Europium-doped strontium gadolinium oxide phosphor: Investigating structural and photoluminescence characteristics via sol-gel combustion synthesis

SrGd2O4 phosphors doped with Eu3+ were successfully synthesized through a sol-gel combustion method, covering a range of dopant concentrations from 0.25 mol% to 3 mol%. The structural analysis of these phosphor materials was comprehensively conducted utilizing various techniques, including X-ray powder diffraction analysis (XRD), Energy Dispersive X-ray (EDX), and Fourier-transform infrared spectroscopy (FTIR). In addition to unveiling the structural characteristics, these analyses provide valuable insights into the compositional aspects, enhancing our understanding of the synthesized SrGd2O4:Eu3+ phosphors across different doping levels. XRD analysis findings validate the successful generation of the intended SrGd2O4 host, demonstrating orthorhombic system structures consistent with JPCD card number 98-019-3592. FTIR analyses conducted on the phosphor samples not only identify bending modes but also reveal intricate details about small vibration bonds within the material. When excited by the 349 nm laser, SrGd2O4:xEu3+ phosphors exhibit distinct photoluminescence (PL) properties like red emission at 614 nm from Eu3+. From the emission spectra, one can clearly observe that Eu3+ with an ionic radius close to the Gd3+ ion preferentially occupies the symmetry sites of the host lattice. The optimal doping concentration was determined to be 0.5 mol%, as revealed by the data in our study. Additionally, a deeper understanding of the luminescence quenching mechanism was attained, pinpointing the involvement of dipole-dipole (d-d) energy transfer in this intriguing phenomenon. This optimal concentration not only enhances the material's properties but also underscores the pivotal role of d-d interactions in governing the luminescence behavior within the doped system.

AB1271 PREVALENCE OF RHEUMATOLOGIC DISEASES IN PATIENTS PRESENTING WITH UVEITIS

Background

Uveitis may occur in the course of systemic inflammatory rheumatic diseases, or it may be the first clinical presentation of these diseases.

Objectives

To determine the prevalence of systemic inflammatory rheumatic disease in patients whose initial clinical manifestation is non-infectious uveitis.

Methods

Adult patients diagnosed with non-infectious uveitis in Dokuz Eylul University Ophthalmology Department and referred to investigate the etiology of rheumatological disease were included in the study. Demographic and clinical features, laboratory and imaging findings of the patients were examined.

Results

106 patients diagnosed with uveitis (42.4% anterior uveitis, 2.8% intermediate uveitis, 19.8% posterior uveitis, 34.9% panuveitis) were included in the study. 52.8% of the patients were male and the mean age was 40.19±14.82 years. The mean age of uveitis attack was 38.7±15.02 years. 33% of the patients were diagnosed with rheumatologic disease (10 SpA, 17 Behçet’s Disease, two vasculitis, two sarcoidosis, three undifferentiated connective tissue disease, one rheumatoid arthritis). SpA was diagnosed in 20% of patients presenting with anterior uveitis. Behçet’s disease was detected in 27% of patients referred with panuveitis and in 33.3% of patients whose first clinical finding was posterior chamber involvement. Bilateral uveitis was detected in two-thirds of patients with posterior chamber affected, and it tends to recur more (p=0.014).

Conclusion

A rheumatological disease was detected in approximately one-third of the patients presenting with uveitis. Investigation of patients referred for uveitis in terms of systemic rheumatological diseases is very important as it may change the diagnosis and treatment process.

Disclosure of Interests

None declared

Evaluation by different mechanisms of the protective effects of vitamin B12 on methotrexate nephrotoxicity

Methotrexate is used for cure of many cancer types. It has many side effects. For this reason, obtaining a nephroprotective agent is obligatory. In the study, our aim is to determine probable effects of Vitamin B12 on MTX caused kidney damages in rats. Rats were randomly divided into 4 groups, including 8 animals in each group. Control group, VitB12 group (3 μg-kg-ip B12 throughout 15 days), MTX group (at the 8th day of experiment, a single dose of 20 mg-kg-ip MTX), Vit B12 + MTX group (3 μg-kg-ip B12 throughout 15 days and at the 8th day of experiment, a single dose of 20 mg-kg-ip MTX) Animals were anesthetized and kidney tissues were removed to evaluate biochemically, immunohistochemically and histopathologycally. There were histopathological deteriorations, rises of apoptotic cells, expressions of heat shock proteins, endoplasmic reticulum stress and inflammation markers in the MTX group. In the MTX group, Superoxide Dismutase (SOD), Total Antioxidant Status (TAS) and Catalase (CAT) levels decreased, but Total Oxidant Status TOS, Malondialdehyde (MDA) and interleukin-6 (IL6) levels increased. In addition, there was amelioration in kidney tissue in Vit B12 + MTX group compared to the MTX group. We suggest that Vit B12 can be used to reduce the toxic effects of MTX.

