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In recent years, there has been an increasing interest in non-hematopoietic pluripotent progenitor cells that are found in the bone marrow. Mesenchymal stem cells (MSCs) are the first non-hematopoietic progenitors to be isolated from the bone marrow and extensively characterized. In addition to their ability to support hematopoiesis, MSCs can differentiate into osteocytes, chondrocytes, tenocytes, adipocytes and smooth muscle cells. This article will review our current understanding of bone marrow stroma and MSCs and their potential therapeutic role in the setting of hematopoietic stem cell transplantation. Bone Marrow Transplantation (2001) 27, 235–239. [ABSTRACT FROM AUTHOR]

High-dose chemotherapy followed by CD34+ enriched peripheral blood progenitor cell (PBPC) transplantation is used for the treatment of primary refractory or relapsed Hodgkin’s and non-Hodgkin’s lymphomas. The CD34+ enrichment procedure, while reducing tumor burden, may compromise immunological reconstitution in the transplanted patient and result in increased rates of post-transplant infection. We compared infectious complications in patients with lymphoma who were treated with high-dose chemotherapy and supported either with CD34+ enriched PBPC (n = 19) or unmanipulated PBPCs (n = 24). Analysis was limited to patients discharged from initial hospitalization for transplantation with a minimum of 1 year follow-up and free of lymphoma recurrence. We found a statistically significant increase in the number of patients with one or more infectious events in the CD34+transplant group (14/19) compared with the unmanipulated PBPC group (9/24, P < 0.01). Greater numbers of patients with two or more infectious events were observed in the CD34+ group (7/19 vs 2/24, P < 0.03) and an increased incidence of bacterial infections was observed in the CD34+ group (10/19 vs 5/24, P < 0.05). Two deaths due to infectious complications were observed in the CD34+ group. There was no significant difference in blood lymphocyte or monocyte recovery between the groups. These data demonstrate a significant increase in the long-term incidence of infectious events in lymphoma patients transplanted with autologous CD34+ enriched PBPCs compared to unmanipulated PBPCs. Thus, patients who undergo CD34+ enriched PBPC transplantation should be followed closely for infectious complications and prolonged infectious prophylaxis should be considered. Bone Marrow Transplantation (2000) 26, 831–836. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether storing mobilized peripheral blood progenitor cell (PBPC) collections overnight before CD34+ selection may delay platelet count recovery after high-dose chemotherapy and CD34+-enriched PBPC re-infusion. Lymphoma patients underwent PBPC mobilization with cyclophosphamide 4 g/m2 i.v. and G-CSF 10 μg/kg/day subcutaneously. Patients were prospectively randomized to have each PBPC collection enriched for CD34+ cells with the CellPro CEPRATE SC System either immediately or after overnight storage at 4°C. Thirty-four patients were randomized to overnight storage and 34 to immediate processing of PBPC; 15 were excluded from analysis due to tumor progression or inadequate CD34+ cell mobilization. PBPC from 23 patients were stored overnight, while 30 subjects underwent immediate CD34+selection and cryopreservation. Median yield of CD34+ enrichment was 43.6% in the immediate processing group compared to 39.1% in the overnight storage group (P = 0.339). neutrophil recovery >500 × 109/l occurred a median of 11 days (range 9–16 days) in the overnight storage group compared to 10.5 days (range 9–21 days) in the immediate processing group (P = 0.421). Median day to platelet transfusion independence was 13 (range 7–43) days in the overnight storage group vs 13.5 (range 8–35) days in those assigned to immediate processing (P = 0.933). We conclude that storage of PBPC overnight at 4°C allows pooling of consecutive-day collections resulting in decreased costs and processing time without compromising neutrophil and platelet engraftment after infusion of CD34+-selected progenitor cells. Bone Marrow Transplantation(2000) 25, 559–566. [ABSTRACT FROM AUTHOR]

Human low-molecular weight salivary mucin (MUC7) is a small, secreted glycoprotein coded by MUC7. In the oral cavity, they inhibit the colonization of oral bacteria, including cariogenic ones, by masking their surface adhesions, thus helping saliva to avoid dental caries. The N-terminal domain is important for low-molecular weight (MG2) mucins to contact with oral microorganisms. In this study, we aimed to identify the N-terminal coding region of the MUC7 gene between individuals with and without caries. Forty-four healthy dental students were enrolled in this study; 24 of them were classified to have caries [decayed, missing, filled-teeth (DMFT) = 5.6] according to the World Health Organization (WHO) criteria, and 20 of them were caries-free (DMFT = 0). Simplified oral hygiene index (OHI-S) and gingival index (GI) were used to determine the oral hygiene and gingival conditions. Total protein levels and salivary total protein levels and salivary buffer capacity (SBC) were determined by Lowry and Ericsson methods. DNA was extracted from peripheral blood cells of all the participants and genotyping was carried out by a polymerase chain reaction (PCR)-sequencing method. No statistical differences were found between two groups in the terms of salivary parameters, oral hygiene and gingival conditions. We detected one common single nucleotide polymorphism (SNP) that leads to a change of asparagine to lysine at codon 80. This substitution was found in 29.0 and 40.0%, respectively, of the groups with and without caries. No other sequence variations were detected. The SNP found in this study may be a specific polymorphism affecting the Turkish population. Further studies with extended numbers are necessary in order to clarify this finding.

