Search

Aim: We investigated the role of the H63D mutation on the development of hepatic iron overload and hepatic injury in non-alcoholic steatohepatitis patients and its association with insulin resistance and metabolic alterations.Material and Methods: Thirty-two patients with NASH, who were diagnosed at Hacettepe University Gastroenterology Outpatient Clinic depending on clinic and laboratory findings, were included into study. Metabolic syndrome was sought. Waist hip ratio and body mass index were calculated. H63D gene mutation, iron level at serum and liver biopsy specimens and histopathologic exam on liver biopsy specimens were studied in study group. Fasting and post-prandial blood sugar, lipid profile, 75-gr-glucose tolerance test and HOMA insulin resistance were measured to document the insulin resistance and metabolic syndrome.Results:Thirty-two patients with mean body mass index was 28.1 kg/m23,3 were included in study. Hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, insulin resistance were found at 25 %, 37 %, 56 %, 28 % and 39 %, respectively. Serum ferritin and transferrin saturation values were within normal limits in all but except 2 patients. Hepatic iron concentration was ≥ 1600g in 12 (41%) of patients. H63D mutation was homozygote in 1 (3%) and heterozygote 12 (40%) patients. Therefore the H63D allele frequencies were 3.3% for homozygous, 20% for heterozygous and as total 23.4%. The patients with H63D mutation had normal serum and tissue iron parameters. There was no statistically significant relationship between H63D mutation and histopathological findings. Two hour blood sugar levels were higher in Stage 2 patients than in Stage 1 patients (p=0.05), and also higher in Class 4 patients than in Class ≤3 patients (p=0.05).Conclusion: The H63D mutation did not affected either serum iron parameters or histopathology. However, the insulin resistance was related with fibrosis in non-alcoholic steatohepatitis patients.

Background and Aims: The aim of the study was to evaluate the etiology, treatment, and prognosis in children who had presented at our clinic with corrosive substance ingestion and comparison of our results with the literature. Materials and Methods: The patients were put on nil by mouth and broad-spectrum antibiotics were administered. Oral fluids were started for patients whose intraoral lesions resolved and who could swallow their saliva. Steroids were not given, a nasogastric catheter was not placed, and early endoscopy was not used. Results: A total of 968 children presented at our clinic for corrosive substance ingestion during the 22-year period. The stricture development rate was 13.5%. Alkali substance ingestion caused a stricture development rate of 23%. A total of 54 patients required 1-52 sessions (mean 15 ± 12) of dilatation. Conclusion: We do not perform early endoscopy, administer steroids, or place a nasogastric catheter at our clinic for patients who had ingested a corrosive substance. This approach has provided results similar to other series. We feel that determining the burn with early esophagoscopy when factors that prevent or decrease the development of corrosive strictures will be very important.

This study was presented as poster presentation at 33rd Annual Meeting of the Turkish Association of Pediatric Surgeons, Antalya, Turkey, on Oct 28-31, 2015. Xanthogranulomatous inflammation is common in interval appendectomy specimens in adults, but it is unusual in children. Histopathologic specimens of interval appendectomy, within an 8-year period, were reevaluated to assess the true incidence. A computer search of the hospital database of all appendectomies was performed between January 2008 and June 2015 to identify all interval appendectomy cases. A total of 2694 patients underwent appendectomies. Of these, 13 were interval appendectomies. After pathologic evaluation, 2 (15.4%) of the specimens were reported as xanthogranulomatous appendicitis (XA). Histopathologic examination of these interval appendectomy specimens, granulomas (59%), xanthogranulomatous inflammation (36%) and Crohn-like changes (50%) were common in adults. However, XA is a particularly rare clinical entity among children. Two cases of XA were reported in children in the English literature. One was a 12-year old boy that underwent interval appendectomy 6 weeks after an episode of acute appendicitis. The other was an 11-year old boy with acute (non-interval) appendicitis, but the complete blood count was suggestive of an acute suppurative inflammation. These two cases are the 3rd and 4th cases of XA reported in children in the English literature, and both were managed by interval appendectomy. Thus, XA may be encountered in interval appendectomy specimens and association with IBD has to be ruled out. © 2016 The Authors. Published by Elsevier Inc.

Atici A, Yilmaz E, Karaman A, Apaydin S, Afsarlar CE. Tuba-ovarian auto-amputation caused by ovarian teratoma in an adolescent girl. Turk J Pediatr 2017; 59: 90-92. Ovarian auto-amputation is an extremely rare condition commonly encountered in the perinatal period. Spontaneous or secondary torsion of the ovary caused by an ovarian lesion may result in infarction and subsequent auto-amputation of the ovary. This paper demonstrates a case that underwent laparoscopic appendectomy with an incidental calcified auto-amputated right ovary. A 16-year-old adolescent girl was admitted to our department with a history of one-day abdominal pain. Physical examination of the patient revealed abdominal tenderness and rigidity on right lower quadrant. Her white blood cell count was 11x103/mL, and C-reactive protein was 69 mg/L. The patient underwent a laparoscopic appendectomy with a provisional diagnosis of acute appendicitis, and further exploration revealed a 2x2 cm white ovoid mass floating freely in the pelvis. The left ovary was clearly identified in its usual localization, but the right tuba was blindly ending without any fimbria or ovary. Postoperative course of the patient was uneventful, and she was discharged on postoperative day 2. The histopathological examination revealed a necrotic calcified ovarian teratoma. Auto-amputated ovary is a rare occasion mostly encountered during perinatal period, and it may be unilateral or bilateral. An auto-amputated ovarian mass may rarely be a teratoma although the most common cause of auto-amputation during perinatal and adolescent period is ovarian torsion due to an ovarian cyst.

Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01994720.

