Effect of hyperbaric oxygen in hepatopulmonary syndrome: an innovative experimental study

OBJECTIVE

This study aimed to analyze the effect of hyperbaric oxygen treatment (HBOT) in hepatopulmonary syndrome (HPS).

MATERIALS AND METHODS

Five-month-old female Wistar-Albino rats were randomly divided into three groups: Group I, the control group; Group II, the cirrhosis group; and Group III, the cirrhosis group + HBOT group. Rats were exposed to HBO sessions (2.4 atm./60 min) for 20 days. Animals were sacrificed 24 hours after the last HBO session. Biochemical analysis, oxygenation parameters, NO and NO synthase (NOS) levels, histopathological changes in the liver and lungs, and pulmonary artery diameter were measured.

RESULTS

A total of 24 rats (10 rats were included in Group I, six rats in Group II, and eight rats in Group III) weighing 220-250 g were included in the study. Significant differences were observed for NO and NOS (9.10±1.05 to 12.17±1.85 μmol/L, p<0.05 and 0.46±0.31 to 1.17±0.39 U/ml, p<0.05, respectively) at baseline and day 36 only in group II. Inflammatory cell infiltration and bronchial injury were significantly increased in group II compared to group I (p=0.007 and p=0.008, respectively) but not in group III (p=0.266 and p=0.275, respectively). Pulmonary artery diameter was significantly lower in group III compared with group II at all sites in both lungs (p<0.05).

CONCLUSIONS

HBOT may be a promising treatment for HPS by reducing NO and NOS activity, perialveolar arteriolar dilation, lung inflammation, and injury and guiding future clinical trials.

The incidence and clinical features of anticancer therapy induced atrial fibrillation in patients with breast cancer without previously established cardiac disorder

Background/Introduction

Anthracyclines (ATC), alkylating (AAg) and anti-microtubule (AMA) agents are established chemotherapeutics in management of breast cancer. Both agents might reveal cardiotoxicity, as well as cancer treatment–induced-arrhythmias at varying established rates and by complex mechanisms. Atrial fibrillation (AF) is one of the debilitating dysrhythmias encountered throughout the cancer treatment with a significant impact on mortality and morbidity.

Purpose

To reveal the incidence and clinical features of new onset AF episodes detected in breast cancer patients using different conventional chemotherapeutic regiments.

Methods

All consecutive adult women diagnosed with breast-carcinoma and getting the first chemotherapy treatment with either ATC+AMA or AAg+AMA were prospectively evaluated for 6 months. Clinical, echocardiographic and ECG parameters (QTc by Bazett's-formula) were obtained and evaluated on baseline, first month and 6th month. Patients with Structural/coronary-heart-disease, complete-bundle-branch-block, non-sinus-rhythms and acute-coronary-syndrome in follow-up were excluded. “AF” is diagnosed on 12-lead-ECG or at least 30s of AF on Rhythm/Holter monitoring indicated by palpitation symptoms.

Results

Of 192 cases, 140 women ([mean±SD] age, 64±12, [range] 36–86 years) were enrolled for analysis. 76 patients received the AAg (cyclophosphamide) and 64 received ATC (daunorubicin) in addition to AMA (docetaxel). Mean follow up time was 4.2±2 months (Min–Max 1–6 months). Incident AF was diagnosed in 38 patients (27.1%) at the end of the 6 month follow up. The clinical findings are presented in picture-1. In patients receiving ATC treatment, incident AF was significantly more common (35.9% vs 19.7, p=0,032) and mostly observed in the first month of ATC-chemotherapy compared with AAg-regiments respectively (69% vs 33% of AF events occurred in first month, P&lt;0,001). Incident AF patients were significantly older, and ATC-receiving patients demonstrated significantly greater heart-rate and PR-interval changes from baseline. Age, ATC use, Delta-PR &gt;10 ms, Delta-QTC &gt;50 ms and Delta HR &gt;10 ms from baseline significantly predicted incident AF in the 6 month follow up in univariate-regression-analysis. However, only age and more significantly Anthracyclin use was found to predict Incident AF in multivariate regression analyses (picture 2) [(OR 3.7 (95% CI 1.2–10) (p=0.02)].

