0.05. Results A total of 76 papers were initially identified addressing childhood and adolescent obesity in Turkey. Fifty-eight papers were selected for analysis. The prevalence of obesity increased from 0.6% to 7.3% with an 11.6-fold increase between the periods 1990-1995 to 2011-2015. The prevalence of obesity increased in both genders. However, boys were more likely to be obese than girls. Conclusion Studies on obesity prevalence in the 5-19 age group in Turkey have gained importance, especially in the 2000s. While a remarkable number of prevalence studies, mostly regional, have been conducted between 2005-2011, a gradual decline was observed thereafter. Further national and population-based surveys on prevalence of obesity in children and adolescents are definitely needed in Turkey.

PubMed: 30862597 Objective: Subthalamic nucleus (STN) is the most targeted localization in the treatment of Parkinson disease (PD) with deep brain stimulation. However, no studies have been found in the literature about possible shape changes of STN in the literature. We aimed to investigate possible shape changes in the STN and the relationship between shape changes and disease duration in PD patients by using statistical analysis. Methods: Patients who were diagnosed with idiopathic PD and controls were enrolled in this study. Age, sex, and disease duration of all cases were recorded. Turbo-spin-echo T2-weighted axial series parallel to the skull base in each case containing midbrain images were obtained, including the whole STN. Standard anatomic landmarks were selected and marked on each digital image using a special software in all cases. Statistical geometric shape and deformation analysis of STN was performed in 2 groups. Results: Forty-three patients with PD and 50 age/sex-matched controls were enrolled in this study. There were statistically significant left and right STN shape differences between the groups. Maximum deformation was seen in the dorsolateral parts of both STNs. General shape variability of the STNs was found on the left (0.096) and right (0.049). Conclusions: Significant shape differences and remarkable deformation of STN are seen in patients with PD compared with controls. Maximum deformation was observed in the dorsolateral part of the STN, and with the increase in the duration of the PD, shape differences and deformations became more prominent. © 2019 Elsevier Inc.

Sports and exercise settings as well as other socio-cultural environments emphasize a thin and physically fit female body. However, there is a clear need for a better understanding of the physical and psychological correlates of social physique anxiety and body image dissatisfaction in female athletes. This study aimed to examine the association of the social physique anxiety, body image satisfaction, and personality with the anthropometric measurements in female college athletes according to their sport type using the Co-Plot technique. The sample included 63 female athletes ranging in age from 18 to 26. Results of the Co-Plot analysis revealed a significant association among social physique anxiety, personality and anthropometric measurements. This means that certain physical measurements may lead to greater social physique anxiety and body image dissatisfaction in female athletes. It was found that females having higher levels of social physique anxiety and thus, lower levels of body image satisfaction may be less emotionally stable and more negatively perfectionist. In conclusion, the results of the present study provided evidence to the claim that both physical self-perception and anthropometric measurements may be closely associated with psychological criteria in female athletes. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

OBJECTIVES This study aims to investigate whether the axial shape of the distal femur is different between normal and osteoarthritic female knees using statistical shape analysis. PATIENTS AND METHODS A total of 126 knee magnetic resonance images of 126 female patients were examined in this study conducted between May 2013 and May 2014. Patients were divided into two groups as study and control groups. The study group consisted of 41 patients (median age 65 years; min. 36 - max. 88 years) who were determined to have knee osteoarthritis, while the control group consisted of 85 patients (median age 43 years; min. 20 - max. 81 years) without knee osteoarthritis. Anatomic and constructive landmarks were selected and marked on each two-dimensional digital image in the axial section of the distal femur. The mean axial shapes of the distal femur were compared between the groups by statistical shape analysis. Shape deformations were investigated by thin plate spline analysis. RESULTS There were significant differences between the groups regarding the axial shape of the distal femur. Maximal deformation was observed in the femoral notch area. CONCLUSION This study showed that there are deformations in the axial shape of the distal femur in female patients with knee osteoarthritis. Further studies are required to determine whether these differences are important for implant design and surgical technique of total knee replacement.

Surgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy due to hippocampal sclerosis but sometimes deciding this diagnosis can be very difficult. We aim to investigate the shape differences in the temporal lobe of mesial temporal sclerosis epilepsy patients compared with healthy controls, investigating the side difference and, if present, assessing the clinical application of this situation. The MRI scans of mesial TLE patients and controls were retrospectively reviewed. Temporal lobe data were collected from the two-dimensional digital images. Standard anthropometric landmarks were selected and marked on each digital image using TPSDIG 2.04 software. Eight anatomic landmarks were marked on images. A generalized Procrustes analysis was used to evaluate the shape difference. The shape deformation of the temporal lobe from control to patient was evaluated using the TPS method. There were statistically significant TL shape differences between groups. High level deformations for the left and right side from the control to patient group were seen in the TPS graphic. The highest deformation was determined at the inferior lateral temporal midpoint of the middle temporal gyri and superior temporal landmark points of both the right and left sides. Our study for the first time demonstrated temporal shape differences in TLE patients using a landmark-based geometrical morphometric method by taking into consideration the topographic distribution of TL.

The authors aim to determine the periorbital soft tissue anthropometric norms for Turkish young adults for right and left eyes using a noninvasive two-dimensional photogrammetric analysis. Anthropometric measurements of the periorbital soft tissue were taken from 172 female and 56 male Turkish adults aged between 18 and 24 years. The periorbital soft tissue profiles (ocular and palpebral) for males and females were digitally analyzed using linear measurements made with standardized photographic records, taken in a natural head position. Statistically significant differences were found for ocular soft tissue measurements according to gender except inner intercanthal distance (P = 0.125) and right horizontal palpebral aperture (P = 0.240). Statistically significant differences were found for palpebral soft tissue measurements according to gender except right pretarsal skin height (P = 0.112) and left pretarsal skin height (P = 0.056). Results were compared with other ethnic groups. Normal periorbital soft tissue measurements are fundamental anatomical parameters utilized in ophthalmology, optometry, ophthalmic industry, oculoplastic surgery, clinical genetics, dermatocosmetology. Further, normal anthropometric measurements generate reference data for studies in craniofacial dysmorphology, oculoplastic surgery, dermatocosmetology, and comparative physical anthropology.

