Postsynaptic ß1 spectrin maintains Na+ channels at the neuromuscular junction.

Spectrins function together with actin as obligatory subunits of the submembranous cytoskeleton. Spectrins maintain cell shape, resist mechanical forces, and stabilize ion channel and transporter protein complexes through binding to scaffolding proteins. Recently, pathogenic variants of SPTBN4 (ß4 spectrin) were reported to cause both neuropathy and myopathy. Although the role of ß4 spectrin in neurons is mostly understood, its function in skeletal muscle, another excitable tissue subject to large forces, is unknown. Here, using a muscle specific ß4 spectrin conditional knockout mouse, we show that ß4 spectrin does not contribute to muscle function. In addition, we show ß4 spectrin is not present in muscle, indicating the previously reported myopathy associated with pathogenic SPTBN4 variants is neurogenic in origin. More broadly, we show that α2, ß1 and ß2 spectrins are found in skeletal muscle, with α2 and ß1 spectrins being enriched at the postsynaptic neuromuscular junction (NMJ). Surprisingly, using muscle specific conditional knockout mice, we show that loss of α2 and ß2 spectrins had no effect on muscle health, function or the enrichment of ß1 spectrin at the NMJ. Muscle specific deletion of ß1 spectrin also had no effect on muscle health, but, with increasing age, resulted in the loss of clustered NMJ Na+ channels. Together, our results suggest that muscle ß1 spectrin functions independently of an associated α spectrin to maintain Na+ channel clustering at the postsynaptic NMJ. Furthermore, despite repeated exposure to strong forces and in contrast to neurons, muscles do not require spectrin cytoskeletons to maintain cell shape or integrity. KEY POINTS: The myopathy found in pathogenic human SPTBN4 variants (where SPTBN4 is the gene encoding ß4 spectrin) is neurogenic in origin. ß1 spectrin plays essential roles in maintaining the density of neuromuscular junction Nav1.4 Na+ channels. By contrast to the canonical view of spectrin organization and function, we show that ß1 spectrin can function independently of an associated α spectrin. Despite the large mechanical forces experienced by muscle, we show that spectrins are not required for muscle cell integrity. This is in stark contrast to red blood cells and the axons of neurons.

Axon Initial Segments Are Required for Efficient Motor Neuron Axon Regeneration and Functional Recovery of Synapses.

The axon initial segment (AIS) generates action potentials and maintains neuronal polarity by regulating the differential trafficking and distribution of proteins, transport vesicles, and organelles. Injury and disease can disrupt the AIS, and the subsequent loss of clustered ion channels and polarity mechanisms may alter neuronal excitability and function. However, the impact of AIS disruption on axon regeneration after injury is unknown. We generated male and female mice with AIS-deficient multipolar motor neurons by deleting AnkyrinG, the master scaffolding protein required for AIS assembly and maintenance. We found that after nerve crush, neuromuscular junction reinnervation was significantly delayed in AIS-deficient motor neurons compared with control mice. In contrast, loss of AnkyrinG from pseudo-unipolar sensory neurons did not impair axon regeneration into the intraepidermal nerve fiber layer. Even after AIS-deficient motor neurons reinnervated the neuromuscular junction, they failed to functionally recover because of reduced synaptic vesicle protein 2 at presynaptic terminals. In addition, mRNA trafficking was disrupted in AIS-deficient axons. Our results show that, after nerve injury, an intact AIS is essential for efficient regeneration and functional recovery of axons in multipolar motor neurons. Our results also suggest that loss of polarity in AIS-deficient motor neurons impairs the delivery of axonal proteins, mRNAs, and other cargoes necessary for regeneration. Thus, therapeutic strategies for axon regeneration must consider preservation or reassembly of the AIS.SIGNIFICANCE STATEMENT Disruption of the axon initial segment is a common event after nervous system injury. For multipolar motor neurons, we show that axon initial segments are essential for axon regeneration and functional recovery after injury. Our results may help explain injuries where axon regeneration fails, and suggest strategies to promote more efficient axon regeneration.

The effects of basic body awareness therapy on balance in patients with chronic neck pain: a randomised crossover trial.

PURPOSE: This study aimed to compare the effects of basic body awareness therapy (BBAT) and conventional treatments (CT) on balance in patients with chronic neck pain. METHODS: Thirty-five patients with neck pain participated in this randomised two-period crossover trial. Patients were divided into A (BBAT/CT) (n = 17) and B (CT/BBAT) (n = 18) groups. Group A received BBAT twice a week for 6 weeks, whereas Group B received CT within the same parameters. After a 5-week washout period, the treatments received by the groups were changed. The primary outcome was balance, assessed via the sensory organisation test (SOT) using the computerised dynamic posturography device. The secondary outcome was pain assessed by the visual analogue scale. Assessments were performed before and after primary and secondary treatments. RESULTS: In Group A, the SOT conditions 4, 5, 6; composites score; and visual and vestibular system scores increased after BBAT; however, only condition five scores and vestibular system scores increased (p < .05) in Group B, which started with CT. Within the groups, both treatments were effective for easing pain (p < .05). CONCLUSIONS: Although patients who started the therapy with BBAT showed more improvement in balance, no differences were observed between the therapies.

Rasch analysis, reliability, and validity of the Turkish version of the Lumbar Spine Instability Questionnaire.

Background/aim: Lumbar instability is an important condition that can be seen frequently in people with low back pain, affecting both the progression and the choice of appropriate exercise. The Lumbar Spine Instability Questionnaire (LSIQ) is a simple and low-cost tool for evaluating disturbed back stability in people with low back pain. The aim of this study is to develop the Turkish version of the LSIQ (LSIQ-T) and to evaluate its psychometric properties using the Rasch model. Materials and methods: One hundred participants with chronic low back pain completed the LSIQ-T. The LSIQ-T was repeated for 30 participants after 1 week to establish its test-retest reliability. While internal and external construct validity were investigated using Rasch analysis and the Spearman correlation coefficient, respectively, reliability was evaluated in terms of internal consistency by Cronbach's alpha and the Person Separation Index (PSI). Results: All items of the LSIQ-T were found to fit the Rasch model (chi-square: 34.07 (df = 15), p = 0.0033). The internal construct validity was good, the overall mean item fit residual was 0 (SD: 0.765), and the mean person fit residual was 0.322 (SD: 1.123). Internal consistency reliability was low with a PSI of 0.63 although Cronbach's alpha was acceptable (0.68). When the test-retest reliability was examined via differential item functioning (DIF) by time, none of the items showed DIF. Conclusion: The LSIQ-T is a valid unidimensional scale for the Turkish population. Although the LSIQ-T had low internal consistency, it demonstrated unidimensionality and is appropriate for use. Therefore, the LSIQ-T can be used in clinical practice and scientific research.

The impact of sarcopenia on pathologic complete response following neoadjuvant chemoradiation in rectal cancer.

PURPOSE: The role of sarcopenia in pathologic complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in non-metastatic locally advanced rectal cancer is currently unknown. The present study investigates the association between sarcopenia and post-nCRT pCR. METHODS: The data of patients operated on following nCRT between January 2013 and January 2020 were collected retrospectively. Sarcopenia was diagnosed based on the calculation of the skeletal muscle index (SMI) from computed tomography carried out at the time of the initial diagnosis. A statistical analysis was then conducted for predictors of pCR. RESULTS: The study included 61 patients with an average age of 57.3 years, 28 of whom formed the non-sarcopenic group (NSG) and 33 the sarcopenic group (SG). Of the patients, 32.7% were at clinical stage 2, and 67.3% were at clinical stage 3. Pathologic data following a mesorectal excision revealed a pCR rate of 21.4% in the NSG compared with 3% in the SG, which was a statistically significant difference (p = 0.025). The TNM downstaging rate was higher in the NSG than in the SG, although the difference was not statistically significant (50% vs. 33.3%, p = 0.28). A univariate analysis revealed the factors affecting pCR to be non-sarcopenia (p = 0.025), age < 61 years (p = 0.004), interval to surgery ≥ 8 weeks (p = 0.029), and serum CEA < 2.5 ng/ml (p = 0.035). CONCLUSION: Sarcopenia was found to be a negative marker of pCR following nCRT in non-metastatic locally advanced rectal cancer.

Analysis of factors affecting outcomes of pregnancy complicated by Echinococcus: an algorithm for approach and management.

