Mass spectrometry-based untargeted metabolomics study of non-obese individuals with non-alcoholic fatty liver disease.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is a disease characterized by the accumulation of excessive fat in the liver, which can lead to fibrosis and has an increasing prevalence. NAFLD requires non-invasive diagnostic biomarkers. While typically observed in overweight individuals, it can also occur in non-obese/non-overweight individuals. Comparative studies on non-obese NAFLD patients are scarce. This study aimed to conduct a using liquid chromatography-high resolution mass spectrometry (LC-MS/MS)-based metabolic profiling of non-obese NAFLD patients and healthy controls. MATERIALS AND METHODS: The patient group consisted of 27 individuals with NAFLD, while the healthy control group included 39 individuals. Both groups were between 18 and 40 years old, had a BMI of less than 25 and had alcohol consumption less than 20 g/week for men and 10 g/week for women. Serum samples were collected and analyzed using LC-MS/MS. The data were analyzed using the TidyMass and MetaboAnalyst. RESULTS: The LC-MS/MS analyses detected significant changes in D-amino acid metabolism, vitamin B6 metabolism, apoptosis, mTOR signaling pathway, lysine degradation, and phenylalanine metabolism pathways in non-obese NAFLD patients. Significant changes were also observed in the metabolites D-pantothenic acid, hypoxanthine, citric acid, citramalic acid, L-phenylalanine, glutamine, and histamine-trifluoromethyl-toluidide, ß-hydroxymyristic acid, DL-Lactic acid, and 3-methyl-2-oxopentanoic. Overall, the study provides valuable insights into the metabolic changes associated with non-obese NAFLD patients and can contribute to the development of non-invasive diagnostic biomarkers for NAFLD. CONCLUSIONS: This study sheds light on the metabolic changes in non-obese NAFLD patients. Further research is needed to better understand the metabolic changes associated with NAFLD and to develop effective treatment options.

A Rare Complication of Umbilical Vein Catheterization: TPNoma: US, X-ray, and MRI Findings.

BACKGROUND: Umbilical vein catheterization (UVC) is an early venous access route in newborns and is frequently used for delivering total parenteral nutrition (TPN) and medications. Vascular, hepatic parenchymal, and infectious complications of UVC can be seen rarely. OBJECTIVE: We present preterm neonates' X-ray, US, and MRI findings with parenchymal TPN extravasation and portal vein thrombosis. Our case was the first case about MRI findings of TPNoma. CASE PRESENTATION: A 30 week female with a birth weight of 1340 g was born via Cesarean section. Due to the diagnosis of transient tachypnea of the newborn and prematurity, the infant was hospitalized in the neonatal intensive care unit. On the first day of hospitalization, UVC was inserted and TPN with 20% lipid content was started. After 10 days, UVC was removed and TPN treatment was continued with a piccline catheter. Abdominal US and portal venous Doppler examination was applied to the patient whose general condition deteriorated on the 12th day. US and Doppler revealed a lesion of 17x17x18mm in size with lobulated contour, hyperechoic heterogeneous internal structure, and no central or peripheral blood supply was observed in the left lobe of the liver. Moreover, a filling defect compatible with a thrombus was observed in the proximal part of the left portal vein. An abdominal MRI was performed to characterize this liver lesion. Axial T1 weighted and T2- weighted images showed a heterogeneous hyperintense lesion without contrast enhancement. Axial fat saturation T1-weighted and out of phase T1-weighted images showed a reduction in signal intensity. US and MRI examinations showed that the thrombosed umbilical vein ended superior to the lesion. In the differential diagnoses, fat-containing lesions such as lipoma-teratoma and fat-containing collection secondary to extravasation of TPN treatment via UVC were thought. CONCLUSION: In the differential diagnosis of liver localized lesions in newborns, UVC-related liver injury should be considered and the localization of the catheter tip should be checked. In case of the doubt based on US and X-ray findings, presence of fat on MRI could be diagnosed. Serious complications should be avoided with catheter revision or removal.

The value of adjacent vessel sign in malignant breast tumors.

