Combined analysis of the MF18-02/MF18-03 NEOSENTITURK studies: ypN-positive disease does not necessitate axillary lymph node dissection in patients with breast cancer with a good response to neoadjuvant chemotherapy as long as radiotherapy is provided.

BACKGROUND: The omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC. METHODS: A joint analysis of two different multicenter cohorts-the retrospective cohort registry MF18-02 and the prospective observational cohort registry MF18-03 (NCT04250129)-was conducted between January 2004 and August 2022. All patients received regional nodal irradiation. RESULTS: Five hundred and one patients with cT1-4, N1-3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow-up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease-free survival (DFS) and disease-specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence. CONCLUSIONS: The omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.

Prevalence and risk factors of attention deficit hyperactivity disorder in children admitted to the emergency department due to traumas.

BACKGROUND: This study aims to determine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms and the associated risk factors in children admitted to the Emergency Department (ED) due to traumas. METHODS: EChildren aged 3-16 years admitted to the ED for traumas were included in the study. The control group consisted of children aged between 3-16, who visited the pediatric ED for non-traumatic reasons. The Revised Conners Parent Rating Scale (CPRS-R) was administered to parents who agreed to participate following initial intervention and stabilization. Trauma patients were divided into two groups: those diagnosed with ADHD and those without ADHD. Risk factors likely to increase the identification of ADHD were assessed. RESULTS: The study included 917 children, with both groups showing similar characteristics regarding age, sex, demographic, and cultural factors. The most common reason for ED visits was extremity traumas, accounting for 296 (35.2%) cases. The majority of trauma patients (95.9%) were discharged from the ED after outpatient interventions. All subscale scores of the CPRS-R, except for the social problems subscale, were significantly higher in the study group compared to the control group. Factors that increased the risk of ADHD included admission with extremity traumas (p<0.001), previous ED admissions due to traumas (p<0.001), and having a family member previously diagnosed with ADHD (p<0.001). CONCLUSION: The prevalence of ADHD symptoms may be higher in children admitted to the ED due to traumas. Furthermore, extremity traumas, previous trauma-related ED-admissions, and a family history of ADHD increase the risk of ADHD.

Effects of hydrogen sulfide on relaxation responses in the lower esophageal sphincter in rabbits: the potential role of potassium channels.

Hydrogen sulfide (H2S) is a significant physiologic inhibitory neurotransmitter. The main goal of this research was to examine the contribution of diverse potassium (K+) channels and nitric oxide (NO) in mediating the H2S effect on electrical field stimulation (EFS)-induced neurogenic contractile responses in the lower esophageal sphincter (LES). EFS-induced contractile responses of rabbit isolated LES strips were recorded using force transducers in organ baths that contain Krebs-Henseleit solutions (20 ml). Cumulative doses of NaHS, L-cysteine, PAG, and AOAA were evaluated in NO-dependent and NO-independent groups. The experiments were conducted again in the presence of K+ channel blockers. In both NO-dependent and NO-independent groups, NaHS, L-cysteine, PAG, and AOAA significantly reduced EFS-induced contractile responses. In the NO-dependent group, the effect of NaHS and L-cysteine decreased in the presence of 4-AP, and also the effect of NaHS decreased in the NO-dependent and independent group in the presence of TEA. In the NO-independent group, K+ channel blockers didn't change L-cysteine-induced relaxations. K+ channel blockers had no impact on the effects of PAG and AOAA. In addition, NaHS significantly relaxed 80-mM KCl-induced contractions, whereas L-cysteine, PAG, and AOAA did not. In the present study, H2S decreased the amplitudes of EFS-induced contraction responses. These results suggest that Kv channels and NO significantly contribute to exogenous H2S and endogenous H2S precursor L-cysteine inhibitory effect on lower esophageal sphincter smooth muscle.

Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy.

Background: Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Methods: Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (<16 mg). Results: Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; p = 0.080) to obtain an effective optimum therapeutic response. At a median of 12 months (range, 4-42), no difference was found in complete response rates between patients in the LSI group and the combined LSI group with OST (52 vs. 53.9%, p = 0.999). However, steroid-related systemic side effects were lower in the LSI alone group (p < 0.008). Conclusion: Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.