research Amaç: Postoperatif yapışıklıklar intestinal obstrüksüyona yol açması, reoperasyon durumlarında abdominal eksplorasyonu zorlaştırması, organ yaralanmalarına sebep olması nedeniyle hem hasta hem de hekimler için önemli bir klinik durumdur. Bu çalışmada brid ileus gelişimine etki eden faktörlerin saptanması ve brid ileusdaki tedavi sonuçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: 2005-2010 yılları arasında çeşitli nedenlerle laparotomi yapılan hastalar brid ileus gelişimi açısından retrospektif olarak değerlendirildi. Bulgular: Bu çalışmaya laparotomi yapılan 3271 hasta dahil edildi. Apandisit en sık laparotomi endikasyonuydu (%66). 152 hastada (%4,6) postoperatif brid ileus geliştiği tespit edildi. Bunların %88'inin postoperatif ilk 6 ayda, %99'unun da ilk 3 yıl içinde geliştiği görüldü. Yaş ve cinsiyet ile brid ileus gelişimi arasında ilişki yoktu. Vakaların %23'ü kirli vasıfta ameliyatlardı. Temiz, temiz kontamine ameliyatlardan sonra brid ileus gelişme oranı %3,4 iken, kontamine ve kirli ameliyatlardan sonra bu oran %10,9 olarak bulundu. Batın içerisine dren yerleştirilmesinin brid ileus gelişimini etkilemediği saptandı. Ameliyat süresi uzadıkça postoperatif brid ileus gelişme oranının arttığı tespit edildi. Ayrıca ameliyatta Meckel divertikülü gibi ek patolojiler araştırılan hastalarda brid ileus gelişme oranının 3 kat arttırdığı görüldü.Brid ileus gelişen hastaların %61'i nonoperatif-konservatif yollarla tedavi edilirken %39'unda cerrahi girişim gerektiği tespit edildi. Sonuçlar: Çalışmamızda batın içinde uygulanan ek girişimlerin, operasyon süresinin uzun olmasının ve intraperitoneal kontaminasyonun brid ileus gelişimini artırdığı gösterilmiştir. Bu konulara dikkat edilmesinin brid ileus gelişimini azaltabileceği düşünülmüştür. Çocuk yaş grubunda uygun vakalarda konservatif tedavi ile daha yüksek oranlarda başarı sağlanabileceği kanısına varılmıştır Aim: Postoperative adhesions become a serious clinical state both for the patients and physicians, in case of reoperation, because adhesions make exploration difficult, may induce organ injury and so increases the operative time. In this study we aimed to asses the factors influencing the developement of brid ileus and to analyse the results of treatment.Material and Method: In terms of adhesive ileus development, a retrospevtive review of laparatomy performed patients in our hospital’s pediatric surgery department was conducted. Results: In this study 3271 patients were included. Most common indication for prior laparotomy was appendicitis (66%). Median age was 8,2 years and 61% of patients were male. Median follow up period was 5 years. Adhesive ileus occurred in 152 patients (4.6%). 88% of adhesive ileus occurred within the first 6 months and 99% within first 3 years. There were no significant relationship among patient age, gender and adhesive ileus development. 23% of the all cases were soiled abdominal procedures. The incidence of adhesive ileus was 3,4% after clean procedures and 10,9% after contaminated and soiled abdominal procedures. The drainage materials that were used following contaminated operations did not affect the development of adhesive ileus. Mean operation time was 60 minutes. It was observed that prolonged operation time increased the development of adhesive ileus, and also exploring additional pathologies such as Meckel’s diverticulum increased adhesive ileus incidence 3 times more.Conservative treatment was successful in 61% of the patients with adhesive ileus and only %39 of them were operated for adhesions. Patients under the age of one with adhesive ileus required surgical correction more frequently than the other age groups. The success rate of conservative treatment was higher in patients who are older than 1 year old and in the setting of first adhesive ileus attack.Conclusion: This study demonstrated that traumatic and unnecessary interventions to tissues, prolonged surgery time and intraperitoneal contamination during the operation have increased the adhesive ileus development. Additionally, we suppose that conservative treatment of adhesive ileus in children has high success rate

Phenotypic heterogeneity in familial Mediterranean fever (FMF) disease indicated that FMF is not a simple monogenic disease. Therefore it has been suggested that epigenetic factors can be one of the reason for the variations. We undertook this study to test potential involvement of miRNAs in the pathogenesis of FMF.miRNA array was performed on whole blood RNA samples from 6 healthy controls (-/-), 6 FMF patients (M694V/M694V), 6 carriers who displayed the disease phenotype (M694V/-) and 6 healthy carriers (M694V/-). The raw data was analysed by Multi Experiment Viewer (MeV) and candidate miRNAs were determined according to fold change (more than 2.0 or less than -2.0). The validation of differentially expressed miRNAs was done by qRT-PCR. Then we performed pathway analyses with using bioinformatics tools.14 miRNAs were found to be significant among groups through the analysis with MeV. miR-20a-5p, miR-197-3p, let-7d-3p and miR-574-3p were found to be associated with inflammatory pathway related genes according to DAVID analysis. MiR-20a-5p (FDR: 0,00, FCH: 5.55) was significantly up regulated whereas miR-197-3p (FDR: 0,00, FCH: -2.27) was down regulated in homozygotes patients. Both let-7d-3p (FDR: 0.00, FCH: 28.75) and miR-574-3p (FDR: 0.00, FCH: 3.95) were up regulated in heterozygote patients group.We showed that there are several differentially expressed miRNAs both in homozygote and heterozygote FMF patients compared to controls and healthy carriers. Thus we suggest that these miRNAs, related with inflammatory pathways may be responsible for the expression of the disease in FMF.

Sanayi devrimi ve modernleşmeye birlikte ihtiyacı ve sürekliliği daha fazla ön plana çıkan enerji kaynaklarının kullanımı, günümüzde gelişmenin ve kalkınmanın motorunu çalıştıran güç olmuştur. Ülkelerin kalkınma planları hazırlanırken göz önünde bulundurdukları parametrelerin içinde önemli bir yere sahip olan enerji kaynakları, kaynakların kullanım stratejileri ve buna bağlı politikaların gelişme süreçlerini yönlendirmektedir.Kalkınmak ve gelişmek için ihtiyaç önceliği her geçen gün artan enerji kaynaklarının ülke genelinde ulaşabilirlik ve kullanabilirlik imkânı her bölgede farklı seviyelerde görülmektedir. Sanayileşmenin fazla, nüfus oranının yüksek olduğu ve ayrıca ülke ekonomisine önemli miktarda döviz girdisi sağlayan bölgelerde bu kaynakların kullanımı daha fazla olmakta, buna bağlı olarak enerji kaynaklarının çeşitliliği de artmaktadır. Araştırmanın evrenini, Van kentinde bulun 17 mahalle oluşturmaktadır. Çalışma alanıyla ilgili gözlem ve mülakatlar yapıldıktan sonra 67 sorudan oluşan anket, bu mahallelerde bulunan toplam 510 haneye uygulanmıştır. Görüşülen kişilerin sosyo-ekonomik ve demografik bilgilerinin yanında; enerji kullanımı ve tüketimi, çevreye olan bakış açıları, yenilenebilir enerji kaynakları ile enerji tasarrufu ve enerjinin kaçak kullanımıyla ilgili düşüncelerinin ölçülmesine yönelik veriler yüz yüze görüşme tekniği ile toplanmıştır. Veriler toplandıktan sonra `Van kentinde enerji tüketiminin mekânla olan bağlantısı` değerlendirilmeye çalışılmıştır. Böylece enerji tüketiminde, öne çıkan tercihlerin ve tüketim alışkanlıklarının üzerinde yaşanılan mekânın ne kadar etkili olduğu belirlenmiştir. Çalışma; anket, mülakat, inceleme ve araştırmalarımız sonucunda elde ettiğimiz bilgilerin sentezlenip yorumlanmasıyla tamamlanmıştır.Araştırmanın sonucunda; kentte, enerji çeşitliğinin sağlanması, bu çeşitlikte yerli ve yenilenebilir kaynakların kullanım oranının arttırılması gerektiği görülmüştür. Ayrıca, enerjinin verimli tüketilmesi için araç-gereçlerin yenilenmesi; sanayi, ulaşım, konut ve hizmet sektörlerinde enerjinin akılcı kullanımına yönelik tasarruf önlemlerinin uygulanması, verimli ve tasarruflu enerji kullanılması için teşviklerin verilmesi gerekmektedir.Anahtar Kelimeler : Van Kenti, Enerjinin Çeşitliliği ve Tüketimi, Mekânsal Analiz. With the revolution of industry and modernization the usage of energy resources coming into prominence has been a power that triggers the motor of improvement and advancement. Energy resources that has an important role in parametres that is being taking into account while development plans of countries are being prepared directs the usage strategies of resources and development processes of policies in paralel with this.To developand progress, the opportunity of accessibility and availability of energy resources whose priority of needis increasing day by day is seen in different levels in every region. In the regions, where the industrilazation and, the population rate are high and the amount of foreign Exchange input to the country's economy is considerable, these resources are used more and consequently the diversity of energy resources also increases.The population of there search is consisted of 17 neighboorhoods stating in the city of Van. After the executed observation sand interviews with the working field, a survey consisted of 67 questions was applied to 510 houses stating in these neighboorhoods. In addition to socioeconomic and demographic data of the interviewed individuals the usage and consumption of energy, perceptions of neighbourhood, energysaving with reneweble energy resources and data aimed at testing thought about the illegal usage of energy are collected via face to face interview technique. After the data being gathered 'therelation of the energy consumption in the city of Van with the place' was tried to be assessed. So, in the consumption of energy the affect of the lived place on the preferences coming into prominence and the habits of consumption were defined. This process was completed with synthesizing and interpreting the data that wegather as there sult of our surveys, interviews, enquiries and researchs.In there sult of there search it is understood that it is needed providing variety of energy in the city and being increased of usagerates of local and renewablere sources in this diversity. Furthermore, for the efficient consumption of energy it is needed replacements of equipment sexecution of saving measures aimed at wisely usage of energy in the industry, transportation housing and service sector sand providing encouragements for the efficiently and economically usage of energy.Key Words : City of Van, The Variety and Consumption of Energy,Spatial Analysis. 176

