Evaluation of angiogenic apelin/apelin receptor axis in normal prostate, high grade prostatic intraepithelial neoplasia and prostatic adenocarcinoma

INTRODUCTION AND OBJECTIVES

Prostate cancer is one of the most commonly diagnosed cancers in American men. Apelin is an endogenous peptide identified as the ligand of the G protein-associated apelin receptor. Apelin and apelin receptor have many tissues distribution and they participate in pathological processes, such as cancer. Apelin stimulates cancer angiogenesis. However, there are insufficient data in the literature regarding the role of apelin/apelin receptor in normal tissue, highgrade prostatic intraepithelial neoplasia, and prostatic adenocarcinoma tissues. Therefore, this study aimed to investigate the apelin and apelin receptor expression levels in tissues of normal prostate tissue, high-grade prostatic intraepithelial neoplasia, and prostatic adenocarcinoma.

MATERIALS AND METHODS

In this study, 38 samples of patients undergoing radical prostatectomy were used. Among 38 samples; 20 patients were with prostatic adenocarcinoma, 18 patients were with high-grade prostatic intraepithelial neoplasia and adjacent normal prostatic tissue areas. The immunolocalisation of apelin and apelin receptor in these tissues were determined immunohistochemically.

RESULTS

Apelin and apelin receptor expressions were higher in prostatic adenocarcinoma than normal prostate tissue and high-grade prostatic intraepithelial neoplasia. Apelin receptor expression was also increased in high-grade prostatic intraepithelial neoplasia compared to normal tissue.

CONCLUSION

Apelin and apelin receptor are increase in the process of prostate carcinogenesis. This increase may adversely affect the clinical course of prostate cancer patients by stimulating angiogenesis, which is important for invasion and metastasis in prostate cancer.

Role of hyponatremia in differentiating complicated appendicitis from uncomplicated appendicitis: a comparative study

OBJECTIVE

Some studies suggest that serum sodium level may decrease at a greater degree in complicated acute appendicitis (CA) because of the increased severity of inflammation. This study aimed to determine the predictive value of some inflammatory markers and hyponatremia in differentiating CA from uncomplicated acute appendicitis (UCA).

PATIENTS AND METHODS

In this retrospective cohort study, the data of patients who underwent urgent appendectomy in Department of General Surgery, Eskisehir Osmangazi University from January 01, 2016 to January 01, 2021, were analyzed. Patients were divided according to appendicitis type, UCA and CA.

RESULTS

In this study, 10.2% (n = 79) of 772 acute appendicitis cases were CA. Multiple logistic regression analysis revealed that high age (p = 0.001), male sex (p = 0.014), high leukocyte count (p = 0.045), low lymphocyte count (p = 0.023) and hyponatremia (p <0.001) were independently associated with CA. Patients with hyponatremia (sodium level ≤134 mEq/L) had 3.050-fold higher risk for CA than patients with normal sodium level (odds ratio: 3.050, 95% confidence interval: 1.668-5.576). The results of the ROC analysis performed to assess the role of sodium level in detecting CA showed a sensitivity of 27.8% and a specificity of 92.1% (cut-off: 133.5 meq/L) (p = 0.001; area under the curve: 0.612 [0.539-0.684]).

CONCLUSIONS

Clinicians should be aware of the higher likelihood of CA occurrence in patients with appendicitis in whom hyponatremia, leukocytosis, or lymphopenia is detected in the laboratory examination.

Characterizing post-covid conditions in a Turkish cohort: A prospective study

Background

Investigating the people who suffer from post-COVID health conditions is necessary to accommodate the demand for accessing healthcare. This study aims to describe post-COVID health conditions within six months after diagnosis.

Methods

This study was conducted at Dokuz Eylul University Hospital, a tertiary care hospital in Ä°zmir-Turkey. Participants aged ≥18 years who were diagnosed as SARS-CoV-2 RNA positive in the hospital from November 1st, 2020 to May 31st were interviewed by phone at one, three and six months after diagnosis. Symptom frequencies were stratified by demographic and clinical characteristics. The dependent variable was having post-COVID condition according to World Health Organization's definition. We estimated logistic regression models to identify associated factors for post-COVID condition in the patients who had symptoms at baseline.

Results

A total of 5083 people completed the third month's interview. The prevalence of post-COVID condition was 21.8% (n = 1108). Tiredness/fatigue (10.2%), muscle or body aches (7.3%) and dyspnea/difficulty breathing (4.8%) were the most common symptoms. Older age (65-74 aged groups versus 18-24 aged group, odds ratio-OR:1.57, 95% confidence interval: 1.10-2.25), female gender (OR: 1.97, 1.71-2.28), bad economic status (OR: 1.44, 1.13-1.84), having more health conditions (≥3 conditions, OR: 1.82, 1.28-2.55), having more symptoms (>5 symptoms, OR: 2.59, 2.20-3.07) and hospitalization (intensive care unit, OR: 1.98, 1.13-3.37) were found to be associated with reporting of post-COVID condition.

Conclusions

This study identifies the prevalence and risk factors for post-COVID conditions in a large cohort of patients. The results of the study would guide the healthcare organizations in the planning of post-COVID management strategies.

Key messages

• The prevalence of post-COVID conditions was 21.8%. Older age, female gender, having more health conditions, disease severity in the acute phase and bad economic status were risk factors.

• Clinical management strategies and country-specific healthcare planning should be devised for the post-COVID condition burden.