PURPOSE The aim of this study was to evaluate the prognostic quality of adjacent vessel sign (AVS) in malignant breast tumors by comparing it with classical prognostic pathological biomarkers and magnetic resonance imaging (MRI) findings. METHODS A total of 124 patients with 133 malignant lesions were included. All the imaging was performed on a 1.5T Avanto scanner and the images were interpreted according to BI-RADS-MR® (fifth ed.) atlas. Maximum intensity projection (MIP) images were constructed from subtracted post-contrast images and were used to investigate AVS. Histopathological results and MRI findings were compared with AVS. RESULTS Interobserver agreement about AVS status was substantial (κ=0.64). AVS positive lesions were significantly bigger in size (P < .001, AVS negative: median 12 mm, AVS positive: median 31 mm). AVS was significantly associated with increased Ki-67 index and axillary lymph node metastasis (P=.009 and P=.019, respectively). Between AVS and lymphovascular invasion (LVI), there was a trend toward positive relationship (P=.076). MRI findings of T2 hypointensity, peritumoral edema, irregular shape, non-homogeneous contrast enhancement, rapid early contrast enhancement, and skin infiltration showed significant positive relation with AVS (P < .001, P < .001, P < .001, P=.02, P=.021, and P=.021, respectively). AVS is found to be associated with increased Ki-67 index, axillary lymph node metastasis, and some MRI findings that point to malignancy or poor prognosis. CONCLUSION AVS indicates poor prognosis since it is related to axillary lymph node metastasis, increased Ki-67 index, LVI, peritumoral edema, rapid early contrast enhancement, increased background enhancement, skin extension, T2 hypointensity, non-homogeneous contrast enhancement, irregular lesion shape, and larger tumor size. AVS is an easy to use sign that shows substantial interobserver agreement.

Assessment of Right Heart Functions in Children with Mild Cystic Fibrosis.

BACKGROUND: Cystic fibrosis (CF) is a multisystemic disease that prevalently involves the lungs. Hypoxemia occurs due to the existing of progressive damage to the pulmonary parenchyma and pulmonary vessels. The condition may cause systolic and diastolic dysfunction to the right ventricle due to the effects of high pulmonary artery systolic pressure (PASP). The study aimed to determine echocardiographic alterations in PASP, right ventricle (RV) anatomy, and functions in mild CF children. MATERIALS AND METHODS: RV anatomy, systolic, and diastolic functions were evaluated with conventional echocardiographic measurements. Estimated PASP was used measured with new echocardiographic modalities, including pulmonary artery acceleration time (PAAT), right ventricular ejection time (RVET), and their ratio (PAAT/RVET). The obtained echocardiographic data were statistically compared between the patient group and the control group. RESULTS: The study consisted of 30 pediatric patients with mild CF and 30 healthy children with similar demographics. In patient group, conventional parameters disclosed differences in RV anatomy, both systolic and diastolic functions of RV compared with the healthy group. We did not compare the patient group with published standard data because of the wide range variability. However, new echocardiographic parameters showed notable increase in pulmonary artery pressure compared with values of control group and published standard data (p<0.001). CONCLUSION: Elevated PASP, RV failure, and Cor pulmonale usually begin early in children with mild CF. In addition to routine echocardiographic measurements to evaluate RV, we recommend the use of new echocardiographic modalities for routine examinations and in the follow up of children with mild CF.

Relationship between KRAS mutation and diffusion weighted imaging in colorectal liver metastases; Preliminary study.

PURPOSE: We aimed to investigate whether there are any differences in apparent diffusion coefficient (ADC) values obtained from colorectal liver metastases (CRLM) according to Kirsten rat sarcoma (KRAS) gene mutation status. METHOD: In this retrospective study, we included 22 patients with 65 liver metastases due to colorectal cancer and performed KRAS gene mutation tests. We divided the patients into two groups as KRAS mutation positive (+) (n:10, 30 lesions) and the wild-type group (n:12, 35 lesions). Mann-Whitney U test was used to compare ADC and ADC mean values of the two groups. In addition, we performed receiver-operating characteristic (ROC) analysis to discriminate the two groups in terms of their ADC and ADCmean values. RESULTS: The ADC and ADCmean values were found to be statistically significantly lower in the KRAS (+) group compared to the wild-type group. ROC curve analysis revealed a statistically significant difference in terms of ADC and ADCmean with area under the curve (AUC) values of 0.680 and 0.760, respectively. The cut-off values for ADC and ADCmean were 986 × 10-6 mm2/s and 823 × 10-6 mm2/s, respectively. CONCLUSION: In our study, the lower ADC and ADCmean values of CRLM are associated with presence of KRAS mutation. ADC and ADCmean values derived from liver metastases due to the colorectal cancer can be used to differentiate KRAS mutation status.

