High frequency of transient congenital hypothyroidism among infants referred for suspected congenital hypothyroidism from the Turkish National screening program: thyroxine dose may guide the prediction of transients.

PURPOSE: We aimed to determine the frequency of transient congenital hypothyroidism (TCH) in 17 participating centers in Türkiye, evaluate the etiological distribution in permanent congenital hypothyroidism (PCH) cases, and investigate the role of laboratory and clinical findings in predicting TCH. METHODS: This retrospective observational multicenter study included patients from 17 pediatric endocrinology centers identified by "National Newborn Screening Program" (NNSP) who were born in 2015 and followed for 6 years. Demographic, clinical, and laboratory information of the cases were compiled through the database http://cedd.saglik-network.org (CEDD-NET). RESULTS: Of the 239 cases initially treated for CH, 128 (53.6%) were determined as transient in whom a trial of levothyroxine (LT4) withdrawal was performed at a median age of 36 (34-38) months. Among the patients with PCH (n = 111), thyroid dysgenesis was diagnosed in 39.6% (n = 44). The predictive factors for TCH were: LT4 dose at the withdrawal of treatment, and initial newborn blood screening (NBS)-TSH level. Based on the receiver operating characteristic (ROC) curve analysis to predict optimal cut-offs for TCH predictors, LT4 dose < 2.0 µg/kg/day at treatment discontinuation was predictive for TCH and was associated with 94.5% specificity and 55.7% sensitivity, with an area under the curve (AUC) of 0.802. The initial NBS-TSH level value < 45 µIU/mL was predictive for TCH with 93.1% specificity and 45.5% sensitivity, with an AUC of 0.641. In patients with eutopic thyroid gland only LT4 dose < 1.1 µg/kg/day at withdrawal time was predictive for TCH with 84.7% sensitivity and 40.4% specificity, with an AUC of 0.750. CONCLUSION: According to our national follow-up data, the frequency of TCH was 53.6%. We determined the LT4 dose < 2.0 µg/kg/day at discontinuation of treatment and the initial NBS-TSH level < 45 µIU/mL as the best cut-off limits to predict TCH.

Evaluation of Transforming Growth Factor Beta-1 in the vein wall of males with varicocele.

OBJECTIVE: This study aims to investigate potential differences in the presence of Transforming Growth Factor-Beta 1 (TGF-ß1) between the vein walls of patients with varicocele and those of healthy individuals. PATIENTS AND METHODS: The study comprised a total of 40 participants, divided into two groups. The control group (Group 1) consisted of 20 patients who underwent coronary bypass surgery, while the varicocele group (Group 2) included 20 patients scheduled for varicocelectomy. The cytoplasmic and nuclear staining patterns of TGF-ß1 immunohistochemistry were assessed in tissue samples under light microscopy, identifying any differences in TGF-ß1 presence between varicocele patient vein walls and normal (saphenous) veins. RESULTS: The varicocele group demonstrated lower nuclear and cytoplasmic TGF-ß1 staining rates compared to the control group. After controlling for the independent factor of age, significantly lower nuclear and cytoplasmic staining was still observed in the varicocele group. CONCLUSIONS: This study is the first of its kind to compare TGF-ß1 staining in the vein walls of varicocele patients and healthy individuals. Previous studies focusing on varicose veins reported elevated TGF-ß1 expression. Contrarily, our study observed lower TGF-ß1 expression in varicocele patient veins, marking a unique contribution to the field.

Can serum basal cortisol values predict successful operations for bariatric surgery patients?

