Operative Nuances of Capsular Dissection Techniques and Capsule Morphology in Pituitary Adenomas: Past 1-Year Case Experiences of a Tertiary Center.

BACKGROUND AND OBJECTIVES: The widespread use of endoscope and increased surgical experiences in pituitary adenomas (PAs) has raised the expectations for higher resection and cure rates. The subject that will meet this expectation in all types of adenomas is the capsule and its dissection. The purpose of this study was to go beyond the commonly mentioned pseudocapsule definition for small-sized adenomas in previous studies and to describe the capsule structure in different morphologies present in pituitary adenomas of all sizes. This includes detailing the nuances of capsular dissection (CD) and presenting postoperative surgical outcomes through the experiences of a high-volume tertiary center. METHODS: In our center, 534 patients underwent endoscopic trans-sphenoidal surgery because of pituitary adenoma in 2022 by the same surgeon. The data of the patients were examined retrospectively. The surgical techniques applied were grouped as adenoma resection only, capsular resection after internal debulking, and direct extracapsular resection. RESULTS: CD was performed in 275 (51.5%) patients. The gross total resection (GTR) rate in nonsecretory adenomas with and without CD was 90.7% (97/107) and 90.7% (97/107), respectively. The remission rate in secretory adenomas with and without CD was 81.0% (136/168) and 44.0% (67/152), respectively. When the patients were examined in 2 groups as those who underwent CD and those who did not, the application of CD had a positive predictive value in terms of GTR/remission (P: .036). Capsule thickness was not found to be statistically significant depending on tumor subtype, size, and aggressiveness, but capsule thickness was statistically significant in terms of total capsular resection (P: .045). CONCLUSION: The morphology of the capsule, tumor size/subtype/consistency, and patient-specific factors are crucial for the selection of the surgical technique to be applied. It is possible to increase the GTR/remission rates in adenomas of all sizes by capsule dissection. Moreover, performing CD does not contribute significantly to the development of potential complications in such cases.

Outcomes of Endoscopic Transsphenoidal Approach for More Aggressive Pediatric Pituitary Adenomas: Early- and Late-Term Results from a Single Center Experience.

OBJECTIVE: Pediatric pituitary adenomas are rare lesions and account for approximately 3% of all supratentorial tumors in children. There is a paucity of reports on endoscopic transsphenoidal surgery in children. The aim of this study was to assess the early/late outcomes of endoscopic pediatric pituitary adenoma surgery at a high-volume tertiary center, as well as to characterize the factors associated with aggressive growth, including the histopathological features. METHODS: Between August 1997 and June 2022, a total of 3256 patients underwent endoscopic transsphenoidal surgery for pituitary adenoma at the Department of Neurosurgery and Pituitary Research Center of the Kocaeli University School of Medicine. Of these, 70 (2.1%) pediatric patients (25 males, 45 females) (age ≤18 years) with a pathological diagnosis of pituitary adenoma were retrospectively reviewed. RESULTS: The mean age of patients was 15.5 ± 2.3 years. Among the hormone-secreting adenomas, 19 (34.5%) were adrenocorticotrophic hormone secreting, 13 (23.6%) were growth hormone secreting, 19 (34.5%) were prolactin secreting, and 4 (7.2%) were both growth hormone-prolactin secreting. Gross total resection was achieved in 93.3% of nonfunctional tumors. The early/late surgical remission rates for hormone-secreting adenomas were 61.5%/46.1% (mean follow-up: 63.7 ± 49.3 months) for acromegaly, 78.9%/68.4% (47.8 ± 51.0 months) for Cushing disease, 57.8%/31.5% (72.2 ± 59.5 months) for prolactinoma, and 25%/25% (35.2 ± 31.4 months) for growth hormone-prolactin-secreting adenomas. Five sparsely granulated corticotroph tumors, 5 sparsely granulated somatotroph tumors, and 11 densely granulated lactotroph tumors were classified as aggressive histopathological subtypes. CONCLUSIONS: The unique characteristics of the pediatric population and the aggressiveness of the disease in this population pose considerable therapeutic challenges. To increase treatment success, current adjuvant therapies that are appropriate for the morphological and biological characteristics of the tumor are required in addition to surgical treatment.

The Use of New Hematological Markers in the Diagnosis of Alopecia Areata.

INTRODUCTION: Alopecia areata (AA) is a non-cicatricial inflammatory and autoimmune hair loss disease. In recent studies, it has been reported that hematological parameters can be used as oxidative stress markers in the diagnosis of many inflammatory diseases due to their low cost and widespread use. OBJECTIVES: In this study, it was aimed to reveal the significant cut-off points of hematological inflammatory markers in AA that can guide clinicians in clinical practice and determine how many times they increase the risk of disease. METHODS: The present study is retrospective case-control type. Seventy patients with AA and seventy healthy controls were included in the study. The hematological parameters in both groups were evaluated retrospectively. RESULTS: Hemoglobulin, monocyte, platelet, monocyte high-density lipoprotein cholesterol (HDL-C) ratio (MHR), monocyte lymphocyte ratio (MLR), platelet lymphocyte ratio (PLR) were high in patients with AA, while the number of lymphocytes was low. In ROC analysis, the optimal cut-off values for the diagnosis of AA were as follows: MLR 0.216, MHR 0.010, and PLR 111.715. In regression analysis, being above the following values of MLR 0.216, MHR 0.010, and PLR 111.715 increased the risk of developing AA by 6.3, 3.8, and 2.7 times, respectively. CONCLUSIONS: It was seen that MHR and PLR, especially MLR, can significantly increase the risk of developing the disease in AA and can also be used as diagnostic markers.

Impact of High Aspect Ratios and Reinforcing Indexes on Mechanical Properties of Hybrid and Non-Hybrid Chopped Glass Fiber Reinforced Concrete.

Due to technological advancements, concrete can be currently produced with varying strengths and durability based on its intended use. However, in many applications, concrete still needs to be improved in terms of its mechanical and physical properties. The addition of fibers to concrete is one of the most widely used methods for improving its mechanical and physical properties. The study focuses on the effects of the high aspect ratios and reinforcing indexes on the mechanical properties of the hybrid and non-hybrid chopped glass fiber reinforced concrete (CGFRC). In this study, the glass chopped fibers (GCFs) (fiber diameter, ϕ = 0.015 mm) with four different volume fractions (0, 0.5, 0.75, and 1%) and four different lengths (3, 6, 12, and 24 mm) were mixed into the concrete considering the aspect ratios between 200 and 2800 and the reinforcing indexes between 1 and 42. A total of 51 samples were prepared for the study that included 3 control, 36 non-hybrid, and 12 hybrid samples. Then, the flexural strength and compressive strength tests were conducted on the CGFRC samples. To obtain detailed information about fiber pullout, fiber breakage, debonding, or cracking in the matrix, digital microscopy and scanning electron microscopy examinations were performed. The flexural strength of the hybrid samples increased with the higher aspect ratios and reinforcing index values, whereas the flexural strength of non-hybrid samples decreased with the higher aspect ratios and reinforcing index values in the CGFRCs. Moreover, all non-hybrid and hybrid CGFRC samples had lower compressive strengths than the control samples in terms of compressive strength. With an increase in the fiber volume fraction, the mixing and workability of the samples considerably decrease, and the increase of the fiber volume fraction caused brittle fractures in concretes to be transformed into ductile fractures.

Seasonal variations and human health risk assessment of trace elements in the bivalve ecosystem in the Sea of Marmara.

Twelve trace elements were studied in four economically important bivalve molluscs (Mediterranean mussel, manila clam, striped venus clam, and truncated wedge clam) from the southern Marmara Sea for seasonal bioaccumulation and human health risk assessment. According to the findings, Fe and Zn were the most accumulative and element concentrations changed considerably (P < 0.05) between seasons and species. Daily, weekly, monthly intake and target hazard quotients of the trace elements were estimated and compared with maximum limits. The results revealed that consuming these bivalve molluscs from the southern Marmara Sea could be considered safe for human consumption. Nevertheless, further monitoring is needed in order to better follow the development in time of elemental pollution due to increasing environmental pressure on the Marmara Sea basin, together with research on other different bioaccumulative organisms.

Clustering Inflammatory Markers with Sociodemographic and Clinical Characteristics of Patients with Diabetes Type 2 Can Support Family Physicians' Clinical Reasoning by Reducing Patients' Complexity.

Diabetes mellitus type 2 (DM2) is a complex disease associated with chronic inflammation, end-organ damage, and multiple comorbidities. Initiatives are emerging for a more personalized approach in managing DM2 patients. We hypothesized that by clustering inflammatory markers with variables indicating the sociodemographic and clinical contexts of patients with DM2, we could gain insights into the hidden phenotypes and the underlying pathophysiological backgrounds thereof. We applied the k-means algorithm and a total of 30 variables in a group of 174 primary care (PC) patients with DM2 aged 50 years and above and of both genders. We included some emerging markers of inflammation, specifically, neutrophil-to-lymphocyte ratio (NLR) and the cytokines IL-17A and IL-37. Multiple regression models were used to assess associations of inflammatory markers with other variables. Overall, we observed that the cytokines were more variable than the marker NLR. The set of inflammatory markers was needed to indicate the capacity of patients in the clusters for inflammatory cell recruitment from the circulation to the tissues, and subsequently for the progression of end-organ damage and vascular complications. The hypothalamus-pituitary-thyroid hormonal axis, in addition to the cytokine IL-37, may have a suppressive, inflammation-regulatory role. These results can help PC physicians with their clinical reasoning by reducing the complexity of diabetic patients.

Ultrasonographic and clinical evaluation of additional contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome

Background and aim: This study aims to ultrasonographically and clinically evaluate the additive contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of mild or moderate carpal tunnel syndrome (CTS). Materials and methods: Thirty-eight wrists of patients (n = 21) with CTS were randomized into two groups as the intervention group (n = 19) and the control group (n = 19). Tendon and nerve gliding exercises were given to both groups. In the intervention group, additional kinesiotaping was performed three times with 5-day intervals. Functional assessments were performed with the Boston Carpal Tunnel Syndrome Questionnaire and the Moberg pick-up test. Hand grip and pinch strength were evaluated. Cross-section area (CSA) of the median nerve was measured by ultrasonography. All assessments were performed at baseline and at 3 and 6 weeks after treatment. Results: In the intervention group, there was a significant improvement in all clinical assessments and in the CSA of the median nerve at the level of proximal carpal bones. In the control group, a significant improvement was detected in all clinical parameters except grip strength and ultrasonographic measurements. There was no significant difference in the clinical and ultrasonographic findings between the groups at 6 weeks. Conclusion: Kinesiotaping may provide a positive contribution to ultrasonographic and clinical outcomes in the treatment of mild or moderate CTS in the short term.

Investigation of BRAF mutation analysis with different technical platforms in metastatic melanoma.

In metastatic melanoma, the detection of somatic mutations in the BRAF gene is crucial regarding patient selection for targeted therapy. Several screening methods have been developed to identify BRAF gene mutations. In this study, our objective was to evaluate the detection of the BRAF V600 mutations using two molecular methods, real-time polymerase chain (real-time PCR) assay and pyrosequencing, and immunohistochemistry (IHC), and to compare the results of these different technical platforms. This study included 98 patients diagnosed with metastatic melanoma at the Hacettepe University, Department of Pathology between 2002 and 2014. BRAF mutation analysis was tested with real-time PCR, pyrosequencing and IHC methods. The results of all three tests were compared with a reference test, and the sensitivity, specificity rates and kappa coefficient values were analysed for each test. We successfully analysed BRAF mutations using all three methods in 92 patients. According to our findings, the pyrosequencing method had the highest kappa value regarding the determination of BRAF V600 mutations. The kappa values were at almost perfect agreement levels in pyrosequencing and real-time PCR assay (kappa coefficient for pyrosequencing=0.895 (95% CI: 0.795-0.995); kappa coefficient for real-time PCR=0.871 (95% CI: 0.761-0.981). The kappa value was at a substantial agreement level in the IHC analysis (kappa coefficient=0.776 (95% CI: 0.629-0.923). According to our results, we found that real-time PCR and pyrosequencing methods were equally excellent in determination of BRAF V600 mutations. The IHC method, which is commonly used in routine pathology practice, can also be safely used as a screening test for determination of BRAF V600 mutations.

Impact of GLP-1 analogue on oxidative damage and hepatic regeneration in experimental 70% hepatectomy model.

BACKGROUND/AIMS: The purpose of our study is researching into impact of glucagon like peptide 1 (GLP 1) analogue on liver regeneration after major hepatectomy. METHODOLOGY: 24 wistar albino rats were consecutively divided into 3 groups. Group 1: Control (sham) group day 14 (n = 8), Group 2: Liver resection group day 14 (n = 8); 70% Liver resection was performed, Group 3: Study group day 14 (n = 8); Subsequent to performing 70% liver resection, GLP-1 analogue was administered 2 times a day. (10 µgr/70 kg x 2 times). After 14 day, rats were sacrificed. Oxi- dative stress and antioxidant enzymes and mitochon- drial permeability transition, cytochrome-c, Bax, Bcl- 2, caspase-3, caspase-8 and caspase-3 activity were examined. RESULTS: 70% Liver resection induced oxi- dative stress of liver tissue was ameliorated by GLP-1 induction. Administration of GLP increased Bcl-2 ex- pression. Decreased expression of cytochrome-c was accompanied by a decrease caspase-3, caspase-8, and Bax expression and caspase-3 activity. CONCLUSIONS: Glp 1 induction plays a regenerative role in the major hepatectomy. This effect is dependent on modulation of the antiapoptotic and antioxidative pathways by GLP 1 expression.

Knowledge discovery of drug data on the example of adverse reaction prediction.

BACKGROUND: Antibiotics are the widely prescribed drugs for children and most likely to be related with adverse reactions. Record on adverse reactions and allergies from antibiotics considerably affect the prescription choices. We consider this a biomedical decision-making problem and explore hidden knowledge in survey results on data extracted from a big data pool of health records of children, from the Health Center of Osijek, Eastern Croatia. RESULTS: We applied and evaluated a k-means algorithm to the dataset to generate some clusters which have similar features. Our results highlight that some type of antibiotics form different clusters, which insight is most helpful for the clinician to support better decision-making. CONCLUSIONS: Medical professionals can investigate the clusters which our study revealed, thus gaining useful knowledge and insight into this data for their clinical studies.

Alternative surgical approach for the management of uterine prolapse in young women: preliminary results.

AIM: To demonstrate an alternative surgical approach for the management of uterine prolapse in young women by a technique that was previously defined for post-hysterectomy vaginal vault suspension in published work and also to demonstrate successful operative results. METHODS: The study population consisted of 12 women aged 28-41 years who had stage 4 uterine prolapse and who were surgically treated by abdominal hysteropexy using autogenous rectus fascia strips. Operative results and postoperative follow-up Pelvic Organ Prolapse Quantification and Prolapse Quality of Life results were recorded. RESULTS: Mean age of patients was 35.5 ± 4.1 years (range, 28-41). Mean parity in the study group was 2.6 ± 1.0 (range, 1-5). Mean operation time was 32.0 ± 5.2 min (range, 25-42). All patients were discharged on the postoperative 3rd day and no complications were observed postoperatively. Mean follow-up period was 20 ± 7.0 months (range, 12-36). All of the patients had complete remission for uterine prolapse and none of the patients had complaints related to the operation. CONCLUSION: Abdominal hysteropexy operation using rectus fascia strips provides a safe and alternative approach for the management of uterine prolapse in young women who desire to preserve their uterus. But further analysis is needed to confirm our results.

Prediction of similarities among rheumatic diseases.

We introduce a method for extracting hidden patterns seen in rheumatic diseases by using articles from the widely used biomedical database MEDLINE. Rheumatic diseases affect hundreds of millions of people worldwide and lead to substantial loss of functioning and mobility. Diagnosing rheumatic diseases can be difficult because some symptoms are common to many of them. We use Facta system as a biomedical text mining tool for finding symptoms and then create a dataset with the frequencies of symptoms for each disease and apply hierarchical clustering analysis to find similarities between diseases. Clustering analysis yields four distinct types or groups of rheumatic diseases. Although our results cannot remove all the uncertainty for the diagnosis of rheumatic diseases, we believe they can contribute to the diagnosis of rheumatic diseases to a certain extent. We hope that some similarities exposed can provide additional information at the stage of decision-making.

Mining MEDLINE for the treatment of osteoporosis.

In this paper, we consider the importance of osteoporosis disease in terms of medical research and pharmaceutical industry and we introduce a knowledge discovery approach regarding the treatment of osteoporosis from a historical perspective. Osteoporosis is a systemic skeletal disease in which osteoporotic fractures are associated with substantial morbidity and mortality and impaired quality of life. Osteoporosis has also higher costs, for example, longer hospital stays than many other diseases such as diabetes and heart attack and it is an attractive market for pharmaceutical companies. We use a freely available biomedical search engine leveraging text-mining technology to extract the drug names used in the treatment of osteoporosis from MEDLINE articles. We conclude that alendronate (Fosamax) and raloxifene (Evista) have the highest number of articles in MEDLINE and seem the dominating drugs for the treatment of osteoporosis in the last decade.

Effects of training about skin cancer on farmers' knowledge level and attitudes.

BACKGROUND: Skin cancer is one of the most common types of cancer. As farmers stay under sun for a long time and handle many different chemicals, they are at risk. This study was carried out to examine the effects of training for protection on their knowledge level and attitudes. METHOD: The subjects were 194 farmers living in a village in Marmara region which most benefits from the sun in Turkey. No sampling was performed. Data were collected before and after six months of training through a personal description form and skin cancer attitude-knowledge form and analyzed using percentage calculations, McNeamer test and t-test in dependent groups. RESULTS: Knowledge level of farmers on skin cancer and the protection from skin cancer was significantly increased after the training (p<0.01) regarding use of sun cream, umbrellas, swimming and traditional behavior (p<.01) but not use of hats, sunglasses and long-sleeved shirts (p>0.01). A significant decrease was also determined in tampering with moles, acnes and scars (p<.01). CONCLUSION: The training given to farmers for protection against skin cancer was found effective for improving knowledge levels and attitudes. Planned and regular education should decrease the skin cancer rate among farmers.