Feasibility of totally extraperitoneal inguinal hernia repair in patients with previous prostatectomy.

Objectives: Laparoscopic totally extraperitoneal inguinal hernia repair (TEP) surgery technique includes three key steps: reaching the preperitoneal space, reducing hernias, and placement of mesh. However, reaching the preperitoneal space can be complicated in patients with previous lower abdominal surgeries. This study aimed to assess the feasibility of laparoscopic inguinal TEP in patients with previous prostatectomies. Material and Methods: Inguinal hernia patients who underwent laparoscopic TEP between January 2015 and February 2021 at Koç University Faculty of Medicine, Department of General Surgery, were included in this retrospective study. The operations were performed by five senior surgeons experienced in laparoscopy. Patients were divided into two study groups, as the radical prostatectomy (RP) group which included patients with previous prostatectomy non-RP which included patients without previous radical prostatectomy. Operative time (OT), length of hospital stay (LOS), and postoperative complications were compared within two groups. Results: Three hundred and forty-nine patients underwent laparoscopic TEP, and 27 had previous prostatectomies. Among them, 190 patients had unilateral inguinal hernias, and 159 had bilateral inguinal hernias. Mean age of the patients in the non-RP and RP groups was 58.1 ± 14.7 and 73.9 ± 9.6 years, respectively. Only one (3.7%) case was complicated with urinary tract infection in the RP group, and 10 (3.1%) were complicated in the non-RP group. Complications for the non-RP group include hematomas in six cases, urinary tract infection in three cases, and urinary retention in one case. No significant difference in mean operative time was seen between non-RP and RP groups (p= 0.43). There was no significant difference in the means of the length of hospital stay between the two groups (p= 0.7). Conclusion: Laparoscopic TEP in patients with a previous prostatectomy can be performed safely without prolonging the operative time and increasing the length of hospital stay.

A comparison of computerized tomography and flair-SWI MRI results of patients with head injury attending the emergency department.

OBJECTIVE: Detection of traumatic brain injury (TBI) is of vital importance in patients who apply to the emergency department with a history of trauma. The aim of initial imaging in patients with suspected TBI is to detect trauma-related injury quickly and accurately. In this study, the effectiveness of prospectively cranial computed tomography (CT) and fluid attenuation inversion recovery (FLAIR) and susceptibility weighted imaging (SWI) sequence magnetic resonance imaging (MRI) examination results of patients diagnosed with TBI in the emergency department in terms of bleeding detection was investigated in the light of the literature. PATIENTS AND METHODS: Patients with traumatic brain injury who applied to the emergency department between 2016 and 2020 were included in this prospective study. Cranial CT and MRI images containing SWI-FLAIR sequence were taken on the same day, immediately after cranial CT, for a total of 500 patients. RESULTS: In our study, TBI was detected in 242 males (70.8%) and 100 females (29.2%), for a total of 342 patients. The mean age was 41.45, the mean GCS was 13.35. There was a history of trauma such as falling in 155 patients (45.3%), traffic accidents in 171 patients (50%), and trauma in 16 patients (4.7%). In the comparative evaluation of CT and FLAIR-SWI MRI examinations no bleeding was detected in the FLAIR-SWI sections of 239 patients who did not have bleeding on CT; however, bleeding was detected in FLAIR-SWI sections in 14 patients who did not have bleeding on CT. CONCLUSIONS: FLAIR-SWI MR, which is a more reliable examination method, should be performed before control CT, especially in patients with incompatible clinical and admission CT.

COVID-19 and physical activity in sedentary individuals: differences in metabolic, cardiovascular, and respiratory responses during aerobic exercise performed with and without a surgical face masks.

