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Even though studies have indicated the usefulness and safety of endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA), elderly patient data are limited due to the small sample sizes. We aimed to evaluate usage and safety of EBUS-TBNA in elderly population. This single-center retrospective study was conducted with patients who underwent an EBUS-TBNA procedure between September 2011 and December 2019. The patients were categorized into two groups: those aged 65 years or older (elderly group) and those younger than 65 years (younger group). 2444 patient data, 1069 of which were in the elderly group, were analyzed. The cytological examination of EBUS-TBNA identified specimen adequacy in 96.8% of patients. One hundred and thirty patients (5.3%) experienced complications, with similar complication rates recorded in both the elderly and younger groups (5.4% vs 5.2%, p: 0.836). Logistic regression analyses revealed that age, and presence of hypertension, diabetes mellitus, coronary artery disease and malignancy are associated significantly with complication-related EBUS-TBNA. For the lymph nodes with a final diagnosis of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EBUS-TBNA revealed a diagnostic performance in excess of 90% except for metastasis and lymphoma. EBUS-TBNA can be considered a safe and effective technique in patients aged 65 years and over.

Our study aimed to evaluate clinical, functional, and prognostic features and to determine the prognosis of idiopathic pulmonary fibrosis, connective tissue disease-associated interstitial lung diseases, and interstitial pneumonia with autoimmune features.Sixty-nine cases with interstitial lung diseases were recruited in this study prospectively. Demographic features, symptoms, radiological findings, functional measurements, and immunological markers were recorded twice (at the time of initial admission and in the 12th month). Twenty-four of 69 cases were idiopathic pulmonary fibrosis, 32 were connective tissue diseaseassociated interstitial lung diseases, and 13 were interstitial pneumonia with autoimmune features .Most of the patients with idiopathic pulmonary fibrosis were male, while there were more female patients in connective tissue disease-associated interstitial lung diseases and interstitial pneumonia with autoimmune features groups. Female patients (65.0%) predominated in connective tissue disease-associated interstitial lung diseases group (P.001). There was no significant difference in the mean ages of the disease groups, yet connective tissue disease-associated interstitial lung diseases patients were generally younger (min- max: 34-82 years). In the idiopathic pulmonary fibrosis group, only low titers of antinuclear antibody positivity were found. Antinuclear antibody positivity in the connective tissue disease-associated interstitial lung diseases group and interstitial pneumonia with autoimmune features group was high (P = .001). The long-term survival of idiopathic pulmonary fibrosis, connective tissue disease-associated interstitial lung diseases, and interstitial pneumonia with autoimmune features patients were 37%, 40 months (median) (95% CI, 5.193- 74.807), 48.6%, 80 months (median) (95% CI, 57.032-102.968), 30.8%, 46 months (median) (95% CI, 26.624-65.376), respectively.Although a consensus report describing interstitial lung diseases with autoimmune features has been published, diagnostic criteria for this group are still vague. Since the interstitial pneumonia with autoimmune features group had the worst results in terms of functional loss and survival rates, the follow-up parameters and follow-up algorithm should be established for this group. Clinical and immunological evaluation of the interstitial pneumonia with autoimmune features group should include detailed parameters because of follow-up and to estimate survival.

Introduction The patients in the intensive care unit have a higher risk of infections because of the poor general condition of these patients and the frequent application of invasive procedures with longer hospitalization length. Also, this group of patients tend to have resistant infections due to empirically widespread and uncontrolled use of broad-spectrum antibiotics. Hence, data are needed to determine appropriate empirical antibiotic therapy in intensive care patients. In this study, it was aimed to assess the distribution of microorganisms and antibiotic resistance profile from the samples taken from the patients in the intensive care unit. Materials and methods Patients who were hospitalized in Ankara University Faculty of Medicine Chest Diseases Intensive Care Unit for more than 24 hours between December 2016 and December 2017 were included in our study. Demographic characteristics, comorbid diseases, clinical findings, results of sputum, tracheal aspirate, blood, urine, gaita and pus culture samples and antibiotic susceptibility test results were recorded prospectively. Result A total of 287 patients, 150 males and 137 females, were included in the study. The mean age of all patients was 69.96 ± 14.4 years. Two hundred twenty-three positive cultures were detected in 1053 samples taken from 287 patients. Gram-negative bacilli constituted 55.1% of the 223 positive cultures. The most common microorganisms were Acinetobacter (16.6%), Staphylococcus (14.8%) and Klebsiella (10.8%). Colistin resistance was found to be 8.3% in the Acinetobacter strains and resistance rates of 97-100% were observed to other antibiotic groups. Thirty-three staphylococcus were isolated, 17 were S. aureus and 16 were coagulase-negative Staphylococcus. While 29.4% of S. aureus were resistant to methicillin (MRSA), vancomycin resistance was not detected. Meanwhile, the MRSA ratio was 62.5%, there was no vancomycin resistance among the coagulase-negative Staphylococcus. Klebsiella was the third most common microorganism and beta-lactamase producing Klebsiella strain was 62.5%. Gentamycin was found to be the most susceptible antibiotic in Klebsiella strains with a resistance rate of 20.8%. Pseudomonas aeruginosa constituted 9.4% of the cultures. While the resistance to colistin was not detected, resistance to piperacillin/tazobactam 42.8%, tobramycin, imipenem and meropenem 50% and ceftazidime 61.9%. The duration of hospitalization in patients with Acinetobacter isolated (23 [10-34] days vs 12.5 [5-24] days, p= 0.011) and the mortality rate (62.5% vs 37.5%, p= 0.008) were significantly higher than those who were not Acinetobacter isolated. Conclusions In conclusion, gram-negative bacilli constitute the majority of the patients in intensive care unit. Acinetobacter, the most common microorganism, has a high resistance rate and has been associated with prolonged hospitalization and mortality.

