First-line immune-checkpoint inhibitor treatment in extensive-disease small-cell lung cancer: A classical and network meta-analysis.

Background: Small-cell lung cancer (SCLC) has a poor prognosis. For the last 30 years, first-line systemic treatment has remained unaltered. After the integration of immunotherapy, a new first-line gold standard, atezolizumab in combination with carboplatin plus etoposide, was approved in extensive-disease SCLC (ED-SCLC) in 2019. Materials and Methods: First-line randomized controlled studies that investigated anti-programmed cell death protein 1 (PD-1)/PD-1 ligand-1 (PD-L1) and anti-T-lymphocyte-associated protein 4 (CTLA-4) agents in combination with platinum plus etoposide (EP) were scoured. A total of six studies (two - anti-CTLA-4 and four - anti-PD1/PD-L1) were included and classic and network meta-analyses (NMAs) were performed. Results: Fixed model for overall survival (OAS) in the PD-1- or PD-L1-treated subgroup yielded a hazard ratio (HR) of 0.746 with a 95% confidence interval (CI) =0.662-0.840 and in the CTLA-4-treated subgroup a HR of 0.941 with a 95% CI = 0.816-1.084 for the immune therapy + chemotherapy versus chemotherapy comparison (CTLA-4-based versus PD-1- or PD-L1-based groups' comparison of OAS effect Q = 6.05, df = 1, P = 0.014). NMA showed that all chemotherapy + immunotherapy combinations were equally potent and more efficient than PE in terms of OAS and progression-free survival (PFS). Rank probability plots demonstrated nivolumab + EP as the most probable effective treatment modality in terms of OAS and PFS. Conclusion: The usage of anti-PD1/PD-L1 immunotherapy agents results in significant OAS advantage, and anti-PD1/PD-L1 agents are superior to anti-CTLA-4 approach in combination with platinum plus etoposide regimen in ED-SCLC.

Effect of Different Types of Adhesive Agents on Orthodontic Bracket Shear Bond Strength: A Cyclic Loading Study.

Bracket failure is one of the most important problems encountered during fixed orthodontic treatment. For this reason, different types of adhesive agents have been developed over the years. Consequently, the aim of this study was to evaluate the shear bond strength of brackets bonded to teeth etched with a conventional acid etching method in a laboratory environment by using different types of adhesive agents and comparing the number of shear strokes. Sixty human maxillary premolars were divided into three groups and Gemini stainless steel metal brackets (3M Unitek, Monrovia, CA, USA) were bonded to all teeth. In Group 1, Transbond™ XT Primer (3M Unitek, Monrovia, CA, USA) and Transbond™ XT Light Cure Adhesive Paste composite (3M Unitek, Monrovia, CA, USA) were used. In Group 2, BracePaste® MTP Primer (American Orthodontics, Sheboygan, CA, USA) and BracePaste® Adhesive composite (American Orthodontics, Sheboygan, WI, USA) were used. In Group 3, Ortho Solo™ Primer (Ormco, Orange, CA, USA) and Grengloo™ Adhesive composite (Ormco, Brea, CA, USA) were used. The samples were subjected to a shear test with a closed-loop controlled, low-cycle fatigue machine with a capacity of 10 N and a crosshead speed of 300 mm/min. The number of shear strokes of the brackets was recorded. According to the Kruskal−Wallis and Mann−Whitney U tests performed on the data obtained, statistically significant differences were found between the groups in terms of the numbers of shear strokes (p < 0.05). Significantly higher numbers of shear strokes and higher shear bond strengths were observed in Group 3 compared with Group 1 and Group 2 (p < 0.05). There was no statistically significant difference between the numbers of shear strokes for Group 1 and Group 2 samples (p > 0.05). To conclude the study, it was observed that the type of adhesive used had an effect on the bond strength of the bracket and that the Grengloo™ adhesive agent showed higher shear bond strength. It was observed that BracePaste® Adhesive and Transbond™ XT Light Cure Adhesive Paste adhesive agents had similar shear bond strengths.

