The Predictors of Postoperative Cerebrospinal Fluid Leak in Endoscopic Endonasal Pituitary Surgery: The Role of Tumor Volume.

Objectives Postoperative cerebrospinal fluid (Po-CSF) leak is still a challenging complication of endoscopic endonasal skull base surgery. However, data describing the predictive factors of Po-CSF leak in pure pituitary adenomas is lacking. Aim of this study is to determine the risk factors of Po-CSF leak in a pituitary adenoma group operated via pure transsellar endoscopic approach. Design This is a retrospective cohort study. Setting A single-center academic hospital. Participants Patients operated for a pituitary adenoma between 2015 and 2021 and followed up until June 2022 were included. Main Outcome Measures Demographics, comorbidities, imaging, and outcome were recorded. Univariate and multivariate logistic regression analyses were used to determine the risk factors of Po-CSF leak. Results Of the total 170 patients with a mean age of 47.5 ± 13.8 (min: 15; max: 80), 11 (6.5%) had Po-CSF leak. Univariate analysis revealed age, diabetes mellitus (DM), and tumor volume as predictors of Po-CSF leak. According to the receiver operating characteristic analysis, 7.5 cm 3 of tumor volume was found to be a good cutoff value with a sensitivity of 82% and a specificity of 75%. Hence, multivariable logistic regression model adjusted by age showed that a tumor volume of > 7.5 cm 3 (odds ratio [OR]: 22.9; 95% confidence interval [CI]: 3.8-135.9, p = 0.001) and DM (OR: 8.9; 95% CI: 1.7-46.5; p = 0.010) are strong independent risk factors of Po-CSF leak in pure endoscopic endonasal pituitary surgery. Conclusion Besides younger age and DM, a cutoff value for tumor volume > 7.5 cm 3 is the most remarkable risk factor for Po-CSF leak in pure endoscopic pituitary surgery. These patients should carefully be assessed preoperatively and potential preemptive surgical strategies should be taken into consideration to avoid complications.

Investigation the effects of 2-aminoethoxydiphenyl borate (2-APB) on aminoglycoside nephrotoxicity.

Investigation the protective effect of transient receptor potential channel modulator 2-Aminoethoxydiphenyl Borate (2-APB) on aminoglycoside nephrotoxicity caused by reactive oxygen species, calcium-induced apoptosis and inflammation was aimed. Forty Wistar rats were divided (n=8) as follows: Control group; DMSO group; 2-APB group; Gentamicin group (injected 100 mg/kg gentamicin intramuscularly for 10 days); Gentamicin+ 2-APB group (injected 2 mg/kg 2-APB intraperitoneally, then after 30 minutes 100 mg/kg gentamicin was injected intramuscularly for 10 days). Blood samples were collected for biochemical analyses, kidney tissue samples were collected for light, electron microscopic and immunohistochemical investigations. In gentamicin group glomerular degeneration, tubular dilatation, vacuolization, desquamation of tubular cells and hyaline cast formation in luminal space and leukocyte infiltration were seen. Disorganization of microvilli of tubular cells, apical cytoplasmic blebbing, lipid accumulation, myelin figure like structure formation, increased lysosomes, mitochondrial swelling and disorganization of cristae structures, apoptotic changes and widening of intercellular space were found. TNF-α, IL-6 and caspase 3 expressions were increased. BUN and creatinine concentrations were increased. Increase in MDA levels and decrease in SOD activities were determined. Even though degeneration still continues in gentamicin+2-APB treatment group, severity and the area it occupied were decreased and the glomerular and tubule structures were generally preserved. TNF-α, IL-6, caspase 3 immunoreactivities and BUN, creatinine, MDA concentrations were reduced and SOD activities were increased markedly compared to gentamicin group. In conclusion, it has been considered that 2-APB can prevent gentamicin mediated nephrotoxicity with its anti-oxidant, anti-apoptotic and anti-inflammatory effects.

The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial.

Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.

Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001).

