P-glycoprotein polymorphism and levothyroxine bioavailability in hypothyroid patients.

OBJECTIVES: P-glycoprotein (P-gp) contributes to the disposition of a wide variety of drugs; therefore, single nucleotide polymorphisms (SNPs) in the P-gp coding gene might affect its activity. It is well known that personalized medicine, instead of empirical treatment, is a clinically important approach for enhancing responses among patients. Indeed, there is a need to evaluate the association between SNPs of P-gp encoded multidrug resistance genes (MDR1, ABCB1), and the dosage requirements of these drugs. In the present study, we evaluated the association between the dosage of Levothyroxine (L-T4) and three common SNPs (C1236T, G2677T/A and C3435T). METHODS: Genotyping was done using a real-time PCR platform with DNA samples isolated from the venous blood of ninety post thyroidectomy hypothyroid patients. Thyroid hormone levels were measured as routine biochemistry laboratories in the Medical School of Istanbul University. RESULTS: In the genotype analysis, the minor allele frequencies were 0.48 for C1236T, 0.51 for G2677T/A, and 0.51 for C3435T. In the haplotype-based analysis, T1236T2677T3435 and C1236G2677C3435 were observed as major haplotypes (50.2 and 32.6%, respectively), in agreement with previous studies. The administered dose of L-T4 to achieve physiological thyroid hormone levels was found to be similar in all genotypes and haplotypes, indicating that there is no significant association between MDR1 polymorphisms and L-T4 doses. CONCLUSION: Because of conflicted previous reports about the genetic contribution of MDR1 polymorphisms to drug disposition, further studies with large numbers of participants are required to clarify this influence.

Effects of mesenchymal stem cells and VEGF on liver regeneration following major resection.

PURPOSE: The study aims to determine the effects of mesenchymal stem cell (MSC) therapy and a combination therapy of MSCs transfected with vascular endothelial growth factor (VEGF) for liver regeneration after major resection. METHODS: Thirty-eight rats were divided into four groups: group 1: control (sham operation); group 2: control (70 % hepatic resection); group 3: 70 % hepatic resection + systemically transplanted MSCs; and group 4: 70 % hepatic resection + systemically transplanted MSCs transfected with the VEGF gene. MSCs were injected via the portal vein route in study groups 3 and 4. Expression levels of VEGF, fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), transforming growth factor (TGF), hepatocyte growth factor (HGF), and augmenter of liver regeneration (ALR) were analyzed in the remnant liver tissue. We investigated the levels of angiogenic factors, VEGF-receptor, angiopoietin-1 (Angpt1) and Angpt2. Biochemical parameters of liver function in blood samples were measured and a histologic assessment of the livers was performed. The postoperative liver weight and volume of each rat were measured 14 days after surgery. RESULTS: The expression levels of all measured growth factors were significantly increased in groups 3 and 4 compared to the control groups. The levels of Angpt1 and Angpt2 correlated with levels of VEGF and thus were also significantly higher in the study groups. There were significant differences between the estimated liver weights and volumes of group 4 and the resected controls in group 2. With the exception of portal inflammation, levels of all histological parameters were observed to be higher in MSC-treated groups when compared with the resected controls in group 2. CONCLUSIONS: Transplanted stem cells and MSCs transfected with VEGF significantly accelerated many parameters of the healing process following major hepatic resection. After the injection of MSCs and VEGF-transfected MSCs into the portal vein following liver resection, they were engrafted in the liver. They increased bile duct and liver hepatocyte proliferation, and secreted many growth factors including HGF, TGFß, VEGF, PDGF, EGF, and FGF via paracrine effects. These effects support liver function, regeneration, and liver volume/weight.

Effect of hyperbaric oxygen treatment on pilonidal disease surgery.