In this study, three new hydrazide–hydrazone derivative compounds which contain choloroacetyl group have been synthesized and characterized. In the characterization, spectral techniques such as IR, 1 H NMR, 13 C NMR and UV–Vis spectroscopy techniques were used. Antibacterial effects of the synthesized compounds were investigated against Staphylococcus aureus ATCC 29213 , Enterococcus faecalis ATCC 29212 , Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853 . In the theoretical calculations Gaussian 09 software was used with the DFT/6-311+(d,p) basis set. Experimental X-ray analysis of compounds has not been studied. Theoretical bond lengths of synthesized compounds were compared with experimental bond lengths of a similar compound. Theoretical and experimental bond lengths are in good agreement with R 2 : 0.896, 0.899 and 0.900 for compounds 1, 2, and 3, respectively. For antibacterial activity, the most effective one was found to be N′-(4-bromobenzylidene)-2-chloro-N-(4-(3-methyl-3-phenylcyclobutyl)-thiazol-2-yl) acetohydrazide against P. a eroginaosa ATTC 27853 , among the studied compounds.

The proinflammatory enzyme caspase-1 plays an important role in the innate immune system and is involved in a variety of inflammatory conditions. Rare naturally occurring human variants of the caspase-1 gene (CASP1) lead to different protein expression and structure and to decreased or absent enzymatic activity. Paradoxically, a significant number of patients with such variants suffer from febrile episodes despite decreased IL-1β production and secretion. In this study, we investigate how variant (pro)caspase-1 can possibly contribute to inflammation. In a transfection model, such variant procaspase-1 binds receptor interacting protein kinase 2 (RIP2) via Caspase activation and recruitment domain (CARD)/CARD interaction and thereby activates NF-κB, whereas wild-type procaspase-1 reduces intracellular RIP2 levels by enzymatic cleavage and release into the supernatant. We approach the protein interactions by coimmunoprecipitation and confocal microscopy and show that NF-κB activation is inhibited by anti–RIP2-short hairpin RNA and by the expression of a RIP2 CARD-only protein. In conclusion, variant procaspase-1 binds RIP2 and thereby activates NF-κB. This pathway could possibly contribute to proinflammatory signaling.

Although response to colchicine has been proposed as one of the diagnostic criteria in patients with Familial Mediterranean fever (FMF), the validity of this response has not been validated. The aim of this study was to assess the efficacy of the response to colchicine and to evaluate the extent of the effect of placebo. A double-blind randomized placebo-controlled trial with a cross-over design was conducted. The frequency of FMF attacks, the disease score, physical examination, and acute phase reactants were assessed at 0, 3, and 6 months. Blood samples were collected for complete blood count (CBC), erythrocyte sedimentation rate (ESR), levels of serum C-reactive protein (CRP) and serum amyloid A (SAA), and MEFV mutation analysis in 79 patients with a preliminary diagnosis of FMF. Patients were randomly allocated to receive either drug A or drug B in a double-blind fashion. The designated drug was switched at 3 months. Patients taking colchicine had less frequent FMF attacks (median 0) and lower FMF disease score (median 0) when compared to those on placebo (median 1 and 3, respectively) (p = 0.002 and p = 0.007, respectively). In genetically confirmed FMF patients, median attack number and median disease score was 0 under colchicine treatment, whereas these parameters were significantly higher in the placebo group (median 2 and 8, respectively) (p = 0.007 and p = 0.02, respectively) suggesting that colchicine is more effective than placebo in reducing attacks and disease score. Positive and negative predictive values were 70.2 and 37.5 %, respectively. During the placebo period, patients had less FMF attacks when compared to that of the pre-study period (median 2 vs 6, respectively) (p

To define the frequency of familial Mediterranean fever gene (MEFV) mutations in ankylosing spondylitis (AS) and describe different clinical aspects of MEFV mutation carrier and noncarrier AS patients. Materials and methods: In 112 AS patients, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores were calculated. The frequencies of 12 different MEFV mutations were studied by multiplex polymerase chain reaction/reverse hybridization method and were compared to those of previously studied healthy controls for 5 common MEFV mutations. Results: MEFV mutations were identified in 46 of 224 (20%) alleles and in 39 (35%) of AS patients. The distribution of mutations was: M694V, 30% (14); E148Q, 30% (14); P369S, 17% (8); V726A, 13% (6); A744S, 8% (4); and K695R, 2% (1). There were no significant differences between MEFV mutation carriers and noncarriers with respect to sex, age of symptom onset, disease duration, peripheral joint involvement, acute phase reactant levels, and BASDAI and BASFI scores (P > 0.05 all). MEFV mutation allelic frequency was not different between AS patients and healthy controls after adjusting for mutations studied (34/224 versus 22/200; P > 0.05). Conclusion: Although we did not find significant clinical and laboratory differences between MEFV mutation carrier and noncarrier AS patients, further investigations are needed to define the impact of MEFV mutations on AS disease course.

Background/Purpose The aim of the study is to evaluate the diagnostic value of interleukin-6 (IL-6) level and neutrophil cluster of differentiation 64 (CD64) expression in diagnosis of acute appendicitis (AA). Methods A prospective controlled trail was performed. Children who were hospitalized with a diagnosis of right lower quadrant pain were our cohort. Serum samples for white blood cell, C-reactive protein (CRP), leukocyte CD64 expression, and IL-6 were obtained from the patients just after their admission. Operation was performed if appendicitis seemed probable, others were observed actively. Patients who had noncomplicated appendicitis were Group 1, patients who had complicated appendicitis were Group 2, and patients who had discharged after observation without operation with a diagnosis of nonspecific abdominal pain and had negative appendectomy without another surgical disease were Group 3. Results In this study, 49 patients were enrolled. CRP and CD64 levels were found higher in Group 2. IL-6 levels were found to be lower in Group 3 than Groups 1 and 2. Conclusions There was a difference between Group 2 and the other groups about CD64 levels. The CRP level and expression of leukocyte CD64 level did not effectively predict the diagnosis of noncomplicated appendicitis, but it predicted well the patients with complicated appendicitis. However, IL-6 levels are statistically significantly different between Group 3 and Groups 1 and 2. According to this result, IL-6 levels predicted well the patient with appendicitis. Applying additional diagnostic methods such as IL-6 levels seems to be helpful in reducing the numbers of false-positive diagnosis of AA.

The aim of this study is to investigate the user requirements of young adults with blindness regarding the information to be included/ mapped in two different types of audio-tactile mobility maps: (a) audio-tactile maps of indoors, and (b) audio-tactile maps of campuses. Forty young adults (aged from 18 years to 30 years) with blindness took part in the research. Participants came from four countries: 14 from Greece, 2 from Cyprus, 18 from Turkey, and 6 from Germany. The researchers developed two lists of information to be included in the two types of audio-tactile maps (indoor and campus) respectively. Participants were asked to evaluate the information, regarding: (a) the significance of the information in regard to safety, location of services, way finding and orientation during movement, and (b) the frequency the participants meet the information (within their surrounding and the environment they move in). The first list of information to be evaluated, related to the maps of indoor places consisted of 136 different information, and the second list of information to be evaluated, related to the campus maps consisted of 213 different information. The result of the study is the definition of the most important information that should be included in each one of the two different types of audio-tactile maps. Thus, the findings of the present study will be particularly important for designers of orientation and mobility (O&M) aids for individuals with blindness. Moreover, the findings can be useful for O&M specialists, rehabilitation specialists, and teachers who design and construct O&M aids for their students with blindness.

