Changes in cytokines and chemokines in an acute pancreatitis model.

BACKGROUND: The immune response secondary to inflammation that develops in acute pancreatitis plays an important role in the clinical course of the disease. This study aims to evaluate the changes in various cytokines and chemokines according to the severity of pancreatitis. METHODS: Twenty-one female Wistar albino rats were divided into three equal groups. The control group received no intervention. Intraperitoneal cerulein was administered to the other groups once per hour for five hours at doses of 50 µg/kg and 80 µg/kg for the mild and severe pancreatitis groups, respectively. The development of pancreatitis and its severity level were confirmed by histological evaluation after euthanization. Blood samples were taken from all rats to measure levels of Interleukin-10 (IL-10), Interferon gamma (IFN-γ), C-X-C Motif Chemokine Ligand 1 (CXCL-1), Monocyte Chemoattractant Protein-1 (MCP-1), Tumor Necrosis Factor alpha (TNF-α), Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF), IL-18, IL-12p70, IL-1ß, IL-17A, IL-33, IL-1α, and IL-6. Additionally, the Schoenberg inflammation scores of pancreatic tissues were evaluated. RESULTS: The acute pancreatitis model was successfully induced in all cases within the study groups, according to histopathological examination. It was found that the levels of CXCL-1, MCP-1, and IL-6 were statistically significantly higher in rats with pancreatitis, with these parameters being elevated in the group with severe pancreatitis. In correlation analyses, MCP-1 and IL-6 showed a moderate correlation with the severity of pancreatitis. CONCLUSION: CXCL-1, MCP-1, and IL-6 exhibit predictive characteristics for the occurrence and clinical course of pancreatitis. Our results highlight the production and working pathways of these cytokines as potential targets for therapeutic intervention.

Could we use PD-1 and PD-L1 expression on lymphocytes and monocytes as predictive markers for prognosis of acute biliary pancreatitis?

PURPOSE: This study aimed to assess the significance of immunophenotyping and serum cytokines in predicting the clinical progression of acute biliary pancreatitis (ABP). MATERIALS AND METHODS: Cytokine levels, T-helper, cytotoxic T, natural killer (NK) cells, monocytes, HLA-DR, and PD-1, as well as PDL-1 immune checkpoints, were measured in ABP patients at the time of diagnosis and compared with results from healthy volunteers. The study also compared leukocyte counts, hematocrit, immunophenotyping results, cytokine statuses, and PD-1, PDL-1 expression between healthy volunteers and ABP subgroups categorized by pancreatitis severity. RESULTS: The study included 65 ABP patients and 20 healthy volunteers. Significant differences were observed between groups in hematocrit, leukocyte counts, total monocytes, lymphocytes, CD3+ total T cells, CD4+ Th cells, PD-1 expression on CD4+ and CD8+T lymphocytes, HLA-DR expression on CD14+ monocytes, NK cells, PD-L1 expression on CD14+ monocytes, classical and intermediate monocytes, as well as levels of IL-6, IL-8, IL-10, IL-18, and IL-33 cytokines. Moderate correlations were found with lymphocyte counts, PD-1+CD4+ cells, PD-L1+CD14+ cells, and strong correlations with HLA-DR+CD14+ cells. Hematocrit, CD3+ total T cells, NK cells, CD4+PD-1 + T cells, and CD8+PD-1 + T cells showed independent associations with the severity of ABP. Lymphocyte counts, CD14+HLA-DR+ cells, CD14+PD-L1+ cells, CD4+PD-1 + T cells, classical, and intermediate monocytes exhibited the highest Area Under the Curve rates in determining organ failure. CONCLUSIONS: Hematocrit, lymphocyte counts, CD14+HLA-DR+ cells, CD14+PD-L1+ cells, and intermediate monocytes emerged as parameters most closely associated with the severity and these parameters could be useful in predicting the severity of ABP.

Predicting the Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using Soluble Immune Checkpoints.

