Comparison of Fibroscan, Shear Wave Elastography, and Shear Wave Dispersion Measurements in Evaluating Fibrosis and Necroinflammation in Patients Who Underwent Liver Biopsy

OBJECTIVE

Our aim was to predict these stages of hepatic fibrosis and necroinflammation using measurements from two-dimensional shear wave elastography (2D-SWE), transient elastography (Fibroscan, TE), and shear wave dispersion (SWD).

MATERIALS AND METHODS

In this prospectively designed study, chronic liver patients with nonspecific etiology whose biopsy was performed for up to 1 week were included. Two-dimensional SWE, SWD, and TE measurements were performed. The METAVIR and F-ISHAK classification was used for histopathological evaluation.

RESULTS

Two-dimensional SWE and TE were considered significant for detecting hepatic fibrosis. In distinguishing ≥F2, for 2D-SWE, area under the receiver operating characteristics (AUROC) was 0.86 (confidence interval [CI], 0.75-0.96) for the cutoff value of 8.05 kPa ( P = 0.003); for TE, AUROC was 0.79 (CI, 0.65-0.94) for the cutoff value of 10.4 kPa ( P < 0.001). No significance was found for TE in distinguishing ≥F3 ( P = 0.132). However, for 2D-SWE, a cutoff value of 10.45 kPa ( P < 0.001), with AUROC = 0.87 (CI, 0.78-0.97) was determined for ≥F3. Shear wave dispersion was able to determine the presence of necroinflammation ( P = 0.016) and a cutoff value of 15.25 (meter/second)/kiloHertz ([m/s]/kHz) ( P = 0.006) and AUROC of 0.71 (CI, 0.57-0.85) were calculated for distinguishing ≥A2. In addition, a cutoff value of 17.25 (m/s)/kHz ( P = 0.023) and AUROC = 0.72 (CI, 0.51-0.93) were found to detect severe necroinflammation. The cutoff value for SWD was 15.25 (m/s)/kHz ( P = 0.013) for detecting ≥A2 in the reversible stage of fibrosis (F0, F1, and F2), and AUROC = 0.72 (CI, 0.56-0.88).

CONCLUSIONS

Two-dimensional SWE and TE measurements were significant in detecting the irreversible stage and the stage that should be treated in hepatic fibrosis noninvasively. Shear wave dispersion measurements were significant in detecting necroinflammation noninvasively.

Retrospective Evaluation of Poisoning Cases Followed Up in a Pediatric Intensive Care Unit-A 12-Year Experience in a Single Center

OBJECTIVES

Poisonings constitute an important part of preventable morbidity and mortality in pediatric intensive care units (PICUs) and hospitalizations. However, information on poisoning requiring intensive care is limited. This study aimed epidemiological evaluation of poisoning cases treated in the PICU in a single center.

METHODS

The records of 504 patients admitted to the PICU due to acute poisoning between 2010 and 2022 were retrospectively reviewed. Data were evaluated using descriptive methods and the χ 2 test, and statistical differences with P value <0.05 were considered significant.

RESULTS

The age range of the patients ranged from 1 month to 216 months (18 years), and the rate of girls was 53.2% (n = 268), whereas the rate of boys was 46.8% (n = 236). The mean age was 4.4 ± 4.3 years for boys, 6.7 ± 5.8 years for girls, and 5.6 ± 5.3 years for all patients. It was determined that 79.6% of the cases were poisoned by accident and 20.4% by suicide. A total of 76.7% of the patients who were poisoned for suicide were girls and 23.3% were boys. The mean age of these patients was 14.3 ± 3.0 years. On the other hand, 47.1% of the children who were accidentally poisoned were girls and 52.9% were boys, and the mean age of these children was 3.4 ± 2.9 years. Although 79.9% of poisonings occurred at home, the causative agent was oral poisoning in 97.4% of the cases. Approximately two thirds (69.2%) of the cases were drug-related, whereas 30.8% were related to nondrug substances. In drug-related poisonings, central nervous system drugs (35.8%) were the most common agent, followed by analgesic/antipyretic (20.9%) agents, whereas among the nonpharmaceutical factors, insecticides (agricultural pesticides, rat poison, pesticides, etc) were the most common, followed by poisonous herbs (beetleweed, widow's weed, cannabis, etc). The mean admission time of the patients to the hospital was 6.3 ± 8.4 hours, and the mean length of stay in the intensive care unit was 1.6 ± 1.3 days. In the 12 years of our study, only 3 patients died due to poisoning, and our mortality rate was 0.5%. Four patients (0.7%) were referred to the Alcohol and Drug Addicts Treatment and Research Center.

