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Introduction: The therapeutic effect of different doses of the traditional aqueous extract of dried leaves of yerba mate (Ilex paraguariensis A. St.-Hil.) was investigated in an experimental cataract model in chicken embryos. Methods and Results: LC-MS/MS analysis allowed the identification and quantification of 53 metabolites. In the hydrocortisone-induced cataract model, lenses were examined morphologically after treatment and parameters related to oxidative stress (total antioxidant/oxidant status (TAS/TOS), glutathione (GSH), and malondialdehyde (MDA)) were evaluated. Antiproliferative cell nuclear antigen (PCNA) and caspase-3 H-scores were determined and crystallin alpha A (CRYAA) gene expression in the lenses was measured by RT-PCR. The degree of cataract decreased in all treatment groups. While there was no significant difference in TAS levels compared to the negative control, TOS, GSH, and MDA levels were dose-dependently regulated. Treatment groups other than the high-dose group regulated the decrease in PCNA and the increase in caspase-3. CRYAA gene expression increased significantly only at the lowest dose. Conclusion: YM, which is becoming increasingly popular as a traditional tea, showed a therapeutic effect on hydrocortisone-induced cataracts in chicken embryos at relatively low doses. [ABSTRACT FROM AUTHOR]

Lung cancer is the most common cause of cancer-related mortality, chemo-resistance, and toxicity limit treatment. The focus is on innovative combined phytotherapy to improve treatment outcomes. Our aim was to investigate the potential effects of daidzein nanosuspension (DZ-NS) and its combination with cisplatin (CIS) on A549 non-small lung cancer cells. Cytotoxicity was investigated using MTT and Chou-Talalay methods. Oxidative, apoptotic, and inflammatory markers were analyzed by ELISA and qRT-PCR. The IC50 value for DZ-NS was 25.23 µM for 24 h and was lower than pure DZ (IC50 = 835 µM for pure DZ). DZ-NS (at IC50x2 and IC50 values) showed synergistic cytotoxicity with CIS. The cells treated with DZ-NS had low TOS and OSI levels. However, DZ-NS failed to regulate Cas3 and TGF-β1 activation in A549 cells. MMP-9 gene expression was significantly suppressed in DZ-NS-treated cells, especially in combination therapy. DZ represents a potential combination option for the treatment of lung cancer, and its poor toxicokinetic properties limit its clinical use. To overcome these limitations, the effects of the nanosuspension formulation were tested. DZ-NS showed a cytotoxic effect on A549 cells and optimized the therapeutic effect of CIS. This in vitro synergistic effect was mediated by suppression of MMP-9 and not by oxidative stress or Cas3-activated apoptosis. This study provides the basis for an in vivo and clinical trial of DZ-NS with concurrent chemotherapy. [ABSTRACT FROM AUTHOR]

Background: The study explores left atrial appendage closure (LAAC) as a safe and effective alternative to anticoagulation for atrial fibrillation (AF) patients at high bleeding risk. Complications, such as cardioembolic events due to left atrial appendage thrombus (LAAT), highlight the need for alternative stroke prevention strategies. Aims: This research assesses LAAC's safety and efficacy in patients with LAAT, aiming to offer valuable insights into its potential as a viable option for stroke prevention in such cases. Methods: The study included 205 patients who underwent LAAC using specific devices between September 2015 and February 2023. Among them, 32 patients had persistent LAAT. Baseline characteristics, antithrombotic medications, risk scores, and LAAC indications were documented. Patients were followed to monitor significant clinical events like stroke, cardiovascular mortality, and all‐cause mortality. Results: The mean age was 71.9 and mostly female. Indications for LAAC were ischemic cerebrovascular events (CVE) despite anticoagulation (25%), bleeding complications (major/minor, 37.5% each), or both. Successful LAA closure was achieved in all cases, with minimal pericardial effusion in one. One‐month follow‐up showed no major events or device‐related issues. Median follow‐up of 16.5 months saw 21.9% non‐cardiac deaths. The study underscores LAAC's efficacy for stroke prevention in patients with persistent LAAT. Conclusions: The LAAC in cases of LAAT, whether pursued initially or as a deferred approach, demonstrates feasibility and safety, exhibiting notable procedural success and minimal incidence of periprocedural complications. [ABSTRACT FROM AUTHOR]

The article explores the integration of left atrial posterior wall isolation (LAPWI) and the emerging pulsed field ablation (PFA) technology in catheter ablation for persistent atrial fibrillation (PeAF). Topics discussed include the mixed evidence regarding the efficacy of combining LAPWI with pulmonary vein isolation (PVI), the initial success and safety of using PFA for LAPWI, and the call for standardized procedures and further research to support these advanced ablation techniques.

Background and objectives: We explored the prognostic usefulness of the pan-immune-inflammation value (PIV) in patients with stage IIIB/C non-small-cell lung cancer (NSCLC) who underwent concurrent chemoradiotherapy (CCRT). Methods and patients: For all patients, the PIV was calculated using platelet (P), monocyte (M), neutrophil (N), and lymphocyte (L) measures obtained on the first day of CCRT: PIV = P × M × N ÷ L. Using receiver operating characteristic (ROC) curve analysis, we searched for the existence of an ideal cutoff that may partition patients into two groups with unique progression-free- (PFS) and overall survival (OS) results. The primary endpoint of this retrospective cohort research was to determine whether there were any significant relationships between pretreatment PIV measures and post-CCRT OS outcomes. Results: The present research included a total of 807 stage IIIB/C NSCLC patients. According to ROC curve analysis, the ideal PIV cutoff was 516 [area under the curve (AUC): 67.7%; sensitivity: 66.4%; specificity: 66.1%], which divided the whole cohort into two: low PIV (L-PIV: PIV < 516; N = 436) and high PIV (H-PIV: PIV ≥ 516; N = 371). The comparisons between the PIV groups indicated that either the median PFS (9.2 vs. 13.4 months; P < 0.001) or OS (16.7 vs. 32.7 months; P < 0.001) durations in the H-PIV group were substantially inferior to their L-PIV counterpart. Apart from the H-PIV (P < 0.001), the N3 nodal stage (P = 0.006), IIIC disease stage (P < 0.001), and receiving only one cycle of concurrent chemotherapy (P = 0.005) were also determined to be significant predictors of poor PFS (P < 0.05, for each) and OS (P < 0.05, for each) outcomes in univariate analysis. The multivariate analysis findings revealed that all four variables had independent negative impacts on PFS (P < 0.05, for each) and OS (P < 0.05, for each). Conclusions: The findings of this hypothesis-generating retrospective analysis claimed that the novel PIV was an independent and steadfast predictor of PFS and OS in stage IIIB/C NSCLC patients. [ABSTRACT FROM AUTHOR]

The aim of the study was to demonstrate the most common genetic alterations and evaluate possible targets involving phosphatidylinositol-3-OH kinase (PIK3)/AKT/mammalian target of rapamycin (mTOR) signaling and DNA damage repair (DDR) pathways for personalized treatment in patients with non-muscle invasive bladder cancer (NMIBC). Alterations of these pathways were observed in 89.5% and 100% of patients, respectively. Among them, BARD1 was more frequently altered in low/intermediate-risk cases, but PARP4 was more frequently affected in intermediate/high-risk patients. The possible target feasibility of BARD1 and PARP4 alterations should be evaluated for personalized treatment using PARP-inhibitors in NMIBC. It is important to detect high tumor mutation burden (TMB) in patients in terms of immunotherapy. [ABSTRACT FROM AUTHOR]

