Investigation of the Effects of N-acetylcysteine and Selenium on Vesicoureteral Reflux Nephropathy: An Experimental Study.

INTRODUCTION: This study aimed to investigate the effects of N-acetylcysteine (NAC) and selenium (Se) on vesicoureteral reflux (VUR) nephropathy. METHODS: A total of 44 rabbits in 7 groups, namely group 1 (Control), group 2 (VUR + sterile urine), group 3 (VUR + sterile urine + NAC), group 4 (VUR + sterile urine + Se), group 5 (VUR + infected urine), group 6 (VUR + infected urine + NAC) and group 7 (VUR + infected urine + Se), were used. 99mTc Dimercaptosuccinic acid renal scan (DMSA), cystogram and urine culture were performed both at the beginning and end of the study. Left VUR was created surgically, and E. coli was inoculated in infected urine groups. NAC and Se were administered daily for 21 days. Malondialdehyde (MDA) measurement, inflammatory response scores (IRSs), and cicatrization response scores (CRSs) in renal tissues were evaluated. RESULTS: VUR did not reduce left renal uptake values in neither group 2 nor group 5. MDA levels of the left kidney were significantly higher in group 5 compared to group 1 (p = 0.001). There was no significant difference in MDA levels between group 5 and group 6, and between group 5 and group 7. Left kidney IRSs were found to be higher in all other groups except group 2 compared to the control group (p < 0.001). Left kidney CRSs were significantly higher in group 5 compared to group 2 (p = 0.026), group 6 (p < 0.001) and group 7 (p = 0.006). CONCLUSION: A decrease in renal functions was not observed in VUR, even if there was infection. When CRSs were evaluated, NAC and Se had protective effects in terms of scar formation in VUR nephropathy. TYPE OF STUDY: Experimental animal study. LEVELS OF EVIDENCE: N/A.

Changes in T-cell subsets occur in interstitial lung disease and may contribute to pathology via complicated immune cascade.

The study aimed to investigate the expression profiles of transcription factors, cytokines, and co-stimulatory molecules in helper T (Th)-cell subsets within bronchoalveolar lavage (BAL) samples of patients with interstitial lung diseases (ILDs). Twenty ILDs patients were included in the study, comprising those with idiopathic pulmonary fibrosis (IPF) (n:8), autoimmune-related ILDs (auto-ILD) (n:4), and orphan diseases (O-ILD) (n:8), alongside five control subjects. Flow cytometry was employed to evaluate the Th to cytotoxic T cell (CTL) ratio in BAL fluid, while cytopathological examination assessed macrophages, lymphocytes, and neutrophils. Quantitative real-time polymerase chain reaction was utilized to investigate the expressions in Th1, Th2, Th17, and regulatory T (Treg) cells. Results revealed elevated Th cell to CTL ratios across all patient groups compared to controls. Furthermore, upregulation of Th1, Th2, Th17, and T-cell factors was observed in all patient groups compared to controls. Interestingly, upregulation of CD28 and downregulation of CTLA-4 and PD-1 gene expression were consistent across all ILDs groups, highlighting potential immune dysregulation. This study provides a comprehensive exploration of molecular immunological mechanisms in ILDs patients, underscoring the dominance of Th2 and Th17 responses and revealing novel findings regarding the dysregulation of CD28, CTLA-4, and PD-1 expressions in ILDs for the first time.

Automated AI-based grading of neuroendocrine tumors using Ki-67 proliferation index: comparative evaluation and performance analysis.

Early detection is critical for successfully diagnosing cancer, and timely analysis of diagnostic tests is increasingly important. In the context of neuroendocrine tumors, the Ki-67 proliferation index serves as a fundamental biomarker, aiding pathologists in grading and diagnosing these tumors based on histopathological images. The appropriate treatment plan for the patient is determined based on the tumor grade. An artificial intelligence-based method is proposed to aid pathologists in the automated calculation and grading of the Ki-67 proliferation index. The proposed system first performs preprocessing to enhance image quality. Then, segmentation process is performed using the U-Net architecture, which is a deep learning algorithm, to separate the nuclei from the background. The identified nuclei are then evaluated as Ki-67 positive or negative based on basic color space information and other features. The Ki-67 proliferation index is then calculated, and the neuroendocrine tumor is graded accordingly. The proposed system's performance was evaluated on a dataset obtained from the Department of Pathology at Meram Faculty of Medicine Hospital, Necmettin Erbakan University. The results of the pathologist and the proposed system were compared, and the proposed system was found to have an accuracy of 95% in tumor grading when compared to the pathologist's report.

