Evaluation of Hemogram Parameters in the Diagnosis of Pulmonary Embolism: Immature Granulocytes and Other New Tips.

Pulmonary embolism (PE) is an important cause of sudden death and is difficult to diagnose. Therefore unnecessary radiological investigations are often resorted to. Although some inflammatory parameters in the hemogram have been found to play a role in the diagnosis of PE, many parameters have not been adequately investigated. We aimed to evaluate potential inflammatory parameters in hemogram in the diagnosis of PE and to determine the parameters with the highest diagnostic value. This single-center, retrospective study was performed by evaluating 114 cases with suspected PE admitted to the emergency department between January 2017 and June 2022. Among 114 cases, 62 cases with a definitive diagnosis of PE by pulmonary computed tomography angiography served as the PE group and 52 cases without PE served as the control group. Admission hemogram parameters of both groups were recorded. Potential chronic diseases and acute conditions affecting hemogram were excluded from the study. In the multivariate model; immature granulocyte (IG), neutrophil/lymphocyte ratio (NLR), monocyte % and platelet large cell ratio (P-LCR) were found to be significantly and independently effective in differentiating cases with and without PE (P˂.05). Our findings suggest that high IG, high NLR, high monocyte %, and low P-LCR values have diagnostic value in cases with suspected PE. However the usability of IGs in the diagnosis of PE is a new finding. Hemogram is cheap, easily accessible, and potential inflammatory biomarkers in hemograms may increase physicians' awareness in the diagnosis of PE.

Investigation of miR221 and miR222 as Biomarkers in Non-small Cell Lung Cancer.

BACKGROUND/AIM: MicroRNAs (miRNA) are a class of small non-coding RNAs of 18-25 nucleotides, which regulate gene expression at the post-transcriptional level by disrupting or blocking translation of messenger RNA targets. Non-small cell lung cancer (NSCLC) represents approximately 85% of all lung cancers. Early and accurate diagnosis of the disease affects the probability of success of treatment. The purpose of this study was to investigate the expression levels of serum specific miRNA221 and miRNA222 as a biomarker in NSCLC. MATERIALS AND METHODS: Thirty-two NSCLC cases and 30 healthy control cases that were diagnosed at Istanbul Yedikule Chest Diseases and Thoracic Surgery Training Hospital were included in this study. miRNAs were detected using miRNA-specific quantitative real-time-PCR. The relative expression of miRNAs was calculated using the 2-ΔΔCt method. RESULTS: miR221 and miR222 showed 1.46 and 1.63-fold higher expression in the samples from patients with NSCLC compared to controls, and the difference of expression was statistically significant for miR221 (p=0.000095) but not for miR222 (p=0.084470). In the presence of metastasis in NSCLC patients, miR221 levels were 2.33-fold higher compared to non-metastatic cases (p=0.014), and those of miR221 and miR222 were expressed 1.44 and 1.52-fold higher, respectively, in advanced stage compared to early stage (p=0.000387, p=0.000302). CONCLUSION: The levels of miR221 and miR222 in the serum of patients could be used as biomarkers for the diagnosis, treatment, and prognosis of NSCLC.

Investigation of the Effectiveness of Surgical Treatment on Respiratory Functions in Patients With Obstructive Sleep Apnea Syndrome.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is a problem that involves many bodily systems and its effects on the respiratory system deserve special attention. Although many studies exist that investigate respiratory functions in patients using continuous positive airway pressure (CPAP) for the treatment of sleep apnea, there is a lack of research regarding the effect of OSAS surgery on respiratory function in the literature, which has motivated us to perform such a study. MATERIALS AND METHODS: Thirty-two patients diagnosed with OSAS with an apnea hypopnea index ranging between 15 and 30 and had undergone robotic tongue base resection and uvulopharyngoplasty were included as study participants. Pulmonary function tests were performed on all participants 1 day prior to, and at 3 and 6 months after the operation. Weight and body mass indices (BMIs) were also recorded at the same intervals for all participants. Data were electronically recorded and analyzed through SPSS 22.0. Values of P < .05 have been considered as statistically significant. RESULTS: Average age of the 32 participants was 43.2±10.7, average body weight was 94.1±12.6, and average BMI was 31.4±4.7. Decreases in body weight and BMI values recorded at 3 and 6 months postoperatively had statistical significance when compared with values recorded preoperatively (P < .05). Comparisons made in terms of pulmonary functions revealed a statistically significant increase in 3 and 6-month postoperative values of FVC, FEV1, FEV1/FVC, PEF, and FEF 25-75 (P < .05). CONCLUSION: Our study shows the positive effects of robotic tongue base resection and uvulopharyngoplasty operation on respiratory function parameters. This suggests that surgical treatment in OSAS patients is as effective as CPAP on respiratory function.

A candidate single nucleotide polymorphism in the 3' untranslated region (rs17878624) of survivin gene for NSCLC.

Survivin is a gene that locates on human chromosome 17q25 and contains 142 amino acid. Survivin (BIRC5) is the first one of the found inhibitors of apoptosis proteins (IAPs) that is an important  protein family and regulates apoptosis. It is expressed particularly in cancer cells. 3'UTR region of gene has components that is necessary for gene function and this region plays a critical role in the regulation of posttranscriptional regulation of the gene expression. Therefore, polymorphisms in this region may affect the function of the gene. The purpose of the study is to investigate possible relationship, that is associated with development and prognosis of the disease, between the 3 'UTR region (rs17878624) polymorphism and NSCLC in a Turkish society.

Comparison of radiofrequency and transoral robotic surgery in obstructive sleep apnea syndrome treatment.

INTRODUCTION: Radiofrequency tissue ablation (RFTA) and transoral robotic surgery (TORS) are the methods used in OSAS surgery. We also aimed to compare the advantages and disadvantages of RF and TORS as treatment methods applied in OSAS patients in terms of many parameters, especially apnea hypopnea index (AHI). MATERIALS AND METHODS: Patients were classified by performing a detailed examination and evaluation before surgery. 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + RFTA (17 males, 3 females) and 20 patients treated with anterior palatoplasty and uvulectomy -/+ tonsillectomy + TORS (16 males, 4 females) were included in the study. PSG was performed preoperatively and postoperatively in all patients and Epworth sleepiness questionnaire was applied. All operations were performed by the same surgeon and these surgical methods -RF and TORS- were compared in terms of many parameters. RESULTS: When the patients treated with RF and TORS were compared in operation time, length of hospitalization and duration of transition to oral feeding; all parameters were significantly greater in the patients treated with TORS. CONCLUSIONS: TORS technique was found to be more successful than RF in terms of reduction of AHI value, correcting minimum arterial oxygen saturation value and decreasing Epworth Sleepiness Scale score.

Comparison of fiber delivered CO2 laser and electrocautery in transoral robot assisted tongue base surgery.

To compare intra-operative and post-operative effectiveness of fiber delivered CO2 laser to monopolar electrocautery in robot assisted tongue base surgery. Prospective non-randomized clinical study. Twenty moderate to severe obstructive sleep apnea (OSA) patients, non-compliant with Continuous Positive Airway Pressure (CPAP), underwent Transoral Robotic Surgery (TORS) using the Da Vinci surgical robot in our University Hospital. OSA was treated with monopolar electrocautery in 10 patients, and with flexible CO2 laser fiber in another 10 patients. The following parameters in the two sets are analyzed: Intraoperative bleeding that required cauterization, robot operating time, need for tracheotomy, postoperative self-limiting bleeding, length of hospitalization, duration until start of oral intake, pre-operative and post-operative minimum arterial oxygen saturation, pre-operative and post-operative Epworth Sleepiness Scale score, postoperative airway complication and postoperative pain. Mean follow-up was 12 months. None of the patients required tracheotomy and there were no intraoperative complications related to the use of the robot or the CO2 laser. The use of CO2 laser in TORS-assisted tongue base surgery resulted in less intraoperative bleeding that required cauterization, shorter robot operating time, shorter length of hospitalization, shorter duration until start of oral intake and less postoperative pain, when compared to electrocautery. Postoperative apnea-hypopnea index scores showed better efficacy of CO2 laser than electrocautery. Comparison of postoperative airway complication rates and Epworth sleepiness scale scores were found to be statistically insignificant between the two groups. The use of CO2 laser in robot assisted tongue base surgery has various intraoperative and post-operative advantages when compared to monopolar electrocautery.

The significance of HSP90AA1, HSP90AB1 and HSP90B1 gene polymorphisms in a Turkish population with non-small cell lung cancer.

