Ocular biometry characteristics and its relationship with age, gender, spherical equivalent in Turkish children.

Background: Studying ocular biometric parameters in different populations and determining the relationship with personal characteristics can provide valuable information about ocular growth and help provide a better understanding of refractive errors. Aims: To describe distributions of ocular biometry and to evaluate its associations with age, gender, spheric equivalent in Turkish children. Patients and Methods: In this prospective study 344 children aged 3-14 years were evaluated. Parameters studied included axial length (AL), anterior chamber depth (ACD), and mean corneal radius (CR) measured with optical biometry. Cycloplegic refraction values were obtained using autorefractometer. The change of biometric parameters according to age and gender were evaluated. The relationship between ocular biometry parameters with refraction and age was analyzed by linear regression. Results: Mean spherical equivalent (SE), AL, ACD and AL/CR observed to be lowest in the preschooler group (P < 0.001). SE reduced with age, and a weak correlation observed between SE and age (r = -0.333). AL and ACD had moderate and weak positive correlations with age respectively (r = 0.511; r = 0.304). There were negative correlations between SE with AL, ACD and AL/CR (r = -0.826; r = -0.540; r = -0.886). The strongest correlation with SE among these parameters was identified for AL/CR. AL and ACD were higher in boys, while the CR was lower in girls (p < 0.001). Conclusion: While AL in children in late schooler group is higher than European countries, it shows similar characteristics in early schooler group. In addition AL is lower in all age groups than Asian population sexcept preschooler group. With age AL increases, SE decreases and AL plays a key role in refractive development.

Alteration of inflammation marker levels with alfa keto analogs in diabetic rats.

Background: Diabetes mellitus is the most well-known and common cause of end-stage renal disease. Excessive inflammatory processes were hypothesized to be one of the reasons for progression to end-stage disease. Even though progression to end stage disease tried to be prevented with some dietary measures such as lowering nitrogen in diet, none of the methods tried were successful enough. Aims: In our study, we aimed to determine the effects of alfa keto analog use in altering levels of inflammatory markers when added to dietary program in a diabetic rat model. Patients and Methods: The study was performed on 22 male Sprague Dawley rats with streptozocine induced diabetic nephropathy. Both groups were fed with low protein diet except for study group with added alfa keto analogs. Biochemical values and inflammatory markers were studied with ELISA assay. Results: Significant difference in serum albumin was found between study group and control group following administration of alfa keto analogs (p <.001). Also mentioned dietary modification made a significant difference in suppression of inflammatory reactions for interleukin (IL)-1, IL-6, IL-10, IL-18 and tumor necrosis factor-α. Conclusion: Adding keto amino acids to diets that are already low on protein, can slow progression to end-stage renal disease by reducing inflammation and protein loss in an animal model.

Asset price dynamics for a two-asset market system.

We present a mathematical model for a market involving two stocks which are traded within a single homogeneous group of investors who have similar motivations and strategies for trading. It is assumed that the market consists of a fixed amount of cash and stocks (additions in time are not allowed, so the system is closed) and that the trading group is affected by trend and valuation motivations while selling or buying each asset, but follows a strategy in which the buying of an asset depends on the other asset's price while the selling does not. By utilizing these assumptions and basic microeconomics principles, the mathematical model is obtained through a dynamical system approach. We analyze the stability of equilibrium points of the model and determine the conditions on parameters for stability. First, we prove that all equilibria are stable in the absence of a clear emphasis on a trend-based value for each stock. Second, for systems in which the group of traders attaches importance to the valuation of one stock and the trend of the other stock for trading, we establish conditions for stability and show with numerical examples that when instability occurs, it is exhibited by oscillations in the price of both stocks. Moreover, we argue the existence of periodic solutions through a Hopf bifurcation by choosing the momentum coefficient as a bifurcation parameter within this setting. Finally, we give examples and numerical simulations to support and extend the analytical results. One of the key conclusions for economics and finance is the existence of a cyclic behavior in the absence of exogenous factors according to the momentum coefficient. In particular, an equilibrium price that is stable becomes unstable as the trend based trading increases.

A comprehensive survey of natal and neonatal teeth in newborns.

