The predictive value, sensitivity, specificity, and accuracy of PET CT in the evaluation of axillary metastases in breast cancer.

OBJECTIVE: This study aims to evaluate the accuracy of preoperative 18F-FDG PET CT in detecting axillary lymph node (ALN) metastases in patients with breast cancer. PATIENTS AND METHODS: A retrospective analysis was performed on the medical records of 114 patients who underwent PET CT for breast cancer between January 2017 and January 2020. Clinicopathological features and the relationship between lymph node metastasis were evaluated. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated based on the PET CT findings compared to histopathological results. RESULTS: Among the 67 patients included in this study, 29 were identified as having no axillary involvement, while 38 showed axillary involvement according to preoperative PET CT. Of the 34 patients with histopathologically confirmed metastatic lymph nodes, 28 had PET CT-detected axillary involvement, while 6 did not. Similarly, among the 33 patients without histopathological evidence of lymph node metastasis, 23 had no axillary involvement according to PET CT, while 10 showed axillary involvement. The calculated values were as follows: sensitivity = 82.4% (67-92%), specificity = 69.7% (53-83%), positive predictive value = 73.7% (62-83%), negative predictive value = 79.3% (64%-89%), and accuracy = 76.1% (64-86%). CONCLUSIONS: The results suggest that preoperative 18F-FDG PET CT, particularly p SUVmax, can serve as an independent prognostic factor for ALN metastasis in breast cancer patients. Therefore, it may be beneficial for preoperative risk stratification and personalized treatment planning.

Investigation of the Effect of Facet Joint Angle Characteristics on the Development of Lumbar Spinal Stenosis in Patients with Lumbar Canal Stenosis.

OBJECTIVES: The aim of our study was to investigate facet tropism and its impact on the development of lumbar spinal canal stenosis (LSCS) in patients with LSCS. MATERIALS AND METHODS Bilateral facet joint angles at the L3-4, L4-5, and L5-S1 levels were measured on axial plane in the lumbar magnetic resonance imaging (MRI) scans of 82 patients aged between 32 and 75 with LSCS, and 82 healthy individuals aged between 30 and 66 without LSCS, who were considered as the normal group. RESULTS Both groups in our study consisted of both males and females. The mean age was 51.4 for patients with LSCS and 44.7 for the healthy group, with no signifi cant difference (p>0.05). A total of 984 facet joint angles were measured, with 164 patients at three intervertebral disc levels each. The presence of facet tropism was found to be a signifi cant risk factor in the LSCS group compared to the healthy group, with an increased risk of 2.125 times at L3-4, 3.389 times at L4-5, and 2.496 times at L5-S1 (p<0.05). CONCLUSIONS In our study, we determined that facet joint tropism is statistically signifi cant in patients with LSCS compared to the control group (p<0.05). We believe that facet tropism plays a predisposing role as a contributing factor in the etiology of LSCS. KEY WORDS: lumbar spinal stenosis, facet tropism, magnetic resonance imaging.

Comparison of dilute and nondilute osmotic equilibrium models for erythrocytes.

Successful cryopreservation requires the addition of cryoprotective agents (CPAs). The addition of permeating CPAs, such as glycerol, is associated with some risk to the cells and tissues. These risks are both related to the CPA themselves (CPA toxicity) and to the volume response of the cell (osmotic damage). To minimize the potential for damage during cryopreservation, mathematical models are often employed to understand the interactions between protocols and cell volume responses. In the literature, this volume response is usually captured using ideal and dilute approximations of chemical potential and osmolality, an approach that has been called into question for cells in high concentrations of CPAs. To address this, the relevance of non-ideal and non-dilute models has been explored in a number of cell types in the presence of permeating CPAs. However, it has not been explored in erythrocytes, which have a cytosolic hemoglobin content of more than 20% by volume and are cryopreserved in 40% glycerol. Because hemoglobin has been suggested to be a highly non-ideal solute, if the non-ideal and non-dilute transport model is relevant to any cells, it should be relevant to erythrocytes. Here we investigate the use, and accuracy, of both the dilute and non-dilute models in predicting cell volume changes during CPA equilibration in erythrocytes, and demonstrate that using published values for the non-ideal and non-dilute model, applied to erythrocytes, leads to model predictions inconsistent with experimental data, whereas dilute approximations align well with experimental data.

