Comparison of Classification Success Rates of Different Machine Learning Algorithms in the Diagnosis of Breast Cancer.

OBJECTIVE: To identify which Machine Learning (ML) algorithms are the most successful in predicting and diagnosing breast cancer according to accuracy rates. METHODS: The "College of Wisconsin Breast Cancer Dataset", which consists of 569 data and 30 features, was classified using Support Vector Machine (SVM), Naive Bayes (NB), Random Forest (RF), Decision Tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), Multilayer Perceptron (MLP), Linear Discriminant Analysis (LDA), XgBoost (XGB), Ada-Boost (ABC) and Gradient Boosting (GBC) ML algorithms. Before the classification process, the dataset was preprocessed. Sensitivity, accuracy, and definiteness metrics were used to measure the success of the methods. RESULT: Compared to other ML algorithms used in the study, the GBC ML algorithm was found to be the most successful method in the classification of tumors with an accuracy of 99.12%. The XGB ML algorithm was found to be the lowest method with an accuracy rate of 88.10%. In addition, it was determined that the general accuracy rates of the 11 ML algorithms used in the study varied between 88-95%. CONCLUSION: When the results obtained from the ML classifiers used in the study are evaluated, the efficiency of the GBC algorithm in the classification of tumors is obvious. It can be said that the success rates obtained from 11 different ML algorithms used in the study are valuable in terms of being used to predict different cancer types.

Coexistence of chronic lymphocytic leukemia and polycythemia vera: a case report and review of the literature.

Polycythemia vera is a Philadelphia chromosome-negative myeloproliferative neoplasm. Chronic lymphocytic leukemia is a monoclonal expansion of a CD5+ CD19+ B lymphocytes. Chronic myeloproliferative neoplasms may coexist with indolent B-cell malignant lymphomas of various types. The association of chronic lymphocytic leukemia with polycythemia vera is a rare event with only a few cases of coexistence ever reported. We report a 56-year-old man in whom these two disorders were diagnosed concomitantly. Possible etiopathogenic relationships between both disorders are discussed in this case report. SIMILAR CASES PUBLISHED: 6.

Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients.

OBJECTIVE: In Robot-assisted radical prostatectomy (RARP) patients, preoperative bowel preparation and intraoperative fluid restriction may cause dehydration and electrolyte imbalance. In these patients, laboratory results that are considered "normal" in the pre-anaesthesia clinic may be misleading, and cardiac arrhythmia due to hypokalaemia and hypocalcaemia, as well as problems, such as prolonged non-depolarising blockade and delayed recovery from anaesthesia, may be observed during anaesthesia practice. In this study, we aimed to determine these disturbances by comparing the preoperative (T1) laboratory values with those at the beginning of the operation (T2) and at the 6(th) hour of the operation (T3) and values at discharge. METHODS: This prospective study comprised 49 American Society of Anesthesiologists (ASA) I-II patients. Bowel preparation was made with a rectal enema (NaP) twice in 12 hours and with one single dose of oral laxative soda (NaP). During surgery, 1 mL kg(-1) h(-1) 0.09% NaCl and 1 mL kg(-1) h(-1) 6% HES 200/05 infusions were applied. RESULTS: The potassium level at T2 was significantly lower than at T1 and T3. The calcium levels at T2 and T3 were significantly lower than at T1, and the level at T3 was significantly lower than at T2. The creatinine level at T3 was significantly higher than at T1 and T2. CONCLUSION: Although there were no severe increases or decreases in laboratory test values due to bowel preparation and fluid restriction in RARP operations, which reflected on the clinical outcome in this ASA I-II patient group, these changes may be important in critically ill or ASA III-IV patients.

Disseminated intravascular coagulopathy caused by Kikuchi-Fujimoto disease resulting in death: first case report in Turkey.

Kikuchi disease, also called Kikuchi-Fujimoto disease or Kikuchi's histiocytic necrotizing lymphadenitis, is a rare, benign condition of unknown cause, usually characterized by cervical lymphadenopathy and fever. The diagnosis is based on histopathology. Our patient was a woman with bilateral cervical lymphadenopathy, fever, chest and abdominal pain, fatigue, maculopapular rash on her face, trunk, and upper and lower extremities. Immunological and rheumatological tests were negative. We took a cervical lymph node biopsy that showed a proliferative and necrotizing process centered in the paracortex characterized by patchy circumscribed or confluent areas of necrosis associated with karyorrhexis, and was remarkable by the absence of granulocytes and the paucity of plasma cells. These findings confirmed the diagnosis of Kikuchi's disease. The patient's hemoglobin values decreased, and the peripheral blood smear revealed schistocytes. Blood tests showed raised D-dimer, activated partial thromboplastin time, prothrombin time, and international normalized ratio with decreased fibrinogen. The patient's condition quickly worsened and disseminated intravascular coagulopathy eventually developed. Her initial management consisted of a corticosteroid and hydroxychloroquine.