Surgical excision and lay-open is a well-known technique for the treatment of sacrococcygeal pilonidal disease, which impairs a patient's quality of life considerably since wound healing takes a substantial amount of time. It is known that with this method total healing period is longer, but recurrence rate of the disease is lower. The beneficial effects of hyperbaric oxygen (HBO2) therapy on wound healing have been well established since it was first put into in clinical use. The purpose of this prospective randomized clinical trial was to investigate the effects of HBO2 therapy on wound healing in the patients who had sacrococcygeal pilonidal disease and surgical treatment. Total epithelialization times of 12 patients (Group 1) who received surgical intervention were compared with those of 10 patients who had surgical intervention and HBO2 therapy (Group 2). In both groups excised tissue volume, excised skin area, body mass index, blood hemoglobin, albumin levels, ages and duration of the complaints were recorded and there was no statistically significant difference in these parameters except albumin levels when compared. The complete epithelialization time was significantly shorter in Group 2 (50 ± 11 vs. 83 ± 18, p⟨0.001). We conclude that HBO2 had beneficial effects on wound healing, in the patients who had sacrococcygeal pilonidal disease and were treated with surgical excision applying lay-open technique.

Comparison of phenol matricectomy and nail-splinting with a flexible tube for the treatment of ingrown toenails.

BACKGROUND: The treatment of ingrown toenail is usually bothersome for patients and doctors. OBJECTIVES: To compare two treatment techniques of ingrown toenails-phenol matricectomy (PM) and nail-splinting using a flexible tube (FT)-in terms of efficacy, postoperative pain, postoperative cosmetic satisfaction, amount of tissue damage, and recurrence. METHODS AND MATERIALS: One hundred twenty ingrown toenails were randomized and divided into PM and FT groups. All cases were evaluated 2 days and 1 and 6 months after treatment. Postoperative pain, cosmetic satisfaction, time to recovery, and recurrence rate were measured. RESULTS: Postoperative pain was less and cosmetic satisfaction was good in both groups (p <.001). Our recurrence rate was 8.4%. There were no statistical differences between groups in these measures. Tissue improvement rate was 6% in the PM group and 93% in the FT group 2 days after the procedures (p <.001). CONCLUSIONS: Although FT provides faster recovery and less postoperative morbidity than PM, the techniques are equally effective in treating ingrown toenails.

Could serum ß-hCG levels and gestational age be the indicative factors for the prediction of the degree of trophoblastic invasion into tubal wall in unruptured ampullary pregnancies?

OBJECTIVE: To evaluate the predictive value of gestational age and maternal serum ß-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. METHODS: This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum ß-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). RESULTS: There was a significant difference in maternal serum ß-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum ß-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. CONCLUSION: The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum ß-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high ß-hCG concentrations.

Differences in Mucociliary activity of volunteers undergoing Ramadan versus Nineveh fasting.

This study, aimed to evaluate the difference in mucociliary clearance among volunteers who underwent Ramadan versus Nineveh fasting regimens as well as the difference between the fasting period and 4 weeks following the fasting period in both groups. In this study, two different fasting groups were established: Ramadan (fasting for an average of 15 h for 29 consecutive days, n = 40) and Nineveh (60 h of nonstop fasting, n = 26). Subjects in each group underwent saccharin testing twice: at the end of the fasting period prior to resumption of eating and at 4 weeks after the end of Ramadan or Nineveh fasting. Statistical analysis was performed using the Mann-Whitney U-test, Wilcoxon, Chi-square, and paired t test. A p value less than 0.05 was considered statistically significant. Forty subjects who underwent Ramadan fasting and 26 subjects who underwent Nineveh fasting were included in this study. Of the 66 study participants, 34 (51.5 %) were men and 32 (48.5 %) were women. Their median age was 31 years (range 17-70 years) for Nineveh fasting subjects and 40 years (range 17-70 years) for Ramadan fasting subjects. Chi-square tests revealed no significant difference between the Ramadan and Nineveh fasting groups in gender (p = 0.418), and the Mann-Whitney U-test showed no difference in age. A statistically significant difference was found in the mucociliary clearance time between the Nineveh fasting and non-fasting periods (p = 0.013). Using Wilcoxon signed-rank tests, we found no significant difference in the mucociliary clearance time between the Ramadan fasting and control (4 weeks after the fasting period) periods (p = 0.121). The percentage difference between the fasting and control periods was similar between groups and was not statistically significant for the Ramadan and Nineveh fasting groups (p = 0.086). The results of the present study indicated that long-term fasting with hypohydration contributed to the deterioration of nasal mucociliary clearance. Our data indicate that optimal hydration, sleep patterns, and fasting times contribute to proper mucociliary clearance.