This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high-intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high-intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high-intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high-intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high-intermediate- and high-risk endometrial cancer cases.

Easier and more explanatory indices by integrating leukocyte lymphocyte ratio (LLR) and prognostic nutritional index (PNI) to IPS systems in cases with classical Hodgkin lymphoma.

The aim of this study is to determine the power of he international prognostic scoring systems (IPS-7 and IPS-3) and to obtain indices by integrating leukocyte lymphocyte ratio (LLR) and prognostic nutritional index (PNI) factors as prognostic indicators in cases with classical Hodgkin lymphoma (cHL). 1012 patients with cHL were evaluated with 2 different IPS-4 scores with four parameters: stage, age, hemoglobin level, and either LLR or PNI. Statistical package SPSS v 22.0 was used. Two different Cox regression models were obtained for OS and PFS. Model 1 showed LLR ≥ 5,8 as the highest risk for OS and anemia as the highest risk for PFS. Model 2 showed PNI ≤ 45,2 as the highest risk for OS and anemia as the highest risk for PFS. IPS-4 scores obtained by integrating either LLR or PNI to IPS-3 integration of a biologic parameter either LLR or PNI need to be determined with clinical risk scoring parameters.

Efficacy and Safety of Trastuzumab Emtansine in Her2 Positive Metastatic Breast Cancer: Real-World Experience.

AIM: The aim of this study is to evaluate the efficacy and toxicity of trastuzumab emtansine (T-DM1) in cases with metastatic breast cancer (mBC) in different lines of treatment. METHOD: Retrospective analysis of T-DM1 results of human epidermal growth factor receptor 2 (Her2) positive 414 cases with mBC from 31 centers in Turkey. FINDINGS: Except 2, all of the cases were female with a median age of 47. T-DM1 had been used as second-line therapy in 37.7% of the cases and the median number of T-DM1 cycles was 9. Progression-free survival (PFS) and overall survival (OS) times were different according to the line of treatment. The median OS was found as 43, 41, 46, 23 and 17 months for 1st, 2nd, 3rd, 4th and 5th line, respectively (p = 0.032) while the median PFS was found as 37, 12, 8, 8 and 8 months, respectively (p = 0.0001). Treatment was well tolerated by the patients. The most common grade 3-4 adverse effects were thrombocytopenia (2.7%) and increased serum gamma-glutamyl transferase (2%). DISCUSSION: The best of our knowledge this is the largest real-life experience about the safety and efficacy of T-DM1 use in cases with mBC after progression of Her2 targeted treatment. This study suggests and supports that T-DM1 is more effective in earlier lines of treatment and is a reliable option for mBC.

IPS-3 Validation in 1012 cases with classical hodgkin lymphoma.

The aim of this study is to validate the IPS-3 scoring system as a prognostic indicator in 1012 patients with advanced stage classical Hodgkin Lymphoma (cHL) treated by doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD). According to the IPS-3 scoring system only 3.5 % had high risk and 50.8 % had low risk disease disease and 45.8 % of the cases had intermediate risk disease. Each factors of IPS-7 and IPS-3 scoring systems (age, sex, stage hemoglobin, albumin, lymphocyte count and white cell count) were found to be significant for overall survival (OS) and progression free survival (PFS) according to univariate analyses. Two different multivariate Cox analyses were performed for OS and PFS including the IPS-3/ IPS-7 scoring system parameters. Among 7 risk factors of IPS scoring system, gender and albumin were not found as independent risk factors for both OS and PFS according to cox regression model. But all parameters such as age, stage and hemoglobin those included in IPS-3, were found to be independent significant risk factors for both models obtained for OS and PFS. The results of the study shows that the IPS-3 scoring system can be used as a prognostic indicator in ABVD treated patients in every day practice which is more easily calculate according to the IPS-7.

Prognostic significance of EGFR, MUC1 and PD-L1 expressions in cases with triple negative breast cancer.

PURPOSE: Twenty percent of the breast cancers are triple negative (TNBC). Despite the impressive progression in the biology of this subgroup, data is limited as compared to hormone and/or HER2 positive cases. Thus, the aim of this study was to detect the expression levels and to identify the prognostic values of MUC1, EGFR and PD-L1 in TNBC. METHODS: MUC1, EGFR and PD-L1 expressions were detected by immunohistochemistry in 97 cases with TNBC. Associations between clinical and histopathological parameters with overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method and compared by the log-rank test. Prognostic effects were analyzed by Cox proportional hazard models. RESULTS: During a median follow-up of 93 months (0.6-168.7) the mean PFS was 110.1 and OS was 121.8 months. Tumor diameter (T), involved lymph node status (N) and TNM were found to be prognostic for PFS and OS. PD-L1 in microenvironment (PD-L1 ME) and EGFR expression were found to be associated with longer PFS and OS, but MUC1 and tumor PD-L1 (PD-L1 TM) expressions were not. All combined analyses showed that in the subgroups of MUC1, PD-L1 TM or ME positive, EGFR expression was correlated with longer PFS and OS than those who were not. Older age (≥70 years), T and N status and also EGFR expression were found to be independent prognostic factors for OS in Cox regression analysis. CONCLUSION: EGFR expression was found to be one of the most important prognostic factors in addition to T and N status in cases with TNBC.

Assessment of potential predictive value of peripheral blood inflammatory indexes in 26 cases with soft tissue sarcoma treated by pazopanib: a retrospective study.

PURPOSE: The aim of this study was to evaluate the prognostic and predictive value of neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (DNLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in soft tissue sarcoma (STS) cases treated with pazopanib. MATERIALS AND METHODS: The study population included 26 STS cases treated with pazopanib for at least 3 months. NLR, DNLR, LMR, and PLR were evaluated at baseline, and at third month of therapy and also compared with response to pazopanib. Median measurements were taken as cutoff for NLR (4.8), DNLR (3.1), LMR (3.6), and PLR (195). The associations between these cutoff values and survival times (progression-free survival [PFS] and overall survival [OS]) were assessed by Kaplan-Meier curves and Cox proportional models. RESULTS: Patients with low pretreatment NLR and DNLR had longer OS (P=0.022, P=0.018), but low PLR was found to be associated only with longer OS. Additionally, decrease in NLR and DNLR after 3 months of therapy as compared with pretreatment measurements was found to be associated with an advantage for OS (P=0.021, P=0.010, respectively) and PFS (P=0.005, P=0.001, respectively). Response to pazopanib; changes in NLR, DNLR, LMR, and PLR; and >3 metastatic sites were found to be independent risk factors in univariate analysis, but NLR was the only independent risk factor in multivariate analysis. CONCLUSION: Low pretreatment and decrease in NLR and DNLR values, and regression/stable disease after 3 months of pazopanib are predictive factors for longer OS and PFS.

Laparoscopic surgery for low, intermediate and high-risk endometrial cancer.

OBJECTIVE: The aim of the present study was to compare the long-term outcomes of the laparotomy (LT) and laparoscopic surgery and to evaluate the results according to low, intermediate, and high-risk groups of endometrial cancer (EC). METHODS: We identified 801 patients with EC and these patients were classified as group 1, who underwent LT (n=515); and group 2, who underwent laparoscopy (LS) (n=286). Patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion, myometrial invasion, lymph node involvement, and risk groups, peri- and post-operative outcomes, and survival outcomes were compared between the groups according to risk classification. Survival outcomes were assessed using Kaplan-Meier method. RESULTS: The demographic characteristics of both groups were similar except age. Shorter hospital stay and fewer complications were observed in group 2. The overall survival (OS) were similar in the low, low-intermediate, high-intermediate and high-risk groups (p=0.269, 0.476, 0.078, and 0.085; respectively) for LS compared to LT. The covariate analysis revealed that the death and recurrence risks were approximately twice higher in the LT group than in the LS group (odds ratio [OR]=1.9; 95% confidence interval [CI]=1.2-3.1 for OS; OR=2.0; 95% CI=1.2-3.3 for disease-free survival). CONCLUSION: The results of our study support the well-known positive aspects of LS as well as safe and effective use in cases of intermediate and high-risk EC.

Prognostic significance of neutrophil/lymphocyte ratio (NLR) and correlation with PET-CT metabolic parameters in small cell lung cancer (SCLC).

PURPOSE: The aim of this study is to detect the prognostic significance of neutrophil/lymphocyte ratio (NLR) in SCLC and to evaluate the relation with 18F-FDG PET-CT metabolic parameters (PET-CT MPs). METHODS: Demographic parameters, laboratory values including NLR and other clinical variables were analyzed in 112 patients with small cell lung cancer (SCLC) and 54 of these patients had results of metabolic parameters detected with 18 FDG PET-CT [including SUVmax, SUVmean, metabolic tumor volume (MTV), whole body MTV (WBMTV), TLG (total lesion glycolysis), whole body TLG (WBTLG)] were evaluated for survival analyses. RESULTS: Mean and median overall survival (OS) and progression-free survival (PFS) were found to be significantly longer in cases with NLR < 4 compared with NLR > 4 in totally. Also stage, performance status, response to first-line therapy, LDH, and lymphocyte count were found to be prognostic for OS and PFS. MTV, WBMTV and WBTLG were found to be prognostic for both OS and PFS, while SUVmax found to be significant for OS. Patients with NLR ≥ 4, MTV ≥ 60.1, WBMTV ≥ 120 and WBTLG ≥ 1000 points had lower OS and PFS. A moderate positive correlation was found between NLR and SUVmean (r: 0.36), SUVmax (r: 0.34), TLG (r: 0.39), MTV (r: 0.51), WBMTV (r: 0.40), and WBTLG (r: 0.46). CONCLUSION: There is relationship between PET-CT metabolic parameters and NLR in SCLC. Highest correlation was found with NLR and MTV, WBMTV, and WBTLG, and evaluation of NLR together with these parameters predicts survival times and tumor biology more clearly in SCLC.

Early propranolol treatment ameliorates endothelial dysfunction in experimental septic lung.

BACKGROUND: Recent reports have indicated an improved prognosis in sepsis with ß-blocker agents; however, the underlying action mechanism is still under debate. OBJECTIVES: The aim of this study was to investigate the potential effect of propranolol on endothelial dysfunction in septic rats. MATERIAL AND METHODS: The cecal ligation and puncture model (CLP) was used to generate sepsis. Adult male Wistar-Albino rats were divided into 4 groups: group 1 was a sham group, group 2 received sterile saline, group 3 received 10 mg/kg of propranolol 3 days before the intervention, and group 4 received 10 mg/kg of propranolol 30 min after CLP. Six rats from each group were sacrificed 24 h postoperatively. The remaining rats were followed for survival. We have also evaluated the effects on systemic inflammation, coagulation and the lung tissue with immunohistochemical and electron microscopic evaluation. RESULTS: Serum tumor necrosis factor alpha (TNF-α) and plasminogen activator inhibitor-1 (PAI-1) levels, as well as tissue TNF-α scores were elevated in septic rats. Electron microscopic examination of the lung tissue showed endothelial dysfunction in the sepsis group. Pretreatment significantly improved survival. Moreover, pre-treatment altered serum vascular endothelial growth factor receptor-1 (VEGFR-1) levels and post-treatment reduced serum PAI-1 and VEGFR-1 levels. In both the preand post-treatment groups, electron microscopic examination revealed improvement of the destroyed lung endothelium and showed only mild alterations in the cytoplasmic organelles, especially in the mitochondria of the endothelial cells. CONCLUSIONS: These results suggest that the improved outcome with ß-blockers in sepsis may be due to the ameliorated endothelial dysfunction. Further studies focusing on the potential effect of ß-blockers on the endothelium may lead to a better understanding of sepsis.

Evaluation of lipid profiles in patients treated with capecitabine

Background/aim: Capecitabine is a prodrug of 5-fluorouracil and has shown significant antitumor activity. The main adverse effects are hand-foot syndrome, diarrhea, and dermatitis. In recent years, hypertriglyceridemia has been reported in patients treated with capecitabine. Dyslipidemia is a rare but important side effect of capecitabine. The aim of this study is to examine the changes in lipid levels during capecitabine treatment and to raise awareness of pharmacovigilance. Materials and methods: In this retrospective study, it was aimed to analyze lipid metabolism after capecitabine treatment and is intended to contribute to the formation of a pharmacoepidemiological database. For this purpose, triglyceride, cholesterol, HDL, LDL, ALT, AST, ALP, MCV, and Hb blood levels of 57 patients treated with capecitabine at the Department of Medical Oncology, Faculty of Medicine, Çukurova University, were examined before and after five cycles of treatment. Results: Blood triglyceride and cholesterol levels were significantly increased after capecitabine treatment. The increase in triglyceride levels was higher than the increase in cholesterol levels. Conclusion: In the light of these findings, monitoring of the lipid profile should be considered in cancer patients treated with capecitabine.

A Single-Institution Radical Surgery Results in Stage IB2/IIA2 (Bulky) Cervical Cancer.

OBJECTIVE: The aim of this study is to evaluate the results of radical surgery in patients with stage IB2 to IIA2 cervical cancer who were operated on at our center between 2002 and 2015. MATERIALS AND METHODS: Forty-seven cases of patients with stage IB2/IIA2 cervical cancer who underwent primary radical surgery between 2002 and 2015 were enrolled in this study. Patients' files and pathological reports were retrospectively reviewed. Surgical, pathological, and clinical variables were analyzed and their impact on survival period was researched. Disease-free survival and overall survival periods were determined using the Kaplan-Meier test. The P value was considered significant if less than 0.05. RESULTS: Type C2 radical hysterectomy with lymphadenectomy (5 pelvic, 42 pelvic and para-aortic) was performed for all of the 47 patients in accordance with the Querleu-Morrow classification. Thirty-three of the cases were stage Ib2 and 14 cases were IIa2. Five years of overall survival was 80%. Recurrence was noted in 10 (7 pelvic, 3 extrapelvic) patients. Adjuvant therapies were needed for 83% of the patients. A univariate analysis was made for all included variables in this research and, other than recurrence, none of them was found to be statistically significant on OS and DFS. CONCLUSIONS: Although adjuvant therapies are often resorted to, primary radical surgery is also a reasonable treatment option for stage IB2/IIA2 cervical cancer, especially in young premenopausal patients when preserving ovarian functions is desired.

Interobserver and Intraobserver Variability among Measurements of FDG PET/CT Parameters in Pulmonary Tumors.

BACKGROUND: 18F-fluorodeoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) provides information about metabolic and morphologic status of malignancies. Tumor size and standardized uptake value (SUV) measurements are crucial for cancer treatment monitoring. AIMS: The purpose of our study was to assess the variability of these measurements performed by observers evaluating lung tumors. STUDY DESIGN: Retrospective cross-sectional study. METHODS: FDG PET/CT images of 97 patients with pulmonary tumors were independently evaluated by two experienced nuclear medicine physicians. Primary tumor size (UDCT), maximum SUV (SUVmax), mean SUV (SUVmean) and maximum SUV normalized to liver mean SUV (SUVnliv max) were measured by each observer at two different times with an interval of at least 2 weeks. Interobserver and intraobserver variabilities of measurements were evaluated through statistical methods. RESULTS: Size of the lesions varied from 0.81 to 13.6 cm (mean 4.29±2.24 cm). Very good agreement was shown with correlation, Bland-Altman and regression analysis for all measured PET/CT parameters. In the interobserver and intraobserver variability analysis, the Pearson correlation coefficients were greater than 0.96 and 0.98, respectively. CONCLUSION: Semi-quantitative measurements of pulmonary tumors were highly reproducible when determined by experienced physicians with clinically available software for routine FDG PET/CT evaluation. Consistency may be improved if the same observer performs serial measurements for any one patient.