Three-Dimensional Computed Tomography Volume and Physiology of Nasal Cavity After Septhorhinoplasty.

OBJECTIVE: In this study, the authors aimed to compare the nasal physiology and nasal cavity volume with three-dimensional computed tomography (3D-CT) 1 year after the operation with the values before the operation to investigate the possible narrowing and loss of function in the nasal cavity after septorhinoplasty (SRP) operation. METHODS: Of 415 patients who had a primary SRP operation, 28 patients who met the criteria were included in the study. Nasal cavity volumes of patients with postoperative CTs were measured three-dimensionally after a mean 13 months, and objective rhinologic measurements (rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow [PNIF]) and subjective assessment methods (Visual Analog Scale [VAS], Nasal Obstruction Symptom Evaluation [NOSE]) were performed. RESULTS: The mean postoperative VAS and PNIF values of the patients were significantly higher than the mean preoperative values. The mean postoperative NOSE value of the patients was significantly lower than the mean preoperative values. Although the mean MCA-1 and MCA-2 levels of the patients increased postoperatively, the increase was not significant. Although the postoperative mean values of VOL-1 and VOL-2 increased compared with the preoperative values, the increase was not significant. In the CT measurements of the patients, the nasal cavity volumes were significantly higher than the preoperative values. CONCLUSION: Nasal cavity volumes in patients undergoing SRP were compared with 3D-CT for the first time in the literature, and a significant increase in nasal volume was observed in the postoperative first year. This finding suggests that the correction of intranasal problems leads to an increase in the nasal volume in SRP operations, although nasal osteotomy is performed.

MRI findings and utility of DWI in the evaluation of solid parathyroid lesions.

PURPOSE: To evaluate the MRI findings of solid parathyroid lesions and to elaborate on a possible improvement of MRI detection of parathyroid lesions by the use of additional DWI. MATERIALS AND METHODS: MRI and DWI properties of pathologically proven 20 solid parathyroid lesions were retrospectively reviewed. Mean ADC values (b50 + b400 + b800/3) of parathyroid lesions were compared with that of normal appearing thyroid parenchyma (TP), sternocleidomastoid muscle (SCM) and jugulodigastric lymph nodes (JDLN). RESULTS: Of lesions, 4 were parathyroid hyperplasia, 13 parathyroid adenoma and 3 parathyroid adenocarcinoma. All parathyroid lesions were very bright on fat-saturated T2W images. Parathyroid hyperplasia and adenoma were small sized, homogenous, well-defined and low on T1W, high on T2W and avidly enhancing. Parathyroid carcinoma was large sized, ill-defined and very heterogeneous on MRI including DWI. Means ADC values of parathyroid hyperplasia, adenoma, and adenocarcinoma, TP, SCM and JDLN were measured as 2.3 ± 0.14 × 10-3, 1.7 ± 0.45 × 10-3, 1.5 ± 1.48 × 10-3, 0.87 ± 0.40 × 10-3, 0.55 ± 0.21 × 10-3 and 0.96 ± 0.33 × 10-3 mm2/s, respectively. All parathyroid lesions had high diffusion properties comparing other soft tissue structures of head and neck region. By increasing strength (b value) of diffusion tensor on DWI, solid parathyroid lesions still kept their brightness comparing other soft tissue structures of head and neck region because of their high T2 properties. CONCLUSION: Solid parathyroid lesions had higher diffusion properties comparing other soft tissues structures of head and neck region. This feature makes them easily differentiate from nearby structures on fat-saturated T2W and DWI.