OBJECTIVE: To evaluate clinical and histological characteristics and determine the incidence of natal/neonatal teeth in a large Turkish population. SUBJECTS AND METHODS: Among 17,829 newborns, who were hospitalized at the Neonatal Clinic of a governmental Children's Hospital between 2005 and 2011, 27 neonates were diagnosed with erupted teeth, which were examined in terms of location, clinical appearance and mobility. Besides histological evaluation, a positive family history was also recorded. The variables were analyzed using Chi-square test. RESULTS: Thirty-two natal/neonatal teeth were observed in 27 infants. The incidence of both natal and neonatal teeth was found to be 1:660, while the incidences were separately recorded as 1:1,048 and 1:1,782, respectively. The histological examination revealed a thin hypoplastic enamel layer and a normal dentin layer. There was no difference between the two genders in terms of natal/neonatal tooth type, positive family history and tooth morphology (p > 0.05); or between normal and conical shapes with regard to natal/neonatal tooth type, positive family history and tooth color (p > 0.05). CONCLUSIONS: This study exhibited a higher incidence in natal teeth than neonatal teeth. Macroscopic features were not found to be positively related to gender and tooth type.

Protection with thymoquinone against formaldehyde-induced neurotoxicity in the rats.

INTRODUCTION: This study aimed to investigate the neurotoxic damage of formaldehyde (FA), which is commonly used in medicine and industrial fields, for the hippocampus of rats and the protective role of thymoquinone (TQ) against this neurotoxicity. METHODS: There were five groups with eight rats in each. Two control groups were formed, in one of them physiological saline was applied and in the other one corn oil was applied. FA was injected in Group 3. Group 4 was exposed to FA and TQ simultaneously. Group 5 received TQ only. At the end of the experiment animals were sacrificed and brain tissues were removed for biochemical and histopathological investigation. RESULTS: catalase (CAT), glutathione peroxidase (GSH-px) and superoxide dismutase (SOD), all known as enzymes with antioxidant activities, were increased in FA and TQ simultaneously administered group. FA caused prominent subarachnoidal hemorrhage and vacuolization. Vacuolization was not observed but occasional subarachnoidal hemorrhage was detected in the FA+TQ group. CONCLUSION: Neurotoxic damage in hippocampus induced by FA was reverted by administration of TQ (Tab. 1, Fig. 1, Ref. 26).

Reliable single sperm cryopreservation in Cell Sleepers for azoospermia management.

Conventional sperm freezing methods perform best when freezing sperm samples containing at least hundreds of spermatozoa. In this severe male factor infertility case series, we examined the reproductive outcomes in 12 intracytoplasmic sperm injection cases where spermatozoa used were frozen in Cell Sleepers. Cell Sleepers are novel devices in which individual spermatozoa can be frozen in microdroplets. The case series included five men with obstructive azoospermia, six with nonobstructive azoospermia and one with cryptozoospermia, in whom microscopic sperm retrievals from testicular sperm extraction (TESE), micro-TESE extracts and a centrifugation procedure resulted in less than 50 spermatozoa. A total of 304 microscopically retrieved spermatozoa were frozen in 20 Cell Sleepers using a rapid manual cryopreservation method. A total of 179 mature oocytes were injected with recovered thawed spermatozoa, resulting in a fertilisation rate of 65.9% (118 of 179), with no total fertilisation failures. In 10 cases, an embryo transfer was performed, three on day 3 and seven on day 5, resulting in a per cycle pregnancy rate of 58.3% (seven of 12). Four of the pregnancies have progressed past 20 gestation weeks. The recovery and use of spermatozoa that were frozen in Cell Sleepers was uncomplicated and effective and eliminated the need to perform any microscopic sperm retrieval procedures on the day of oocyte collection. Modification of the routine sperm cryopreservation methodology to include the use of Cell Sleepers increases the range of sperm samples that can be effectively cryopreserved, to include men with severe male factor fertility.

Temperature rises in the round window caused by various light sources during insertion of rigid endoscopes: an experimental animal study.