Assessment High-Risk Breast Cancer in Older Patients: A Comparative Analysis of PREDICT Scores and TAILORx Risk Categorization.

Objective: This study aimed to evaluate the relationship between PREDICT tool overall survival (OS) scores and high-risk patients according to TAILORx risk categorization in elderly hormone reseptor (HR) positive human epidermal growth factor negative early breast-cancer patients. Materials and Methods: We conducted a retrospective study, extracting data from medical records of 64 patients diagnosed with breast cancer. A retrospective analysis was performed on all patients who had Oncotype Dx Recurrence Scores across five medical centers between 2017 and 2022. PREDICT scores were defined as calculated 10-year OS rates via PREDICT tool. Results: The median age of the patients was 67, with a range between 65-75 years. Low-risk patients had a slightly higher two PREDICT scores compared to high-risk patients (78% vs. 73%), (81% vs. 77%), which were statistically significant. The progesterone receptor (PR) level was significantly lower in the high-risk group (3.5% vs. 80%). A unit decrease in the PREDICT scores was associated with a 11% increase in the odds of being in the high-risk group. However, these effects weren't statistically significant in the multivariate analysis. A unit decrease in the PR level was significantly associated with increased odds (by 5% in the multivariate analysis) of being in the high-risk group. Conclusion: Our study underscores the importance of using a combination of tools, including the PREDICT tool, PR levels, and TAILORx risk categorization, for a comprehensive risk assessment in these patients, especially in the older population. Accurate risk assessment is crucial for tailoring the treatment and optimizing outcomes in this vulnerable population. Future studies are warranted to further validate these findings in larger cohorts and to explore additional biomarkers and genomic signatures that may aid in the risk assessment and management of breast cancer in older patients.

Evaluation of the effect of pitavastatin on motor deficit and functional recovery in sciatic nerve injury: A CatWalk study.

Objectives: This study aims to investigate the electrophysiological, scintigraphic, and histopathological effects of pitavastatin and its impact on functional status in rats with sciatic nerve injury. Materials and methods: A total of 30 Wistar albino rats were divided into three equal groups including 10 rats in each group: sham group (no injury), control group (nerve injury induced), and pitavastatin group (nerve injury induced and 2 mg/kg of pitavastatin administered orally once a day for 21 days). Before and at the end of intervention, quantitative gait analysis with the CatWalk system and sciatic nerve conduction studies were performed. After the intervention, the gastrocnemius muscle was scintigraphically evaluated, and the sciatic nerve was histopathologically examined. Results: There was no significant difference in the sciatic nerve conduction before the intervention and Day 21 among the groups (p>0.05). According to the quantitative gait analysis, there were significant differences in the control group in terms of the individual, static, dynamic, and coordination parameters (p<0.05). The histopathological examination revealed a significant difference in the total myelinated axon count and mean axon diameter among the groups (p<0.001). Conclusion: Pitavastatin is effective in nerve regeneration and motor function recovery in rats with sciatic nerve injury.

Sentinel lymph node biopsy after nipple-sparing mastectomy in early postoperative period: Is it feasible?

Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple-sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and Methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow-up of 42.82 (19-70) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM.

Galectin-3 levels in school aged children with autism spectrum disorder.

Objective: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with underlying pathogenesis and etiological factors not fully understood. We assumed that galectin-3, which is also linked with inflammatory responses, may be central to the ethiopathogenesis of ASD. Method: The current study consisted of 33 psychotropic medication-naive children with ASD and 32 control subjects. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime Version-DSM-5 (K-SADS-PL-DSM-5) was used to screen healthy controls for psychiatric disorders by a psychiatrist after a physical examination by a pediatrician. The clinical severity of the ASD symptoms has been assessed by the Childhood Autism Rating Scale (CARS). Venous blood samples were collected and serum galectin-3 levels were measured. Results: When the ASD and control groups are compared, the mean galectin-3 level is 417.77 (SD = 200.20) in the ASD group and 243.08 (SD = 64.65) in the control group, and there is a statistically significant difference between the groups (p < 0.001). When examining whether there is a correlation between galectin-3 levels and CARS total scores, no statistically significant correlation was found between them (r = 0.015, p = 0.933). Discussion: In this study, we examined whether serum galectin-3 levels have a relation with ASD in childhood or not. Our findings have indicated that the children with ASD have higher serum galectin-3 levels compared to the controls. However, no significant relationship has been found between serum galectin-3 levels and ASD symptom severity.

Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey.

Background: The Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions. Patients and methods: Estrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS. Results: A total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18. Conclusion: This first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS.

Tamoxifen related chorioretinal structural changes.

PURPOSE: To evaluate the vascular structure of the choroid and each retinal layer in patients with breast cancer on tamoxifen therapy and compare them with healthy subjects. MATERIALS AND METHODS: 124 eyes of 62 patients with breast cancer who were on tamoxifen therapy (group 1) and 80 eyes of 40 healthy controls (group 2) were included in this prospective cohort study. The structure of the choroid was evaluated using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and choroidal binarisation. Spectral-domain OCT (SD-OCT) was performed to analyse the peripapillary nerve fibre layer thickness (pRNFL) and each retinal layer thickness. A subgroup analysis was performed based on chemotherapy history in Group 1. All parameters were compared between Group 1 and the healthy controls and between the subgroups of Group 1. RESULTS: The subfoveal choroidal thickness and temporal and nasal directions were increased in Group 1 when compared with Group 2 (p < 0.05, each comparison). Choroidal vascularity index was significantly decreased in Group 1 compared with Group 2 (63.15 ± 3.11% and 65.37 ± 4.63%, p < 0.001). There were no significant differences in each retinal layer, pRNFL thickness, and choroid structural parameters between the subgroups of Group 1. CONCLUSIONS: Increased choroidal thickness may be the initial finding of subclinical tamoxifen-induced retinopathy. Patients with breast cancer undergoing tamoxifen therapy may be screened prior to tamoxifen therapy and followed during treatment by SD-OCT.

Do prognosis and clinicopathological features differ in young early-stage breast cancer?

Background: Breast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young patients. Young age remains a controversial topic in the literature. This study aimed to identify subtype differences and the effect of age on early-stage breast cancer outcomes. Methods: A total of 300 consecutive patients underwent surgery between 2011 and 2015 for early-stage breast cancer. Of these, 248 were eligible for this study and were divided into three groups: group Y (aged ≤35 years), group M (aged >35 and ≤45 years), and group E (aged >45 years). The clinical and pathological features and data related to recurrence, metastasis, and death were recorded. Results: No statistical differences were found between groups regarding histopathological features except for higher histological grade and Ki-67 levels in group M. Additionally, group Y recorded no progression (recurrence or metastasis) or death. Disease-free survival was 117.8 months (95% CI 111.8-123.8) for group M, which was significantly shorter than that for group E (p < 0.001). Additionally, the hazard ratio (HR) for progression from group M to group E was 10.21 with significant difference (p = 0.003, 95% CI 2.26-46.08). However, the HR of group Y to group E was 0.04, without significance (p = 0.788, 95% CI 0.18-345 × 106). The overall 5-year survival was 100% in group Y, 98.8% in group M, and 99.3% in group E, without significance. Conclusion: A very young age cannot be considered an independent risk factor for poor prognosis. Rather than age, histological grade and Ki-67 index are more important factors in early-stage breast cancer.

Favorable locoregional control in clinically node-negative hormone-receptor positive breast cancer with low 21-gene recurrence scores: a single-institution study with 10-year follow-up.

BACKGROUND: Recent studies have shown a lower likelihood of locoregional recurrences in patients with a low 21-gene recurrence score (RS). In this single-institution study, we investigated whether there are any associations between different cutoff values of 21-gene RS, histopathological factors, and outcome in patients with long-term follow-up. METHODS: The study included 61 patients who had early-stage (I-II) clinically node-negative hormone receptor-positive and HER2-negative breast cancer and were tested with the 21-gene RS assay between February 2010 and February 2013. Demographic, clinicopathological, treatment, and outcome characteristics were analyzed. RESULTS: The median age was 48 years (range, 29-72 years). Patients with high histologic grade (HG), Ki-67 ≥ 25%, or Ki-67 ≥ 30% were more likely to have intermediate/high RS (≥ 18). Based on the 21-gene RS assay, only 19 patients (31%) received adjuvant chemotherapy. At a median follow-up of 112 months, 3 patients developed locoregional recurrences (4.9%), which were treated with endocrine therapy alone. Among patients treated with endocrine treatment alone (n = 42), the following clinicopathological characteristics were not found to be significantly associated with 10-year locoregional recurrence free survival (LRRFS): age < 40 years, age < 50 years, high histological or nuclear grade, high Ki-67-scores (≥ 15%, ≥ 20%, ≥ 25%, ≥ 30%), presence of lymphovascular invasion, luminal-A type, multifocality, lymph node positivity, tumor size more than 2 cm, RS ≥ 18, and RS > 11. However, patients with RS ≥ 16 had significantly poorer 10-year LRRFS compared to those with RS < 16 (75% vs. 100%, respectively; p = 0.039). CONCLUSIONS: The results suggest that patients with clinically node-negative disease and RS ≥ 16 are more likely to benefit from adjuvant chemotherapies. However, those with RS < 16 have an excellent outcome and local control in long-term follow-up with endocrine treatment alone.