Objective: To evaluate and discuss the outcomes of a combination of ventriculocystostomy (VC) and endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus (HCP) due to ventricular/cisternal arachnoid cysts, and only ETV for obstructive HCP due to different etiologies. Methods: We retrospectively reviewed all 40 symptomatic patients (aged 4 months – 61 years) of obstructive HCP treated by ETV or VC+ETV during October 2014 – April 2019. VC+ETV was performed in 7 patients with intraventricular/cisternal arachnoid cyst and obstructive HCP. Only ETV was performed in 33 patients with obstructive HCP due to other etiologies. Results: Successful ETV or VC+ETV surgery was performed in 35 patients. The procedure failed in 5 patients aged < 1 year; all these 5 patients had a head circumference (HC) of > 90 percentile at the time of surgery. Another 5 patients aged < 1 year showed successful ETV, with a HC of 75–90 percentiles. Conclusion: ETV is a successful alternative treatment for obstructive HCP. The ventricular size may not demonstrate a remarkable reduction post-ETV than post-shunting. Accordingly, increased intracranial pressure may not effectively decrease during the early period post-ETV than post-shunting. Therefore, the success rates of VC and/or ETV are low in very young patients with very high HCs (> 90 percentile).

Prone positioning is a well-known supportive maneuver to improve oxygenation for patients with moderate to severe acute respiratory distress syndrome (ARDS). Although this technique is usually performed to sedated patients on invasive mechanical ventilation, it has been used in non-intubated patients frequently during the coronavirus diseases-2019 (COVID-19) pandemic. Favorable outcomes have been reported mainly in combining the prone positioning with high flow nasal cannula (HFNC) or non-invasive ventilation (NIV). Due to limited data, a standard approach for the awake prone positioning has not yet been defined. In this manuscript, we reviewed the literature data about prone positioning in non-intubated patients with COVID-19. According to available literature data, we concluded that prone positioning in non-intubated COVID-19 patients may improve oxygenation and prevent the need for invasive mechanical ventilation. But the efficacy is still controversial in the early stage of the disease due to pulmonary mechanics. Further studies are needed to the defined optimal approach of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure.

Purpose Partial carbon dioxide pressure (PaCO2) is widely used to evaluate alveolar ventilation. Transcutaneous CO2 (TcCO2) monitoring has been developed as a noninvasive alternative to ABG. Studies demonstrated an association between hypoperfusion and increased tissue CO2. The research question of this study is if there is any relation between lactate level and TcCO2-PaCO2 among hypercapnic patients receiving noninvasive ventilation (NIV). Methods In this prospective study, simultaneously measured TcCO2 and PaCO2 values of hypercapnic patients receiving NIV were recorded. Each paired measurement was categorized into two groups; normal lactate (

Background/aim: During theCOVID-19 pandemic, the risk of transmission of SARS-CoV-2 has not been precisely known in bronchoscopy procedures. We have designed a cabinet device called Ankara University Bronchoscopy Cabinet (Aubrocab') to protect healthcare. We aimed to evaluate preventing effect of Aubrocab' on aerosol spreading by measuring the particles in the bronchoscopy suite.

Although thorax ultrasound has been used to diagnose pneumonia in recent years, the role of ultrasonic diaphragm evaluation in the prognosis of pneumonia is unknown. This study aimed to assess the impact of diaphragmatic excursion (Dex) measured by ultrasound on the prognosis of severe pneumonia in critical care patients.We prospectively recruited patients with severe pneumonia who were admitted to the intensive care unit (ICU) between January 2019 and July 2021. Patients' Dex values, vital signs, clinical features, laboratory parameters, APACHE-II scores on the first admission day of ICU, mortality and respiratory support status at follow-up were recorded.There were 39 patients enrolled in the study. Mean Dex of the study patients was 30.66 ± 12.17 mm. Mean Dex was significantly lower in deceased patients than survivors (18.37 ± 8.12 vs 34.90 ± 10.36 p0.001). Dex was lower in patients who required invasive mechanical ventilation than those not (24.90 ± 10.93 vs 34.26 ± 11.70, p= 0.017). The cut-off value of Dex was found 19.0 mm for significantly predicted (p≤ 0.001) survival with the sensitivity of 96.6% and specificity of 70%. Among the study group, diaphragm excursion was negatively correlated with APACHE-II score (r= -0.688, p≤ 0.001) and respiratory rate (r= -0.531, p= 0.001).Dex measured on the day of ICU admission can be used to evaluate the prognosis of patients with severe pneumonia.

Aim This study aimed to histopathologically evaluate and compare bone morphogenetic protein (BMP)-2, vascular endothelial growth factor (VEGF), and vitamin D receptor (VDR) levels in the ligamentum flavum (LF) of patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). Material and methods Surgical specimens of the LF in 25 patients who underwent surgery for LDH and 25 patients who underwent surgery for LSS were examined histopathologically. The prevalence and severity of BMP-2, VEGF, and VDR immunoreactivity were evaluated to create histoscores (prevalence × severity), which were compared between groups. Results The mean BMP-2 histoscore was similar in both groups. In the LSS group, the mean VEGF histoscore was significantly higher and the mean VDR histoscore was significantly lower. Conclusion Elevated VEGF and decreased VDR levels in the LF in LSS are associated with more intense inflammation and chronic process of the disease. The prominent expression of BMP-2 in the LF in both diseases suggests that BMP-2 might be affected by inflammation regardless of chronic pressure and degeneration.