In order to demonstrate the feasibility of mobilization, enrichment and engraftment of autologous peripheral blood CD34+ cells in patients with relapsed lymphoma, 59 peripheral blood progenitor cell (PBPC) collections from 21 patients were enriched for CD34+ cells using CEPRATE SC (CellPro, Bothell, WA, USA) immunoaffinity column. Following high-dose chemotherapy, a mean of 17 × 108 (range, 3–34) nucleated cells/kg containing 8.7 × 106 (0.3–26) CD34+ cells/kg were re-infused. Blood cell recovery in these patients was compared to engraftment capacity of unenriched PBPCs in a cohort of lymphoma patients treated with an identical high-dose chemotherapy regimen. Neutrophil and platelet engraftment was rapid in both groups including five patients who received 1 × 106 CD34+ cells/kg. After infusion of CD34+ enriched cells, neutrophils exceeded 0.5 × 109/l in 11 (8–14) days and platelets exceeded 20 × 109/l (untransfused) in 15 (9–39) days. In order to optimize the immunoaffinity column utilization we stored the first PBPC collections overnight at 4°C and combined them with the next day’s collection prior to the CD34+ enrichment procedure in 11 patients. This maneuver resulted in a significant decrease in the CD34+ cell recovery (resulting in reinfusion of a mean of 42% less CD34+ cells). Although overnight storage did not affect neutrophil engraftment, platelet engraftment was prolonged in this group of patients even when >2.0 × 106 CD34+ cells/kg were re-infused. The overnight storage procedure should be further evaluated for its effects on the CD34+ immunoaffinity enrichment procedure, megakaryocyte progenitors and platelet engraftment. We conclude that CD34+ cells enriched from peripheral blood result in... [ABSTRACT FROM AUTHOR]

We evaluated induction of lymphomas by the methylating carcinogen, N-methylnitrosourea [MNU], in transgenic mice expressing both LMO1 and the DNA repair gene, MGMT, in the thymus. The goal was to determine whether environmental mutagens shorten the latency or increase the incidence of LMO1+lymphomas and whether mice transgenic for both LMO1 and MGMT, and thereby able to repair O6-methylguanine DNA adducts induced by MNU, would be protected. Mice heterozygous for LMO1 or MGMT were crossed and offspring treated with MNU at 6 weeks of age. MNU induced lymphoma incidence was highest in the LMO1 mice, 91% and lowest in the hMGMT+mice, 15%. MNU induced K-ras mutations in codon 12 in non-MGMT transgenics resulted in a shorter latency of tumors and accounting for half of the early lymphomas in LMO1 mice. The effect of MNU was abrogated in the LMO1/hMGMT transgenic mice, indicating the ability of MGMT expression to block the carcinogenic effect of MNU even in cancer prone mice. Thus, methylating agents potentiate lymphomagenesis of LMO1, in part through activation of K-ras and the MAPK pathway, a process which appear to synergize with LMO1 mediated transcription activation. O6-alkylguanine DNA-alkyltransferase mediated DNA repair effectively blocks chemical carcinogenesis in mice carrying the LMO1 oncogene. [ABSTRACT FROM AUTHOR]

Jiska M Balk,1 Guido RMM Haenen,1 Özgür M Koc,2 Ron Peters,3 Aalt Bast,1 Wim JF van der Vijgh,1 Ger H Koek,4 1Department of Toxicology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, 2Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 3DSM Resolve, Geleen, 4Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands Background: The combination of ribavirin (RBV) and pegylated interferon (PEG-IFN) is effective in the treatment of chronic hepatitis C infection. Reducing the frequency of RBV intake from twice to once a day will improve compliance and opens up the opportunity to combine RBV with new and more specific direct-acting agents in one pill. Therefore, the purpose of this study was to evaluate the pharmacokinetic profile of RBV in a once-daily to twice-daily regimen. The secondary aim was to determine tolerability as well as the severity and differences in side effects of both treatment regimens. Methods: In this randomized open-label crossover study, twelve patients with chronic type 1 hepatitis C infection and weighing more than 75 kg were treated with 180 µg of PEG-IFN weekly and 1,200 mg RBV daily for 24 weeks. The patients received RBV dosed as 1,200 mg once-daily for 12 weeks followed by RBV dosed as 600 mg twice-daily for 12 weeks, or vice versa. In addition to the pharmacokinetic profile, the hematological profile and side effects were recorded. The RBV concentrations in plasma were determined using liquid chromatography-tandem mass spectrometry. Results: Eight of twelve patients completed the study. Neither the time taken for RBV to reach peak plasma concentration nor the AUC0-last (adjusted for difference in dose) was significantly different between the two groups (P>0.05). Furthermore, the once-daily regimen did not give more side effects than the twice-daily regimen (P>0.05). No significant differences in the hematological profile were observed (P>0.05). Conclusion: The standard twice-daily RBV regimen is interchangeable with the once-daily regimen. The once-daily regimen will improve compliance and opens the opportunity to combine RBV with other drugs dosed once a day, in a single pill. Keywords: hepatitis C, dose regimen, ribavirin, pegylated interferon

