SOCS-1 1478 CA/del gene polymorphism affects survival in colorectal carcinoma.

Aims and Background: Suppressor of cytokine signaling 1 (SOCS1) is a prototype molecule of the SOCS family. Alterations in the SOCS1 expression have been reported in human cancers and some studies suggest that SOCS1 might act as a tumor suppressor in carcinogenesis. In the present study, we aimed to evaluate the association of SOCS1 promoter -1478CA/del gene polymorphism detected in DNA isolated from the tissues of patients with colorectal cancer (CRC) for histopathological characteristics and survival. Patients and Methods: For the study, we retrospectively enrolled 53 patients with resected colon due to CRC and 23 control subjects with no systemic illness. SOCS1- 1478CA/del gene polymorphism was determined using the polymerase chain reaction-restriction fragment length polymorphism methodology. These results were evaluated in relation to histopathological features and survival results and analyzed statistically. A P value equal to or less than 0.05 was considered significant. Results: Neither control subjects nor the CRC group showed a significant association with SOCS1 -1478CA/del gene polymorphism (p = 0.248). SOCS1 -1478CA/del gene polymorphism was not significantly associated with histopathological features either. However, in the overall survival (OS) analysis, those patients with the del/del allele were found to have a 3.9-fold greater risk of mortality compared to those with CA/CA allele (p = 0.05). Progression-free survival (PFS) was also significantly different in such patients (p = 0.05). Conclusion: The present study examining the association of SOCS1 -1478CA/del gene polymorphism with CRC showed that CRC patients with del/del allele had both significantly shorter PFS and OS versus those with CA/CA or CA/del allele.

The Gastric Bypass and Fundoplication in Bariatric Surgery: the Comments on Published Papers and Our Classification of Combination Procedures.

TRIAL REGISTRATION: NCT04834635 (https://clinicaltrials.gov/ct2/show/NCT04834635).

Surgical technique of laparoscopic mini-gastric bypass with obstructive stapleless pouch creation: A case series.

BACKGROUND: Laparoscopic mini-gastric bypass (MGB) is a bariatric procedure which is gaining popularity worldwide. The original Rutledge technique is known to have good outcomes, but this and other surgical procedures that involve the use of staplers are very expensive for use in low-income countries. For this reason, the laparoscopic band-separated gastric bypass was developed. This paper aimed to describe a modified MGB technique without the use of staplers. METHODS: We present a modification of the MGB with the use of an obstructive stapleless pouch and anastomosis (MGB-Ospanov procedure). The technique is based on our experience in 32 patients who underwent the procedure involving this technique between January 2016 and December 2018. RESULTS: As in the original Rutledge version that uses staples, a long conduit is created below the crow's foot, extending up to the angle of His. The main differences between the MGB-Ospanov procedure and the stapler technique are as follows: creation of a gastric pouch from the anterior wall of the stomach; non-use of staplers; non-intersection of the stomach; use of semi-absorbable (or absorbable) strips of mesh; use of gastroplication to obstruct the communication between the gastric pouch and the bypassed greater part of the stomach. Gastrojejunostomy is performed using a hand-sewn suture at 150-200 cm distal from the ligament of Treitz. The body mass index (kg/m2) was 26.36 ±â€¯4.0 after surgery vs 41.6 ±â€¯6.1 before surgery (P < 0.0001). CONCLUSION: The MGB-Ospanov procedure with an obstructive stapleless pouch and hand-sewn anastomosis is more feasible and cheaper than the stapler technique. Not using staplers could potentially help in avoiding bleeding and leakage along the stapler line when creating a gastric pouch. However, further research is warranted to confirm these results.

Laparoscopic Band-Separated One Anastomosis Gastric Bypass.