Air quality mitigation in European cities: Status and challenges ahead

Cities are currently at the core of air quality (AQ) improvement. The present work provides an overview of AQ management strategies and outcomes in 10 European cities (Antwerp, Berlin, Dublin, Madrid, Malmö, Milan, Paris, Plovdiv, Prague, Vienna) in 2018, and their evolution since 2013 (same cities, plus Ploiesti and Vilnius), based on first-hand input from AQ managers. The status of AQ mitigation in 2018, and its evolution since 2013, were assessed. While results evidenced that the majority of mitigation strategies targeted road traffic, emerging sources such as inland shipping, construction/demolition and recreational wood burning were identified. Several cities had in 2018 the ambition to continue decreasing air pollution concentrations to meet WHO guidelines, an ambition which had not yet been identified in 2013. Specific needs identified by all of the cities assessed were tools to quantify the effectiveness of mitigation strategies and for cost-benefit analysis, as well as specific and up to date technical guidance on real-world road vehicle emissions. The cities also requested guidance to identify mitigation measures promoting co-benefits, e.g., in terms of AQ, climate change, and noise. Support from administrations at local-regional-national-EU scales, and especially involving local policy-makers early on in the air quality management process, was considered essential. This work provides insight into the drivers of successful/unsuccessful AQ policies as well as on the challenges faced during their implementation. We identify knowledge gaps and provide input to the research and policy-making communities as to specific needs of cities.

Alterations in the immunoreactivity of laminin, type IV collagen and α3β1 integrin in diabetic rat ovarian follicles

AIM

In order to determine the possible effects of diabetes, we aimed to investigate the expression of extracellular matrix proteins in the theca and granulosa layers in different follicular stages.

METHODS

Thirty-two adult Wistar albino male rats were divided into 4 groups as control and sampled groups. Four, eight and twelve weeks after inducing diabetes with an intraperitoneal injection of streptozotocin (40 mg/kg), the expressions of laminin, type IV collagen and α3β1 integrin in ovarian tissues were evaluated by immunohistochemical method.

RESULTS

In our study, in the first month of diabetes, a significant increase was observed in laminin, type IV collagen and α3β1 integrin expressions in all follicle types compared to the control group in both the theca and granulosa layers. Laminin and type IV collagen immunoreactivity tended to increase in D2 and D3 groups also. Integrin expression did not change in the newly formed follicles in the D2 and D3 groups, however, it tended to change and increase in the developing follicles.

CONCLUSIONS

The changes in the expression of laminin, type IV collagen and α3β1 integrin, which are the extracellular matrix proteins in the follicle, along with diabetes, show that diabetes plays a role in the regulation of follicular development (Tab. 4, Fig. 36, Ref. 29).

Randomized controlled trial of 8 weeks' vs 12 weeks' interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer

AIM

The aim was to compare the pathological complete response (pCR) rate at 8 compared to 12 weeks' interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery in patients with locally advanced rectal cancer.

METHOD

This was a randomized trial which included a total of 330 patients from two institutions. Patients with locally advanced (T3-4N0M0, TxN+M0) rectal cancer were randomized into 8- and 12-week interval groups. All the patients received long-course CRT (45 Gy in 1.8 Gy fractions and concomitant oral capecitabine or 5-fluorouracil infusion). Surgery was performed at either 8 or 12 weeks after CRT. The primary end-point was pCR. Secondary end-points were sphincter preservation, postoperative morbidity and mortality.

RESULTS

Two-hundred and fifty-two patients (n = 125 in the 8-week group, n = 127 in the 12-week group) were included. Demographic and clinical characteristics were similar between groups. The overall pCR rate was 17.9% (n = 45): 12% (n = 15) in the 8-week group and 23.6% (n = 30) in the 12-week group (P = 0.021). Sphincter-preserving surgery was performed in 107 (85.6%) patients which was significantly higher than the 94 (74%) patients in the 12-week group (P = 0.016). Postoperative mortality was seen in three (1.2%) patients overall and was not different between groups (1.6% in 8 weeks vs 0.8% in 12 weeks, P = 0.494). Groups were similar in anastomotic leak (10.8% in 8 weeks vs 4.5% in 12 weeks, P = 0.088) and morbidity (30.4% in 8 weeks and 20.1% in 12 weeks, P = 0.083).

CONCLUSION

Extending the interval between CRT and surgery from 8 to 12 weeks resulted in a 2-fold increase in pCR rate without any difference in mortality and morbidity.

Longitudinal change in cerebroplacental ratio in small-for-gestational-age fetuses and risk of stillbirth

OBJECTIVE

To investigate whether assessment of longitudinal change in Doppler variables in small-for-gestational-age (SGA) fetuses improves the prediction of those at risk of stillbirth.