Expression of placental growth factor, neuropilin-1, and neuropilin-2 in primary pterygium tissue.

PURPOSE: The aim of this study was to evaluate the expression of placental growth factor (PLGF), neuropilin-1 (NP-1), and neuropilin-2 (NP-2) molecules in primary pterygium tissue compared with normal conjunctival tissue. METHODS: The records of 42 patients who underwent excision surgery with autografts for primary pterygium (pterygium group) and 20 patients who underwent conjunctival nevus excision surgery (control group) in the same period were reviewed retrospectively. The samples obtained from the pterygium tissues in the pterygium group and the clean conjunctival tissues adjacent to the nevus in the control group were collected from the archive. Immunohistochemical stains of the primary antibodies-1/100 diluted PLGF, NP-1, and NP-2 (Abcam Cambridge Science Park, UK)-were applied to all groups. Staining intensities and the percentage of positive cells in epithelial, endothelial, stromal, and inflammatory cells were analyzed by an experienced pathologist. RESULTS: The positivity rates of PLGF and NP-2 expression in epithelial, endothelial, stromal, and inflammatory cells were found to be higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively; NP-2: p < 0.001 for all). Staining intensities for PLGF and NP-2 were higher in the pterygium group than in the control group (PLGF: p < 0.001, p < 0.001, p = 0.005, and p < 0.001, respectively; NP-2: p < 0.001, p < 0.001, p = 0.001, and p < 0.001, respectively). However, no significant differences were found in any cell type in terms of NP-1 expression positivity rates (p = 0.730, p = 0.121, p = 0.524, and p = 0.624, respectively) or staining intensity (p = 0.716, p = 0.147, p = 0.147, and p = 0.780, respectively). CONCLUSION: PLGF and NP-2 levels were found to be higher in pterygium tissue, while there was no difference in NP-1. These results indicate the possible roles of NP-2 and PLGF in primary pterygium.

The Effect of Rhinoplasty Dissection Planes (Sub-SMAS, Subperichondrial, and Subperiosteal) on the Viability of Diced Cartilage Grafts in a Rabbit Model.

BACKGROUND: Dorsal preservation surgeries in which the subperichondral and subperiosteal planes are used to elevate the soft tissue envelope of the nose have become increasingly widespread because they can reduce postoperative edema and promote faster healing. However, the effects of surgical dissection planes on the viability of cartilage grafts are not known. OBJECTIVE: The aim of this study was to determine, in a rabbit model, the viability of diced cartilage grafts in different rhinoplasty dissection planes (sub-superficial musculoaponeurotic system [SMAS], subperichondral, subperiosteal). METHODS: Diced cartilage samples were placed in the sub-SMAS, subperichondrial, and subperiosteal planes, and after 90 days, histopathologic analysis was performed. Cartilage graft viability was evaluated based on the loss of chondrocyte nuclei in the lacuna, the presence of peripheral chondrocyte proliferation, and the loss of matrix metachromasia in the chondroid matrix. RESULTS: The median [interquartile range] percentages of live chondrocyte nucleus viability in the sub-SMAS, subperichondrial, and subperiosteal groups were 67.5% [18.75%] (range, 60%-80%), 35% [17.5%] (range, 20%-45%), and 20% [30.0%] (range, 10%-45%), respectively; and the percentages of peripheral chondrocyte proliferation were 80.0% [22.5%] (range, 60%-90%), 30% [28.75%] (range, 15%-60%), and 20% [28.75%] (range, 5%-60%), respectively. There was strong statistical significance in both parameters (P = .001). Intergroup examination revealed a difference between the sub-SMAS and the other surgical planes (P = .001 for both parameters). A smaller loss of chondrocyte matrix was observed in the sub-SMAS group compared with the other 2 groups, which supports the findings of cartilage viability (P = .006). CONCLUSIONS: Elevating the soft tissue envelope of the nose in the sub-SMAS surgical plane preserves the viability of cartilage grafts better than subperichondrial and subperiosteal elevation.