The assessment of high sensitivity C-reactive protein as a systemic marker in moderate asthma patients and changing levels by inhaled corticosteroids.

OBJECTIVES: To see if high-sensitivity C-reactive protein levels increase even in the early stages of asthma, and to evaluate if corticosteroid therapy affects the levels in asthma patients. METHODS: The case-control pilot study was conducted at Yedikule Chest Disease and Surgery Education and Research Hospital, Turkey, from February to April 2011. Patients newly diagnosed with asthma who reported symptoms that occurred six months before diagnosis were included in the study.The protein levels were measured pre-treatment and one month post-treatment. In addition, pulmonary function test and total Immunoglobulin-E measurements were taken and the prick test was performed. Statistical analysis was done using SPSS 15. RESULTS: There were 15 cases; 8 (53%) females and 7 (47%) males. Besides, there were 19 Controls; 9 (47%) females and 10 (53%) males. The mean age of the Cases was 29.13+/-10.30 years, while for the Controls it was 28.9+/-5.35 years. The difference was not statistically significant (p<0.54). The difference in protein levels pre and post-treatment was not significant. However, a higher level in the pre-treatment period was found compared to the Controls. Posttreatment levels in the Cases were not significantly different than the Controls. CONCLUSION: Elevated high-sensitivity C-reactive protein levels in asthmatic patients may indicate an increased risk for cardiovascular disease. Future studies in asthma patients should focus on this relationship.

Alpha-1 protease inhibitor and antichymotrypsin levels in acute pancreatitis.

BACKGROUND: Acute pancreatitis with high mortality of severe onset is still a major problem in medicine. Early identification of the severity of the disease is critical for effective treatment. Many markers have been tried and are still being tested. The ideal marker should be able to identify the cases and distinguish between mild and severe. METHODS: This prospective study included 34 cases (14 males, 20 females, mean age: 58 years) of acute pancreatitis and 33 cases (17 males, 16 females, mean age: 53 years) as a control group. Mild (n=29) and severe (n=5) cases were compared with respect to serum levels of amylase, C-reactive protein (CRP), alpha-1-protease inhibitor, and antichymotrypsin on admission and 24 and 48 hours (h) after admission. RESULTS: Alpha-1 protease inhibitor and antichymotrypsin levels were significantly elevated in the first 24 h; however, CRP peaked after 48 h in the acute pancreatitis group. While CRP showed significantly higher concentrations in patients with severe pancreatitis, alpha-1-protease inhibitor and antichymotrypsin levels changed slightly, but without significance, in severe cases. CONCLUSION: Alpha-1 protease inhibitor and antichymotrypsin are early events in acute pancreatitis, with high levels on admission. Activation of these variables declines after 24 h. These markers may have early diagnostic value in patients with acute pancreatitis. Because neither of them is good at discrimination of mild and severe cases in the disease, they should not be incorporated into routine clinical investigations.

Are we aware of restless legs syndrome in COPD patients who are in an exacerbation period? Frequency and probable factors related to underlying mechanism.

A few previous studies have reported that the patients with chronic obstructive pulmonary disease (COPD) have a 29.1% to 36.8% frequency of restless legs syndrome (RLS). In this study, we observed RLS symptoms in patients experiencing COPD exacerbation to better understand the relationship between the many clinical parameters of COPD and the presence of RLS and to attract the attention of specialists on the association between the two conditions. Twenty-two male patients in COPD exacerbation; 17 healthy individuals were evaluated in this study. The patients were evaluated using the 2003 RLS symptom criteria outlined by the International Restless Legs Syndrome Study Groups (IRLSSG). The Pittsburgh Sleep Quality Index and Epworth daytime sleepiness scale were used to assess the sleep quality of patients. The RLS symptoms were correlated with blood levels of laboratory and clinical parameters. Statistical analyses were performed using SPSS 17.0 statistical software packet. The Pittsburgh Sleep Quality Index and Epworth daytime sleepiness scale scores were increased in COPD patients and correlated significantly with RLS symptoms. It was found that 54.5% of COPD patients with acute exacerbations were observed to have RLS symptoms. The Pittsburgh Sleep Quality Index was significantly higher in COPD patients with RLS symptoms compared to COPD patients without RLS symptoms (p < 0.05). We did not observe any significant difference in the previously reported metabolic and clinical parameters associated with RLS in COPD patients with and without RLS. RLS symptoms increase during COPD exacerbation and lead to decreased sleep quality.