BACKGROUND: Female gender is accepted as a poor prognostic factor for Fournier's gangrene (FG). However, there is a paucity of data in the literature regarding this matter. This case-matched study was designed to investigate the impact of gender on outcomes of FG. METHODS: Study patient data were retrieved from 120-patient, prospectively maintained database. Thirty-two female patients with FG were case-matched to 32 male patients based on symptom duration (days), FG severity index score, patient age, etiology, and presence of diabetes mellitus (DM) terms. Outcomes of FG were compared between the 2 groups. RESULTS: Median age was 57 years (range: 22-80 years), and 35 (54.7%) patients had DM. Patients underwent average of 3 debridement procedures (range: 1-9 debridements), and 15 (23.4%) received diverting stoma. Overall mortality rate was 28.1% (18 of 64 patients). Female gender was associated with widespread disease (p=0.009), increased need for consecutive debridements (p=0.005), prolonged length of intensive care unit stay (p=0.035), and increased requirement for split-thickness skin graft reconstruction (p=0.040). However, mortality rates were comparable between genders (p=0.264). CONCLUSION: FG is often more extensive in females and seems to be associated with anatomical features of female pelvis. However, female gender is not a factor affecting prognosis of patients with FG. AMAÇ: Kadın cinsiyet Fournier gangreni (FG) için olumsuz bir prognostik faktör olarak görülmektedir. Ancak literatürde bu konuya özgün yeterli veri yoktur. Bu olgu-eşleme çalışması kadın cinsiyetin FG prognozuna etkisini incelemek için yapıldı. GEREÇ VE YÖNTEM: Çalışmaya alınan hastalar kliniğimizin 120 hastalık ileriye yönelik olarak tutulan veritabanından çekildi. Otuz iki kadın hasta aşağıdaki kriterler baz alınarak 32 erkek hastayla eşleştirildi: Semptom süresi, FG severity indeks (FGSI) skoru, hasta yaşı, etiyoloji ve eşlik eden diyabetes mellitus (DM) varlığı. Daha sonra iki grup hasta klinik sonuçlar açsından karşılaştırıldı. BULGULAR: Medyan yaş 57 (22–80) idi ve 35 (%54.7) hastada DM vardı. Hastalara ortalama 3 (1–9) debridman yapıldı ve 15 hastaya (%23.4) saptırıcı stoma açıldı. Mortalite oranı %28.1 (64’te 18 hasta) idi. Kadınlarda FG daha yaygındı (p=0.009), daha fazla debridmana ihtiyaç duyulmuştu (p=0.005), kadınlar yoğun bakım ünitesinde daha fazla oranda kalmıştı (p=0.035) ve kadınlarda split thickness skin graft (STSG) ile rekonstrüksiyon daha fazla oranda yapılmıştı (p=0.040), ancak mortalite oranları iki grup arasında benzerdi (p=0.264). TARTIŞMA: Fournier gangreni kadınlarda erkeklere oranla daha yaygın seyreder. Bu muhtemelen kadınların anatomik yapısı ile ilgilidir. Ancak kadın cinsiyet FG mortalitesini artıran bir faktör değildir.

Asli Gorek Dilektasli,1 Ezgi Demirdogen Cetinoglu,1 Esra Uzaslan,1 Ferah Budak,2 Funda Coskun,1 Ahmet Ursavas,1 Ilker Ercan,3 Ercument Ege1 1Department of Pulmonary Disesaes, 2Department of Immunology, 3Department of Biostatistics, Uludag University Faculty of Medicine, Bursa, Turkey Introduction: Chemokine (C-C motif) ligand 18 (CCL-18) has been shown to be elevated in chronic obstructive pulmonary disease (COPD) patients. This study primarily aimed to evaluate whether the serum CCL-18 level differentiates the frequent exacerbator COPD phenotype from infrequent exacerbators. The secondary aim was to investigate whether serum CCL-18 level is a risk factor for exacerbations requiring hospitalization. Materials and methods: Clinically stable COPD patients and participants with smoking history but normal spirometry (NSp) were recruited for the study. Modified Medical Research Council Dyspnea Scale, COPD Assessment Test, spirometry, and 6-min walking test were performed. Serum CCL-18 levels were measured with a commercial ELISA Kit. Results: Sixty COPD patients and 20 NSp patients were recruited. Serum CCL-18 levels were higher in COPD patients than those in NSp patients (169 vs 94 ng/mL,P

Rationale and Objectives. To investigate the contribution of chemical shift magnetic resonance imaging for assessment of the margins of solid breast masses by benefiting from India ink artifact. Methods and Materials. Eighty-eight masses in 64 patients were evaluated in T1- and T2-weighted images, dynamic contrast and chemical shift studies according to Breast Imaging Reporting and Data System magnetic resonance lexicon. Subtraction images were automatically obtained by chemical shift imaging and dynamic studies. Each Sequence was scored using a scale of 1 to 5 according to its ability to demonstrate mar ins separate from surrounding parenchyma. Breast parenchyma was evaluated as fatty and dense. The results were compared with the histopathologic results. Results. Twenty-eight (31.8%) of the lesions were localized in fatty breast, and the remaining 60 (68.2%) lesions were localized in dense breast. There were 34 (38.6%) benign and 54 (61.4%) malignant masses. In fatty breast, chemical shift subtraction and T1-weighted images were valuable both for the demonstration and differentiation of benign lesions (P < .05). None of the sequence was valuable for both the demonstration and differentiation of malignant lesions in fatty breasts (P > .05). In dense breasts, chemical shift subtraction and dynamic contrast Subtraction images were valuable for both the demonstration and differentiation of benign and malignant lesions. Additional to these sequences, T2-weighted images was also valuable for benign lesions (P < .05). Conclusion. Chemical shift subtraction call contribute to routine dynamic contrast subtraction in morphologic analysis particularly for the evaluation of margins of benign lesions in fatty breasts. It can also help in morphologic analysis of masses in dense breast.

The purpose of this study was to establish facial soft tissue norms for Turkish young adults. Anthropometric measurements of the facial soft tissue were taken from 281 female and 149 male Turkish adults aged between 18 and 24 years. The soft tissue facial profiles were digitally analyzed using linear (17 vertical and 10 horizontal) measurements made with standardized photographic records, taken in a natural head position, to determine the average soft tissue facial profile for males and females. A statistically significant difference was found between males and females in 20 of 27 measurements taken (p < 0.001). The most prominent differences between the sexes were observed in the measurements taken from the face region. Results were compared with other ethnic groups.

Statistical shape analysis, a relatively a new method for biological research, compares body forms by using specific landmarks determined by anatomical prominences. In this study, we aimed to identify normal facial asymmetry between the right and the left sides of the face. Facial landmark data were collected from two-dimensional digital images of 321 young healthy subjects (150 males and 171 females). These data were analysed using Euclidean distance matrix analysis. The number of significantly asymmetric linear distances between the two halves of the face was greater in females than in males. We found that the left side of the face was most commonly dominant in both males and females. Such data may be useful in establishing a database for future similar studies.

The aim of this study was to compare serum insulin-like growth factor (IGF-1) levels in patients with obstructive sleep apnea syndrome (OSAS) with those of nonapneic controls and to determine the risk factors of low IGF-1 levels in patients with OSAS. The study included 39 newly diagnosed moderate-to-severe OSAS patients and 36 nonapneic controls. Overnight polysomnography (PSG) was performed in all patients. The circulating levels of IGF-1 in the OSAS group were significantly lower than those of the control group (p < 0.05). There was a significant negative correlation between IGF-1 and logarithmic transformation (Ln) of the apnea-hypopnea index (AHI), duration of apnea-hypopnea, arousal index, average desaturation, and oxygen desaturation index (ODI). The result of stepwise regression analyses showed that OSAS (p = 0.001) was a risk factor for a low IGF-1 level, independent of age, gender, and body mass index (BMI). Our findings demonstrated that there was a significant negative correlation between IGF-1 and Ln AHI and that OSAS reduced the circulating levels of IGF-1.