Health-related QoL and fatality in CHD patients: findings from a national cohort study, Turkey

Background

Although strong association between self-reported health and coronary heart disease (CHD) exists, health related quality of life (HRQOL) has not been conceptualized as a predictor for fatality in CHD patients. We investigated whether HRQOL may predict the risk of death in six years in CHD patients.

Methods

There were overall, 614 of CHD cases in the national representative Chronic Diseases and Risk Factors Survey in Turkey, 2011. Baseline self-reported health data on EuroQol- 5 Dimension (EQ-5D) and a Visual Analog Scale (VAS) were used from the same survey. The cases were followed-up for all-cause and CHD specific fatality (ICD-10 diagnostic codes: I20- I25) through electronic health records by 2017. Kaplan Meier and Cox regression models were used for data analysis. Age and sex adjusted HRs [aHR 95% CIs] were estimated for having some or extreme problems in EQ5D domains and VAS.

Results

Median follow-up years (IQR) was 6.46 (6.39-6.47). The number of deaths from all causes and CHD were 103 and 26, respectively. Age and sex adjusted HRs for all causes fatality were statistically significant for some or extreme problems in usual activities [2.48 (95%CI 1.60-3.83)], in pain/comfort [2.28 (95% CI 1.44-3.62)], in self-care [2.25 (95% CI 1.46-3.46)] and in mobility [1.85 (95% CI 1.16-2.96)]. Age and sex adjusted HRs for CHD specific fatality were statistically significant for some or extreme problems in self-care [3.45 (95% CI 1.48-8.07)] and pain/comfort [3.07(95% CI 1.19-7.93)]. VAS was negatively associated with overall fatality.

Conclusions

In CHD cases, poor self reported health might be a good indicator for overall and CHD specific fatality in 6 years. Especially having some or extreme problems in selfcare and pain/comfort are closely related with overall fatality as well as CHD specific fatality.

Key messages

There are strong relationships between HRQOL and all causes fatality as well as CHD specific fatality. Poor self- reported health might be a predictor for overall and CHD specific fatality in CHD cases.

Healthcare use of COVID-19 patients within 3 months of diagnosis and associated factors

Background and aim

Healthcare utilization of the population changed by the COVID-19 pandemic. There is limited research on the healthcare use of COVID-19 patients. This study aimed to describe the healthcare use of COVID-19 patients within 3 months after diagnosis and to investigate the associated factors.

Methods

Patients older than 18-years who tested positive for SARS-CoV-2 RNA in Dokuz Eylül University Hospital-Turkey in November and December 2020 (n = 3597) were included in this retrospective cohort study. In total, data from 2978 patients were analyzed. Data were collected through telephone interviews. Dependent variables were patient-reported general healthcare use and COVID-19 related healthcare use within 3 months of follow-up. Age, gender, chronic disease history, number of initial symptoms, and hospitalization status were independent variables. Chi-square was used to compare categorical variables. Univariate and multivariate (backward elimination method) logistic regression models were conducted to identify predictive factors.

Results

In total, 32% of the cases sought healthcare within three months of diagnosis while 11.4% of the visits were due to COVID-19. The most common outpatient visits related to COVID-19 included chest diseases (30.3%), the emergency room (29.1%), and internal medicine (16.2%). Backward stepwise selection identified female gender (OR = 1.23, 1.05-1.44), having more than 3 comorbidities (OR = 2.64, 1.95-3.56), hospitalization (OR = 1.54, 1.16-2.03) for general healthcare use, and having more than 5 symptoms (OR = 1.52, 1.13-2.04), having more than 3 comorbidities (OR = 1.65, 1.09-2.43), hospitalization (OR = 1.77, 1.22-2.51) for COVID-19 related healthcare use.

Conclusions

Having comorbidities, the number of initial symptoms, and the need for hospitalization are the main determinants of general and COVID-19 related health care use in three months of COVID-19 infection.

Key messages

Indicators of severe clinical conditions are the main determinants of general and COVID-19 related healthcare use in the post COVID-19 patients. Healthcare resource planning should consider the needs of post COVID-19 patients.

Persistent symptoms after three months follow-up of in and out-patient COVID-19 cases

Background and aim

There is limited research on how common the longer-term effects of COVID-19. This study aimed to describe changes in symptoms of COVID-19 patients at the 1st and 3rd months after diagnosis.

Methods

Patients older than 18-years who tested positive for SARS-CoV-2 RNA in Dokuz Eylül University Hospital-Turkey in December 2020 (n = 1434) were included in this prospective cohort study. Overall, 1029 patients (71.8%) completed the 1st month and 3rd-month follow-up. Data on demographic characteristics, chronic disease history, symptom history and hospitalization were collected via telephone interviews. Based on the relapsing nature of the disease, the presence or absence of any COVID-19 related symptoms within a week before the 1st and 3rd-month interview was questioned. Categorical variables (n, %) were compared using the chi-square test.

Results

Of the 1029 patients, 92.8% were symptomatic. The most common initial symptoms were muscle or body aches (58.5%), fatigue (57.8%) and loss of smell (53.1%). Among the symptomatic patients, 40.8% and 27.6% reported at least one symptom in the 1st and 3rd months, respectively. Mean number of symptoms was 4.5±2.6 at diagnosis, 2.3±1.7 at the 1st month and 2.5±2.3 at the 3rd month. The most common persistent symptoms by the 1st month were muscle or body aches (11.1%), heart palpitations (6.4%), and shortness of breath (5.8%). Muscle or body aches (9.5%), shortness of breath (4.2%) and fatigue (4.2%) were reported as persistent by the 3rd month. Persistent symptoms up to the 3rd month were more common in women (33.3% vs 21.3%, p &lt; 0.001), in the patients aged &gt;50 years (32.8% vs 25%, p = 0.01) and in the patients with comorbidities (31.8% vs 25.1%, p = 0.03).

