Serum nectin-2 levels are diagnostic and prognostic in patients with colorectal carcinoma

INTRODUCTION

Nectins are a family of integral protein and immunoglobulin-like cell adhesion molecules involved in the formation of functioning adherence and tight junctions. Aberrant expression is associated with cancer progression, apoptosis and cell proliferation but little is known how these effects change in cell behavior. The objective of this study was to evaluate the serum levels of nectin-2 with regard to diagnostic, predictive and prognostic value in colorectal cancer (CRC) patients.

MATERIALS AND METHODS

One-hundred and forty CRC patients were enrolled in this study. Serum nectin-2 levels were determined by enzyme-linked immunosorbent assay method. Age- and sex-matched 40 healthy controls were included in the analysis.

RESULTS

Median age of patients was 60 years old, range 24-84 years. The localization of tumor in majority of the patients was colon (n = 81, 58 %). Non-metastatic (stage II and III) and metastatic patients' baseline serum nectin-2 levels were significantly higher than those in the healthy control group (p < 0.001; for two group). However, known clinical variables including response to CTx (chemotherapy) were not found to be correlated with serum nectin-2 concentrations (p > 0.05). While non-metastatic group patients with elevated serum nectin-2 levels showed significant adverse effect on PFS, metastatic group patients with elevated serum nectin-2 levels showed no significant adverse effect on PFS (p = 0.05 and p = 0.29, respectively). On the other hand, our study results did not show statistically significant serum nectin-2 concentrations regarding overall survival rates.

CONCLUSION

Serum levels of nectin-2 may have diagnostic roles for CRC patients. Moreover, our study results show the prognostic role of nectin-2 in non-metastatic group patients.

Emergency surgery of the abdominal wall hernias: risk factors that increase morbidity and mortality-a single-center experience

PURPOSE

Morbidity and mortality are higher in urgently operated abdominal hernia cases compared to elective surgeries. The present study aims to investigate the factors that cause increased morbidity and mortality in emergency surgical operations.

METHODS

The files of a total of 426 patients who were operated for non-reducible abdominal hernia between 2015 and 2020 were reviewed retrospectively. Patients' ages, genders, comorbidities, Charlson Comorbidity Index (CCI), ASA score, BMI, hernia types, duration of symptom, laboratory values, intestinal strangulations or necroses, whether intestinal resection was performed, whether mesh was preferred for hernia repair, and rates of morbidity and mortality were recorded. Factors affecting morbidity and mortality rates were analyzed.

RESULTS

Factors such as gender, BMI (> 30), duration of symptom (> 24 h), presence of bowel necrosis and resection, type of hernia and prolonged operation time were found to cause an increase in morbidity. In the multivariate analysis, however, gender, duration of symptom and BMI (> 30) were statistically significant factors causing increased morbidity (p = 0.009, p < 0.001, p = 0.032, respectively). Advanced age, high ASA scores, CCI and duration of symptom were determined as factors affecting the increase in mortality. In the multivariate analysis, the effect of high ASA scores and advanced age on high mortality rate was statistically significant (p < 0.023, p = 0.039, respectively).

CONCLUSIONS

The mortality rate is higher, especially in elderly patients with high comorbidity. Therefore, we argue that the cases of abdominal wall hernia should be operated under elective conditions even if they do not give any clinical findings to prevent problems in older ages.

Mild and Severe Anal Incontinence after Lateral Internal Sphincterotomy: Risk Factors, Postoperative Anatomical Findings and Quality of Life

<i>Aim:</i> This study aims to evaluate the risk factors for incontinence after lateral internal sphincterotomy (LIS) and assess quality of life in different levels of incontinence. <i>Methods:</i> All consecutive patients (n = 253) with chronic anal fissure who underwent LIS between 2003 and 2006 were retrospectively reviewed. All patients were questioned for possible anal incontinence according to the Wexner Incontinence Score (WIS). Demographics, vaginal delivery history, additional procedures and surgeon’s experience were evaluated as risk factors. Endoanal ultrasound (EUS) was performed in incontinent patients to assess the thickness of the remaining internal sphincter and to evaluate any injury in the external sphincter. Quality of life was questioned with SF-36. <i>Results:</i> Twenty-eight (11.7%) patients suffered from incontinence (mean WIS = 3.6 ± 2.5). The search for a risk factor was unsuccessful when continent and incontinent groups were compared. In subgroup analyses, patients were found to be suffering from mild (WIS <5, n = 19) or severe (WIS >5, n = 9) incontinence. Vaginal delivery history was found more often in the severely incontinent subgroup than in the continent group (p < 0.05). Also, vaginal delivery history and the additional procedures were more frequently observed in the severely incontinent subgroup than in the mildly incontinent subgroup. EUS did not find any external sphincter injury in these cases. WIS had negative correlations with the physical and mental component scores of SF-36. <i>Conclusion:</i> In our opinion, the threat for incontinence is unpredictable; however, vaginal delivery history may increase the risk of severe incontinence.