Variations in systemic biomarkers of oxidative/nitrosative stress and DNA damage before and during the consequent two cycles of chemotherapy in breast cancer patients.

BACKGROUND: Previous studies have suggested the importance of redox regulation in carcinogenesis. The aim of this study was to evaluate the prognostic role of altered redox homeostasis and oxidative DNA damage in patients with breast carcinoma before and during two cycles of chemotherapy. METHODS: This study included 30 patients whose serum samples were obtained on admission before treatment, and after the first and second cycles of chemotherapy, and 20 controls. We investigated serum total antioxidant status (TAS), thiobarbituric acid reacting substances (TBARS), total nitrite/nitrate (NOx), nitrotyrosine (NT), and 8-hydroxydeoxy-guanosine (8-OHdG), as well as antioxidant enzyme activities, such as glutathione peroxidase (GPx), glutathione reductase (GRx). RESULTS: TBARS, NOx, NT and 8-OHdG concentrations were significantly increased, while antioxidant enzyme activities and TAS were significantly decreased in patients when compared to controls. A concurrent increase in TBARS, NOx, NT, and 8-OHdG and a decrease in antioxidant enzyme activities and TAS were also seen after chemotherapy. No difference was observed in the second cycle of chemotherapy when compared with the first course. CONCLUSIONS: In conclusion, decreased activities of these antioxidant enzymes and low TAS concentrations observed in our study might be due to the depletion of the antioxidant defense system to combat the free radical storm produced by chemotherapy. We suggest that the increased 8-OHdG and other oxidative/nitrosative stress products that we have measured in breast cancer patients may be prognostic risk factors for the magnitude of oxidation in serum.

Erosive esophagitis worsens reflux signs and symptoms in asthma patients without affecting pulmonary function tests.

OBJECTIVES: To determine whether erosive esophagitis (EO) worsens reflux signs and symptoms and affects pulmonary function test in asthma patients. METHODS: Sixty asthma patients with gastroesophageal and laryngopharyngeal reflux symptoms were included. Spirometry, reversibility test, esophagogastroscopy, laryngoscopy, and esophagogastroscopic biopsies were conducted. RESULTS: EO was diagnosed in 25% (n = 15) of the patients. The remaining 45 patients were placed into the non-erosive esophagitis (NEO) group. Of the 15 EO patients, grade 1 esophagitis was identified in 75% (n = 9), grade 2 in 12.5% (n = 3), and grade 3 in 12.5% (n = 3). Pulmonary function test results were not significantly different between the EO and NEO groups. Gastroesophageal and laryngopharyngeal reflux symptoms such as regurgitation, dysphagia, dyspnea, globus sensation, dysphonia, and sore throat were more frequent in EO patients than in the NEO group. The reflux finding score (RFS) was 7.33 and 4.55 in EO and NEO patients, respectively (p < .001). Posterior commissure hypertrophy was the most common laryngoscopic finding in both of the groups followed by diffuse laryngeal edema, erythema, and pseudosulcus. CONCLUSIONS: Gastroesophageal and laryngopharyngeal reflux symptoms were more frequent in EO patients than in the NEO group. The laryngoscopic findings of laryngopharyngeal reflux were more severe and the RFS was significantly higher in EO patients than in NEO patients. The presence of EO seems to be associated with an increase in reflux without affecting pulmonary function as EO did not cause a significant decrease in pulmonary function tests.

Human vascular adhesion protein-1 (VAP-1): serum levels for hepatocellular carcinoma in non-alcoholic and alcoholic fatty liver disease.

