Treatment Responses in Histologic Versus Molecular Diagnoses of Lung Rejection.

Histologic evaluation of allograft biopsies after lung transplantation has several limitations, suggesting that molecular assessment using tissue transcriptomics could improve biopsy interpretation. This single-center, retrospective cohort study evaluated discrepancies between the histology of transbronchial biopsies (TBBs) with no rejection (NR) and T-cell mediated rejection (TCMR) by molecular diagnosis. The accuracy of diagnosis was assessed based on response to treatment. 54 TBBs from Prague Lung Transplant Program obtained between December 2015 and January 2020 were included. Patients with acute cellular rejection (ACR) grade ≥ 1 by histology received anti-rejection treatment. Response to therapy was defined as an increase in FEV1 of ≥ 10% 4 weeks post-biopsy compared to the pre-biopsy value. Among the 54 analyzed TBBs, 25 (46%) were concordant with histology, while 29 (54%) showed discrepancies. ACR grade 0 was found in 12 TBBs (22%) and grade A1 ≥ 1 in 42 TBBs (78%). Treatment response was present in 14% in the NR group and in 50% in the TCMR group (p = 0.024). Our findings suggest that low-grade acute cellular rejection is less likely to be associated with molecular TCMR, which might better identify lung transplant recipients who benefit from therapy.

The role of reactive oxygen species in the antibacterial photodynamic treatment: photoinactivation vs proliferation.

UNLABELLED: Low-level light/low concentration of reactive oxygen species (ROS) may trigger some biochemical pathways that lead to cell proliferation. Thus, there is a risk of stimulation of bacterial cell proliferation during photodynamic therapy (PDT). In this study, PDT with different doses of 809-nm laser and indocyanine green (ICG) was investigated in vitro for safe bactericidal application. The combined effect of laser doses with ICG concentrations were examined on Pseudomonas aeruginosa in vitro. Data showed that low energy dose and ICG concentration caused bacterial cell proliferation. When these parameters were increased high enough, photoinactivation of the bacteria was achieved. Energy dose and photosensitizer concentration ranges at which proliferation, cell death or neither observed were determined. Furthermore, l-histidine was used as a scavenger of ROS to block the mechanism of biostimulation and cell killing. It inhibited proliferation when laser dose and ICG concentrations were low. It also inhibited cell killing when dose and concentration were high. Data showed that mechanisms of proliferation and cell killing depend on the amount of ROS and antibacterial photodynamic treatment have serious biostimulative risk. Effective range might need to be determined before any therapeutic usage. The risk seems to exist specifically at lower energy doses and photosensitizer concentrations. SIGNIFICANCE AND IMPACT OF THE STUDY: The main purpose in antibacterial photodynamic therapy (PDT) is to kill the micro-organisms that cannot be destroyed by conventional methods. Low-level light and/or low concentration of reactive oxygen species may trigger some biochemical pathways that lead to cell proliferation. Thus, there is a risk of bacterial cell proliferation during PDT. In this study we report that PDT with ICG application can induce biostimulation when laser dose and photosensitizer concentration are not optimized properly. Therefore, optimum dosimetry in PDT possesses great importance in the treatment of wounds infected by antibiotic-resistant bacteria.

Effect of increasing paternal body mass index on pregnancy and live birth rates in couples undergoing intracytoplasmic sperm injection.

