Dosimetric comparison of free-breathing versus respiratory motion-managed radiotherapy via four-dimensional computed tomography-based volumetric-modulated arctherapy for lung cancer

PURPOSE

The aim of this study is to use respiratory motion-managed radiotherapy (RT) to reduce side effects and to compare dosimetric factors with free-breathing planning in patients with lung cancer.

MATERIALS AND METHODS

Simulation images were obtained in 10 respiratory phases with free breathing using four-dimensional computed tomography (4D-CT) scanner. Planning target volume (PTV) was created with 5mm margins in each direction of the internal target volume delineated using the maximum intensity projection. A volumetric arc treatment (VMAT) plan was created so that the prescribed dose would cover 98% of the PTV. Target volumes for the free-breathing VMAT plan were created according to ICRU Reports 62 and the same prescribed dose was used.

RESULTS

Patients were evaluated during January 2020. Median 63Gy (59.4-64) RT was administered. Median PTV volumes were 173.53 and 494.50cm3 (P=0.008) and dose covering 95% of PTV volume was 62.97 and 60.51Gy (P=0.13) in 4D-CT based and free-breathing VMAT plans, respectively. The mean and V50 heart dose was 6.03Gy (vs. 10.36Gy, P=0.043) and 8.2% (vs. 33.9%, P=0.007), and significantly lower in 4D-CT based VMAT plans and there was also found a non-significant reduction for other risky organ doses.

CONCLUSION

Ten patients treated with respiratory motion-managed RT with 4D-CT based VMAT technique. It was observed that PTV did not increase, the target was covered with 95% accuracy, and with statistical significance in heart doses, all risky organ doses were found to be less.

Assessment of quantitative zonal parameters of prostate gland in discrimination of normal, benign, and malignant conditions: are these the more reliable parameters in the diagnosis of prostate cancer?

OBJECTIVE

Prostate cancer diagnosis and treatment are increasing in current public healthcare programs. An improved resolution multiparametric magnetic resonance imaging (MRI) has shown the potential to enhance the detection and differentiation of this medical condition. In this study, MR perfusion parameters were investigated in different ages and diseases to differentiate clinically significant prostate cancer.

PATIENTS AND METHODS

From January 2017 to December 2022, 72 consecutive patients, who had undergone multiparametric MR imaging were enrolled in this study. Four different patient groups were formed: (1) those with prostate cancer, (2) those with prostatitis, (3) those with benign prostate hyperplasia (BPH), and (4) a control group. Quantitative dynamic contrast-enhanced (DCE)-MRI pharmacokinetic parameters included Ktrans, Kep, Ve, and iAUG. Different measurements were obtained from both the peripheral and transitional zones (PZ and TZ, respectively). Means values were compared between groups based on a univariate analysis.

RESULTS

Ktrans and Kep values in the PZ were found to be statistically significantly lower in the control group (p = 0. 003 and p = 0. 011, respectively). It was seen that Ktrans and Ve measurements obtained from PZ had a statistically significant determinant in detecting malignancy (p = 0. 013 and p = 0. 036, respectively). It was seen that Ktrans, Ve, and iAUG obtained from the TZ showed a statistically significant difference in prostate cancer (p = 0.025, p = 0.005, and p = 0. 011, respectively) in contrast to other cases. Peripheral Ve values were statistically significantly lower than those measured Ve values from the TZ in prostate cancer cases (p = 0.002) in contrast to the other cases.

CONCLUSIONS

Quantitative DCE-MRI parameters may vary according to age, disease, and zonal anatomy. These differences may contribute to the diagnosis of clinically relevant prostate cancer.

Wound healing activity of Salvia huberi ethanolic extract in streptozocin-induced diabetic rats

Objective: The aim of this study was to examine the in vivo wound healing potential of Salvia huberi Hedge (endemic to Turkey) on excision and incision wound models in diabetic rats. Method: Male Wistar albino rats, 3-4 months old and weighing 180-240g were used. The animals were randomly divided into five groups including Control, Vehicle and Fito reference, and two different concentrations (0.5% and 1% weight/weight (w/w)) of ethanol extract of Salvia huberi were investigated in both wound models on streptozocin-induced diabetic rats using macroscopic, biomechanical, biochemical, histopathological, genotoxic and gene expression methods over both seven and 14 days. Fito cream (Tripharma Drug Industry and Trade Inc., Turkey) was used as the reference drug. Results: A total of 60 rats were used in this study. Salvia huberi ointments at 0.5% and 1% (w/w) concentrations and Fito cream showed 99.3%, 99.4% and 99.1% contraction for excision wounds, and 99.9%, 97.0% and 99% contraction for incision wounds, respectively. In Salvia huberi ointments and Fito cream groups, re-epithelialisation increased dramatically by both day 7 and day 14 (p<0.05). By day 14, low hydroxyproline and malondialdehyde (MDA) levels, and high glutathione (GSH) levels were observed in the Salvia huberi ointment groups. After two application periods, damaged cell percent and genetic damage index values and micronucleus frequency of Salvia huberi ointment treatment groups were lower than Control and Vehicle groups (p<0.001). A growth factor expression reached a high level by day 7 in the Control group; in Salvia huberi-treated groups it was decreased. Conclusion: The study showed that application of Salvia huberi ointments ameliorated the healing process in diabetic rats with excisional and incisional wounds and may serve as a potent healing agent.

