Prognostic significance of mediastinal standardized uptake value on positron emission tomography/computed tomography in patients with left upper lobe non-small cell lung cancer: Is invasive staging of aortopulmonary window lymph nodes necessary?

Background: This study aims to investigate whether the invasive staging of aortopulmonary window lymph nodes could be omitted in the presence of a suspected isolated metastasis in the aortopulmonary window lymph node on positron emission tomography/computed tomography. Methods: Between January 2010 and January 2016, a total of 67 patients (54 males, 13 females; mean age: 59.9±8.7 years; range, 44 to 76 years) with metastatic left upper lobe tumors to aortopulmonary window lymph nodes were retrospectively analyzed. According to positron emission tomography/computed tomography findings in clinical staging, the patients were classified as positive (+) (n=33) and negative (-) (n=34) groups. Results: There was a statistically significant difference between the two groups in terms of sex distribution, lymph node diameter on computed tomography, maximum standardized uptake value of aortopulmonary window lymph nodes, and tumor diameter (p<0.001 for all). A trend toward significance was found to be in pT status, LN #6 metastases, and pathological stage between the two groups (p=0.067). The five-year overall survival rate for all patients was 42.4% and there was no significant difference between the groups (p=0.896). The maximum standardized uptake value of the aortopulmonary window lymph nodes was a poor prognostic factor for survival (area under the curve=0.533, 95% confidence interval: 0.407-0.675, p=0.648). Conclusion: Invasive staging of aortopulmonary window lymph nodes can be omitted in patients with isolated suspected metastasis to aortopulmonary window lymph nodes in non-small cell lung cancer of the left upper lobe.

Bilateral Fracture-Dislocation of the Shoulder After Defibrillation.

BACKGROUND: There are multiple reported injuries associated with cardiopulmonary resuscitation, most of them caused by the force of compressions, like sternal and rib fractures, abdominal organ injuries like splenic rupture, liver lacerations, and injuries to the upper airway and skin. Injuries related to defibrillation and cardioversion are rare, mostly related to skin and muscle injuries on where the defibrillation paddles were placed. CASE REPORT: A 52-year-old man presented to the Emergency Department with crushing chest pain. The patient was suffering from a myocardial infarction, and during percutaneous coronary intervention, had to be defibrillated on the angioplasty table. This resulted in fracture-dislocations on both shoulders. The patient was transferred to our orthopedics clinic and was operated on within 5 days of angioplasty. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early diagnosis and treatment are important, and can prevent long-term morbidity. However, cardiopulmonary resuscitation and defibrillation are acts that are most commonly performed in the emergency department. Injury prevention by controlling the patient's position, in this case, positions of the shoulders, is an important factor that emergency physicians can control and effect.

Comparison of anatomical and functional outcomes of different surgical techniques in myopic macular hole without retinal detachment.

AIM: To define the anatomic and functional outcomes of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, inverted ILM flap and free ILM patch graft technique for the treatment of myopic macular hole (MH) without retinal detachment. METHODS: Sixty-four eyes of 64 patients who underwent PPV for myopic MH were included. Group 1 consists of patients underwent ILM peeling (n=26), and Groups 2 and 3 consists of patient underwent free ILM patch graft (n=20) and inverted ILM flap procedure (n=18) respectively. Outcomes following surgery were MH closure and best corrected visual acuity (BCVA) in logMAR at 6mo. RESULTS: Closure of MH was obtained in 20 eyes (76.9%) of the Group 1, in 16 eyes (80%) of the Group 2 and in 16 eyes (88.9%) of the Group 3. The mean preoperative and postoperative BCVA was 1.60±0.53 logMAR and 1.27±0.58 logMAR, respectively (P<0.05). There was no significant difference in the postoperative BCVA and anatomical closure rates in the three groups. Although the anatomical closure rate did not differ significantly in the groups, closure of MH tended to be better in the inverted ILM flap technique group at 6mo. CONCLUSION: Different surgical techniques may provide favorable visual and anatomical results for myopic MH surgery. ILM flap techniques offer higher closure rates compared to ILM peeling technique. However, in terms of visual outcomes, the study reveals no difference in three surgical techniques.