The implementation of multisensory environments in the field of map construction for individuals with visual impairments can be a challenging area for both users and designers of orientation and mobility aids. Audio-tactile maps can utilize a large amount of spatial information represented by audio symbols, tactile symbols, audio-tactile symbols (combined) and Braille labels. In regard to audio-tactile maps an important clarification needs to be elaborated and in particular what needs to be carefully examined is the basic query of which information should be presented in haptic mode and which information should be presented in audio or audio-haptic mode. In practice this means that a reasoned process of defining the appropriate symbols for audio-tactile maps should be implemented. The fundamental aim of project “ATMAPS” - Specification of symbols used on Audio-Tactile Maps for individuals with blindness” presented in this paper is the specification of symbols to be used in audio-tactile maps for individuals with blindness.

L’objet de cette étude est d’identifier les déterminants de la rentabilité et, par là, de comprendre l’hétérogénéité des situations financières des établissements de santé à travers une approche multi-variée, en intégrant des facteurs structurels (activités, facteurs de production) et contextuels. Plusieurs sources, à la fois comptables, administratives et médicales, ont été mobilisées. L’échantillon retenu est constitué d’hôpitaux publics et de cliniques privées à but lucratif ayantune activité de court séjour entre 2005 et 2009. Les résultats mettent en évidence, outre l’importance des facteurs « organisationnels » (taux d’occupation des lits, durée de séjour, quantité de personnel), l’impact de la spécialisation sur la performance économique. The objective of this study is to identify the determinants of hospitals profitability and understand the heterogeneity of hospitals’ financial situations through a multivariate approach, incorporating structural (activities, inputs, specialization) and contextual factors. Several sources of information have been mobilized to handle this problem: clinical, financial and administrative data. The sample consists of public hospitals and private for-profit hospitals with activities in medicine, surgery or obstetrics throughout the period 2005-2009. The results indicate a significant influence of "organizational" factors (bed occupancy rate, length of stay) on the economic performance. The specialization would also contribute to profitability.

MEFV which encodes pyrin, cause familial Mediterranean fever (FMF), the most common auto-inflammatory disease. Pyrin is believed to be a regulator of inflammation, though the nature of this regulatory activity remains to be identified. Prophylactic treatment with colchicine, a microtubule toxin, has had a remarkable effect on disease progression and outcome. It has been thought that, inhibition of microtubule polymerization is the main mechanism of action of colchicine. But, the exact cellular mechanism explaining the efficacy of colchicine in suppressing FMF attacks is still unclear. Given the ability of colchicine treatment to be considered as a differential diagnosis criteria of FMF, we hypothesized that colchicine may have a specific effect on pyrin and pyrin interacting proteins. This study showed that colchicine prevents reticulated fibrils formed by PSTPIP1 filaments and reduces ASC speck rates in transfected cells. We further noted that, colchicine down-regulates MEFV expression in THP-1 cells. We also observed that colchicine causes re-organization of actin cytoskeleton in THP-1 cells. Pyrin is an actin-binding protein that specifically localizes with polymerizing actin filaments. Thus, MEFV expression might be affected by re-organization of actin cytoskeleton. The data presented here reveal an important connection between colchicine and pyrin which might explain the remarkable efficacy of colchicine in preventing FMF attacks. J. Cell. Biochem. 113: 35363546, 2012. (C) 2012 Wiley Periodicals, Inc.

Ectopic breast tissue (EBT) is a well-described entity in the English literature. However, fibroadenoma of the ectopic breast is a rare entity. We present a case of a 13-year-old adolescent girl with a subcutaneous mass in the right axilla that was pathologically identical to fibroadenoma seen in the EBT. To our knowledge, this is the second youngest patient reported with axillary EBT, which should be considered as a part of the differential diagnosis for axillary masses. Keywords : adolescent, axilla, ectopic breast tissue, fibroadenoma, mass Departments of aPediatric Surgery, bPathology, Sami Ulus Maternity and Children’s Hospital and cDepartment of Reproductive Endocrinology, Zubeyde Hanim Women Health Hospital, Ankara, Turkey

This study aimed to investigate renal arterial resistive index measurements and urine electrolytes before and after enalapril therapy in a rat model of unilateral ureteropelvic obstruction. The transforming growth factor (TGF)-β1 response of the renal tissue was also investigated. 30 Wistar albino rats were randomly allocated into 5 groups (n=6). Group C rats served as controls. Group S rats had only laparotomy. Group E rats were only treated with enalapril. Rats in group UP and group UPE underwent laparotomy to create a left unilateral moderate partial obstruction. 2 weeks after establishing partial ureteropelvic junction obstruction, group UPE rats were treated with enalapril. Urine was collected over 24 h in all groups. Intrarenal arterial resistive index measurements were performed before and 2 weeks after surgery and after enalapril treatment in group UPE, and before and after enalapril treatment in group E. Rats were sacrificed by intracardiac puncture and left kidneys were harvested to evaluate levels of mRNA TGF-β1. There was no significant difference in ARI values in group E. In group UPE, the difference between ARI values before and after surgery was statistically significant; the difference between ARI values after surgery and after enalapril treatment was also statistically significant. There was no statistically significant intra-group difference in urine electrolyte levels for UP group or UPE group. There was no difference in renal mRNA TGF-β1 levels. Enalapril maintained renal blood flow by decreasing the arterial resistive index and maintained renal tubular function by protecting urine concentration and dilution ability in a rat model with unilateral ureteropelvic junction obstruction.

The implementation of activity-based payment system named T2A-tarification à l'activité-in 2004 profoundly modified the financing of French hospitals. Presently applied to activities concerning medicine, surgery and obstetrics, the pricing for these activities was developed using the National Costs Study. The considerable differences observed between costs in the private sector and those in the public sector are in part justified, by the latter, by caring for patients with social deprivation. The goal of this study is to measure the influence of social deprivation on the length of hospitalisation. A survey on inpatient social deprivation was carried out from November to December 2008 by the French Ministry of Health (Department of Research, Study, Evaluation and Statistics-DREES, and technical agency of Hospital information-ATIH). Four dimensions of social deprivation were taken into consideration after a previous qualitative study: social isolation, quality of housing, level of income and access to rights. The sample is based on 27 hospitals, including public and private (for-profit and not-for-profit), representing 57,175 stays, 6,800 of which were patients with social deprivation. After multivariate analyses adjusted for age, severity of illness and DRG, we found that there was a longer length of stay for inpatients with social deprivation (+16%), and in particular for patients living in social isolation (+17%) and for patients with inadequate housing (+17%). The impact of low income on the length of stay is less important. However, low income associated with inadequate housing significantly increases lengths of stay (+24%).

In two siblings of consanguineous parents with intermittent nephrotic-range proteinuria, we identified a homozygous deleterious frameshift mutation in the gene CUBN, which encodes cubulin, using exome capture and massively parallel re-sequencing. The mutation segregated with affected members of this family and was absent from 92 healthy individuals, thereby identifying a recessive mutation in CUBN as the single-gene cause of proteinuria in this sibship. Cubulin mutations cause a hereditary form of megaloblastic anemia secondary to vitamin B(12) deficiency, and proteinuria occurs in 50% of cases since cubilin is coreceptor for both the intestinal vitamin B(12)-intrinsic factor complex and the tubular reabsorption of protein in the proximal tubule. In summary, we report successful use of exome capture and massively parallel re-sequencing to identify a rare, single-gene cause of nephropathy.