Conclusion(s)

Compared with alkylating-agents, anthracycline-regimens seem to induce significantly more incident-AF-events and profound ECG changes on the acute phase of chemotherapy for breast-cancer in women. They seem to exert their effects irrespective of conventional AF risk-factors apart from advanced-age. Affected ECG-parameters of delayed-conduction and repolarization-heterogeneity might be suggested as a surrogate for multiple-ion-channel-interactions and a possible mechanism underlying higher incident-AF.

Funding Acknowledgement

Type of funding sources: None.

The value of potential immunohistochemical biomarkers and clinicopathological findings in predicting response to neoadjuvant chemotherapy in breast cancer

OBJECTIVE

Following neoadjuvant chemotherapy (NAC) in breast cancer (BC), complete treatment response is achieved in some patients, while treatment response is limited in others. Predicting non-responder patients can prevent exposure to adverse effects associated with chemotherapeutic agents and delays in selecting other treatment modalities. In this study, we aimed at identifying predictive factors related to tumor regression in patients with BC who received NAC.

PATIENTS AND METHODS

This single-center cohort included 91 patients with BC who underwent surgery following NAC based on pretreatment tumor biopsy. According to BC molecular subtype, tumor regression grade (TRG) was determined using the Miller-Payne scoring system in patients who received standard NAC. Immunohistochemical stainings for VEGFR3 and CD44 were applied to needle core biopsies obtained prior to NAC in these patients.

RESULTS

Pathological complete response (pCR) was achieved in 20 patients (22%). In univariate analysis, high Ki-67 expression, ER negativity, and HER2 positivity were determined to be predictive factors of TRG (p < 0.05). In multivariate analysis, Ki-67 was the single independent predictor of TRG, with a 1.05-fold effect size. CD44 and VEGFR3 levels did not affect TRG or survival (p > 0.05). There was a significant difference in TRG according to molecular subtype of BC (p < 0.001). The treatment response was 5.5-fold higher in HER2-positive patients compared with HER2-negative patients.

CONCLUSIONS

pCR rates were significantly higher in TNBC, HER2, and luminal HER2+ subtypes when compared with luminal HER2- subtype. Ki-67 >25% and ER negativity had a favorable effect on TRG after NAC. CD44 and VEGFR3 were not effective in predicting treatment response.

Evaluation of IL-17A expressions in high-grade glial tumors receiving radiotherapy

Aim

In this study, we aimed to investigate the interleukin-17A (IL-17A) levels in patients with high-grade glial tumors before receiving radiotherapy, immediately after radiotherapy, and 3 months after radiotherapy.

Patients and Methods

A total of 33 patients who applied to Adana City Training and Research Hospital, Department of Radiation Oncology between December 2016 and May 2018 was included in this study. A total of three blood samples was taken from each patient to assess IL-17A levels before and after radiotherapy and 3 months after the completion of radiotherapy.

Results

The differences in IL-17A levels between genders were not statistically significant. IL-17A levels progressively decreased after the radiotherapy and 3 months after the radiotherapy as compared to the levels before radiotherapy. However, this was not statistically significant. IL-17A levels in the non-surviving patients were high before and after radiotherapy as compared to the surviving ones, but this was also not statistically significant.

Conclusion

As compared to the period before radiotherapy, IL-17A levels tend to decrease in the period of acute and chronic phases of radiotherapy in all patient groups.

Comparison of clinical features and the impact of reproductive factors on by age at diagnosis young and elderly breast cancer patients in the middle Anatolian region of Turkey

OBJECTIVE

Reproductive risk factors have been shown to influence breast cancer etiology for women of different origin worldwide; most studies in young/older patients have been limited to analyzing survival or tumor characteristics within their age group. This study aimed to compare the clinicopathological characteristics, treatment regimens, survival outcomes, and the impact of reproductive risk factors on young and elderly breast cancer patients.

PATIENTS AND METHODS

The data were collected retrospectively between October 2015 and March 2021, where 77 young patients (≤ 40 years) and 107 elderly patients (>65 years) were included out of a total of 567 patients undergoing treatment at Kayseri City Training and Research Hospital General Surgery Clinic, Turkey. Logistic regression analysis was performed to assess the impact of risk factors according to age.