The role of age, gender and smoking on both the genotoxic effects of Helicobacter pylori and the efficacy of eradication therapy in a group of patients with gastritis was investigated. Gastritis was confirmed by endoscopy and biopsy, and the presence of H. pylori by urease testing. Pre- and post-treatment peripheral blood lymphocyte cultures were prepared from 17 patients and 25 metaphases per patients were analysed for sister chromatid exchange (SCE), a well-established technique for the evaluation of human exposure to toxic agents. Treatment with omeprazole, clarithromycin and amoxycillin triple therapy eradicated H. pylori in 94% of patients and significantly reduced the SCE frequency. Pre-treatment SCE frequency was found to be positively correlated with age. Female smokers tended to have higher post-treatment SCE frequencies than male smokers, and pre- and post-treatment SCE frequencies were higher in older males than in older females. Eradication therapy decreased the genotoxicity of H. pylori, but age in males and smoking in females may decrease treatment efficacy.

Background Fournier's gangrene (FG) is a devastating and potentially fatal disease requiring prompt and aggressive debridement. In this study, it was aimed to assess the predictors of mortality in a large cohort. Methods Prospectively maintained data of patients with FG were analyzed. Demographic data, duration of symptoms, Uludag Fournier's Gangrene Severity Index (UFGSI) scores, co-morbidities [particularly diabetes mellitus (DM)], etiologies, number of debridement, stoma requirements, length of intensive care unit and hospital stay, and morbidity and mortality rates were reviewed. Multivariate analysis was performed in order to determine factors affecting mortality. Results 120 patients (81 males) were included in the study. Median age was 58 (22-85) years. UFGSI score was median 9 (1-30). DM was present in 69 (57.5%) patients. Etiology of FG was perianal in fifty-nine, urogenital in 52, and skin in 9 patients. Median debridement count was 3 (1-12). Thirty-one patients required stoma. Forty-eight patients were admitted to intensive care unit and 25 patients required mechanical ventilation. Overall mortality rate was 20.8%. Multivariate analysis revealed UFGSI as the only predictor of mortality (p=0.001). Mortality rate was 13.64 times higher for patients with a UFGSI score of 9 or higher. Conclusion Fournier's gangrene is a mortal disease requiring emergency surgery. UFGSI is an efficient predictor of mortality for patients with FG.

OBJECTIVE The aim of this study is to investigate the distribution of anti-Toxoplasma gondii IgG and IgM antibodies in patients with suspected toxoplasmosis referred to the Uludag University Medical School, Department of Medical Microbiology Enzyme-Linked Immunosorbent Assay (ELISA) laboratory over a 72-month period (March 2002-December 2008). METHODS The samples were analyzed using VIDAS (BioMerieux, France) IgG-avidity tests and the fluorescent enzyme-linked assay (ELFA) technique. RESULTS Results showed that the prevalence of anti-T. gondii IgG and IgM among women (29.2% and 2.02%, respectively) was higher than that of men (21.2% and 1.7%, respectively). The seroprevalence of anti-T. gondii IgG was 30.7% in childbearing-aged women, with rates ranging from 35.8% and 27.4% over the years. Avidity was found to be high, borderline, and lower (81.9%, 10.2%, and 7.9%, respectively) in the fertile age group of 166 women receiving the IgG avidity test. CONCLUSION Although the study data may not reflect our entire province, it virtually turns out that the risk of toxoplasmosis must be seriously taken into account, particularly when approaching some risk groups, such as seronegative women of fertile age, pregnant women, and immunocompromised patients.

The aim of this study is to reevaluate validity of Turkish version of the ECOS-16 questionnaire by using Rasch analysis in post-menopausal women with osteoporosis. ECOS-16 (Assessment of health related quality of life in osteoporosis) is a quality of life questionnaire, which is convenient for measuring the quality of life of post-menopausal women with osteoporosis. 132 post-menopausal women with osteoporosis who attended Uludag Universtity, Atatürk Rehabilitation and Research Center between January 2010 and March 2011 were included in this study. The subjects filled out Turkish version of ECOS-16 questionnaire by themselves. The Rasch model was used for assessing construct validity of ECOS-16 data. Internal consistency was assessed by Cronbach's alpha coefficient. The mean infit and outfit mean square (z std) were found as 1.08 (0.1) and 1.02 (-0.1), respectively. The separation indices for the item and person were found as 7.72 and 3.13; the separation reliabilities were 0.98 and 0.91, respectively. Cronbach's alpha coefficient was found as 0.90. The construct validity of ECOS-16 questionnaire was assessed by Rasch analysis.

Background: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings.Aim: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests.Methods: We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture.Results: In GABHS cases (n = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (n = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC.Conclusion: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.

Aims and background The optimal treatment of cancer cachexia remains unknown. In this study, we compared the efficacy of three different treatment modalities in the management of cancer cachexia. Methods Sixty-two assessable cachectic cancer patients were randomized to one of the following three arms: 1) megesterol acetate (MA) plus meloxicam (n = 23); 2) MA plus meloxicam plus oral eicosapentaenoic acid (EPA)-enriched nutritional supplement (n = 21); or 3) meloxicam plus oral EPA-enriched nutritional supplement (n = 18). Treatment duration was 3 months. Results The treatment arms were well balanced at baseline. The primary efficacy (body weight and lean body mass) and secondary efficacy (body mass index, quality of life, and serum levels of IL-6 and TNF-α) parameters improved after treatment in all three arms. There were no statistically significant differences between treatment groups in the mean percentage changes in all efficacy parameters from baseline to end of study. Conclusions MA plus meloxicam or EPA supplement plus meloxicam may be effective treatment options in the management of cancer cachexia. The combined use of these agents does not provide further advantages.

The aim of this study was to investigate the shape differences in the corpus callosum (CC) and cerebellum of female relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients compared with healthy controls. This study was conducted using the magnetic resonance imaging scans of 15 control subjects, 26 RRMS, and 14 SPMS patients. The data obtained from the landmark coordinates were analyzed with statistical shape analysis. The landmarks that were chosen to determine the shape differences of the CC and cerebellum have been identified and used in previous studies. In addition to these landmarks, constructed landmarks were determined and used to assess regional shape differences better. The shapes of the CC and cerebellum showed statistically significant differences from the controls when compared with both the RRMS and SPMS patients. It was found that the deformation observed from controls to SPMS was greater than the deformation from controls to RRMS, both for the CC and cerebellum. In conclusion, this study revealed CC and cerebellar shape change in RRMS and SPMS, and showed that deformations both in CC and cerebellum advances with the disease progression. Anat Rec, 2012. © 2012 Wiley-Periodicals, Inc.

Objective: In this study we aimed to investigate the genotoxic effects of antineoplastic agents in occupationaly exposed oncology nurses. Genotoxic effects mean the disruptive effects in the integrity of DNA and they are associated with cancer development. Biomonitoring of health care workers handling antineoplastic agents is helpful for the evaluation of exposure to cytostatics. Participants: The study included an exposed and two control groups. The exposed group (n = 9) was comprised of oncology nurses. The first (n = 9) and second (n = 10) control groups were comprised of subjects who did not come into contact with antineoplastic drugs working respectively in the same department with oncology nurses and in different departments. Methods: Genotoxicity evaluation was performed using SCE analysis. After applying culture, harvest and chromosome staining procedures, a total of 25 metaphases were analyzed per person. Kruskal Wallis test was used to perform statistical analysis. Result: A statistically significant difference of sister chromatid exchange frequencies was not observed between the exposed and control groups. Conclusion: Lack of genotoxicity in medical oncology nurses might be due to good working conditions with high standards of technical equipment and improved personal protection.

The aim of this study was to assess the shape differences of the corpus callosum (CC) in patients with Behçet's disease using statistical shape analysis (SSA). Additionally, an attempt was made to investigate the changes in CC size according to disease duration. Twenty-five adults with clinically diagnosed Behçet's disease and 25 age- and gender-matched controls were examined by high-resolution structural magnetic resonance imaging. The data obtained from the coordinate of landmarks were analyzed with Euclidean distance matrix analysis and a thin-plate spline analysis. SSA and growth curve models were performed to investigate group differences and to fit the curves. A significant difference was determined between CC shape of Behçet patients and controls (P = 0.006). Based on the analysis, a decrease occurred in the CC size of the Behçet patients as the duration of disease increased. Maximum deformations were determined in the landmarks of interior notch of the splenium, inferior tip of the splenium, posterior-most point of the CC, and topmost point of the CC. Similarly, the landmark of anterior-most point of the CC was identified as having the minimum deformation. Behçet patients had significantly different CC shapes from control subjects. The results suggest that SSA is a promising tool for distinguishing Behçet patients from normal subjects, and that it can give useful information to assist clinicians. Additionally, SSA might be applied to detect shape differences in anatomical structures that are affected by a broad range of neurological diseases.

Objective: Inflammatory response associated with radiation-induced lung injury (RILI) results in an increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT). In this study, we aimed to analyze the degree of FDG uptake within specific isodose regions (IR) of the irradiated lung using standardized uptake value (SUV) measurements, and to correlate posttreatment FDG uptake with radiotherapy (RT) dose parameters, patient characteristics and the imaging time interval after RT completion. Material and Methods: Data from 30 patients with non-small cell lung cancer (NSCLC) who underwent FDG PET/CT imaging at least 12 weeks (72-668 days) after completion of RT were evaluated. In each patient, side-by-side visual registration of the treatment planning CT slices including IR curves with the corresponding PET/CT slices was performed. Using SUV measurements, FDG uptake levels were analyzed within specific IRs of the irradiated lung. The statistical difference between SUVmax of each IR was determined. The RT dose parameters, patient characteristics and time interval between RT and PET/CT were tested for correlation with SUVmax of IRs. Results: The mean SUVmax in the IRs of the lung that received 2000-4000cGy was 1.51 +/- 0.66 (mean +/- SD) (mm-max: 0.69-2.84), 4000-6000cGy was 2.67 +/- 1.16 (min-max: 0.71-6.0), and >6000Gy was 3.55 +/- 1.09 (min-max: 1.2-5.72). We found statistically significant differences between the SUVmax values of all IRs (SUV2000 vs. SUV4000, p = 0.001; SUV2000 vs. 6000, p = 0.002; SUV4000 vs. 6000, p = 0.001). No statistically significant correlation was found between SUVmax and the other variables. Conclusion: The findings of this study showed that, although some overlap occurs between IRs, the degree of radiation-related parenchymal FDG uptake gets higher with increasing dose levels. Persistent high FDG uptake levels may be observed in radiation fibrosis areas on PET/CT even several months after RT. Amaç: Radyasyona bağlı akciğer hasarı (RBAH) ile ilişkili inflamatuvar yanıt pozitron emisyon tomografisi/bilgisayarlı tomografide (PET/BT) artmış 18F-florodeoksiglukoz (FDG) tutulumu ile sonuçlanır. Bu çalışmada, standardize tutulum değeri (standard uptake value; SUV) ölçümlerini kullanarak ışınlanmış akciğerin belirli izodoz alanlarında (İA) FDG tutulumunun derecesini incelemeyi ve tedavi sonrası FDG tutulumu ile radyoterapi (RT) doz parametreleri, hasta özellikleri ve RT tamamlandıktan sonra görüntüleme zamanı aralığı arasında bağıntı kurmayı amaçladık. Gereç ve Yöntemler: RT tamamlandıktan en az 12 hafta (72-668 gün) sonra FDG PET/BT yapılan küçük hücreli dışı akciğer kanserli (KHDAK) 30 hastanın verileri değerlendirildi. Her hastada, PET/BT kesitlerine karşılık gelen ve İA eğrilerini içeren tedavi planlama BT kesitlerinin yan yana görsel kaydı yapıldı. SUV ölçümleri kullanılarak, ışınlanmış akciğerin belirli İA içindeki FDG tutulum düzeyleri incelendi. Her ışınlanmış bölgenin SUVmax arasındaki istatistiksel fark belirlendi. İAnın SUVmax ile korelasyonu için RT doz parametreleri, hasta özellikleri ve RT ile PET/BT arasındaki zaman aralığı istatistiksel olarak test edildi. Bulgular: 2000-4000 cGy alan akciğer İAdaki ortalama SUVmax 1.51 ± 0.66 (mean ± SS) (min-max: 0.69-2.84) idi, 4000-6000 cGy ve >6000 alanlarda sırasıyla 2.67 ± 1.16 (min-max: 0.71-6.0) ve 3.55 ± 1.09 (min-max: 1.2-5.72) idi. Tüm İAnın SUVmax değerleri arasında istatistiksel olarak anlamlı farklar bulduk (SUV2000 ile SUV4000, p= 0.001; SUV2000 ile SUV6000, p= 0.002; SUV4000 ile SUV6000, p=0.001). SUVmax ve diğer değişkenler arasında istatistiksel olarak anlamlı ilişki bulunmadı. Sonuç: Bu çalışmanın sonuçları, izodoz alanları arasında bir miktar çakışma olmakla birlikte, radyasyonla ilişkili parankimal FDG tutulumunun derecesinin artan dozlarla arttığını göstermiştir. RT bitiminden aylar sonra bile, radyasyona bağlı fibrozis gelişen alanlarda yüksek düzeylerde FDG tutulumunun sebat ettiği görülebilmektedir.

The objective of this study was to prospectively quantify the fatty degeneration of supraspinatus (SSP) muscle due to SSP tendon injuries by using chemical-shift magnetic resonance imaging (CS-MRI). Forty-one patients with suspected rotator cuff tear or impingement examined with MR arthrography were included in the study. The following images were obtained after injection of diluted gadolinium chelate into glenohumeral joint: fat-saturated T1-weighted spin echo in the coronal, axial, and sagittal-oblique plane; fat-saturated T2-weighted and intermediate-weighted fast spin-echo in the coronal-oblique plane; and T1-weighted spin echo in the sagittal-oblique plane. CS-MRI was performed in the coronal plane using a double-echo fast low-angle shot (FLASH) sequence. SSP tendon changes were classified as normal, tendinosis, and partial and complete tear according to MR arthrography findings. Fatty degeneration was quantified after measurement of signal intensity values within the region of interest (ROI) placed over SSP muscle. Signal intensity (SI) suppression ratio and SI index were calculated with the values obtained. Degrees of fatty degeneration depicted in normal subjects and subjects with rotator cuff injuries were compared. Median (min:max) was used as descriptive values. SI suppression ratio was -3.5% (-15.5:3.03) in normal subjects, whereas it was -13.5% (-28.55:-6.60), -30.7% (-41.5:-20.35), and -43.75% (-62:-24.90) in tendinosis, partial and complete tears, respectively. SI index was 0.75% (-6:11.5) in normal subjects. It was 10% (4.50:27), 26.5% (19.15:35.5), and 41% (23.9:57) in tendinosis, partial and complete tears, respectively. The increase in degree of fatty degeneration parallels the seriousness of tendon pathology. CS-MRI is a useful method for grading fat accumulation within SSP muscle.

Background and Design: Pityriasis rosea (PR) is an acute onset, self-limiting papulosquamous skin disease. The etiology of the disease is totally unknown, however, many epidemiological and clinical studies have suggested that infectious agents may cause the disease. Seasonal changes in the incidence may be an epidemiologic evidence for potential infectious etiology. In this study, we aimed to analyze the demographic data of PR patients and to explore the role of climatic factors in the etiology of the disease. Material and Method: We retrospectively reviewed the patient files of PR cases that had been followed up in our clinic between 2000 and 2005. Demographic data of the patients as well as the date of applications were recorded. Temperature, raining, pressure and humidity data for the City of Bursa for years 2000-2005 were obtained from the General Directorate of Meteorology, Republic of Turkey. Any potential relationship between onset time of PR and meteorological parameters was investigated statistically by using cluster analysis. Results: We reviewed the medical records of 413 patients, of whom 271 were female and 142 were male. Herald plaque was seen in 88 patients (21.3%). Pityriasis rosea was observed predominantly in persons between 20 and 29 years of age (139 patients; 33.6%). Distribution of number of cases between 2000-2005 was 51, 57, 80, 75, 63, 87. The highest number of patients was seen in winter (n:122; 29.5%) followed by spring (n:101; 24.4%), autumn (n:101; 24.4%) and summer (n:89; 21.7%). No statistically significant difference was found between annual and seasonal changes in the incidence of PR (p>0.05). Conclusion: We conclude that although the relation between PR and seasonal factors was not statistically significant in our study, multi-centric studies on large series of patients are needed to further investigate this topic.

To create a better scoring system for outcome prediction for patients with Fournier's gangrene in order to design more appropriate and feasible management strategies. Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier's gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with the Fournier's gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score. The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P < 0.001). The receiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002). The power of the novel scoring system introduced in this study proves that in patients with Fournier's gangrene, the extent of the gangrene as well as the patient's age and physiological status have a significant effect on the outcome.

Deficient dental root development has been reported after conventional pediatric anticancer therapy but less information is available on children with solid tumors and lymphomas.We examined dental development from panoramic radiographs (PRGs) of 37 childhood cancer survivors (CCS) treated under the age of 10 years with multimodal chemotherapy (CT) and/or head and neck radiotherapy (RT). A novel defect index (DeI) was used to describe the total damage to permanent dentition. The DeI was also tested in matched controls.All CCS had dental disturbances including abnormal root development (86.4%), microdontia (13.5%) and tooth agenesis (16.2%). Testing the controls gave the mean DeI value 1.9 ± 2.7 (range, 0-12), while the index scores in the study group varied from 0 to 49 (mean 10.8 ± 11.2) (P0.01). The statistical differences in the mean DeI values were insignificant between CT and CT and RT groups (P0.05).Children treated for solid tumors and lymphomas are at considerable risk of some disturbances in developing dental structures. RT increased the severity of disturbances induced by CT. Studies should further elucidate dose-, age and time-related effects of anticancer treatment on dental development.

The objective of this study was to test the reliability of the Turkish version of PRTEE (PRTEE-T) as a specific scale for LE, and to investigate the validity of this version by correlating and comparing its outcomes with those of the scales DASH (the Disabilities of the Arm, Shoulder, and Hand questionnaire) and Quick DASH (QDASH), pain (VAS), tenderness, and maximal grip strength (MGS). Fifty patients (14 males and 36 females) with the diagnosis of lateral epicondylitis were included in this study. PRTEE Questionnaire was translated into Turkish according to the guideline for the cross-cultural adaptation process. All patients filled the PRTEE-T questionnaire. Maximal grip strength, pain, and tenderness were measured. Next, the patients filled the DASH forms. The patients were asked to reevaluate PRTEE-T 2 h after they filled the first form. The internal consistency reliability of PRTEE-T was assessed by calculating 'if item deleted' using Cronbach alpha and 'Item-total correction' coefficient for each item of the questionnaire. Consistency of subscales was assessed using Spearman's rho correlation coefficient. In addition to correlation analysis, test-retest values were compared using Wilcoxon test to assess the changes on the basis of the items. Criterion validity of the scale was measured using DASH and QDASH scales, and construct validity was measured using tenderness and maximal grip strength values by Spearman's rho correlation coefficient. For internal reliability; Cronbach alpha coefficient was calculated 0.837 by the overall assessment of the scale. For test-retest reliability; correlation coefficient was found 0.920 (P < 0.001). Comparison of the scores obtained from test-retest measurements showed no significant difference (P > 0.05). The pain sub-scale, the function sub-scales, and the overall score from the PRTEE-T each showed significant correlations with the DASH score (P < 0.001), QDASH score (P < 0.001), and maximal grip strength (P < 0.001). Significant correlation was found between the sub-scales of the scale. The results of our study have shown that the Turkish version of a specific and practical scale developed for LE can be both valid and reliable. PRTEE-T is easy to apply in a relatively short period and may prove to be valuable for evaluation and follow up of the patients in daily clinical practice.

This study provides insight into the prevalence and correlates of anxiety among university students in Bursa, Turkey. A total of 4850 students participated in the study. Students completed Spielberger’s State—Trait Anxiety Inventory, as well as a questionnaire designed to determine risk factors of anxiety. About 29.6% and 36.7% of the students in the study reported state and trait anxiety scores of more than 45 points, respectively. Controlling for gender and family socioeconomic status, the following characteristics predict both state and trait anxiety: the status of family relationships, difficulty understanding lectures, difficulty adapting to university life, having to solve problems independently, a vision of self-sufficiency in problem solving, negative life experience, and satisfaction with their department of study. The following factors are predictive of only state anxiety: boarding conditions, having a chronic disease, and exam periods. The risk factors for trait anxiety scores include the following: anxiety about the future, preparation for work life, class of study, private relationships, and attitude of the family toward their child. Families, secondary education institutions, and universities should cooperate to eliminate risk factors for anxiety among university students.