Conclusions

Over a quarter of patients (27.6%) reported persistent symptoms even after 3 months of diagnosis. Rehabilitation and long-term monitoring programs for patients aged &gt;50 years with comorbidities could be useful in responding to this problem.

Key messages

Over a quarter of patients report persisting symptoms even after 3 months of initial diagnosis. Follow-up programs could be useful in appropriately managing any persistent or emerging long-term sequelae.

Sex differences in the risk of coronary heart disease associated with socioeconomic status in Turkey

Background

Studies in high-income countries have demonstrated that low SES status is associated with increased risk of CHD, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries.

Methods

The database of the Chronic Diseases and Risk Factors Survey In Turkey from 2013 and 2019 was used. Education level and employment status were chosen as proxy indicators for SES. Cox regression analyses were conducted to assess the effect of SES on incident CHD controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess multiplicative interaction between sex and SES on the occurrence of stroke.

Results

The study included 13 975 participants (7 450 females (53.3%) and 6525 males (46.7%)). During 74.2±9.87 months of follow-up, 474 CHD cases occurred among females (10.28 cases per 1000 person-year) and 445 CHD cases occurred among males (11.05 cases per 1000 person-year). Incident CHD was not associated with education level among either sex. Retirement was associated with increased risk of CVD (HR = 1.31, 95%Cl: 1.18-1.66) among males. Both retirement (HR = 2.12, 95%Cl: 1.16-3.88) and unemployment (HR = 1.93, 95%Cl: 1.14-3.25) were associated with increased risk of CHD in females after adjustment for behavioral and biological risk factors. There was no multiplicative interaction between sex and employment status on the risk of CHD (p = 0.091).

Conclusions

This study of health outcomes in Turkey did not find sex differences in CVD in association with educational status but did show sex differences in association with employment status. This finding suggests that social determinants in middle-income countries may affect men and women differently than in high-income countries.

Key messages

Social determinants in middle-income countries may affect men and women differently with regards to the risk of CHD than in high-income countries. Employment status can predict the risk of CHD in middle-income countries.

Sex differences in the associations of socioeconomic status with stroke in the Turkish Population

Background

Low SES status is associated with the risk of stroke, with sex differences in the risk profiles. Recent evidence suggests that this association may differ in middle-income countries. We explored this association in the Turkish population.

Methods

The database of the Chronic Diseases and Risk Factors Survey in Turkey from 2013 and 2019 was used. The education level and employment status of the participants were chosen as a proxy indicator for SES. Cox regression analyses were conducted to assess the effect of SES on incident stroke controlled by age, settlement, behavioral and biological risk factors. Interaction terms were introduced to the Cox models to assess the multiplicative interaction between sex and SES on the risk of stroke.

Results

The study included 13 975 participants; 7 450 females (53.3%) and 6525 males (46.7%). During 74.2±9.87 months of follow-up, 108 strokes occurred among females (2.34 cases per 1000 person-years) and 81 stroke cases occurred among males (2.01 cases per 1000 person-years). Completion of primary school education was associated with decreased risk of stroke (HR = 0.46, 95%Cl: 0.25-0.84) among males. Education level had a linear protective effect against stroke among females after adjustment for behavioral and biological risk factors (HR = 0.50, 95%Cl: 0.30-0.81; HR = 0.30, 95%Cl: 0.12-0.71; respectively for primary education and secondary or higher education). Employment status did not predict the incident stroke for both sexes. There was no evidence of an interaction between sex and education (p = 0.68).

Conclusions

In this Turkish population, stroke risk was greater in women than in men. Increasing education was associated with a reduced risk of stroke in Turkish women, whereas the only completion of primary education was protective for men, with no further protection at increased educational levels. Further exploration of sex and gender risk differences in moderate-income countries may lead to improved efforts at risk reduction.

Key messages

Education level as a social determinant of health in middle-income countries may affect men and women differently with regards to the risk of stroke Understanding sex differences in the associations of socioeconomic status with stroke may lead to improved efforts at risk reduction of stroke in MICs.

Three months follow-up of children infected with COVID-19

Background

There is limited research on children infected with Covid-19 after initial diagnosis. The aim of this study was to describe changes in symptoms in children infected by Covid-19 after 1st and 3rd months of diagnosis.

Methods

Covid-19 patients age under 18 admitted to the Dokuz Eylul University Hospital, Izmir, Turkey during December 2020 (n = 144) and completed three months follow-up (n = 123) were included in this prospective cohort study. Data on age, sex, parents' educational status, perceived economic status, presence of Covid-19 patient at household, chronic diseases history, initial and existing symptoms and perception of recovery were collected via telephone interviews. Persistent symptom was defined as any symptom reported within a week of the interview. Chi-square and Mann-Whitney U Test were used for univariate analyses.

Results

Out of 124 patients, 89.3% reported a symptom at time of diagnosis, 21.0% at 1st month and 11.4% at the 3rd-month follow-up. Median number of symptoms was 2 at diagnosis, 0 at 1st and the 3rd month. The most common initial symptoms were fever (52.4%), weakness (40.3%), flu like symptoms (25.8%) and cough (24.4%). The most common persistent symptoms by the 1st month were fatigue (5.7%), cough (4.1%) and gastrointestinal symptoms (4.1%), and by the 3rd month were fatigue (2.4%), weakness (2.4%), respiratory symptoms and chest pain (2.4%). 10.6% of the patients were not fully recovered by the 3rd month. Persistent symptoms at the end of 1st month were more common in children with chronic diseases (36.6% vs 13.3%, p = 0.003) and who were not recovered fully (63.6% vs 15.5%, p = 0.001). Parents' education level, perceived economic status, and presence of Covid-19 patients at household were not associated with persisting symptoms.

Conclusions

COVID-19 symptoms may persist by three months of infection, especially in children with chronic conditions. Health care providers should consider following up those children with special care.

Key messages

COVID-19 symptoms may persist by three months of infection, especially in children with chronic conditions. Health care providers should consider following up those children with special care.

Anthropometric indicators and diabetes incidence: results from a national cohort study, Turkey

Background

Anthropometric indicators such as Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and Body Shape Index (ABSI) are used globally to evaluate the risk of type 2 diabetes (T2DM). Our study aimed to investigate associations between different anthropometric indicators and the risk of T2DM using data from a national cohort.

Methods

The data on anthropometric measures and other risk factors of diabetes were obtained from Turkey Chronic Diseases and Risk Factors Survey in 2011 (n = 18,477). Disease information for the years 2012-2017 of the cohort has been reached through electronic health records and DM was ascertained by standard ICD-10 Codes. Four logistic regression models were generated based on different groups of confounders: unmodifiable risk factors, behavioral risk factors, comorbidities and socioeconomic variables. Categorical BMI, WC, WHR, WHtR, and ABSI values were used and adjusted RRs (95% CIs) of measurements were computed for men and women separately.

Results

Median follow-up year (IQR) was 6,46 (0,06). Between 2012 and 2017, 540 people were diagnosed with new diabetes. All anthropometric measurements except ABSI were associated with T2DM risk in all models. Among the anthropometric measures, BMI showed the strongest effect on incident diabetes, both in men (BMI ≥30; RRadj: 3.06, 95% CI 1.93-4.86) and women (BMI ≥30; RRadj: 2.58; 95%CI 1.73-3.85) in model 4 (adjusting for all confounding factors). WHtR provided the second strongest association with a RRadj of 2.57 in men (95% CI 1.78-3.71) and 2.55 in women (95%CI 1.87-3.47).

Conclusions

Independent of other risk factors, individuals with high BMI, WHR, WHtR and WC are at higher risk of developing T2DM. Public health strategies aimed at prevention of weight gain and obesity will probably be the most effective way to struggle with diabetes.

Key messages

There is a strong association between anthropometric measurements and type 2 diabetes incidence. Anthropometric indicators can be used to predict the risk of type 2 diabetes in males and females by clinicians and public health practitioners.

Noncommunicable disease incidences in 2012-2017, Turkey

Background

Globally, 88% of deaths are caused by noncommunicable diseases (NCD) and they are increasing in our country as in many parts of the world. Effective control, prevention and treatment of NCD, can begin from knowing the disease incidence by age, sex and regions.

Methods

This study aimed to determine the incidence of chronic diseases (coronary heart disease, stroke, diabetes, hypertension and cancer) by record linkage of the data from the Turkey Chronic Diseases and Risk Factors Prevalence Study 2011 (TCD-RFS) with health service databases, which are Family Medicine Information System, Medulla- E-Pulse and Death Notification System. The cohort (18.477 people above age 15) from TCD-RFS is followed up to determine the incidence of coronary heart disease, hypertension, diabetes, stroke and cancer, from the electronic health record systems for the period between 2012 and 2017 (6 years). Cumulative incidences were calculated, age and sex standardized incidences were given with 95% CI.

Results

The age and sex standardized cumulative incidences are, 5939 (95% CI 5933-5945) for CHD 1378 (95%CI:1369-1388) for stroke, 2254 (95% CI 2 253 -2 255) for cancer, 4200 (95% CI 4194-4204) for diabetes and 20788 (95% CI 1369-1388) for hypertension (per 100,000). The annual incidences are approximately 990 for CHD, 229 for stroke, 375 for cancer, 700 for diabetes and 3464 for hypertension (per 100,000). CHD and cancer incidences are higher in men, while diabetes, hypertension and stroke incidences are higher in women.

Conclusions

Regardless of the difficulties in comparing incidence of NCD with other countries, we think our results show that hypertension, diabetes, stroke and CHD have higher incidence than Western European countries. We also showed that these metrics can be obtained through data linkage of National Health Records for the first time in Turkey.

Key messages

The NCDs needs to be monitored by surveillance using the current data sources for health services. This data can provide very useful information regularly to monitor and control NCDs if necessary actions are taken to adjust data management.

Pneumonia severity indices predict prognosis in coronavirus disease-2019

Background

Early recognition of the severe illness is critical in coronavirus disease-19 (COVID-19) to provide best care and optimize the use of limited resources.

Objectives

We aimed to determine the predictive properties of common community-acquired pneumonia (CAP) severity scores and COVID-19 specific indices.

Methods

In this retrospective cohort, COVID-19 patients hospitalized in a teaching hospital between 18 March-20 May 2020 were included. Demographic, clinical, and laboratory characteristics related to severity and mortality were measured and CURB-65, PSI, A-DROP, CALL, and COVID-GRAM scores were calculated as defined previously in the literature. Progression to severe disease and in-hospital/overall mortality during the follow-up of the patients were determined from electronic records. Kaplan-Meier, log-rank test, and Cox proportional hazard regression model was used. The discrimination capability of pneumonia severity indices was evaluated by receiver-operating-characteristic (ROC) analysis.

Results

Two hundred ninety-eight patients were included in the study. Sixty-two patients (20.8%) presented with severe COVID-19 while thirty-one (10.4%) developed severe COVID-19 at any time from the admission. In-hospital mortality was 39 (13.1%) while the overall mortality was 44 (14.8%). The mortality in low-risk groups that were identified to manage outside the hospital was 0 in CALL Class A, 1.67% in PSI low risk, and 2.68% in CURB-65 low-risk. However, the AUCs for the mortality prediction in COVID-19 were 0.875, 0.873, 0.859, 0.855, and 0.828 for A-DROP, PSI, CURB-65, COVID-GRAM, and CALL scores respectively. The AUCs for the prediction of progression to severe disease was 0.739, 0.711, 0,697, 0.673, and 0.668 for CURB-65, CALL, PSI, COVID-GRAM, A-DROP respectively. The hazard ratios (HR) for the tested pneumonia severity indices demonstrated that A-DROP and CURB-65 scores had the strongest association with mortality, and PSI, and COVID-GRAM scores predicted mortality independent from age and comorbidity.

Conclusion

Community-acquired pneumonia (CAP) scores can predict in COVID-19. The indices proposed specifically to COVID-19 work less than nonspecific scoring systems surprisingly. The CALL score may be used to decide outpatient management in COVID-19.

Quantifying gender inequalities in obesity: findings from the Turkish population-based Balcova Heart Study

OBJECTIVES

Sparse evidence is available to explain obesity variations between genders in the Turkish population. To our knowledge, no previous study has analysed the magnitude of gender differences in obesity using common social determinants of health. We aimed to quantify gender inequalities in obesity in terms of education, employment status, occupation and perceived income in a Turkish population.

STUDY DESIGN

The study design used is a cross-sectional study.

METHODS

Population-based data from the Balcova Heart Study (n = 16,080) were analysed. Logistic regression models were used to calculate the crude and adjusted odds ratios (ORs) when comparing obesity prevalence in women vs men within each category of social determinants.

RESULTS

Women had a higher risk of being obese than men (adjusted OR [aOR] = 2.04 [95% confidence interval {CI}: 1.7-2.1]). Gender inequality in obesity decreased as the level of education increased, from 'primary school' (aOR = 2.5 [95% CI: 2.2-2.8]) to 'university' (aOR = 0.9 [95% CI: 0.6-1.1]). Women had a higher risk of obesity within the 'unemployed' category compared with men (aOR = 2.2 [95% CI: 1.6-3.0]). Gender inequality in obesity decreased with a higher perception of income, from 'low' (aOR = 2.1 [95% CI: 1.6-3.0]) to 'high' (aOR = 1.5 [95% CI: 1.2-2.0]).

CONCLUSIONS

These findings highlight the fact that gender inequalities in obesity are greatest within populations of low education, unemployment and lower perception of income. Reduced gender inequality in obesity prevalence was seen for the subpopulation with professional occupations, with women having decreased odds of obesity compared with men. Conversely, unemployed women had increased odds of obesity compared with unemployed men. Increasing the status of women should be prioritised in policies to tackle obesity in the Turkish population and in similar developing populations elsewhere.

Early Hepatic Artery Thrombosis After Pediatric Living Donor Liver Transplantation

AIM

Hepatic artery thrombosis is one of the major complications affecting patient and graft survival after liver transplantation. In this study, we analyzed the factors affecting the development of early hepatic artery thrombosis (eHAT) and its outcomes in pediatric liver transplantation.

METHODS

A total of 175 pediatric patients underwent living donor liver transplantation between January 2013 and November 2018. Factors affecting eHAT and its outcomes were examined.

RESULTS

Nine patients (5.1%) developed eHAT. In multivariate analysis, intraoperative hepatic artery revision and Roux-en-Y hepaticojejunostomy biliary reconstruction type were statistically significant (all, P < .05). Thrombectomy and reanastomosis was performed in 5 patients. Two of them were successful. In total, 3 retransplantations were performed and all of those patients are still alive.

CONCLUSION

The factors affecting eHAT are still a matter of debate. Intraoperative hepatic artery anastomosis revision and Roux-en-Y hepaticojejunostomy reconstruction were independent risk factors for development of eHAT. In the present study, the confidence interval of the variables is high, therefore exact determination of the risk factors may not be possible. Early detection and thrombectomy and reanastomosis may be the first treatment of choice to rescue the patient and graft. When it fails, retransplantation must be an alternative. The results of the present study state that at least once a day the vascular anastomosis must be examined by Doppler ultrasonography in the post-transplant first week. It must be repeated when liver enzymes increase. The patients under high risk for eHAT may be followed up closer.

Factors affecting the accuracy of 18F-FDG PET/CT in evaluating axillary metastases in invasive breast cancer

Background and Aim

There are conflicting results of studies on accuracy of positron emission tomography (PET)/computed tomography (CT) for axillary staging. The aim of this study is to determine the factors affecting the efficacy of 18F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT in detecting axillary metastases in invasive breast cancer.

Materials and Methods

Data of 232 patients with invasive breast cancer who underwent ¹⁸F-FDG PET/CT examination before surgery between January 2013 and September 2017 were reviewed retrospectively. Histopathological examination of axillary lymph nodes (ALNs) was used as a reference to assess the efficacy of ¹⁸F-FDG PET/CT in detecting axillary metastases.