Introduction: Personalizing neoadjuvant therapy for locally advanced rectal cancer (LARC) requires identifying biomarkers that predict treatment response. This study evaluates soluble immune checkpoints (sICPs) as predictive markers for neoadjuvant treatment response in LARC patients located in the middle and lower rectum. Materials and Methods: This prospective study included patients diagnosed with clinical stage T3 or T4 rectal cancer (RC) based on pelvic magnetic resonance imaging, with or without pelvic lymph node involvement. The modified Ryan scoring system was used to assess the response to neoadjuvant chemoradiotherapy (nCRT). Blood samples were collected from all RC patients before initiating nCRT. Various sICPs (sCD25, 4-1BB, B7.2, free active TGF-ß1, CTLA-4, PD-L1, PD-1, Tim-3, LAG-3, galectin-9), along with age, gender, stage, blood cell counts, and biochemical variables, were recorded and compared based on tumor regression grade (TRG). Results: Among 38 participants, lymphocyte count was higher, and platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and platelet count were lower in patients with complete/near-complete response (TRG 0/1). In addition, TRG 0/1 patients had significantly lower levels of soluble galectin-9 than TRG 2/3 patients. Furthermore, platelet count was the only parameter that showed a significant difference among the three groups (TRG 0/1, TRG 2, and TRG 3). PLR demonstrated the highest sensitivity and specificity, with >80% for both measures. Conclusions: Lymphocyte count, PLR, NLR, platelet count, and galectin-9 may help predict favorable neoadjuvant treatment response in LARC patients, although without providing a definitive outcome. Personalized therapy based on these markers could enhance treatment decision making in LARC management.

Illuminating insights: Exploring the effect of 16/8 intermittent fasting on serum cytokine levels in overweight adults.

BACKGROUND: The immune system's pivotal role extends to numerous diseases, and maintaining a balance between dietary and consumed energy is vital for preventing chronic illnesses and increasing life expectancy. Intermittent fasting (IF), a dietary approach typically implemented through time restrictions, exerts positive effects on the immune system and shows promising outcomes in managing various diseases. OBJECTIVES: To evaluate the effectiveness of IF on the immune system with a wide cytokine panel. MATERIAL AND METHODS: A total of 21 volunteers with body mass index (BMI) between 25 and 30 were included in the study. Fasting was applied for 16 h in a day to the volunteers, and they were free to consume food for the rest of the day. The weight, BMI, interleukin (IL)-1ß, interferon (IFN)-α2, IFN-γ, tumor necrosis factor (TNF)-α, monocyte chemoattractant protein (MCP)-1, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, and IL-33 values were measured using flow cytometry and compared before and after 21 days follow-up. RESULTS: The mean age of study participants was 37.76 ±8.06 years and weight loss of the volunteers was 3.35 percentile compared to the values obtained before fasting. The pro-inflammatory cytokines decreased, while anti-inflammatory cytokines increased after fasting; there was a significant difference in TNF-α, MCP-1, IL-6, IL-8, and IL-33 values. Also, IL-1ß, IL-8 and IL-12p70 had moderately positive, IL-33 had strongly negative, and IL-10 had moderately negative correlation with the BMI change over time. CONCLUSIONS: Intermittent fasting has positive effects on obesity-induced inflammation and promotes decrease in proinflammatory cytokines and increase in IL-33 values, which is known to have a protective effect on fat-associated inflammation.

Clinical and Laboratory Parameters for Differential Diagnosis of Necrotizing Faciitis and Cellulitis.

ObjectiveS: Necrotizing fasciitis (NF) requires surgical intervention and has high morbidity and mortality. Furthermore, it can be confusing with some skin diseases such as cellulitis. We investigated the roles of clinical and laboratory parameters at the time of admission to the hospital in the differential diagnosis of NF and cellulitis patients. Methods: Patients with cellulitis and NF located between the nipple level and the knee between January 2018 and January 2021 were included in our retrospective study. The fever, history, complete blood count results, blood biochemistry, C-reactive protein and procalcitonin values of the patients at the time of admission to the emergency department, length of hospital stay, mortality rates, and laboratory risk indicator for necrotizing fasciitis (LRINEC) scores were recorded and evaluated whether there was a difference in both patient groups. Results: A total of 55 patients, including 26 patients in the NF group and 29 patients in the cellulite group, were included in the study. It was observed that patients with NF applied to the hospital statistically earlier, had higher leukocyte, platelet and neutrophil levels, had longer hospital stays and had higher mortality numbers. Conclusion: In high leukocyte, platelet, and neutrophil levels in the case of cellulitis patients, the clinician should follow the patient's clinic course closely and keep NF in mind.

