Comparison of low-dose contrast computed tomography angiography findings with surgical results in living kidney donors

Aim: To analyze the image quality and diagnostic performance of CT angiography using low dose (60 ml) contrast medium for living kidney donors and compare with surgical results. Material and Method: Angiographic findings of 81 renal donor Candidates in 128-slice MDCT were evaluated by two independent radiologists in terms of renal artery number, early bifurcation, renal vein variations, pelvicalyceal system and ureter variations. Results were compared with intraoperative findings. The image quality, diagnostic performance and interobserver agreement of MDCT obtained with low dose contrast material were analyzed. Results: The mean age of the 81 living kidney donors included in the study was 49±12 (24-68) years. Left nephrectomy was performed in 71% (n=64) and right nephrectomy in 29% (n=17) of the donors. Intraoperative accessory arteries were detected in 22.2% (n:18) of the donors. The specificity, sensitivity, and accuracy for detecting accessory artery variation in MDCT were 100%, 88.9%, and 97.5%, respectively. Early bifurcation was observed in 21% (n=17) of the donors. Specificity, sensitivity and accuracy for early bifurcation detection were 98.4%, 94.1% and 97.5%, respectively. Renal vein variation was detected in 12.3% (n=10) of the donors. Specificity, sensitivity, and accuracy for renal vein variation detection were 100%. Variations of the pelvicalyceal system and ureter were observed in 3.7% (n=3) of the donors. The specificity, sensitivity, and accuracy for detecting pelvicalyceal system and ureteral variations were 100%. Interobserver agreement was excellent in detecting variations of accessory arteries, renal venous anomalies, pelvicalyceal system and ureters by MDCT (kappa: 1,000; p< 0.001). It was higher in early bifurcation detection (kappa: 0.853; p< 0.001). Conclusion: MDCT angiography with a lower dose of iodine contrast at 60 mL in kidney donors is sufficient to detect vascular anomalies and provide anatomical information. It is possible to reduce the contrast agent dose in CTA without affecting the preoperative evaluation

Tip 2 diyabetik hastaların birinci derece yakınlarında total homosistein ve asimetrik dimetilargininin plazma düzeyleri

Amaç: Tip 2 diyabetik hastaların birinci derece yakınlarında, ailesinde diyabet öyküsü olmayan sağlıklı olgulara göre kardiyovasküler hastalıklar daha sık görülmektedir. Asimetrik dimetilarginin (ADMA) ve homosistein (Hcy) plazma düzeyleri kardiyovasküler hastalıklar ve endotel disfonksiyonuyla ilişkili göstergelerdir. Bu çalışmada, tip 2 diyabetik hastaların birinci derece yakınlarında ADMA ve Hcy plazma düzeyleri ile bu göstergelerle kardiyovasküler risk faktörleri arasındaki ilişkilerin incelenmesi amaçlandı. Hastalar ve Yöntemler: Dolaşımdaki ADMA ve Hcy düzeyleri 15 tip 2 diyabet hastasının birinci derece yakınında ve ailesinde diyabet öyküsü olmayan 15 kontrol olgusunda ölçüldü. Bulgular: Her iki grup arasında ADMA ve Hcy plazma düzeyleri açısından anlamlı farklılık saptanmadı (p>0.05). Asimetrik dimetilarginin plazma düzeyi tip 2 diyabetik olguların birinci derece yakınlarında, bel çevresi (p=0.02), açlık insülin düzeyi (p=0.03), insülin direnci (p=0.01), total kolesterol (p=0.04) ve HDL kolesterol (p=0.03) ile ilişkiliydi. Sonuç: Bu sonuçlara göre, kardiyovasküler risk faktörlerine sahip olan tip 2 diyabetik olguların birinci derece yakınlarında, ADMA plazma düzeylerinin doğrudan endotel disfonksiyonunun gelişimine katkıda bulunmadığını düşünmekteyiz.Objectives: Cardiovascular diseases are more common among first degree relatives of type 2 diabetic patients than healthy subjects without a family history of diabetes. Plasma asymmetric dimethylarginine (ADMA) and homocysteine (Hcy) levels are markers of endothelial dysfunction and cardiovascular disease. The objective of this study was to evaluate levels of ADMA, Hcy and their association with cardiovascular risk factors in first degree relatives of type 2 diabetic patients. Patients and Methods: The circulating ADMA and Hcy levels were measured in 15 first degree relatives of type 2 diabetic patients and 15 control subjects without a known family history of diabetes. Results: No statistically significant differences were found in plasma levels of ADMA and Hcy between the two groups (p&gt;0.05). Plasma ADMA levels correlated significantly with waist circumference (p=0.02), fasting insulin levels (p=0.03), insulin resistance (p=0.01), total cholesterol (p=0.04) and HDL-cholesterol (p=0.03) levels in the first degree relatives of type 2 diabetic patients. Conclusion: These results suggest that plasma ADMA levels do not directly contribute to the development of endothelial dysfunction in first degree relatives of type 2 diabetic patients with cardiovascular risk factors

Dosimetric Impact of Bladder Volumetric Changes During Helical Radiotherapy for Rectal Cancer

