The association between exocrine pancreatic dysfunction and insulin resistance in an insulin-resistant population in Turkey: A cross-sectional study.

Background: In insulin resistance (IR), it is thought that pancreatic fat accumulation may decrease pancreatic volume, cause an impaired endocrine function, and simultaneously lead to an exocrine dysfunction before diabetes develops. Aim: The association between pancreatic exocrine function and insulin resistance (IR) was assessed in a population with insulin resistance. Method: This was a descriptive cross-sectional study that included 43 IR cases with no other comorbid diseases or pregnancy and 41 healthy controls. Fasting blood adiponectin, leptin, pancreatic amylase, lipase, and stool fecal elastase-1 (FE-1) were studied and compared in both groups. Results: The IR group consisted of 38 females (88.3%) and five males (11.6%), while the control group consisted of 31 females (75.6%) and ten males (24.3%). FE-1 levels were significantly lower in the IR group (P-value <0.01). Blood glucose, insulin, and HbA1c levels were significantly higher in the IR group than in the control (P-value of <0.01, <0.01, <0.01, respectively). Leptin levels were significantly higher in the IR group compared to the controls (P-value = 0.013). After dividing the whole group (n: 84) into two groups as FE-1 <200 µg/g (n: 61) and FE-1 ≥200 µg/g (n: 23), logistic regression analysis was performed; the significant predictor of low FE-1 was HOMA-IR (ODD ratio: 4.27, P-value <0.01, 95% confidence interval for ODD ratio: 1.95-9.30). Conclusion: This study showed that IR is associated with pancreatic exocrine dysfunction.

Embolización vesical supraselectiva versus formalina intravesical para la hematuria intratable en pacientes con cáncer de vejiga / Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer

Objetivo La hematuria intratable en los pacientes con cáncer de vejiga (CV) en estadio avanzado no subsidiarios de cistectomía radical es una de las condiciones de más complejo abordaje. El objetivo del presente estudio, pionero en la literatura, fue comparar la eficacia de la formalina intravesical (FI) y la embolización supraselectiva de la arteria vesical (ESAV) en el manejo de la hematuria intratable y potencialmente mortal en pacientes con CV.Métodos El estudio retrospectivo incluyó a 40 pacientes con CV que se sometieron a tratamiento con ESAV o FI por hematuria intratable tras el fracaso de otros métodos. Los pacientes se dividieron en dos grupos de acuerdo con los procedimientos administrados: grupo ESAV (n=24) y grupo FI (n=16).Resultados La tasa de éxito en la terapia de primera línea fue del 50% (12/24) en el grupo ESAV y del 82% (13/16) en el grupo FI (p=0,046). Con base en las tasas de éxito en los tratamientos de primera y segunda línea, la tasa de éxito global en el grupo ESAV fue del 75%; similar a la del grupo FI (p=0,439). La tasa de complicaciones fue significativamente mayor en los pacientes de FI que en los de ESAV (37,5% frente a 8,3%; p=0,024), mientras que la duración de la estancia hospitalaria postoperatoria fue significativamente mayor en el grupo ESAV (15,8 frente a 6 días; p=0,041).Conclusión Entre las ventajas de la FI parecen estar una estancia hospitalaria postoperatoria más corta y mayores tasas de éxito tras una sola sesión, mientras que las ventajas de la ESAV parecen incluir la realización sin anestesia espinal/general, la fácil repetibilidad del procedimiento y las bajas tasas de complicaciones. En el tratamiento de los pacientes con hematuria intratable, se debe tener en cuenta el estado general de los pacientes, las comorbilidades y los riesgos relacionados con la anestesia (AU)

Objective Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients.Methods The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n=24) and IF Group (n=16).Results The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p=0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p=0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p=0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p=0.041).Conclusion The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients’ general condition, comorbidities, and anesthesia-related risks should be taken into consideration (AU)

Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer.

OBJECTIVE: Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. METHODS: The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n = 24) and IF Group (n = 16). RESULTS: The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p = 0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p = 0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p = 0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p = 0.041). CONCLUSION: The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients' general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer. / Embolización vesical supraselectiva versus formalina intravesical para la hematuria intratable en pacientes con cáncer de vejiga.

OBJECTIVE: Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. METHODS: The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n=24) and IF Group (n=16). RESULTS: The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p=0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p=0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p=0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p=0.041). CONCLUSION: The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients' general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy.

OBJECTIVE: To investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA < 10 ng/mL undergoing fusion prostate biopsy. METHODS: The prospective study included patients who were planned for fusion prostate biopsy and had PSA < 10 ng/mL and a PI-RADS ≥ 3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII = platelet × neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity + specificity - 1). RESULTS: The study included 508 patients with a mean age of 62.49 ±â€¯6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/mL. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC = 0.487, P = 0.622), it was revealed as a significant marker in PCa patients with an ISUP grade ≥ 3 (AUC = 0.811, P < 0.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII. CONCLUSION: SII and SII combination with PI-RADS score appear to be a significant diagnostic marker in patients with high-grade PCa (ISUP grade 3-5). These values were found to be higher compared to those of patients with a benign pathology and patients with lower ISUP scores.

Eficacia diagnóstica del índice de inmunidad-inflamación sistémica en la biopsia de próstata por fusión / Diagnostic efficiency of systemic immune-inflammation index in fusion prostate biopsy

Objetivo: Evaluar la eficacia diagnóstica del índice de inmunidad-inflamación sistémica (IIS) en el cáncer de próstata (CaP) en pacientes con PSA<10ng/ml sometidos a una biopsia de próstata por fusión.MétodosEl estudio prospectivo incluyó a pacientes con una biopsia de próstata por fusión planificada, con un PSA<10ng/ml y un PI-RADS≥3. Todos los pacientes se sometieron a una biopsia prostática transrectal estándar de 12 cilindros, seguida de una biopsia dirigida (biopsia combinada). Con base en los parámetros del recuento sanguíneo completo preoperatorio, el IIS se calculó mediante la siguiente fórmula: IIS=plaquetas×índice neutrófilo-linfocito. Las correlaciones entre la puntuación PI-RADS, las plaquetas, el índice neutrófilo-linfocito, el PSA, la densidad de PSA, el IIS y el CaP se determinaron utilizando el análisis de curvas ROC. Los valores de corte óptimos se determinaron utilizando el máximo del índice de Youden (definido como: sensibilidad+especificidad−1).ResultadosEl estudio incluyó 508 pacientes con una media de edad de 62,49±6,86 años y un nivel medio de PSA de 7,28 (5,69-8,70) ng/ml. La tasa global de CaP clínicamente significativo fue del 39,4%. Aunque el IIS no tenía un valor diagnóstico significativo en los pacientes con CaP de bajo grado ISUP (grado 1 y 2) (AUC=0,487, p=0,622), se reveló como un marcador significativo en los pacientes con CaP con un grado de ISUP≥3 (AUC=0,811, p<0,001). El valor de corte del IIS fue de 533,0. Aunque la combinación de IIS con la puntuación PI-RADS conforman el marcador más efectivo, el índice neutrófilo-linfocito y las plaquetas también se mostraron como marcadores efectivos en la predicción del CaP de grado ISUP 3-5, aunque no tanto como el IIS. (AU)

Objective: To investigate the diagnostic efficiency of systemic immune response (SII) in prostate cancer (PCa) in patients with PSA<10ng/ml undergoing fusion prostate biopsy.MethodsThe prospective study included patients who were planned for fusion prostate biopsy and had PSA<10ng/ml and a PI-RADS≥3. All the patients underwent 12-core standard transrectal prostate biopsy followed targeted biopsy (combined biopsy). Based on preoperative complete blood count parameters, SII was calculated using the following formula: SII=platelet×neutrophil-to-lymphocyte ratio. Correlations between PI-RADS score, platelet, neutrophil-to-lymphocyte ratio, PSA, PSA density, SII and PCa were determined using ROC curve analysis. Optimal cut-off values were determined using the maximum Youden Index (defined as: sensitivity+specificity−1).ResultsThe study included 508 patients with a mean age of 62.49±6.86 years and a median PSA level of 7.28 (5.69-8.70) ng/ml. The overall clinically significant PCa rate was 39.4%. Although SII had no significant diagnostic value in PCa patients with low ISUP grades (grade 1 and 2) (AUC=0.487, P=.622), it was revealed as a significant marker in PCa patients with an ISUP grade≥3 (AUC=0.811, P<.001). The cut-off value of SII was 533.0. While the combination of SII with PI-RADS score is the most effective marker, neutrophil-to-lymphocyte ratio and platelet were also revealed as effective markers in predicting ISUP grade 3-5 PCa, though not as effective as SII. (AU)

Imaging findings of a rare pararectal splenosis and literature review.

Pararectal splenosis is an extremely rare lesion caused by ectopic auto-transplantation of splenic tissue after splenic trauma or splenectomy. It is often asymptomatic and detected incidentally during radiologic evaluation. We present a 24-year-old male with pararectal splenosis. The patient had a history of splenectomy and presented with complaints of abdominal discomfort and chronic constipation. Contrast-enhanced computed tomography (CT) revealed multiple well-enhanced masses located in the abdominal cavity and one mass in pararectal area. Additionally, the pararectal lesion showed diffusion restriction on diffusion-weighted magnetic resonance imaging (DW-MRI). In this case report, we aim to highlight the significance of taking a detailed medical history; and using DW-MRI for diagnosis of splenosis by presenting a case in a rare location.

Accuracy of CBCT images in the volumetric assessment of residual root canal filling material: Effect of voxel size.

AIMS: Our aim was to compare three different voxel sizes of CBCT images for the determination of residual filling material volume in root canals when compared with micro CT. MATERIAL AND METHODS: Forty-two root canals of 14 extracted human maxillary molar teeth were retreated by using ProFile® instruments. Images were obtained after retreatment by using ProMax 3D Max CBCT at 3 different voxel sizes (1) High resolution (0.1 mm); (2) High definition (0.15 mm); and (3) Normal resolution (0.2 mm). Two observers measured volumes of residual filling materials in exported CBCT images by means of 3D Doctor Software. Micro CT measurements were served as gold standard. Mann-Whitney U test and Wilcoxon Test were used for the comparison of CBCT and micro CT measurements. Statistical significance was set at P < 0.05. RESULTS: No statistically differences were found between the two observers for all measurements (P > 0.05). There were no significant differences among different CBCT voxel sizes used (0.1 mm, 0.15 mm, and 0.2 mm) (P > 0.05). The Spearman correlation coefficients between CBCT at different voxel sizes significantly highly correlated with micro CT measurements for each observer (P < 0.05). Furthermore, no significant differences were found between the measurements obtained by the two observers in consideration to root canal location (P > 0.05). CONCLUSION: CBCT images may provide useful information in the volumetric assessment of the amount of residual filling material in root canals for retreatment procedures.

Ability to detect endodontic complications using three different cone beam computed tomography units with and without artefact reduction modes: an ex vivo study.

AIM: To assess observer performance in detecting endodontic complications using three different cone beam computed tomography (CBCT) units with and without the application of artefact reduction modes. METHODOLOGY: The study involved 40 freshly extracted human mandibular teeth (n = 10 per group) and divided randomly into four endodontic complication groups. Group 1) Instrument fracture; Group 2) Strip perforation; Group 3) Canal underfilling; and Group 4) Canal overfilling. Images of each tooth were obtained using three different CBCT units offering artefact reduction algorithms: the ProMax 3D Max, the Pax Flex 3D and the Dentri S. Four observers evaluated the images for the presence/absence of the four simulated endodontic complications. Weighted kappa coefficients and intra-class correlation coefficients (ICCs) were calculated to reveal the intra- and inter-observer agreement for each imaging mode, respectively. Receiver operating characteristic (ROC) analysis was used to evaluate the observers' performance. DeLong tests were used to compare the results for each image mode and observer using a significance level of α = 0.05. RESULTS: In each of the four simulated endodontic complication groups, no significant differences were observed with and without application of artefact reduction for any of the three CBCT units tested. Only two significant differences were detected, and both were between the ProMax 3D Max at low mode AR and ProMax 3D Max without AR: observer 2 in group 1 (P = 0.0001) and observer 4 in group 4 (P = 0.0256). CONCLUSION: For each of the three CBCT units tested, application of artefact reduction for detecting endodontic complications is not recommended as a routine tool.

Effects of Varied Versus Constant Loading Zones on Muscular Adaptations in Trained Men.

The purpose of this study was to compare the effects of a protocol employing a combination of loading zones vs. one employing a constant medium-repetition loading zone on muscular adaptations in resistance-trained men. 19 trained men (height=176.9±7.0 cm; body mass=83.1±11.8 kg; age=23.3±2.9 years) were randomly assigned to 1 of 2 experimental groups: a constant-rep resistance training (RT) routine (CONSTANT) that trained using 8-12 RM per set, or a varied-rep RT routine (VARIED) that trained with 2-4 RM per set on Day 1, 8-12 RM per set on Day 2, and 20-30 RM on Day 3 for 8 weeks. Results showed that both groups significantly increased markers of muscle strength, muscle thickness, and local muscular endurance, with no differences noted between groups. Effect sizes favored VARIED over CONSTANT condition for elbow flexor thickness (0.72 vs. 0.57), elbow extensor thickness (0.77 vs. 0.48), maximal bench press strength (0.80 vs. 0.57), and upper body muscle endurance (1.91 vs. 1.28). In conclusion, findings indicate that both varied and constant loading approaches can promote significant improvements in muscular adaptations in trained young men.

Solitary tuberculous brain lesions: 24 new cases and a review of the literature.

A solitary tuberculous brain lesion (STBL) can be difficult to distinguish from a glioma, metastasis or other infectious disease, especially from a pyogenic brain abscess. We analyzed the clinical characteristics, diagnostic procedures and outcomes of 24 patients with STBL diagnosed in three centers from France, India and Mexico. We also reviewed 92 STBL cases previously reported in the literature. General symptoms were found in 54% of our patients, including enlarged lymph nodes in 20%. Cerebrospinal fluid was typically abnormal, with lymphocytic pleocytosis and a high protein level. The lung CT scan was abnormal in 56% of patients, showing lymphadenopathy or pachipleuritis. Brain MRI or CT was always abnormal, showing contrast-enhanced lesions. Typically, MRI abnormalities were hypointense on T1-weighted sequences, while T2-weighted sequences showed both a peripheral hypersignal and a central hyposignal. The diagnosis was documented microbiologically or supported histologically in 71% of cases. Clinical outcome was good in 83% of cases.

Effects of different volume-equated resistance training loading strategies on muscular adaptations in well-trained men.

Regimented resistance training has been shown to promote marked increases in skeletal muscle mass. Although muscle hypertrophy can be attained through a wide range of resistance training programs, the principle of specificity, which states that adaptations are specific to the nature of the applied stimulus, dictates that some programs will promote greater hypertrophy than others. Research is lacking, however, as to the best combination of variables required to maximize hypertophic gains. The purpose of this study was to investigate muscular adaptations to a volume-equated bodybuilding-type training program vs. a powerlifting-type routine in well-trained subjects. Seventeen young men were randomly assigned to either a hypertrophy-type resistance training group that performed 3 sets of 10 repetition maximum (RM) with 90 seconds rest or a strength-type resistance training (ST) group that performed 7 sets of 3RM with a 3-minute rest interval. After 8 weeks, no significant differences were noted in muscle thickness of the biceps brachii. Significant strength differences were found in favor of ST for the 1RM bench press, and a trend was found for greater increases in the 1RM squat. In conclusion, this study showed that both bodybuilding- and powerlifting-type training promote similar increases in muscular size, but powerlifting-type training is superior for enhancing maximal strength.

Effect of exercise on appetite-regulating hormones in overweight women.

Over the past decade, our knowledge of how homeostatic systems regulate food intake and body weight has increased with the discovery of circulating peptides such as leptin, acyl ghrelin, des-acyl ghrelin and obestatin. These hormones regulate the appetite and food intake by sending signals to the brain regarding the body's nutritional status. The purpose of this study was to investigate the response of appetite-regulating hormones to exercise. Nine overweight women undertook two 2 h trials in a randomized crossover design. In the exercise trial, subjects ran for 60 min at 50% of maximal oxygen uptake followed by a 60 min rest period. In the control trial, subjects rested for 2 h. Obestatin, acyl ghrelin, des-acyl ghrelin and leptin concentrations were measured at baseline and at 20, 40, 60, 90 and 120 min after baseline. A two-way ANOVA revealed a significant (P < 0.05) interaction effect for leptin and acyl ghrelin. However, changes in obestatin and des-acyl ghrelin concentration were statistically insignificant (P > 0.05). The data indicated that although acute treadmill exercise resulted in a significant change in acyl ghrelin and leptin levels, it had no effect on plasma obestatin and des-acyl ghrelin levels.

Using diffusion weighted MR imaging in a lipomatous chest wall lesion.

Hibemoma is a rare benign soft tissue tumor derived from brown fat.The tumor is also known as "fetal lipoma, lipoma of embryogenic fat and lipoma of immature adipose tissue. Hibemomas are slow-growing, painless soft tissue tumors which do not recur after surgical resection. Preferred locations are brown fat containing sites as thigh, interscapular region, shoulder, axilla, and mediastinum.The tumor occurs most commonly in adults, with a mean age of 38 years (age range, 2-75 years). We present a rare case of hibernoma with radiological and pathological findings.

Intramedullary hydatid cyst of the cervical spine.

Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions.