Does nutritional status affect treatment tolerability, chemotherapy response and survival in metastatic gastric cancer patients? Results of a prospective multicenter study in Turkey.

BACKGROUND: The possible impact of malnutrition on the efficacy and tolerability of modern chemotherapy for metastatic gastic adenocarcinoma (mGC) patients is unclear. With this study, we aimed to represent the possible impact of malnutrition on the efficacy and tolerability of chemotherapy, and also on the overall survival of mGC patients. METHODS: In this prospective multicenter study, we collected demographic, oncological and nutritional data of our mGC patients. The nutritional status of patients were assessed with the Nutritional Risk Index (NRI), Body Mass Index (BMI) and weight loss percentage within 21-day period, between the chemotherapy cycles. All of these parameters along with toxicity assessment were evaluated after each courses of chemotherapy in order to determine inter-treatment weight loss. NRIs were calculated with a formula as follows; [1.519 × serum albumin level(g/L) + 41.7 × current weight/basic weight]. Patients were classified as having 'no malnutrition' (NRI > 97.5), 'moderate malnutrition' (97.5 ≥ NRI ≥ 83.5) or 'severe malnutrition' (NRI < 83.5). Drug-induced toxicities and treatment responses were evaluated via National Cancer Institute CTCAE version 4.0 and RECIST Criteria 1.1, respectively. RESULTS: One hundred and sixteen mGC patients were enrolled into the study. Median age was 60 years with range 32-83. Primary location of the tumor was antrum in 40% of the patients and of which 24% had undergone primary tumor resection. Ninety-eight percent of the patients had WHO performance status 0 or 1. Malnutrition was diagnosed in 67% of the patients and was severe in 31% of them. All patients received chemotherapy as first-line setting. Severe malnutrition was not associated with chemotherapy responses (p = 0.57). Moderate/severe malnutrition was associated with more cytopenia, nausea/vomiting, diarrhea, neuropathy, (p < 0.05 for all parameters). Moderate/severe malnutrition is associated with worser non-hematological toxicities (p = 0.038). Forty-one percent of patients died during the follow up period (Median: 138 days, range: 21-378). Malnutritional level was associated with significantly reduced overall survival. Severe malnutrition was associated with shorter median overall survival (74 days (95% CI, 20.7-111.0) vs. 237 (95% CI, 148.4-325.6) in none/moderate groups, p = 0.007). CONCLUSIONS: In mGC patients, moderate/severe malnutrition is associated with worse non-hematological toxicities. Severe malnutrition is also associated with reduced overall survival.

[Investigation of the Contribution of Autoantibodies to Clinical Diagnosis in Liver Pathologies and the Identification of Accompanying Autoimmune Diseases]. / Karaciger Patolojilerinde Otoantikorlarin Klinik Taniya Katkisinin ve Eslik Eden Otoimmün Hastaliklarin Tanimlanmasindaki Rolünün Arastirilmasi.