The aim was to investigate the effectiveness of Kinesio taping for lymphedema following head and neck cancer therapy and its effect on patient compliance and quality of life. A total of 66 patients with lymphedema following head and neck cancer therapy were randomly allocated to the therapeutic Kinesio taping group (n = 33) and the sham Kinesio taping group (n = 33). All participants received manual lymphatic drainage, Kinesio taping, and home exercises for the first four weeks, and only home exercises for the second four weeks. The tape measurements, a scale of external lymphedema, a scale of the internal lymphedema, and quality of life were evaluated in both groups. The perceived discomfort consisting of limitation of daily living activities, pain, tightness, stiffness, and heaviness were also recorded. When the group x time effect was evaluated, it was observed that external lymphedema was significantly reduced in both groups according to neck and face composite measurements (p <.001). However, in these measurements, a significant difference was found between the groups in favor of the KT group (p =.001, p =.032, respectively). At the end of the study, there was no significant difference in terms of internal lymphedema in both groups (p =.860). The quality of life parameters such as global health status and swallowing were significantly better in the Kinesio taping group (p <.001). There was no significant difference in the parameters of perceived discomfort between the two groups (p =.282, p =.225, p =.090, p =.155, p =.183, respectively). Kinesio taping is effective in tape measurements and positively affects the quality of life in lymphedema following head and neck cancer therapy. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple sclerosis (MS) who discontinue fingolimod might present with rebound activity. The reasons for the development of rebound have been identified, but there are limited data on the long‐term clinical outcomes of these patients. This study aimed to compare the long‐term outcomes of patients with MS with and without rebound activity after fingolimod discontinuation. Methods: A total of 31 patients who discontinued fingolimod for various reasons with a minimum follow‐up of 5 years were included in the study. Of these, 10 were assigned to the rebound group and 21 to the non‐rebound group. Clinical and demographic data and 5‐year clinical outcomes of both groups were prospectively examined. Results: At fingolimod initiation, there were no significant differences in age, disease duration, and Expanded Disability Status Scale (EDSS) score. The annualized relapse rate (ARR) was significantly higher in the rebound group than in the non‐rebound group before the fingolimod treatment (p = 0.005). In the rebound group, EDSS scores 2 months after rebound treatment and at the 5‐year follow‐up were not significantly different than before fingolimod initiation (p = 0.14 and p = 0.46, respectively). The last recorded EDSS was significantly higher in the non‐rebound group than in the rebound group (3.6 ± 2.3 vs. 2.15 ± 1.4, p = 0.045). At the last follow‐up, one patient was diagnosed with secondary progressive multiple sclerosis in the rebound group (10%), and 11 patients were in the non‐rebound group (52.4%, p = 0.05). Conclusion: When rebound activity is well‐monitored and treated after fingolimod discontinuation, no overall EDSS change is expected in the long‐term follow‐up. [ABSTRACT FROM AUTHOR]

Introduction: Nivolumab is s a human monoclonal antibody. Due to its widespread use in many cancers, including Merkel cell carcinoma, adverse reactions associated with nivolumab, such as neuropathies, endocrinopathies, gastrointestinal problems, and skin toxicities have been increasing. Sensory ganlionopathy is rarely observed in these patients. Case description: We present a 63-year-old male with a medical history of Merkel cell carcinoma that recurred two times in the inguinal region. After undergoing surgery with adjuvant radiotherapy, a second surgery was performed. The patient suffered from tingling in all four limbs plus difficulty in walking after initiation of the third dose of nivolumab. Management and outcome: After 1 month of 1 mg/kg/day methylprednisolone treatment, he showed significant improvement. Subsequently, the systemic corticosteroid regimen was tapered to 5 mg every other day. The treatment resulted in significant improvement in all extremities. Discussion: Sensory ganlionopathy can be seen as a side effect of an immune checkpoint inhibitor, even though it is very extraordinary. This is the case in the literature to develop sensory ganlionopathy due to nivolumab. We believe that patients using nivolumab may develop sensory ganlionopathy and management should be taken on this point. [ABSTRACT FROM AUTHOR]

Background: The no preparation technique which is a reversible form of treatment characterized by the absence of tooth tissue preparation and preserves the soft tissue architecture while preserving all natural tooth structures is indicated in cases where the tooth structure allows material to be added. The aim of this study is to evaluate the clinical performance and survival rates of indirect composite laminate veneers with no preparation after 7 years. Materials and methods: A total of 80 indirect composite veneers were placed on maxillary anterior teeth in 35 patients (n = 80). Diastema (n = 64), wedge tooth anomalies (n = 9) and re-shaping (n = 7) were the main indications for veneer treatments. All laminate veneers were fabricated with an indirect microhybrid composite material (Gradia, GC Dental). No tooth preparation was performed. Light-cured resin cement (Choice 2, Bisco) was used to lute the veneers. Composite veneers were evaluated using Modified United States Public Health Service criteria. Survival rates of the veneers were calculated using Kaplan-Meier statistics. The data containing the results of the USPHS criteria at baseline, 2 years and 7 years was statistically analyzed using Wilcoxon Signed Rank test at the 0.05 level of significance. Results: The overall survival rate was 91.3%. After 7 years, 7 absolute failures including 4 debonding (marginal adaptation, score 4) and 3 fractures (fracture of restoration, score 3) were noted. Color match was scored as 1 (n = 34) and 2 (n = 15). Slightly rough surfaces (41 of 73 laminates) and slight marginal discoloration (15 of 73 laminates) were noted. The overall scores after 84 months were significantly higher than the baseline scores for the marginal adaptation (p = 0.008), color match (p = 0.000), marginal discoloration (p = 0.000), surface roughness (p = 0.000), and fracture of restoration (p = 0.001) criteria. Conclusions: In this study, indirect composite veneers without any preparation on maxillary anterior teeth showed acceptable performance in terms of both survival rate and quality of restorations. This procedure offers a predictable and successful treatment that ensures maximum preservation of the intact tooth. [ABSTRACT FROM AUTHOR]

Histologically aggressive micropapillary thyroid carcinomas (PTMC) subtypes are thought to be associated with an aggressive clinical course. However, evidence for unfavorable clinical outcomes in patients with aggressive PTMC subtypes is not clear. In this study, we intended to determine the difference in clinical outcomes between patients with aggressive and non-aggressive PTMC subtypes. In this multicenter cohort study, the computer-recorded clinical and histopathological data of patients who underwent thyroid surgery between January 2000 - January 2021 in 9 referral centers and were diagnosed as PTMC were analyzed. A total of 1585 patients [female 1340 (84.5%), male 245 (15.5%), mean age 47.9±11.63 years), with a mean follow-up time of 66.55±37.16 months], were included in the study. Ninety-eight cases were diagnosed as aggressive and 1487 as non-aggressive subtypes. Persistent/recurrent disease was observed in 33 (33.7%)and 41 (2.8%) patients with aggressive and non-aggressive subtypes (p<0.001). Diseases-free survival rates were markedly lower in patients with aggressive than in those with non-aggressive PTMC subtypes (66.3 vs. 94.8%, log-rank p<0.001). Moreover, in multivariate analysis, aggressive histology was an independent predictor of persistent/recurrent disease, after controlling for other contributing factors (HR 5.78, 95% CI 3.32–10, p<0.001). Patients with aggressive PTMC subtypes had higher rates of incomplete biochemical and structural response than patients with non-aggressive subtypes as well (p<0.001). Aggressive PTMC subtypes share many characteristics with histologically identical tumors>1 cm in size. Therefore, the histopathological subtype of PTMC should be taken into consideration to tailor a personalized management plan. [ABSTRACT FROM AUTHOR]

Background: In glycolysis, hydroxyl radicals emerge via the auto-oxidation pathway in a status of hyperglycemia, and by binding to proteins or lipids, form advanced glycation end-products (AGE). Glyoxal (GO) and methylglyoxal (MGO) are precursors of AGEs. The aim of this prospective, case-control study was to investigate the difference in levels of AGE precursors in patients with and without diabetes and to investigate the relationship between the change in rates of the AGE precursors and treatment in diabetic patients. Methods: The study included 21 treatment-naive patients diagnosed with type 2 diabetes and 21 age and gender-matched healthy control subjects. Throughout an observation period of 3 months, the diabetic patients were started on anti-diabetic treatment and used no additional treatment or supplementary products. The GO and MGO levels were examined with the HPLC method. Results: The GO and MGO levels were determined to be 1.74 and 0.024μg/mL respectively in the diabetic patients and 1.14 and 0.002 μg/mL in the control group. After 3 months of treatment, a statistically significant decrease compared to pre-treatment values was determined of 0.684 μg/mL in GO and 0.01989 μg/mL in MGO (p=0.001, p<0.01). No statistically significant relationship was determined between the change in HbA1c at 3 months compared to pre-treatment and the changes in GO and MGO (p>0.05). Conclusion: The level of AGE precursors was found to be significantly higher in diabetic patients than in the healthy control group. Although there was a significant decrease in AGE precursors when the HbA1c level fell in patients who followed anti-diabetic treatment and diabetes-appropriate diet recommendations, this decrease was at different rates in each patient, which demonstrated that the HbA1c level is not the only determinant of AGE level in plasma. It can be concluded that with appropriate diet and antidiabetic treatment, significant reductions can be obtained in several risk factors which increase the level of AGE precursors. [ABSTRACT FROM AUTHOR]

