Background: Information regarding the effect of a multidisciplinary team (MDT) to improve cardiometabolic risk factors (CMRF) in routine clinical settings is lacking. Methods: In this one-year retrospective chart review (2018), 598 adults (African American 59%, Hispanic 35%, Caucasian 6%) with a mean age of 43.8 ± 14.0 were included. Qualifying patients (≥ 1 CMRF of overweight/obesity, prediabetes/diabetes, or hypertension) who were treated under an MDT protocol were compared to patients who qualified for MDT but were treated solely by a primary care provider (PCP). The MDT protocol included endocrinology-oriented visits, lifestyle counseling, care coordination, and shared medical appointments. Linear and binary regression were performed to identify the factors associated with CMRF changes. Results: Patients treated by MDT had a greater reduction (β, 95% CI) in weight (- 4.29 kg, -7.62, -0.97), BMI (-1.43 kg/m2, -2.68, -0.18), SBP (- 2.18 mmHg, -4.09, -0.26), and DBP (- 1.97 mmHg, -3.34, -0.60). They also had 77% higher odds of reducing ≥ 5% their initial weight, 83% higher odds of reducing 1 point of BMI, and 59% higher odds of reducing ≥2 mmHg DBP. No association was observed for MDT intervention and A1c changes. Conclusion: Compared to PCP, MDT-protocolized intervention improves CMRF in a multi-ethnic adult cohort in a routine clinical setting. Patient’s activation to access the best care and overcoming barriers from patients (weight perception, social determinants increasing no-shows to visits), providers (obesity stigma, clinical inertia), and health system (time constraints and high paperwork imposed by payers) is a priority.

15 patients successfully received submental artery perforator flaps with its pedicle elongated. The lesions were located in tongue,oropharynx,gingiva,mandible,auricle,infraorbital skin,buccal mucosa and parotid gland.All patients are satisfied with the reconstruction. 15 patients’ donor sites were recovered well and the flaps survival was 100% with no post-operation or further major complications occurred

Stuck drain tube is a rare postoperative complication. We present a case of 27 years female who underwent right salpingectomy with abdominal drain on left side. Postoperatively drain couldn't be removed and diagnosis of stuck drain was made. Laparotomy revealed Fallopian tube entering through both eyes of the drain tube.

Background: Diabetes mellitus has been associated with many different musculoskeletal system problems. Objective: This study aims to show the prevalence of musculoskeletal disorders in patients with diabetes and to reveal their relationship to the metabolic parameters and microvascular complications. Methods: Seven hundred two diabetic patients who consecutively applied to our clinic between March 2017 and February 2018 were included in this prospective cross-sectional study. The relationship of the musculoskeletal disorders including carpal tunnel syndrome, Dupuytren’s contracture, adhesive capsulitis, flexor tenosynovitis, limited joint mobility syndrome, Charcot arthropathy, diabetic foot and gout to the patients’ age, gender, type of diabetes, duration of diabetes, metabolic parameters, and microvascular complications were evaluated. Results: Musculoskeletal system disorders were detected in 45.9% (n = 322) of the 702 diabetic patients evaluated in our study. The most common disorders were carpal tunnel syndrome 17.7% (n = 124), Dupuytren’s contracture 14.4% (n = 101), and adhesive capsulitis 13.8% (n = 97). A statistically significant relationship of the HbA1c level with Dupuytren’s contracture, carpal tunnel syndrome, and adhesive capsulitis was detected (p<0.05). Conclusions: Patients’ age, duration of diabetes, HbA1c level, and presence of microvascular complications are associated with musculoskeletal disorders in this population.

Objective: Chemotherapy and radiotherapy, used to treat childhood hematological malignancies (HM), can negatively impact oral tissues and organs. This study aimed to evaluate oral health-related quality of life in children with HM. Material and Methods: A total of 99 children, including 49 undergoing HM (41 for acute lymphocytic leukemia, 8 for acute myelocytic leukemia,) and 50 healthy volunteers, were included in this cross-sectional study. The mean age of the entire study group was 78.63 ± 34.41 months. The mean age of the HM and control groups was 87.12 ± 35.04 and 70.95 ± 34.85 months, respectively. The Simplified Oral Hygiene Index (SOHI), Decayed, Missing, and Filled Teeth (DMFT/dmft) index, and Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS-T) were administered to all children. The data were analyzed using SPSS software (version 22.0). Results: The age and gender distributions of the two groups were similar. The SOHI was significantly higher in the HM group, whereas the DMFT/dmft score was similar between the groups. No significant difference in the total ECOHIS-T score was observed between the two groups, but there was a group difference in the responses to questions on pain and psychological processes. Conclusions: Oral health and self-care were negatively affected by childhood HM and the treatment thereof. Close clinical dental follow-up of such patients is required.