Autoantibodies are frequently detected in the presence of autoimmune liver diseases (ALD) [autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC)] and are widely used to classify the disease clinically. The aim of this study was to investigate the contribution of autoantibodies for the diagnosis of ALD and the identification of other accompanying systemic autoimmune rheumatic diseases (SARD). In addition, it was aimed to compare the results of indirect immunofluorescence (IIF) antinuclear antibody (ANA) patterns and extractable nuclear antigen (ENA) antibodies. A total of 593 patients, including 544 patients with high liver function tests from general surgery/gastroenterology clinics and 49 patients referred from internal medicine/rheumatology clinics to investigate ALD, were included in the study. HBsAg and anti-HCV test results of the patients were found to be negative. ANA, anti-mitochondrial antibody (AMA)/anti-liver-kidney microsomal antibody (LKM), anti-smooth muscle antibody (ASMA), antineutrophil cytoplasmic antibody (ANCA) assays were performed by indirect immunofluorescence method (IIF) (Euroimmune AG, Luebeck, Germany). Extractable nuclear antigen (ENA) (nRNP/Sm, Sm, SS-A, SS-B, Scl-70, Jo-1, dsDNA, nucleosome, histone, ribosomal P-protein, AMA-M2, Ro-52, PM-Scl, CENP-B, PCNA, DFS70) and liver profiles [soluble liver antigen\liver pancreas antigen (SLA/LP), liver cytosolic antigen1(LC-1), LKM-1, anti-mitochondrial antibody M2(AMA-M2)] (Euroimmune AG, Luebeck, Germany) were detected by immunoblot (IB) method. Demographic characteristics, clinical data, presence of systemic autoimmune rheumatic diseases (SARD), radiological and laboratory findings were determined from the medical records. Autoantibody tests were found to be negative in 461 (77.7%) of 593 patients (mean age= 53.3 ± 15.6, age range= 18-90), and were positive in 132 (22.3%) (86.4% female) of the patients. Of the patients with positive autoantibodies, 60.6% (80/132) were diagnosed as PBS and 1.5% (2/132) were diagnosed as AIH (positive anti-LC-1 and anti-LKM1 antibodies). Fourteen of the patients (10.6%) with centromere, nuclear membrane (NM), multiple nuclear dot (MND) staining patterns and elevated liver enzymes could not be diagnosed as a specific disease and were followed up. PBS (13/30) was detected in approximately half of the patients diagnosed with SARD. The most common accompanying SARD in PBC patients was Sjögren's syndrome (SS) (7.5%, 6/80), followed by rheumatoid arthritis (RA) (5.0%, 4/80), scleroderma (2.5%, 2/80), and systemic lupus erythematosus (SLE) (1.3%, 1/80) respectively. The most common pattern was the AMA staining pattern (34.8%, 46/132) among the autoantibody positive patients. AMA and ANA staining patterns were detected together in 31.1% (41/132) of the patients. In the ENA profile results of these patients, the most common profile detected was anti-Ro-52 (65.9%, 27/41), followed by anti-SSA (34.1%, 14/41), anti-SSB (22.0%, 9/41) and anti-CENP-B (12.2%, 5/41) autoantibodies , respectively. ANA patterns were detected in 32.6% (43/132) of the patients (NM 9.1%, centromere 9.1%, MND 6.8%, respectively). In our study, 87.5% (70/80) of the patients diagnosed as PBS were found to have AMA positivity and 12.5% (10/80) of them had ANA positivity (such as NM, CNN, centromere). The characteristics, laboratory and radiological findings of the patients with isolated AMA positivity alone (Group 1) and patients with multiple patterns/autoantibodies (Group 2) were compared. In patients with multiple patterns/autoantibodies (Group 2), the presence of cirrhosis and liver heterogeneity were found to be higher than Group 1 (p= 0.049). ALD associated autoantibodies can be detected before years from the clinical disease. ALD may be associated with various SARD. Detection of ALD-related autoantibodies in patients diagnosed with SARD can provide early diagnosis of these patients. These autoantibodies guide both diagnosis and prognosis as in PBC. Collaboration between the laboratory specialist and the clinician is critical in the diagnosis, management and early recognition of these patients before clinical disease.

[Investigation of the Clinical Significance of Anti-Dense Fine Speckled 70 (anti-DFS70) Autoantibody and Determination of Accompanying Pathologies]. / Anti-Dense Fine Speckled 70 (anti-DFS70) Otoantikorunun Klinik Öneminin Arastirilmasi ve Eslik Eden Patolojilerin Belirlenmesi.