Objectives To assess the efficacy and the cost of a French team work experiment between nurses and GPs for managing type 2 diabetes patients. Methods Based on a case control study design we compare the evolution of process (standard follow-up procedures) and final (glycemic control) outcomes, and of cost, between two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by “standard” GPs (controlled group). Results After a 11 months of follow-up, patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 and 6.8, p ≤ 5%) and under glycemic control (with OR comprise between 1.8 and 2.7, p ≤ 5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled group. Conclusions This experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiment to be launched by French health authorities.

In this article, definition of the name are discussed. In traditional definitions, name is in the form of tangible or intangible assets due to have an approach. But, According to modern linguistics the name is on our minds as a result of the naming process appears to be concrete or abstract concepts, the linguistic equivalents. Bu makalede, adın anlamı tartışılmıştır. Geleneksel tanımlarda ad, somut veya soyut varlıkların karşılığıdır şeklinde bir yaklaşım vardır. Bir sözcük türü olan adın tanımıyla ilgili başlıca dil bilgisi, dil bilimi kaynaklarında yapılan tanımlara bakıldığında, ontolojik bir yaklaşımın hakim olduğu görülmektedir. Bu çerçevede ad tanımlanırken daha çok “canlı ya da cansız, somut ya da soyut, varlıkları karşılayan sözcükler” olduğu belirtilmektedir. Mevcut tanımlar, modern dilbiliminin verileriyle uyuşmamaktadır. Modern dilbiliminde, adlar ontolojik değil, kavramsal (conceptual) bir bakış açısıyla ele alınmakta ve tanımlanmaktadır.

YILMAZ, Engin/0000-0001-8873-7645; Akarsu, Nurten/0000-0001-5432-0032; Ozdag, Hilal/0000-0001-7940-2499; Liehr, Thomas/0000-0003-1672-3054; Alanay, Yasemin/0000-0003-0683-9731; von Eggeling, Ferdinand/0000-0002-8062-6999 WOS: 000278045300015 PubMed: 20451171 We present an autosomal-recessive frontonasal dysplasia (FND) characterized by bilateral extreme microphthalmia, bilateral oblique facial cleft, complete cleft palate, hypertelorism, wide nasal bridge with hypoplasia of the ala nasi, and low-set, posteriorly rotated ears in two distinct families. Using Affymetrix 250K SNP array genotyping and homozygosity mapping, we mapped this clinical entity to chromosome 12q21. In one of the families, three siblings were affected, and CNV analysis of the critical region showed a homozygous 3.7 Mb deletion containing the ALX1 (CART1) gene, which encodes the aristaless-like homeobox 1 transcription factor. In the second family we identified a homozygous donor-splice-site mutation (c.531+1G > A) in the ALX1 gene, providing evidence that complete loss of function of ALX1 protein causes severe disruption of early craniofacial development. Unlike loss of its murine ortholog, loss of human ALX1 does not result in neural-tube defects; however, it does severely affect the orchestrated fusion between frontonasal, nasomedial, nasolateral, and maxillary processes during early-stage embryogenesis. This study further expands the spectrum of the recently recognized autosomal-recessive ALX-related FND phenotype in humans. Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [108S420]; European Research Area Network (E-RARE) [R07197KS] We are grateful to the families for their participation in the study. We thank Han Brunner for critical reading and comments, Ebru Oralli Bircan for illustrations, Hacettepe University Craniofacial Surgery Study Group members Yucel Erk, Emin Mavili, Aycan Kayikcioglu (Plastic and Reconstructive Surgery), Kemal Benli (Neurosurgery), Aysenur Cila (Radiology), Tulin Taner, and liken Kocadereli (Orthodonty) for evaluating the frontonasal malformation cases in the registry. This work was supported by the Scientific and Technological Research Council of Turkey (TUBITAK) (grant numbers 108S420 to N.A.A), and the overall consortium (CRANIRARE) was supported by the European Research Area Network (E-RARE) (project number R07197KS).

Familial Mediterranean fever (FMF) and inflammatory bowel disease (IBD) concordance has been investigated in a few studies. We investigated MEFV mutations and prevalence of FMF disease in Turkish children with IBD and their relationship with the disease severity. Sixteen patients with ulcerative colitis (UC), 14 with Crohn’s disease (CD) and three with indeterminate colitis (IC) were enrolled in the study (median age 13 years, range 0.6–16 years, n = 19 boys). Demographic, clinical and laboratory characteristics of the patients were evaluated as well as the parameters of disease severity. All patients were screened for 12 common MEFV mutations. MEFV mutations were detected in 17 of 66 (25.7%) alleles. Seven patients (four patients with CD, two with IC, and one with UC) were also diagnosed as FMF. FMF disease was found in seven of all IBD patients (21.2%) and four of them had CD. M694V was the leading mutation, and as a disease-causing mutation, it was found to be significantly more frequent in CD patients than UC patients (Fisher’s exact test P = 0.03). Demographics, laboratory evaluations, growth parameters, extraintestinal manifestations, and treatment with immunosuppressive agents other than steroids were comparable between the patients with and without FMF in most aspects. Although this is a small cohort, disease-causing MEFV mutations and FMF disease rate were increased among our patients with IBD. The increase was prominent among CD patients, whereas in UC the rate was similar to the Turkish healthy control population.

We conducted this study to determine familial Mediterranean fever (FMF)-associated central nervous system involvement including demyelinating lesions, stroke, and posterior reversible leukoencephalopathy syndrome (PRES). Patients with MEFV mutations were systematically reviewed through the Medical Biology Unit database. All samples sent for mutation analysis were screened for 10 common MEFV mutations. Patients with FMF and neurologic disorders according to the clinical records were invited for reevaluation. Lumbar puncture, electroencephalography, and evoked potentials were used to determine the type of neurologic involvement in selected cases. Electrocardiography, transthoracic and/or transesophageal echocardiography, and magnetic resonance imaging and/or angiography were performed to clarify the etiology of cerebrovascular disease. Of 8864 patients in the genetic testing database, 18 with neurologic signs were assessed. The mean age of patients was 31.0 +/- 11.8 years, mean age at first FMF symptom was 12.6 +/- 5.6 years, and mean age at neurologic involvement was 25.8 +/- 12.2 years. Fifty-five percent of patients were women. A homozygote MEFV mutation was detected in 16 of 18 patients (88.8%), and a homozygote M694V mutation was found in 72.2% of patients. We found 7 FMF patients with demyelinating lesions, 7 with cerebrovascular disease, and 4 with PRES. The mean interval between first FMF sign and neurologic involvement was 13.7 +/- 8.9 years in the demyelinating group, and 23.4 +/- 10.3 years in the group with cerebrovascular disease. Mean stroke age was 28.5 +/- 16.4 years. All patients in the PRES group had hypertension. Three different neurologic conditions in FMF patients were noticeable. Demyelinating lesions and cerebrovascular disease were the most common clinical presentations. Approximately 70% of patients had the homozygote M694V mutation. Neurologic involvement is rare but serious in FMF.