The structures and interactions of systems formed by the MPBCP (meta-Phenylene-Bridged Cyclic Oligopyrrole) functionalized with lanthanum atom were studied for investigating the abilities of MPBCP, [La-MPBCP]+3 and La-MPBCP to absorb biogas (CO2, N2, H2 and CH4) using density functional theory. The Eads calculated values for biogas molecules on [La-MPBCP]+3 and La-MPBCP showed that these gas molecules have favorable interactions with the lanthanum atom coordinated on the MPBCP. CO2 molecule shows strong interactions, with Eads values of -28.63 and -15.95 kcal/mol. In the case of H2 molecule, the Eads is lower with values of -7.51 and -5.28. It is easy to observe the CO2 molecule on the [La-MPBCP]+3 system has four times higher energy value than adsorption energy for the H2 molecule. The natural bond orbital analysis reveals that gas molecules are electron donator in the systems and the acceptor orbitals belong to lanthanum atom. Computational studies suggest that CO2, N2, CH4 and H2 molecules on [La-MPBCP]+3 and La-MPBCP present physisorption. Our findings divulge promising potential of the [La-MPBCP]+3 as an adsorber/separator CO2/H2.

Purple butter clam (Saxidomus purpuratus) is an economically important bivalve shellfish. This species belongs to the subclass Heterodonta that diverged in calcite seas with low magnesium concentrations. We sequenced and assembled its genome and performed an evolutionary comparative analysis. A total of 911 Mb assembly of S. purpuratus was anchored into 19 chromosomes and a total of 48,090 protein-coding genes were predicted. We identified its repeat-based expanded genes that are associated with the sodium/potassium-exchange ATPase complex. In addition, different types of ion transporters were enriched in the common ancestor of Heterodonta (calcium, sulfate, and lipid transporters) and the specific evolution of S. purpuratus (calcium and sodium transporters). These differences seem to be related to the divergence times of Heterodonta (calcitic sea) and Veneraidea (aragonitic sea). Furthermore, we analyzed the evolution of scavenger receptor (SR) proteins in S. purpuratus, which are involved in a wide range of immune responses, and compared them to the closely related Cyclina sinensis. We showed that a small number of SR proteins, exhibited collinearity between the two genomes, which is indicative of independent gene evolution. Our genomic study provides an evolutionary perspective on the genetic diversity of bivalves and their adaptation to historical changes in the marine environment.

Lymphoma work-up involves immunohistochemical stains to help reach the diagnosis. It is imperative to have clinical information and sound knowledge of staining pattern of antibodies to avoid misinterpretation of results. We describe two cases in which pre-biopsy steroid hindered antigenic profile, leading to “cytoplasmic granular staining” and causing delay.

Aim: The aim of this study was to evaluate the efficacy and side effects of silymarin in the treatment of CIPN. Methods: Patients who referred to outpatient oncology department of a referral educational hospital affiliated to Mazandaran University of Medical Sciences and experienced CIPN were randomized to receive silymarin or placebo. Intervention group received 140 mg of the Silymarin twice daily accompanied and 300 mg/day Gabapentin, whereas control group received 300 mg/day of Gabapentin and placebo twice daily for 3 months. The grade of neuropathy was determined according to the CTCAE criterion. The improvement of neuropathy was defined as the reduction of at least one neuropathic score. The visual analogue scale (VAS) was used to assess the severity of patients’ pain and the EORTC-QLQ-C30 criterion was used to assess the quality of life. Patients were evaluated initially and at the follow up visit 3 months after the enrollment. Results: A total of 80 patients were enrolled in the study. There was no significant difference between the groups in terms of severity of neuropathy at baseline. At the end of the study, the number of people with improved neuropathy in the silymarin group was 82.8% patients, which was significantly higher than 48.4% observed in the patients received placebo (P= 0.005). The silymarin-treated group showed a significant reduction in pain compared with those receiving placebo. Despite the improvement in quality of life in the intervention group compared to the comparison group, this difference was not statistically significant. Gastrointestinal symptoms were the only reported side effects with a similar incidence in two groups. Conclusion: The present data demonstrate the potential clinical use of silymarin as an adjuvant therapy to reduce CIPN symptoms.