BACKGROUND: The Coronavirus-19 (COVID-19) impairs metabolic, cardiovascular, and pulmonary functions in human metabolism, and wearing face masks is recommended for the prevention of contracting or exposing others to cardio-respiratory infections. Since the effect of wearing a surgical face mask (SFM) on cardiopulmonary exercise capacity has not been systematically reported we aimed to determine the effects of wearing SFM during an incremental walking test on metabolic, cardiovascular, and pulmonary gas exchange responses in sedentary individuals. METHODS: The evaluations were performed using a repeated measures study design. Seven sedentary males (age: 40 years, height: 178 cm, weight: 88 kg, BMI: 28 kg/m2, VO2max: 32.7±3.9 mL/kg/min) and 7 sedentary female participants (age: 34 years, height: 169 cm, weight: 62 kg, BMI: 22 kg/m2, VO2max: 32.1±6.8 mL/kg/min) volunteered to participate in the current study. Anthropometric parameters were measured using a Bioelectrical impedance analysis prior to each testing session. The measures of lung function assessed by spirometry, breathing pattern, maximal exercise capacity with-and-without mask were measured with a breath-by-breath automated exercise metabolic system during incremental Bruce protocol on a treadmill with two consecutive sessions with 48-h intervals. Blood pressure values (systolic and diastolic pressure) of the individuals were taken and recorded within 1 minute at the end of every ten minutes, without speed changes. RESULTS: VO2, VCO2, and VE were significantly lower during exercise performed with SFM (P<0.001). Heart rate, systolic and diastolic blood pressure were also found significantly higher during exercise performed with SFM (P<0.01). CONCLUSIONS: Wearing a SFM during incremental walking predispose a decrease in oxygen delivery while increasing pulmonary ventilation in sedentary individuals. Thus, it could be speculated that surgical face masks have a negative impact on oxygen delivery during exercise which results in decreased exercise performance due to the restricted ventilatory conditions.

The Value of Preoperative Volumetric Analysis by Computerised Tomography of Retrosternal Goiter to Predict the Need for an Extra-Cervical Approach.

BACKGROUND: A thyroidectomy can be performed via a cervical incision in most patients with retrosternal goiter. AIMS: To investigate the correlation between the volume of the mediastinal portion of the thyroid gland and the need for an extra-cervical approach for retrosternal goiter. STUDY DESIGN: Diagnostic accuracy study. METHODS: The measurement of craniocaudal length and the volume of the mediastinal component of the thyroid gland on computerised tomography images was performed in 47 patients with retrosternal goiter. Of these 47 patients, 8 (17%) required an extra-cervical approach and were classified as group 1, and 39 (83%) patients that required a cervical incision were classified as group 2. Receiver operating characteristic analysis was performed to determine the cut-off value for the craniocaudal length and the volume of the mediastinal thyroid mass, which significantly correlated with an extra-cervical approach for retrosternal goiter. RESULTS: Reoperative surgery was significantly more frequent in group 1 than in group 2 (50% vs 13%; p=0.03). The craniocaudal length of the mediastinal thyroid gland was significantly longer in group 1 than in group 2 (77±11 mm vs 31±21 mm, respectively; p=0.0001). The volume of the mediastinal component was significantly larger in group 1 compared to group 2 (264±106 cm3 vs 40±41 cm3, respectively; p=0.0001). The receiver operating characteristic curve of craniocaudal length and the volume of the mediastinal component identified ≥66 mm and ≥162 cm3 as the cut-off values with the maximum accuracy, respectively. The craniocaudal length of the thyroid mass below the thoracic inlet ≥66 mm or a volume of the mediastinal portion ≥162 cm3 were significantly associated with an extra-cervical approach (p=0.0001). For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off value for craniocaudal length was 87.5%, 64% and 97%, respectively. For predicting an extra-cervical approach, the sensitivity, positive predictive value and negative predictive value of the cut-off values for the mediastinal volume were 100%, 89% and 100%, respectively. CONCLUSION: A thyroid volume of ≥162 cm3 extending below the thoracic inlet was a significant determining factor for an extra-cervical approach, with a negative predictive value for the extra-cervical approach of 100% for retrosternal goiter with smaller volumes. Further studies with an increased number of patients are needed to determine the value of volumetric analysis of retrosternal goiter to predict the need for an extra-cervical approach in retrosternal goiter.

Cellular Model of Alzheimer's Disease: Aß1-42 Peptide Induces Amyloid Deposition and a Decrease in Topo Isomerase IIß and Nurr1 Expression.