Can Echinococcus Granulosus Infestation Prevent Pancreatic Cancer? An invivo Experimental Study.

Hydatid cyst is a zoonotic infestation caused by Echinococcus granulosus, and it is known that some parasites found in humans cause cancer in humans or some may have a protective effect against cancer. Cancer is one of the most serious health problems of today and it has been shown in some studies that parasites such as Echinococcus granulosus can have an inhibitory effect. The aim of this study was determined as whether Echinococcus granulosus has an inhibitory effect on exocrine pancreatic cancer with the help of the azaserine-rat model used in different cancer studies.  Material and Methods: During experimental process a total of 45 male Wistar rats used, 14-day-old male Wistar rats were divided into groups according to the experimental protocol, administered azaserine injection protocol or kept as a control group without azaserine injection. Animals are grouped as Group 1, Control Group (group not treated with Azaserine and not injected with protoscolex.) (E-A-) (n=7); Group 2, Group injected with (IP) Azaserine only (30mg/kg) (E-A+)  (n=8);Group 3, Group injected (IP) with protoscolex suspension of 1 cc only (E+A-) (n=15);Group 4, Group injected both Azaserine (IP) and protoscolex suspension (IP) (E+A+) (n=15). Atypical Acinar Cell Foci (AACF) load in the exocrine pancreas of each rat was measured quantitatively with the help of a video image analyzer and the AACF load was calculated with the help of a mathematical model. Results: Findings showed that the Atypical Acinar Cell Foci (AACF) burden was statistically significantly lower in the Azaserine+ protoscolex (Azaserine-injected-protoscolex-implanted) rat group compared to the other groups, suggesting that Echinococcosis in the azaserine-rat model could inhibit the development of precursor foci of neoplastic changes in the exocrine pancreas. Conclusion: The most significant aspect of our study is that it contributes new insights into the controversy that Echinococcosis suppresses pancreatic cancer.

How do endoscopic bladder tumor resection techniques affect pathology practice? EAU Section of Uro-Technology (ESUT) and Uropathology (ESUP) survey.

PURPOSE: We aimed to examine how different endoscopic bladder tumor resection techniques affect pathologists' clinical practice patterns. METHODS: An online survey including 28 questions clustered in four main sections was prepared by the ESUT ERBT Working Group and released to the pathologists working in the institutions of experts of the ESUT Board and the working groups and experts in the uropathology working group. A descriptive analysis was performed using the collected data. RESULTS: Sixty-eight pathologists from 23 countries responded to the survey. 37.3% of the participants stated that they always report the T1 sub-staging. Of those who gave sub-staging, 61.3% used T1a, b. 85.2% think that en bloc samples provide spatial orientation faster than piecemeal samples, and 60% think en bloc samples are timesaving during an inspection. 55.7% stated that whether the tissue sample is en bloc or piecemeal is essential. 57.4% think en bloc sample reduces turnaround time and is cost-effective for 44.1%. A large number of pathologists find that the pathology examination of piecemeal samples has a longer learning curve. CONCLUSION: The survey shows that pathologists think that they can diagnose faster, accurately, and cost-effectively with ERBT samples, but they do not often encounter them in practice. Moreover, en bloc samples may be a better choice in pathology resident training. Evidence from real-life observational pathology practice and clinical research can reveal the current situation more clearly and increase awareness on proper treatment in endoscopic management of bladder tumors.

Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology.

PURPOSE: To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity. METHODS: One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups. RESULTS: The mean value of the Schirmer I test was 15.03±10.16 (1-35) mm in the control group, whereas it was found as 13.39±8.80 (3-35) mm, 9.85±7.81 (1-30) mm, and 9.41±7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.002). Although the mean TBUT score was 9.83±5.03 (3-23) seconds in the control group, it was 11.04±6.22 (3-20), 6.26±3.48 (1-16), and 5.44±3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P <0.001). Although the mean OSDI score was 12.76±14.84 (range, 0-41.65) in the control group, it was 11.52±12.95 (range, 0-44.40), 25.06±19.45 (range, 0-75), and 20.31±19.87 (range, 0-77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.015). Although the mean CIC stage was 0.47±0.60 (0-2) in the control group, it was 0.89±0.74 (0-2), 1.52±0.75 (0-3), and 1.83±0.69 (1-3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant ( P <0.001). CONCLUSION: In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.