BACKGROUND: The incidence of hepatocellular cancer in complicated alcoholic and non-alcoholic fatty liver diseases is on the rise in western countries as well in our country. Vascular adhesion protein-1 (VAP-1) levels have been presented as new marker. In our study protocol, we assessed the value of this serum protein, as a newly postulant biomarker for hepatocellular cancer in patients with a history of alcoholic and non-alcoholic fatty liver diseases. METHODS: Pre-operative serum samples from 55 patients with hepatocellular cancer with a history of alcoholic and non-alcoholic fatty liver diseases and patients with cirrhosis were assessed by a quantitative sandwich ELISA using anti-VAP-1 mAbs. This technique is used to determine the levels of soluble VAP-1 (sVAP-1) in the serum. RESULTS: sVAP-1 levels were evaluated in patients with hepatocellular cancer and liver cirrhosis. There was a significant difference in mean VAP-1 levels between groups. Serum VAP-1 levels were found higher in patients with hepatocellular cancer. CONCLUSION: These findings indicate that the serum level of sVAP-1 might be a beneficial marker of disease activity in chronic liver diseases.

The relationship among acute-phase response proteins, cytokines and hormones in cachectic patients with colon cancer.

BACKGROUND: Acute-phase response proteins (APRP), cytokines and hormones have been claimed to be an independent prognostic factor of malignancies, however the basis for their association with prognosis remains unexplained. We suggest that in colon malignancies, as similar to pancreatic and lung cancers, changes in APRP are associated with angiogenesis. METHODS: C-reactive protein (CRP), albumin, IL-1α, IL-1ß, IL-6, IL-8, IL-10, TNF-α, midkine, VEGF-A, VEGF-C, leptin, adiponectin, and ghrelin serum levels are studied in 126 colon cancer patients and 36 healthy subjects. RESULTS: We found statistically significant difference and correlations between two groups. We found significantly higher serum CRP, IL-1α, IL-1ß, IL-6, IL-8, IL-10, TNF-α, VEGF-A, VEGF-C and leptin concentrations in patients relative to controls (p < 0.001). We found lower levels of the serum albumin, midkine, adiponectin and ghrelin in patients compared to control subjects (p < 0.001). CONCLUSIONS: Cachexia in patients with colon cancers is associated with changes in APRP, cytokines and hormone concentrations. These biomarkers and cachexia together have a direct relationship with accelerated angiogenesis. This may lead to a connection between the outcomes in malignancies and the biomarkers.

The role of osteopontin: a shared pathway in the pathogenesis of multiple sclerosis and osteoporosis?

Osteopontin (OPN) was suggested to have a role in the pathophysiology of MS and in bone metabolism. However, we formerly reported increased presence of osteoporosis in MS patients independent of corticosteroid treatment, there is only limited information about the mechanism of bone loss. In this study, we investigated the role of OPN on bone mineral density in MS patients. Thirty-three relapsing-remitting (RR), 12 secondary progressive (SP), and 5 primary progressive (PP) MS patients and 30 healthy controls were prospectively enrolled. Students' t test, chi-square test, and Pearson correlations were used. The mean OPN level was 155.4+/-81.8 ng/ml in controls, and 15.9+/-36.2 ng/ml in MS patients (p<0.001).No statistical difference was observed among RR, SP and PPMS patients (p=0.162). No relationship was found between OPN levels and age at onset of disease (p=0.830), gender (p=0.785), MS subtypes (p=0.330), disease duration (p=0.744), or EDSS scores (p=0.633).About 34% of MS patients versus 10.3% of controls had osteoporosis (p=0.017).Osteopontin levels showed no significant correlation with osteoporosis in controls, but were lower in MS patients with osteoporosis in femur neck (r=0.85, p=0.010).The cumulative dose of corticosteroid treatment did not correlate with OPN levels (p=0.285).In conclusion, our results suggest that OPN may have a role as a shared cytokine in pathogenesis of MS and osteoporosis.

Effects of serum homocysteine and adiponectin levels on platelet aggregation in untreated patients with essential hypertension.