During the COVID-19 pandemic, the risk of transmission of SARS-CoV-2 has not been precisely known in bronchoscopy procedures. We have designed a cabinet device called Ankara University Bronchoscopy Cabinet (Aubrocab®) to protect healthcare. We aimed to evaluate preventing effect of Aubrocab® on aerosol spreading by measuring the particles in the bronchoscopy suite.The patients were categorized into two groups as those who underwent bronchoscopy with and without Aubrocab®. We measured PM 0.5 levels before and after bronchoscopy in the bronchoscopy suite.A total of 82 patients, 62 of whom underwent bronchoscopy with Aubrocab®, were enrolled in the study. The PM 0.5 level measured before bronchoscopy was similar in both groups, whereas the PM 0.5 level measured after bronchoscopy was lower in the Aubrocab® group (42,603 ± 8,632 vs. 50,377 ± 10,487, p = 0.001). The percent of particle change (50.76 ± 19.91 vs 67.15 ± 24.24, p = 0.003) and the difference of the particle numbers between pre and postprocedure (13,638 ± 4,292 and 19,501 ± 5,891, p0.001) were lower in the Aubrocab® group.Our institution developed a barrier device named Aubrocab® which was shown to prevent excessive aerosol release in addition to routine precautions during bronchoscopy procedures.

The patients in the intensive care unit have a higher risk of infections because of the poor general condition of these patients and the frequent application of invasive procedures with longer hospitalization length. Also, this group of patients tend to have resistant infections due to empirically widespread and uncontrolled use of broad-spectrum antibiotics. Hence, data are needed to determine appropriate empirical antibiotic therapy in intensive care patients. In this study, it was aimed to assess the distribution of microorganisms and antibiotic resistance profile from the samples taken from the patients in the intensive care unit.Patients who were hospitalized in Ankara University Faculty of Medicine Chest Diseases Intensive Care Unit for more than 24 hours between December 2016 and December 2017 were included in our study. Demographic characteristics, comorbid diseases, clinical findings, results of sputum, tracheal aspirate, blood, urine, gaita and pus culture samples and antibiotic susceptibility test results were recorded prospectively.A total of 287 patients, 150 males and 137 females, were included in the study. The mean age of all patients was 69.96 ± 14.4 years. Two hundred twenty-three positive cultures were detected in 1053 samples taken from 287 patients. Gram-negative bacilli constituted 55.1% of the 223 positive cultures. The most common microorganisms were Acinetobacter (16.6%), Staphylococcus (14.8%) and Klebsiella (10.8%). Colistin resistance was found to be 8.3% in the Acinetobacter strains and resistance rates of 97-100% were observed to other antibiotic groups. Thirty-three staphylococcus were isolated, 17 were S. aureus and 16 were coagulase-negative Staphylococcus. While 29.4% of S. aureus were resistant to methicillin (MRSA), vancomycin resistance was not detected. Meanwhile, the MRSA ratio was 62.5%, there was no vancomycin resistance among the coagulase-negative Staphylococcus. Klebsiella was the third most common microorganism and beta-lactamase producing Klebsiella strain was 62.5%. Gentamycin was found to be the most susceptible antibiotic in Klebsiella strains with a resistance rate of 20.8%. Pseudomonas aeruginosa constituted 9.4% of the cultures. While the resistance to colistin was not detected, resistance to piperacillin/tazobactam 42.8%, tobramycin, imipenem and meropenem 50% and ceftazidime 61.9%. The duration of hospitalization in patients with Acinetobacter isolated (23 [10-34] days vs 12.5 [5-24] days, p= 0.011) and the mortality rate (62.5% vs 37.5%, p= 0.008) were significantly higher than those who were not Acinetobacter isolated.In conclusion, gram-negative bacilli constitute the majority of the patients in intensive care unit. Acinetobacter, the most common microorganism, has a high resistance rate and has been associated with prolonged hospitalization and mortality.

Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of emerging atypical pneumonia. In patients with tracheostomy, coronavirus hypothetically coexists with well-known bacterial agents. A 61-year-old male patient with tracheostomy was admitted to the hospital with dyspnea, fever and increased tracheal secretions. Laboratory findings revealed lymphopenia and elevated C-reactive protein and procalcitonin levels. Chest computed tomography showed consolidation areas and ground-glass opacities more prominent in subpleural areas. Although; two consecutive RT-PCR analyses of combined nasopharengeal/oropharengeal swabs were found to be negative for SARS-CoV-2 RNA, positivity was reported for endotracheal aspirate (ETA) sample. Significant growth of Pseudomonas aeruginosa and Stenotrophomonas maltophilia was detected in the bacterial culture of ETA sample. In conclusion, clinical samples for SARS-CoV-2 should be obtained through the lower respiratory tract, if possible and if upper airway samples are negative. To the best our knowledge, our paper is the first report of the patient with tracheostomy who was treated successfully for COVID-19.

Aims Patients with acute pulmonary embolism (PE) at low risk for short-term death are candidates for home treatment or short-hospital stay. We aimed at determining whether the assessment of right ventricle dysfunction (RVD) or elevated troponin improves identification of low-risk patients over clinical models alone.Methods and results Individual patient data meta-analysis of studies assessing the relationship between RVD or elevated troponin and short-term mortality in patients with acute PE at low risk for death based on clinical models (Pulmonary Embolism Severity Index, simplified Pulmonary Embolism Severity Index or Hestia). The primary study outcome was short-term death defined as death occurring in hospital or within 30 days. Individual data of 5010 low-risk patients from 18 studies were pooled. Short-term mortality was 0.7% [95% confidence interval (CI) 0.4–1.3]. RVD at echocardiography, computed tomography or B-type natriuretic peptide (BNP)/N-terminal pro BNP (NT-proBNP) was associated with increased risk for short-term death (1.5 vs. 0.3%; OR 4.81, 95% CI 1.98–11.68), death within 3 months (1.6 vs. 0.4%; OR 4.03, 95% CI 2.01–8.08), and PE-related death (1.1 vs. 0.04%; OR 22.9, 95% CI 2.89–181). Elevated troponin was associated with short-term death (OR 2.78, 95% CI 1.06–7.26) and death within 3 months (OR 3.68, 95% CI 1.75–7.74).Conclusion RVD assessed by echocardiography, computed tomography, or elevated BNP/NT-proBNP levels and increased troponin are associated with short-term death in patients with acute PE at low risk based on clinical models. RVD assessment, mainly by BNP/NT-proBNP or echocardiography, should be considered to improve identification of low-risk patients that may be candidates for outpatient management or short hospital stay.