The effects of botulinum toxin A and papaverine on human saphenous vein and internal mammary artery grafts: an in vitro study.

Introduction: Autologous saphenous vein (SV) and internal mammary artery (IMA) are used as bypass conduits during coronary artery bypass graft surgery. Vasospasm of the arterial and venous grafts may constitute a significant clinical problem. Pretreatment with a vasodilator drug of the graft ex vivo or intraluminal injection before implantation may be used for spasm prophylaxis. This in vitro study was designed to assess the vasoactive effects and time-dependent changes of botulinum toxin A (BTX-A) and papaverine pretreatment on vasospasm of human SV and IMA grafts. Also, histomorphology of the vessels was assessed. Material and methods: SV and IMA segments were suspended in organ baths, and isometric contraction responses to 2 different concentrations of 5-hydroxytryptamine (5-HT) and endothelin-1 (ET-1) were recorded after incubation with 2 different concentrations of BTX-A and papaverine at 2 time points (0 h and 2 h). Results: The results revealed the following: 1) incubation with BTX-A and papaverine relaxes both SV and IMA rings contracted with 5-HT and ET-1; 2) the duration of the relaxant effect of BTX-A lasts longer than papaverine; and 3) no apparent histomorphological changes were observed in the grafts under light microscopy. Conclusions: This study demonstrates that in human SV and IMA grafts, pretreatment with both BTX-A and papaverine are safe and have a potent inhibitory effect depending on the vessel and vasoconstrictor agent. The long-lasting vasodilatory effect of BTX-A on vascular smooth muscle may provide promising results in the prevention of venous and arterial graft spasm.

Prognostic importance of expression of mini-chromosome maintenance proteins (MCMs) in patients with nasopharyngeal cancer treated with curative radiotherapy

Abstract Objective: The prognostic importance of minichromosome maintenance complex expression in nasopharyngeal cancer is still unknown. We aimed to find whether minichromosome maintenance complex 2-7 expression may potentially be used to predict the prognosis of nasopharyngeal cancer patients treated with definitive radiotherapy. Methods: Between April 2007 and July 2020, patients with nasopharyngeal cancer treated with radiotherapy were identified. Immunohistochemical analysis was performed on formalin-fixed paraffin-embedded tissues of cases. A single pathologist analyzed the histologic specimens of all patients. Results: Totally, 67 patients were included. The median followup was 75.3 months. Higher tumor (T) stage was correlated with minichromosome maintenance complex 2 overexpression. Minichromosome maintenance complex s expression was also associated with histopathologic subgroups. According to univariate analysis, AJCC stage, histopathological subgroups, tumor response after treatment, minichromosome maintenance complex 2, 3, 5, 6 and 7 expression were the prognostic factors that predict overall survival. According to multivariate analysis minichromosome maintenance complex 7 expression was the only prognostic marker for both progression-free survival and overall survival. Conclusion: The overexpression of minichromosome maintenance complex 2, 3, 5, 6 and 7 indicated bad prognosis. Minichromosome maintenance complex 7 was an independent prognostic factor for survival outcomes in nasopharyngeal cancer and may be a potential therapeutic target for treatment.

Impact of unilateral trigeminal neuralgia on bilateral ocular surface alterations.