The aim of the present study is to determine and correlate adiponectin, homocysteine, nitric oxide, and ADP-induced platelet aggregation levels in untreated patients with essential hypertension and healthy individuals. A total of 36 individuals, 23 untreated patients with essential hypertension and 13 healthy individuals, were included in the scope of this study. Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum adiponectin and TNF-alpha levels. The levels of serum homocysteine were measured by using competitive chemiluminescent enzyme immunoassay. Serum concentrations of hsCRP were measured by the Nephelometer. Plasma nitrite, nitrate, and total nitric oxide (NOx) levels were determined by colorimetric method. Homocysteine and hsCRP levels in patients with essential hypertension were found to be significantly higher than those in the control group (P = 0.02, P = 0.001, respectively). The average platelet aggregation levels in patient group were higher than control group, but there were no statistically significant differences between them (P > 0.05). In addition, in patients with essential hypertension adiponectin and nitrite levels are significantly lower than control group (P < 0.001, P = 0.045, respectively). We have also found significant correlations between nitrite-platelet aggregation amplitude, nitrite-platelet aggregation slope, nitrite-adiponectin, homocysteine-platelet aggregation amplitude, and sistolic blood pressure-platelet aggregation amplitude levels (r = -0.844; P < 0.001, r = -0.680; P = 0.011, r = 0.454; P = 0.05, r = 0.414; P = 0.05, r = 0.442; P = 0.035, respectively). Increased homocysteine and decreased adiponectin serum levels in patients with essential hypertension correlate well with changes in ADP-induced conventional platelet aggregation. This association may potentially contribute to future thrombus formation and higher risks for cardiovascular events in hypertensive patients.

Increase in the circulating level of hepatocyte growth factor in pancreatic cancer patients.

OBJECTIVE: Hepatocyte growth factor (HGF) has been reported the cause of many biological events, including cell proliferation, invasiveness, morphogenesis, and angiogenesis. Elevated HGF content in tumor tissue was reported to predict a more aggressive biology in breast and gastric cancer patients. MATERIALS AND METHODS: Eighty patients with invasive pancreatic cancer investigated. Venous blood samples were collected before the surgery. Sera were obtained by centrifugation and stored at -70 degrees C until assayed. The control group created from healthy individuals. Serum concentrations of soluble HGF were measured by the quantitative sandwich enzyme immunoassay technique. RESULTS: The mean value of serum soluble HGF in patients with invasive pancreatic cancer was 497.2 +/- 53.8 pg/ml and that of control group was 53.6 +/- 7.5 pg/ml and the difference was significant (p < 0.001). CONCLUSION: The serum levels of soluble HGF might reflect the severity of invasive pancreatic cancer and deserve further evaluation (Tab. 2, Ref. 19). Full Text (Free, PDF) www.bmj.sk.

Relationship of radiometabolic biomarkers to KRAS mutation status and ALK rearrangements in cases of lung adenocarcinoma.

PURPOSE: Rapid diagnosis of genetic mutations is important for targeted therapies such as EGFR tyrosine kinase inhibitors. KRAS mutation and ALK rearrangement are also important in determining treatment. The purpose of our study was to evaluate the diagnostic value of 18F-FDG PET to predict KRAS mutation and ALK rearrangement in order to determine the frequency of these genetic markers in our lung adenocarcinoma cases and contribute to forthcoming meta-analysis studies. METHODS: A total of 218 patients with lung adenocarcinoma (EGFR analyzed) who were seen at our clinic between 2012 and 2014 were included in the study. The results of the 18 F-FDG-PET scans for each patient were retrospectively recorded with the associated medical documents. ALK rearrangements were analyzed in 166 of the 218 patients, while 50 of the 218 patients were analyzed for KRAS mutational status. SPSS 15.0 for Windows was used for statistical analysis. RESULTS: FDG avidity was higher in cases with KRAS mutations and ALK rearrangements than those without, but the difference was not significant. ALK rearrangements were more common in younger, female, and nonsmoking patients with lung adenocarcinoma. CONCLUSIONS: The small numbers of KRAS mutations and ALK rearrangements are the limitation of this study for evaluation of diagnostic imaging. The frequency of these genetic alterations was as reported in the literature. We believe that our work will contribute to future meta-analysis.