Background: Our aim in the present study was to describe the quality of life (QOL), evaluate pulmonary function, and compare demographic and clinical characteristics with QOL in long-term survivors of non-small cell lung cancer treated with radical or postoperative radiotherapy. Methods: Twenty-eight patients were recruited in the study. QOL was evaluated using The European Organization for Research and Treatment of Cancer, Quality of Life Core Questionnaire (EORTC QLQ-C30, v.3). Statistical analysis was performed by SPSS 14. Results: Patients' files were reviewed in October 2006. Median duration of follow-up was 46 months (range: 25-125 months). Seven of 9 scales were found to meet the minimal reliability limit (Cronbach's alpha >0.70). The lowest and highest reliability coefficients were 0.56 and 0.93 for social and role functioning, respectively. All interscale correlations were statistically significant (P < 0.01). The strongest positive correlation was found between physical functioning and, role and cognitive functioning (r = 0.59, r = 0.37 or P = 0.01, P = 0.05, respectively). The highest correlation of EORTC QLQ-C30 and the Katnofsky performance scale (KPS) during the questionnaire was found to be with physical functioning and constipation (r = 0.41. r = 0.44 or P = 0.02, P = 0.01, respectively). When the effect of various demographic and clinical parameters on QOL was evaluated; initial KPS, age, educational level, health insurance status, stage, chemotherapy, comorbid disease, and passive smoking were determined as significant factors influencing QOL. Physical, role, cognitive, and emotional functions were found to be significantly lower in the presence of dyspnea (r = 0.42, r = 0.58, r = 0.50, r = 0.63 or P = 0.02, P < 0.01, P < 0.01, P < 0.05, respectively). Regarding the symptom scales, dyspnea was found to be correlated with increasing of fatigue, pain, insomnia, and appetite loss (r = 0.52, r = 0.40, r = 0.64, r = 0.38 or P < 0.01, P = 0.03, P < 0.05, P = 0.04, respectively). The parameters of pulmonary function tests (FEV1, FVC, and FEV1/FVC) did not show any significant relation with any scale of QOL. Conclusion: Overall, we found that QOL of our patients who survived at least 2 years after radiotherapy, was good. The Turkish version of the EORTC QLQ-C30, v.3 is a valid and reliable instrument for Turkish lung cancer patients and can be used in clinical studies. We believe further studies are needed to have a better understanding of patients' pretreatment and posttreatment .

Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >= mmol/l and hemoglobin glycated (A1C) >= 9% under maximal CAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty Patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9 +/- 1.4% to 7.7 +/- 1.1% in group 1 and 11.0 +/- 1.4% to 8.1 +/- 1.4% in group 2. FBG levels were significantly decreased from 11.9 +/- 2.7 to 7.1 +/- 2.3 mmol/l in group 1 and 11.1 +/- 2.5 to 6.8 +/- 1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3 +/- 3.8 to 10.3 +/- 3.0 mmol/l in group 1 and 14.0 +/- 3.1 to 8.9 +/- 2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Syptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulance incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.

Students start their medical study with the opinion that saving lives and preventing deaths are the main goals of medicine. So, what will they do when faced with dying patients? How will they feel; how will they communicate? These are important, but often unspoken and neglected, issues.We assessed the attitudes and opinions of first-year medical students regarding doctor-patient communication, chronic diseases, death, and dying patients at Uludag University Medical School in Bursa/Turkey. Our secondary objective was to delineate the educational needs related to this field.Cross-sectional survey of the first-year students in the class of 2004-2005. Students were evaluated using a questionnaire consisting of six questions and 18 Likert-type statements.Completed questionnaires were received from 253 of the 265 (95.5%) students. According to the students, the most fatal diseases were cancer and AIDS. Students strongly agreed with the importance of talking to patients, where female students agreed more than males with this statement (p0.05). Most students disagreed that patients should be informed that they are dying. Older students feared less for the death of patients. Female students would like to work in an environment where they can communicate with their patients and where they can be with them for a longer period.The results of this survey indicate that the need of providing palliative care, enhancing communication skills with terminally ill patients, and integrating different teaching strategies are important aspects of the undergraduate medical curriculum.

This study was performed to compare the efficacies of Injury Severity Score (ISS) and New Injury Severity Score (NISS), and to investigate whether replacing ISS with NISS in Trauma and Injury Severity Score (TRISS) changes the predictive power for mortality.We retrospectively analyzed 550 patients aged over 16 years seen in our center over a period of four years who had injuries in at least two organ systems. The ISS, NISS and TRISS were calculated for each patient. TRISS was calculated in two ways: TRISS 1 with age, Revised Trauma Score (RTS) and ISS, and TRISS 2 with age, RTS and NISS. The cut-off values for TRISS 1, TRISS 2, ISS and NISS were determined by ROC analysis.The ideal cut-off values for the prediction of mortality were 21.0 (AUC: 0.907) for ISS and 25.0 (AUC: 0.914) for NISS. There was no statistically significant difference between the ROC curves of ISS and NISS. The ideal cut-off values for predicting mortality were 90 (AUC: 0.934) for TRISS 1 and 86 (AUC: 0.935) for TRISS 2. There was no statistically significant difference between the ROC curves of TRISS 1 and TRISS 2.Use of NISS instead of ISS in the TRISS model demonstrated no significant difference, and it can thus be recommended for use.

Being aware of the morphologic differences in the nasal anatomy between men and women during the cosmetic rhinoplasty is essential because feminization of a male nose is not a very rare complication. Although there is no difference in the techniques of male and female rhinoplasty, the anthropometric differences have to be considered. This morphometric study evaluated the nasal shapes in both sexes and the related differences in the nostril forms. The nostril forms were separated into 4 main groups such as teardrop, heart shaped, round, and triangular. In this landmark-based morphometric study, significant relations of nostril forms to the nasal shape, frontonasal, and nasolabial angles were found. The results of this study should make us think about these relations of nostril forms to the nasal shapes and should be a basement for further clinical studies enhancing the plans of the corrective surgery.

5-Fluorouracil-based chemoradiotherapy is the most widely used treatment modality in the adjuvant treatment of rectal cancer. Capecitabine represents a valuable alternative to 5-Fluorouracil in this situation.Patients with stage II and stage III rectal adenocarcinoma, who were included in this analysis, received adjuvant chemoradiotherapy consisting of external-beam radiotherapy (50.4-54Gy) either with 5-Fluorouracil at a median dose of 300 mg/m2/day by protracted venous infusion for 5 days a week, or capecitabine at a median dose of 1650 mg/m2/day for 5 days a week after surgery. The data concerning the toxicity and the efficacy of the treatments were compared in patients treated with 5-Fluorouracil- and capecitabine-based chemoradiotherapy.Forty-three patients received 5-Fluorouracil, and 24 patients received capecitabine during adjuvant radiotherapy. Although there were no differences between the groups in terms of toxicity rates, distant metastasis-free survival, disease-free survival, and overall survival rates; a trend for improved loco-regional recurrence-free survival rate was observed in the capecitabine arm (p = 0.063).Capecitabine is at least as effective as 5-Fluorouracil in the postoperative treatment of rectal adenocarcinoma. Considering the trend for improved loco-regional recurrence-free survival rate in the capecitabine arm, it seems that the drug exerts better synergy with radiotherapy in this situation.

