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Problems with epidural catheter
No full textContinuous epidural analgesia has widespread clinical applications in obstetrics, surgery, acute postoperative pain management, and chronic pain relief by administering epidural infusions of local anesthetics and opioids via a catheter. However, due to some problems encountered while using the epidural catheter, it may not function or develop various complications. This section reviews the problems encountered while inserting, using, and removing epidural catheters and their solutions. © 2022 Elsevier Inc. All rights reserved
Oxytocin and cabergoline alleviate ovarian hyperstimulation syndrome (OHSS) by suppressing vascular endothelial growth factor (VEGF) in an experimental model
No full textPurpose: Ovarian hyperstimulation syndrome (OHSS) is a life-threatening complication of ovarian stimulation in reproductive medicine. Here, we aimed to investigate the role of oxytocin (OT) and cabergoline in the prevention and alleviation of the OHSS in an animal model. Methods: Thirty-five female immature Wistar rats were randomly assigned to five groups. The control group (n = 7) received saline only for five consecutive days. Remaining twenty-eight rats received 10 IU of pregnant mare serum gonadotropin (PMSG) followed by 30 IU of human chorionic gonadotropin (hCG) to induce OHSS. Group 2 (n = 7) was managed with no additional intervention after the induction of OHSS. Group 3 (n = 7) received 100 μg/kg cabergoline 2 h before the PMSG injection for four consecutive days and 2 h before the hCG injection on the fifth day. Group 4 (n = 7) and group 5 (n = 7) received 80 μg/kg and 160 μg/kg OT after induction of OHSS, respectively. Oxytocin was administered 2 h before the PMSG injection for four consecutive days and 2 h before the hCG injection on the fifth day. Body and ovary weight, vascular permeability (VP), VEGF expression in the ovaries, and levels of VEGF in the peritoneal fluids were examined in all animals. Results: Cabergoline and OT reduced body weight, ovary weight, and VP compared to that of the OHSS group (p < 0.05). VEGF expressions in ovaries and peritoneal VEGF levels were decreased in cabergoline and OT groups compared to that of the OHSS groups (p < 0.001 for cabergoline and OT—80 μg/kg; p < 0.00001 for OT—160 μg/kg). However, there was no statistically significant difference in these parameters between the OT and cabergoline groups. Conclusion: Both OT and cabergoline were active in the alleviation of OHSS through suppression of VEGF and VP. Overall, we conclude that OT is effective for downregulation for VEGF and improvement in vascular permeability in OHSS. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature
Evaluation of Chest CT Findings using the Reporting and Data System of Patients with Suspected COVID-19 Infection
No full textBackground: The simultaneous interpretation of computed tomography (CT) scans performed on patients with suspected clinical signs of coronavirus disease 2019 (COVID-19) or a history of contact may accelerate patient isolation, particularly during the peak of the pandemic. The use of an appropriate scoring system can lead to the conveyance of the findings in a more understandable way and the elimination of differences in interpretations. Objectives: This study aimed to evaluate the diagnostic performance of the coronavirus disease 2019 (COVID-19) imaging reporting and data system (CO-RADS) in admitted patients with suspected COVID-19 infection. Methods: This retrospective study included all patients admitted to our hospital with COVID-19 pneumonia suspicion within March 20-May 15, 2020, who were examined by both CT and real-time reverse transcription polymerase chain reaction (rRT-PCR) at initial presentation. Four radiologists, who were blinded to the rRT-PCR results and medical history, assessed all images independently and classified the CT findings according to the CO-RADS previously defined. Diagnostic value of the scoring system and interobserver agreement in rRT-PCR positive-negative groups and for CO-RADS 1-5 were evaluated. Results: In this study, 274 (153 men and 121 women; 48.8 +/- 17.3 years) rRT-PCR positive and 437 (208 men and 229 women; 49.0 +/- 19.5 years) rRT-PCR negative individuals were included. It was found that CO-RADS had a good diagnostic performance with area under the receiver operating characteristic roc curve of 0.857. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were obtained at 81.9%, 89.4%, 75.7%, 92.5%, and 84.8%, respectively. The interobserver agreement of four radiologists in CO-RADS 1 and 5 was substantial to almost perfect according to the kappa values. Other CO-RADS scores showed a fair to moderate agreement. The interrater agreement was slightly higher in the PCR (-) patient group than in the positive one. Conclusion: In conclusion, CO-RADS was a successful scoring system for distinguishing highly suspicious cases in terms of COVID-19 infection lung involvement, showing high interobserver agreement
