The genetic structure of the Turkish population reveals high levels of variation and admixture.

The construction of population-based variomes has contributed substantially to our understanding of the genetic basis of human inherited disease. Here, we investigated the genetic structure of Turkey from 3,362 unrelated subjects whose whole exomes (n = 2,589) or whole genomes (n = 773) were sequenced to generate a Turkish (TR) Variome that should serve to facilitate disease gene discovery in Turkey. Consistent with the history of present-day Turkey as a crossroads between Europe and Asia, we found extensive admixture between Balkan, Caucasus, Middle Eastern, and European populations with a closer genetic relationship of the TR population to Europeans than hitherto appreciated. We determined that 50% of TR individuals had high inbreeding coefficients (≥0.0156) with runs of homozygosity longer than 4 Mb being found exclusively in the TR population when compared to 1000 Genomes Project populations. We also found that 28% of exome and 49% of genome variants in the very rare range (allele frequency < 0.005) are unique to the modern TR population. We annotated these variants based on their functional consequences to establish a TR Variome containing alleles of potential medical relevance, a repository of homozygous loss-of-function variants and a TR reference panel for genotype imputation using high-quality haplotypes, to facilitate genome-wide association studies. In addition to providing information on the genetic structure of the modern TR population, these data provide an invaluable resource for future studies to identify variants that are associated with specific phenotypes as well as establishing the phenotypic consequences of mutations in specific genes.

Differential diagnosis of an osseous cranial tumor from Hellenistic Mugla, Turkey.

OBJECTIVE: This project evaluates a cranial lesion from a Hellenistic-era individual excavated by the Mugla Archaeological Museum in Gülagzi, Turkey. MATERIALS: An osseous tumor measuring 3.02 × 3.54 × 2.98 cm originating from the occipital bone of a probable young adult male. METHODS: The tumor was examined using gross morphological inspection, plain radiography (x-ray), and computed tomography (CT) imaging to identify potential differential diagnoses for the osseous cranial tumor. RESULTS: The lesion in question displays features highly consistent with both osteoid osteoma and osteoblastoma. The tumor had a non-sclerotic, sharply demarcated border, a radiolucent nidus measuring less than 2 centimeters in diameter, and homogeneous sclerotic bone surrounding the nidus. CONCLUSIONS: Differential diagnosis determined the osseous tumor to be a benign neoplasm, and in this case the features of the tumor are highly consistent with a diagnosis of either osteoblastoma or osteoid osteoma. SIGNIFICANCE: The identification of novel neoplastic cases in paleopathology represents an important contribution to ongoing discussions regarding the temporality and regional variability of neoplastic conditions in the past. Additionally, a rigorous diagnostic study augmented by x-ray, CT scans, and 3D modeling provides data that can be utilized in future paleopathological studies. LIMITATIONS: Diagnostic interpretation would be aided by histological examination of the tumor, which was impossible in this case. Histological examination would provide a definitive diagnosis. SUGGESTIONS FOR FURTHER RESEARCH: Given the high incidence of benign tumors in the clinical literature but a paucity of reports in the paleopathological record, further research is indicated to better understand the implications of benign neoplasms in antiquity.

A new ape from Türkiye and the radiation of late Miocene hominines.

Fossil apes from the eastern Mediterranean are central to the debate on African ape and human (hominine) origins. Current research places them either as hominines, as hominins (humans and our fossil relatives) or as stem hominids, no more closely related to hominines than to pongines (orangutans and their fossil relatives). Here we show, based on our analysis of a newly identified genus, Anadoluvius, from the 8.7 Ma site of Çorakyerler in central Anatolia, that Mediterranean fossil apes are diverse, and are part of the first known radiation of early members of the hominines. The members of this radiation are currently only identified in Europe and Anatolia; generally accepted hominins are only found in Africa from the late Miocene until the Pleistocene. Hominines may have originated in Eurasia during the late Miocene, or they may have dispersed into Eurasia from an unknown African ancestor. The diversity of hominines in Eurasia suggests an in situ origin but does not exclude a dispersal hypothesis.

Comparison of Thiol-Disulfide Hemostasis With Inflammatory Markers in the Inflammatory Process of Acute Appendicitis.