Aim: Autoimmune disorders are considered to be associated with a Th1 immune response whereas allergic diseases with a Th2 response. Studies mainly performed on children revealed conflicting results regarding the association of atopy/allergic disease and autoimmune disorders. Therefore, we aimed to investigate the prevalence of allergic diseases in adult Type 1 diabetic patients. Methods: Eighty-nine Type 1 diabetic patients and 64 controls were enrolled into the study. Skin-prick test and European Community Respiratory Health Survey questionnaire were performed on all cases. Patients who gave at least one positive answer to questions about asthma in the questionnaire underwent pulmonary function test and methacholine challenge test. Results: Patients’ mean age were similar in diabetic patients and controls (28.2±8.9 and 28.1±5.2 yr; respectively). In skin-prick test. the rate of positive response to at least one allergen was not significantly different in diabetes (29.2%) and in the control group (31.3%). In European Community Respiratory Health Survey questionnaire, diabetic patients waked up by an attack of cough more than controls did. The rate of physician-diagnosed asthma was similar in both groups. There was no difference between the 2 groups based on the answers of other questions about asthma and other allergic diseases such as allergic rhinitis, eczema, and drug allergy. Conclusion: We found that atopy frequencies were similar in an adult population of Type 1 diabetic patients and controls. Although asthmatic symptom prevalence is increased in diabetic patients, the incidence of current asthma was similar in both groups.

Background: Physical and hormonal changes during pregnancy alter breathing patterns of pregnant women. It is possible that occult disordered breathing during sleep may be a risk factor for the development of pregnancy-induced hypertension (PIH) and preeclampsia. Objective: Our aim was to determine the incidence of self-reported snoring in pregnant women, and to investigate the relationship of snoring, obesity and neck circumference to PIH and preeclampsia. Methods: 469 pregnant women and 208 age-matched nonpregnant women were included in the study. Both groups were asked to complete a questionnaire. Maternal complications were retrieved from the medical records. Results: Habitual snoring was reported from 1.9% of nonpregnant women, 2.5% of pregnant women prior to pregnancy and 11.9% of those same women during the third trimester of pregnancy (p < 0.001). Age, smoking during pregnancy, and weight before delivery were independent risk factors for habitual snoring in pregnancy. PIH and preeclampsia developed in 20 and 10.9% of pregnant women with habitual snoring, as compared to 11 and 5.8% of non-snoring pregnant women (p = 0.045, p = 0.125, p = 0.415), respectively. In women who developed preeclampsia, weight before pregnancy, weight before delivery and neck circumference were significantly higher in univariate analysis. Neck circumference was an independent risk factor for PIH and preeclampsia according to logistic regression analysis. Conclusion: The incidence of snoring is significantly higher in pregnant women than in nonpregnant women. Snoring may indicate a risk of PIH. Neck circumference was an independent risk factor for both PIH and preeclampsia.

Background/Aim: Mortality resulting from cardiovascular disease in patients with end-stage renal disease (ESRD) is high. In this study we sought to investigate the clinical value of the malnutrition-inflammation-atherosclerosis (MIA) syndrome for long-term prediction of cardiovascular mortality in patients treated with ESRD. Methods: A total of 42 ESRD patients on hemodialysis were enrolled. Inflammatory markers and nutritional parameters were determined. Carotid atherosclerosis was investigated by ultrasonographically evaluated carotid intima-media thickness (cIMT). Mortality was evaluated at a 5-year follow-up. Results: No correlation was evident between nutritional markers and inflammatory indexes. cIMT was inversely correlated with predialysis serum albumin. In the overall population of 42 patients, 11 (26.2%) died of cardiovascular causes during follow-up. Kaplan-Meier survival curves indicate that cIMT (≧0.9 mm), C-reactive protein (CRP) (>1 mg/dl), and serum albumin (Conclusions: We have demonstrated that cIMT, CRP and serum albumin predict long-term mortality in ERSD patients. Our study suggests that further investigation of the MIA syndrome will provide insights into the susceptibility to CVD in this patient group.

To determine the role of ultrasonography (US) and computed tomography (CT) in the evaluation of ascites etiology.From 2000-2006, patients admitted to the Radiology Department, Uludag University Medical School Hospital, Bursa, Turkey, were studied to determine the etiology of ascites, or those in whom ascites was determined during the course of other investigations were evaluated using US and CT. Existence of septa-debris, accompanying organ pathology, omental involvement, intestinal wall thickening, peritoneal implant, lymph node, diameter of portal vein, thickening of gall bladder wall, pleural effusion, collateral vascular structure, and cavernous transformation were also investigated.A total of 30 cases were included. Causes were determined to be malignant in 15 (50%) cases and 15 (50%) benign. The US was significantly superior to CT in the evaluation of gall bladder thickening. Omental thickening, thickening of intestinal wall, and peritoneal implant development were seen significantly more frequently in malignant compared to benign cases, while thickening of the gall bladder wall was seen more frequently in benign cases. Ascites density of malignant cases detected in slices without contrast was higher than in benign cases. The probability of malignancy was 98% when omental thickening, thickening of intestinal wall, and peritoneal implant were present together in the same case.Although CT and US may help to evaluate ascites, however, the differential diagnosis of ascites etiology remains a challenge.

To compare accuracy and to check the suitability of the Glasgow Coma Scale (GCS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the New Injury Severity Score (NISS) and the Trauma and Injury Severity Score (TRISS), the scoring systems widely used in international trauma studies, in the evaluation of the "life threatening injury" concept established by the Turkish Penal Code.The age, sex, type of trauma, type and localizations of wounds, GCS, RTS, ISS, NISS and TRISS values, the decision of life threatening injury of 627 trauma patients admitted to Emergency Department of the Uludag University Medical School Hospital in year 2003 were examined.A life-threatening injury was present in 35.2% of the cases examined. GCS, RTS, ISS, NISS and TRISS confirmed the decision of life threatening injury with percentages of 74.8%, 76.9%, 88.7%, 86.6% and 68.6%, respectively. The best cut-off point 14 was determined in the ISS system with 79.6% sensitivity and 93.6% specificity. All of the cases with sole linear skull fracture officially decided as life threatening injury had an ISS of 5, a NISS of 6 and the best scores of GCS (15), RTS (7.8408) and TRISS (100%).ISS and NISS appeared to be the best trauma scoring systems that can be used for the decision of life threatening injury, compared with GCS, RTS and TRISS. Thus, ISS and NISS can be acceptable for using the evaluation of the life threatening injury concept established by the Turkish Penal Code.

To determine whether there is a difference between risk factors in patients diagnosed to have clinically documented lower extremity venous disease after confirming the diagnosis radiologically by ultrasonographic and venographic evaluation.This study was performed from January 2002 to January 2005 in Bursa, the fourth biggest city of Turkey, situated in the west of the country in the Marmara Region. The study center is a private imaging center working in conjunction with the Department of Health, which performs diagnostic, and therapeutic vascular protocols in the region. Five hundred and fifty-three cases with clinically and radiologically documented diagnoses were evaluated with Multi-Variate Statistical Package 3.13 for the presence of pre-defined clusters of 14 different variables. Other statistical analyses were performed by the Statistical Package for Social Sciences, version 13.0.Three different clusters were defined. The variables used to define the clusters were: age, gender, educational level, presence of smoking, amount of smoking (pack/per year), disease symptoms, presence of heart disease, and radiologically documented diagnosis.Chronic venous insufficiency and varicose veins are venous system diseases that are most commonly present in association with more than one concomitant risk factor.

