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Objective: To explore the effect of baicalein on the development and treatment of renal stones in a rat model induced by ethylene glycol or hydroxyproline. Materials and Methods: A grand total of 63 rats were split into nine distinct groups, each comprising seven rats: control, baicalein, ethylene glycol (EG), baicalein+ethylene glycol (BE), ethylene glycol+baicalein (EB), dimethyl sulfoxide (DMSO), hydroxy-L-proline (HP), baicalein+hydroxyproline (BH), and hydroxyproline+baicalein (HB) respectively. Urinary stone formation was induced in rats using EG or HP. Rat kidneys were examined by two histologists using light and electron microscopes. Calcium oxalate crystals and cellular changes were examined. Kidney injury molecule-1 (KIM-1), N-acetyl-β-D-glucosaminidase (NAG), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin and interleukin-18 (IL-18) levels were measured as potential biomarkers in both the kidney tissue and blood. Results: There was no noticeable difference in histological features when the specimens were examined under a light microscope. Kidney stone formation and mitochondrial differences were observed in the EG and HP groups in electron microscopic (EM) examinations; however, EM findings were normal in all preventive and therapeutic groups. Serum IL-18 and KIM-1 levels were significantly lower in the therapeutic group than in the EG and HP groups (p

Objective: This study aimed to investigate epicardial adipose tissue thickness (EATT) and related factors in patients with ankylosing spondylitis (AS) and to compare the results with those of healthy controls. Materials and Methods: This cross-sectional study included 30 patients diagnosed with AS based on the modified New York criteria. The control group consisted of 31 healthy volunteers. Demographic characteristics were recorded, and EATT was measured by transthoracic echocardiography. The Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI), AS Disease Activity Score (ASDAS), AS Quality of Life (ASQoL), and International Physical Activity Questionnaire Short Form were used. Functional capacity was assessed using the six-minute walk test (6-MWT). Results: The mean age was 41.67±7.56, and 21 (70%) participants were male in the AS group. The mean disease duration was 10.0 (standard deviation ±7.2) years in the AS group. The mean EATT values were 4.40±1.65 mm and 2.85±1.12 mm in the AS and control groups, respectively (p0.05). Conclusion: EATT values were higher in patients with AS than in those without AS. The factors related to EATT were BMI, ESR, BASFI, BASMI, and the severity of sacroiliitis.

Objective: There is a continued need for biomarkers for patients with gastric cancer that can aid in diagnosis, treatment follow-up, and relapse detection. The objective of this study was to investigate the role of serum microRNA (miRNAs) in diagnosing gastric cancer and their relationship with prognostic factors that impact the choice of surgical approach. Methods: We compared the serum miRNA expression levels of 35 patients who underwent gastrectomy and D2 lymph node dissection for gastric adenocarcinoma between 2015-2018 with those of 33 controls. We also evaluated the relationship between serum miRNA expression levels and pathological prognostic factors. Results: The serum levels of miR-17-5p, miR-21-5p, miR-27a-3p, miR-146a-5p, miR-148a-3p, and miR-203a-3p were significantly higher in gastric cancer patients. In early gastric cancer patients, serum levels of miR-21-5p, miR-27a-3p, miR-106b-5p, miR-146a-5p, and miR-148a-3p levels were significantly higher. Furthermore, serum levels of miR-106b-5p and miR-146a-5p were associated with tumor localization [area under the curve (AUC): 0.773, 0.797; p=0.049, 0.036], while serum levels of miR-27a-3p and miR-148a-5p were associated with the T-stage of the tumor (AUC: 0.748, 0.729; p=0.036, 0.049). Conclusion: Serum levels of miR-17-5p, miR-21-5p, miR-27a-3p, and miR-203a-3p were found to be diagnostic biomarkers in gastric cancers. The expression levels of serum miR-106b-5p and miR-146a-5p were found to be related to tumor location, whereas the expression levels of serum miR-27a-3p and miR-148a-5p were found to be related to the T-stage of the tumor. These findings can impact the surgical approach for gastric cancer patients.

Abstract Objective To compare the functional (obstruction relieving) outcomes and complications of unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed for mesh‐related urethral obstruction (MRUO) in females. Methods Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow‐up data. Variables were compared between the three groups. Results Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow‐up of 48 (17–96) months. Unilateral J‐cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25–34), 40 (35–56) and 60 (60–70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post‐void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J‐cut division, partial and subtotal removal groups, respectively (p = 0.007). Conclusions The unilateral J‐cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.