Effect of bariatric surgery procedures on serum cytokine and Nesfatin-1 levels.

BACKGROUND: and Purpose: Obesity is known to cause chronic inflammation. We aimed to evaluate the changes in Nesfatin-1 and serum cytokine levels of patients who underwent sleeve gastrectomy or gastric bypass surgery. METHODS: A total of 30 patients with BMI>35 and undergoing bariatric surgery were divided in two group, sleeve gastrectomy (SG) (group-1), Roux-en-Y gastric bypass (RYGB) (group-2). Demographic data, weight, BMI, AST, ALT, blood glucose, CRP values, and IL-1ß, IFN-α, IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33 cytokine, and Nesfatin-1 values were noted at the time of hospitalization and in the 6th month postoperative follow-up. RESULTS: The mean age of the patients was 37.56 ± 11.73 years, and there were 16 females and 14 males in the study. Body weight and excess body weight change were slightly higher in RYGB patients than in SG patients. In RYGB and SG patients, a significant decrease was found in glucose, AST, ALT, CRP, IL-6, IL-10, and IL-18 values compared to the preoperative period, and serum Nesfatin-1 levels were significantly increased in RYGB patients and not significantly in SG patients. There were also significant decreases in IL-1ß levels in RYGB patients. On the other hand, a decrease in cytokines was observed in both surgical methods, except for IL-17A, although it was not significant. CONCLUSION: The present study showed that there is also a regression in inflammation, which can be associated with NLRP3 inflammasome, due to weight loss after bariatric surgery, more specifically in RYGB.

The role of serum nesfatin-1 in a rat model of acute pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a disease that can still be fatal despite rapid advances in medicine. The relationship between serum nesfatin-1 levels and AP is still to be fully resolved. OBJECTIVES: To investigate the utility of serum nesfatin-1 levels in the diagnosis of AP. MATERIAL AND METHODS: Twenty-four male Sprague Dawley rats were divided into control, mild pancreatitis and severe pancreatitis groups (n = 8/group). Acute pancreatitis was induced by cerulein injection and the control group received saline injections. Then, the serum nesfatin-1, amylase, lipase, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels were determined. A pathologist blinded to the study scored the severity of pancreatitis. RESULTS: There was a considerable decrease in serum nesfatin-1 levels in parallel to the severity of pancreatitis, though there was no statistically significant relationship observed between pancreatitis and nesfatin-1. In addition, there was no significant difference in AST or ALT levels among the groups. However, a strong positive correlation between amylase and lipase levels was observed (p < 0.05). The severe pancreatitis group (group 3) had a higher lipase level and pathology score than mild pancreatitis group (group 2), and this difference was statistically significant. CONCLUSIONS: Serum nesfatin-1 may be used as a diagnostic and severity marker in pancreatitis in the future.

The Importance of Mapping Vagus and Laryngeal Nerves Monitoring During Thyroid Surgery.

OBJECTIVE: To determine the location of thyroid-related nerves by nerve monitoring and demonstrate the usefulness of Nerve Integrity Monitor in thyroid surgery. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Turkey, from February 2017 to January 2020. METHODOLOGY: Patients, who underwent thyroid surgery, were evaluated for age, gender, preoperative diagnosis, type of surgery, histopathological result, postoperative hoarseness, and postoperative vocal cord examinations. The vagus nerve, recurrent laryngeal nerve (RLN), and superior laryngeal nerve (SLN) were mapped by nerve monitoring. RESULTS: A total of 328 patients were included in this study. On both sides, the vagus nerve was most often located in the posterior of the internal carotid artery and internal jugular vein and less frequently anterior to this vein. A total of 303 right RLNs and 305 left RLNs were verified. The SLN was visualised or motor activity was verified by nerve monitoring on the right side in 181 patients and on the left side in 179 patients. The SLN's location was classified most frequently as type I and least frequently as type IIb on the right and left sides. CONCLUSION: The reported variations, the experience of the surgeon, and these anatomical markers cannot be adequate in preventing nerve injuries. Furthermore, the variations can be identified more clearly peroperatively with the use of nerve monitoring. KEY WORDS: Laryngeal nerves, Nerve mapping, Nerve monitoring, Nervus vagus, Thyroid surgery, Zuckerkandl tubercles.