Diode laser for harvesting de-epithelialized palatal graft in the treatment of gingival recession defects: a randomized clinical trial.

AIMS: The aim of present randomized controlled clinical study was to evaluate the effects of the use of diode laser for graft harvesting and palatal wound irradiation on post-operative morbidity and root coverage outcomes after a coronally advanced flap (CAF) with de-epithelialized gingival grafts (DGG). METHODS: Fifty-two patients with isolated recessions were treated. The CTG resulted from the de-epithelialization of a free gingival graft (FGG) with blade (control group:DGG-B) or diode laser (DL) (test group:DGG-L). The DL was used to de-epithelialize the outer part of the FGG and photo-biostimulate the palatal wound area. Post-operative morbidity was evaluated by using Oral Health-related Quality of Life (OHQoL) and Visual Analogue Scale-discomfort (VAS). Root coverage outcomes were also evaluated 6 months after operation. RESULTS: Statistically significant differences were found for OHQoL (p = 0.0001) and VAS (p = 0.0001) at the 7th day post-operatively favouring test sites. Root coverage results did not show a statistically significant difference. CONCLUSIONS: While both techniques were effective with regard to root coverage at 6 months, the DGG-L technique decreased post-operative morbidity associated with palatal donor-site surgery.

Comparison of two misoprostol regimens for mid-trimester pregnancy terminations after FIGO's misoprostol dosage recommendation in 2012.

OBJECTIVE: To compare the safety and efficacy of two misoprostol regimens for mid-trimester pregnancy terminations. METHODS: Retrospective analysis of 263 cases of pregnancy terminations with misoprostol between 12 and 24 weeks was performed. Group 1 (total 129 patients) consisted of patients who were given 200 mcg vaginal misoprostol every 4 h until the abortion, whereas Group 2 patients (total 134 patients) were given misoprostol as in International Federation of Gynecology and Obstetrics's (FIGO) 2012 recommendation. In case of a previous cesarean section doses were halved in both groups. Primary outcomes of the study were the time to abortion and the total drug dose used. Secondary outcome was the rate of complications. RESULTS: Total dose and time to abortion did not differ between the groups. As for complications, one patient (%0.8) in group 1 developed HELLP syndrome and had hysterotomy. One patient (%0.8) in group 2 had uterine rupture and had total hysterectomy. Two patients in both groups considered failure of induction and terminated with surgery (hysterotomy). Groups did not show difference in induction failure rates. CONCLUSIONS: We respect the presence of dose recommendation stated by the FIGO and found similar results with our recent protocol. Other misoprostol regimens used worldwide should also be compared with this guideline in order to improve its efficacy.

Prediction of root coverage for single recessions in anterior teeth: a 6-month study.

BACKGROUND: The aim of this study was to evaluate the predictive values of baseline inter-dental papilla height (IPH), loss of inter-dental papilla height (LPH), avascular exposed root surface area (AERSA) and inter-dental clinical attachment level (ICAL) measurements on complete root coverage (CRC) of single recession defects treated with coronally advanced flap and connective tissue graft technique (CAF+CTG). MATERIAL & METHODS: A total of 122 patients with one isolated gingival recession were enrolled. All recession defects without loss of ICAL (ID-CAL) (RT1) and with an amount of ID-CAL equal or smaller to the buccal attachment loss (RT2), located at upper and lower anterior teeth were treated with CAF+CTG. IPH, LPH, AERSA and ICAL parameters were analysed for possible correlation with CRC after 6 months. RESULTS: The CRC was 86.7% for RT1, 74.2% for RT2 groups. The ROC analyses revealed acceptable cut-off points for baseline AERSA, IPH and LPH for achieving CRC. The results of logistic regression analyses showed that having baseline AERSA≥19 mm(2) (OR:23.7), IPH lower ≤1 mm (OR:97.3) and belonging to RT2 group (OR:15.0) were found to be independent risk factors related with not achieving final CRC. CONCLUSION: This study indicates that AERSA and IPH may be used to predict the final CRC outcomes in RT1 and RT2 defects treated with CAF+CTG.