Srinivas Chava,1 Nergiz Ekmen,2 Pauline Ferraris,1 Yucel Aydin,2 Krzysztof Moroz,1 Tong Wu,1 Swan N Thung,3 Srikanta Dash1,2,4 1Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; 2Department of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA; 3Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Southeast Louisiana Veterans Health Care System, New Orleans, LA, USACorrespondence: Srikanta Dash, Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA, 70112, USA, Tel +1 504-988-2519, Fax +1 504-988-7389, Email sdash@tulane.eduIntroduction: Sorafenib, an FDA-approved drug for advanced hepatocellular carcinoma (HCC) treatment, encounters resistance in many patients. Deciphering the mechanisms underlying sorafenib resistance is crucial for devising alternative strategies to overcome it.Aim: This study aimed to investigate sorafenib resistance mechanisms using a diverse panel of HCC cell lines.Methods: HCC cell lines were subjected to continuous sorafenib treatment, and stable cell lines (Huh 7.5 and Huh 7PX) exhibiting sustained growth in its presence were isolated. The investigation of drug resistance mechanisms involved a comparative analysis of drug-targeted signal transduction pathways (EGFR/RAF/MEK/ERK/Cyclin D), sorafenib uptake, and membrane expression of the drug uptake transporter.Results: HCC cell lines (Huh 7.5 and Huh 7PX) with a higher IC50 (10μM) displayed a more frequent development of sorafenib resistance compared to those with a lower IC50 (2– 4.8μM), indicating a potential impact of IC50 variation on initial treatment response. Our findings reveal that activated overexpression of Raf1 kinases and impaired sorafenib uptake, mediated by reduced membrane expression of organic cation transporter-1 (OCT1), contribute to sorafenib resistance in HCC cultures. Stable expression of the drug transporter OCT1 through cDNA transfection or adenoviral delivery of OCT1 mRNA increased sorafenib uptake and successfully overcame sorafenib resistance. Additionally, consistent with sorafenib resistance in HCC cultures, cirrhotic liver-associated human HCC tumors often exhibited impaired membrane expression of OCT1 and OCT3.Conclusion: Intrinsic differences among HCC cell clones, affecting sorafenib sensitivity at the expression level of Raf kinases, drug uptake, and OCT1 transporters, were identified. This study underscores the potential of HCC tumor targeted OCT1 expression to enhance sorafenib treatment response.Keywords: hepatocellular carcinoma, HCC, cholangiocarcinoma, CCA, tyrosine kinase inhibitors, TKI, organic cation transporter-1, OCT1, organic cation transporter-3, OCT3, sorafenib resistance cell lines, SR huh 7

Abstract Background Neoadjuvant treatment is the standard treatment in locally advanced ESCC. However, the optimal chemotherapy regimen is not known. Method This is a retrospective observational cohort study conducted with propensity score matching. Patients with resectable ESCC from 13 tertiary centers from Türkiye were screened between January 2011 and December 2021. We compared the efficacy and safety of neoadjuvant chemoradiotherapy with the CF and the CROSS regimens in patients with ESCC. Results Three hundred and sixty‐two patients were screened. Patients who received induction chemotherapy (n = 72) and CROSS‐ineligible (n = 31) were excluded. Two hundred and fifty nine patients received neoadjuvant chemoradiotherapy. After propensity score matching (n = 97 in both groups), the mPFS was 18.4 months (95% CI, 9.3–27.4) and 25.7 months (95% CI, 15.6–35.7; p = 0.974), and the mOS was 35.2 months (95% CI, 18.9–51.5) and 39.6 months (95% CI 20.1–59.2; p = 0.534), in the CF and the CROSS groups, respectively. There was no difference between subgroups regarding PFS and OS. Compared with the CF group, the CROSS group had a higher incidence of neutropenia (34.0% vs. 62.9%, p

Objective: Hypocalcemia remains a common problem after thyroidectomy. One of the most common causes of this condition is incidental parathyroidectomy. This study aimed to evaluate the risk factors for incidental parathyroidectomy and the clinical outcomes of incidental parathyroidectomy in patients undergoing thyroidectomy. Methods: A retrospective analysis was conducted on 817 patients who underwent thyroidectomy at the Department of General Surgery at Gazi University between January 2015 and June 2022. Medical records were reviewed for demographic, pathological, and clinical variables. The primary outcome measure was the factors affecting incidental parathyroidectomy, and the secondary outcome measure was the clinical results of incidental parathyroidectomy. Results: Adding lymph node dissection to thyroidectomy statistically increased the frequency of incidental parathyroidectomy (p