Season of diagnosis and survival of advanced lung cancer cases--any correlation?

INTRODUCTION: The influence of season at diagnosis on cancer survival has been an intriguing issue for many years. Most studies have shown a possible correlation in between the seasonality and some cancer type survival. With short expected survival, lung cancer is an arena that still is in need of new prognostic factors and models. We aimed to investigate the effect of season of diagnosis on 3 months, 1 and 2 years survival rates and overall survival of non small cell lung cancer patients. MATERIALS AND METHODS: The files of non small cell lung cancer patients that were stages IIIB and IV at diagnosis were reviewed retrospectively. According to diagnosis date, the patients were grouped into 4 season groups, autumn, winter, spring and summer. RESULTS: A total of 279 advanced non small cell lung cancer patients' files were reviewed. Median overall survival was 15 months in the entire population. Overall 3 months, 1 and 2 years survival rates were 91.0%, 58.2% and 31.2% respectively. The season of diagnosis was significantly correlated with 3 months survival rates, being diagnosed in spring being associated with better survival . Also the season was significantly correlated with T stage of the disease. For 1 and 2 years survival rates and overall survival, the season of diagnosis was not significantly correlated. There was no correlation detected between season and overall survivals according to histological subtypes of non small cell lung cancer. CONCLUSION: As a new finding in advanced non small cell lung cancer patients, it can be concluded that being diagnosed in spring can be a favorable prognostic factor for short term survival.

Investigation of the esophageal Rho-kinase expression in patients with Barrett's esophagus.

The mechanisms responsible for the malignant transformation in Barrett's esophagus (BE) are still poorly understood. The authors have evaluated the role of Rho-kinase (ROCK1 and ROCK2) expressions in patients with BE. All patients underwent upper gastrointestinal system endoscopy, which was confirmed histologically. Real-time PCR revealed no marked change in gene expressions of ROCK1 and ROCK2 at mRNA levels in BE when compared to controls. Immunohistochemical and western blot analyses showed no change in ROCK1 and ROCK2 protein expressions in BE. This study demonstrates that Rho-kinase gene and protein expressions are not modified in BE.

Melatonin expresses powerful anti-inflammatory and antioxidant activities resulting in complete improvement of acetic-acid-induced colitis in rats.

INTRODUCTION: Increased free-radical production, decreased antioxidant capacity, and excessive inflammation are well-known features in the pathogenesis of inflammatory bowel disease. Melatonin is a powerful antioxidant and a scavenger of hydroxyl radicals. Melatonin has also been shown to have anti-inflammatory activities in tissues. Our study objective is to investigate the effects of melatonin on tissue inflammatory activities using an ulcerative colitis (UC) model induced by acetic acid (AA) in rats. METHODS: Wistar rats (n = 32) were divided into four groups. AA-induced colitis was performed in two of the groups, while the other two groups were injected with saline intrarectally. One of the AA-induced colitis groups and one of the control groups were administered 100 mg/kg/day melatonin intraperitoneally, and the pair groups were given saline. After 4 days, colonic changes were evaluated biochemically by measuring proinflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, and IL-6], myeloperoxidase (MPO), malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) levels in tissue homogenates and by histopathological examination. RESULTS: AA caused colonic mucosal injury, whereas melatonin suppressed these changes in the AA-induced colitis group (P < 0.001). AA administration resulted in increased TNF-α, IL-1ß, IL-6, MPO, and MDA levels, and decreased GSH and SOD levels, whereas melatonin administration reversed these effects (all P < 0.001). CONCLUSIONS: The present study proposes that melatonin has a dual action as an effective anti-inflammatory and an antioxidant, and may be a hopeful therapeutic agent for UC.

Splenic hydatic cyst as a cause of sinistral portal hypertension and isolated gastric variceal bleeding.