OBJECTIVES: The instruments used in endoscopic surgery include rigid endoscopes of different diameters and angles, sources of light and monitors. In this study, we explored temperature rises in the round window caused by insertion of rigid endoscopes of different diameters into the middle ear; the endoscopes were fitted with different light sources. DESIGN: An experimental animal study. SETTING: We subjected seven guinea pigs to simulate otological surgery at room temperature. We monitored body temperatures, along with temperature rises caused by the use of 0° rigid endoscopes of diameters 3 or 4 mm, fitted with light sources including a halogen light, a light-emitting diode (LED) and a xenon light. Data were collected every second from a sensor placed in the round window. PARTICIPANTS: An experimental study on 7 guinea pigs. MAIN OUTCOME MEASURES: Rise of the temperature on round window. RESULTS: Rigid endoscopes caused the temperature of the tympanum to rise when xenon and halogen light sources were used, regardless of endoscope diameter. However, the temperature rise was less when a LED light source was employed. CONCLUSION: The endoscopic instruments used in middle ear surgery caused the temperature of the round window to rise. The rise varied with endoscope diameter and the type of light source used.

The limbic degradation of aging brain: a quantitative analysis with diffusion tensor imaging.

INTRODUCTION: The limbic system primarily responsible for our emotional life and memories is known to undergo degradation with aging and diffusion tensor imaging (DTI) is capable of revealing the white matter integrity. The aim of this study is to investigate age-related changes of quantitative diffusivity parameters and fiber characteristics on limbic system in healthy volunteers. METHODS: 31 healthy subjects aged 25-70 years were examined at 1,5 TMR. Quantitative fiber tracking was performed of fornix, cingulum, and the parahippocampal gyrus. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements of bilateral hippocampus, amygdala, fornix, cingulum, and parahippocampal gyrus were obtained as related components. RESULTS: The FA values of left hippocampus, bilateral parahippocampal gyrus, and fornix showed negative correlations with aging. The ADC values of right amygdala and left cingulum interestingly showed negative relation and the left hippocampus represented positive relation with age. The cingulum showed no correlation. The significant relative changes per decade of age were found in the cingulum and parahippocampal gyrus FA measurements. CONCLUSION: Our approach shows that aging affects hippocampus, parahippocampus, and fornix significantly but not cingulum. These findings reveal age-related changes of limbic system in normal population that may contribute to future DTI studies.

Can M-30, M-65, and IL-6 serum levels be useful markers in the diagnosis of preeclampsia and gestational diabetes?

OBJECTIVE: We aimed to evaluate the maternal and fetal serum M-30, M-65 and IL-6 levels in preeclampsia and gestational diabetes mellitus (GDM) in both maternal and cord blood. PATIENTS AND METHODS: Women with preeclampsia (n=30), GDM (n=30), and uncomplicated pregnancy (n=28) were evaluated in a cross-sectional study. After clamping during delivery, the serum M-30, M-65, and IL-6 levels were measured in both maternal venous blood and cord blood. RESULTS: The serum M-30, M-65, and IL-6 levels were significantly higher in preeclampsia and GDM patients' maternal blood and cord blood samples compared to the control group. In the preeclampsia group, M-65 was significantly higher in cord blood compared with the level in maternal serum, but there was no significant difference between the GDM and control groups. The control group's IL-6 level in cord blood was statistically significantly lower than the other groups. Although the M-30 value in both maternal and cord blood was statistically lower in the control group than in the GDM group, there was no significant difference between the two groups when compared to the preeclampsia group. CONCLUSIONS: M-30 and M-65 molecules appear to have the potential to serve as biochemical markers in placental diseases, particularly preeclampsia and gestational diabetes. Due to the insufficient sample sizes, more research is needed.

Use of multiparametric magnetic resonance imaging as a screening tool for the determination of acute ischemic stroke duration.

OBJECTIVE: This study aimed to assess the usability of magnetic resonance imaging (MRI) parameters in the treatment of stroke patients whose symptom onset time is unknown. PATIENTS AND METHODS: We evaluated MRI of the patients whose stroke symptoms began within 12-hours. For quantitative analysis, fluid-attenuated-inversion-recovery (FLAIR) and diffusion-weighted-imaging (DWI) signal-intensity-ratios (SIR) of the lesions were computed. For qualitative analysis, 'mismatch' between visibility of lesion on DWI-FLAIR was evaluated. Patients were analyzed according to the first 4.5/6 hours of stroke onset time. RESULTS: There was a moderate (r=0.569, p<0.001) correlation between symptom MRI time and FLAIR SIR and a weak correlation with DWI SIR (r=0.355, p=0.001). A FLAIR SIR threshold of ≤1.18 for predicted symptom onset 4.5 hours increased specificity (0.77 vs. 0.74) and sensitivity (0.77 vs. 0.69) as compared with visual analysis. A FLAIR SIR threshold of ≤1.19 for predicted symptom onset 6 hours increased sensitivity (0.76 vs. 0.67) and equal specificity (0.75 vs. 0.75) as compared with visual analysis. CONCLUSIONS: In hyperacute ischemic stroke, lesion age can be determined more accurately by the FLAIR SIR analysis than visual analysis. In patients whose stroke onset time is unknown, the FLAIR SIR can be used as a biomarker in the management of stroke patients.