Introduction: Tracheotomy is one of the most commonly performed procedure by otolaryngologists, but no consensus exists on the effect of suturing techniques on postoperative complications. Stay sutures and Bjork flaps are utilized frequently for securing the tracheal incision to the neck skin in order to create a tract for recannulation. Methods: Retrospective cohort study of tracheotomies performed by Otolaryngology‐Head and Neck Surgery providers (May 2014 to August 2020) was conducted to determine the effect of suturing technique on postoperative complications and patient outcomes. Patient demographics, medical comorbidities, indication for tracheostomy, and postoperative complications were analyzed with a statistical alpha set of.05. Results: Out of 1395 total tracheostomies performed at our institution during the study period, 518 met inclusion criteria for this study. Three hundred and seventeen tracheostomies were secured by utilizing a Bjork flap, while 201 were secured with up and down stay sutures. Neither technique was noted to be more commonly associated with tracheal bleeding, infection, mucus plugging, pneumothorax, or false passage of the tracheostomy tube. One mortality was noted following decannulation during the study period. Conclusion: Though various techniques exist; adverse outcomes are not associated with the manner in which a new tracheostomy stoma is secured. Medical comorbidities and the indications for tracheostomy likely play a more significant role in postoperative outcomes and complications. Level of evidence: Level 3. [ABSTRACT FROM AUTHOR]

To which extent the pre-existing hypothyroidism or hyperthyroidism has an impact on coronavirus infection 2019 (COVID-19) outcomes remains unclear. The objective of this study was to evaluate COVID-19 morbidity and mortality in patients with pre-existing thyroid dysfunction. A retrospective cohort of patients with a polymerase chain reaction (PCR)-confirmed COVID-19 infection (n=14 966) from March 11 to May 30, 2020, was established using the database of the Turkish Ministry of Health. We compared the morbidity and mortality rates of COVID-19 patients with pre-existing hypothyroidism (n=8813) and hyperthyroidism (n=1822) to those patients with normal thyroid function (n=4331). Univariate and multivariate regression analyses were performed to identify the factors associated with mortality. Mortality rates were higher in patients with hyperthyroidism (7.7%) and hypothyroidism (4.4%) than those with normal thyroid function (3.4%) (p<0.001 and p=0.008, respectively). Pre-existing hyperthyroidism was significantly associated with an increased risk of mortality (OR 1.54; 95% CI, 1.02–2.33; p=0.042) along with advanced age, male gender, lymphopenia and chronic kidney disease (p<0.001 for all). Although a potential trend was noted, the association between pre-existing hypothyroidism and mortality was not significant (OR 1.36; 95% CI, 0.99–1.86; p=0.055). In conclusion, this study showed an association between pre-existing hyperthyroidism with higher COVID-19 mortality. A potential trend towards increased mortality was also observed for hypothyroidism. The risk was more pronounced in patients with hyperthyroidism. [ABSTRACT FROM AUTHOR]

Human papilloma virus (HPV) infection is a causative agent for several cancers types (genital, anal and head and neck region). The HPV E6 and E7 proteins are oncogenic drivers and thus are ideal candidates for therapeutic vaccination. We recently reported that a novel ribonucleic acid lipoplex (RNA-LPX)-based HPV16 vaccine, E7 RNA-LPX, mediates regression of mouse HPV16+ tumors and establishes protective T cell memory. An HPV16 E6/E7 RNA-LPX vaccine is currently being investigated in two phase I and II clinical trials in various HPV-driven cancer types; however, it remains a high unmet medical need for treatments for patients with radiosensitive HPV16+ tumors. Therefore, we set out to investigate the therapeutic efficacy of E7 RNA-LPX vaccine combined with standard-of-care local radiotherapy (LRT). We demonstrate that E7 RNA-LPX synergizes with LRT in HPV16+ mouse tumors, with potent therapeutic effects exceeding those of either monotherapy. Mode of action studies revealed that the E7 RNA-LPX vaccine induced high numbers of intratumoral-E7-specific CD8+T cells, rendering cold tumors immunologically hot, whereas LRT primarily acted as a cytotoxic therapy, reducing tumor mass and intratumor hypoxia by predisposing tumor cells to antigen-specific T cell-mediated killing. Overall, LRT enhanced the effector function of E7 RNA-LPX-primed T cell responses. The therapeutic synergy was dependent on total radiation dose, rather than radiation dose-fractionation. Together, these results show that LRT synergizes with E7 RNA-LPX and enhances its anti-tumor activity against HPV16+ cancer models. This work paves into a new translational therapy for HPV16+ cancer patients. [ABSTRACT FROM AUTHOR]

Background: Lifestyle modifications and advances in surgical and endovascular techniques for treating unruptured intracranial aneurysm (UIA) have vastly evolved over the last few decades and may have reduced the incidence of aneurysmal subarachnoid hemorrhage (aSAH). However, the actual impact of these changes on the rates and outcomes of aSAH remain unexplored. Thus, we studied national aSAH admissions and outcome trends and changes of major risk factors over time. Methods: We queried the National Inpatient Sample between 2006 and 2018 to identify adult patients admitted and treated for UIA or ruptured aneurysm with aSAH. The Cochran–Armitage test was conducted to assess the linear trend of proportion of prevalence, inpatient mortality, hypertension, and current smoking status among aSAH admissions. Multivariable logistic regression was conducted to assess the odds of presenting with aSAH versus UIA, in addition to the odds of inpatient mortality among patients with aSAH. Results: A total of 159,913 patients presented with UIA and 133,567 presented with aSAH. Admissions for aSAH decreased by 0.97% (p < 0.001) per year. Current smoking and hypertension were associated with higher odds of being admitted for aSAH compared with the treatment for UIA (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.29–1.48; OR 1.15, 95% CI 1.08–1.22, respectively). Compared with White patients, Black patients (OR 1.32, 95% CI 1.21–1.43), Hispanic patients (OR 1.38, 95% CI 1.25–1.52), and patients of other races and/or ethnicities (OR 1.73, 95% CI 1.54–1.95) had a higher chance of presenting with aSAH. Rates of inpatient mortality among aSAH admissions showed no change over time (p = 0.21). Among patients admitted with aSAH, current smoking and hypertension showed an upward trend of 0.58% (p < 0.001) and 1.60% (p < 0.001) per year, respectively. Conclusions: Despite a downward trend in the annual frequency of hospitalizations for aSAH, inpatient mortality rates for patients undergoing treatment of the ruptured aneurysm have remained unchanged in the United States. Smoking and hypertension are increasingly prevalent among patients with aSAH. Thus, efforts to control these modifiable risk factors must be further strengthened. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to report surgical outcomes of the neonates who have undergone various surgical procedures. Materials and Methods: In this retrospective study, 39 neonates who have undergone a surgical procedure in Mogadishu Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital, between October 2018 and March 2019 were included. Data regarding age, gender, diagnosis, surgical procedure, length of hospital stay, mortality, and cause of mortality were recorded. Results: Of 39 neonates, 12 were female (30.7%) and 27 were male (69.3%). The mean age of the neonates at admission was 7.7 ± 7.6 days (1–30 days) days. The most common diagnoses were anal atresia (n = 12, 30.8%), esophageal atresia (n = 9, 23.1%), and pyloric stenosis (n = 5, 12.8%). The most common surgical procedures were colostomy creation (n = 10, 25.6%), esophageal anastomosis (n = 9, 20.5%), primary closure of anterior abdominal wall defects including bladder exstrophy (n = 6, 15.4%), and pyloromyotomy (n = 5, 12.8%). Mortality rate was 17.9%, and mortality causes were sepsis (n = 4, 57.1%) and congenital heart disease (n = 3, 42.9%). Neonates with the highest mortality by underlying primary surgical diagnosis were esophageal atresia (n=4, 57.1%). Conclusion: The mortality rate from the surgical procedures of the neonates in Somalia is extremely high when compared with the developed countries. Employment of experienced pediatric surgeons and well-trained nurses, strict attention to the sanitary measures and shortening the time from birth to presentation might improve the surgical outcomes of the neonates in Somalia. [ABSTRACT FROM AUTHOR]