Aim:The European Society Cardiology guidelines state that advanced risk stratification is unnecessary in patients with simplified pulmonary embolism severity index (sPESI) of 0 because it does not affect treatment decision. Also, these patients can be discharged early or treated as outpatients if feasible. There were three aims of the present study. The first was to determine the rate of patients with sPESI of 0 but classified into intermediate risk category with advanced risk stratification. is the second was to determine the clinical impact of this risk classification change. And the third was to define risk factors for this condition.Patients and Methods:This is prospective single-center cohort study. All patients underwent advanced risk stratification at admission independent from the sPESI score. Patients with a sPESI score 0 were included.Results:There were 33 patients with sPESI score of 0. With advanced risk stratification; 60.6% of patients were low risk, 30.3% were intermediate low risk and 9.1% were intermediate-high risk. In 2 (6.1%) patients, respiratory failure developed. One of these patients became hypotensive and required thrombolytic treatment. D-dimer value (p=0.017) and thrombus in main pulmonary arteries (p=0.000) were statistically significantly high in intermediate risk group.Conclusions:Advanced risk stratification in sPESI 0 patients has an impact on management decisions. Early discharge or outpatient treatment decisions based on sPESI alone may cause the discharge of unstable patients especially in patients with main pulmonary artery thromboembolism or D-dimer level over 3600 ng/ml.

OBJECTIVE: In bronchiectasis cases, isolation of the bacterial infection agent is related with disease severity. The purpose of the study was to find the impact of bacterial infections on the prognosis of bronchiectasis exacerbations in patients hospitalized in the Intensive Care Unit (ICU). MATERIALS AND METHODS: A retrospective, single-center, clinical study was performed on 48 patients who were diagnosed as having bronchiectasis exacerbation in the ICU. Sputum cultures of the patients were collected at the time of ICU admission. Clinical characteristics, treatment with noninvasive ventilation, IV requirement, and mortality were recorded. RESULTS: The bacteriologic sputum examination was positive in 24 patients. The bacteriologic analysis of sputum cultures revealed Pseudomonas aeruginosa in 12 patients, Streptococcus pneumoniae in 4, Haemophilus influenzae in 3, Acinetobacter baumannii in 3, and Escherichia coli in 2 patients. Seventeen patients needed IV during ICU follow-up, 7 of whom died. Bacterial proliferation in sputum culture was correlated to IV treatment need (P = 0.005). The radiologic disease extent was greater in patients with culture proliferation (P = 0.028). The patients who needed IV treatment had a greater radiologic disease extent (P = 0.007), pulmonary artery systolic pressure pulmonary arterial pressure (PAP) (P = 0.004), C-reactive protein (P = 0.014), and number of hospital admissions (P = 0.017). A multiple regression analysis for treatment success involving the variables of PAP, culture results, and radiologic disease extent revealed that bacterial proliferation was the most important factor for treatment success (odds ratio: 2.05; confidential interval: [0.87–3.23]; P = 0.04). CONCLUSION: Positive bacterial examination of sputum is the most important prognostic factor for patients with bronchiectasis exacerbation admitted to the ICU.

OBJECTIVES: In some studies, it has been hypothesized that anthracotic pigmentation in mediastinal lymph nodes is a sign of benign conditions and excludes metastasis from thoracic and extrathoracic malignancies. The aim of this study was to evaluate the clinical significance of mediastinal lymph node anthracosis in cancer patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIALS AND METHODS: In this study, medical data of patients with lung cancer or extrathoracic cancer who underwent EBUS-TBNA for investigation of mediastinal lymph node metastasis were evaluated retrospectively. EBUS-TBNA cytology reported as anthracotic pigmentation was included in this study. Patients were excluded from the study if cytology of aspirated lymph nodes reported as “benign,” “malignancy,” or “granulomatous inflammation.” RESULTS: There were 50 eligible patients. Thirty-one (62%) patients underwent EBUS-TBNA for lung cancer staging and 19 (38%) for evaluation of extrathoracic metastasis. A total of 120 lymph nodes were sampled. The most sampled station was subcarinal. EBUS-TBNA was false negative in eight of 31 (25.8%) lung cancer patients and one of 19 (5.2%) extrathoracic malignancy patients. CONCLUSIONS: Anthracotic pigmentation of lymph nodes in EBUS-TBNA cannot exclude metastasis in lung cancer patients and mediastinoscopy should be performed before surgery in this group. In patients with extrathoracic malignancy, anthracotic pigmentation is associated with benign conditions. However, further investigation with larger cohort is needed.