Oxidative stress and DNA damage due to one-lung ventilation.

AIM: One-lung ventilation (OLV) is an anesthesia technique used to provide visualization in thoracoscopic lung surgeries and increase surgical site visibility during operation. In OLV, atelectasis occurs and blood from the lung participates in circulation without receiving oxygen. We designed a prospective study on patients we implemented surgery in order to research whether OLV leads to oxidative stress and DNA damage or not. METHODS: It was taken 5cc blood samples 4 times from these patients in the postoperative preparatory stage (T1), on the 60th minute after the start of OLV (T2), on the 60th minute after the termination of OLV (T3) and 24 hours after surgery (T4). Total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI) values were examined with regards to DNA damages in the blood samples taken. RESULTS: DNA damage was statistically increased with OLV compared to baseline level (p<0.05) and statistically decreased in 24 hour (p<0.05). TAC level was statistically decreased with OLV compared to baseline level and statistically increased in 24 hour (p<0.05 ). TOS level was statistically increased with OLV compared to baseline level (p<0.05) and statistically decreased in 24 hour (p<0.05 ). OSI level was statistically increased with OLV compared to baseline level (p<0.05) and statistically decreased in 24 hour (p<0.05 ). CONCLUSION: To the best of our knowledge this is the first study showing DNA damage in thoracic surgery which was operated with OLV. This DNA damage found to be decreased in first postoperative day and might be related to changes in oxidative status of this patient group. KEY WORDS: Oxidative stress, lung ventilation, DNA damage.

The Efficacy of Platelet-Rich Plasma in the Treatment of Rib Fractures.

Background Rib fracture is the most common result of thoracic traumas. Intrapulmonary shunt, alveolar capillary membrane damage, intra-alveolar hemorrhage, and hypoxia may develop following rib fractures. Therefore, prompt treatment is important. The aim of this experimental study was to analyze the effects of platelet-rich plasma (PRP) on rib fractures to secure a speedier and more efficient treatment method. Materials and Methods The study involved 18 New Zealand white rabbits, randomly divided into three groups as Group 1, the sham group with no surgical intervention; Group 2, the control group in which simple rib fractures were applied and no treatment; and Group 3, in which rib fractures were applied and then PRP treatment was administered. Results The mean recovery plate thickness measurements were found to be statistically significantly higher in the PRP group compared with the other groups (p < 0.005). A thicker fibrotic cell proliferation and the formation of many capillaries were observed around the growth plate in the PRP group compared with the other groups. These structures were lesser in the control group compared with the PRP group and at the lowest level in the sham group. Larger and distinct callus formation was observed and a new intramedullary field in the PRP group. Conclusions PRP is a reliable and effective autologous product with minimal side effects, which can be considered as an alternative treatment in patients with rib fractures and used easily in pseudoarthrosis, surgical fracture, or flail chest.

Surgical treatment of hepatic hydatid cysts A retrospective analysis of 425 patients.

BACKGROUND: We aimed to retrospectively analyze patients who underwent surgical treatment in our clinic for hydatid cysts in terms of the surgical methods implemented and their results. METHODS: Archival records of the patients who underwent surgery for the treatment of hydatid cysts between 2007 and 2014 were analyzed retrospectively. RESULTS: The records of 425 patients who underwent surgery with varying ages of 16 to 88 years (mean: 44.5) were obtained. Among the patients, 33.9% (n=144) were male and 66.1% (n=281) were female. The most frequent symptoms were abdominal pain (46.4%) and dyspepsia (30.9%). About 79.5% of the patients had hydatid cysts in their livers, and 66.8% of these cysts were on the right lobe of the liver. Surgical intervention was performed on 513 cysts. The average diameter of these cysts was 8.3 cm. About 85.5% (n= 438) of the interventions implemented were partial cystectomy. Laparotomy was performed through the right subcostal incision on 81% (n=345) of the patients who underwent conventional surgery. The most frequently encountered complication was biliary fistula. The mortality rate was 0%. CONCLUSIONS: The results showed that most of the cases were uncomplicated isolated hepatic hydatid cysts frequently found on the right lobe of the liver. The most frequently implemented surgical procedure was partial cystectomy. This procedure was simple, fast and applicable for uncomplicated hepatic hydatid cysts. KEY WORDS: Hepatic hydatid cyst, Mortality, Partial cystectomy.