BACKGROUND/AIM: Heat-shock proteins (HSPs) are molecular chaperones which modify the structures and interactions of other proteins. The aim of our study was to investigate HSP90AA1, HSP90AB1 and HSP90B1 gene polymorphisms in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Ninety-seven patients with NSCLC and 97 healthy controls were included in the study. Real-time polymerase chain reaction was used for genotyping. RESULTS: The frequency of mutant CC genotype for HSP90AA1 (rs4947C/T), mutant AA genotype for HSP90AB1 (rs13296A/G) and mutant CC genotype for HSP90B1 (rs2070908 C/G) was significantly higher in the patient group than in controls (p=0.019, p=0.004 and p=0.036, respectively). The frequency of patients with homozygote mutant allele was also significantly higher than that of controls and possessing of the mutant genotype increased the risk for disease by approximately 2.9, 4.8, 1.9 for HSP90AA1, HSP90AB1 and HSP90B1, respectively. The present study appears to be the first of its kind to report data on these gene polymorphisms in patients with NSCLC in the Turkish population.

Analysis of serum micro-RNAs as potential biomarker in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) as a complex disease with genetic and environmental compound is one of the leading causes of death in worldwide. This disease is characterized by lower airway inflammation, and increases risk of lung cancer in smokers. Micro-RNA (miRNA) molecules are key regulators in gene expression that have been widely associated with a several diseases. Differential expression of miRNAs is involved in lung tissue of COPD, but there is no information about biomarker potential of circulating miRNAs in patients. To analyze the miRNA expression profile in COPD, levels of serum miRNAs were profiled by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) array system. The authors examined 72 miRNAs by qRT-PCR array, in 20 COPD patients and 12 control subjects. U6snRNA was used for normalization of the expression of miRNAs for each sample. According to the results, 5 miRNAs were found to be significantly dysregulated. There was down-regulation of miR-20a, miR-28-3p, miR-34c-5p, and miR-100, and up-regulation of miR-7, compared with the controls. This was the first study in COPD for screening of serum miRNAs for searching for biomarker. These results are preliminary screening data and should be confirmed with large patient groups. If so, these miRNAs are likely being involved in pathogenesis of COPD and may give clues for designing therapeutic strategy.

Argon plasma coagulation as an alternative treatment for bronchopleural fistulas developed after sleeve pneumonectomy.

We present a case that used argon plasma coagulation (APC) for the healing of bronchopleural fistulas (BPF), which most probably developed secondary to tracheobronchial anastomotic failure (TBAF). We aimed to show this procedure as an alternative treatment for the small fistulas that could develop after pneumonectomy. In a 56-year old male patient, right upper lobe squamous cell carcinoma was detected in 2009. Sleeve pneumonectomy was done because of the carina and major fissure invasion. There was no morbidity in the early post-operative period. The patient was discharged on the seventh day without any problems. Three cycles of chemotherapy were applied. In the third month after operation, the patient complained of a cough, and odorous sputum starting 15 days earlier. Two fistula orifices (1 and 3 mm) were detected in the fibre-optic bronchoscopy (FOB). No sign of tumour recurrences was detected in either chest computed tomography (CT) or FOB. BPF had entered the mediastinal chamber, which isolated the infection from the pleural cavity. The APC procedure was applied using FOB under local anaesthesia. The processing time was 30 min. There were no complications during or after the procedure. FOB was repeated 30 days later, and none of the previously opened orifices were observed. The patient was followed up for 18 months without any symptoms. APC was generally used for the treatment of oesophageal and intestinal fistula. We could not find any cases in the literature about APC application to treat BPF. APC could be an alternative treatment for the selected cases with small, uncomplicated BPF.

Is MMP-7 gene polymorphism a possible risk factor for chronic obstructive pulmonary disease in Turkish patients.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease that leads to fixed narrowing of small airways and alveolar wall destruction (emphysema). This study was performed to test the association between MMP-7 (rs155668818) and MMP-12 (rs56184183) polymorphisms in the MMP-7 gene and COPD risk and its severity in the Turkish population. MMP-7 and MMP-12 polymorphisms were genotyped in 85 patients with COPD and 73 healthy control subjects using real-time polymerase chain reaction analysis. There were significant differences in the distribution of MMP-7 genotypes but not in the frequencies of these alleles between COPD patients and controls (p=0.009, p=0.102, respectively). The MMP-7 AA genotype was found to be associated with an increased risk of COPD (p=0.004; odds ratio: 2.576; confidence interval: 1.297-5.119). The lowest values of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC in patients with GG homozygosity were determined and these values were statistically significant compared to the control subjects (p<0.001, p<0.001, p<0.001). When the present study groups were analyzed for MMP-12 polymorphism, it was found that all the subjects had wild-type genotype for this polymorphism. These findings have suggested that MMP-7 polymorphism might be associated with the risk and progression of COPD in the Turkish population.