The expression of BMP, integrin, ZEB2 in ovarian high-grade serous carcinoma in relation with lymph node metastasis.

Ovarian cancer (OC) is clinically important because it is diagnosed late and has metastasis when it is diagnosed. Mortality risk increases 2.75 times in the presence of lymph node (LN) metastasis. During metastasis, many molecules including BMPs originated from stroma, and tumor cells participate through transcription factors and integrins for cytoskeleton regulation during cell migration. We hypothesized an inverse correlation between BMP2 and BMP7 along with changes in ZEB2, and integrin α5ß1 in high-grade OCs in relation to LN metastasis. The BMP2 immunoreactivity was strong along with strong ZEB2 and weak integrins' immunoreactivity in samples with LN metastasis. Strong immunoreactivity of BMP7 was accompanied by strong immunoreactivity of integrins in the samples without LN metastasis. Study results showed BMP2's strong positive immunoreactivity and weak BMP7 immunoreactivity in tumor cells with a significantly weak inverse correlation. This inverse correlation should be considered as both BMPs have different effects in the window of cancer progression and invasion.

Bayesian estimation of the effect of health inequality in disease detection.

BACKGROUND: Measuring health inequality is essential to ensure that everyone has equal accessibility to health care. Studies in the past have continuously presented and showed areas or groups of people affected by various inequality in accessing the health resources and services to help improve this matter. Alongside, disease prevention is as important to minimise the disease burden and improve health and quality of life. These aspects are interlinked and greatly contributes to one's health. METHOD: In this study, the Gini coefficient and Lorenz curve are used to give an indication of the overall health inequality. The impact of this inequality in granular level is demonstrated using Bayesian estimation for disease detection. The Bayesian estimation used a two-component modelling approach that separates the case detection process and incidence rate using a mixed Poisson distribution while capturing underlying spatio-temporal characteristics. Bayesian model averaging is used in conjunction with the two-component modelling approach to improve the accuracy of estimates by incorporating many candidate models into the analysis instead of using fixed component models. This method is applied to an infectious disease, influenza, in Victoria, Australia between 2013 and 2016 and the corresponding primary health care of the state. RESULT: There is a relatively equal distribution of health resources and services pertaining to general practitioners (GP) and GP clinics in Victoria, Australia. Roughly 80 percent of the population shares 70 percent of the number of GPs and GP clinics. The Bayesian estimation with model averaging revealed that access difficulty to health services impacts both case detection probability and incidence rate. Minimal differences are recorded in the observed and estimated incidence of influenza cases considering social deprivation factors. In most years, areas in Victoria's southwest and eastern parts have potential under-reported cases consistent with their relatively lower number of GP or GP clinics. CONCLUSION: The Bayesian model estimated a slight discrepancy between the estimated incidence and the observed cases of influenza in Victoria, Australia in 2013-2016 period. This is consistent with the relatively equal health resources and services in the state. This finding is beneficial in determining areas with potential under-reported cases and under-served health care. The proposed approach in this study provides insight into the impact of health inequality in disease detection without requiring costly and time-extensive surveys and relying mainly on the data at hand. Furthermore, the application of Bayesian model averaging provided a flexible modelling framework that allows covariates to move between case detection and incidence models.

The impact of grey zones on the accuracy of agreement measures for ordinal tables.

BACKGROUND: In an inter-rater agreement study, if two raters tend to rate considering different aspects of the subject of interest or have different experience levels, a grey zone occurs among the levels of a square contingency table showing the inter-rater agreement. These grey zones distort the degree of agreement between raters and negatively impact the decisions based on the inter-rater agreement tables. In this sense, it is important to know how the existence of a grey zone impacts the inter-rater agreement coefficients to choose the most reliable agreement coefficient against the grey zones to reach out with more reliable decisions. METHODS: In this article, we propose two approaches to create grey zones in simulations setting and conduct an extensive Monte Carlo simulation study to figure out the impact of having grey zones on the weighted inter-rater agreement measures for ordinal tables over a comprehensive simulation space. RESULTS: The weighted inter-rater agreement coefficients are not reliable against the existence of grey zones. Increasing sample size and the number of categories in the agreement table decreases the accuracy of weighted inter-rater agreement measures when there is a grey zone. When the degree of agreement between the raters is high, the agreement measures are not significantly impacted by the existence of grey zones. However, if there is a medium to low degree of inter-rater agreement, all the weighted coefficients are more or less impacted. CONCLUSIONS: It is observed in this study that the existence of grey zones has a significant negative impact on the accuracy of agreement measures especially for a low degree of true agreement and high sample and tables sizes. In general, Gwet's AC2 and Brennan-Prediger's κ with quadratic or ordinal weights are reliable against the grey zones.