METHODS

This was a longitudinal study of two cohorts of singleton pregnancies, which included SGA and appropriate-for-gestational-age (AGA) fetuses, respectively. The inclusion criteria for the SGA cohort were singleton pregnancy at ≥ 20 weeks' gestation, classified as SGA (estimated fetal weight < 10^th centile). The AGA cohort consisted of singleton pregnancies deemed at high risk of being SGA, which were followed up longitudinally but remained AGA. Fetal middle cerebral artery (MCA) pulsatility index (PI) and umbilical artery (UA)-PI were measured longitudinally and cerebroplacental ratio (CPR) was calculated, and values were converted to multiples of the median. The last two measurements prior to delivery were included in the analysis. Longitudinal models for Doppler variables were developed using linear-mixed models and their accuracy in the prediction of stillbirth was tested using generalized linear models. A Bayesian framework was employed to compare the accuracy of longitudinal and standard (last-scan measurement) models.

RESULTS

In total, 1549 AGA and 941 SGA pregnancies were included in the analysis. There were 30 (3.2%) and no stillbirth cases in the SGA and AGA groups, respectively. Change in MCA-PI, UA-PI and CPR with advancing gestation was significantly different between liveborn AGA and SGA fetuses, with a less pronounced difference with advancing gestation. Using the last measurement, the best models for the prediction of stillbirth in SGA pregnancies were those based on CPR (accuracy, 75.0%; 95% CI, 72.6-77.2%) and UA-PI (accuracy, 71.0%; 95% CI, 68.6-73.4%). The posterior probability of the standard CPR model having a higher accuracy compared with the UA-PI model was 97.2% (magnitude of change (MC), 3.9%; 95% credible interval (CrI), 0.5-7.3%). The accuracies of the standard, compared with the longitudinal, models for UA-PI (71.0% vs 72.8%), MCA-PI (64.6% vs 63.8%) and CPR (75.0% vs 74.9%) in the prediction of stillbirth were not significantly different. The posterior probabilities for improvement in accuracy using longitudinal, compared with standard, assessment were 50.1% (MC, < 0.1%; 95% CrI, -3.3 to 3.3%), 35.2% (MC, -0.1%; 95% CrI, -4.5 to 2.8%) and 82.2% (MC, 1.9%; 95% CrI, -1.5 to 5.3%) for CPR, MCA-PI and UA-PI models, respectively. Therefore, change in Doppler parameters did not improve the accuracy of the prediction of stillbirth, compared with that of the last-scan measurement.

CONCLUSION

Longitudinal assessment of Doppler parameters was not useful in improving the detection of stillbirth in SGA pregnancies, as compared with a single-point assessment. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

MINIMALLY INVASIVE PARATHYROIDECTOMY FOR PRIMARY HYPERPARATHYROIDISM

Context

Primary hyperparathyroidism (PHPT), characterized by the inappropriate secretion of parathyroid hormone (PTH) with respect to the extracellular calcium concentration. Curative treatment of PHPT is surgery and bilateral neck exploration has been replaced by minimally invasive parathyroidectomy (MIP), with the advanced imaging technologies combined with radio-guided occult lesion localization (ROLL).

Objectives

The present study analyzes the MIP data from 45 patients who underwent surgery for parathyroid adenoma and debates if MIP is a feasible technique for the treatment of PHPT.

Design

The study presents the MIP excision data of 45 hyperparathyroidism patients with a 58-month follow up period.

Results

Forty-five operations were performed for 48 parathyroid adenomas. The mean duration of operation was 22.7 (12-55) minutes. Mean follow-up was 14.2 (6-26) months. All patients had normal postoperative calcium levels and PTH levels were normal in the follow-up period, except for one persistent hyperparathyroidism.

Conclusions

ROLL-guided MIP is a feasible technique for parathyroid surgery and reduces surgeon based failure. It also provides the widespread application of parathyroid surgery by decreasing the need for specific experience.

Experimental Observation of Proton Bunch Modulation in a Plasma at Varying Plasma Densities

We give direct experimental evidence for the observation of the full transverse self-modulation of a long, relativistic proton bunch propagating through a dense plasma. The bunch exits the plasma with a periodic density modulation resulting from radial wakefield effects. We show that the modulation is seeded by a relativistic ionization front created using an intense laser pulse copropagating with the proton bunch. The modulation extends over the length of the proton bunch following the seed point. By varying the plasma density over one order of magnitude, we show that the modulation frequency scales with the expected dependence on the plasma density, i.e., it is equal to the plasma frequency, as expected from theory.

Experimental Observation of Plasma Wakefield Growth Driven by the Seeded Self-Modulation of a Proton Bunch

We measure the effects of transverse wakefields driven by a relativistic proton bunch in plasma with densities of 2.1×10^{14} and 7.7×10^{14}  electrons/cm^{3}. We show that these wakefields periodically defocus the proton bunch itself, consistently with the development of the seeded self-modulation process. We show that the defocusing increases both along the bunch and along the plasma by using time resolved and time-integrated measurements of the proton bunch transverse distribution. We evaluate the transverse wakefield amplitudes and show that they exceed their seed value (<15  MV/m) and reach over 300  MV/m. All these results confirm the development of the seeded self-modulation process, a necessary condition for external injection of low energy and acceleration of electrons to multi-GeV energy levels.

The efficacy of tissue factor -603A/G and +5466A>G polimorphisms at the development of venous thromboembolism in cancer patients

Venous thromboembolism (VTE) is one of the most common complications in cancer patients. Although factor V Leiden (FVL) is the most common genetic defect causing thrombosis, the impact of gene abnormalities on thrombotic tendency in cancer patients remains poorly explored. Tissue factor (TF) is a major physiologic initiator of blood coagulation. This is the first study regarding the association of TF gene -603A/G and +5466A>G polymorphisms with VTE in malignancy. Materials and Me-thods: The study consists of two groups: cancer patients with VTE were included as Group 1 (n = 46); Group 2 comprises 196 cancer patients without VTE. Restriction fragment length polymorphism method was used for the detection of polymorphisms of TF -603A/G in the 5՛upstream region and TF 5466A/G in intron 2. FVL, PT G20210A and MTHFR C677T polymorphisms were determined by using commercially available Light Cycler kits. The genotype and allele frequencies between the groups were compared using χ2 or Fisher exact test, if appropriate.

RESULTS

No differences were observed in the distribution of TF gene -603A/G genotype frequencies between the groups. Although a slightly increased incidence of +5466GA genotype was in Group 1 (17.4% vs 11.2%), it did not achieve statistical significance. The prevalence of FVL was significantly greater in Group 1 compared with Group 2 (41.3% vs 4.1%, p < 0.05). Difference in frequency of 677TT+CT (MTHFR) + 5466GG (TF) genotypes combination was found in women of two investigated Groups (p < 0.05). No differences were also in genotypes and allele frequencies of MTHFR C677T and PT G20210A between two Groups (p > 0.05).

CONCLUSIONS

The present study did not show significant association of TF gene -603A/G and +5466A>G polymorphisms with VTE in malignancy, however, further larger studies including different ethnic population are needed to confirm our findings.

Treatment of recurrent anal fistula using an autologous cartilage plug: a pilot study

BACKGROUND

The aim of the present study was to assess a novel autologous cartilage plug technique used to treat anal fistula in ten patients.

METHODS

All ten patients had undergone at least two prior operations for recurrent fistulas. The plugs were prepared using the patients' own cartilage, which was obtained from either the nose or the ear, diced into pieces, and wrapped with oxidized regenerated cellulose. During the same session, fistula tracts were curetted using cytology brushes, and then, the cartilage plug was inserted into the tract. Routine postoperative examinations were performed at 2, 4, 8, 12, and 24 weeks after surgery. Magnetic resonance imaging was performed before surgery and at 3 and 6 months postoperatively. Relief of symptoms, radiological healing, recurrence, and continence were evaluated.

RESULTS

The ten patients included six males and four females, with a median age of 39 years (range 25-70 years) and a median of three previous fistula operations (range 2-7 operations). Nine patients had cryptoglandular abscess, and one patient had Crohn's disease. The majority of the patients had transsphincteric fistulas with substantial anal sphincter involvement. The cartilage donor site was the nose for one patient and the ear for nine patients. The median follow-up time was 24 months (range 10-32 months). Of the ten patients, nine had fistula treatment without any short-term complications. The fistula failed to heal in one patient. Among the nine patients whose operations were initially successful, two late recurrences were observed.

CONCLUSIONS

The cartilage plug seems to be a promising alternative for anal fistula treatment.

Can the effect of adhesion barriers and/or intravesical balloon inflation improve bladder autoaugmentation outcomes in a rabbit model?

INTRODUCTION

Bladder augmentation is used for the treatment of bladder dysfunction in order to minimize intravesical pressure and increase bladder capacity. However, less-invasive procedures, such as autoaugmentation, have been proposed due to several complications that have occurred using bowel and gastric segments. The technique of autoaugmentation involves wide excision of the detrusor by leaving the bladder mucosa intact and has shown increased bladder capacity and compliance. An additional step to keep the achieved surface area of this non-contractible bladder segment and, thus, bladder capacity, was reported by using an intravesical balloon to prevent shrinkage of the surgically achieved diverticulum during autoaugmentation. On the other hand, adhesion barriers (AB) with absorbable hydrogel, which can spare tissue and organ plans, are used to prevent postsurgical adhesions. The efficacy of sprayable AB has been demonstrated in animal models and it is now mostly used in laparoscopic surgeries.

OBJECTIVE

The present study aimed to compare the efficacy of AB and/or intravesical balloon insertion, which might potentially improve the urodynamic and histopathological outcomes of autoaugmentation in a rabbit model.

METHODS

A total of 25 New Zealand rabbits were included in the study. Following the surgical reduction to form a low-capacity bladder model (35-40% of the initial volume), standard detrusorotomy was performed in all groups except the sham group. Group 2 had only autoaugmentation as the control group. The bladders in Group 3 were supported with an intravesical balloon. An Adhesion Barrier System (CUI Tissue Expander) was used for all bladders in Group 4, without balloon inflation. In Group 5, both intravesical balloon inflation and adhesion barrier application were performed following autoaugmentation. Urodynamic evaluations were performed at day 0 before reduction, day 0 after reduction, and the 90th postoperative day. Capacity and compliance measurements were noted. Bladders were histopathologically evaluated. Expression of CD31 (microvessel density) and fibrosis were noted.

RESULTS

Autoaugmentation does not result in a reliable increase in bladder capacity and compliance when compared to a sham group. Urodynamic measurements were similar in balloon-inflated groups (Group 3 and Group 5), showing a statistically significant improvement. Sprayable AB system alone revealed a slight, but not statistically significant, increase (Table). No significant differences between all five groups were detected regarding microvessel density (CD31 expression) and fibrosis.

DISCUSSION

In the present study, the intravesical balloon application (IVBA) efficiency was investigated alone and in combination with AB. The main basis of this study were the previous findings, which demonstrated prevention or decrease in the contraction of diverticula by IVBA. The role of AB alone or within a combination was also evaluated. Adhesion barriers are mostly used in laparoscopic gynecologic and colorectal operations. They decrease the postoperative adhesions by forming a physical barrier. In the present study, it was thought that AB might reduce postoperative adhesions and enhance the outcome of autoaugmentation. One of the most important outcomes was the inconsistency of fibrosis density with final bladder capacity and compliance values; this finding did not support the role of fibrosis prevention with IVBA. The present study had some limitations: the partial cystectomy method, which was used to form a low-compliance bladder, is a different clinical condition to neurogenic bladder, and a rectal catheter was not used during urodynamic evaluation. General anesthesia and muscle relaxant were performed during urodynamy and abdominal contractions were not seen.

CONCLUSION

Bladder autoaugmentation in a rabbit model, followed by intravesical balloon inflation offers improvement in bladder capacity and compliance. The use of sprayable adhesion barrier hydrogel technology may facilitate tissue healing and result in it being easier to maintain the success achieved by surgery when only supported with an intravesical balloon.

Successful first round results of a Turkish breast cancer screening program with mammography in Bahcesehir, Istanbul

BACKGROUND

The Bahcesehir Breast Cancer Screening Project is the first organized population based breast cancer mammographic screening project in Turkey. The objective of this prospective observational study was to demonstrate the feasibility of a screening program in a developing country and to determine the appropriate age (40 or 50 years old) to start with screening in Turkish women.

MATERIALS AND METHODS

Between January 2009 to December 2010, a total of 3,758 women aged 40-69 years were recruited in this prospective study. Screening was conducted biannually, and five rounds were planned. After clinical breast examination (CBE), two-view mammograms were obtained. True positivity, false positivity, positive predictive values (PPV) according to ACR, cancer detection rate, minimal cancer detection rate, axillary node positivity and recall rate were calculated. Breast ultrasound and biopsy were performed in suspicious cases.

RESULTS

Breast biopsy was performed in 55 patients, and 18 cancers were detected in the first round. The overall cancer detection rate was 4.8 per 1,000 women. Most of the screened women (54%) and detected cancers (56%) were in women aged 40- 49. Ductal carcinoma in situ (DCIS) and stage I cancer and axillary node positivity rates were 22%, 61%, and 16.6%, respectively. The positive predictivity for biopsy was 32.7%, whereas the overall recall rate was 18.4 %.

CONCLUSIONS

Preliminary results of the study suggest that population based organized screening are feasible and age of onset of mammographic screening should be 40 years in Turkey.

Sclerostin as a new key player in arteriovenous fistula calcification

BACKGROUND

The osteocyte-derived sclerostin has been shown to play a key inhibitor role in determining the normal extent of bone formation, and it consequently protects against the deleterious effects of uncontrolled bone growth. Sclerostin has been demonstrated to be upregulated during vascular smooth muscle cell calcification in vitro and has recently been identified in the human aorta at the protein level. Whether the effects of sclerostin on bone turnover and its vascular expression also translate into clinically significant changes in arteriovenous fistula patency is unknown.

PATIENTS AND METHODS

The primary outcome was loss of unassisted arteriovenous fistula patency, defined as arteriovenous fistula thrombosis or need for intervention. In this prospective cohort study, 350 prevalent hemodialysis patients were followed up for 12 months. Serum sclerostin levels were measured and arteriovenous fistula calcification was detected using a 64-detector computerized tomographic scanner.

RESULTS

Patients with calcified arteriovenous fistula had higher serum sclerostin levels than patients without. Overall, 26 % of the patients reached the outcome during the follow-up. The 12-month arteriovenous fistula survival was reduced in patients with calcified arteriovenous fistulas. Patients with serum sclerostin levels above median levels at the start of the observation period had a worse arteriovenous fistula survival. Multivariable-adjusted Cox regression analyses revealed that only presence of arteriovenous fistula calcification and serum C-reactive protein level independently predicted loss of unassisted arteriovenous fistula patency.

CONCLUSION

Our study suggests that the detection of arteriovenous fistula calcification and serum C-reactive protein levels might be useful for identifying patients at an increased risk for loss of unassisted arteriovenous fistula patency.

