Advancing Prostate Cancer Diagnosis: A Deep Learning Approach for Enhanced Detection in MRI Images.

Prostate cancer remains a leading cause of mortality among men globally, necessitating advancements in diagnostic methodologies to improve detection and treatment outcomes. Magnetic Resonance Imaging has emerged as a crucial technique for the detection of prostate cancer, with current research focusing on the integration of deep learning frameworks to refine this diagnostic process. This study employs a comprehensive approach using multiple deep learning models, including a three-dimensional (3D) Convolutional Neural Network, a Residual Network, and an Inception Network to enhance the accuracy and robustness of prostate cancer detection. By leveraging the complementary strengths of these models through an ensemble method and soft voting technique, the study aims to achieve superior diagnostic performance. The proposed methodology demonstrates state-of-the-art results, with the ensemble model achieving an overall accuracy of 91.3%, a sensitivity of 90.2%, a specificity of 92.1%, a precision of 89.8%, and an F1 score of 90.0% when applied to MRI images from the SPIE-AAPM-NCI PROSTATEx dataset. Evaluation of the models involved meticulous pre-processing, data augmentation, and the use of advanced deep-learning architectures to analyze the whole MRI slices and volumes. The findings highlight the potential of using an ensemble approach to significantly improve prostate cancer diagnostics, offering a robust and precise tool for clinical applications.

The comparison of 2D and 3D systems in total laparoscopic hysterectomy: a systematic review and meta-analysis.

PURPOSE: To evaluate the existing evidence regarding the comparison between 2 and 3D systems in Total Laparoscopic Hysterectomy (TLH) in terms of surgical outcomes. METHODS: A systematic review of electronic databases, including PubMed/MEDLINE and Web of Science, was conducted to identify relevant studies comparing 2D and 3D systems in TLH. The search employed a combination of Medical Subject Headings (MeSH) terms and keywords related to the topic. Studies meeting predefined criteria were included, while case reports and studies not directly comparing 2D and 3D systems were excluded. Two independent reviewers evaluated study eligibility and performed quality assessment. The quantitative synthesis was conducted using meta-analysis techniques. RESULTS: A statistically significant longer operation time in the 2D group compared to the 3D group (7 studies, mean difference [MD]: 13.67, 95% confidence interval [CI] 9.35-18.00, I2 = 16%). However, no statistically significant differences were found between the groups in terms of vaginal cuff closure time (2 studies, MD: 3.22, CI - 6.58-13.02, I2 = 96%), complication rate (7 studies, odds ratio [OD]: 1.74, CI 0.70-4.30, I2 = 0%), blood loss (3 studies, MD: 2.92, CI - 15.44-21.28, I2 = 0%), and Hb drop (3 studies, MD: 0.17, CI - 0.08-0.42, I2 = 1%). CONCLUSION: Our results revealed a significant difference favoring 3D systems in operation time, while clinical outcomes between the two systems were found to be comparable in TLH. However, further research, particularly prospective studies with larger cohorts and longer-term follow-up, along with economic analyses, is needed to provide clinicians and healthcare decision-makers with essential guidance for practice and resource allocation.

Effect of three different exercise trainings on functional capacity in early stage severe burn patients: A randomized controlled trial.

BACKGROUND: This study investigated the effects of three different exercise protocols on functional capacity in early-stage burn patients. METHODS: A total of 25 patients hospitalized in the Burn Center (wards and intensive care unit) were included in the study. The individuals were divided into three groups by covariate adaptive randomization according to burn percentage and type: 1 - standard treatment, 2 - standard treatment + aerobic exercise training, 3 - standard treatment + combined exercise (aerobic and resistance) determined by metabolic status. Individuals were evaluated weekly for six weeks from the first day of hospitalization using the 6-minute walk test, physiological cost index, and Medical Research Council muscle-strength measurements to assess functional capacity. A portable metabolism tracker device measured the metabolic status of all patients. RESULTS: Aerobic exercises and combined exercise (aerobic and resistance), when added to standard treatment and determined by metabolic status, were more effective in enhancing functional capacity than standard treatment alone (p<0.05). Patients performing the combined exercise (aerobic and resistance) showed faster improvement in functional capacity determined according to metabolic status than those in the other two groups (p<0.05). CONCLUSION: Aerobic exercises, when added to standard treatment and combined with aerobic and resistance exercises based on metabolic status, are more effective at improving functional capacity than standard treatment alone. Further controlled studies are required to explore the potential long-term benefits of this approach.