RESULTS

Luminal-like tumors were in the majority in both age groups; there was no difference in diagnostic stages and survival between groups. The nulliparity ratio, total breastfeeding duration, number of biological children, first full-term pregnancy age, body mass index (BMI), and breast density distribution were significantly statistically different between groups. According to the multiple binary logistic regression analysis results for age, the most significant factors with risk effects were variables age of menarche OR= 3.36 (95% CI: 1.44-7.86) and child number OR= 2.58 (95% CI: 1.75-3.79), respectively.

CONCLUSIONS

The importance of looking at the impact of different risk factors on breast cancer risk lies in the potential to develop valid risk prediction models that can allow targeted screening and preventive interventions for high-risk women. By identifying more influential risk factors in different geographical profiles, risk-based screening, and targeted prevention efforts can be encouraged, and these factors can be included in risk prediction models.

Effects of combined the trendelenburg and passive leg raising positions on the cross-sectional area of the right internal jugular vein

Objective

The primary aim of this study was to assess the effects of a combination of the passive leg raising (PLR) and Trendelenburg positions on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) using ultrasound measurement in awake patients.

Methods

This prospective observational cross-over study measured the CSA of RIJV in patients in supine (Supine-I), Trendelenburg, Trendelenburg with passive leg raising (T + PLR position), and repeated supine position (Supine-II). The CSA and vertical and horizontal diameters of the RIJVs were compared before and after each position.

Results

A total of 120 adult patients were enrolled in the study. The mean CSA of the RIJV significantly increased from 91.2 ± 31.7 mm² to 110.4 ± 38.2 mm² in the Trendelenburg position compared to the supine position (P < 0.05). However, there were no statistically significant differences in CSA were observed between the Trendelenburg and Trendelenburg + PLR positions.

Conclusion

Although the PLR + Trendelenburg position increased the jugular vein diameter relative to the supine position, its clinical usefulness is limited as this increase was still lower than that achieved with the Trendelenburg position alone.

Clinical comparison of patients with angiography: Negative perimesencephalic and nonperimesencephalic subarachnoid hemorrhages

Aims

This study aimed to compare the clinical courses, complications, and clinical outcome scores of patients with perimesencephalic (PM) and nonperimesencephalic (n-PM) subarachnoid hemorrhage (SAH) with no vascular pathology observed on cerebral angiography.

Materials and Methods

This retrospective study included 52 of 310 patients who underwent cerebral digital subtraction angiography for SAH between October 2016 and April 2018. The patients were categorized into PM and n-PM groups based on the type of hemorrhage observed on brain CT. The patients Fischer's grades, Glasgow Coma Scale scores, and World Federation of Neurosurgical Societies SAH grades were recorded. Hydrocephalus, vasospasm findings in both groups, and modified Rankin scale (mRS) scores were assessed, and vascular pathology factors (diabetes mellitus, hypertension, and smoking) were compared between the patient groups.

Results

The PM group included 30 patients, the n-PM group 22 patients. Minimal hydrocephalus was observed in two patients in the PM group and six patients developed apparent hydrocephalus in the n-PM group. Angiographic vasospasm was observed in four patients in the n-PM group but none of the patients in the PM group. On discharge, all patients in the PM group had mRS scores of 0. One patient in the n-PM group become exitus and 18 patients were discharged mRS 0, 2 for two patients, and 3 for one patient.

Conclusion

The patients with PM SAH experienced a benign course, whereas those with n-PM SAH showed a higher risk of vasospasm and hydrocephalus as well as worse exit scores.

Endoscopic treatment of suprasellar arachnoid cysts indenting third ventricle with obstructive hydrocephalus in children: Thirteen cases

Aims

The present study aimed to evaluate the clinical usefulness of endoscopic treatment of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus and discuss the clinical features and outcomes of thirteen children treated at our institution.

Method

We treated thirteen pediatric cases of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus between January 2012 and September 2018. Five female and eight male patients were enrolled in the study. The patients had increased intracranial pressure symptoms due to hydrocephaly. Endoscopic treatment was performed in all cases.

Results

The patients were followed-up for an average of 36.8 months. The postoperative intracranial pressure findings improved. There was a reduction in the size of the cyst and ventricles and enlargement of the cortical sulci. One patient suffered transient oculomotor nerve deficit. No further surgical interventions, such as shunt placement, were required during the follow-up period. The head circumference of two of the patients with macrocephaly were stable during the follow-up. There were no postoperative recurrences detected.