Background: Pneumonia is one of the leading causes of mortality and morbidity worldwide. Microbiology tests play a critical role in the diagnosis of pneumonia. Our study aimed to determine microbiology result reporting times and evaluate its association with outcomes of adult patients (≥18 years) hospitalized with pneumonia. Methods: A 3-year (2016-2018) retrospective cohort study in six hospitals in New South Wales, Australia. Study data were obtained by linking hospital and laboratory system databases. Result reporting times including time from admission to the first and the last microbiology test results were determined. The outcome measures were hospital length of stay (LOS) and in-hospital mortality. We fit median and logistic regression to evaluate the association of time-to-first microbiological result with hospital LOS and in-hospital mortality respectively. Results: A total of 6,298 patients met the inclusion criteria. Of these, 85.3% (n=5,375) ordered at least one microbiology test. The top 5 microbiology tests were blood culture, urine culture, respiratory polymerase chain reaction (PCR), urine antigen and sputum culture. The median time-to-first microbiology result was 26 hrs while the median time-to last test result was 144 hrs. The rate of in-hospital mortality was 5.9% (n=371). After adjusting for confounders, every 5 hrs increase in the time to-first microbiology test was associated with an increase of 3.9 hrs in the median hospital LOS [95% Confidence Interval (CI), 3.5 to 4.3; P<0.001]. There was no association between time-to-first microbiology result and in-hospital mortality (OR 1.01; 95% CI 1.00-1.02; P=0.122). Conclusion: Time-to-first microbiology result reporting was significantly associated with hospital LOS but not with in-hospital mortality. Further research should be conducted to understand if improving result reporting times can reduce the length of hospital stay of patients. Key words: Microbiology diagnostics; Test result reporting; Pneumonia; Diagnostic informatics

Perimedullary spinal AVM is a rare type of spinal arteriovenous malformations. We present a case of 70 yrs female who presented with motor weakness in her bilateral limbs. Initial MRI was misinterpreted as ependymal myxoma; however, histopathology revealed spinal AVM. MRA or DSA should be conducted if AVM is suspected.

Objective: Characterize the presentation of vulvar lichen scleorsus (LS) among premenopausal women. Design: Cross-sectional study. Setting: An international web-based survey distributed on social media support groups and in two urban gynecology offices specializing in LS. Population: A total of 503 premenopausal women with biopsy-confirmed vulvar LS between the ages of 18-50. Methods: Participants completed an anonymous 28-question web-based survey between January to March 2021. Main Outcome Measures: Symptoms, timing and accuracy of diagnosis, and presence of concomitant autoimmune conditions. Results: Symptoms reported to be most present and affect the individual were dyspareunia (68%; 44%) and tearing with intercourse or vaginal insertion (63%; 39%). Symptoms that most frequently prompted patients to seek medical attention were dyspareunia (35%), pruritus (31%), and tearing with intercourse or vaginal insertion (26%). Most common skin changes included hypopigmentation (81%), vulvar fissures (72%) and labial resorption (60%), with fissures affecting the individual the most (48%). There was a 4-year delay in diagnosis with an average age of symptom onset of 27 years and average age of diagnosis of 32 years. Sixty-six percent of respondents initially received an alternative diagnosis, most commonly vulvovaginal yeast infection (49%). There is an increased incidence of hypothyroidism, vitiligo, pernicious anemia, and celiac disease. Conclusion: Premenopausal women with vulvar LS more commonly present with dyspareunia and tearing with intercourse, less often than vulvar pruritis. This condition should be considered and evaluated in women of all ages presenting with vulvar symptoms and sexual pain. Funding: None Keywords: lichen sclerosus; vulvar dermatoses; vulvar pruritis; dyspareunia