Angiogenic factors and evaluation of vascular status in preeclampsia
No full textAim: The aim of this study was to measure serum levels of the angiogenic factors nitric oxide (NO), soluble endoglin (s Eng), soluble fms-like tyrosine kinase-1 (s Flt-1), placental-derived growth factor (PIGF) and vascular endothelial growth factor (VEGF) and to measure uterine and umbilical arterial blood flow using Doppler ultrasonography to investigate the physiopathology of preeclampsia and endovascular dysfunction by comparing brachial artery dilatation and the thickness of the carotid artery with normal pregnant women. Material and Methods: Forty pregnant women with preeclampsia and 40 healthy pregnant women (control group) were recruited for the study in April 2011 and October 2011 at Van Yuzuncu Yil University. Systolic and diastolic blood pressure, urinary protein in spot urine samples, complete blood counts, aspartate transaminase (AST), alanine aminotransferase (ALT) levels of sEng, sFlt-1, VEGF, PIGF and NO, and APGAR scores at one and five minutes after birth were recorded and compared in all patients. Intima-media thickness of the carotid artery, brachial artery dilatation and umbilical artery Doppler parameters of all pregnant women were assessed and recorded. Results: When compared to the control group, systolic and diastolic blood pressures urinary protein in spot and 24-hour urine collection, levels of AST, ALT and sFlt-1, and uterine artery Doppler parameters were significantly higher, whereas VEGF, platelet count and APGAR scores at one and five minutes after birth were lower in the preeclampsia group (p<0.001). Brachial artery dilatation before obstruction was found to be insignificant in both groups, while post obstructive dilatation was found to be significantly higher in the control group. Discussion: Uterine artery Doppler evaluation, assessment of brachial artery dilatation and measurement of VEGF and sFlt-1 levels seem to be useful in preeclampsia
PREDICTING NUCLEAR RENOGRAPHY BASED SPLIT RENAL FUNCTION IN LIVING DONOR TRANSPLANTATION WITH CT BASED MEASURED SPLIT RENAL VOLUMES
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The Efficacy of Hydrodilatation for the Prevention of Vasospasm following Microsurgical Anastomosis
No full textIntroduction Vasospasm is a major problem following microsurgical reconstruction which can result in the partial or complete loss of the flap tissue. The aim of this study was to investigate the efficiency of hydrodilatation for the prevention of vasospasm. Material and Methods Thirty male Wistar rats were used for this experimental study. Femoral arteries of were exposed, photographed, and transected. In group 1, group 2, and group 3 papaverine solution, hydrodilatation, and minimal mechanical dilatation (control group) was performed, respectively. The anastomosis was completed and the arteries were photographed again 10minutes after completion of the anastomosis. Following 7-day period samples for transmission electron microscopy (TEM) and light microscopy were obtained. Results The mean vessel diameters prior to transection were 0.43, 0.45, and 0.52mm in the papaverine, hydrodilatation, and control groups, respectively. The mean vessel diameter 10minutes following the completion of anastomosis was 0.76, 0.75, and 0.51mm in the papaverine, hydrodilatation, and control groups, respectively. Median score for papaverine group regarding histological parameters of regular endothelial lining and lumen, neutrophil infiltration, vascular congestion, and edema in tunica adventitia was 2, 3, 2, and 3 positive, respectively. Median score for the papaverine group regarding histological parameters of regular endothelial lining and lumen, neutrophil infiltration, vascular congestion, and edema in tunica adventitia was 3, 3, 3, and 3 positive, respectively. All the histological scores were negative in the control group. The difference between the control group and the experiment groups 1 and 2 was significant regarding all four histological parameters ( p <0.05). Conclusion Hydrodilatation and papaverine application were both effective in preventing vasospasm following microsurgical intervention but papaverine caused slightly less damage to the endothelial lining and less edema in the tunica adventitia when compared with the hydrodilatation. Hydrodilatation group showed a vasodilatory effect that was statistically similar to that of papaverine, which has a proven efficacy