The synthesis, spectroscopic, electrochemical, and optical properties of tetrasubstituted CoII, CuII, and double-decker LuIII phthalocyanines are reported. The new compounds were characterized by elemental analysis, IR and UV/Vis spectroscopy, and MALDI TOF mass spectrometry. Their electrochemistry was studied by cyclic voltammetry and Osteryoung square-wave voltammetry in nonaqueous medium. Nonlinear absorption and optical limiting performance of peripheral-substituted (C30H28N30)4Co (5), (C30H28N30)4Cu (6), and [(C30H28N30)4]2Lu (7) were investigated by the Z-scan technique. Whereas 6 and 7 showed good nonlinear absorption, 5 did not. Optical limiting parameters of the ratio of the excited state to the ground state absorption cross sections κ, the effective nonlinear absorption coefficient βeff, the linear absorption coefficient α0, limiting threshold Fth, and the saturation density or energy density Fsat values were determined for 6 and 7. The results indicated that both compounds exhibited good optical limiting performances. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009)

Cette etude evalue l’influence des caracteristiques des systemes de sante sur l’equite horizontale du recours aux soins en Europe. L’utilisation d’un ensemble des donnees issues d’enquetes nationales recentes de treize pays europeens confirme l’existence d’inegalites sociales de recours aux soins, a besoin de soins egal, dans tous les pays etudies et montre que l’ampleur des inegalites varie de maniere significative entre les pays. Une analyse multiniveaux permet d’identifier differentes caracteristiques des systemes de sante qui semblent contribuer a la reduction ou a la formation de ces inegalites. Les resultats sou nt l’importance du role des medecins generalistes et de l’organisation des soins primaires pour reduire ces inegalites au-dela du partage des couts entre les spheres publique et privee.

Familial Mediterranean fever (FMF) is characterized by recurrent attacks of fever and serositis; in some cases, ensuing amyloidosis results in kidney damage. Treatment with colchicine reduces the frequency and severity of FMF attacks and prevents amyloidosis, although the mechanisms behind these effects are unknown. Pyrin, the protein product of the MEFV gene, interacts with ASC, a key molecule in apoptotic and inflammatory processes. ASC forms intracellular speck-like aggregates that presage cell death. Here we show that cell death after ASC speck formation is much slower in nonmyeloid cells than in myeloid cells. Additionally, we demonstrate that colchicine prevents speck formation and show that specks can survive in the extracellular space after cell death. Because we also found that ASC is expressed in renal glomeruli of patients with FMF but not in those of control patients, we posit that high local ASC expression may result in speck formation and that specks from dying cells may persist in the extracellular space where they have the potential (perhaps in association with pyrin) to nucleate amyloid. The fact that speck formation requires an intact microtubule network as shown here could potentially account for the ability of prophylactic colchicine to prevent or reverse amyloidosis in patients with FMF.

Mutations in pyrin cause the autoinflammatory disorder familial Mediterranean fever (FMF), a syndrome characterized by sporadic and unpredictable attacks of fever and localized severe pain. Currently, it is not clear how attacks are triggered, nor why they spontaneously resolve after 2 or 3 days. In fact, the cellular function of the pyrin protein and the molecular underpinnings of its malfunction in FMF have so far eluded clear definition. The identification of pyrin-interacting proteins has the potential to increase our understanding of the cellular networks in which pyrin functions. Previous reports have established that pyrin interacts with the apoptotic protein ASC, the cytoskeletal adaptor protein PSTPIP1, the inflammatory caspase, Caspase-1 and certain forms of the cytosolic anchoring protein 14-3-3. Here, we report that pyrin also interacts with Siva, a pro-apoptotic protein first identified for its interaction with the cytosolic tail of CD27, a TNF family receptor. The interaction between pyrin and Siva involves the C-terminal B30.2/rfp/SRPY domain of pyrin and exon 1 of Siva. We show that Siva and pyrin are indeed co-expressed in human neutrophils, monocytes, and synovial cells. Furthermore, using a novel protein/ protein interaction assay, we demonstrate that pyrin can recruit Siva to ASC specks, establishing a potential platform for intersection of ASC and Siva function. Finally, we show that pyrin modulates the apoptotic response to oxidative stress mediated by Siva. Thus, the Siva‐pyrin interaction may be a potential target for future therapeutic strategies. J. Cell. Physiol. 216: 595‐602, 2008. 2008 Wiley-Liss, Inc. Familial Mediterranean fever (FMF) is classified as an autosomal recessive disease that is characterized by sporadic attacks of fever and localized inflammation (Livhen et al., 1997). Although FMF is prevalent among eastern Mediterranean populations, mainly non-Ashkenazi Jews, Armenians, Turks and Arabs, it is observed throughout the world due to extensive population movements of the 20th century (Schaner and Gumucio, 2005). The FMF gene, which is located on the short arm of chromosome 16 and symbolized as ‘MEFV’ (for mediterranean

FMF is the most common of the autoinflammatory diseases and is characterized by recurrent attacks of fever and painful inflammation. Treatment of colchicine reduces the frequency and severity of FMF attacks. The FMF gene, MEFV, encodes a protein called pyrin, appears to be a regulator of inflammation through its interactions with several proteins that are related to regulation of cytokine secretion, cytoskeletal signaling and cell death. ASC (Apoptosis-associated Speck-like protein containing a Caspase recruitment domain) is a pyrin-interacting protein, which is a key adaptor component of the inflammasome. In this study, we hypothesized that many anti-inflammatory drugs with different mechanisms of action may have an effect on ASC gene expression level and cellular viability.

Familial Mediterranean Fever (FMF) is caused by mutations in the MEFV (Mediterranean FeVer) gene, which encodes pyrin. Phenotypic heterogeneity is very common in FMF patients and may partly rely on genetic heterogeneity. However, many cases having weak phenotypic-genotypic correlation, different clinical findings and therapeutic approaches with the same genotype show that FMF is not a simple monogenic disorder. Thus we hypothesized that possible epigenetic factors such as; DNA methylation, post-transcriptional histone modifications and microRNAs may contribute to disease phenotype in FMF patients and decided to analyze MEFV gene expression and compare the levels according to DNA methylation status in neutrophils.

Amaç: Labial füzyon, puberte öncesi kız çocuklarında sık görülen iyi huylu bir genital hastalıktır. Bu yazıda, hastanemizde labial füzyon tanısı alan hastaların özelliklerini ve tedavi sonuçlarını belirlemeyi amaçladık.Gereç ve Yöntemler: Polikliniğimize başvuran labial füzyonlu kız hastalar, yaşları, şikayetleri, topikal östrojen tedavisi kullanımı, nüks oranları, nüks zamanı ve komplikasyonlar açısından geriye dönük olarak gözden geçirildi.Bulgular: Labial füzyon 334 hastada tespit edildi. Hastaların yaşları 40 gün ile 8,5 yaş arasında değişmekteydi. Hastaların %90’ında labial füzyon, sadece klitorise yakın küçük bir açıklık kalacak şekilde vajen ve üretrayı kapatmıştı. Hastaların %35’inde labial füzyona bağlı idrar şikayetleri ve akıntı gibi ek sorunlar mevcuttu. Hastalar östrojenli topikal kremler ve manuel füzyon ayrılmasıyla tedavi edildi, %25 tekrarlama görüldü. Hasta yaşının büyük olmasının ve füzyona bağlı ek sorunların, füzyon tekrarı üzerinde etkili olduğu bulundu.Sonuç: Labial füzyon puberte öncesi kız çocuklarında sık görülen, çocuklarda idrar yollarıyla ilgili şikayetlere, ailelerde ise ciddi anksiyeteye yol açabilen bir patolojidir. Labial füzyonun erken saptanıp, gerekli önlemler uygulanmasıyla, tedavisinin daha kolay ve tekrarlama riskinin daha az olduğu kanısındayız., Objective: Labial fusion is a common benign genital disorder in prepubertal girls. Herein we aim to identify the characteristics and treatment outcomes of patients with labial fusion who were diagnosed and treated at our hospital.Material and Methods: Girls with labial fusion who presented to our outpatient department were retrospectively reviewed for their age, complaints, use of topical estrogen treatment, recurrence rate, time of recurrence and complications.Results: A total of 334 patients with labial fusion were identified. The ages of the patients varied between forty days and 8.5 years. Both the vagina and urethra were covered by the labial fusion and only a small gap could be seen near the clitoris in 90% of patients. Additional urinary disorders and vaginal discharge caused by labial fusion were identified in 35% of the patients. Patients were treated with manual detachment of the fusion and topical estrogen creams. Recurrence rate was 25%. Recurrence rates were higher in patients with older age and additional problems.conclusion: Labial fusion is a common benign condition in prepubertal girls. But it can cause urinary disorders in patients and serious anxiety in parents. The treatment can be easier and the recurrence rates lower if it is prevented effectively or diagnosed earlier

