Synthesis, Biological Activity Evaluation and Molecular Docking of Imidazole Derivatives Possessing Hydrazone Moiety

In an attempt to identify potential active anticancer agents with low cytotoxic properties and CA inhibitors, a new series of hybrid compounds incorporating imidazole ring and hydrazone moiety as part of their structure were synthesized by aza-Michael addition reaction followed by intramolecular cyclization. The structure of synthesized compounds was elucidated using various spectral techniques. Synthesized compounds were evaluated for their in vitro anticancer (prostate cell lines; PC3) and CA inhibitory (hCA I and hCA II) activity. Among them, some compound displayed remarkable anticancer activity and CA inhibitory activity with Ki values in range of 17.53±7.19-150.50±68.87 nM against cytosolic hCA I isoform associated with epilepsy, and 28.82±14.26-153.27±55.80 nM against dominant cytosolic hCA II isoforms associated with glaucoma. Furthermore, the theoretical parameters of the bioactive molecules were calculated to establish their drug-likeness qualities. The proteins used for the calculations are prostate cancer protein (PDB ID: 3RUK and 6XXP). ADME/T analysis was carried out to examine the drug properties of the studied molecules.

Factors affecting anxiety, depression, and stress among patients with hepatocellular carcinoma during COVID-19 pandemic

OBJECTIVE

Patients with chronic disease whose treatments are limited may experience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure.

PATIENTS AND METHODS

118 patients with advanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a donor were enrolled. To evaluate the stress, depression, and anxiety levels during the COVID-19 process, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were administered to 118 patients through a face-to-face interview. Sociodemographic and clinical characteristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was constructed to predict the scores of the DASS-21 total.

RESULTS

There were significant differences between DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not significant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most important predictors for the DASS total.

CONCLUSIONS

Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. Therefore, the crucial factors were clinically considered for managing depression, stress, and anxiety in HCC patients.

Is minimal invasive technique harmful in treatment of urethral stricture?

Objective

Our goal was to evaluate the effect of previous history of direct vision internal urethrotomy (DVIU) on success rate of open urethroplasty in patients with bulbar urethral stricture.

Patients and Methods

We analyzed 133 patients who underwent open urethroplasty for bulbar urethral stricture between January 2008 and May 2017. Patients with penile and fossa navicularis stricture were excluded. We evaluated the effect of previous history of DVIU on success rate of open urethroplasty in patients with urethral stricture. Success of open urethroplasty was defined as disappear of voiding symptoms with maximum flow rate above 15 ml/s. The patients were followed for complications and outcome.

Results

Mean age was 54.05 ± 16.5 years. Mean length of stricture was 23.74 ± 10.23 mm. Mean follow-up was 39.77 ± 28.0 months. A total of 76 patients (57.1%) had no history of DVIU. On the contrary, 15.8% had history of DVIU once, 12% had twice, and 15.2% had more than twice. Success rate of open urethroplasty in patients who had no history of DVIU was 84%. However, this success rate was 71.4% in patients who had history of DVIU (P = 0.001).

Conclusion

DVIU is easy, simple, and noninvasive technique in treatment of urethral stricture, so it is frequently used among urologists. However, it could not be an alternative technique to open urethroplasty. Internal urethrotomy can be used in some certain indications. Success rate of open urethroplasty can be affected by previous history of any endoscopic procedures.

Active surveillance or radical prostatectomy? Which treatment is best?

OBJECTIVE

We evaluated the patients who are candidates for active surveillance and treated with radical prostatectomy. These patients were compared with other patients who had not met the criteria of active surveillance.

METHODS

In total, 135 patients were included in the study. The patients were divided into two groups. The patients in Group 1 had less than three positive cores, Gleason 6 (3 + 3) and PSA level equal to or less than 10 ng/ml. Patients in Group 2 had three or more positive cores, Gleason 6 (3 + 3) and PSA level equal to or higher than 10 ng/ml. Pathological results of each groups were compared.