The Association of MHC Molecules with COVID-19
No full textNovel SARS-CoV-2, has approximately 30 kb genome and belongs to the Betacoronavirus type. SARS-CoV-2 codes several structural spike (S) protein, envelope (E) protein, membrane (M) protein, nucleocapsid (N) protein and nonstructural proteins like the other coronaviruses. Various studies on SARS-CoV suggest that both humoral and celluler immune responses play a role in defense against this virus. Major histocompatibility complex (MHC) molecules have an important role in cellular and humoral immune response, various autoimmune diseases and rejection mechanisms. These properties of MC molecules emphasizes the importance of regulated MHC expressionlor the control of the immune response. The defects in the expression of MHC molecules may result in severe immunopathologic consequences. CD8+ T cells are the main effectors in antiviral immunity. Cytotoxic CD8+ T lymphocytes responses are crucial for initial viral clearance and immunologic memory. Heterogeneity in CD8+ T cell responses to SARS-CoV-2 may be associated with the capacity to recognize Class 1 HLA antigens , and genetic susceptibility to viral infections may be associated with HLA haplotypes. The strongest immunogenic epitopes of spike glycoproteins for 8 and T cells would bind HLA Class l molecules and these epitopes could be used when designing vaccine candidates against SARS-CoV-2. The relation of 'SARS-Cov-2 with HLA locus in MHC region was investigated in the present review
The miRNA content of circulating exosomes in DLBCL patients and in vitro influence of DLBCL-derived exosomes on miRNA expression of healthy B-cells from peripheral blood
No full textBACKGROUND: Due to the heterogeneous nature of Diffuse Large B-cell Lymphoma (DLBCL), the mechanisms underlying tumor development and progression have not yet been fully elucidated. OBJECTIVE: This study aimed to compare the characteristics of plasma exosomes of DLBCL patients and healthy individuals and to evaluate the exosomal interactions between DLBCL cell lines and normal B-cells. METHODS: Exosome isolation was performed using an ultracentrifugation-based protocol from plasma of 20 patients with DLBCL and 20 controls. The expression of miRNAs from exosome samples was analyzed using a miRNA expression microarray. The presence of exosome-mediated communication between the lymphoma cells and normal B -cells was determined by the co-culture model. RESULTS: A significant increase in plasma exosome concentrations of DLBCL patients was observed. There was also a significant decrease in the expression of 33 miRNAs in plasma exosomes of DLBCL patients. It was determined that normal B-cells internalize DLBCL-derived exosomes and then miRNA expression differences observed in normal B-cells are specific to lymphoma-subtypes. CONCLUSIONS: MiR-3960, miR-6089 and miR-939-5p can be used as the miRNA signature in DLBCL diagnosis. We suppose that the exosomes changed the molecular signature of the target cells depending on the genomic characterization of the lymphoma cells they have originated.Scientific and Technological Research Council of Turkey, TUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [114S442]This study was supported by a grant from The Scientific and Technological Research Council of Turkey, TUBITAK (Grant No. 114S442). The authors are grateful to Dr. Sevil Zencir for helpful discussions and Dr.Nazan Keskin for STEM and TEM assistance
KARACİĞER FİBROZİSİNİN DEĞERLENDİRİLMESİNDE KONVANSİYONEL DİFÜZYON, DİFÜZYON TENSÖR GÖRÜNTÜLEME VE DİNAMİK DUYARLILIK KONTRASTLI MANYETİK REZONANS PERFÜZYON GÖRÜNTÜLEMENİN ETKİNLİĞİNİN KARŞILAŞTIRILMASI