In this study, our purpose was to investigate the possible effect of paternal obesity on intracytoplasmic sperm injection (ICSI) outcomes on the basis of clinical pregnancy outcome. Antropometric measurements of 155 couples, referred to our infertility clinic and who underwent an ICSI cycle, have been evaluated. The study sample were divided into three groups with respect to paternal body mass index (BMI), as normal weight (BMI: 20-24.9), overweight (BMI: 25-29.9) and obese (BMI ≥ 30). Results of conventional semen analysis were also analysed. Clinical pregnancy data, including fertilisation rate, implantation rate, clinical pregnancy rate and live birth rate, were evaluated. Paternal obesity was a significant negative factor for sperm concentration and sperm motility (P = 0.03 and P = 0.01 respectively). A significant decrease of clinical pregnancy rate and live birth rate was associated with increased paternal BMI (P = 0.04 and P = 0.03 respectively). We have not determined a significant difference among groups in terms of fertilisation rate and implantation rate. This study demonstrates that increasing paternal BMI has a negative influence on ICSI success, including clinical pregnancy rate and live birth rate. There is a need for further studies to point the importance of lifestyle changes in order to overcome the negative influence of paternal obesity on couple's fertility.

Tamoxifen and giant endometrial polyp.

We present the case of a woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for breast cancer. In her gynecologic examination, she had a mass measuring 3 x 4 x 4 cm protruding from the cervical os. The mass was extirpated under general anesthesia. The mass originated from the endometrial cavity. The endometrial polyp measured 10 x 6 x 3 cm macroscopically and was found to be benign under microscopic examination. We conclude that physicians should be aware of the confounding effects of tamoxifen on the histological and ultrasonographic appearance of the endometrium.

Immunohistochemical expression of MMP-2, MMP-9 and COX-2 in Stage IA malignant polyps of the endometrium.

OBJECTIVE: To study whether endometrioid type malignant endometrial polyps (MEP) are different from endometrium cancer not associated with polyps (ECNAP) in means of immunohistochemical expressions of MMP-2, MMP-9 and COX-2. METHODS: Archived tissue samples of eight MEP, eight ECNAP and 16 benign endometrial polyps were selected and immunohistochemically analyzed for MMP-2, MMP-9 and COX-2 expression. RESULTS: MMP-2 and MMP-9 were overexpressed in ECNAP compared to MEP and benign endometrial polyps (p < 0.05). MMP-2 and MMP-9 expressions were not different in the malignant part of MEP, benign part of MEP and benign endometrial polyps. COX-2 expression was found to be higher in benign lesions, although this was not statistically significant. CONCLUSION: Similar immunohistochemical expression of MMP-2, MMP-9 and COX-2 within a polyp and with benign polyps may indicate an immunohistochemically indolent characteristic of MEP.

Intrauterine lidocaine plus buccal misoprostol in the endometrial biopsy.

OBJECTIVE: To evaluate the efficacy of intrauterine lidocaine plus buccal misoprostol in reducing the discomfort caused by endometrial biopsy with a suction curette. METHODS: In this double-blind, randomized, placebo-controlled trial 126 women undergoing endometrial biopsy were administered a 200-microg tablet of misoprostol buccally, followed by a 5-mL uterine instillation of either of 2% lidocaine or a saline solution. The main outcome measures were the intensity of pain during, immediately following, and 20 min following the biopsy, as assessed on a 10-cm visual analog scale. Statistical analysis was performed using the Friedman test with the Bonferroni correction, the t test, and the chi(2) test. RESULTS: There were no statistically significant differences between the study and control groups in mean age, parity, or relevant medical history. A statistically significant difference in pain scores was noted in premenopausal women during the procedure (lidocaine, 4.93+/-1.67; placebo, 6.17+/-1.26; P<0.001) as well as immediately later (lidocaine, 4.12+/-1.14 vs. placebo, 5.42+/-1.08; P<0.001) and 20 min later (lidocaine, 3.60+/-1.10; placebo, 4.22+/-1.46; P<0.001). No significant differences in pain scores were observed in postmenopausal women for any of the 3 time points (6.72+/-2.01, 5.18+/-1.22, and 4.56+/-0.80, respectively; P>0.05). The number needed to treat was 2.6 (95% confidence interval, 1.9-4.8). CONCLUSION: Intrauterine lidocaine plus buccal misoprostol appears to be effective in decreasing pain in premenopausal women undergoing endometrial biopsy with a suction curette.

