Aesthetic outcomes of breast-conserving surgery and oncoplastic surgery with the new scale named Quality of Life Questionnaire Breast Reconstruction Module-23.

Purpose: Oncoplastic surgery (OPS) has been developed with the aim of improving breast-conserving surgery (BCS) to provide better aesthetic and functional outcomes for breast cancer patients. We aimed to compare overall quality of life (QoL) and satisfaction with breast reconstruction in patients undergoing BCS and OPS using the Quality of Life Questionnaire Core 30 (QLQ-C30) and recently validated QLQ-Breast Reconstruction module (QLQ-BRECON23). Methods: A total of 87 patients were included in this single-center study between January 1, 2018 and December 31, 2021; 43 underwent OPS (49.4%) and 44 underwent BCS (50.6%). The data on patient, tumor, and treatment characteristics were obtained from the prospectively collected database at the hospital. QLQ-C30 and QLQ-BRECON23 were used to evaluate psychosocial well-being, fatigue symptoms, overall QoL, sexual well-being, sensation of the operative area, and satisfaction with the reconstruction. Results: According to QLQ-C30 evaluation there were significantly better outcomes for patients treated with OPS than BCS in terms of psychosocial well-being, fatigue symptoms, and overall QoL (P = 0.005, P = 0.016, and P = 0.004; respectively), according to QLQ-BRECON23 evaluation there were also significantly better outcomes in terms of sexual well-being, sensation of the operative area, and satisfaction of the reconstruction (P < 0.001, P = 0.002, and P < 0.001; respectively). Conclusion: We found that the overall QoL and satisfaction with breast reconstruction in patients undergoing OPS are better than those undergoing BCS. Our study is critical because it is the first study comparing OPS and BCS using the QLQ-BRECON23, which was recently validated.

Prognostic value of Prognostic Nutritional Index (PNI) for 5-year recurrence-free survival in surgically resected gastrointestinal stromal tumors.

BACKGROUND: Recent studies have investigated the role of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and prognostic nutritional index (PNI) on prognosis for various malignancies. However, the value of these markers in determining the prognosis for gastrointestinal stromal tumors (GIST) remains controversial. We investigated the effect of NLR, PLR, SII, and PNI on 5-year recurrence-free survival (RFS) in patients with surgically resected GIST. MATERIALS AND METHODS: We retrospectively analyzed patients (n=47) who had undergone surgical resection for primary, localized GIST at a single institution between 2010 and 2021. The patients were divided into two groups according to the recurrence status in the 5-year period as 5-year RFS(+) (patients with no recurrence (n=25) and 5-year RFS(-) (patients with recurrence (n=22) groups. RESULTS: In univariate analyses, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), tumor localization, tumor size, PNI, and risk category were significantly different between the RFS(+) and RFS(-) groups while NLR, PLR, SII were not. Multivariate analyses revealed that only the tumor size (HR =5.485, 95% CI: 0.210-143.266, p=0.016), and PNI (HR= 112.020, 95% CI: 8.755-1433.278, p<0.001) were independent prognostic factors for RFS. The patients with a high PNI (≥46.25) had a higher 5-year RFS rate than the patients with low PNI (<46.25) (95.2% to 19.2%, p<0.001). CONCLUSION: A higher preoperative PNI is an independent positive predictor for 5-year RFS for patients with surgically resected GIST. However, NLR, PLR, and SII have no significant effect. KEY WORDS: GIST, Prognostic Nutritional Index, Prognostic Marker.

The effects of Capparis ovata seed oil on the healing of traumatic skin wounds.

BACKGROUND: Capparis ovata contains alkaloids, lipids, polyphenols, flavonoids, and also is rich in antioxidants. Conventionally, in Turkey, the flower buds, root, bark, and fruits of C. ovata are used for their analgesic, anti-inflammatory, anti-rheumatism, tonic, and diuretic effects. The aim of this study was to examine the effect on wound healing of C. ovata seed oil (COSO), which is known to have antioxidant, anti-inflammatory, and antibacterial properties. METHODS: In the study, 20 Wistar albino female rats were randomly divided into two groups of 10 animals each. A standard full-thickness skin defect was created on the back area of the rats. In both groups, after cleaning the wounds with saline daily, no active substance other than saline was applied to the control group, while 1 cc/day COSO was applied to the wounds of the rats in the study group. On the post-operative 14th day, the rats were reanesthetized and wound area measurements were made. Then, excision was performed to include 1 cm of intact tissue around the wound, which remained unhealed, and samples were taken for histopathological examination. RESULTS: The changes in wound areas showed that after 14 days, the improvement in the group treated with caper oil (32.78; 95% confidence interval, 17.21-48.36) was significantly higher than that of the control group (65.41; 95% confidence interval, 49.84-80.98) (p=0.009). The histopathological scores showed a significant difference between the groups in respect of epithelial formation, inflam-mation, and fibrosis development. No epithelial tissue formation was observed in the control group (90%), and more incomplete re-epithelization and focal epidermal hyperplasia were observed in the treatment group (60%). Fibrosis development was mild and weak (70%) in the control group and was evaluated as severe and intense (60%) in the treatment group. Perivascular edema was mild (50%) and vascularity was immature (60% - an indicator of neovascularization) in the treatment group. These histopathological results showed that the treatment group inflammation phase was completed and the proliferation phase started, as well as the effectiveness of the use of caper oil on epithelization, angiogenesis, and fibrosis, which are important histopathological parameters in the evaluation of wound healing compared to the control group. CONCLUSION: From the results of this study, it was concluded that COSO significantly enhances the healing of full-thickness skin wounds and this effect is primarily related to its anti-inflammatory effect.

Effect of Topical Application and/or Systemic Use of Red Ginseng Extract on Wound Healing in Rats With Experimentally Induced Diabetes.

BACKGROUND: Red ginseng (Rg) is an herbal product that has been used in traditional medicine in Asian and European countries for many years. PURPOSE: To study the effects of Rg extract on wound healing when used systemically, locally, or in combination in rats with experimentally induced diabetes. METHODS: A total of 60 rats were randomly divided into 4 groups: saline (control), local Rg (LRg), systemic Rg (SRg), and local + systemic = combined Rg (CRg). A full-thickness wound (2 cm × 1 cm) was created on the back of the rats, and treatment protocols were carried out for 14 days. Wound areas of all rats were measured on days 0 and 14. Tissue samples were taken from the wound areas for histopathologic evaluation of inflammation, epithelialization, and fibrosis. Vascular endothelial growth factor (VEGF), CD4+, and CD8+ expressions were examined by immunohistochemistry. RESULTS: Wound contraction measurements were 63.8%, 80.5%, 88.5%, and 86.6% in the control, LRg, SRg and CRg groups, respectively. Although significant differences were observed for all treated groups (LRg, SRg, and CRg) compared with the control group in terms of wound contraction, there was no difference among the treatment groups. VEGF-positive vessel/mm2 was observed 4.00 ± 0.75, 5.93 ± 0.70, 5.93 ± 1.93, and 7.93 ± 0.70 in the control, LRg, SRg and CRg groups, respectively. There was no difference between LRg and SRg in terms of VEGF expression, but there was significant difference for all other groups compared with each other. CONCLUSION: All usage methods of Rg extract increased wound contraction, and differences were observed compared with the control group. However, the authors believe that the combined usage was more effective due to higher VEGF expression levels and lower CD4+:CD8+ ratio.

Squamous-cell carcinoma due to mesh infection after umbilical hernia operation: third case of the literature.

INTRODUCTION: Polypropylene (PP) meshes are safe synthetic products used for hernia repairs and associated with minimal complication. Chronic inflammation is thought to play a pathophysiological role in the development of cancer.Case presentation: We present a 67-year-old female case of squamous cell-cancer (SCC) that developed due to mesh after umbilical hernia operation. The mass in the anterior abdominal wall was totally resected. Pathology was reported as T2N0, moderately differentiated acantholytic type SCC. No recurrence or complication was detected in the fourth-month follow-up. CONCLUSION: Cancer development after mesh is very rare and our case is the third case in the literature. Cancer development should be kept in mind in patients presenting with ulcerated masses if do not regress with infection treatment after mesh application.

Topical and Systemic Effects of N-acetyl Cysteine on Wound Healing in a Diabetic Rat Model.

OBJECTIVE: This study evaluates the effects of topical and systemic N-acetyl cysteine (NAC) treatment on wound healing in a diabetic rat model. MATERIALS AND METHODS: A total of 48 male Wistar Albino rats were randomly divided into 4 groups of 12. Diabetes was induced with an intraperitoneal injection of 60 mg/kg streptozotocin. A 2-cm x 1-cm full-thickness wound was created on the back of each animal. In group 1 (control) and group 3 (systemic NAC), the wounds were closed with 0.9% sodium chloride-treated sterile gauze. In group 2 (topical NAC) and group 4 (topical + systemic NAC), the wounds were closed with sterile gauze treated with 3 mL (300 mg) of NAC. The animals in groups 3 and 4 were administered 200 mg/kg of NAC once daily through an orogastric tube. On days 1 and 14, the wounded areas were measured. Tissue and blood samples were taken on day 14 for histopathological and biochemical examination. RESULTS: On day 14, the wounded area in groups 2, 3, and 4 was found to be smaller than in group 1 (control). Histopathologically, epithelialization and fibrosis scores were significantly lower, whereas the inflammation score was higher in group 1 than in the other groups. Tissue oxidative stress parameters (malondialdehyde, fluorescent oxidation products, total oxidative stress) were higher in the control group than in the other groups. In groups 3 and 4 (which received systemic NAC), the oxidative stress parameters in serum samples were lower than those of the control group and group 2. Serum sulphydryl levels were the lowest in group 1. CONCLUSIONS: The results of this study show that both topical and systemic administration of NAC improved wound healing in a diabetic rat model. This effect of NAC may be related to its antioxidant properties since a reduction in oxidative stress parameters in both tissue and serum were shown in the present study.

The Preventive Effect of Dexmedetomidine Against Postoperative Intra-abdominal Adhesions in Rats.

This study aimed to determine the possible preventive effects of dexmedetomidine on postoperative intra-abdominal adhesions. Dexmedetomidine is a highly selective and potent α2 adrenergic agonist with sedative, analgesic, anxiolytic, sympatholytic, hemodynamic, and diuretic properties. In recent years, investigations have shown that dexmedetomidine possesses secondary antioxidant and also anti-inflammatory effects. Thirty Wistar albino male rats were randomized and divided into 3 groups of 10 animals each: group 1, sham-operated; group 2, cecal abrasion + peritoneal dissection; group 3, cecal abrasion + peritoneal dissection followed by daily intravenous injection of 10 µg/kg dexmedetomidine for 10 days. The animals were killed on postoperative day 21. Blood and cecal samples were taken for biochemical and histopathologic evaluation. In this study, biochemical and pathologic parameters were significantly better in the cecal abrasion + peritoneal dissection + dexmedetomidine group when compared with the cecal abrasion + peritoneal dissection group. Tissue malondialdehyde, myeloperoxidase, total sulfhydryl, and catalase were found to be significantly different between the cecal abrasion/peritoneal dissection + dexmedetomidine and the cecal abrasion/peritoneal dissection groups. Plasma malondialdehyde and total sulfhydryl values were also statistically different between these groups (P < 0.05). Statistical analyses of mean pathologic scores showed that the histopathologic damage in the cecal abrasion/peritoneal dissection + dexmedetomidine group was significantly less than the damage in the control group (P < 0.05 for all pathologic parameters). The results of this study show that dexmedetomidine had a significant preventive effect on postoperative intra-abdominal adhesions. We concluded that these effects might be due to antioxidant and anti-inflammatory activities.

Effects of the Oral Nutritional Supplement Containing Arginine, Glutamine, and Hydroxymethylbutyrate (Abound®) on Healing of Colonic Anastomoses in Rats.

We evaluated the effects of the oral nutritional supplement containing arginine, glutamine, and hydroxymethylbutyrate (Abound®) on healing of colonic anastomoses in experimental rat model. Seventy Wistar-Albino male rats were divided into seven groups. Colon transection and anastomosis were performed in all groups except for the sham group. In groups 2 and 5, rats were fed with standard rat chow after the operation. Oral nutritional supplement was added to standard nutrition for 3 days postoperatively in group 3 and 7 days in group 6 and preoperative 7 days plus postoperative 3 days in group 4 and preoperative 7 days plus postoperative 7 days in group 7. Bursting pressures were measured, adhesions were evaluated, and tissue samples were taken for measurement of tissue hydroxyproline levels and for histopathological examination. The usage of oral nutritional supplement had positive effects on bursting pressures, tissue hydroxyproline levels, and histopathological findings of anastomoses, but feeding with oral nutritional supplement both preoperatively and postoperatively had no additive effect on these parameters when compared with the groups that were fed only postoperatively. The mixture of arginine, glutamine, and hydroxymethylbutyrate may be safely used for achieving better healing results after colonic anastomoses.