OBJECTIVE: Obesity is a chronic metabolic disease declared as the 21st century pandemic by the World Health Organization. Obesity has become an alarming situation for society, and it has to be treated. If the appropriate criteria are met by patients, bariatric surgery is an effective treatment method that provides weight loss in a short time. There are no definitive criteria regarding which groups of patients and characteristics may benefit most from bariatric surgery. In this study, we evaluate whether serum basal cortisol levels can predict successful outcomes of bariatric surgery and whether there is any difference in outcome between diabetic and non-diabetic patients. PATIENTS AND METHODS: This observational study included 244 obese patients who had undergone laparoscopic sleeve gastrectomy (LSG). Preoperative and postoperative 6-month weight, body mass index (BMI), serum basal cortisol, fasting plasma glucose, 1-mg dexamethasone suppression test (DST) results, and Type 2 Diabetes Mellitus (T2D) history were recorded. We analyzed the patients first by dividing them into two groups as excessive weight loss (%EWL) ≥50% and %EWL< 50%, and then into two groups as diabetic and nondiabetic patients. RESULTS: The mean age of patients with %EWL≥ 50% was found to be statistically significantly lower than that of patients with %EWL< 50% [39 (19-60) vs. 47 (36-61) years; p=0.046]. While there was no significant difference in basal cortisol values (p=0.513), DST results were statistically significantly lower in patients with %EWL≥ 50% than patients with %EWL< 50% [0.6 (0.1-2.1) vs. 0.8 (0.7-1.1); p=0.040]. CONCLUSIONS: In obese patients undergoing LSG, serum basal cortisol level may not predict the success of operation. However, the result of 1 mg DST may predict the operation success.

What is the effect of subepithelial lesions of the esophagus on esophageal motility?

OBJECTIVE: Esophageal motility is regulated both by coordinated stimulation and inhibition of the circular and longitudinal muscle layers of the esophagus. Although there are many diseases known to have an effect on esophageal motility, the effect of subepithelial lesions (SELs) of the esophagus on esophageal motility, which is often detected incidentally, remains still unclear. The aim of this study is to reveal the effect of SELs of the esophagus on esophageal motility evaluating it by high-resolution manometry (HRM). PATIENTS AND METHODS: A total of 32 patients with SELs in the esophagus and 12 healthy individuals were included. All patients and controls included in the study underwent HRM using a Unisensor UniTip High Resolution catheter (Laborie, Amsterdam, Netherlands) and endosonographic examination. RESULTS: The mean age was 52.60±15.56 years (range: 23-79) and the average body mass index (BMI) was 26.63±4.71 kg/m2. Gender, height, weight, and BMI measurements, smoking status, alcohol use, and DM status did not statistically differ significantly between the groups (p>0.05). Of 32 patients with SELs, 65.6% (n=21) had lesions originating in the muscularis propria, while 34.4% had lesions originating in the submucosa. The rate of abnormal motility both in the supine and in upright positions of patients with SELs was found to be significantly higher than in the control group (p=0.001, p<0.01, respectively). In patients with SELs, the incidence of infective motility was higher than the normal group (p=0.001, p<0.01, respectively). As the size of the lesion increases (>2 cm), the probability of abnormal HRM results increased. CONCLUSIONS: SELs of the esophagus have pathological effects on esophageal motility, mainly ineffective esophageal motility disorder.

Are neutrophil-to-lymphocyte ratios and large unstained cells different in hospitalized COVID-19 PCR-positive patients with and without diabetes mellitus?

OBJECTIVE: SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung alveoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the metabolic and immune systems. The hematological effects of COVID-19 and the relationship of lymphopenia with the severity of the disease have been reported previously. The parameter of percentage of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardiac diseases, solid tumors, and sepsis. The present study aimed to evaluate whether the parameters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Associations with disease severity were also sought. MATERIALS AND METHODS: In our retrospective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records. RESULTS: When diabetic patients were compared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs.  5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53±12.3 vs.  64.08±13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively). CONCLUSIONS: We determined that LUC counts and NLR values in COVID-19-positive patients with diabetes were statistically significantly higher compared to nondiabetic patients.

A novel rapid and accurate method for detecting Helicobacter Pylori: the modified antigen test.

OBJECTIVE: We aim to assess the diagnostic accuracy of the gastric biopsy Helicobacter pylori (H. pylori) antigen stool test as a novel method for detecting H. pylori, comparing this test with the histopathological evaluation of H. pylori and H. pylori antigen stool test as the reference standards. PATIENTS AND METHODS: The study involves patients who are scheduled for an upper gastrointestinal endoscopy. Gastric biopsies were endoscopically obtained from all patients, and H. pylori antigen stool tests were performed for all patients. Results from the gastric biopsies that were studied using the H. pylori antigen stool test in terms of the novel method were obtained and recorded. The inter-rater agreement between the H. pylori tests in determining positive and negative results was investigated using Fleiss' and Cohen's kappa tests. The capacity of applied tests in predicting the presence of H. pylori was analyzed using a receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 55 patients were studied (32 females and 23 males). The strongest coherence was obtained between the gastric biopsy test and histopathological evaluation with a kappa value of 0.664 in Cohen's kappa analysis of overall coherence between tests. The most accurate sensitivity and specificity values were obtained for the gastric biopsy test and histopathological evaluation crosstabulation for both overall comparisons at 90.5% sensitivity and 79.4% specificity. CONCLUSIONS: With this new, rapid, and easy-to-apply method, patients' endoscopies and gastric biopsies looking for the presence of H. pylori would be determined with more sensitive and more specific accuracy rates than current antigen stool tests, and H. pylori can be eradicated immediately without waiting for the histopathological evaluation period.