Conclusions

Endoscopic cyst fenestration and third ventriculostomy are less invasive, safer, and more effective ways to treat suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus in children with hydrocephaly.

Comparison of 1-year results of single transforaminal epidural steroid injection among patients with different spinal pathologies-related radicular pain

Aims

This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies.

Methods

One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months.

Results

Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001).

Conclusion

TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.

Silibinin and ellagic acid increase the expression of insulin receptor substrate 1 protein in ultraviolet irradiated rat skin

Daily exposure to ultraviolet (UV) light induces inflammation and tumorigenesis in the skin. Silibinin and ellagic acid are natural products that exhibit anti-inflammatory and anti-tumorigenic properties. Insulin receptor substrate protein 1 (IRS1) is important for skin homeostasis and physiology, but its activity following UV radiation remains unclear. We investigated the effects of ellagic acid and silibinin on IRS1 expression in ultraviolet A (UVA) and ultraviolet B (UVB) irradiated rat skin. Forty-two female Wistar rats were divided randomly into six groups of seven animals. The dorsal skin of rats was exposed to UVA + UVB, then treated with ellagic acid and silibinin by gavage. IRS1 expression in skin tissues was determined by western blot analysis. IRS1 expression increased significantly following treatment with ellagic acid and silibinin in UVA + UVB irradiated skin compared to the UVA + UVB only group. After UVA + UVB treatment, ellagic acid effected greater induction of IRS1 expression than silibinin. Our findings suggest that the photoprotective roles of ellagic acid and silibinin may be due to induction of IRS1 expression in UVA + UVB treated rat skin.

Using intra-articular tranexamic acid in total knee replacement surgery with and without bleeding control: a prospective randomized double blind study

OBJECTIVE

To investigate the effectiveness of tranexamic acid (TA) application in two techniques: in the first one wound closure is performed before the tourniquet is released; in the second one, wound closure is performed after the tourniquet is released.

PATIENTS AND METHODS

The study is conducted on four groups of patients: (1) TA + TNR (tourniquet not released) where there is no bleeding control and TA is applied after wound closure without tourniquet release; (2) TA - TNR where placebo is applied after wound closure without tourniquet release; (3) TA + TR (tourniquet released) where tourniquet is released first and TA is applied after bleeding control and wound closure; and (4) TA - TR where tourniquet release is followed by bleeding control and placebo application.

RESULTS

The amount of hemorrhage in hemovac drains in each group was as follows: 217.4 ± 99.6 (100-590) ml in the TA + TNR group; 411.6 ± 133.7 (175-850) ml in the TA - TNR group; 291.2 ± 89.5 (160-650) ml in the TA + TR group; and 458.2 ± 138.6 (200-920) ml in the TA - TR group (p<0.0001). The TA + TNR group differed significantly from other groups in terms of the hemorrhage in drains.  Similarly, the TA + TNR group was notably different from the TA - TNR and TA - TR groups with regard to the hemoglobin and hematocrit values.

CONCLUSIONS

The study reveals that the amount of blood in hemovac drains is reduced significantly after the application of tranexamic acid to the suprapatellar space in the technique where wound closure is performed without bleeding control and before the tourniquet is released.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer

OBJECTIVES

NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer.

METHODS

This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation.

RESULTS

There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels.

CONCLUSION

In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis.

Postpartum depression and affecting factors in primary care

Aim

The aim of this study was to determine the frequency and affecting factors of postpartum depression (PPD) in Edirne city center. This cross-sectional study was conducted among 111 pregnant women in their third trimester in Family Health Centers in Edirne, Turkey.

Materials and Methods

The participants filled out a questionnaire on sociodemographic factors developed by the researchers along with the Beck Depression Inventory for Primary Care (BDI-PC) before childbirth. Women with a probability of depression, determined with the BDI-PC, were excluded, and the remaining 100 participants were applied the Edinburgh postpartum depression scale (EPDS) in the first and second months after childbirth.

Results

The frequency of PPD was 14% (n = 14) in the first month and 17% (n = 17) in the second month of delivery. Thus, 24 different mothers out of 100 were determined to have PPD in the first two months after childbirth. The probability of PPD, measured with EPDS, was significantly higher among younger mothers, mothers with unemployed husbands, mothers with lower income, mothers with a health problem of the child, and mothers who do not breastfeed. There was no significant relationship between PPD and mother's education status, marriage age, the age of first labor, PPD after previous childbirth, psychiatric disorders in first-degree relatives, higher number of children, method of delivery, and unwanted pregnancies.

Conclusion

PPD is an important community problem. Thus, it is useful to monitor the risky mothers in primary care and screen them with the practical EPDS in order to prevent the negative effects on the baby and the mother.

Mechanical and tribological performance of a hybrid MMC coating deposited on Al-17Si piston alloy by laser composite surfacing technique

Laser composite surfacing (LCS) is a photon driven manufacturing technology that can be utilized for depositing hybrid metal matrix composite coatings (HMMC) on softer Ti/Al/Mg alloys to enhance their tribo-mechanical properties. LCS offers the advantages of higher directionality, localized microstructural refinement and higher metallurgical bonding between coating and substrate. The current research presents the tribo-mechanical evaluation and characterization of solid lubricant based Ni–WC coatings deposited by LCS on Al–Si piston alloy by varying the concentration of graphite between 5-to-15-weight percentage. The tribological behavior of LCS samples was investigated using a ball-on-plate tribometer. Results indicate that the surface hardness, wear rate and friction coefficient of the Al–Si hypereutectic piston alloy were improved after LCS of graphite based HMMC coatings. The maximum surface hardness of 781H_v was acquired for the Ni–WC coating containing 5 wt% graphite. The friction coefficient of Al–Si under dry sliding conditions was reduced from 0.47 to 0.21. The reduction in the friction coefficient was attributed to the formation of a shearable transfer layer, which prevented delamination and reduced adhesion, abrasion and fatigue cracking.

The addition of graphite as solid lubricant has significantly reduced the friction coefficient and wear of a Ni–WC composite coating.

Amputation predictors in diabetic foot ulcers treated with hyperbaric oxygen

OBJECTIVE

Although hyperbaric oxygen therapy (HBOT) has long been used for diabetic foot ulcers (DFUs), its effectiveness is still controversial. The aim of this study was to investigate the efficacy of HBOT in the management of DFUs and identify amputation predictors.

METHOD

Patients with chronic DFUs (Wanger grade 2-5) were included in the study, which took place between January 2010 and December 2012. HBOT, 100% oxygen, 2.4 atmosphere absolute (ATA) for 120 minutes, was administered to all patients in addition to standard treatment. DFUs were monitored for at least 3 years, or until healing or amputation occurred.

RESULTS

Patients with a total of 146 chronic DFUswere recruited. Complete healing (69.6%) and significant improvement (17.9%) was observed in 87.5% of the patients. The cases with no improvement resulted in amputation (minor amputation: 15.0%; major amputation: 8.2%). The duration of diabetes (p=0.037), new wound formation (p=0.045), C-reactive protein (p=0.001) and Wagner grade (p=0.0001) were correlated with amputation in multiple regression analysis. Mortality was higher in the amputation group than in the non-amputation group (47.1 % versus 21.4 %, p=0.007).

CONCLUSION

The inclusion of HBOT with standard treatment and a multidisciplinary approach may be useful in the treatment of DFUs. We found the most important predictors of amputation to be Wagner grade and wound infection. Multicentre, prospective, randomised studies are needed to provide more evidence.

Effect of gasoline–bioethanol blends on the properties and lubrication characteristics of commercial engine oil

The increasing use of bioethanol causes tribological effects on engine components. It is crucial to study the effect of bioethanol on oil degradation and friction and wear behaviors of engine oil, using four-ball wear tester.

Mucinous ductal ectasia of the biliary tree secondary to mucous metaplasia: A case report

Mucinous ductal ectasia is an uncommon disorder, characterized by ductal dilatation and filling with thick, viscid mucus, described in the pancreas. We report a case of mucinous ductal ectasia of the biliary tree. The cause of the mucus production was mucous metaplasia in the biliary epithelium. The patient was followed for 16 years, treated with serial saline flushings of the biliary tree whenever he became symptomatic.