The evolution of bone marrow signal changes at the skull base in nasopharyngeal carcinoma patients treated with radiation therapy.

BACKGROUND: Clival infiltration is frequently seen in nasopharyngeal carcinoma (NPC) and the resultant bone marrow signal changes (BMSC) can persist even after complete tumor response to the radiation therapy (RT). The differentiation of those residual BMSC from recurrent/persistent disease may be challenging. We performed serial analysis of the clival BMSC after RT, to define an expected temporal evolution of those signal changes during the follow-up. MATERIALS AND METHODS: Serial MRI studies of 50 NPC patients (with or without initial clival infiltration) who had undergone RT were retrospectively examined. Abnormal clival BMSC and contrast enhancement (CE) were evaluated on each follow-up scan. Duration of BMSC/CE was correlated with the degree of baseline clival involvement (BCID), RT dose, and primary mass volume (PMV). RESULTS: Clival BMSC persisted without any evidence of recurrence, for a mean of 66.5 (max. 137) months (with accompanying CE for up to 125 months) in 26 patients with clival infiltration at diagnosis. Duration of BMSC and CE showed statistical correlations with PMW (p < 0.05), but not with RT dose or BCID. The rate of recurrence in clivus was 14%. New clival lesions that occurred within the first 12 months after RT (in six patients) did not develop recurrence suggesting radiation osteitis (12%). CONCLUSION: After RT, residual clival medullary signal change/enhancement is seen in most NPC patients and can persist even years without recurrence.

Maxillary Sinus and Surrounding Bone Anatomy With Cone Beam Computed Tomography After Multiple Teeth Loss: A Retrospective Multicenter Clinical Study.

PURPOSE: The aim of this multicenter study was to examine the residual alveolar bone anatomy and sinus mucosa pattern at maxillary sinus regions in multiple teeth loss. MATERIALS AND METHODS: This study was conducted with cone beam computed tomography images of 518 patients (267 females and 251 males) with multiple posterior maxillary teeth loss. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height and ridge width, posterior superior alveolar artery, and adjacent roots were evaluated. RESULTS: No (58.2%) or flat (19.3%) thickening morphology was detected at most of the SMs. Membrane thickening and mucosal-like morphology was more prevalent for male patients (P = 0.005). The mean sinus width was relatively low (3.64 ± 3.33 mm) at the 5-mm level and showed an expected increase toward upper levels. Most of the sinus spaces were dimensionally average (39.5%) or wide (44.7%), and no effect of gender was observed in terms of sinus dimensions (P > 0.05). CONCLUSION: Multiple teeth loss plays a role in creating an imaginary sinus anatomy constituted of a relatively narrow space compared with single-tooth loss cases, from 3.6-mm mean coronal width to 11.3 mm in the apical portion.

Impaired Placentation and Early Pregnancy Loss in Patients with MTHFR Polymorphisms and Type-1 Diabetes Mellitus.

Objective: To evaluate the impact of type-1 diabetes mellitus (DM) and methylenetetrahydrofolate reductase (MTHFR) polymorphisms on impaired placentation leading to early pregnancy loss. Methods: Miscarriage materials were obtained from eight pregnant women with type-1 DM without MTHFR polymorphism, eight with MTHFR polymorphisms without type-1 DM, and eight controls with neither DM nor MTHFR polymorphisms. Insulin-like growth factor-1 (IGF-1), leukemia inhibitory factor (LIF), and Beclin-1 expression were assessed to evaluate placentation. Results: Cytoplasmic LIF, IGF-1, and Beclin-1 expression were decreased in the superficial and glandular epithelial cells of the decidua in both study groups. LIF expression was increased in interstitial trophoblasts in the MTHFR group. IGF-1 expression was decreased in the decidual cells and interstitial trophoblasts in both study groups, while the decrease in stromal cells was noted only in type-1 DM group. Beclin-1 expression was increased in interstitial and villous trophoblasts in both study groups. Conclusion: The expression of IGF-1, LIF, and Beclin-1 are altered in both the decidua and the trophoblasts in pregnancies of women with type-1 DM and MTHFR polymorphisms, compared to normal pregnancies undergoing (elective) terminations.

Anterior inferior iliac spine morphology: quantitative and qualitative assessment in an asymptomatic population.

PURPOSE: To assess the prevalence of anterior inferior iliac spine (AIIS) types, and to investigate the quantitative measurements that characterize AIIS morphology in an asymptomatic adult population. METHODS: In this prospective study, 358 hips from 179 consecutive subjects (age range, 19-82 years; 91 males, 88 females), who underwent CT examination for reasons other than hip problems and were negative for hip impingement test, were analyzed. AIIS types were determined (1, flat wall of the ilium between distal end of AIIS and acetebular rim; 2, bony eminence between distal end of AIIS and acetebular rim; and 3, extension of AIIS to the anterior superior acetebular rim) and AIIS tip angle (TA), direct distance (DD) of the anterior acetabular rim to AIIS as well as projectional distances in vertical (VD) and horizontal (HD) planes were measured. Age- and gender-related factors were searched using two-way ANOVA test under three age groups (18-39, 40-59, and ≥ 60 years). RESULTS: There were 238 (66.5%) type 1, 118 (33.0%) type 2, and two (0.5%) type 3 AIISs, with significant difference between AIIS types among age groups and genders (P < 0.001). VD and DD showed age- and gender-related (P < 0.001, P < 0.001), and TA demonstrated gender-related differences (P < 0.001). Inter-observer agreement was good for TA and moderate to poor for other measurements. CONCLUSIONS: Type 1 AIIS is the most common shape across all age groups in adult females and in young and middle-aged adult males. TA, DD, and VD might be reliably used for the evaluation of AIIS morphology.

Evaluation of Single Tooth Loss to Maxillary Sinus and Surrounding Bone Anatomy With Cone-Beam Computed Tomography: A Multicenter Study.

BACKGROUND: Posterior maxillary tooth loss may complicate the implant treatment due to the alterations in alveolar anatomy and maxillary sinus pneumatization. This study aimed to comprehensively examine the anatomical structure of this region from cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The posterior maxilla regions with single tooth loss were analyzed by dividing the variables into 3 subgroups from images of 597 patients chosen from 1160 CBCTs. Variables associated with sinus membrane (SM), sinus dimensions, ostium, septa, sinus neighborhood, alveolar bone height (ABH) and width (RW), posterior superior alveolar artery (PSAA), and adjacent roots were evaluated. RESULTS: The majority of the patients demonstrated 0 to 5 mm membrane thickness. Irregular SM thickening was lower for female patients. While females showed higher number of narrow sinus, males had higher RW than females. Sinus augmentation classification showed negative correlation with ABH, root-tip sinus floor and edentulous site classification. Posterior septa height was correlated with number of septa and ABH. PSAA diameter and location were also correlated between each other. CONCLUSION: The present results define formation of a sinus space with 11 mm coronal and 16 mm apical width after single tooth loss. A flat or semispherical thickening around 4 mm is usual in most cases with 51% possibility of anterior septum existence. A ridge anatomy, around 7.5 mm ABH and 7.2 to 9.3 RW from coronal to apical, complements this anatomy. Further studies are needed to clarify the reasons behind the SM and crestal anatomy variations between genders.

Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases.

Histologic classification of ampullary carcinomas as intestinal versus pancreatobiliary is rapidly becoming a part of management algorithms, with immunohistochemical classification schemes also being devised using this classification scheme as their basis. However, data on the reproducibility and prognostic relevance of this classification system are limited. In this study, five observers independently evaluated 232 resected ampullary carcinomas with invasive component >3 mm. Overall interobserver agreement was 'fair' (κ 0.39; P<0.001) with complete agreement in 23%. Using agreement by 3/5 observers as 'consensus' 40% of cases were classified as 'mixed' pancreatobiliary and intestinal. When observers were asked to provide a final diagnosis based on the predominant pattern in cases initially classified as mixed, there was 'moderate' agreement (κ 0.44; P<0.0001) with 5/5 agreeing in 35%. Cases classified as pancreatobiliary by consensus (including those with pure-pancreatobiliary or mixed-predominantly pancreatobiliary features) had shorter overall (median 41 months) and 5-year survival (38%) than those classified as pure-intestinal/mixed-predominantly intestinal (80 months and 57%, respectively; P=0.026); however, on multivariate analysis this was not independent of established prognostic parameters. Interestingly, when compared with 476 cases of pancreatic ductal adenocarcinomas, the pancreatobiliary-type ampullary carcinomas had better survival (16 versus 41 months, P<0.001), even when matched by size and node status. In conclusion, presumably because of the various cell types comprising the region, ampullary carcinomas frequently show mixed phenotypes and intratumoral heterogeneity, which should be considered when devising management protocols. Caution is especially warranted when applying this histologic classification to biopsies and tissue microarrays. While ampullary carcinomas with more pancreatobiliary morphology have a worse prognosis than intestinal ones this does not appear to be an independent prognostic factor. However, pancreatobiliary-type ampullary carcinomas have a much better prognosis than their pancreatic counterparts.

Changes in composition and sulfation patterns of glycoaminoglycans in renal cell carcinoma.

Glycosaminoglycans (GAGs) are heterogeneous, linear, highly charged, anionic polysaccharides consisting of repeating disaccharides units. GAGs have some biological significance in cancer progression (invasion and metastasis) and cell signaling. In different cancer types, GAGs undergo specific structural changes. In the present study, in depth investigation of changes in sulfation pattern and composition of GAGs, heparan sulfate (HS)/heparin (HP), chondroitin sulfate (CS)/dermatan sulfate and hyaluronan (HA) in normal renal tissue (NRT) and renal cell carcinoma tissue (RCCT) were evaluated. The statistical evaluation showed that alteration of the HS (HSNRT = 415.1 ± 115.3; HSRCCT = 277.5 ± 134.3), and CS (CSNRT = 35.3 ± 12.3; CSRCCT = 166.7 ± 108.8) amounts (in ng/mg dry tissue) were statistically significant (p < 0.05). Sulfation pattern in NRT and RCCT was evaluated to reveal disaccharide profiles. Statistical analyses showed that RCCT samples contain significantly increased amounts (in units of ng/mg dry tissue) of 4SCS (NRT = 25.7 ± 9.4; RCCT = 117.1 ± 73.9), SECS (NRT = 0.7 ± 0.3; RCCT = 4.7 ± 4.5), 6SCS (NRT = 6.1 ± 2.7; RCCT = 39.4 ± 34.7) and significantly decreased amounts (in units of ng/mg dry tissue) of NS6SHS (RCCT = 28.6 ± 6.5, RCCT = 10.2 ± 8.0), NS2SHS (RCCT = 44.2 ± 13.8; RCCT = 27.2 ± 15.0), NSHS (NRT = 68.4 ± 15.8; RCCT = 50.4 ± 21.2), 2S6SHS (NRT = 1.0 ± 0.4; RCCT = 0.4 ± 0.3), and 6SHS (NRT = 60.6 ± 17.5; RCCT = 24.9 ± 12.3). If these changes in GAGs are proven to be specific and sensitive, they may serve as potential biomarkers in RCC. Our findings are likely to help us to show the direction for further investigations to be able to bring different diagnostic and prognostic approaches in renal tumors.

Evaluation of the adjunctive effect of platelet-rich fibrin to enamel matrix derivative in the treatment of intrabony defects. Six-month results of a randomized, split-mouth, controlled clinical study.

AIM: This study aimed to compare the results obtained with enamel matrix derivative (EMD) and EMD + platelet-rich fibrin (PRF) in the treatment of intrabony defects (IBDs) in chronic periodontitis patients. MATERIALS AND METHODS: Using a split-mouth design, 28 paired IBDs were randomly treated either with EMD or with EMD + PRF. Clinical and radiographic measurements including clinical attachment level (CAL), probing depth (PD), gingival recession (GR), defect depth (DD), defect width (DW) and defect angle (DA) were recorded at baseline (BL) and at six months following therapy. RESULTS: BL clinical and radiographic measurements were similar for EMD and EMD + PRF groups. Although postsurgical measurements revealed significant reduction for PD and CAL in both groups, no intergroup difference was detected. When EMD and EMD + PRF groups were compared, defect fill was not also statistically different. CONCLUSIONS: Both therapies resulted in significant clinical improvement in IBD treatment. Addition of PRF did not improve the clinical and radiographic outcomes.

Serum Osteoprotegerin Levels Related With Cardiovascular Risk Factors in Chronic Kidney Disease.

BACKGROUND: To evaluate osteoprotegerin (OPG) levels in relation to cardiovascular (CV) risk factors in patients with chronic kidney disease (CKD) on different regimens of renal replacement therapy. METHODS: A total of 143 patients with CKD and 30 healthy controls were included in this study and divided into five categories, including predialysis patients with chronic renal failure (preD; n = 36), chronic peritoneal dialysis patients (PD; n = 36), hemodialysis patients (HD; n = 35), renal transplant patients (RT; n = 36), and controls (n = 30). Data on demographics, concomitant diseases and CV risk factors, serum OPG levels, and correlates of serum OPG levels were determined. RESULTS: Serum OPG (pmol/l) levels were significantly higher in HD (P <0.001 for each), PD (P <0.001 for each), and preD (P <0.01 vs. control, P <0.05 vs. RT) groups than RT and control groups. Diabetics than nondiabetics in HD (P = 0.008), PD (P = 0.024), and RT (P = 0.004) groups and males than females in PD group (P = 0.021) had higher OPG levels. Serum OPG levels were associated positively with age in HD (P <0.001), PD (P = 0.001), and in overall population (P <0.001). CONCLUSION: Our findings revealed increased serum levels of OPG in dialysis and preD patients compared to RT and controls. In the patient groups receiving two dialysis treatment, the levels were worse, indicating a more pronounced vascular injury. Age, C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C), and cystatin C (CysC) in CKD patients, CRP and PTH in the control subjects, and age and BMI in the overall population were the significant correlates of serum OPG levels.

Serous versus high-grade endometrioid endometrial carcinoma: immunohistochemistry of RFP is not useful for differentiation.

We evaluated the immunohistochemical expression of ret finger protein (RFP) along with conventional immunohistochemical markers in endometrioid and serous carcinomas of the endometrium. A total of 124 endometrial carcinoma cases (24 grade 1 endometrioid, 60 grade 3 endometrioid, 40 serous) were retrieved from pathology archives. Tissue microarrays were constructed. The expression of RFP, WT1, ER, PR, p53 and p16 was examined immunohistochemically. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve,  statistic for interobserver reproducibility, Kruskal-Wallis test, Mann-Whitney U test and Fisher's exact tests were performed for statistical analyses. The mean RFP score was 1.54 in grade 1 endometrioid, 4.31 in grade 3 endometrioid, and 6.31 in serous carcinomas (p < 0.001). Overall, RFP scores were higher both in serous and grade 3 endometrioid carcinoma (p > 0.05), and significantly lower in grade 1 endometrioid carcinoma (p < 0.05). p16 and p53 staining patterns were able to differentiate between high-grade endometrioid and serous carcinoma (p < 0.001). ER, PR and WT-1 did not reach statistical significance for subtyping. The  values of the general agreement between the observers were 0.737 and 0.727 for endometrioid and serous carcinomas respectively (p < 0.001). Diffuse p53 and p16 staining provides the most sensitive and specific immunomarkers for differentiating high-grade endometrioid and serous carcinomas.

Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery.

AIM: Evaluating effectiveness of a medicinal plant extract (MPE) in achieving haemostasis and early wound healing at free gingival graft (FGG) donor site in a randomized controlled fashion. METHODS: Forty patients requiring FGG at lower anterior area were randomly assigned into two groups. FGG was performed to all patients and following graft procurement; wet gauze (WG) was applied alone (control: WG group) or with MPE (test: MPE + WG group) for haemostasis. Donor site working time, bleeding (BLE), colour match (CM), pain, epithelization (EP) and sensation loss (SL) were evaluated. RESULTS: Thirty-three participants completed a 6-month period study. In the test group, primary BLE was shorter (p < 0.001) and fewer individuals showed secondary BLE during 3 days (p < 0.001). During the 6 days, pain scores were higher in WG patients (p < 0.05). Later on, no inter-group difference was observed. EP was relatively faster (p < 0.001) and CM was slightly better (p < 0.05) in MPE + WG group. CONCLUSION: MPE provided faster and continuous haemostasis that made a positive contribution to the early soft tissue healing to some extent but due to limitations; further trials are needed to demonstrate the efficiency of this material.

