Retrospective study evaluating dental side effects of radiotherapy in patients treated for head and neck cancer.

INTRODUCTION: Head and neck cancer squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide with around 600,000 new diagnosis each year. Nowadays, in locally advanced disease, radiotherapy (RT) play an important role, this with or without chemotherapy in organ preservation strategies. More specific for early stage localized disease, RT (or surgery) seems to give similar results on locoregional control (LRC) and choice is made according to the organ preservation issue. Despite the fact that technical improvements have been made to optimize the radiation dose delivery and minimize the normal tissue toxicity, RT is associated with potential early and late toxicities. Osteoradionecrosis of the jaw (ORNJ), especially seen after teeth extraction, is one of the associated toxicities and can significantly impair the patient's quality of life. Because of the fear of developing ORNJ, one is very reluctant to extract or place a dental implant post-radiotherapy, especially in high irradiation dose zones (>40 Gy). Hence, it is important to define teeth at risk of future extraction before initiating RT and to handle those in high-risk irradiation zones. In order to optimise extractions, we created a predictive model of the expected irradiation dose, and thus the need for extraction, to the teeth bearing bones. The aim of this study is to validate our model and to define the potential relationship between the radiation dose received by each tooth and the dental complications observed. MATERIAL AND METHODS: Between March 2012 and March 2018, patients with HNSCC treated by intensity modulated RT were retrospectively analysed. The mean irradiation dose for each tooth was generated on the administered treatment plan by contouring each tooth separately on each dosimetric scan section using dedicated software (Eclipse, Varian). In order to validate our predictive model, we compared the actual generated/administered teeth irradiation doses with the irradiation doses predicted by our model. RESULTS: Our predictive model was accurate in 69.6% of the cases. In 12.5% of cases the predicted dose was higher than the calculated dose and lower in 17,8% of the cases. A correct- or over-estimation (is the latter being clinically less worrying than an underestimated dose) was achieved in 82% of cases. For the 18% of cases underfitting, the mean margin of error was 5.7 Gy. No statistically significant association was found between the development of caries and doses to the teeth, doses to the parotid glands or dental hygiene. However, a significant association between dental irradiation at more than 40 Gy and the occurrence of dental fractures (p = 0.0002) were demonstrated. CONCLUSIONS: Our predictive model seems to be 82% accurate for dose prediction, hence might be helpful for optimizing/minimizing prophylactic extractions. Indeed, following our model, professionals could decide not to extract damaged teeth in areas not at risk of ORNJ, lowering morbidity during and after RT. Contrary to the literature, no relationship was found between the occurrence of dental caries and parotid irradiation and the patient's oral hygiene. However, for the first time, a highly significant correlation between the occurrence of dental fracture and dental irradiation at more than 40 Gy was observed.

A new promising indicator in prostate cancer screening: Prostate-specific antigen fluctuation rate.

OBJECTIVES: To evaluate whether PSA fluctuation can be used to predict the risk of prostate cancer. MATERIALS AND METHODS: The study included 1244 patients who underwent prostate biopsy at Kartal Dr. Lutfi Kirdar City Hospital between 2013 and 2021 (848 in non-cancer; 396 in cancer). The patient's age, last two PSA values (PSA1 and PSA2) within three months before the biopsy, the duration between two PSAs (days), prostate size (g) and PSA density (PSAD) were all recorded. PSA fluctuation rate (PSAfr) was defined as the change rate between two PSA values. RESULTS: PSAfr was significantly higher in the non-cancer group than in the prostate cancer group (15.2% (20.5) and 9.6% (14.4), P=.019). A Simple linear regression was used to examine the relationship between PSAfr and other factors such as age, PSA, PSAD, and prostate volume, but it was shown that these had no effect on PSA fluctuations. ROC analysis revealed a relatively low Area Under the Curve (AUC) for PSAfr (AUC, 0.584 (0.515-0.653)). However, the cut-off value of 12.35% was found to be significant, with a sensitivity of 58% and a specificity of 59% (P:.019, 95%CI). The odds ratio, adjusted for age, PSAD, and PSA2, was calculated as 0.545 (0.33-0.89) using logistic regression analysis to show the relationship between prostate cancer and PSAfr. As a result, those with high PSAfr were found to be 1.83 times less likely to be diagnosed with prostate cancer than those with low fluctuations. CONCLUSION: PSAfr could be used in nomograms to predict prostate cancer risk and reduce the number of unnecessary biopsies.

Non-invasive assessment of the tear film after LASIK.