Impact of preoperative PET/CT for axillary staging in patients with early breast cancer.

BACKGROUND: Preoperative evaluation of axillary lymph node status is very important for the choice of primary treatment in breast cancer. This study assessed predictive properties of positron emission tomography-computerized tomography for axillary lymph node metastasis. METHODS: Patients who were operated between 2014-2019 for early breast cancer and who had preoperative positron emission tomography-computerized tomography images were included. Positron emission tomography-computerized tomography results and histopathologic results were compared retrospectively. RESULTS: Medical records of 223 patients who were operated for early breast cancer and have had positron emission tomography-computerized tomography were evaluated. positron emission tomography-computerized tomography revealed that axillary lymph node status is positive in 97 patients and negative in 126 patients. In histopathological examination, tumor cells were found in 86 patients, of those 27 were negative while 59 were positive in positron emission tomography-computerized tomography. Furthermore, 137 patients were free from tumor cells, in which 99 were negative and 38 were positive in positron emission tomography-computerized tomography. Positive and negative predictive value of positron emission tomography-computerized tomography for metastatic axillary lymph nodes were found 60.8% and 78.5%, respectively. CONCLUSIONS: Clinically, positron emission tomography-computerized tomography has low negative predictivity for determination of axilla in early stage or operable breast cancer. Even though it is valuable for the systematic scanning, positron emission tomography-computerized tomography can be overlooked for axillary evolution. KEY WORDS: Axilla, Breast Cancer, Cancer Staging, PET-CT.

One step nucleic acid amplification (OSNA) for detection of lymph node metastasis during robotic radical prostatectomy for prostate cancer: A pilot study.

INTRODUCTION: The OSNA technique is based on reverse transcription loop-mediated DNA amplification for the detection of cytokeratin 19 (CK19) messen-ger RNA (mRNA). The purpose of our paper, which represents the first study in the literature, is to test the accuracy of this method in the detection of lymph node metastases in patients undergoing robotic radical prostatectomy with lymph node dis-section. METHODS: Our cohort consisted of patients that have undergone robotic radical prostatectomy with extended lymph node dissec-tion. Lymph nodes were evaluated with imprint technique and then with frozen section examination. The remaining tissue was evaluated by OSNA method. Lymph nodes were defined as 'neg-ative' or 'positive' according to mRNA copy number. RESULTS: 7 patients and 25 lymph nodes were included in our cohort. Two patients were found negative with all pathology methods. In one patient the standard stains revealed a suspi-cious outcome but it was positive for micrometastasis with OSNA. In another patient the outcome was positive for standard stains and negative for OSNA. Finally, 2 patients were found positive for OSNA and negative for imprint methods. CONCLUSIONS: One Step Nucleic Acid Amplification (OSNA) method using CK19 seems to fail in detection of lymph node metastases in prostate cancer patients undergoing radical prostatectomy and lymph node dissection.

Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume?

BACKGROUND: This study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. METHODS: Data of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. RESULTS: A significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period (p = 0.024). No statistical significance was found for age, sex, side of the tumor, type of tumor, surgery to breast, and axilla. Following the early period of the pandemic, it was observed that patients with mostly luminal, early-stage, and less axillary nodal involvement (p < 0.05) were admitted, and as a result, it was founded that upfront surgeries increased, although no change in TNM staging was observed. However, it did affect the decision of initial treatment. Thus, the number of upfront surgeries was significantly higher than the NCT group (p = 0.027) following the early period. CONCLUSION: Surgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.