BACKGROUND: This video demonstrates laparoscopic band-separated one anastomosis gastric bypass-combining the advantages of banding and gastric bypass without stapler and cutter use. This is basically a gastrojejunal loop bypass above an obstructive band in the upper stomach. MATERIALS AND SURGICAL TECHNIQUE: An adjustable low pressure "Medsil" gastric band was introduced in the abdomen and retracted through the retrogastric tunnel. The front wall of the stomach below the band was displaced in the upward direction through the ring band, increasing the size of the anterior portion of the stomach pouch so that a gastroenteroanastomosis could be created at this point. Gastro-gastric sutures were placed to create a gastro-gastric plication around the band and hold it in position. The band tubing was exteriorized and connected to a special port, which was secured to the abdominal wall fascia. A jejunal loop was created about 200 cm from the ligament of Treitz and anastomosed to the gastric pouch by hand using Vicryl 2/0 sutures. RESULTS: Between November 2015 and February 2016, the study was performed on 10 patients. The average operating time for all cases was 75 min (range 63-87). There was no morbidity or mortality. No complications were observed, including band erosion and band infection. Operation costs were about $2000 lower with this method than with standard gastric bypass surgery. Postop the patients lost weight by 3-4 kg per month. CONCLUSION: Preliminary results show that laparoscopic band-separated one anastomosis gastric bypass have feasibility, safety, efficacy, and reduced operating costs.

Relationship between the interleukin-6-174 gene and mannose-binding lectin codon 54 gene polymorphisms and condyloma acuminatum.

BACKGROUND: Several genes encoding different Th1 and Th2 cytokines may play crucial roles in host susceptibility to Condyloma acuminatum (CA). Mannose-binding lectin (MBL) is a serum lectin that mediates complement activation, and it is a member of innate immune system. MBL gene polymorphisms are considered to be associated with several infectious diseases. OBJECTIVE: In this study, we investigated the association between cytokines and MBL gene polymorphisms with CA. METHODS: Forty patients with CA and 40 healthy controls were enrolled in this study. These patients had not responded to at least a therapy modality and all patients had recurrent lesions. Polymorphism of cytokine [Th1 cytokines; tumour necrosis factor-α and interferon (IFN)-γ, Th2 cytokine; IL-6, T regulatory/suppressor cytokines; IL-10 and transforming growth factor-ß] genes studies were performed by Polymerase chain reaction sequence-specific primers method and MBL genotyping were studied by PCR-restriction fragment length polymorphism method. RESULTS: With the aid of agglomerative hierarchical cluster analysis, we categorized subjects into two main clusters (cluster 1; formed by the majority of patients with CA, cluster 2; formed by the majority of healthy controls), which were found to have significantly different distributions of IL-6 and MBL genotypes. Frequencies of IL-6 (-174) G/G (P < 0.001) and MBL AA (P < 0.001) polymorphisms were significantly greater in the cluster 1. In contrast, significantly lower frequencies of the IL-6 G/C (P = 0.046) genotype and MBL AB (P < 0.001) genotype were observed in cluster 1. CONCLUSION: These results suggest that the IL-6 G/G and MBL AA gene polymorphisms are potential risk factors and that the IL-6 G/C and MBL AB polymorphisms are a protective factor for occurrence and recurrence of CA.

Serum mannose-binding lectin (MBL) gene polymorphism and low MBL levels are associated with neonatal sepsis and pneumonia.

OBJECTIVE: The aim of this study was to determine the serum mannose-binding lectin (MBL) levels and the frequency of MBL gene polymorphisms in infants with neonatal sepsis. STUDY DESIGN: Between January 2008 and January 2010, a total of 93 infants were included in this study and 53 of them had neonatal sepsis diagnosis as study group and 40 infants who had no sepsis according to clinical and laboratory findings as control group. RESULT: Serum MBL levels were found to be low in 17 of 93 infants. Eleven of them were in the sepsis group and six of them were in the control group. Serum MBL levels were significantly lower in infants with sepsis compared with the control group. Frequencies of genotype AB and BB were also significantly higher in the study group compared with the control group. Most importantly, presence of B allele of MBL exon 1 gene was found to be associated with an increased risk for neonatal sepsis. Additionally, in the study group, the mean serum MBL levels were found to be significantly lower in the premature infants compared with the term infants. Pneumonia, bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) were significantly higher in infants with MBL deficiency compared with infants with normal MBL levels. CONCLUSION: Low MBL levels and presence of B allele of MBL exon 1 gene were found to be important risk factors for development of both neonatal sepsis and pneumonia, especially in premature infants. Low MBL levels and MBL gene polymorphisms might also be associated with inflammation-related neonatal morbidities such as BPD and IVH.