Autoantibodies targeting nuclear and cytoplasmic autoantigens are used as markers in the diagnosis and classification of systemic autoimmune rheumatic diseases (SARD). The dense fine speckled (DFS) pattern is characterized by the fine-granular fluorescence of the nuclei in the interphase and the metaphase chromatin. DFS70 antibodies have been reported in healthy individuals, various autoimmune disorders, infection, cancer and inflammatory conditions. But there is still lack of information about its clinical significance. This study aimed to investigate the clinical significance of anti-DFS70 autoantibodies and the determination of accompanying pathologies. A total of 5710 serum samples routinely requested for ANA screening were tested between 2017 and 2019. Antinuclear antibody (ANA) and dsDNA were performed by indirect immunofluorescence method (IIF) (Euroimmun, Germany). Immunoblot (IB) method was used for the extractable nuclear antigen profile (ENA) (Euroimmun, Germany). Demographic and clinical data, were investigated from the medical records. Among 5710 samples tested for ANA, 23.7% were ANA positive by IIF. Mean age of the patients were 47.9 and 79.5% were female. Only 8.1% of the study group had SARD. The frequency of DFS pattern by ANA-IIF was 6.0% (342/5710), (mean age ± SD= 44.4 ± 16.7, 88% female). DFS70 pattern-positive patients were sub-grouped according to their diagnosis. SARD were detected 10.8% (mean age ± SD= 55.12 ± 14.10) in DFS70 pattern positive patient group (RA 6.1%, SS 2.6%, SLE 0.9%, SSc 0.6%, UCTD 0.6%). Autoantibodies accompanying anti-DFS70 antibody were determined as Ro-52, SS-A, nucleosome, histone, AMA-M2, dsDNA, respectively. Non-SARD diseases were determined in 89.2% of the patients with positive DFS70 pattern. Non-SARD diseases were detected as musculoskeletal complaints (47.4%), other rheumatic diseases like fibromyalgia (14.3%), dermatological diseases (9.4%), gastrointestinal system diseases (5.6%), hematological disorders (3.8%), thyroid /parathyroid diseases (3.5%), allergic diseases (2.3%), neurological diseases (2.3%) and neoplasia (breast cancer) (0.6%). The anti-DFS70 autoantibody is widely used to exclude the diagnosis of SARD in the absence of concomitant SARD-related autoantibodies. It has been observed that anti-DFS70 autoantibody may be associated with non-SARD rheumatic diseases and in many diseases (dermatological, gastrointestinal system, hematological, thyroid diseases) related to other systems. Therefore it is essential to evaluate these pathologies in patients positive for anti-DFS70 antibodies.

A rare cause of inguinal hernia: scrotal cystocele.

Herniation of the urinary bladder into the inguinal canal is rare. It constitutes 1-3% of all inguinal hernias. Bladder herniation is usually asymptomatic, and it is usually diagnosed during surgery or as a result of intra-operative bladder injury. Male patients with lower urinary tract symptoms or with a history of previous hernia surgery are at increased risk of bladder herniation. Typically, patients complain of inguinal or scrotal swelling, dysuria and shrinkage of scrotal swelling after voiding. Early diagnosis with radiological imaging is important to prevent complications during surgery. Intravenous pyelography, retrograde cystography, pelvic ultrasound, computed tomography and magnetic resonance imaging can be used for preoperative diagnosis. In this report, a patient is presented who presented to our clinic with scrotal swelling and was diagnosed with scrotal bladder herniation by retrograde cystography, taken due to clinical suspicion based on his history.

Separation and Enrichment of Gold in Water, Geological and Environmental Samples by Solid Phase Extraction on Multiwalled Carbon Nanotubes Prior to its Determination by Flame Atomic Absorption Spectrometry.

This study proposes the application of multi-walled carbon nanotubes as a solid sorbent for the preconcentration of gold prior to its flame atomic absorption spectrometry determination. Extraction was achieved by using a glass column (15.0 cm in length and 1.0 cm in diameter). Quantitative recoveries were obtained in the pH range of 2.5-4.0; the elution step was carried out with 5.0 ml of 1.0 mol/L HNO3 in acetone. In the ligand-free study, variables such as pH, eluent type, sample volume, flow rates, and matrix effect were examined for the optimum recovery of gold ions. The gold ions were able to be pre-concentrated by a factor of 150 and their LOD was determined to be 1.71 µg/L. In order to evaluate the accuracy of the developed method, addition-recovery tests were applied for the tap water, mineral water, and sea water samples. Gold recovery studies were implemented using a wet digestion technique for mine and soil samples taken from various media, and this method was also applied for anodic slime samples taken from the factories located in the Kayseri Industrial Zone of Turkey.

Adjuvant versus neoadjuvant chemoradiotherapy in distal rectal cancer: Comparison of two decades in a single center.