PURPOSE: The management of hydatid disease (HD) co-occurring with pregnancy remains a challenge for physicians. We aimed to determine factors that were related to fetal and maternal outcomes in HD complicated pregnancies and then develop an approach/treatment algorithm. METHOD: All patients at the participating hospitals were first analyzed to determine whether they had HD. Only patients diagnosed with HD during the course of their pregnancy were included. Certain cyst-related factors (diameter, localization, increase in size, and viability) and certain pregnancy-related factors (treatments, gestational week, maternal co-morbidities, and delivery type) were investigated. Nonlinear principal component analysis (NPCA) was performed to determine the relationships between the categories of variables. RESULTS: Out of 12,926 pregnancies, 27 cases were diagnosed with HD. In 13 cases, each developed at least one fetal problem. Using Albendazol in first trimester, presence of an active cyst, increased diameter by more than 1 cm during pregnancy and a cyst diagnosed in the second trimester were associated with at least one fetal problem. According to the NPCA results, cyst diameter when first diagnosed was related to fetal outcomes; a cyst greater than 10 cm was associated with "at least one fetal problem". Cysts 5-10 cm in diameter were in a neutral position, while 2-5 cm in diameter were in the "no problems" group. CONCLUSIONS: HD mostly affects fetus. If cyst-related and pregnancy-related variables are optimal, close follow-up on a monthly is the best course of action. However, in high-risk conditions, percutaneous interventions or surgery should be considered.

Comparison of head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls: A cross-sectional study.

BACKGROUND: Chronic pain can affect body perception at the central level by causing the somatosensory cortex to rearrange. Additionally, cervical afferent abnormalities in individuals with neck pain can impair proprioceptive sensitivity, potentially leading to alterations in body alignment and biomechanics. Nevertheless, there are insufficient studies exploring these notions. OBJECTIVE: The main objective of this study was to compare the head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls. METHODS: Utilizing a cross-sectional study, a total of 76 volunteers comprising 38 individuals with neck pain and 38 matched healthy controls participated in the study. Head posture and cervical joint position sense were measured using a Cervical Range of Motion Deluxe (CROM) device. Firstly, the deviation angles of the head in three planes were evaluated, then the Head Repositioning Accuracy (HRA) test was performed to determine the joint position error. Visual Analogue Scale (VAS) was used to determine the severity of pain in individuals with neck pain. RESULTS: The deviation angles of the head in all three planes were significantly lower in the healthy control group (p< 0.05). Joint position error values were significantly higher in all directions (flexion-extension, right-left lateral flexion, and rotation) in the neck pain group (p< 0.001). CONCLUSION: The findings show that the proprioceptive sensation of the cervical region in individuals with neck pain was adversely affected, with changes were observed in the head posture. NOTE: The abstract of this study was presented as a verbal declaration at the International Congress of Health Sciences-ICHES-IDU 2020 that was held in Izmir on 20-21 June 2020.

The effects of aromatherapy massage in menopausal women with knee osteoarthritis: A randomized controlled study.

OBJECTIVE: Knee Osteoarthritis (OA)'s prevalence increases during menopause. Aromatherapy massage with different oils is applied in the treatment of knee OA. The aim of this study was to determine the effects of aromatherapy massage with Bergamot essential oil (BEO) on pain, functionality, sleep quality and menopausal symptoms in menopausal women with knee OA. MATERIALS AND METHODS: This study included 60 menopausal participants diagnosed with grade II-III OA. Participants were randomly divided into three groups: BEO (n=20), placebo (n=20) and control (n=20). The participants in the BEO group, received aromatherapy massage with BEO, in the placebo group aromatherapy massage with sweet almond oil was applied twice a week for 4 weeks. All participants underwent conventional physiotherapy. Visual Analog Scale was used to assess the severity of pain, Osteoarthritis Index to assess functionality, Pittsburgh Sleep Quality Index to assess sleep quality and Menopausal Symptoms Rating Scale to assess menopausal symptoms. All measurements were performed before and after the study. RESULTS: The results of the study showed that all three groups were effective on pain, functionality, sleep quality and menopausal symptoms (p<0.001). The results of the study showed that, aromatherapy massage with BEO was found to be more effective on functionality (p<0.001), pain (p<0.001) and menopausal symptoms (somatic and psychological symptoms) (p<0.001) compared to the control and placebo groups. It was determined that aromatherapy massage with BEO did not create a significant difference between the sleep quality scale scores in the control group and the placebo group (p=0.454). CONCLUSION: This study found that aromatherapy massage with BEO improved functionality, reduced pain and menopausal symptoms, and did not affect sleep quality. We consider that its application in addition to routine treatment may be useful to reduce symptoms.

The effect of brace use on balance in individuals with adolescent idiopathic scoliosis.