OBJECTIVE: To evaluate ocular surface alterations in both eyes of patients with unilateral trigeminal neuralgia (TN) compared with controls. BACKGROUND: Corneal nerves mainly originate from the trigeminal nerve, and neurosensory abnormalities are important factors in ocular surface alterations and dry eye etiopathogenesis. METHODS: Twenty-four patients with idiopathic unilateral TN and 24 healthy controls with similar sex and age distributions were included in this cross-sectional study conducted from February 15 to September 15, 2021. The eyes on the affected sides of the patients with TN were treated as Group 1, their contralateral eyes as Group 2, and the right eyes of the controls as Group 3. All participants were evaluated for tear film and ocular surface using the Schirmer 1 test, tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) score, and conjunctival impression cytology grading. RESULTS: The mean (SD) ages of the patients with TN (17 of 24 females, 70.8%) and controls (15 of 24 females, 62.5%) were 49.7 (11.7) and 48.5 (9. 6) years, respectively. The median [25th, 75th percentile] Schirmer 1 test results in Groups 1, 2, and 3 were 5.0 [4.0, 14.0], 7.0 [3.2, 11.7], and 10.0 [6.0, 15.7] mm, respectively, with no statistically significant differences between Groups 1 and 2 (p = 0.697), Groups 1 and 3 (p = 0.133), or Groups 2 and 3 (p = 0.129). The median TBUT scores in Groups 1, 2, and 3 were 7.0 [5.0, 10.0], 8.0 [5.2, 10.0], and 12.5 [8.0, 13.0] s, respectively, showing reduced times for both Groups 1 and 2 versus Group 3 (median difference = -3.0 [95% CI: -5.0, -1.0], p = 0.001, and median difference = -3.0 [95% CI: -5.0, -2.0], p = 0.001, respectively). Conjunctival impression cytology grades were significantly higher in Groups 1 and 2 versus Group 3 (median difference = 2.0 [95% CI: 1.0, 2.0], p < 0.001, and median difference = 1.0 [95% CI: 1.0, 2.0], p < 0.001, respectively). The median OSDI score in TN patients (30.2 [25.0, 34.9]) was significantly higher than in the controls (8.3 [0.0, 18.7]), with a median difference of 20.8 (95% CI: 14.7, 27.1), p < 0.001. CONCLUSION: Even if pain is unilateral in patients with TN, there are significant abnormalities in conjunctival cytology and tear functions in both eyes. There seem to be various pathophysiological mechanisms of TN that affect the bilateral ocular surface and lead to significant alterations.

Dry eye disease and ocular surface characteristics in patients with keratoconus.

PURPOSE: The purpose of this study is to investigate the ocular surface alterations in patients with mild or severe keratoconus (KC). METHODS: A total of 80 participants were included in the study. The corneal topography was performed on each participant using Pentacam and the grouping was done accordingly. The patients with Kmax ≥52.0 D (severe KC) were considered Group 1 (n = 28), the patients with Kmax ≥47.2 and <52.0 D (mild KC) were considered Group 2 (n = 30). Healthy control participants with Kmax <47.2 D were considered Group 3 (n = 22). Tear breakup time (TBUT), Schirmer-I test, ocular surface disease index (OSDI) questionnaire, and conjunctival impression cytology (CIC) were evaluated among the groups. RESULTS: The mean values of TBUT and Schirmer-I test were significantly lower (P = 0.012, P = 0.012) and the mean scores of OSDI and CIC were significantly higher (P = 0.006, P < 0.001) in Group 1 and Group 2 than in Group 3. The mean values of TBUT and Schirmer-I test were lower and the mean scores of OSDI and CIC were higher in Group 1 than in Group 2 but the differences were insignificant (P > 0.05 for all). CONCLUSION: These results indicated that the tests associated with dry eye disease are correlated with KC. Tear film alterations and goblet cell loss are higher in severe KC.

Relationship between histomorphological findings and platelet activation in psoriasis.

BACKGROUND: Elevated platelet count (PC), mean platelet volume (MPV), and Platelet Mass Index (PMI) are reported in patients with psoriasis, while platelet activation is associated with psoriasis severity. Available studies examining the relationship between platelet activation markers and psoriasis have mostly focused on psoriasis area severity index. To the best of our knowledge, there is no study examining the relationship between histopathological features of a single psoriatic plaque and platelet activation. The present study examined the relationship between histomorphological findings obtained by morphometric analysis and psoriasis patients' PC, MPV, and PMI values. MATERIALS AND METHODS: Morphometric analysis was performed on hematoxylin and eosin-stained preparations of skin biopsies to measure minimum suprapapillary epidermis thickness (SPETmin ) and maximum epidermal thickness (ETmax ), maximum suprapapillary keratosis thickness (SPKTmax ), and maximum keratosis thickness (KTmax ). The relationship between PC, MPV, PMI, and morphometric skin biopsy outcomes was evaluated. RESULTS: While an inverse correlation was found between SPETmin and PC and PMI in cases with psoriasis (p values = 0.015 and 0.005, r values = -0.238 and -0.271, respectively), no significant correlation was found between SPETmin and MPV (p value = 0.600, r value = -. 052). On the contrary, no significant correlation was found between SPKTmax, ETmax, and KTmax values and platelet parameters. CONCLUSION: We assume that an increased risk of platelet activation-related diseases is expected in psoriasis patients displaying histopathological findings of suprapapillary thinning due to increased platelet activation; therefore, it may be beneficial to monitor these patients in terms of such risks.