No full textObjective: Liver fibrosis is a dynamic, reversible process that can result in liver failure. There has been considerable interest in developing noninvasivemethods for diagnosis and staging. To investigate the diffusion and perfusion changes of the fibrotic liver parenchyma with conventional diffusion-weightedimaging (CDI), diffusion tensor imaging (DTI), and T2*weighted dynamic susceptibility contrast-magnetic resonance perfusion imaging (DSC-MRPI) at3Tesla MR scanner.Methods: Twenty-seven patients with chronic viral hepatitis and 24 volunteers were evaluated, prospectively. The standard MRI protocols of the abdomen,CDI, and DTI were performed. Apparent diffusion coefficient (ADC) maps were obtained, D and FA values were calculated for DTI. Signal Intensity(SI)-time curves were obtained and “blood volume”(BV), “blood flow” (BF), “time to peak”(TTP), “mean transit time”(MTT) were measured. All patients withhepatitis underwent liver biopsy. The efficacy of diffusion and perfusion parameters used in the diagnosis of fibrosis was analyzed with the receiver operatingcharacteristic curve (ROC).Results: Patients had significantly lower liver ADC when compared to the control group, either with CDI and DTI. D values obtained from DTI were lowerin patients than those of the normal volunteers, and the difference was statistically significant. On DSC-MRPI; BF, BV, MTT, and TTP of the liver werelower than those of the control group but only BV and MTT values showed statistical significance. Liver ADC, D, and BV values had a negative correlationwith fibrosis.Conclusion: The results showed that the D values obtained from DTI, BV, and MTT values obtained from DSC-MRPI can be an efficient diagnostic tool forliver fibrosis in patients with chronic hepatitis.Amaç: Karaciğer fibrozu, karaciğer yetmezliğine neden olabilen dinamik, geri dönüşümlü bir süreçtir. Teşhis ve evreleme için noninvaziv yöntemlerin geliştirilmesine büyük ilgi vardır. 3Tesla MR'da konvansiyonel difüzyon ağırlıklı görüntüleme (DAG), difüzyon tensör görüntüleme (DTG) ve T2* ağırlıklı dinamik duyarlılık kontrastlı manyetik rezonans perfüzyon görüntüleme (DDK-MRPG) ile fibrotik karaciğer parankiminin difüzyon ve perfüzyon değişikliklerini araştırmayı amaçladık. Yöntem: Kronik viral hepatiti olan 27 hasta ve 24 gönüllü prospektif olarak değerlendirildi. Rutin batın MR protokolüne ek olarak DAG ve DTG uygulandı. Görünür difüzyon katsayısı (ADC) haritaları elde edildi, DTG için D ve FA değerleri hesaplandı. Sinyal Yoğunluğu (SI)-zaman eğrisi elde edildi ve “kan volümü” (KV), “kan akımı” (KA), “pik zamanı” (PZ), “ortalama geçiş zamanı” (OGZ) ölçüldü. Hepatitli tüm hastalara karaciğer biyopsisi yapıldı. Fibrozis tanısında kullanılan difüzyon ve perfüzyon parametrelerinin etkinliği, ROC eğrisi ile analiz edildi. Bulgular: Hastalar, DAG ve DTG de kontrol grubuna kıyasla önemli ölçüde daha düşük karaciğer ADC'sine sahipti, DTG’den elde edilen D değerleri hastalarda, sağlıklı gönüllülere göre düşük olup fark istatistiksel olarak anlamlıydı. DDK-MRPG hakkında; Karaciğerin KA, KV, OGZ ve PZ’nı kontrol grubuna göre daha düşüktü ancak sadece KV ve OGZ değerleri istatistiksel anlamlılık gösterdi. Karaciğer ADC, D ve KV değerleri fibrozis ile negatif korelasyona sahipti. Sonuç: DDK-MRPG'den elde edilen KV ve OGZ, DTG’den elde edilen D değerlerinin kronik hepatitli hastalarda karaciğer fibrozisi için etkili bir tanı aracı olabileceğini gösterdi
Autoimmune Encephalitis After Treatment of Hodgkin’s Lymphoma with the Immune Checkpoint Inhibitor Nivolumab
No full textSon yıllarda, monoklonal antikorların çeşitli onkolojik hastalıklardakullanılmaya başlanmasıyla birlikte, nörolojik yan etkiler daha sıkgörülmeye başlamıştır. Monoklonal antikorlardan biri olan nivolumab,programlanmış hücre ölüm proteini 1’i bloke eder ve metastatikmelanoma, skuamöz hücreli akciğer kanseri, renal hücre karsinomasıve Hodgkin lenfoma tedavisinde onaylanmış bir insan IgG4 antikorudur.Burada, Hodgkin lenfoma tanısı ile nivolumab tedavisi uygulanmasısonrası ensefalopati tablosu gelişen 40 yaşında bir olguyu sunmaktayız.Literatürde, monoklonal antikorlardan ipilimumab ve nivolumabınkombinasyon tedavisi sonrası otoimmün ensefalit vakaları dahaönce bildirilmiştir. Bildiğimiz kadarıyla bu olgu, Hodgkin lenfomaiçin kullanılan nivolumab monoterapi tedavisi sonrası bildirilen ilkensefalopati vakasıdır.In recent years, by the usage of new immune therapeutic agents for cancer treatment, the neurologic adverse events began to be seen more frequently. Nivolumab, one of the immune checkpoint inhibitor, is a human IgG4 antibody that blocks programmed cell death protein 1 and is approved against metastatic melanoma, squamous cell lung cancer, renal cell carcinoma, and Hodgkin’s lymphoma after failure of prior line of chemotherapy. Here, we present a 40-year-old patient developing encephalopathy after treatment of Hodgkin’s lymphoma with the immune checkpoint inhibitor nivolumab. In literature, cases of autoimmune encephalitis after receiving combination therapy of immune checkpoint inhibitors ipilimumab and nivolumab were described before. As far as we know, this is the unique case of encephalopathy reported after monotherapy with nivolumab treatment used for Hodgkin’s lymphoma