BACKGROUND: Patients with adolescent idiopathic scoliosis (AIS) have poorer standing balance compared with their healthy peers. However, the immediate effects of the braces used in the treatment on balance remain uncertain. OBJECTIVE: To investigate the effect of brace use on balance and weight-bearing symmetry in patients with AIS and to compare the results of different brace designs. STUDY DESIGN: Observational. METHODS: A total of 21 patients with AIS aged 10-17 years using 10 Boston and 11 Cheneau braces participated. Immediate balance and weight-bearing symmetries of patients with and without their own braces were evaluated. Balance assessment was performed using the Sensory Organization Test (SOT) on a computerized dynamic posturography device. Weight-bearing symmetry was evaluated on the computerized dynamic posturography device with the knees in full extension, with the knees flexed at 30°, 60°, and 90°. RESULTS: Regardless of its design, it was found that brace use had no effect on immediate balance and weight-bearing symmetry (p > 0.05). Of the patients using a Boston brace, unbraced SOT condition 2, 3, and 5 and composite scores were found to be higher than their braced scores (p < 0.05). Braced SOT condition 3 scores of the patients using a Cheneau brace were higher than those using a Boston brace (p = 0.037). Brace use and brace types have no statistical effect on weight-bearing symmetry. CONCLUSIONS: It was observed that brace use in patients with AIS has no positive effect on immediate balance and weight-bearing symmetry, and the use of Boston brace negatively affects immediate balance scores and increases visual dependence.

Effects of different exercises on respiratory parameters: A randomized controlled trial.

This study was designed to compare the effects of core stabilisation (CS) and auxiliary respiratory muscle strengthening exercises on oxygen consumption and respiratory parameters. A total of 51 participants were divided into three groups with block randomization method according to age and gender: CS Group (n = 17), Auxiliary Respiratory Muscles Exercise (ARM) Group (n = 17) and Control (C) Group (n = 17). Maximum oxygen uptake (VO2 max), first second of forced expiration (FEV1)/Forced vital capacity (FVC) and maximal voluntary ventilation (MVV) values were evaluated before and after the study. CS and ARM strengthening exercises were applied 3 days a week for 6 weeks. The increase in the FEV1/VC values was higher in the CS and ARM groups than in the C group (p < 0.05), whereas no statistically significant difference was observed between the ARM and CS groups (p < 0.05). There was no statistically significant difference between the groups in terms of VO2 max values before and after the study (p > 0.05). The increase in the MVV values was higher in the CS and ARM groups than in the C group (p < 0.05), whereas no statistically significant difference was observed between the ARM and CS groups (p > 0.05). CS and ARM exercises had positive effects on FEV1/FVC and MVV.

A randomized controlled trial on pain, grip strength, and functionality in lateral elbow pain: Mulligan vs muscle energy techniques.

BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most common lesions of the upper extremity. The level of evidence from studies on LET treatment protocols is insufficient. OBJECTIVE: The aim of this study was to compare the acute effects of mobilization with movement (MWM) and muscle energy technique (MET) on pain, grip strength, and functionality in patients diagnosed with LET. METHODS: Forty-five patients with LET aged 30-55 years were enrolled in this study. Patients were divided into three groups: MWM, MET, and control group. The control group received a 4-week home exercise program. In addition to the home exercise program in the MWM group, 12 sessions of MWM and 12 sessions of MET were performed in the MET group. Participants' pain, grip strength, and functionality were assessed before and after the study. RESULTS: After the treatment period, greater improvement in pain, grip strength, finger strength, and functionality were observed in the MWM and MET groups than in the control group (p< 0.05), but no statistically significant difference was found between the MWM and MET groups (p> 0.05). CONCLUSIONS: This study shows that MWM and MET, used in addition to home exercises, can be used to relieve pain and increase grip strength, finger strength, and functionality.

Wearing a surgical mask: Effects on gas exchange and hemodynamic responses during maximal exercise.

