Nucleosome assembly protein 1-like 1 (NAP1L1) in colon cancer patients: a potential biomarker with diagnostic and prognostic utility.

OBJECTIVE: To evaluate the diagnostic and prognostic utility of nucleosome assembly protein 1-like 1 (NAP1L1) in colon cancer patients. PATIENTS AND METHODS: A total of 95 patients with colon cancer [mean (SD) age: 61.0 (1.7) years, 58.9% were males] and 50 healthy individuals [mean (SD) age: 61.0 (2.3) years, 52.0% were males] were included in this prospective multicenter study. Data on patient demographics (age, gender) and serum NAP1L1 levels were recorded in both control and colon cancer groups. In colon cancer patients, serum NAP1L1 levels were further analyzed with respect to TNM stages and tumor size. RESULTS: Serum NAP1L1 levels were significantly higher in colon cancer patients as compared with control subjects [median (min-max) 14(12-16) vs. 2(1-2) ng/mL, p<0.001]. In colon cancer patients, serum NAP1L1 levels were significantly higher for tumor size of >4 cm vs. <4 cm [15(12-16) vs. 12(12-14) ng/mL), p<0.001] and for M1 vs. M0 stage [15(12-16) vs. 12(12-14) ng/mL), p<0.001]. Serum NAP1L1 levels were significantly higher in T4 stage tumors vs. T1, T2 and T3 stage tumors (p<0.001 for each), in T3 stage tumors vs. T1 and T2 stage tumors (p<0.001 for each) and in N2 stage tumors vs. N0 and N1 stage tumors (p<0.001 for each). CONCLUSIONS: Our findings revealed for the first time the substantial rise in serum NAP1L1 levels among colon cancer patients as compared to controls and as correlated with the disease progression. Accordingly, NAP1L1 seems to be a potential biomarker for colon cancer, offering clinically important information on early diagnosis and risk stratification.

The Role of Diffusion-Weighted Magnetic Resonance Imaging in the Differential Diagnosis of Simple and Hydatid Cysts of the Liver.

INTRODUCTION: The present study indicates that simple and hydatid cysts in liver are a common health problem in Turkey. The aim of the study is to differentiate different types of hydatid cysts from simple cysts by using diffusion-weighted images. MATERIALS AND METHODS: In total, 37 hydatid cysts and 36 simple cysts in the liver were diagnosed. We retrospectively reviewed the medical records of the patients who had both ultrasonography and magnetic resonance imaging. We measured apparent diffusion coefficient (ADC) values of all the cysts and then compared the findings. RESULTS: There was no statistically meaningful difference between the ADC values of simple cysts and type 1 hydatid cysts. However, for the other types of hydatid cysts, it is possible to differentiate hydatid cysts from simple cysts using the ADC values. CONCLUSION: Although in our study we cannot differentiate between type I hydatid cysts and simple cysts in the liver, diffusion-weighted images are very useful to differentiate different types of hydatid cysts from simple cysts using the ADC values.

A novel screening test for esophageal squamous cell carcinoma: sirtuin-3.

OBJECTIVE: Human sirtuin-3, a protein involved in the mediation of tumors, has been shown to be present in malignancies. The goal of this study was to measure serum sirtuin-3 levels in esophageal squamous cancer cells and to determine whether sirtuin-3 may possess predictive value in advanced cases of esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS: A total of 130 ESCC patients and 50 healthy control subjects participated to the study. Serum sirtuin-3 levels for all 180 subjects were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: Median sirtuin-3 levels were significantly higher in patients with ESCC than in the control subjects. CONCLUSIONS: The presence of considerably elevated levels of sirtuin-3, could be a powerful mediator of advanced ESCC in ESCC patients, suggests that sirtuin-3 may be a useful indicator of the disease.

Unpredictable behavior of breast phyllodes tumors.

