Investigation of the effects of different drugs on the prevention of intrapleural adhesion in a rat model.

Background: The aim of this study was to investigate the antifibrinolytic and anti-inflammatory effects of hesperidin, tenoxicam and enoxaparin on intrapleural adhesions in an experimental rat model. Methods: A total of 52 healthy adult male Wistar Albino rats from the same colony were randomly divided into six groups as sham (Group 1), surgical control (Group 2), low-dose hesperidin (Group 3), high-dose hesperidin (Group 4), tenoxicam (Group 5), and enoxaparin (Group 6). All subjects underwent left thoracotomy and except for the sham group, an adhesion model was applied and, postoperatively, the drugs were administered intraperitoneally. On Day 11 postoperatively, the rats were sacrificed and their blood levels of interleukin-1ß and interleukin-10 were examined and they were evaluated for pleural adhesion area, adhesion severity score, mesothelial cell proliferation score, mononuclear cell infiltration score, and macrophage infiltration score in the collagen layer. Results: The lowest adhesion area and adhesion severity score were found in Group 6. There was a statistically significant difference between Group 2 and Group 6 and between Group 3 and Group 6 in terms of both parameters (p=0.04 and p=0.02). As for adhesion area, a statistically significant difference was found between Group 5 and Group 6 (p=0.04). Statistically significant differences were also found between Group 2 and Group 5 in terms of mesothelial cell proliferation scores and between Group 1 and Group 4 in terms of mononuclear cell infiltration scores (p=0.03 and p=0.02). Conclusion: Enoxaparin, tenoxicam, and high-dose hesperidin act at different points to prevent adhesion in rats.

Analysis of wound types and wound care methods after the 2023 Kahramanmaras earthquake.

OBJECTIVES: This study aims to investigate the types of wounds and wound care in earthquake victims rescued from collapsed buildings after the 2023 Kahramanmaras earthquake. PATIENTS AND METHODS: Between February 8th, 2023 and March 1st, 2023, a total of 94 patients (46 males, 48 females; mean age: 40.2±15.5 years; range, 16 to 77 years) with earthquake-related wounds who were trapped under rubble were retrospectively analyzed. Data including age, sex, duration of being trapped under rubble, type and location of the wound, bacterial cultures from deep tissue, and wound care methods used were recorded. RESULTS: The mean duration of being trapped under rubble was 58±38.1 h. Wounds were most commonly located on the lower extremities, followed by the upper extremities. The most common type of wounds were abrasions, followed by necrotic wounds due to crushing. Wound and skin antiseptics, debridement and negative pressure wound therapy (NPWT) were the most common wound care methods used. CONCLUSION: Various types of injuries and wounds may occur after natural disasters. Chronic wound care is as important as the management of life-threatening acute pathologies. Preparations should be made properly for the long-term treatment of patients after disasters. Methods such as NPWT, debridement creams containing collagenase, wound and skin antiseptics, and hyperbaric oxygen therapy can provide satisfactory short-term results. A broader and more intense application of these treatments is thought to be beneficial, particularly in crush injuries.

Is just enzyme replacement therapy enough for Fabry disease treatment? Have we missed a trick?

BACKGROUND AND AIM: In Fabry disease (FD), primary factors such as glycosphingolipid deposition that initiate kidney damage and secondary factors that advance kidney damage to fibrosis are different. Periostin is a molecule of proven importance in renal inflammation and fibrosis. It was previously shown that periostin plays an essential role in the process leading to renal fibrosis and its expression is increased in many kidney diseases. In the present study, we aimed to reveal the relationship between periostin and Fabry nephropathy. MATERIAL-METHOD: This cross-sectional study included 18 FD patients (10 males, 8 females) with enzyme replacement therapy (ERT) indications and 22 healthy control patients of similar age and gender. At the time of diagnosis, plasma alpha-galactosidase A (α-gal-A) and globotriaosylsphingosine (lyso-Gb3), proteinuria, and kidney function tests of all FD patients before ERT were scanned from the hospital system. Periostin was studied from serum samples collected and stored before ERT. Parameters related to serum periostin levels in Fabry disease were investigated. RESULTS: In FD patients, serum periostin was negatively correlated with age of first symptom and GFR; and positively correlated with proteinuria and lyso-Gb3. In regression analysis, we found that serum periostin was the only independent determinant of proteinuria in patients with Fabry disease. The serum periostin levels were significantly lower in patients with low proteinuria, and the serum periostin levels were correlated with proteinuria. DISCUSSION: Periostin may be a valuable marker of Fabry nephropathy and proteinuria. Periostin seems to be one of the molecules that may have an important role in the management of the fibrotic process in Fabry nephropathy. We think that the role of periostin among these mechanisms is worth investigating. In addition to standard ERTs, periostin-reducing therapies may contribute to better kidney survival in Fabry disease. Progressive fibrosis processes caused by periostin in patients with Fabry disease are still a hidden issue waiting to be clarified. Progressive fibrosis processes caused by periostin in Fabry patients are still a hidden issue waiting to be clarified.

How does neurokinin 3 receptor agonism affect pathological and cognitive impairments in an Alzheimer's disease-like rat model?

Alzheimer's disease (AD) is accepted as a form of progressive dementia. Cholinergic systems are commonly affected in AD. Neurokinin 3 receptor (NK3R) is involved in learning memory-related processes. It is known that the activation of NK3R affects the release of many neurotransmitters. The aim of this project was to investigate the effects of NK3R agonist senktide administration on neurobehavioral mechanisms in the experimental AD-like rat model. 50 male Wistar albino rats were divided into Control (C), AD, Control + NK3R agonist (CS), AD + NK3R agonist (ADS), AD + NK3Ragonist + antagonist groups (ADSO). We designed AD-like model by intrahippocampal administration of Aß1-42. After NK3R agonist + antagonist injections, open field (OF), Morris water maze (MWM) tests were applied. Cholinergic mechanism analysis from hippocampus-cortex tissues was performed by ELISA and catecholamine analysis from brain stem tissue were performed by HPLC method. The transitions from edge to center, rearing, grooming parameters were found to be reduced in final values of OF. While the group-time interaction was significant in the OF test findings, there was no significant difference between the groups. In MWM test, ADS group showed a learning level close to control group and animals in AD and ADSO groups could not learn target quadrant in MWM test. The brain stem NA and DA concentrations were not statistically significant. Hippocampal AChE-ChAT levels were supported by positive effects of senktide on learning via the cholinergic mechanisms. As a result, NK3R agonists were found to be effective in improving cognitive functions in rats with AD pathology. In the experimental AD model, positive effects of NK3R on learning memory may be mediated by cholinergic mechanisms.

Serum claudin-5, claudin-11, occludin, vinculin, paxillin, and beta-catenin levels in preschool children with autism spectrum disorder.

AIM: Increased intestinal and blood-brain barriers (BBB) permeability has been suggested to have a role in autism spectrum disorder (ASD). Claudin-5, claudin-11, occludin, ß-catenin, vinculin, and paxillin are crucial components of these barriers. This study assessed concentrations of these molecules in preschool children with ASD. METHODS: A total of 80 children with ASD and 40 controls aged 18-60 months were enrolled in this study. Serum levels of biochemical variables were determined using commercial enzyme-linked immunosorbent assay kits. RESULTS: Serum claudin-11, occludin, and ß-catenin levels were significantly higher in the ASD group than in the control group. However, no significant difference for serum claudin-5, vinculin, and paxillin levels was detected between the groups. CONCLUSION: These findings suggest that claudin-11, occludin, and ß-catenin may be involved in the pathogenesis of ASD. These proteins may affect the brain by causing dysregulation in intestinal or blood-brain barrier permeability or with other unknown mechanisms.

Association of thiol/disulphide homeostasis with Bethesda classification of thyroid nodules and thyroid cancer.