The importance of using masks during exercise has increased since the coronavirus disease-2019 (COVID-19). This study aimed to investigate the effects of using surgical masks on gas exchange and exercise responses in maximal exercise. Twenty-six participants were included. Participants performed the maximal exercise tests twice, masked, and unmasked. Gas exchange parameters (at maximal exercise and anaerobic threshold [AT]) and hemodynamic responses were measured. In the hemodynamic responses measured at rest, only the saturation of peripheral oxygen (SpO2 ) was lower in the masked (mean: 97.23 ± 1.33%) measurement than in the unmasked (mean: 97.96 ± 1.07%) measurement (p = 0.006). Test duration was lower in the masked test (unmasked: 10.32 ± 1.36 min vs. masked: 10.03 ± 1.42 min, p = 0.030). Peak oxygen consumption (VO2peak ) (unmasked: 31.23 ± 5.37 vs. masked: 27.03 ± 6.46 ml/kg/min), minute ventilation (VE ) l/min, and energy expenditure (EE) kcal/hour were higher in unmasked tests (p < 0.001). There was no difference in the gas exchange parameters measured at the AT in the masked and unmasked tests (p > 0.05). Respiratory gas exchange parameters were affected in peak exercise due to increased respiratory workload, but not at the AT. There was no change in hemodynamic responses because vascular control may not be affected by mask usage.

Constipation in the period of limited isolation during COVID-19 pandemic.

OBJECTIVE: COVID-19 outbreak has become widespread globally and caused a new global chaos. This outbreak that completely affected the lifestyle of individuals resulted in periods of isolation. Here, we evaluated the effects of lifestyle changes with isolation on constipation. METHODS: A survey on constipation was performed during the 12-week isolation period starting in March 2020 in Turkey. Data of 390 individuals who participated in the survey through the social media and who were actively employed prior to isolation were analyzed. Rome IV criteria were used to evaluate constipation. RESULTS: Among the participants in the study, 253 (64.9%) were women with the mean age of 39.5±9.5 years. A statistically significant association was found between the decreased water consumption during the isolation period and constipation after the isolation (p=0.020; p<0.05). A significant association was found between the changes in physical activity and constipation after the isolation (p=0.013; p<0.05). New development of constipation during the isolation or declaration of increased constipation was found to be statistically associated with post-isolation constipation according to Rome criteria (p=0.000; p<0.05). CONCLUSION: The data of this present study demonstrated that isolation period was effective on the newly developed constipation. Decreased physical activity and water consumption are also effective on constipation.

Maximal exercise outcomes with a face mask: the effects of gender and age differences on cardiorespiratory responses.

BACKGROUND: Surgical masks have become an important accessory of physical activity in daily life due to the COVID-19 pandemic. AIMS: To determine the effects of the surgical mask on respiratory gas exchange parameters, dyspnoea, and hemodynamic responses during maximal exercise in different age groups and gender. METHODS: Twenty-six healthy participants between 18 and 65 years (mean 37.35 ± 15.99) performed a maximal exercise test twice randomly, with and without a mask. To determine the respiratory gas exchange parameters (peak oxygen consumption (VO2peak), minute ventilation (VE), energy expenditure (EE), respiratory rate), and hemodynamic responses, each participant underwent a maximal exercise test with Bruce protocol on the treadmill. The modified Borg scale (MBS) was used to determine the dyspnoea before and after exercise test. RESULTS: Test duration (min), metabolic equivalents (MET), VO2peak ml/kg/min, respiratory rate, and peak heart rate (HRpeak) of young participants after exercise test with and without a mask were higher than in middle-aged participants (p < 0.01). There was no significant difference between males and females in test duration, VO2peak ml/kg/min, VO2peak ml/min, MET, VE l/min, respiratory rate, MBS, and EE in masked tests (p > 0.05). CONCLUSION: The surgical mask use affected the maximal exercise capacity of middle-aged participants more than young participants. Although males performed better than females in tests without masks, the decrease in exercise capacity with mask use was greater than in females. Advanced age and male gender may be factors that need more attention during exercise with mask use. TRIAL REGISTRATION NUMBER AND DATE: NCT04498546-02/17/2021.

Reliability and validity of the Turkish version of Fullerton Advanced Balance Scale in cerebral palsy.

