Pancreatic morphology/contour variations should be recognized and remembered.

Background: Pancreatic contour variations can be detected incidentally on computed tomography (CT). Recognition and remembering of these variations are important in volumetric measurements and surgery as well as in preventing misdiagnosis. Aim: This study aims to evaluate the morphology/contour variations in the pancreas head-neck, body-tail, and uncinate process with multi-detector CT (MDCT) examinations (triple phase CT abdomen). Material and Method: Around 1662 adult age (>18 years old) patients were evaluated retrospectively, and after exclusion criteria, 945 patients were included in the study. Aplasia and hypoplasia of the uncinate process were determined, and pancreatic contour variances were categorized according to the Ross et al. and Omeri et al. classifications. Pancreatic head-neck variants were categorized into Type I-anterior, Type II-posterior, and Type III-horizontal variations. Pancreatic body-tail variants were sectioned into Type Ia-anterior protrusion, Type Ib-posterior protrusion, and Types IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. Results: Of the 945 patients, 481 (50.9%) were female. The mean age was 43.28 ± 10.49 (min. 20-max. 68). In the evaluations made according to the uncinate process morphology variant, hypoplasia was detected in 66 (7%) patients and aplasia in 12 (1.3%) patients. Pancreatic head-neck and body-tail contour variations were observed in 596 (63.1%) patients. The most common head-neck variation was Type II in 233 (24.6%) patients, followed by type III in 96 (10.2%). There were Type Ia in 83 (8.8%) patients and Type Ib in 14 (1.5%) patients. The pancreatic tail configuration was normal in 792 (83.8%) patients; it was Type IIa in 62 (6.6%) patients and IIb in 50 (5.3%) patients. The most common variation was head and tail in 33 (3.5%) patients. Discussion: Pancreatic variations detected in CT examinations for distinct reasons are not rare; these variations should be recognized and remembered.

Role of augmenter of liver regeneration on testicular ischemia and ischemia/reperfusion injury: An experimental study.

Background: Testicular torsion causes ischemic injury, and torsion causes reperfusion injury. Aim: Evaluating the role of augmenter of liver regeneration (ALR) in testicular ischemia and ischemia/reperfusion injury. Materials and Method(s): Seventy-eight (78) healthy Wistar albino male rats were randomly divided into four groups; control (C) (n = 6), sham (S) (n = 24), torsion (T) (n = 24), and torsion/detorsion (T/D) (n = 24). S, T, and T/D groups were divided into four subgroups (n = 6) as 1st, 2nd, 3rd, and 4th hours. Blood, tissue ALR, and histology analyses were performed between groups and subgroups. Results: The increase in plasma ALR values at the 3rd and 4th hours compared to the 1st hour in the T group were significant (P < 0.01, P < 0.001, respectively). In the T/D group, a significant increase was observed in plasma ALR values at the 3rd and 4th hours compared to the 1st hour (P < 0.05, P < 0.001, respectively). Plasma ALR values at the 1st, 2nd, 3rd, and 4th hours were higher in the T and T/D groups than in the C group (P < 0.001, P < 0.05, respectively). Plasma ALR values were higher in the T group at the 1st, 2nd, 3rd, and 4th hours than in the S group (P < 0.05). A significant increase was observed in tissue ALR at the 3rd and 4th hours than at the 1st hour in the T group (P < 0.05, P < 0.001, respectively). A significant increase was observed in tissue ALR at the 3rd and 4th hours than in the 1st hour in the T/D group (P < 0.05, P < 0.001, respectively). Discussion: ALR in plasma and testicular tissue has a potential role in the early diagnosis of testicular torsion and in predicting the prognosis of T and T/D.

Helios-Negative Regulatory T Cells as a Key Factor of Immune Tolerance in Nonallergic Beekeepers.

BACKGROUND AND OBJECTIVES: Although exposure to stings has been identified as the leading risk factor for anaphylaxis due to Hymenoptera venom allergy, professional beekeepers receive hundreds of stings yearly without developing systemic reactions. This study aims to analyze the mechanisms underlying bee venom tolerance in beekeepers. METHODS: A cross-sectional study was conducted. Participants were recruited and classified into 3 groups: allergic patients (APs), who experienced systemic reactions after bee stings, with a positive intradermal test and specific IgE (sIgE) to Apis mellifera venom (AmV); tolerant beekeepers (TBKs), who received ≥50 stings/year; and healthy nonexposed controls (HCs). We measured serum levels of sIgE and specific IgG4 (sIgG4) to AmV, rApi m 1, rApi m 2, rApi m 3, Api m 4, rApi m 5, and rApi m10, as well as AmV-induced basophil degranulation, percentage of T-cell subsets, regulatory T cells (Treg), and IL-10 production. RESULTS: Compared with TBKs, APs had high levels of sIgE to AmV and all its allergic components (P<.001), together with a high basophil activation rate (P<.001). Conversely, compared with APs, TBKs had higher levels of sIgG4 (P<.001) and IL-10 (P<.0001), as well as an enhanced CTLA-4+ Treg population (P=.001), expanded Helios- Treg (P<.003), and reduced type 1 helper T cells (TH1) (P=.008), TH2 (P=.004), and TH17 (P=.007) subsets. CONCLUSIONS: The profile of TBKs, which was strongly marked by Treg activity, differed from that of TBKs. This natural tolerance would be led by the expansion of inducible Helios- Treg cells at the peripheral level. The Helios- Treg population could be a novel candidate biomarker for monitoring tolerance.