Prognostic effect of Nesfatin-1 on the diagnosis and staging of acute cholecystitis.

BACKGROUND: Gallbladder diseases are an important health concern affecting approximately 20% of the population in developed countries. Acute cholecystitis is the most common complication of gallstones. The aim of our study is to determine the use of Nesfatin-1, which is an easily applicable and fast resulting and is thought to have an association with inflammatory events, in the diagnosis and grading of acute cholecystitis. METHODS: Patients who admitted and were hospitalized and treated with the acute cholecystitis diagnosis in Istanbul Training and Research Hospital between July 1, 2020, and December 1, 2020, were included in the study. The patients were divided in threemain groups as mild, moderate, and severe according to Tokyo Guidelines 2018 based on their routine blood tests and imaging results. All patients who are included in the study were tested for their blood leukocyte, neutrophil, lymphocyte, Nesfatin-1 levels, and neutrophil/lymphocyte ratios within the first 24 h of their hospitalization. RESULTS: With at least 15 patients in each group, 61 volunteers in total were included in the study as healthy volunteers, mild, moderate, and severe cholecystitis. The average age of the participants were 58.11±19.76 years. About 47.54% of the participants were female and 52.46% weremale. In the study, Nesfatin-1 levels in the patient groups were found to be lower than the control group. In the subgroup analyzes, Nesfatin-1 values in the middle patient group were found to be significantly lower than the control group; however, there was no statistically significant relationship between the severity of the disease and Nesfatin-1. CONCLUSION: Nesfatin-1 may guide the clinician for the diagnosis of the disease; however, no significant relationship was found between Nesfatin-1 and the severity or stage of the disease.

Effectiveness of Mesenchymal Stem Cell Therapy for COVID-19 Patients in the Intensive Care Unit: A Case-Control Study

Objective: Many methods are used in the treatment of coronavirus disease 2019 (COVID-19), which causes acute respiratory distress syndrome (ARDS), and there are conflicting reports in the literature regarding the results of mesenchymal stem cell (MSC) therapy, which is one of those methods. The aim of our study is to evaluate the effect of MSC treatment applied together with standard treatments on survival. Materials and Methods: This retrospective case-control study evaluates the survival effect of MSC treatment administered to patients treated in intensive care after the development of ARDS due to COVID-19 between March 2020 and March 2021. The age, gender, comorbid disease status, APACHE II score, and overall and comorbidity-based survival rates were compared between patients who received standard medical treatment (SMT) and patients who received MSC treatment together with SMT. Results: There were 62 patients in the group receiving only SMT and 81 patients in the group receiving SMT and MSC. No difference was observed between the groups in terms of age, gender, presence of comorbid diseases, or APACHE II scores. There were also no differences according to Kaplan-Maier analysis for the survival statuses of the groups. There was no serious adverse effect due to MSC treatment among these patients. Conclusion: Our study presents the largest case series in the literature, and it was observed that MSC treatment may not significantly affect overall survival or comorbid disease-based survival, in contrast to many other studies in the literature.

Cytokines the Etiology of Idiopathic Granulomatous Mastitis.