Results

While 134 (57.8%) patients had axillary metastases as detected in ¹⁸F-FDG PET/CT scans, histopathologically axillary metastases were detected in 164 (70.7%) patients. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of ¹⁸F-FDG PET/CT in detection of axillary metastasis were 72.56%, 77.94%, 88.8%, 54%, and 74.1%, respectively. The false-negative and false-positive rates were 27.4% and 22%, respectively. In univariate analysis, patients' age, estrogen receptor positivity, higher ALN SUVmax, greater tumor size, and lymph node size determined by ¹⁸F-FDG PET/CT were all significantly associated with accuracy of ¹⁸F-FDG PET/CT for axillary metastasis. In multivariate analysis, tumor size determined by ¹⁸F-FDG PET/CT and ALN SUVmax were independent variables associated with axillary metastasis. The accuracy of ¹⁸F-FDG PET/CT for axillary metastasis was higher in patients with a larger tumor (≥19.5 mm) and a higher ALN SUVmax (≥3.2).

Conclusion

¹⁸F-FDG PET/CT should not be routinely used for axillary staging, especially in patients with small tumors. It cannot eliminiate the necessity of sentinel lymph node biopsy. When it is used, both visual information and optimal cut-off value of axillary node SUVmax should be taken into consideration.

The Effects of Cyclopentolate on Intraocular Pressure and Retrobulbar Hemodynamics in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma

Purpose

To evaluate the changes of intraocular pressure (IOP) and retrobulbar hemodynamics after cyclopentolate administration in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

Methods

Eighteen patients with pseudoexfoliation syndrome and 18 patients with pseudoexfoliation glaucoma were enrolled in the study. After baseline measurements of IOP, the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of the ophthalmic, central retinal, and posterior ciliary arteries were investigated by color Doppler imaging. Then, 1% cyclopentolate was instilled in one eye of each subject. After 45 minutes of instillation of the cyclopentolate, the measurements of IOP and retrobulbar blood flow velocities were repeated. The results were compared with those of 20 age-matched normal subjects.

Results

Neither IOP nor retrobulbar blood flow velocities changed significantly in control subjects after cyclopentolate administration. IOP increased significantly after cyclopentolate instillation in pseudoexfoliation syndrome (p=0.004). Retrobulbar blood velocities did not change significantly after the cyclopentolate in this group. In pseudoexfoliation glaucoma group, it was observed that basal mean IOP showed a statistically significant increase after cyclopentolate drop (p=0.002). Although blood flow velocities of ophthalmic artery did not change significantly, PSV and EDV of the central retinal and posterior ciliary arteries decreased significantly (p<0.05) and RI of the posterior ciliary artery increased significantly (p=0.01) after cyclopentolate instillation.

Conclusions

On the basis of our findings, pseudoexfoliation appears to be a predictive factor for an IOP rise after cyclopentolate. In pseudoexfoliation glaucoma patients, an increase of IOP after cyclopentolate could lead to a decreased retrobulbar blood flow. IOP must be rechecked after cyclopentolate administration in these patients to avoid further damage to the ganglion cells.

Association between seroprevalence of measles and various social determinants in the year following a measles outbreak in Turkey

OBJECTIVES

Despite an ongoing measles elimination programme, a measles outbreak occurred in 2013 in Turkey. Population-based seroprevalence studies are needed to determine seronegativity and explore the reasons for this outbreak. This study aimed to explore the seroprevalence of measles and its association with various social determinants in a provincial population in Turkey in the year following a measles outbreak.

STUDY DESIGN

Cross-sectional study.

METHODS

This study was conducted in Manisa Province in 2014 in a sample of 1740 people aged >2 years. The dependent variable was the seroprevalence of measles. Independent variables were sex, age, migration, household size, household density, income, education level, existence of chronic disease and occupational class. Blood samples were collected from participants at family health centres. The presence of specific measles antibodies in serum samples was determined using an anti-measles virus IgG enzyme-linked immunosorbent assay test. Chi-squared test and logistic regression analysis were performed.

RESULTS

Overall, data from 1250 people were analysed. The seroprevalence of measles in the whole study population was 82.2% (95% confidence interval 80.0-84.2). Seroprevalence was 55.4% among subjects aged 2-9 years, 48.7% among subjects aged 10-19 years, 74.1% among subjects aged 20-29 years and 93.6% among subjects aged 30-39 years (P < 0.01). Seroprevalence in subjects aged >40 years was >95%. The lowest seroprevalence was found in primary school children (40.2%), followed by those below the age for primary education (69.8%) and secondary school graduates (75.1%). The prevalence of measles seronegativity was not associated with any of the social determinants when adjusted for age.

CONCLUSIONS

The seroprevalence of measles was lower than expected in the study population and was particularly low in subjects aged <30 years of age despite previous vaccination. Seroprevalence was not associated with social determinants of health that confirmed either an even distribution of virus exposure or fair access to vaccination services. However, the current seroprevalence cannot be sufficiently effective to reach the measles elimination targets, suggesting that it may be necessary to re-evaluate the need for an extra dose of measles vaccine.

Abstract P6-16-01: The importance of loco-regional tumor burden and surgery on survival in patients with de novo stage IV breast cancer; post-hoc analyses of protocol MF07-01

Background: The MF07-01 trial is a multicenter phase III randomized controlled trial of treatment naive stage IV BC patients comparing loco-regional surgery (LRS) followed by appropriate systemic therapy (ST) versus ST alone.

Aims: To evaluate the importance of loco-regional tumor burden and surgery on overall survival rate in patients with de novo stage IV breast cancer.