The aim of the present study was to evaluate pre-treatment concentrations of leptin in patients with advanced lung cancer and to investigate possible associations between their levels and clinicopathological variables, response to therapy and overall survival.There are 71 previously untreated patients with cytological or histological evidence of primary lung cancer who were admitted to the oncology department between November 2013 and August 2014. Forty-five healthy individuals with age, sex and BMI matching the lung cancer patients, were recruited to take part in the study as a control group. Leptin levels were measured quantitatively by using a microELISA kit.The serum leptin levels at diagnosis were significantly lower in lung cancer patients than those in control subjects (4.75±4.91 ng/ml, 9.67±8.02 ng/ml; p0.001). We did not find any significant difference in leptin values related to clinicopathological parameters such as ECOG PS, weight loss, histological type, disease stage and TNM classification. Nevertheless, we demonstrated a significant correlation between serum leptin levels and BMI in lung cancer patients (correlation coefficient: 0.303; p0.010). The analysis of serum leptin values did not show any association with the overall survival of the patients.Our results showed that the serum leptin level has no prognostic indications in advanced lung cancer patients. Leptin is decreased in lung cancer, and there is lack of correlation with tumour‑related factors including prognosis. Therefore, leptin is not a useful clinical marker in lung cancer (Tab. 2, Fig. 2, Ref. 22).

Objective/Aim: The aim of this report was to investigate the effect of ventriculoperitoneal shunt insertion for the treatment of hydrocephalus on thyroid hormones in the first 3 months of life. Methods: Thyroid-stimulating hormone (TSH), free T3 (fT3), and free T4 (fT4) levels were compared at 7 days (preoperatively) and at 30 and 90 days (postoperatively) after birth between 25 ventriculoperitoneal shunt-inserted hydrocephalic newborns and 20 healthy newborns. Results: The TSH level at 7 days was higher in the hydrocephalic patient group (6.33 µIU) compared to the control group (3.76 µIU). This value was significantly decreased at 90 days in the ventriculoperitoneal shunt-inserted newborns (2.35 µIU) compared to the control group (3.33 µIU; p < 0.05). There were no significant differences between time points for fT4 and fT3 values in the patient group or for TSH, fT4, and fT3 values in the control group. Conclusion: We propose that a ventriculoperitoneal shunt inserted in the early period of life may have beneficial effects on thyroid hormones.

To investigate the effects of intrathecal caffeic acid phenethyl ester (CAPE) on tissue and serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-?) levels following spinal cord injury (SCI) as well as its effects on edema and microhemorrhage.Forty rats were divided into four groups. The sham group underwent single-level laminectomy and then received an intrathecal injection of isotonic saline. The control group received an intrathecal injection of isotonic saline following SCI induction. The methylprednisolone (MP) group received a single dose of MP intrathecally following SCI. The CAPE group received a single dose of CAPE intrathecally following SCI. IL-6 and TNF-? levels were determined using the enzyme-linked immunosorbent assay (ELISA) method. Spinal cord samples were evaluated histopathologically.The decrease in IL-6 levels in the CAPE group was significantly higher than that in the sham and control groups. However, this decrease was not as significant as that in the MP group. No significant decrease was identified in TNF-? levels. A significant decrease was observed in spinal cord edema and microhemorrhage in the CAPE group. A decrease in edema was observed in the MP group, but no effect was observed on microhemorrhage.Intrathecal CAPE administration following SCI decreases tissue and serum IL-6 levels as well as decreases spinal cord edema and microhemorrhage.

Objective: Concomitant chemoradiotherapy (CRT) is the standard treatment for patients with stage III non-small cell lung cancer (NSCLC). Myelosuppression can be a significant problem in concomitant CRT. The aim of this study was to assess the parameters obtained before concomitant CRT to define the risk factors for myelosuppression in patients with locally advanced NSCLC. Methods: We retrospectively analyzed 81 patients with NSCLC who received concomitant platinum-based chemoradiotherapy between January 2008 and December 2012. Seventy-eight patients (96.2%) received etoposide (50 mg/m2, intravenously on days 1–5, 29–33) plus cisplatin (50 mg/m2, on days 1, 8, 29, and 36), and 3 patients (3.8%) received docetaxel (20 mg/m2/w, on weeks 1–8) plus cisplatin (20 mg/m2/w, on weeks 1–8) concurrently with thoracic radiotherapy to a total dose of 40–66.6 Gy. The risk factors were examined for their association with myelosupression (grade 3 or 4 leukopenia, neutropenia, thrombocytopenia, or anemia) by logistic regression analysis. Results: Grade 3 or higher neutropenia, leukopenia, thrombocytopenia, or anemia occurred in 51.8%, 53%, 8.6%, and 7.4% of the patients, respectively. Multivariate analysis revealed that the risk factors for neutropenia were performance status (p=0.032), white blood cell count (p=0.023), and pretreatment creatinine level (p=0.018). On multivariate analysis, white blood cell count (OR, 3.311; p=0.027; 95% CI, 1.148–9.545) was found as significant risk factor for CRT-induced leukopenia Conclusion: Patients with a poor pretreatment performance status, low white blood cell count, and high creatinine level are at a risk of myelosupression. These characteristics of the patients should be considered while making treatment decisions.

Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was toanalyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lungcancer in Turkey.Materials and Methods: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter studyconducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleepproblems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and informationabout disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who havedifficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia.Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale.Results: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalenceof insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weightloss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, andanxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxietyhad 2-3 times higher rates of insomnia.Conclusion: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that,adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