Purpose While obesity is related to more severe outcomes of coronavirus disease 2019 (COVID-19), factors leading to poor prognosis still remain unclear. The present study evaluated the outcomes of COVID-19 patients who were overweight or obese and variables associated with severe disease in a large group of consecutive cases. Methods A nationwide retrospective cohort study was performed using the Turkish National Healthcare Database. Demographic characteristics, laboratory tests, comorbidities, and medications of patients registered between March 11 and May 30, 2020, were recorded. Results A total of 14, 625 patients (median age:42, IQR:26 years; female 57.4%) with normal weight (34.7%), overweight (35.6%), and obesity (29.7%) were included. Hospitalization, ICU admission, intubation/mechanical ventilation, pulmonary involvement, and mortality were significantly higher in patients who were overweight or obese. In adjusted analyses, both overweight (OR, 95% CI: 1.82, 1.04–3.21; p=0.037) and obesity (OR, 95% CI: 2.69, 1.02–1.05; p<0.001) were associated with a higher intubation/mechanical ventilation rate but only obesity was associated with increased mortality (OR, 95% CI: 2.56, 1.40–4.67; p=0.002). Old age, male gender, chronic kidney disease, and high C reactive protein levels were independently associated with COVID-19 mortality in overweight or obese patients. Conclusions COVID-19 patients who were overweight or obese were more likely to have adverse outcomes but only obesity was a predictor of mortality. Such patients should receive urgent medical attention and active management, especially the elderly, men, and people with chronic kidney disease. [ABSTRACT FROM AUTHOR]

Background: There are scarce published data in differentiated thyroid cancer patients about new coronavirus disease 2019 (COVID‐19) disease outcomes and mortality. Here, we evaluated COVID‐19 infection outcomes and mortality in thyroid cancer patients with COVID‐19 infection. Design and methods: We included a cohort of patients with thyroid cancer with PCR‐confirmed COVID‐19 disease from 11 March to 30 May 2020 from the Turkish Ministry of Health database in our nationwide, retrospective study. We compared the mortality and morbidity of COVID patients with or without thyroid cancer. Univariate and multivariate analyses were used to assess the independent factors for mortality, length of hospital stay and intensive care unit (ICU) admission and mechanical ventilation. We also analysed the effect of radioiodine treatment on severity and death rate of COVID‐19 disease. Results: We evaluated 388 COVID‐19 patients with thyroid cancer [median age: 54 years, interquartile range (IQR) 18 years, males: 23%] and age and gender‐matched 388 COVID‐19 patients without thyroid cancer. Patients with thyroid cancer had a similar mortality ratio compared with the non‐cancer group. Among patients with thyroid cancer, age, presence of diabetes mellitus, asthma/COPD, heart failure, chronic kidney disease, prior coronary artery disease, RAS blocker usage and low lymphocyte count were associated with mortality. Radioactive iodine (RAI) treatment and cumulative radioactive iodine dosage did not negatively affect the severity and mortality of COVID‐19 disease in our patient group. Conclusions: Our study indicated that history of thyroid cancer did not have an increased risk of mortality or morbidity in COVID‐19 disease. Besides, RAI therapy history and doses of radioactive iodine did not affect mortality or outcome. [ABSTRACT FROM AUTHOR]

Background: Appendix tumors are rare tumors found in the gastrointestinal tract, observed at a rate of about 0.2%-0.3%. Our aim in this study was to present the clinicopathological classification, treatment and long-term prognosis of patients with low grade appendiceal mucinous neoplasm (LAMN) Methods: Patients who underwent surgery in the Erciyes University Department of (Kayseri, Turkey), Department of General Surgery between December 2010 and December 2018, and who had LAMN as a result of pathology were included in our study. Demographic data, clinical and pathological features of the disease, their treatment and follow-up results after treatment were reviewed retrospectively. Results: We included 24 patients in the study. Of these patients, 10 (41.6%) were male. The mean age distribution was 56.4 ± 20.3 (21-91) years. Appendectomy was performed in 14 patients, and additional organ resections were performed in 8 patients. The most common symptom at the time of presentation was abdominal pain (79.1%; 95% CI, 58.3-91.7). The most common preliminary diagnosis in the preoperative period was acute appendicitis (50%; 95% CI, 29.2-70.8). Mean postoperative hospitalization time was 7.4 ± 7.96 (2-31) days. On pathological examination, appendectomy resection margins were positive in two patients. The mean (median) postoperative follow-up was 31.25 ± 23.9 (27) (1-90) months. One-year survival was 91.6%, and 5-year survival was 83.3%. Recurrence was detected in three patients during the follow-up period. Conclusion: If appendix mucinous neoplasia (AMN) is suspected in patients undergoing surgery with an initial diagnosis of acute or plastron appendicitis, care should be taken to remove the lesion without perforation. Pseudomyxoma peritonei, which may develop as a result of perforation, is associated with recurrence and decreased survival. [ABSTRACT FROM AUTHOR]

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Background: We aimed to evaluate the cost and consequences of failed osteosynthesis of intertrochanteric femur fracture (ITFF) patients and compare with primary ITFF patients. Methods: We retrospectively evaluated 689 patients who underwent surgery due to ITFF via cephalomedullary nail. 31 patients (5.8%) had revision surgery because of osteosynthesis failure of ITFF. Each revision case included in the study was matched with four primary ITFF cases as control group based on age, gender, year of operation, type of fracture and American Society of Anesthesiologists (ASA) grade. Total cost for the admission that patients underwent surgery, mortality rate at first year, infection rate, length of stay at hospital, length of stay at intensive care unit, and erythrocyte transfusion amounts were recorded from hospital registry records. Tip apex distances (TAD) were noted. Results: The mean total cost of the revision cases and primary cases was 10,027 ± 6387 and 5261 ± 1773 Turkish Liras, respectively (p < 0.001). TAD was ≥ 20 mm in 32.3% (10/31) of patients in revision group while 2.4% (3/124) of the patients in control group (p < 0.001). The mean length of stay at hospital, length of stay at intensive care unit, erythrocyte transfusion amounts, infection rate and mortality rate at first year were significantly higher in revision cases compared to matched primary control cases (p < 0.05). Conclusion: Revision surgeries due to failed osteosynthesis of ITFFs with cephalomedullary nail have at least two times higher mean total cost than primary cases. The awareness of the cost, morbidity and mortality of the revision surgeries may reduce the modifiable risk factors of osteosynthesis failure including maintenance of TAD below 20 mm, obtaining optimal lag screw position and reduction quality. Level of Evidence: Level 3, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Diverting stoma has many complications and requires another operation. Ghost ileostomy is an option for occasional cases. We aimed to present the clinical data and early postoperative outcomes of our patients who had undergone ghost ileostomy. Ghost ileostomy was performed in 58 patients, depending on the level of the anastomosis, together with the experience and intraoperative decision of the surgeon. The patients were evaluated in terms of comorbidities, type of colorectal disease, and postoperative complications. Thirty-eight patients were male, the mean age was 59 ± 9 years, and the mean body mass index was 27 ± 5 kg/m2. Forty-six patients in whom a ghost ileostomy procedure was performed had sigmoid colon or proximal/middle rectal cancer, whereas eight patients had sigmoid diverticulitis, and four patients had ulcerative colitis. Anastomotic leakage was identified in 3 (5.1%) patients. In one patient, laparoscopic peritoneal lavage was performed, and ghost ileostomy was converted to diverting stoma, whereas in the other two patients, ghost ileostomy was converted to diverting stoma under local anesthesia. Ghost ileostomy can easily be converted to diverting stoma in some patients with no need for general anesthesia to reduce the morbidity of anastomotic leakage. With this method in selected patients, it is possible to avoid diverting stoma and unwanted complications of ileostomy. [ABSTRACT FROM AUTHOR]