OBJECTIVE: Standard surgery alone was not able to decrease local recurrence (LR) rate below 20% in rectal cancer treatment. Thus, many centers administered neoadjuvant radiotherapy (preopRTx) with or without concomitant chemotherapy for the prevention of LR. In this study, the results of 164 consecutive patients with mid- and distal rectal cancer who received surgery and adjuvant chemoradiotherapy (Group A) or neoadjuvant chemoradiotherapy (Group NA) followed by surgery are presented. MATERIAL AND METHODS: The staging system used in this study is that of the American Joint Committee on Cancer (AJCC), also known as the TNM system. Eligible patients were required to have radiologically assessed stage 1 (only T2N0M0) to stage 3C (T4bN1-2M0) tumor with pathologically confirmed R0 resection. The surgical method was total mesorectal excision (TME). Radiotherapy was applied with daily 180 cGy fractions for 28 consecutive days. Chemo-therapy comprised 5-fluorouracil (450 mg/m(2)/d) and leucovorin (20 mg/m(2)/d) bolus at days 1-5 and 29-33. RESULTS: Nine patients (13%) in Group NA achieved pathologic complete response (pCR). In Group NA and Group A, locoregional recurrence (LRR) rates were 6.7% and 30.8%, (p<0.001), the mean LR-free survival was 190.0±7.3 months and 148.0±11.7 months (p=0.002) and the mean overall survival (OS) was 119.2±15.3 months and 103.0±9.4 months (p=0.23), respectively. A significant difference with regard to LR has been obtained with a statistical power of 0.92. Secondary outcome measures (DFS and OS) have not been met. CONCLUSION: Neoadjuvant chemoradiotherapy with TME is an efficient treatment protocol, particularly for the treatment of magnetic resonance imaging-staged 2A to 3C patients with two or three distal rectal adenocarcinomas. Given that a considerable proportion of patients with cT2N0M0 would develop pCR, this method of treatment can be considered for further studies.

Assessment of trace metal concentrations in muscle tissue of certain commercially available fish species from Kayseri, Turkey.

Regular consumption of fish has been widely recommended by health authorities. However, it is known that some species accumulate high levels of contaminants including heavy metals (e.g., Hg, Cd, Pb, and As). In this study, Cu, Pb, Co, Ni, Cr, Mn, Cd, and Fe were determined in the muscle tissue of 11 commercially available fish species (Sparus auratus, Dicentrarchus labrax, Mullus barbatus, Belone belone, Psetta maxima, Epinephelus aeneus, Salmothymus, Soleidae, Pomatomus saltatrix, Engraulis encrasicolus, and Sarda sarda) supplied from retailers in Kayseri, Turkey. Determinations were carried out by flame atomic absorption spectrometry after the wet digestion method. The average metal concentrations of the 11 species were determined in the range of 0.54-1.79, 0.82-1.40, 2.38-4.54, 1.23-3.67, 5.01-5.97, 0.77-3.59, 0.48-1.06, and 5.05-122.8 µg/g wet weight for Cu, Pb, Co, Ni, Cr, Mn, Cd, and Fe, respectively. The permissible tolerable daily intake (PTDI) and calculated daily intake (CDI) values were compared, and the calculated daily intake values of the samples were found to be below the established values. Correlations between the metal contents in samples were investigated by performing correlation tests with SPSS 13.0 for windows.

The effect of using nitroderm TTS in ERCP on precut, selective cannulation, and bleeding.

BACKGROUND: The aim of the study was to investigate the use of prophylactic nitroglycerin patch in patients who applied to our clinic with occlusion icter and underwent endoscopic retrograde cholangiopancreatography (ERCP) for complications such as pancreatitis, bleeding, perforation that may occur during and after the procedure, duration of the procedure, length of hospitalization, precut and selective cannulation rates, and mortality. METHODS: Patients were searched retrospectively using the hospital database. Patients under the age of 18, patients with poor general condition and patients treated under emergency conditions were excluded from the study. The effects of the drug on morbidity, mortality, duration of procedure, length of hospital stay, and cannulation techniques were investigated in patient groups with and without nitroglycerin patch. RESULTS: It was observed that using nitroglycerin decreased the precut probability by 2.28 times (p<0.001), and decreased periop-erative bleeding by 3.4 times (p<0.001). 75.1% selective cannulation was observed in the group not administered nitroglycerin, this rate was determined as 87.3% in the group administered nitroderm(p<0.001). In the regression model, it was observed that the presence of nitroderm increased the probability of selective cannulation 2.21 times (p<0.001). The effects of nitroglycerin use on mortality, patient's history of malignancy, presence of stones and mud, gender, age, post-operative pancreatitis, and perioperative bleeding variables were evaluated by regression analysis, and age increased mortality by 1.09 (p=0.023). CONCLUSION: It has been shown that the use of prophylactic nitroglycerin patch in ERCP procedure increases the prophylactic selective cannulation rate, shortens the precut rate, pre-operative bleeding, hospital stay, and procedure time.

Scharioth Macula Lens for patients with high myopia: a novel approach to achieve spectacle independence (binocular trifocal monovision).