Lack of association between catalase gene polymorphism (T/C exon 9) and susceptibility to vitiligo in a Turkish population.

Accumulation of hydrogen peroxide (H(2)O(2)) and low catalase (CAT) activity have been demonstrated in the epidermis of vitiligo patients. We investigated a possible association between the CAT exon 9 (Asp-389) gene and vitiligo susceptibility in the Turkish population. Thirty-four patients with vitiligo and 49 gender, age and ethnic matched controls were enrolled in the study. Genotyping was done by PCR-RFLP. The CAT exon 9 (Asp-389) genotype and allele frequencies of vitiligo patients did not differ significantly from those of healthy controls. We found no association between CAT (Asp-389) gene polymorphism and vitiligo susceptibility in Turkish vitiligo patients.

Zero to five years: First dental visit.

AIM: The aim of this study is to determine the age and most common reasons of the first dental visit among preschool children, taking into account family income and parental education in Turkey. METHODS: This cross-sectional study was conducted in a state dental hospital on 519 children aged 0-5 years who had their first dental visit with no previous dental experience. Data on age and reasons for the first dental visit of the children and parent relevant data on family income, educational level, dental visit frequency, and satisfaction about the oral health care information was collected by means of a questionnaire. RESULTS: Of the 519 children of the study, 47.4% were males and 52.6% were females. The mean age of first dental visit was 3.62±1.32 and 2.9% of the children had been visited under the age of 1 year. Pain (36.4%) was the main reason for the visit followed mostly by check-up (23.1%), other reasons (21.4%), and decay noted by parents (15.6%). There was no referral from paediatricians. Parental educational level was not found as an impact factor for the reasons and the age of the visit (p=0.394; p=0.245). Children of low-income-family were more likely to have dental visit due to pain (p=0.002). The frequency of parents' dental visits was not a determinant factor for the reason and the age of the child's visit (p>0.05; p>0.05). All the parents were satisfied with the oral health information. CONCLUSION: It is necessary to raise awareness about early dental visits and oral health care among parents and paediatricians.

A step to infant oral health promotion intervention among parents.

AIM: Providing oral health care to children from infant to toddler age can be achieved by educating and informing parents about their children’s oral health. The aims of this study were to determine the basic knowledge of oral health and to evaluate the efficacy of an infant oral health education programme among parents in Turkey. METHODS: Study Design: One hundred and fifty parents of infants between 3 and 12 months of age attending the well-baby clinic, Dr. Behcet Uz Children’s Hospital (Izmir, Turkey), participated in the study. A pre-test questionnaire was administered to each parent to assess their infant oral health knowledge. The educational intervention was in the form of a 30-minute interactive explanation of a PowerPoint presentation. The parents completed a post-test after the education in the same session (a questionnaire was administered). RESULTS: The range of correct answers on the pre-test was 7–20 of 26 with a mean of 13.7 (SD=2.76). The range of correct answers on the post-test was 12–26 of 26 with a mean of 21.2 (SD=3.34). The difference of correct responses between before and after education was found to be statistically significant (p<0.01). CONCLUSION: Under the conditions of this study, educational presentation improved parents’ knowledge on infant oral health care and provided anticipatory guidance.

Protective effects of caffeic acid phenethyl ester and thymoquinone on toluene induced liver toxicity.

