The Relationship between Breast Cancer Subtypes, Prognostic Factors, and Apparent Diffusion Coefficient Histogram Analysis.

BACKGROUND: Diffusion Magnetic Resonance Imaging (MRI) is a useful method to evaluate tumor biology and tumor microstructure. The apparent diffusion coefficient (ADC) value correlates negatively with the cellular density of the tumor. OBJECTIVE: This study aimed to investigate the effectiveness of the ADC histogram analysis in showing the relationship between breast cancer prognostic factors and ADC parameters. METHODS: This study is a retrospective observational descriptive study. ADC histogram parameters were evaluated in all tumor volumes of 67 breast cancer patients. Minimum, 5, 10, 25, 50, 75, 90, 95 percentiles, maximum, mean, median ADC values, kurtosis, and skewness were calculated. Breast MRI examinations were performed on a 3T MR scanner. We evaluated the fibroglandular tissue density of bilateral breasts, background enhancement, localization of masses, multifocality-multicentricity, shape, rim, internal contrast enhancement, and kinetic curve on breast MRI. BIRADS scoring was performed according to breast MRI. Pathologically, histologic type, histologic grade, HER 2, Ki 67, ER-, and PR status were evaluated. RESULTS: A significant correlation was found between tumor volume and ADC scores. There is a significant correlation between min ADC values (p< 0.031), max ADC (p< 0.001), and skewness (p< 0.019). A significant correlation was found between tumor kurtosis and lymph nodes (p< 0.029). There was a significant difference in ADC mean, ADC10%, ADC25%, ADC50%, ADC75%, ADC90%, ADC 95% and ADCmax values depending on ER-and PRstatus. (for ER p = 0.004, p = 0.018, p = 0.010, p = 0.008, p = 0.004, p = 0.004, p = 0.02, p = 0.02 and p = 0.038, for PR p < 0.001, p = 0.028, p = 0.011, p = 0.001, p < 0.001, p =<0.001, p < 0.001, and p < 0.001, respectively; p < 0.05). These values were lower in ER-and PR-positive status than in ER-and PR-negative receptor status. According to HER2 status, there was a statistically significant difference in ADC5% and measurements of the lesions (p = 0.041; p < 0.05). Our study found no significant correlation between other prognostic factors, such as histological grade, Ki-67 indices, and ADC values. CONCLUSION: Our study found a significant difference between tumor volume, ER- and, PR status, HER2, and lymph node involvement, and some ADC values among prognostic factors for breast cancer. Furthermore, ADC histogram analysis can provide additional value in predicting some prognostic factors.

An effective colorectal polyp classification for histopathological images based on supervised contrastive learning.

Early detection of colon adenomatous polyps is pivotal in reducing colon cancer risk. In this context, accurately distinguishing between adenomatous polyp subtypes, especially tubular and tubulovillous, from hyperplastic variants is crucial. This study introduces a cutting-edge computer-aided diagnosis system optimized for this task. Our system employs advanced Supervised Contrastive learning to ensure precise classification of colon histopathology images. Significantly, we have integrated the Big Transfer model, which has gained prominence for its exemplary adaptability to visual tasks in medical imaging. Our novel approach discerns between in-class and out-of-class images, thereby elevating its discriminatory power for polyp subtypes. We validated our system using two datasets: a specially curated one and the publicly accessible UniToPatho dataset. The results reveal that our model markedly surpasses traditional deep convolutional neural networks, registering classification accuracies of 87.1% and 70.3% for the custom and UniToPatho datasets, respectively. Such results emphasize the transformative potential of our model in polyp classification endeavors.

Tetramethylpyrazine Attenuates Radiation-Induced Ototoxicity in a Rat Model.

