The association of PD-L1 expression and CD8-positive T cell infiltration rate with the pathological complete response after neoadjuvant treatment in HER2-positive breast cancer.

PURPOSE: Achieving a pathological complete response (pCR) after neoadjuvant therapy in HER2-positive breast cancer patients is the most significant prognostic indicator, suggesting a low risk of recurrence and a survival advantage. This study aims to investigate clinicopathological parameters that can predict the response to neoadjuvant treatment in HER2 + breast cancers and to explore the roles of tumour-infiltrating lymphocytes (TILs), CD8 + T lymphocytes and PD-L1 expression. METHODS: This single-centre retrospective study was conducted with 85 HER2-positive breast cancer patients who underwent surgery after receiving neoadjuvant therapy between January 2017 and January 2020. Paraffin blocks from these patients were selected for immunohistochemical studies. RESULTS: A complete pathological response to neoadjuvant treatment was determined in 39 (45.9%) patients. High Ki-67 index (> 30%), moderate to high TIL infiltration, PD-L1 positivity and high CD8 cell count (≥ 25) were significantly associated with pCR in univariate analyses (p: 0.023, 0.025, 0.017 and 0.003, respectively). Multivariate regression analysis identified high Ki-67 index (> 30%) and CD8 cell infiltration as independent predictors for pCR in HER2-positive breast cancer. CONCLUSIONS: High Ki-67 index, and high CD8 cell count are strong predictors for pCR in HER2-positive breast cancer. Tumours with high Ki-67 index, high TILs and CD8 infiltration may represent a subgroup where standard therapies are adequate. Conversely, those with low TILs and CD8 infiltration may identify a subgroup where use of novel strategies, including those that increase CD8 infiltration could be applied.

Contribution of Turkey in Liver Transplant Research: A Scopus Database Search.

OBJECTIVES: Liver transplantation is considered the most effective treatment modality for end-stage liver failure. The first deceased donor liver transplant in Turkey was performed by Haberal and colleagues in 1988; in 2019, a total of 1776 livertransplant procedures were performed in Turkey. While these are well-known and documented facts, the scientific output of publications on liver transplantation from Turkey is unknown.This study aimed to analyze the contribution of Turkey in liver transplant global research. MATERIALS AND METHODS: Publications from Turkey on liver transplantation were analyzed using the bibliometric study method. The following research parameters were analyzed: year of publication, institutions and authors, funding, themes, sample population, and methods. We used the Scopus database to research key words containing "liver" or "hepatic"and"transplantation" in the titles, abstracts, and key words. Among duplications or multiple results, only 1 publication was included in the study. Data were analyzed by quantitative and qualitative methods. RESULTS: We identified 45 763 publications on liver transplant. Most of the publications were in the field of medicine (93.48%). Turkey ranked fourteenth with 843 publications. The top productive affiliation was Baskent University, and the most productive author was Prof. Haberal. CONCLUSIONS: Among countries, Turkey had the most living donor liver transplants in 2019 and could serve as a modelto European countries for donor shortages. Although the United States performs 5 times more liver transplants than Turkey, their publications rate was almost 22 times more. Combining a workload of performing research and publishing along with transplant surgery is together hard to master. Although Turkey has valuable experiences and has opened frontiers in transplantation, publications need to keep up with their hard work and innovations.

Hypochlorous Acid: A Novel Agent Against Echinococcus granulosus Protoscoleces.

Objective: We aimed to determine the scolicidal effect of hypochlorous acid and its efficiency at different concentrations. Materials and Methods: We tested the effectiveness of hypochlorous acid in-vitro on sterile gauze at different concentrations in test tubes. In addition, we compared its effectiveness with the scolicidal activity of other agents, povidone-iodine 10% and chlorhexidine-gluconate 0.04%. Results: Hypochlorous acid was 100% effective in 5 minutes at 1/1 (200 ppm/mL), 1/10 (20 ppm/ml), and 1/100 (2 ppm/mL) concentrations and in 10 minutes at 1/1000 (0.2 ppm/mL) concentration. Povidone-iodine 10%, and chlorhexidine-gluconate 0.04% were studied undiluted and were effective at all study times. Hypochlorous acid maintained the same scolicidal activity on gauze at all study times at the described dilutions. Conclusion: Hypochlorous acid is an effective scolicidal agent in 5 minutes at even 1/100 concentrations. In addition, it maintains the same scolicidal activity on gauze used in surgery to wall the surgical site.

Pancreatic inflammatory myofibroblastic tumor presenting with extracolonic obstruction.