WOS:000455820300004, PubMed ID: 30683024, Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was toanalyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. Materials and Methods: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. Results: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. Conclusion: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer., Giriş: Uyku kalitesinin, kanser semptomlarının şiddetiyle ilişkili olduğu bilinmektedir. Bu çalışmada, Türkiye’de akciğer kanseri hastalarında uyku ile ilişkili sorunların prevalansı ve kanser semptomlarının insomnia üzerine etkisinin araştırılması amaçlandı. Materyal ve Metod: Türkiye’de 26 merkezin katılımıyla gerçekleştirilen, akciğer kanserli olguların dahil edildiği çok merkezli bir çalışma olan ASPECT çalışması verileri, bu hastalarda görülen uyku sorunları, insomni ve bunların kanser semptomları ile ilişkisi yönüyle yeniden değerlendirildi. Hastaların demografik özellikleri ve hastalıkları hakkında bilgi, hasta ile yüz yüze görüşülerek ve hastane kayıtları aracılığıyla derlendi. Uykuyu başlatma ve sürdürme zorluğu (DIMS) ile gündüz artmış uyku hali veya yorgunluk tanımlayan olgular insomni olarak değerlendirildi. Gündüz uyku hali, yorgunluk ve akciğer kanseri semptomları Edmonton Semptom Değerlendirme Skalası kullanılarak kaydedildi. Bulgular: Katılan 1245 olgunun, %48.4’ünde DIMS, %60.8’inde gündüz uyku hali ve %82.1’inde yorgunluk mevcuttu. Insomni prevalansı %44.7 olarak bulundu. Kadın cinsiyet, evre 3-4 hastalık, metastatik hastalık, komorbid hastalıklar ve kilo kaybı 5 kg olan olgularda insomnia oranı anlamlı olarak daha yüksekti. Diğer yandan insomnisi olan hastalarda ağrı, bulantı, dispne ve anksiyete semptomları anlamlı düzeyde yüksek bulundu. Multivariate lojistik regresyon analizi, orta ileri şiddetli ağrısı ve dispnesi olan, ayrıca ciddi anksiyetesi olan hastalarda insomni sıklığının 2-3 kat fazla olduğunu ortaya koydu. Sonuç: Çalışmamız, kanser semptomları ile uyku kalitesi arasında yakın bir ilişki olduğunu ortaya koymuştur. Bu nedenle, akciğer kanserli hastalarda kaliteli bir uyku için, kanser semptomların yeterince kontrol edilmesi gereklidir.

AIM To investigate the possible role of ELABELA (ELA) in the histopathological grading of gliomas. MATERIAL AND METHODS We retrospectively assessed pathological specimens of patients who underwent surgery for intracranial space-occupying lesions. Only primary glioma specimens were included in this study. We enrolled 11 patients histologically diagnosed with low-grade glioma and 22 patients with high-grade glioma. The ELA antibody was applied to 4?6-?m-thick sections obtained from paraffin blocks. Histoscores were calculated using the distribution and intensity of staining immunoreactivity. An independent sample t-test was used for two-point inter-group assessments, whereas one-way analysis of variance was used for the other assessments. p < 0.05 was considered statistically significant. RESULTS The histoscores of the control brain, low-grade glioma, and high-grade glioma tissues were found to be 0.08, 0.37, and 0.92, respectively. The difference in ELA immunoreactivity between the control brain tissue and glioma tissue was statistically significant (p < 0.05). In addition, a statistically significant increase was observed in ELA immunoreactivity in high-grade glioma tissues compared with that in low-grade glioma tissues (p < 0.05). CONCLUSION ELA has an angiogenetic role in the progression of glial tumors. ELA, which is an endogenous ligand of the apelin receptor, activates the apelinergic system and causes the progression of glial tumors. Further studies with a large number of patients are necessary to investigate the angiogenetic role of ELA in glial tumors.

Background/aim: Mediastinal lymph nodes are the second most commonly affected lymph nodes in tuberculous lymphadenitis. It is often difficult to diagnose tuberculosis in patients with lymphadenopathy without parenchymal lesions. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isolated mediastinal tuberculous lymphadenitis (MTLA). Materials and methods: This study included 527 patients who had undergone EBUS-TBNA between December 2012 and December 2014. Patients with the final diagnosis of MTLA were evaluated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of EBUS-TBNA were calculated.Results: The prevalence of MTLA in all patients who had undergone EBUS-TBNA for mediastinal lymphadenopathy of unknown etiology was 5.2% (28/527). EBUS-TBNA was diagnostic in 21/28 (75%) patients, and the remaining 7 patients required additional procedures for confirmation of diagnosis. Sensitivity, specificity, PPV, NPV, and accuracy of combined cytopathological and microbiological examinations of EBUS-TBNA in the diagnosis of MTLA were 87.5%, 98.5%, 91.4%, 98%, and 94.4%, respectively. There were no major complications.Conclusion: EBUS-TBNA is a safe and effective procedure for the diagnosis of MTLA. When microbiological and cytopathological examinations of samples are combined, EBUS-TBNA demonstrates good diagnostic accuracy and NPV for the diagnosis of MTLA.

Background/aim: The objective of this study was to carry out a detailed analysis and assess the outcomes for the Minerva cervical thoracic jacket (CTJ) in patients with type II odontoid fractures who could not be surgically treated. Materials and methods: Twenty-six patients for whom the Minerva CTJ was used rather than surgery for different reasons were included in the study. All patients were fitted with the Minerva CTJ within the first 24 h following diagnosis. The patients were followed 4 weeks after hospital discharge and then at 2-week intervals. Results were considered significant at P < 0.05 and a 95% confidence interval was calculated. Results: Of the 26 patients, 17 were male and 9 were female. The mean age was 49.03 years old (range: 16?86 years old). Fusion occurred in 25 of the 26 patients (P = 0.004), and the mean time to fusion was 6.8 weeks (P = 0.002). The mean length of hospital stay was 4 days and the mean follow-up period was 7.3 weeks. None of the patients had any complications due to the Minerva CTJ and the mortality rate was 0%. Conclusions: The Minerva CTJ application was a safe and cheap technique in the management of type II odontoid fractures. It had a high fusion rate and no complications.