Correlation Between DTI Findings and Volume of Corpus Callosum in Children with AUTISM.

BACKGROUND: Autism Spectrum Disorder (ASD) is a complex developmental disorder in which neurological basis is largely unknown. The Corpus Callosum (CC) is the main commissure that connects the cerebral hemispheres. Previous evidence suggests the involvement of the CC in the pathophysiology of autism. AIM: The aim of our study is to assess whether there were any changes in Corpus Callosum (CC) area and volume and to reveal the relationship between Diffusion Tensor Imaging (DTI) features in genu and splenium of corpus callosum in children with ASD. METHODS: Eighteen patient and 15 controls were recruited. The volumetric sagittal TI images were used to provide measurements of midsagittal corpus callosum surface area while FA, MD, RD, and ADC values were extracted from genu and splenium of corpus callosum after which the correlation in the area and volume in ASD children was examined. RESULTS: CC area and volume in children with ASD were decreased than controls. FA values obtained from the genu and splenum of CC were significantly lower and RD values were significantly higher. A positive correlation was observed between the FA of the genu and splenium and area and volume of the CC. There was a negative correlation between ADC, MD and RD of CC and area and volume measurements. CONCLUSION: The conclusions in the interrelations of morphometric and DTI data may demonstrate a likelihood of damages in the axons and cortical neurons. The results showed that there existed microstructural damages from the DTI findings. Furthermore, the decrease in FA could be a representation of the reduction in the myelination in nerve pathways, impaired integrity, reduced axonal density, and organization. Indeed, the changes in volumetric and microstructural of CC could be useful in evaluating underlying pathophysiology in children with autism.

Value of Shear Wave Elastography for differentiating benign and malignant renal lesions.

AIMS: To investigate the diagnostic accuracy of shear-wave elastography (SWE) for assessing malignant and benign kidneymasses. MATERIALS AND METHODS: Forty patients with solid renal masses underwent US elastographic evaluation. SWE values of the lesions and adjacent cortical renal parenchyma and SWER were detected prospectively. Malignant tumors were recorded as group 1 and benign tumors were recorded as group 2. RESULTS: The highest elasticity values were 27.27±25.66 kPa for group 1 and 16.13±8.89 kPa for group 2. The mean±SD elasticity values for adjacent renal cortex for groups 1 and 2 were 2.7±2.08 and 2.75±1.35, respectively. For group 1, a negative correlation was observed between the age of the patients and SWER value (p=0.047, rs=­0.401). There was also a negative correlation between the SWER value and the SWE value of adjacent renal cortex (p=0.004, rs=­0.555). CONCLUSION: SWE is a noninvasive method that provides quantitative elasticity informationon tissues. Overlaps among different types of renal lesions may be due to heterogeneity of the lesions. Larger studygroups may clarify the other factors affecting SWE values under both normal and pathological conditions.

Neoadjuvant hyperfractionated accelerated radiotherapy plus concomitant 5-fluorouracil infusion in locally advanced rectal cancer: A phase II study.

AIM: To evaluate the efficacy and tolerability of neoadjuvant hyperfractionated accelerated radiotherapy (HART) and concurrent chemotherapy in patients with locally advanced infraperitoneal rectal cancer. METHODS: A total of 30 patients with histopathologically confirmed T2-3/N0+ infraperitoneal adenocarcinoma of rectum cancer patients received preoperative 42 Gy/1.5 Gy/18 days/bid radiotherapy and continuous infusion of 5-fluorouracil (325 mg/m2). All patients were operated 4-8 wk after neoadjuvant concomitant therapy. RESULTS: In the early phase of treatment, 6 patients had grade III-IV gastrointestinal toxicity, 2 patients had grade III-IV hematologic toxicity, and 1 patient had grade V toxicity due to postoperative sepsis during chemotherapy. Only 1 patient had radiotherapy-related late side effects, i.e., grade IV tenesmus. Complete pathological response was achieved in 6 patients (21%), while near-complete pathological response was obtained in 9 (31%). After a median follow-up period of 60 mo, the local tumor control rate was 96.6%. In 13 patients, distant metastasis occurred. Disease-free survival rates at 2 and 5 years were 63.3% and 53%, and corresponding overall survival rates were 70% and 53.1%, respectively. CONCLUSION: Although it has excellent local control and complete pathological response rates, neoadjuvant HART concurrent chemotherapy appears to not be a feasible treatment regimen in locally advanced rectal cancer, having high perioperative complication and intolerable side effects. Effects of reduced 5-fluorouracil dose or omission of chemotherapy with the aim of reducing toxicity may be examined in further studies.

Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer: A pictorial review.

High-resolution pelvic magnetic resonance imaging (MRI) is the primary method for staging rectal cancer. MRI is highly accurate in the primary staging of rectal cancer; however, it has not proven to be effective in re-staging, especially in complete response evaluation after neoadjuvant therapy. Neoadjuvant chemoradiotherapy produces many changes in rectal tumors and on adjacent area, as a result, local tumor extent may not be accurately determined. However, adding diffusion-weighted sequences to the standard approach can improve diagnostic accuracy. In this pictorial review, an overview of the situation of MRI in the staging and re-staging of rectal cancer is exhibited as a pictorial assay. An experience- and literature-based discussion of limitations and difficulties in interpretation are also presented.

Valve sparing surgery in an adult patient with dextrocardia and annuloaortic ectasia.

We report the case of a patient with situs inversus totalis, annuloaortic ectasia complicated by aortic insufficiency and mitral regurgitation which induced congestive heart failure. Both valvular lesions were repaired physiologically using aortic root sparing Yacoub 'remodeling' technique and mitral ring annuloplasty. Valve sparing techniques can be used effectively even in patients with complicated clinical scenarios (like dextrocardia and annuloaortic ectasia) to avoid the potential risks related to prosthetic valve implantation and lifelong anticoagulation therapy.

Effects of different biomaterials on augmented bone volume resorptions.

OBJECTIVES: The aim of this study was to assess the effects of platelet-rich fibrin (PRF), deproteinized bovine bone graft (DBBG), and biphasic calcium phosphate (BCP) biomaterials on total volume resorption levels and bone augmentation. MATERIALS AND METHODS: Nine New Zealand rabbits were divided into three groups (PRF, DBBG, and BCP). Two titanium barriers were fixed bilaterally to each rabbit's calvarium; a total of 18 titanium barriers were used. All barriers were removed on the 90th day. Computed tomography (CT) images of the animals were taken on the 90th, 120th, 150th, and 180th days. RESULTS: When the resorption level of the total volume in all groups on the 120th, 150th, and 180th days was compared with that of the 90th day, no significant differences among all groups were found in all intervals. According to the total volume on the 90th and 180th days, statistically significant differences between groups DBBG and BCP were not found; however, statistically significant differences were found between group PRF and the others groups (P < 0.001). On the other hand, there were statistically significant differences in regenerated bone area between group PRF and BCP. CONCLUSION: According to the results of this study, grafts such as DBBG or BCP must be used to augment bone volume sufficiently in guided bone regeneration.

The effect of obesity on brain diffusion alteration in patients with obstructive sleep apnea.

PURPOSE: We investigated diffusion alterations in specific regions of the brain in morbid obese, obese, and nonobese OSA patients and searched whether there is a correlation between BMI and ADC values. MATERIALS AND METHODS: DWIs of 65 patients with OSA were evaluated. The patients were classified according to BMI as morbid obese (n = 16), obese (n = 27), and nonobese (control, n = 22) groups. ADC measurements were performed from 24 different regions of the brain in each patient. The relationship of BMI with ADC values was searched. RESULTS: The ADC values in hypothalamus, insular cortex, parietal cortex, caudate nucleus, frontal white matter, and posterior limb of internal capsule were all increased in obese patients (n = 43) compared to control group. The ADC values of midbrain, hypothalamus, orbitofrontal cortex, and parietal cortex were significantly increased in morbid obese compared to obese patients. In obese patients, the degree of BMI was positively correlated with ADC values of orbitofrontal cortex, parietal cortex, and hypothalamus. CONCLUSION: We observed increasing brain vasogenic edema with increasing BMI, suggesting that the main reason of brain diffusion alteration in patients with OSA could be obesity related.