CONCLUSIONS

In this study, in which we retrospectively analyzed the profiles of poisoning cases hospitalized in the PICU for 12 years, we determined that poisonous weeds were the major factor in accidental poisonings, and suicidal poisonings were above the expected rates even at the young age group such as 8-12 years old. These results show the importance of determining the poisoning profile of the health care service area.

Descriptive and Clinical Characteristics of Nonsurvivors in a Tertiary Pediatric Intensive Care Unit in Turkey: 6 Years of Experience

The objective of this study was to identify the characteristics of nonsurvivors in a pediatric intensive care unit (PICU) in Turkey. This is a retrospective analysis of patients who died in a tertiary PICU over a 6-year period from 2016 to 2021. Data were drawn from electronic medical records and resuscitation notes. Mode of death was categorized as failed cardiopulmonary resuscitation (F-CPR) or brain death. Among the 161 deaths, 136 nonsurvivors were included and 30.1% were younger than 1 year. Severe pneumonia, respiratory failure, and acute respiratory distress syndrome (ARDS) (31.6%) were the most common primary diagnoses. The most common mode of death was F-CPR (86.8%). More than half of the subjects had been admitted from pediatric emergency departments (58.1%), and more than half (53.7%) had died within 7 days in the PICU. Patients admitted from pediatric emergency departments had the lowest frequency of comorbidities (p < 0.001). Severe pneumonia, respiratory failure, and ARDS diagnoses were significantly more frequent in those who died after 7 days (p < 0.001), whereas septicemia, shock, and multiple organ dysfunction were more common among those who died within the first day of PICU admission (p < 0.001). It may be important to note that patients referred from wards are highly likely to have comorbidities, while those referred from pediatric emergency departments may be relatively younger. Additionally, patients with septicemia, shock, or multiple organ dysfunction were more likely to die earlier (within 7 days), especially compared with those with severe pneumonia, respiratory failure, or ARDS.

Qualitative evaluation of reasons for healthcare professionals being unvaccinated against COVID-19

Background and Aim

The importance of immunization has increased even more during the pandemic. This study aimed to evaluate the reasons for healthcare professionals not being vaccinated against COVID-19 and to develop solutions for the causes.

Subject and Methods

This qualitative study was carried out with in-depth interviews between July 2021 and October 2021, with 32 healthcare professionals and five key people who had never been vaccinated against COVID-19.

Results

The most common reasons that healthcare professionals were not vaccinated against COVID-19 were concerns about vaccine side effects, believing that the vaccine is not effective, distrust of the vaccine content and COVID-19 treatment methods, the rapid production of the vaccine, the fact that the vaccine is produced with a new technology, thinking that the vaccine is not the definitive solution, seeing themselves as healthy and young, and the belief that they would have a mild case of the disease and recover. The main themes were COVID-19 vaccine-related reasons, individual reasons/group effects, contextual reasons, and vaccination-related general issues. The main sub-themes were vaccine production, distrust, risk perception, policies and infodemic.

Conclusion

It has been seen that the uncertainty, infodemic, and insecurity that emerged especially during the pandemic period are related to each other. As knowledge and awareness about the disease increase, there is an increase in risk perception. For this reason, social information studies should be increased and physicians should be enabled to use media tools more effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01822-7.

GATA3 expression in clear cell adenocarcinoma of the lower urinary tract: a potential diagnostic pitfall

BACKGROUND

Clear cell adenocarcinoma of the lower urinary tract (CCACLUT) is a rare primary malignant neoplasm with heterogenous morphology. There is a paucity of data in the literature regarding its immunohistochemical profile.