Evaluation of retinal microvascular changes in patients with prediabetes.

AIM: Diabetic retinopathy is a chronic progressive complication with neuronal cell and retinal microvascular involvement and is closely associated with blood sugar and blood pressure levels. Studies have shown that retinal neural dysfunction takes place before the microvascular changes in patients with Type 2 diabetes mellitus. The aim of this study is to compare the retinal microvascular changes of patients who are at the prediabetes stage and healthy volunteers. METHOD: Our study included 41 patients with prediabetes who were referred to the internal medicine outpatient clinic and 47 healthy volunteers. All patients underwent ophthalmologic examinations, including best visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination. Refractive error measurements were performed with the same automatic refractor-keratometer device. Typically, 3 × 3 mm macular images centered on foveola were obtained by using XR Avanti Optical Coherence Tomography Angiography with AngioVue (RTVue XR AVANTI, Optovue, Fremont, CA, USA) device. In the statistical analysis of the measurements, it was examined by Kolmogorov Smirnov test. Conditions expressed as IFG or IGT are considered as prediabetes; IFG is defined as fasting blood sugar to be between 100 and 125 mg/dL, while IGT is the condition in which the second hour value of the oral glucose tolerance test is 140-199 mg/dL. RESULTS: There was no statistically significant difference between the control and pre-DM groups in terms of mean age. The distribution of males and females between groups was statistically similar (P = 0.087). In the pre-DM group, 24 (58.6%) patients had IFG, 16 (39.0%) had IFG + IGT, and 1 (2.4%) had IGT. There were no statistically significant differences between the groups for the nonflow area (NFA) and the foveal avascular zone (FAZ) area (P > 0.05). The mean values of superficial and deep capillary plexus (DCP) density were not statistically significant differences between the groups. No statistically significant difference was found between the control group and pre-DM group in terms of the mean measurements of clinical ocular findings (P > 0.05). Retinal thicknesses were also not statistically significant differences between the groups (P > 0.05). CONCLUSION: All of the retinal measurements of both patients with prediabetes and healthy volunteers are similar. We did not find any difference between prediabetes and control groups. The ophthalmologic examinations which contain best-visual acuity, intraocular pressure measurement, slit-lamp examination, and dilated fundus examination are similar.

Challenges of CYP21A2 genotyping in children with 21-hydroxylase deficiency: determination of genotype-phenotype correlation using next generation sequencing in Southeastern Anatolia.

BACKGROUND/PURPOSE: Although it is known that there is generally a good correlation between genotypes and phenotypes, the number of studies reporting discrepancies has recently increased, exclusively between milder genotypes and their phenotypes due to the complex nature of the CYP21A2 gene and methodological pitfalls. This study aimed to assess CYP21A2 genotyping in children with 21-hydroxylase deficiency (21-OHD) and establish their predictive genotype-phenotype correlation features using a large cohort in Southeastern Anatolia's ethnically diverse population. METHODS: The patients were classified into three groups: salt-wasting (SW), simple virilizing (SV) and non-classical (NC). The genotypes were categorized into six groups due to residual enzyme activity: null-A-B-C-D-E. CYP21A2 genotyping was performed by sequence-specific primer and sequenced with next generation sequencing (NGS), and the expected phenotypes were compared to the observed phenotypes. RESULTS: A total of 118 unrelated children with 21-OHD were included in this study (61% SW, 24.5% SV and 14.5% NC). The pathogenic variants were found in 79.5% of 171 mutated alleles (60.2%, 22.2%, and 17.6% in SW, SV and NC, respectively). Patient distribution based on genotype groups was as follows: null-16.1%, A-41.4%, B-6.0%, C-14.4%, E-22%). In2G was the most common pathogenic variant (33.9% of all alleles) and the most common variant in the three phenotype groups (SW-38.8%, SV-22.2% and NC-23.3%). The total genotype-phenotype correlation was 81.5%. The correlations of the null and A groups were 100% and 76.1%, respectively, while it was lower in group B and poor in group C (71.4% and 23.5%, respectively). CONCLUSION: This study revealed that the concordance rates of the severe genotypes with their phenotypes were good, while those of the milder genotypes were poor. The discrepancies could have resulted from the complex characteristics of 21-OHD genotyping and the limitations of using NGS alone without integrating with other comprehensive methods.