Background: Cardiac troponin I, a particular biomarker, is released into the bloodstream in response to myocardial injury., Objectives: To evaluate perioperative changes in high-sensitivity cardiac troponin I (hs-cTnI) concentration during ovariohysterectomy in cats undergoing three different anaesthesia protocols., Methods:  Twenty-one female mixed-breed cats owned by clients aged (2.2 ± 0.7 years) and weight (3.2 ± 0.5 kg) were included in our study. The cats were divided into three groups: propofol-isoflurane (PI) group (n = 7), xylazine-ketamine (XK) group (n = 7) and xylazine-isoflurane (XI) group (n = 7). After pre-anaesthetic propofol (6 mg/kg IV) was administered to cats in Group PI, a mask was placed, and anaesthesia was maintained with 3.0% isoflurane in oxygen. Cats in Group XK underwent general anesthetization with xylazine hydrochloride (2 mg/kg IM) and, 10 min later, ketamine hydrochloride (10 mg/kg IM). Cats in Group XI were administered xylazine hydrochloride (2 mg/kg IM), and then anaesthesia (3.0% isoflurane and oxygen) was continued with a mask. Blood samples were collected from all cats; preoperatively and postoperatively at 0 and 12 h (Pre-, Post-0 h and Post-12 h, respectively). Serum hs-cTnI concentrations were measured with the Advia Centaur TnI-Ultra., Results: In all 21 cats, hs-cTnI concentration increased at Post-0 h and 12 h measurement points compared to Pre-. In the XK group, hs-cTnI concentrations exhibited a significant increase at the Post-0 h (51.30 ng/L) and Post-12 h (157.70 ng/L) time points compared to Pre- (6.70 ng/L) (p < 0.05)., Conclusions: The XK group increased the concentration of hs-cTnI more than other protocols. In the PI group, the increase in hs-cTnI concentrations at Post-0 and 12 h increased less than the other two groups (p < 0.05). The PI group was found to induce less myocardial damage., (© None The Author(s). Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Purpose: This study aims to assess the impact of different surgical techniques and three expansion appliances on maxillary expansion in adults using finite element analysis (FEA), with a focus on maxillary displacement and stress on surrounding structures., Methods: Seven different FEA models were created to compare different surgical techniques and three different expansion appliances. Model I represented a bone-supported appliance without surgical assistance. Model II, Model III, and Model IV were surgically assisted rapid palatal expansion (SARPE) models without pterygomaxillary suture disjunction (PMD). Model V, Model VI, and Model VII were SARPE models with PMD., Results: The largest displacement at the anterior nasal spine (ANS) was recorded for Model II (2.95 mm). For the posterior nasal spine (PNS), the highest displacement was observed in Models V, VI, VII (2.50 mm), with the lowest in Model III (0.79 mm). Stress analysis revealed the highest stress in Model I, with models featuring PMD displaying nearly zero stress at all anatomical points, highlighting distinct expansion patterns and stress distributions between models with and without PMD., Conclusion: SARPE models with PMD demonstrated a parallel expansion of the maxilla with minimal stress, while the miniscrew assisted rapid maxillary expansion (MARPE) model displayed transverse rotation. SARPE models without PMD exhibited a V-shaped expansion pattern. SARPE models with PMD represent an optimal approach for achieving uniform expansion and minimizing stress, with stress levels nearly negligible at all anatomical points in models with PMD., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Limiting postoperative edema, pain, trismus, and infection is crucial for smooth healing. This prospective, controlled clinical trial investigated and compared the effectiveness of dexamethasone and hyaluronidase in relieving these complications., Methods: In groups Ia and IIa, 8 mg of dexamethasone and 150 IU of hyaluronidase were administered following the removal of impacted teeth, respectively. The contralateral sides (groups Ib and IIb) were determined as control groups. Edema, pain, trismus, and infection were clinically evaluated on the 1st, 2nd, 3rd, and 7th postoperative days., Results: 60 patients were enrolled in the study. Hyaluronidase provided significantly more edema relief than dexamethasone on the 1st, 2nd, 3rd, and 7th postoperative days (P = 0.031, 0.002, 0.000, and 0.009, respectively). No statistical difference was found between dexamethasone and hyaluronidase in VAS and rescue analgesic intake amount values for all time points. Hyaluronidase was more effective in reducing trismus than dexamethasone on the 2nd and 3rd postoperative days (P = 0.029, 0.024, respectively). Neither of the agents significantly increased the postoperative infection rate., Conclusions: Hyaluronidase can be selected when postoperative excessive edema and trismus are anticipated. Dexamethasone may be a cost-effective option if postoperative pain control is merely targeted., Trial Registration: This trial was registered in the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov identifier number: NCT05466604) on 20/07/2022., (© 2024. The Author(s).)