Background Acute appendicitis is one of the events most frequently encountered by general surgeons. Despite the high incidence, serious problems are experienced in the diagnosis and clinical follow-up. In the pathogenesis of the disease, oxidative stress and impaired antioxidant defense mechanisms created in the body by this stress play an important role. As dynamic thiol-disulfide hemostasis is closely related to oxidative stress and is known to have a crucial role in the pathogenesis of oxidative stress, this study aimed to compare its value with other inflammatory markers in the diagnosis and follow-up of acute appendicitis. Methodology This study included cases admitted for surgery with a diagnosis of acute abdomen at Keçiören Research and Training Hospital General Surgery Clinic between April 2015 and July 2015 who were intraoperatively diagnosed with acute appendicitis and underwent routine appendectomy. In the preoperative period and after clinical healing before discharge, blood samples were obtained to examine white blood cell (WBC), mean platelet volume (MPV), total bilirubin, C-reactive protein (CRP), and thiol-disulfide balance, and the results were recorded. Results A total of 68 cases were operated on for acute appendicitis, and 59 were evaluated comprising 23 (39%) females and 36 (61%) males with a mean age of 35.6 years (range = 19-65 years). The mean duration of hospital stay was two days (range = 1-8 days). The results of the tests performed preoperatively and before discharge and their p-values were as follows: native thiol (-SH) 393.5 ± 9.4 µmol/L and 369.3 ± 9.5 µmol/L (p = 0.04), total thiol 434 ± 9.7 µmol/L and 396.7 ± 10.2 µmol/L (p = 0.03), disulfide (-S-S) 16.8 ± 0.7 µmol/L and 15.7 ± 0.9 µmol/L (p = 0.3), WBC 13.2 ± 0.5 × 10³/mL and 9.2 ± 0.4 × 10³/mL (p = 0.0), CRP 8.17 ± 1.24 mg/L and 7.84 ± 0.82 mg/L (p = 0.17), MPV 7.4 ± 0.37 fL and 7.97 ± 0.19 fL (p = 1.0), and total bilirubin 0.86 ± 0.08 mg/dL and 0.69 ± 0.06 mg/dL (p = 0.08). Conclusions In the clinical follow-up of acute appendicitis patients, the decrease in WBC, total thiol, and native thiol values can be helpful to clinicians as markers of clinical healing. However, CRP may not be a useful marker of clinical healing in acute appendicitis patients who are discharged early.

The faith of ilioinguinal nerve after preserving, cutting, or ligating it: an experimental study of mesh placement on inguinal floor.

BACKGROUND: Postherniorrhaphy chronic pain may be related to the trauma to the regional nerves or prosthetic mesh. This study was aimed to search the objective findings of prosthetic mesh placement on the ilioinguinal nerve in three different nerve treatment patterns with two different mesh types. MATERIALS AND METHODS: Thirty New Zealand rabbits were used. Bilateral ilioinguinal nerves were identified. A 2×1 cm standard polypropylene mesh was laid on the nerve on right side, whereas a same sized lightweight polypropylene was applied on the left after three different nerve treatments were carried out. The nerve was completely preserved in the first group [G1], cut by scissors without a further process in the second [G2], and proximal cut end was ligated with 5/0 polyglactin. Three months after the surgery, bilateral nerve samples were taken from the contiguous nerve segment for light microscopy and electron microscopy. RESULTS: Nerve protection could not prevent microscopic changes entirely. Prosthetic mesh itself seemed to cause histopathologic changes. Overall incidence of histopathologic changes in light microscopy, without taking the nerve treatment pattern into account, was somewhat lower at standard mesh side than that of lightweight mesh side. However this difference did not reach the level of significance (P=0.39). When three groups were evaluated in respect to overall nerve damage without paying attention to mesh type, the highest damage rate was observed in G3 (cut and ligate). When each group was compared separately within itself for histopathologic changes, no differences were observed between heavy and light mesh sides in any group. When the microscopic changes were compared in respect to the different nerve treatment patterns on heavyweight mesh side, the rates were 12.5%, 12.5%, and 33.3%, respectively. On lightweight mesh side, all three groups exhibited similar microscopic finding rates, 37.5%, 25.0%, and 33.3%, respectively. Protection of the nerve resulted in virtually zero neuroma formation after two types of mesh use. Surgical trauma to the nerve was observed to have an obvious potential for neuroma formation. Mesh type did not affect the overall neuroma rate within the whole subject pool; both groups displayed same 40% overall neuroma development rate. The neuroma incidence was in 43.8% G2 and 72.2% in G3, however the difference did not attain level of significance (P=0.09). The highest rate was observed when a lightweight mesh was used after dividing and ligating the nerve. CONCLUSIONS: Light mesh could not provide a protection in subjects whose nerves were injured during surgery. Ligation of the cut end of the nerve also could not be helpful. Nerve protection still seems to be the best way for a nerve-related complaint-free postoperative period. The merit of nerve end implantation into the muscle should also be reconsidered.

The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias.

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

The Effect of Reinforcement Methods with Knotted and Knotless Sutures: Comparison of Burst Pressures.

Sleeve gastrectomy operations have become popular among restrictive obesity surgeons, due to its effectiveness for losing weight and acceptable complication rates. However, leakage is a significant problem in these operations. In this ex vivo study, we tried to understand mechanisms of leakage and to examine the effects of two different types of frequently referred reinforcement techniques using sutures. The resected gastric specimens that were removed during sleeve gastrectomy operations were used in this ex vivo study. Foley catheters were inserted to stomach from two different areas along the greater curvature of stomach, and one of these catheters was connected to monitoring apparatus with intra-abdominal pressure measurement system. The other Foley catheter was connected to syringe apparatus with 1000 cc physiological saline. No reinforcement procedure was applied to staple line in the first group. In the second group, staple line was sutured continuously with 2/0 knotless absorbable suturing material. In the third group, continuous suturing was applied using 2/0 knotted absorbable sutures. Next, stomach was filled with physiological saline, and the site of leak and the pressure value at the level of leakage were noted. Pressure values that caused leakage in no reinforcement suture, knotless suture, and knotted suture groups were 42.7 (±1), 98.7 (± 3.9), and 97.7 (±4.1) mmHg, respectively. The pressure difference between the groups was statistically significant (P = .000). As for the site of leaks, 26 (58%) were in corpus, 14 (31%) were in antrum, and 5 (11%) were in fundus, and there was no significant difference between the groups in terms of leakage sites (P = .97). In sleeve gastrectomy operations, reinforcement of staple line using either knotless or knotted sutures may help to prevent leakage.