Is idiopathic mild hyperprolactinemia a cardiovascular risk factor?

BACKGROUND: There is a strong relationship between arterial stiffness and endothelial dysfunction and hypertension. How arterial stiffness is affected in elevated PRL conditions is uncertain. Biological action of prolactin contributing to the atherosclerotic process is a new research area. AIMS: We aimed at investigating cardiovascular risk predictability by conducting arterial stiffness measurement in patients with idiopathic hyperprolactinemia. SUBJECTS AND METHODS: The biochemical parameters and arterial stiffness analyses of 54 patients with idiopathic hyperprolactinemia, who had applied to our polyclinic in 2017 and 2018, and 55 healthy volunteers having similar characteristics with regard to age, sex and body mass index. RESULTS: The median prolactin level of the idiopathic hyperprolactinemia patients with a median age of 31 was found to be 45 ng/mL. The peripheral and central blood pressures and pulse wave velocities (PWV) of both the patient group and the control group were found to be similar. Any relations between prolactin levels and blood pressure and arterial stiffness could not be found. DISCUSSION: Our study showed that arterial stiffness did not increase in young patients with idiopathic mild hyperprolactinemia. However, the long-term effects of mildly elevated prolactin levels are unknown. Prospective randomized studies are required, that could reveal more clearly the prolactin-cardiovascular risk relation, and the clinical effects of extra-pituitary hyperprolactinemia.

Changes in thyroid volume and insulin-like growth factor 1 in pre- and post-pubertal obese children.

BACKGROUND: There is a mutual dynamic interaction between thyroid volume (TV), insulin-like growth factor-1 (IGF-1), and body mass index (BMI). These covariates undergo a change with the transition into puberty. The heterogeneity of the variates and study populations complicate the evaluation of the role of pure pubertal effect. OBJECTIVE: The purpose of this study was to investigate the effect of puberty on IGF-1 and TV in a predetermined homogenous population such as obese children. SUBJECTS AND METHODS: Three hundred and eighty children (202 girls and 178 boys) aged between 6 and 18 were enrolled in this prospective study. The children were assigned to two groups according to their pubertal status, i.e., prepubertal (n = 169) and postpubertal (n = 211). According to age and sex, the obese group (n = 222) was made up of children at and above the 95th percentile, and the control group (n = 158) of children under the 85th percentile. The following parameters were evaluated in all children: BMI, pubertal status, TV, and serum IGF-1, IGFBP-3, and IGF-1:IGFBP-3 molar ratio. RESULTS: In comparison to the prepubertal obese group, the obese group at Tanner stage 2 had a larger mean TV (P = 0.008) and higher IGF-1 level (P = 0.033). There was a positive correlation between IGF-1 and TV both in the prepubertal and pubertal group (r169= 0.369, P = 0.001; r211= 0.316, P = 0.004, respectively), whereas there was no correlation between IGF-1 and BMI (r169= 0.99, P = 0.092; r211= 0.094, P = 0.088, respectively). CONCLUSION: This study showed that the TV and serum IGF-1 levels were increased in obese children in the early stage of puberty and that there was a positive correlation between these two variables in all children, which shows the specific effect of the early stage of puberty on the increase in TV and IGF-1 levels and suggests that increased TV is associated with the increase in IGF-1 levels in a homogenous group such as obese children.

The evaluation of preoperative and postoperative fetuin-A levels in patients with primary hyperparathyroidism.