Expression of gelatinase (MMP-2 and MMP-9) and cyclooxygenase-2 (COX-2) in endometrial carcinoma.

OBJECTIVE: Matrix metalloproteinases (MMPs) are key players in the degradation of extracellular matrix and basement membranes, and are thus important in tumor invasion. Gelatinases (MMP-2 and MMP-9) in particular are prognostic factors in many solid tumors. In this study the immunohistochemical expression of both COX-2 and matrix metalloproteinases has been shown for the first time in endometrium carcinoma. METHODS: Forty-two endometrial carcinoma tissues were immunostained for MMP2 antibody (1:100, Rabbit polyclonal), MMP9 antibody (1:100, Rabbit polyclonal) and CoX2 antibody (1:100, Epitope specific rabbit antibody). RESULTS: 90.5% of the cases were positive for MMP-2 and MMP-9, and 83.3% of the cases were positive for COX-2. A statistically significant association was found between COX-2 overexpression and FIGO stage (p = 0.001). A positive correlation was also found with histological grade (p = 0.006), myometrial invasion (p = 0.033), vascular invasion (p = 0.017), and lymphatic invasion (p = 0.007). A positive correlation was found between MMP-2 overexpression and vascular and lymphatic invasion (p = 0.030 and p = 0.003, respectively). MMP-9 overexpression was also found to be correlated with vascular and lymphatic invasion (p = 0.001 and p = 0.012, respectively). Furthermore, there was a statistically significant correlation between MMP-2 and MMP-9 overexpression (p = 0.0001). CONCLUSION: The results showed that COX-2, MMP-2 and MMP-9 were expressed in a high percentage of primary endometrial carcinomas and their expressions may be associated closely with parameters of tumor aggressiveness.

Mucinous adenocarcinoma arising from the gastrointestinal epithelium in benign cystic teratoma of the ovary--case report.

Benign cystic teratoma of the ovary (BCTO) is the most common ovarian germ cell tumor occurring predominantly in early adulthood. Malignant transformation of a BCTO is rare, with an incidence of 2%. Most benign cystic teratomas with malignant transformations are squamous cell carcinomas with just 6.8% being adenocarcinomas. We present a rare case of adenocarcinoma arising from the gastrointestinal epithelial elements of BCTO based on the microscopic examination and immunohistochemical studies. Adenocarcinoma arising from gastrointestinal epithelium within BCTOs is extremely rare. This is the fifth reported case of adenocarcinoma arising in gastrointestinal epithelium of a BCTO.

CD24 expression is a poor prognostic marker in endometrial carcinoma.

OBJECTIVE: CD24 is a cell adhesion molecule that has been implicated in metastatic tumor progression of various solid tumors. Its expression is known to be related to the prognosis of several kinds of tumors. This study was designed to examine the prognostic significance of CD24 in endometrial cancer patients. METHODS: Forty-four endometrial carcinoma tissues were immunostained for CD24 antibody (Ab2, clone 24 C02). Cytoplasmic and membranous immunoreactivity were scored semiquantitatively by Fisher's exact test. RESULTS: CD24 expression was detected in 34 (77.3%) out of 44 cases. Membranous and cytoplasmic staining of CD24 was significantly associated with the International Federation of Gynecology and Obstetrics (FIGO) grade (p = 0.011 and p = 0.002, respectively) and nodal status (p = 0.002 and p = 0.000, respectively). CONCLUSION: Our data suggests that CD24 expression in endometrial carcinoma as detected by immunohistochemistry might be a new marker for a more aggressive endometrial cancer biology. CD24 is commonly up-regulated in endometrial cancer and this corroborates the importance of CD24 in tumor progression among these cases.

Serum uric acid level predicts new-onset atrial fibrillation after coronary artery bypass graft operation.