Wound healing activity of Salvia huberi ethanolic extract in streptozocin-induced diabetic rats

Objective: The aim of this study was to examine the in vivo wound healing potential of Salvia huberi Hedge (endemic to Turkey) on excision and incision wound models in diabetic rats. Method: Male Wistar albino rats, 3-4 months old and weighing 180-240g were used. The animals were randomly divided into five groups including Control, Vehicle and Fito reference, and two different concentrations (0.5% and 1% weight/weight (w/w)) of ethanol extract of Salvia huberi were investigated in both wound models on streptozocin-induced diabetic rats using macroscopic, biomechanical, biochemical, histopathological, genotoxic and gene expression methods over both seven and 14 days. Fito cream (Tripharma Drug Industry and Trade Inc., Turkey) was used as the reference drug. Results: A total of 60 rats were used in this study. Salvia huberi ointments at 0.5% and 1% (w/w) concentrations and Fito cream showed 99.3%, 99.4% and 99.1% contraction for excision wounds, and 99.9%, 97.0% and 99% contraction for incision wounds, respectively. In Salvia huberi ointments and Fito cream groups, re-epithelialisation increased dramatically by both day 7 and day 14 (p<0.05). By day 14, low hydroxyproline and malondialdehyde (MDA) levels, and high glutathione (GSH) levels were observed in the Salvia huberi ointment groups. After two application periods, damaged cell percent and genetic damage index values and micronucleus frequency of Salvia huberi ointment treatment groups were lower than Control and Vehicle groups (p<0.001). A growth factor expression reached a high level by day 7 in the Control group; in Salvia huberi-treated groups it was decreased. Conclusion: The study showed that application of Salvia huberi ointments ameliorated the healing process in diabetic rats with excisional and incisional wounds and may serve as a potent healing agent.

Endometrial carcinoma detection with 3.0 Tesla imaging: which sequence is more useful

OBJECTIVE

Detection of endometrial cancer (EC) is crucial in pre-operative EC management. The study aimed at determining the most reliable sequence in magnetic resonance imaging (MRI) evaluation at the EC. Different sequences were compared using histopathological results as the gold standard.

PATIENTS AND METHODS

In this retrospective study, 62 women diagnosed with EC were examined using 3 Tesla MR and post-hysterectomy histopathological examination. The MRI protocol included diffusion-weighted imaging (DWI), T2 weighted images, Dynamic Contrast T1 weighted images, and ZOOMit DWI. Apparent diffusion coefficient (ADC) maps were also obtained. ADC maps were calculated for both DWI and ZOOMit DWI. All serial images were analyzed by endometrial distance to account for myometrial invasion and tumor size. All sequences and histopathological results were compared using the paired sample t-test.

RESULTS

In all 32 women, post-hysterectomy histopathological confirmation was obtained. Mean myometrial invasion values were not significantly different after comparing DWI, ZOOM it DWI, and Dynamic contrast enhancement (DCE)-T1WI (p=0.054, p=0.039). The first strong correlation was found between DWI and ZOOMit DWI (0.943). The second was between ZOOMit DWI and DCE-T1 WI (0.949). Comparing each set of sequences, no statistically significant differences in tumor size (p > 0.05) were found. Also, no statistically significant differences between images and histopathological size were found. The ADC values of ZOOMit DWI indicated that this method detected significant differences between EC histological subtypes.

CONCLUSIONS

Each sequence is essential and valuable, whereas priorities may vary depending on the desired information. The most valuable sequences for the myometrial invasion were ZOOMit and conventional DWI. T2WI and DCE T1 WI were more valuable sequences the size of EC.

An Experimental Methodology to Determine Components of Power Losses of a Gearbox

In this study, an experimental methodology is presented to separate various components of the power loss of a gearbox. The methodology relies on two separate measurements. One is designed to measure total power loss of a gearbox housing a single spur gear pair under both loaded and unloaded conditions such that load-independent (spin) and load-dependent (mechanical) components can be separated. With the assumption that gear pair and rolling element bearings constitute the bulk of the gearbox power loss, a second measurement system designed to quantify rolling element bearing losses is proposed. With this setup, spin and mechanical power losses of rolling element bearings used in the gearbox experiments are measured. Combining the sets of gearbox and bearing data, power loss components attributable to the gear pair and rolling element bearings are quantified as a function of speed and torque. The results indicate that all gear and bearing related components are significant and a methodology such as the one proposed in this study is warranted.

Rosmarinic and carnosic acid contents and correlated antioxidant and antidiabetic activities of 14 Salvia species from Anatolia

Herbal medicine has been used worldwide as an alternative treatment. Salvia genus is one of the most remarked herbs which is traditionally used in the treatment of many diseases. Therefore, it is a crucial issue to reveal the chemical and biological profiles of different Salvia species. Rosmarinic and carnosic acid are the most well-known bioactive components generally accepted as the main antioxidant compounds in Salvia. This study firstly aims the determination of rosmarinic and carnosic acid contents of 14 Anatolian Salvia species by a simple and rapid capillary electrophoresis method. Moreover, the antioxidant activities and total phenolic contents of the Salvia samples were investigated. α-Glucosidase enzyme inhibitory effects of the samples were tested concerning their antidiabetic activities. The rosmarinic acid contents in the samples were well-correlated with the bioactivities.