Autoimmunity and hepatitis A vaccine in children.

BACKGROUND: Universal vaccination remains the most effective way of preventing the spread of many infectious diseases. Although most adverse effects attributed to vaccines are mild, rare reactions such as autoimmunity do occur. OBJECTIVES: We aimed to evaluate the possible role played by hepatitis A vaccine (HAV) in inducing the synthesis of autoantibodies. The study included 40 healthy children vaccinated with 2 doses of HAV at a 6-month interval. The children were investigated for autoantibodies including anti-nuclear antibodies (ANAs), anti-smooth muscle antibodies, anti-nDNA, anti-microsomal antibodies, anti-cardiolipin (aCL) immunoglobulin (Ig) M/IgG, anti-ds DNA, ANA profile, and anti-neutrophil cytoplasmic antibody profile. RESULTS: One month after the first dose, ANAs at a titer of 1:100 and aCL IgG at 23.7 IgM phospholipid units were detected in 4 children and 1 child, respectively. Of the ANA-positive children, 1 also had ASMA positivity, and another had perinuclear and cytoplasmic ANCA positivity. After the second dose, 3 of the children had aCL IgM. In addition, 2 distinct children had positive anti-thyroid microsomal antibodies and ANA after the second dose. The presence of these autoantibodies following vaccination was statistically significant (P = .002). At month 12 of the study, only 2 children continued to be ANA-positive at the same titer as after the first vaccine dose. CONCLUSIONS: Although HAV can induce the production of autoantibodies, none of the children developed autoimmune disorders. Long-term follow up is necessary to check whether autoimmune disorders develop in children who still have ANA. Genetic, immunological, environmental, and hormonal factors are also important in the development of vaccine-induced autoimmunity.

Expression of gelatinase (MMP-2 and MMP-9) and cyclooxygenase-2 (COX-2) in endometrial carcinoma.

OBJECTIVE: Matrix metalloproteinases (MMPs) are key players in the degradation of extracellular matrix and basement membranes, and are thus important in tumor invasion. Gelatinases (MMP-2 and MMP-9) in particular are prognostic factors in many solid tumors. In this study the immunohistochemical expression of both COX-2 and matrix metalloproteinases has been shown for the first time in endometrium carcinoma. METHODS: Forty-two endometrial carcinoma tissues were immunostained for MMP2 antibody (1:100, Rabbit polyclonal), MMP9 antibody (1:100, Rabbit polyclonal) and CoX2 antibody (1:100, Epitope specific rabbit antibody). RESULTS: 90.5% of the cases were positive for MMP-2 and MMP-9, and 83.3% of the cases were positive for COX-2. A statistically significant association was found between COX-2 overexpression and FIGO stage (p = 0.001). A positive correlation was also found with histological grade (p = 0.006), myometrial invasion (p = 0.033), vascular invasion (p = 0.017), and lymphatic invasion (p = 0.007). A positive correlation was found between MMP-2 overexpression and vascular and lymphatic invasion (p = 0.030 and p = 0.003, respectively). MMP-9 overexpression was also found to be correlated with vascular and lymphatic invasion (p = 0.001 and p = 0.012, respectively). Furthermore, there was a statistically significant correlation between MMP-2 and MMP-9 overexpression (p = 0.0001). CONCLUSION: The results showed that COX-2, MMP-2 and MMP-9 were expressed in a high percentage of primary endometrial carcinomas and their expressions may be associated closely with parameters of tumor aggressiveness.

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy.