The impact of granulocyte colony-stimulating factor (G-CSF) on thin endometrium of an animal model with rats.

MATERIALS AND METHODS: After forming of the thin endometrium by uterine injection of 0.2 ml 96% ethyl alcohol to the rats, five days of subcutaneous injections of 40 µg/kg G-CSF or saline were given. Endometrial thickness, immunohistochemically expression of vascular endothelial growth factor receptor-2 (VEGF-R2), proliferative cell nuclear antigen (PCNA) and fibronectin apoptosis with TUNEL method were compared in specimens among four groups of post-model rats. RESULTS: Endometrial thickness was significantly improved in thin but not in normal endometrium group with GCSF when compared to saline injection. Stromal and glandular epithelial expression of PCNA and pericapillary VEGF-R2 was significantly increased, and apoptosis was significantly decreased with G-CSF. Although fibronectin was also increased with G-CSF in the thin endometrium, the difference was non-significant. In further, G-CSF decreased apoptotic cells and increased expression of PCNA when compared to saline injection in normal endometrium. CONCLUSIONS: G-CSF improves endometrial thickness, proliferation, angiogenesis and DNA fragmentation in thin endometrium.

Interindividual differences in the clinical effectiveness of liraglutide in Type 2 diabetes: a real-world retrospective study conducted in Spain.

AIMS: To study the response of clinical variables (HbA1c , body weight, lipid profile and blood pressure) over 24 months of liraglutide treatment in a real-world clinical setting, and to describe the evolution of HbA1c and body weight reduction in response to liraglutide treatment by employing generalized additive mixed models (GAMMs). METHODS: We included people aged ≥ 18 years with Type 2 diabetes mellitus that initiated liraglutide treatment between November 2011 and May 2015. Demographic and clinical data were retrieved retrospectively over 24 months from electronic medical records with a median duration of observation of 7.0 (IQR 3.0-12.0) months. RESULTS: Individuals that initiated liraglutide therapy were obese (BMI 39.1 kg/m2 ), with inadequate HbA1c (68 mmol/mol [8.4%]), blood pressure and lipid levels. Upon liraglutide treatment, HbA1c , body weight, mean systolic and diastolic blood pressure, and lipid levels decreased gradually. GAMMs demonstrated that longer treatment with liraglutide was a predictor of improved HbA1c response, whereas higher baseline HbA1c , longer Type 2 diabetes duration and treatment with insulin were predictors of worse HbA1c response. Higher baseline weight, longer treatment with liraglutide and the interaction between metformin and time were predictors of improved weight response. CONCLUSIONS: In this real-world study, we showed the effectiveness of liraglutide in improving body weight, HbA1c , mean systolic and diastolic blood pressure, and lipid levels. GAMMs indicated that baseline HbA1c and weight, time of treatment with liraglutide, diabetes duration and the use of metformin or insulin are predictors of clinical response to liraglutide.

Characteristic features of thermoluminescence in neodymium-doped gallium sulfide.

The thermoluminescence (TL) of neodymium-doped gallium sulfide (GaS:Nd) single crystals was measured from 10 K to room temperature with various heating rates between 0.2 and 1.0 K/sec. Two peaks centered at 70.9 K and 116.0 K were observed when using a heating rate of 0.8 K/sec. Initial rise and curve fitting methods were used to obtain information on trap activation energies. Activation energies of 94 and 216 meV were found for two analyzable peaks. The heating rate dependencies of TL intensities revealed that one of the observed peaks showed normal behavior according to the one trap-one recombination model, whereas the other model showed anomalous heating rate behavior. TL experiments were also carried out at different illumination temperatures from 10 to 32 K; maximum peak temperature remained almost the same at various illumination temperatures. This behavior indicated that the revealed trapping centers are single, discrete levels. The TL glow curves of undoped GaS crystals were also investigated and the effect of Nd doping on the TL characteristics of crystals is discussed in the manuscript.