Toluene is an organic solvent that is toxic to humans. Caffeic acid phenethyl ester (CAPE) and thymoquinone (TQ) exhibit antioxidant and antitoxic effects. We investigated the protective effects of CAPE and TQ on toluene induced hepatotoxicity. Wistar albino rats were divided into seven groups of eight. The animals were injected intraperitoneally (i.p.) with 0.1 ml/10 g/day corn oil (control I), 0.1 ml/10 g/day corn oil + 2 ml/kg/day 10% ethanol (control II), 20 mg/kg/day TQ dissolved in 0.1 ml/10 g corn oil (TQ), 10 µmol/kg/day CAPE dissolved in 10% ethanol (CAPE), 500 mg/kg/day toluene (T), toluene and TQ together (T + TQ), or toluene and CAPE together (T + CAPE). All rats were sacrificed on day 15. Liver samples were obtained for histological analysis. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were measured to evaluate liver function. Liver sections from the control I and TQ groups exhibited normal histology. Sections from the T group exhibited sinusoid dilation, hemorrhage, vacuolization and necrosis. TQ and CAPE protected against toluene induced histopathological changes. AST and ALT levels were increased significantly in T group compared to both control groups. CAPE decreased significantly the toluene induced increase in AST and ALT levels, while TQ did not. CAPE and TQ exhibited some antitoxic and hepato-protective effects on toluene induced liver damage.

Effects of Oenothera biennis L. and Hypericum perforatum L. extracts on some central nervous system myelin proteins, brain histopathology and oxidative stress in mice with experimental autoimmune encephalomyelitis.

We investigated the effects of Oenothera biennis L. and Hypericum perforatum L. extracts on brain tissue histopathology, myelin oligodendrocyte glycoprotein (MOG), myelin basic protein (MBP), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) in mice with experimental autoimmune encephalomyelitis (EAE). Forty-seven C57BL/6J mice were divided into the following groups: multiple sclerosis (MS), control (healthy mice), MS + H. perforatum treated (MS + HP), MS + O. biennis treated (MS + OB). All groups except the control group were immunized by EAE methods. Two weeks after the immunization, the mice in the MS + HP group were fed normal food containing 18 - 21 g/kg H. perforatum extract, the mice in MS + OB group were fed normal food containing 18 - 21 g/kg O. biennis extract, and the mice in control and MS groups were fed normal food for six weeks. Brain tissue samples were collected from all mice for histopathological and biochemical analysis. Clinical signs of the disease were scored using functional systems scores (FSS) daily. The H. perforatum and O. biennis extracts ameliorated the increased brain tissue MOG and MBP values for animals with MS. H. perforatum and O. biennis extract decreased the TOS and OSI values for brain tissue and increased TAS levels in brain tissue of animals with MS. In addition, H. perforatum and O. biennis extracts decreased the clinical signs at the end of the experiment compared to the beginning of extract administration. We found that myelin was lost in MS group vs. control group. H. perforatum and O. biennis extract treatments decreased the amount of myelin loss in the MS + HP and MS + OB groups. We also observed amyloid deposition on vascular walls, in the cytoplasm of the neurons and in the intercellular space in the MS group. O. biennis and H. perforatum treated groups exhibited neither abnormal amyloid deposition nor obvious cell infiltration. The beneficial effects of O. biennis and H. perforatum for attenuating myelin loss and amyloid deposition suggest their therapeutic utility for treatment of MS.

Vascular endothelial growth factor production by rat granulated metrial gland cells and their morphological features in normal and pathological conditions.

Granulated metrial gland (GMG) cells are pregnancy-specific cells that may have many functions in successful placentation and pregnancy. In the present study, changes in the rat GMG cell structure, distribution and vascular endothelial growth factor (VEGF) expression during early pregnancy were evaluated by light microscopy. Implantation sites taken from females with spontaneous abortion were also investigated. On Day 7 of pregnancy, GMG cells were distributed through the implantation and interimplantation sites. They formed metrial glands in the mesometrial triangle on Day 9, and were observed in the decidua basalis on Day 14 of pregnancy. Avidin-biotin complex immunohistochemistry revealed that GMG cells showed moderate staining for VEGF at the beginning of pregnancy and intense staining on Days 9 and 10 of pregnancy. They were localised mostly near the newly formed blood vessels. The implantation sites from spontaneously aborting females showed numerous leucocytes in the lumen of mesometrial blood vessels. In spontaneously aborting females, GMG cells showed a distinct morphology, increased in number and volume, their granules were denser and degranulation was observed. These results suggest that rat GMG cells might be a guide for placental angiogenesis and they might share a role with leucocytes in pathological conditions.