BACKGROUND: Ultrasonography and fine-needle aspiration biopsy are frequently used to diagnose thyroid cancer. However, supportive data might be required in case of diagnostic difficulty. This study investigated whether there is a relationship between thiol/ disulphide homeostasis and cytological and histopathological diagnosis of thyroid nodules. METHODS: The patient group consisted of 81 individuals with euthyroid nodular (single/multiple) goiter scheduled for thyroidectomy, and the control group consisted of 28 age- and sex-matched healthy volunteers who had no thyroid nodule on ultrasonographic evaluation. All participants were selected among the admissions to the study clinic between June 2017 and June 2018, and venous blood samples were collected. The samples of the patients were taken before surgery. Thiol and disulphide levels were analysed with the automated spectrophotometric method. RESULTS: The mean age of the patient group was 45.66 ± 10.45 years, and the mean age of the control group was 43.53 ± 11.49 years (p = 0.365). The increasing Bethesda categories were positively correlated with the disulphide level (r = 0.281, p = 0.011), disulphide/native thiol ratio (r = 0.241, p = 0.030) and disulphide/total thiol ratio (r = 0.250, p = 0.024). Disulphide/native thiol ratio and disulphide/ total thiol ratio were significantly higher in the histopathologically malignant (euthyroid nodular goiter but final pathology reported malignant) compared to histopathologically benign (euthyroid nodular goiter but final pathology reported benign) (p = 0.012; p = 0.007, respectively) and control groups (p = 0.006; p = 0.004, respectively), but no significant difference was found in these ratios between benign and control group (p = 0.711; p = 0.749, respectively). DISCUSSION: Oxidative stress parameters were significantly higher in thyroid cancer. A positive correlation was detected between Bethesda categories with increased risk of malignancy and the disulphide/native thiol ratio and the disulphide/total thiol ratio.

Oxytocin and Vasopressin Levels and Related Factors in Adolescents with Social Phobia and Other Anxiety Disorders.

Objective: This study aimed to determine whether a difference exists in plasma oxytocin and vasopressin levels among social anxiety disorder, other anxiety disorders, and healthy control groups in adolescents. The relationship between several psychiatric variables (i.e., state and trait anxiety, social anxiety, childhood trauma, and behavioral inhibition) and oxytocin or vasopressin levels were also investigated in adolescents with anxiety disorders. Methods: The study included three groups of adolescents: social anxiety disorder (n = 29), those with other anxiety disorders (n = 27), and the control group (n = 28). The participants filled out self-report scales to determine various psychological variables. Oxytocin and vasopressin levels were determined from the blood samples of the participants. Results: The oxytocin levels did not show a significant difference between the social anxiety disorder group and the other anxiety disorders group. However, the oxytocin levels were significantly higher in the social anxiety disorder and other anxiety disorders groups than in the control group. The vasopressin levels did not show a significant difference among the groups. According to the hierarchical regression analysis, the state and trait anxiety levels predicted oxytocin in opposite directions. Oxytocin showed positive and negative relationship with trait and state anxiety respectively. No predictive factors were found for the vasopressin levels. Conclusion: We found that the oxytocin levels of adolescents with social anxiety disorder were not different from those of adolescents with other anxiety disorders. Further studies can improve our knowledge of the relationship among anxiety disorders and oxytocin or vasopressin.

Role of thiol-disulfide hemostasis in early diagnosis of acute mesentery ischemia: An experimental study.

BACKGROUND: Acute mesenteric ischemia (AMI) is a rarely observed acute abdominal disease that may be mortal and is difficult to diagnose early. The aim of our study is to assess the role of Thiol-Disulphide Haemostasis (TDH), a new method for AMI which still has no specific biochemical markers for early diagnosis, and to assess it together with Ischemia-Modified Albumin (IMA) which has previously proven reliability for AMI. METHODS: The study included 32 Wistar albino rats in four groups. The 1st group (n=8) was the control group, 2nd group (n=8) was the sham group, 3rd group (n=8) had 3 h of arterial mesentery ischemia and the 4th group (n=8) had 6 h of arterial mesentery ischemia. TDH, IMA, and serum lactate values were measured at h 0, 1, 3, and 6. RESULTS: In the 3rd and 6th h, serum total thiol and native thiol values significantly reduced (p<0.001), while serum disulfide, IMA, and lactate values clearly increased (p<0.001). Serum thiol values were observed to reduce from the 1st h. CONCLUSION: TDH changes in the early period of AMI. The TDH parameters can be used with IMA as diagnostic parameters for patients with suspected AMI in the early period.

