Depression and socio‐economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross‐sectional survey study using a 5‐point Likert‐type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho‐social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.     

The effects of reactive oxygen species on calcium- and carbachol- induced contractile responses in β-escin permeabilized rat bladder

The effect of reactive oxygen species on contractions in beta-escin permeabilized rat detrusor was investigated. Cumulative calcium contractions were inhibited by hydrogen peroxide (H(2)O(2)) and hydroxyl (*OH) but not by superoxide (O(2) *). The sarcoplasmic reticulum calcium-ATPase inhibitor cyclopiazonic acid (CPA) and the mitochondrial blocker carbonyl cyanide p-trifluromethoxyphenylhydrazone (FCCP) decreased the calcium contractions, however in their presence, H(2)O(2) and *OH did not have further effect. Carbachol contractions were inhibited by either H(2)O(2)/*OH/O(2) * or CPA/FCCP. In the presence of CPA, carbachol contractions were not affected by H(2)O(2) and *OH but further decreased by O(2) *. On the other hand, only H(2)O(2) and *OH elicited additional inhibition in carbachol responses in the presence of FCCP. Inositol triphosphate contraction was inhibited by *OH whereas none of the radicals affect carbachol induced calcium sensitization. These results show that H(2)O(2) and *OH affects sarcoplasmic reticulum where O(2) * acts on mitochondria to change contractions in rat detrusor smooth muscle.     

The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility

As of late, polyphenols have increasingly interested the scientific community due to their proposed health benefits. Much of this attention has focused on their bioavailability. Polyphenol–gut microbiota interactions should be considered to understand their biological functions. The dichotomy between the biotransformation of polyphenols into their metabolites by gut microbiota and the modulation of gut microbiota composition by polyphenols contributes to positive health outcomes. Although there are many studies on the in vivo bioavailability of polyphenols, the mutual relationship between polyphenols and gut microbiota is not fully understood. This review focuses on the biotransformation of polyphenols by gut microbiota, modulation of gut microbiota by polyphenols, and the effects of these two-way mutual interactions on polyphenol bioavailability, and ultimately, human health.     

Role of magnetic resonance spectroscopy in differential diagnosis of solitary pulmonary lesions

PURPOSEThe aim of our study was to evaluate the availability of magnetic resonance spectroscopy (MRS) for the differentiation of benign or malignant pulmonary nodules and masses.METHODSA total of 59 patients (45 male, 14 female) with pulmonary nodules and masses were included in this prospective study. MRS was applied to the pulmonary lesions of the patients and choline levels were determined. Afterwards CT-guided percutaneous needle biopsy was performed. According to the biopsy results, pulmonary lesions were benign in 25 patients and malignant in 34 patients.RESULTSCholine levels were significantly higher in malignant lesions compared with benign lesions (p < 0.001). When the other conditions were kept constant, the probability of malignancy significantly increased by 17.38-fold (95% CI, 3.78–79.93) in those with choline levels >1.65 μmol/g compared to those with choline levels ≤1.65 μmol/g (p < 0.001).CONCLUSIONMRS is a noninvasive method that can be used in the differential diagnosis of pulmonary nodules and masses.

The majority of the solitary pulmonary nodules have a benign character (1). However, all pulmonary nodules should be considered as malignant lesions unless proven otherwise (2). The differential diagnosis of these lesions may be an important problem in routine medical practice. Computed tomography (CT) is the standard method for the examination of the nodules and mass lesions (3). CT imaging of morphological features like size, margins, and calcification enables the investigation of malignancy (4). However, there is some overlap so that some malignant lesions may appear benign, while some benign nodules may show morphological features typical for malignancy (5). CT imaging for differantial diagnosis have problems like false-negative and false-positive results, over-diagnosis, benign nodule resections, and exposure to radiation (6). Biopsy is the most reliable and effective method for the diagnosis of the pulmonary nodules and mass lesions. However, it may cause serious complications such as pneumothorax, hemoptysis, air embolism, tumor cell seeding and death (7, 8). In addition, the tolerability of this invasive intervention is rather low among patients.Magnetic resonance imaging (MRI) provides information about the tumor morphology and magnetic resonance spectroscopy (MRS) provides biochemical information about the physiology and metabolism of the disease (9). MRS enables molecular analysis of the tissues based on the display of different chemical shifts of certain nuclei in the magnetic field (10). MRS was initially used in neuroradiology for characterization of tumor, stroke, epilepsy, infection, and neurodegenerative diseases. In recent years, it was also introduced in the evaluation of lesions in other organs like breast (11), liver (12), pancreas (13), and prostate (14). There are some in vitro studies in the literature on the use of MRS in lung cancer showing higher lactate and total choline peaks compared with normal tissues (15, 16). Also there is one case report in the literature regarding the feasibility of using MRS in lung cancer (17).The objective of this study was to demonstrate the value of MRS, which is a noninvasive method and does not require a contrast agent, in the differential diagnosis of pulmonary nodules and mass lesions.     

Designing high energy density flow batteries by tuning active-material thermodynamics

The cost of electricity generated by wind and solar installations has become competitive with that generated by burning fossil fuels. While this paves the way for a carbon-neutral electrical grid, short- and long-term intermittency necessitates energy storage. Flow batteries are a promising technology to accommodate this need, with numerous advantages, including decoupled power and energy ratings, which imparts flexibility, thermal stability, and safety. Further, development of robust nonaqueous systems has the potential to greatly improve energy density, approaching that of lithium-ion batteries, while maintaining the advantages of flow systems. Herein we report a breakthrough on a bio-inspired nonaqueous redox flow battery (NRFB) electrolyte, which contains high-concentration active-material and maintains stability during deep cycling for extended time-periods. These advances are reinforced by thermodynamic considerations and computational investigations, which provide a clear path to further improvements. Electrochemical studies confirm that the active-material maintains its high stability at high concentration. This molecular scaffold clears two important hurdles in designing active-materials for nonaqueous electrolytes – low solubility and poor stability – providing an in-road to development of high-performance NRFB systems.

