Results:The pre-analytical process in the reception area was improved by eliminating 3 h and 22.5 min of non-value-adding work. Turnaround time also improved for stat samples from 68 to 59 min after applying Lean. Steps prone to medical errors and posing potential biological hazards to receptionists were reduced from 30% to 3%. Conclusion:Successful implementation of Lean Six Sigma significantly improved all of the selected performance metrics. This quality-improvement methodology has the potential to significantly improve clinical laboratories. K E Y W O R D Smedical error, pre-analytical, process flow, quality improvement, quality management, workflow

Purpose Natural killer (NK) cells express killer immunoglobulinlike receptors (KIRs) which recognize HLA class I molecules on trophoblasts. KIRs could either activate NK cells or inhibit them to produce soluble factors necessary for the maintenance of pregnancy, thus they are suspected of being involved in the causes of recurrent miscarriage. The aim of this study was to evaluate whether there is any possible association between KIR genes, genotypes and recurrent miscarriage. Methods The present study was carried out on 40 women who had unexplained recurrent miscarriage and 90 controls. Sequence-specific oligonucleotide probes analysis were used to investigate 16 KIR genes. All data were statistically analyzed by Fisher Exact Test. Results The rate of Bx genotypes that consists elevated number of activating KIR genes was significantly higher (p00.014) in women with recurrent miscarriage when compared with the control group. Additionally, the frequency of AA genotype (AA1) of the subjects in the study group was significantly lower than the frequency of the subjects in the control group (p00,014). Furthermore, there were no statistically significant differences in the frequencies of the individual KIR genes between women with recurrent miscarriage and the control group. Conclusions Inclined balance of KIRs toward an activating state in NK cells may contribute to recurrent miscarriage.

Killer cell immunoglobulin-like receptors (KIRs) contribute to the pathogenesis of diverse kind of diseases. Previous studies have shown associations between KIR genes, their ligands and either protection or susceptibility to leukemias or virally associated solid tumors. However, the possible roles of KIR gene polymorphisms in the development of breast cancer remain largely unknown. To investigate the association of KIR gene polymorphisms with breast cancer, we carried out the present study on 33 breast cancer patients and 77 healthy controls by means of sequence-specific oligonucleotide probes analysis, and then all data were statistically analyzed by Fisher exact test. Our results showed that the frame genes KIR2DL4, 3DL2, 3DL3, and 3DP1 were found in all patients and all controls. The rate of activating KIR2DS1 was much higher in patients with breast cancer than that in healthy controls (P = 0.032) while the allelic types of activating 2DS4 (2DS4 003/4/6/7) were lower in patients with breast cancer compared with healthy controls (P = 0.028). Additionally, there was a statistically significant negative correlation between 2DL1 genes and breast cancer development (P = 0.025). In conclusion, this study suggests that the activating KIR2DS1 may trigger breast cancer development, while 2DL1 gene and 2DS4 003/4/6/7 alleles are possibly protectors for breast cancer.

Class-II human leukocyte antigens (HLA) present tumor antigenic peptides on the cell surface in order to be recognized by T lymphocytes. Thereby, these molecules can play an important role in the immune response to breast cancer tumor antigens. The aim of this study was to determine the relation between breast cancer and HLA class-II alleles in Turkey. The study groups consisted of 69 breast cancer patients and 45 healthy controls. Typing of HLA-DRB1 and HLA-DQB1 from DNA samples was performed by Sequence Specific Oligonucletide Hybridisation. Significant negative correlations were observed between HLA-DRB1 03 and HLA-DQB1 02 alleles and breast cancer (p1 = 0.019; p2 = 0.019) and also between HLA-DQB1 02 allele and postmenopausal breast cancer (P = 0.022) and c-erb-B2 positivity (P = 0.038). Furthermore, there was a significant positive correlation between HLA-DRB1 13 and HLA-DQB1 06 alleles and progesteron receptor positivity (p1 = 0.012; p2 = 0.001); and a significant negative correlation between HLA-DQB1 03 allele and progesteron receptor positivity (P = 0.009) in breast cancer. Additionally, another significant positive correlation was seen between HLA-DRB1 04 allele and c-erb-B2 positivity (P = 0.036). As a result, while HLA-DRB1 03, HLA-DQB1 02, HLA-DRB1 13, and HLA-DQB1 06 alleles were found to be involved in protectiveness against breast cancer and good prognosis; HLA-DQB1 03 and HLA-DRB1 04 alleles were found to be involved in poor prognosis. In conclusion, by determining allele types showing predisposition to breast cancer, a systematical screening and follow up systems can be developed for patients who are at high risk.

Increased bilirubin formation and decreased bilirubin conjugation play an important role in the pathogenesis of the newborn jaundice. Although physiologic jaundice is seen in most of the newborns, there are many risk factors that affect the severity and duration of hyperbilirubinemia. The latest studies showed that the frequency and severity of neonatal jaundice have been increased when mutations of the gene coding UDP-glucuronosyltransferase(UGT)1A1 coexist with other risk factors. Healthy term newborns weighing over 2500 g. were included in this study. The patient group consisted of 107 newborns either with total bilirubin level over 15 mg dl(-1) within 7 days or 5 mg dl(-1) after 15 days of age. The control group consisted of 55 newborns with bilirubin levels in physiological ranges. We investigated the frequency of promoter region [thymine-adenine(TA)]7 polymorphism in UGT1A1 gene. Factors which might cause pathologic and prolonged jaundice with coexisting polymorphism were also investigated. UGT1A1 6/7 genotype was found to be 11% in patient group and 13% in the control group. The difference between patient and control groups was not statistically significant. (TA)7 allele frequency was 0.069 and it is concluded that UGT1A1 promoter region polymorphism was not a risk factor for neonatal jaundice.

An extensive research has been performed to investigate the mechanisms of action by which the application of subatmospheric pressure to wounds increases the rate of healing. Increased blood flow with vacuum-assisted closure (VAC) use is the most popular aspect. Fibronectin, which is an adhesion molecule, has several functional domains mediating chemotaxis, adhesion and migration. This is thereby involved in differentiation, proliferation, inflammation and thus in wound healing. In this study, plasma fibronectin levels were measured before and after VAC in patients with wounds. The results showed that there was an increase in pre- and post-VAC levels of plasma fibronectin. This statistically significant increase could be another explanation of how VAC therapy promotes wound healing.

Biodegradable drug delivery systems have advanced treatment of a wide spectrum of musculoskeletal problems. However, their lack of availability and cost can restrict use. To find an easily available and inexpensive biodegradable implant, we tested a widely used tissue adhesive, n-butyl-2-cyanoacrylate, as a drug-trapping material. We tested vancomycin with commercially available absorbable gelatin-sponge pieces as the scaffold. We evaluated the in vitro and in vivo drug release profiles and in vivo inflammatory response. A mouse muscle pouch model was used for in vivo evaluations. The released vancomycin level was measured by fluorescence polarization immunoassay technique, and a leukocyte count-based grading system was used to evaluate inflammatory response. Our findings suggest the proposed implant provides effective drug release for as much as 42 days in vitro and 14 days in vivo. The presence of n-butyl-2-cyanoacrylate led to a local inflammatory response which decreased after 3 weeks in the group with less adhesive. These results showed that n-butyl-2-cyanoacrylate could efficiently trap and slowly release a drug when used in the structure of a biodegradable local drug delivery device.

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