OBJECTIVE: To evaluate the efficacy of intrauterine lidocaine plus buccal misoprostol in reducing the discomfort caused by endometrial biopsy with a suction curette. METHODS: In this double-blind, randomized, placebo-controlled trial 126 women undergoing endometrial biopsy were administered a 200-microg tablet of misoprostol buccally, followed by a 5-mL uterine instillation of either of 2% lidocaine or a saline solution. The main outcome measures were the intensity of pain during, immediately following, and 20 min following the biopsy, as assessed on a 10-cm visual analog scale. Statistical analysis was performed using the Friedman test with the Bonferroni correction, the t test, and the chi(2) test. RESULTS: There were no statistically significant differences between the study and control groups in mean age, parity, or relevant medical history. A statistically significant difference in pain scores was noted in premenopausal women during the procedure (lidocaine, 4.93+/-1.67; placebo, 6.17+/-1.26; P<0.001) as well as immediately later (lidocaine, 4.12+/-1.14 vs. placebo, 5.42+/-1.08; P<0.001) and 20 min later (lidocaine, 3.60+/-1.10; placebo, 4.22+/-1.46; P<0.001). No significant differences in pain scores were observed in postmenopausal women for any of the 3 time points (6.72+/-2.01, 5.18+/-1.22, and 4.56+/-0.80, respectively; P>0.05). The number needed to treat was 2.6 (95% confidence interval, 1.9-4.8). CONCLUSION: Intrauterine lidocaine plus buccal misoprostol appears to be effective in decreasing pain in premenopausal women undergoing endometrial biopsy with a suction curette.

CD24 expression is a poor prognostic marker in endometrial carcinoma.

OBJECTIVE: CD24 is a cell adhesion molecule that has been implicated in metastatic tumor progression of various solid tumors. Its expression is known to be related to the prognosis of several kinds of tumors. This study was designed to examine the prognostic significance of CD24 in endometrial cancer patients. METHODS: Forty-four endometrial carcinoma tissues were immunostained for CD24 antibody (Ab2, clone 24 C02). Cytoplasmic and membranous immunoreactivity were scored semiquantitatively by Fisher's exact test. RESULTS: CD24 expression was detected in 34 (77.3%) out of 44 cases. Membranous and cytoplasmic staining of CD24 was significantly associated with the International Federation of Gynecology and Obstetrics (FIGO) grade (p = 0.011 and p = 0.002, respectively) and nodal status (p = 0.002 and p = 0.000, respectively). CONCLUSION: Our data suggests that CD24 expression in endometrial carcinoma as detected by immunohistochemistry might be a new marker for a more aggressive endometrial cancer biology. CD24 is commonly up-regulated in endometrial cancer and this corroborates the importance of CD24 in tumor progression among these cases.

Evaluation of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, and interleukin-10 levels as diagnostic and prognostic parameters in patients with community-acquired sepsis, severe sepsis, and septic shock.

The diagnostic value of procalcitonin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-10 levels in differentiating sepsis from severe sepsis and the prognostic value of these levels in predicting outcome were evaluated and compared in patients with community-acquired sepsis, severe sepsis, and septic shock in the first 72 h of admission to the hospital. Thirty-nine patients were included in the study. The severe sepsis and septic shock cases were combined in a single "severe sepsis" group, and all comparisons were made between the sepsis (n=21 patients) and the severe sepsis (n=18 patients) groups. Procalcitonin levels in the severe sepsis group were found to be significantly higher at all times of measurements within the first 72 h and were significantly higher at the 72nd hour in patients who died. Procalcitonin levels that remain elevated at the 72nd hour indicated a poor prognosis. C-reactive protein levels were not significantly different between the groups, nor were they indicative of prognosis. No significant differences in the levels of tumor necrosis factor-alpha were found between the sepsis and severe sepsis groups; however, levels were higher at the early stages (at admission and the 24th hour) in patients who died. Interleukin-10 levels were also higher in the severe sepsis group and significantly higher at all times of measurement in patients who died. When the diagnostic and prognostic values at admission were evaluated, procalcitonin and interleukin-10 levels were useful in discriminating between sepsis and severe sepsis, whereas tumor necrosis factor-alpha and interleukin-10 levels were useful in predicting which cases were likely to have a fatal outcome.