OBJECTIVE: To investigate the association between serum uric acid levels and the risk of incident atrial fibrillation in patients after coronary artery bypass graft (cABG) operation. PATIENTS AND METHODS: A total of 174 patients undergoing nonemergency coronary artery bypass graft operation were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We prospectively analyzed 174 patients (mean age: 59.8 years; 109 male and 65 female). The serum uric acid level was determined preoperatively. RESULTS: After a coronary artery bypass graft operation operation, 35 (20%) patients developed atrial fibrillation. Preoperative uric acid levels were significantly higher in patients who developed atrial fibrillation than in those who did not (7.8 ± 1.1 vs 5 ± 0.9). Using a cutpoint of 6.55, the preoperative level correlated with the appearance of atrial fibrillation with a sensitivity of 91.4% and specificity of 84.2%. CONCLUSIONS: Serum uric acid level can increase the sensitivity and specificity in predicting atrial fibrillation in patients after CABG operation.

Bilateral globus pallidus lesions in a patient with Tourette syndrome and related disorders.

BACKGROUND: The neuroanatomic and pathologic basis of Tourette's syndrome or related disorders such as obsessive-compulsive disorder and attention deficit-hyperactivity disorder remains unknown. Although a substantial body of neuroimaging and other data implicate basal ganglia and some point out specifically the globus pallidus in the etiopathogenesis of these three related disorders, no clear or pathologically significant isolated lesions restricted to this region have yet been demonstrated, with the exception of obsessive-compulsive disorder. METHODS: A seventeen-year-old male case of Tourette syndrome with comorbid obsessive-compulsive disorder, attention deficit-hyperactivity disorder, stuttering and gait disturbance, who had negative family history is presented. RESULTS: The patient has failed to respond to drug treatment and his MRI scan revealed bilateral and symmetrical globus pallidus lesions with specific "tiger's eye" appearance of unknown etiology. CONCLUSIONS: Well-localized lesions in the globus pallidus support growing data suggesting the involvement of this brain region in Tourette syndrome and related disorders.

Primary repairing in penetrating colon injuries.

BACKGROUND/AIMS: The large bowel is injured in about 10% of penetrated abdominal injuries. Primary repair with colostomy has been discussed recently. MATERIALS AND METHODS: Between 1987 and 1995, sixty-five patients were operated on with penetrated colon injuries were treated with primary repair without colostomy. Any patient with one or more of the following criteria was excluded: Age > 60 years, blood pressure < 80/60 mmHg, time from injury to treatment > 8 hours, Penetrating abdominal trauma index > 50. RESULTS: The mean age of the patients was 31 and female/male ratio was 1/7. Fifty-one patients (78.5%) were exposed to colon injury by stabbing and 14 patients (21.5%) by gunshot. The most frequently injured segment was the transverse colon (36.9%). The liver was the most commonly injured organ associated with colon injury (32.3%). Colon wounds of 48 patients (73.8%) were treated with simple repair consisting of meticulous debridement. All gunshot wounds (14 patients) and 3 of the stab wounds were treated with segmentary resection and two layered anastomosis because of the massive colonic wall injury and/or impairment of the blood supply. The most common postoperative complication was wound infection (12.3%). Intraabdominal infection and leakage of the anastomosis were not observed. CONCLUSION: Primary repair or, if necessary, segmentary resection and anastomosis will be more appropriate in civilian colon injuries.

Stress hormones and acid-base status in human fetuses at term delivery: the effect of delivery method.