BACKGROUND: The Fullerton Advanced Balance Scale (FAB) is a multi-item balance assessment test designed to measure balance in relatively higher functioning individuals. The aim of this study was to examine the reliability and validity of the Turkish version of the FAB (FAB-T) in children with cerebral palsy (CP). RESEARCH QUESTION: Is the Turkish version of the Fullerton Advance Balance Scale valid and reliable in determining balance problems in children with cerebral palsy and determining the underlying cause of this condition? METHODS: Forty-six children with CP participated in this study. Rasch analysis was used to investigate item adherence. Internal consistency of the FAB-T was established using Cronbach's alpha coefficient. Test-retest reliability was also evaluated. In addition, to assess concurrent validity, FAB-T scores were compared with the Pediatric Balance Scale (PBS) using the Spearman correlation coefficient. RESULTS: The FAB-T showed satisfactory internal consistency (Cronbach's alpha value=0.94) and excellent test-retest reliability (ICC=0.99). The FAB and the PBS exhibited concurrent positive validity (r = 0.913; p < 0.001). All items of the FAB-T were found to fit the Rasch Model (Chi-square 16.01(df=20), p = 0.716). SIGNIFICANCE: The FAB-T is a reliable and valid tool that can be used to measure balance skills and to identify the source of the problem in children with CP.

The factors of pancreatic fistula development in patients who underwent classical pancreaticoduodenectomy.

AIM: Pancreatic fistula (PF) and anastomotic leakage are significant complications of the pancreaticoduodenectomy (PD). The PF is considered as the root cause of other major complications of PD. The aim of the study was to investigate the risk factors underlying PF that occurred after PD and the effects of the PF on postoperative morbidity. MATERIAL AND METHODS: In this study, fifty patients who underwent classic PD were evaluated, retrospectively. Patients were divided into two groups as patients with PF and patients without PF. The following demographical, clinical and operative parameters were collected to evaluate the PF; age, gender, preoperative biochemical parameters, resection type, duration of the operation, patient's comorbidities, amount of perioperative transfusion, localization of the tumour, texture of the residual pancreas, type of the anastomosis and the diameter of the pancreatic duct. RESULTS: A statistically significant relation was found between the texture of the remnant pancreatic parenchyma and PF (p<0.001). A significant relation was determined between PF and preoperative ALP, GGT, AST, ALT, hemoglobin levels and length of the hospitalization (p<0.05). In this study, we found that mortality, abdominal bleeding, bile leakage, intra-abdominal abscess were associated with reoperation and prolonged hospitalization. CONCLUSION: The lack of internationally accepted definition of a fistula is an important issue. Preoperative high ALP, ALT, AST, GGT values, low hemoglobin values and soft texture of remnant pancreatic tissue were found to be related with PF that occurs after PD. Residual pancreatic tissue has been shown as an independent risk factor. KEY WORDS: ISPGF, Pancreaticoduodenectomy, Pancreatic fistula, Risk factors.

The learning curve of laparoscopic inguinal hernia repair: a comparison of three inexperienced surgeons.

INTRODUCTION: Studies with inexperienced surgeons in terms of the learning curve for laparoscopic totally extraperitoneal (TEP) inguinal hernia repair are limited. AIM: To compare three inexperienced surgeons in terms of the learning curve without supervision. MATERIAL AND METHODS: Patients' data, which were from consecutive laparoscopic TEP hernioplasties between December 2017 and February 2020, were analysed retrospectively. The primary outcome was to compare the learning curve of three surgeons (Surgeon A, B, and C) in terms of complications, conversion, and duration of surgery. Secondary outcomes were recurrence rates. RESULTS: A total of 299 patients were included in the study. Conversion and intraoperative complication rates decreased after the first 60 cases (from 10% to 2.5%, p = 0.013 and from 9% to 2.5%, p = 0.027, respectively). The mean operative time reached a plateau of less than 40 min after 51-81 cases (Surgeon A 51, B 71, and C 81 cases). Ageing was a risk factor for intraoperative complications and recurrence (p < 0.001, p = 0.008, respectively), and higher body mass index (BMI) was a risk factor for conversion (p = 0.004). Age ≥ 60 years compared to age < 60 years increased intraoperative complications five-fold and recurrence six-fold (p = 0.001). On the other hand, BMI ≥ 30 kg/m2 increased the possibility of conversion to open surgery nine-fold (p < 0.001). In addition, a positive correlation was found between the operative time and the BMI and VAS score (p = 0.004, p = 0.015, respectively). CONCLUSIONS: In order to reach the plateau in the operative time during the TEP learning curve period, more than 50 cases should be experienced, whereas more than 60 cases are needed for conversion, intraoperative complications, and recurrence.

The risk of post-polypectomy bleeding among patients receiving antithrombotic agents: A prospective observational study.