Molecular imprinted based microcryogels for thrombin purification.

In addition to understanding and explaining the functions of proteins, the need for low-cost, easy and efficient purification methods has been increasing in the field of protein purification, which is also important for enzyme production. In this context, an alternative approach has been developed for the purification of thrombin, which has a crucial role in the hemostatic process, via thrombin imprinted microcryogels that allow reuse and have high selectivity. The characterization studies of the microcryogels were accomplished with micro-computed tomography (µCT), scanning electron microscopy (SEM), optical microscope, surface area measurements (BET analyses) and swelling test measurements. By scanning various parameters affecting thrombin adsorption, the maximum thrombin adsorption capacity (Qmax) was found to be 55.86 mg/g. Also, the selectivity of microcryogels was investigated with the competitive agents and reusability studies were performed. The purity of thrombin was evaluated by Fast Performance Liquid Chromatography (FPLC) method. Experimental results indicated that adsorption of thrombin by the developed microcryogels fit the Langmuir isotherm model (Qmax: 55.86 mg/g, R2: 0.9505) and pseudo-second order for three different thrombin concentrations (R2: 0.9978, R2: 0.9998, R2: 0.9999).

Bietti crystalline dystrophy complicated by choroidal neovascularization treated with a single dose of aflibercept.

Bietti crystalline dystrophy is a rare hereditary autosomal recessive disease that causes photoreceptor loss secondary to degeneration of retinal pigment epithelium due to intracellular retinal pigment epithelial crystalline deposits and abnormal lipid metabolism. We aimed to present a case of choroidal neovascular membrane secondary to Bietti crystalline dystrophy diagnosed with multimodal imaging and treated with an intravitreal injection of aflibercept. A single dose of aflibercept injection might be effective due to its higher affinity for vascular endothelial growth factor (VEGF) in comparison with other anti-VEGFs. It might be a treatment alternative that can be considered in the choroidal neovascular membrane due to uncommon etiologies.

Human serum albumin depletion based on dye ligand affinity chromatography via magnetic microcryogels.

One of the primary purposes of proteomic studies is to analyze the proteins in the blood to be considered as biomarkers. Albumin, which constitutes the majority of total serum proteins, complicates the discovery of low-density proteins that are important for the diagnosis of diseases. Based on this, an alternative approach for albumin depletion was developed in this study by covalently attached Cibacron Blue 3GA (CB) to magnetic microcryogels. After detailed characterization of CB attached magnetic microcryogels synthesized via a microstencil array chip, albumin adsorption studies were performed to examine the optimum depletion conditions. In the presented study, the maximum albumin adsorption capacity (Qmax) was calculated as 149.25 mg/mL in pH 5.0 acetate buffer solution, which is the optimum pH value for albumin. Experimental studies have demonstrated that CB-attached magnetic microcryogels can be reused without loss of performance for albumin depletion after 10 adsorption-desorption cycles.

Nutrient Homeostasis of Aegilops Accessions Differing in B Tolerance Level under Boron Toxic Growth Conditions.

Boron (B) is a crucial microelement for several biological processes in plants; however, it becomes hazardous when present in excess in the soil. B toxicity adversely affects the wheat yield all around the world, particularly in the arid and semiarid regions. Aegilops, the nearest wild wheat relatives, could be an efficient source to develop B toxicity tolerance in modern cultivars. However, to potentially utilize these species, it is necessary to understand the underlying mechanisms that are involved in providing them tolerance. Other than hampering cellular and physiological activities, high B inhibits the uptake of nutrients in wheat plants that lead to nutrients deficiency causing a hindered growth. Thus, it is crucial to determine the effect of B toxicity on nutrient uptake and finally, to understand the role of nutrient homeostasis in developing the adaptive mechanism in tolerant species. Unfortunately, none of the studies to date has explored the effect of high B supply on the nutrient uptake in B toxicity tolerant wild wheat species. In this study, we explored the effect of 1 mM B (toxic B), and 10 mM B (very toxic B) B on the nutrient uptake in 19 Aegilops genotypes differing in B tolerance in contrast to Bolal 2973, the familiar B tolerant genotype. The obtained outcomes suggested a significant association between the B toxicity tolerance and the level of nutrient uptake in different genotypes. The B toxicity tolerant genotypes, Ab2 (TGB 026219, A. biuncialis genotype) and Ac4 (TGB 000107, A. columnaris genotype) were clustered together in the nutrient homeostasis-based heat map. Though B toxicity mostly had an inhibitory effect on the uptake of nutrients in root-shoot tissues, the tolerant genotypes revealed an increase in nutrient uptake under B toxicity in contrast with Control. The study directs towards future research where the role of external supply of few nutrients in enhancing the B toxicity tolerance of susceptible genotypes can be studied. Moreover, the genotype-dependent variation in the nutrient profile of the studied Aegilops genotypes under high B suggested that increasing number of Aegilops germplasm should be screened for B toxicity tolerance for their successful inclusion in the pre-breeding programs focusing on this issue.

