The effect of alpha-lipoic acid on oxidative parameters, SCUBE-1 and SCUBE-2 in hepatic ischemia-reperfusion injury in cholestatic rats.

OBJECTIVE: The aim of the study was to evaluate the protective effects of alpha-lipoic acid (ALA) on the liver, oxidative parameters, and signal peptide-CUB-epidermal growth factor-like domain-containing proteins 1 and 2 (SCUBE-1 and -2) in an experimental cholestatic hepatic ischemia-reperfusion (IR) model. MATERIALS AND METHODS: Twenty-four female rats were included in the study and divided into four groups of six rats each. Group 1 was the control group, in which only laparotomy was performed; Group 2 underwent laparotomy and received alpha-lipoic acid (ALA) on a daily basis; bile duct ligation was performed in Group 3; bile duct ligation was performed, and ALA was administered to Group 4. All rats underwent relaparotomy on the seventh day, followed by 30 minutes of hepatic ischemia and 60 minutes of reperfusion in Groups 3 and 4. Liver tissue and blood samples were taken for histopathological and biochemical examinations. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), albumin, ischemia modified albumin (IMA), SCUBE-1, SCUBE-2, total antioxidant status (TAS) and total oxidant status (TOS) levels were also examined. RESULTS: The SCUBE-1 and SCUBE-2 values in Group 4 were lower than in Group 3, but no significant difference was observed between all the groups. The AST, TBIL, and DBIL levels were significantly higher in Groups 3 and 4 than in Groups 1 and 2 (p<0.0001). Although TOS was the highest in Group 3, the measurements were similar across the groups (p=0.464). IMA and TAS were similar between Groups 3 and 4 but significantly higher in these groups than in Groups 1 and 2 (p=0.001). The hepatic injury observed in Groups 3 and 4 was significantly higher than that observed in Groups 1 and 2 (p<0.0001). In the histopathological examination, neutrophilic infiltration and bile duct proliferation were less commonly detected in the portal areas in Group 4 than in Group 3, and necrotic foci were not observed due to the administration of ALA. CONCLUSIONS: The promising effects of ALA, known for its powerful antioxidant properties, on the IR injury of the liver can allow it to enter clinical practice in the future.

Comparison of robotic-assisted resection alone and with natural orifice specimen extraction for rectal cancer by using Da Vinci Xi.

OBJECTIVE: The aim of our study is to compare the results of robotic surgery-assisted Low Anterior Resection (LAR) and Natural Orifice Specimen Extraction (NOSE) for Rectal Cancer (RC). PATIENTS AND METHODS: From November 2015 to June 2021, patients receiving robotic NOSES and robotic surgery assisted resection (RSAR) were retrospectively enrolled in the study. All robotic-assisted LAR of the rectum, NOSE, colorectal anastomosis and loop ileostomies were performed using the Da Vinci Xi system. RESULTS: A total of 57 patients with robotic NOSES and 93 with robotic RC resection were enrolled. Total mesorectal excision of the rectum, trans-anal or transvaginal specimen extraction (TVSE), anastomoses and protective ileostomy were conducted in all patients. ASA, BMI, tumor histology, stage, nodal stage, mean operative time, estimated blood loss, tumor size, lymph nodes removal, hospital stay morbidity and mortality were evaluated. No patient required conversion to conventional surgery. NOSE has less morbidity and significantly reduces postoperative pain and hospital stay (5.0 vs. 5.5). The two groups were similar in long-term survival. CONCLUSIONS: According to our literature search, this is the first study to compare RSAR and NOSE for RC using the Da Vinci Xi system. NOSE can be performed safely and successfully on selected patients, providing excellent good results.

TWIST1 Gene Expression as a Biomarker for Predicting Primary Doxorubicin Resistance in Breast Cancer.

Doxorubicin is one of the most commonly used chemotherapeutic agents for adjuvant chemotherapy of breast cancer. In the studies focused on finding biomarkers to predict the response of the patients and tumors to the drugs used, the Twist transcription factor has been suggested as a candidate biomarker for predicting chemo-resistance of breast tumors. In this study, we aimed to investigate the relationship between TWIST transcription factor expression and the effectiveness of doxorubicin treatment on directly taken primary tumor samples from chemotherapy-naive breast cancer patients. Twenty-six primary breast tumor samples taken from 26 different breast cancer patients were included in this study. Adenosine triphosphate tumor chemo-sensitivity assay (ATP-TCA) has been used to determine tumor response to doxorubicin and real-time reverse-transcription polymerase chain reaction (RT-PCR) was used for analyzing the TWIST1 gene expression of tumors. There was a significant difference in TWIST gene expression between responder and non responder tumors (p <0.05). The TWIST gene expression of the drug-resistant group was higher than the responsive group. This difference was not dependent on the histopathological features of tumors. In conclusion, compatible with earlier studies that have been performed with cell lines, the current study supports the role of higher TWIST gene expression as a biomarker for predicting the response of breast tumors to chemo-therapeutic agent doxorubicin.

Spectrum of gastric histopathologies in morbidly obese Turkish patients undergoing laparoscopic sleeve gastrectomy.

OBJECTIVE: In this study, we aimed to describe the findings associated with gastric pathology and to identify the prevalence of Helicobacter pylori (H. pylori) in patients undergoing laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: Gastric specimens of a total of 291 patients (225 females, 66 males; mean age: 42 years; range: 18 to 60 years) who underwent LSG for the treatment of morbid obesity were analyzed. Histopathologic diagnoses and their relation with body mass index (BMI), age and gender were evaluated. RESULTS: In the histopathological examination of sleeve specimens, 58 patients (19.93%) had chronic gastritis, 102 patients (35.05%) had chronic active gastritis, 27 patients (9.27%) had follicular gastritis, 47 patients (16.15%) had active follicular gastritis, one patient (0.34%) had a glomus tumor, and one patient (0.34%) had a gastrointestinal stromal tumor. The gastric mucosa was normal in 55 patients (18.90%). Intestinal metaplasia was detected in eight patients (2.74%). The H. pylori test result was positive in 126 patients (43.29%). There was no statistically significant difference between the pathological diagnoses and age and sex of the patient. CONCLUSIONS: Our study results suggest that the prevalence of chronic active gastritis and H. pylori positivity is high in morbidly obese Turkish patient population. No significant difference was found between the pathological diagnosis in obese patients with LSG operation in terms of age and sex.

The impact of laparoscopic sleeve gastrectomy on plasma obestatin and ghrelin levels.

OBJECTIVE: To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on the levels of obestatin and ghrelin hormones and body mass index (BMI) in morbidly obese patients. PATIENTS AND METHODS: The study included 30 morbidly obese patients who had LSG. Five cc blood samples were taken from the patients preoperatively and at postoperative months 3 and 6. After serum extraction, the levels of obestatin and ghrelin hormones and the levels of fasting insulin and glucose were studied using the enzyme-linked immunosorbent assay (ELISA) method. The homeostatic model assessment of insulin resistance (HOMA-IR) score was calculated. Preoperative and postoperative 3- and 6-month BMI were calculated. Kruskal-Wallis Analysis of Variance, Bonferroni-Dunn Test, Spearman's correlation test, and Pearson's correlation test were used for statistical analysis. RESULTS: BMI of the patients were statistically significantly reduced at postoperative months 3 and 6 compared to preoperative values, and at postoperative month 3 compared to month 6 values (p < 0.001). Ghrelin values were higher at postoperative month 6 compared to the preoperative and postoperative month 3 values (p < 0.001). Obestatin values of the patients were lower at postoperative month 6 compared to the preoperative and postoperative month3 values (p < 0.001). Insulin and glucose values were statistically significantly lower at postoperative months 3 and 6 compared to preoperative values (p < 0.001), whereas there was no difference between months 3 and 6. HOMA-IR score was significantly lower at postoperative month 3 compared to preoperative values (p < 0.001). CONCLUSIONS: LSG enables effective weight loss and glucose regulation in obese patients. LSG has also effects on obestatin and ghrelin hormones, which are coded by the same gene and have opposing effects, and the associated mechanisms of which are still controversial. Obestatin produces a feeling of satiety, whereas ghrelin initiates eating by producing a feeling of hunger. The patients were observed to have increased ghrelin and reduced obestatin postoperatively due to a negative energy balance.

Nesfatin-1 hormone levels in morbidly obese patients after laparoscopic sleeve gastrectomy.

OBJECTIVE: To investigate changes in body mass index (BMI) and nesfatin-1 levels in patients with morbid obesity who had undergone laparoscopic sleeve gastrectomy (LSG). PATIENTS AND METHODS: Blood samples were collected from, and the BMI calculated of 30 morbidly obese patients pre-surgery and at 3 and 6 months post-surgery. Nesfatin-1 hormone levels were measured using enzyme-linked immunosorbent assay (ELISA). Descriptive statistical analysis of the data was performed using Kruskal-Wallis variance analysis, one-way ANOVA, and the Bonferroni-Dunn test. The correlations between continuous variables not displaying normal distribution and those displaying normal distributions were analyzed using the Spearman correlation test and the Pearson correlation test, respectively. RESULTS: The mean age of the 30 patients was 41.23 ± 10.37 years. The mean BMI values (kg/m2) were 49.30 ± 7.92, 39,48 ± 7.32, and 34.39 ± 7.56 presurgery, three months post-surgery, and six months post-surgery, respectively (p < 0.001). Mean nesfatin-1 levels (ng/ml) were 22.80 ± 14.16, 60.23 ± 52.92, and 96.99 ± 40.20 presurgery, three months post-surgery, and six months post-surgery, respectively (p < 0.001). The postoperative months 3 and 6 BMI values were significantly lower than the preoperative BMI value and the postoperative month 6 BMI value was significantly lower than the postoperative month 3 BMI value (p < 0.001). The postoperative months 3 and 6 nesfatin-1 levels were significantly higher than the preoperative nesfatin-1 levels. A negative correlation was found between age and preoperative nesfatin-1 values (p = 0.001, r = -0.0557). CONCLUSIONS: Observation of significant increases in nesfatin-1 hormone levels in morbidly obese patients who had undergone LSG indicate that nesfatin-1 has important anorexigenic effects post-surgery and may be an important component of future obesity treatments.

Effect of sildenafil on intestinal adaptation parameters in a rat model of short bowel syndrome.

OBJECTIVE: We aimed to evaluate the effect of sildenafil on the intestinal adaptation in short bowel syndrome (SBS). MATERIALS AND METHODS: Forty-eight male Wistar-albino rats (weight, 231-390 g) were randomly divided into four groups with 12 rats in each. Group TA had only ileal transection+anastomosis, Group TA+S was given sildenafil after ileal transection+anastomosis, Group RA had a resection of 75% of the small bowel+anastomosis, Group RA+S was given sildenafil after small bowel resection+anastomosis. Sildenafil was injected subcutaneously at 60 mg/kg/day dose throughout 3-21 days postoperatively. Bowel and mucosal weights, villus height, crypt depth, DNA and protein concentrations were determined. RESULTS: Jejunal bowel weight was lower in TA and TA+S groups than RA and RA+S groups (p < 0.05). RA+S group had higher ileal and jejunal mucosal weights than RA and TA+S groups (p < 0.05). Villus height was highest in RA+S group both in ileum and jejunum (466.1 ± 38.6 µm and 648.1 ± 65.7 µm, respectively). Jejunal crypt depth was highest in RA+S group (255.1 ± 21.9 µm) compared to other groups (p < 0.05). There was no significant difference in ileal and jejunal protein concentration between TA and TA+S groups and in ileal protein concentration between RA ve RA+S groups (p > 0.05). Ileal DNA concentration was higher in TA+S group, and jejunal DNA concentration was higher in RA and RA+S groups than TA and TA+S groups (p < 0.05). CONCLUSIONS: Sildenafil has a positive effect on intestinal adaptation parameters, particularly in jejunum in a rat SBS model. Thus, its role in the treatment of SBS should be further investigated with clinical studies.

The effect of alpha lipoic acid on rat kidneys in methotrexate induced oxidative injury.

OBJECTIVE: The purpose of this study is to determine the antioxidant and anti-inflammatory effects of alpha lipoic acid (ALA) on methotrexate (MTX) induced kidney injury in rats. MATERIALS AND METHODS: Thirty-two rats were equally divided into four groups; control, ALA, MTX and MTX with ALA groups. A single dose of MTX (20 mg/kg) was administered to make kidney injury to groups 3 and 4, intraperitoneally. The ALA was administered intraperitonealy in groups 2 and 4 and the other groups received saline injection for five days. On the sixth day the blood samples and kidney tissues were obtained for the measurement of TNF-α, IL-1ß, malondialdehyde, glutathione, myeloperoxidase and sodium potassium-adenosine triphosphatase levels and histological examination. RESULTS: Administration of MTX caused a decrease in tissue GSH, and Na+, K+-ATPase activity significantly. A significant increase in tissue MDA and MPO activities were also seen. The pro-inflammatory cytokines (TNF-α, IL-ß) were increased in the MTX group significantly. ALA treatment reversed all biochemical indices as well as histopathological alterations induced by MTX administration. CONCLUSIONS: MTX made oxidative damage on kidneys of rat and it was partially prevented by anti-inflammatory and antioxidant effects of ALA treatment.

Frailty prevalence and related factors in the older adult-FrailTURK Project.

Frailty is one of the geriatric syndromes and has an important relationship with mortality and morbidity. The aim of this study is to present the characteristics, prevalence, and related factors of frailty in older adults in our country. The study included 1126 individuals over 65 years of age from 13 centers. Frailty was evaluated using the Fried Frailty criteria, and patients were grouped as "frail," "pre-frail," and "non-frail." Nutritional status was assessed with "Mini Nutritional Test," psychological status with the "Center for Epidemiological Studies Depression Scale-CES-D," and additional diseases with the "Charlson Comorbidity index." Approximately 66.5 % of the participants were between 65 and 74 years of age and 65.7 % were women. Some 39.2 and 43.3 % of the participants were rated as frail and pre-frail, respectively. The multinomial logistic regression analysis was used to determine the factors associated with frailty. It was observed that age, female gender, low education level, being a housewife, living with the family, being sedentary, presence of an additional disease, using 4 or more drugs/day, avoiding to go outside, at least one visit to any emergency department within the past year, hospitalization within the past year, non-functional ambulation, and malnutrition increased the risk of frailty (p < 0.05). Establishing the factors associated with frailty is highly important for both clinical practice and national economy. This is the first study on this subject in our country and will provide guidance in determining treatment strategies.