Introduction: Raynaud phenomenon (RP) is a multifactorial disorder. If any underlying disease cannot be detected responsible for RP then it considered as primary RP (pRP). We aimed to investigate the differences between laboratory markers and impaired endothelial function in pRP. Material and Methods: Forty-two pRP patients included as study and control groups were created from 30 healthy individuals. The endothelial function was evaluated with flow-mediated dilatation (FMD) of the brachial artery. The blood samples were obtained both groups and white blood cell [WBC], hemoglobin, platelet, mean platelet volume [MPV], creatinine, alanine aminotransferase [ALT], aspartate aminotransferase[AST], D-dimer, fibrinogen, albumin, fibrinogen to albumin ratio [FAR], Neutrophil to Lymphocyte ratio [NLR], D-dimer to albumin ratio [DDAR] and monocyte chemo-attractant protein-1 [MCP-1]. Obtained blood parameters and FMD values were compared between groups. Results: The groups were found as similar in regards to age, gender, smoking history (p<0.05). There was no difference between the two groups in regards to hemoglobin, platelet, MPV, creatinine, ALT, D-dimer, albumin, FAR, NLR, DDAR levels (p<0.05). AST levels were slightly higher in pRP group (p=0.027). Markedly increased WBC, fibrinogen, MPV and MCP-1 values were detected in pRP group (p=0.000). Additionally, higher abnormal FMD responses were detected in pRP group (p=0.000). There was a direct correlation between abnormal FMD response and serum MCP-1 values in patients with pRP (R: 0.308, R2: 0.095, p: 0.044). Conclusion: It seems to be that MCP-1 levels are higher in patients with pRP and increased values of MCP-1 levels seem to be related to impaired endothelial functions

Background: The evaluation of solitary lung nodules via FDG PET/CT has high sensitivity for nodules larger than 8 mm and is utilized to exclude lung cancer. Aim: This study aimed to retrospectively explore whether the lesions in patients who underwent F18 fluorodeoxyglucose-positron emission tomography/computed tomography imaging with the staging of the solitary pulmonary nodule and lung mass were within the local imaging area. It also investigated whether a relationship existed between the size of the lung lesion and extrathoracic spread. Materials and Method: Three hundred eight patients histopathologically diagnosed lung cancer were included in this study. All patients lung lesions were measured and patients were classified as four groups according to the size of the lung lesion. In all groups, the F18 FDG PET/CT examination was used to detect liver, adrenal, bone and supraclavicular lymph node metastasis, besides extrathoracic metastasis. Results: Liver, bone and extrathoracic metastasis of group-1 was statistically lower than group-2 (P < 0.001, p<0.01 and P = 0.03, respectively). Liver, extrathoracic, adrenal and bone metastasis of group-3 was statistically lower than the group-4 (P<0.001, P = 0.01, and P = 0.04, p<0.01 respectively). Extrathoracic extension was observed in only one patient in the group-3. In addition liver, adrenal, and bone metastases were not observed in any group-3 patients. Conclusions: PET/CT may be a more appropriate approach to be aplied in cases with nodule diameter ≤20mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could not only reduce radiation exposure but also save radiopharmaceuticals used in PET/CT imaging. Keywords: lung cancer, solitary pulmonary nodule, PET/CT, fluorodeoxyglucos

Objective: Behçet’s syndrome (BS) is a systemic vasculitis with several clinical manifestations. Neutrophils hyperactivation mediates vascular BS involvement, via a massive production of reactive oxygen species (ROS) and the release of neutrophil extracellular traps (NETs). We investigated neutrophil-mediated mechanisms of damage in non-vascular BS manifestations and explored in vitro the effects of colchicine in counteracting these mechanisms. Methods: NETs and intracellular ROS production was assessed in blood samples from 80 BS patients (46 with active non-vascular BS, 34 with inactive disease) and 80 healthy controls. Moreover, isolated neutrophils were incubated for 1 hour with an oxidating agent (2,2′-azobis (2-amidinopropane) dihydrochloride; 250nM), and the ability of pure colchicine pre-treatment (100ng/ml) to counteract oxidation-induced damage was assessed. Results: Patients with active non-vascular BS had remarkably increased NET levels [21.2 (IQR 18.3-25.9) mU/ml] compared to patients with inactive disease [16.8 (13.3-20.2) mU/ml] and to controls [7.1 (5.1-8.7) mU/ml], p<0.001]. Also, intracellular ROS tended to be increased in active BS, although not significantly. In active non-vascular BS, NETs correlated with neutrophils ROS production (p<0.001) and were particularly increased in patients with active mucosal (p<0.001), articular (p=0.004), and gastrointestinal symptoms (p=0.006). On isolated neutrophils, colchicine significantly reduced oxidation-induced NET production and cell apoptosis, though not via an antioxidant activity. Conclusion: Neutrophil-mediated mechanisms might be directly involved in non-vascular BS, and NETs, more than ROS, might drive the pathogenesis of mucosal, articular and intestinal manifestations. Colchicine might be effective to counteract neutrophils-mediated damage in BS, although further studies are needed.