Ali Riza Koksal,1 Nergiz Ekmen,2 Yucel Aydin,2 Kelley Nunez,3 Tyler Sandow,4 Molly Delk,2 Martin Moehlen,2 Paul Thevenot,3 Ari Cohen,3,5 Srikanta Dash1,2,6 1Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; 2Department of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA; 3Department of Gastroenterology and Hepatology, Institute of Translational Research, Ochsner Health, New Orleans, LA, USA; 4Department of Radiology, Institute of Translational Research, Ochsner Health, New Orleans, LA, USA; 5Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, USA; 6Southeast Louisiana Veterans Health Care System, New Orleans, LA, USACorrespondence: Srikanta Dash, Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA, 70112, USA, Tel +1 504-988-2519, Fax +1 504-988-7389, Email sdash@tulane.eduIntroduction: Extracellular vesicles could serve as a non-invasive biomarker for early cancer detection. However, limited methods to quantitate cancer-derived vesicles in the native state remain a significant barrier to clinical translation.Aim: This research aims to develop a rapid, one-step immunoaffinity approach to quantify HCC exosomes directly from a small serum volume.Methods: HCC-derived exosomes in the serum were captured using fluorescent phycoerythrin (PE)-conjugated antibodies targeted to GPC3 and alpha-fetoprotein (AFP). Total and HCC-specific exosomes were then quantified in culture supernatant or patient-derived serums using fluorescence nanoparticle tracking analysis (F-NTA). The performance of HCC exosome quantification in the serum was compared with the tumor size determined by MRI.Results: Initially we tested the detection limits of the F-NTA using synthetic fluorescent and non-fluorescent beads. The assay showed an acceptable sensitivity with a detection range of 104– 108 particles/mL. Additionally, the combination of immunocapture followed by size-exclusion column purification allows the isolation of smaller-size EVs and quantification by F-NTA. Our assay demonstrated that HCC cell culture releases a significantly higher quantity of GPC3 or GPC3+AFP positive EVs (100– 200 particles/cell) compared to non-HCC culture (10– 40 particles/cell) (p< 0.01 and p< 0.05 respectively). The F-NTA enables absolute counting of HCC-specific exosomes in the clinical samples with preserved biological immunoreactivity. The performance of F-NTA was clinically validated in serum from patients ± cirrhosis and with confirmed HCC. F-NTA quantification data show selective enrichment of AFP and GPC3 positive EVs in HCC serum compared to malignancy-free cirrhosis (AUC values for GPC3, AFP, and GPC3/AFP were found 0.79, 0.71, and 0.72 respectively). The MRI-confirmed patient cohort indicated that there was a positive correlation between total tumor size and GPC3-positive exosome concentration (r:0.78 and p< 0.001).Conclusion: We developed an immunocapture assay that can be used for simultaneous isolation and quantification of HCC-derived exosomes from a small serum volume with high accuracy.Keywords: hepatocellular carcinoma, HCC, extracellular vesicles, EVs, glypican 3, GPC3, alpha-fetoprotein, AFP, magnetic resonance imaging, MRI, area under the curve, AUC

Benign anorectal diseases such as hemorrhoidal disease, anal fissure, anal pruritus, perianal abscess, and fistula are the most common ones. The aim of this study was to assess sexual function in patients after surgery for benign anorectal diseases. Sixty-one male patients with perianal fistulas, operated on at Department of General Surgery, Faculty of Medicine, completed a self-administered questionnaire including the International Index of Erectile Function (IIEF) score. The median IIEF score of the postoperative patients was significantly higher (24, range [10–25]) than that of preoperative patients (22, range [5–25]), p < .0001. Sexual function is significantly influenced by surgery for benign anorectal diseases.

All around the globe, the development of digital skills is considered a priority because individuals are increasingly asked to interact with digital information. Digital literacy is required to communicate effectively and accomplish social and work-related tasks. Although there is a significant body of literature on the development of digital proficiencies in educational settings from elementary school to university, there is limited research with adults who are continuing their education later in life, usually outside of formal educational systems. The purpose of this paper is to report results from a study conducted with English learners in an adult education program in the U.S. The study evaluated the digital component of a new curriculum named CILIA-T (Content-Integrated Language Instruction for Adults with Technology Support), CILIA-T is a 16-module curriculum supporting adult learners to build their English skills, US History and Civics knowledge and digital proficiencies. In this study, researchers partnered with teachers to introduce part of the digital literacy content of the curriculum. There was a test given before and after the teaching. To determine the effectiveness of the digital literacy curriculum, the scores on the pre and post-tests and the duration to complete the pre and post-tests were analyzed. There were also learner and teacher surveys to evaluate the usability and utility of the curriculum. Main findings indicated that explicit instruction in digital literacy skills led to significant improvement across all participants. Teachers and learners found the digital literacy curriculum to be helpful and relevant.

