Purpose: Obesity has become a very significant health problem in childhood. Fructose taken in an uncontrolled manner and consumed in excessive amounts is rapidly metabolized in the body and gets converted into fatty acids. This single center prospective case-control study aims to investigate the relationship between fructose consumption and obesity and the role of fructose consumption in development of atherosclerotic diseases. Methods: A total of 40 obese and 40 healthy children who were of similar ages (between 8 and 18 years) and sexes were included in the study. In the patient and control groups, the urine fructose levels, as well as the levels of oxidized low-density lipoprotein (LDL), small dense LDL, Apolipoprotein A and Apolipoprotein B values, which have been shown to play a role in development of atherosclerotic diseases, were measured. Results: The levels of oxidized LDL and small dense LDL and the ratio of Apolipoprotein A/Apolipoprotein B were found to be significantly higher in the patient group. Conclusion We found that urinary fructose levels were higher in the obese children than the healthy children. Our results suggest that overconsumption of fructose in children triggers atherogenic diseases by increasing the levels of small dense LDL and oxidized LDL and the ratio of Apolipoprotein B/Apolipoprotein A.

Purpose: Obesity has become a very significant health problem in childhood. Fructose taken in an uncontrolled manner and consumed in excessive amounts is rapidly metabolized in the body and gets converted into fatty acids. This single center prospective case-control study aims to investigate the relationship between fructose consumption and obesity and the role of fructose consumption in development of atherosclerotic diseases. Methods: A total of 40 obese and 40 healthy children who were of similar ages (between 8 and 18 years) and sexes were included in the study. In the patient and control groups, the urine fructose levels, as well as the levels of oxidized low-density lipoprotein (LDL), small dense LDL, Apolipoprotein A and Apolipoprotein B values, which have been shown to play a role in development of atherosclerotic diseases, were measured. Results: The levels of oxidized LDL and small dense LDL and the ratio of Apolipoprotein A/Apolipoprotein B were found to be significantly higher in the patient group. Conclusion We found that urinary fructose levels were higher in the obese children than the healthy children. Our results suggest that overconsumption of fructose in children triggers atherogenic diseases by increasing the levels of small dense LDL and oxidized LDL and the ratio of Apolipoprotein B/Apolipoprotein A.

Objective: Attention deficit hyperactivity disorder (ADHD) is a heterogeneous, highly heritable, a common childhood neurobehavioural disorder resulting from complex gene-gene and gene-environment interactions. The erythropoietin (Epo)/erythropoietin receptors (EpoR) system turned out to have additional important functions in nonhematopoietic tissue. In this study, we aimed to investigate the levels of Epo and and EpoR, and also their diagnostic values in children with ADHD. Methods: A total of 70 children were included in the study, 35 drug-naive patients with ADHD (age: 6−12 years; male/female: 20/15) and 35 healthy controls (age: 6−12 years; male/female: 22/13). Serum Epo and EpoR levels was determined using a commercial sandwich enzyme-linked immunosorbent assay kit. Results: The results indicated that the levels of Epo decreased in patients with ADHD compared to control (p ＜ 0.05).On the other hand, EpoR levels increased in these patients (p ＜ 0.05). Furthermore, the ratio of Epo/EpoR was significantly lower in ADHD patients than controls (p ＜ 0.05). Receiver operator characteristic curve analysis showed high diagnostic performance for Epo and EpoR, areas under curve were 0.980 and 1.000, respectively. Conclusion This is the first report to investigate the association between serum Epo and EpoR levels in ADHD patients. Our results indicated that Epo may play a role in the etiology of ADHD, and Epo therapy may be beneficial in these disorders if given in addition to the routine treatment of children with ADHD. Furthermore, our results reveal possible diagnostic value of Epo and EpoR.

Purpose: We aimed to present our initial clinical experience on the implementation of a stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic disease. Methods: and Materials: Twenty-one patients (24 lesions) with liver metastasis treated with SMART were included in this retrospective study. Step-and-shoot intensity-modulated radiotherapy technique was used with daily plan adaptation. During delivery, real-time imaging was used by acquiring planar magnetic resonance images in sagittal plane for monitoring and gating. Acute and late toxicities were recorded both during treatment and follow-up visits. Results: The median follow-up time was 11.6 months (range, 2.2 to 24.6 months). The median delivered total dose was 50 Gy (range, 40 to 60 Gy); with a median fraction number of 5 (range, 3 to 8 fractions) and the median fraction dose was 10 Gy (range, 7.5 to 18 Gy). Ninety-three fractions (83.7%) among 111 fractions were re-optimized. No patients were lost to follow-up and all patients were alive except one at the time of analysis. All of the patients had either complete (80.9%) or partial (19.1%) response at irradiated sites. Estimated 1-year overall survival was 93.3%. Intrahepatic and extrahepatic progression-free survival was 89.7% and 73.5% at 1 year, respectively. There was no grade 3 or higher acute or late toxicities experienced during the treatment and follow-up course. Conclusion SMART represents a new, noninvasive and effective alternative to current ablative radiotherapy methods for treatment of liver metastases in oligometastatic disease with the advantages of better visualization of soft tissue, real-time tumor tracking and potentially reduced toxicity to organs at risk.