BACKGROUND: DNA topoisomerase IIß (topo IIß) plays a crucial role in neural differentiation and axonogenesis. Inhibition of topo IIß activity in vitro and in vivo results in shorter axons and increased DNA damage. These molecular events also involve in Alzheimer's disease (AD); however, the role of topo IIß in the pathogenesis of AD remains to be elucidated. OBJECTIVES: We aimed to investigate the role of topo IIß association with Nuclear receptor related 1 protein (Nurr1) in the onset of AD. METHODS: In vitro AD model was established by the incubation of fibrillar amyloid-ß 1-42 (Aß1-42) for 48 hours with cultured cerebellar granule neurons (CGNs) isolated from post-natal eight-day rats. The regulatory role of topo IIß on the transcription of Nurr1 was analyzed in topo IIß silenced CGNs, and also topo IIß silenced and overexpressed in a neurally-differentiated human mesenchymal (hMSC) cell line. RESULTS: Aß1-42 fibrils led to the upregulation of Presenilin1 and Cofilin1 genes as measured at mRNA levels and hyperphosphorylation of tau protein, all are distinctive characteristics of AD pathology. A significant decrease in topo IIß expression at mRNA and protein levels and Nurr1 at mRNA level was also observed. In both cell types, Nurr1 expression was dramatically down-regulated due to topo IIß deficiency, and was increased in topo IIß overexpressing hMSCs. CONCLUSION: Our findings suggest that topo IIß could be a down-stream target of signaling pathways contributing to AD-like pathology. However, further studies must be carried out in vivo to elucidate the precise association topo IIß with AD.

Differential roles of postsynaptic density-93 isoforms in regulating synaptic transmission.

In the postsynaptic density of glutamatergic synapses, the discs large (DLG)-membrane-associated guanylate kinase (MAGUK) family of scaffolding proteins coordinates a multiplicity of signaling pathways to maintain and regulate synaptic transmission. Postsynaptic density-93 (PSD-93) is the most variable paralog in this family; it exists in six different N-terminal isoforms. Probably because of the structural and functional variability of these isoforms, the synaptic role of PSD-93 remains controversial. To accurately characterize the synaptic role of PSD-93, we quantified the expression of all six isoforms in the mouse hippocampus and examined them individually in hippocampal synapses. Using molecular manipulations, including overexpression, gene knockdown, PSD-93 knock-out mice combined with biochemical assays, and slice electrophysiology both in rat and mice, we demonstrate that PSD-93 is required at different developmental synaptic states to maintain the strength of excitatory synaptic transmission. This strength is differentially regulated by the six isoforms of PSD-93, including regulations of α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) receptor-active and inactive synapses, and activity-dependent modulations. Collectively, these results demonstrate that alternative combinations of N-terminal PSD-93 isoforms and DLG-MAGUK paralogs can fine-tune signaling scaffolds to adjust synaptic needs to regulate synaptic transmission.

Synaptic state-dependent functional interplay between postsynaptic density-95 and synapse-associated protein 102.

Activity-dependent regulation of AMPA receptor (AMPAR)-mediated synaptic transmission is the basis for establishing differences in synaptic weights among individual synapses during developmental and experience-dependent synaptic plasticity. Synaptic signaling scaffolds of the Discs large (DLG)-membrane-associated guanylate kinase (MAGUK) protein family regulate these processes by tethering signaling proteins to receptor complexes. Using a molecular replacement strategy with RNAi-mediated knockdown in rat and mouse hippocampal organotypic slice cultures, a postsynaptic density-95 (PSD-95) knock-out mouse line and electrophysiological analysis, our current study identified a functional interplay between two paralogs, PSD-95 and synapse-associated protein 102 (SAP102) to regulate synaptic AMPARs. During synaptic development, the SAP102 protein levels normally plateau but double if PSD-95 expression is prevented during synaptogenesis. For an autonomous function of PSD-95 in regulating synaptic AMPARs, in addition to the previously demonstrated N-terminal multimerization and the first two PDZ (PSD-95, Dlg1, zona occludens-1) domains, the PDZ3 and guanylate kinase domains were required. The Src homology 3 domain was dispensable for the PSD-95-autonomous regulation of basal synaptic transmission. However, it mediated the functional interaction with SAP102 of PSD-95 mutants to enhance AMPARs. These results depict a protein domain-based multifunctional aspect of PSD-95 in regulating excitatory synaptic transmission and unveil a novel form of domain-based interplay between signaling scaffolds of the DLG-MAGUK family.