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Background Antenatal steroid administrations lead to not only accelerated lung maturation, improved blood gas measurements but also lung dynamics and lung compliance. This study aimed to investigate structural and functional changes in diaphragm after antenatal steroid administration. Methods The 79 volunteers were divided into 2 groups according to presence of preterm delivery. Betamethasone (CelestoneR) 12 mg intramuscularly was routinely administered to pregnancies complicated with preterm delivery between 28th -34th weeks of gestation. Same dose was repeated 24 h later. In all patients, diaphragm thickness, diaphragmatic excursion and costophrenic angle were measured in both the inspirium and expirium stage of respiration. This is an observational cross-sectional study. Results Diaphragm thickness, diaphragmatic excursion and diaphragm thickening fraction parameters were improved but costophrenic angle was not different 7 days after steroid administration. Diaphragm thickness, diaphragmatic excursion and costophrenic angle changes during inspiration and expiration stage after 7 days of betamethasone treatment reflects the effect of steroid administration on diaphragm muscle. Comparisons of the differences that occur after steroid rescue protocol were done by subtracting the diaphragm thickness, diaphragmatic excursion and costophrenic angle parameters before the treatment from the diaphragm thickness, diaphragmatic excursion and costophrenic angle parameters 7 days after steroid treatment respectively. Conclusion Diaphragm became more mobile in patients with preterm labor, 7 days after steroid administration. This situation reflects positive effect of steroid administration on diaphragm function.

Background: Cell homeostasis relies on the concerted actions of several genes; and dysregulated genes lead to disease manifestations. In living organisms, genes or their products do not act alone, but instead act within a large network. Subsets of these networks can be viewed as modules which provide certain functionality in an organism. Kyoto Encyclopedia of Genes and Genomes (KEGG) systematically analyzes gene functions, proteins, molecules, and provides a PATHWAY database. Measurements of gene expression (e.g., RNA-seq data) can be mapped into KEGG pathways in order to determine which modules are affected or dysregulated in a disease. However, genes acting in multiple pathways, and some other inherent issues complicate such analyses. To detect dysregulated pathways, current approaches may only employ gene expression data and neglect some of the existing knowledge stored in KEGG pathways. For a more holistic association between gene expression and pathways, new approaches which take into account more of the compiled information are required. Results: PriPath is a novel approach that transfers the generic approach of grouping, scoring followed by modeling for the analysis of gene expression with KEGG pathways. In PriPath, we utilize the KEGG pathway as the grouping information and insert this information into a machine learning algorithm for selecting the most significant KEGG pathways. Those groups are utilized to train a machine learning model for the classification task. We have tested PriPath on 13 gene expression datasets of various cancers and other diseases. Our proposed approach successfully assigned biologically and clinically relevant KEGG terms to the differentially expressed genes. We have comparatively evaluated the performance of PriPath against other tools, which are similar in their merit. For each dataset, we manually confirmed the top results of PriPath in literature, and we compared PriPath predictions to the predictions of Reactome and DAVID. Conclusions: PriPath can thus aid in determining dysregulated pathways, which is applicable to medical diagnostics. In the future, we aim to advance this approach in such a way that it will be possible to perform patient stratification based on gene expression and to identify druggable targets. Thereby, we cover two aspects of precision medicine.

© 2020 Informa UK Limited, trading as Taylor & Francis Group.Objective: The ductus venosus, a small blood vessel in the fetal venous system, has extraordinary physiologic significance because it connects the umbilical vein to the inferior vena cava in the fetus circulation system and transports highly oxygenated blood from the placenta to the fetus’ heart. Hence, assessment of ductus venosus flows is helpful in evaluating fetal hemodynamics. Considering the critical function of the ductus venosus, we hypothesized that the diameter of the midtrimester ductus venosus and its peak velocity index can be related to adequate fetal growth; therefore, the aim of this study was to evaluate the role of the midtrimester umbilical venous blood flow, ductus venosus diameter, and ductus venosus peak systolic velocity to help predict uncomplicated deliveries of late onset small for gestational age (SGA) fetuses. Methods: In this prospective study we analyzed the pregnancies and deliveries of 398 pregnant women who met the inclusion criteria and divided them into three groups according to fetal birth weight as follows: birth weight