RESULTS

The patients' ages were between 52 and 76, and 50 and 77 in groups 1 and 2, retrospectively. There were 69 and 66 patients in groups 1 and 2, retrospectively. The mean age of patients, PSA levels, PSA density, and prostate volumes were 63.89 ± 5.89 years, 5.82 ± 1.84 ng/ml, 0.14 ± 0.07 and 51.21 ± 31.75 cc (Group 1) and 65.77 ± 6.36 years, 13.65 ± 17.11 ng/ml, 0.63 ± 1.03 and 45.44 ± 26.77 cc (Group 2). T2a, T2c, T3a and T3b were reported in 28 patients, 36 patients, 3 patients and 2 patients after pathological evaluation in Group 1,respectively. T2a, T2c, T3a and T3b were reported in 13 patients, 47 patients, 5 patients and 1 patient in the other group, respectively.

CONCLUSION

The final pathology showed that there is no difference in the positive surgical margin, proportion of insignificant prostate cancer and Gleason upgrading between groups. The clinicians must be aware of the fact that active surveillance can be misdiagnosed in some patients (Tab. 2, Ref. 20).

Ultrasonographic Tinel Sign: two case reports

Peripheral nerve sonography has been regarded as an important tool for evaluating anatomic changes within nerves and muscles. Over the last few years, the role of ultrasonographic Tinel (UST) in diagnostic sensitivity and its relationship to neurophysiologic findings has increased. Ultrasonographic Tinel sign helps to interpret the ultrasonographic and clinical findings and have proven useful in making a diagnosis.

Plasma homocysteine and liver tissue S-adenosylmethionine, S-adenosylhomocysteine status in vitamin B6-deficient rats

OBJECTIVE

The aim of this study was to evaluate plasma homocysteine (Hcy), malondialdehyde (MDA), glutathione (GSH) levels, glutathione peroxidase (GSH-Px) and glutathione-S-transferase (GST) activities and liver tissue S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) levels in control and vitamin B6-deficient rats.

MATERIALS AND METHODS

Thirty-two male rats with a weight of 65-75 g were used for the experiment. The rats were divided into control (n=16) and vitamin B6-deficient groups. At the end of the experiment, the animals were anesthetized with ketamine-HCl (Ketalar, 20 mg/kg, i.p.), and the blood was collected by cardiac puncture after thoracotomy. Plasma Hcy, pyridoxal phosphate (PLP), liver SAM, SAH levels measured by an isocratic system with high performance liquid chromatography. Plasma GSH-Px, GSH activities and GSH, MDA levels were carried out using a spectrophotometer.

RESULTS

Plasma Hcy, MDA, liver tissue SAH levels were significantly increased, whereas plasma GSH, PLP, liver tissue SAM levels, plasma GST, GSH-Px activities and SAM/SAH ratio were decreased compared to those of control group.

CONCLUSIONS

Vitamin B6 deficiency causes an increase in plasma homocysteine levels. Thus, we think that vitamin B6 supplementation could be used for therapeutic purposes in hyperhomocysteinemia condition.

A rare cause of recurrent priapism: hereditary angioedema

Hereditary angioedema is a rare disease, which is caused by deficiency of compleman c1 esterase inhibitor regulatory protein in the compleman system. Priapism is involuntary, painful and prolonged erection of penis more than 4 h without sexual desire. In this case report, we elucidated a patient diagnosed with hereditary angioedema while he had recurrent priapism.

Comparison of two surgical techniques for carotid endarterectomy: conventional and eversion

BACKGROUND

The role of carotid endarterectomy for the treatment of atherosclerotic carotid bifurcation disease is now well established. The aim of this study was to compare durability, postoperative death, stroke, minor strokes, cranial nerve injuries, neck hematomas, myocardial infarctions, or surgical defects and restenosis at the operative site following short- and mid-term duration of the advantages eversion carotid endarterectomy (E-CEA) compared to conventional carotid endarterectomy (C-CEA).

PATIENTS AND METHODS

Between March 2003 and November 2012, primary CEAs were performed in 380 consecutive patients by the same surgical groups. These patients were evaluated retrospectively. C-CEA was performed in 202 patients, and E-CEA was performed in 178 patients. Carotid duplex ultrasonography was performed in all patients at 1, 6, 12 and 24 months after CEA to identify residual atherosclerotic carotid disease.

RESULTS

Mean age was 67.3±13.4 years in the E-CEA group and 64.8±14.8 years in the C-CEA group. Mean cross-clamping time in the E-CEA group was 9.54±2.6 minutes and 12.62±2.7 minutes for C-CEA group (P=0.236). Three postoperative strokes occurred (one after E-CEA and two after C-CEA). In the E-CEA group and C-CEA group respectively, carotid stenosis rates were found in 4 patients (2.24%) and in 5 (2.97%) at a follow-up period of 26 months.

