Using Canadian Water Quality Index method to evaluate the spatio-variation of water quality and the impacts of quality parameters: a case study of Amasya's surface water (Northern Turkey).

In this study, the spatial variation of water quality in Yesilirmak River passing through Amasya was investigated using the Canadian Water Quality Index (CWQI). For this aim, the measured 15 parameters in 3-month periods between the years 2008 and 2015 were used at 11 sample points from the Yesilirmak River and its tributaries. The calculated CWQI scores using parameters of pH, Dissolved Oxygen (DO), Chemical Oxygen Demand (COD), ammonia, ammonium, nitrite, nitrate, phosphate, iron, copper, zinc, potassium, sulfate, sulfite and chlorine range from 33 to 64. These scores indicate that the surface waters in the studied area are poor to marginal in quality. The effect of each parameter on the CWQI scores by excluding each parameter, one by one, considering the water quality of the Yesilirmak River was investigated using the Hierarchical Cluster Analysis (HCA) method. It was determined that the presence and/or absence of the parameters, which caused an increase or decrease in CWQI scores, were ammonia, phosphate, COD, sulfide, iron, ammonium, nitrite, DO. On the other hand, the parameters having positive effects on CWQI are nitrate, chlorine and potassium. The HCA statistical analysis method is suitable for interpreting complex water quality datasets and understanding time/location dependent changes in water quality. HCA can be used effectively to group parameters in river water quality monitoring programs.

Short term outcome of laparoscopic ventral mesh rectopexy for rectal and complex pelvic organ prolapse: case series.

OBJECTIVES: Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. LVMR also allows correction of coexisted pelvic organ prolapse. This study aimed to evaluate the safety, efficacy and functional outcome of LVMR for rectal and complex pelvic organ prolapse. MATERIAL AND METHODS: All patients who underwent LVMR from February 2014 to October 2017 were included into the study. The patients were evaluated preoperatively and three months postoperatively. Surgical complications and functional results in terms of fecal incontinence (measured with the Wexner Incontinence Score= WIS) and constipation (measured with the Wexner Constipation Score= WCS) were analyzed. RESULTS: Thirty (4 males) patients underwent LVMR. Seventeen (56.6%) patients had complex pelvic organ prolapse according to MRI findings. Median operative time and postoperative stay were 110 minutes and 4 days, respectively. No mesh-related complication and recurrence were observed. Before surgery, 21 (70%) patients had complained about symptoms of obstructed defecation. WCS decreased significantly from median 19 to 6 (p <0.001). Preoperative median WIS of 9 patients was 14 and went down to 6 postoperatively (p= 0.008). WCS significantly improved after LVMR in patients with symptomatic rectocele combined with enterocele or sigmoidocele (p= 0.005), and significant improvement was also observed in patients with symptomatic rectocele combined with gynecologic organ prolapse, preoperative median WCS was 18 and the postoperative value fell to 8 (p= 0.005). CONCLUSION: LVMR is an effective surgical option for rectal and complex pelvic organ prolapse with short-term follow-up.

Effects of ozone preconditioning on recovery of rat colon anastomosis after preoperative radiotherapy.