Electrospun polystyrene fibers knitted around imprinted acrylate microspheres as sorbent for paraben derivatives.

Parabens are used as antimicrobial preservatives in food, cosmetic products and pharmaceuticals regardless of their endocrine disrupting effect. In this study, highly selective molecular imprinted polymers (MIPs) were synthesized in submicron-sizes and converted to an SPME fiber coating through electrospinning process in order to determine parabens in water samples. Conversion of MIP to a fiber is achieved via creation of spacial knitting around MIP by polystyrene. The selectivity and extraction ability of the fibers were compared with the commercial fibers and the corresponding non-imprinted polymer (NIP) coated fiber. The coated fiber showed better extraction ability among them. Also, the results revealed that the fiber has better selectivity for benzyl paraben and the other structurally-related compounds, such as methyl and propyl paraben. Extraction efficiency of prepared fibers for three parabens has been tested by spiking bottled, tap and sea water samples. The recoveries changed between 92.2 ±â€¯0.8 and 99.8 ±â€¯0.1 for three different water types. This method could be used for selective and sensitive determination of parabens in aqueous samples.

Comparison of Surgical Correction Techniques for Post-Renal Transplantation Vesicoureteral Reflux.

BACKGROUND: Symptomatic urinary tract infection (UTI) after renal transplantation (RT) is an important morbidity in transplant recipients and may cause pyelonephritis and sepsis. Surgical correction of high-grade vesicoureteral reflux (VUR) after RT is suggested, performing ureteral reimplantation or pyelo-ureteral/uretero-ureteral anastomosis. Recently, extravesical seromuscular tunnel lengthening techniques have been reported with favorable results and low complication rates. METHODS: We retrospectively reviewed the charts of 38 patients with post-transplantation VUR who underwent reflux correction surgery. Patient characteristics were analyzed to compare our extravesical seromuscular tunnel lengthening technique with uretero-ureteral and pyelo-ureteral anastomosis techniques. RESULTS: Twenty patients were treated with the extravesical approach (group I) and 18 patients by pyelo-ureteral or uretero-ureteral anastomosis with the use of native ureter (group II). Mean operative time was significantly shorter in group I than in group II (64.8 vs 110.1 min; P < .05), and mean duration of hospital stay after the operation also was shorter in group I (1.5 vs 5.1 d; P < .05). We determined persistent VUR in postoperative voiding cystouretrography in 2 patients (10%) in group I, but there was regression in VUR grades of all of the patients. There was no significant difference in postoperative number of UTI episodes and serum creatinine levels between the 2 groups. CONCLUSIONS: Extravesical seromuscular tunnel lengthening is an effective and safe technique for post-transplantation VUR management.

End-To-Side Versus End-to-End Uretero-Ureteral Anastomosis in Kidney Transplant Recipients With Disused Atrophic Bladder.

BACKGROUND: Extravesical Lich-Gregoir ureteroneocystostomy (UC) is the most widely used method for urinary reconstruction during kidney transplantation. Sometimes it is difficult to perform UC in cases with disused atrophic bladder. Pyelo-ureteral anastomosis (PUA) and uretero-ureteral anastomosis (UUA) may be preferred to UC for these patients. METHODS: We retrospectively reviewed the charts of 833 kidney transplant recipients operated on by our transplantation team between July 2010 and November 2014. The patients were divided into two groups: Group I consisted of 16 patients who underwent end-to-side UUA and Group II consisted of 20 patients who underwent end-to-end UUA. The two groups were compared in terms of efficacy, safety, and graft function. RESULTS: As we performed end-to-side UUA as a relatively new technique compared with end-to-end UUA, the post-transplantation follow-up period of Group II was significantly longer than Group I (P = .000), but all the patients in both groups had at least 1 year of follow-up. Because the first two patients in Group II, who underwent native ureteral ligation without nephrectomy, developed hydronephrosis in their native kidneys, requiring nephrectomy in the post-transplantation period, we performed native nephrectomy in all of the remaining patients in this group. That is why the mean operative time was significantly longer in Group II compared with Group I (P = .000). There was no significant difference between the two groups in terms of postoperative surgical complications, post-transplantation urinary infections, and graft function. CONCLUSION: End-to-side UUA without native ureteral ligation is a safe surgical technique for urinary tract reconstruction during kidney transplantation in patients with disused atrophic bladder.