Comparison of ductoscopy, galactography, and imaging modalities for the evaluation of intraductal lesions: a critical review

BACKGROUND

Today, in cases of nipple discharge of unclear origin, the abundance of diagnostic procedures - a, diagnostic dilemma' - becomes apparent, because unequivocal indications and a current, standardized examination sequence are presently not available. The diagnostic workup of patients with nipple discharge usually includes the clinical history, physical examination, mammography, ultrasonography, galactography, and nipple discharge cytology, but not ductoscopy.

METHODS

In this review we analyze and discuss the possible role of ductoscopy in evaluating intraductal pathologies and its combined use with diagnostic imaging modalities. For this purpose, we reviewed and compared the results of the radiological, pathological, and surgical studies independently.

CONCLUSIONS

Currently, there is no solitary accurate modality to reach our definitive purpose. Being aware of the capability of each diagnostic modality may take us closer to our target. Therefore, adjunct and appropriate use of multiple imaging modalities and ductoscopy is necessary to evaluate patients with nipple discharge.

Frequency of alterations in the MEFV gene and clinical signs in familial Mediterranean fever in Central Anatolia, Turkey

Familial Mediterranean fever is a recessive autoinflammatory disease that is frequent in Armenians, Jews, Arabs, and Turks. The MEFV gene is responsible for this disease. We looked for MEFV gene variations (polymorphism and mutations) in a population that resides in Central Anatolia, Turkey. DNA was extracted from peripheral blood leukocytes of 802 familial Mediterranean fever patients. The DNA sequence data were examined for approximately 150 different mutations and polymorphisms, including single nucleotide polymorphisms in different exons of the MEFV gene. The male:female ratio of these patients was 1.44:1. Mutations were detected in 48.1% of the patients; 7.5% were homozygous, 11.1% were compound heterozygous and 31.5% had only one identifiable mutant allele. No mutations were detected in 51.9% of the patients. The main clinical characteristics of the patients were: abdominal pain in 20.6%, arthritis in 22.9% and amyloidosis in 4.6%. Sixty-six percent of patients had a family history of familial Mediterranean fever; 19.4% of the patients were found to have parental consanguinity. We conclude that the genetics of familial Mediterranean fever is more complex than has previously been reported; heterozygous patients presenting a severe phenotype should be further analyzed for less common secondary MEFV mutations, using gene sequencing.

Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre

OBJECTIVE

To discuss common pitfalls in diagnosis and management of distal vaginal agenesis, and summarize 10 years of experience among 11 patients using an interposition full-thickness graft and fibrin glue.

STUDY DESIGN

Eleven patients with distal vaginal agenesis were evaluated and managed with an interposition full-thickness graft to bridge the gap between the upper vagina and the introitus. Associated renal abnormalities and complications including infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, vaginal stricture and graft uptake were all investigated.

RESULTS

The mean age of the patients was 12.91 (standard deviation 1.22) years. All patients had primary amenorrhoea, cryptomenorrhea, and cyclical or constant pelvic pain. None of the patients had associated urological abnormalities, and there were no cases of infection, total lack of skin graft take, stress urinary incontinence, partial graft loss or vaginal stricture. Graft uptake was 100% in 10 of the 11 patients. Four patients have subsequently married and report a satisfactory sex life.

CONCLUSION

Accurate diagnosis of distal vaginal agenesis and careful pre-operative set-up, including evaluation of associated anomalies, bowel preparation, available vaginal stents and a multidisciplinary approach for the potential need for grafts, may be key to success.

Do high levels of CA 19-9 in women with mature cystic teratomas of the ovary warrant further evaluation?

PURPOSE

To evaluate the serum levels of tumor markers (particularly CA 19-9) in patients with ovarian mature cystic teratomas (MCT) with respect to age, size, bilaterality, menopause, presence of adhesions, complications and the postoperative levels.

METHODS

We evaluated clinical characteristics and tumor markers of 157 patients with MCT of the ovary operated at our clinic.

RESULTS

CA19-9 was the only tumor marker with a mean serum level (46.95 +/- 101.11 U/ml) above the cut-off value and the elevated rate was 33.1%. Tumor size, presence of adhesions and CA 125 levels were significantly higher in patients with elevated CA 19-9. Bilaterality rate was 10.8%. The most common complication was torsion (6.4%).

CONCLUSION

We suggest that elevated levels of CA 19-9 may be expected in MCTs of the ovary and that they will probably be decreased postoperatively. Therefore, postponing evaluation of other possible sources of CA 19-9 elevation in asymptomatic and young patients is more common sense.

What are the indications for a stoma in Fournier's gangrene?

AIM

This study examined the indications for a stoma in patients with Fournier's gangrene and its impact on outcome.

METHOD

Patients with Fournier's gangrene were retrospectively reviewed for indications for a stoma. Patients with and without a stoma were compared, based on demographics, disease severity, surgical therapy, length of hospital stay, clinical outcome and cost.