OBJECTIVE: Phyllodes Tumor is a rare fibroepithelial breast tumor with variable malignant potential. These tumors that currently accepted nomenclature are benign, borderline and malignant according to the World Health Organization. It tends to behave in a benign way but it may undergo a malignant transformation. The purpose of this study was to present our Case load of phyllodes tumor, and evaluate the management and follow-up the behavior of these tumors. PATIENTS AND METHODS: 36 patients with phyllodes tumor were treated in Bezmialem Vakif University and Okmeydani Training and Research Hospitals analyzed retrospectively. Demographics, presenting symptoms, history, local examination, preoperative clinical diagnosis, treatment, postoperative histopatology, follow-up period were evaluated retrospectively and studied. RESULTS: A total of 36 patients treated for phyllodes tumor were analyzed. Mean age of the patients was 38 (14-79) and all were females. The presentation of the patients was breast lump in all cases, either as a primary or recurrent lump presentation. The right and left breast were affected 58% and 42% respectively. 34 of these 36 cases are briefly mentioned in this paper but the two cases, one with sarcomatous malignant transformation and the other with fatal metastatic phyllodes tumor in an adolescent female are discussed in detail. The mean duration of the symptomatic mass was 9.8 ± 7.3 months (range 0.5 to 24). CONCLUSIONS: Phyllodes tumor is a type of tumor that may be benign or malignant. The type with malignant features may be fatal. The tumors diagnosed as benign may transform and become malignant because of unknown reasons and may be an aggressive tumor.

A novel screening test for colon cancer: Talin-1.

OBJECTIVE: Cell adhesion and angiogenesis within the extracellular matrix involve special signaling molecules, such as integrins and the actin binding protein Talin-1. The aim of this study was to investigate and describe the expression of Talin-1 for the early detection of colon cancer. PATIENTS AND METHODS: Blood serum samples were collected from 50 healthy volunteers and from 90 patients with colon cancer. Using an enzyme-linked immunosorbent assay (ELISA), all 140 samples were analyzed. RESULTS: Preoperative levels of Talin-1 in the serum were significantly higher in patients with colon cancer (p < 0.001). No significant correlation was found between preoperative levels of Talin-1 in the serum and the age and gender of the patients (p < 0.05). However, a significant correlation was found between Talin-1 levels and the tumor grade, TNM stage, and lymph node metastasis (p < 0.001). CONCLUSIONS: Talin-1 may play a role in the reinforcement of cell proliferation, cell adhesion, and angiogenesis in colon cancer. Thus, the Talin-1 protein activity may be a novel biomarker to detect colon cancer in humans.

LigaSure® versus clamp tie technique for thyroid surgery; decreased operative time versus increased inflammatory effect: a prospective randomized study.

OBJECTIVE: The aim of this study was to compare the LigaSure® Small Jaw Instrument (LSJI) with the conventional clamp-and-tie (CT) technique in thyroid surgery regarding complication rates (hematoma, hypocalcemia and recurrent nerve palsy), the duration of the operative procedure, and systemic and local inflammatory effects. PATIENTS AND METHODS: Fifty-four consecutive patients were randomized prospectively into two groups, a Conventional Clamp-Tie (CT) group and a LigaSure® Vessel Sealing System (LVSS) Group. Pre- and postoperative blood plasma samples were taken to measure the tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), calcium, parathormon, CRP levels and WBC, as well as the lymphocyte subset (CD3, CD4, CD8, CD16/56, CD19) counts. The drain fluid samples were collected after the removal of the drains to measure the levels of IL-6 and TNF-α. RESULTS: Both groups showed significant changes regarding peripheral blood CD3+, CD4+, and CD8+ T cell levels (p < 0.05). In the LVSS group, the level of CD16+56+ NK cells showed a significant decrease compared with the CT group (p < 0.05). The IL-6 and TNF-α levels in the drainage fluid were significantly higher in the LVSS group. CONCLUSIONS: We demonstrated that LSJI can decrease operative time. Although the systemic inflammatory effect of LSJI remains inconclusive, the local inflammatory effect was significant, which could cause early and late postoperative problems.

Is Hashimoto's thyroiditis a prognostic factor for thyroid papillary microcarcinoma?

AIM: The relationship between papillary thyroid carcinoma (PTC) and accompanying Hashimoto's thyroiditis (HT) has been investigated extensively. However, there is no agreement among the authors. We aimed with this study to investigate this relationship in a limited subtype of PTC called papillary thyroid microcarcinoma (PTMC). PATIENTS AND METHODS: Between January 1999 and December 2012, 1923 thyroids were surgically resected in two referral centers and thoroughly inspected for evidence of PTMC. Of these patients, 172 who were diagnosed with PTMC had demographic and pathological features recorded. RESULTS: Fourteen patients (8.1%) were found to have CLN metastases. Eleven (78.6%) of the patients with CLN metastases had tumors larger than 5 mm, and 3 (21.4%) patients with CLN metastases had small tumors (≤ 5 mm), but there was no statistical significance (p > 0.05). Accompanying Hashimoto's thyroiditis (HT) was detected in 67 (39%) patients. The CLN metastasis rate was slightly higher in cases with HT in surrounding thyroid tissue. However, there was no statistical significance; the CLN rate was 6.7% (n=7) in patients without thyroiditis and 10.4% (n=7) with Hashimoto's thyroiditis. Insufficient FNA results in patients with thyroiditis were associated with HT (p < 0.05). CONCLUSIONS: Surgeons and other clinicians who play a role in the treatment of thyroid cancers should be aware that some PTMC cases may show a worse course, as with some PTCs, contrary to expectations.

The association between serum Dickkopf-1 levels and esophageal squamous cell carcinoma.

Serum Dickkopf-1(DKK-1) is elevated in many malignancies and is an important indicator of malignant potential. However, its significance in esophageal squamous cell cancer (ESCC) has not yet been clarified. We hypothesized a role for DKK-1 in patients with ESCC. The study consisted of 90 ESCC patients and 85 healthy controls. After diagnosis, the level of DKK-1 was measured in the serum samples by enzyme-linked immunosorbent assay and the levels of DKK-1 were much higher in the ESCC patients than in the healthy control group (p < 0.0001). For serum DKK-1, the sensitivity and specificity of the assay were 70 and 80%, respectively. The preoperative serum DKK-1 level was elevated in the ESCC patients. Although serum DKK-1 is not a specific biomarker for ESCC, it might be a useful marker for the diagnosis and treatment of ESCC.

The relationship between serum tumor-associated trypsin inhibitor levels and clinicopathological parameters in patients with gastric cancer.

BACKGROUND: Tumor-associated trypsin inhibitor (TATI) is expressed with trypsinogen in tumors. We studied the clinical-pathologic association and significance of preoperative serum levels of TATI in gastric cancer patients. PATIENTS AND METHODS: Pre-treatment serum levels of TATI in patients with gastric cancer and healthy controls were analyzed by a specific enzyme-linked immunosorbent assay (ELISA). RESULTS: Statistically significant differences were found in serum TATI levels between patients with gastric cancer and healthy controls (p < 0.0001). There was a significant relationship between the serum levels of TATI and clinicopathological parameters. However, serum levels of TATI were significantly higher in patients with an advanced T stage (T3) (p < 0.001), lymph node metastasis (p < 0.001) and an advanced TNM stage (stage III or IV; p < 0.001). CONCLUSIONS: Our study suggests that TATI may be used to identify potentially high-risk groups of upper gastric carcinoma. Elevated level of TATI was associated with progressive disease or advanced stage.

Evaluation of the effects of hyperbaric oxygen treatment and enoxaparin on left colon anastomosis. An experimental study.

BACKGROUND: Surgical interventions on left colon lead to high morbidity. The problems in wound healing are the main cause of this morbidity. Hypoxia retards wound healing and hyperbaric oxygen treatment (HBOT) has an anti-hypoxic effect. MATERIALS AND METHODS: In this experimental study we divided eighty Wistar albino rats into eight groups and numbered between 1 and 8. Normal (non-ischemic) and ischemic left colon anastomosis were performed in the first and second four groups respectively. HBOT and subcutaneous enoxaparin were applied to the groups separately and in combination for four days, except the control groups. (Group-1 and Group-5). We measured anastomotic bursting pressures and performed pathological examinations besides electron microscopic study in one sample from each group after sacrificing the rats on the fourth day. RESULTS: There were no statistically significant differences in bursting pressures when we compared Group-1 with other non-ischemic groups, and Group-5 with Group-6, but there were statistically significant differences when we compared Group-5 with Group-7 and 8. In pathological examination, there were no statistically significant differences between the groups concerning necrosis, epithelization, granulation tissue formation and collagen deposition. Statistically significant differences were found in the scores of neovascularization when we compared Group-1 with Group-3 and 4, and Group-5 with Group-8. Electron microscopic evaluation revealed a prominent increase both in neovascularization and collagen fibers in the samples taken from the groups received enoxaparine and hyperbaric oxygen treatment in combination. CONCLUSIONS: These findings suggest that HBOT increases neovascularization and bursting pressures in ischemic colon anastomosis in contrast with enoxaparin.

Treatment of ischemic colonic anastomoses with systemic transplanted bone marrow derived mesenchymal stem cells.

BACKGROUND: The aim of the study is to investigate the healing effect of the bone-marrow derived mesenchymal stem cells (BM-MSCs) on ischemic colon anastomosis in systemic application and to recovery the adverse effect of ischemia. MATERIALS AND METHODS: Fourty male Wistar Albino rats weigthing 250-300 g were divided into four equal groups (n=10 Group 1: control; ischemic left colonic anastomoses (4th day); Group 2: control; ischemic left colonic anastomoses (7th day); Group 3: ischemic left colonic anastomoses + systemic transplanted BM-MSCs (4th day); Group 4: ischemic left colonic anastomoses + systemic transplanted BM-MSCs (7th day). BMSCs labelled with bromodeoxyuridine (BrdU) were transplanted into the vena cava. Group 1 and group 3 were killed four days after surgery. In group 2 and group 4 were sacrificed seven days after the surgical procedure. Histopathological features, hydroxyproline levels in the tissue, and anastomotic strength were investigated. RESULTS: There was no mortality all of the groups.The mean bursting pressures of ischemic colonic anastomoses in group 3 were higher than in control group 1 (4th day). We found significantly higher hydroxyproline values in group 3 and were significantly higher in group 4 than in control groups. We investigated the early period of wound healing (4th day and 7th day). When comparing between group 1 and group 3, we found higher levels for all of the histological parameters except inflammation in group 3. On day 7, when comparing between group 2 and group 4, we found higher levels for parameters of necrosis, collagen deposition. CONCLUSIONS: BM-MSCs therapy significantly accelerated all of the healing parameters for ischemic colonic anastomosis except for inflammation on fourth day. On the seventh day, BM-MSCs augmented the levels of the hydroxyproline. Histological parameters, necrosis and collagen deposition were also found to be important for healing of ischemic colonic anastomoses. However, they did not accelerate the others histological parameters especially angiogenesis.

Comparison of the right and left laparoscopic live donor nephrectomies: a clinical case load.

BACKGROUND: The aim of the present study was to retrospectively compare the results of right- and left-laparoscopic donor nephrectomy (LDN) performed in our Center. PATIENTS AND METHODS: Two hundred and eight patients who were operated on between October 2010 and October 2011 were included. Of the patients, 65 underwent right-LDN and 143 underwent left-LDN. The groups were compared in terms of duration of surgery, warm ischemia time, postoperative complications, length of hospital stay, and donor outcomes. RESULTS: The mean duration of surgery was 144±19.7 min and 147.8±20.2 min in the right- and left-LDN groups, respectively. The mean warm ischemia times were 139.1±54.1 s and 141.5±37.9 in the right- and left-LDN groups, respectively. The mean length of hospital stay was 2.4±1.0 days for both groups. No major complications were observed in the groups. There was no significant difference between the groups in terms of donor outcomes. CONCLUSIONS: The right-LDN is approached cautiously because of short length of vein and the risk for thrombosis. The results of the present study demonstrated that the right-LDN is as safe and effective as the left-LDN.

Human neutrophil peptides 1, 2 and 3 (HNP 1-3): elevated serum levels in colorectal cancer and novel marker of lymphatic and hepatic metastasis.