METHODS

The immunohistochemical features (extent and intensity) of a multinational cohort of CCACLUT were evaluated with comparison between clear cell adenocarcinoma of the female genital tract (CCACFGT, tissue microarray) and nephrogenic adenoma (NA).

RESULTS

33 CCACLUT (24 female, 9 male; mean age 59 years) were collected. CCACLUT most commonly arose from the urinary bladder (26/33, 78%), particularly from the trigone (10/33, 30.3%) followed by the urethra (8/33, 22%). All 12 NA cases were located at the urinary bladder, whereas the most common CCACFGT location was the ovary (29/56, 52%). None of the CCACLUT patients had, intestinal metaplasia, NA, or urothelial carcinoma. One patient had concurrent endometriosis of the sigmoid colon. Most frequently observed morphology in CCACLUT was papillary/tubulocystic (9/3; 27.3%), followed by papillary/tubular (6/33; 18.2%) and papillary/solid (5/33; 15.2%). GATA3 expression was significantly higher in CCACLUT (18/33, 54.5%) and NA (6/12, 50%), when compared to CCACFGT cases 6/56, 11.7%)(p = 0.001 and p = 0.022, respectively). The extent of GATA3 was significantly higher in CCACLUT group (19.2 ± 16.6%) than the other groups (9.6 ± 22.5% in NA and 2.6 ± 9% in CCACFGT group) (p = 0.001). 4/33 patients (12.1) had weak, 10/33 patients (30.3%) had moderate, and 4/33 patients (12.1%) had strong GATA3 intensity in CCACLUT group. In NA group, one patient (8.3%, 1/12) had weak, one patient (8.3%, 1/12) had moderate and 4 patients (33.3%, 4/12) had strong GATA3 intensity. Most cases (CCACLUT 29/33, 88%; NA 11/12, 92%; CCACFGT 46/56, 82.1%) had positive Napsin A expression, by which CCACLUT had significantly more cases with Napsin A expression (p = 0.034). p63 was consistently negative in all cases (30/33 (91.9%) CCACLUT; 12/12 (100%) NA; 42/56 (75%) CCACFGT. Ki67 (MIB) proliferation index was significantly higher in CCACLUT group (54.6 ± 21%) when compared to NA group (4.5 ± 2.7%) and CCACFGT group (35.5 ± 25.8%) (p = 0.001).

CONCLUSION

CCACLUT has consistent GATA3 expression, which may cause challenge in the diagnosis of urothelial carcinoma but can be used to distinguish CCACLUT from CCACFGT.

On the instability of the giant direct magnetocaloric effect in CoMn0.915Fe0.085Ge at. % metamagnetic compounds

The giant magnetocaloric effect was quantified in CoMn_1-xFe_xGe (x = 0.085–0.12) nom. at. % polycrystals across the high temperature hexagonal (P6₃/mmc) to low temperature orthorhombic (Pnma) phase transition via differential scanning calorimetry (DSC) and multiple (thermo) magnetization measurements. It was found that increasing Fe content led to the decrease of both the martensitic transformation temperature and entropy change (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\Delta S$$\end{document}ΔS) at the point of the phase transition. Moreover, first-time magnetocaloric measurements resulted in irreproducible entropy change versus temperature diagrams, which was attributed to the release of internal pressure in bulk samples that disintegrated into powder upon transformation. CoMn_1-xFe_xGe demonstrated larger magnetic field-induced entropy changes and giant magnetocaloric effect (MCE) compared to other CoMnGe alloys doped with Si, Sn, Ti, and Ga. However, the observed brittleness and apparent change in volume at the magnetic transition was posited to influence the material’s potential for regenerative applications.

Protective effects of thymoquinone and alpha-tocopherol on the sciatic nerve and femoral muscle due to lower limb ischemia-reperfusion injury

OBJECTIVE

Thymoquinone (TQ) is an antioxidant and anti-apoptotic substance found in the Nigella sativa plant. Alpha-tocopherol (α-TP) is a potent antioxidant. We aimed to determine whether or not TQ and TP have a protective effect against lower limb ischemia-reperfusion (IR) injury of muscle and the sciatic nerve.

MATERIALS AND METHODS

A single dose of TQ 25 mg/kg was given intraperitoneally to the TQ group, a single dose of α-TP 200 mg/kg was given intraperitoneally to the α-TP group. IR was performed for 45 minutes after the drugs' applications.