Objective The aim of this study is to assess the correlation between the poor perinatal outcomes and the serum biochemical markers such as maternal serum alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3) and inhibin-A (INH-A) checked during the quad screening test. Methods In this retrospective study, the results of 485 pregnant women who underwent quad screening test in the Outpatient Clinic of Gynecology and Obstetrics of Faculty of Medicine at Erciyes University, Kayseri, Turkey between January 2018 and January 2019 and met the inclusion criteria were analyzed. The primary result of the study was established as the development of poor perinatal outcomes. The poor perinatal outcomes were defined as gestational diabetes (GDM), gestational hypertension (GHT), preeclampsia, intrauterine growth restriction (IUGR), preterm labor, premature rupture of membranes (PRM), oligohydramnios, polyhydramnios, HELLP syndrome, and intrahepatic cholestasis of pregnancy (ICP). Results A total of 485 pregnant women, who met the inclusion criteria, were included in the study. A significant correlation was found between AFP MoM≥2 and GHT, PRM, preterm labor, and the development of IUGR (p=0.017, p=0.033, p=0.037, and p=0.038, respectively). It was seen that the risk increased 5.1 times for GHT, 3.2 times for preterm labor, and 3.8 times for the development of IUGR. There was a significant correlation between hCG MoM≥2 and the risk of GHT development (p=0.024); however, the risk of GHT development increased for 3.8 times above this value. A significant correlation was found between INH-A being MoM≥2 and the development of GHT and HELLP syndrome (p=0.009 and p=0.005, respectively). In these pregnant women, the risk increased 31 times for the development of HELLP syndrome, and 9.4 times for GHT. In the cases with uE3 MoM£0.5, there was a significant correlation for the development of preeclampsia and HELLP syndrome (p=0.033 and p=0.049, respectively). On the other hand, there was no significant correlation between GDM, ICP, polyhydramnios, and oligohydramnios and AFP MoM, beta-hCG MoM, uE3 MoM and INH-A MoM values. Conclusion In our study, we found correlation between poor perinatal outcomes and the changes in AFP, hCG, uE3 and INH-A levels.

Background Skin temperature measurements after peripheral nerve block can be used as an easy and objective method to help predict block success. Thermochromic nail polishes are popular cosmetic products especially among young women. The colour change of nail polish is based on a thermochromic reaction as the temperature changes. Objective The aim of this study was to test the hypothesis that the success of infraclavicular brachial plexus blocks (IBPBs) can be predicted by the colour change in thermochromic nail polish, which depends on skin temperature changes. Design A prospective cohort study. Setting Training and research hospital from December 2018 to March 2019. Patients A total of 50 patients who received IBPB for forearm, wrist or hand surgery were included. Main outcome measures Thermochromic nail polish was applied to the nails of both hands of all patients before the block. Reaction of the nail polish in both hands was photographed immediately after application of nail polish and at 30 min after performing the block. The digital photographs of each patient were evaluated by observers. To evaluate the validity of the colour change in nail polish in predicting a successful IBPB, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios were estimated. Results The positive predictive value for colour change in thermochromic nail polish predicting a successful IBPB was 96% [95% confidence interval (CI) 90 to 98] and sensitivity was 94% (95% CI 87 to 97). Fleiss kappa value showed substantial agreement (0.76; 95% CI 0.59 to 0.93) in the assessment of interobserver agreement. Conclusion The current study demonstrates that the colour change in thermochromic nail polish is a valid and reliable indicator for the prediction of block success. Trial registration ClinicalTrials.gov identifier: NCT03767868.

Polymethyl methacrylate (PMMA) bone cement with the addition of magnetic glass-ceramic (MGC) has attracted much attention for the treatment of deep-seated tumour tissues. Since PMMA bone cement has been a gold standard in orthopaedic surgery and magnetic glass-ceramic can generate heat under a magnetic field, the combination of these two materials could show promising results for magnetic induction hyperthermia treatment. Thus, magnetic glass-ceramic powders were mixed with the commercial Palacos MV® cement in amounts up to 40 ​wt%. The resulted magnetic bone cement composites were assessed in vitro for bioactivity and cytocompatibility. In vitro bioactivity was evaluated using a simulated body fluid (SBF). The effect of magnetic cement composition on the viability of cancerous and normal (non-cancerous) cells was assessed using U2OS osteosarcoma and OBS human osteoblast cells, respectively. Cell attachment to the surface of the magnetic composite samples was observed using fluorescence and scanning electron microscopy. The magnetic composites showed bioactive properties. After two weeks of immersion in SBF, a non-uniform layer of hydroxyapatite was observed on their surface. Alamar blue cytotoxicity tests after 3 days in cell culture indicated that magnetic composites are cytotoxic for U2OS cancer cells, but they are cytocompatible to OBS normal cells.