Biochemical, Histopathologic, and Genotoxic Effects of Ethanol Extract of Salvia hypargeia (Fisch. & Mey.) on Incisional and Excisional Wounded Diabetic Rats

Purpose: Nonhealing wounds are a serious problem of diabetic patients. Salvia species are traditionally used for the treatment of wounds. The aim of the study was to investigate the effects of ointment prepared with ethanol extract obtained from the aerial parts of Salvia hypargeia, an endemic plant from Turkey, on diabetic rat incisional and excisional skin wounds. Materials and Methods: Male Wistar albino rats (n: 60) were divided into five groups. Diabetes was induced and two concentrations (0.5% and 1%) of the extract were used for ointments and applied on wounds for 7 and 14 days. Fito cream was chosen as a reference drug. Results: In excisional wounds, healing ratios of 0.5% (63.4% and 99.3%) and 1% (65.5% and 99.9%) S. hypargeia groups were higher compared to control (35.9% and 75.1%), and in incisional wounds, healing ratios of 0.5% (78.1% and 98.5%) and 1% (84.4% and 99.4%) S. hypargeia groups were higher compared to control (30.5% and 72.9%) (p < .01). Hydroxyproline (0.31 ± 0.3 and 0.34 ± 0.2) levels were lower and GSH (10.7 ± 3.1 and 7.6 ± 0.9) levels were higher in 0.5% and 1% S. hypargeia groups on the 14th day (p < .01). Histopathological results revealed re-epithelialization and formation of granulation tissue in all S. hypargeia groups. Genotoxicologic results indicated, GDI, DCP values, and MN frequency of 0.5% and 1% S. hypargeia groups did not reach to significant levels both on the 7 and 14 days. Conclusions: S. hypargeia may have a potential for therapeutic use in treatment and management of diabetic wounds with a successful topical application.

Evaluation of adiponectin and leptin levels and oxidative stress in bipolar disorder patients with metabolic syndrome treated by valproic acid

INTRODUCTION

An increased risk for metabolic syndrome (MS) has been described for people with psychotic and mood disorders. The aim of this study was to determine the influence of valproic acid (VPA) treatment on adiponectin, leptin levels and oxidative stress in bipolar disorder (BD).

METHODS

Forty patients with BD receiving VPA monotherapy and 20 healthy control subjects were included in this study. BD patients were divided into two groups with and without MS as group 1 and group 2, respectively. Twenty BD patients diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders (DSM IV) were assessed for MS according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP III) criteria. Adiponectin, leptin, protein carbonyls, sulfhydryl (-SH) and malondialdehyde (MDA) levels were measured in 40 BD patients and 20 control subjects.

RESULTS

Serum adiponectin levels were significantly lower in group 1 patients than in group 2 and control subjects ( p<.001). Serum leptin levels were significantly higher in group 1 patients than in group 2 and control subjects ( p<.001). Serum -SH levels were significantly lower in group 2 patients than in group 1 ( p<.001) and control subjects ( p<.05). Serum carbonyl levels were significantly higher in group 1 and group 2 patients than in control subjects ( p<.001). Serum MDA levels were significantly higher in group 1 patients than in group 2 and control subjects ( p<.001).

CONCLUSION

These results provide further evidence that VPA treatment for patients with BD contributed to the metabolic disturbances, such as the decreased serum adiponectin and -SH levels, as well as the increased serum leptin, MDA and carbonyl levels.

Investigation of RadFET response to X-ray and electron beams

The irradiation response of Radiation Sensing Field Effect Transistor (RadFET), also known as MOSFET/pMOS dosimeter, to high energy X-rays and electron beams was investigated. The threshold voltages before and after irradiation were measured and the trap densities in the gate oxide and oxide/silicon interface of the RadFETs are evaluated. The RadFETs were irradiated with 6MV X-rays, and 10 and 18MeV electron beams emitted from a Linear accelerator (LINAC). Linear and non-linear fits to experimental results showed that after an initial linear response up to several Gy, deviation from the linearity occurred due to electric field screening by the radiation induced oxide trapped charges. The radiation-induced fixed traps (FTs) and switching traps (STs) were analysed and the FT density was found to be higher than the ST density for all beam types and doses. The radiation response, fading characteristics, and variation of the trapped charges of the RadFETs showed similar behaviour in tests.

Role of Uremic Toxins on Apoptosis With Varying Periods of Hemodialysis

Increased apoptotic cell death in uremic patients has been confirmed by a variety of studies. The present study aimed to investigate the effect of uremic toxins and duration of hemodialysis (HD) therapy on apoptosis by means of measuring serum caspase cleaved CK18 (CCCK-18) levels. Seventy chronic HD patients were recruited and divided into three groups with differing periods of HD, from 6 months to 10 years. Twelve healthy subjects served as controls. Serum CCCK-18 level was found significantly higher in HD patient groups (Group 2; 189 ± 71 IU/L, Group 3; 182 ± 65 IU/L, Group 4; 204 ± 111 IU/L) as compared to the control group (122 ± 20 U/L) (P < 0.05). When all hemodialysis patients considered together serum CCCK-18 showed positive correlation with serum uric acid and phosphorus (P < 0.05). In conclusion, our results suggest that apoptosis is enhanced in HD patients, phosphorus and uric acid might play a role in this increment, but duration of HD therapy has no effect on apoptosis.

Protective effect of quercetin on homocysteine-induced oxidative stress

OBJECTIVE

The aim of this study was to evaluate whether quercetin (QUER) treatment could have a protective effect against oxidative stress induced by homocysteinemia in rats.

MATERIALS AND METHODS

Thirty-two male Sprague-Dawley rats (adult) were assigned randomly to four groups: the control group was given physiological saline (PS; 1.5 mL/d); the QUER group was given QUER (50 mg/kg body weight [BW] daily) in distilled water and 0.25 mL PS; the homocysteine (HCY) group was given HCY (1 mg/kg BW daily) in distilled water and 1.25 mL PS; and the QUER + HCY group was given QUER 1 h before the administration of HCY. QUER, HCY, and PS were injected intraperitoneally every other day for 30 d. Plasma malondialdehyde (MDA), carbonyl, erythrocyte-reduced glutathione (GSH), plasma sulphydril (-SH) levels, erythrocyte catalase (CAT), and superoxide dismutase (SOD) activities were determined.