Background: To retrospectively assess the impact of prognostic nutritional index (PNI) on survival outcomes of patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with concurrent chemoradiotherapy (CCRT). Methods: This study incorporated 154 patients with LA-NPC who received exclusive cisplatinum-based CCRT. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of pretreatment PNI cutoffs influencing survival results. The primary end point was the interaction between the overall survival (OS) and PNI values, while cancer-specific survival (CSS) locoregional progression-free survival (LR-PFS), distant metastasis–free survival (DMFS), and PFS were the secondary end points. Results: A rounded PNI cutoff value of 51 was identified in ROC curve analyses to exhibit significant link with CSS, OS, DMFS, and PFS outcomes, but not LR-PFS. Patients grouping per PNI value (≥51 [N = 95] vs <51 [N = 49]) revealed that PNI < 51 group had significantly shorter median CSS (P <.001), OS (P <.001), DMFS (P <.001), and PFS (P <.001) times than the PNI ≥ 51 group, and the multivariate results confirmed the PNI < 51 as an independent predictor of poor outcomes for each end point (P <.05 for each). The unfavorable impact of the low PNI was also continued at 10-year time point with survival rates of 77.9% versus 42.4%, 73.6% versus 33.9%, 57.9% versus 27.1%, and 52.6% versus 23.7% for CSS, OS, DMFS, and PFS, respectively. Additionally, we found that PNI < 51 was significantly associated with higher rates of weight loss >5% over past 6 months (49.2% versus 11.6%; P =.002) compared to PNI < 51 group. Conclusion: Low pre-CCRT PNI levels were independently associated with significantly reduced CSS, OS, DMFS, and PFS outcomes in patients with LA-NPC treated with definitive CCRT. [ABSTRACT FROM AUTHOR]

28024723 4 Schweyen R, Stang A, Wienke A, Eckert A, Kuhnt T, Hey J. The influence of dental treatment on the development of osteoradionecrosis after radiotherapy by modern irradiation techniques. This exploratory study's primary objective was to assess the clinical outcomes of 311 head and neck squamous cell carcinoma (HNSCC) patients treated with radiotherapy (RT) in a tier-three town. [Extracted from the article]

Aim: In our study, we aimed to investigate the effect of BMI on surgical treatments and general outcomes, as well as on the severity of the injury caused by the sharp object. From an anatomical point of view, increased body mass index (BMI) is expected to have a protective effect in limiting organ damage in the case of sharp object injuries. Material and Methods: Data of the patients with penetrating abdominal injuries who applied to the emergency service of the University between January 2015 and January 2020 were analyzed retrospectively. Patients’ ages, genders, body mass indexes (BMIs), needs for surgical intervention, injury severity scores (ISS) and mortality were evaluated. Patients were divided into 2 groups: obese patients (BMI>30; Group1) and non-obese patients (BMI<30; Group2). Results: Seventy-eight patients whose data were available were included in the study. Thirty-three of the patients were determined to be obese (Group1) while 45 were determined to be non-obese (Group2). The mean age of the patients in group1 was significantly higher than the patients in group 2 (p=0.011). The mean ISS of the patients in group 1 was 11.03±8.24 while it was 16.93±13.68 in group 2. The ISS was significantly higher in group2 (p=0.031). Alcohol intoxication levels of the patients in Group 2 were significantly higher than Group 1 (p=0.006). A statistically significant difference was not present between the groups in terms of number of past surgical interventions (p=0.627); however, it was determined that 57% of the surgical interventions in Group 1 were performed for diagnostic purposes and that no pathologies were detected in 45% thereof. Discussion: As a result, increased BMI is associated with lower injury severity scores and decreased need for operation in sharp object injuries. Slim patients are more likely to need surgery and be severely injured. [ABSTRACT FROM AUTHOR]

The fibrotic tissue that appears following nerve damage can prevent axonal regeneration. Expanded polytetrafluor ethylene (ePTFE) is a synthetic polymer with antiadhesive properties and a safe history of use in neurosurgery. The aim of this study was to use ePTFE to prevent postsurgical adhesions in patients undergoing anastomosis surgery and report the results. Between January 2014 and May 2018, six patients with primary and secondary peripheral nerve cuts underwent anastomosis (one with allograft and five with autografts). The anastomotic region was wrapped with ePTFE to form a barrier. The mean follow-up period was 28 months (minimum 3 months, maximum 4 years). In three of six patients whose nerve integrity was lost due to various reasons, there was an improvement in electrophysiological recordings. The allograft was used in a patient with peroneal nerve injury; the sural nerve was used as a graft in other patients. In three patients, the defect was more than 4 cm. Early surgery and defect size are important factors to consider when treating peripheral nerve anastomosis. Development of intraneural and perineural adhesions postsurgery can be problematic. ePTFE is an inert polymer that prevents adhesions from forming after anastomosis surgery. [ABSTRACT FROM AUTHOR]

Introduction Management approaches for intracranial atherosclerosis include medical, surgical, or endovascular treatment. Among endovascular treatments, recent studies have stated that submaximal angioplasty (SA) may offer considerable benefits and be a promising alternative to aggressive medical therapyand/or stenting in the treatment of intracranial atherosclerotic disease (ICAD). Objective To investigate the rates of periprocedural and long-term cerebrovascular accidents, mortality, and restenosis in patients with symptomatic ICAD who were treated with SA. Methods An electronic database search was performed for relevant studies that reported clinical outcomes of patients with ICAD following SA. Outcomes of interest were incidence of transient ischemic attack, intracerebral hemorrhage, stroke, and mortality in the periprocedural period and at 1-year. The periprocedural period was defined as the time from SA until 30 days after the procedure. Technical success and restenosis rates after the procedure were also analyzed. Results A total of 19 studies with 777 patients were identified. The technical success rate was 93% (95% CI 85% to 98%). The incidence of 30-day and 1-year stroke (all types) was 3% (95% CI 1% to 5%) and 5% (95% CI 4% to 8%), respectively. Thirty-day and 1-year mortality was found to be 1% (95% CI 0% to 2%) and 2% (95% CI 0% to 4%), respectively. The combined incidence of stroke or death was 5% (95% CI 3% to 8%) at 30 days, and 9% (95% CI 7% to 12%) at 1-year. Conclusion The findings suggest that SA might be a promising alternative treatment in the treatment of symptomatic ICAD due to its favorable technical profile, periprocedural safety, and long-term efficacy. A randomized clinical trial is warranted to compare the safety and efficacy of SA with 'gold standard' medical treatment. [ABSTRACT FROM AUTHOR]

Objective: A restrictive diet applied before bariatric surgery can be required to reduce the liver volume or as a necessity imposed by insurance companies. However, the benefits of preoperative weight loss remain controversial. The present study aimed to investigate the perioperative and postoperative outcomes of a restrictive diet applied before laparoscopic sleeve gastrectomy.Materials and Methods: The data of 128 patients who received surgery in 2015 and 2016 were retrospectively analyzed. All patients were advised to follow a 4-week low-calorie (1000 cal) restrictive diet. Nevertheless, approximately 50% of patients did not accept the diet plan. We divided the patients into two groups as dieters (group 1) and non-dieters (group 2).Results: In group 1, changes in after-diet BMI and liver size were statistically significant (p < 0.001). In group 2, mean operation duration, mean hospitalization duration values, mean BMI values, and mean body weight at postoperative 1, 3, 6, and 12 months were statistically significantly higher than in group 1. No statistically significant difference was found between early complication rates of the groups (p = 0.844).Conclusion: Low-calorie restrictive diet applied before laparoscopic sleeve gastrectomy has reduced liver volume and shortens surgery and hospitalization time but does not have any significance concerning early complications and weight loss after operation in 1 year. Also, non-adherence of the bariatric surgery candidate patients to the diet seems to be a challenge. [ABSTRACT FROM AUTHOR]