Methods: At initial diagnosis patients were randomized 1:1 to LRS group or ST group. The surgery was a lumpectomy (L) or mastectomy (M) and sentinel lymph node biopsy (SLNB) ± axillary lymph node dissection (ALND). After surgery all patients received systemic treatment + endocrine treatment (ET) and Trastuzumab based on pathology results. The demographic, pathologic, and clinical characteristics of the patients were recorded.

Results:274 patients were accrued; 138 in the LRS group and 136 in the ST group. The groups were comparable regarding age, BMI, HER2 neu, tumor type and size, histologic grade, and bone and visceral metastasis (all p&gt;0.05). In the LRS group 36 patients (26%) had L+ALND, 92 patients (67%) had M+ALND and 10 patients (7%) had M+SLNB, respectively.

The patients and tumor characteristicsPatients and Tumors Characteristics and Surgical TreatmentSurgerySystemic TherapyP ValueAge (mean /year±SD)51.8 ±12.651.5±13.6NSMedian follow-up (25%,75%)41.0 (24,54)37 (18,49) Tumor Size (%)   T18.7 (12) NST252.2 (72) NST321.7 (30) NST417.4 (24) NSHistologic Grade (%)   I4.4 (6)9.6 (10)NSII39.9 (55)31.7 (33)NSIII55.8 (77)58.9 (61)NS    Surgical Treatment   Lumpectomy+ ALND26 (36)--M + SLNB7 (10)--M + ALND67 (92)---SLNB17 (23)--ALND92.8 (128)--pN+89.1 (123)--30-day mortality1.4 (2)1.5 (2)0.98SLNB-Sentinel Lymph Node Biopsy; ALND-Axillary Lymph Node Dissection; M-Mastectomy

The axillary positivity rate was 89.1%. There were 76 (55%) deaths in the LRS group and 101 (74%) in the ST group during the median 40 (20-51) month follow-up. Overall survival (OS) was 34% higher in the LRS group compared to the ST group (HR: 0.66, 95%CI 0.49-0.88: p = 0.005).

Overall survival rate was higher in LN (+) (p=0.01), tumor size&lt;5cm (p&lt;0.0001), and high histologic grade (HG III, p&lt;0.008) patients who underwent axillary surgery than ST group ; OS rate was with a marginal significant level in patients without axillary involvement (pN0) in the LRS group compared with ST group (p=0.05).

Conclusion: In this subgroup analysis, we observed that patients with high grade tumor, without skin or chest wall involvement and positive axilla who underwent surgery for primary breast tumor and axilla had better overall survival than ST in de novo stage IV breast. These results can be considered in clinical research design for stratification.

Citation Format: Ozmen V, Ozbas S, Karanlik H, Muslumanoglu M, Igci A, Canturk Z, Utkan NZ, Ozaslan C, Evrensel T, Uras C, Aksaz E, Soyder A, Ugurlu UM, Col C, Cabioglu N, Bozkurt B, Sezgin E, Dagoglu T, Uzunkoy A, Dulger M, Koksal N, Cengiz O, Gulluoglu B, Unal B, Atalay C, Yildirim E, Erdem E, Salimoglu S, Sezer A, Koyuncu A, Gurleyik G, Alagol H, Ulufi N, Berberoglu U, Soran A. The importance of loco-regional tumor burden and surgery on survival in patients with de novo stage IV breast cancer; post-hoc analyses of protocol MF07-01 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-01.

Predicting the health impact of lowering salt consumption in Turkey using the DYNAMO health impact assessment tool

OBJECTIVE

To estimate the impact of three daily salt consumption scenarios on the prevalence and incidence of ischaemic heart disease (IHD) and cerebrovascular disease in 2025 in the Turkish population aged ≥30 years using the DYNAMO Health Impact Assessment tool.

STUDY DESIGN

Statistical disease modelling study.

METHODS

DYNAMO health impact assessment was populated using data from Turkey to estimate the prevalence and incidence of IHD and cerebrovascular disease in 2025. TurkSTAT data were used for demographic data, and national surveys were used for salt consumption and disease-specific burden. Three salt consumption scenarios were modelled: (1) reference scenario: mean salt consumption stays the same from 2012-2013 until 2025; (2) gradual decline: daily salt intake reduces steadily by 0.47 g per year by lowering salt intake from bread by 50% and from table salt by 40% by 2025; and (3) World Health Organization (WHO) advice: daily salt intake of 5 g per day from 2013 until 2025.

RESULTS

The gradual decline scenario would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.3% and 0.2%, respectively, and a decrease in the incidence by 0.6 and 0.4 per 1000, respectively. Following WHO's advice would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.8% and 0.5%, respectively, and a decrease in the incidence by 1.0 and 0.7 per 1000, respectively.

CONCLUSION

This model indicates that Turkey can lower its future cardiovascular disease burden by following the gradual decline scenario. Following WHO's advice would achieve an even greater benefit.

A Rare Cause of Diarrhea in a Kidney Transplant Recipient: Dipylidium caninum

We report the first case of dipylidiasis in a kidney transplant recipient. Watery diarrhea due to Dipylidium caninum was observed in a male patient who had been undergone kidney transplantation 2 years before. The patient was successfully treated with niclosamide. D. caninum should be considered as an agent of diarrhea in transplant patients.