The aim of this study was to describe and report the results of our new pediatric inguinal hernia repair technique, in which single-port laparoscopic percutaneous extraperitoneal closure (SPEC) technique was modified by using optical foreign-body forceps (OFF) of the rigid bronchoscope. Between January 2012 and January 2014, a total of 79 children who were operated using SPEC assisted with OFF (SPEC–OFF) were included in this study. Demographic and clinical features of the children were obtained and reviewed retrospectively. Ninety-nine hernia repairs were performed on a total of 79 children (51 boys, 28 girls). All of the patients were operated by SPEC–OFF without the need of introducing extra forceps, with or without an additional trocar. The mean operating time was 17.6 ± 5.5 min. The mean follow-up period was 17.5 ± 7.1 months. There were six recurrences (two boys, four girls). No wound infection, hydroceles or testicular atrophy occurred in any patients during post-surgery follow-up. The technique left a very small scar with excellent cosmesis in the umbilicus and groin area. SPEC–OFF is a simple, safe and effective technique for laparoscopic inguinal hernia repair, and for determining contralateral hernia. There is no need to use additional working forceps for the technique and the surgeon can perform the procedure without any assistance for laparoscope.

Objective: Pediatric appendicitis score (PAS) is a scoring system which is improved to simplify the diagnosis of appendicitis in children. In this article it is aimed to investigate the efficiency of PAS and additional laboratory data in diagnosing appendicitis.Material and Methods: Between 1st January 2010 and 31st December 2010, patients admitted to our department that are followed up and treated with an initial diagnosis of acute abdomen were reviewed retrospectively. Patients which were operated and histopathological examination confirmed the diagnosis appendicitis is defined as 1st group, and the patients with negative exploration and the ones that are non-operated are defined as 2nd group. Groups are compared in terms of demographic data, hospitalization time, PAS and laboratory data. Results: A total of 562 patients (321 male, 241 female) with an initial diagnosis of acute abdomen are admitted to our department in the one-year period. There were 350 patients (224 acute, 126 complicated appendicitis) in the 1st group, and 212 patients (31 negative exploration, 181 follow-up) in the 2nd group. While the preoperative hospitalization time between the acute and complicated cases did not have significant difference (p>0.05), complicated cases had a long postoperative hospitalization time (p, Amaç: Pediatrik apandisit skoru (PAS) çocuklarda akut apandisit tanısı koymayı kolaylaştırmak amacıyla geliştirilen bir skorlama sistemidir. Bu çalışmada, PAS ve ek laboratuvar verilerinin apandisit tanısı koymadaki etkinliklerinin araştırılması amaçlanmıştır.Gereç ve Yöntemler: 1 Ocak 2010–31 Aralık 2010 tarihleri arasında kliniğimize akut batın ön tanısıyla yatırılarak takip ve tedavi edilen hastalar geriye dönük olarak değerlendirildi. Bu hastalardan opere edilip, patoloji sonucuyla apandisit tanısı doğrulananlar 1. grup, opere edilip negatif çıkan ve opere edilmeyen hastalar 2. grup olarak isimlendirildi. Gruplar demografik verileri, yatış süreleri, PAS ve laboratuvar bulguları açısından karşılaştırıldı.Bulgular: Bir yıllık süre içerisinde kliniğimize akut batın ön tanısıyla 562 hasta (321 erkek, 241 kız) yatırıldı. 1. grupta 350 hasta (224 akut, 126 komplike apandisit), 2. grupta 212 hasta (31 negatif apendektomi, 181 gözlem) vardı. Preoperatif yatış süreleri açısından akut ve komplike olgular arasında anlamlı fark yokken (p>0,05), postoperatif yatış süreleri komplike olgularda daha uzundu (p

To evaluate the differential diagnosis of testicular torsion and acute epididymo-orchitis by measuring the acute increase in plasma d-dimer levels in an experimental rat model.Thirty male Wistar rats were randomly divided into 5 groups, 1--sham operated group (acute term; 4 hours), 2--early torsion group (acute term; 4 hours), 3--late torsion group (long-term; 72 hours), 4--control of epididymitis group (vehicle injected; 0.1 ml physiologic saline injected into the left ductus deferens) (long term; 72 hours), 5--epididymitis group (0.1 ml Escherichia coli injected into the left ductus deferens), (n=6 for each group).Serum d-dimer levels were significantly higher compared with the sham operated group with early torsion (p=0.002). This elevation remained mildly in the late torsion group compared with the control group (p0.001), but there was no difference between 4 and 72 hours of the testis torsions (p=0.794). On the other hand, d-dimer levels were significantly higher in the torsion groups compared to the epididymitis group (p=0.042).The present study demonstrated that testicular damage that occurs following testicular torsion shows a higher increase in d-dimer levels than epididymitis, suggesting that d-dimer level can be used as a diagnostic marker of testicular torsion.

In this study, the assumption of “the weighted price elasticity of tax is a unit in the developing countries” suggested in the first studies which examine the impacts of the inflation on tax revenues, will be reevaluated for Turkey in the period of 1998-2013. We use Turkish tax and price index data for calculating the weighted price elasticity of tax. Via the method of dynamic ordinary least squares (DOLS), the long run weighted price elasticity of tax system is guessed. The importance of this study is the fact that this is first study intended to the calculation of the weighted price elasticity of tax for Turkey. In this sense, it will be instructive study for the reconsideration of the assumption of “the weighted price elasticity of tax is a unit in the developing countries”., Bu çalışma içerisinde, enflasyonun vergi gelirleri üzerindeki etkilerini inceleyen ilk çalışmalarda ortaya konulan, “gelişmekte olan ülkelerde verginin ağırlıklandırılmış fiyat elastikiyetinin birim olduğu” varsayımı Türkiye için 1998 -2013 periyodu için yeniden değerlendirilecektir. Ağırlıklandırılmış fiyat elastikiyetinin hesaplanmasında Türk vergi gelirleri ve fiyat endeksleri verileri kullanılmıştır. Dinamik En Küçük Kareler (DOLS) yöntemiyle, vergi sisteminin uzun dönem ağırlıklandırılmış fiyat elastikiyeti tahmin edilmiştir. Çalışmanın önemi Türkiye için verginin ağırlıklandırılmış fiyat elastikiyetini hesaplamaya yönelik ilk çalışma olmasıdır. Bu anlamda “gelişmekte olan ülkelerde verginin ağırlıklandırılmış fiyat elastikiyetinin birim olduğu” varsayımının yeniden gözden geçirilmesi için yol gösterici bir çalışma olacaktır.