Endometriosis is a chronic inflammatory disorder resulting in pelvic pain and infertility. The role of T helper 17 (Th17) cells in endometriosis remains elusive. In this study, through detecting CXCR3, CCR4, CCR10, CCR6, interleukin-17 Receptor E (IL-17RE), and CD27, live RORγt-and-IL-17A-expressing Th17 cells were distinguished and sorted from peritoneal fluid (PF) of patients with stage III and IV endometriosis. Furthermore, we found that IL-17RE and CD27 were the labels of heterogeneous PF Th17 subsets, i.e. IL-17RE-CD27- subset, IL-17RE+CD27- subset, and IL-17RE+CD27+ subset. The former two subsets expressed higher IL-17A, GM-CSF, and IL-22 and were more proliferative than the latter subset. RNA-Seq analysis on IL-17RE+ Th17 subset and IL-17RE- Th17 subset revealed up-regulation of genes involved in oxidative phosphorylation and electron transport chain in IL-17RE+ Th17 subset relative to IL-17RE- Th17 subset. Consistently, the IL-17RE+ Th17 subset produced more adenosine triphosphate (ATP) and reactive oxygen species (ROS) than IL-17RE- Th17 subset. In conclusion, this study provides a novel method to detect and isolate live PF Th17 cells from endometriosis patients and unveils the functional and metabolic heterogeneity of PF Th17 subsets. Therefore, it sheds light on the elucidation of molecular mechanisms that modulate the function of pathological Th17 cells in endometriosis.

Sexual dimorphism (SD) is a main source of intraspecific morphological variation, however sexual shape dimorphism (SShD) was long time neglected in evolutionary research. Especially in cold-blooded animal groups only subtle shape differences are expressed between males and females and the selective forces behind it are poorly understood. Crocodile newts of the genera Echinotriton and Tylototriton are highly polymorphic in their reproductive ecology and hence, are a highly suitable model system to investigate potential evolutionary forces leading to SShD differences. We applied 3D geometric morphometrics to the cranial and humerus morphology of nine species of crocodile newts to investigate patterns of SShD in relation to the different mating modes. Trajectories of shape differences between males and females differ in both, cranium and humerus but mating mode does explain differences in SShD trajectories between species only in cranial morphology. Nevertheless, cranial morphology shape differed between the amplecting and circle dancing species. Hence, other selective forces must act here. Variable interspecific allometric trajectories are a potential source of shape differences whereas these trajectories are quite stable for the sexes irrespective of the species.

Introduction: In this study, we aimed to compare the early postoperative period results of type 2 diabetes patients taking oral antidiabetics or insulin medications, with microalbuminuria and normal creatinine levels after coronary artery bypass. Materials and methods: Eighty patients with type 2 diabetes and taking oral antidiabetics or receiving insulin medication all with normal creatinine levels with microalbuminuria were included in this study. Preoperative creatinine values of the patients, albumin levels in spot urine, creatinine levels on the postoperative 3rd day, duration of ventilation, amount of drainage, length of stay in the intensive care unit, length of stay in the hospital, mediastinitis and mortality rates were recorded. Results: A statistically significant increase in creatinine was found in both taking oral antidiabetics type 2 diabetes and insulin medication patient groups with microalbuminuria. When the two groups were compared with each other, increase in creatinine levels of the patients using insulin was higher than the patients taking oral antidiabetics, and was statistically significant. Conclusion: According to the result of our study it can be suggested that postoperative creatinine elevation is observed in patients with type 2 diabetes mellitus with microalbuminuria and with normal creatinine levels, either having insulin medication or not. The elevation is higher in patients having insulin medication while other results are similar, except for impaired renal function. Keywords: Type 2 diabetes mellitus, insulin, microalbuminuria, coronary artery bypass.