Reliability and validity of the Turkish King's Health Questionnaire in women with urinary incontinence.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to translate the King's Health Questionnaire (KHQ) into Turkish and to test its reliability and validity among Turkish women with urinary incontinence (UI). METHODS: Three hundred and thirty-five women with symptoms of UI completed the Turkish versions of the KHQ, short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and the Incontinence Severity Index (ISI). Psychometric analysis of the KHQ included assessments of test-retest reliability, internal consistency, construct, and criterion validity. Factor analysis was used to explore the underlying structure of the KHQ. RESULTS: The internal consistency (Cronbach's alpha ≥0.68) and test-retest reliability of the KHQ were found to be high (p < 0.001). Interdomain correlation analysis showed good convergent validity among Role, Physical, and Social Limitations, with relatively higher correlations and divergent validity between Personal Relationships and other domains, with relatively lower correlations. Exploratory factor analysis identified three factors, namely, Daily Life and Emotions, Personal Relationship, and General Health Perception. The KHQ was also significantly correlated with IIQ-7, UDI-6, and ISI (p < 0.01). CONCLUSIONS: The results suggest that the Turkish KHQ is a valid and reliable condition-specific quality of life instrument for Turkish women with UI.

White matter involvement beyond the optic nerves in CRION as assessed by diffusion tensor imaging.

BACKGROUND: Chronic relapsing inflammatory optic neuropathy (CRION) is an inflammatory optic neuropathy, characterized by relapses and remissions in patients with normal brain and spinal magnetic resonance imaging (MRI). Discrepancy from other demyelinating diseases is important, and it is still uncertain whether CRION is restricted to the optic pathways or it affects other brain white matter (WM) structures. OBJECTIVE: To assess WM structure in patients with CRION by using diffusion tensor imaging (DTI). METHODS: DTI was performed in six CRION patients and six age- and sex-matched healthy controls on a 3 T scanner. Tract-based spatial statistics (TBSS) was used for voxelwise statistical analysis of DTI data. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) measures were obtained. RESULTS: TBSS analysis revealed two different patterns of WM alterations in patients with CRION. The optic chiasm and connected structures had significantly higher FA and lower RD, AD and MD in the patients than in the healthy controls. On the other hand, anterior frontal bundles of inferior fronto-occipital tracts, left uncinate fascicule and internal capsule showed decreased FA and increased RD. No correlation was found between the clinical variables and diffusion measures. CONCLUSION: WM appearing normal on brain MRI shows widespread abnormalities in a cohort of CRION patients as assessed by DTI.

Changes in serum ghrelin and resistin levels after sleeve gastrectomy versus one anastomosis gastric bypass: prospective cohort study.

INTRODUCTION: Humoral factors and neural mechanisms play a central role in the pathogenesis of obesity and in weight loss following bariatric surgery. Although various hormones and adipokines, including ghrelin and resistin, are linked to obesity, studies analyzing the changes in fasting ghrelin and resistin levels in patients following one anastomosis gastric bypass are lacking. AIM: We aimed to investigate resistin and ghrelin levels before and after two commonly used bariatric procedures with different mechanisms of action: sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB). PATIENTS AND METHODS: Fasting serum ghrelin and resistin levels were evaluated by using ELISA in a non-randomized, prospective cohort study for the pattern of changes in the preoperative period and one week, one month, three months and, 12 months after surgery in age and sex-matched patients with BMI ≥40 kg/m2 undergoing either sleeve gastrectomy (n=40) or one anastomosis gastric bypass (n=40). Their relationships with demographic parameters such as body weight, Body mass index (BMI), presence of T2DM, HbA1C, and HOMA-IR index were also evaluated. RESULTS: OAGB was superior in weight control compared to the SG group. There were significant differences in resistin and ghrelin levels between the OAGB and SG groups. Ghrelin decreased more in the SG group than the preoperative values. This change in ghrelin levels was more significant at one year after sleeve gastrectomy (preoperative mean(range) level of 334.2 (36.6-972.1) pg/mL decreased to 84 (9.1-227) pg/ml at one year) whereas in the OAGB group no significant change was observed (preoperative mean(range) level of 310 (146-548)pg/mL decreased to 264 (112-418)pg/mL at one year). Resistin levels decreased in both groups, especially after three months and onward following both operations (the mean(range) resistin levels were 2.6 (0.87-5.4)ng/mL and decreased to 1.1 (0.5-2.4)ng/mL in the SG group vs 2.48 (0.89-6.43)ng/mL decreased to 0.72 (0.35-1.8)ng/mL in OAGB group at one year), which was in parallel with changes in HOMA-IR index, body weight, and BMI changes at 1st year. HOMA-IR index changes were similar, but more prominent after OAGB. OAGB was also superior in T2DM control, parallel with weight loss, fasting resistin levels (especially after three months and onward), and HOMA-IR changes. CONCLUSION: This is the first study to compare fasting ghrelin and resistin levels after one anastomosis gastric bypass and sleeve gastrectomy. Although similar changes were observed, ghrelin changes were more prominent after SG, whereas resistin were observed after OAGB. OAGB was superior in T2DM control which was in parallel with weight loss, fasting resistin levels, and HOMA-IR changes suggesting a possible effect of resistin after OAGB in glucose metabolism and insulin resistance.

Molecular Subgrouping Based on Immunohistochemistry in Medulloblastoma: a Single-Center Experience.

AIM: Medulloblastomas (MBs) are the most commonly observed malignant brain tumors affecting children; they can be classified into molecular subgroups based on the 2016 and 2021 WHO classifications, as WNT-activated, SHH-activated and TP53-wild type, SHH-activated and TP53-mutant, and non-WNT/non-SHH. However, the molecular methods to determine these subgroups are not easily accessible for routine testing as they are expensive. Here, we investigated the efficacy of immunohistochemical methods to determine molecular subgroups and prognostic predictions of MB. MATERIAL AND METHODS: ß-catenin, GAB1, YAP1, filamin A and p53 were immunohistochemically stained, and MYC and MYCN fluorescent in situ hybridization (FISH) procedures were applied to 218 cases in our series. RESULTS: Based on the histomorphological characteristics of the cases, 67.9% were deemed classic MB; 15.6% as desmoplastic/nodular medulloblastoma (DNMB); 12.8% as large cell/anaplastic (LC/A) MB; 3.7% as medulloblastoma with extensive nodularity (MBEN). Molecular characteristics revealed that 50.5% had non-WNT/non-SHH; 33.9% had SHH-activated and TP53-wildtype; 8.7% had WNT-activated; 6.9% had SHH-activated and TP53-mutant. According to the survival curves, LC/A MBs or non-WNT/non-SHH tumors showed the worst prognosis, whereas DNMBs and WNT-activated tumors showed the best prognosis. Classic MBs or SHH-activated tumors showed a moderate course. MYCN amplification was found to act as an independent poor prognostic factor in the study. CONCLUSION: The distribution of histological subtypes and molecular subgroups, amplification rates, and prognostic data obtained through immunohistochemical methods in our study were consistent with those reported in the literature. It was therefore hypothesized that the determination of molecular subgroups by immunohistochemical methods can be useful in daily diagnostic practice, especially in centers with limited access to molecular techniques.

Carcinoma of the oral tongue: a case series analysis of prognostic factors and surgical outcomes.

PURPOSE: To identify factors affecting the clinical course and survival of patients with squamous cell carcinoma of the tongue. MATERIALS AND METHODS: One hundred thirty-eight patients who were treated with surgical excision of primary tongue cancer and neck dissection were analyzed retrospectively. The study had a median follow-up period of 23 months. Univariate and multivariate statistical analyses for prognostic risk factors were performed using the Cox regression method. Survival curves were processed with the Kaplan-Meier method. RESULTS: The 138 patients (73 male, 65 female) had a median age of 60 years. The 5-year overall, disease-specific, and relapse-free survival rates were 81%, 73%, and 71%, respectively. Tumor thickness greater than 8 mm was the only independent prognostic factor indicating a poor prognosis in overall survival (P = .049). Presence of involved lymph nodes indicated a tendency toward a poorer prognosis in disease-specific survival (P = .026) and relapse-free survival (P = .043). CONCLUSIONS: The present findings indicated that tumor thickness greater than 8 mm and lymph node metastasis were independent predictors of worse survival in patients with squamous cell carcinoma of the tongue. Because similar regional recurrence rates were observed in selective and radical neck dissections, supraomohyoid neck dissection is supported as a primary treatment for patients with clinical N0 tumor.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists.

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.