A case report of metastasis of malignant mesothelioma to the retromolar trigone

Background

Malignant mesothelioma is a rare and aggressive tumor with a poor prognosis. Distant metastases are very rare, and the oral cavity metastases are exceedingly rare. Only a few cases with metastasis to oral gingiva are reported. To our knowledge, this is the first case report of pleural mesothelioma metastasized to the retromolar trigone.

Case presentation

A 59-year-old male was referred with a painless growth at retromolar trigone area. It had been present for 2 months and had increased in size during this period of time. Past medical history revealed a malignant mesothelioma. Intraoral examination showed a soft, haemorrhagic, ulcerated lesion at the right retromolar trigone area. There was no destruction of the bony architecture. An incisional biopsy was performed under local anaesthesia. Based on the histopathological and immunohistochemical findings, a final diagnosis of metastatic mesothelioma was made. The patient was informed about the possibility of multiple metastases within the body, but he succumbed after 45 days following deterioration of his medical condition.

Conclusions

Biopsy, history of the patient and clinical picture were provided to the clinicians to make an efficient differential diagnosis. Differential diagnosis must be performed with other oral cancers, because the management is totally different.

Analysis of thermal stability and lubrication characteristics of Millettia pinnata oil

Lubricants are mostly used to reduce the friction and wear between sliding and metal contact surfaces, allowing them to move smoothly over each other.

A review on the effect of bioethanol dilution on the properties and performance of automotive lubricants in gasoline engines

Owing to the growing concern over the depletion of fossil fuels and the rising rate of greenhouse gas emissions which will lead to global warming, many researchers are now dedicated to producing biofuels in order to solve the above-mentioned issues.

Use of proton pump inhibitors in hematopoietic stem cell transplantation does not increase the frequency of febrile neutropenia

OBJECTIVE

Despite the fact that proton pump inhibitor (PPI) use is a risk factor for infections in heterogeneous groups of patients, there are only a limited data related to PPI use and febrile neutropenic episodes (FNEs) in hematopoietic stem cell transplantation (HSCT) patients.

PATIENTS AND METHODS

In a 7-year period, we retrospectively reviewed 145 HSCT data to identify a risk factor for PPI use for febrile neutropenia. The follow-up process of 125 (86.2%) of the HSCTs was complicated with FNEs.

RESULTS

A multivariate analysis indicated that PPI use was not significantly associated with FNEs (Odds ratio [OR]: 0.46; 95% Confidence Interval [CI] 0.12-2.16; p = 0.24) or bacterial culture positivity (OR: 1.37; 95% CI 0.45-4.18; p = 0.58).

CONCLUSIONS

Our study revealed that PPI use does not appear to be a risk factor for FNE or bacterial culture positivity for HSCT patients but further studies are needed.

Reduced gene expression of bikunin as a prognostic marker for renal cell carcinoma

AIM

Experimental and clinical studies showed that bikunin, a Kunitz-type protease inhibitor, found in urine and amniotic fluid has a role in spread of tumor cells by providing a significant reduction in the levels of urokinase-type plasminogen activator (uPA) and its specific receptor urokinase-type plasminogen activator receptor (uPAR). The aim of this study was to investigate expression of bikunin at the mRNA level and screen for mutations in exon sequence in renal cell carcinoma (RCC) tissues.

MATERIALS AND METHODS

Total RNA and DNA were extracted from paired normal and tumor tissues of total 50 RCC (11 papillary, 8 chromophobe, 26 clear cell, and 5 other types) patients (23 females, mean age: 53.55 ± 14.17; 27 males mean age: 62.1 ± 7.92). Bikunin mRNA levels were detected using semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). Mutational screening was performed by using single strand conformation polymorphism (SSCP) method and nucleotide sequence analysis.

RESULTS

There was a statistically significant decrease in the 25 (50%) of tumor tissues comparing to normal tissues in terms of mRNA levels of bikunin (Wilcoxon signed rank test, p = 0.0337). According to the classification based on subtypes of RCC; clear cell RCC samples displayed a reduced gene expression (p = 0.0148). Additionally, the patients with the age above 50 had low bikunin expression. The SNP rs80057939 spanning 4(th) exon of bikunin was detected in 13 tumor tissues. However, it was not statistically significant (p > 0.05).