Relation between weight loss and age after laparoscopic sleeve gastrectomy.

OBJECTIVE: As a bariatric surgery; Laparoscopic Sleeve Gastrectomy (LSG) has gained popularity in recent years. In our study, we aimed to investigate the impact of age on postoperative weight loss at one year after laparoscopic sleeve gastrectomy. PATIENTS AND METHODS: In our clinic between May 2011 and July 2013, 55 patients who underwent LSG with the diagnosis of obesity were included in the study. Patients were divided into two groups below and over an age of 40. Preoperative and postoperative first year Body Mass Index (BMI), percent of Body Mass Index Lost (% BMIL) and Excess Body Mass Index Lost (% EBMIL) were recorded. RESULTS: A total of 55 patients with a mean age of 37.2 ± 8.6 years were included in the study. 37 were women. Patients divided into the age below 40 years old (group 1, n = 29) and over 40 years old (group 2, n = 26). The average age of the groups was 29.9 ± 4.63 and 45.3 ± 7.02, respectively. Characteristics of patients among groups were similar. The preoperative average BMI of groups were 49.34 ± 5.87 kg/m² and 49.73 ± 5.38 kg/m², postoperative first year mean BMI of groups were 30.05 ± 5.78 kg/m² and 36.15 ± 6.64 kg/m², respectively. Percentage loss in BMI was 19.29 ± 3.14% and 13.58 ± 2.96%, respectively; and % EBMIL was 82.95 ± 21.88% and 56.75 ± 15.90%, respectively. CONCLUSIONS: We suggest that age might be as a major determining factor for weight loss and patients over forty years old undergoing LSG for bariatric surgery should be informed about that they will have a lower weight lost.

Using autologous peritoneal graft for portal vein injury due to blunt thoracoabdominal trauma.

BACKGROUND: Autologous vein or prosthetic materials are used as patch or tube graft for portal or caval vein reconstruction after trauma or tumor resection. Preparation of autologous veins requires extra incisions and is time consuming that is crucial especially in trauma patients. This condition adversely affects postoperative morbidity and mortality, particularly in trauma cases. Prosthetic materials may not be available in some centers, and their use is associated with an increased risk of infection. DESCRIPTION OF CASE: A 28-year-old hemodynamically unstable man presented to the emergency room with complete transection of main portal vein, right hepatic artery and common bile duct with tissue defect on hepatoduodenal ligament due to blunt thoracoabdominal trauma. Reconstructing of the portal vein was performed using an autologous peritoneal tube graft. CONCLUSION: Autologous peritoneal graft is a very good option in the treatment of major vascular injuries which can not be repaired with primary suturing. It is also easy to prepare and use, safe, without a need of additional incision, as an alternative to autologous veins and prosthetic materials especially under emergency conditions. Hippokratia 2015; 19 (3): 260-262.

Modelling of calcium dynamics in brain energy metabolism and Alzheimer's disease.

Functional imaging techniques play a major role in the study of brain activation by monitoring the changes in blood flow and energy metabolism. In order to interpret functional neuroimaging data better, the existing mathematical models describing the links that may exist between electrical activity, energy metabolism and hemodynamics in literature are thoroughly analyzed for their advantages and disadvantages in terms of their prediction of available experimental data. Then, these models are combined within a single model that includes membrane ionic currents, glycolysis, mitochondrial activity, exchanges through the blood-brain barrier, as well as brain hemodynamics. Particular attention is paid to the transport and storage of calcium ions in neurons since calcium is not only an important molecule for signalling in neurons, but it is also essential for memory storage. Multiple efforts have underlined the importance of calcium dependent cellular processes in the biochemical characterization of Alzheimer's disease (AD), suggesting that abnormalities in calcium homeostasis might be involved in the pathophysiology of the disease. The ultimate goal of this study is to investigate the hypotheses about the physiological or biochemical changes in health and disease and to correlate them to measurable physiological parameters obtained from functional neuroimaging data as in the time course of blood oxygenation level dependent (BOLD) signal. When calcium dynamics are included in the model, both BOLD signal and metabolite concentration profiles are shown to exhibit temporal behaviour consistent with the experimental data found in literature. In the case of Alzheimer's disease, the effect of halved cerebral blood flow increase results in a negative BOLD signal implying suppressed neural activity.