Introduction: This study aims to investigate the dosimetric impact of bladder volumetric changes during helical radiotherapy (RT) for rectal cancer (RC).Material and Methods: A total of 42 RC patients' helical RT treatment plans were analyzed. The bladder volumes were divided into 3 groups (Group1: V200ml). Planning target volume (PTV), PTV boost, bladder, bowel, right, and left femoral head dose values were analyzed and compared between groups. Statistical analysis was done with a one-way ANOVA test in SPSS18.0 program. A value of p <0.05 was considered statistically significant.Results: The median age of the patients was 59 (range:22-87) and bladder volume ranged from 41.44ml-620.82ml. In the dosimetric data comparison of the patient groups with different bladder volumes, the D50 dose values of PTV and PTV boost volume was highest in Group 3 (p=0.039). No statistical significance was found between PTV and PTV boost’ doses of D98 and D2 ​​and groups. The optimum PTV dose value was in Group2. Bowel doses were highest in Group 1. As the bladder volume increased, the Dmax, Dmean, V15%, and V30% values of the bowel doses decreased. There was a statistically significant relationship between bladder Dmax doses and groups (p = 0.024). Femoral heads doses increased in proportion to increasing bladder volume groups and these results were statistically significant for V5% and V30% (p <0.05).Conclusion: In our study, as the bladder volume increased, there was an inversely proportional decrease in the bowel doses and a directly proportional increase in the femoral head and bladder doses. Bladder volume values significantly affected values of the target and critical organs dose during helical RT for R

Recent advances in location analysis

The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.cor.2015.04.013 © 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Introduction to a special issue of Computers & Operations Research dedicated to recent advances in location analysis

Spatial Analysis of Single Allocation Hub Location Problems

The final publication is available at Springer via http://dx.doi.org/10.1007/s11067-015-9311-9Hubs are special facilities that serve as switching, transshipment and sorting nodes in many-to-many distribution systems. Flow is consolidated at hubs to exploit economies of scale and to reduce transportation costs between hubs. In this article, we first identify general features of optimal hub locations for single allocation hub location problems based on only the fundamental problem data (demand for travel and spatial locations). We then exploit this knowledge to develop a straightforward heuristic methodology based on spatial proximity of nodes, dispersion and measures of node importance to delineate subsets of nodes likely to contain optimal hubs. We then develop constraints for these subsets for use in mathematical programming formulations to solve hub location problems. Our methodology can also help narrow an organization's focus to concentrate on more detailed and qualitative analyses of promising potential hub locations. Results document the value of including both demand magnitude and centrality in measuring node importance and the relevant tradeoffs in solution quality and time.Turkish Academy of Science

Problems encountered in conventional HIV 1/2 Algorithms: lack of necessity for immunoblot assays to confirm repeated ELISA reactive results

Background: The use of conventional (serologically based) HIV 1/2 diagnostic algorithms has become controversial in recent years.Objectives: Sera from patients who underwent verification tests were evaluated because repeated ELISA-reactive results demonstrated a HIV1+HIV2 positive band pattern.Methods: The line immunoassay (LIA) test was used for repeated HIV enzyme immunoassays (EIA)-reactive sera in patients at three centers. The Bio-Rad Geenius™ HIV 1/2 and the HIV-1 RNA tests were used. HIV-1 and RNA HIV-2 were investigated using PCR.Results: LIA was used to evaluate 3,224 out of 10,591 samples with repeated ELISA reactivity (30%). We found that 32 (1%) of the sera, along with HIV1 bands and HIV2 gp36 bands, were positive. Only 28 of the 32 verified serum samples with gp36 bands were repeated, and no gp36 band positivity was detected using the Bio-Rad Geenius™ HIV-1/2 confirmatory assay in these serum samples. The HIV-2 proviral DNAs were also negative. Therefore, we excluded the possibility of HIV1+2 co-infection. All samples from the 32 patients were positive for HIV-1 RNA.Conclusion: Our findings highlight the need to exclude confirmatory tests like the LIA test from the current diagnostic HIV algorithm and replace it with rapid HIV-1 and HIV-2 confirmatory immunochromotographic tests.Keywords: HIV, AIDS, HIV-2

Problems encountered in conventional HIV 1/2 Algorithms: lack of necessity for immunoblot assays to confirm repeated ELISA reactive results

Background: The use of conventional (serologically based) HIV 1/2 diagnostic algorithms has become controversial in recent years. Objectives: Sera from patients who underwent verification tests were evaluated because repeated ELISA-reactive results demonstrated a HIV1+HIV2 positive band pattern. Methods: The line immunoassay (LIA) test was used for repeated HIV enzyme immunoassays (EIA)-reactive sera in patients at three centers. The Bio-Rad Geenius\u2122 HIV 1/2 and the HIV-1 RNA tests were used. HIV-1 and RNA HIV-2 were investigated using PCR. Results: LIA was used to evaluate 3,224 out of 10,591 samples with repeated ELISA reactivity (30%). We found that 32 (1%) of the sera, along with HIV1 bands and HIV2 gp36 bands, were positive. Only 28 of the 32 verified serum samples with gp36 bands were repeated, and no gp36 band positivity was detected using the Bio-Rad Geenius\u2122 HIV-1/2 confirmatory assay in these serum samples. The HIV-2 proviral DNAs were also negative. Therefore, we excluded the possibility of HIV1+2 co-infection. All samples from the 32 patients were positive for HIV-1 RNA. Conclusion: Our findings highlight the need to exclude confirmatory tests like the LIA test from the current diagnostic HIV algorithm and replace it with rapid HIV-1 and HIV-2 confirmatory immunochromotographic tests

Operational Research: Methods and Applications

Throughout its history, Operational Research has evolved to include a variety of methods, models and algorithms that have been applied to a diverse and wide range of contexts. This encyclopedic article consists of two main sections: methods and applications. The first aims to summarise the up-to-date knowledge and provide an overview of the state-of-the-art methods and key developments in the various subdomains of the field. The second offers a wide-ranging list of areas where Operational Research has been applied. The article is meant to be read in a nonlinear fashion. It should be used as a point of reference or first-port-of-call for a diverse pool of readers: academics, researchers, students, and practitioners. The entries within the methods and applications sections are presented in alphabetical order

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (&lt;4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs