Background: Erector spinae plane block (ESPB) is a well-established method for managing postoperative and chronic pain. ESPB applications for the sacral area procedures are called sacral ESPBs (SESPBs). This cadaveric study aimed to determine the distribution of local anesthesia using the median and intermediate approaches to the SESPB. Methods: Four cadavers were categorized into the median and intermediate approach groups. Ultrasound-guided SESPBs were performed using a mixture of radiopaque agents and dye. Following confirmation of the solution distribution through computed tomography (CT), the cadavers were dissected to observe the solution distribution. Results: CT images of the median group demonstrated subcutaneous pooling of the radiopaque solution between the S1 and S5 horizontal planes. Radiopaque solution also passed from the sacral foramina to the anterior sacrum via the spinal nerves between S2 and S5. In the intermediate group, the solution distribution was observed along the bilateral erector spinae muscle between the L2 and S3 horizontal planes; no anterior transition was detected. Dissection in the median group revealed blue solution distribution in subcutaneous tissue between horizontal planes S1 and S5, but no distribution in superficial fascia or muscle. In the intermediate group, red solution was detected in the erector spinae muscle between the L2 and S3 intervertebral levels. Conclusions Radiologic and anatomic findings revealed the presence of radiopaque dye in the superficial and erector spinae compartments in both the median and intermediate groups. However, anterior transition of the radiopaque dye was detected only in the median group.

Purpose: Obesity is defined as the abnormal or excessive accumulation of fat over acceptable limits. Leptin is a metabolic hormone present in the circulation in amounts proportional to fat mass. Leptin reduces food intake and increases energy expenditure, thus regulating body weight and homeostasis. Various polymorphisms are present in the leptin gene and its receptor. These polymorphisms may be associated with obesity. This study aimed to show the association of leptin (+19) AG, leptin (2548) GA, and Gln223Arg leptin receptor polymorphisms with obesity and metabolic syndrome in Turkish children aged 6–17 years, and to conduct further investigations regarding the genetic etiology of obesity. Methods: A total of 174 patients diagnosed with obesity and 150 healthy children who were treated at Tokat Gaziosmanpaşa Medical School Hospital between September 2014 and March 2015 were included in this study. The ages of the children were between 6 and 17 years, and anthropometric and laboratory results were recorded. Genotyping of leptin (+19) AG, leptin (2548) GA, and leptin receptor Gln223Arg polymorphisms was performed by polymerase chain reaction. Results: An association between leptin receptor Gln223Arg gene polymorphism and obesity was detected. Conclusion Further studies are needed to determine the role of genetic etiologies and to indicate the role of leptin signal transmission impairment in the pathogenesis of obesity. We hope that gene therapy can soon provide a solution for obesity.

Purpose: Obesity is defined as the abnormal or excessive accumulation of fat over acceptable limits. Leptin is a metabolic hormone present in the circulation in amounts proportional to fat mass. Leptin reduces food intake and increases energy expenditure, thus regulating body weight and homeostasis. Various polymorphisms are present in the leptin gene and its receptor. These polymorphisms may be associated with obesity. This study aimed to show the association of leptin (+19) AG, leptin (2548) GA, and Gln223Arg leptin receptor polymorphisms with obesity and metabolic syndrome in Turkish children aged 6–17 years, and to conduct further investigations regarding the genetic etiology of obesity. Methods: A total of 174 patients diagnosed with obesity and 150 healthy children who were treated at Tokat Gaziosmanpaşa Medical School Hospital between September 2014 and March 2015 were included in this study. The ages of the children were between 6 and 17 years, and anthropometric and laboratory results were recorded. Genotyping of leptin (+19) AG, leptin (2548) GA, and leptin receptor Gln223Arg polymorphisms was performed by polymerase chain reaction. Results: An association between leptin receptor Gln223Arg gene polymorphism and obesity was detected. Conclusion Further studies are needed to determine the role of genetic etiologies and to indicate the role of leptin signal transmission impairment in the pathogenesis of obesity. We hope that gene therapy can soon provide a solution for obesity.