To evaluate the effect of delivery mode on fetal stress hormones and acid-base status and also to investigate the relationship between fetal acidemia and these hormones. 64 women with term pregnancies were studied. All had singleton, healthy pregnancies. Twenty one women were delivered by spontaneous vaginal route, 23 by vaginal route following oxytocin infusion and 20 by elective caesarean section. Umbilical cord blood samples were obtained immediately following the delivery. Blood gas (pH, pCO2, pO2) and hormonal analysis (Cortisol, dehydroepiandrosterone sulphate, prolactin, androstenedione) were done in arterial and venous cord blood samples respectively. Higher pO2 and prolactin, lower pH levels were found in caesarean section compared to other two groups (p < 0.05). At the time of delivery 11 infants had acidemia (pH < 7.20) as judged by pH of umbilical arterial blood. Acidemic group had higher cortisol and pCO2; lower pH and pO2 levels compared to non-acidemic group (p < 0.05). Method of delivery may affect acid-base and hormonal status of human fetus. Fetal acidemia may alter fetal adrenal steroidogenesis leading to increased fetal cortisol production.

Investigating the ablation efficiency of a 1940-nm thulium fibre laser for intraoral surgery.

The use of a laser in surgical procedures involving the soft tissues is advantageous due to its sterile and hemostatic nature. Several different lasers are in use for intraoral soft tissue surgery; however, small, efficient, and fibre-coupled lasers are favoured due to the tightly confined nature of the intraoral environment. This study proposes the use of a 1940-nm thulium fibre laser (Tm:fibre laser) for intraoral soft tissue procedures. Its thermal effects when used to make incisions were investigated. This laser was chosen due to its output wavelength, which is absorbed well by water in biological tissues. Lamb tongues were used in the experiments. The laser was coupled to a 600-µm silica fibre and incisions were made in contact mode with a continuous wave. The extent of ablation and coagulation produced were measured at three different speeds, powers, and numbers of passes. The thermal effects of laser power, movement speed, and number of passes on incision depth and ablation efficiency were determined. The Tm:fibre laser is a promising tool for intraoral surgery, with excellent absorption by tissue, good coagulative qualities, and easy to manipulate fibre output. Its use as an incisional tool with very little to no carbonization is shown in this study.

Validity and reliability of VEINES-QOL/Sym questionnaire in chronic venous disorders.

AIM: The aim of this study was to translate the VEINES-QOL/Sym questionnaire into Turkish, which is used mainly in Western European countries, and to study its reliability and validity. METHODS: Standard "forward-backward" translation method was used to translate the questionnaire. The internal consistency was assessed with Cronbach's α, test-retest reliability was assessed with the intraclass correlation and Spearman-Brown coefficients. Validity was examined by correlation of VEINES-QOL/Sym with SF-36, Venous Clinical Severity (VCSS), and Venous Disability Scores (VDS). RESULTS: Out of 100 patients included (mean age 41.9 ± 12.5 years; 32% male, 68% female), 30 were given the questionnaire twice with 24-hour intervals for test-retest; a final completion rate of 99.2% was achieved. The Cronbach's α was 0.914. The Spearman-Brown coefficients and the intraclass correlation coefficients were 0.994, 0.988 and 0.966, 0.933 for VQOL and VSym scores, respectively. For the total quality of life and for several domains the correlations between VEINES-QOL/Sym and SF-36 were high, and significant. Inverse and significant correlations were observed with VCSS. CONCLUSION: Conclusively, the Turkish version of VEINSES-QOL/Sym questionnaire is reliable and valid; thus, it is highly recommended to use Turkish version of VEINSES-QOL/Sym to evaluate the quality of life and symptoms of patients with venous insufficiency in Turkey.

Placenta accreta associated with a ruptured pregnant rudimentary uterine horn. Case report and review of the literature.

Pregnancy in a rudimentary uterine horn is rare and is usually associated with fetal death and serious maternal morbidity and mortality. A case of pregnancy in a rudimentary uterine horn with rupture 14 weeks after last menstrual period and is complicated with placenta accreta is presented. The patient had signs and symptoms of massive hemoperitoneum. An emergency exploratory laparotomy revealed rupture of the gravid rudimentary horn of a bicornuate uterus. Histologic examination of the specimen showed that placenta was accreta. The relative literature is reviewed and the association of placenta accreta in such situations is pointed out.