RESULTS

Plasma CAT levels in the QUER group were found to be significantly higher than in the control group, whereas plasma MDA levels in the QUER group significantly decreased compared with the control group. In the HCY group, plasma MDA and carbonyl levels significantly increased and GSH and SOD levels significantly decreased compared with the control group. Plasma MDA levels significantly decreased and GSH and CAT levels significantly increased in the QUER + HCY group compared with the HCY group. Plasma -SH levels were significantly lower in the HCY group than in the control group. Plasma -SH levels were higher in the QUER + HCY group than in the HCY group, but they were not significant.

CONCLUSION

The exposure of rats to HCY leads to oxidative stress reflected in increased MDA and decreased antioxidant enzyme levels. Administration of QUER might attenuate oxidative damage induced by HCY or have a protective effect against it.

Primary mucinous carcinoma of the vulva with signet ring cells deriving from the cloaca

Vulvar neoplasias are rarely encountered lesions at female genital tract, regardless if they are primary or metastatic. Presence of signet ring cells in a tumour at female genito-urinary tract is highly suggestive of a metastatic lesion particularly from a gastrointestinal tumour. Here the authors present a case of vulvar carcinoma with signet ring cells with an undetermined primary site possibly originating from embryonic cloaca.

Snake Envenomation to the Face of a Child--Rare Case

Snakebites are seen in summer season in the southern part of Turkey, including Hatay province. In average of 40 patients with snakebites are admitted to our hospital every year. Viper is the most common venomous snakes in our region. Their hemotoxins and necrotoxins lead to local or systemic tissue damage and is responsible for the mortality and morbidity. In this report, we described a rare pediatric case, a six-year-old boy having been bitten on the left side of his face when he was looking around from their home's balcony. The patient was orotracheally intubated and mechanically ventilated because of airway obstruction due to severe edema. 12 flacon of anti-snake venom, mannitol infusion, fresh frozen plasma, erythrocytes suspension and antibiotherapy were administered to the patient. Seven days after the admission, clinical and laboratory findings were improved and the patient was discharged in a good condition. Snakebites inflicted on face and neck areas may cause rapidly progressive edema in respiratory tract and lead to life-threatening conditions. Therefore early orotracheal intubation is very important to prevent mortality.

Evaluation of aqueductal CSF flow dynamics with phase contrast cine MR imaging in idiopathic intracranial hypertension patients: preliminary results

OBJECTIVE

We aimed to evaluate dynamic cerebrospinal fluid (CSF) flow in idiopathic intracranial hypertension (IIH) patients with new MRI technology phase contrast cine (PCC) MRI.

PATIENTS AND METHODS

Nineteen patients diagnosed with idiopathic intracranial hypertension and 11 healthy volunteers were included in this study. Nine of the IIH cases had been previously diagnosed and had been on drug treatment and 10 cases were diagnosed with IIH recently and had not been put on drug treatment yet. All CSF flow datas were evaluated by phase contrast-MRI using a 1,5 T MRI. The CSF flow was calculated in the equidistant MRI sequence which was taken through a cardiac cycle.

RESULTS

Mean aqueduct area in the IIH group was 3.04 ± 1.14 mm², mean peak rate was 3.29 ± 1.77 cm/sec, mean average rate was 0.35 ± 0.33 cm/sec and mean flow was 0.67 ± 0.95 ml/min. In the control group mean aqueduct area was 2.87 ± 1.01 mm², mean peak rate was 4.20 ± 1.40 cm/sec, mean average rate was 0.37 ± 0.18 cm/sec and mean flow was 0.64 ± 0.40 ml/min. A statistically significant difference was found for the PCC MRI parameter of mean rate value (p: 0.007) between the control group and IIH patients. A statistically insignificant (p: 0.058) but marked difference was found for mean flow value.

CONCLUSIONS

To our knowledge this study is the first CSF flow study in the idiopathic intracranial hypertension patients. We found a difference between the IIH groups and controls in mean rate and flow parameters. It was interesting that the mean rate and flow values of the untreated group that were higher than the controls. CSF flow analysis may be a marker to follow up IIH patients.

Evaluating the effect of polytetrafluoroethylene and extractum cepae-heparin-allantoin gel in peripheral nerve injuries in a rat model

BACKGROUND

Peripheral nerves can be injured by congenital, mechanical, thermal or chemical causes. Peripheral nerve injuries are increasing in frequency, particularly in countries that are becoming more industrialized. Nerve and extremity injuries result in work loss and high treatment costs, and can lead to separation of patients from their social environment. Failure of nerve repair causes muscle functional losses, sensory losses and painful neuropathies.

OBJECTIVES

To compare the effects of condensed polytetrafluoroethylene (cPTFE) and cPTFE-extractum cepae-heparin-allantoin (cPTFE-EHA) gel compound on nerve and functional recovery, and the prevention of adhesion and scar tissue formation after total peripheral nerve injury repaired by primary suture in a rat model.

RESULTS

cPTFE alone and cPTFE-EHA gel was found to provide better functional recovery and nerve regeneration compared with primary repair only. In the macroscopic evaluation, the cPTFE-EHA gel was found to have no negative effect on wound healing and, despite increasing extra-neural scar tissue and adhesions, it had no negative effect on nerve function; in addition, it facilitated functional recovery.

CONCLUSIONS

Compared with the cPTFE application alone, the application of perineural cPTFE-EHA gel during peripheral nerve surgery appeared to provide better functional recovery without causing any significant changes in epineural and extraneural scar tissue formation.

Evaluating the effect of polytetrafluoroethylene and extractum cepae-heparin-allantoin gel in peripheral nerve injuries in a rat model

Background

Peripheral nerves can be injured by congenital, mechanical, thermal or chemical causes. Peripheral nerve injuries are increasing in frequency, particularly in countries that are becoming more industrialized. Nerve and extremity injuries result in work loss and high treatment costs, and can lead to separation of patients from their social environment. Failure of nerve repair causes muscle functional losses, sensory losses and painful neuropathies.