Ercan, Ilker/0000-0002-2382-290X; Guney, ibrahim/0000-0001-8290-6532 WOS: 000247821500008 PubMed: 17538981 Sexual dimorphic characteristics, which play an important role in human evolution studies and biological research, can be studied morphologically and metrically. Geometric morphometrics allows a better assessment of morphological characteristics. Statistical shape analysis has a long history in neuroanatomical and other research. The aim of this study was to identify shape differences of the corpus callosum between genders. Landmark coordinate data were collected from two-dimensional magnetic resonance imaging scans of 93 homogeneously aged patients, 45 men and 48 women. These data were analyzed using Euclidean distance matrix analysis and thin plate spline analysis. The general shape variability of the corpus callosum of men was greater than that of women (men, 0.134; women, 0.097). We found no significant difference between sexes in the general shape of the corpus callosum, but we did find significant differences in the distances between some landmarks. Deformation of the corpus callosum between men to women was mainly detected in the posterior of the corpus callosum. These results serve as a reference for future studies on shape alterations of the corpus callosum associated with certain conditions.

Objective: We hypothesized that intermittent hypoxia might influence serum substance P levels, and that this effect might in turn contribute in excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS). Patients and methods: Fifty-five patients with newly diagnosed OSAS and 15 age-matched nonapneic control subjects were enrolled in this study. Full polysomnography was performed in all patients. Single blood samples were drawn between 8:00 Am and 9:00 Am after the sleep study. Substance P levels were analyzed with a competitive enzyme immunoassay (substance P EIA kit; Cayman Chemical; Ann Arbor, MI). Results: There were no significant differences in age, gender, body mass index, smoking habit, and snoring between the two groups. Serum substance P levels in the OSAS group were significantly lower than that in the control group (p < 0.0001). Serum substance P levels were positively correlated with rapid eye movement sleep (r = 0.330, p = 0.049) and slow-wave sleep (r = 0.324, p = 0.049) phases. Serum substance P levels were negatively correlated with Epworth sleepiness scale score (r = - 0.253, p = 0.048), number of total apneas during the night (r = - 0.247, p = 0.036), number of respiratory events during the night (r = - 0.266, p = 0.024), apnea-hypopnea index (r = - 0.287, p = 0.015), respiratory arousal index (r = - 0.267, p 0.026), time spent in apnea and hypopnea (r = - 0.307, p 0.01), average oxygen desaturation (r=- 0.265, p = 0.026), and oxygen desaturation index (r=- 0.254, p = 0.031). Conclusion: We concluded that EDS seen in some of the OSAS patients might be associated with various pathophysiologic mechanisms including substance P levels.

PURPOSE. To compare the amount of ultrasound (US) energy and balanced solution (BS) re- quired for burst mode and pulse mode during bimanual phacoemulsification surgery. METHODS. One hundred cases were divided into two groups (the pulse mode Group 1 (50 eyes), the burst mode Group 2 (50 eyes)). One surgeon (M.B.) performed phaco - emulsification procedures using topical anesthesia with the AMO Sovereign in all patients. The technique was based on the nuclear hardness and surgeon's criteria and performed bi- manually. The surgery time, total ultrasound time (UST) and effective US power (USP), and used balanced solution (BS) were retrospectively compared. RESULTS. The mean surgery time, mean UST, and mean used BS volume were not statisti- cally different in both groups (p>0.05). The mean EPT was statistically highly different in both groups (p>0.001). There was a slight tendency toward more surgery time in Group 2 than in Group 1, although the difference was not significant (p=0.146). Statistically signif- icant higher results (Group 1: r=0,889, p

The M30-monoclonal antibody recognizes a neo-epitope of cytokeratin 18 which is formed after caspase-cleavage during apoptosis. Caspase-cleaved cytokeratin 18 is released from apoptotic cells into circulation. The aim of this study was to evaluate the relationship between M30-antigen level and chemotherapy response in neoadjuvant treatment of breast cancer. Forty-two patients with invasive breast carcinoma received 4 cycles of anthracycline based neoadjuvant chemotherapy. Serum samples were obtained for assessment of M30-antigen levels before the administration of first chemotherapy cycle (baseline), and then after 24 and 48 hours for determination of chemotherapy induced apoptosis. M30-antigen levels at 24 and 48 hours were found to be significantly higher than baseline (p < 0.001, p = 0.003, respectively). M30-antigen levels in responders showed statistically significant increases at 24 and 48 hours (p < 0.001; p = 0.004, respectively), while statistically significant increases were not observed in nonresponders. Percentage change of M30-antigen levels was significantly higher in responders than nonresponders at 24 hours (p = 0.020). In conclusion, our study revealed a significant relationship between increases of M30-antigen levels in serum and overall response to therapy.

To investigate the effects of venous diseases at different anatomical localizations on the qualities of life of patients with varicose veins.The study included 354 cases, which was referred to a private vascular and interventional radiology center in Bursa, Turkey between January 2005 to January 2006. The cases were diagnosed with visual inspection and were clinically indicative of varicose veins. Color Doppler ultrasonography was used to radiologically examine the varicose veins. All cases were accepted as class II criteria according to the Clinical, Etiologic, Anatomic, Pathophysiologic classification. The generic Short Form Health Survey-36 (SF-36) was used to measure physical and mental quality of life (QOL). High scores indicated good QOL. The Statistical Package for Social Sciences version 13.0 program was used for the statistical evaluation.When the life SF-36 quality parameters of cases with different anatomical localizations of the varicose veins were examined, only the mental health scores were found to differ in different groups (p0.01). In females and males with superficial venous disease, significant differences were found in physical function, physical role and pain among the physical health scale components, and in vitality and emotional role scores among the mental state determinants. When females and males with deep vein disease were compared, significant differences were found among both physical and mental health determinants.Anatomical localization of lower extremity varicose veins can be accepted as a predictive factor in determining the life qualities of patients with varicosities in their lower limb, and should be used to regulate their therapy and follow up protocols.

Objective To examine the relationships between the expression of protein Nm23 and surgical stage, histologic grade, histopathologic findings, and survival in women with endometrial carcinoma. Methods 19 patients with lymph node involvement were matched with 24 patients without lymph node involvement and the best paraffin-embedded blocks were selected for Nm23 immunohistochemical staining. The slides were evaluated semiquantitatively according to their degree of cytoplasmic staining. Statistical analysis was performed to determine whether there was a relationship between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, lymph node metastasis, and/or lymphovascular space involvement. Survival analysis was also performed. Results Slides from 15 patients (79%) with lymph node involvement and 22 patients (88%) without lymph node involvement were found to be positive for Nm23 ( P = 0.01). No significant relations were observed between Nm23 expression and surgical stage, histologic grade, depth of myometrial invasion, or lymphovascular space involvement. Nm23 expression was found to be significantly related to lower rates of lymph node metastasis and longer survival ( P = 0.02). Conclusion Elevated Nm23 expression is related to lower rates of lymph node metastasis and longer survival.