INTRODUCTION: Tetramethylpyrazine (TMP) is a chemical compound, which has been shown to possess numerous biological features such as anticoagulation, inhibition of platelet aggregation, anti-inflammation, capillary dilatation, improvement in microcirculation, and protection against reactive oxygen radicals. The aim of the present study was to investigate the protective effect of TMP against radiation-induced ototoxicity. MATERIALS AND METHODS: 40 rats were divided into four groups. The first group was irradiated for 5 days. The second group received a single dose of 140 mg/kg/day intraperitoneal TMP given to the rats 30 min before radiotherapy (RT) for 5 days. The third group received a single dose of 140 mg/kg/day i.p. TMP for 5 days, whereas the fourth group was administered saline. All rats underwent distortion product otoacoustic emission (DPOAE) and auditory brainstem response measurements before and after the application. The temporal bulla of animals was removed for immunohistopathological examination. RESULTS: Signal-noise ratio values were significantly decreased in the RT group for the frequencies of 2-32 kHz after RT (p < 0.05), whereas the difference was not significant in terms of pre- and posttreatment values for the other groups. Also in the RT group, the ABR thresholds were significantly increased after treatment. In H&E staining, the mean scores for outer hair cells (OHCs), stria vascularis (SV), and spiral ganglion (SG) injuries were significantly higher in RT and RT + TMP groups than in the other groups. The mean OHCs and SV injury scores were also significantly higher in the RT group than in the RT + TMP group (p < 0.05). The number of cochleas that showed cytoplasmic caspase-3 immunoreactivity in the OHC, SV, and SG was significantly higher in RT and RT + TMP groups than in the other groups. CONCLUSION: The findings of the present study suggest that TMP may have a therapeutic potential for preventing sensorineural hearing loss (SNHL) related to RT.

Improved classification of colorectal polyps on histopathological images with ensemble learning and stain normalization.

BACKGROUND AND OBJECTIVE: Early detection of colon adenomatous polyps is critically important because correct detection of it significantly reduces the potential of developing colon cancers in the future. The key challenge in the detection of adenomatous polyps is differentiating it from its visually similar counterpart, non-adenomatous tissues. Currently, it solely depends on the experience of the pathologist. To assist the pathologists, the objective of this work is to provide a novel non-knowledge-based Clinical Decision Support System (CDSS) for improved detection of adenomatous polyps on colon histopathology images. METHODS: The domain shift problem arises when the train and test data are coming from different distributions of diverse settings and unequal color levels. This problem, which can be tackled by stain normalization techniques, restricts the machine learning models to attain higher classification accuracies. In this work, the proposed method integrates stain normalization techniques with ensemble of competitively accurate, scalable and robust variants of CNNs, ConvNexts. The improvement is empirically analyzed for five widely employed stain normalization techniques. The classification performance of the proposed method is evaluated on three datasets comprising more than 10k colon histopathology images. RESULTS: The comprehensive experiments demonstrate that the proposed method outperforms the state-of-the-art deep convolutional neural network based models by attaining 95% classification accuracy on the curated dataset, and 91.1% and 90% on EBHI and UniToPatho public datasets, respectively. CONCLUSIONS: These results show that the proposed method can accurately classify colon adenomatous polyps on histopathology images. It retains remarkable performance scores even for different datasets coming from different distributions. This indicates that the model has a notable generalization ability.

What factors drive gender differences in the body mass index? Evidence from Turkish adults.

In recent years, studies show that obesity has become an important health condition, especially among adults. The first aim of this study is to examine socio-demographic and behavioural factors on body mass index distribution of male and female adults over 20 years old in Turkey. The second aim is to determine the body mass index disparity by gender and the socio-demographic and behavioural factors that might wider or narrow it. This study adopts unconditional quantile regression and decomposition methods, and the data set covers the Turkish Health Surveys for 2014, 2016, and 2019. The findings document that high level of body mass index are associated with being married, aging, and physical inactivity. Interestingly, employment status has different contributions on the body mass index of males and females. The results also claim a body mass index gap among males and females as a result of differences in some potential socio-demographic and behavioural factors, and the gap gets higher at the upper and lower quantiles of BMI distribution. This study may provide a clear understanding for policymakers on how to design efficacious obesity policies considering the differences in the effect of socio-demographic and behavioural factors on the distribution of body mass index across females and males. The results suggest that the Ministry of Health should specifically target different groups for males and females and should reduce the differences in socio-demographic and behavioural determinants between females and males to prevent and reduce obesity prevalence in Turkey.

Students in Turkey During the Early Days of the COVID-19 Pandemic.

This study aims to analyse the subjective well-being of university students during the early days of the COVID-19 pandemic process and to examine how students have been affected economically, psychologically and socially. Other subjects included in the scope of the study are the suitability of the physical conditions during the process of online education, the students' motivation, and their expectations towards the future. The study also analyses the connection between these factors and the subjective well-being concepts of happiness and life satisfaction. The study focuses on students of the Faculty of Economics at Marmara University in Turkey. In total, 428 students took part in the survey prepared for the study. Descriptive analyses indicate that students have been negatively affected in terms of psychological and socio-economic factors along with subjective well-being. Ordered probit models show a statistically significant relationship between a major part of these changes and subjective well-being variables.

Bibliometric analysis of the published literature on machine learning in economics and econometrics.

An extensive literature providing information on published materials in machine learning exists. However, machine learning is still a rather new concept in the fields of economics and econometrics. This study aims to identify different properties of published documents about machine learning in economics and econometrics and therefore to draw a detailed picture of recent publications from bibliometric analysis perspectives. For the aim of the study, the data are collected from the publications indexed by Web of Science and Scopus databases from the period 1991 to 2020. Inthe study, the data have been illustrated by VOSviewer for science mapping. The analysis of variance has also been used to identify the links between the number of citations of articles and years. The findings obtained provides information about the studies on machine learning in the relevant field conducted in the past, as well as providing an opportunity to gain knowledge about the researched area by shedding light on what the future research areas would be. There is no doubt that it attracts attention has increased significantly on machine learning in the field of economics and econometrics and academic publications on machine learning in the relevant field have increased over the last decade.

Mucinous appendiceal neoplasms and pseudomyxoma peritonei: Morphological and clinical findings, differential diagnosis, and prognosis.

Background: Low-grade appendiceal mucinous neoplasms (LAMN) of the appendix have bland cytological features and well-differentiated morphology. Despite this, they may cause a pseudomyxoma peritonei (PMP) disease characterized by mucinous deposits in the peritoneal cavity and may exhibit malignant behavior. Aims and Objectives: In this study, we evaluated the clinical course and histopathological findings of LAMN. The rate of progression to PMP, factors affecting its development, and the clinical course of cases with PMP were investigated. Materials and Methods: Twelve thousand and forty-seven cases who underwent appendectomy were reviewed, and 71 mucinous lesions cases whose slides are in our archive were included in the study. Histopathological findings were re-evaluated. Morphological findings that guide the differential diagnosis, the clinical course of the patients, and factors affecting PMP development were determined. Results: The cases were divided into group 1 non-neoplastic (9.9%), group 2 benign (18.3%), group 3 LAMN (60.6), and group 4 malignant neoplasms (11.3%). Age, gender, appendix diameter, gross appearance, epithelial characteristics, and presence of microcalcification were significantly different between the patient groups. The presence of mucin in the ileocecal region was found to be significant in the development of PMP. It was observed that the additional procedure performed after the appendectomy did not prevent a recurrence. Conclusion: LAMNs are lesions with characteristic findings and different behaviors. The only method to distinguish from the lesions included in the differential diagnosis is to interpret the histopathological findings correctly. Additional operations after appendectomy do not contribute to preventing recurrence.

Effect of boric acid on cartilage formation of osteochondral defects in rabbit knee: An experimental study.

BACKGROUND: The present study aimed to investigate the healing of articular cartilage with boric acid (BA) injection in an experimental cartilage defect model of rabbit knee. METHODS: Nine skeletally mature female New Zealand White rabbits were used. The right knees of the rabbits were assigned as the study group and injected with the BA solution and the left knees of the rabbits as the control group. Under anesthesia, a cylindrical full-thickness osteochondral defect (4 mm in diameter and 3 mm in depth) was formed using a drill on the anterior side of the articular surface of the medial femur condyle. The BA solution was administered to the right knees of rabbits in the form of an intra-articular injection (8 mg/kg) for 6 weeks, at the same day and hours each week. The animals were euthanized at the end of the 2nd month. RESULTS: In both macroscopic evaluation and microscopic evaluation, statistically significant differences were observed in the BA injection group compared with the control group (p<0.05). In the macroscopic examination of the defect area, statistically significant differences were observed between the groups in terms of degree of defect repair, integration to border zone, and macroscopic appearance (p<0.05). The averaged results of all evaluated parameters of the International Cartilage Repair Society visual histological assessment score were better for the BA group. CONCLUSION: The healing process of the cartilage injury could be improved by BA injection administration. In future, BA may safely be used as an additional treatment modality in clinical practice to enhance the healing process of cartilage injuries, which are commonly observed orthopedic problem.

The Effect of Allantoin on Chronic Perforation of Rat Tympanic Membrane.

OBJECTIVES: This study aimed to investigate the effectiveness of topical allantoin application on wound healing in a rat chronic tympanic membrane perforation (TMP) model. METHODS: A chronic TMP model was established with 25 healthy, female, 6-month-old, Sprague Dawley rats with chemical damage (trichloroacetic acid 50%). The rats were randomly assigned into 3 groups as follows: Group 1 (10 rats, 20 ears) was administered intratympanic (IT) 20 µL/day 0.57% allantoin solution 7 times, every other day; Group 2 (5 rats, 10 ears) received no substance; Group 3 (10 rats, 20 ears) received IT 20 µl/day distilled water 7 times, every other day. After tympanic membrane (TM) examination with an otoendoscope, histopathological examination of the TM was performed to evaluate neutrophil activity, chronicity, histiocytes, keratin accumulation, subepithelial edema, congestion, fibroblast proliferation, neovascularization, and tympanic membrane thickness. RESULTS: Two TM perforations, 1 in Group 1 and 1 in Group 3, were not healed whereas TM perforations in 48 ears demonstrated closure at the end of the study. According to the histopathological examination, neutrophil activity and fibroblast proliferation were significantly higher in Group 1. There was no significant difference between the groups in terms of other histopathological parameters. CONCLUSION: To the best of our knowledge, this is the first study investigating the effect of allantoin in an experimental chronic TMP model. According to the histopathological findings, allantoin may have positive effects on the wound healing process of chronic TMP.

The Prognostic Effects of Clinicopathological Features on Rectal Cancer Patients undergoing Neoadjuvant Chemoradiotherapy.

OBJECTIVE: To investigate the effects of clinicopathological features on disease-free survival (DFS) and overall survival (OS) in in-patients with local advanced rectal cancer (LARC) who received neoadjuvant chemoradiotherapy (nCRT). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Clinic of Radiation Oncology, Kayseri Training and Research Hospital and Kayseri City Hospital, Turkey, between January 2014 and June 2019. METHODOLOGY: The pre-nCRT, post-nCRT, and postoperative imaging methods of 51 patients, who were operated upon, were examined. Radiological images (CT and MRI) of the patients were reviewed using the hospital's PACS system. Pathology reports and preparations were re-evaluated, and TNM staging and the pathological tumour regression grade (pTRG) were graded according to the American Joint Committee on Cancer's (AJCC) 2018 version. For the descriptive statistics of the data, the mean, standard deviation, lowest-highest median, frequency, and ratio values were used. Cox regression (univariate-multivariate analysis) and Kaplan-Meier curves were used for survival analysis. RESULTS: In the univariate model, the postoperative pathological T and N stages (ypT and ypN), pathological stage, positive lymph node count (pLN+, pathological sampling) and lymphovascular invasion (LVI) positivity had a significant effect (p <0.05) on DFS. In the multivariate reduced model, a significant independent (p <0.05) effect of the ypT and pLN+ number was observed on DFS. In the univariate model, the pathological tumour diameter after nCRT, the ypT, perineural invasion (PNI) positivity, and relapse presence had a significant effect (p <0.05) on OS. In the multivariate reduced model, a significant independent (p <0.05) effect of recurrence was observed on OS. CONCLUSION: LVI, the ypTN stage, and the pLN+ number affected the disease-free survival, while the residual tumour diameter after nCRT, ypT stage, and PNI affected the overall survival. The predicted DFS time decreased as the ypT stage increased and the predicted OS time decreased as the recurrence increased. Key Words: Rectal cancer, Neoadjuvant chemoradiotherapy, Disease-free survival, Overall survival.

Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 22-G Needle for Hepatic Lesions: Single-Center Experience.

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively. METHODS: Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed. RESULTS: A total of 25 patients (10 females) were included in the study. The mean age was 62.73±15.2 years. The mean size of the masses was 34.50±16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications. CONCLUSION: For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates.

Identifying the systemically important banks of Turkey with the CoVaR method.

The purpose of this paper is to measure the systemic risk contributions of Turkish banks and to identify the systemically important banks of Turkey during the period from 2005 to 2016. We apply the conditional value-at-risk (CoVaR) method proposed by Adrian and Brunnermeier (2009) using quantile regression. The study includes thirteen major banks of Turkey, including both public and private banks, out of a total of 52 banks. The banks are ranked in terms of their systemic risk contribution to the Turkish financial system based on their asset returns, macroeconomic variables and individual bank variables. The study reveals that Akbank, Garanti, Yapi Kredi and Isbank have the highest systemic risk contribution to the financial system when adding macroeconomic variables to the model. This ranking is changed to Yapi Kredi, Garanti, TEB, Sekerbank and Akbank when taking into account bank-specific variables. One surprising result is that risk in isolation and the spillover risks of public banks are smaller than in large private banks. Furthermore, the marginal systemic risk contributions of public banks are smaller than those of private banks. In conclusion, authorities improve the regulatory framework according to the context of CoVaR in addition to monitor the idiosyncratic risks of banks.

Do PD-1 and PD-L2 expressions have prognostic impact in hematologic malignancies?

Background/aim: PD-1 (programmed death-1) is an immune checkpoint receptor that modulates T-cell activity in peripheral tissues via interaction with its ligands, PD-L1 (programmed death-ligand 1) and PD-L2 (programmed death-ligand 2). Tumor cells upregulate PD-L1 or PD-L2 to inhibit this T lymphocyte attack. Our goal was to determine the PD-1 and PD-L2 expression rates of various hematologic malignancies, and evaluate whether PD-1 and PD-L2 expressions have an impact on prognosis. Materials and methods: For this purpose, pretreatment bone marrow biopsy specimens of 83 patients [42 multiple myeloma (MM), 21 acute leukemia, and 20 chronic lymphocytic leukemia (CLL)] were stained with monoclonal antibody immunostains of PD-1 and PD-L2. Results: As a result, the overall expression rate of PD-1 was 26.2%, 4.8%, and 60% in patients with MM, acute leukemia, and CLL, respectively, whereas the PD-L2 expression rate was 61.9%, 14.3%, and 10% in patients with MM, acute leukemia, and CLL, respectively. Conclusion: Finally, we concluded that the role of the PD-1 pathway can be demonstrated by immunohistochemistry (IHC). Since we evaluated whether there is a correlation between the (IHC) results and survival of patients with MM, acute leukemia, and CLL, we could not demonstrate meaningful evidence that these markers have an impact on prognosis.

The protective role of tetramethylpyrazine against cisplatin-induced ototoxicity.

OBJECTIVES: The aim of the present study was to investigate the protective effect of tetramethylpyrazine (TMP) on cisplatin-induced ototoxicity in rats. METHODS: Forty healthy, female, 24-week-old, Sprague-Dawley rats (n = 40) were randomly assigned to four groups as follows: group one (n = 10) received intraperitoneal (i.p.) physiological saline at daily doses of 3 mg/kg for seven days; group two (n = 10) received a single dose of i.p. 15 mg/kg cisplatin; group three (n = 10) received i.p. 140 mg/kg TMP daily for seven days plus a single dose of i.p. 15 mg/kg cisplatin on the fourth day; group four (n = 10) received i.p. 140 mg/kg TMP daily for seven days. Auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) measurements were obtained from the animals (40 rats, 80 ears) under general anesthesia before and after drug administration. The temporal bulla of animals were bilaterally removed for immunohistopathological examination. RESULTS: In group two, DPOAE and ABR values were significantly deteriorated after drug administration, whereas there was no statistically significant difference between the pre- and posttreatment DPOAE and ABR values for all frequencies for groups one, three and four. The mean scores for external ciliated cells (ECCs), stria vascularis (SV) and spiral ganglion (SG) injuries in hematoxylin and eosin (H&E) staining, and also caspase-3 immunoreactivity were significantly higher in group two than in the other groups. CONCLUSION: In the present study, the protective effect of TMP on cisplatin ototoxicity was demonstrated through studies of electrophysiology and immunohistopathology. Co-administration of TMP may have potential protective effects against cisplatin-induced ototoxicity.

Gastric metastasis of renal cell carcinoma 20 years after radical nephrectomy.

Renal cell carcinomas account for 2-3% of malignant neoplasms in adults. The lung, soft tissues and bone represent the most frequent sites of distant metastasis in renal cell carcinoma. Gastric metastasis is rare. Our case was a 72-year-old man with complaints of fatigue and loss of appetite. In history, he had unergone radical nephrectomy due to renal cell carcinoma in 1993. A polypoid lesion was observed in upper gastrointestinal endoscopy. Histopathology of gastric biopsy specimen was reported as renal cell carcinoma. In English literature, there are 50 cases diagnosed as gastric metastasis from renal cell carcinoma. To date, there are only 4 cases with extremely late gastric metastasis of renal cell carcinoma. Herein, we present a rare case which underwent radical nephrectomy due to renal cell carcinoma and found to have gastric metastasis at 20. year of his follow-up.

A Rare Cause of Hoarseness: Laryngeal Verruca Vulgaris.

Verruca vulgaris is a cutaneous disease manifested with a single or multiple, small painless lesions that may involve keratinized or nonkeratinized epithelium. It can be localized at skin or mucosa. It is a benign lesion; however, it is of importance to discriminate from verrucous carcinoma to plan treatment, especially in those with laryngeal localization. Total excision is adequate in the management of verruca vulgaris; thus, accurate differential diagnosis is essential to avoid unnecessary surgical interventions. Here, the authors presented a patient with verruca vulgaris which was totally excised by cold-blade surgical excision.

Primary Small Cell Carcinoma of the Hypopharynx: A Case Report of a Rare Tumor.

Introduction. Primary hypopharynx involvement of small cell carcinoma is very rare and very few cases have been reported in the literature. Here, we report a case of primary small cell carcinoma of the hypopharynx in a male patient. Case Report. A 50-year-old man presented with a 6-month history of sore throat and swellings in the right side of the neck. Direct laryngoscopy and biopsy revealed small cell carcinoma of the hypopharynx located in the right pyriform sinus. Discussion. Small cell carcinoma of the hypopharynx has no clear treatment modality due to the rarity of the disease. Systemic chemotherapy and radiotherapy should have priority among the therapy regimens because of the high metastatic potential of the tumor.

A Rare Tumor of the Retropharyngeal Area: Solitary Fibrous Tumor.

We describe a case of retropharyngeal solitary fibrous tumor (SFT) in a 46-year-old female patient. Total removal of the tumor without any complications was performed by transoral surgery. Intraoral resection of retropharyngeal SFT can be preoperatively performed by meticulous assessment of the extent and vasculature of the tumor with radiological guidance.