Comparison of PET-CT and MRI for evaluation of axillary lymph nodes in early breast cancer patients.

BACKGROUND: Evaluation of axillary lymph node in women with breast cancer is very important as it can change the initial treatment decision. None of the noninvasive methods used for assessment of axilla is accurate as sentinel lymph node biopsy (SLNB) yet. This study compared the diagnostic performance of 18-fluorodeoxyglucose positron emission tomography/ computed tomography (PET-CT) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) in preoperative axillary evaluation of women diagnosed with early breast cancer (EBC). METHODS: The records of 1246 patients operated for EBC between 2016-2019 were analyzed retrospectively. Pathological evaluations of axillary lymph nodes and the data of these two imaging modalities were analyzed. RESULTS: Forty patients operated for EBC had both DCE-MRI and PET-CT. Axillary metastasis were detected in 12 patients (27.5%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of DCE-MRI/ PET-CT for determining axillary lymph node metastases were 25/66.6%, 75/67.8%, 30/47%, 70/82.6%, and 60/67.5%, respectively. DISCUSSION: Any method has yet reached the performance of sentinel lymph node biopsy in the axillary mapping of patients with EBC. If a clinically EBC patient is suspected of axillary involvement in DCE-MRI or PET-CT (since have low PPV and sensitivity), a biopsy should be performed. KEY WORDS: Breast Cancer, Magnetic Resonance Imaging, Positron Emission Tomography, Staging.

Detachment and embolization of totally implantable central venous access devices: diagnosis and management.

BACKGROUND: Detachment and embolization (DE) is a rare complication of totally implantable central venous access devices (TIVADs). This study aimed to analyze clinical findings, etiology, and treatment options in DE of TIVADs. METHODS: Patients who experienced DE between 2010-2019 were included. Indications, implantation techniques, time to diagnosis, patient complaints, diagnostic methods, rupture site, location of embolization, treatment methods, and chest X-rays prior to detachment were analyzed retrospectively. RESULTS: DE of TIVAD was detected in 12(1.2%) patients. Eleven patients had breast cancer and one had colon cancer. Mean age at implantation was 45.3 ± 9.6(31-61.3) years. Seven (58%) patients were asymptomatic, four (33.3%) had TIVAD malfunction, and one (8.3%) had pain and swelling at port site after injection. Mean time from implantation to diagnosis was 1149.92(16-2795) days. The etiologies comprised Pinch-off Syndrome (POS) in eight (66%) patients, detachment directly adjacent to the lock mechanism in three (25%) patients, and probable iatrogenic injury during explantation in one (9%) patient. The most common site of embolism was the superior vena cava (25%). While the embolized fragment was removed percutaneously in 11 patients, medical follow-up was treatment choice for one patient. CONCLUSIONS: DE is a rare complication with an incidence rate of 1.2% in this study. Since most patients were asymptomatic, chest radiography plays an important role in diagnosis. The most common cause was POS, and it can be prevented by inserting the catheter from lateral third of the clavicle during subclavian vein catheterization. The first-choice treatment was percutaneous femoral retrieval. However, if not technically possible, alternative treatment options are thoracotomy or follow-up with anticoagulant therapy.

Is pseudomyopia associated with anxiety and related disorders?