OBJECTIVE: To investigate the roles of cytokines in the etiopathogenesis of idiopathic granulomatous mastitis (IGM). DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Istanbul Training and Research Hospital, Istanbul, Turkey, from September 2020 to January 2021. METHODOLOGY: Idiopathic Granulomatous Mastitis patients in active or remission who were admitted to the breast diseases outpatient clinic and healthy volunteers were included prospectively in the present study. The IL-1ß, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-6, IL-8, IL-10, IL-12p (p70), IL-17A, IL-18, IL-23 and IL-33 values were measured with Flow Cytometry. The blood samples were taken before the treatment in the active IGM group. The ages, physical examination findings, menopausal and smoking conditions, and treatment methods were also evaluated. RESULTS: A total of 32 patients including 19 patients with active and 13 in remission, and 18 controls, were inducted making up a total of 50 subjects. The mean age was 37.18±7.15. The IL-1ß, TNF-α, IL-10, and IL-18 values were lower in patients with IGM than in the control group. Granulomatous Mastitis patients smoked more than the healthy participants. When the active patients, remission patients, and control group were evaluated together, no significant differences were detected in cytokine levels. CONCLUSION: The autoimmune and granulomatous reactions may not play a role in the etiopathogenesis of IGM because of the low levels of Th1 and Th17-related cytokines. However, some to baseline reference ranges were established. KEY WORDS: Idiopathic granulomatous mastitis, Cytokine, Autoimmunity, Smoking.

The Potential Role of Model for End-Stage Liver Disease (MELD)-Sodium Score in Predicting the Severity of Acute Pancreatitis.

Background and aim Acute pancreatitis is a common inflammation of the pancreas which can be severe and even potentially mortal. High rates of mortality showed the importance of immediate identification of patients at high risk and led the clinicians to refer to various scoring systems. Our aim was to investigate a clinical predictive model using the Model for End-Stage Liver Disease-Sodium (MELD-sodium) scoring system, adapting it to acute pancreatitis patients referring to the systemic inflammatory nature of the disease and potential multi-organ failures in severe form. Methods Our multicenter study was designed retrospectively. The medical records were reviewed for the period of two years. Demographics, biochemical results, MELD-sodium scores and mortality rates were analysed. Results MELD-sodium score was found to be statistically correlated with both mortality and the severity of pancreatitis (p<0.001) and significant difference between both mild and severe (p<0.001), moderate and severe groups (p<0.001). Mortality was found to be significantly higher in patients with MELD-Na score when the cut-off value was accepted as '≥11'. Conclusion We found that MELD-sodium score was significantly associated with both severity of disease and mortality rates and also significantly effective between both mild/severe and moderate/severe groups which may be a guide for future multi-center reviews with larger patient and control groups, which can define the potential role of this non-invasive and easy-to-use predictive model in acute pancreatitis patients.

Comparison of the effectiveness of two treatment modalities for chronic anal fissure: Botox versus sphincterotomy.

OBJECTIVES: Anal fissure is a common health problem that affects the quality of life of young patients. The aim of our study was to benchmark results of lateral internal sphincterotomy (LIS) and botulinum toxin injection in the treatment of chronic anal fissure. MATERIAL AND METHODS: This multi-center, retrospective study used data from 135 chronic anal fissure patients. Patients' demographic features, clinical findings, fissure characteristics, post-defecation pain score, rectal bleeding or pruritus, and treatment satisfaction scores were recorded. Patients' data were collected from the hospital records and patients with all of this data available were called and invited to the hospital for examination. RESULTS: Seventy-four LIS and 61 botulinum toxin applied patients were included. Symptom duration, hospitalization period, and duration of remission of complaints after the treatment were significantly higher in the LIS group (p<0.001). However, pruritus in anus and relapses were found to be higher in the botulinum toxin group (p=¬ 0.04 and p= 0.043, respectively). Abscess and fistula were observed in one patient's perianal region in the LIS group, and an abscess was observed in one patient in the botulinum toxin group. There was no significant difference in treatment satisfaction rates and postoperative complications. CONCLUSION: Botulinum toxin yields satisfying results that are comparable to LIS. Patient selection may help mitigate this disease and allow it to be considered a good alternative option to surgery.

The Impact of Micropapillary Component Ratio on the Prognosis of Patients With Invasive Micropapillary Breast Carcinoma.

