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Background: The current study's objective is to evaluate the molecular genetic mechanisms influencing the biological behavior of hepatocellular carcinoma (HCC) by analyzing the transcriptomic and epigenetic signatures of the tumors. Methods: Transcriptomic data were downloaded from the NCBI GEO database. We investigated the expression differences between the GSE46444 (48 cirrhotic tissues versus 88 HCC tissues) and GSE63898 (168 cirrhotic tissues versus 228 HCC tissues) data sets using GEO2R. Differentially expressed genes were evaluated using GO and KEGG metabolic pathway analysis websites. Whole genome bisulfite sequencing (WGBS) and Methylated DNA Immunoprecipitation Sequencing (MeDIP-Seq) data sets (26 HCC tissues versus 26 adjacent non-tumoral tissues) were also downloaded from the NCBI SRA database. These data sets were analyzed using Bismark and QSEA, respectively. The methylation differences between the groups were assessed using functional enrichment analysis. Results: In the GSE46444 data set, 80 genes were upregulated, and 315 genes were downregulated in the tumor tissue (HCC tissue) compared to the non-tumor cirrhotic tissue. In the GSE63898 data set, 1261 genes were upregulated, and 458 genes were downregulated in the cirrhotic tissue compared to the tumor tissues. WGBS revealed that 20 protein-coding loci were hypermethylated. while the hypomethylated regions were non-protein-coding. The methylated residues of the tumor tissue, non-tumorous cirrhotic tissue, and healthy tissue were comparable. MeDIP-Seq, conducted on tumoral and non-tumoral tissues, identified hypermethylated or hypomethylated areas as protein-coding regions. The functional enrichment analysis indicated that these genes were related to pathways including peroxisome, focal adhesion, mTOR, RAP1, Phospholipase D, Ras, and PI3K/AKT signal transduction. Conclusions: The investigation of transcriptomic and epigenetic mechanisms identified several genes significant in the biological behavior of HCC. These genes present potential targets for the development of targeted therapy. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to determine the burden of care of individuals caring for pediatric patients who have undergone liver transplantation. Methods: The study was conducted at the Inonu University Liver Transplant Institute pediatric liver transplantation ward between May 2022 and February 2023. Data were the "Zarit Care Burden Scale," and the "Beck Depression Scale," and demographic characteristics of the patients and their caregivers. Results: The average age of the caregivers was 38.35±11.82 years; 72.7% were women, 69.7% were the child's mother, and 81.8% reported that caregiving impacted their daily lives. The effect of caregivers' burden of care on their daily lives was found to be statistically significant (p = 0.021). Among the pediatric recipients, 42.4% were aged 13-18 years, 60.6% were female, 45.5% had been post-transplant for more than 25 months, and 54.5% developed complications. The burden of care was severe at 38.87±10.21, and the depression was mild at 10.81±8.65. A moderate positive relationship was observed between burden of care and depression level (r: .602, p: 0.000). Simple linear regression analysis showed that caregivers' depression levels significantly affected their burden of care, (R²=0.363). Conclusion: The study concluded that caregivers of pediatric liver transplant patients experience a very high burden of care and mild depression. This high burden of care negatively impacts their daily lives and leaves them with less personal time. Providing social support to these families can improve caregivers' quality of life by reducing their depression levels. [ABSTRACT FROM AUTHOR]

Gallbladder cancers are relatively rare malignancies. While early-stage cases can achieve good outcomes with cholecystectomy, the 5-year survival rate in advanced stages is extremely low. Primary sclerosing cholangitis is a progressive liver disease characterized by inflammation of the bile ducts and is associated with an increased risk of gallbladder cancers. A 32-year-old male patient with primary sclerosing cholangitis was referred for liver transplantation. Imaging revealed a suspicious polypoid lesion, 2.5 cm in diameter, in the gallbladder. With a Meld score of 30, the patient was placed on the transplant waiting list. After waiting period of one month a deceased donor liver transplant was performed. The hepatectomy specimen revealed T2 gallbladder cancer. No recurrence or metastasis was detected during 1 year of follow-up. There is no consensus on the management of suspicious gallbladder lesions in patients with primary sclerosing cholangitis. Cholecystectomy in these patients carries a risk of decompensation in cirrhosis. Considering the decompensated liver cirrhosis and high Meld score, we preferred transplantation over cholecystectomy. Therefore, liver transplantation can be considered as primary treatment option instead of cholecystectomy. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Methods and Materials: A total of 108 patients (54 living liver donors and 54 liver recipients) who underwent donor hepatectomy and recipients who living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n = 27) and Pringle maneuver not applied (n = 27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as the Pringle maneuver was performed (n = 27) and not performed (n = 27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0 h day (day of surgery), post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day, and liver tissue was taken from the graft during the back table procedures. Liver function tests and complete blood count, coagulation tests, IL-1, IL-2, IL-6, TNF-α, and β-galactosidase measurements, and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all periods in the donors with and without the Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without the Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p = 0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p = 0.001). Conclusions: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not augment ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses. [ABSTRACT FROM AUTHOR]

Biliary atresia is the leading cause of liver transplantation in patients with biliary atresia. Biliary atresia is a complex disease that requires a multidisciplinary approach. Close monitoring of the patients in terms of nutritional indices, signs and symptoms of portal hypertension, and complications of cirrhosis is necessary. The two-step surgical therapy involving Kasai Porto-enterostomy followed by liver transplantation at an optimal time is the key to obtaining good patient and graft outcomes. The optimal timing is the most controversial point in the management of patients with biliary atresia. If porto-enterostomy results in good bile flow, the transplant-free survival of the patients is very good. However, things do not always go smoothly and there can be an early failure of the Kasai Porto-enterostomy, or cases may be complex and diagnosed later in infancy. In these cases, liver transplantation should be considered early to provide better graft and patient survival. Eventually, all patients with biliary atresia will develop end-stage liver disease and these patients will be transplanted later in life. As the patient's age is older, the success of liver transplantation will increase in this setting. The success of liver transplantation also depends on the nutritional status of the patients, the presence of recurrent cholangitis, and the presence of extrahepatic organ system failure. Physicians must have a good clinical perception to treat patients with biliary atresia. [ABSTRACT FROM AUTHOR]

Aim: Acute cholecystitis is the most common causes of acute abdomen in elderly population. This study aimed to present the early postoperative period (≤ 30 days) outcomes of elderly patients (≥ 65 years old) with acute cholecystitis who underwent early or delayed cholecystectomy. Materials and Methods: Between January 2016 and December 2020, 74 patients aged 65 and over underwent cholecystectomy for acute cholecystitis were included in the study. The patients were divided into two groups as early (time between diagnosis and cholecystectomy 7 days or less, n= 43, 58.1%) or delayed (time between diagnosis and cholecystectomy over 7 days, n= 31, 41.9%) cholecystectomy. Demographic characteristics, preoperative laboratory and radiological findings, and perioperative data of patients were evaluated, and the groups were compared. Results: The median age of patients was 73 (65-90) years, and 39 (52.7%) were male. Sixty-one (82.4%) patients underwent laparoscopic, 8 open (10.8%) and 5 (6.8%) conversion cholecystectomy. The rate of laparoscopic cholecystectomy was higher in the delayed group (n= 29, 93.5%) than in the early group (n= 32, 74.4%), but no statistically significant difference was detected (p=.06). The rate of open cholecystectomy was statistically significantly higher in the early group (n=8, 18.6%) than in the delayed group (n=0) (P=.017), the conversion rate was similar between the groups (p=1). There was no significant difference between the groups in terms of intraoperative complications (p=1). The length of hospital stay was statistically significantly longer in the early compared to the delayed group (5 (1-21) days and 2 (1-12) days, respectively, p< .001). Conclusion: There was no statistical difference regarding intraoperative complications in patients underwent early or delayed cholecystectomy. We believe that the patient’s clinical presentation and early or delayed cholecystectomy experience of the team are vital in determining the timing of cholecystectomy, as well as the severity of acute cholecystitis. [ABSTRACT FROM AUTHOR]

Biopterin as a stable metabolite is produced by oxidation of 5,6,7,8-tetrahydrobiopterin (BH4). It is known that many diseases may cause changes in BH4 concentration and/or dihydropteridine reductase (DHPR) enzyme activity. There is only a limited number of studies correlating DHPR activity in malignancies. The main goal of the present study was to evaluate alterations in the DHPR activity and biopterin levels in patients with breast and thyroid cancers. The breast cancer patients (n=24) were compared to patients with benign breast diseases (n=19) and controls (n=30). In addition; the patients with thyroid cancer (n=17) were compared to patients with benign thyroid diseases (n=42) and the control group. We did not observe any significant difference between the benign disorders and the malignancies. Biopterin concentrations in patients with benign and malign thyroid and breast diseases were lower than the controls (all p

The aim of the study was to determine folate reserve in patients with thyroid and breast diseases. Erythrocyte folate concentrations of ninety-eight patients and thirty healthy subjects were determined by a modified microbiological assay. An increase in folate levels was observed in of both thyroid (n = 15) and breast (n = 22) cancer patients compared to controls, while a decrease was observed in benign breast disease patients (n = 24) compared to both control group and breast cancer patients. Patients with benign thyroid diseases (n = 37) had significantly lower folate concentrations as compared to both control and thyroid cancer groups. The results pointed out the elevated erythrocyte folate levels in the patients with malignant tumors.

The aim of the present study was to evaluate the relationship between the levels of neopterin among patients with benign and malignant breast disease and the relation with the stage of the malignant process. In this study, neopterin concentrations and enzyme activities of superoxide dismutase (SOD) and catalase (CAT) were determined in malign (n=30) and benign breast tumor patients (n=30) by high performance liquid chromatographic and spectrophotometric methods, respectively. Results were compared with a healthy control group (n=20). The correlations between neopterin, CAT and SOD were also evaluated in controls and patients. Urinary neopterin level of the control group was (mean value ± S.D.) 128.6 ± 64.6 μmol/mol creatinine. Neopterin concentrations in patients with breast malignancy were 153.6 ± 71.2 μmol/mol creatinine and 107.8 ± 32.1 μmol/mol creatinine in benign disorders patients. The mean neopterin level in the benign group was found to be statistically different from the malign tumor group (p = 0.039). SOD and CAT activities in controls were found as 3.57 ± 0.84 U/mg protein and 2.19 ± 0.20 U/mg protein, respectively. In patients with malignancy, the SOD activity was 3.84 ± 0.73 U/mg protein while CAT activity was 1.03 ± 0.13 U/mg protein. Patients with benign breast disorders, SOD activity was 4.09 ± 1.00 U/mg protein and CAT activity was 1.02 ± 0.18 U/mg protein. Whereas SOD activity did not differ between the groups of patients and controls, the mean catalase level in the control group was higher than in the benign and malign tumor groups (both p