Mucinous adenocarcinoma arising from the gastrointestinal epithelium in benign cystic teratoma of the ovary--case report.

Benign cystic teratoma of the ovary (BCTO) is the most common ovarian germ cell tumor occurring predominantly in early adulthood. Malignant transformation of a BCTO is rare, with an incidence of 2%. Most benign cystic teratomas with malignant transformations are squamous cell carcinomas with just 6.8% being adenocarcinomas. We present a rare case of adenocarcinoma arising from the gastrointestinal epithelial elements of BCTO based on the microscopic examination and immunohistochemical studies. Adenocarcinoma arising from gastrointestinal epithelium within BCTOs is extremely rare. This is the fifth reported case of adenocarcinoma arising in gastrointestinal epithelium of a BCTO.

Synthesis of some novel azo derivatives of 3,5-dimethyl-1-(2-hydroxyethyl)pyrazole as potent analgesic agents.

A series of 1-(2-hydroxyethyl)-3,5-dimethylpyrazolylazo derivatives, incorporating thiosemicarbazide 2a-c, 1,3,4-thiadiazole 3a-c, and 1,2,4-triazole-3-thione 4a-c were synthesized. The structure of these novel synthesized compounds 2a-c, 3a-c, and 4a-c was confirmed by spectral analysis. All these compounds were screened for their analgesic activity. Hot-plate and tail-immersion tests were used for the determination of the analgesic activity. Morphine, an analgesic through both spinal and supraspinal pathways, was used as a standard test drug. All compounds were administered at a dose of 100 mg/kg i.p. Among the compounds, 2-(butylamino)-5-[((1-(2-hydroxyethyl)-3,5-dimethylpyrazole-4-yl)azo)phenyl]-1,3,4-thiadiazole 3a and 4-[((1-(2-hydroxyethyl)-3,5-dimethylpyrazole-4-yl)azo)phenyl]-4-(2-phenethyl)-2,4-dihydro-3H-1,2,4-triazole-3-thione 4c showed analgesic effects in both tests. Especially 4c exerted strong analgesia starting at 30 min after injection.

Therapy of acute hepatitis C with interferon-alpha2b plus ribavirin in a health care worker.

Hepatitis C virus can be transmitted to health care workers through needlestick accidents. In this report, the result of short-term therapy with interferon-alpha2b plus ribavirin combination of acute hepatitis C in a health care worker who infected through laboratory accident was presented. The patient received combination of interferon-alpha2b (5 MU three times a week) plus ribavirin (1000 mg daily) for three months. Aminotransferase levels were normalised and clearance of HCV RNA was obtained in the first month of the therapy. After 19 months of follow-up, he had undetectable levels of HCV RNA so sustained response (clearance of HCV RNA and normalisation of aminotransferases at least six months after cessation of therapy) was achieved. According to this result, short-term therapy of acute hepatitis C with interferon-alpha2b plus ribavirin may be an alternate to others.

Magnetic resonance imaging and diffusion-weighted imaging in methylmalonic acidemia.

Methylmalonic acidemia (MMA) is an inborn disorder of amino acid metabolism, often presenting with neurological symptoms. We present the results of magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) of the brain in a 16-month-old male patient with classic neurological and laboratory findings for MMA. MRI demonstrated the hyperintensity within globi pallidi both on T2-weighted image and DWI during the acute episode of metabolic acidosis.

Bone mineral density of the spine and femur in early postmenopausal Turkish women with endemic skeletal fluorosis.

