The Association between SLAP Lesions and Critical Shoulder Angle and Glenoid Depth.

PURPOSE OF THE STUDY: The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. MATERIAL AND METHODS: Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. RESULTS: A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically signifi cant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically signifi cant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). CONCLUSIONS: Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

One-year follow-up of the oxidative stress profile of patients after laparoscopic sleeve gastrectomy.

OBJECTIVE: Obesity is a major risk factor for developing a number of serious diseases, such as cardiometabolic changes and cancer. An increase in adipose tissue and a decrease in antioxidant capacity both contribute to the etiopathogenesis of these comorbidities. The most effective method in the treatment of morbid obesity is bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) is the most preferred method in bariatric surgery today. In this study, the potential improvement effect of laparoscopic sleeve gastrectomy (LSG) surgery in the restoration of weight loss and endocrine and tissue-based deterioration was obtained by evaluating changes in oxidative stress, antioxidant agents, and lipid oxidation levels. PATIENTS AND METHODS: Fifty patients who had LSG surgery were chosen, along with 50 healthy volunteers who were the same age and gender as these patients. Serum total antioxidant capacity measurement, total oxidant capacity measurement, malondialdehyde (MDA) for the measurement of lipid peroxidation degree, and superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels for the measurement of antioxidant levels were measured colorimetrically with the help of a commercial kit. RESULTS: Oxidative stress indices, MDA levels, and GPx levels of patients with morbid obesity treated with LSG were observed to decrease significantly compared to the preoperative period, while no significant changes were observed in SOD levels. CONCLUSIONS: In patients with morbidly obese conditions, the weight control achieved by sleeve gastrectomy, which is a restrictive method and thus causes a decrease in adipose tissue, causes a decrease in oxidative stress and an increase in the antioxidant response.

DETERMINATION OF MANDIBULAR BONE CHANGES IN PATIENTS WITH PRIMARY HYPOTHYROIDISM TREATED WITH LEVOTHYROXINE SODIUM.

Background: This study aimed to assess fractal dimension (FD) and the radiomorphometric indexes on the digital panoramic radiography (DPR) of patient with primary hypothyroidism receiving levothyroxine sodium replacement therapy. Methods: A total of 115 subjects were included in this cross sectional retrospective study. According to the results of the thyroid function tests, the subjects were divided into two groups as primary hypothyroidism (levothyroxine sodium replacement therapy given), (n = 57) and the healthy control group (n = 58). The fractal dimension (FD), panoramic mandibular index (PMI), mandibular cortical width (MCW), gonial index (GI) and mandibular cortical index (MCI) values of all patients were calculated on DPRs. The statistical analysis of all data was performed with SPSS version 22. Results: The distributions of age and gender in the primary hypothroidism group were similar to control group (p = 0.19 and p = 0.62, respectively). The two groups did not differ statistically significantly in terms of FD, PMI, MCW, GI, and MCI. Conclusion: We determined that mandibular cortical and trabecular bone structure did not significantly differ between healthy individuals and patients receiving drug replacement theraphy due to hypothyroidism, but our results should be further supported with the investigation of clinical parameters.

The relationship between Salusin-α, Salusin-ß, and Klotho levels with subclinical atherosclerosis in ankylosing spondylitis.

OBJECTIVE: Subclinical atherosclerosis (SA) is often observed in ankylosing spondylitis (AS) patients; Salusin-α (Sal-α), Salusin-ß (Sal-ß), and Klotho hormones are thought to be associated with atherosclerosis. This study aims to evaluate the relationship between Sal-α, Sal-ß, and Klotho levels with SA in AS. PATIENTS AND METHODS: The study included patients older than 18 years who applied between August 1, 2019, and September 1, 2019. Patients with AS were included in the AS group, and patients without a known disease were included in the healthy group. Epicardial adipose tissue thickness (EATT) and carotid intima-media thickness (CIMT) measurements were used to assess SA. RESULTS: The study group included 38 (40.9%) patients diagnosed with AS, and the control group included 55 (59.1%) participants. CIMT and EATT levels were higher in the AS group than in the healthy group [0.37 (0.17) vs. 0.54±0.18, p<0.001; 0.44±0.11 vs. 0.54 (0.18), p=0.004, respectively]. There was no significant difference in Sal-α, Sal-ß, and Klotho levels between the AS and healthy groups (p>0.05). Furthermore, there was no observed relationship between EATT or CIMT and Klotho, Sal-α, or Sal-ß in either group (p>0.05). CONCLUSIONS: Although SA level was higher in AS patients, there was no relationship between SA and Sal-α, Sal-ß, and Klotho levels.

The effect of preemptive magnesium sulfate on postoperative pain in patients undergoing mastectomy: a clinical trial.