RESULTS

While serum levels of malondialdehyde (MDA) and interleukin-6 (IL-6) of the IR group were significantly higher than those of the TQ plus α-TP, TQ and α-TP groups (p<0.001, p<0.001, p=0.008, respectively) and IL-6 (all p<0.001), the reduced glutathione (GSH) level of the IR group was lower than that of the other three groups. While neuronal nitric oxide synthase activity of nerve tissues of the IR group was significantly lower than that of the TQ plus α-TP group, the muscle tissue caspase-3 activity was higher than that of the TQ plus α-TP group.

CONCLUSIONS

Administration of TQ plus α-TP may strongly protect muscle and nerve tissues against IR injury via their synergistic effects.

Topiramate has protective effect on renal injury

BACKGROUND

Topiramate (TPM) decreases tumor necrosis factor-alpha (TNF-α) and oxidative stress. We investigated protective effects of TPM on cell damage in kidney tissue during ischemia-reperfusion (I/R) damage.

METHODS

A total of 30 male Wistar albino rats were divided into three groups: control, I/R, and I/R plus TPM (I/R+TPM). Laparotomy without I/R injury was performed in control group. After laparotomy, cross ligation of infrarenal abdominal aorta was applied for two hours in I/R groups which was followed by two hours of reperfusion. TPM (100 mg/kg/day) was orally administrated to animals in the I/R+TPM group for seven consecutive days before I/R.

RESULTS

The I/R group's TNF-α and interleukin-1 beta (IL-1β) levels were significantly higher (1184.2 ± 129.1 pg/mg protein; 413.1 ± 28.8 pg/mg protein, respectively) than those of the control (907.8 ± 113.0 pg/mg protein, p = 0.002; 374.7 ± 23.7 pg/mg protein, p = 0.010, respectively) and I/R+TPM groups (999.5 ± 115.2 pg/mg protein, p < 0.001; 377.9 ± 30.9 pg/mg protein, p = 0.007, respectively).

CONCLUSION

TPM may partially prevent renal damage in rats. The opening of new horizons of this kind of knowledge will help understand the complex challenge in the prevention of renal I/R damage (Tab. 1, Fig. 3, Ref. 42).

Comparison of the effect of the rotation palatoplasty and V-Y pushback palatoplasty techniques on palate elongation with magnetic resonance imaging

Most surgical techniques used in cleft palate repair require the extension of the palate to the pharynx. However, no adequate information exists regarding the extent to which this elongation obtained during operation continues in late postoperative period. In this study, we compared and measured palate elongation in patients with a cleft palate who underwent a V-Y pushback or rotation palatoplasty, by means of magnetic resonance images obtained before and 1 year after surgery. The hard palate, soft palate, and total palate lengths were measured for all of the patients, and the velopharyngeal opening area width was calculated. In patients who underwent the V-Y pushback technique (n=13), the total palate and soft palate lengths were shortened by an average of 0.10 and 0.14cm after surgery, respectively. However, the hard palate length was elongated by an average of 0.13cm. In the rotation palatoplasty group (n=13), the total palate, hard palate, and soft palate lengths were elongated by 0.57, 0.10, and 0.49cm, respectively. The velopharyngeal opening was narrowed by 0.06cm(2) using the V-Y pushback technique and by 0.29cm(2) using the rotational palatoplasty. This study demonstrated that the palate does not elongate during the V-Y pushback technique, as expected. However, rotational palatoplasty elongates the soft palate.

Topiramate has protective effect on renal injury

BACKGROUND

Topiramate (TPM) decreases tumor necrosis factor-alpha (TNF-α) and oxidative stress. We investigated protective effects of TPM on cell damage in kidney tissue during ischemia-reperfusion (I/R) damage.

METHODS

A total of 30 male Wistar albino rats were divided into three groups: control, I/R, and I/R plus TPM (I/R+TPM). Laparotomy without I/R injury was performed in control group. After laparotomy, cross ligation of infrarenal abdominal aorta was applied for two hours in I/R groups which was followed by two hours of reperfusion. TPM (100 mg/kg/day) was orally administrated to animals in the I/R+TPM group for seven consecutive days before I/R.

