HBV viral load and tumor and non-tumor factors in patients with HBV-associated HCC.

Background and Aim: Several tumor and non-tumor factors affect the prognosis of hepatocellular carcinoma (HCC) patients. This study aimed to investigate the effects of hepatitis B virus (HBV) viral load on tumor and non-tumor factors in patients with HBV-associated HCC. Materials and Methods: Patients with hepatitis B and HCC who presented to the HCC council at the Faculty of Medicine, Marmara University Liver Transplantation Institute, were included in our study. Patients were divided into two groups according to the presence or absence of HBV-DNA, and it was determined whether there were differences between these two groups with respect to tumor and non-tumor parameters. Results: Comparison of serum alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), hepatitis B surface antigen (HBsAg), and C-reactive protein (CRP) levels between HBV-DNA negative and positive patients showed significant differences (respectively p<0.01, p<0.01, p<0.05, and p<0.05). A major finding was a very significant difference between the two patient groups in terms of portal vein invasion (PVI) and venous invasion (p<0.001 and p<0.01, respectively). However, there was no significant difference in metastasis or lymph node involvement between HBV-DNA negative and positive patients. Conclusion: Our findings suggest that HBV viral load plays an important role in PVI in HCC patients, and there is a significant relationship between HBV viral load and inflammation.

Evaluation of psychiatrist's communication with psychosis patients / Evaluación de la comunicación de psiquiatras con pacientes psicóticos / Avaliação da comunicação de psiquiatras com pacientes psicóticos

Abstract: Evaluation of the physician-patient relationship is very important in determining priorities in medical practice and medicine. For this purpose, in this study the psychiatrist's communication with psychotic patients as a sensitive group was evaluated. A questionnaire was administered to 210 patients in a psychiatric clinic of Inonu University Hospital in Turkey to determine how the examination is performed in the facility for outpatients in the psychosis unit. According to the study conducted, it was observed that the evaluation score of the psychiatrist's communication with psychotic patients increased positively with increasing consultation duration. Our work is particularly noteworthy because it deals with a sensitive area, such as a group of psychiatric patients. The scores were obtained based on data from the evaluation of the questionnaires, which showed that the communication between the psychiatrist and the psychotic patient was conducted in a sensitive and careful manner, and without ethical problems.

Resumen: La evaluación de la relación médico-paciente es muy importante para determinar las prioridades en la práctica médica y la medicina. Para este propósito, en este estudio se evaluó la comunicación del médico psiquiatra con los pacientes psicóticos como grupo sensible. Se administró un cuestionario a 210 pacientes de una clínica psiquiátrica del Hospital de la Universidad de Inonu en Turquía, para determinar cómo se realiza el examen en el establecimiento para los pacientes externos de la unidad de psicosis. De acuerdo con el estudio realizado, se observó que el puntaje de evaluación de la comunicación del psiquiatra con los pacientes psicóticos se incrementó positivamente al aumentar la duración de la consulta. Nuestro trabajo se destaca particularmente por tratarse de un área sensible, como es un grupo de pacientes psiquiátricos. Los puntajes se obtuvieron basándose en datos de la evaluación de los cuestionarios, que mostraron que la comunicación entre el psiquiatra y el paciente psicótico se realizó de una forma sensible y cuidadosa, y sin problemas éticos.

Resumo: A avaliação da relação médico-paciente é muito importante para determinar as prioridades na prática médica e na medicina. Para este fim, neste estudo foi avaliada a comunicação do psiquiatra com pacientes psicóticos como um grupo sensível. Um questionário foi aplicado a 210 pacientes em uma clínica psiquiátrica do Hospital Universitário Inonu na Turquia para determinar como o exame é conduzido nas instalações para pacientes ambulatoriais da unidade de psicose. De acordo com o estudo realizado, observou-se que a pontuação da avaliação da comunicação do psiquiatra com pacientes psicóticos aumentou positivamente à medida que a duração da consulta aumentava. Nosso trabalho é particularmente notável porque trata de uma área sensível, tal como um grupo de pacientes psiquiátricos. Os resultados foram obtidos com base nos dados da avaliação dos questionários, que mostraram que a comunicação entre psiquiatra e paciente psicótico foi realizada de forma sensível e cuidadosa, e sem problemas éticos.