BACKGROUND: In July 2012, the Japan Gastroenterological Endoscopy Society updated their guidelines for gastroenterological endoscopy in patients receiving antithrombotic therapy. Colonoscopic polypectomy procedures are associated with a high risk of bleeding. OBJECTIVES: The present study evaluated the safety of colonoscopic polypectomy procedures in terms of bleeding, among patients receiving antithrombotic therapy. DESIGN AND SETTING: Prospective observational study conducted in a tertiary-level public cardiovascular hospital in Istanbul, Turkey. METHODS: Colonoscopic polypectomies carried out in a single endoscopy unit between July 2018 and July 2019 were evaluated prospectively. The patients' data, including age, gender, comorbidities, whether antithrombotic drug use was ceased or whether patients were switched to bridging therapy, polyp size, polyp type, polyp location, histopathology, resection methods (hot snare, cold snare or forceps) and complications relating to the procedures were recorded. RESULTS: The study was completed with 94 patients who underwent a total of 167 polypectomy procedures. As per the advice of the physicians who prescribed antithrombotic medications, 108 polypectomy procedures were performed on 60 patients without discontinuing medication and 59 polypectomy procedures were performed on 34 patients after discontinuing medication. The age, gender distribution and rate of bleeding did not differ significantly between the patients whose medication was discontinued and those whose medication was continued (P > 0.05). CONCLUSION: This study found that the colonoscopic polypectomy procedure without discontinuation of antithrombotic medication did not increase the risk of bleeding. This procedure can be safely performed by experienced endoscopists in patients with an international normalized ratio (INR) below 2.5.

Ankyrin-dependent Na+ channel clustering prevents neuromuscular synapse fatigue.

Skeletal muscle contraction depends on activation of clustered acetylcholine receptors (AchRs) and muscle-specific Na+ channels (Nav1.4). Some Nav1.4 channels are highly enriched at the neuromuscular junction (NMJ), and their clustering is thought to be essential for effective muscle excitation. However, this has not been experimentally tested, and how NMJ Na+ channels are clustered is unknown. Here, using muscle-specific ankyrinR, ankyrinB, and ankyrinG single, double, and triple-conditional knockout mice, we show that Nav1.4 channels fail to cluster only after deletion of all three ankyrins. Remarkably, ankyrin-deficient muscles have normal NMJ morphology, AchR clustering, sarcolemmal levels of Nav1.4, and muscle force, and they show no indication of degeneration. However, mice lacking clustered NMJ Na+ channels have significantly reduced levels of motor activity and their NMJs rapidly fatigue after repeated nerve-dependent stimulation. Thus, the triple redundancy of ankyrins facilitates NMJ Na+ channel clustering to prevent neuromuscular synapse fatigue.

Clinical importance of serum CEA and CA-19-9 levels in oesophagogastric junction adenocarcinomas.

INTRODUCTION: In recent years, the incidence of gastroesophageal junction tumors has increased rapidly in worldwide. AIM: To evaluate pretreatment serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in oesophagogastric junction (OGJ) adenocarcinomas regarding clinicopathologic characteristics and overall survival. MATERIAL AND METHODS: Patients undergoing curative surgery diagnosed with OGJ adenocarcinoma in the gastrointestinal surgery clinic between 2007 and 2019 were included in the study retrospectively. Kaplan Meier and Log Rank tests were performed in survival analyses. Logistic regression analysis was performed to state the independent variables affecting survival. RESULTS: The mean age of the 70 patients included in the study was 59.78 ±10.49 (31-76) years. Serum CEA and CA 19-9 were high in 19 (27.1%) patients. CEA ≥ 5 ng/ml was found to be statistically significant in patients receiving neoadjuvant chemotherapy (NAC) and in patients with a high number of positive lymph nodes (N +) (p = 0.041 and p = 0.042, respectively). CA 19-9 positivity was statistically higher in patients with lymphovascular invasion (LVI) and diabetes mellitus (DM) (p = 0.042 and p = 0.012, respectively). The age and N+ findings of the patients in the CA 19-9-positive group were statistically significant compared to the patients in the CA 19-9-negative group (p = 0.039 and p = 0.007, respectively). Overall survival rates of 1-3 and 5 years were statistically significantly lower in patients who were CA 19-9 positive (p = 0.016). For patients in whom both tumour markers were positive, the N+ mean value was statistically significantly higher (p = 0.001). CONCLUSIONS: In our study, a significant relationship was found in terms of overall survival and serum CA 19-9 in OGJ adenocarcinoma, and it was associated with both tumour markers being positive and the mean N+ value.