We aimed to test a novel concept based on multiple IOL-implantation, targeting spectacle independence for patients with high and excessive myopia (26.0 mm < axial length; 6.0 D < refractive error). Therefore, we introduced the first results of five patients with high myopia. After clear lens extraction, one eye was targeted to emmetropia, and the other to mild myopia by implanting monofocal capsular bag IOLs with appropriate refractive powers in each case. The emmetropic eye was aimed to result in magnification and improved distance vision, while the mild myopic eye was supposed to ensure good intermediate vision. Thereafter, a Scharioth Macula Lens (SML) was implanted into the emmetropic eye in order to achieve sharp near vision. Visual acuity curves and defocus curves were plotted postoperatively. According to our results, this new concept seems to be an efficient approach of achieving appropriate uncorrected vision at all distances, by creating binocular trifocal monovision.

Is phenytoin a safe agent for staple line recovery after gastric sleeve surgery in rats?

BACKGROUND: The most challenging and mortal complication of gastric sleeve surgery (SG) is staple line leakage. Although many agents have been used for increasing tissue healing on the stapler line, there is still no consensus on its effectiveness and efficacy. The aim of study is to determine the effect of phenytoin on the healing process of gastric sleeve surgery in rats. METHODS: On the 10th post-operative day, the effects of phenytoin on bursting pressure in the stapler line were evaluated along-side pathohistological examinations. To investigate the molecular impact of phenytoin on the expression of TGF-ß, VEGF, FGF2, and p53 genes, quantitative real-time polymerase chain reaction was utilized. In addition, gene expressions at the protein level were deter-mined by immunohistochemical analysis. RESULTS: No signs of intra-abdominal leakage were observed in the resected samples. A statistically essential extend in stable line bursting pressure measure was observed between the control group and the group treated with phenytoin application. Pathohisto-logical results indicate that the mean score of collagens of the study group (3.2±0.42) was significantly higher than the control group (2.3±0.48) (P=0.003). In addition, the mean epithelization score of the study group (3.4±0.52) was significantly higher than the control group (2.1±0.57) (P=0.001). mRNA of TGFß, FGF2, VEGF, and p53 genes drastically increased phenytoin treated group. High FGF2 protein expression levels were determined from phenytoin use compared to the control group. CONCLUSION: Molecular studies suggest that phenytoin may increase the healing process of Gastric sleeve following SG in rats and may become a new agent for the prevention of human gastric leaks.

Nanoclay- and TiO2 Nanoparticle-Modified Poly(N-vinyl pyrrolidone) Hydrogels: A Multifunctional Material for Application in Photocatalytic Degradation and Adsorption-Based Removal of Organic Contaminants.

In recent times, access to clean water has become increasingly difficult and one of the most important problems for the sustainability of life due to environmental pollution. Based on this thought, in this study, a multifunctional hydrogel nanocomposite (nanoclay@TiO2@PNVP) containing linear poly(N-vinyl pyrrolidone) (PNVP), nanoclay, and TiO2 nanoparticles was synthesized and used as an adsorbent and photocatalyst for the adsorption-based and photocatalytic degradation-based removal of organic and pharmaceutical pollutants such as methylene blue (MB) and sildenafil citrate (SLD). The modification of the hydrogel with TiO2 nanoparticles and nanoclay aimed to increase the adsorption capacity of the PNVP hydrogel as well as to gain photocatalytic properties for the effective removal of organic contaminants. This hybrid material, which can be cleaned in two different ways, can be reused and recycled at least 10 times. Characterization studies were carried out using Fourier transform infrared spectroscopy, scanning electron microscopy, Raman spectroscopy, thermogravimetric analysis, differential thermogravimetry, and viscosimetry techniques. Optimization studies for the adsorption-based removal of organic contaminants were carried out on MB and SLD as model organic compounds. The optimum parameters for MB were found at pH 10 of the sample solution when 50 mg of the nanoclay@TiO2@PNVP hydrogel nanocomposite was used for 420 min of contact time. It was observed that 99% of the MB was photocatalytically degraded within 150 min at pH 10. Our material had multifunctional applicability properties, showing high adsorption and photocatalytic performances over 99% for at least 10 times of use. For the removal of organic and pharmaceutical contaminants from wastewater, the synthesized material can be used in two treatment processes separately or in combination in one step, providing an important advantage for its usability in environmental applications.

Importance of HALP Score in Breast Cancer and its Diagnostic Value in Predicting Axillary Lymph Node Status.

OBJECTIVE: To determine the diagnostic value of the haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting axillary lymph node (ALN) involvement. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Balikesir University and Mersin City Hospital, Turkey from January 2016-December 2021. METHODOLOGY: Included in the study were 307 patients who underwent surgical treatment for breast cancer. HALP values were calculated by multiplying the haemoglobin, albumin, and lymphocyte values and dividing the resulting value by the platelet number. The patients were divided in two groups, being those with low HALP (Group 1) and high HALP (Group 2) scores. We examined the potential of the HALP score for the prediction of ALN involvement. RESULT: Group 1 had 65 patients and the Group 2 had 242 patients. At the cut-off point, a HALP score of <29.01 predicted the presence of axillary involvement with a sensitivity of 84.33% and a specificity of 26.1%. The sentinel lymph node sampling rate was similar in both groups (12.3% vs. 16.9% p=0.365). The presence of positive lymph nodes in the axilla was higher in group 1 (67.7% vs. 53.3% p=0.038). There was no correlation between HALP score, and the metastatic lymph node and total lymph node count. CONCLUSION: The use of HALP score alone for the prediction of axillary lymph node positivity in patients with breast cancer is not advised. In the present study, a low HALP score was associated with aggressive tumour activity, such as advanced tumour and axillary lymph node positivity. KEY WORDS: Breast cancer, Axillary lymph node involvement, Immunity, Nutrition.

Investigation of the effects of post-operative intraperitoneal, oral, and rectal phenytoin administration on colorectal anastomosis in rats.

BACKGROUND: Anastomotic leakage is the most feared complication after colonic anastomosis. The purpose of the study is to determine the effects of phenytoin applied by different application routes, on the healing process of colorectal anastomoses. METHODS: Wistar Albino rats were divided into Intraperitoneal Phenytoin Group, Oral Phenytoin Group (OAP), Rectal Phenytoin Group (RAP), and control groups. The molecular effect of phenytoin on the expression of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-ß), fibroblast growth factor 2 (FGF2), and p53 genes was evaluated at mRNA and protein level. The effects of phenytoin on anastomotic bursting pressure analysis measured as well as pathohistological examinations. RESULTS: There are statistically significant increase in anastomotic bursting pressure values between control and application groups. Inflammatory cell infiltration of all groups increased in the intestinal anastomosis region compared to control. Collagen scores were found to be significantly higher in the OAP and RAP groups compared to the control group. mRNA of TGF-ß and FGF2 expression increased in all routes of phenytoin applications. CONCLUSION: Three different administration routes show considerably increase on the bursting pressure. Regarding the results of the expression of FGF2, TGF-ß, p53, and VEGF genes, there is a significant increase FGF2 and TGF-ß at mRNA and protein level in most administration routes.

Effect of Education and Regular Examination on the Prevalence of Head Louse Infestations in Adana

Objective: The current study provides training to parents and teachers about pediculosis in schools in three villages in Adana to measure their knowledge level by conducting surveys and to determine the prevalence of pediculosis in these foci. Methods: Pre- and post-questionnaires including 30 questions about pediculosis were handed to parents and teachers. The answers were analyzed with the Pearson correlation analysis. Overall, 418 school pupils s were examined for lice. The results of the head louse control were analyzed by the chi-square test and t-test. Results: We observed that the level of awareness increased in parents and teachers. Additionally, the gender of both teachers and parents was determined as the most important factor in increasing this awareness. Because of interventions for the control of head and lice, the prevalence of pediculosis decreased from 15.22% to 1.71%. Conclusion: It is very important that parents and teachers are aware of the health problems related to pediculosis, while regular combing of school children may be essential for the control of this common infestation.

Predictive Factors of Success in Sleeve Gastrectomy: One-Year Follow-up and the Significance of HALP Score.