Early therapeutic plasma exchange may improve treatment outcomes in severe acute toxic Hepatitis.

BACKGROUND AND OBJECTIVES: Acute toxic hepatitis can result in a different clinical course from a completely curable disease to subacute hepatitis, chronic hepatitis, and fulminant hepatitis failure, which is quite mortal. For this purpose, therapeutic plasma exchange (TPE) can be used for improving treatment outcomes by reducing the harmful substances caused with and/or without liver function in acute toxic hepatitis. We aimed to evaluate treatment outcomes in severe acute toxic hepatitis patients who applied early TPE procedure. MATERIALS AND METHODS: A total of 335 patients who received TPE between 2010-2021 were retrospectively screened and 59 (male/female, 30/29; min/max-age, 22-84) patients with acute toxic hepatitis who underwent TPE in the first 24 h were included in the study. TPE was performed in patients who had high total bilirubin level (>10 mg/dL). Laboratory parameters of the patients before and after the TPE procedure, number of patients developed complications of acute toxic hepatitis and mortality rates were evaluated for effectiveness of TPE. RESULTS: Acute toxic hepatitis was associated with hepatotoxic drugs in 44 (74.5 %), herbal medication 6 (10.2 %), mushroom poisoning 6 (10.2 %) and with substance abuse 3 (5.1 %) in patients. When the patients were compared based on INR, liver function tests, ammonia, lactate and Model For End-Stage Liver Disease (MELD) score at baseline, 48 h after TPE (independently of TPE number) and before final state a statistically significant decrease was observed in all parameters (p < 0.05). Fifty three (90 %) of patients improved without complications, the remaining 6 (10 %) patients were diagnosed with fulminant hepatitis. All these remaining patients died before liver transplantation (LTx) could be performed. CONCLUSION: TPE is a safe, tolerable therapy option and early TPE may improve treatment outcomes in severe acute toxic hepatitis.

Comparison of Antiaging Effects on Rat Skin of Cog Thread and Poly-L-Lactic Acid Thread.

BACKGROUND: Polydioxanone Cog thread and poly-L-lactic acid (PLLA) thread have been used clinically for lifting and antiaging purposes. However, the histological changes in tissue and the efficacy of these 2 different types of thread have not been compared. OBJECTIVE: This study used hematoxylin and eosin (H&E) staining, Masson's trichrome staining, and electron microscopy (EM) to compare the results associated with the use of Cog thread and PLLA thread in rat skin. METHODS: Thirty female rats were divided into 3 groups of 10 rats each: a control group; a Cog group; and a PLLA group. Biopsy specimens obtained at 1, 3, and 6 months were examined using H&E, MT, and EM. RESULTS: Although significant increases were observed in dermal thickness and the numbers of fibroblasts in the PLLA group compared with the control group within the first month (p: .019), there were no significant differences between the Cog and control groups during this period (p: .245). Dermal thickness (p: .002) and numbers of fibroblasts (p: .001) were similar in samples obtained from the PLLA and Cog groups at 3 and 6 months, and both groups showed significantly improved outcomes compared with the control group. CONCLUSION: Poly-L-lactic acid and Cog sutures were effective in facial rejuvenation; both increased dermis thickness and stimulated collagen production.

Reconstruction of Anomalous Portal Venous Branching in Right Lobe Living Donor Liver Transplantation: Malatya Approach.