Metal-chelated polyamide hollow fiber membranes for ovalbumin purification from egg white.

In the study, purification of ovalbumin was performed by modifying polyamide hollow fiber membranes using immobilized metal affinity chromatography technique. For this purpose, firstly polyethyleneimine (PEI) solutions of different concentrations were attached to hollow fiber membranes. Then, Cu(II), Ni(II) and Zn(II) metal ions were chelated separately to polyethyleneimine attached hollow fiber membranes. Characterization studies of modified hollow fiber membranes were performed with scanning electron microscopy (SEM). Also, the surface area was measured with the Brunner Emmet Teller (BET) method and the porosity was measured with mercury porosimeter. pH, ionic strength, initial ovalbumin concentration, temperature and reusability parameters affecting adsorption capacity were investigated. The maximum ovalbumin adsorption capacities of hollow fiber membranes were found to be 317 mg/g for Cu(II), 169 mg/g for Ni(II) and 101 mg/g for Zn(II), respectively. Desorption ratio of metal ions were calculated as 91.6% for Cu(II), 92.9% for Ni(II) and 91.8% for Zn(II), which are quite high and suitable. When examined in terms of adsorption isotherm models, it was concluded that the Langmuir model is suitable. Purification of ovalbumin from egg white was carried out by fast performance liquid chromatography (FPLC), and the purity of ovalbumin was evaluated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) method.

Did primary spontaneous pneumomediastinum risk factor alter in the period of COVID-19 pandemia?

OBJECTIVES: In this study, we aimed to establish risk factors for primary spontaneous pneumomediastinum associated with Coronavirus disease 2019 (COVID-19) and reveal those which are significant. METHODS: The study included 62 patients with primary spontaneous pneumomediastinum who presented to our hospital between 11 March 2020, the date of the first-reported COVID-19 case in our country, and 3 January 2021. Of these, 14 patients (22.6%) had COVID-19 and 48 patients (77.4%) did not have COVID-19. RESULTS: Of the 62 patients included in the study, 41 (66.1%) were male and 21 (33.9%) were female. The mean age was 28.90 ± 16.86 (range, 16-84) years. The most common symptom at admission was chest pain (54.8%). The mean age of the patients with COVID-19 was 39.35 ± 23.04 years and that of the patients without COVID-19 was 25.85 ± 13.45 years (P < 0.001). In receiver-operating characteristic curve analysis, the area under the curve for age was 0.785 (95% confidence interval: 0.648-0.922) and the optimal cut-off value was 24 years for COVID-19-positive patients. The highest sensitivity and specificity values were 0.857 and 0.729. Twelve (85.79%) of the COVID-19-positive primary spontaneous pneumomediastinum patients were aged 24 years or older (P < 0.001). Five patients (8.1%) had positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test but no abnormal findings on computed tomography. CONCLUSIONS: Having an age of more than 24 years was associated with a higher prevalence of pneumomediastinum in COVID-19 patients and emerged as an important risk factor. Multicentre studies with more cases are needed to determine whether pneumomediastinum is associated with additional other risk factors related to COVID-19.

Variability in Physiological Traits Reveals Boron Toxicity Tolerance in Aegilops Species.