Evaluation of Endocervical Curettage in Colposcopy in the Turkish Cervical Cancer Screening Program.

Background/Objectives: To investigate the risk factors for CIN2+ lesions (cervical intraepithelial neoplasia 3 or worse) in endocervical curettage (ECC) and to evaluate the relationship between the addition of ECC to punch biopsy in terms of the yield of CIN2+ lesions. Methods: Between February 2018 and 2019, data on colposcopy results from 11,944 patients were gathered from the Cancer Department of the Turkish Ministry of Health across the country. A total of 6370 women whom were referred to colposcopy were included in this study. Risk factors were identified using both univariate and multivariate logistic analyses. Results: The median age was 42 years old (range, 30-65). ASC-H (atypical squamous cells-suggestive of high-grade squamous intraepithelial lesion)/HSIL (high-grade intraepithelial lesion) cytology (OR 7.648 95% CI (3.933-14.871)) and HPV (human papillomavirus)-16/18 infection (OR 2.541 95% CI (1.788-3.611)) were identified as risk factors for having CIN2+ lesions. CIN2+ diagnostic yield by ECC is only 1.2% all patients. CIN2+ diagnostic yield by punch biopsy and ECC are 9.7% and 6% of patients, respectively. A higher CIN2+ yield by ECC was observed with increasing age. Among cytology groups, ASC-H/HSIL has highest CIN2+ yield by ECC. Finally, in patients with incomplete visualization of the squamocolumnar junction (SCJ), ECC yields approximately twice as many CIN2+ lesions. Conclusions: ECC should be considered in cases of advanced patient age and in situations where the SCJ is not routinely visualized. In addition, evaluation of the endocervical canal is necessary in HPV-positive cases infected with HPV-16/18 types and in cases infected with HPV of any type but with cytological abnormalities.

The knowledge level of the healthcare professionals responsible for newborns' heel prick tests.

PURPOSE: This study was conducted to determine the level of knowledge of healthcare professionals involved in newborn heel prick tests. METHODS: The study was conducted between 10.02.2021-10.03.2021 with 147 healthcare workers working in heel prick screening in health institutions where heel prick blood samples were collected in a province and districts in the Central Anatolia region of Turkey. As a data collection tool, a questionnaire prepared by the researcher in line with the literature was used. The data were evaluated by number, percentage, mean and standard deviation analysis and chi-square analysis was performed in IBM SPSS for Windows 29.0v programme. RESULTS: The majority of healthcare professionals gave correct answers to the questions regarding the collection, storage and transfer of heel prick. It has been observed that healthcare professionals do not have sufficient information regarding the definition of Congenital Metabolic Diseases, their findings and where to refer patients whose results are suspicious.The most significance was found in the distribution of answers regarding the symptoms of the screened diseases according to occupational groups. CONCLUSION: In diseases that can be controlled with treatment and nutrition if detected early, errors in the collection, storage and transport of the sample can affect the test result and delay the diagnosis. Healthcare professionals have important responsibilities issues from genetic counseling before marriage, taking heel blood, from informing the family to caring for the diagnosed baby. PRACTICE IMPLICATIONS: This study will provide valuable information to health professionals involved in newborn screening and to future studies in this field.

Erythroferrone and hepcidin levels in children with iron deficiency anemia.

BACKGROUND: Iron deficiency anemia remains a significant public health issue in developing countries. The regulation of iron metabolism is primarily controlled by hepcidin, a key regulatory protein. During erythropoiesis, erythroferrone (ERFE), a hormone produced by erythroblasts in response to erythropoietin (EPO) synthesis, mediates the suppression of hepcidin. In this study, it was aimed to determine the correlation between erythroferrone (ERFE) and hepcidin levels in children with iron deficiency anemia. METHODS: This is a case-control study conducted at Kirsehir Ahi Evran University Training and Research Hospital Pediatrics Clinic between 1 and 31 September 2020. The study included 26 healthy children and 26 children with iron deficiency anemia. In order to evaluate iron status,whole blood count, serum iron, total iron binding capacity (TIBC), and ferritin levels were analyzed. The study measured the levels of hepcidin and erythroferrone in the serum of children diagnosed with iron deficiency before and after one month of iron treatment, as well as in a control group, using the ELISA method. Correlation between whole blood count, initial ferritin, hepcidin, ERFE and ferritin in the iron deficiency group was evaluated. RESULTS: Compared with healthy controls, the iron-deficient group had significantly lower haemoglobin (p < 0.001), MCV (p = 0.001), MCH (p < 0.001), MCHC (p < 0.001), iron (p < 0.001), ferritin (p < 0.001) and hepcidin (p = 0.001). Ferritin and hepcidin levels increased while erythroferrone levels remained unchanged after iron deficiency treatment. There was no correlation between hepcidin and ferritin levels in treatment group. CONCLUSIONS: The study found a strong and positive correlation between ferritin and hepcidin levels in iron-deficient children, but not between ERFE levels, suggesting that hepcidin is largely regulated by iron deposition levels. In addition, there was an increase in ferritin and hepcidin levels after iron treatment. The study found no significant difference in erythroferrone levels between the iron-deficient group and the control group. It is thought that this may be due to the short duration of iron treatment given to the patients with iron deficiency anemia included in the study.

Identifying Diabetic Retinopathy in the Human Eye: A Hybrid Approach Based on a Computer-Aided Diagnosis System Combined with Deep Learning.

Diagnosing and screening for diabetic retinopathy is a well-known issue in the biomedical field. A component of computer-aided diagnosis that has advanced significantly over the past few years as a result of the development and effectiveness of deep learning is the use of medical imagery from a patient's eye to identify the damage caused to blood vessels. Issues with unbalanced datasets, incorrect annotations, a lack of sample images, and improper performance evaluation measures have negatively impacted the performance of deep learning models. Using three benchmark datasets of diabetic retinopathy, we conducted a detailed comparison study comparing various state-of-the-art approaches to address the effect caused by class imbalance, with precision scores of 93%, 89%, 81%, 76%, and 96%, respectively, for normal, mild, moderate, severe, and DR phases. The analyses of the hybrid modeling, including CNN analysis and SHAP model derivation results, are compared at the end of the paper, and ideal hybrid modeling strategies for deep learning classification models for automated DR detection are identified.

Evaluation of colposcopy after the addition of human papillomavirus testing to the Turkish cervical cancer screening program.

OBJECTIVE: To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. METHODS: Women aged 30-65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high-risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy-require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non-required. National data on colposcopy outcomes and unnecessary performance rates in February 2018-2019 were evaluated via a questionnaire. RESULTS: A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non-required group (3657 of 4057 patients). In the colposcopy-required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), "see and treat" in the non-required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)-3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy-required group and 63.7% (n = 1777) from the non-required group. The ECC samples included 19 cervical cancers and 212 ≥CIN-3 lesions in the colposcopy-required group, and four cancers and 41 ≥CIN-3 lesions in the non-required group. The proportion of ≥CIN-3 lesions detected by ECC only was 4.7% (35 of 746 ≥CIN-3 lesions). CONCLUSION: Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC.

The effect of earthquake experience on pregnancy outcomes: A systematic review and meta-analysis.

OBJECTIVES: Pregnant women are vulnerable to the health consequences of earthquakes, experiencing stress and limited access to healthcare. Despite the widespread impact of these events, knowledge about their effects on pregnancy outcomes is scarce and inconsistent. This systematic review and meta-analysis aimed to evaluate the available evidence, estimate the overall effect, and identify key research gaps about earthquake on pregnant women. STUDY DESIGN: A comprehensive search of English-language peer-reviewed articles was conducted using PubMed and Web of Science Core Collection. Various combinations of keywords related to earthquakes and pregnancy outcomes were used. Studies comparing quantitative data on pregnancy outcomes between earthquake-affected and unaffected pregnant women were included. Random and fixed-effects models were used to estimate the pooled effect size. RESULTS: The meta-analysis revealed no significant difference in preterm delivery rates (OR: 1.18; 95 % CI: 0.94-1.47; I2 = 75 %; five studies, 26,365 women) and low birth weight (LBW) infant delivery rates (OR: 1.19; 95 % CI: 0.83-1.71; I2 = 72 %; three studies, 16,127 women) between the earthquake-affected and control groups. However, a statistically significant increase in small-for-gestational-age (SGA) infants was observed in the earthquake-affected group (OR: 1.25; 95 % CI: 1.08-1.43; I2 = 0 %; two studies, 10,238 women). Data on miscarriage and stillbirth rates were not suitable for meta-analysis. CONCLUSIONS: Limited evidence suggests that exposure to earthquakes may be associated with adverse pregnancy outcomes. Further studies are needed to confirm the increased risk of SGA in the affected population and to inform disaster management plans by enhancing our understanding of the adversities associated with earthquake exposure through more comprehensive epidemiologic research.

Investigation of glucose, serum insulin levels, and insulin resistance in patients with major burn: a retrospective cross-sectional study.

BACKGROUND: Many studies have reported that insulin resistance (IR) is present and persistent in patients with major burns; however, the evidence remains insufficient. This study was planned to investigate insulin levels and IR in the early post-traumatic period in patients with major burns and to determine the prevalence of IR after burn injury. METHODS: This study included 68 patients. These patients were followed up once a week for 4 weeks after hospitalization. In the follow-up examinations, demographic and burn injury characteristics; HbA1c, procalcitonin serum glucose, and insulin levels; and IR were evaluated. RESULTS: IR was seen in some weeks only in 25 of the 68 patients included in the study. Among all patients, IR was determined in only 11 (16.17%) patients from the 1st day of hospitalization until discharge. Patients with and without IR were evaluated as 2 groups, and their biochemical parameters were compared, and no significant difference was found between glucose and procalcitonin levels (P>0.05). Glucose levels were >100 mg/dL in the first few weeks in all patients who were followed up; however, they returned to the normal range in the following weeks. CONCLUSION: In patients with IR, there was insufficient evidence to conclude that the condition persists. We believe that the HOMA-IR value is not directly related to burn injuries and that other additional pathologies may cause it during treatment.

Gestational trophoblastic neoplasia of intermediate trophoblasts: Epithelioid trophoblastic tumor and placental site trophoblastic tumor, a study of morphologic, immunohistochemical, and next generation sequencing.

Objective: Gestational trophoblastic tumors are very rare neoplasms. We determined the distinctive morphological, immunohistochemical, and clinical features of placental site trophoblastic tumors (PSTT) and epithelioid trophoblastic tumors (ETT) in our cohort. Materials and Methods: Nine cases of PSTT and four cases of ETT were retrieved from the archives. Histomorphologic, immunohistochemical, and clinical features were noted. A molecular study was performed on one PSTT and one ETT case using next-generation sequencing. Results: While the nodular pattern, geographic necrosis, and extracellular eosinophilic globules were peculiar to ETTs, vessel wall affinity, marked pleomorphism, intranuclear pseudoinclusion, spindle tumor cell, and vacuolar degeneration were more specific for PSTTs in our series. An immunohistochemical panel of p63, hPL, and CD146 were helpful for the exact typing of the tumor. p63 positivity supports the ETT and diffuse staining of hPL and CD146 supports the PSTT diagnosis. Three of the patients with metastatic disease (lung and brain metastasis) except one have a high mitotic count (12 and 8) and a long interval between (8 and 10 years) antecedent pregnancy and diagnosis. While KIT and TP53 mutations were observed only in PSTT, amino acid changes in KDR, APC, and SMAD4 genes were detected both in the ETT and PSTT cases. Conclusion: In the prediction of metastasis, the long intervals between antecedent pregnancy and diagnosis, deep myometrial invasion, mitotic count, and Ki67 proliferation index were involved rather than other histomorphological parameters, but none of the parameters is an absolute predictor of the metastasis.

A novel adaptive momentum method for medical image classification using convolutional neural network.

BACKGROUND: AI for medical diagnosis has made a tremendous impact by applying convolutional neural networks (CNNs) to medical image classification and momentum plays an essential role in stochastic gradient optimization algorithms for accelerating or improving training convolutional neural networks. In traditional optimizers in CNNs, the momentum is usually weighted by a constant. However, tuning hyperparameters for momentum can be computationally complex. In this paper, we propose a novel adaptive momentum for fast and stable convergence. METHOD: Applying adaptive momentum rate proposes increasing or decreasing based on every epoch's error changes, and it eliminates the need for momentum hyperparameter optimization. We tested the proposed method with 3 different datasets: REMBRANDT Brain Cancer, NIH Chest X-ray, COVID-19 CT scan. We compared the performance of a novel adaptive momentum optimizer with Stochastic gradient descent (SGD) and other adaptive optimizers such as Adam and RMSprop. RESULTS: Proposed method improves SGD performance by reducing classification error from 6.12 to 5.44%, and it achieved the lowest error and highest accuracy compared with other optimizers. To strengthen the outcomes of this study, we investigated the performance comparison for the state-of-the-art CNN architectures with adaptive momentum. The results shows that the proposed method achieved the highest with 95% compared to state-of-the-art CNN architectures while using the same dataset. The proposed method improves convergence performance by reducing classification error and achieves high accuracy compared with other optimizers.

Pilot study of the diagnostic value of CRP:albumin ratio for osteomyelitis in patients with diabetic foot ulcers.

OBJECTIVE: Osteomyelitis may complicate diabetic foot ulcers (DFUs). As a new inflammation-based prognostic factor, CRP:albumin ratio's significance is not known in osteomyelitis among patients with or without diabetes. METHOD: Patients with type 2 diabetes and DFUs were divided into two groups: group 1 (n=47) comprised patients without osteomyelitis, and group 2 (n=50) comprised patients with osteomyelitis. RESULTS: Erythrocyte sedimentation rate (ESR) (88.5±23.0 versus 42.0±22.2), white blood cell count (WBC) (14.7±6.9x103 versus 10.0±4.4x103), C-reactive protein (CRP) level (15.6±9.9 versus 2.4±3.3) and CRP:albumin ratio (6.6±4.9 versus 0.7±1.0) were significantly higher, and albumin level was significantly lower in group 2 compared to group 1 (p<0.001 for all). The presence of osteomyelitis was significantly and positively correlated with ESR (r=0.721; p<0.001), WBC (r=0.380; p<0.001), CRP (r=0.667; p<0.001) and CRP:albumin ratio (r=0.638; p<0.001), and negatively correlated with albumin (r=-0.590; p<0.001). A CRP:albumin ratio of 1.74 or above could predict osteomyelitis with 92.0% sensitivity, 80.9% specificity, and the best area under the curve (AUC) score (AUC=0.957; 95% CI: 0.924-0.991). ESR (odds ratio (OR): 1.071 (1.025-1.119); p=0.02) and CRP:albumin ratio (OR: 2.65 (1.437-4.885); p=0.002) were independent predictors in the final model for stepwise linear regression analyses for the estimation of osteomyelitis. CONCLUSION: CRP:albumin ratio is a cheap and repeatable inflammatory marker and can successfully detect osteomyelitis in patients with DFU.

Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience.

OBJECTIVES: To analyze intraoperative and postoperative complications according to Clavian-Dindo Classification (CDC) and evaluate the influence of clinicopathological features on the feasibility and safety of total laparoscopic hysterectomy (TLH) in patients that underwent surgery in a tertiary center. MATERIAL AND METHODS: We retrospectively reviewed the database of 469 patients that underwent surgery for patients who underwent extra facial TLH from 2013 to 2020. RESULTS: A total of 86 (18.3%) peri-postoperative complications were observed. The incidence of intraoperative complications was 2% (n = 10). The overall conversion rate to open surgery was 1.9% (n = 9). A total of 76 postoperative complications were observed in 61 patients (14.3%). The incidence of minor (Grade I [n = 16, 3.4%] and II [n = 42, 8.9%]) and major complications (Grade III [n = 15, 3.2%], IV [n = 2, 0.4%] and V [n = 1, 0.2 %]) were 12.3% and 3.8%, respectively. A higher BMI and performing surgery at the first step of learning are found to be associated with intraoperative and postoperative complications (p < 0.05). Postoperative complications related to having a history of the cesarean section, additional comorbidities, and uterine weight ≥ 300 g (p < 0.05). CONCLUSIONS: The implementation of TLH by experienced surgeons appears to have remarkable advantages over open surgery. However, the risk factor for complications should be taken into account by surgeons in the learning curve in selecting the appropriate patient for surgery.