Inflammatory myofibroblastic tumor is a rare soft tissue tumor which can be detected in many parts of the body. Its etiology and clinical behavior are not fully understood, and its treatment is controversial. This study aimed to present the management of a pancreatic tail case presenting with extracolonic obstruction findings. Unblock distal pancreatectomy + left surrenalectomy + left hemicolectomy + splenectomy operation was made with R0 resection principles. Although there are some medical treatments reported in children and unresectable tumors in the medical literature, complete surgical resection following oncological principles seems to be the most important and main treatment modality in the treatment of inflammatory myofibroblastic tumors. However, inflammatory myofibroblastic tumor has many aspects that are not yet clearly understood, and it is a disease being continuously researched.

Characteristics of the injuries of Syrian refugees sustained during the civil war.

BACKGROUND: During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery. METHODS: Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively RESULTS: Most of the patients reported having been injured due to firearms (83.75%). Of the 707 cases studied in this work, 93.2% was male. Male patients reported a mean age of 26.1±12.1 years, while pediatric cases reported a mean age of 11.7±3.41 years. The most frequently injured region of the body was the head-neck region (52.7%). The New Injury Severity Score (NISS) of the cases was 42.5±11.2 and their American Society of Anesthesiologists (ASA) score was 3.2±0.7. The number of cases with intraoperative exitus was 7, while the number of cases who had undergone damage control surgery was 204. The number of cases hospitalized in the ICU during the postoperative period was 233, and the average hospitalization duration in the ICU was 4.67±1.32 days. Among survivor patients, the first 24-hour invasive measurements (i.e., pH, hemoglobin, body temperature, and mean arterial blood pressure) and international normalized ratio were found to be high. The number of blood products used for surviving patients was fewer relative to that used for non-surviving patients, and these NISS of these patients was 29.7±10.1. The mortality rate of all patients followed up in the ICU after emergency surgery was 45%, and neurosurgical cases showed the lowest level of survival (24.1%). CONCLUSION: The results of this study indicated that head-neck, chest-abdomen, and multiple body injuries are the most widely seen among civilians brought to Turkey because of gunshot injuries sustained during the Civil War in Syria. The number of emergency operations performed in the study sample was high, and critical care follow-up durations were long. In addition, the NISS and ASA scores of mortal cases were fairly high.

Spontaneous idiopathic pneumoperitoneum with acute abdomen.

Pneumoperitoneum is often caused by visceral perforation, and usually manifests with symptoms of peritonitis requiring surgical intervention. Non-surgical spontaneous pneumoperitoneum (ie. not associated with organ perforation) is a rare entity due to intrathoracic, intra-abdominal, gynecologic, iatrogenic or other reasons, and is usually treated conservatively. Idiopathic spontaneous pneumoperitoneum is even rarer than visceral perforation or other causes of free intra-abdominal air. In this report, we present a case of idiopathic spontaneous pneumoperitoneum. A seventy-five-year-old female patient presented with acute abdominal pain, low-grade fever, and nausea. Her abdominal examination findings were vague, and she did not have leukocytosis. Free intra-abdominal air was detected on plain X-ray, she was followed-up with cessation of oral intake, nasogastric tube, fluid resuscitation and prophylactic antibiotics for one day. There were no signs of acute abdomen except diffuse abdominal tenderness by deep palpation on the first day examination. There was a mild leukocytosis with a shift to the left in leukocytes, and pneumoperitoneum on abdominal X-ray. The abdominal computed tomography revealed free intra-abdominal air and minimal free fluid in Douglas pouch. Her past medical history revealed cholecystectomy (10 years ago) with no chronic diseases, regular medications, smoking, or alcohol consumption. The patient underwent emergency laparotomy. Despite lack of an identifiable cause and uncertainty of etiology, the patient was discharged on postoperative day 5. A thorough medical history, appropriate laboratory tests and radiological techniques and physical examination should be combined for identification of patients with non-surgical pneumoperitoneum, and avoid unnecessary laparotomy, while minimally invasive techniques such as laparoscopy should be considered as part of evaluation.

Could total thyroidectomy become the standard treatment for Graves' disease?

PURPOSE: Graves' disease is the most frequent cause of hyperthyroidism. Although treatment with antithyroid drugs or radioactive iodine is effective, surgery remains the preferred treatment for many patients. We analyzed the results of 55 prospectively followed patients who underwent total thyroidectomy for Graves' disease. METHODS: Total thyroidectomy was performed by experienced endocrine surgeons in all 55 patients. We monitored the patients postoperatively for early and late complications. RESULTS: There were 19 men, with a mean age of 42 years (range, 34-68 years) and 36 women, with a mean age of 38 years (range, 19-78 years). One patient suffered postoperative hemorrhage and subsequent wound infection, two patients had transient recurrent laryngeal nerve palsy, and 24 patients had transient hypocalcemia. The mean follow-up time was 4 years (range, 10 months to 6 years). Recurrence of hyperthyroidism was not reported in this period. CONCLUSION: Removal of all thyroid tissue offers the best chance of preventing recurrent hyperthyroidism. Total thyroidectomy is the most effective surgery for achieving the goal of treatment of Graves' disease to ensure that hyperthyroidism will not recur.