OBJECTIVES: Our objective was to evaluate preoperative and postoperative serum fetuin-A levels in female patients with primary hyperparathyroidism (PHPT) and search for the relationship with parathyroid hormone (PTH) and vitamin D (25OHD). Although a role for fetuin-A is suggested in regulating bone mineralization, its function has not been completely defined. MATERIALS AND METHODS: In this cross-sectional study, 43 female patients with PHPT and 30 healthy women were recruited as the control group. We evaluated 73 women because we had only women patients with PHPT. Of the 43 patients, 10 symptomatic and 23 asymptomatic patients were surgically treated, whereas 10 patients were not operated. In all 43 patients, 25OHD, PTH, fetuin-A levels, and bone mineral densitometry were evaluated. The biochemical parameters of 33 operated patients were reevaluated at the postoperative sixth week. RESULTS: Fetuin-A levels of the patients with PHPT were significantly higher than that in the controls (56.6 ± 13.8 vs. 42.6 ± 20.7 ng/mL; P = 0.010). Fetuin-A levels of the operated patients were higher than nonoperated group. Furthermore, serum fetuin-A levels of the nonoperated patients were not different from those of controls. After parathyroidectomy, fetuin-A (41.5 ± 25.2 vs. 56.4 ± 13.7 ng/mL; P = 0.003), PTH [80.0 (51.5-137.5) vs. 211.0 (151.5-278.5) pg/mL; P < 0.001], and calcium (9.2 ± 0.7 vs. 10.7 ± 0.8 mg/dL; P < 0.001) values were found to be decreased significantly. CONCLUSION: In this study, fetuin-A levels of patients with PHPT were higher than those of the controls and significantly decreased after parathyroidectomy compared with the preoperative levels. Fetuin-A levels could be a beneficial marker to determine the changes in bone metabolism of the patients with PHPT and to detect the patients suitable for surgery.

Predictive value of pre-operative inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in testicular sperm extraction: a pilot study.

To investigate the ability of some hematologic prognostic scores demonstrating inflammation in predicting sperm presence in testicular sperm extraction (TESE). We retrospectively investigated the medical data of 430 patients with the diagnosis of non-obstruc tive azoospermia (NOA) who had undergone TESE operation consecutively in our institution between the dates of January 2009 and February 2017. In all, 352 patients with the diagnosis of NOA, with bilaterally palpable vas deferens, who had undergone TESE for the first time, were included in the study. Patients with genetic anomalies, genital infection, history of surgery or vasectomy, chronic diseases, history of inflammatory, metabolic, rheumatologic, or malignant diseases, morbid obesity, with the diagnosis of clinical varicocele, or patients who had undergone TESE for the second time were excluded from the study. According to the results of TESE, the patients were divided into two groups as those with sperm retrieval and those without sperm retrieval. These groups were compared in terms of age, infertility duration, body mass index, hormone profile, hematologic parameters, neutrophil-to-lymphocyte ratio (NRL), monocyte-to-eosinophil ratio (MER), and platelet-to-lymphocyte ratio (PLR). The NLR and PLR levels were found to be significantly higher in patients without sperm retrieval at TESE compared to those with sperm retrieval. The logistic regression analysis showed NLR as an independent factor that showed the presence of spermatozoa at TESE (odds ratio: 4.786, %95 confidence interval: 2.667-8.589, p < 0.001). The area under the ROC curve (AUC) for the PLR was determined to be 0.574. As the calculated AUC value of the PLR was below 0.6, there was insufficient evidence determined at TESE to say that it was a reliable marker to indicate the presence of spermatozoa. The area of the MER value under the ROC curve was not statistically significant. It has been demonstrated that systemic inflammation negatively affects the probability of extracting spermatozoa in TESE and NLR is an independent factor indicating the presence of spermatozoa in TESE.

Effect of alginate in patients with GERD hiatal hernia matters.