Introduction: The aim of the present study was to evaluate the relationship between diaphragmatic thickness, during both inspiratory (DTI) and expiratory (DTE) stages; diaphragmatic excursion (DE); diaphragm thickening fraction (DTF); and adverse fetal outcomes in pregnant women with intrauterine growth restriction (IUGR). Materials and methods: A total of 77 participants were included in this case-control study. The case group was diagnosed as having both symmetric and asymmetric IUGR (n = 39). The control group included gestational age (GA)-matched healthy pregnant women (n = 38). DTI, DTE, DE (reflecting the capability of diaphragmatic movement during the respiratory cycle), and DTF were analyzed. Results: Maternal demographic characteristics were similar between groups. DTI and DTE were significantly lower in the IUGR group compared to the control group (p < 0.001 and p < 0.001). DE was similar between the groups (p = 0.07). Additionally, in the IUGR group, DTI, DTE, and DE were significantly altered in newborns that required treatment in the neonatal intensive care unit (NICU). ROC curve analysis determined that the DTI cut-off was 1.36 for NICU admission with 78% sensitivity and 100% specificity. DTE cut-off was 1.195 for NICU admission with 78% sensitivity and 96% specificity. DE cut-off was 4.25 for NICU admission with 71% sensitivity and 80% specificity. Conclusion: Measurement of DTI, DTE and DE may help clinicians to predict whether newborns with IUGR would require NICU hospitalization. (c) 2020 Elsevier Ltd. All rights reserved.

The purpose of this trial was to appraise the effects of preeclampsia and its intensity on maternal serum neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) levels during pregnancy and the post-pregnancy period.Firstly pregnant participants (n = 156) were separated into three groups, as control, mild, and severe preeclampsia. Secondly women in post-pregnancy period (n = 368) were separated into three groups according to history of pregnancy, as healthy control, mild, and severe preeclampsia. These women were identified through the hospital data system and contacted by telephone to participate in the study.Our study comprised 147 patients, 77 of whom were pregnant and 70 of whom were in their post-pregnancy period after the exclusion criteria had been applied. In terms of maternal serum NGAL levels, there is a significant increase in the severe preeclampsia group compared with that in the mild preeclampsia and normal pregnancy groups (p0.001). During the post-pregnancy period, the maternal serum NGAL levels were found significantly higher in the severe preeclampsia group than in the mild preeclampsia group and non-hypertension control group (p0.001). Maternal serum KIM-1 levels were found as significantly higher in the severe and mild preeclampsia groups than in the non-hypertension pregnancy group (p = 0.004). During the post-pregnancy period, maternal serum KIM-1 levels were found as similar among all post pregnant groups (p = 0.792).Our results indicated that as the severity of preeclampsia increases, kidney damage as assessed using NGAL levels continues for a long period of time, even during the post-pregnancy period.

Background The aim of the study was to evaluate the effect of preeclampsia and its severity on insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), and betatrophin levels in non-diabetic pregnant women. Methods Our study comprised 102 pregnant women who were divided into the following three groups: (1) control, (2) severe preeclampsia, and (3) mild preeclampsia. The women were screened with the single-stage 75-g oral glucose tolerance test (OGTT), and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria were used for diagnosis. Those women with type 2 diabetes (T2D) mellitus or gestational diabetes mellitus (GDM) were excluded from the study. Results Maternal demographic characteristics were similar among the groups. Fasting plasma glucose and postprandial 2-h plasma glucose levels were significantly increased in the severe-preeclampsia group compared to that in the other groups. Fasting insulin levels were 14.3 ± 8.7uU/mL in the severe-preeclampsia group, 19.1 ± 6.0uU/mL in the mild-preeclampsia group, and 20.5 ± 12.5uU/mL in the control group and significantly lower in the severe-preeclampsia group than in the mild-preeclampsia and control groups. The serum betatrophin level was 7.8 ± 2.6 ng/mL in the severe-preeclampsia group, 6.1 ± 1.8 ng/mL in the mild-preeclampsia group, and 5.8 ± 1.3 ng/mL in the control group and significantly increased in the severe-preeclampsia group compared to other groups. HOMA-IR was similar among the groups. Maternal serum insulin levels were negatively (r = −0,255; P = 0.010) and serum betatrophin levels were positively (r = 0.368; P ≤ 0.001) correlated with preeclampsia severity. Conclusion Our results indicated that severe preeclampsia effect maternal serum glucose, insulin and betatrophin levels. Histhopatholical and immunohistochemical demostrations on pancreatic cells in new preeclampsia rat models will expand the information on the current situation.

