Permafrost conditions in the Mediterranean region since the Last Glaciation.

Cold-climate geomorphological processes today in the Mediterranean region are only distributed in the highest mountain environments. However, climate condition prevailing during the Late Pleistocene and Holocene have conditioned significant spatio-temporal variations of the glacial and periglacial domain in these mountains, including permafrost. In this communication we examine permafrost condition in the Mediterranean region taking into account five periods: Last Glaciation, deglaciation, Holocene, Little Ice Age (LIA) and present-day. The distribution of currently inactive permafrost-derived landforms and sedimentary records indicates that the permafrost elevation during the Last Glaciation was ca. 1000 m lower than present. Permafrost was also widespread in non-glaciated slopes above the snowline forming rock glaciers and block streams, as well as in relatively flat summit areas where meter-sized stone circles developed. As in most areas of the Northern Hemisphere, the deglaciation in the Mediterranean region started ca. 19-20 ka. The exposed terrain by retreating glaciers was affected by paraglacial dynamics and intense periglacial processes, mostly associated with permafrost condition. Many rock glaciers, protalus lobes and block streams formed in these recently deglaciated environments, becoming gradually inactive as temperatures rose during the Bølling-Allerød. Following the Younger Dryas glacial advance, the last massive deglaciation in Mediterranean mountains took place during the Early Holocene together with a progressive shift of the periglacial belt to higher elevations. It is unlikely that widespread permafrost have existed in Mediterranean mountains during the Holocene, except in the highest massifs exceeding 2500-3000 m. The colder climate prevailing during the LIA favoured a minor glacial advance and the spatial expansion of permafrost, with the development of new protalus lobes and rock glaciers in the highest massifs. Finally, the warming started during the second half of the 19th century has led to glacial retreat and/or complete melting, increased paraglacial activity, migration of periglacial processes to the highest lands and degradation of alpine permafrost along with geoecological changes

Co-circulation of West Nile virus and distinct insect-specific flaviviruses in Turkey

Background: Active vector surveillance provides an efficient tool for monitoring the presence or spread of emerging or re-emerging vector-borne viruses. This study was undertaken to investigate the circulation of flaviviruses. Mosquitoes were collected from 58 locations in 10 provinces across the Aegean, Thrace and Mediterranean Anatolian regions of Turkey in 2014 and 2015. Following morphological identification, mosquitoes were pooled and screened by nested and real-time PCR assays. Detected viruses were further characterised by sequencing. Positive pools were inoculated onto cell lines for virus isolation. Next generation sequencing was employed for genomic characterisation of the isolates. Results: A total of 12,711 mosquito specimens representing 15 species were screened in 594 pools. Eleven pools (2%) were reactive in the virus screening assays. Sequencing revealed West Nile virus (WNV) in one Culex pipiens (s.l.) pool from Thrace. WNV sequence corresponded to lineage one clade 1a but clustered distinctly from the Turkish prototype isolate. In 10 pools, insect-specific flaviviruses were characterised as Culex theileri flavivirus in 5 pools of Culex theileri and one pool of Cx. pipiens (s.l.), Ochlerotatus caspius flavivirus in two pools of Aedes (Ochlerotatus) caspius, Flavivirus AV-2011 in one pool of Culiseta annulata, and an undetermined flavivirus in one pool of Uranotaenia unguiculata from the Aegean and Thrace regions. DNA forms or integration of the detected insect-specific flaviviruses were not observed. A virus strain, tentatively named as “Ochlerotatus caspius flavivirus Turkey”, was isolated from an Ae. caspius pool in C6/36 cells. The viral genome comprised 10,370 nucleotides with a putative polyprotein of 3,385 amino acids that follows the canonical flavivirus polyprotein organisation. Sequence comparisons and phylogenetic analyses revealed the close relationship of this strain with Ochlerotatus caspius flavivirus from Portugal and Hanko virus from Finland. Several conserved structural and amino acid motifs were identified. Conclusions: We identified WNV and several distinct insect-specific flaviviruses during an extensive biosurveillance study of mosquitoes in various regions of Turkey in 2014 and 2015. Ongoing circulation of WNV is revealed, with an unprecedented genetic diversity. A probable replicating form of an insect flavivirus identified only in DNA form was detected

Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: a global survey, current guidelines, and expert recommendations.

PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Surgical reconstruction of hip subluxation and dislocation in children with cerebral palsy.

OBJECTIVES: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. PATIENTS AND METHODS: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1±10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre- and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. RESULTS: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2° preoperatively and 20.4° postoperatively. In preoperative period, MP and NSA were 72.7% and 160°, respectively, which improved to 24.3% and 130°, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p<0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. CONCLUSION: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery

The effect of long-term use of intranasal steroids on intraocular pressure

Ali Şimşek,1 Cem Bayraktar,2 Sedat Doğan,2 Mehmet Karataş,2 Yasin Sarıkaya2 1Department of Ophthalmology, 2Department of Otolaryngology Head and Neck Surgery, Adıyaman University Research and Education Hospital, Adıyaman, Turkey Abstract: Long-term use of topical nasal steroids (especially older generation steroids) has been shown to elevate intraocular pressure (IOP), but newer intranasal steroids are thought to have a minimal effect on IOP because of their low bioavailability. This study aimed to investigate alterations in IOP with two commonly used intranasal steroids for a 6-month period of time. One-hundred allergic rhinitis patients, divided equally into two groups, used mometasone furoate and fluticasone furoate intranasal steroids for 6 months. IOPs were measured before treatment and repeated at the 3rd, 6th, 12th, and 24th weeks of treatment. The IOPs of the groups were then compared. No statistically significant alteration was observed between the groups during the treatment time period. It was found that new generation intranasal steroids can be used safely, and there may not be an increased risk of IOP elevation in prolonged use in normal healthy people. Keywords: intraocular pressure, nasal steroids, prolonged use, allergic rhiniti

Chlorine degassing constrained by cosmogenic 36Cl and radiocarbon dating of early Holocene rhyodacitic lava domes on Erciyes stratovolcano, central Turkey

The Erciyes stratovolcano in central Turkey has several young rhyodacite lava domes that show evidence of clear exposure histories but have hitherto unknown ages. We collected 27 surface samples from three volcanic domes namely Karagüllü Perikartın and Dikkartın for cosmogenic 36Cl dating. The Perikartın eruption generated a pyroclastic flow, which buried trees that were converted to charcoal. The radiocarbon (14C) dating yielded an average age of 9728 ± 110 cal. years B.P. (calibrated using Calib 7.1). We analyzed the cosmogenic 36Cl ages, however, were found that they were probably affected by Cl degassing of the magma. Our study suggests that the radiocarbon age indeed lies between the 0% Cl degassing (6.8 ± 0.5 ka, under nucleogenic 36Cl equilibrium) and the 100% degassing conditions (9.9 ± 0.6 ka, under nucleogenic 36Cl disequilibrium), which implies a partial Cl degassing (93%) during the eruption. This value is somewhat higher than earlier estimates and the difference may result from the miscalculated nucleogenic and/or low-energy neutron production of 36Cl, uncertainties arising from the corrections due to hydrogen-rich cover (i.e., snow) of lava surfaces or due to unconsidered geological complications. Our findings provide a novel approach to estimate the Cl degassing on young lavas and deliver a new evidence of the Holocene volcano-chronology of the central Anatolia. © 2018 Elsevier B.V.This work is supported by the Scientific and Technological Research Council of Turkey (TUBİTAK, project numbers 101Y002 and 107Y069 ) granted to A.Ç. and the US National Science Foundation (Grant 0115298 ) granted to M.Z. We thank A. M. Celal Şengör (İstanbul Technical University) for translating the ancient Greek to English from Strabo's book of Geography. We thank to reviewers Fred M. Phillips and Silke Mechernich and editor Heidy Mader for their help that substantially improved this paper. Appendix