Associations of IL-4, IL-4R, IL-17A, and IL-17F Polymorphisms with Colorectal Cancer Risk: A Meta-Analysis, Meta-Regression, and Trial Sequential Analysis.

Both interleukin (IL)-4 and IL-17 polymorphisms may be involved in the pathogenesis and progression of colorectal cancer (CRC). Herein, we designed a meta-analysis to assess the associations between IL-4, IL-4R, IL-17A, and IL-17F polymorphisms and CRC risk. Scopus, Web of Science, Cochrane Library, and PubMed databases were searched to retrieve articles published until October 21, 2021. We used crude odds ratio (OR) and 95% confidence interval assessing the association of the polymorphisms and CRC risk in 5 genetic models. Trial sequential analysis for the primary analyses was used to control random errors. Twenty-three studies (8: IL-4 rs2243250, 4: IL-4R rs1801275, 5: IL-17A rs2275913, and 6: IL-17F rs763780) were involved in the meta-analysis. The pooled OR (P-value) for the association between IL-4 rs2243250 polymorphism and the CRC risk was 1.11 (0.08), 1.27 (0.12), 1.07 (0.37), 1.09 (0.17), and 1.22 (0.12), for IL-4R rs1801275 polymorphism was 0.71 (0.18), 1.05 (0.76), 0.86 (0.37), 0.87 (0.41), and 0.69 (0.39), for IL-17A rs2275913 polymorphism was 1.83 (0.0003), 1.73 (0.06), 1.47 (<0.001), 1.61 (0.001), and 1.42 (0.15), and for IL-17F rs763780 polymorphism was 1.07 (0.48), 5.33 (0.02), 1.08 (0.49), 1.08 (0.47), and 8.42 (0.002) in allelic, homozygous, heterozygous, recessive, and dominant models, respectively. The G allele and GA genotype of IL-17A rs2275913 polymorphism and the CC genotype of IL-17F rs763780 polymorphism had an elevated risk in CRC cases. The ethnicity and genotyping method, sample size, control, and publication year were effective factors on the pooled results.

The effects of subconjunctival bevacizumab, ranibizumab, and aflibercept on corneal neovascularization.

PURPOSE: To investigate the effects of subconjunctival bevacizumab, ranibizumab, and aflibercept in an experimental corneal neovascularization model. MATERIALS AND METHODS: The eyes of 24 rats were chemically cauterized and randomly divided into four groups: bevacizumab group (0.05 mL/1.25 mg bevacizumab), ranibizumab group (0.05 mL/0.5 mg ranibizumab), aflibercept group (0.05 mL/1.25 mg aflibercept), and control group (0.05 mL saline solution). Plasma vascular endothelial growth factor (VEGF) levels were among the major measurement outcomes to assess corneal neovascularization. The collected plasmas were analyzed using the SIGMA RAB0511 Rat VEGF Elisa kit. The PCR technique and VEGF amplification procedures were used for molecular analysis. Each cornea was removed and histologically examined on day 21. Corneal images were evaluated by image analyzer software. RESULTS: In the post-injection period, the number of major corneal arteries decreased significantly in the injection groups when compared to the control group (p = 0.037), but no statistically significant differences were noted among the injection groups (p > 0.05). The aflibercept group had the lowest area of neovascularization. Immunohistochemical staining revealed substantially lower VEGF percentages in neovascularized arteries of the injection groups than the control group (p = 0.015). In TUNEL staining, the mean TUNEL value (number/1hpf) was substantially greater in the control group than in the injection groups, but the mean TUNEL values were similar between the injection groups (p = 0.019, p > 0.05, respectively). No statistically significant differences were observed between the groups in terms of corneal surface area with increased cellularity, edema, and inflammation (p = 0.263). The mean plasma VEGF concentration in the control group was statistically greater than those in the injection groups (p = 0.001). CONCLUSION: Subconjunctival bevacizumab, ranibizumab, and aflibercept crossed the blood and seemed to be effective in inhibiting corneal neovascularization without causing epitheliopathy in an experimental rat model compared to the controls. However, no significant results were noted between these three anti-VEGF molecules.

The effect of a gap concept on peripheral nerve recovery in modified epineurial neurorrhaphy: An experimental study in rats.

BACKGROUND: Several factors such as surgical approach that only consider topographic anatomy; inadequate fascicular alignment, extraepineurial sprouting in the repair zone; contact of axons with the suture area are the disadvantages of epineurial neurorrhaphy. Accordingly, axonal mismatch, neuroma, and unfavorable nerve recovery become inevitable. Neurotropism is the theory clarifying appropriate matching of the nerve fibers independently without needing surgical approach. The studies comparing the primary nerve repair with the nerve defects bridged in different ways demonstrated better outcomes of nerve recovery in the groups with a nerve gap. In this study, we aimed to demonstrate the effects of the gap concept in primary nerve repair bridged by own epineurium. We hypothesized that this technique will provide better results in terms of peripheral nerve recovery and will significantly eliminate the occurrence of a neuroma, which is quite possible in epineurial neurorrhaphy. MATERIALS AND METHODS: A total of 35 Wistar female rats weighing 200 ~ 250 g were randomly divided into five groups each with seven rats. Sham controls constituted Group 1, while the rats with epineural neurorrhaphy were included in Group 2. The remaining three groups were the study groups. In Group 3, after the sciatic nerve transection, epineurium of the distal segment was sleeved and preserved. A 2-mm axonal segment was removed from the epineurium free distal ending and no any procedure was applied to the proximal ending of the transected sciatic nerve. Epineuriums of the both sides were approximated and repaired. In Group 4, a 2-mm axonal segment was removed from the proximal ending of the sciatic nerve after preservation of epineurium and no any procedure was applied to the distal part of sciatic nerve. Epineuriums of the both sides were approximated and repaired. In addition, in Group 5, after epineuriums were sleeved in the both distal and proximal stumps, a 1-mm nerve segment was removed from both endings and epineuriums were repaired in the middle bridging a 2-mm axonal gap again. After a 3 months follow-up period Sciatic Functional Index (SFI) was measured by walking track analysis; the area under the evoked compound muscle action potential (CMAP) and latency periods were calculated via electromyographic (EMG) analysis; and histopathological evaluation were performed to compare the parameters of edema, fibrosis, inflammation, vascularization, axonal degeneration, axonal density, myelination, disorganization, and neuroma occurrence. Vascular structures and nerve fibers were counted at ×200 magnification: +1, +2, and +3 indicated the presence of 0-15, 16-30, and >30 structures, respectively. For uncountable parameters (edema, disorganization, myelination, fibrosis, and inflammation): +1 indicated mild, +2 indicated moderate, and +3 indicated severe. RESULTS: The differences between the groups with axonal gap repair and epineural neurorrhaphy were not significant regarding to SFI. The areas under CMAP were as follows: 27.9 ± 5.9 (Δ = 12.1%) in Group 1; 16.5 ± 5.5 (Δ = 6.3%) in Group 2; 14.1 ± 6.2 (Δ = 4.8%) in group 3; 13.8 ± 2.3 (Δ = 9.2%) in Group 4, and 22.5 ± 18.3 (Δ = 2.2%) in Group 5. Group 5 (1 mm gap in the distal +1 mm gap in the proximal segments) had a significantly better result in terms of the area under CMAP with the value of 22.5 ± 18.3 m/Mv (p = .031). Axonal density was 0.9 ± 0.6 (Δ = 2.2%) in Group 2, 2.4 ± 0.3 (Δ = 5.1%) in Group 3, 2.8 ± 0.1 (Δ = 7.7%) in Group 4, and 2.8 ± 0.2 (Δ = 4.8%) in Group 5. Myelination was 1.1 ± 0.5 (Δ = 3.4%) in group 2, 2.2 ± 0.2 (Δ = 6.7%) in group 3, 2.4 ± 0.4 (Δ = 6.0%) in Group 4, and 2.7 ± 0.3 (Δ = 4.6%) in Group 5. Disorganization was 2.3 ± 0.4 (Δ = 4.1%) in Group 2, 1.2 ± 0.2 (Δ = 7.7%) in Group 3, 1.3 ± 0.2 (Δ = 6.5%) in Group 4, and 1 ± 0.3 (Δ = 5.9%) in Group 5. And, neuroma occurrence was found 2.2 ± 0.6 (Δ = 2.8%) in Group 2 and 0.3 ± 0.2 (Δ = 0.1%) in Group 4 while neuroma was not encountered in Group 3 and Group 5. Comparison between the epineurial neurorrhaphy group and the groups with axonal defect revealed the statistically significant results in the factors of axonal density (p = .001), myelination (p = .028), disorganization (p = .016) and neuroma (p = .001). CONCLUSIONS: Creating axonal gap bridged by own epineurium showed favorable results comparing with epineurial neurorrhaphy. Resection of a 1 mm axonal segment from the proximal and distal stumps following the epineurial sleeve procedure and performing the epineurium- only repair can facilitate the nerve regeneration. The feasibility of the described technique has been demonstrated in a small rat model and must be further validated in larger animals before clinical testing.

The role of prostate inflammation in the pathogenesis of urethral strictures occurring after transurethral resections.

OBJECTIVE: To make an extensive evaluation about the effects of histopathological findings acquired from the resection materials of patients who underwent transurethral resection of prostate (TUR-P) due to benign prostate hyperplasia (BPH) on postoperative urethral stricture formation. MATERIALS AND METHODS: Among patients who had TUR-P due to BPH and were followed up for minimum 6 months, 51 patients detected to have urethral stricture based on endoscopic imaging were included in the urethral stricture group (Group 1) and 52 patients without urethral stricture were included in the control group (Group 2). The relation between histopathological findings of TURP materials and postoperative stricture occurrence was investigated. RESULTS: No difference in age, prostate volume, operation time and postoperative catheterization time was detected among the groups (p=0.86, p=0.13, p=0.06, p=0.32, respectively). Average time until the urethral stricture diagnosis in the group with urethral stricture was measured as 57.9±27.2 days. In our study, inflammation intensity in peri-urethral, stromal and periglandular areas and intraglandular destruction ratios were higher in urethral stricture group (Group 1) (p=0.048, p=0.3, p=0.03, p=0.01, respectively). Again, it was detected that neutrophil, plasmocyte and eosinophil cell ratios were higher in peri-urethral, stromal and periglandular areas and lymphocyte values were lower compared to the control group. CONCLUSION: Acquired data has shown that acute inflammatory attacks may be related to urethral stricture with a mostly chronic inflammation background in the prostate. During histopathological examination of prostate tissue acquired through TURP, especially high peri-urethral neutrophil, plasmocyte and eosinophil cell ratios and intra-glandular destruction ratios are important for predicting postoperative urethral stricture occurrences.

The ocular surface findings in alopecia areata patients: clinical parameters and impression cytology.

PURPOSE: The objective of this study was to examine the effects of alopecia areata (AA) on the ocular surface and conjunctival cytology. METHODS: A total of 48 subjects were included in the present study. Twenty-three subjects were assigned to group 1 as the patient group, and 25 healthy individuals were included in group 2 as the control group. The ocular surface examination was performed, and the right eyes of all participants were included in the analysis. Both groups underwent the following tests for evaluation of ocular surface: tear break-up time (TBUT), Schirmer I test, Ocular Surface Disease Index (OSDI), and conjunctival impression cytology (CIC). Results obtained from the tests were then analyzed and compared between the groups. RESULTS: The mean TBUT value was significantly lower in Group 1 compared to Group 2 (4.96 ± 3.4 vs 10.52 ± 4.8 s) (p < 0.001). There was no significant difference between Group 1 and Group 2 in terms of the mean Schirmer I test score (p = 0.129). The mean OSDI score was higher in Group 1 compared to Group 2 (15.48 ± 10.4 vs 9.61 ± 13.4), but the difference between both groups was not statistically significant (p = 0.1). The mean CIC score was statistically significantly higher in Group 1 than in Group 2 (1.65 ± 0.7 vs 0.52 ± 0.5) (p < 0.001). CONCLUSION: The results of this study showed that AA was correlated with significant disturbances in conjunctival cytology and the tear function.