Objectives

To compare the effects of condensed polytetrafluoroethylene (cPTFE) and cPTFE-extractum cepae-heparin-allantoin (cPTFE-EHA) gel compound on nerve and functional recovery, and the prevention of adhesion and scar tissue formation after total peripheral nerve injury repaired by primary suture in a rat model.

Results

cPTFE alone and cPTFE-EHA gel was found to provide better functional recovery and nerve regeneration compared with primary repair only. In the macroscopic evaluation, the cPTFE-EHA gel was found to have no negative effect on wound healing and, despite increasing extraneural scar tissue and adhesions, it had no negative effect on nerve function; in addition, it facilitated functional recovery.

Conclusions

Compared with the cPTFE application alone, the application of perineural cPTFE-EHA gel during peripheral nerve surgery appeared to provide better functional recovery without causing any significant changes in epineural and extraneural scar tissue formation.

Hepatocyte apoptotic index and p53 expression in obstructive jaundice rats

OBJECTIVE

Obstructive jaundice is a serious disease. It can deteriorate critical functions in the liver.

MATERIAL AND METHOD

A total of 20 male Wistar-Albino rats were randomly allocated into two groups consisting of ten in each as follows: Group I (Control) was subjected to a sham operation isolating the bile duct. Group II(Study) was subjected to acute cholestasis induced by bile duct ligation with 4/0 silk suture from two different places and full fold cut between ligatures. On the 7th day, group II rats were re-operated for liver sampling and sacrification-aimed histological analysis through the old incision with anaesthesia. Hepatic tissues were histologically and immunohistochemically processed. The number of apoptotic and p53(+) cells were measured.

RESULTS

On the 7th day, the averages of direct and indirect bilirubin values in Group II rats were found to be 6.99 and 11.70 mg/dl, respectively. They were observed to be statistically significant. In the immunohistochemical evaluation p53 expression in hepatocytes was assessed, p53-positive hepatocytes were determined to exist quite widely in the tissue samples taken from the livers of rats in the study group. Nevertheless, no cells exhibiting p53 expression were found in the tissue samples of the control group.

CONCLUSION

Apoptosis is a closed box and it might make it possible to stop the many disease processes or accelerate the healing. If the principal effective mechanism in the liver under a certain stress factor is apoptosis, it is definite that it will make a difference in the treatment approach. Consequently, we can say that both apoptotic index and p53 expression increase in the rats' liver with biliary obstruction (Fig. 4, Ref. 51).

[Comparison of extracorporeal liver assist devices - albumin dialysis versus plasma exchange - in acute-on-chronic liver failure]

BACKGROUND AND AIM

Extracorporeal liver assist devices are besides causal and symptomatic approaches important therapeutic options in acute-on-chronic (AOC) liver failure. In this retrospective analysis, albumin dialysis was compared to therapeutic plasma exchange (TPA) under various aspects.

PATIENTS AND METHODS

Data from 20 patients per group (10 women, 10 men in each group, mean age 51 ± 12,6 years and 48,2 ± 15,2 years, respectively) treated over a period of 3 months were analyzed. During the first treatment, 5 sessions of dialysis were performed (week 1) for both procedures, 3 more sessions were completed in the second and in the third week each. Data were acquired on days 1, 8, 13, 20, 28 and 90.

RESULTS

After 28 days, 13 out of 20 patients following albumin dialysis and 7 out of 20 patients following plasma exchange had survived (p = 0,11). After 90 days, 10 patients following albumin dialysis and 5 patients following plasma exchange were alive (p = 0,19). Degree of hepatic encephalopathy (HE) had not improved significantly. Rates of complication (infections, bleeding or system clotting) were similar under both procedures.

CONCLUSION

Extracorporeal liver assist devices can be considered equally well as a therapeutic option in acute-on-chronic liver failure. Differences in 90-day survival were not observed in our study.

Cost-effective usage of membrane oxygenators in extracorporeal membrane oxygenation in infants

Although the poly-methylpentene (PMP) oxygenators have significant advantages in ECMO implementation, their usage may be limited in some situations, which may be related to economic constraints. In this report, we aimed to emphasize our cost-effective usage of a membrane oxygenator at the ECMO setup. We implemented ECMO with eight Capiox® FX05 or Baby RX05 hollow-fiber membrane oxygenators in five neonatal patients. The average ECMO duration was 121 hours (ranging from 41 to 272 hours). Following the termination of the ECMO, the system was broken down into its components for macroscopic analysis. Neither gross blood clots nor plasma leakage were observed in any of the components. The integration of a centrifugal pump and a separate hollow-fiber oxygenator may provide a cost-effective ECMO implementation setup with no adverse effects which may be an encouraging alternative for the low cost usage of ECMO in neonates.

Tacrolimus as a reasonable alternative in a patient with steroid-dependent and thiopurine-refractory autoimmune pancreatitis with IgG4-associated cholangitis

BACKGROUND

More recently, autoimmune pancreatitis (AIP) in association with IgG4-positive cholangitis (IAC) has been recognised as a new and challenging entity. Currently, initiation of high dose steroids (e.g., prednisolone 0.5 - 1 mg/kg/day) followed by a steroid dose taper in combination with purine antagonists (e.g., azathioprine or 6-mercaptopurine) after resolution has been recommended as standard therapy.