OBJECTIVE: To investigate whether HALP score [hemoglobin, albumin, lymphocyte (LY), platelet] can predict weight loss in patients undergoing sleeve gastrectomy. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: Department of General Surgery, Balikesir University, Turkey from July 2019 to July 2020. METHODOLOGY: One-year data of 64 patients, who underwent sleeve gastrectomy due to obesity were included for the analysis. The cut-off value of HALP score was calculated to be 41.2971. Those below the cut-off value were classified into Group 1 (low HALP score) and those above it were classified into Group 2 (high HALP score). Preoperative and postoperative body mass index (BMI), hemotologic parameters, platelet/LY ratios (PLR), and neutrophil/LY ratios (NLR), were compared. According to the percentage of excess BMI loss, patients were divided into 3 groups: Group A (≤40%), Group B (40%-60%), Group C (≥60%). RESULTS: The decrease in postoperative BMI was significantly high in Group 2 (p<0.001). There was a significant difference between the groups in terms of percentage change of hemoglobin (p=0.012). The increase in postoperative LY value and decrease in postoperative PLR value were significantly high in Group 1 (p=0.019, p=0.003). Furthermore, patient distribution was significantly different among groups A, B, and C (p <0.001). Comparison of groups showed a significant difference between groups A and B and between groups A and C, but not between groups B and C (p=0.006, p<0.001, and p=0.192, respectively). CONCLUSION: In patients with high HALP scores, the rate of weight loss was higher, and most of their laboratory parameters were improved compared to those patients with low HALP scores. Key Words: Body mass index, Sleeve gastrectomy, obesity, Weight loss, HAIP score.

Determination of total Cr in wastewaters of Cr electroplating factories in the I.organize industry region (Kayseri, Turkey) by ICP-AES.

The wastewater pollution in industrial areas is one of the most important environmental problems. Heavy metal pollution, especially chromium pollution in the wastewater sources from electroplating, dyeing, and tannery, has affected the life on earth. This pollution can affect on all ecosystems and human health directly or by food chain. Therefore, the determination of total chromium in this study is of great importance. In this study, accurate, rapid, sensitive, selective, simple, and low-cost technique for the direct determination of total Cr in wastewater samples collected from the some Cr electroplating factories in March 2008 by inductively coupled plasma-atomic emission spectrometry has been developed. The analysis of a given sample is completed in about 15 min by this technique applied. As the result of the chromium analysis, the limit of quantification for the total Cr were founded to be over the limit value (0.05 mg L(-1); WHO, EPA, TSE 266, and inland water quality classification) as 1,898.78+/-0.34 mg/L at station 1 and 3,189.02+/-0.56 mg/L at station 2. The found concentration of total Cr has been determined to be IV class quality water according to the inland water classification. In order to validate the applied method, recovery studies were performed.

Trace metal contents in chewing gums and candies marketed in Turkey.

Cu, Ni, Pb, Fe, Mn, Cr and Cd contents were determined in 17 different brands of chewing gum and candy samples available in local markets of Kayseri, Turkey. Concentration of selected trace metals were estimated using flame atomic absorption spectrometer after dry and wet digestion methods. Out of 17 brands of chewing gums and candies analysed, four were cocoa based, two were sugar based and other were of fruit based. Copper level ranged from 0.219 to 2.455 microg/g with an average of 1.390 microg/g. Nickel ranged from 0.120 to 2.588 microg/g with an average of 0.846 microg/g. Lead level ranged from 0.031 to 2.46 microg/g with an average of 0.746 microg/g. Iron level ranged from 3.963 to 9.863 microg/g with an average of 6.618 microg/g. Manganese level ranged from 1.872 to 5.067 microg/g with an average of 3.196 microg/g. Chromium ranged from 0.740 to 6.265 microg/g with an average of 2.473 microg/g and cadmium level ranged from 0.027 to 0.825 microg/g with an average of 0.296 microg/g. Cocoa based samples were found to have higher contents of the analysed metals than sugar and fruit based samples.

Poly(vinyl pyridine-poly ethylene glycol methacrylate-ethylene glycol dimethacrylate) beads for heavy metal removal.