OBJECTIVE: Biological levels of localized colon tumors are needed for the diagnosis and prevention of colon cancer. Numerous biomarker studies are produced currently through research. We investigated some peptides with the aim of identifying biomarkers for colorectal cancer and lymphatic and hepatic metastasis. MATERIALS AND METHODS: A total of 100 patients with histologically proven colorectal cancer and 60 normal volunteers were included in this study. Preoperative serum was collected for analysis. Human neutrophil peptides levels (HNP) were assayed by solid phase RIA (Radio Immun Assay) based on monoclonal antibodies. RESULTS: The HNP-1, -2 and -3-also known as α-defensin-1, -2 and -3-are present in elevated concentrations in the plasma from colorectal cancer patients. CONCLUSION: Preoperative high plasma HNP 1-3 levels are associated with colorectal cancer. The HNP 1-3 levels may procure information on patients with lymph node or hepatic metastasis.

Serum thymidine kinase is associated with gastric adenocarcinoma.

Thymidine kinase (TK) plays an essential role in the processing of thymidine within the cell and therefore it is an important marker of proliferation, particularly in tumor cells. The aim of our study was to determine the diagnostic and prognostic importance of TK measurement in gastric adenocarcinoma. The serum level of TK was measured in 72 patients with gastric adenocarcinoma. Serum levels of TK were significantly elevated in gastric adenocarcinoma in comparison with healthy individuals. Also, we have found that there are significant variations in TK serum concentrations when measured that correlate with important variations in clinico-pathological features and prognostic significance (Tab. 2, Ref. 16).

Serum des-gamma-carboxyprothrombin in patients with pancreatic head adenocarcinoma.

The total des-gamma-carboxyprothrombin (DCP) produced in pancreatic adenocarcinoma and the correlation between the tissue DCP and serum DCP levels has been examined. Fifty patients with resectable pancreatic head cancer were examined regarding both the tissue and serum levels of DCP. The mean tissue DCP in the cancer tissue, non-cancer tissue, the serum levels in patients, and the serum levels in controls was 190.500 mAU/ml mg protein, 32.000 mAU/ml mg protein, and 46.000 mAU, and 10.000 mAU, respectively. The elevation of tissue and serum levels of DCP in pancreatic adenocarcinoma patients is a very useful marker for pancreatic adnocarcinoma and should be used without any other tumor marker (Tab. 2, Ref. 15).

Circulating levels of VEGF family and their receptors in hepatocellular carcinoma.

To analyze the serum levels and prognostic significance of vascular endothelial growth factor (VEGF) family (VEGF-A, -C and -D) and their receptors (VEGFR-1 and -2) in patients with hepatocellular carcinoma. The serum levels of VEGF family members were measured in 56 control subjects and 68 patients with hepatocellular carcinoma using an enzyme-linked immunosorbent assay (ELISA). These measurements were correlated with clinic pathological features. The serum levels of VEGF-A and its receptor, VEGFR-1, were significantly higher in patients with hepatocellular carcinoma than in controls (p < 0.001). There was no significant difference in serum levels of VEGF-C and VEGFR-2 between patients and controls. VEGF-A levels were associated with advanced tumor stage and presence of metastases. VEGFR-1 was associated with metastases, advanced overall stage, tumor differentiation. VEGFR-2 levels were associated with poor tumor differentiation. Serum VEGF levels are significantly in the same cohort of patients with variable clinic pathological features and prognostic values. The measurement of VEGF-A and its VEGFR-1 levels in sera may reflect the development of tumor, metastasis and angiogenesis (Tab. 2, Ref. 20).

Imbalance of VEGF family serum levels and receptors in patients with inflammatory bowel disease.

The aim of this study was to analyze the serum levels and prognostic significance of vascular endothelial growth factor (VEGF)-A, -C, and -D, and their receptors, VEGFR-1 and -2 in inflammatory bowel disease (IBD). The serum levels of VEGF family members were measured in 80 control subjects and 200 patients with inflammatory bowel disease using an enzyme linked immunosorbent assay (ELISA). These measurements were evaluated with regard to the levels of inflammatory markers, such as C reactive protein (CRP) and serum amyloid A (SAA) and the clinical characteristics of patients, so that potential correlations could be recorded. A correlation between VEGF and their receptors serum levels is present in IBD patients. These new findings open the question on the potential role of VEGF and their receptors in IBD (Tab. 2, Ref. 9).