CASE REPORT

A 68-year-old male patient was referred to our institution in February 2012 for therapy evaluation of a steroid-dependent course of autoimmune pancreatitis type 1 with IgG4-associated cholangitis. Since the first diagnosis in March 2011, the patient was treated with high-dose steroids with good response. Whenever steroids were tapered down to a daily dose <20 mg, cholestatic liver enzymes increased dramatically despite concurrent immunosuppressive therapy primarily with azathioprine and 6-MP thereafter. Therefore, we restarted steroid therapy (1 mg/kg/day) in combination with tacrolimus achieving a target level of 5 - 7 ng/mL. During the down-tapering phase, follow-up examinations presented a patient in good general condition without jaundice. Moreover, liver and pancreatic enzymes and also immunoglobulins returned to normal values without any evidence of relapse up today (66 weeks).

CONCLUSION

In this case, the combination of steroids with tacrolimus seems to be a reasonable alternative in a patient with steroid-dependent and thiopurine-refractory autoimmune pancreatitis with IgG4-associated cholangitis. To date, this is the first description of such a therapeutic approach for this entity.

The effects of exogenous glutathione on reduced glutathione level, glutathione peroxidase and glutathione reductase activities of rats with different ages and gender after whole-body Γ-irradiation

Age-and gender-related changes on reduced glutathione (GSH) level, glutathione peroxidase (GPx) and glutathione reductase (GR) activities in the liver of rat exposed to different dose of whole-body g-ray irradiation were determined. In addition, the effect of administration of exogenous GSH on endogenous GSH levels, GPx and GR activities was investigated. For this aim, male and female rats aged 1 and 5 moths were divided into two groups as g-ray and g-ray+GSH. Both groups were again divided into four groups as irradiated with 2, 4, 6 and 8 Gy doses. GSH level and GPx activity did not change with age while GR activity was decreased with age. Gender-dependent changes in GPx and GR activities were observed, but GSH values were not affect by sex. GSH levels, GPx and GR activities were not observed dose-associated changes of g-irradiation. GSH level and GPx activity in the 8Gy group were increased by GSH. GR activities of old male rats were found to be increased by glutathione in the 6 and 8Gy groups. These results indicate that radiation and administration of exogenous GSH affect gender-and age-dependent GSH level, GPx and GR activities in the rats.

Non-alcoholic steatohepatitis occurs in celiac disease and is associated with cellular stress

BACKGROUND AND AIMS

Liver and gut not only share alimentary but also immunological features. Major histocompatibility complex class I-related chains A and B (MIC A/B) function as indicators for cellular stress. These so called stress-induced ligands are suggested to play an important role in the progression of non-alcoholic fatty liver disease (NAFLD) and are a prominent feature of celiac disease (CD).

PATIENTS AND METHODS

In the present study, 24 patients with celiac disease and 20 patients with non-alcoholic steatohepatitis (NASH) were included. Liver enzymes, serum cell death markers (M30, M65), MIC B and expression of adiponectin were determined.

RESULTS

Mean patient age was 42 years (18 - 69) for CD and 49 years (33 - 68) for the NASH group. ALT and AST values were lower in CD compared to NASH patients. While serum cell death markers were higher in NASH, the predominant type of cell death in CD was apoptosis. Also, expression of MIC B was significantly up-regulated in CD patients as compared to NASH patients. Adiponectin values were significantly lower in NASH compared to CD patients.

CONCLUSION

Stress-induced ligands and apoptosis are induced in CD. Prospective studies need to determine the exact role of cellular stress and apoptosis in the gut-liver axis and the clinical implications to screen for NAFLD in CD patients.

The investigation of radionuclide distributions in soil samples collected from Bursa, Turkey

The distributions of (226)Ra, (232)Th, (40)K and (137)Cs activity concentrations were determined using a high-purity germanium detector in uncultivated surface soil samples collected from Bursa. The range of (226)Ra, (232)Th, (40)K and (137)Cs activity concentrations varied from 10±1 to 61±3 Bq kg(-1) (mean value 25±3 Bq kg(-1)), from 12±1 to 50±2 Bq kg(-1) (mean value 26±3 Bq kg(-1)), from 257±5 to 1010±11 Bq kg(-1) (mean value 435±44 Bq kg(-1)) and from 1.01±0.07 to 48.97±0.54 Bq kg(-1) (mean value 8.52±2.59 Bq kg(-1)), respectively. In addition, the mean outdoor absorbed dose rates in air, annual effective dose equivalent, radium equivalent activity and external hazard index were found to be 45 nGy h(-1), 56 μSv y(-1), 96 Bq kg(-1) and 0.26, respectively. The gross beta activity concentrations were determined using a Tennelec LB 1000-PW detector. The range of gross beta activity concentrations varied from 46±9 to 1199±113 Bq kg(-1) with a mean value of 541±19 Bq kg(-1).

Laparoscopy can aggravate the severity of pancreatitis in an experimental rat model

PURPOSE

Over the past decade, laparoscopic techniques have markedly evolved, and it has been shown that minimally invasive surgery can provide a safe, effective, and less traumatic management of various surgical diseases. Additionally, it is well known that pancreatitis itself also produced severe oxidative tissue injury by increasing levels of reactive oxygen species. This study therefore aimed to investigate the effects of pneumoperitoneum on the severity of pancreatitis in a rat model of acute pancreatitis induced by cerulein.

MATERIALS AND METHODS

Thirty-five Wistar albino rats were divided into five groups with seven rats in each. Experimental pancreatitis was induced using intraperitoneal injection of cerulein. The first group received open laparotomy. Groups 2-5 were treated with 5, 10, 15, and 20 mm Hg, respectively, achieved by applying pressure and waiting for 60 minutes. After this waiting interval, all of the rats were sacrificed; blood samples were taken by intracardiac puncture for biochemical assays, and pancreatic tissue samples were taken for light microscope analysis. Histopathology was scored according to edema, granulation, polymorphonuclear leukocytes, and mononuclear cells in all groups.