Objective The present study aimed to evaluate an anatomical region, the anterior uterocervical angle (UCA), to determine whether it plays a role in unexplained infertility. Methods In this prospective, cross-sectional study, unexplained infertile and healthy fertile (controls) women were compared. The longitudinal and transverse axes of the uterine cervix and uterine corpus were measured by transvaginal ultrasonography. The UCA was determined as the angle between two lines. One line was drawn between the internal and the external os, and the other was drawn through the internal cervical os and was parallel to the lower side of the front part of the uterine wall in the internal os. Demographic characteristics and uterocervical ultrasonographic measurements were compared between the two groups. Results Eighty participants, aged from 20 to 35 years, were enrolled (unexplained infertile [n = 30] and healthy fertile women [n = 50)]. The mean lengths of the uterine corpus longitudinal axis, uterine corpus transverse axis, and uterine cervix longitudinal axis were similar between the groups. The mean UCA was significantly higher in healthy fertile women (131.9 ± 22.9 degrees) than in women with unexplained infertility (114.2 ± 17.3 degrees). Conclusion The present study shows that a narrow anterior UCA is associated with unexplained infertility.

Çalışmada, Meloidogyne incognita ırk 2'nin iki izolatı (G7 ve K4) 'nın farklı inokulasyon yoğunluklarının Kök-ur nematodlarına dayanıklı Carolina Wonder, PM 217, CM334 biber hatları ile M. incognita 'ya duyarlı Yolo Wonder hattında reaksiyonu kontrollü koşullar altında (25±2°C sıcaklık, % 60±5 nem ve 16:8 fotoperiyot) araştırılmıştır. Denemeler, tesadüf blokları deneme desenine göre 5 tekerrürlü olarak kurulmuştur. İnokulum kaynağı olarak yumurta paketi kullanılmış ve bitkiler 4 gerçek yapraklı fide dönemlerine geldiklerinde bitki kök bölgesinde açılan 2 cm derinliğe 1-5-10-20 ve 50 yumurta paketi inokule edilmiştir. Biber bitkileri inokulasyondan 9 hafta sonra sökülmüş ve köklerdeki gal oranı 0-5 skalasına göre indekslenmiştir. Köklerde gal sayısı, yumurta paketi ve yumurta sayısı ışık mikroskobu altında sayılmış ve üreme gücü hesaplanmıştır. Carolina Wonder ve CM334 dayanıklı biber hatlarında G7 ve K4 izolatı tüm inokulum yoğunluklarında avirülent reaksiyon göstermiştir. PM217 dayanıklı biber hattında G7 izolatının 50 yumurta paketi inokulum yoğunluğunda üreme oranı 1.1 olarak bulunmuş ve dayanıklı biber hattında dayanıklılığı kırdığı saptanmıştır. K4 izolatı PM217 dayanıklı biber hattında 10-20 ve 50 yumurta paketi inokulum yoğunluğunda virülent reaksiyon göstermiştir. Bu inokulum yoğunluklarında üreme oranı sırasıyla 1.4,3.5 ve 4.4 olarak bulunmuştur. Yolo Wonder biber hattında her iki izolatın patojenitesi yüksek bulunmuştur.

BACKGROUND The aim of this study was to evaluate the effect of oral contraceptive pills (OCP) on the macula, the retinal nerve fiber layer (RNFL), and choroidal thickness (CT). MATERIAL AND METHODS A total of 24 healthy women taking monophasic OCP (3 mg drospirenone and 0.03 mg ethinylestradiol) for contraception only for at least one year were compared with a control group of 24 healthy women who were not taking an OCP. Optical coherence tomography (OCT) was used to evaluate the posterior ocular segments, and measurements were taken in the follicular phase (day 3) of the cycle in all women. RESULTS No disparity in terms of age and body mass index between the groups was observed (p=0.436, p=0.538, respectively). In comparison of the macular region and CT between groups, we found that all variables except foveal center thickness and CT were significantly thinner in the OCP group. Nasal and temporal inferior parts of the RNFL and average RNFL were significantly slimmer in the study group versus the control group (p=0.013, p=0.018, and p

Background: “Small for gestational age” (SGA) is a term used to define an important risk factor for both neonatal morbidity and mortality. Our hypothesis suggests that adverse neonatal morbidity (ANM) in fetuses can occur when the birth weight is closer to 10th percentile. For example, although a fetus with a birth weight within the 11th or 12th percentile is appropriate for gestational age (AGA), it is difficult to clearly distinguish these fetuses from SGA fetuses for ANM; therefore we suggest defining a transition zone, or “grey zone”, for ANM. The aim of the present study was to examine ANM frequency in fetuses using this newly defined grey-zone percentile. Methods: This retrospective analysis comprised 7,817 pregnant women with uncomplicated pregnancies and single deliveries between 37 0/7 and 41 6/7 gestational weeks. The babies were divided into groups according to birth weight percentiles as follows: (1) SGA, (2) 10–20 percentile, and 21–90 percentile. The primary outcome was ANM, defined as any of the following: Apgar score

Introduction. Many patients who were diagnosed as polycystic ovary syndrome- (PCOS-) related acne were not capable of sustaining or beginning oral contraceptive pills (OCPs) due to pill scaring, contraindications of OCP use, migraine, or smoking. In this situation, oral isotretinoin treatment may become an important option for PCOS-related acne. The aim of the study was to determine the effects of isotretinoin treatment on PCOS patients who were complicated with severe cystic acne. Materials and Methods. This study consisted of 40 female patients diagnosed as PCOS complicated with severe cystic acne. These patients were not eligible candidates for OCP use due to migraine, thrombophilia, heavy smoking, or pill scare. To establish baseline values of hormone levels, on days 2–5 of the menstrual cycle, venous blood samples were obtained. Moreover Modified Ferriman-Gallwey (mFG) score, acne score (AS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment. Results. Isotretinoin treatment significantly decreased Ferriman-Gallwey score, free testosterone, insulin level, hemoglobin level, acne score, and ovarian volume. Increased triglyceride and cholesterol levels were detected after treatment. Conclusion. Isotretinoin treatment may have beneficial effects on free testosterone, insulin, acne score, and Ferriman-Gallwey score. Solely isotretinoin administration may supply adequate healing in PCOS patients’ symptoms complicated with severe cystic acne who is not eligible candidates for OCP use. This trial is registered with Clinicaltrials.gov NCT02855138.

Aim: Non-operating room anesthesia is frequently used in all areas. Gastrointestinal endoscopy is one of the procedures requiring sedation outside the operating room. This study aimed to investigate the drugs used for sedation and the complications during gastrointestinal procedures in our hospital.Materials and Methods: The files of the patients who underwent anesthesia for gastrointestinal endoscopy between 01.01.2018- 31.12.2018 in our hospital were retrospectively reviewed. ASA score, age, gender, vital signs, drugs, doses, complications, and need for intensive care were evaluated.Results: A total of 508 patients were sedated. The 187 cases (36.3%) were male, and 321 (63.2%) were female. The mean age was 54.9 ± 15.6 years. Two hundred fifty-two cases (49.6%) were found to be ASA II. Colonoscopy was performed in 134 cases (26.4%), gastroscopy in 270 cases (53.1%), both colonoscopy and gastroscopy in 99 cases (19.5%), and PEG in 5 cases (1%). The most frequently used anesthetic drug in sedated patients was observed to be propofol. Complications occurred in 28 patients (5.5%).Conclusions: Drug selection becomes crucial in non-operating room anesthesia applications in terms of early recovery and patient safety. In this study, it was seen that the most used drug was propofol, and accordingly, it was concluded that mortal complications were not observed.

Objective: To evaluate the relation between nephrin levels and preeclampsia severity by comparing serum and urine levels of nephrin in the severe and mild groups according to severity of associated intrauterine growth retardation (IUGR) development. Methods: A total of 150 patients who attended our ante-natal clinic (ANC) were included in this study. We had 5 groups; Group 1:30 patients with mild preeclampsia (MP) and normal fetal development (NFD), Group 2:30 patients with severe preeclampsia (SP) and NFD, Group 3: 30 patients with MP and IUGR, Group 4: 30 patients with SP and IUGR and Group 5: 30 volunteers who were normotensive and non-preeclamptic. We obtained both blood and urine samples for measuring nephrin levels. Results: Both serum and urine nephrin levels were significantly higher for the fourth group compared with all other groups (p

Background. Primary dysmenorrhea, defined as painful menstrual cramps originating in the uterus without underlying pathology, is a gynecological disease that affects quality of life and school success. Our goal was to determine the effect of anterior uterocervical angle on primary dysmenorrhea and disease severity. Methods. A total of 200 virgin adolescents, 16 to 20 years of age, were included in the study. The Andersch and Milsom scale was used to determine dysmenorrhea severity. Those with pathologies causing secondary dysmenorrhea were excluded from the study. Study subjects were grouped based on severity of pain. Demographic characteristics and uterocervical ultrasonographic measurements were compared among groups. Results. Of the 200 participants enrolled in the study, 50 were healthy controls and 150 had primary dysmenorrhea. Those with primary dysmenorrhea had a significant family history of primary dysmenorrhea compared with controls (P<0.001). Age (P=0.668), body mass index (P=0.898), menarche age (P=0.915), and length of menstrual cycles (P=0.740) were similar in all groups. The uterine corpus longitudinal axis, uterine corpus transverse axis, and uterine cervix longitudinal axis were also similar (P=0.359, P=0.279, and P=0.369, resp.). The mean uterocervical angle was 146.8 ± 6.0 in controls and 143.3 ± 7.3 in those with mild pain with no significant difference between the groups. In those with moderate pain, the mean uterocervical angle was 121.2 ± 7.3 compared with 101 ± 9.2 in those with severe pain, which was a significant difference. Additionally, there was also a significant difference in the uterocervical angle among those with mild, moderate, and severe pain (P<0.001). Conclusion. Our results indicate that a narrower anterior uterocervical angle is associated with primary dysmenorrhea and disease severity.