RESULTS

Forty-four patients (median age 57 years, range 28-77 years) were evaluated. Eighteen had a temporary stoma and 26 did not. A stoma was 5 times more likely in males. Patients with Fournier's gangrene originating from an anorectal disorder received a stoma more often than patients with disease originating from an urogenital disorder. Clinical outcomes were similar for patients with or without a stoma. Stoma closure was associated with an extra cost of about $6650 per patient.

CONCLUSION

Stoma creation in the management of Fournier's gangrene was needed for selected patients. Having a stoma did not appear to affect outcomes and resulted in a significant increase in cost of care.

Stargazin and AMPA receptor membrane expression is increased in the somatosensory cortex of Genetic Absence Epilepsy Rats from Strasbourg

Absence-like seizures in the Genetic Absence Epilepsy Rats from Strasbourg (GAERS) model are believed to arise in hyperexcitable somatosensory cortical neurons, however the cellular basis of this increased excitability remains unknown. We have previously shown that expression of the Transmembrane AMPA receptor Regulatory Protein (TARP), stargazin, is elevated in the somatosensory cortex of GAERS. TARPs are critical regulators of the trafficking and function of AMPA receptors. Here we examine the developmental expression of stargazin and the impact this may have on AMPA receptor trafficking in the GAERS model. We show that elevated stargazin in GAERS is associated with an increase in AMPA receptor proteins, GluA1 and GluA2 in the somatosensory cortex plasma membrane of adult epileptic GAERS. Elevated stargazin expression is not seen in the epileptic WAG/Rij rat, which is a genetically distinct but phenotypically similar rat model also manifesting absence seizures, indicating that the changes seen in GAERS are unlikely to be a secondary consequence of the seizures. In juvenile (6 week old) GAERS, at the age when seizures are just starting to be expressed, there is elevated stargazin mRNA, but not protein expression for stargazin or the AMPA receptor subunits. In neonatal (7 day old) pre-epileptic GAERS there was no alteration in stargazin mRNA expression in any brain region examined. These data demonstrate that stargazin and AMPA receptor membrane targeting is altered in GAERS, potentially contributing to hyperexcitability in somatosensory cortex, with a developmental time course that would suggest a pathophysiological role in the epilepsy phenotype.

Imatinib-induced apoptosis: a possible link to topoisomerase enzyme inhibition

WHAT IS KNOWN AND OBJECTIVE

Imatinib is a specific BCR/ABL inhibitor, commonly used for the treatment of chronic myeloid leukaemia (CML), a hematological malignancy resulting from a chromosomal translocation that generates the BCR/ABL fusion protein. Recent studies showed that the imatinib has cytotoxic and apoptotic effects on many BCR/ABL-negative cancers. Numerous compounds with cytotoxic potential exert their functions by interfering with the DNA topoisomerase. In this study, we examined the effects of imatinib on tumour cell-killing in relation to DNA topoisomerase enzyme inhibition.

METHODS

We determined the cytotoxicity by cell proliferation assay (XTT; tetrazolium hydroxide), using the human K562 CML cells, and loss of mitochondrial membrane potential by monitoring the changes in caspase-3 enzyme activity. Type I and II topoisomerase activities were measured by supercoiled plasmid relaxation and minicircle DNA decatenation assays respectively.

RESULTS AND DISCUSSION

Imatinib-induced apoptosis and inhibited cell proliferation in a dose-dependent manner. We also found that the imatinib was effective in both type I and type II topoisomerase reactions to a varying degree between 94% and 7% for the concentration range of 1 mm-0.02 mm in a dose-dependent manner.

WHAT IS NEW AND CONCLUSION

Our results suggest that the inhibition of topoisomerases may be a significant factor in imatinib-induced apoptosis in CML.

Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality

AIM

We aimed to define the learning curve for hand-assisted laparoscopic colectomy (HALC).

METHOD

A retrospective analysis of prospectively recorded data was performed. Consecutive segmental and total HALC performed by a single surgeon with no prior HALC experience was included. Operative time and quality-related outcomes, including conversions, operative and postoperative complications, length of stay, reoperations and readmissions were compared for consecutive cohorts of 25 HALC. A subgroup analysis of right, left, total and proctocolectomy performed in each cohort of 25 HALC was also performed.

RESULTS

From December 2005 to February 2009, 200 HALC were performed. When evaluated in cohorts of 25 consecutive cases, operative times (155-206 min), operative complications (4-12%), postoperative complications (8-36%), length of stay (4-5 days), reoperations (0-8%) and readmissions (0-16%) were similar. In the subgroup analysis, there were no changes in the quality-related measures for any colectomy type or the operative time for right and proctocolectomy as experience was gained. Operative time decreased for left (183-127 min) and total HALC (259-218 min) after experience with 50 cases (P < 0.05).

CONCLUSION

HALC operative times decreased with surgeon experience. For quality-related outcomes, there was no learning curve for HALC.