Boron (B) is an important micronutrient required for the normal growth and development of plants. However, its excess in the soil causes severe damage to plant tissues, which affects the final yield. Wheat, one of the main staple crops, has been reported to be largely affected by B toxicity stress in arid and semi-arid regions of the world. The prevalence of B toxicity stress can be addressed by utilizing wild wheat genotypes with a variant level of stress tolerance. Wild wheat relatives have been identified as a prominent source of several abiotic stress-tolerant genes. However, Aegilops species in the tertiary gene pool of wheat have not been well exploited as a source of B toxicity tolerance. This study explores the root and shoot growth, proline induction, and extent of lipid peroxidation in 19 Aegilops accessions comprising 6 different species and the B-tolerant check wheat cultivar Bolal 2973 grown under Control (3.1 µM B), toxic (1 mM B), and highly toxic (10 mM B) B stress treatment. B toxicity stress had a more decisive impact on growth parameters as compared to the malondialdehyde (MDA) and proline content. The obtained results suggested that even the genotypes with high shoot B (SB) accumulation can be tolerant to B toxicity stress, and the mechanism of B redistribution in leaves should be studied in detail. It has been proposed that the studied Aegilops accessions can be potentially used for genetically improving the B toxicity-tolerance trait due to a high level of variation in the response toward high B toxicity. Though a number of accessions showed suppression in the root and shoot growth, very few accessions with stress adaptive plasticity to B toxicity stress leading to an improvement of shoot growth parameters could be determined. The two accessions, Aegilops biuncialis accession TGB 026219 and Aegilops columnaris accession TGB 000107, were identified as the potential genotypes with B toxicity stress tolerance and can be utilized for developing a pre-breeding material in B tolerance-based breeding programs.

Determination of the retinal toxicity of intravitreal colistin in rabbit eyes.

PURPOSE: To determine the possible adverse effects and safe dose range of intravitreal colistin, an antibiotic, after its intravitreal application. METHODS: Twenty eyes of 20 adult male and female New Zealand white rabbits were selected. Various concentrations of colistin were prepared. In each rabbit, 0.1 mL of colistin solution or saline solution was injected intravitreally into the right eye. Electroretinographic recordings were taken before and 2 weeks after injection. Histopathological examination was made using a light microscope following enucleation and fixation procedures. In histopathologic cross-sections, the differences between drug-injected eyes and control eyes were evaluated. RESULTS: Electroretinographic examination showed a decrease of 30% as a significant value in the a and b wave amplitudes of the rabbits that injected 400 µg/0.1 ml and higher concentrations. Histological examination revealed histiocytic infiltration, histiocytic vacuoles, inflammation, and retinal degeneration in rabbit eyes given 400 µg/0.1 ml, 800 µg/0.1 ml, and 1.6 mg/0.1 ml concentrations of colistin. CONCLUSION: Based on our findings, the safe concentration of colistin is 0.2 mg/0.1 ml. Administration of 0.4 mg/0.1 ml was associated with cataract development, electrophysiological depression, and pathological changes in retinal layers.

Injectable Cryogels in Biomedicine.

Cryogels are interconnected macroporous materials that are synthesized from a monomer solution at sub-zero temperatures. Cryogels, which are used in various applications in many research areas, are frequently used in biomedicine applications due to their excellent properties, such as biocompatibility, physical resistance and sensitivity. Cryogels can also be prepared in powder, column, bead, sphere, membrane, monolithic, and injectable forms. In this review, various examples of recent developments in biomedical applications of injectable cryogels, which are currently scarce in the literature, made from synthetic and natural polymers are discussed. In the present review, several biomedical applications of injectable cryogels, such as tissue engineering, drug delivery, therapeutic, therapy, cell transplantation, and immunotherapy, are emphasized. Moreover, it aims to provide a different perspective on the studies to be conducted on injectable cryogels, which are newly emerging trend.

The assessment of macular electrophysiology and macular morphology in patients with vitiligo.