Çalışmada 21 Meloidogyne javanica ırk1 izolatı'nın California Wonder duyarlı biber çeşidi ile Kök-ur nematodlarına dayanıklılık sağlayan N (Carolina Wonder), Me1 - Mech2 (PM 217), Me5 (Yolo Wonder) ve Me7 - Mech1 (CM334) genlerini taşıyan biber hatlarında patojeniteleri kontrollü koşullar altında araştırılmıştır. Denemeler 5 tekerrürlü olarak tesadüf blokları deneme desenine göre kurulmuştur. Bitkiler 4 gerçek yapraklı dönemlerine geldiklerinde 4800 Meloidogyne javanica ırk1 yumurta + ikinci dönem larva olarak bitki kök bölgesine inokule edilmiştir. İnokulasyondan yaklaşık 9 hafta sonra çalışma sonlandırılmıştır. Biber köklerinde gal indeksi, gal sayısı, yumurta paketi ve yumurta sayısı belirlenerek infeksiyon frekansı, dişi doğurganlığı ve üreme potansiyeli hesaplanmıştır. Carolina Wonder, CM334 ve PM217 dayanıklı biber hatlarında birçok izolatın az da olsa geliştiği görülmesine rağmen infeksiyon değerleri çok düşük bulunmuş ve tüm izolatlar avirülent reaksiyon göstermiştir. Carolina Wonder biber hattında en yüksek gal sayısı, gal indeksi, yumurta paketi ve yumurta sayısı tespit edilen AKS-3 izolatının üreme oranı 0.037 bulunmuştur. CM334 biber hattında ise sadece F4, K13 ve M11 izolatlarında yumurta paketi ve yumurta bulunmuştur. Me1-Mech2 genlerini içeren PM217 biber hattında yumurta paketi sayısı 3.8 değeri ile en yüksek ISP29 izolatında bulunmuştur. Yolo Wonder biber hattında 18 izolat gelişmiş ve 4 izolat (A1, K16, F7, F4) virülent reaksiyon göstermiştir. A1 virülent izolatı 3.23 üreme oranı ile en yüksek değerdedir. California Wonder duyarlı biber çeşidinde 21 izolatın gal indeks değeri 0-1.8 arasında değişim gösterirken, üreme oranları 0-0.06 arasında değişmiştir.

This chapter presents an overview of calcium phosphate cements (CPCs) used for medical applications. The hardening mechanism and the two types of CPCs apatite and brushite, are discussed. A description of the main properties (and testing methods) of CPCs such as setting time, cohesion time, mechanical properties and injectability and different strategies adopted to improve them are reported. The chapter includes a description of the preparation steps of a typical cement before implantation in the bone defect and some examples of current medical applications and limitations of CPCs.

Objectives. The personnel of Emergency Service (ES) is under stress due to the intensity of the resulting from the very nature of the work to be performed in this department, which is characterized by the need of providing rapidly medical care to patients with often severe or even life-treating health problem and by though working conditions. In our study, we aimed to determine the satisfaction of resident physicians about choosing the emergency medicine, the factors affecting this satisfaction, and the plans of these resident doctors. Methods. In our study, we surveyed 66 resident physicians working in 4 emergency centres. The resident physicians completed the survey form given to them. Results. Regarding the occupational satisfaction of 66 resident physicians participating working in emergency medicine department, we obtained the following results: 54.5% (n=36) satisfied, 22.7% (n=15) not satisfied, 9.1% (n=6) more satisfied than expected, and 9.1% (n=6) neither satisfied nor not satisfied. When the opinions of residents were asked about how likely it was that they would be working in emergency medicine in 10 years hence, 40.9% (n=27) of the participants stated that they wanted to work there, 36.4% (n=24) stated that they were not sure, and 22.7% (n=15) stated that they didn’t want to work. Conclusions. The encouraging legal regulations in regard to physicians’ rights about working in emergency medicine branch should be revised, working conditions should be improved, and it is important to provide young doctors with carrier and educational opportunities. Otherwise, it is likely that we might lose our national and international achievements in emergency medicine branch.

To evaluate the diagnostic significance of neutrophil gelatinase-associated lipocalin in detecting the development of contrast-induced nephropathy in patients undergoing contrast imaging in an emergency department setting.The case-control study was conducted at the emergency department of Uludag University, Turkey, between January 1 and July 1, 2012, and comprised patients who underwent a diagnostic thoracic or abdominal Computed Tomography examination with contrast agent. At 2 hours and 72 hours after the scan, control urea, creatinine, and neutrophil gelatinase-associated lipocalin values were recorded. Plasma lipocalin measurement was performed using fluorescence-detected immunoassay method. An increase in serum creatinine of more than 0.5 mg/dl or 25% elevation from the basal level was considered to be a marker for the occurrence of contrast-induced nephropathy. SPSS 13 was used for statistical analysis.Of the 80 subjects in the study, 60 (75%) were cases and 20 (25%) were controls. Contrast-induced nephropathy did not develop in any of the patients, and, accordingly, no significant increase of plasma urea, creatinine, or neutrophil gelatinase-associated lipocalin levels was observed. A significant positive relationship was found between urea and creatinine levels at 2 hours (p0.009) and at 72 hours (p0.001).Diagnostic contrast computed tomography examination in patients with normal renal function did not lead to Contrast-induced nephropathy or increased neutrophil gelatinase-associated lipocalin levels, an accepted early indicator of kidney injury.

A 14-week pregnant woman was admitted to the hospital for pregnancy termination because of early rupture of membranes. Dilatation and curettage were performed because the placenta did not separate spontaneously after fetus evacuation. The placenta could not be extracted and severe vaginal bleeding occurred. The patient's condition deteriorated. Placenta percreta was detected intraoperatively. Emergency hysterectomy was performed. Because of the high risk of maternal morbidity and mortality, it is important to consider placenta percreta in the presence of prolonged first and second trimester pregnancy termination, especially in those patients with a history of uterine surgery.

The correlation between plasma D-dimer level and reperfusion has not been clarified yet in thrombolytic therapy applied for acute myocardial infarction patients. The aim of this study was to investigate whether there is a relationship between reperfusion and fibrinolytic activity in acute myocardial infarction patients treated with thrombolytic therapy. Fibrinolytic activity was reflected by plasma D-dimer levels. During the study period, 186 patients were initially analyzed. But 18 of these patients were excluded from the study because they were not suitable for study criteria. Blood was collected from 168 acute myocardial infarction patients within first 6 h. Intravenous tissue plasminogen activator (100 mg) or streptokinase (1,500,000 U) was applied to patients. Mean age of the patients was 58 (28-86) years and majority was men (86%). The number of anterior, inferior, and lateral myocardial infarction patients were 76 (45.2%), 85 (50.6%), and seven (4.2%), respectively. The mean time from symptom onset to thrombolytic application was 134 (95-212) min. Reperfusion occurred in 115 (68.5%) patients. D-dimer levels were markedly high after thrombolytic therapy versus before (155 mg/dl, 362 mg/dl, P

BACKGROUND: The necessity of routine tests as regarded in the Advanced Trauma Life Support protocols has become controversial in recent years. The aim of this study was to analyze the necessity of routine tests in trauma patients. METHODS: This was a prospective study. A total of 103 blunt trauma patients aged between 15 and 65 years who presented to the emergency department with major trauma, Glasgow Coma Scale of 15 and Revised Trauma Score of 12 were admitted to the study. RESULTS: The average age of the patients (30.1% female, 69.9% male) was 35 +/- 12.97 years. A total of 72.8% of the patients presented for motor vehicle crashes, 12.6% for pedestrian injury and 14.6% for fall from a height. All of the routine tests were evaluated separately. With the exception of cervical examination-lateral cervical X-ray results and pelvic examination-complete blood count and urinalysis test results, significant relations were determined between the reason for requiring a test and the results of the other tests (complete blood count, lateral cervical X-ray and abdominal ultrasonography). CONCLUSION: According to our study, biochemical tests, anterior-posterior chest X-ray and anterior-posterior pelvic X-ray can be ordered as targeted tests. Conducting targeted tests will reduce costs and workload. Son yıllarda ileri travma yaşam desteği protokollerine göre rutin testlerin gerekliliği tartışılmaktadır. Bu çalışmanın amacı, majör travma hastalarında rutin testlerin gerekliliği ve tanısal değerini analiz etmektir. GEREÇ VE YÖNTEM Bu prospektif çalışmada, Glasgow Koma Skoru 15, Revize Travma Skoru 12 olan ve 15-65 yaş arası majör travma ile acil servise başvuran toplam 103 künt travma hastası değerlendirildi. BULGULAR Hastaların (%30,1 kadın,%69,9 erkek) yaş ortalaması 35±12.97 idi. Tüm hastaların %72,8’i araç içi trafik kazası, %12,6’sı araç dışı trafik kazası ve %14,6’sı yüksekten düşme ile başvurdu. Rutin testlerin hepsi ayrı ayrı değerlendirildi. Servikal inceleme ile lateral servikal röntgen istemi, pelvik muayene ile tam kan sayımı ve idrar testi istemi hariç, tam kan sayımı, yan servikal röntgen ve karın ultrasonografisi istem nedenleri ile diğer test sonuçları ve istem nedenleri karşılaştırıldığında önemli farklılıklar saptandı. SONUÇ Çalışmamıza göre biyokimyasal testler, ön-arka göğüs grafisi ve ön-arka pelvis grafisi hedefe yönelik testler olarak istenebilir. Hedefe yönelik testlerin istemi ile maliyet ve iş yükü azalacaktır.