This paper examines the relationship between roll rotation of the jaws and changes in alar base or lip line asymmetry in the coronal plane following orthognathic correction. The study involved patients with preoperative frontal alar base and lip line asymmetries greater than 0.5° (because it corresponds to the minimum asymmetry perception threshold) and underwent bimaxillary orthognathic surgery without (Group I) or with (Group II) genioplasty. The alar base angle (ABA), lip line cant angle (LLCA), maxillary cant angle (MxCA), and mandibular cant angle (MnCA) were measured using preoperative and 12 months postoperative cone beam computed tomography (CBCT) images. Thirty-four patients were included in the study. Significant correlations were found between changes in MxCA and ABA besides between changes in MnCA and LCA in Groups I (P = 0.016, P˂0.001, respectively) and II (P = 0.002, P˂0.001, respectively). The mean of the change in ABA/the change in MxCA and the change in LLCA/the change in MnCA ratios for Group I were 0.59 ± 1.57 and 0.73 ± 0.94, respectively, while those for Group II were 0.46 ± 3.70 and 0.39 ± 2.00, respectively. Angular measurements from jugular and mental foramina points, aligned with the bony midline, offer a convenient tool for predicting alar base and lip symmetry during bimaxillary orthognathic surgery planning., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: In recent years, the use of dietary supplements has increased in all age groups. Parents may also use these supplements for their children for different reasons. This study aims to determine the use of dietary supplements by children, the factors affecting this use, and the attitudes of parents about these products., Methods: A total of 1038 children aged 2-18 years without any chronic disease who presented to the pediatric outpatient clinics of Ege University Children's Hospital were included in this study. Parents ( n = 1000) who agreed to participate in the study were interviewed face-to-face, and a comprehensive questionnaire including questions about children's use of dietary supplements, sociodemographic characteristics, and parents' attitudes towards dietary supplements was administered. Analyses were performed with SPSS 25.0., Results: The mean age of the children included in our study was 8.6 ± 4.8 years, and 51% ( n = 510) were male. It was found that 32.5% of the children used nutritional supplements, and vitamin-mineral preparations (23.2%) were the most frequently used. Omega-3 (19.3%) and immune support products (9.4%) were the second and third most frequently used supplements, respectively. A significant relationship was found between the use of dietary supplements and the child's age, body weight, body mass index, parents' educational level, being health worker, and economic status ( p < 0.05). It was found that most of the families thought that vitamin-mineral and omega-3 products were beneficial for growth and development and that they received information from doctors most frequently before taking these products. However, it was found that families followed the media as the second most frequent source of information for these products., Conclusions: Approximately one-third of the children in our study use dietary supplements. It is very important to raise awareness among families about the use of these products when necessary and with the recommendation of a physician. To prevent families from using dietary supplements that are not necessary for their children, especially due to misinformation in the media, pediatricians should provide correct information to parents about these products at every clinic visit. A concerted effort is needed from policy makers, media organizations, and health care providers to guide the safe use of DS. The results obtained from this study will shed light on future randomized controlled prospective studies.

Introduction: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures., Objective: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis., Material and Methods: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures., Results: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest)., Conclusions: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

Background: It is important to investigate the factors that may delay the diagnosis and treatment process of ischemic stroke. The aim of this study was to investigate whether in-hospital mortality increased in patients who presented to the emergency department out-of-hours and underwent thrombectomy., Methods: A total of 59 patients who applied to the emergency department between January 1, 2018 and November 1, 2021 and underwent thrombectomy due to ischemic stroke were included in the study. Patient age, gender, thrombectomy success (successful recanalization), in-hospital mortality status, intracranial hemorrhage status after thrombectomy, and out-of-hours admission status were recorded and compared according to out-of-hours admission status., Results: Twenty-seven (45.8%) patients were male, and the median age was 74 (61-81) years. Forty-two (71.2%) patients applied to the emergency department out-of-hours. In-hospital mortality occurred in 27 (45.8%) patients. There was no statistically significant difference in out-of-hours admission status between the non-survivor group and the survivor group (non-survivor: 24 [75%]; survivor: 18 [66.7%], p = 0.481). Nor was a statistically significant difference found in the intracranial hemorrhage complication rate of the patients admitted out-of-hours compared to the patients admitted during working hours (out-of-hours: 17 [40.5%]; during working hours: 6 [35.3%], p = 0.712)., Conclusion: No statistically significant difference was found in the rate of in-hospital mortality and intracranial bleeding complications in patients who underwent thrombectomy out of working hours compared to during working hours.

Skeletal orthopedic expansion of maxilla is accepted as a reliable method for the treatment of transverse maxillar deficiency in growing patients. The aim of the study was to evaluate the effects of different palatal distractor positions on the expansion, stress and displacement patterns of the structures of craniofacial complex in surgical assisted rapid maxillary expansion without pterygomaxillary disjunction (PTMD) with the help of finite element analysis(FEA). Four facial skeleton models with different distractor positions (first premolar, second premolar, first molar, second molar regions) were created. In all finite element models median and lateral osteotomies were performed, without PTMD. Stress distribution was evaluated after 5 mm activation of the transpalatal distraction in all models using the nonlinear solution method in FEA. Unilateral displacement(mm) and stress distribution(MPa) were measured in three directions (x, y, and z axes) of craniofacial and maxillofacial structures in the symmetrical finite element models. In all models, the unilateral transverse displacements of the anterior teeth were greater than those of the posterior teeth, and the greatest displacement was at the central incisor level. The greatest displacement values at the central incisor level, at the anterior nasal spine(ANS) and at the posterior nasal spine(PNS) levels was measured in Model-IV, III, II and I, respectively. Mean elemental stress(von Mises stress) in the medial pterygoid plate, screw and lateral pterygoid plate regions from highest to lowest was measured in Model-IV, III, II and I, respectively. The maxilla performed outward rotation and tipping movement in all models during the expansion period. Among the distractor positions, the second molar region was found to be the most advantageous one in terms of expansion pattern. Considering the patient's anatomy and clinical conditions, placing the palatal distractor as posteriorly as possible will result in more effective maxillary expansion.

Objective: The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry., Methods: A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups., Results: Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively)., Conclusions: SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment., Clinical Relevance: Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: This study aimed to compare the effects of 3 different bone-borne type expansion appliances used in the surgically-assisted rapid palatal expansion (SARPE) by finite element analysis., Methods: Three different miniscrew-supported palatal expansion appliances were modeled. Median and lateral osteotomies were performed without pterygomaxillary suture separation. Model I consisted of a palatal expander with 2 miniscrews placed 4 mm far from the midpalatal suture. In model II, 2 miniscrews were located at the alveolar ridge between the first molar and the second premolar. In model III, 4 miniscrews were placed as a combination of the first and second models. Stress distributions and amount of displacements were evaluated with Ansys software (version 19.2; Ansys, Canonsburg, Pa) for 5-mm expansion in a symmetrical finite element analysis model to reflect the clinical situation., Results: SARPE simulation using miniscrew-assisted maxillary expanders for all models showed a rotation and tipping of the maxilla. The largest displacement was found for the anterior part of the palate in model II and the posterior part in model III. Although a wedge-shaped expansion pattern was observed in all models, this form was more prominent in model II. The highest stress value (0.91 MPa) was measured in model I, and the lowest value (0.004 MPa) was measured in model II for the anterior nasal spine region. The highest stress value (0.51 MPa) was measured in model III, and the lowest value (0.12 MPa) was measured in model II for the posterior nasal spine region. The lowest stress values were measured in model II for all the craniofacial and maxillofacial structures., Conclusions: Among the models, the lowest stress distribution conditions for craniofacial and maxillofacial structures were found in model II. The largest displacement was found at the incisors and anterior part of the maxilla for model II. The greatest displacement was found at the posterior region for model III., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