A 60-year-old male, living in a rural area, presented with recurrent upper gastrointestinal bleeding. Isolated fundal varices were seen on endoscopy. A lesion similar to cyst hydatid was seen in the spleen on abdominal ultrasonography and computerized tomography scanning. Also, sinistral (left-sided) portal hypertension and collaterals were seen due to the compression of the splenic vein by the cyst. Indirect hemagglutination antibody test for Echinococcus granulosus was positive. By screening, no other cyst was found in any other site of the body. The patient underwent open abdominal surgery, and the anterior wall of the cyst was resected partially; within it were multiple daughter cysts and hydatid fluid. After decontamination of the daughter cysts and hydatid fluid, germinative membrane omentoplasty was performed with a part of the omentum. However, the patient suffered from recurrent gastrointestinal bleeding postoperatively and he was re-evaluated. Later, splenectomy was performed in order to relieve left-sided portal hypertension. The patient did not experience further bleeding and gastric varices disappeared following splenectomy.

Yersinia pseudotuberculosis colitis presented with severe gastrointestinal bleeding.

We report an adult case of Yersinia pseudotuberculosis colitis who presented with severe gastrointestinal bleeding. A 25-year-old male had admitted with fever, vomiting, body aches, and massive lower gastrointestinal bleeding. Since diagnostic tests were unremarkable and the patient's hemodynamic condition was unstable, emergency explorative laparotomy was performed. During the operation, localized wall thickening and ulcers were seen in the cecum. Right hemicolectomy was performed. Histological examination showed non-caseation granulomas in mesenteric lymph nodes and transmural inflammation in the cecum. Y. pseudotuberculosis serology, based on histological suspicion, was positive. The patient was discharged with cure 12 days after the operation following gentamicin treatment. To our knowledge, there are only two reports about massive lower gastrointestinal bleeding due to Y. pseudotuberculosis. Although this is a rare entity, lower gastrointestinal bleeding due to Y. pseudotuberculosis should be taken into consideration in the differential diagnosis of patients presenting with massive lower gastrointestinal bleeding, as a possible cause.

Oddi sphincter fibrosis due to chemotherapy agents in small cell lung cancer: case report.

A 62-year-old, man patient was diagnosed as small cell lung cancer. Cisplatin (80 mg/m(2), first day) and etoposide (100 mg/m(2), three days) chemotherapy was started for once 21 days. As the patient received third course of chemotherapy, jaundice and hyperbilirubinemia were detected. Hepatic ultrasonography showed dilated choledochus and intrahepatic biliary tract. Hepatic markers and serologic tests for viral hepatitis were found as normal. Finally endoscopic retrograde cholangiopancreatography (ERCP) was performed. Endoscopic sphincterotomy was performed in the first ERCP and two days later, second ERCP was performed and oddi sphincter was seen as fibrotic and stenotic and stent was placed. One day after the stent placement, direct bilirubin was found as 6.2 mg/dL and 10 days later laboratory parameters were detected as normal. Oddi sphincter fibrosis occurred due to lung cancer chemotherapy treatment is an interesting case for fibrosis not having been reported due to cisplatin or etoposide before.

Hoffmann's syndrome: a case report.

OBJECTIVE: We report a very rare case of Hoffmann's syndrome with musclehypertrophy complicating hypothyroidism. CLINICAL PRESENTATION: A 24-year-old man presented with a 2-year history of forgetfulness, swelling in his face, shoulder and calf, and motor weakness in his lower extremities. His calf and shoulder muscles were hypertrophic. Neurological examination revealed hoarseness of the voice, proximal muscle weakness, reduced deep tendon reflexes and a mildly ataxic gait. Laboratory tests indicated markedly elevated serum muscle enzymes and lipids, a high thyroid-stimulating hormone level and low free triiodothyronine and free thyroxine levels. Electromyographic evaluation showed myopathy. INTERVENTION: Oral L-thyroxine treatment was started and at a 1-month follow-up examination, mental status and physical performance were improved. CONCLUSION: This report shows that in the differential diagnosis of myopathy with pseudohypertrophy, Hoffmann's syndrome should be considered.

Expression of homeodomain protein CDX2 in colorectal adenoma and adenocarcinoma.

CDX2 is a homeobox domain-containing transcription factor that is important in the development and differentiation of the intestine. In this study, we examined CDX2 expression in normal and neoplastic human colon using a newly isolated monoclonal antibody. When compared to the intensity observed in adjacent normal mucosal epithelial cells, strong nuclear staining for CDX2 was observed in 10 (100%) of 10 colonic adenomas, 30 (88.2%) of 34 colorectal adenocarcinomas, including 17(94.47%) of 18 well-or moderately differentiated tumors and 13(81.2%) of 16 high-grade tumors. The percentage of CDX2 immunopositive cells was generally lower in carcinomas than in adenomas (p<0.001) and lower in moderately or poorly differentiated tumors than in well-differentiated tumors (p<0.001). There was an inverse correlation between CDX2 expression and tumor grade, tumor stage and lymph node metastasis (respectively, p<0.001; p<0.05; p<0.001), but this was not associated with age, gender, or tumor location and size. These results indicate that loss of expression of CDX2 protein may play an important role in the tumorigenesis of colorectal cancers. Down-regulation of CDX2 may cause dedifferentiation of gastrointestinal epithelial cells.