OBJECTIVE: The effects of preemptive magnesium sulfate (MgSO4) infusion on perioperative hemodynamics and postoperative analgesia in female patients who underwent mastectomy were evaluated. PATIENTS AND METHODS: American Society of Anesthesiologists (ASA) I-II female patients aged 18 years and over who underwent mastectomy were randomized into 2 groups, including 34 individuals each. The study group (Group I) was given 50 mg/kg MgSO4 in 250 ml isotonic 30 minutes before the induction, and the control group (Group II) was given 250 ml of normal isotonic solution. Standardized anesthesia was applied. Perioperative oxygen saturation, mean arterial pressure (MAP), pulse (HR), sedation scores (ss) in the recovery unit, Verbal Numeric Rating Scale (VNRS), need for rescuer fentanyl, and analgesic needs in the surgical period were evaluated. RESULTS: Demographic variables were similar. There was no statistical difference between the two groups in terms of the MAP, HR, and oxygen saturation values measured at entry, post-intubation, 15th, 30th, 45th, 60th minutes, and after extubation. There was a statistically significant difference between the two groups in terms of VNRS scores in the recovery unit and at the 2nd, 4th, 8th, and 12th hours during the postoperative surgical period (p=0.0001, 0.001, 0.001, 0.004, 0.021, respectively). The need for rescue analgesics in the first 2 hours of recovery was found to be lower in the study group (p=0.005). The need for postoperative analgesics in the surgical period was not statistically significant (p=0.1). CONCLUSIONS: Preemptive use of MgSO4 reduces postoperative VNRS scores without affecting hemodynamic parameters during induction and maintenance of general anesthesia.

Epidemiological trends and seasonal dynamics of tuberculosis in Southeastern Turkey.

Background: Tuberculosis (TB) is an important public health issue. Determining TB trend and seasonal variability provides useful information for designing treatment strategies and control programs. Aim: The present study attempts to investigate the epidemiological trend and the seasonal variations. Materials and Methods: TB data containing 2450 cases were collected over a period of seven years in the province of Diyarbakir in southeast Turkey. Trend function and seasonal variability were investigated by statistical curve fitting, surface fitting, and autoregressive time series analysis. Results: The study revealed a gradually decreasing trend in the number of TB cases over a period of seven years. Total TB incidence had seasonal variations (P = 0.04); there was a greater number of TB cases between April and July, with a peak in June. There were significant monthly seasonal variations with June peaks among females (P < 0.001), in patients in the age groups of 0-15 (P < 0.001) and 36-45 years (P < 0.001), in new cases (P < 0.001) and in the patients with pulmonary TB (P = 0.01). The extra-pulmonary TB cases peak in May (P = 0.01). Pulmonary TB and TB patients in the 36-45 age group had summer peak, while the other groups peaked at spring. Conclusions: Spring and summer peaks detected in total TB cases and in many subgroups indicate that multicenter and comprehensive clinical studies are needed to explain these variations.

Investigation of the effect of rhamnetin on mice injected with solid and ehrlich ascites tumor.

Rhamnetin is a flavonoid which contained in especially clove, such as apple, tea, and onion plant. Rhamnetin has been used in cancer research due to its antitumor and antioxidant properties. In this study, effects of rhamnetin administration at different doses on ascites and solid tumors were investigated in Balb/C mice bearing EAT model that originating from rat breast adenocarcinoma. Experimental procedure: Overall, 92 Balb-c mice were used in this study. EAT cells (1 × 106 cells) that harvested from stock animals were injected to all rats via intraperitoneal and subcutaneous route. Rhamnetin (100 µg/kg-200 µg/kg) were given intraperitoneally and subcutaneously during 10 and 15 days to the animals bearing ascites tumor and solid tumor, respectively. Throughout experiments, weight changes were recorded in all groups. The maximum weight increase was observed in the control group among all groups (ascites and solid tumor groups). In the treatment groups, the least weight increase were determined in 200-µg/kg rhamnetin applied. The lowest increase in tumor volume was observed in the group that received 200-µg/kg rhamnetin (2.84) when compared to tumor control group (3.67). Result and conclusion: We determined that the number of live and dead cells in the treatment groups administered with the mean rhamnetin dose (2.5 µg/ml) was found in the count made in the EAT cell line after the incubation periods. We observed that rhamnetin plays an important role against cancer formation. We have obtained important results in our study, but detailed studies on the relationship between rhamnetin and cancer are needed.

Factors affecting anxiety, depression, and stress among patients with hepatocellular carcinoma during COVID-19 pandemic.