Impact of testicular histopathology as a predictor of sperm retrieval and pregnancy outcome in patients with nonobstructive azoospermia: correlation with clinical and hormonal factors.

In this study, our objective was to evaluate the impact of testicular histopathology on the outcome of intracytoplasmic sperm injection (ICSI) cycles of patients with nonobstructive azoospermia and correlate with clinical and hormonal parameters. For this purpose, 271 patients with nonobstructive azospermia (NOA) who underwent testicular sperm extraction (TESE) for ICSI cycles were retrospectively evaluated for sperm retrieval, fertilisation, embryo cleavage, clinical pregnancy and live birth rates among different testicular histology groups. We also correlated hormonal and clinical factors with histological findings. Sperm retrieval and fertilisation rates (FR) were found to be significantly different among all testicular histological groups of NOA except for embryo cleavage, clinical pregnancy and live birth rates. Furthermore, serum follicle stimulating hormone (FSH) level was the most significant variable to predict sperm recovery on TESE. Separate analyses within each testicular histological group revealed that higher FSH was also associated with lower pregnancy rates in only maturation arrest group. In conclusion, testicular histology significantly influences sperm retrieval and FRs but not pregnancy and live birth rates in nonobstructive azoospermia. However, FSH is the best predictor of a successful TESE.

Human papillomavirus effect on the development of endometrial polyps.

AIM: Although the association of human papillomavirus (HPV) with warts arising in different parts of the human body has been well-demonstrated, the association of HPV with endometrial polyps has never been studied in the literature up to now. MATERIALS AND METHODS: Detection of the HPV DNA was carried out by using 13 high-risk HPV real-time PCR Kit and five low-risk HPV real-time PCR Kit. RESULTS: Among 50 endometrial polyp samples, one endometrial polyp sample revealed a positive result for the presence of HPV type 18. CONCLUSIONS: This first study in the medical literature investigating the possible effect of HPV on the development of endometrial polyps has demonstrated that HPV might have a role in the development of some of the endometrial polyps. If the present authors' hypothesis that endometrial polyps caused by carcinogenic HPV types are prone to proceed to endometrial cancer if left untreated is correct, HPV vaccine has a potential to prevent development of at least some of the endometrial polyps and endometrial cancers.

Rare ovarian tumors: a single center experience of 15 years.

OBJECTIVE: The present study aims to review cases of extremely rare primary ovarian tumors and thus, to evaluate the distribution of rare primary ovarian pathologies. Various aspects of the presentation, diagnosis, and treatment of these tumors are discussed. MATERIALS AND METHODS: A retrospective review of women with final pathology of rare primary ovarian tumors, which were managed at the Gynecologic Oncology Department of Zekai Tahir Burak Women's Health Education and Research Hospital, from 1995 to 2010 was undertaken. RESULTS: Among the 2,210 women treated during the study period, extremely rare ovarian tumors accounted for 1.62% (36/2210) of all cases. CONCLUSION: It is important to be aware of these rare entities in the pathological diagnosis of ovarian tumors. Intraoperative frozen examination should be performed because rare benign conditions that mimic malignancy may not require radical surgery. The rarity of these tumors renders basic scientific advances more challenging.

Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study.

AIMS: To analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation. DESIGN: A retrospective cohort study was carried out. SCOPE: A single university hospital. PATIENTS: A total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR). MAIN VARIABLES OF INTEREST: Recipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors. RESULTS: The crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25-3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26-3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45-6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70-30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93-2.76; p=0.086). CONCLUSIONS: The crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).

Chronic obstructive pulmonary disease in severe mental illness: A timely diagnosis to advance the process of quitting smoking.

BACKGROUND: This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention. METHOD: A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group-studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)-or to the active control group, who followed the 5 A's intervention. RESULTS: The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group. CONCLUSION: In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A's intervention.

The impact of expectant management, systemic methotrexate and surgery on subsequent pregnancy outcomes in tubal ectopic pregnancy.

BACKGROUND: The most common treatment modalities of ectopic pregnancy may influence long-term subsequent fertility outcomes in women who previously treated for ectopic pregnancy. AIMS: Our objective was to compare long-term subsequent fertility outcomes after treatment with expectant management, systemic methotrexate (MTX) and surgery in tubal ectopic pregnancy. METHODS: We searched our database for all women diagnosed with tubal ectopic pregnancy between January 2007 and January 2011 who were managed expectantly, with systemic MTX and with surgery. Treatment success and spontaneous pregnancy rates were compared in patients who desire to conceive following a tubal pregnancy. RESULTS: One hundred twelve of 151 women desired to conceive following tubal ectopic pregnancy. Twenty-seven of 112 (24.1 %) patients were managed expectantly. Fifty-three (47.3 %) and 32 (28.5 %) patients were managed with systemic MTX or surgery, respectively. All patients in expectant and surgery groups were managed successfully. Two (3.7 %) patients had surgery after failed treatment with systemic MTX. Spontaneous intrauterine pregnancy rates were 62.9 % in expectantly managed women, 58.4 % in women with systemic MTX and 68.7 % in women with surgery (p > 0.05). CONCLUSIONS: Treatment of ectopic pregnancy with either expectant management or systemic MTX is equally effective as compared to surgery. Spontaneous intrauterine pregnancy rates were comparable in expectant management, systemic methotrexate and surgery.