CONCLUSION

Classical endarterectomy still remains the gold standard surgical technique for patients who are selected for coronary artery disease surgery. Nevertheless, we believe that eversion endarterectomy, which has some advantages, must be kept in mind as an alternative approach.

Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymptomatic nerve thickness

There is still no consensus on a normal value for the cross-sectional area of the ulnar nerve at the elbow. Such data would be valuable for the ultrasound diagnosis of ulnar neuropathy. Comparison of the symptomatic and contralateral asymptomatic sides has been recommended. The aim of this study was to investigate whether or not the asymptomatic ulnar nerve could be a reference value. High-resolution ultrasonic measurements of the cross-sectional areas of the ulnar nerves at the elbow were compared with 38 contralateral asymptomatic elbows of patients with unilateral ulnar neuropathy and 38 healthy controls. There were significant differences in the cross-sectional areas at all levels between the healthy control subjects and asymptomatic side of the ulnar neuropathy patients (p < 0.05). The findings of this study suggest that there is a limitation in using the asymptomatic side for obtaining reference values in ultrasonographic studies. Each ultrasonographic laboratory should determine its own reference values.

Difficulties in treatment of CSF leakage associated with a temporal meningocele

Temporal meningocele is a rarely encountered pathology. It is caused by communication between the subarachnoid space of the middle fossa and lateral extension of the sphenoid sinus. Cerebrospinal fluid (CSF) pressures and the hydrostatic pulsatile forces may lead to the development of pitholes on the middle fossa at the sites of arachnoid villi with herniation of dura/arachnoid or brain tissue into the sinus. We describe an adult patient who presented with spontaneous CSF rhinorrhea due to a temporal meningocele. She was first operated on transsphenoidally, but the CSF rhinorrea did not cessate, therefore she was operated transcranially five days after the first operation. There has been no CSF rhinorrhea for three and a half years. Transcranial temporal encephalocele repairment is more effective than transsphenoidal surgery. Recurrent CSF leaks can occur due to both the increased CSF pressure and the insufficient operation technique.

'Use of electrothermal vessel sealing with LigaSure device during laparoscopic splenectomy'

PURPOSE

Main causes of conversion to open surgery are uncontrolled bleeding from splenic hilum and capsular injury of spleen during laparoscopic splenectomy (LS). We present the use of LigaSure in laparoscopic splenectomy for hemostasis.

MATERIAL & METHOD

Between January 2005 and May 2006, LS was performed in a total of 29 patients (6 male and 23 female) with a mean age of 35.44 +/- 13.63. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP) in 20 patients, thrombotic thrombocytopenic purpura (TTP) in 2, hereditary spherocytosis (HS) in 3, lymphangioma in 2, hodgkin lymphoma in 1 and splenic cyst in one patient. LS was performed in the right semilateral position with three 10 mm trocars. LigaSure was used in dissection and division of splenic ligaments and hilar vascular structures.

RESULTS

Conversion to open surgery was necessary in one patient due to peroperative bleeding. The mean duration of the operation was 71.3 +/- 19.8 minutes and the estimated blood loss was 85 +/- 23 ml. The diameter and the weight of the spleen were 10.7 +/- 2.68 cm and 250 +/- 90 g, respectively. There was no mortality. Postoperative complications included pancreatic fistula, trocar site infection and deep venous thrombosis that were encountered in three patients. These were managed without morbidity. The overall complication rate was 10.3% (n = 3). The mean duration of postoperative hospital stay was 2.86 +/- 1.59 days.

CONCLUSION

LigaSureTM use in LS had easy application, provided sufficient hemostasis, and shortened the operative time.

The effects of fenestration of the interpeduncular cistern membrane arousted to the opening of lamina terminalis in patients with ruptured ACoA aneurysms: a prospective, comparative study

BACKGROUND

The incidence of chronic hydrocephalus requiring shunt placement is a well-known and common complication of aneurysmal subarachnoid hemorrhage (aSAH). It was suggested that fenestration of the lamina terminalis (LT) during microsurgery for aSAH may be associated with a reduced rate of shunt-dependent chronic hydrocephalus (SDCH). We analyzed that, fenestrations of the LT and Liliequist membrane (LM) would reduce rate of SDCH and improve rate of favorable outcome.