Prediction of mortality in trauma patients is an important part of trauma care. Trauma scoring systems are the current methods used for prediction of mortality. We aimed to evaluate and compare the performances of Injury Severity Score (ISS) and New Injury Severity Score (NISS) in firearm injuries.Records of 135 firearm-injured patients who applied to Uludag University Emergency Department between January 2001 and December 2005 were analyzed retrospectively. All patients' data, including age, gender, cause of injury, initial vital signs, injury region, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), mortality, operation data, and final diagnosis, were collected, and ISS, NISS and Trauma and Injury Severity Score (TRISS) were calculated.Mortality rate was 12.6%. The patients' mean GCS, RTS, ISS, NISS, and TRISS scores were 13.41 +/- 0.31, 10.65 +/- 0.26, 17.04 +/-1.20, 21.94 +/- 1.45, and 9.52 +/- 2.37, respectively. The patients were divided into two groups as ISS = NISS (53.3%) and ISSNISS (46.7%).ISS and NISS both performed well in mortality prediction of firearm injuries. NISS demonstrated no superiority to ISS for prediction of mortality in these patients.

The aim of this study was to determine the epidemiology and clinical features of the trauma in elderly patients, to investigate the factors influencing mortality and morbidity and to make a contribution to the national trauma data.We retrospectively investigated the medical records of three hundred seventy-one trauma patients (231 males (62,3%); 140 females (37,7%); mean age 71,9), aged 65 and older presenting to our hospital. Patients' census data, diagnosis, dispositions, prognosis, trauma scores (GCS (Glasgow Coma Score), RTS (Adult Trauma Score), ISS (Injury Severity Score)), sites of injury were analyzed.During the study period 187.326 patients were admitted to our emergency department (ED). A total of 9.520 patients were trauma patients. There were 371 patients 65 years and older. Mean GCS, mean RTS and mean ISS were 13,6, 11,3, and 9,3 respectively. A total of 213 patients were hospitalized. Mean length of stay was 7,9 days. Sixty-six patients were discharged from the ED. Mortality rate was 10,2% (38/371). The mechanism of injury, injury severity, increasing age were predictors of mortality (p0.001). Major injuries included head trauma (36,4%), extremity trauma (36,4%), and thoracic trauma (18%). Head trauma and abdominal trauma were significantly more frequent in the nonsurvivors (p0.001 and p=0.02 respectively).Injury severity and increasing age were the predictors of mortality. Also pedestrian- vehicle collision patients were high mortality rate than the other trauma mechanisms. The most common injured organs were head and extremities.

Objective - The aim of this study is to analyse the factors affecting emergency department (ED) cardiopulmonary resuscitation (CPR) outcome. Methods - A standard CPR protocol was performed in all patients and certain pre and post-resuscitation parameters including age, sex, initial arrest rhythm, primary underlying disease, initiation time of advanced cardiac life support, duration of return of spontaneous circulation were recorded. Patients were followed up to determine rates of successful CPR, survival and one-year survival. Results - From December 1999 to May 2001, 80 consecutive adult patients in whom a standard CPR was performed in the ED were prospectively included in the study. The overall rate for successful CPR, survival and one-year survival were found to be 58.8% (47/80), 15% (12/80) and 10% (8/80), respectively. Survival and one-year survival rates were better in patients with an initial arrest rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) than both pulseless electrical activity (pEA) and asystole; survival and one-year survival rates were better in patients with a primary underlying disease of cardiac origin than non-cardiac origin. Acute myocardial infarction had the best prognosis among conditions causing arrest. Presence of sudden death was found to have a better survival and one-year survival rate. Conclusion - Initial cardiac rhythm of VF/pVT, cardiac origin as the primary disease causing cardiopulmonary arrest and presence of sudden death were found to be good prognostic factors in CPR.