RESULTS

Great increases in malondialdehyde and reduced glutathione levels were seen in all of the groups in which pancreatitis was induced. In Group 2-5, more significant increases were detected than in the open laparotomy group (P<.005). In the histopathological examination, Groups 2-5 showed more inflammatory cell infiltration, edema, and granulation tissue than the open laparotomy group (P<.005).

CONCLUSIONS

It is useful to remember the parameters of the medical treatment of pancreatitis. While surgical treatment is being decided, we think that the process of all kinds of surgery, including laparoscopic surgery, can increase the severity of pancreatitis.

Laparoscopic preconditioning protects against oxidative injury in cerulein-induced pancreatitis rats (an experimental study)

BACKGROUND

Laparoscopic cholecystectomy, particularly in the same hospital stay, has been widely recommended to treat gallstone-pancreatitis over the last decade. Although pancreatitis produces severe oxidative injury, laparoscopy exerts an additional effect over that is produced by pancreatitis. The preconditioning phenomenon previously reported as protective in open surgery is a beneficial maneuver also in laparoscopic surgery. So in the present study we have tried to find out the effect of laparoscopic preconditioning over the pancreatitis in cerulein-induced pancreatitis rats.

METHODS

Acute pancreatitis was induced in 24 rats weighing between 280 and 350 g by three subcutaneous injection of 80 μg/kg of body weight cerulein. A 1-cm midline laparotomy was performed for all rats, and then they were randomly assigned to one of the following three groups (n=8 for each): Group I (control), Group II (laparoscopy), and Group III (laparoscopic preconditioning [L-Pre]). After that, a catheter was placed into the peritoneum for the creation of the pneumoperitoneum (Pp) in all the animals except the control group. The rats of Groups II and III were subjected to 60 minutes of Pp with 15 mm Hg intraabdominal pressure followed by 30 minutes of deflation. The L-Pre procedure was applied to Group III immediately before the laparoscopic procedure. Blood samples were taken for biochemical assays. Pancreas tissue samples were taken for light microscope analysis.

RESULTS

The light microscopy of the pancreas tissues revealed that cerulein injection caused edema and sparse inflammatory cell infiltration mimicking the edematous pancreatitis. However, the application of laparoscopy over the pancreatitis produced significant inflammatory cell infiltration, acinus vacuolization, and necrosis (in one case) in addition to edema. But, the laparoscopic preconditioning maneuver applied before the laparoscopy significantly decreased in particular acinary vacuolization and cell infiltration. Therefore the total sum of the histopathological score of the L-Pre group was significantly less than that of the laparoscopy group. The biochemical analysis of the groups revealed that laparoscopy caused significant elevation of malondialdehyde levels and decrease of reduced glutathione values. However, the addition of preceding preconditioning produced significant amelioration of these parameters.

CONCLUSION

Laparoscopic preconditioning may be a useful method to decrease the oxidative injury in cases undergoing cholecystectomy for biliary pancreatitis. But, it should be emphasized that this was a restricted experimental study, and further clinical studies are needed to adopt these results into clinical settings.

Modulator effects of the methylenetetrahydrofolate reductase C677T polymorphism on response to vitamin B12 therapy and homocysteine metabolism

In this study, our aim was to investigate the association of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism on the vitamin B12 therapy response in 95 patients with vitamin B12 deficiency and 92 healthy control subjects using vitamin B12, plasma total homocysteine (tHcy), and folate as the main measure of outcome. MTHFR C677T genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism techniques. There were no differences in the distribution of MTHFR genotypes in the cases versus the controls. Mean concentrations of plasma tHcy and B12 vitamin were 18.84 μM and 142.47 pg/mL in patients with TT (10.5%) genotypes. Furthermore, mean concentrations of B12 vitamin after cobalamin therapy were 697.62, 656.64, and 488.76 pg/mL in patients with the CC, CT, and TT genotypes, respectively. The MTHFR 677 TT genotype has decreasing effect in B12 vitamin and increasing effect in tHcy. In comparison with the patients having CC and CT genotypes, patients with the TT genotype had a lower response to vitamin B12 therapy.

Evaluation of cholinesterase inhibitory and antioxidant activities of wild and cultivated samples of sage (Salvia fruticosa) by activity-guided fractionation

In European folk medicine, Salvia species have traditionally been used to enhance memory. In our previous study of 55 Salvia taxa, we explored significant anticholinesterase activity of cultivated S. fruticosa. In this study, we compared the inhibitory activity of dichloromethane, ethyl acetate, and ethanol extracts of 3 wild-grown samples and 1 cultivated sample of S. fruticosa against acetylcholinesterase and butyrylcholinesterase enzymes (which are associated with pathogenesis of Alzheimer's disease) by using the spectrophotometric Ellman method. Antioxidant activities were assessed by determining 2,2-diphenyl-1-picrylhydrazyl radical-scavenging activity, iron-chelating capacity, and ferric-reducing antioxidant power. The dichloromethane extract of the cultivated sample was then subjected to fractionation by using open column chromatography and medium-pressure liquid chromatography to obtain the most active fraction by activity-guided fractionation. All fractions and subfractions were tested in the same manner, and inactive subfractions were discarded. The essential oil of the cultivated sample was analyzed by gas chromatography-mass spectrometry.

Comparison of three different immunoassay methods for the evaluation of intact parathyroid hormone levels in hemodialysis patients

BACKGROUND

Intact parathyroid hormone (iPTH) assays react with the non-(1-84) molecular form of PTH. This form behaves as a carboxy-terminal fragment and accumulates during renal failure. We wanted to examine the variation of iPTH levels between the more commonly used different immunoassay methods in hemodialysis patients.