OBJECTIVE: The aim of the study was to compare the assessment of the ocular surface using classic methods with the newly developed keratoscopy-based MYAH (Topcon EU, Visia Imaging, Japan) device after femtosecond laser-assisted in situ keratomileusis (LASIK). PATIENTS AND METHODS: This cross-sectional and observational study analyzed 80 eyes of 40 patients. Tear film and ocular surface evaluation were performed at baseline, postoperative week 1, and month 1. Measurements obtained using the Schirmer I test and invasive tear-film breakup time (I-TBT) were compared with non-invasive evaluation of the tear break-up time (NI-TBT), tear meniscus height (TMH) and blink analysis obtained using the MYAH device. Findings were correlated with the Ocular Surface Disease Index (OSDI) questionnaire in all subjects. RESULTS: The study included 80 eyes of 40 consecutive patients (21 males and 19 females) with a mean age of 26.6 ± 5.9 years (18-40 years) and a mean spherical equivalent value of -3.64 D (-9.63 to -0.25 D). There was a significant decrease in Schirmer I test (19.21 ± 8.4 vs. 16.61 ± 9.1 vs. 14.69 ± 9.86, p= 0.02, respectively) and I-TBT values (8.59 ± 3.4 vs. 7.4 ± 3.25 vs. 6.17 ± 3.01, p=0.03 respectively). OSDI values showed a significant increase after LASIK (11.56 ± 6.3 vs. 17.24 ± 7.5 vs. 14.71 ± 9.6, p=0.03, respectively). 5% level NI-TBT was significantly lower at 1 week 6.75 and 1 month 7.45 than baseline 13.2 at follow-up (p=0.037). Ocular protection index (6.6 vs. 2.3 vs. 2.6, p=0.009, respectively) and blink/minutes (18 vs. 17 vs. 15, p=0.002, respectively) values showed a statistically significant decrease. Our data detected a weak correlation between I-TBT and noninvasive first TBT, 5% level TBT parameters at month 1 follow-up. This study also found no correlation between contact lens use, older age, female gender, and pre-operative refractive error with the noninvasive MYAH dry eye parameters. CONCLUSIONS: This study demonstrated the ability of the new keratoscopy-based MYAH device to detect changes in the short term after LASIK surgery.

Neutrophil-to-albumin ratio: a promising tool for CAD assessment in non-ST elevation AMI.

OBJECTIVE: In the context of coronary artery disease (CAD) pathogenesis, inflammation has emerged as a critical player. This study investigates the potential of the Neutrophil-to-Albumin Ratio (NAR) as a novel biomarker for assessing CAD severity and extension in patients suffering from acute myocardial infarction (AMI) without ST-segment elevation. PATIENTS AND METHODS: We conducted a comprehensive analysis of consecutive patient records (n = 211) from a single center, focusing on individuals diagnosed with non-ST elevation AMI. To gauge CAD severity, we employed Syntax Scores (SS) and examined their correlation with NAR, C-reactive protein-albumin ratio (CRPALB), and the systemic immune inflammation index (SII). Statistical analyses were conducted to establish associations and predictive capabilities. RESULTS: Our analysis revealed a significant correlation between NAR and Syntax Scores (r: .416, p<0.01). Notably, patients with intermediate-high SS exhibited significantly elevated NAR values compared to those in the low SS group [20.86+5.38 vs. 16.41+6.30 (p<0.001)]. Furthermore, NAR outperformed CRPALB, SII, and Neutrophil Percent-to-Albumin Ratio (NPAR) in discriminating CAD severity, as demonstrated by the Receiver Operating Characteristic (ROC) curve analysis (NAR AUC: 0.736; CRPALB AUC: 0.673; SII AUC: 0.660; NPAR AUC: 0.717). CONCLUSIONS: This study underscores the potential of NAR as a robust predictor of CAD severity and extension in non-ST elevation AMI patients. While previous markers, such as CRPALB and SII, are advantageous, NAR's superior predictive capabilities are a valuable addition to the clinician's toolkit, offering enhanced risk assessment for this specific patient subgroup.

Colonization resistance against multi-drug-resistant bacteria: a narrative review.