CONCLUSION

Decreased bikunin mRNA level in renal cells might be associated with poor prognosis of renal carcinoma. Therefore, gene constructs or exogenous administration of bikunin might be a potential adjuvant therapy for RCC treatment.

Mandibular angle fractures during third molar removal: a report of two cases

Although fracture of the tooth during surgical removal is common, mandibular fracture during lower third molar removal is an unusual and major complication. Possible aetiologies are age, gender, the position of the tooth, uncontrolled excessive force applied, insufficient surgical experience and improper instrumentation. Symptoms can vary widely and treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. We present two cases of the treatment and follow-up of fracture of the angle region of the mandible during removal.

Intrusion of an overerupted mandibular molar using mini-screws and mini-implants: a case report

Overeruption of mandibular molars due to the loss of antagonist teeth causes occlusal functional disturbances. To restore proper occlusion, intrusion of the overerupted molars becomes essential before multidisciplinary reconstructive dental approaches can be initiated. Treatment protocols involving prosthodontic reduction, surgical impaction, and conventional orthodontic intrusion have been introduced. Orthodontic intrusion seems to be a favourable procedure which requires calibrated anchorage support. This case illustrates the management of a complex dental and functional problem with an interdisciplinary approach through the use of orthodontic, periodontal, restorative and implant therapy. In order to intrude the overerupted molar, a partial orthodontic appliance was used in conjunction with mini-implants and mini-screws. The results showed that the biological responses of the teeth and the surrounding bony structures to the intrusion appeared normal and acceptable. Periodontal health and vitality of the teeth were maintained throughout the treatment and even after one-year follow-up.

Evaluation of erythrocyte deformability in experimentally induced osteoporosis in female rats and the effects of vitamin C supplementation on erythrocyte deformability

OBJECTIVE

The aim of this study was to evaluate the possible variations in antioxidant enzymes, lipid peroxidation and erythrocyte deformability in experimentally induced osteoporosis in female rats and to assess the effects of vitamin C supplementation on those variations.

MATERIAL

A total of 20 female Wistar Albino Rats were randomized into the three groups as controls (Group C, n = 6), ovariectomized rats (Group O, n = 7) and ovariectomized rats receiving vitamin C supplementation (Group OVC, n = 7). After the surgical procedure of ovariectomy, group OVC received 1 g ascorbic acid in 500 mL water daily. After 100 days following the ovariectomy, bone mineral density (BMD) was measured by using dual-energy X-ray absorptiometry.

RESULTS

BMD was significantly lower in the group O than in the group C (p = 0.015), whereas it was significantly higher in the group OVC than in the group O (p = 0.003). MDA activity was significantly higher in the group O than in the group C (p = 0.032), whereas it was significantly lower in the group OVC than in the group O (p = 0.025). SOD activity was significantly higher in the group O than in the group C (p = 0.032). Erythrocyte deformability was significantly higher in the group O than in the group C and OVC (p = 0.008, p = 0.021, respectively).

CONCLUSION

Erythrocyte deformability may show negative variations, suggesting a causative role in disruption of blood flow and tissue perfusion, which also negatively affect bone metabolism. Vitamin C supplementation seems to reverse those negative effects of variations in erythrocyte deformability. However, our preliminary results should be confirmed in more experimental studies and clinical trials (Tab. 3, Ref. 28).