Abstract Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed in a wide range, from minimal sedation to general anesthesia. Advanced age increases perioperative risks related to anesthesia and is also associated with many pathological processes that further increase morbidity and mortality. The ideal sedation protocol for EBUS-TBNA has yet to be determined in geriatric patients. Deep sedation (DS) may increase the safety and performance of the procedure. There are limited studies evaluating the effectiveness and safety of EBUS-TBNA under DS in elderly patients. Methods 280 patients who underwent EBUS-TBNA under DS were included in this retrospective study. 156 patients aged 65 years and over (Group 1) and 124 patients under 45 (Group 2) were compared. Demographic data, comorbidities, pulmonary function tests (PFTs), hemodynamic measurements, and peripheral oxygen saturation (SpO2) before the procedure were evaluated. In addition, the duration of the EBUS-TBNA procedure, sedation agents and dosages, recovery time, and complications related to the procedure in the 24 h and applied medications and treatments were recorded. Results There was no difference in body mass index, EBUS-TBNA procedure duration, and recovery time between geriatric and young patients(p > 0.05). The proportion of female patients, pre-anesthesia SpO2, and PFTs were found to be significantly lower in geriatric patients(p

Surgical site infections are one of the most important factors that increase morbidity and length of stay, especially after abdominal surgical procedures. With the COVID-19 pandemic, serious isolation and contact measures have been taken in hospital clinics in Turkey and all over the world. The aim of this study is to compare the rate of surgical site infection in patients who underwent abdominal surgery between March 15, 2020 and May 31, 2020 in Gazi University Faculty of Medicine, General Surgery Clinic, and patients who underwent abdominal surgery between the same dates a year ago. The features were examined with the SSI between the two periods. A statistically significant difference was found between the patients who were operated on before and during the pandemic in terms of smoking status (p=0.020), urgency of surgery (p=0.001) and chemotherapy receiving status (p=0.002). A statistically significant difference was not recorded between patients with and without surgical site infection in terms of the season in which the operation was performed, the surgery over the previous incision, the type of operation, the urgency of the operation and the presence of a drain. The precautions taken due to the COVID-19 pandemic do not change the risk of developing SSI after abdominal surgery. In preventing the risk of SSI, the factors related to the wound and the patient, which have been defined before, are at the forefront. [Med-Science 2023; 12(2.000): 442-7]

ABSTRACTThis study aimed to investigate the effects of fullerene C60 on rat liver tissue in a liver ischemia reperfusion injury (IRI) model under sevoflurane anesthesia to evaluate the ability of nanoparticles to prevent hepatic complications. A total of 36 adult female Wistar Albino rats were divided into six groups, each containing six groups as follows: sham group (Group S), fullerene C60 group (Group FC60), ischemia-reperfusion group (Group IR), ischemia-reperfusion-sevoflurane group (Group IR-Sevo), ischemia-reperfusion-fullerene C60 group (Group IR-FC60), and ischemia-reperfusion-fullerene C60-sevoflurane group (Group IR-FC60-Sevo). Fullerene C60 100 mg/kg was administered to IR-FC60 and IR-FC60-Sevo groups. In the IR group, 2 h of ischemia and 2 h of reperfusion were performed. At the end of reperfusion, liver tissues were removed for biochemical assays and histopathological examinations. Hepatocyte degeneration, sinusoidal dilatation, prenecrotic cells, and mononuclear cell infiltration in the parenchyma were significantly higher in Group IR than in all other groups. Thiobarbituric acid reactive substances levels were significantly higher in Group IR than in the other groups, and the lowest thiobarbituric acid reactive substances level was in Group IR-FC60 than in the other groups, except for Groups S and FC60. Catalase and Glutathione-S-transferase activities were reduced in the IR group compared to all other groups. Fullerene C60 had protective effects against liver IR injury in rats under sevoflurane anesthesia. The use of fullerene C60 could reduce the adverse effects of IRI and the associated costs of liver transplantation surgery.