Effects of melatonin on both testicular regeneration and recovery of spermatogenesis in busulfan-treated rats

Abstract Testicular damage is one of the most hazardous effects of chemotherapy as it is frequently associated with oligozoospermia and azoospermia. This study aimed at evaluating the protective effect of melatonin in a rat model of busulfan-induced testicular injury. Rats were divided into four groups: control, melatonin, busulfan, busulfan plus melatonin. After 15 days, the semen was collected from the epididymis and testes were assessed. Sperm removed from cauda epididymis and analyzed for sperm count and viability. Testis tissues were also removed, fixed in formalin and were embedded in paraffin. Sections of testis tissue were stained with hematoxylin-eosin for histological examination and prepared for TUNEL (Terminal deoxynucleotide transferase dUTP Nick End Labeling) assay to detect apoptosis and PCNA (proliferating cell nuclear antigenassay) to detect proliferation cells. Serum and testes supernatants were separated to detect testosteron level and oxidative stress parameters. In histological examination, degenerative changes in seminiferous tubules were observed in the experimental groups. In biochemical examination, the total oxidant status (TOS) levels in Busulfan group were significantly higher than in the control group while the total antioxidant status (TAS) levels of all the groups were similar. In conclusion, the beneficial properties of melatonin treatment by its potent anti-oxidants may reduce adverse effects of chemotherapy in the reproductive system in a rodent system.

The effect of mechanical bowel preparation on colonic anastomotic healing: an experimental study.

PURPOSE: Although bowel preparation is traditionally used in elective colorectal surgery, its value is debatable. The aim of this study was to evaluate the influence of mechanical bowel preparation on healing of colonic anastomoses. MATERIAL AND METHODS: Twenty-seven rats were divided into three groups, each of nine animals. All rats had left colonic resection and anastomosis. Group 1 and group 2 were the control and sham group, respectively. Group 3 had colonic lavage before resection and anastomosis. On the fourth postoperative day, animals were killed; bursting pressure and tissue hydroxyproline concentrations were measured and compared. RESULTS: The median bursting pressure values were 87 (range 4-135) mmHg in group 1, 88 (range 78-136) mmHg in group 2 and 76.0 (range 57.0-125) mmHg in group 3. The differences between bursting pressure values of the groups were not statistically significant (p= 0.07). The median tissue hydroxyproline concentrations were 3.25 (range 2.63-5.16) mg/mg in group 1, 4.15 (range 1.54-5.72) mg/mg in group 2 and 3.52 (range 2.04-5.27) mg/mg in group 3. The differences between tissue hydroxyproline concentrations of the groups were not statistically significant (p = 0.7). CONCLUSION: Mechanical bowel preparation is not necessary for enhancing colonic anastomotic integrity in the rat.

The prognostic significance of total lymph node number in patients with axillary lymph node-negative breast cancer.

AIM: In node-negative breast cancer patients, several factors for survival have been evaluated and currently, some of them are accepted for their prognostic and/or predictive values after validation in the separate data sets. The prognostic significance of increases in the number of pathologically detectable axillary lymph nodes in the node-negative patients could not been established clearly. To address this question, we have reviewed our patients' records. METHODS: A retrospective cohort study was conducted in pathologically node-negative patients who underwent modified radical mastectomy for stage I and II breast cancer. Survival and multivariate prognostic factor analyses were carried out to determine whether the number of tumour-free lymph nodes in complete axillary dissection material in addition to known factors was significant for the outcomes. RESULTS: Two hundred and seventy consecutive patients were eligible to enter the trial. The median observation time and the median number of tumour-free lymph nodes were 61 (from 30 to 120) months and 18 (from 10 to 44), respectively. The cohort was divided into the groups according to the number of nodes. The 5-year event-free and overall survivals were 92.5 and 98.3% for patients who had 18 lymph nodes or less, and 70 and 86.7% for those who had more than 18 negative nodes, respectively (P < 0.00001). Multivariate analysis for event-free survival demonstrated that the number of lymph nodes (Relative risk: 3.2 and 95% confidence interval: 1.7 to 5.9) in addition to the pathological tumour size and age was the most important independent prognosticator. In similar, multivariate analysis for overall survival showed that the number of lymph nodes together with the tumour size was the significant indicator (RR of cancer-specific dying in patients who had more than 18 nodes: 3.1 and 95% CI: 1.2 to 8.5). CONCLUSION: The increases in number of tumour-free lymph nodes are clinically important and this parameter should be taken into consideration in the breast cancer patients without metastatic lymph nodes.