The efficacy of tissue factor -603A/G and +5466A>G polimorphisms at the development of venous thromboembolism in cancer patients.

UNLABELLED: Venous thromboembolism (VTE) is one of the most common complications in cancer patients. Although factor V Leiden (FVL) is the most common genetic defect causing thrombosis, the impact of gene abnormalities on thrombotic tendency in cancer patients remains poorly explored. Tissue factor (TF) is a major physiologic initiator of blood coagulation. This is the first study regarding the association of TF gene -603A/G and +5466A>G polymorphisms with VTE in malignancy. Materials and Me-thods: The study consists of two groups: cancer patients with VTE were included as Group 1 (n = 46); Group 2 comprises 196 cancer patients without VTE. Restriction fragment length polymorphism method was used for the detection of polymorphisms of TF -603A/G in the 5՛upstream region and TF 5466A/G in intron 2. FVL, PT G20210A and MTHFR C677T polymorphisms were determined by using commercially available Light Cycler kits. The genotype and allele frequencies between the groups were compared using χ2 or Fisher exact test, if appropriate. RESULTS: No differences were observed in the distribution of TF gene -603A/G genotype frequencies between the groups. Although a slightly increased incidence of +5466GA genotype was in Group 1 (17.4% vs 11.2%), it did not achieve statistical significance. The prevalence of FVL was significantly greater in Group 1 compared with Group 2 (41.3% vs 4.1%, p < 0.05). Difference in frequency of 677TT+CT (MTHFR) + 5466GG (TF) genotypes combination was found in women of two investigated Groups (p < 0.05). No differences were also in genotypes and allele frequencies of MTHFR C677T and PT G20210A between two Groups (p > 0.05). CONCLUSIONS: The present study did not show significant association of TF gene -603A/G and +5466A>G polymorphisms with VTE in malignancy, however, further larger studies including different ethnic population are needed to confirm our findings.

Do Atmospheric Changes and the Synodic Lunar Cycle Affect the Development of Spontaneous Pneumothorax?

BACKGROUND: Pneumothorax is defined as air in pleural space. The etiology of spontaneous pneumothorax (SP) is still under investigation and, despite many studies, remains uncertain. The aim of this study was to investigate the effects of the lunar cycle and daily weather changes on SP development. METHODS: The data of patients admitted to our clinic with SP were analysed retrospectively. The daily atmospheric pressure, relative ratio of humidity and temperature in degrees Celsius of each day were obtained. The mean values for each day, from the first to the 29th day, of the synodic lunar cycle (SLC) were calculated for the five-year study period. The attacks were allocated to the appropriate day of an ideal 29-day SLC, irrespective of the calendar date. RESULTS: A total of 131 patients who were admitted to our hospital with SP (130 males and 1 female with an average age of 32.4±12.2) were included in this study. The number of patients with SP showed a statistically significant correlation with mean atmospheric pressure (p=0.005), relative humidity (p=0.007) and outdoor temperature (p=0.02) but not with the SLC. CONCLUSIONS: SP is significantly influenced by weather-related factors. Changes in atmospheric pressure, humidity and outdoor temperature had obvious effects on the development of SP. However, the SLC had no effect on SP.

Preemptive Kidney Transplantation: The Initial Experience of a Single Center.

BACKGROUND: Kidney transplantation is the best treatment method for end-stage renal disease. Outcomes of the preemptive kidney transplantation are better than non-preemptive kidney transplantation. Preemptive kidney transplantation is performed as a small percentage of kidney transplantations worldwide. We performed 15 preemptive kidney transplantations from living donors between November 2010 and April 2014. We present our experiences and outcomes for these 15 preemptive kidney transplantations. METHODS: We performed 110 kidney transplantations between November 2010 and April 2014. Fifteen of the kidney transplantations were performed from living related donors to preemptive recipients. These 15 preemptive recipients and their donors' data were collected and retrospectively analyzed. RESULTS: The mean age of recipients and donors was 37.2 years (range, 4-60) and 50.6 years (range, 28-64), respectively. The male-female ratios were 10:5 in the recipients and 8:7 in the donors. Nine left kidneys and 6 right kidneys were recovered. Nine kidneys had a single artery; the other 6 kidneys had 2 renal arteries. The mean warm ischemic time was 219.5 seconds (range, 90-480). The mean hospitalization times were 5.9 days (range, 4-10) and 4.9 days (range, 3-9) for the recipients and the donors, respectively. The mean follow-up time was 20.3 months (range, 0.5-37) for recipients. Graft survival was 100% in this period. BK virus nephropathy occurred in only 1 pediatric recipient. One patient had a recurrent disease that was the cause of the renal failure. They graft functions were stable. No kidney was lost from rejection, technical causes, infection, or recurrent disease. The donors live their lives with no problems. CONCLUSIONS: Preemptive kidney transplantation is a better therapeutic option than is non-preemptive kidney transplantation for patients with chronic renal failure. Kidney transplantation should be performed if possible before beginning dialysis for these patients.

Femoro-femoral Bypass for Graft Salvage in a Renal Transplant Patient With Aorto-iliac Occlusion: A Case Report.

As vascular diseases are becoming more prevalent among renal transplant recipients, complications related to renal artery anastomosis are likely to occur more often. Here we report a renal transplant patient treated with femoro-femoral bypass who had renal allograft dysfunction due to aorto-iliac occlusive disease (AIOD) proximal to renal artery anastomosis. We performed living donor renal transplantation in the left iliac fossa of a 41-year-old male. At post-transplant 30 months, he was admitted with hypertension, increase in serum creatinine, and claudication of his left leg. Doppler ultrasonography showed poor flow characteristics of the renal allograft. Total occlusion of the left common iliac artery was diagnosed on angiography. Since endovascular approach was unsuccessful, we performed right-to-left femoro-femoral bypass to provide retrograde blood flow to the renal allograft. The patient was discharged at postoperative day 3 with decreased serum creatinine, normal blood pressure, no claudication, and normal flow characteristics in Doppler ultrasonography. AIOD should be suspected in renal transplant patients in case of hypertension, allograft dysfunction, and ipsilateral leg ischemia. Femoro-femoral bypass is a safe surgical procedure that may be performed in patients who cannot be treated using an endovascular approach.

Escherichia Coli-Related Necrotizing Fasciitis After Renal Transplantation: A Case Report.

A 39-year-old man who had received cadaveric renal transplantation (RT) 1 month previously presented with rash and pain on his left lower extremity. Initially, bacterial cellulitis was suspected, and ampicillin/sulbactam was initiated; however, 3 days later, skin necrosis occurred and pain increased. Ampicillin/sulbactam was replaced with imipenem+ciprofloxacin, and surgical debridement was performed. Escherichia coli was identified in the wound culture, urine culture, and blood culture. After repeated debridement, wound care, and appropriate antimicrobial treatment, wounds began to heal and skin grafting was planned at the 4th month of therapy. However, the patient died of viral pneumonia. To date, 20 cases of necrotizing fasciitis (NF) after RT have been reported (including our case), and, as far as we know, this is the second E coli-related NF case. An analysis of all 20 cases showed that the most common infection site was the extremities (90%) and that 45% of pathogens were fungus. The mortality rate was 30%. NF is a rare but rapidly developing and life-threatening soft-tissue infection in RT patients. To reduce mortality rates, early diagnosis, recurrent surgical debridement, and aggressive therapy are mandatory.