With the cost of renewable energy near parity with fossil fuels, energy storage is paramount. We report a breakthrough on a bioinspired NRFB active-material, with greatly improved solubility, and place it in a predictive theoretical framework.     

Investigation of the Factors Affecting Allograft Kidney Functions: Results of 10 Years

IntroductionSignificant improvements in patient and graft survival and reductions in the frequency of acute rejection were obtained in the early period after renal transplantation, but this success was not sufficiently reflected in the long term. Allograft kidney losses in the long term remain a significant problem. In this study, we investigated the specific causes of graft losses in patients who had a good clinical course in the first year but developed graft loss in the long term.MethodsA total of 118 patients who underwent kidney transplantation in 2005 and 2006 in the Organ Transplantation Center of Ege University Medical Faculty Hospital were evaluated. The inclusion criteria were to be older than 18 years and have a serum creatinine value of <2 mg/dL at the 12th month after transplantation.ResultsSixty-one percent of the recipients were male, and the mean age at the time of transplantation was 34 ± 11 years (18 to 61). We observed 29 graft losses during the mean follow-up period of 129 ± 35 months (27 to 162). Three of the graft losses were death by functional graft. Of the 26 patients with graft loss, 16 had chronic rejection, and 8 had recurrent glomerulonephritis. The relationship between nonimmune causes and graft loss was not detected.ConclusionsIn conclusion, nonimmune factors may not be as important as we think in relatively young and healthier recipients. Chronic rejection and recurrent glomerulonephritis are the main causes of long-term graft loss of patients with good graft function at the end of the first year. Improvement of long-term survival will be possible with the prevention and effective treatment of these 2 problems.     

Mucormycosis Presented with Facial Pain in a Renal Transplant Patient: A Case Report

IntroductionMucormycosis is a severe infection in renal transplant recipients. Here, we report a case of maxillary sinus mucormycosis in a patient who presented with a facial pain complaint.CaseA 51-year-old female patient with renal transplantation due to autosomal dominant, polycystic kidney disease and diabetic nephropathy was admitted to our hospital with facial pain and minimal edema of the left half of her face on the 8th month of transplantation. On physical examination, there was only tenderness and slight edema on the left half of the face. On the paranasal computed tomography, extensive soft tissue densities involving septations, filling the left maxillary sinus, extending to the nasal cavity, and obliterating the left osteometeal unit were observed. Because facial pain was not relieved by antibiotics and several, potent analgesic drugs on the second day, mucormycosis infection with bone involvement was suspected. A left maxillary sinus excision was performed. Microscopic examination of the debridement specimen revealed necrotic bone interspersed with fungal hyphae, and culture isolated Rhizopus oryzae. Liposomal amphotericin B was started. The patient was on tacrolimus, prednisolone, and mycophenolate mofetil. Tacrolimus was switched to cyclosporine to regulate serum glucose levels. The left maxillary sinus was washed with liposomal amphoterin B daily and curetted with intervals. The patient started dialysis because of severe renal function loss. The patient was discharged on the 96th day of liposomal amphotericin B.ConclusionIt should be kept in mind that mucormycosis may be present in the sinuses even if there is no evidence for nasal, oral, and dental examination in renal transplant patients with facial pain.     

Antenatally detected ureterocele: Associated anomalies and postnatal prognosis

ObjectiveWe purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients.Material and methodsWe reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010–March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained.ResultsThe mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy.ConclusionUreterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.     

Hydrogen sulphide inhibits carbachol-induced contractile responses in β-escin permeabilized guinea-pig taenia caecum

Hydrogen sulphide (H(2)S) is an endogenous mediator producing a potent relaxation response in vascular and non-vascular smooth muscles. While ATP-sensitive potassium channels are mainly involved in this relaxant effect in vascular smooth muscle, the mechanism in other smooth muscles has not been revealed yet. In the present study, we investigated how H(2)S relaxes non-vascular smooth muscle by using intact and β-escin permeabilized guinea-pig taenia caecum. In intact tissues, concentration-dependent relaxation response to H(2)S donor NaHS in carbachol-precontracted preparations did not change in the presence of a K(ATP) channel blocker glibenclamide, adenylate cyclase inhibitor SQ-22536, guanylate cyclase inhibitor ODQ, protein kinase A inhibitor KT-5720, protein kinase C inhibitor H-7, tetrodotoxin, apamin/charybdotoxin, NOS inhibitor L-NAME and cyclooxygenase inhibitor indomethacin. We then studied how H(2)S affected carbachol- or Ca(2+)-induced contractions in permeabilized tissues. When Ca(2+) was clamped to a constant value (pCa6), a further contraction could be elicited by carbachol that was decreased by NaHS. This decrease in contraction was reversed by catalase but not by superoxide dismutase or N-acetyl cysteine. The sarcoplasmic reticulum Ca(2+)-ATPase pump inhibitor, cyclopiazonic acid, also decreased the carbachol-induced contraction that was further inhibited by NaHS. Mitochondrial proton pump inhibitor carbonyl cyanide p-trifluromethoxyphenylhydrazone also decreased the carbachol-induced contraction but this was not additionally changed by NaHS. The carbachol-induced Ca(2+) sensitization, calcium concentration-response curves, IP(3)- and caffeine-induced contractions were not affected by NaHS. In conclusion, we propose that hydrogen peroxide and mitochondria may have a role in H(2)S-induced relaxation response in taenia caecum.