Poly(vinyl pyridine-poly ethylene glycol methacrylate-ethylene glycol dimethacrylate) [poly(VP-PEGMA-EGDMA)] beads with an average size of 30-100 microm were prepared by suspension polymerization. Poly(VP-PEGMA-EGDMA) beads were characterized by swelling studies, scanning electron microscopy (SEM), elemental analysis, Fourier Transform Infrared Spectroscopy (FTIR). The beads with a swelling ratio of 65% were used for the heavy metal removal studies. Chelation capacity of the beads for the selected metal ions, i.e., Pb(II), Cd(II), Cr(III) and Cu(II) were investigated in aqueous media containing different amounts of these ions (5-80 mg/l) and at different pH values (2.0-10.0). The maximum chelation capacities of the poly(VP-PEGMA-EGDMA) beads were 18.23 mg/g for Pb(II), 16.50 mg/g for Cd(II), 17.38 mg/g for Cr(III) and 18.25 mg/g for Cu(II). The affinity order on mass basis was observed as follows: Cu(II)>Pb(II)>Cr(III)>Cd(II). pH significantly affected the chelation capacity of VP incorporated beads. Heavy metal adsorption on the poly(PEGMA-EGDMA) control microspheres was negligible. Regeneration of the chelating beads was easily performed with 0.1 M HNO3. It was shown that these beads can be used effectively for heavy metal removal from aqueous solutions with repeatedly adsorption-desorption operations. These features show that poly(VP-PEGMA-EGDMA) beads are potential candidate sorbent for heavy metal removal.

Development of metabolic syndrome after bilateral total thyroidectomy despite the L-t4 replacement therapy: A prospective study.

OBJECTIVES: The literature about the frequency of metabolic syndrome in patients with multinodular goitre and a new onset of metabolic syndrome after total thyroidectomy is limited. The aim of this study was to investigate the effects of total thyroidectomy and thyroid hormones on a new onset of metabolic syndrome in patients who underwent total thyroidectomy and have received thyroid hormone replacement. MATERIAL AND METHODS: Fifty-nine patients who underwent total thyroidectomy for multinodular goitre were included in this prospective study. Patients' height, weight, and waist circumference were measured, and the body mass index was calculated. Peripheral blood samples were obtained preoperatively and at the 12th and 24th month after total thyroidectomy to examine the lipid profile, glucose homeostasis, and thyroid function tests. RESULTS: The lipid profile and blood pressure parameters deteriorated, and the mean body mass index and waist circumference with the metabolic syndrome rates significantly increased at the 12th and 24th months follow-up. Preoperative body mass index (Exp[B] 1.60; p=0.003) was independently associated with metabolic syndrome at the 2nd year after total thyroidectomyin a multivariate regression analysis. CONCLUSION: The frequency and severity of MetS is high in adult patients with non-toxic multinodular goitre after total thyroidectomy. The frequency of metabolic syndrome increased in patients with a high body mass index after total thyroidectomy.

Survival outcomes after D1 and D2 lymphadenectomy with R0 resection in stage II-III gastric cancer: Longitudinal follow-up in a single center.

OBJECTIVE: D2 lymphadenectomy (D2-LND) with curative resection (R0) is the cornerstone of gastric cancer treatment. In this study, we compared survival outcomes of D2-LDN with D1-LDN in patients who had undergone curative resection for Stages II and III primary gastric adenocarcinoma. MATERIAL AND METHODS: Between April 1996 and March 2014, 153 consecutive patients with adenocarcinoma of the stomach underwent total gastrectomy with D1-LND or D2-LND. Among those, 118 patients (38 D1 vs. 80 D2) with a complete history and having been followed for at least 1 year after surgery were enrolled. Both groups were compared in terms of demographic and clinico-pathologic characteristics. RESULTS: The mean follow-up was 42.6±52.5 months (mo.). The demographic characteristics of the groups were similar. The Tumor, Node and Metastases (TNM) stage distribution was 25% for Stage II and 75% for Stage III for both groups. Eighteen patients (47.4%) in the D1 and 47 patients (58.8%) in the D2 group were free from locoregional recurrence. The median disease-free survival was 22.0±4.1 mo. for the D1 and 28.0±4.3 mo. for the D2 group (p=0.36). Eight patients (21%) in the D1 and 39 patients (49%) in the D2 group were alive at the last follow-up. The median overall survival (OS) was 22.0±3.7 mo. for the D1 and 31.0±5.4 mo. for the D2 group (p=0.13). The 5-year disease-free survival and OS by the Kaplan-Meier estimates were 41% vs. 51% and 30% vs. 42% in the D1 and D2 groups, respectively. The median 5-year OS for patients with Stages IIIB and IIIC tumors was 14.0±2.2 mo. for the D1 and 20.0±5.0 mo. for the D2 group, respectively (p: 0.048). CONCLUSION: When compared to D1-LND, D2-LND with R0 resection have yielded a trend toward a better outcome in patients with primary gastric adenocarcinoma.