Hepatocellular adenomas in the Turkish population: reclassification according to updated World Health Organization criteria.

AIMS: Hepatocellular adenoma (HCA) is an uncommon liver neoplasm, and studies of HCA subtypes have been primarily limited to France, the USA, and Japan. The aim of this study was to describe the clinicopathological features of HCA subtypes in Turkey. METHODS AND RESULTS: The resection specimens of 59 cases diagnosed as 'hepatocellular adenoma' collected from 15 institutions were reviewed to confirm the diagnosis and to classify them according to the current World Health Organization 2019 classification. Immunostaining for glutamine synthetase, liver fatty acid-binding protein, C-reactive protein, ß-catenin and reticulin was performed. Of the 59 cases, 48 (81%) were diagnosed as HCA. We identified 24 (50%) hepatocyte nuclear factor 1α (HNF1α)-inactivated HCAs, five (10%) inflammatory HCAs, 15 (32%) ß-catenin-activated HCAs, three (6%) ß-catenin-activated inflammatory HCAs, and one (2%) unclassified HCA. HCA patients were predominantly female (female/male ratio of 5:1); they had a median age of 34 years and a median tumour diameter of 60 mm. In the ß-catenin-activated HCA group, nine cases (19%) showed cytoarchitectural atypia, and were also referred to as atypical hepatocellular neoplasms. In the ß-catenin-activated HCA group, three cases (6%) showed focal areas supportive of transition to HCA. The original diagnosis of HCA was changed to well-differentiated hepatocellular carcinoma in nine cases and to focal nodular hyperplasia in two cases. CONCLUSION: In our series, the major HCA subtype was HNF1α-inactivated HCA. We found a low incidence of inflammatory-type HCA. Our data also showed that ß-catenin-activated hepatocellular neoplasms, including cases with atypical histology, constituted a relatively high proportion of the cases. These findings are in contrast to those of most other studies of HCA subtypes.

The Diagnostic Value of SCUBE1 in Acute Appendicitis.

BACKGROUND: SCUBE1 has recently been studied as a diagnostic biomarker for acute coronary syndrome, ischemic stroke, and acute mesenteric ischemia. The aim of this study is to evaluate the value of SCUBE1 and routine parameters used in patients diagnosed with acute appendicitis. METHODS: Of the 150 patients admitted to the emergency department whose initial diagnosis were acute appendicitis (AA), 103 patients were excluded from the study for various reasons. Forty-seven patients with a definitive diagnose of AA and 43 volunteers were enrolled in the study. SCUBE1, Alvarado scoring (ASK), C-reactive protein (CRP), and routine tests were compared between the two groups. RESULTS: SCUBE1 was not statistically significant between the patient and the control groups (p = 0.209). SCUBE1 was significantly higher in the CRP (+) group (p = 0.048). Both the diameter of the appendix on computerized tomography (CT) and SCUBE1 levels increased proportionally (p = 0.043). CRP was significantly higher in the perforated appendicitis (PA) compared to non-perforated appendicitis (NPA) (p = 0.007). White blood cell (WBC) count was not differential for perforation (p = 0.06). CONCLUSIONS: Although SCUBE1 was significantly higher in CRP (+) patients, it was not a diagnostic biomarker for AA. There was a positive correlation between SCUBE1 values and the diameter of appendix measured on CT.

The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial.

BACKGROUND: Previous research indicates a high prevalence of post-traumatic stress disorder (PTSD) and depression among refugees. Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD for victims of natural disasters, car accidents or other traumatic events. The current study examined the effect of EMDR on symptoms of PTSD and depression by comparing the treatment with a wait-list control condition in Syrian refugees. METHOD: Adult refugees located in Kilis Refugee Camp at the Turkish-Syrian border with a PTSD diagnosis were randomly allocated to either EMDR (n = 37) or wait-list control (n = 33) conditions. All participants were assessed with the Mini-International Neuropsychiatric Interview Plus at pre-intervention, at 1 week after finishing the intervention and at 5 weeks after finishing the intervention. The main outcome measures were the Harvard Trauma Questionnaire (HTQ) and the Impact of Event Scale-Revised. The Beck Depression Inventory and the Hopkins Symptoms Checklist-25 were included as secondary outcome measures. The Trial Registration no. is NCT01847742. RESULTS: Mixed-model analyses adjusted for the baseline scores indicated a significant effect of group at post-treatment indicating that the EMDR therapy group showed a significantly larger reduction of PTSD symptoms as assessed with the HTQ. Similar findings were found on the other outcome measures. There was no effect of time or group × time interaction on any measure, showing that the difference between the groups at the post-treatment was maintained to the 5-week follow-up. CONCLUSIONS: EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees with PTSD located in a refugee camp.

Value of High-Sensitive Cardiac Troponin in Predicting Mortality in the Emergency Department.

BACKGROUND: The present study aimed to determine the validity of hs-cTnT in predicting the mortality among patients presented to the emergency department (ED) likely to be acute coronary syndrome (ACS). METHOD: Patients in whom hs-cTnT was tested in the ED for a possible ACS composed the study cohort. Hs-cTnT levels of the study patients were obtained from the hospital computerized database. The outcome and mortality of the study patients was detected using the digitalized national mortality registry. All-cause mortality and cardiac mortality at the end of one month was the primary outcome. RESULTS: 11795 patients were eligible for mortality detection and included into the final analysis. 1246 of 11795 patients were established to be dead during the study period and 358 of them supposed to be cardiac in origin. The Area Under the Curve (AUC) value of initial hs-cTnT for predicting one-month cardiac mortality was 0.869 (95% CI: 0.863 - 0.875) and 0.861 (95% CI: 0.855 - 0.867) for one-month all-cause mortality. The upper reference limit, 14 ng/L, has a sensitivity and specificity of 87% (95% CI: 77% to 94%) and 69% (95% CI: 68% to 70%), respectively, for predicting one-month cardiac mortality. CONCLUSIONS: The reference value of initial hs-cTnT does not have the ability to predict the cardiac mortality in a sufficient manner. However, reductions or increases in absolute or relative hs-cTnT levels are in concordance with mortality rates.

Oxidative Status and DNA Damage Following Analgesic Treatment in Patients with Acute Pancreatitis.

BACKGROUND: This study is designed to investigate the effect of three different analgesics, used to treat pain in AP, on oxidative stress, DNA damage in mononuclear leukocytes, and on oxidative status. METHODS: This parallel design randomized controlled trial is composed of three treatment arms, intravenous paracetamol, intravenous dexketoprofen, and intravenous tramadol. RESULTS: A total of 107 patients were diagnosed with acute pancreatitis within the study period in the ED. Seventyseven of them were included in the study; 26 patients for the paracetamol group, 24 patients for the dexketoprofen group, and 27 patients for the tramadol group. The mean age of study subjects was 52.73 ± 15.38 and 66% (n = 51) of them were men. At the beginning of the study (before treatment), mean levels of DNA damage, TOS, and OSI levels were significantly higher and TAS was significantly lower in the acute pancreatitis groups than in the control group. DNA damage and OSI in HAPS-positive patients were found to be significantly greater than HAPS-negative patients (p = 0.046). DNA damage and oxidative stress were compared between the three groups. There were no differences between the groups in terms of DNA damage (p = 0.42) and also for the oxidatif stress parameters (OSI,TAS,TOS had p-values of p = 0.26, p = 0.78, p = 0.35, respectively). CONCLUSIONS: There is no difference between the effects of paracetamol, dexketoprofen, and tramadol, which are commonly used to manage acute pain in AP, on DNA damage in human T-lymphocytes and on serine parameters of oxidative status.