INTRODUCTION In 2017 update, GOLD separated spirometry from ABCD classification. OBJECTIVES The aim was to investigate the predictive reliability of GOLD 2017 grading system in terms of future moderate and severe exacerbations. METHODS COPD patients were classified into A to D groups according to GOLD 2011 and 2017. Patients who were assigned to C/D groups according to GOLD 2011 were divided into subgroups C 1/D1, C2/D2, C3/D3 according to FEV1 % of predicted and exacerbation history. C1/D1 patients defined as FEV1

We have discussed the importance of sacrococcygeal sinus angle (SSA), which is a new anatomical landmark in the surgery of presacral lesions. Because of its anatomical structure, the sacrum limits the surgical exposure like a compact barrier for the posterior surgical approach. The main aim of this paper is to explain the anatomical description and clinical importance of SSA in the surgery of presacral lesions.Three groups were designated, consisting of ten patients in each group, as early childhood (group 1), late childhood (group 2) and adulthood (group 3). Patients were selected randomly. The degree of SSA measurement was performed between the line tangent to the anterior margin of the first sacral vertebra and the line from the promontorium to the tip of the coccyx. The measurement of SSA was performed on patients' lumbosacral magnetic resonance images. When the SSA forms a triangle via a parallel line starting from the inferior tip of the sacrum and running parallel to the ground, the area of the triangle also covers the field of view of the presacral region. In addition, the sacral region needed to be resected for maximum exposure is also within this area.The mean SSA was measured to be 53.9 ± 11.4° in group 1, 77.8 ± 11.2° in group 2 and 74.5 ± 12.5° in group 3. Intergroup comparisons revealed a significant difference between group 1 and the other two groups statistically. It was found that the SSA was 20° less in group 1 as compared to the other age groups (p = 0.0005). The area of a triangle is calculated using the sine area formula, and according to this formula the area of a triangle increases when the degree of the angle increases, thus comprising larger part of the sacrum. This condition requires more and wide sacral resection to obtain maximum exposure in the presacral zone.We have observed that the SSA is significantly smaller during early childhood compared with the other age groups. This feature provides an anatomical superiority in this age group for the posterior approach in the surgical treatment of presacral masses.

To describe the intra- and postoperative results of patients who received a transforaminal anterior epidural steroid injection (TAESI) prior to lumbar microdiscectomy.Sixty-four patients who did not improve after minimally invasive techniques (MIT) for lumbar radiculopathy were evaluated. Thirty-two of them treated with techniques other than TAESI and those receiving thrombolytic or anticoagulant drugs before microdiscectomy were excluded. We recorded the type of MIT, numbers of levels and injections, time interval between the last MIT and microdiscectomy, duration of surgery, amount of intraoperative blood loss, rate of incidental durotomy, postoperative infection, and visual analogue scale (VAS) scores for leg pain before and after microdiscectomy at 24 hours, and the 1st and 3rd months (Group 1). A total of 35 patients with no history of MIT or lumbar surgery who had undergone unilateral, single-level lumbar microdiscectomy at our clinic were randomly selected to be included in the control group (Group 2) and same parameters were recorded for the comparison of both groups.The mean duration of lumbar discectomy was 140 minutes, and the amount of average intraoperative blood loss was 227 cc in the study group (Group 1), and 65 minutes and 73 cc, respectively in the control group (Group 2)(p0.05). The comparison of VAS scores revealed that lumbar discectomy was still effective after TAESI (p=0.00).Although epidural steroid injection is an effective modality for the management of chronic pain, these patients should be informed preoperatively about the relatively long duration of surgery and the possible requirement for blood transfusion.

AIM To evaluate the preoperative and postoperative 6th month mean apparent diffusion coefficient (ADC) values of the cerebellar tonsils and bulbus in patients with Chiari Malformation Type I (CMI), and to compare the results with healthy controls. MATERIAL AND METHODS We included 15 patients with CMI who underwent suboccipital decompression, upper cervical laminectomy, and duraplasty surgery, and compared them with 10 healthy individuals. Three regions of interest were placed, one each in the cerebellar tonsils and one in the bulbus. The mean ADC values were measured separately in each region. RESULTS Among the patients, mean ADC values were significantly decreased after surgery compared with before surgery. The mean ADC values before surgery were significantly higher for patients than for controls; however, although mean ADC values were slightly higher after surgery for patients than for controls, the differences were not significant. Thus, after surgical intervention, ADC values in patients with CMI became close to those of normal individuals. CONCLUSION The increased ADC values in patients with CMI before surgery implied that not only morphologic changes but also increased diffusivity may play a key role in the pathophysiology and clinical presentation of the disease. We conclude that decompression surgery can produce favorable diffusional alterations.

Aim To evaluate microcirculatory changes in neighboring parenchyma as a result of pressure due to chronic subdural hematoma (CSDH) in early and late periods after hematoma drainage. Material and methods The subject group consisted of 25 patients who underwent CSDH drainage. Brain diffusion and perfusion magnetic resonance images (MRIs) were obtained preoperatively, and at 48 hours (early period) and 2 months (late period) postoperatively. Measurements were performed on 1 cm2 regions of interest (ROI) in the neighboring parenchymal tissue. Results The early postoperative diffusion values showed improvement compared to the preoperative values. The late postoperative values showed improvement compared to the preoperative and early postoperative values. The early postoperative perfusion values showed slight decline compared to the preoperative values. However, the late postoperative values showed improvement compared to the preoperative and early postoperative values. Conclusion The fact that there was an increase in diffusion values from early to late postoperative periods, compared with the preoperative period, indicates that the beneficial effects of surgery increase over time. Brain perfusion was found to be slightly decreased in early postoperative period. Following CSDH drainage, neurological deteriorations are observed in some patients in the early postoperative periods; a slight impairment in perfusion may account for this. However, during the late postoperative period, perfusion was seen to recover prominently.