High serum 8-hydroxy-2'-deoxyguanosine levels predict DNA damage and aging in professional divers.

OBJECTIVE: Reactive oxygen species and oxygen free radicals cause oxidative damage to lipids, proteins, and cell DNA in the cell membrane. Although many DNA products are produced during oxidative DNA damage, 8-hydroxy-2'-deoxyguanosine (8-OHdG) is the most common one, since it can be produced in in vivo environment. In recent years, diving has been done quite frequently for business and sports purposes all over the world. Increased environmental pressure in diving leads to hyperoxia and causes oxidative stress. METHODS: The acute effects of diving on DNA damage were evaluated by comparing 8-hydroxy-2'-deoxyguanosine values of 15 professional diver groups before and after diving. In addition to the demographic characteristics, the serum 8-hydroxy-2'-deoxyguanosine levels of these 15 divers were compared with the control group consisting of nondiving medical students to examine the chronic effect of diving on DNA damage. RESULTS: After deep dive, the amount of 8-hydroxy-2'-deoxyguanosine increased significantly in the diver group and acute DNA damage was observed (T1: 38.86±4.7; T2: 51.77±4.53; p<0.05). In the control group, the amount of 8-hydroxy-2'-deoxyguanosine was insignificant (C1: 47.48±3.73; T1: 38.86±4.7; p>0.05). CONCLUSIONS: It was found that air dives caused an increase in serum 8-hydroxy-2'-deoxyguanosine levels, leading to acute oxidative stress and aging. However, there is no chronic side effect, according to the study of samples taken from the control group. This was thought to be due to the relative sedentary life of the control group. The duration of the effect or the ability to return to normal values should be investigated with further studies planned with large populations.

Evaluation of macular, retinal nerve fiber layer and choroidal thickness by optical coherence tomography in children and adolescents with vitamin B12 deficiency.

PURPOSE: To investigate macular, Retinal Nerve Fiber Layer (RNFL) and choroidal thickness in children and adolescents with vitamin B12 deficiency and no neurological examination finding. METHODS: The study group includes of thirty-three children aged 8-17 years who were brought to the Pediatric outpatient clinic with the symptoms of fatigue and forgetfulness and whose Vitamin B12 levels were detected < 200 pg/ml. The control group was the 30 children and adolescents applied to the same policlinic with various symptoms and whose Vitamin B12 levels were found normal. Children and adolescents with chronic systemic/ocular disease history and myopia or hyperopia more than 4 diopters were not included in both groups. Spectral Domain-Optical Coherence Tomography (SD-OCT) was used for measurements. RESULTS: Mean Macular thickness value was 261.2 ± 17.6 in the Vitamin B12 deficiency group and 267.7 ± 17.4 in the control group. Mean value of Retinal Nerve Fiber Layer (RNFL) thickness was 103.5 ± 7.5 in the Vitamin B12 deficiency group and 104.3 ± 8.9 in the control group. The mean values of Choroidal thickness were 360.1 ± 59.8 and 316.9 ± 95.4 in Vitamin B12 deficiency and control groups, respectively. There was a statistically significant increase in choroidal thickness in Vitamin B12 deficiency group compared to controls. CONCLUSION: Statistically significant increase in the Choroidal thicknesses of children and adolescents with Vitamin B12 deficiency is important in terms of shedding light on studies that will contribute to a better understanding of the relationship between vitamin B12 and inflammation. CLINICAL TRIAL REGISTRATION: This study is an observational study.

Adnexal masses in patients with colorectal cancer.

OBJECTIVE: To evaluate the clinicopathological features and outcomes of patients undergone surgery for benign and metastatic adnexal masses during the surveillance of colorectal cancer (CRC). METHODS: A single institute retrospective study involving 90 patients diagnosed with CRC that undergone surgery at Hacettepe University Hospital between 2000-2018. Clinicopathological and survival data was obtained from hospital records. RESULTS: Elevated blood levels of CEA (HR, 1.23; 95 % CI: 1.03-1.24; p = 0.01), adnexal masses larger than 5 cm (HR, 3.296; 95 % CI: 1.527-7.076; p = 0.002), bilaterality of adnexal mass (HR, 2.200; 95 % CI: 2.464-11.969; p = 0.001) and high PCI score (HR, 0.150; 95 % CI: 0.044-0.479; p = 0.01) were found to be significantly associated with ovarian metastasis. There was a significant difference in overall survival (OS), with respect to complete and incomplete resection in adnexal surgery of ovarian metastasis (46.6 vs. 29.6 months; p = 0.004). The median survival time was 32.8 months for patients with ≤ 24 months interval time to adnexal metastasis surgery, and 48.5 months for patients with >24 months interval time to adnexal metastasis surgery (p = 0.001). CONCLUSION: This study showed that numerous clinicopathological variables such as bilaterality and size of adnexal mass, serum blood levels of CEA and PCI score may have a significant impact on the prediction and management of ovarian masses diagnosed during CRC surveillance. Complete resection and interval time to adnexal surgery is significantly associated with OS.

The role of the platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers: A retrospective comparative study.

OBJECTIVE: The aim of this study was to determine the role of new inflammatory markers, including the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers (DFUs). METHODS: A total of 78 patients with DFUs who were admitted to our endocrinology clinic between January 2016 and July 2017 were included. Patients were then divided into three groups according to the Wagner DFU classification system: group 1: 18 patients with grade 2 DFU (11 men, 7 women; mean age = 57.5±7 years); group 2: 44 patients with grade 3 DFU (18 men, 26 women; mean age = 59.7±8.7 years); and group 3: 16 patients with grade 4 DFU (10 men, 6 women; mean age = 59.9±11.6 years). Laboratory findings were retrospectively obtained from hospital records; the PLR and NLR were calculated in all groups. Length and cost of hospital stay were recorded. Hospital costs were estimated in Turkish Lira (TL) based on the evaluation of glucose regulation, wound care, and antibiotic treatment. RESULTS: The mean NLR was significantly lower in group 1 (2.8±0.9) than in group 2 (6.0±5.2; p=0.017) and group 3 (6.9±5.3; p=0.011). The mean PLR was significantly lower in group 1 (140.8±42.6) than in group 3 (222.1±95.5; p=0.006). The mean length of stay was 7.9±2.7 days in group 1, 15.0±8.9 days in group 2, and 12.5±8.9 days in group 3. The mean cost was 1,310.8±500 TL in group 1, 2,966.9±2105 TL in group 2, and 3,488.1±3603.1 TL in group 3. Length and cost of stay were both significantly lower in group 1 than in groups 2 and 3 (p=0.011 and p=0.002, respectively). Comparative results showed that the length and cost of hospital stay increased with increasing severity of DFUs. Furthermore, correlation analyses demonstrated no correlation of length of stay with PLR and NLR but an obvious correlation between cost of stay and PLR (r=0.412; p<0.001). Additionally, there was no correlation between cost of stay and NLR (r=0.158, p>0.05). CONCLUSION: The PLR is inflammatory marker that can be measured by an inexpensive and easily accessible test and can aid in the prediction of length and cost of hospital stay in patients with DFUs. LEVEL OF EVIDENCE: Level III, Therapeutic study.

A remarkable point for evaluating the severity of burns: Thiol-disulfide profile.

AIM: The objective of this study was to examine the thiol-disulfide profile tests in patients suffering from burn injuries. METHODS: This case-control study comprised 48 patients with thermal burn injuries and 61 healthy individuals. Thiol-disulfide tests were conducted in both groups, and also, the changes of thiol-disulfide parameters were analyzed at zero time and on days 3, 7, 15, and 30 of the admission in patients with burn injuries. RESULTS: The patients had significantly decreased native and total thiol levels and native thiol/total thiol ratios, and significantly increased disulfide/native thiol and disulfide/total thiol ratios compared to control individuals (p<0.001 for all). The variations of native thiol levels, total thiol levels, and disulfide/native thiol ratios were significantly different over time in patients with burn injuries (p<0.001, p<0.001, p<0.05, respectively). There were strong associations with the clinical parameters and thiol-disulfide profile tests (p<0.05 for all). CONCLUSION: There was a metabolic disturbance of the thiol-disulfide system among patients with burn injuries. The courses of thiol-disulfide variables in time overlapped with the burn mechanism. Strong associations provide that thiol-disulfide homeostasis might be a notable key for evaluating the severity of burns and predicting the survival.