OBJECTIVE: Patients with chronic disease whose treatments are limited may experience depression, anxiety, and stress-related symptoms, as well as an increase in the levels of these conditions. This study aims to determine the factors affecting the depression, stress, and anxiety levels of hepatocellular carcinoma (HCC) patients due to the fear of COVID-19 exposure. PATIENTS AND METHODS: 118 patients with advanced HCC treated with non-transplant treatment options or on the waiting list due to the lack of a donor were enrolled. To evaluate the stress, depression, and anxiety levels during the COVID-19 process, Depression Anxiety Stress Scales (DASS-21) and the Coronavirus Anxiety Scale (CAS) were administered to 118 patients through a face-to-face interview. Sociodemographic and clinical characteristics were recorded, and the primary endpoint measure was the total score of DASS. In addition, the multilayer perceptron (MLP) model was constructed to predict the scores of the DASS-21 total. RESULTS: There were significant differences between DASS depression (p=0.010; p=0.030) DASS anxiety (p=0.010; p=0.010) and DASS total (p=0.046; p=0.023) scores in terms of gender and protective effect of the vaccine. Also, a significant difference between gender for the CAS scale was determined (p=0.044). The median score of the DASS total in the COVID-19 group was higher than in the non-COVID-19 group; however, the increase was not significant. MLP model revealed that chronic disease, gender, age, place of residence, smoking, type of vaccine, and COVID-19 exposure were the most important predictors for the DASS total. CONCLUSIONS: Chronic disease, gender, and age were prominent factors in predicting the DASS-21 total score in HCC patients. Therefore, the crucial factors were clinically considered for managing depression, stress, and anxiety in HCC patients.

Management of wet ascitic type of peritoneal tuberculosis: single center experience.

OBJECTIVE: We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). PATIENTS AND METHODS: Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. RESULTS: Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures.  However, seven were converted to open laparotomy. CONCLUSIONS: Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment.

Effect of ursodeoxycholic acid on liver regeneration capacity after living donor hepatectomy: a prospective, randomized, double-blind clinical trial.

OBJECTIVE: Ursodeoxycholic acid (UDCA) has multiple hepatoprotective activities: it modifies the bile acid pool, decreases levels of endogenous, hydrophobic bile acids while increasing the proportion of nontoxic hydrophilic bile acids. It also has cytoprotective, antiapoptotic, and immunomodulatory properties. The aim of this study was to analyze the effect of postoperative administration of UDCA on liver regeneration capacity. PATIENTS AND METHODS: This is a single-center, prospective, randomized, double-blind study that was carried out in our Liver transplant Institute. Sixty living liver donors (LLDs) who underwent right lobe living donor hepatectomy were divided into two groups using computer-generated random numbers: one group received oral UDCA 500 mg 12 hourly for 7 days (UDCA group; n=30) from the first postoperative day (POD) and the other did not receive UDCA (non-UDCA group; n=30). Both groups were compared in terms of the following parameters: clinical and demographic parameters, liver enzymes (ALT, AST, ALP, GGT, total bilirubin, direct Bilirubin), and INR. RESULTS: The median ages in the UDCA and non-UDCA were 31 years (95% CI for median: 26-38) and 24 years (95% CI for median: 23-29), respectively. Liver function tests showed significant differences at various times within the first seven PODs. The INR was lower in UDCA group patients on POD3 and POD4. However, GGT was significantly lower on POD6 and POD7 for the UDCA group. Total bilirubin was also significantly lower on POD3 for the UDCA group patients, but ALP was lower all from POD1 to POD7. A significant difference was also observed in AST on POD3, POD5 and POD6. CONCLUSIONS: Postoperative administration of oral UDCA significantly improves liver function tests and INR among LLDs.

Evaluation of jaw bone changes in patients with asthma using inhaled corticosteroids with mandibular radiomorphometric indices on dental panoramic radiographs.

BACKGROUND: Inhaled corticosteroids (ICSs) are an effective drug commonly used in asthma treatment. It is known that osteoporotic changes can occur secondary to steroid usage, depending on dosage and duration. The aim of this study was to compare radiomorphometric indices and fractal dimension on panoramic images of patients with asthma using ICSs and healthy controls. MATERIAL AND METHODS: A total of 66 dental panoramic radiographs (DPRs) taken from 32 patients with asthma using ICSs and 34 healthy individuals were evaluated in this retrospective study. Panoramic mandibular index inferior and superior (PMI-i,PMI-s), mandibular cortical width (MCW), gonial index (GI), antegonial index (AI), mandibular cortical index (MCI), and fractal dimension analysis (FDA) were measured on DPRs. RESULTS: PMI-s (p=0.02), MCW (p<0.001), GI (p<0.001) and AI (p<0.001) values were significantly lower in the group of the asthma using ICSs than control group. However, the PMI-i (p ˃0.05) measurement, the MCI (p ˃0.05) and FDA values distribution were similar in both groups. CONCLUSIONS: The use of ICSs in asthma patients can affect bone quality. The evaluation of PMI-s, MCW, GI, and AI on DPR can help determine the effect of this drug on the jawbones in the early period and select dental and surgical treatment plans appropriately.

Vessel sealing system vs. conventional knot-tying for hilar dissection during living donor hepatectomy: a prospective, randomized, double-blinded study.

OBJECTIVE: LT has become the gold standard treatment for many liver diseases, especially chronic liver disease. A commonly seen problem, even in donors who do not develop any major complications after living donor hepatectomy (LDH), is the persistent drainage of lymphatic fluid from the hepatectomy site drain, which causes extensive hospitalization and consequent loss to the workforce. To our knowledge, no study has yet been published comparing LVSS and conventional knot-tying methods for hilar dissection, which is an important stage of the LDH procedure. We aimed to prospectively compare the outcomes of these two treatment methods. PATIENTS AND METHODS: Donor candidates were divided into two groups: conventional suture tying (conventional knot tying group; n=34) and Ligasure vessel sealing system (LVSS; n=34). A simple randomization method of drawing lots was used to assign the patients to each group. The following parameters were analyzed for all patients: age, gender, BMI, duration of surgery, postoperative drainage amounts, drain removal times and complications, length of hospital stay, morbidity, and mortality. RESULTS: There were no significant differences in terms of operative times, postoperative drainage levels, hospital stay or drain removal times. CONCLUSIONS: In this study, the use of LVSS in LDH was found to be safe, although it did not offer any advantage over conventional methods. Nevertheless, it seems probable that the use of LVSS could reduce operative time and amounts of lymphatic drainage, especially in centers with minimal experience with LDH, such as new LDH centers.

Diffusion-weighted imaging of the liver in assessing chronic liver disease: effects of fat and iron deposition on ADC values.

OBJECTIVE: This study was designed to evaluate whether fat and iron affect the apparent diffusion coefficient (ADC) values of the liver parenchyma in the settings of fibrosis and inflammation. PATIENTS AND METHODS: We evaluated the diffusion-weighted images (DWIs) of 58 patients with chronic liver disease and 48 control subjects. Liver specimens of patients were assessed for fibrosis, necroinflammation, iron, and steatosis. Liver ADCs, spleen ADCs, and normalized liver ADCs (defined as the ratio of the liver ADC to spleen ADC) values were analyzed after stratifying patients with either fibrosis stages or histology activity index (HAI) scores. The relationship between ADC values and histopathological findings was studied using multiple linear regression analysis. RESULTS: The median liver and normalized liver ADC values were significantly lower in higher stages of fibrosis and HAI scores. Compared to the control group, patients with the highest stages of fibrosis and inflammation had significantly higher spleen ADCs. The effect of the fibrosis stage on liver ADC and normalized liver ADC values was significant in the setting of inflammation, whereas the degree of steatosis and iron grade did not affect these ADC values. CONCLUSIONS: ADC values can distinguish both later stages of liver fibrosis and inflammation. There is no significant effect of fat and iron on ADC values. Therefore, DWI may be reliable in evaluating liver fibrosis and inflammation.

Identification of bacterial species in milk by MALDI-TOF and assessment of some oxidant-antioxidant parameters in blood and milk from cows with different health status of the udder.

This study aimed to identify bacterial pathogens in milk samples from dairy cows with subclinical and clinical mastitis as well as to assess the concentrations of oxidant-antioxidant parameters [malondialdehyde (MDA), reduced glutathione (GSH), and total GSH levels] in both blood and milk samples. From a total of 200 dairy cows in 8 farms, 800 quarter milk samples obtained from each udder were tested in the laboratory for the presence of udder pathogens. Cultivated bacteria causing intramammary infection from milk samples were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF). In addition, from tested animals 60 cows were selected including 20 healthy cows that were CMT negative, 20 cows with subclinical mastitis (SM), and 20 cows with clinical mastitis (CM) for detection of MDA, GSH, and total GSH levels in blood and milk samples. Three hundred and eighty (47.5%; 380/800), 300 (37.5%; 300/800), and 120 (15%; 120/800) of milk samples, respectively were CMT positive or SM and CM, and those positives were cows from different farms. We observed that 87.4% (332/380), 25.3% (76/300), and 34.2% (41/120) of cows with CMT positive, CMT negative, and CM had bacterial growth. The most predominantly identified bacteria were Staphylococcus chromogenes (18.7%) obtained mainly from SM and Staphylococcus aureus (16.7%) as the most frequent cause of CM. According to our results, dairy cows with CM had the highest MDA levels, the lowest GSH, and total GSH levels in both blood and milk samples however, high MDA levels and low GSH levels in milk samples with SM were observed. Based on our results, lipid oxidant MDA and antioxidant GSH could be excellent biomarkers of cow's milk for developing inflammation of the mammary gland. In addition, there was no link between nutrition and MDA and GSH levels.