Colonization resistance by gut microbiota is a fundamental phenomenon in infection prevention and control. Hospitalized patients may be exposed to multi-drug-resistant bacteria when hand hygiene compliance among healthcare workers is not adequate. An additional layer of defence is provided by the healthy gut microbiota, which helps clear the exogenous bacteria and acts as a safety net when hand hygiene procedures are not followed. This narrative review focuses on the role of the gut microbiota in colonization resistance against multi-drug-resistant bacteria, and its implications for infection control. The review discusses the underlying mechanisms of colonization resistance (direct or indirect), the concept of resilience of the gut microbiota, the link between the antimicrobial spectrum and gut dysbiosis, and possible therapeutic strategies. Antimicrobial stewardship is crucial to maximize the effects of colonization resistance. Avoiding unnecessary antimicrobial therapy, shortening the antimicrobial duration as much as possible, and favouring antibiotics with low anti-anaerobe activity may decrease the acquisition and expansion of multi-drug-resistant bacteria. Even after antimicrobial therapy, the resilience of the gut microbiota often occurs spontaneously. Spontaneous resilience explains the existence of a window of opportunity for colonization of multi-drug-resistant bacteria during or just after antimicrobial therapy. Strategies favouring resilience of the gut microbiota, such as high-fibre diets or precision probiotics, should be evaluated.

Cerebral Oximetry as an Auxiliary Diagnostic Tool in the Diagnosis of Brain Death.

AIM: To investigate the efficacy of cerebral oximetry (CO) as an auxiliary diagnostic tool in brain death (BD). MATERIALS AND METHODS: This observational case-control study was performed on patients with suspected BD. Patients with diagnosis of BD confirmed by the brain death committee were enrolled as the BD group and other patients as the non-BD group. CO monitoring was performed at least 6 h, and cerebral tissue oxygen saturation (ScO2) parameters were compared. RESULTS: Mean ScO2 level in the BD group was lower than non-brain-dead patients: mean difference for right lobe = 6.48 (95% confidence interval [CI] 0.08-12.88) and for left lobe = 6.09 (95% CI -0.22-12.41). Maximum ScO2 values in the BD group were significantly lower than the non-BD group: mean difference for right lobe = 8.20 (95% CI 1.64-14.77) and for left lobe = 9.54 (95% CI 3.06-16.03). The area under the curve for right lobe maximum ScO2 was 0.69 (95% CI 0.55-0.81) and for left lobe was 0.72 (95% CI 0.58-0.84). CONCLUSION: Maximum ScO2 in brain-dead patients at CO monitoring is significantly low. However, this cannot be used to differentiate brain-dead and non-brain-dead patients. CO monitoring is therefore not an appropriate auxiliary diagnostic tool for confirming BD.

Rank Determination of Mental Functions by 1D Wavelets and Partial Correlation.

The main aim of this paper is to classify mental functions by the Wechsler Adult Intelligence Scale-Revised tests with a mixed method based on wavelets and partial correlation. The Wechsler Adult Intelligence Scale-Revised is a widely used test designed and applied for the classification of the adults cognitive skills in a comprehensive manner. In this paper, many different intellectual profiles have been taken into consideration to measure the relationship between the mental functioning and psychological disorder. We propose a method based on wavelets and correlation analysis for classifying mental functioning, by the analysis of some selected parameters measured by the Wechsler Adult Intelligence Scale-Revised tests. In particular, 1-D Continuous Wavelet Analysis, 1-D Wavelet Coefficient Method and Partial Correlation Method have been analyzed on some Wechsler Adult Intelligence Scale-Revised parameters such as School Education, Gender, Age, Performance Information Verbal and Full Scale Intelligence Quotient. In particular, we will show that gender variable has a negative but a significant role on age and Performance Information Verbal factors. The age parameters also has a significant relation in its role on Performance Information Verbal and Full Scale Intelligence Quotient change.

The effect of mad honey on testosterone levels of male rats.

OBJECTIVE: We aimed to investigate the effect of mad honey on sexual performance. BACKGROUND: In traditional medicine in Turkey, mad honey is used to improve appetite, to heighten mental alertness, to reduce joint pain, to eliminate gastrointestinal system pains and to increase sexual performance. METHODS: In this experimental animal study eighteen Sprague Dawley male rats were randomized into three groups, a control group, a normal honey group and a mad honey group. Rats in the treatment groups were given a daily dose of 80 mg/kg normal honey or mad honey throughout the 30-day study period. Total testosterone, free testosterone, FSH, LH, estradiol, and progesterone levels were subsequently investigated from blood sera on day 30. RESULTS: Comparison of blood total testosterone levels among the groups revealed significantly higher levels in the mad honey group compared to the normal honey and control groups (p = 0.006, p = 0.00). Free testosterone levels were also significantly higher in the mad honey group than in the normal honey and control groups (p = 0.023, p = 0.01). No statistically significant differences were determined for other hormonal measurements. CONCLUSIONS: This study revealed a significant increase in both total and free testosterone levels in mad-honey group (Tab. 1, Fig. 2, Ref. 16).