Investigation of the Relation between Epithelial Barrier Function and Autism Symptom Severity in Children with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by limitations in mutual communication and social interaction as well as restricted, repetitive patterns of behaviors, interests, or activities. The possible role of biological abnormalities in the etiopathogenesis of this disorder arouses research interest in this area. This is a case-control study evaluating epithelial barrier function by comparing serum concentrations of occludin and zonulin in children with ASD (n = 60) and controls (n = 30). The Childhood Autism Rating Scale (CARS) was used to evaluate autism symptom levels in all children. Serum occludin and zonulin levels were analyzed using an enzyme-linked immunosorbent assay. Serum occludin was significantly lower in children with ASD than in control subjects. In children with ASD, a decrease in occludin level was significantly associated with the disorder symptom levels items mean score (CARS total scores). Our findings showed that children with ASD had alterations in epithelial barrier function compared to the control group. The investigation of the mechanism underlying the different levels of occludin between ASD and controls may be of importance in clarifying the etiopathogenesis of ASD, as well as its follow-up and treatment.

Investigation of Relaxin-3 Serum Levels in terms of Social Interaction, Communication, and Appetite as a Biomarker in Children with Autism.

OBJECTIVE: To investigate the possible relationship between relaxin-3 and autism spectrum disorder (ASD). METHODS: Serum relaxin-3 was measured in 80 children (50 children diagnosed with ASD and 30 controls). Symptom severity in the ASD group was evaluated by the Childhood Autism Rating Scale (CARS). Behavioral and nutritional problems in the groups were evaluated using the Abnormal Behavior Checklist (ABC) and the Children's Eating Behavior Questionnaire (CEBQ). RESULTS: Our findings showed that serum relaxin-3 levels were higher in children with ASD than in the controls. The listening response sub-scale score of the CARS scale was found to decrease as the level of relaxin-3 increased. However, as relaxin-3 levels increased in children with ASD, it was found that the speech problem sub-scale score on the ABC scale and the desire to drink score on the CEBQ scale increased, but the satiety responsiveness and food fussiness scores decreased. CONCLUSION: This study the first to investigate serum levels of relaxin-3, which has a role in regulating social behavior and nutritional behavior in children with ASD.

Serum B12, homocysteine, and anti-parietal cell antibody levels in children with autism.

AIMS: To compare vitamin B12, homocysteine, and anti-parietal cell antibody (APCA) levels between children with ASD and controls, paired in terms of age, sex, and socioeconomic level. METHODS: The research group consisted of 69 children, 36 with ASD and 33 controls. The severity of ASD was determined using the Childhood Autism Rating Scale (CARS). Serum vitamin B12, homocysteine and human anti-parietal cell levels were analysed using enzyme-linked immunosorbent assay. RESULTS: The serum vitamin B12 and homocysteine levels in children with ASD were lower than in the control group, but there was no significant difference in terms of APCA levels. CONCLUSIONS: Deficiencies in micronutrients, such as B12, may play a role in the pathogenesis and clinical symptoms of autism. However, it is believed that these parameters should be analysed in a wider population to clarify their effect on the aetiology of ASD.KEY POINTWe hypothesised that low levels of vitamin B12 and homocysteine levels reported in previous studies might be associated with APCA levels.The homocysteine and B12 levels were found to be significantly lower in children with ASD. There was no significant difference in serum APCA levels.No significant relationship was found between B12 levels and APCA.Given all these findings, it can be stated that vitamin B12 deficiency is not associated with an absorption-related mechanism due to the presence of APCA.Deficiencies in micronutrients, such as B12, may play a role in the pathogenesis and clinical symptoms of autism.In future studies, it will be beneficial to investigate other mechanisms that may cause vitamin B12 deficiency.

Effects of Combined Sertraline and Magnesium in Rat Atrium.

The objective of this study is to determine the synergistic effects of an antioxidant ion Mg+2, combined with selective serotonin reuptake inhibitor sertraline, in treatment or prevention of major depression and regulation of inotropic effect in the early postoperative period. Adult male 40 Wistar albino rats were randomly divided into 6 groups. Three to 4-mm long atrium strips were placed in organ bath, tension was adjusted to 2 g. Isometric contractions were induced with 10-3 M adrenaline. Group 1 was the control group, cumulative sertraline was given to group 2, cumulative MgSO4 to group 3, combined cumulative sertraline and MgSO4 to group 4, intraperitoneal sertraline injection for 29 days to group 5, and intraperitoneal MgSO4 injection for 14 days to group 6. Changes in weight, tensions, bleeding/clotting time, and biochemical findings were evaluated statistically. Isometric tension relationship between groups 1 and 3 was statistically significant after 4 mmol/L MgSO4 (p < 0.05). A rapid inhibition of contraction was observed in group 4. Inhibition of spontaneous contractions of groups 5 and 6 was found to be statistically significant at close values, p < 0.05. When blood clotting times were compared, a statistically marked decrease was found in group 6, p < 0.05. Compared to control group, there was a significant decrease in blood lipids in group 4. While LDH and CK-MB increased from plasma enzymes in groups 5 and 6, no significant change was observed in NT-proBNP. Combined treatment of high dose MgSO4 with antidepressants for pre or post-operative depression may cause fatal risks. Shortening clotting time may increase the risk of embolism and stroke. In order to reduce the risk of post-operative depression preoperatively, care should be taken when using magnesium combined with antidepressants and more studies are needed to be considered.

Increased serum brain-derived neurotrophic factor and adrenocorticotropic hormone levels are associated with obsessive compulsive disorder in medication­free children.

This study aimed to investigate serum levels of neurotrophins, including brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3), and hypothalamic-pituitary-adrenal axis (HPA) members including adrenocorticotropic hormone (ACTH) and cortisol in children with obsessive-compulsive disorder (OCD). The possible relationships between serum neurotrophins and HPA axis members were also addressed. A total of 60 medication-free children with OCD and 57 controls aged 8-18 years were enrolled in this study. The severity of OCD symptoms was determined by the Children's Yale-Brown Obsessive Compulsive Scale. The severity of anxiety and depression symptoms were assessed by self-report inventories. The serum levels of neurotrophins, ACTH, and cortisol were measured using enzyme-linked immunosorbent assay kits. Serum BDNF levels were significantly higher in the OCD group than in the control group for either sex and for the whole sample. Compared to controls, serum ACTH levels were significantly higher in the OCD group for the whole sample. An analysis of covariance was also conducted for the whole sample and indicated that, while controlling the potential confounders, including body-mass index percentile, age, sex, and the severity of depression and anxiety, the results did not change. Strong negative correlations between BDNF, NGF and NTF3, and HPA axis members were determined in the patient group for either sex and for the whole sample. These findings suggest that dysregulations of BDNF and ACTH may be associated with childhood OCD. Furthermore, there may be inverse relationships between certain neurotrophins and HPA axis members in these patients.

Factors associated with bleeding complications in hernia repair of warfarin users.

OBJECTIVE: In this retrospective study, we aimed to determine factors associated with bleeding complications in patients on long-term warfarin, undergoing inguinal hernia repair using low-molecular-weight heparin (LMWH) bridging. METHODS: Two-year hospital records yielded 44 inguinal hernia repair patients on long-term warfarin (26 men, 4 women, aged 57.4 [38-72] years). All patients were managed with LMWH bridging. Patient and operative characteristics, LMWH bridging characteristics, and international normalized ratio (INR) values were compared between patients with and without postoperative bleeding complications. RESULTS: Indication for warfarin use was heart valve disease (n=15), atrial fibrillation (n=7), deep venous thrombosis (n=3), cerebrovascular event (n=3), and pulmonary embolism (n=2). Four of the operations were urgent, while the remaining were elective. There were four ecchymosis cases and three hematoma cases in a total of seven patients. Baseline (2.94±0.26 versus 2.16±0.38, p<0.001) and preoperative INR values (1.69±0.67 versus 1.31±0.35, p=0.027) were significantly higher, while postoperative INR values (1.04±0.09 versus 1.2±0.13, p=0.004) were significantly lower in patients having bleeding complications. CONCLUSIONS: Baseline, preoperative INR, and postoperative INR were the only variables associated with postoperative bleeding complications in patients undergoing LMWH-bridged inguinal hernia repair. We suggest close monitoring of INR levels in long-term warfarin users, even for relatively low-bleeding risk operations such as inguinal hernia repair.

Effect of learning curve on the perioperative course of robotic-assisted laparoscopic donor nephrectomy compared with laparoscopic donor nephrectomy.

OBJECTIVE: This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon's learning curve on these parameters. METHODS: This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21-72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients. Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy. RESULTS: Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p<0.001) and Group 3 (24.0±9.4 min, p<0.001). On the other hand, duration of operation and time for laparoscopic system setup was similar between Groups 1 and 3. CONCLUSIONS: Learning curve extends the operative time and laparoscopic system setup time in robotic-assisted laparoscopic donor nephrectomy, however, after the learning process was completed, these parameters were similar between robotic-assisted and standard laparoscopic nephrectomy.