Intraperitoneal EMLA (lidocaine/prilocaine) to prevent abdominal adhesion formation in a rat peritonitis model.

OBJECTIVE: The accelerative effect of EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) in the wound healing process is known. We hypothesised that post-operative peritoneal adhesions may be reduced with intra-peritoneal EMLA administration in a model of bacterial peritonitis. STUDY DESIGN: Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of four groups. Group 1 (n=6)) received EMLA intraperitoneally, group 2 (n=6) received 2% lidocaine hcl solution intraperitoneally, the third group received one dose (100 mg/kg) of ceftriaxone sodium (Rocephin, Roche, 1 g) intraperitoneally one day after cecal ligation and puncture procedure, and in control group (group 4, n=6), no fluid or medicine was introduced into the abdomens of the rats. All animals were killed 14 days later in order to assess the adhesion score. Tissue antioxidant levels were measured in 1 g tissue samples taken from the abdominal wall. RESULTS: The adhesion score was significantly lower in the EMLA group than in the lidocaine and control groups. The catalase levels were higher in the lidocaine and control groups than in EMLA group. CONCLUSIONS: Intraperitoneal EMLA inhibited the formation of postoperative intra-abdominal adhesions without compromising the wound healing in this bacterial peritonitis rat model. EMLA also decreased the oxidative stress during peritonitis (Tab. 1, Fig. 7, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

N-acetylcysteine ameliorates methotrexate-induced oxidative liver damage in rats.

BACKGROUND: Methotrexate (MTX), a folic acid antagonist, is widely used as a cytotoxic chemotherapeutic agent for malignancies as well as in the treatment of various inflammatory diseases. The efficacy of this agent is often limited by severe side effects and toxic conditions. The present study was undertaken to determine whether N-acetylcysteine (NAC), as a potent antioxidant compound, could ameliorate MTX-induced oxidative liver damage. MATERIAL/METHODS: A single dose of MTX (20 mg/kg, intraperitoneal) to rats was followed by intraperitoneal saline or NAC administration (150 mg/kg, MTX + NAC group) for the next 5 days. On the fifth day the rats were sacrificed and liver tissue samples were obtained and stored to measure reduced glutathione (GSH) and malondialdehyde (MDA) levels and myeloperoxidase (MPO), superoxide dismutase (SOD), and catalase (CAT) activity. RESULTS: MTX caused decreased GSH level and SOD and CAT activity and increased MDA level and MPO activity in the liver homogenates. These changes were significantly reversed by NAC treatment. CONCLUSIONS: These results confirm that administration of NAC decreases MTX-induced oxidative damage to the liver. These data indicate that NAC may be of therapeutic use in preventing hepatotoxicity in patients receiving MTX treatment.

Tuberculosis of the thyroid gland: review of the literature.

OBJECTIVE: Thyroid tuberculosis (TTB) is a very rare condition, even in countries with a high prevalence of tuberculosis. The aim of this article is to review and retrieve data about thyroid tuberculosis from the English-language literature in order to gain a better understanding of the clinical characteristics of TTB. STUDY DESIGN: We performed Medline, PubMed, and library searches using the key words "thyroid tuberculosis," "throid disease," "tuberculosis and thyroid." Reference lists of the articles obtained and previous reviews were also examined. RESULTS: We retrieved 76 cases matching our selection criteria from the search. Review of the cases with TTB revealed a slight female preponderance. The patients reported in the literature ranged in age from 9 to 83 years, with a median age of 40+/-16 years for men and 44+/-17 years for women. In the articles surveyed, TTB presented with a broad spectrum of manifestations, ranging from an isolated nodule to thyrotoxicosis. It seems that diagnosis of thyroid tuberculosis has recently been increasing, perhaps because of the growing incidence of tuberculosis and the diagnostic use of fine-needle aspiration cytology in the diagnosis. Although, in the past, the diagnosis was generally made by the examination of the specimens, at present, fine-needle aspiration cytology seems to be a useful method in diagnosis tuberculous thyroiditis. The role of surgery is limited after the diagnosis. The choice of treatment should be medical antituberculous therapy. CONCLUSIONS: Preoperative diagnosis of thyroid tuberculosis is important because of the availability of medical treatment and the limited role of surgery. This condition should be kept in mind in evaluating patients with a thyroid nodule, in communities where the prevalence of tuberculosis is high.