COVID-19 has caused a major crisis all over the world. To manage this crisis, a fixed shift system was applied to nursing home staff in Turkey to protect nursing home residents from the COVID-19 pandemic. Staff were not allowed to leave the institution during fixed shifts. It is thought that this practice for the COVID-19 outbreak, while protecting nursing home residents on the one hand, increased the workload and related stress of nursing home staff on the other hand. To the best of our knowledge, there is no study examining the workload and stress caused by the COVID-19 pandemic for nursing home staff in Turkey. The aim of this study was to examine the level of workload and work stress experienced by staff working in nursing homes during the COVID-19 pandemic in Turkey., Methods: A cross-sectional research design was used in the study. The sample of the study consisted of nursing home personnel working in nursing homes in the provinces of Istanbul, Ankara, Izmir and Antalya between October 2021 and January 2022. A personal information form and a workload and stress scale were used for collecting the data. Cluster analysis was performed with SPSS software., Results: In total, 154 nursing home personnel participated in the study. A statistically significant difference was found between the mean age of the two clusters. The first cluster was described as "old" and the second as "young". Statistically significant and high values were found in the quantitative workload, qualitative workload, job organization, social work area and fatigue factors in the nursing home staff in the older participant cluster., Conclusion: The results of this study provide new information about the concepts of workload and work stress experienced during the COVID-19 pandemic in Turkey, which will serve as a guide for the management of future pandemics. Therefore, this study will contribute to the strategies to be followed in future pandemics in Turkey.

Dysfunctional and destructive leadership behaviors have begun to be seen frequently in today's business world. Likewise, toxic leadership, with incompetent supervision elements results with negative outputs for organizations and heavily for the employees. Employees may experience long-term stress in the work environment and develop emotional exhaustion, resulting in mental breakdown. Hence, this study aims to reveal the effects of toxic leadership on emotional exhaustion within the healthcare industry as a first step. Moreover, we also attempt to reveal the contingency of intrinsic motivation to lessen the reflections of toxic leadership on emotional exhaustion as a second step. Using PLS-SEM, we find that toxic leadership is positively associated with emotional exhaustion. Furthermore, our findings provide empirical evidence supporting the moderator role of intrinsic motivation on the relationship between toxic leadership and emotional exhaustion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer AG declared a shared affiliation with the author AG to the handling editor at the time of review., (Copyright © 2022 Koç, Bozkurt, Taşdemir and Günsel.)

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

Toxic leadership is becoming increasingly common in healthcare organizations and there is strong need for studies focusing on organizational factors that can trigger revenge. Additionally, how psychological well-being functions in shielding against toxicity has not been adequately studied. Hence, this study aims to examine the relationship between toxic leadership and vengeful behaviors of nurses, along with the contingency of psychological well-being on the relationship during the COVID-19 pandemic. In this exploratory cross-sectional study, we attempt to examine the antecedent effect of toxic leadership on vengeful behaviors based on self-reports from 311 nurses. Using partial least squares and moderation analyses, the results show that toxic leadership is an important antecedent of vengeful behaviors among nurses. However, the results provide no statistical evidence to support a moderating role of psychological well-being in the relationship between toxic leadership and vengeful behaviors. This study reveals that nurses exposed to toxic behaviors by their superiors are more likely to engage in vengeance and highlights the fact that nurses are suffering psychologically during the pandemic.

The study aimed to evaluate the effects of fibers insertion and restorative material type on the stress distribution in endocrowns with finite element analysis. Five 3D models of first mandibular molars were created and restored as follows: (1) IN: intact tooth, (2) IPS-E: tooth restored with lithium disilicat ceramic endocrowns, (3) C-E: tooth restored with composite endocrowns, (4) IPS-E + F: lithium disilicate ceramic endocrowns + fiber, (5) C-E + F: composite endocrowns + fiber. Vertical masticatory load was imitated with finite element analysis. The equivalent stress of von Mises failure criterion (mvM) was calculated. The maximum mvM stress, enamel/crown, dentin and cement were compared among models and strength of the materials. Endocrowns presented a lower mvM stress level than intact tooth. In IPS-E, the mvM stress values in the crown and dentin were higher than C-E, while the mvM stress values in cement were higher in C-E group. Fibers insertion did not affect the stress level of IPS-E and C-E groups. In IPS model, fiber showed more stress absorption than C-E. The restorative material type changed the stress distribution of endocrown restorations. The fiber application did not affect the stress distribution in either endocrown group. But, more stress absorption was observed in fiber under IPS-E than C-E.

Communication is a keystone of animal behavior. However, the physiological states underlying natural vocal signaling are still largely unknown. In this study, we investigated the correlation of affective vocal utterances with concomitant cardiorespiratory mechanisms. We telemetrically recorded electrocardiography, blood pressure, and physical activity in six freely moving and interacting cynomolgus monkeys ( Macaca fascicularis ). Our results demonstrate that vocal onsets are strengthened during states of sympathetic activation, and are phase locked to a slower Mayer wave and a faster heart rate signal at ∼2.5 Hz. Vocalizations are coupled with a distinct peri-vocal physiological signature based on which we were able to predict the onset of vocal output using three machine learning classification models. These findings emphasize the role of cardiorespiratory mechanisms correlated with vocal onsets to optimize arousal levels and minimize energy expenditure during natural vocal production., Competing Interests: None of the authors have any competing financial interests., (© 2021 The Author(s).)

Objective: The aim of study is to evaluate the results of deployment of Percutaneous Radiological Gastrostomy (PRG), which is a good alternative to Surgical Gastrostomy (SG), with transoral approach in cases where Percutaneous Endoscopic Gastrostomy (PEG) is contraindicated, difficult or unsuccessful, in patients with high risk of American Society of Anesthesiologists with four scores. In addition, we aimed to demonstrate the advantages of mushroom pull type catheters over push type gastrostomy catheters., Methods: This retrospective study included a total of 40 patients (18 females and 22 males) aged 21-92 years who underwent PRG with the antegrade transoral approach. PRG was performed by retrograde passing through the esophagus or snaring the guidewire from the stomach and taking out of the anterior abdominal wall. Patients' demographic data, indications for PRG, procedural outcomes and complications were screened and recorded., Results: PRG was performed in 39 of 40 patients included in the study. Technical success rate was 97.5%. Procedure-dependent major complications such as death, aspiration, colon perforation, and deep abscess were not observed. Aspiration occurred in the first patient during the first feeding on the day after the procedure. Major complication rate was 2.5%. The total minor complication rate was 17.5% in 7 patients; parastomal leakage in 2 patients (5%), skin rash and infection in 3 (7.5%) patients, minor bleeding in 2 (5%) patients with oropharynx cancer, minimal bleeding from the gastrostomy catheter 1 week after the procedure in 1 (2.5%) patient. None of the cases had buried buffer. Tube functionality was preserved in all patients without any damage., Conclusion: Mushroom tip (pull type) gastrostomy catheter is a safe treatment method for patients requiring prolonged feeding because of wide diameter, endurance, long staying opening duration, less excessive dilatation and parastomal leakage, and no need for gastropexy. Lower cost and easier access are advantageous for mushroom tip pull type catheters compared to push type gastrostomy catheters in our country. The less invasive PRG is an alternative option in patients who are difficult to administer PEG, are at high anesthesia risk and cannot be sedated., Advances in Knowledge: This article is valuable in terms of its contribution to develop an alternative radiological method for the deployment of gastrostomy tubes in medical difficult patients. This method has shortened the duration of the procedure and increased the success rate in patients with difficulty in transition from the stomach to the esophagus or with difficulty in the upper gastrointestinal tract. Mushroom tip catheters can be placed successfully by radiological methods.

Purpose: The present study evaluated the potential bone regeneration capacity of combining melatonin and simvastatin, with a goal of producing more osteogenic bone substitutes., Materials and Methods: A total of 48 male Wistar rats were randomly divided into 4 groups. The following were administered into critical-sized calvarial defects of the rats: Group I-human allograft; Group II-human allograft + 10 mg melatonin; Group III-human allograft + 0.1 mg simvastatin; and Group IV-human allograft + 10 mg melatonin + 0.1 mg simvastatin. Histopathologic, histomorphometric, and microcomputed tomographic evaluations were performed postprocedurally at 4 and 8 weeks. A P value < .05 was considered significant for all evaluations., Results: Groups II and III had significantly superior regeneration compared to Group I at weeks 4 and 8. Group III had significantly superior regeneration compared to Group II, particularly in week 4. Group IV had significantly superior regeneration compared to all groups at week 8., Conclusions: The local administration of melatonin and simvastatin resulted in increased new bone mass and quality of bone microstructure than was seen in the control group. Simvastatin shortened the defect regeneration time more effectively than melatonin did. The combined use of melatonin and simvastatin provided a synergic effect on bone regeneration, particularly in the late phase of healing., (Copyright © 2021 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia., Methods: Forty-six patients aged 18-70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements., Results: The average age of the patients was 56.6±15.1. The MAP of the patients before induction was 76.28±5.13 mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338)., Conclusion: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.

Objectives: We aimed to determine the characteristics of physicians who had attended the Readers Training of the International Labour Organization International Classification of Radiographs of Pneumoconioses (ILO ICRP) in Turkey., Materials and Methods: This study included 601 physicians attending the Reader Training of the ILO ICRP. Data were collected using an electronic questionnaire, and the inclusiveness of the study was 29.8% (n=179)., Results: In this study, 70.6% of the physicians were men, and the mean age was 48.6±9.6 years; 46.6% of the participants had at least one medical specialty or side branch specialty, and 51.8% were pulmonologists. Furthermore, 52.6% of the physicians worked in the private sector, and 86.6% had an occupational physician certificate. Moreover, 55.3% of the participants evaluated the radiographs using the authority gained by the certification, and 68.3% of those who did not evaluate the films stated that the reason for not evaluating the films was a lack of demand. Participants who evaluated radiographs had received a demand for films most frequently from 1 to 2 different jobs (33.4%) and from 1 to 3 different workplaces (30.1%). Most films came from the mining (47.5%) and quarrying (50.5%) sectors. Some participants (64.3%) stated that the quality of the radiographs was insufficient, 59.2% experienced difficulties because the radiographs were not obtained using proper techniques, 23.4% stated that the fees per film evaluated were low, and 81.5% believed that update training is necessary., Conclusion: The demand for these services will increase in line with the training and surveillance as stipulated by the legislation.

Currently, usual approaches for fast robot control are largely reliant on solving online optimal control problems. Such methods are known to be computationally intensive and sensitive to model accuracy. On the other hand, animals plan complex motor actions not only fast but seemingly with little effort even on unseen tasks. This natural sense to infer temporal dynamics and coordination motivates us to approach robot control from a motor skill learning perspective to design fast and computationally light controllers that can be learned autonomously by the robot under mild modeling assumptions. This article introduces Phase Portrait Movement Primitives (PPMP), a primitive that predicts dynamics on a low dimensional phase space which in turn is used to govern the high dimensional kinematics of the task. The stark difference with other primitive formulations is a built-in mechanism for phase prediction in the form of coupled oscillators that replaces model-based state estimators such as Kalman filters. The policy is trained by optimizing the parameters of the oscillators whose output is connected to a kinematic distribution in the form of a phase portrait. The drastic reduction in dimensionality allows us to efficiently train and execute PPMPs on a real human-sized, dual-arm humanoid upper body on a task involving 20 degrees-of-freedom. We demonstrate PPMPs in interactions requiring fast reactions times while generating anticipative pose adaptation in both discrete and cyclic tasks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent causes for morbidity and mortality, and it creates a cumulative economic and social burden., Aims: To determine the distribution of the prevalence of patients in Turkey who were diagnosed with COPD and their morbidity rates, according to the regions and cities they belong to. Moreover, the study contributes to the prevention and cure services of COPD that should be planned in the future., Study Design: A retrospective cohort., Methods: The database of the Social Security Institution from 2016 has been scanned. All the data with prescription registration, with the code ICD-10, J44.0-J44.9, which were aimed for diagnosing and/or cure, have been evaluated with a retrospective cohort., Results: In 2016, 955,369 patients who were admitted as outpatients to the hospitals were diagnosed with COPD. The average number of annual COPD cases that were admitted was 2.09. Twenty percent (20%) of the outpatient applications were via emergency room. The rate of hospitalization among the applicants was 17.75%, with a total of 1,994,325. The average annual number of hospitalizations of men was higher than that of women. The average number of hospitalization days was 6.52. The region with the highest prevalence of outpatient admission and hospitalization was the Black Sea Region., Conclusion: The high rate of hospitalization was considered to be the outcome of the insufficient “outpatient” management.

Background/aim: Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow limitation and respiratory symptoms. It is a leading cause of morbidity and mortality all over the world. Our data on COPD in Turkey are limited. This study was intended to examine the epidemiologic characteristics of COPD in the Turkish population, between 2012 and 2016., Materials and Methods: This population-based, descriptive, surveillance study examined physician-diagnosed COPD prevalence, incidence, and mortality in Turkey. The database of the Social Security System of Turkey was scanned and ICD-10 J44.0-J44.9 codes for diagnostic and/ or therapeutic purposes were evaluated retrospectively., Results: In 2016, there were 3,434,262 cases of COPD (56.2% men) in Turkey, and the mean age of patients was 61.62 ± 14.76 years. From 2012 to 2016, the annual overall prevalence rates of physician-diagnosed COPD rose from 4.3% to 5.8%, which was a 35.0% relative increase (P < 0.05). In women, this rate rose from 3.7% to 5.1% (38% increase), and in men, it rose from 4.9% to 6.7% (37% increase). During the study period, the overall incidence decreased from 8.5 per 1000 adults in 2012 to 6.3 per 1000 adults in 2016, representing a decrease of 26.6% (P < 0.001). The annual incidence rates of physician-diagnosed COPD decreased 25.4% in women and 27.9% in men. The overall mortality was 4.3% in 2012, and 4.2% in 2016. The mortality rate in women was 3.5% in 2012 and 3.7% in 2016, and 5% in 2012 and 4.7% in 2016 in men. The mean prevalence by region was 5.26% (range 3.79%–7.65%). The Black Sea region had the highest COPD prevalence., Conclusion: COPD is a very common and serious cause of morbidity and mortality in Turkey, as it is worldwide. Current data will contribute to a better understanding of the epidemiologic dimension of COPD in our country., Competing Interests: None declared, (This work is licensed under a Creative Commons Attribution 4.0 International License.)