Evaluation of Stump Pressure in Three Types of Appendectomy: Harmonic Scalpel, LigaSure, and Conventional Technique.

INTRODUCTION AND OBJECTIVE: Appendectomy is one of the most common operations carried out by general surgeons. The recent introduction of the alternative energy-based devices in surgery and their use in the laparoscopic appendectomy shortened the duration of operations, but these devices are used generally for meso dissection. These devices did not receive wide acceptance among surgeons as there is not enough evidence confirming their use in appendicular lumen operations. Our objective in this study was to test the safety of three types of appendectomy. MATERIALS AND METHODS: Twenty-four cases with right hemicolectomy or subtotal colectomy were enrolled into this study. The patients were distributed in three groups. After the colectomy specimen was removed, in Group 1 conventional appendectomy (it was dissected with mesoappendiceal fixation and with electro cauterization) was performed in the operating room, the appendicular stump was ligated with a silk suture; in Group 2 appendectomy was performed with LigaSure™ and the stump was closed also with LigaSure; in Group 3 appendectomy was performed with Harmonic Scalpel™ and the stump was closed also with Harmonic Scalpel. Stump opening pressures were measured in all patients in the groups. RESULTS: Three groups were compared in terms of age, gender, concomitant diseases, clinical diagnosis, previous operations, pathological findings, and applied maximum pressure levels. No statistical difference was detected among the groups. CONCLUSION: Appendectomies carried out with LigaSure and Harmonic Scalpel are as safe as appendectomies carried out with the conventional methods.

How to approach Incidentally detected Gastrointestinal Stromal Tumor during Laparoscopic Sleeve Gastrectomy: A Report of Two Cases.

Laparoscopic sleeve gastrectomy (LSG) is a frequently used bariatric surgery method. It is possible to incidentally detect gastrointestinal stromal tumors (GISTs) of stomach or other gastric tumors during this procedure. In the literature, there is limited data about cooccurrence of GIST in obesity, and treatment of such cases is still controversial. On the contrary, currently accepted treatment of local and nonmetastatic GIST cases is surgery alone, and of cases with systemic disease is surgery combined with imatinib mesylate therapy. Incidental detection of GIST during bariatric surgery may require a modification in the planned procedure, and an extensive exploration and picking a convenient surgical procedure will become necessary. Here, we present two cases - a gastric GIST and a GIST of small intestine - both of which were incidentally detected during LSG performed for obesity. HOW TO CITE THIS ARTICLE: Atas H, Bulus H, Akkurt G, Yavuz A, Tantoglu U, Alimogullari M, Aydin A. How to approach Incidentally detected Gastrointestinal Stromal Tumor during Laparoscopic Sleeve Gastrectomy: A Report of Two Cases. Euroasian J Hepato-Gastroenterol 2016;6(2):173-175.

Fibrin sealant effects on the ilioinguinal nerve.

BACKGROUND: Chronic pain after mesh repair for inguinal hernia may be related to the trauma to the regional nerves by direct compression with sutures, staples, or tacks during mesh fixation. Fibrin sealant (FS) has been recommended to eliminate this risk. In this experimental study, the effects of FS on the ilioinguinal nerve when a mesh was applied was searched. MATERIALS AND METHODS: Fifteen New Zealand rabbits were used in three groups. In Group 1, a 2×1 cm, standard monofilament, pure polypropylene mesh was laid over ilioinguinal nerve. In Group 2, 0.5 ml FS was applied on the nerve without using an onlay mesh. In Group 3, a 2×1 cm mesh was laid onlay and secured with 0.5 ml FS with no fixating suture. Three months after surgery bilateral nerve samples were taken from the contiguous nerve segment for microscopic study. RESULTS: Group 1 showed prominent findings with regard to all parameters. There were significant differences between Group 1 and Group 2 in respect of fibrosis, lymphocyte, and edema scores, and foreignbody reaction. The values of Group 3, where the mesh was secured by the application of FS with no suture, were roughly placed in between Group 1 and Group 2. Prominent fibrosis and increased collagen proliferation in peripheral area of mesh was seen in Group 1 subjects, whereas a mild fibroblastic activity among mesh fibers in Group 3 subjects. CONCLUSIONS: FS has no negative effect on ilioinguinal nerve. FS application may protect the nerve from the harmful effects of polypropylene mesh in inguinal hernia repair.