Trends in cancer incidence and mortality

Time trends in cancer risk have often been summarised by the observation that mortality from cancers associated with tobacco is increasing rapidly, while mortality from all other cancers is either stable or falling slightly, this slight decline being dominated by the decrease in mortality from stomach cancer. Until recently, and with some variation between the sexes, this simple summary of cancer mortality trends would have been broadly correct for a number of developed countries, and it remains useful in dismissing claims of an impending and unexplained epidemic of cancer, but it does not apply to all countries, and in some there have recently been striking changes in the trends in mortality from cancers associated with tobacco. Cancer mortality has been widely accepted as the most important measure of progress against cancer, since it reflects the impact of cancer on people, and has been considered less subject to distortion than incidence or survival, although this is open to question. Cancer mortality also reflects trends in incidence and survival to a greater or lesser extent. There has been controversy, however, over how cancer mortality trends should be interpreted, as well as over which measures should be used to assess progress in cancer control. An overall summary of trends in mortality from all cancers combined is of limited value in assessing progress against cancer, in any case. Increases in a common lethal cancer may numerically dominate overall mortality trends, perhaps concealing declines in less common or less lethal cancers, while opposite trends in cancers of the lung and stomach, for example, might lead to an overall impression that little has changed. Further, up to a third of cancer patients will not die of cancer, and cancer mortality statistics do not reflect their experience at all. Cancer mortality trends only indirectly reflect trends in the number of people who are diagnosed with cancer in a given year, and those who do die of cancer in a given year may have been diagnosed more than 3 years previously, even though many die earlier: this blurs the responsiveness of routine cancer mortality statistics as a measure of recent progress, and alternative measures have been proposed. Trends in competing risks of death, especially at higher ages, may also complicate the interpretation of cancer mortality trends. The chance of developing cancer, and in that event, the chances of surviving it, are of direct interest to individuals.(ABSTRACT TRUNCATED AT 400 WORDS)

Leiomyoma of the seminal vesicle mimicking tumoral extension of prostatic carcinoma

Leiomyoma of the seminal vesicle is an extremely rare tumour. The diagnosis of this entity is important when it co-exists with prostatic carcinoma, since it can simulate tumour extension from prostate or bladder cancer on MR imaging and lead to overstaging. In this report, we describe a 74-year-old man with a leiomyoma of the seminal vesicle that mimics tumour extension from co-existent prostatic cancer on T2-weighted MR imaging. To our knowledge, this is the first description of imaging findings of concurrent leiomyoma of the seminal vesicle and prostatic carcinoma.

A support vector machine using the lazy learning approach for multi-class classification

Support vector machines can be used in a new machine learning technique based on statistical learning. In this paper, we develop least squares support vector machines (LS-SVMs) using the lazy learning approach to classify data in unclassifiable regions in the case of multi-class classification. LS-SVMs use a set of linear equations while SVMs use a quadratic programming problem. The lazy learning approach is a local and memory-based technique. Therefore, it is an alternative technique to fuzzy inference systems. Our studies show that LS-SVMs with the lazy learning approach can give comparable results to fuzzy LS-SVMs for multi-class classification.

GABA(A) receptors: structure and function in the basal ganglia

gamma-Aminobutyric acid type A (GABA(A)) receptors, the major inhibitory neurotransmitter receptors responsible for fast inhibition in the basal ganglia, belong to the superfamily of "cys-cys loop" ligand-gated ion channels. GABA(A) receptors form as pentameric assemblies of subunits, with a central Cl(-) permeable pore. On binding of two GABA molecules to the extracellular receptor domain, a conformational change is induced in the oligomer and Cl(-), in most adult neurons, moves into the cell leading to an inhibitory hyperpolarization. Nineteen mammalian subunit genes have been identified, each showing distinct regional and cell-type-specific expression. The combinatorial assembly of the subunits generates considerable functional diversity. Here we place the focus on GABA(A) receptor expression in the basal ganglia: striatum, globus pallidus, substantia nigra and subthalamic nucleus, where, in addition to the standard alpha1beta2/3gamma2 receptor subtype, significant levels of other subunits (alpha2, alpha3, alpha4, gamma1, gamma3 and delta) are expressed in some nuclei.

Diffusion weighted MR imaging in non-infarct lesions of the brain

Diffusion weighted imaging (DWI) is a relatively new method in which the images are formed by the contrast produced by the random microscopic motion of water molecules in different tissues. Although DWI has been tried for different organ systems, it has been found its primary use in the central nervous system. The most widely used clinical application is in the detection of hyperacute infarcts and the differentiation of acute or subacute infarction from chronic infarction. Recently DWI has been applied to various other cerebral diseases. In this pictorial paper the authors demonstrated different DWI patterns of non-infarct lesions of the brain which are hyperintense in the diffusion trace image, such as infectious, neoplastic and demyelinating diseases, encephalopathies - including hypoxic-ischemic, hypertensive, eclamptic, toxic, metabolic and mitochondrial encephalopathies - leukodystrophies, vasculitis and vasculopathies, hemorrhage and trauma.