BACKGROUND: Anastomotic leakage is a devastating complication of colorectal surgery. Neoadjuvant radiotherapy for colorectal cancer can affect the mechanical and biochemical parameters of anastomotic healing. It has been reported that ozone increases antioxidant enzyme activity and stimulates adaptive processes to oppose the pathophysiologic conditions mediated by reactive oxygen species (ROS). OBJECTIVES: The objective of this study was to investigate the effect of controlled administration of ozone on the healing of anastomosis and the activation of antioxidant enzymes in the colon after radiotherapy. MATERIAL AND METHODS: Rats (n = 48) were randomly assigned to the following groups: control groups (1 and 2), saline-treated and irradiated (IR) groups (3 and 4) and ozone oxidative preconditioning (OOP) and IR groups (5 and 6). Rats were exposed to whole-body IR (6 Gy) after pretreatment with either saline or ozone. Rats in groups 1, 3 and 5 were euthanized on postoperative day 3, whereas those in groups 2, 4 and 6 were euthanized on postoperative day 7. The anastomoses were performed on day 7 post-IR. The anastomotic segment was resected to measure hydroxyproline (HPO) content, myeloperoxidase (MPO) activity and malondialdehyde (MDA) concentration and for histopathological evaluation. RESULTS: The mean bursting pressure of the groups that underwent radiotherapy was lower than that of the control groups (p < 0.001). In groups 5 and 6, the tissue HPO concentrations were higher than those in groups 3 and 4. Although mean values for MPO activity in groups 5 and 6 were higher than those in groups 3 and 4, the differences were not significant. Regarding oxidative damage markers, MDA concentrations were significantly lower in group 5 than those in group 3. CONCLUSIONS: In this experimental model, OOP exerted favorable effects on colon anastomotic healing after radiation exposure.

Effects of humanin on experimental colitis induced by 2,4,6-trinitrobenzene sulphonic acid in rats.

BACKGROUND/AIM: The excessive apoptosis of intestinal epithelial cells (IECs) partly accounts for the development of colonic inflammation and eventually results in ulcerative colitis (UC). Humanin, an endogenous anti-apoptotic peptide, has previously been shown to protect against Alzheimer's disease and a variety of cellular insults. The present study aimed to investigate the effects of glysin variant of humanin (HNG) on 2,4,6-trinitrobenzene sulphonic acid (TNBS)-induced colitis in rats. MATERIALS AND METHODS: Rats were divided into four groups as follows: Group 1 (n = 8): control; isotonic saline solution 0.1 ml/rat rectally, Group 2 (n = 8): TNBS colitis; 0.1 ml of a 2.5% (w/v) TNBS solution in 50% ethanol rectally, Group 3 (n = 8): 10 µM HNG, and Group 4 (n = 8): 20 µM HNG intraperitoneal (ip) on day 2 and 6 after rectal TNBS administration. Rats were sacrificed 7 days after the induction of colitis. Blood and tissue samples were harvested for biochemical and histopathological analysis. RESULTS: HNG treatment significantly ameliorated weight loss and macroscopic and microscopic scores. TNBS-induced colitis significantly increased the colonic mRNA expression of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1ß), and caspase-3 activities in group II in comparison to the group I. HNG treatment was associated with an inhibition of mRNA expression of TNF-α and IL-1ß, and a decrease in caspase-3 activities in colon tissues in group III and IV when compared to group II. CONCLUSION: The results of this study indicate that HNG treatment may exert beneficial effects in UC by decreasing inflammatory reactions and apoptosis.

Robotic versus laparoscopic surgery for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of short-term outcomes.

The aim of our study was to compare short-term outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision (TME) in male patients with mid-low rectal cancer (RC) after neadjuvant chemoradiotherapy (NCRT). The study was conducted as a retrospective review of a prospectively maintained database, and we analyzed 14 robotic and 65 laparoscopic sphincter saving TME (R-TME and L-TME, respectively) performed by one surgeon between 2005 and 2013. Patient characteristics, perioperative recovery, postoperative complications and and pathology results were compared between the two groups. The patient characteristics did not differ significantly between the two groups. Median operating time was longer in the R-TME than in the L-TME group (182 min versus 140 min). Only two conversions occurred in the L-TME group. No difference was found between groups regarding perioperative recovery and postoperative complication rates. The median number of harvested lymph nodes was higher in the RTME than in the L-TME group (32 versus 23, p = 0.008). The median circumferential margin (CRM) was 10 mm in the R-TME group, 6.5 mm in the L-TME group (p = 0.047. The median distal resection margin (DRM) was 27.5 mm in the R-TME, 15 mm in the L-TME group (p = 0.014). Macroscopic grading of the specimen in the R-TME group was complete in all patients. In the L-TME group, grading was complete in 52 (80%) and incomplete in 13 (20%) cases (p = 0.109). R-TME is a safe and feasible procedure that facilitates performing of TME in male patients with mid-low RC after NCRT.

Safety of laparoscopic ventral rectopexy in the elderly: results from a nationwide database.

BACKGROUND: Laparoscopic ventral rectopexy is an established procedure in the treatment of posterior pelvic organ prolapse. It is still unclear whether this procedure can be performed safely in the elderly. OBJECTIVE: This study aimed to assess the effects of age on the outcome of laparoscopic ventral rectopexy performed for patients with pelvic organ prolapse. DESIGN: This study was a retrospective cohort analysis with data from a national registry. SETTINGS: The study was conducted in a tertiary care setting. PATIENTS: Patients undergoing laparoscopic ventral rectopexy were identified from discharge summaries. Patients were stratified according to age, including patients <70 (group A) and ≥ 70 (group B) years old. MAIN OUTCOME MEASURES: Variables analyzed included sex, age, diagnosis, associated pelvic organ prolapse, comorbidities, length of stay, complications (Clavien-Dindo scale), and mortality. RESULTS: Among 4303 patients (98.2% women) who underwent a laparoscopic ventral rectopexy, 1263 (29.4%) were >70 years old (mean age, 76.2 ± 5.0 years). Main diagnoses were vaginal vault prolapse (53.0% [group A] vs 47.0% [group B]; p value not significant) and rectal prolapse (17.7 vs 26.8%; p value not significant). Comorbidity was significantly increased in group B (mean length of stay, 5.6 ± 3.6 vs 4.7 ± 1.8 days; p < 0.001) and minor complications (8.4% vs 5.0%; p < 0.001) were significantly increased in group B, whereas major complications were not different (group A, 0.7%; group B, 0.9%; p = 0.40) after univariate analysis. Multivariate analysis found no significant differences between groups. The subgroup analysis of patients >80 years old (n = 299) showed no differences. Each group had 1 postoperative mortality. LIMITATIONS: Limitations of the study include its retrospective design, lack of prestudy power calculation, possible inaccuracy of an administrative database, and selection bias. CONCLUSIONS: Laparoscopic ventral rectopexy appears to be safe in select elderly patients.

Chronic pelvic abscedation after completion proctectomy in a rectal stump insufficiency; treatment with gracilis muscle flap following vacuum assisted closure therapy.

Presacral abscess formation due to rectal stump insufficiency following Hartmann procedure is very rare complication. If the abscess cavity is large, it might delay the reversal of the stoma and will probably result in a devastating future functioning of the neorectum. Moreover, very invasive treatments will be required in order to prevent severe septic complications. We present the case of a 58-year-old man with a past history of Hartmann procedure for a low rectal carcinoma who presented with rectal stump insufficiency and a large presacral abscess. Following extensive debridement and rectal stump resection, a vacuum-assisted closure (VAC) system was applied to the large abscess cavity to facilitate gracilis muscle flap reconstruction and to optimize wound healing. The satisfactory results showed in the present report led us to favor a combination of VAC therapy and a gracilis muscle flap in intrapelvic and perineal reconstruction in the case of large defects associated with high risks of septic complications.

Effects of ozone oxidative preconditioning on liver regeneration after partial hepatectomy in rats.

AIM: Similar protective effect of ischemic and ozone oxidative preconditioning (OzoneOP) in hepatic ischemia-reperfusion (I/R) injury was demonstrated, providing evidences that both preconditioning settings shared similar biochemical mechanisms of protection. We investigated the effects of OzoneOP on liver regeneration after 70% partial hepatectomy (PHx) in rats. METHODS: Rats were divided into three groups: PHx, I/R + PHx, and OzoneOP + I/R + PHx groups. Ozone (intraperitoneal, 1.2 mg/kg) was given to rats subjected to I/R and 70% hepatectomy daily five times before operation. At 24 hr and 48 hr after resection, samples were collected for the measurement of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor alpha (TNF-α), and interleukin-6 (IL-6). Moreover, liver regeneration rate, proliferating cell nuclear antigen (PCNA) labeling index, mitotic index, and histopathological examination were evaluated. RESULTS: OzoneOP reduced liver injury determined by liver histology and serum transaminases. There was a rise in serum TNF-α and IL-6 levels in the I/R + PHx group whereas OzoneOP significantly decreased the rise in the level of TNF-α but not IL-6 on the 24 hr and 48 hr of reperfusion. Moreover, liver regeneration in OzoneOP + PHx group, as assessed by the regenerated liver weight, mitotic, and PCNA-labeling index, was significantly improved when compared to I/R + PHx group. CONCLUSION: These results suggest that OzoneOP ameliorates the hepatic injury associated with I/R and has a stimulatory effect on liver cell regeneration that may make it valuable as a hepatoprotective modality.

Effects of ozonated olive oil on acute radiation proctitis in rats.

BACKGROUND: Acute radiation proctitis is a common complication of pelvic radiation and management of acute radiation proctitis is under evaluation. The beneficial effects of ozonated olive oil (OzOO) have already been shown in the treatment of chronic wounds. Thus, this study was designed to evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. AIMS: To evaluate the therapeutic effects of topical OzOO on acute radiation proctitis. STUDY DESIGN: Animal experimentation. METHODS: RATS WERE DIVIDED INTO THREE GROUPS: control; irradiation+saline (1 mL); and irradiation +OzOO (1 mL). A single fraction of 17.5 Gy was delivered to each rat. The OzOO was administered rectally each day after irradiation. Each rat was observed daily for signs of proctitis. Irradiated rats were euthanised on days 5 and 10. The mucosal changes were evaluated macroscopically and pathologically. RESULTS: According to the clinical findings, five rats in the irradiation+saline group showed Grade 4 symptoms on the 10(th) day. Macroscopic finding scores on the 10(th) day in the irradiation+saline and irradiation+OzOO groups were statistically significantly different. On pathological examination, radiation-induced mucosal damage was the most prominent 10 days after irradiation in saline-treated rats. On the 10(th) day, the irradiation+OzOO group showed mild inflammation and slight crypt change, which corresponded to Grade 1 pathological findings. CONCLUSION: OzOO attenuates macroscopic and pathological findings of acute radiation proctitis in rats.

Effects of ozone oxidative preconditioning on radiation-induced organ damage in rats.

Because radiation-induced cellular damage is attributed primarily to harmful effects of free radicals, molecules with direct free radical scavenging properties are particularly promising as radioprotectors. It has been demonstrated that controlled ozone administration may promote an adaptation to oxidative stress, preventing the damage induced by reactive oxygen species. Thus, we hypothesized that ozone would ameliorate oxidative damage caused by total body irradiation (TBI) with a single dose of 6 Gy in rat liver and ileum tissues. Rats were randomly divided into groups as follows: control group; saline-treated and irradiated (IR) groups; and ozone oxidative preconditioning (OOP) and IR groups. Animals were exposed to TBI after a 5-day intraperitoneal pretreatment with either saline or ozone (1 mg/kg/day). They were decapitated at either 6 h or 72 h after TBI. Plasma, liver and ileum samples were obtained. Serum AST, ALT and TNF-α levels were elevated in the IR groups compared with the control group and were decreased after treatment with OOP. TBI resulted in a significant increase in the levels of MDA in the liver and ileal tissues and a decrease of SOD activities. The results demonstrated that the levels of MDA liver and ileal tissues in irradiated rats that were pretreated with ozone were significantly decreased, while SOD activities were significantly increased. OOP reversed all histopathological alterations induced by irradiation. In conclusion, data obtained from this study indicated that ozone could increase the endogenous antioxidant defense mechanism in rats and there by protect the animals from radiation-induced organ toxicity.

Diagnostic adequacy of surgeon-performed ultrasound-guided fine needle aspiration biopsy of thyroid nodules.

BACKGROUND: Surgeon-performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention. OBJECTIVE: To evaluate the diagnostic adequacy of surgeon-performed ultrasonography guided fine needle aspiration biopsy (FNAB) of thyroid nodules, the factors responsible for diagnostic adequacy and the impact of surgeon-performed US on treatment approach. METHODS: Retrospective review of a single surgeon performed 621 US-guided FNABs without on-site cytological specimen assessment. Outside US findings were compared to the surgeon-performed US. Measured variables and outcomes for the study included diagnostic adequacy rates and the effects of detected differences between US reports on treatment variability. RESULTS: Diagnostic adequacy rate of surgeon-performed US-guided FNAB was determined to be 94.52% without on-site specimen evaluation by cytologist. Non-diagnostic specimens occurred in 34 of 621 (5.48%) nodules. The differences detected between the outside US and surgeon-performed US altered invasive treatment algorithm in 30 (5.47%) patients. FNAB was avoided for 15 (2.7%) patients. Total thyroidectomy became the preferred surgical option in 15 (2.7%) patients after the discovery of additional nodules in the contralateral lobe. CONCLUSION: Surgeon-performed US offers clear clinical benefits in terms of diagnostic yield of FNAB with providing valuable additional data that might alter surgical treatment approach.

Our long-term results of Tenckhoff peritoneal dialysis catheters placement via laparoscopic preperitoneal tunneling technique.

Previously we described the technique to lessen complications of continuous ambulatory peritoneal dialysis (CAPD) and to achieve immediate use of the catheter. In this study we evaluated our long-term results of the technique. A total of 61 procedures were carried out in 58 patients from September 2003 to February 2009. All patients were followed in our hospital CAPD clinic. Demographic, medical, operative, postoperative, and other information regarding complications and continued patient management was obtained retrospectively from the patients' medical records and entered into a computerized database. There were 33 men and 25 women. The mean age was 58 years. In 29 of the 58 patients indication of catheter placement was end stage renal failure combined with diabetes mellitus. Mean follow-up time was 33.31 ± 20.11 months. Catheter related complications were outflow obstruction (n=3, 5.2%) and peritonitis (n=2, 3.4%). Etiologies of catheter removal were out flow obstruction (n=2), recovery from renal disease (n=2), peritonitis (n=1), and pregnancy (n=1). The mean catheter survival time was found 5.57 ± 0.17 years. Our long-term results showed that the method ensured accurate placement, preperitoneal fixation, and immediate use of the catheter for routine peritoneal dialysis. Preperitoneal fixation of the catheter decreased outflow obstruction over long-term follow-up.

Does intraabdominal use of Ankaferd Blood Stopper cause increased intraperitoneal adhesions?

BACKGROUND: The aim of this study was to investigate whether intraabdominal Ankaferd Blood Stopper (ABS) causes increased intraabdominal adhesion formation and to determine any side effects of ABS in vivo. METHODS: The present experimental study was designed to examine the effects of Ankaferd solution on peritoneal adhesion formation in a rat model of cecal abrasion. Intraperitoneal adhesions were assessed macroscopically and histopathologically on the 10th postoperative day. The possible adverse affects of ABS on liver and lung tissues were analyzed histopathologically, and blood chemistry was also evaluated. RESULTS: Our study revealed that ABS reduced intraperitoneal adhesion formation in an experimental rat model. The blood chemistry was not disturbed due to ABS administration. Intraperitoneal administration of ABS led to some minor changes in the lungs and serosal surfaces of the intestines, with minor architectural changes in the liver that were not considered as toxic. Further studies with various application doses and routes with more detailed cellular analysis are thus warranted to clarify the possible pleiotropic and adverse effects of this new agent away from hemostasis. CONCLUSION: There was less intraperitoneal adhesion formation in the ABS group than in the control group and saline group. Intraperitoneal administration of ABS has no toxic effects on blood chemistry or the lungs, kidneys and the liver, but it has some minor adverse effects.

Ergothioneine modulates proinflammatory cytokines and heat shock protein 70 in mesenteric ischemia and reperfusion injury.

BACKGROUND AND AIM: Ergothioneine (EGT) is a natural compound that is synthesized by soil bacteria in fungal substrates and exhibits antioxidant functions in many cell models. The purpose of this study was to investigate the effect of EGT on mesenteric ischemia and reperfusion injury. MATERIALS AND METHODS: Rats were supplemented with or without l-ergothioneine (10 mg/kg/d) for 15 days prior to intestinal ischemia. Animals were subjected to ischemia induced by clamping the superior mesenteric artery for 60 min followed by reperfusion. Serum tumor necrosis factor (TNF)-alpha and interleukin-1beta (IL-1beta) levels, tissue malondialdehide (MDA), myleoperoxidase (MPO), and heat shock protein (HSP) 70 levels, as well as histological findings, were evaluated after 1, 2, and 4 h of reperfusion. RESULTS: Serum TNF-alpha and IL-1beta levels, and tissue MDA and MPO activities at 1, 2 and 4 h after reperfusion in the EGT group, were significantly lower than the control group (P < 0.05). Tissue HSP-70 levels of the study group were significantly greater than the control group at any time point of reperfusion. No significant differences in tissue damage including morphological changes ranging from villous denudation to focal necrosis, ulceration, hemorrhage, and architectural disintegration at 1 and 2 h after reperfusion exist between the two groups; however, after 4 h of reperfusion, the tissue damage based on histopathologic scores by Chiu was considerably lower in the study group (P < 0.05). After 4 h of reperfusion, focal epithelial lifting and occasional areas of denuded villi could be seen in the samples of the treated animals, thus preserving villous height and mucosal architecture. CONCLUSION: EGT attenuates mesenteric ischemia reperfusion injury in rat intestine by increasing tissue HSP-70 and decreasing TNF-alpha, IL-1beta, MDA, and MPO levels. EGT also improves morphological alterations, which occurred after IR injury after prolonged periods of reperfusion.

Leptin treatment ameliorates acute lung injury in rats with cerulein-induced acute pancreatitis.

AIM: To determine the effect of exogenous leptin on acute lung injury (ALI) in cerulein-induced acute pancreatitis (AP). METHODS: Forty-eight rats were randomly divided into 3 groups. AP was induced by intraperitoneal (i.p.) injection of cerulein (50 microg/kg) four times, at 1 h intervals. The rats received a single i.p. injection of 10 mug/kg leptin (leptin group) or 2 mL saline (AP group) after cerulein injections. In the sham group, animals were given a single i.p. injection of 2 mL saline. Experimental samples were collected for biochemical and histological evaluations at 24 h and 48 h after the induction of AP or saline administration. Blood samples were obtained for the determination of amylase, lipase, tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, macrophage inflammatory peptide (MIP)-2 and soluble intercellular adhesion molecule (sICAM)-1 levels, while pancreatic and lung tissues were removed for myeloperoxidase (MPO) activity, nitric oxide (NOx) level, CD40 expression and histological evaluation. RESULTS: Cerulein injection caused severe AP, confirmed by an increase in serum amylase and lipase levels, histopathological findings of severe AP, and pancreatic MPO activity, compared to the values obtained in the sham group. In the leptin group, serum levels of MIP-2, sICMA-1, TNF-alpha, and IL-1beta, pancreatic MPO activity, CD40 expression in pancreas and lung tissues, and NOx level in the lung tissue were lower compared to those in the AP group. Histologically, pancreatic and lung damage was less severe following leptin administration. CONCLUSION: Exogenous leptin attenuates inflamma-tory changes, and reduces pro-inflammatory cytokines, nitric oxide levels, and CD40 expression in cerulein-induced AP and may be protective in AP associated ALI.

Spontaneous gastrosplenic fistula in primary gastric lymphoma: Surgical management.

Gastrosplenic fistula formation resulting from primary gastric malignancy is rare and should be managed as a matter of emergency. We report a patient who was diagnosed with primary non-Hodgkin's lymphoma and who underwent surgical treatment for gastrosplenic fistula.