Rapid percutaneous nephrostomy catheter placement in neonates with the trocar technique.

PURPOSE: The purpose of this study was to assess the efficacy of a modified percutaneous nephrostomy procedure for grade III-IV hydronephrosis in neonates. MATERIAL AND METHODS: Eleven neonates (five girls, six boys) with a mean age of 13.7days±9.9 (SD) (range, 4-28days) with pronounced hydronephrosis had percutaneous nephrostomy using a modified procedure. In all patients, percutaneous nephrostomy was performed with a trocar catheter under ultrasound guidance and then the catheter was placed into the collecting system without prior dilatation. RESULTS: Technical success was achieved in all patients. There were no major procedure-related complications. There was no perirenal hematoma on control ultrasound examinations and no hematuria was observed after the procedure. The median drainage time was 75days (range: 42-120days). Two children had urinary tract infection, which was controlled by using antibiotics. CONCLUSION: The trocar nephrostomy is a practical and feasible method, which can be used for neonates with grade III-IV hydronephrosis.

Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenoses.

PURPOSE: "Flash Spiral" imaging is a new prospective ECG-triggered spiral scan mode that uses a very high-pitch for coronary computed tomography angiography (CTA). This enables complete image acquisition within one cardiac cycle with a very low radiation exposure. The aim of this study was to investigate the diagnostic accuracy, image quality, and effective radiation dose of prospectively ECG-triggered high-pitch spiral method (Flash spiral mode) of coronary CTA using dual-source technology for the evaluation of coronary artery stenoses. MATERIAL AND METHODS: The study included 186 consecutive patients (115men, 71women; mean age: 53.37 years) who underwent coronary CTA. Coronary CTA was performed with a 128×2-slice dual-source CT (Somatom Definition Flash, Siemens, Germany) using a prospectively ECG-triggered high-pitch spiral mode. Patients were divided into three groups according to heart rate (≤65bpm, 66-75bpm, ≥76bpm) and body mass index (BMI) (20-24kg/m(2), 25-29kg/m(2), 30-34kg/m(2)) values. The correlation between heart rates, image quality and BMI values are investigated. A four-point scale (1=excellent, 4=poor/non-diagnostic) was used to rank the comparative image quality. Effective radiation doses were calculated. Also the correlation between radiation dose, sex and BMI values were investigated. In addition, diagnostic accuracy of CTA for detection of significant (≥50%) coronary artery stenoses was compared with invasive coronary angiography findings of 612vessel segments in 38patients. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were calculated. RESULTS: A total of 2976coronary artery segments were present. Of all coronary artery segments, 2381 (80%) had an image quality score of 1, and 1.5% segments were rated as "poor/non-diagnostic". When the correlation between heart rate and image quality is investigated, there was a significant difference between ≤65bpm and ≥76bpm groups. However, there was no significant difference between ≤65bpm and 66-75bpm groups. The mean effective dose was found as 1.3mSv (min: 0.5, max: 2.4mSv). The correlation between effective radiation dose and BMI was moderate. However, the correlation between gender and radiation dose was significant. Sensitivity, specificity, negative predictive value and accuracy of coronary CTA on a per-vessel segment were 90.1%, 97.4%, 98.6%, and 96.5%, respectively. CONCLUSIONS: Prospectively ECG-triggered high-pitch spiral mode coronary CTA provides high image quality and diagnostic accuracy, with very low radiation dose for evaluation and exclusion of coronary artery stenoses.

A case of hypercalcaemic crisis secondary to coexistence of primary hyperparathyroidism and Graves' disease.

A 46 year-old female patient presented to the hospital with ongoing and progressively increasing fatigue, severe nausea and vomiting, loss of appetite, constipation, palpitations and somnolence. Laboratory evaluation revealed a severe hypercalcaemia and overt hyperthyroidism. She was diagnosed with primary hyperparathyroidism accompanied by Graves' disease. The patient underwent total thyroidectomy and right inferior parathyroid gland adenoma excision on the 24th day of her admission to the hospital after calcium levels and free thyroid hormone levels were brought to normal ranges. We suggest that a possibility of simultaneous thyrotoxicosis and primary hyperparathyroidism in cases presenting with a hypercalcaemic crisis should be considered.