Purpose: We sought to determine changes in the conjunctival bacterial flora and antibiotic resistance after topical antibiotic drops for infection prophylaxis were administered following intravitreal injections in patients with type 2 diabetes. Methods: This prospective and nonrandomized cohort study included 116 eyes of 116 treatment-naive patients with type 2 diabetes who received six serial intravitreal anti-vascular endothelial growth factor injections for macular edema. Three conjunctival cultures were obtained from each eye over the course of the study (Culture 1, baseline; Culture 2, 1 month after the third injection; and Culture 3, 1 month after the sixth injection). The study subjects were given topical moxifloxacin hydrochloride for 4 days after each monthly intravitreal injection. The growth patterns of conjunctival bacterial flora and the antibiotic resistance to several commonly used antibiotics were examined. Results: The rate of culture positivity increased significantly during the observation period (Culture 1, n = 47, 40.5%; Culture 2, n = 58, 50%; Culture 3, n = 76, 65.5%, p < 0.001). The bacterium with the highest baseline culture positivity was Staphylococcus epidermidis (n = 45, 38.8%), which increased significantly during the observation period (p < 0.001). No significant increase was noted in the culture positivity of the other bacteria with baseline culture positivity (p > 0.05). Regarding antibiotic susceptibility, significant increases in resistance to the fluoroquinolone group of drugs were noted (p < 0.001). No significant changes in sensitivity were detected in the other 11 investigated antibiotics that are commonly used in clinical practice (p > 0.05). Conclusions The use of topical moxifloxacin after each intravitreal injection significantly increases the fluoroquinolone resistance of the ocular surface flora and the culture-positivity rate of S. epidermidis in patients with type 2 diabetes.

Background: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons’ illness, has not been studied previously in pediatric psoriasis patients. Objective: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. Methods: This multicenter,cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. Results: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. Conclusion Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

BACKGROUND AND PURPOSE: This randomized controlled study examined the effect of repetitive transcranial magnetic stimulation (rTMS) on spasticity in patients with multiple sclerosis (MS). METHODS: This study included 16 patients with a history of MS and spasticity in the adductor hip muscles according to the Modified Ashworth Scale (MAS). The participants were randomized into the active group (n=10) and control group (n=6), in which active rTMS and sham rTMS were applied in 10 sessions, respectively. A physical therapy and rehabilitation program was applied along with rTMS sessions in both groups. The evaluation parameters were assessed at baseline and then 1 week and 1 month after applying rTMS. RESULTS: Statistical analyses with post-hoc correction revealed statistically significant improvements in the active group compared to the control group in the bilateral MAS score, Penn Spasm Frequency Scale score, patient satisfaction, amount of urine leakage, actual health status, perceived health status, energy and fatigue, role limitations due to physical problems, social function, overall quality of life, cognitive functioning, physical health composite score, mental health composite score, and total score on the Multiple Sclerosis Quality of Life-54 (MSQOL-54) (p<0.05). Statistically significant changes were detected in the MSQOL-54 social function and physical health composite scores of patients in the control group (p<0.05). CONCLUSIONS: Active rTMS combined with a physical therapy program reduced spasticity in MS patients compared to the control group that received only physical therapy. Further comprehensive and more advanced studies are needed to confirm the present findings.
Fatigue ; Hip ; Humans ; Mental Health ; Multiple Sclerosis ; Muscle Spasticity ; Muscles ; Patient Satisfaction ; Quality of Life ; Rehabilitation ; Social Problems ; Spasm ; Transcranial Magnetic Stimulation

PURPOSE: The purpose of the present study was to evaluate the effect of thermocycling and mechanical loading on the biaxial flexural strength and the phase transformation of one Ce-TZP/Al2O3 and two Y-TZP core materials. MATERIALS AND METHODS: Thirty disc-shaped specimens were obtained from each material. The specimens were randomly divided into three groups (control, thermocycled, and mechanically loaded). Thermocycling was subjected in distilled water for 10000 cycles. Mechanical loading was subjected with 200 N loads at a frequency of 2 Hz for 100000 times. The mean biaxial flexural strength and phase transformation of the specimens were tested. The Weibull modulus, characteristic strength, 10%, 5% and 1% probabilities of failure were calculated using the biaxial flexural strength data. RESULTS: The characteristic strengths of Ce-TZP/Al2O3 specimens were significantly higher in all groups compared with the other tested materials (P<.001). Statistical results of X-ray diffraction showed that thermocycling and mechanical loading did not affect the monoclinic phase content of the materials. According to Raman spectroscopy results, at the same point and the same material, mechanical loading significantly affected the phase fraction of all materials (P<.05). CONCLUSION: It was concluded that thermocycling and mechanical loading did not show negative effect on the mean biaxial strength of the tested materials.
Spectrum Analysis, Raman ; Water ; X-Ray Diffraction

Carcinosarcomas are rare biphasic malignant neoplasms with an epithelial and a spindle cell component. We present a 62-year-old man with a history of noticeably abdominal distension, proved by surgery to be caused by carcinosarcoma of the renal pelvis and urinary bladder, occupying the entire left abdominal flank. We also illustrate the appearance of this rare entity on sonography and computed tomography.
Bladder/*pathology/radiography/surgery/ultrasonography ; Bladder Neoplasms/radiography/*surgery/ultrasonography ; Carcinosarcoma/radiography/*surgery/ultrasonography ; Contrast Media/administration & dosage ; Human ; Kidney Neoplasms/radiography/*surgery/ultrasonography ; Kidney Pelvis/*pathology/radiography/surgery/ultrasonography ; Male ; Middle Aged ; Tomography, X-Ray Computed