Current biomedical research relies primarily on in silico studies to model complex systems like cardiovascular hemodynamics. However, for comprehensive validation of mathematical models, real in vitro experiments are indispensable. This paper introduces a framework that bridges these approaches through the hybrid mock circulatory loop (hMCL), offering precise control, flexibility, and reproducibility. This innovation enables the investigation of cardiovascular disease mechanisms in a controlled setting, overcoming the limitations of live organism studies. The framework employs a modified autoencoder with a partially guided latent space, incorporating physiological insights into a deep neural network. It leverages time-delayed cardiovascular signals, including pressures, flow rates, and unmeasurable cardiovascular system (CVS) parameters, to estimate critical parameters like aortic and mitral resistance, systemic resistance, and left ventricle elastance. The autoencoder’s loss function is tailored to predict these parameters, enhancing the understanding of cardiovascular dynamics. The study utilizes in silico data to train the model and validates it through in vitro tests using a hybrid mock loop device, yielding a remarkable accuracy of less than 5.7% error in replicating CVS signals. Furthermore, the framework demonstrates the adaptability of CVS variables to perturbations in closed-loop conditions and exhibits a diagnostic model with an impressive 98.55% F1 score for classifying cardiovascular disease severity. This research significantly advances the field by modifying the autoencoder to include physiological signals, introducing a novel loss function, developing a structured network, presenting a diagnostic model, and proposing an innovative approach for generating transient responses in cardiovascular hemodynamics, validated through in vitro and in silico experiments.

Ali Riza Koksal,1,2 Paul Thevenot,3 Yucel Aydin,1 Kelley Nunez,3 Tyler Sandow,4 Kyle Widmer,5 Leela Nayak,5 John Scott,1 Molly Delk,2 Martin W Moehlen,2 Ari J Cohen,3,6 Srikanta Dash1,2,5 1Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; 2Department of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA; 3Department of Gastroenterology and Hepatology, Institute of Translational Research, Ochsner Health, New Orleans, LA, USA; 4Department of Radiology, Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, USA; 5Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA; 6Department of General Surgery, Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, USACorrespondence: Srikanta Dash, Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA, 70112, USA, Tel +1 504-988-2519, Fax +1 504-988-7389, Email sdash@tulane.eduBackground and Aim: HCC development in liver cirrhosis is associated with impaired autophagy leading to increased production of extracellular vesicles (EVs) including exosomes and microvesicles. The goal of the study is to determine which of these particles is primarily involved in releasing of HCC-specific biomarker glypican-3 (GPC3) when autophagy is impaired.Methods: Streptavidin-coated magnetic beads were coupled with either biotinylated CD63 or Annexin A1 antibodies. Coupled beads were incubated with EVs isolated from either HCC culture or serum. EVs captured by immuno-magnetic beads were then stained with FITC or PE fluorescent-conjugated antibodies targeting exosomes (CD81), and microvesicles (ARF6). The percentage of GPC3 enrichment in the microvesicles and exosomes was quantified by flow cytometry. The impact of autophagy modulation on GPC3 enrichment in exosomes and microvesicles was assessed by treating cells with Torin 1 and Bafilomycin A1. For clinical validation, GPC3 content was quantified in microvesicles, and exosomes were isolated from the serum of patients with a recent HCC diagnosis.Results: The immune-magnetic bead assay distinguishes membrane-derived microvesicles from endosome-derived exosomes. The GPC3 expression was only seen in the CD63 beads group but not in the Annexin A1 beads group, confirming that in HCC, GPC3 is preferentially released through exosomes. Furthermore, we found that autophagy induction by Torin1 decreased GPC3-positive exosome secretion and decreased microvesicle release. Conversely, autophagy inhibition by Bafilomycin A1 increased the secretion of GPC3-positive exosomes. Serum analysis showed CD81+ve EVs were detected in exosomes and ARF6+ve vesicles were detected in microvesicles, suggesting that immunoaffinity assay is specific. The exosomal GPC3 enrichment was confirmed in isolated EVs from the serum of patients with HCC. The frequency of GPC3-positive exosomes was higher in patients with HCC (12.4%) compared to exosomes isolated from non-cirrhotic and healthy controls (3.7% and 1.3% respectively, p< 0.001).Conclusion: Our results show that GPC3 is enriched in the endolysosomal compartment and released in exosome fractions when autophagy is impaired.Keywords: hepatocellular carcinoma, glypican 3, exosome, biomarker, magnetic beads