Objective: The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC). In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients undergoing LC. Materials and Methods: Data of the patients who underwent LC between May 2018 and November 2018 were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and 24-hour tramadol consumption and rescue analgesia requirements were compared. Results: Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically significant difference between the NRS averages at different time frames between the two block groups. Conclusion: We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of SIPB alone and in a combination with other blocks in LC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Novel biomarkers are needed to predict the effectiveness of the treatment of presurgical neoadjuvant chemotherapy (NAC) in breast cancer (BC). OBJECTIVE: This is an exploratory study to assess the impact of 3 cancer-related long non-coding RNAs (lncRNAs) (H19, MALAT1 and GA5) in blood plasma of patients with BC in predicting the response to NAC. METHODS: The plasma levels of RNAs were relatively measured by quantitative PCR at baseline, and at the end of the fourth cycle of NAC in patients with locally advanced BC. RESULTS: Only H19 was associated with patients' characteristics, and with the response to NAC. Higher plasma expression of H19 was associated with younger age at diagnosis, triple negative tumors, and Ki-67 index. Patients with a pathological complete response (20%) had lower pre-therapeutic levels of H19 compared with the non-complete responders (relative levels 0.1 vs 0.2, respectively, P : 0.04). In addition, the patients with higher degree of downstaging of initial tumors had lower baseline levels of H19 among non-complete responders. CONCLUSION: Our study reveals that H19, but not MALAT1 and GAS5, may be a useful marker of response to NAC in BC. [ABSTRACT FROM AUTHOR]

• Chitosan oligosaccharide contributes to clinical improvement in lambs with experimentally cryptosporidiosis. • Chitosan oligosaccharide reduces C. parvum oocysts. • Chitosan oligosaccharide can be used in the treatment of cryptosporidiosis. In this study, it was aimed to investigate the efficacy of chitosan oligosaccharide administrations in different doses of experimental infected lambs with Cryptosporidium parvum. 32 male lambs were used in the study and the lambs were divided into 4 groups with 8 lambs in each group. Groups 1, 2 and 3, twice a day, were administered chitosan oligosaccharide at a dose of 100, 500, and 1000 mg/kg for 7 days, respectively, with milk replacer. In group 4, lambs with cryptosporidiosis were subjected to normal feeding as control without drug administration. Clinical examinations of lambs were made before treatment (day 0) and on days 1, 3, 5 and 7 after treatment and 5 ml of blood was collected from vena jugularis for blood analysis of all lambs. Weight changes of lambs were recorded at 0, 7, 14, and 21 days. Stool specimens were collected pre-treatment (day 0) and on days 1, 3, 5, 7, 14 and 21 post-treatment to determine oocyst excretion of lambs with cryptosporidiosis. Lambs with a mean oocyte counts >10 after stool examination were included to the treatment. Changes in clinical hematology, blood gases and biochemical parameters were observed during the course of treatment, but these changes were limited. Weight loss was observed at 7th day according to 0th day the lambs with experimental cryptosporidiosis but gradually weight increase was observed at 14th and 21st days and these changes were similar in all groups. Oocyst excretion decreased in all groups during treatment. According to 0th day, there was a significant (p < 0.05) decrease in oocyte excretions in the third day in group 1 and 2, and in day 5 in the group 3 and 4. Significant changes (p < 0.05) were observed in oocyst excretions on the third and fifth days among the groups. As a result, in lambs with experimental cryptosporidiosis, chitosan oligosaccharide improved in clinical signs and stool character shorter than the positive control group and the administration of chitosan oligosaccharide at doses of 100, 500 and 1000 mg/kg for 7 days significantly reduced oocyst excretion but not enough to remove cryptosporidiosis completely. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study is to understand the impact of adjuvant radiotherapy (RT) and prognostic factors for patients diagnosed with uterine carcinosarcoma.Materials and Methods: The records of 31 patients receiving adjuvant RT between the dates of September 2003-January 2013 in our clinic were evaluated retrospectively. Surgery was performed in 27 (87%) patients as staging laparotomy, for 4 patients as total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pelvic external beam radiotherapy (EBRT) was 4500-5040 cGy in 25-28 fractions. In addition, 23 patients received brachytherapy following EBRT, 12 patients received adjuvant, and 1 patient received neoadjuvant chemotherapy (CT).Results: The median age was 63 (between 30 and 78). The stage distribution of the patients was as follows: Stage I, 20 (64%); Stage II, 7 (23%), and Stage III, 4 (13%) patients. Five-year locoregional control (LRC) rate was 100%, disease-free survival (DFS) and overall survival (OS) rates were 65.5% and 66.2%, respectively. Stage I or II patients have a tendency for better 5-year OS and DFS rates than Stage III patients (73.1% vs. 42.9% and 72.7% vs. 42.9%; P = 0.065 and 0.051). Regarding lymph node dissection was performed or not, 5-year OS (64.7% vs. 75.0%) was not statistically different between groups (P = 0.77). Five-year OS and DFS rates were 69.2% and 61.5% for patients receiving CT (adjuvant or neoadjuvant) versus 63.7% and 68.8% for patients not receiving CT; P = 0.63 and P = 0.89, respectively. Based on the analysis of peritoneal washings, 5-year OS was 0% for patients with malignant or suspicious cytology whereas 89% for patients with benign cytology (P = 0.000). A negative correlation was observed between mitotic count of sarcomatous component and DFS time (rs = -0.812 and P = 0.05).Conclusions: Surgery and adjuvant RT seem beneficial for excellent LRC rate. However, survival rates are low due to distant metastases. Thus, there is a great need for better systemic therapies. [ABSTRACT FROM AUTHOR]

Background: We evaluated the association of P wave duration (PWD) with left atrial scar (LAS) in patients with paroxysmal atrial fibrillation (PAF). Methods: Consecutive patients with PAF undergoing their first catheter ablation were screened and only those in sinus rhythm at baseline were included in the analysis. A standard 12‐lead electrocardiogram (ECG) was performed in all and three‐dimensional voltage mapping of the left atrium was generated for identification of low‐voltage areas (≤0.2 mV) before the procedure. Results: In total, 411 patients with PAF were included in this study of which 181 had LASs (scar group), while 230 had no scar (nonscar group). In the scar group, patients were older (65.5 ± 8.8 vs 59.7 ± 11.7 years; P < .001), the proportion of female was higher (47.5% vs 37.4%; P = .04) and left atrial (LA) diameter (4.1 ± 0.6 vs 3.9 ± 0.6 cm; P < .001) was larger compared with the nonscar group. There was no significant difference in terms of hypertension, sleep apnea, and diabetes between the two groups. When comparing ECG characteristics between the two groups, PWD was significantly longer in the scar group (122.9 ± 18.5 and 116.9 ± 28.0 ms; P = .01). A multivariate analysis was performed, after adjustment of age, sex, LA diameter, PWD ≥ 120 ms was found to be an independent predictor of LA scarring (OR: 1.69, p‐value: 0.02). Conclusion: In the current series, prolonged PWD was found to be independently associated with LA scarring in PAF, even after adjustment for age, sex, and LA diameter. [ABSTRACT FROM AUTHOR]