Alginate-based formulations are frequently used as add-on proton pump inhibitor (PPI) therapy to help control of heartburn and regurgitation. There are limited data regarding the mechanisms and effects of alginate-based formulations. We aimed to evaluate the effects of the sodium alginate intake and its likely temporal relations on intraesophageal reflux events by MII-pH in patients with and without hiatal hernia (HH). Fifty GERD patients (18 with HH, 32 without HH) with heartburn or regurgitation once a week or more common were included. After combined multichannel intraluminal impedance and pH-metry (MII-pH) had been performed, all patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g regular yoghurt, and 200 mL water with total energy value of 744 kcal: 37.6% of carbohydrates, 21.2% of proteins, and 41.2% of lipids) during two consecutive days. On separate random two consecutive days, all patients took 10 mL of sodium alginate (GA; Gaviscon Advance; Reckitt Benckiser Healthcare, Hull, UK) or 10 mL of water, 30 minutes after the refluxogenic meal. After eating refluxogenic meal, patients were examined ½ hour for basal conditions, 1 hour in upright, and 1 hour in supine positions. Alginate significantly decreased acid reflux after intake at the first hour in comparison to water in patients with HH (6.1 vs. 13.7, P = 0.004) and without HH (3.5 vs. 5.5, P = 0.001). Weakly acid reflux were increased at the first hour in patients with HH (3.4 vs. 1.3, P = 0.019) and without HH (1.7 vs. 5, P = 0.02) compared to water. There was no distinctive effect of alginate on the height of proximal migration of reflux events in patients with HH and without HH. Alginate decreases acid reflux events within a limited time period, especially at the first hour both in patients with and without HH. Alginate has no effect on the height of reflux events along the esophagus both in patients with and without HH.

Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches.

AIM: Studies have demonstrated a relationship between lymph node (LN) yield and survival after colectomy for cancer. The impact of surgical technique on LN yield has not been well explored. METHOD: This is a retrospective study of right colectomy (RC) for cancer at a single institution from 2012 to 2014. Exclusion criteria were previous colectomy and emergent and palliative operations. All data were collected by chart review. Primary outcomes were LN yield and the LN to length of surgical specimen (LN-LSS) ratio. Multivariable mixed models were created with surgeon and pathologist as random effects. Sensitivity analyses were performed to exclude Stage IV cancers and to analyse groups on an 'as-treated' basis. RESULTS: We identified 181 open (O-RC), 163 laparoscopic (L-RC) and 119 robotic (R-RC) right colectomies. O-RC was more commonly performed in women with metastatic disease. The mean LN yield was 28, 29 and 34 in O-RC, L-RC and R-RC, respectively; the respective mean LN-LSS ratios were 0.83, 0.91 and 1.0. The R-RC approach produced a higher LN yield than the other approaches (P < 0.01), and a higher LN-LSS ratio than O-RC (P < 0.01). These findings were unchanged in sensitivity analyses. CONCLUSION: Robotic right colectomy improves LN yield and the LN-LSS ratio, which may reflect better mesocolic excision. The effect of these findings on survival requires further investigation.

A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index.

BACKGROUND AND AIM: The prognostic impact of poor nutritional status and cardiac cachexia in myocardial infarction is not clearly understood. Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in colorectal surgeries and postoperative septic complications. The present study aimed to evaluate the prognostic value of PNI in ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS: We evaluated the in-hospital and long-term (3 years) prognostic impact of PNI on 1823 patients with STEMI undergoing primary percutaneous coronary intervention. Patients with lower PNI had significantly higher in-hospital and long-term mortality and major adverse cardiac events. After adjustment for all confounders, the in-hospital mortality rates were 7.9 times higher at the lower PNI level (95% CI: 5.0-15.8) than those at the higher PNI level. The long-term mortality rates were also 6.4 times higher at the lower PNI level (95% CI: 4.4-12.4) than those at the higher PNI level. CONCLUSION: The present study demonstrated that the PNI, calculated based on the serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with STEMI.

Microvascular dysfunction affects the development and prognosis of sudden idiopathic hearing loss.