Abstract Background Nonimmune hydrops fetalis (NIHF) can be caused by different types of etiologies. Some rare intrathoracic lesions are associated with NIHF. Combination of mediastinal teratoma, NIHF, and chylothorax is extremely rare. Mediastinal teratomas which are located in midline should be difficult to be detected. Thoracic imaging should be performed with unknown etiology for hydrops, and in case of chylothorax, the presence of a mass compressing the ductus thoracicus should be considered primarily. Case presentation An infant was born with a diagnosis of NIHF. Bilateral chest tubes were inserted cause of bilateral pleural effusions. After enteral feeding, the previously clear pleural fluid became chylous. Medium-chain triglyceride infant formula and somatostatin analog octreotide were initiated. A mass was appeared on her neck with the disappearance of skin edema. Magnetic resonance imaging confirmed a large, heterogeneous mass which was suggesting immature teratoma originating from thyroid gland. Complete surgical excision of the mass was performed. Histology confirmed high-grade immature teratoma. The neonate made an uneventful recovery. Following complete cessation of pleural fluid drainage, octreotide was stopped. She was discharged home on exclusive breast milk on day 34 of life. Conclusions Mediastinal teratomas are rare masses that cause hydrops fetalis. Although the association of NIHF and mediastinal teratoma is rare, thoracic imaging can be performed if an etiology cannot be found despite basic evaluations for hydrops. In case of chylothorax, the presence of a mass compressing the ductus thoracicus should be considered primarily, and thoracic imaging should be performed.

Objective: The decreased number of dopamine receptors in the putamen are considered to play an important role in the pathophysiology of restless legs syndrome (RLS). Retinal dopamine plays an important role in contrast sensitivity (CS) by establishing communication between retinal cells. It is also suggested that retinal dopaminergic neurons protect other retinal neurons. In this study, we aimed to investigate the thickness of retinal layers and CS function (CSF) of patients with RLS. Materials and Methods: A total of 68 participants were included in this prospective case-control study. The participants were divided into two groups as those with RLS (n=35) in group 1 and control subjects (n=33) in group 2. Optical coherence tomography was used to measure central macular thickness, retinal nerve fiber layer thickness (RNFL), and retinal ganglion cell inner plexiform layer thickness (GCIPL). RNFL thickness was measured as average and as sectoral (superior, inferior, nasal and temporal). Additionally, the CS test measured at all spatial frequencies of 1.5, 3, 6, 12 and 18 cycle per degree (cpd) was performed in all participants. Results: The average and superior sectoral RNFL thicknesses in group 1 were statistically significantly thinner than group 2 (p=0.03 and p=0.01 respectively). However, the thicknesses of other RNFL sectors were not different between group 1 and group 2. There were no statistically significant differences between group 1 and group 2 regarding the thicknesses of GCIPL and central macula. The mean values of CSF at all spatial frequencies of 1.5 cpd, 3 cpd, 6 cpd, 12 cpd and 18 cpd were statistically significantly higher in group 2 in comparison to group 1 (p

Yucel Aydin,1 Ali Riza Koksal,1,2 Paul Thevenot,3 Srinivas Chava,1 Zahra Heidari,4 Dong Lin,1 Tyler Sandow,5 Krzysztof Moroz,1 Mansour A Parsi,2 John Scott,1 Ari Cohen,3,6 Srikanta Dash1,7 1Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; 2Department of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA; 3Institute of Translational Research, Ochsner Health, New Orleans, LA, USA; 4Chemical and Biomedical Engineering, Tulane University, New Orleans, LA, USA; 5Department of Radiology, Institute of Translational Research, Ochsner Health, New Orleans, LA, USA; 6Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, USA; 7Southeast Louisiana Veterans Health Care System, New Orleans, LA, USACorrespondence: Srikanta Dash Email sdash@tulane.eduBackground and Aims: Hepatocellular carcinoma (HCC) developing in the context of preexisting cirrhosis is characterized by impaired autophagy that results in increased exosome release. This study was conducted to determine whether circulating exosomes expressing glypican 3 (GPC3) could be utilized as a biomarker for HCC detection and treatment response in patients with cirrhosis.Methods: Immunohistochemistry was performed to assess p62 and GPC3 expression in the lesion and adjacent tissue from cirrhosis with HCC. GPC3-enriched exosomes were captured by an enzyme-linked immunosorbent assay (ELISA). The diagnostic specificity of serum exosome-derived GPC3 (eGPC3) was determined using samples obtained from malignancy-free controls, malignancy-free cirrhotics, cirrhotics with confirmed HCC, and patients with a non-HCC malignancy. The performance of eGPC3 was validated using serum samples of HCC patients received chemotherapy.Results: We found that the expression of p62 and GPC3 was significantly increased in HCC tissues compared to adjacent cirrhotic liver. Impaired autophagy and exosome shedding were confirmed in HCC cell lines. Mass spectroscopic analysis revealed that GPC3 was enriched in exosomes isolated from HCC cell lines. An affinity ELISA assay was developed that specifically captures GPC3 positive exosomes in the serum. Total exosome concentration and eGPC3 were significantly elevated in cirrhotic patients with HCC as compared to the reference control groups. Furthermore, decreases in post-treatment exosome concentration and eGPC3 levels were more closely correlated with response to locoregional chemotherapy compared to change in serum AFP in HCC patients awaiting liver transplantation.Conclusion: We developed an affinity exosome capture assay to detect GPC3 enriched exosomes. Our preliminary assessment shows that GPC3 positive exosomes can be used for HCC detection and prediction of treatment outcomes.Keywords: hepatocellular carcinoma, autophagy, exosome, glypican 3, surveillance