Renal Transplantation After Thoracic Endovascular Repair of Type B Aortic Dissection--A Case Report.

Because of the strong association between uremia and atherosclerosis, incidence of aortic aneurysms is increasing among renal failure patients awaiting renal transplantation (RT). Successful RTs have been performed in these patients after surgical repair of the aneurysms. Since Parodi et al introduced endovascular aortic aneurysm repair (EVAR) in patients with high risk for conventional surgery, a new era has begun. The 1st successful RT after EVAR was published in 2001. Herein we report the 1st successful RT after thoracic EVAR (TEVAR) reported to date. We performed RT in a 54-year-old man with end-stage renal failure due to diabetic nephropathy, who had undergone TEVAR for type B aortic dissection (TBAD) 6 months earlier. The postoperative period was uneventful and the patient was discharged from the hospital at postoperative day 6 with a serum creatinine of 0.9 mg/dL. At follow-up examination at postoperative 6 months, graft function was stable. Because of its advantages over open surgery, including low mortality and morbidity, TEVAR is becoming more common among renal failure patients with thoracic aortic aneurysms and TBAD. Our case shows that successful RT can be performed in renal failure patients who have undergone TEVAR.

Absence of Inferior Vena Cava in a Renal Transplant Recipient: A Case Report.

A 27-year-old woman was admitted to our department with end-stage renal failure due to reflux nephropathy. She had no history of deep venous thrombosis. After pretransplantation evaluation, her father was accepted for kidney donation. We observed intraoperatively that the patient's iliac veins and inferior vena cava (IVC) were absent. There were many venous collaterals, but none of them was dilated enough for renal vein anastomosis. Since we could not find a suitable vein for venous drainage of the allograft, we decided to stop donor surgery and postpone renal transplantation (RT) for detailed radiologic examination. Contrast-enhanced computed tomography revealed the absence of an infrahepatic segment of IVC. Superior mesenteric vein was thin. Portal and splenic veins were normal, but we decided not to use them for venous drainage because of increased risk of torsion. We informed the patient and her family about the situation and cancelled RT. Iliac vein and IVC anomalies are not absolute contraindications for RT, but when a dilated collateral vein is not present or when there is no option for safe renal vein anastomosis as in our case, RT may not be possible.

Effects of heavy metals (Cd, Cu, Cr, Pb, Zn) on fish glutathione metabolism.

The glutathione metabolism contains crucial antioxidant molecules to defend the organisms against oxidants. Thus, the aim of this study was to investigate the response of the glutathione metabolism in the liver of freshwater fish Oreochromis niloticus exposed to metals (Cu, Cd, Cr, Pb, Zn) in different periods. Fish were exposed to metals (as 1 µg/mL) individually for 1, 7, and 14 days and subsequently antioxidant enzymes (glutathione peroxidase, GPX; glutathione reductase, GR and glutathione S-transferase, GST) and glutathione levels (total glutathione, tGSH; reduced glutathione, rGSH; oxidized glutathione, GSSG and GSH/GSSG ratios) in the liver were measured. There was no fish mortality during the experiments, except Cu exposure. The antioxidant enzymes responded differently to metal exposures depending on metal types and exposure durations. GPX activity increased only after Cd exposure, while GST activity increased following 7 days of all metal exposures. However, GR activity did not alter in most cases. Total GSH and GSH/GSSG levels generally decreased, especially after 7 days. Data showed that metal exposures significantly altered the response of antioxidant system parameters, particularly at day 7 and some recovery occurred after 14 days. This study suggests that the response of antioxidant system could help to predict metal toxicity in the aquatic environments and be useful as an "early warning tool" in natural monitoring studies.