OBJECTIVE: The aim of our study is to investigate whether systemic microvascular function affects the development and prognosis of sudden idiopathic hearing loss (SHL). TYPE OF STUDY: A prospective case-control study. MATERIALS AND METHODS: Fifty patients diagnosed with SHL at our hospital between September 2015 and May 2016 were included as the SHL group, and 50 healthy volunteers who came to the hospital for medical screening were included in the control group. Thirty-one patients from the SHL group who responded to treatment and 19 patients who did not respond to treatment were identified according to the Siegel criteria and were grouped. Patients with comorbid disorders were excluded from the study. To determine microvascular function, the videocapillaroscopic examination was conducted from the nailfold, measuring the capillary density (CD) and post-occlusive reactive hyperaemia (PORH) values and statistical analysis was performed between the groups. RESULT: While CD was an average of 83.1 ± 6 in the SHL group, it was measured as 96.2 ± 10 in the control group. The CD value was significantly lower in the SHL group than the control group (P < 0.05). While the average PORH value in the SHL group was 80.5 ± 7.7, it was measured as 97.5 ± 10 in the control group. The PORH value was significantly lower in the SHL group than the control group (P < 0.05). The CD value did not differ significantly (P > 0.05) between the group that responded to treatment (83.4 ± 5.5) and the group that did not respond to treatment (82.7 ± 6.9). The PORH value was significantly lower (P < 0.05) in the group that did not respond to treatment (75.2 ± 7.9) than the group that did (83.8 ± 5.6). CONCLUSION: To our best knowledge, our study is the first study in the literature. Although the role of specific mechanisms in SHL is not entirely understood, the capillaroscopic examination can show the importance of microvascular function in SHL. CD and PORH values were found to be low in SHL patients, and a low PORH value was found to be a factor of poor prognosis.

Incisional hernias after laparoscopic and robotic right colectomy.

PURPOSE: Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies. METHODS: This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH. RESULTS: 276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03). CONCLUSIONS: This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.

Snap-fits and upper limb functional limitations in German automotive workers.

BACKGROUND: The use of snap-fit fasteners in automotive assembly has increased in the last 10 years. Their impact on musculoskeletal function of the upper limbs in assembly workers is not well described. AIMS: To investigate the association between snap-fit assembly and upper limb functional limitations (ULFLs) in workers after a large-scale expansion of snap-fit assembly by a German automotive company. METHODS: Cross-sectional data on blue-collar production workers' exposure to snap-fit assembly and ULFLs were collected from medical check-ups and company registers. The association between duration of snap-fit assembly and ULFLs, and the dose-response relationship between the two were analysed using logistic regression, adjusted for body mass index, gender and employment duration before snap-fit exposure. RESULTS: The study group included 10722 workers. Within the company, 8.4, 6.9 and 10.3% were exposed to snap-fit 1-12, 13-24 and ≥25 months, respectively. After adjusting for confounders, snap-fit exposure for 1-12 months [odds ratio (OR) = 1.59, 95% confidence interval (CI) 0.88-2.88] and 13-24 months (OR = 1.48, 95% CI 0.76-2.88) was not statistically significantly associated with ULFLs compared with an unexposed group. However, exposure to ≥25 months of snap-fit assembly was statistically significant associated with ULFLs showing >2-fold risk (OR = 2.44, 95% CI 1.52-3.92). No clear dose-response relationship was found. CONCLUSIONS: Our study suggests a negative long-term impact from snap-fit assembly on workers' upper limb function. Company physicians should be vigilant for signs of upper limb musculoskeletal disorders among workers exposed to snap-fit assembly.

Preoperative neutrophil-to-lymphocyte ratio (NLR) may be predictive of pathologic stage in patients with bladder cancer larger than 3 cm.

OBJECTIVE: Bladder cancer (BCa) is the most common malignancy of the urinary tract. In this study, we aimed to evaluate the ability of preoperative neutrophil-to-lymphocyte ratio (NLR) to predict pathologic stage of at the time of first transurethral resection of bladder tumor (TUR-BT) in patients with BCa larger than 3 cm. PATIENTS AND METHODS: Records of consecutive patients undergoing TUR-BT for BCa with a diameter >3 cm were reviewed. A total of 222 patients were eligible for analysis, and were divided into two groups: 162 patients in non-muscle-invasive BCa (NMIBC) group and 60 patients in muscle-invasive BCa (MIBC) group. Differences in preoperative blood parameters and NLR were evaluated between groups with an unequal variance t-test. RESULTS: In the NMIBC group, 59 patients had low-grade and 103 high-grade papillary urothelial carcinomas. 60 patients had T2 stage carcinoma. The mean age of the patients was 71.8 and 75.7 years, and mean NLR was 3.44 ± 2.03 and 4.6 ± 2.8 in NMIBC and MIBC groups, respectively. In terms of NLR, there was a statistically significant difference between the NMIBC and MIBC groups (p = 0.005). CONCLUSIONS: Our results showed that NLR might act as a significant predictive biomarker on the staging of BCa. Also, NLR could be used as a cost-effective, simple, common usable biomarker in urology clinic practice.