Serum Brain-Derived Neurotrophic Factor, Glial-Derived Neurotrophic Factor, Nerve Growth Factor and Neurotrophin-3 Levels in Preschool Children with Language Disorder.

INTRODUCTION: Accumulating studies demonstrate that neurotrophins may play a crucial role in a variety of neurodevelopmental disorders. However, little data are available regarding the potential role of neurotrophins in language disorder (LD). This study aimed to investigate serum brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF) and neurotrophin-3 (NTF3) levels in preschool children with LD. METHODS: A total of 43 cases with LD and 43 healthy controls aged 18 to 60 months were enrolled in the study. The development levels and psychiatric symptoms of the children were determined by the Ankara Developmental Screening Inventory and Child Behavior Checklist 1.5-5, respectively. Serum neurotrophin levels were assessed by enzyme-linked immunosorbent assay kits. RESULTS: Serum GDNF and NGF levels were significantly higher, serum BDNF and NTF3 levels were significantly lower in the LD group than in the control group. However, with logistic regression analyses, only negative relationship of BDNF and NTF3 levels with the presence of LD remained significant after accounting for the confounders including development level and coexisting psychiatric symptoms. CONCLUSIONS: These results suggest that low BDNF and NTF3 levels have independent negative relationships with LD, which could be contribute to etiopathogenesis of the disorder.

Are clinicopathological features of the isthmic thyroid nodule different from nodules in thyroid lobes? A single center experience

ABSTRACT Objectives: Thyroid nodules located in isthmus were found less prevalent, although papillary thyroid cancer in this location was reported to be more aggressive behaviour in some studies. Our aim was to evaluate hormonal,ultrasonographic, and cytopathologic features of nodules located in isthmus (isthmic nodules). Subjects and methods: Patients who underwent thyroidectomy between 2006-2014 reviewed retrospectively. Hormonal, ultrasonographic, and cytopathologic features compared between patients with isthmic (Group-1) and with lober (non-isthmic, Group-2) nodules. Results: Group-1 and Group-2 consisted of 251 and 2076 patients, respectively. 260 isthmic (5.5%) and 4433 non-isthmic (94.5%) nodules were compared.However,most ultrasonographical features such as presence of microcalcification and halo, diameters, echogenicity, texture, margin, and vascularity were similar between groups, macrocalcification rate was lower in isthmic nodules (18.8%, 25.9%; p = 0.012). Cytologic results were also similar.Although malignancy rate was lower in isthmic nodules (6.2%, 12.5%; p = 0.002), type of thyroid cancer was similar in isthmic and non-isthmic nodules.When malignant isthmic (n = 16,2.8%) and malignant non-isthmic nodules (n = 553, 97.2%) were compared, diameter and type of tumor, lymphovascular and capsular invasions, extrathyroidal extension and multifocality rates were not statistically significant.Malignant isthmic nodules (n = 16, 6.2%) had smaller size [10.1 (7.5-34.5) mm, 19.95 (8.4-74.1) mm; p = 0.002], and higher hypoechogenicity rate (31.3%, 5.7%, p = 0.003) compared to benign isthmic nodules (n = 244, 93.8%). Negative predictive value was higher and positive predictive value was lower in isthmic nodules compared to non-isthmic nodules (p = 0.033, p = 0.047, respectively). Conclusion: Isthmic nodules appear to be indolent because of having lower malignancy rate. FNAB might be required in isthmic nodules even if it has relatively small size.The surgery with limited extent or follow-up might seem to be reliable in the management of patients having isthmic nodules especially with indeterminate cytology.

Prognostic Value of Immunosuppressive Acidic Protein and Oxidative Stress Status in Critically Ill Patients.