The effect of local simvastatin application on critical size defects in the diabetic rats.

OBJECTIVES: To evaluate bone-healing effects of local simvastatin application to critical size defects (CSDs) in the experimental diabetes mellitus (DM) rat model. MATERIALS AND METHODS: A total of 35 male Sprague-Dawley rats with an average weight of 350 g and aged 3 months were used in this study. The rats were divided into five groups of seven animals each: passive control (group A), active control (group B), 0.5 mg simvastatin (group C), 1.0 mg simvastatin (group D), and 1.5 mg simvastatin (group E). Streptozotocin was used to induce Type 1 diabetes in all rats. Eight mm CSDs were created under anesthesia in each rat calvarium. CSDs were left empty in group A. Defects in group B were grafted alone with a gelatin sponge mixed with normal saline. Defects in the experimental groups (groups A, B, and C) were grafted with gelatin sponge mixed saline solutions contain 0.5, 1.0, 1.5 mg simvastatin. Rats were sacrificed after 1 month, and the defects were prepared for radiologic and histomorphometric assessment of regenerated bone. RESULTS: None of the specimens exhibited complete closure of new bone across the 8-mm defect. A correlation between computed tomography and histomorphometric analysis was not determined. Both amount of volume and area of regenerated bone were found higher in the experimental groups than in the control groups. However, these values were not found statistically significant degree (P < 0.05) for each groups. The density of regenerated bone in the region of interest was higher in the control groups in contrast to in the experimental groups. However, statistical significance was just found between groups C and A and between groups C and B (P < 0.05). CONCLUSION: The local simvastatin application enhanced healing of the bone defects in the diabetic rat model CSDs.

Integration of ultrasound findings with Alvarado score in children with suspected appendicitis.

BACKGROUND: The aim of this study was to investigate the integration of ultrasound (US) findings with Alvarado score in diagnosing or excluding acute appendicitis. METHODS: Data were analyzed in 122 pediatric patients with suspected appendicitis who had undergone US. The US findings were classified into four groups, and the patients were classified into three groups according to Alvarado score. US results and Alvarado score were compared. RESULTS: Alvarado score was a good predictor of appendicitis for scores ≥7. CONCLUSION: In the case of non-visualization of the appendix without a high Alvarado score, appendicitis can be safely ruled out.

Brain diffusion changes in obstructive sleep apnoea syndrome.

BACKGROUND: Obstructive sleep apnoea syndrome (OSAS) is a disorder characterized by repeated apnoeic episodes during sleep. Neurocognitive changes secondary to OSAS are likely to occur due to hypoxia in certain brain locations. Advances in magnetic resonance imaging technology, such as diffusion-weighted imaging (DWI), enable non-invasive and accurate identification of OSAS-induced changes. OBJECTIVE: We aimed to use DWI to investigate changes in the brain secondary to hypoxia in OSAS. METHODS: Eighty-eight patients underwent polysomnography and were classified as non-OSAS, mild-moderate OSAS and severe OSAS sufferers. DWI was used to evaluate 14 areas of the brain, and apparent diffusion coefficients (ADCs) were calculated. We investigated whether there were differences in the ADC values in specific areas of the brain between the non-OSAS and OSAS patients. RESULTS: We measured the ADC values of the 68 newly diagnosed OSAS patients (21 mild, 15 moderate and 32 severe) and of 20 healthy controls. There were significant increases in the ADC values in the hippocampus, amygdala and putamen in OSAS patients. Compared to the non-OSAS subjects, the ADC values of the putamen in severe OSAS patients, those of the hippocampus in moderate or severe OSAS patients and those of the amygdala in moderate OSAS patients were significantly increased. A negative correlation between the lowest oxygen saturation during sleep and the ADC values of the hippocampus and amygdala was found. CONCLUSIONS: Increased ADC levels in the hippocampus, amygdala and putamen in OSAS patients indicate hypoxia and likely cause vasogenic oedema in specific regions of the brain.