Fournier's gangrene: an analysis of 80 patients and a novel scoring system

BACKGROUND

To create a better scoring system for outcome prediction for patients with Fournier's gangrene in order to design more appropriate and feasible management strategies.

METHODS

Using logistic regression, the medical records of 80 patients who underwent surgery for Fournier's gangrene in the last 10 years were reviewed using a prospectively maintained database, and a novel scoring system was adopted combining this data with the Fournier's gangrene severity index (FGSI). The new system consists of a physiological score, an age score, and an extent of gangrene score.

RESULTS

The mortality rate of the 80 patients was 21%. Using the new scoring system (UFGSI), at a threshold value of 9, there was a 94% probability of death with a score greater than 9 and an 81% probability of survival with a score of 9 or less (P < 0.001). The receiver operating characteristics (ROC) analysis concluded that the new scoring system was more powerful than the FGSI (P = 0.002).

CONCLUSIONS

The power of the novel scoring system introduced in this study proves that in patients with Fournier's gangrene, the extent of the gangrene as well as the patient's age and physiological status have a significant effect on the outcome.

Factors affecting the prognosis of patients with colorectal liver metastasis

PURPOSE

To determine factors affecting the survival of colorectal cancer patients developing liver metastasis.

MATERIAL AND METHODS

850 colorectal cancer patients who had been operated on between 1995 and 2005 were retrospectively reviewed and patients who developed liver metastases were selected. Patients' demographics and data regarding the characteristics and management of primary tumors and liver metastases were assessed. Survival data were analyzed using Cox proportional hazard method to identify factors affecting prognosis of such patients.

RESULTS

154 (18.1%) patients developed liver metastasis; however, only 60 patients (39 males and 21 females; median age: 61 (31-77) years) had complete follow-up data, of whom 28 had undergone metastasis resection. The median survival time of patients who underwent resection and who did not was 42 (22-118) vs. 13 (2-52) months (p < 0.001). Curative resection of the primary tumor (p = 0.32; Exp(B) = 2.93), metastases that were less than 5 in number and localized to one of the right or left lobes (p = 0.004; Exp(B) = 3.38), and surgical resection of the metastases (p = 0.001 ; Exp(B) = 3.76) were independent risk factors.

CONCLUSIONS

Patients with colorectal liver metastases that are less than 5 and confined into one lobe, could benefit from metastasis surgery most if the primary tumor is resected.

Hand-assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy

OBJECTIVE

We evaluated outcomes after hand-assisted (HALC) and straight laparoscopic (LC) techniques for the initial laparoscopic total abdominal colectomy (TAC) procedures performed by surgeons starting their laparoscopic careers.

METHOD

The first eight HALC cases of two surgeons performing TAC by this technique (Group A) were compared with the first (Group B) and last eight (Group C) TAC cases of three surgeons performing LC. Groups A and B were compared with a matched group of open total colectomy cases (Group D) and to the eight cases performed by an experienced surgeon (Group E). Demographics, intra-operative and postoperative outcomes including operation time, morbidity, conversion and readmission rates and length of hospital stay (LOS) were compared using Wilcoxon or Chi-squared tests.

RESULTS

Demographics of the patients were similar. Groups A, B C and E had similar operating time (P = 0.10) which was significantly longer than Group D (P < 0.0001). Morbidity (P = 0.75) and readmission rates were similar (P = 0.89). Conversion rate was significantly higher for Group B (Group B: 41.7%vs Group A: 0%, P = 0.008), in the early period. LOS was comparable between minimally invasive groups but significantly shorter than open surgery group (P = 0.0005). For Groups A and C, operating time (P = 0.55), conversion rate (P = 0.11), morbidity (P = 0.83) and LOS (P = 0.12) were similar.

CONCLUSIONS

Hand-assisted laparoscopic colectomy may be associated with a significantly shorter learning curve for TAC as results are better than early LC and comparable with LC performed by experienced laparoscopic surgeons. It may be a better option for surgeons early in their laparoscopic career.

A comparison of three fibrinolytic agents in prevention of intra-abdominal adhesions

PURPOSE

Three different drugs affecting the coagulation process at various stages were studied for their effectiveness in preventing intra-peritoneal adhesion formation in rats.

MATERIAL AND METHODS

Forty female Wistar-Albino rats divided into four groups based on the drugs administered during the experimental laparotomy and caecal abrasion: the control group--no drug administered, the intra-peritoneal tissue plasminogen activator (TPA) group, the subcutaneous fondaparinux sodium (FS) group and the intra-peritoneal activated drotrecogin alfa (ADA) group. After two weeks, intra-peritoneal adhesions were macroscopically and microscopically scored.

RESULTS

The macroscopic scores of the three groups were similar but all lower than the control group (p = 0.002). Inflammation (p = 0.023) and fibrosis (p = 0.019) scores were lower in just the ADA group when compared to the control group.

CONCLUSIONS

All three agents were effective in preventing adhesions when compared to the control group. Nevertheless, ADA seemed the most effective except when considering clinical applicability, in which case FS seemed to offer the greatest advantage.