Thymoquinone protects end organs from abdominal aorta ischemia/reperfusion injury in a rat model.

INTRODUCTION: Previous studies have demonstrated that thymoquinone has protective effects against ischemia reperfusion injury to various organs like lungs, kidneys and liver in different experimental models. OBJECTIVE: We aimed to determine whether thymoquinone has favorable effects on lung, renal, heart tissues and oxidative stress in abdominal aorta ischemia-reperfusion injury. METHODS: Thirty rats were divided into three groups as sham (n=10), control (n=10) and thymoquinone (TQ) treatment group (n=10). Control and TQ-treatment groups underwent abdominal aorta ischemia for 45 minutes followed by a 120-min period of reperfusion. In the TQ-treatment group, thymoquinone was given 5 minutes. before reperfusion at a dose of 20 mg/kg via an intraperitoneal route. Total antioxidant capacity, total oxidative status (TOS), and oxidative stress index (OSI) in blood serum were measured and lung, kidney, and heart tissue histopathology were evaluated with light microscopy. RESULTS: Total oxidative status and oxidative stress index activity in blood samples were statistically higher in the control group compared to the sham and TQ-treatment groups (P<0.001 for TOS and OSI). Control group injury scores were statistically higher compared to sham and TQ-treatment groups (P<0.001 for all comparisons). CONCLUSION: Thymoquinone administered intraperitoneally was effective in reducing oxidative stress and histopathologic injury in an acute abdominal aorta ischemia-reperfusion rat model.

Pulmonary hydatid disease is difficult recognized in children.

PURPOSE: Pulmonary hydatid disease is a significant health problem for children in endemic areas. Pulmonary hydatid disease is more frequent than hepatic hydatid disease in children. The aim of this study was to evaluate the characteristics of pulmonary hydatid disease for children in our province which is endemic for echinococcosis. PATIENTS AND METHODS: This study was performed retrospectively between 2007 and 2012 by reviewing the medical records of patients (≤17 years) who were diagnosed with pulmonary hydatid disease. The medical records of these patients were evaluated with respect to the demographic characteristics of patients, management strategies, length of hospital stay, and outcomes. RESULTS: A total of 120 (52.9% boys and 46.3% girls) patients with the diagnosis of pulmonary hydatid disease were enrolled in this study. The mean age was 10.15 ± 3.93 years. The significant numbers of patients were admitted with a ruptured hydatid disease and managed with lung preservation. The mean follow-up was 11.3 ± 3.8 (3-24) months. Recurrence was detected in three patients during follow-up. CONCLUSION: Pulmonary hydatid disease is usually symptomatic. Hydatid disease must be considered in differential diagnosis while evaluating thoracic lesions in endemic areas.

Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion.

PURPOSE: We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. MATERIALS AND METHODS: This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. RESULTS: According to Light's criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4-33) was significantly higher than that of the transudates (median, 5; range, 2-15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CONCLUSION: CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation.

Surgical approach for patients with unusually located hydatid cyst.