PRAME Expression and Its Clinical Relevance in Hodgkin's Lymphoma.

OBJECTIVES: Although Hodgkin's lymphoma (HL) is one of the most curable cancers in adult patients, new targets have to be defined in cases resistant to traditional chemotherapy. The preferentially expressed antigen of melanoma (PRAME) is a cancer testis antigen and its expression is very scarce or absent in normal tissues. For this reason PRAME is a promising candidate for tumor immunotherapy. The aim of this study is to understand the correlation of PRAME expression with prognostic factors in HL, to determine the utility of PRAME as a targeted molecule for immunotherapy and to compare real-time polymerase chain reaction (real-time PCR) and immunohistochemistry (IHC) for the detection of PRAME. METHODS: In 82 patients, PRAME was studied using real-time PCR and IHC. Data analyses were performed using statistical methods such as t test, Mann-Whitney U test, χ 2 test, Kaplan-Meier method, log-rank test and Cox regression analysis. RESULTS: PRAME was detected in 15 (18.3%) patients using IHC and in 8 (9.8%) patients using real-time PCR. A correlation was found between PRAME positivity and higher International Prognostic Score (p = 0.039). PRAME positivity detected using real-time PCR was found to be correlated with shorter disease-free survival (DFS) and overall survival (OS, p = 0.0005). DISCUSSION: The demonstration of PRAME especially in histiocytes and Reed-Sternberg cells may provide guidance for immunotherapy. Although PRAME positivity increases the risk for death (3.56), independent risk factors that affected DFS and OS occurred in advanced age and high-risk groups. CONCLUSION: Although real-time PCR is sensitive in the detection of PRAME, IHC can be another useful method. Despite the need for studies conducted on larger patient samples, PRAME expression is considered as a poor prognostic parameter in HL.

Programmed death-1 (PD-1), programmed death-ligand 1 (PD-L1), and EBV-encoded RNA (EBER) expression in Hodgkin lymphoma.

Programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) are new targets in cancer immunotherapy. PD-1 protein is an immune checkpoint expressed in many tumors. Epstein-Barr virus (EBV) is present in malignant Hodgkin/Reed-Sternberg (HRS) cells in approximately 40-50 % of Hodgkin lymphoma (HL). The aim of this study is to evaluate the clinical and prognostic importance of PD-1 and/or PD-L1 in HL and also to determine the association between EBV-encoded RNA (EBER) and PD-1/PD-L1. Formalin-fixed, paraffin-embedded tissue samples from 87 cases with HL were analyzed in this study. Immunohistochemical staining was performed to detect the PD-1 and PD-L1 expressions. Chromogenic in situ hybridization for EBER was performed using fluorescein-labeled oligonucleotide probes. PD-1 and PD-L1 expressions were found in 20 % of the cases. The EBER positivity was found in 40 cases (45 %). It has been found that co-expression of PD-1 and PD-L1 was associated with shorter survival although PD-1 or PD-L1 expressions were not found to be related with survival. Overall survival (OS) and disease-free survival (DFS) in cases without PD-1 and PD-L1 expressions were 135 and 107 months, respectively. OS and DFS in cases with co-expression for PD-1 and PD-L1 were 24 and 20 months, respectively, and these differences were found to be statistically significant for both OS and DFS (p = 0.002 and p = 0.003, respectively). Cox regression analysis showed that co-expression of PD-1 and PD-L1 was found to be an independent risk factor for prognosis (OR 6.9, 95 % CI 1.9-24.3). Targeting PD-1 and/or PD-L1 is meaningful due to the 20 % expression of each in HL, and we did not find an important association between PD-1 and PD-L1 and EBER expression in HL. Very poor outcome in cases with co-expression of PD-1/PD-L1 suggests new avenues to detect the new prognostic markers and also therapeutic approaches in HL.