Background: Currently available second‐generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exist about 1‐year outcomes of CB2 ablation, data on long‐term outcomes are scarce. Objective: We aimed to assess the long‐term outcomes of PVI using CB2 in a large‐scale symptomatic atrial fibrillation (AF) population at our tertiary referral center. Methods: In this nonrandomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa)‐free survival was defined as the absence of AF, atrial flutter, or atrial tachycardia recurrence ≥30 s following a 3 months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results: Acute procedural success rate was 99.8% (1898/1902 PVs). Mean procedural and fluoroscopy time were 64.9 ± 9.2 and 12.1 ± 2.6, respectively. At median 39 (interquartile range: 26‐56) months follow‐up, ATa‐free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs. 102/141 [72.3%] for persistent AF, P =.019) and 84.4% after a mean 1.48 ± 0.42 ablations. Cox regression analysis showed that left atrium diameter, duration of AF history, and early ATa recurrence were found as the independent predictors of late recurrence. Phrenic nerve palsy was observed in 17 (3.5%) patients. Conclusions: CB2‐based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and persistent AF patients with an acceptable complication rate at long‐term follow‐up. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to compare the effectiveness of kinesio taping (KT) treatments and conventional physical therapy (PT) modalities that are applied to reduce pain and improve physical movements and functions of patients with sub acromial impingement syndrome (SIS). Materials and Methods: Forty patients were randomly divided into two equal groups. The first group was assigned KT plus home exercise program (HEP) for 15 days. The second group was given 15 sessions of PT and HEP Patients were assessed using active joint range of motion (ROM), Visual Analogue Scale (VAS; rest, movement, and night pain), the Society of the American Shoulder and Elbow Surgeons Evaluation (ASESS-100), Constant-Murley (C-M) scale, and Western Ontario Rotator Cuff (WORC) index at before and after treatment and at the end of the study (first month control visit). Results: Physical therapy was found to be more effective than KT when these two treatment modalities were assessed based on ASESS-100, WORC index values, night pain, and movement pain. PT and KT treatments have similar effects in active ROM, rest pain, and C-M scale. At the end of the study, they were found to have similar effects except the night pain value. PT was found to be more effective for night pain than KT Conclusion: Physical therapy was concluded to be more effective after treatment. The application of KT does not appear to be an alternative treatment method for SIS, but it can provide a potential supportive care for SIS. However the outcomes suggest that KT can provide a remarkable benefit. [ABSTRACT FROM AUTHOR]

Introduction: Renal cell carcinomas account for 90% of all malignant neoplasms of the kidney. The most common types of renal cancer in adults are clear cell and papillary renal cell carcinoma; sporadic cases of renal carcinomas containing chromosomal translocations are rare, more usually occurring in children and young adults. Nivolumab (a fully human immunoglobulin G4 PD-1 checkpoint inhibitor antibody) has received the Food and Drug Administration approval for the treatment of metastatic renal cell carcinoma in patients who have received prior antiangiogenic therapy. Skin reactions are the most common side-effects under treatment with anti-PD-1 antibodies and play an important role for patients. Case report: We report a nivolumab-induced lichen planus as an immune-related adverse event in a young woman who was treated for advanced renal cell carcinoma. After the ninth dose of nivolumab treatment, she was consulted to the dermatologist because of skin lesions, and lichen planus was diagnosed. Management and outcome: She was treated with topical corticosteroids and clobetasol propionate cream. Her lesions regressed after the local therapy within one month, allowing for uninterrupted nivolumab therapy. Discussion: Skin adverse events are the most common side-effects under immunotherapy and play an important role for patients and usually develop early in the course of treatment. The most frequent skin reactions are rash, pruritus, and vitiligo. Serious skin adverse events are rare and do not usually require dose reductions or treatment discontinuation. We report a nivolumab-induced lichen planus after the ninth dose of nivolumab. [ABSTRACT FROM AUTHOR]

Cancer is characterized by an accumulation of genetic alterations. Somatic mutations can generate cancer-specific neoepitopes that are recognized by autologous T cells as foreign and constitute ideal cancer vaccine targets. Every tumor has its own unique composition of mutations, with only a small fraction shared between patients. Technological advances in genomics, data science, and cancer immunotherapy now enable the rapid mapping of the mutations within a genome, rational selection of vaccine targets, and on-demand production of a therapy customized to a patient’s individual tumor. First-in-human clinical trials of personalized cancer vaccines have shown the feasibility, safety, and immunotherapeutic activity of targeting individual tumor mutation signatures. With vaccination development being promoted by emerging innovations of the digital age, vaccinating a patient with individual tumor mutations may become the first truly personalized treatment for cancer. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: The aim of this study was to show the effects of an 8-week Neurodevelopmental Treatment based posture and balance training on postural control and balance in diparetic and hemiparetic Cerebral Palsied children (CPC). METHODS: Fifteen CPC (aged 5–15 yrs) were recruited from Denizli Yağmur Çocukları Rehabilitation Centre. Gross Motor Function Classification System, Gross Motor Function Measure, 1-Min Walking Test, Modified Timed Up and Go Test, Paediatric Balance Scale, Functional Independence Measure for Children and Seated Postural Control Measure were used for assessment before and after treatment. An 8-week NDT based posture and balance training was applied to the CPC in one session (60-min) 2 days in a week. RESULTS: After the treatment program, all participants showed statistically significant improvements in terms of gross motor function ( p < 0.05). They also showed statistically significant improvements about balance abilities and independence in terms of daily living activities ( p < 0.05). Seated Postural Control Measure scores increased after the treatment program ( p < 0.05). CONCLUSIONS: The results of this study indicate that an 8-week Neurodevelopmental Treatment based posture and balance training is an effective approach in order to improve functional motor level and functional independency by improving postural control and balance in diparetic and hemiparetic CPC. [ABSTRACT FROM AUTHOR]

Aims: In this study, we sought to evaluate the safety and efficacy of cryoballoon (CB) based empirical left atrial appendage (LAA) isolation as an adjunct to pulmonary vein isolation (PVI) compared to the PVI-only strategy in patients with persistent AF.Objectives: Clinical outcomes of catheter ablation were less beneficial for persistent atrial fibrillation (AF) than paroxysmal AF.Methods and Results: A total of 100 consecutive patients with persistent AF underwent both PVI and additional LAA isolation using CB (Group II). As a control group (Group I), among persistent AF patients, we conducted a retrospective, propensity-score matched cohort, in whom only PVI was performed using CB. Recurrence of atrial tachyarrhythmia (Ata) at the 12th month follow-up was the primary endpoint. Baseline demographic and clinical characteristics were similar between two groups. At the 12th month follow-up, 67 (67%) patients in Group I and 86 (86%) patients in Group II were free of ATa after the index procedure (P < 0.001). As a unique complication of LAA isolation, left circumflex artery spasm was observed in 4% of the Group II. After adjusting for several baseline variables, PVI-only strategy was found as a significant predictor for recurrence (HR: 3.37; 95% CI: 1.73-6.56; P < 0.001). Transoesophageal echocardiography examination during the follow-up revealed no thrombus in the LAA.Conclusion: Our findings indicated that LAA isolation as an adjunct to PVI improved 1-year outcomes in persistent AF compared with the PVI-only strategy using CB without an increase in thromboembolic complications. [ABSTRACT FROM AUTHOR]

Background: Earlier commencement of clozapine has been related to a better response in treatment-resistant schizophrenia.Objectives: To identify variables that predict clozapine use after a first episode of schizophrenia (FES).Methods: Patients with FES and ≤15 days of lifetime antipsychotic treatment were followed up during naturalistic treatment, and the patients who were initiated on clozapine were compared with those receiving non-clozapine antipsychotics for ≥24 months regarding demographic and clinical baseline characteristics, adherence, and relapse patterns during follow-up. Treatment-resistant schizophrenia was defined as two or more antipsychotic trials of adequate dose for ≥6 weeks.Results: Twenty-eight patients who used clozapine and 77 non-clozapine antipsychotic users were included. Clozapine was initiated after a mean of 2.5 ± 1.1 adequate antipsychotic trials. Eight of the 28 clozapine-treated patients (28.6 %) began their clozapine treatment during the first 12 months of follow-up (mean 7.1 ± 3.3 months) and their premorbid childhood adjustment was significantly worse than those who started clozapine later (mean 78.5 ± 43.0 months). Compared with non-clozapine users, patients who started clozapine had significantly more relapses in the first 6 months of follow-up prior to clozapine use (35.7 vs. 11.7 %, p = 0.005), and were significantly more likely to have a first relapse despite treatment adherence (38.1 vs. 73.3 %, p = 0.01). In the multivariate analyses, antipsychotic polypharmacy and first relapse despite adherence to antipsychotic treatment independently predicted subsequent clozapine use.Conclusions: Clozapine use after a FES was predicted by a first relapse while being adherent to non-clozapine antipsychotics, especially if the first relapse occurred within the first 6 months. Developmental childhood difficulties predicted significantly earlier clozapine use. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the utility of margin-reflex distance (MRD) as an alternative to levator function (LF) in choosing the appropriate surgical procedure for congenital blepharoptosis.Settings and Design: This was a retrospective, observational study.Subjects and Methods: Records of patients with simple (dystrophic) congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm.Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure.Results: Of one hundred and three eyes of ninety patients (44 female/46 male), levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826.Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations. [ABSTRACT FROM AUTHOR]