Aim To investigate the effects of intrathecal caffeic acid phenethyl ester (CAPE) on tissue and serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-?) levels following spinal cord injury (SCI) as well as its effects on edema and microhemorrhage. Material and methods Forty rats were divided into four groups. The sham group underwent single-level laminectomy and then received an intrathecal injection of isotonic saline. The control group received an intrathecal injection of isotonic saline following SCI induction. The methylprednisolone (MP) group received a single dose of MP intrathecally following SCI. The CAPE group received a single dose of CAPE intrathecally following SCI. IL-6 and TNF-? levels were determined using the enzyme-linked immunosorbent assay (ELISA) method. Spinal cord samples were evaluated histopathologically. Results The decrease in IL-6 levels in the CAPE group was significantly higher than that in the sham and control groups. However, this decrease was not as significant as that in the MP group. No significant decrease was identified in TNF-? levels. A significant decrease was observed in spinal cord edema and microhemorrhage in the CAPE group. A decrease in edema was observed in the MP group, but no effect was observed on microhemorrhage. Conclusion Intrathecal CAPE administration following SCI decreases tissue and serum IL-6 levels as well as decreases spinal cord edema and microhemorrhage.

Introduction The pulmonary embolism severity index (PESI) or simplified version (sPESI) are widely validated risk scores for the identification of eligible patients for outpatient treatment. Saturation is one of these criteria. For this metric, saturation of 90% or greater is assigned zero points. However, 90% saturation does not always exclude hypoxemic respiratory failure. Objective The aims of this study were first was to define corresponding partial arterial oxygen pressure (PaO2 ) values according to saturation in pulmonary embolism (PE) patients, and the second was to define a target saturation that can exclude hypoxemic respiratory failure and enable secure discharge of PE patients from emergency departments. Methods This is a retrospective study. To determine the optimal saturation value by which to detect hypoxemic respiratory failure, we generated receiver operating characteristic (ROC) curves and calculated the negative predictive value. Results Total of 65 patients were included in this study. Mean PaO2 levels from SaO2 89% to SaO2 93% were 52.8, 57.1, 57.3, 61, and 63.8 mmHg, respectively. ROC curve analysis revealed SaO2 level of 91.5% to be optimal target saturation for excluding respiratory failure with 84.6% specificity and 89.7% sensitivity; area under the curve was 0.885 (95% CI 0.796-0.975). The negative predictive value was 80% for SaO2 level of 92%. Conclusion Patients with PE may be in respiratory failure despite an oxyhemoglobin saturation of ≥90%. Although saturation is likely more important than precise PaO2 in tissue oxygenation, clinicians should be aware of the physiological effects of hypoxemia and take this into account before making outpatient treatment decisions.

Aim: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure that can be performed in outpatient settings. Several studies have demonstrated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis and malignant diseases. This study focused on the role of cell block (CB) analysis in determining the diagnostic yield of EBUS-TBNA in malignant diseases and sarcoidosis. Materials and Methods: The study was conducted at a training and research hospital. Records of patients who underwent EBUS-TBNA between March 2011 and December 2014 for diagnosed sarcoidosis or malignancy were retrospectively analyzed. Results of all EBUS-TBNA smears and CB were separately evaluated to determine the diagnostic value of each. Results: There were 84 sarcoidosis and 179 malignancy patients. In the malignancy group, CB contributed to cancer diagnosis in 15 (8.3%) patients and subclassification in 19 (10.6%) patients. In the sarcoidosis group, for 45.2% of patients (38/84), smears were not diagnostic but CB showed granulomatous inflammation. Conclusion: CB significantly increases the diagnostic yield of EBUS-TBNA for sarcoidosis. In our study, in the malignancy group the diagnostic yield was low but it was helpful for subclassification, especially for adenocarcinoma.

WOS:000378176100060 PubMed: 27072260 Aim: Concurrent chemoradiotherapy (CRT) is the standard therapy for patients with unresectable Stage III nonsmall cell lung cancer (NSCLC). The aim of this study was to assess the efficacy and safety of concurrent CRT in unresectable Stage III NSCLC in Turkey. Patients and Methods: The study included 82 patients with histologically proven unresectable Stage III NSCLC, Eastern Cooperative Oncology Group performance status 0-1, who received concurrent CRT in two different referral centers. Treatment consisted of two cycles of cisplatin at 50 mg/m(2) on days 1, 8, 29, and 36 and etoposide 50 mg/m(2) between days 1 and 5, 29-33 and concurrent radiotherapy administered once daily, 1.8-2.0 Gy per fraction, at a total dose of 60-66 Gy. Results: The stages of the patients were Stage IIIA in 39 (47.5%) and IIIB in 43 (52.5%) patients. Complete and partial responses were achieved in 15 (18.2%) and 31 (37.8%) of the patients, respectively. Twenty-eight (34.2%) patients had stable disease and 8 (9.8) had progressive disease. Forty-one (50%) patients recurred during follow-up. The primary site of recurrence was as distant metastasis in 19 (23.2%) patients. Median overall survival (OS) was 20 months (95% confidence interval; 12.9-27.09 months), 3 and 4 years survivals were 27.9% and 20.9%, respectively. Median progression-free survival (PFS) was 9 months, 3 and 4 years PFSs were 20.1% and 16.1%. Myelosuppression was the most common toxicity. In 15 (19.2%) patients grade 2-3 lung toxicity and in seven (8.5%) patients' grade 2-3 dysphagia were reported. Conclusion: Concurrent CRT with cisplatin and etoposide schedule is a well-tolerated regimen with acceptable toxicity profile and survival rates in patients with unresectable Stage IIIA/IIIB NSCLC. Median survival and OS results were consistent with the literature.