Reconstruction of anomalous portal vein branching (APVB) during right lobe living donor liver transplantation (LDLT) can be challenging. The goal of this article is to describe our surgical technique, named the Malatya Approach, in case of APVB during right lobe LDLT. The technique unifies the APVB and obtains a funnel-shaped common extension with a circumferential fence by a saphenous vein conduit. In total, 126 (10.6%) of 1192 right lobe grafts had APVB that were divided into 2 groups according to the adopted surgical techniques: the Malatya Approach group (n = 91) and the previously defined other techniques group (n = 35). Both groups were compared regarding portal vein thrombosis (PVT), postoperative 90-day mortality and survival. PVT developed in 3 patients (3.3%) in the Malatya Approach group and developed in 10 (28.6%) patients for the other group (P < 0.001). There were 8 (8.8%) 90-day mortalities in the Malatya Approach group (1 PVT related) and 15 patients (9 PVT related) died in the other techniques group (P < 0.001). Mean follow-up time for both groups was similar (999.1 days for the Malatya Approach group versus 1024.7 days for the other group; P = 0.47), but longterm survival in the Malatya Approach group was better than in the other group (84.6% versus 40%; P < 0.001). Multivariate analysis revealed that the Malatya Approach group showed less PVT development and longer survival (P < 0.001). This technique is promising to avoid PVT and mortalities in cases of APVB during right lobe LDLT. Liver Transplantation 23 751-761 2017 AASLD.

Association of eNOS Gene Polymorphisms G894T and T-786C with Risk of Hepatorenal Syndrome.

Background. There are no studies investigating the relationship between endothelial nitric oxide synthase (eNOS) gene polymorphisms and hepatorenal syndrome (HRS). Aim. The purpose of this study is to elucidate whether eNOS gene polymorphisms (G894T and T-786C) play a role in the development of type-2 HRS. Methods. This study was carried out in a group of 92 patients with cirrhosis (44 patients with type-2 HRS and 48 without HRS) and 50 healthy controls. Polymorphisms were determined by polymerase chain reaction (PCR) and melting curve analysis. Results. We did not find any significant difference in allele and genotype distributions of the eNOS -T-786C polymorphism among the groups (p = 0.440). However, the frequency of GT (40.9%) and TT (13.6%) genotypes and mutant allele T (34.1%) for the eNOS G894T polymorphism were significantly higher (p < 0.001 and p < 0.001, resp.) in the HRS group than in both the stable cirrhosis (14.6%, 4.2%, and 11.5%, resp.) and the control (22.0%, 2.0%, and 13.0%, resp.) groups. Conclusion. The occurrence of mutant genotypes (GT/TT) and mutant allele T in eNOS -G894T polymorphisms should be considered as a potential risk factor in cirrhotic patients with HRS.

Outcome of transtibial AperFix system in anterior cruciate ligament injuries.

BACKGROUND: The anterior cruciate ligament (ACL) is one of the major stabilizing factor of the knee that resist anterior translation, valgus and varus forces. ACL is the most commonly ruptured ligament of the knee. The graft fixation to bone is considered to be the weakest link of the reconstruction. According to the parallel forces to the tibial drill hole and the quality of tibial metaphyseal bone is inferior to femoral bone stock, graft fixation to the tibia is more difficult to secure. AperFix system (Cayenne Medical, Inc., Scottsdale, Arizona, USA) which consists femoral and tibial component that includes bioinert polymer polyetheretherketone (PEEK) is one of the new choice for ACL reconstruction surgery. aim of this study was to assess the clinical outcomes and fixation durability of the AperFix (Cayenne Madical, Inc., Scottsdale, Arizona, USA) system and to determine the effect of patient's age in arthroscopic reconstruction of the anterior cruciate ligament. MATERIALS AND METHODS: Patients with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. Femoral tunnel widening was assessed by computer tomography scans. Early postoperative and last followup radiographs were compared. RESULTS: Fifty one patients were evaluated with mean followup of 29 months (range 25-34 months). Mean age at the surgery was 26.5 ± 7.2 years. Lysholm, Cincinati and Tegner activity scales were significantly higher from preoperative scores (Lysholm scores: Preoperative: 51.4 ± 17.2, postoperative: 88.6 ± 7.7 [P < 0.001]; Tegner activity scores: Preoperative 3.3 ± 1.38, postoperative: 5.3 ± 1.6 [P < 0.001]; Cincinati scores: Preoperative: 44.3 ± 17, postoperative: 81.3 ± 13.9 [P < 0.001]). The mean femoral tunnel diameter increased significantly from 9.94 ± 0.79 mm postoperatively to 10.79 ± 0.95 mm (P < 0.05). The mean ROM deficit (involved vs. contra knee) was -7.2 ± 16 (P < 0.001). There was no significant difference for knee score, ROM deficits (<30 years: -7.3 ± 15 and >30 years -7.06 ± 19) and femoral tunnel enlargement (<30 years: 0.83 ± 0.52 and >30 years 0.87 ± 0.43) of the patients with below and above 30 year. There was no significant difference for knee scores and femoral tunnel enlargement between patients with meniscal injuries and don't have meniscus lesions. CONCLUSION: The AperFix system gives satisfactory clinical and radiological results with low complication rate. However, long term clinical and radiological results are needed to decide the ideal anterior cruciate ligament reconstruction method.