To describe Single Incision Pediatric Endoscopic Surgery (SIPES) performed on children with various diagnoses, emphasizing its advantages.An observational case series.Department of Pediatric Surgery, Dr. Sami Ulus Maternity and Child Health Hospital, Ankara, Turkey, from January 2011 to November 2014.A review of patient charts was conducted in which SIPES was preferred as the surgical procedure. Patient demographics, operative details, operative time, clinical outcomes, postoperative pain and cosmesis were analyzed.SIPES was performed on 45 patients (21 girls, 24 boys). Thirty-three appendectomies, 5 varicocelectomies, 3 oophorectomies, 2 ovarian and one paratubal cyst excision, and one fallopian tube excision were performed. All except one procedures were performed through our standard 2 cm umbilical vertical or smile incision. In 18 cases, abdominal irrigation/aspiration was easily performed through the existing larger incision, as is done with open surgical technique. None of the patients had early postoperative shoulder/back pain since complete disinflation of CO2could be ensured. All of the patients/parents were satisfied with the cosmesis.SIPES has the advantages of limiting the surgical scar to within the umbilicus and providing easy disinflation of CO2, allowing intraabdominal cleaning and extraction of large volume tissue samples through a single large umbilical incision.

Background— Genetic studies demonstrated the presence of risk alleles in the genes ANRIL and CAMTA1/VAMP3 that are shared between coronary artery disease (CAD) and periodontitis. We aimed to identify further shared genetic risk factors to better understand conjoint disease mechanisms. Methods and Results— In-depth genotyping of 46 published CAD risk loci of genome-wide significance in the worldwide largest case–control sample of the severe early-onset phenotype aggressive periodontitis (AgP) with the Illumina Immunochip (600 German AgP cases, 1448 controls) and the Affymetrix 500K array set (283 German AgP cases and 972 controls) highlighted ANRIL as the major risk gene and revealed further associations with AgP for the gene PLASMINOGEN ( PLG ; rs4252120: P =5.9×10 −5 ; odds ratio, 1.27; 95% confidence interval, 1.3–1.4 [adjusted for smoking and sex]; 818 cases; 5309 controls). Subsequent combined analyses of several genome-wide data sets of CAD and AgP suggested TGFBRAP1 to be associated with AgP (rs2679895: P =0.0016; odds ratio, 1.27 [95% confidence interval, 1.1–1.5]; 703 cases; 2.143 controls) and CAD ( P =0.0003; odds ratio, 0.84 [95% confidence interval, 0.8–0.9]; n=4117 cases; 5824 controls). The study further provides evidence that in addition to PLG , the currently known shared susceptibility loci of CAD and periodontitis, ANRIL and CAMTA1/VAMP3 , are subjected to transforming growth factor-β regulation. Conclusions— PLG is the third replicated shared genetic risk factor of atherosclerosis and periodontitis. All known shared risk genes of CAD and periodontitis are members of transforming growth factor-β signaling.

De nombreux pays de l’OCDE ont introduit des systèmes de paiement à l’activité pour financer leurs établissements de santé. La France a ainsi adopté en 2004 la réforme dite de «tarification à l’activité » (T2A) afin d’inciter ces établissements à davantage d’efficience. La mise en place de cette réforme a surtout intégré jusqu’ici l’impératif économique comme première préoccupation. Toutefois, pour le régulateur, il est important de suivre les effets de cette réforme sous l’angle de la qualité des soins. Une mesure de la qualité des prises en charge peut être appréhendée par le taux de réadmission à trente jours. L’objet de cette étude est de s’intéresser à la réadmission à la fois sur la période qui précède la T2A et sur la période faisant suite à sa mise en place. La période d’étude s’étend de 2002 à 2012. À partir des données du Programme médicalisé du système d’informations (PMSI), pour chaque séjour chirurgical, la réadmission à trente jours après la sortie est déterminée au moyen du chaînage PMSI, sous réserve que ces réadmissions ne soient ni des séances de traitements ni de la néonatalogie. La probabilité de réadmission est modélisée à l’aide d’une régression logistique multiple comprenant les cofacteurs suivants : année, âge, sexe, mode d’entrée, durée de séjour, morbidité, statut juridique de l’établissement ainsi que des termes d’interactions. Les résultats mettent en avant une augmentation du risque de réadmission observé au niveau global, mais qui s’explique par une modification de la structure de la population (vieillissement) ainsi que par les modifications de prise en charge. Cette hausse des réadmissions ne s’explique pas par la mise en place de la T2A., Yilmaz Engin, Vuagnat Albert. Tarification à l'activité et réadmission. In: Economie et statistique, n°475-476, 2015. La santé et les soins. pp. 71-87.

Modeling and forecasting techniques of the tourist arrivals are many and diverse. There is no unique model that exactly outperforms the other models in every situation. Actually a few studies have realized modeling and forecasting the tourist arrivals to Turkey and these studies have not focused on the total tourist arrivals. These studies have focused on the tourist arrivals to Turkey country by country (or OECD countries). In addition to this, structural time series models have not been used in modeling and forecasting the tourist arrivals to Turkey. In this sense, this paper is the first study which uses the seasonal autoregressive integrated moving average model and the structural time series model in order to forecast the total tourist arrivals to Turkey. Two different models are developed to forecast the total tourist arrivals to Turkey using monthly data for the period 2002-2013. The results of the study show that two models provide accurate predictions but the seasonal autoregressive integrated moving average model produces more accurate short-term forecasts than the structural time series model. It is noted that the seasonal autoregressive integrated moving average model shows a very successful performance in the forecasting the total tourist arrivals to Turkey.

The most important complication of FMF is the development of amyloidosis. It is more common in the eastern Mediterranean compared to the US. The individual response to endotoxin may have a significant effect on the development of amyloidosis in FMF patients. To investigate the association between CD14 promotor C-159T polymorphism and development of amyloidosis, one hundred and forty-six patients who had FMF and had not developed amyloidosis; 26 with FMF and secondary amyloidosis and 92 controls were genotyped at the CD14-C159T locus. There was no difference between the genotype distribution of FMF patients (CC 30.0%, CT 50.0%, TT 20.0%) and controls (CC 29.2%, CT 45.8%, TT 25%); or between FMF patients with amyloidosis (CC 30.8%, CT 53.8%, TT 15.4%) or without amyloidosis (CC 29.2%, CT 45.8%, TT 25%). Our study shows that the CD14-C159T polymorphism is not associated with FMF or development of amyloidosis in the population studied. The effect of the genetic variations in the endotoxin signaling pathway under different environmental conditions such as high and low endotoxin exposure remain to be determined.

The neurologic manifestations of patients with phenylketonuria treated at different ages are illustrated in this series of 146 cases, including 9 sib pairs. In addition to well-known findings such as mental retardation, autistic features, microcephaly, and tremor, motor retardation was common and responded promptly to dietary treatment. Hypotonia and diminished reflexes were more frequent findings than hypertonia. Four sib pairs showed divergent features, such as the later-treated sibling having higher function than the early-treated one. Because siblings have a similar genotype and similar environmental and dietary conditions, this observation can be explained by differences in phenylalanine transport to the brain or additional metabolic or perinatal factors influencing the neurologic outcome. (J Child Neurol 2006;21:987—990; DOI 10.2310/7010.2006.00228).

A new ligand, 4-chloromethyl-2-(2-hydroxynaphthylidenehydrazino) thiazole, has been synthesized from dichloroacetone and 2-hydroxynaphthylidenethiosemicarbazone. Metal complexes of the ligand were prepared from acetate salts of Co(II), Cu(II), Ni(II), and chloride of Cr(III) in dry acetone. Characterization of the ligand and its complexes were made by microanalyses, FT-IR, 13C, 1H NMR, and UV-Visible spectroscopy, magnetic susceptibility, thermogravimetric analysis. In the light of these results it was suggested that two ligands coordinate to each metal atom by hydroxyl oxygen, imino nitrogen and thiazole ring nitrogen to form high spin octahedral complexes with Cr(III), Co(II), Ni(II), and Cu(II).