INTRODUCTION: The aim of this study was to determine the prognostic value of admission immunosuppressive acidic protein (IAP), interleukin-6 (IL-6), total oxidant status (TOS), and total antioxidant status (TAS) in 161 critically ill patients. MATERIALS AND METHODS: This prospective observational study was carried out in the Emergency Department ICU for 6 months. Critically ill patients were included in the study consecutively. The main outcomes were the need for early mechanical ventilation (MV) and in-hospital mortality. RESULTS: The mean age of 161 patients was 66.5 ± 17.1 years. The median IL-6 levels of patients who required early MV were significantly higher than of the patients who required no MV (p < 0.001), and the median IL-6 levels in the nonsurvivors were significantly higher than in the survivors (p < 0.001). The median IAP levels were not significantly different between the groups (p = 0.464 for early MV and p = 0.340 for the in-hospital mortality group). The AUCs of IL-6 and TOS for predicting in-hospital mortality were 0.819 and 0.608, respectively. CONCLUSION: The IAP level on admission to ICU is ineffective in predicting the need for early MV and in-hospital mortality; however, IL-6 level on admission is a strong prognostic predictor in critically ill patients. Our findings showed that the burden of oxidative stress was high in general ICU patients. CLINICAL SIGNIFICANCE: Our study showed that increased oxidative stress is an important problem in critically ill patients. If measures are taken to reduce oxidative stress by physicians, the prognosis of critically ill patients will be better. HOW TO CITE THIS ARTICLE: Tutuncu EO, Dundar ZD, Kilinc I, Tutuncu A, Kocak S, Girisgin AS. Prognostic Value of Immunosuppressive Acidic Protein and Oxidative Stress Status in Critically Ill Patients. Indian J Crit Care Med 2021;25(4):405-410.

Are clinicopathological features of the isthmic thyroid nodule different from nodules in thyroid lobes? A single center experience.

OBJECTIVE: Thyroid nodules located in isthmus were found less prevalent, although papillary thyroid cancer in this location was reported to be more aggressive behaviour in some studies. Our aim was to evaluate hormonal, ultrasonographic, and cytopathologic features of nodules located in isthmus (isthmic nodules). METHODS: Patients who underwent thyroidectomy between 2006-2014 reviewed retrospectively. Hormonal, ultrasonographic, and cytopathologic features compared between patients with isthmic (Group-1) and with lober (non-isthmic, Group-2) nodules. RESULTS: Group-1 and Group-2 consisted of 251 and 2076 patients, respectively. 260 isthmic (5.5%) and 4433 non-isthmic (94.5%) nodules were compared. However, most ultrasonographical features such as presence of microcalcification and halo, diameters, echogenicity, texture, margin, and vascularity were similar between groups, macrocalcification rate was lower in isthmic nodules (18.8%, 25.9%; p = 0.012). Cytologic results were also similar. Although malignancy rate was lower in isthmic nodules (6.2%, 12.5%; p = 0.002), type of thyroid cancer was similar in isthmic and non-isthmic nodules. When malignant isthmic (n = 16,2.8%) and malignant non-isthmic nodules (n = 553, 97.2%) were compared, diameter and type of tumor, lymphovascular and capsular invasions, extrathyroidal extension and multifocality rates were not statistically significant. Malignant isthmic nodules (n = 16, 6.2%) had smaller size [10.1 (7.5-34.5) mm, 19.95 (8.4-74.1) mm; p = 0.002], and higher hypoechogenicity rate (31.3%, 5.7%, p = 0.003) compared to benign isthmic nodules (n = 244, 93.8%). Negative predictive value was higher and positive predictive value was lower in isthmic nodules compared to non-isthmic nodules (p = 0.033, p = 0.047, respectively). CONCLUSION: Isthmic nodules appear to be indolent because of having lower malignancy rate. FNAB might be required in isthmic nodules even if it has relatively small size. The surgery with limited extent or follow-up might seem to be reliable in the management of patients having isthmic nodules especially with indeterminate cytology.

Evaluation of Appetite-Regulating Hormones in Young Children with Autism Spectrum Disorder.

This study aimed to investigate the role of leptin, ghrelin, neuropeptide Y, and nesfatin-1 in young children with autism spectrum disorder (ASD). A total of 44 children with ASD and 44 healthy controls aged 18-60 months were included. Plasma levels of hormones were measured using commercial enzyme-linked immunosorbent assay kits. Plasma leptin and ghrelin levels were significantly higher in the ASD group than in the control group. However, no significant difference for plasma neuropeptide Y and nesfatin-1 levels was detected between the groups. No relation was found between the severity of ASD symptoms, severity of eating problems, and plasma levels of hormones. Leptin and ghrelin may play a potential role in the pathogenesis of ASD.