METHODS

145 patients who were analyzed in the study were treated in our department with ruptured anterior communicating artery (ACoA) aneurysms. We compared the rate of shunting and clinical outcome in patients in whom only fenestration of the LT (Group 1) was performed with that in patients in whom fenestrations of both the LT and LM (Group 2) were performed.

RESULTS

Chronic hydrocephalus requiring shunting amounted to 9.8% (7 patients) in Group 1 and 4% (3 patients) in Group 2 (p=0.203). Also, there were no differences in the rate of shunt dependent hydrocephalus between the two groups in patients with Fisher's CT grades 3 (p=0.343) and 4 (p=0.667), and HH grades 4 (p=0.306) and 5 (p=0.361). Favorable clinical outcomes were observed with rates of 74.6% in Group 1 and 79.7% in Group 2 (p=0.693). Also there were no differences in the rates of favorable clinical outcome between the two groups in patients with Fisher's CT grades 3-4, HH grades 4-5.

CONCLUSIONS

Our study shows that fenestration of the LM coupled with the opening of the LT reduced-relatively-the incidence of SDCH; this however was not significant. This positive effect was particularly noticeable in patients in whom a cisternal "overflow" was observed at surgery when opening the LM. This corresponded to cases with ventricular dilatation and a IVth ventricle with clots.

Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery

BACKGROUND

After surgery for ruptured anterior communicating artery (ACoA) aneurysm, several patients who have achieved a favorable neurological outcome yet have been observed to suffer from a poor cognitive outcome. The aim of this study was to explore the possible effects of temporary clip applications on frontal lobe functions in the patients with ruptured ACoA aneurysm.

METHODS

Forty patients were chosen among a series of cases who underwent an early surgery (within 96 h) after ACoA aneurysm bleeding. All of them were in Hunt-Hess grade 1 or grade 2. Of the 40 patients, temporary clipping was used in 22 patients (group A), whereas it was not used in 18 patients (group B). These two groups were compared with 20 volunteers (group C) without neurologic or psychiatric disorders.

RESULTS

The mean duration of temporary vessel occlusion for both A1 was 8.2 +/- 2.9 min (4-15) in group A. Neither clinical nor radiographic strokes were detected. An improvement in frontal lobe function occurred at long term in group B patients. Whereas, cognitive deficits were persisting at long-term follow-up in group A, especially in patients who had temporary clipping duration longer than 9 min.

CONCLUSIONS

The results emphasize that the negative effects of temporary vessel occlusion on cognitive changes occur before ischemic damage. Thus, such negative effects of temporary clipping on cognitive functions should not be neglected by surgeons during surgery.

The effects of environmental light--dark changes on experimental mild traumatic brain injury

OBJECTIVES

The aim of this study was to investigate the effects of environmental light-dark changes on the outcome of mild traumatic brain injury (MTBI) using an experimental rodent model. The functions of endogenous and exogenous melatonin on the outcome of injury were also investigated

METHODS

Mild traumatic brain injury was experimentally induced in 56 male Sprague-Dawley rats using a weight-drop device. Animals were divided into four groups of 14 each as follows: (i) sham-operated (trauma only, normal day-night cycle), (ii) treated with melatonin (trauma+melatonin, normal day-night cycle), (iii) darkness-induced (trauma+48 h constant dark), and (iv) treated with melatonin and darkness-induced (trauma+48 h constant dark+melatonin). Melatonin (50 mg/kg) was administered, intraperitoneally, immediately after trauma. EEG recordings were taken at three time periods (pretrauma, immediately after trauma, and 48 h after trauma). Motor functions were tested pretrauma, 24 and 48 h post-trauma. Serum melatonin levels were determined pretrauma and 48 h post-trauma. Tissue samples from right frontal area were taken 48 h after trauma for light and electron microscopic examinations.

CONCLUSION

Following MTBI light deprivation alone and light deprivation in combination with exogenously administered melatonin indicated significant neuroprotective effects. Although there may be other important pathways, darkness-induced elevation in endogenous melatonin secretion appears to play an important role in this neuroprotective outcome.