INTRODUCTION: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus whose people is the intermediate host. Although this parasite can settle in any part of the human body, it is frequently seen in liver and lungs. The rate of unusual located hydatid cyst outside of liver and lungs is 13,9%. In this study, we aimed presenting unusual located hydatic cysts regarding 51 patients. MATERIAL AND METHOD: In this retrospective study, the files of the patients operated in our department between 2005 and 2012 with the diagnosis of hydatid cyst, characterized be an additional location besides liver and lung involvement and located outside of liver and lung were controlled. FINDINGS: We had a total of 51 patients between the ages of 6-79 (average age 35,34), 20 of them were men (39%) and the others were women (61%) (men/women = 1.56). The cysts outside of liver and lung were frequently seen in spleen (24/51), ovarium (9/51), intraabdominal (8/51), brain (8/51), kidney (6/51), psoas muscle (1/51), bladder (1/51), cervical lymph node (1/51), the heart(1/51) respectively. The most frequent symptom in our patients was stomachache. Besides, symptoms of cough, fever, respiratory disorder were present; only one patient suffered from hemophtysis. While 32 patient out of 51 were treated by laparotomy, 8 patients were operated with laparotomy and thoracotomy in the same session; the patient with 2 ovarian cysts was submitted to cystectomy through laparoscopic surgery. As a patient had a cyst both in brain and liver, he was submutted to laparotomy and craniotomy. 46 cysts in 9 patients with lung involvement were treated with lung resections: 7 wedges resection and 2 segmentectomies. The other lung cysts of the analysed patients were treated by cystectomy and capitonnage. Bile leakage was detected in a total of 7 patients: 3 of them were treated with T tube drainage and the others were endoscopically healed by means of ERCP. CONCLUSION: The incidence of hydatid cyst, which is an important health problem in endemic areas, can be reduced by means of simple preventive measures. Its basic treatment is surgery. Main objective of the surgery should be parenchyma sparing while taking off completely the cysts. Although the disease is frequently seen in liver and lung, other organ involvements should be considered. Thus, it does not matter where hydatid cyst is seen, abdomen and thorax should be attentively controlled by the simplest imaging method also outside of clinical symptoms. Abdomen and thorax imaging should be carried out at least once in the two following years to have an early detection of an eventual recurrence.

Characteristics and outcomes of liver and lung hydatid disease in children.

Our study retrospectively evaluates and compares the characteristics of lung and liver hydatid disease (HD) in children. This retrospective study was performed between 2007 and 2012 using the medical records of patients aged ≤17 years of age who had liver and/or lung HD. They were evaluated using the demographic characteristics of the patients, clinical presentation, hospital stay and outcome. A total of 252 cysts were identified in 152 of the patients. The incidence of HD increased with age and the majority of patients were older than 9 years. Overall, lung HD was more complicated and symptomatic than liver HD on initial admission.

Tracheal stenosis aftertracheostomy or intubation: review with special regard to cause and management.

To investigate the management outcomes of patients who developed tracheal stenosis after tracheostomy or intubation, we reviewed the courses of 45 patients who had experienced tracheal stenosis at a single institution, over 19 years from February 1985 through January 2004. There were 38 tracheal and 7 infraglottic stenoses. Twenty-nine stenoses were associated with the stoma, 12 with the cuff, and 2 with the endotracheal tube resulting in infraglottic lesions; the remaining 2 were double stenoses. Eleven patients were treated by bronchoscopic surgery, and 34 patients were treated by tracheal or laryngotracheal resection. The overall success rate was 93%. The complication rate was 18%. A 2nd operation was required in 3 patients, and 1 of the 3 died of sepsis. Our management strategy of treating tracheal stenosis with resection and end-to-end anastomosis has been associated with good outcomes. Management of infraglottic stenosis is difficult, particularly when there is a large laryngeal defect or when there have been previous surgical attempts at the same site.

Posterior mediastinal localization of Castleman's disease: report of a case.

Castleman's disease, defined as angiofollicular lymphoid hyperplasia, is a rare lymphoproliferative disorder, which usually occurs in the chest. The tumor is often asymptomatic, but it can cause nonspecific thoracic symptoms such as cough and dyspnea. Surgical removal is curative and malignant transformation has not been described. We report an unusual case of Castleman's disease localized in the posterior mediastinum and bordering the chest wall, and review the relevant literature.