METHODS

Our study was designed to compare three commercial second-generation immunoassays based on electrochemiluminescent immunoassay (ECLIA), enzyme immunoassay (EIA) and immunoradiometric assay (IRMA) for intact PTH. The serum samples from 88 patients were collected and the iPTH concentrations measured.

RESULTS

The median iPTH (IRMA) concentration (99 pg/mL) was lower than both median iPTH (ECLIA) concentration (290.5 pg/ml; p < 0.001) and iPTH (EIA) concentration (369 pg/mL; p < 0.001). The Bland-Altman graphs, which are plots of the percentage differences between the two methods against their mean, suggested that the IRMA methods are not in agreement with the other methods.

CONCLUSION

It would be useful to reduce the variability among the methods with the use of a more standardized calibrator and of the same specific antibodies that only recognize the active PTH molecule.

Smoothing factor and voice perturbation measurements

OBJECTIVE

Although gradual frequency and amplitude variations originating from intonation or vocal instability are not related to voice quality, jitter and shimmer are sensitive to such variations. These parameters are therefore calculated by subtracting the average of a group of successive periods from the middle period; the period number that is averaged is called the smoothing factor. The aim of this study was to investigate the effect of smoothing factor size on frequency and amplitude perturbation measurements.

METHODOLOGY

A prospective study was designed, incorporating recorded voice samples from ten male and ten female healthy adult volunteers; samples were analyzed with the Multi Dimensional Voice Program for Multi-Speech. We used all low smoothing factor sizes up to 21, and then skipped smoothing factor sizes in steps of ten, resulting in 28 different levels.

RESULTS

Smoothed pitch perturbation quotient and smoothed amplitude perturbation quotient values increased as the smoothing factor size increased. Smoothing factor size was correlated with smoothed pitch perturbation quotient and smoothed amplitude perturbation quotient values in males (r = 0.589 and r = 0.698, respectively) and females (r = 0.736 and r = 0.847, respectively).

CONCLUSION

Our study revealed an exact relationship between smoothing factor values and perturbation measures. At low smoothing factor values, perturbation measures are sensitive to short-term variations, whereas at high smoothing factor values, they are less sensitive to short-term but more sensitive to long-term variations.

Impact of immunosuppressive therapy on hepatitis C infection after renal transplantation

BACKGROUND

Among patients after renal transplantation (NTx), hepatitis C virus (HCV) infection is a risk factor for graft loss and patient death caused by hepatic decompensation. Also, HCV has been implicated in the pathogenesis of glomerular diseases in native and transplanted kidneys. Therefore, the aim of this retrospective cohort study was to determine the effects of the widely used calcineurin inhibitors (CNI) cyclosporine A (CsA) and tacrolimus (Tac) on hepatitis C virus replication, inflammatory activity, development of liver fibrosis, and long-term renal graft function.

SUBJECTS AND METHODS

A cohort of 71 patients with HCV infection after kidney transplantation under immunosuppression with either CsA or Tac were analyzed for viral kinetics and serum transaminases. In addition, presence of liver fibrosis was detected by non-invasive measurements using the FibroScan. Graft function was determined biochemically. Patients with interferon therapy prior to transplantation were excluded from the study in order to avoid any impact of the antiviral therapy on outcomes.

RESULTS

In the early period after transplantation, hepatitis C viral load was lower in patients treated with Tac as compared to CsA. This effect became negligible 3 months after transplantation. However, hepatic inflammatory activity was reduced in the CsA-treated group. Extent of liver fibrosis was similar in both groups of HCV-infected patients as well as in a control group of non-HCV-infected patients after renal transplantation (NTx), respectively. Renal function and glomerular filtration rate, as calculated by the modification of diet in renal disease (MDRD) formula, were significantly better in patients treated with Tac.

CONCLUSIONS

During long-term immunosuppression, the CNIs cyclosporine A versus tacrolimus showed no significant differences in HCV-infected patients after renal transplantation with respect to viral replication and development of liver fibrosis. However, function of the renal graft is significantly better preserved in patients receiving tacrolimus.

Short period of preconditioning protects by decreasing the TNF-alpha and IL-6 values before laparoscopic surgery (a rat experiment)

BACKGROUND

Laparoscopy produces ischemia reperfusion injury mediated by inflammatory cytokines. Preconditioning is a protective maneuver in laparoscopic surgery; however, there is an argument in the literature about the length and number of the preconditioning sequence(s), thus the present study evaluates the effects of short (5 min) and long (10 min) periods of preconditioning on laparoscopy-induced inflammatory response.

MATERIAL/METHODS

Thirty-two rats were enrolled into 4 groups: control, laparoscopy, 5 min preconditioning and 10 min preconditioning groups, each containing 8 rats. Laparoscopy was performed by application of 60 min of pneumoperitoneum with 15 mmHg. The preconditioning maneuvers were performed before laparoscopy in respective groups. Following the cessation of experiment blood samples were obtained to determine the TNF-alpha and IL-6 levels.

RESULTS

Laparoscopy produced significantly increased levels of plasma TNF-alpha and IL-6 values as compared to the sham group. Five min preconditioning caused significant decrease in plasma TNF-alpha and IL-6 values compared to laparoscopy group. Although 10 min preconditioning caused partially decreased levels of TNF-alpha and IL-6 values, they were still higher than that of the 5 min preconditioning group.

CONCLUSIONS

Preconditioning maneuvers longer than 5 min lose protective activity and begin to produce ischemia reperfusion injury. We found that 5 min of inflation followed by 5 min of deflation seems to protect against subsequent post-laparoscopic inflammatory response. Thus it is advisable not to use any preconditioning maneuvers longer than 5 min in order to avoid increasing the operation and anesthesia times.