The Effect of Ormocer Filling Material Implanted into Rabbit Connective Tissue on Erythrocytes Oxidative Stress

Recently, there have been considerable developments regarding esthetic restorative material. The aims of our study were to assess whether the increased oxidative stress in rabbits, with implanted ormocer filling materials, is reflected by erythrocytes lipid peroxidation and also to check the alterations in the oxidant and antioxidant enzyme activities in erythrocytes of rabbits. Erythrocytes total (enzymatic plus non-enzymatic) superoxide scavenger activity (TSSA), non-enzymatic superoxide scavenger activity (NSSA), superoxide dismutase (SOD), catalase (CAT), xanthine oxidase (XO) activities and malondialdehyde (MDA) level were measured in all groups. Erythrocyte CAT and SOD activities were significantly increased in both day 1 and day 7 when compared to the baseline values. Erythrocyte TSSA activities were significantly higher in group 2 than those of the baseline and day 7 values. Erythrocyte NSSA activities were significantly lower in the day 7 values than those of group 1. Erythrocyte NSSA activities were significantly higher in the day 1 values than those of the baseline values. On the other hand, there was no significant difference in all groups in terms of XO activities and MDA values. In conclusion, our results showed that ormocer filling material in rabbit implants, did not induce oxidative stress and it prevented lipid peroxidation by increasing antioxidant defense system.

Bladder-filling sensation in patients with spinal cord injury and the potential for sensation-dependent bladder emptying

STUDY DESIGN

Investigation of bladder-filling sensation in 73 consecutive traumatic spinal cord injury (SCI) patients during laboratory cystometry.

OBJECTIVES

To determine the frequencies of bladder-filling sensation in SCI patients with complete lesions above T11 and below T10 and with incomplete lesions, to examine the quality of the preserved sensation, as well as to determine the potential for sensation-dependent bladder emptying in this patient group.

SETTING

Physical Medicine and Rehabilitation Education and Research Hospital of Ministry of Health, Ankara, Turkey.

METHODS

Bladder-filling sensation was investigated in 73 consecutive patients with traumatic SCI using continuous medium fill cystometry. Bladder-filling sensation was categorised as absent, partially preserved or preserved. Presence of bladder-filling sensation before intravesical pressure (Pves) reached 25 and 40 cmH2O, and simultaneous presence of bladder capacity of more than 150 ml were investigated as the measures of the quality of the sensation.

RESULTS

Bladder-filling sensation was present to some degree in all incomplete SCI patients, in 82.4% of the patients with complete lesions below T10, and 38.9% of the patients with complete lesions above T11. There were statistically significant differences between three groups with respect to bladder sensation category (P<0.001). About 86% of the patients with incomplete lesions, 53% of the patients with complete lesions below T10 and 22% of those with lesions above T11 had bladder-filling sensation before Pves reached 25 cmH2O and simultaneous bladder capacity of more than 150 ml was present in 61.2, 41.2 and 22.2% of the patients in the groups, respectively. Bladder-filling sensation investigations were reliable in terms of bladder filling sensation category in 36 SCI patients who had second cystometric examination.

CONCLUSION

Presence of bladder-filling sensation in many of the SCI patients observed in this study revealed the potential for sensation-dependent bladder emptying in SCI patients, especially in the ones with complete lesions below T10 and the ones with incomplete lesions. This method may prevent early emptying attempts, unnecessary catheterisations and overdistension episodes and may improve the patient's self-esteem and quality of life. However, further studies on clinical experience and patient compliance for this method are needed.

Bilateral cerebellopontine angle arachnoid cysts: case report

OBJECTIVE AND IMPORTANCE

A rare case of bilateral cerebellopontine angle (CPA) arachnoid cysts (ACs), accompanied by cerebellar tonsillar displacement toward the foramen magnum, is presented.

CLINICAL PRESENTATION

A 45-year-old woman presented with progressive dysphagia, vertigo, and truncal ataxia. Magnetic resonance imaging revealed bilateral CPA ACs and cerebellar tonsillar displacement.

INTERVENTION

The right CPA AC was excised via a suboccipital approach. Decompression of the foramen magnum and duraplasty were also performed.

CONCLUSION

The case reported here is the first case of bilateral CPA ACs. Decompression of the foramen magnum and excision of the cyst resulted in complete relief of symptoms.