The aim of this prospective, comparative study was to investigate the bone mineral density (BMD) changes in a group of early postmenopausal Turkish women with endemic skeletal fluorosis and to study effects of endemic fluorosis on BMD. Bone mineral density of L2-L4 vertebra, femur neck, femur trochanter, and Ward's triangle were measured in 45 female patients with endemic skeletal fluorosis and 41 age-matched controls by dual X-ray absorbtiometry (DXA). The BMD of L2-L4 vertebra and Ward's triangle were higher in the endemic fluorosis group than in the control group (P < 0.001). Patients with endemic fluorosis had higher femur neck and femur trochanter BMDs than did controls (P < 0.01 and P < 0.05, respectively). There was a positive correlation between serum fluoride content and BMD at the spine (r = 0.345, P = 0.001), femoral neck (r = 0.274, P = 0.011), Ward's triangle (r = 0.295, P = 0.006), and trochanter (r = 0.217, P = 0.045). In conclusion, higher bone mineral density levels were seen in early postmenopausal women with endemic skeletal fluorosis. BMD measurement is a tool in the diagnosis and management of this preventable crippling disease.

Clinical equivalence of intranasal estradiol and oral estrogens for postmenopausal symptoms.

OBJECTIVES: The aim was to demonstrate the equivalent efficacy of intranasal estradiol (Aerodiol Servier, Istanbul, Turkey) 300 mg/day relative to a standard oral estradiol therapy of 2 mg/day and to assess the therapeutic value of the potential benefits of Aerodiol. METHODS: Two hundred and one postmenopausal women with severe menopausal symptoms were recruited to the trial. Women received either intranasal Aerodiol 300 microg/day (one spray delivery of 150 microg per nostril) or an oral estradiol 2 mg for 24 weeks. Severity of symptoms were compared based on the Kupperman index (KI) at the end of 24 weeks. RESULTS: The KI score decreased markedly in both groups between W0 and W24. At W24, the two treatments were shown to be statistically equivalent (P<0.001). The incidence of adverse events was very similar in both groups; those related to treatment were of mild or moderate intensity in 95% of cases for the nasal group and 90% for the oral group. CONCLUSIONS: In conclusion, pulsed estrogen therapy using Aerodiol is safe, easily used and highly efficient in alleviating postmenopausal symptoms with a dose of 300 microg. The dose of 300 microg in one administration per day offers the optimal therapy whilst being easily adaptable to each patient's clinical response.

Placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature.

Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.

Lipid peroxidation in umbilical arterial blood at birth: the effects of breech delivery.

OBJECTIVE: To determine oxygen free radical activity in breech presentation at birth and relate it to umbilical cord blood acid-base status. DESIGN: A series of 63 singleton deliveries (28 cephalic deliveries as controls), 23 breech deliveries with normoacidemia, and 12 breech deliveries with mild acidaemia) had determination of malondialdehyde and acid-base parameters. SETTING: The delivery suite in the Department of Obstetrics and Gynaecology at the Süleyman Demirel University, Isparta, Turkey. PARTICIPANTS: Sixty-three singleton infants born at term with spontaneous or induced labour and initially normal fetal heart rate tracing. METHODS: After delivery, umbilical cord arterial and venous blood samples were collected for the determination of malondialdehyde concentrations. Oxygen saturation, pO2, pCO2, pH, and base excess were also measured. MAIN OUTCOME MEASURES: Umbilical cord arterial and venous blood gases and malondialdehyde levels. RESULTS: There was a significant correlation between umbilical arterial and venous levels of malondialdehyde and all acid-base parameters (P < 0.001). There were negative correlations between malondialdehyde levels and pH, pO2 and bicarbonate, while there was a positive correlation between malondialdehyde concentrations and pCO2. A positive correlation between malondialdehyde levels and base excess was present in the control group and total breech group (n = 35). The malondialdehyde levels in the total breech group, nonacidaemic breech group (n = 23) and the mildly acidaemic breech group (n = 12) were significantly higher than those in the control group (P < 0.0001). However, acid-base parameters in the nonacidaemic breech group were not statistically different from those in the control group. CONCLUSION: Lipid peroxidation products (malondialdehyde) existed to some extent in the umbilical cords of newborns with normal acid-base parameters in breech delivery. Our data support the contention that lipid peroxide may be a more sensitive measure for metabolic dysfunctions due to fetal hypoxia than acid-base balance.