1921 yılında kurulan Irak Krallığı, General Kasım ve arkadaşları tarafından 14 Temmuz 1958 tarihinde gerçekleştirilen ihtilal ile devrilmiş ve ülkede Cumhuriyet ilan edilerek “Irak Cumhuriyeti” kurulmuştur. Ülkenin başında bulunan Kral II.Faysal, Veliaht Abdullah ve Başbakan Nuri Sait Paşa olaylar sırasında öldürülürken, yönetime General Abdülkerim Kasım hakim olmuştur. Komünistler ile Kürtlere dayanarak ülkeyi yönetmeye çalışan General Kasım, içlerinde yakın arkadaşlarının da bulunduğu milliyetçileri ise tasfiye etmeye ve sindirmeye başlamıştır. Bu durum, Komünist-Kürt İttifakı’nın doğup özellikle Irak’ın kuzey bölgelerinde etkin olmaya çalışmalarına yol açarken, milliyetçiler başta olmak üzere ülkenin pek çok kesimi tarafından tepkiye karşılanmıştır. Bu tarz bir yönetim anlayışıyla hareket eden General Kasım ve desteklediği Kürt-Komünist İttifakı ise önce Kerkük’te 24-26 Ekim Olaylarının, ardından da Musul’da Albay Şevvaf İsyanı’nın çıkmasına sebep olmuştur. Dolayısıyla bu çalışmada, 14 Temmuz 1958 İhtilali neticesinde özellikle Irak’ın kuzeyinde yaşanan gelişmeler, şiddet olayları ve gerek Irak içinde gerekse uluslararası arenada doğurduğu sonuçlar ağırlıklı olarak Türk basınına yansıdığı şekliyle ortaya konulmaya çalışılacaktır.

Objective: Achalasia is a disease characterized by lower esophageal sphincter motility disorder. Whereas there is no clear algorithm in treating achalasia in children, Heller myotomy is known to be as the most effective method. Gastroesophageal reflux after myotomy is a frequently reported complication. Therefore, the fundoplication procedure should be added to the myotomy simultaneously. Our study aimed to present the results of patients who underwent Heller myotomy and fundoplication for achalasia. Materails and Methods: Twelve patients who underwent laparoscopic Heller myotomy with the diagnosis of achalasia between the 2006 and 2019 have been included in the study. Results: There were 12 children. 75% of them were male, and 25% were female. Laparoscopic Heller myotomy and antireflux procedure were applied to all patients. The average nasogastric withdrawal time was 1.75 days, the average time to start feeding was 2.25 days. The average hospital stay was 6.75 days. Dysphagia persisted in 3 patients who underwent Dor fundoplication and in 1 patient who underwent Toupet fundoplication at postoperative 3rd-week controls. It was observed that the symptoms improved after the one-time endoscopic dilatation procedure. Conclusion: Heller myotomy is gold standard method in the treatment of achalasia in children.We believe that partial fundoplication added to myotomy reduces the risk of GER.