OBJECTIVES: To investigate in detail the exact relationship between Pseudomyopia, also termed accommodative spasm, and psychiatric disorders. METHODS: Twenty-one young people between the ages of 12-18 who were diagnosed with pseudomyopia between March 2019 and July 2020 in the ophthalmology eye clinic of a university hospital, Turkey were included in the study. A difference of at least 2.20 D between refractive error measurements before and after cycloplegic drop was accepted as pseudomyopia. Scl-90-r symptom screening scale was applied to each case. Afterwards, each case was evaluated by k-sads-pl-dsm-5-t semi-structured technique according to age. The relationship between psychiatric disorders in cases of pseudomyopia was examined. RESULTS: The average age of patients in the study was 15,4 ± 1,9 (12-18), 13 (61,9%) girl and 8 (38,1%) boy. The mean initial refraction was -4,19D ± 2,48D (-1,75D /-8,50D), and the result refraction was +0,38D ± 0,22D (0,25D / -1,00D). The average amount of accommodation was 4,56D ± 2,59D (2,25D / 9,50D). Following the SCL-90-R screening scale and psychiatric evaluation, five generalized anxiety disorders, three obsessive compulsive disorders, three panic disorders, one social anxiety disorder, one posttraumatic stress disorder, one conversion disorder, one major depressive disorder were diagnosed. As a result, 15 (71,4%) of 21 patients were treated with a psychiatric diagnosis. In addition, a positive correlation (p: 0,010-r: 0,621, p: 0,029-r: 0,546) was detected between anxiety- somatization scores and accommodation amount. CONCLUSIONS: It is necessary to request psychiatric consultation in each case of pseudomyopia. Comorbidity of anxiety and depressive disorders is more common in pseudomyopia cases. In addition, as the severity of psychiatric symptoms increases, the amount of accommodation also appears to increase.

Evaluation of Different Intraarticular Injection Therapies with Gait Analysis in a Rat Osteoarthritis Model.

OBJECTIVE: Osteoarthritis (OA) is a degenerative disease that causes serious damage to joints, especially in elderly patients. The aim of study was to demonstrate the effectiveness of intraarticular therapies that are currently used or recently popularized in the treatment of OA. DESIGN: The baseline values were determined by walking the rats on the CatWalk system. Afterwards, a monosodium iodoacetate (MIA)-induced knee OA model was created with intraarticular MIA, and the rats were walked again on the CatWalk system and post-OA values were recorded. At this stage, the rats were divided into 4 groups, and intraarticular astaxanthin, intraarticular corticosteroid, intraarticular hyaluronic acid, and intraarticular astaxanthin + hyaluronic acid were applied to the groups, respectively. The rats were walked once more and posttreatment values were obtained. Nine different dynamic gait parameters were used in the comparison. RESULTS: Significant changes were measured in 6 of the 9 dynamic gait parameters after the MIA-induced knee OA model. While the best improvement was observed in run duration (P = 0.0022), stride length (P < 0.0001), and swing speed (P = 0.0355) in the astaxanthin group, the results closest to basal values in paw print length (P < 0.0001), paw print width (P = 0.0101), and paw print area (P = 0.0277) were seen in the astaxanthin + hyaluronic acid group. CONCLUSION: Astaxanthin gave better outcomes than corticosteroid and hyaluronic acid in both dynamic gait parameters and histological examinations. Intraarticular astaxanthin therapy can be a good alternative to corticosteroid and hyaluronic acid currently used in intraarticular therapy to treat OA.

Comparison of a manual walking platform and the CatWalk gait analysis system in a rat osteoarthritis model.

BACKGROUND: Effects of osteoarthritis (OA) are observed in experimental animal models using different gait analysis systems. OBJECTIVES: The aim of this study was to determine whether the Noldus CatWalk XT v. 10.9 gait analysis system (CatWalk) device can be used effectively in a chemically induced rat OA model and to reveal the strengths and weaknesses of the system compared to manual gait analysis. MATERIAL AND METHODS: Ten Wistar rats were run on a manual walking platform as well as on the CatWalk and the basal values were recorded. For OA induction, monosodium iodoacetate (MIA) was injected into the left knee of all rats under anesthesia. After a period of 4 weeks for OA development, the rats were again run on both the manual and CatWalk gait platforms. For manual gait analysis, the stride length, paw print width and paw print length were measured on both knees. In addition to these parameters, the average run speed, run duration, maximum contact intensity, paw print area, mean stance, and swing speed were measured on the left knee (affected knee) using the CatWalk device. RESULTS: Significant differences were observed in the stride width (p = 0.0272), left stride length (p = 0.0344), and left paw print length (p = 0.0233) recorded before and after OA via the manual walking platform. For CatWalk, a significant difference was detected in the left knee's average run speed (p = 0.0010), maximum contact intensity (p = 0.0155), paw print length (p = 0.0058), paw print width (p = 0.0324), and swing speed (p = 0.0066) based on data obtained before and after OA. CONCLUSIONS: The CatWalk gait analysis system is suitable for the evaluation of OA rat models and related interventions. It also provides additional parameters compared to the manual system and minimizes human-related variation.