Background and Objectives: Invasive micropapillary carcinoma (IMPC) of the breast is a rare and aggressive variant of invasive ductal carcinoma characterized by high-grade lymphovascular invasion and high rates of nodal metastasis. The prognostic significance of the micropapillary component (MC) ratio that constitutes this aggressive variation is controversial. In this study, we aimed to investigate the effect of the MC ratio on the prognosis of these patients. Methods: The data of 47 patients with IMPC were retrospectively reviewed. Patients were divided into two groups: MC ratio of 10-75% (Group 1) and greater than 75% (Group 2). The demographic characteristics of the patients, histopathologic features of the tumors, and survival rates were compared. Results: We detected no significant difference in demographic characteristics between groups 1 and 2 (p = 0.21). No significant difference was detected in terms of tumor diameter, lymph node metastasis, lymphovascular invasion, histologic grade, multicentricity, local recurrence, distant metastasis, and overall survival. Conclusion: In the micropapillary subgroup of invasive ductal carcinoma, although positive receptor characteristics are directly proportional to the increase in MC ratio, recurrence and survival rates are not affected by micropapillary component level.

May Nesfatin-1 be a Biomarker in Acute Mesenteric Ischemia?

OBJECTIVE: To investigate the diagnostic value of nesfatin-1 in cases of intestinal ischemia and ischemia/reperfusion. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: The Experimental Animals Laboratory of Bezmialem University, in June 2018. METHODOLOGY: Twenty-one healthy male Sprague Dawley rats were randomly divided into three groups of 7 rats each. In group 1: 1-hour intestinal ischemia followed by 5-hour reperfusion was performed. In group 2: rats were subjected to 6-hour intestinal ischemia. In group 3: rats underwent laparotomy and closure without performing any further procedure. Changes in leukocyte count, amylase, blood sugar, LDH, SGOT, CRP, and nesfatin-1 levels were determined. For histopathological examination, a small intestinal sample was taken and preserved in 10% formaldehyde. RESULTS: Nesfatin-1 value in group 2 was significantly higher than that in group 1 and group 3 (p=0.005, and p <0.001 respectively). Nesfatin-1 value in group 1 was significantly higher than that in group 3. A significant (r = 0.864/p <0.001) positive correlation was observed between nesfatin-1 value and pathology score. The pathology score of group 2 was significantly higher than that of group 1 and group 3 (p <0.001). CONCLUSION: Serum nesfatin-1 can be a biomarker in acute mesenteric ischemia.

Discharging a Patient Treated With Parathyroid Allotransplantation After Having Been Hospitalized for 3.5 Years With Permanent Hypoparathyroidism: A Case Report.

INTRODUCTION: Parathyroid allotransplantation is one of the methods used in the treatment of permanent hypoparathyroidism. We present a patient who underwent continuous intravenous (IV) calcium replacement therapy because of permanent hypoparathyroidism after total thyroidectomy. CASE PRESENTATION: A 47-year-old woman who underwent a total thyroidectomy with a multinodular goiter developed hypoparathyroidism and hypocalcemia 1 week after discharge. The patient was started on daily oral calcitriol, magnesium effervescent, vitamin D, and IV calcium gluconate and was unable to be discharged because the IV calcium could not be stopped. After 3.5 years, 50×106 parathyroid cells were transplanted by injecting the cells into the left deltoid muscle of the patient. The immunosuppression of the patient, who used 20-mg methylprednisolone for the first month, was completely discontinued. RESULTS: No complications were observed in the patient after transplantation. The parenteral calcium replacement of the patient was progressively interrupted after transplantation. The patient's serum calcium level was 7.8 mg/dL and the PTH level was 6.9 pg/mL without IV calcium replacement at 12 weeks after transplantation, and the patient was discharged using oral ionized calcium. In the 10-week follow-up after discharge, the need for IV calcium was not observed in the patient. CONCLUSION: Parathyroid allotransplantation is a simple, fast, and cost-effective method that should be tried in patients with persistent hypoparathyroidism, especially those who have to take IV calcium replacement, because its cost is much cheaper than standard medical care, its morbidity is much more limited, and it increases the patient's quality of life.

Prospective multi-center study of surgeon's assessment of the gallbladder compared to histopathological examination to detect incidental malignancy.