RESULTS

The I/R group's TNF-α and interleukin-1 beta (IL-1β) levels were significantly higher (1184.2 ± 129.1 pg/mg protein; 413.1 ± 28.8 pg/mg protein, respectively) than those of the control (907.8 ± 113.0 pg/mg protein, p = 0.002; 374.7 ± 23.7 pg/mg protein, p = 0.010, respectively) and I/R+TPM groups (999.5 ± 115.2 pg/mg protein, p < 0.001; 377.9 ± 30.9 pg/mg protein, p = 0.007, respectively).

CONCLUSION

TPM may partially prevent renal damage in rats. The opening of new horizons of this kind of knowledge will help understand the complex challenge in the prevention of renal I/R damage (Tab. 1, Fig. 3, Ref. 42).

Middle ear pressure changes with sevoflurane and propofol-remifentanil

The present study aimed to compare the effects of sevoflurane (a commonly used inhalation anesthetic) and intravenous propofol on middle ear pressure (MEP) and determine the more appropriate option for middle ear operations. Fifty-seven American Society of Anesthesiologists risk class I-II patients aged 18-65 years who were not scheduled for ear or tympanic membrane operations were included in the study. The patients were randomly divided into two groups using the sealed envelope method. Propofol (0.2-0.5 mg/kg; Group P) and sevoflurane (1-2%; Group S) were used to maintain anesthesia. Baseline tympanometry was conducted on both ears and recorded before anesthesia was induced. Four additional measurements were performed and recorded at 5, 10, 15, and 30 minutes after induction. All post-induction MEP values were significantly higher than baseline measurements in Group S (P < 0.05 for all); there were no differences between post-induction and baseline measurements in Group P. At 10, 15, and 30 min post-induction, MEP values were significantly higher in Group S than in Group P (P < 0.05). Sevoflurane increased MEP values significantly compared with propofol anesthesia. We conclude that propofol can be used more reliably than sevoflurane in middle ear operations.

A case report of retroperitoneal extrahepatic hepatocellular carcinoma presented with elevated level of Alpha fetoprotein

BACKGROUND

High level of alpha-fetoprotein is usually associated with testis cancer or hepatocellular carcinoma a primary tumor of the liver.

CASE

We report the case of a 72-year-old male patient with chronic renal failure who presented with a high alpha-fetoprotein (AFP) level and a retroperitoneal mass, which was subsequently diagnosed to be an extrahepatic hepatocellular carcinoma.

CONCLUSION

A retroperitoneal mass with elevated AFP level and no detected liver lesions is not always caused by a testicular cancer.

Prognostic value of serum Tie-2 and vascular endothelial growth factor levels in cancer patients

BACKGROUND

Angiogenesis is a very essential process in tumor biology. Vascular endothelial growth factor (VEGF), angiopoietin and its receptor (TIE-2) are very important mediators for angiogenesis. In this trial, we aimed to analyze the role of these mediators on chemotherapy response and survival.

PATIENTS AND METHODS

Forty four cancer patients and 22 healthy controls were included in the study. Baseline serum samples were obtained from all participants and post-chemotherapy serum samples were obtained from the cancer patients. Serum vascular endothelial growth factor and TIE-2 levels were measured with quantitative enzyme-linked immunosorbent assay techniques.

RESULTS

The baseline serum vascular endothelial growth factor level was 187.5 and 120.2 pg/ml in cancer patients and the control group (p = 0.006). The baseline serum TIE-2 level was 615.9 and 242.5 pg/ml in the patients and control group (p < 0.001). There was a significant difference between patients' baseline and post-chemotherapy VEGF levels (111.9 pg/ml; p < 0.001) and patients' baseline and post-chemotherapy TIE-2 levels (344.5 pg/ml; p < 0.001). The overall survival rate was better in patients who had lower baseline VEGF and TIE-2 levels and whose TIE-2 level had decreased with chemotherapy.

CONCLUSIONS

Higher baseline TIE-2 and VEGF levels are related and worsen survival. Decreasing levels of TIE-2, but not VEGF, which, with chemotherapy, may be predictive for survival.