Antecedentes: La incidencia de metástasis en ganglios linfáticos retropancreáticos en pacientes con cáncer gástrico no es despreciable. Objetivo: Determinar los factores de riesgo de metástasis en los ganglios linfáticos (GL) retropancreáticos e investigar su importancia clínica. Método: Se analizaron retrospectivamente los datos clínicos patológicos de 237 pacientes con cáncer gástrico entre junio de 2012 y junio de 2017. Resultados: Hubo 14 pacientes (5.9%) que presentaron metástasis de GL retropancreático. La mediana de supervivencia de los pacientes con y sin metástasis del GL retropancreático fue de 13.1 y 25.7 meses, respectivamente. Según el análisis univariado, se encontró que el tamaño tumoral ≥ 8 cm, Bormann tipo III/IV, tipo indiferenciado, presencia de invasión angiolinfática, profundidad de invasión (pT4), estadio N3 y metástasis GL No. 3, 7, 8, 9 y 12p se asociaba con metástasis de GL retropancreático. Según el análisis multivariante, se encontró que el tamaño tumoral ≥ 8 cm, Bormann tipo III/IV, tipo indiferenciado, pT4, estadio N3, metástasis de GL No. 9 y metástasis de GL No. 12p eran variables pronósticas independientes para la metástasis de GL retropancreático. Conclusiones: La metástasis del GL retropancreático es un factor de mal pronóstico para el cáncer gástrico. El tamaño del tumor ≥ 8 cm, el tipo III/IV de Bormann, el tumor indiferenciado, el estadio pT4, N3 y las metástasis de GL No. 9 y 12p son factores de riesgo de metástasis en los GL retropancreáticos.

The hybrid mock circulatory loop (hMCL) serves as a crucial hemodynamic simulation tool, offering exceptional flexibility, controllability, and reproducibility for investigating the mechanisms underlying cardiovascular diseases (CVD) in a controlled environment, circumventing the limitations of live organism studies. This paper introduces a novel design and control strategy for hMCL, introducing a novel left ventricle volume–elastance (LVVE) equation that unifies the autoregulation of the Frank–Starling mechanism (FSM) with left ventricle contractility (LVC). LVVE establishes a dynamic link between left ventricular volume (LVV) and LVC, inherently satisfying the regulatory relationship between left ventricular pressure (LVP) and LVV through a mathematical equation. For the first time, LVVE integration significantly enhances the physiological relevance of hMCL by faithfully replicating FSM responses across diverse conditions, including aortic stenosis (AS), variations in systemic vascular resistance (SVR), and heart rate (HR) variations. Furthermore, this study introduces the stability proofs for the discrete closed-loop hMCL, enabling real-time proportional valve control through discrete feedback linearization—an innovative departure from conventional methods. Notably, FSM emulation is achieved by tracking reference maximum and minimum LVV values, eliminating the reliance on predefined functions or existing data, such as the maximum LV elastance value. Rigorous experimental validation, encompassing numerical simulations and comparative analyses with prior research, attests to the precision and efficacy of the proposed hMCL in faithfully replicating both normal and abnormal CV conditions. Significantly, the hMCL demonstrates that increasing HR enhances LVC while maintaining physiological pressures; however, this increase in LVC corresponds with a decrease in LVV, in alignment with human data and FSM principles. Crucially, the coupling mechanism between the FSM and LVC yields results of enhanced physiological fidelity, significantly advancing the hMCL’s utility in physiological research. Moreover, the hMCL’s capacity to simulate critical cardiovascular scenarios, including AS, SVR fluctuations, and HR variations, underscores its versatility and substantial potential for investigating complex CV dynamics.

This study proposes a closed-form direction-of-arrival (DoA) solution derived from multilateration equations for microphone arrays of co-centered and orthogonal pairs. The generalized cross-correlation phase transform (GCC-Phat) algorithm is used to obtain the time-difference-of-arrival (TDoA) values. Simulation studies have shown the success of our proposed method compared to existing DoA methods in the literature by varying the sampling frequency of the sound signal, inter-microphone distances, and the source distance. The results from the simulation are validated by the measurements from our experiments. Our proposed solution gives better results than the far-field solution against the angle error, which is more pronounced at incidence angles smaller than 15°. These angle errors, which approach 3° using the far-field method, are reduced to less than 0.5 degrees using our proposed solution. Our solution also gives more stable results against TDoA measurement errors. Our proposed solution achieves a 66% improvement for azimuth angle and 5.88% improvement for elevation angle compared to the simulation results in the absence of TDoA measurement error, outperforming the far-field approach. When normally distributed sampling error is added to TDoA measurements, with a standard deviation of three samples, our proposed solution achieves a 41% improvement for azimuth angle and a 5.44% improvement for elevation angle. In our field measurements, an absolute mean error of 0.94 degrees was observed with our proposed method for azimuth angle. It is shown to be a more stable and faster solution method for real-time applications.