PURPOSE: We aimed to analyze the electrophysiologic function and morphology of macula in vitiligo patients. METHODS: Seventeen patients with vitiligo and 11 healthy subjects were studied. All participants underwent multifocal electroretinography (mfERG) and spectral domain optical coherence tomography (SD-OCT) evaluations. The mfERG (P1 mfERG responses central and peripheral) and retinal layer segmentation parameters (nine ETDRS subfields) were compared in vitiligo and control groups. RESULTS: The mean P1 response amplitudes were significantly decreased in central and peripheral rings of the fovea in patients with vitiligo compared with controls (p = 0.002 and p = 0.006, respectively). There was a tendency toward a prolonged mean implicit time for both central and peripheral in patients with vitiligo compared to controls, however, with no statistical significance (p = 0.453 and p = 0.05, respectively). There was no statistically significant difference in all retinal layers thickness between two groups. CONCLUSION: In patients with vitiligo, while photoreceptor segment preserved in SD-OCT, mfERG reduced showing potential decline in central retinal function. This study showed a potential decline in central retinal function in patients with vitiligo even if they have normal fundus appearance and SD-OCT findings.

Posterior Polar Central Choroidal Dystrophy: A Case Report.

A 52-year-old male presented with a 25-year history of decreasing vision. Best corrected visual acuity was 0.3 in his right and 0.2 in his left eye. Fundoscopic examination showed bilateral symmetric atrophy of the retinal pigment epithelium and choriocapillaris in the posterior polar areas between vascular arcades and surrounding the optic disc. On fluorescein angiography, the large choroidal vessels beneath these affected regions were easily seen. Fundus autofluorescence imaging showed clearly defined hypoautofluorescent areas that corresponded to the aforementioned lesions. Atrophy of the choriocapillaris and outer retinal layer were detected in optical coherence tomography. Photopic and scotopic responses were subnormal in flash electroretinogram (ERG), and responses were also minimal in pattern ERG and multifocal ERG. The patient was diagnosed with posterior polar central choroidal dystrophy. We aimed to present the results of fluorescein angiography, fundus autofluorescence imaging, optical coherence tomography, and electrophysiological tests in this rare case of posterior polar central choroidal dystrophy.

Green laser induced foveal cyst sustained in a recreational laser light show.

We report the case of a 9-year-old boy complained of visual loss in his right eye after watching green laser light show being hit by a ray of a laser at shopping center before five days ago. The laser had a maximum power rating of 30 mW (US Food and Drug Administration class IIIB). Best-corrected visual acuity in his right eye was 0.2 with Snellen at 5 days after the injury. Dilated fundoscopic examination demonstrated a macular hole appearance in the right eye. Spectral domain optical coherence tomography (OCT, Spectralis, Heidelberg Engineering, Heidelberg, Germany) demonstrates a steep fovea contour, a thickening of the macular edges, intraretinal cysts, disruption of the photoreceptor inner segment/outer segment layer and macular pseudohole formation. Central foveal thickness (515 µm) was increased. Two months after the injury, the patient's visual acuity improved to 0.9 in the right eye without any ocular treatment. Spectral domain OCT revealed the closure of the macular hole with the resolution of the cystic spaces. At 6-months follow-up, visual function had fully recovered and macular assessment was normal.

Changes in Anterior Chamber Depth after Combined Phacovitrectomy.

OBJECTIVES: To evaluate changes in anterior chamber depth (ACD) and postoperative refractive outcomes after combined phacovitrectomy. MATERIALS AND METHODS: This study included 10 eyes of 10 patients that underwent combined phacovitrectomy (study group) and 14 eyes of 14 patients that underwent phacoemulsification surgery (control group) at Istanbul Medipol University Ophthalmology Department. Preoperative and 3-month postoperative best corrected visual acuity (BCVA), ACD, change in ACD and refractive outcomes were compared between the two groups. RESULTS: Preoperative ACD, postoperative ACD at 3 months and change in ACD were similar between two groups (p=0.403, p=0.886, p=0.841). Postoperative mean refractive outcomes were 0.22±0.51 diopter in the phacovitrectomy group and -0.39±0.53 diopter in the phacoemulsification group (p=0.019). BCVA was increased in both groups (p=0.001). CONCLUSION: Postoperative refractive outcomes in eyes that underwent combined phacovitrectomy are different from those in eyes that underwent only phacoemulsification surgery. This is important in determining preoperative intraocular lens power before combined phacovitrectomy.