The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Poststroke Hemiplegia

OBJECTIVE

To determine if whole body vibration therapy (WBV) effectively improves functional outcome in patients with poststroke hemiplegia.

MATERIALS AND METHODS

In this single-blind RCT, WBV group (n = 10) had 40 hz frequency/4 mm amplitude vibration during 5 minutes/session, 3 days a week, for a duration of 4 weeks. The control group (n = 11) had no vibration therapy for the same duration while standing on the same platform. Patients in both of the groups did 15 minutes of stretching and active range of motion exercises before the intervention. Outcome measures were Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM), and Timed 10-Meter Walk Test (10 mWT).

RESULTS

Only 10 mWT improved at the 1st week (p = 0.002), 1st month (p < 0.001), and 3rd month (p < 0.001) in favor of the intervention group. There was positive correlation also between 10 mWT and ankle spasticity (p < 0.001, r = 0.931).

CONCLUSION

This study suggests that WBV therapy may be a complementary therapy in gait rehabilitation and functional outcome of the patients with calf muscle spasticity.

The variations and degenerative changes of sacroiliac joints in asymptomatic adults

BACKGROUND

The sacroiliac joint has a structure in which the direction of the load relative to the articular surface is irrational, as the joint surface is not perpendicular to the trunk load axis; it is likely to incur more degenerative changes than other weight-bearing joints.

MATERIALS AND METHODS

This retrospective study consisted of a total of 145 cases - 104 (71.7%) men and 41 (28.3%) women - who were referred to Gaziantep University Medical Faculty Radiology Department Polyclinic for pelvic computed tomography (CT) from 2013 to 2018. The mean age was 33.5 years (range: 18-60 years). Pelvis CT images were performed according to the exclusion criteria specified by the experienced orthopaedic surgeon. Patients were excluded from the study if they were younger than the age of 18, had a condition involving the sacroiliac joint, had an endocrine disorder, or had a history of a trauma affecting the pelvis CT examination.

RESULTS

In this current study, six types of anatomic variations were detected. Iliosacral complex variation has been determined as the most common type of variation. The incidence of variations of sacroiliac joint in all cases was 28.9%. Degenerative changes were seen in 5.5% of patients fewer than 30 years of age. When it comes to the patients whose age range is 30-60, the percentage of the degenerative changes is 12.4%. In patients who were 30 years and older, the prevalence of degenerative changes increased progressively with increasing age.

CONCLUSIONS

In this study, it is thought that the knowledge of variations in normal population and degenerative changes will contribute to the better understanding of normal morphological structure of sacroiliac joint and to the anatomical literature. It's seen that there is not a statistically significant relationship between degenerative changes and anatomical variations.

Technological Advances Have Improved Surgical Outcome in Thyroid Surgery: Myth or Reality?

Aim

In this study, we aimed to investigate the effects of Ultrasonic Coagulation (UC), Bipolar Energy Sealing System (BESS), Intra Operative Nerve Monitoring (IONM) and surgical experience on the complications of thyroid surgery.

Method

The data of 1627 patients who underwent thyroid surgery for various indications in our department between 2009 and 2018 were analyzed retrospectively and the effects of different technological devices on complications were investigated.

Results

Transient recurrent laryngeal nerve (RLN) palsy was higher between 2009 and 2013, when IONM was not in routine use (p=0.029). There were no significant differences between two energy devices (UC and BESS) in terms of transient or permanent RLN palsy, bleeding, and transient or permanent hypocalcemia. Multivariate analysis showed that young age (0.006), female gender (0.016), surgery type (p<0.001), and lateral neck dissection (p=0.026) are independent risk factors for transient hypocalcemia.

Conclusion

The results indicate that there is no superior hemostatic device. IONM and specific branching decrease transient RLN palsy. Female gender, young age, completion thyroidectomy, and lateral neck dissection were independent risk factors for the development of transient hypocalcemia.