Effects of N-acetylcysteine on methotrexate-induced small intestinal damage in rats.

Methotrexate (MTX) is known to cause damage to the small intestine, leading to its dysfunction. The aim of the present study was to examine whether the administration of N-acetylcysteine (NAC) provides protection against the MTX-induced damage to small intestinal epithelium in rats. A single dose of MTX (20 mg/kg, intraperitoneal) was followed by intraperitoneal saline or NAC administration (150 mg/kg, MTX+NAC group) for the next 5 days. Afterward, the rats were sacrificed and small intestinal segments were fixed for light microscopic examinations. Glutathione and malondialdehyde levels, myeloperoxidase, superoxide dismutase and catalase activities were measured in the other intestinal segments. MTX caused an increase in the levels of glutathione and malondialdehyde and in the activities of myeloperoxidase, superoxide dismutase and catalase. These changes were significantly reversed in MTX+NAC-treated rats. Light microscopy in the MTX group revealed mucosal damage, which decreased with NAC treatment. Our results confirmed that administration of NAC decreased the MTX-induced damage to the small intestine. This protective effect of NAC may have clinical applications in chemotherapy.

Beneficial effects of N-acetylcysteine on acetic acid-induced colitis in rats.

Ulcerative colitis is a chronic recurrent inflammatory bowel disease in which oxidative stress has been implicated. The aim of the present study was to evaluate possible protective effects of N-acetylcysteine against acetic acid-induced colitis in a rat model. Rats were administered intrarectal saline (control group) or acetic acid (colitis model group). Rats with acetic acid-induced colitis were treated by intraperitoneal or intrarectal administration of N-acetylcysteine (500 mg/kg) (treated group). Another series of rats were pre-treated by intraperitoneal or intrarectal administration of N-acetylcysteine, then administered intrarectal acetic acid (pre-treated group). The degree of tissue injuries was assessed by macroscopical and histopathological scores of the colonic mucosa. Malondialdehyde, myeloperoxidase, reduced glutathione, superoxide dismutase, and catalase levels were measured in tissue extracts of the dissected colon. Administration of N-acetylcysteine intraperitoneally or intrarectally ameliorated macroscopic score alterations produced by acetic acid in treated groups. In addition, microscopical improvement was observed in all N-acetylcysteine-treated rats compared to untreated animals with colitis. In the colonic tissues of the acetic acid-induced colitis, myeloperoxidase activity and malondialdehyde levels were elevated, while the reduced glutathione levels and superoxide dismutase and catalase activities were decreased. However, intraperitoneal or intrarectal treatment with N-acetylcysteine reversed these parameters, compared to the untreated colitis group. Notably, intrarectal administration of N-acetylcysteine elevated the reduced glutathione levels more markedly compared to the other treatment groups. Superoxide dismutase levels were increased in intraperitoneally or intrarectally N-acetylcysteine-treated groups significantly compared to the control, colitis and pre-treated groups. But there was no significant increase in catalase activity. In conclusion, N-acetylcysteine could be beneficial as a complementary agent in treatment of ulcerative colitis.

Urinary tract infection aggravates oxidative stress in diabetic patients.

To investigate the effect of urinary tract infection on oxidative stress in diabetic patients, we measured the activities of antioxidant enzymes such as catalase and superoxide dismutase, and lipid peroxidation levels in urine specimens of type II diabetic patents with urinary tract infection. A total of 69 patients were included into this study: 23 non-diabetic patients with urinary tract infection, 28 patients with diabetes mellitus, and 18 diabetic patients with urinary tract infection. Twenty-five healthy subjects, matched for age, sex, body mass index and smoking status were also included as control. Urine cultures were performed by the standard techniques, and all grown bacteria were identified as Escherichia coli. Antioxidant enzymes and lipid peroxidation levels in urine were measured by spectrophotometric method. In urine samples of diabetic patients with or without urinary tract infection and in urine samples of non-diabetic patients with urinary tract infection, catalase and superoxide dismutase activities were lower and lipid peroxidation levels were higher than those of the healthy subjects (p < 0.05). Diabetic patients without urinary tract infection were similar to non-diabetic patients with urinary tract infection. Decreased antioxidant capacity and the increased levels of lipid peroxidation were profoundly higher in diabetic patients with urinary tract infection. These results indicate that urinary tract infection aggravates the oxidative stress in diabetic patients. Therefore we believe that diabetic patients with urinary tract infection need antioxidant treatment.