Living-Donor Liver Transplantation for Budd-Chiari Syndrome--Resection and Reconstruction of the Suprahepatic Inferior Vena Cava With the Use of Cadaveric Aortic Allograft: Case Report

BACKGROUND

Living-donor liver transplantation with inferior vena cava resection and reconstruction is rarely indicated for Budd-Chiari syndrome. The aim of this case presentation was to present and discuss the inferior vena cava reconstruction with the use of cadaveric aortic allograft after resection of the suprahepatic inferior vena cava in a patient with Budd-Chiari syndrome who was treated with living-donor liver transplantation.

CASE REPORT

A 29-year-old male patient with end-stage liver disease and suprahepatic inferior vena cava obstruction was referred to our center. He was scheduled for living-donor liver transplantation. The suprahepatic inferior vena cava was resected and reconstruction was achieved by means of interposition of the cadaveric aortic allograft between the right atrium and inferior vena cava. Postoperative course was uneventful.

DISCUSSION

Liver transplantation and vena cava reconstruction is indicated in some patients with end-stage liver disease and Budd-Chiari syndrome. Limitations in cadaveric organ donation may be compensated for with the use of living-donor liver. In this condition, various aspects of inferior vena cava reconstruction may be discussed.

CONCLUSIONS

Budd-Chiari syndrome due to suprahepatic inferior vena cava obstruction close to the right atrium may be treated with vascular reconstruction with the use of a cadaveric aortic allograft.

Significant worsening sperm parameters are associated to testicular hypotrophy in patients with a high grade varicocele

OBJECTIVE

To investigate the relationship between testicular volume and semen parameter sin patients with unilateral high grade left varicocele.

MATERIAL AND METHODS

One hundred eighty seven patients who had left high grade varicocele aged 19-to-25 years were included in this study. All patients underwent a standard evaluation, including medical history and physical examination. The percentage testicular volume difference between the right and left testicles was calculated. The patients were divided into the following three groups; Group 1 (n=72) testicular volume difference <10%, testicular volume difference 10%-20% Group 2 (n=74) and testicular volume difference >20% Group 3 (n=41).

RESULTS

The mean age and BMI of the patients were 21.5 years and 23.1kg/m(2), respectively (P=.596, P=.943). The semen parameters and testicular volumes of the three groups were compared. The total motile sperm count, percentage of motile sperm, percentage of normal morphology sperm were found to be lower in Group 3 (P=.011, P=.012, P=.029 respectively). The mean testicular volumes for the left and the right testis were found to be 15.2cm(3) and 17.7cm(3) (P<.001), respectively. No significant difference was found in the right testicular volumes between groups (17.4, 17.7 and 18.1cm(3), P=.573).

CONCLUSIONS

A high grade left testicular varicocele is associated with ipsilateral testicular hypotrophy and parallel to worsened sperm parameters.

Circumferential Fence With the Use of Polyethylene Terephthalate (Dacron) Vascular Graft for All-in-One Hepatic Venous Reconstruction in Right-Lobe Living-Donor Liver Transplantation

Integration of hepatic vein tributaries with a diameter ≥ 5 mm into the drainage system in right-lobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522-1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.

Living related donor liver transplantation with atrio-caval anastomosis of inferior vena cava graft stored in deep-freeze for budd-Chiari syndrome

We have previously reported our experience in inferior vena cava resection and reconstruction techniques during liver transplantation for Budd-Chiari syndrome. Herein, we present on a case that demonstrates the importance of experience in complex vascular reconstruction techniques for living donor liver transplantation. A 15-year-old boy was scheduled for living donor liver transplantation for Budd-Chiari syndrome. Venous occlusion was extended up to the right atrial orifice of the supra-hepatic vena cava. Retro- and supra-hepatic segments of the vena cava was resected. Inferior vena cava graft stored in deep-freeze was available. Venous reconstruction was performed with end-to-end atrio-caval anastomosis. Surgical treatment was completed with the implantation of the right liver lobe donated by the patient's mother. Post-surgical course was uneventful.

Hepatic artery thrombosis-related risk factors after living donor liver transplantation: single-center experience from Turkey

AIM

The purpose of this retrospective study is to evaluate the risk factors hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) in a consecutive series from a single center.

MATERIALS AND METHODS

Between January 2010 and May 2012, we performed 278 living donor liver transplantations, including 189 males and 89 females. We compared the risk factors between HAT and non-HAT groups according to the following variables: age, gender, body mass index (BMI), graft weight, use of graft, Child-Pugh and model for end stage liver disease score, level of hemoglobin, blood pressure, operation time, blood transfusion, presence of ascites, international normalized ratio (INR) level, and etiology.

RESULTS

Eighteen patients, including 15 males and 3 female, had HAT after the operation (mean age, 45.1 years; age range, 22-60 years). There were no pediatric patients in the HAT group. HAT rate was 6.5% in our series. Graft loss and retransplantation due to HAT was 38.7% in a 2-year period. Biliary leakage was observed in 72 (25.8%) living donor liver transplantations; this rate was higher in patients with HAT (n = 8; 44.4%). The infection rate was 50% (n = 9) in the HAT group and was 32.7% (n = 91) in the non-HAT group. Mean INR value was 2.15 in the HAT group and 1.72 in the non-HAT group. When we compared the groups according to use of graft for anastomosis, biliary lekage, infection, and INR value, the differences were statistically significant (P < .05).

CONCLUSION

Although the results of OLT have improved over the past years, HAT is still associated with substantial morbidity, high incidence of graft failure, and high mortality rates. The most important findings associated with HAT in our series were found as INR levels, bile leakage, and resistant infections. Use of vascular graft for hepatic artery anastomosis was found to increase HAT risk.