Analysis of general surgery outpatient clinic admissions and operations during COVID-19 pandemic in Turkey: Reactions of 12728 patients

Covid-19 pandemic is spreading rapidly in Turkey. We aimed to examine the numbers and demographic data of patients who applied to the general surgery outpatient clinics and operated in this process. Our primary outcome is to reveal the response of general surgery patients to the Covid-19 pandemic.The first Covid-19 case in Turkey has appeared in March 11, 2020. Patients who were operated on due to a surgical emergency or trauma were evaluated separately. Patients in 3 periods were compared with each other. A total of 12728 patients were examined in general surgery outpatient clinics in 26 working days. It is seen that patients come to the outpatient clinic after the first time the Covid-19 patient is seen. All patients reduced hospitalization after the first death due to Covid-19. Women had reduced going to the hospital earlier than men. There was no change in the number of emergency surgeries. Rapid decrease was observed in the number of elective surgeries.It is not easy to control the entrance and exit of these busy hospitals. The remote diagnosis (mail, phone or video-call) and treatment methods that can be expected in the near future may be even closer with the Corona virus (Tab. 3, Fig. 4, Ref. 15). Keywords: general surgery, Covid-19, outpatient clinics, operation, reaction of patients.

A caffeine containing weight loss supplement augments hemodynamic responses after exercise

BACKGROUND

Since the effects of supplements can be potentially harmful and/or ineffective to obtain desired positive benefits, there is a need to investigate supplementation to understand the responses of physiological systems, to educate consumers, and to provide feedback for businesses creating these supplements. The purpose of the current study was to test hemodynamic responses of a weight loss supplement and determine its effects on hemodynamic variables.

METHODS

31 participants underwent a randomized, double-blind, crossover study design and received a placebo or supplement on two separate days. Baseline measures of all variables were assessed prior to exercise. During exercise, each participant performed treadmill running at 80% VO_2PEAK until volitional fatigue. Immediately post-exercise, hemodynamic measures were recorded at multiple time points.

RESULTS

There was a significant condition∗time interaction with the supplement having a higher PWV for the carotid to femoral segment (p=0.004). There were also significant condition∗time interactions for heart rate (p=0.001). Large arterial elasticity was significantly lower for the supplement (p=0.005). Systolic blood pressure was conditionally higher (p=0.001), as was diastolic blood pressure (p=0.003) and mean arterial pressure (p=0.003). Vascular resistance was conditionally higher for the supplement (p=0.044).

CONCLUSIONS

Ingredients in the supplement caused multiple negative effects within hemodynamics and were ineffective at increasing running time.

Associations between pQCT-based fat and muscle area and density and DXA-based total and leg soft tissue mass in healthy women and men

Peripheral Quantitative Computed Tomography (pQCT) can be used for muscle and fat area and density assessments. These may independently influence muscle and fat mass measurements from Dual Energy X-ray Absorptiometry (DXA).

OBJECTIVE

To determine associations between pQCT-derived soft tissue density and area measures and DXA-derived soft tissue mass.

METHODS

Linear regression models were developed based on BMI and calf fat and muscle cross-sectional area (FCSA and MCSA) and density measured by pQCT in healthy women (n=76) and men (n=82) aged 20-59 years. Independent variables for these models were leg and total bone-free lean mass (BFLM) and fat mass (FM) measured by DXA.

RESULTS

Sex differences (p<0.01) were found in both muscle (Mean±SE: Women: 78.6±0.4; Men: 79.9±0.2 mg/cm(3)) and fat (Women: 0.8±0.4 Men: 9.1±0.6 mg/cm(3)) density. BMI, fat density, and age (R(2)=0.86, p<0.01) best accounted for the variability in total FM. FCSA, BMI, and fat density explained the variance in leg FM (R(2)=0.87, p<0.01). MCSA and muscle density explained the variance in total (R(2)=0.65, p<0.01) and leg BFLM (R(2)=0.70, p<0.01).

CONCLUSION

Calf muscle and fat area and density independently predict lean and fat tissue mass.

Is sporadic colorectal cancer more aggressive in young people and should the age of colonoscopy screening be reduced?

OBJECTIVES

The present study aims to report the incidence of colorectal cancer patients under 50 years of age and to compare its aggressiveness with colorectal cancer patients over 50 years of age.