PURPOSE: Routine histopathological examination after cholecystectomy for gallstones is performed despite the low rates of incidental findings of malignancy. The aim of this study was to assess predictive values of macroscopic examination of cholecystectomy specimens by surgeons in gallstone disease. METHODS: A prospective multi-center diagnostic study was carried out between December 2015 and March 2017 at four different centers. All patients undergoing cholecystectomy for gallstone disease were consecutively screened for eligibility. Patients whose ages are 18 to 80 years, and preoperative imaging findings without any pathology except cholelithiasis were included. The gallbladder was first evaluated macroscopically ex situ by two operating surgeons and rated as macroscopically benign (group S1), suspicious for a benign diagnosis (group S2), and suspicious for malignancy (group S3). Thereafter, a pathologist made a final histopathological examination whose results are grouped as chronic cholecystitis (group P1), benign or precancerous lesions in which only cholecystectomy is the adequate treatment modality (group P2), and carcinoma (group P3). Diagnostic accuracy of the surgeon's assessment to the histopathological examination was evaluated using sensitivity, specificity, positive and negative predictive values, and accuracy, and correlated by a kappa agreement coefficient. RESULTS: A total of 1112 patients were included in this trial. The specificity rates were 96.5%, 100%, and 98.7% for group S1-group S2, group S1-group S3, and group S2-group S3, respectively. Accuracy rates to detect malignancy were 100% and 95. 2% for group S1 and group S2, respectively. Kappa coefficient values were 1.0 and 0.64 for group S1-group S3 and group S2-group S3, respectively (p < 0.001 for both). CONCLUSION: Assessment of the gallbladder specimen and selective histopathological examination may be adequate after cholecystectomy for gallstone diseases. Such a procedure would have the potential to reduce costs and prevent unnecessary loss of labor productivity without affecting patients' safety. However, higher number of patients in more centers is needed to confirm this hypothesis.

Effect of Dexketoprofene Trometamol on Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

OBJECTIVE: To evaluate the efficacy of dexketoprofene trometamol solution following the administration of contrast agent for Endoscopic Retrograde Cholangiopancreatography (ERCP) in decreasing the rate of pancreatitis, in experimental rat model. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Faculty of Medicine, Research and Animal Laboratory of Bezmialem University, Istanbul, Turkey in January 2018. METHODOLOGY: Forty Wistar-Albino® male rats of 250-300g were divided into 4 equal groups. Group I underwent cannulation; group II had cannulation with saline; group III had cannulation and contrast agent; group IV had cannulation with contrast agent and dexketoprofene trometamol intra-muscular (IM). Twenty four hours following the procedure, the rats were sacrified and pancreatic tissues were examined histopathologically, with evaluation of blood levels of leukocyte, glucose, SGOT, LDH, amylase, and C-reactive protein (CRP) level. Histopathological grading of acute pancreatitis was performed using haematoxylin and eosin staining. RESULTS: Mean levels of amylase and leukocyte were found to be significantly higher in groups II, III, IV when compared to group I (p=0.001). CRP level was found to be highest in group III (p=0.001). Histopathological grade of pancreatitis was found to be significantly higher in groups II, III, IV than group I (p: 0.001, 0.001, 0.028, and 0.001, respectively). Scores of edema, acinar necrosis, inflammation and perivascular infiltration of group III were higher than in group IV (p=0.001). CONCLUSION: Intra-muscular administration of dexketoprofen trometamol during ERCP procedure may be beneficial in decreasing the rate of post-ERCP pancreatitis, as shown by histopathological and laboratory profile.

Effects of boric acid-linked ampicillin on the rat intra-abdominal sepsis model.

The aim of this study was to determine efficiency of a new molecule that was obtained by linking boric acid with ampicillin in treating intra-abdominal infection.Following intraperitoneal E. coli injection totwenty-one female Wistar albino rats, group 1 was administered boron-linked ampicillin, group 2 was administered only ampicillin and group 3 was injected intraperitoneally with physiological serum. IL-6, and a white blood cell analysis was performed from the blood before and on the seventh day of treatment.No statistically significant difference in blood WBC levels after treatment was found among the groups. There was no statistically significant difference in the IL-6 values of group 2 and group 3 before and after the treatment (p=0.195 and 0.193, respectively); however, the reduction in the serum IL-6 values of group 1 was statistically significant (p=0.003).Boric acid-linked ampicillin is a more effective intra-abdominal infection treatment compared with ampicillin alone.