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency. Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates. Results. Mean age of patients was 48 (26–68) years; mean body mass index (BMI) was 25.3 (17.6–33.2); and mean parity was 2.5 (2–5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p<0.01), 3.06 and 4.04 (p<0.01), and 9.43 and 9.43 (p=0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n=4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina. Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of nasal continuous positive airway pressure (NCPAP) and nasal intermittent positive-pressure ventilation (NIPPV) as the initial respiratory support within the minimally invasive surfactant therapy (MIST) approach in preterm infants with respiratory distress syndrome.Design: Prospective, randomised controlled study.Setting: Tertiary neonatal intensive care unit.Patients and Interventions: This study enrolled 200 preterm infants with a gestational age of 26-32 weeks who showed signs of respiratory distress but did not require intubation in the delivery room. Surfactant therapy was performed using the MIST approach in the patients who met the criteria for surfactant administration.Main Outcome Measures: The primary outcomes were a need for intubation within the first 72 h of life and a surfactant requirement.Results: The infants in the study displayed similar characteristics at birth. Fewer infants in the NIPPV group required surfactant therapy (38% vs 60%; p=0.002) or invasive ventilation during the first 72 h of life (13% vs 29%; p=0.005), and NIPPV reduced the rate of moderate-to-severe bronchopulmonary dysplasia (BPD) (7% vs 16%; p=0.046). Multivariate logistic regression analysis showed that NIPPV support (OR: 0.36, 95% CI 0.17 to 0.76; p=0.008) and higher gestational age (OR: 0.76, 95% CI 0.59 to 0.98; p=0.041) reduced the need for invasive ventilation within the first 72 h of life. Surfactant requirement was also decreased with NIPPV support (OR: 0.39, 95% CI 0.22 to 0.71; p=0.002). However, there was no impact on BPD, based on the multivariate analysis.Conclusions: In infants born at 26-32 weeks' gestation, NIPPV reduced the need for invasive ventilation and the surfactant requirement within the MIST approach.Trial Registration Number: ClinicalTrials.gov under identifier NCT01741129. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the outcomes in patients treated with robotically assisted patello-femoral arthroplasty (PFA).Methods: This technique offers a safe, reliable, and reproducible way of obtaining correct implant positioning in patello-femoral arthroplasty, and as a result, reduces revision surgery due to implant malalignment. We evaluated 30 knees in 29 patients who underwent robotically assisted patello-femoral arthroplasty between June 2009 and May 2011. Mean follow-up was 15.9 months. This was a retrospective study that involved chart reviews and radiographic analysis. Radiographic analysis included pre-operative and postoperative plain films for implant positioning. Functional outcomes were evaluated using the Oxford Knee Score (OKS), range of motion, University of California at Los Angeles (UCLA) patient activity-level ratings, visual analog pain scale (VAS), and the Knee Society Score (KSS).Results: The patients had an average OKS of 21.7 pre-operatively and reached an average of 33.5 postoperatively (p = 0.0033). Pre-operative UCLA patient activity-level ratings was 3.1, compared with 4.8 postoperatively. Average VAS pre-operatively was 8 and postoperatively it decreased to 2.1 (p = 0.0033). The average KSS final score pre-operatively was 56 and postoperatively it increased to 68.3 while the functional score pre-operatively was 47.2 compared to 68.1 postoperatively (p = 0.011). As a result, patello-femoral arthroplasty is an emerging knee resurfacing technique that is an alternative to the total knee arthroplasty.Conclusions: The early retrospective data for robotically-assisted PFA show encouraging results. Advantages of this technique include a smaller incision, faster rehabilitation, preservation of bone stock, and implantation without malalignment. [ABSTRACT FROM AUTHOR]

Objective: To compare the long-term clinical outcomes between Resolute zotarolimus-eluting stent (R-ZES) and paclitaxel-eluting stent (PES) in patients with small coronary artery disease. Background: Patients with a small vessel diameter are independently associated with increased risk of adverse cardiac events after drug-eluting stent implantation. Methods: A cohort of 265 patients treated with R-ZES (185 patients with 211 lesions) or PES (80 patients with 100 lesions) in small vessel (≤2.5 mm) lesions were retrospectively analyzed. The primary end point of the study was the composite of major adverse cardiac events. The secondary end points included target lesion revascularization (TLR), target vessel revascularization (TVR), and stent thrombosis at 3 years. Results: The baseline characteristics were similar between the 2 groups. In the R-ZES group, the mean stent diameter was smaller and the total stent length per lesion was longer. Major adverse cardiac events occurred in 8 (10%) patients who had received PES and in 7 (3.8%) patients who had received R-ZES (P = .07). The rates of 3-year TLR (2.2% vs 2.5%; P = 1.00) and TVR (5.4% vs 10.0%; P = .17) showed no statistically significant difference between the R-ZES and PES groups. The rate of stent thrombosis was 0.5% in the R-ZES group and 2.5% in the PES group (P = .21). Conclusion: The rates of major adverse cardiac events and cardiac death were similar in the R-ZES-treated group compared with the PES-treated group. [ABSTRACT FROM AUTHOR]

Objectives: Butyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants.Study Design: We designed a prospective, controlled, pilot single-center study. Thirty (n=30) pregnant women who were scheduled for cesarean section under general anesthesia (refusal of regional anesthesia) with RSI involved. Group 1 included ten (n=10) preeclamptic pregnancies, Group 2 included ten (n=10) gestational diabetic (GD) pregnancies and Group 3 included ten (n=10) healthy pregnancies.Main Outcome Measures: BChE levels of all patients were measured prior to the initiation of cesarean section. Train-of-four recovery of 90% (TOF T1) was used to monitor the degree of neuromuscular block beginning from the administration of succinylcholine.Results: No statistically significant difference was found between the groups comparing BChE levels and the duration between tracheal intubation and formation of TOF T1 (p>0.05).Conclusions: As similar results were gathered from normal and high-risk pregnancies (preeclamptic pregnancy or gestational diabetic pregnancy) who underwent cesarean section under general anesthesia, we believe that succinylcholine is still neuromuscular agent of choice in cesarean section. [ABSTRACT FROM AUTHOR]

Objective The main aim of this study was to measure short-term effects of kinesiotaping on pain and joint alignment in the conservative treatment of hallux valgus. Method Twenty-one female patients diagnosed with a total of 34 feet with hallux valgus (13 bilateral, 6 right, and 2 left) participated in this study. Kinesiotaping was implemented after the first assessment and renewed in days 3, 7, and 10. The main outcome measures were pain, as assessed using visual analog scale, and hallux adduction angle, as measured by goniometry. Secondary outcome measure was patients' functional status, as measured by Foot Function Index and the hallux valgus scale of the American Orthopaedic Foot and Ankle Society (AOFAS). The radiographic results were also measured before and after 1 month of treatment. The Wilcoxon test was used to compare the differences between initial and final scores of AOFAS, as well as FFI scales and hallux valgus angle assessment scores. Results There was a significant reduction in goniometric measurement of hallux valgus angle ( P = .001). There was a significant reduction in pain intensity ( P = .001) and AOFAS and Foot Function Index scores at the end of the treatment ( P = .001 and P = .001, respectively). There was a significant difference between radiographic results in 1-month control ( P = .009). Conclusions For this group of female patients, pain and joint alignment were improved after a 10-day kinesiotape implementation in patients with hallux valgus. The findings showed short-term decreased pain and disability in hallux valgus deformity. [ABSTRACT FROM AUTHOR]