Association between latent toxoplasmosis and clinical course of schizophrenia - continuous course of the disease is characteristic for Toxoplasma gondii-infected patients.

The aim of the present study was to investigate the association between various clinical aspects of schizophrenia and seropositivity against Toxoplasma gondii (Nicolle et Manceaux, 1908). We selected 94 patients with schizophrenia and investigated the seropositivity rate for anti-T. gondii IgG antibodies by ELISA. Clinical parameters of schizophrenic patients such as illness type and status, clinical course, awareness of the illness and need for electroconvulsive therapy (ECT) were compared with their serological status. Anti-T. gondii IgG antibodies were detected in 43 (46%) of schizophrenic patients. Chronic patients had a rate of 34 (72%) seropositivity, whereas 9 (22%) of the patients with partial remission showed evidence of latent toxoplasmosis. Of continuous patients, 35 (81%) were found to be seropositive and this rate was significantly more than in the other groups. The rate of latent toxoplasmosis was detected significantly higher in patients who lack awareness of schizophrenia (36, i.e. 72%) than the patients who were aware of their illnesses (7, i.e. 16%). Anti-T. gondii IgG antibodies were detected in 38 (70%) of ECT performed patients while this percentage was 13% in the ones who had never been treated with ECT. This difference was also statistically significant. We showed that Toxoplasma-infected subjects had 15× higher probability of having continuous course of disease than Toxoplasma-free subjects. Our results put forth the possibility of latent toxoplasmosis to have a negative impact on the course of schizophrenia and treatment response of schizophrenic patients.

Time-dependent decalcifying effects of endodontic irrigants with antibacterial properties.

The aim of this study was to investigate the extent of calcium ion (Ca(2+)) removal on root dentin after treatment with 1.25% NaOCl, 2.5% NaOCl, 5.25% NaOCl, 2% chlorhexidine (CHX), 2% iodine potassium iodide (IKI), and MTAD in 3 immersion time periods. Extracted human mandibular premolars were bisected longitudinally, and the root halves (n = 70) were isolated with nail varnish, leaving the root canal exposed. The specimens were immersed in the test solutions, during which the amount of Ca(2+) release into the solutions was determined at 5, 10, and 15 minutes by flame photometry. The decalcifying effect of 5%, 2.5%, and 1.25% NaOCl and 2% IKI significantly increased within time (P < .05), with 5% NaOCl extracting the greatest amount of Ca(2+) at all treatment times. For 2% CHX and distilled water, a significant increase in the amount of Ca(2+) extraction from root dentin was only evident at 10 minutes (P < .05) and did not change at 15-minute readings. Between the 5- to 10-minute and 10- to 15-minute intervals, the greatest amount of increase in the rate of Ca(2+) extraction from root dentin was observed in the 2.5% NaOCl group. At 15 minutes, 2% CHX and distilled water showed the least amount of change. Among the test solutions, MTAD extracted the least amount of Ca(2+) at 5 minutes.