Purpose: We aimed to present our initial clinical experience on the implementation of a stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of liver metastases in oligometastatic disease. Methods: and Materials: Twenty-one patients (24 lesions) with liver metastasis treated with SMART were included in this retrospective study. Step-and-shoot intensity-modulated radiotherapy technique was used with daily plan adaptation. During delivery, real-time imaging was used by acquiring planar magnetic resonance images in sagittal plane for monitoring and gating. Acute and late toxicities were recorded both during treatment and follow-up visits. Results: The median follow-up time was 11.6 months (range, 2.2 to 24.6 months). The median delivered total dose was 50 Gy (range, 40 to 60 Gy); with a median fraction number of 5 (range, 3 to 8 fractions) and the median fraction dose was 10 Gy (range, 7.5 to 18 Gy). Ninety-three fractions (83.7%) among 111 fractions were re-optimized. No patients were lost to follow-up and all patients were alive except one at the time of analysis. All of the patients had either complete (80.9%) or partial (19.1%) response at irradiated sites. Estimated 1-year overall survival was 93.3%. Intrahepatic and extrahepatic progression-free survival was 89.7% and 73.5% at 1 year, respectively. There was no grade 3 or higher acute or late toxicities experienced during the treatment and follow-up course. Conclusion SMART represents a new, noninvasive and effective alternative to current ablative radiotherapy methods for treatment of liver metastases in oligometastatic disease with the advantages of better visualization of soft tissue, real-time tumor tracking and potentially reduced toxicity to organs at risk.

Objective: Attention deficit hyperactivity disorder (ADHD) is a heterogeneous, highly heritable, a common childhood neurobehavioural disorder resulting from complex gene-gene and gene-environment interactions. The erythropoietin (Epo)/erythropoietin receptors (EpoR) system turned out to have additional important functions in nonhematopoietic tissue. In this study, we aimed to investigate the levels of Epo and and EpoR, and also their diagnostic values in children with ADHD. Methods: A total of 70 children were included in the study, 35 drug-naive patients with ADHD (age: 6−12 years; male/female: 20/15) and 35 healthy controls (age: 6−12 years; male/female: 22/13). Serum Epo and EpoR levels was determined using a commercial sandwich enzyme-linked immunosorbent assay kit. Results: The results indicated that the levels of Epo decreased in patients with ADHD compared to control (p ＜ 0.05).On the other hand, EpoR levels increased in these patients (p ＜ 0.05). Furthermore, the ratio of Epo/EpoR was significantly lower in ADHD patients than controls (p ＜ 0.05). Receiver operator characteristic curve analysis showed high diagnostic performance for Epo and EpoR, areas under curve were 0.980 and 1.000, respectively. Conclusion This is the first report to investigate the association between serum Epo and EpoR levels in ADHD patients. Our results indicated that Epo may play a role in the etiology of ADHD, and Epo therapy may be beneficial in these disorders if given in addition to the routine treatment of children with ADHD. Furthermore, our results reveal possible diagnostic value of Epo and EpoR.

INTRODUCTION: This study aimed to compare early and on-demand maternal feeding after Caesarean delivery in terms of gastrointestinal complaints and patient satisfaction. METHODS: A total of 262 women with uncomplicated singleton term pregnancies who underwent a Caesarean section under regional anaesthesia were randomised to a soft food diet served at Postoperative Hour 2 (early feeding group) or eating whenever they wanted to upon return to the ward (on-demand group). Patient satisfaction scores at the time of discharge and gastrointestinal complaints were compared. RESULTS: The fed-early group comprised 133 (50.8%) women and the on-demand group comprised 129 (49.2%) women. Major characteristics and surgical procedures were comparable between the two groups. No significant between-group differences in demographic criteria or surgical procedures were evident (p > 0.05). The mean time to the first feeding was 120.00 ± 00.00 minutes for the early feeding group as compared to 236.59 ± 107.74 minutes for the on-demand feeding group (p = 0.001). Satisfaction levels did not differ significantly between the two groups (p = 0.366). Duration to first breastfeeding, analgesia on the ward, passage of flatus, defecation, mobilisation and urination after catheter removal did not differ significantly between the two groups (p > 0.05). CONCLUSION Early initiation of solid food in low-risk women after Caesarean delivery under regional anaesthesia was associated with high satisfaction and did not increase gastrointestinal complaints. We suggest having flexibility in terms of postoperative feeding time. This may shorten hospitalisation time and reduce hospitalisation costs.

BACKGROUNDOutcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP). Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD). We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.

METHODSFifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.

RESULTSTwenty-seven patients had poor CCC and 28 patients had good CCC. In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs. 4 (13%), P = 0.013). Preoperative hemoglobin level (OR: 0.752; 95% CI, 0.571-0.991, P = 0.043), chronic obstructive pulmonary disease (OR: 6.731; 95% CI, 1.159-39.085, P = 0.034) and poor CCC grade (OR: 5.750; 95% CI, 1.575±20.986, P = 0.008) were associated with post-CABG in-hospital mortality. Poor CCC grade (OR: 4.853; 95% CI, 1.124-20.952, P = 0.034) and preoperative hemoglobin level (OR: 0.624; 95% CI, 0.476-0.954, P = 0.026) were independent predictors of in-hospital mortality after CABG.

CONCLUSIONPreoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

Aged ; Collateral Circulation ; physiology ; Coronary Artery Bypass ; adverse effects ; mortality ; Female ; Hospital Mortality ; Humans ; Intra-Aortic Balloon Pumping ; adverse effects ; mortality ; Male ; Middle Aged