Evaluation of the effects of subcostal transversus abdominis plane block on acute and subacute pain development following inguinal herniography: Randomized clinical study.

OBJECTIVES: The effect of subcostal transversus abdominis plane (TAP) block on postoperative pain is contradictive. The aim of this study was to evaluate the effect of subcostal TAP block on subacute pain in patients who have undergone inguinal herniography. METHODS: Patients aged between 18 and 75 years with American Society of Anesthesiologists 1-3 and who were to undergo elective unilateral inguinal herniography with mesh under general anesthesia were included. Fifty patients were under an intravenous analgesic regimen (group I) and 50 patients underwent subcostal TAP block postoperatively in addition to the intravenous analgesic regimen (group II). The primary outcome measure was pain scores 1 month postoperatively by comparing Numerical Rating Scale values with the Mann-Whitney U test between groups I and II. Secondary outcome measures were life qualification scores 1 month postoperatively and pain scores 24 h and 15 days postoperatively. RESULTS: Postoperative 15th-min; 1st-, 6th-, 12th-, and 24th-h; 15th-day (p=0.00); and 1st-month Numerical Rating Scale values were significantly lower in group II than in group I (p=0.02). No significant difference was observed between the groups in terms of LQS 15 days postoperatively (p=0.013). On group comparison, LQS was higher in the 1st month than at the 15th day postoperatively in group I (p=0.201). CONCLUSION: Subcostal TAP block provides an effective postoperative pain treatment in the acute period and in the 1st postoperative month in patients undergoing inguinal herniography.

The effect of the pooling method on the live birth rate in poor ovarian responders according to the Bologna criteria.

OBJECTIVE: Pooling is an alternative method to achieve in vitro fertilization outcomes. This study was to investigate the effect of pooling method on pregnancy outcomes in poor responder patients according to Bologna criteria. MATERIALS AND METHODS: Two hundred-fifty five poor responder patients were enrolled in this study. Pooling embryo transfer (ET) group had 110 and fresh ET group had 145 patients. RESULTS: Although, age was similar between both treatment groups (p=0.31), antral follicle count (p<0.001), total number of retrieved oocyte (p<0.001), total metaphase II oocyte count (p<0.001), number of stimulation cycles (p<0.001), were significantly different between the groups. The day of ET were similiar between two groups (p=0.72) but the number of ET procedure was significantly higher in pooling ET group compared to fresh ET (p<0.001). Positive pregnancy test [35/110 (32%) vs 53/145 (37%)] (p=0.43) and clinical pregnacy rates [31/110 (28%) vs 49/145 (34%)] (p=0.33) were similar between groups, whereas, implantation [31/191 (16%) vs 49/198 (25%)] (p=0.03) and live birth rates [15/110 (14%) vs 36/145 (25%)] (p=0.04) were significantly higher in fresh ET group. Despite that, abortion rates were significantly higher in pooling ET group [16/31 (52%) vs 13/49 (27%)] (p=0.04). Binary logistic regression analyese has revealed no effect of variables on live birth rates. CONCLUSION: Even though, pooling strategy seems to have a slight positive effect on pregnancy outcomes, there is no benefical effect on live birth rates. Furthermore, this strategy is increasing the abortion rates in parallel with clinical pregnancy rates.

Serum vascular endothelial growth factor receptor-3 levels in patients with esophageal squamous cell cancer.

AIM: Esophageal cancer is one of the most aggressive tumors of the gastrointestinal tract. In this study, we quantified the serum vascular endothelial growth factor-3 (VEGFR-3) expression in patients with esophageal squamous cell carcinoma (ESCC) to evaluate the role of VEGFR-3 in ESCC. MATERIALS AND METHODS: Ninety five patients with ESCC were studied. Pre-therapy and preoperative samples were stored and ELISA was used to designate the concentrations of VEGFR-3. RESULTS: The serum values of VEGFR-3 were significantly higher in patients with ESCC than in healthy donors (p<0.0001). CONCLUSIONS: The results imply a very good sensitivity of VEGFR-3 in ESCC. VEGFR-3 may be a good diagnostic biomarker for ESCC. KEY WORDS: Biomarker, ESCC, VEGFR-3.