BACKGROUND

Recently, the incidence of colorectal cancer at younger ages has increased, and colorectal cancers in young people have a more aggressive course due to late screening programs.

METHOD

The files of patients who were operated for colorectal cancer were reviewed retrospectively. Information on the patients such as gender, age, BMI, type and duration of symptoms, location of the tumor, TNM staging, pathology results, operative procedure, morbidity and mortality rates were recorded. Admission complaints, symptom onset time, tumor locations, pathological findings and tumor stages were compared between patients under and over the age of 50.

RESULTS

The incidence of colorectal cancer under 50 was 21 % (56/267). The age group of 40‒49 was found to be the most common age range under the age of 50, with a colorectal cancer rate of 68%. In patients under the age of 50, higher invasion of the tumor to the serosa, low differentiation of the tumor in terms of histological findings in a higher number of patients and higher mucin component of the tumors and higher N2 lymph node involvement ratio and the tumor was located more in the lower rectum were statistically significant when compared to patients over the age of 50 (p=0.026, p=0.018, p=0.002, p=0.042, p=0.006; respectively).

CONCLUSION

The incidence of colorectal cancer has increased at younger ages and has a more aggressive course. Screening programs should be modified (Tab. 4, Fig. 2, Ref. 45).

Protective Effects of Bromelain in Testicular Torsion-Detorsion: Reducing Inflammation, Oxidative Stress, and Apoptosis While Enhancing Sperm Quality

Inflammation and increased oxidative stress in testicular tissue are documented side effects of torsion of the testicles. The preventive role of Bromelain (Bro) against testicle torsion-induced ischemia/reperfusion (I/R) injury was investigated in this research. Five groups of six animals each were created: ischemia, Ischemia+Reperfusion (I+R), Ischemia+Reperfusion+Bromelain (I+R+Bro; 10 mg/kg), control (sham), and Bromelain (Bro; 10 mg/kg). An I/R damage resulted from two hours of 720° clockwise twisting of the left testis. Blood samples and epididymal sperm were collected after reperfusion to analyze sperm parameters (recovery, motility, viability, and morphology) and cytokines that promote inflammation (IL-1β, IL-6, and TNF-α). Using Western blotting, testicular tissue was examined for histopathological alterations, antioxidant enzymes (GSH, SOD), lipid peroxidation (MDA), apoptosis, and survival-related proteins (TLR4, Caspase-3, Bcl-2, NRF-2, HO-1, PI3K, mTOR, AKT-1). While raising the activities of GSH and SOD, two antioxidant enzymes, Bro administration dramatically reduced MDA concentrations. The I+R+Bro group had significantly reduced amounts of cytokines that promoted inflammation compared to the I+R group. Bro's protective properties are also attributed to proteins that are altered by it and participate in the apoptosis and survival of cells. Sperm morphology, motility, and concentration notably improved in the bromelain-treated group, according to spermatological examination. Testicular samples treated with bromelain showed less tissue damage according to histological evaluations than the untreated I+R group. These findings imply that Bro has anti-inflammatory, anti-apoptotic, and antioxidant qualities. It effectively reduces oxidative stress and inflammation by modulating the PI3K/Akt/mTOR and NRF-2/HO-1 pathways, hence minimizing I/R injury.

Age comparisons of bone density and geometry in men

OBJECTIVES

The purposes of this study were to examine tibia bone density and geometry in young and middle aged men, and to explore relationships between pQCT- and DXA-derived body composition variables.

METHODS

Healthy males (18-30 years old, n=31; 50-64 years old, n=37) had their total body areal bone mineral density (aBMD) and body composition measured with Dual Energy X-ray Absorptiometry (DXA). Volumetric bone characteristics, muscle cross-sectional area (MCSA) and fat cross-sectional area (FCSA) of the leg were measured with peripheral Quantitative Computed Tomography (pQCT).

RESULTS

Young men were significantly (p<0.05) lighter and had less fat mass than older men. Total volumetric BMD (vBMD) at 66% of the tibia length was significantly lower (p<0.05) in older men. Bone-free lean body mass values were useful predictors of total and cortical area and content (R(2)=0.338-0.467). MCSA was more predictive of leg BFLBM than total body BFLBM, and those relationships were stronger in older men.

CONCLUSIONS

Differences in tibial bone area and density existed between young and middle-aged men, and relationships between pQCT- and DXA-derived body composition variables were age-dependent.