Comparison of the effects of Ho: YAG laser virtual Basket™ pulse modulation and Thulium fiber laser on kidney tissue - an ex vivo experimental study.

Through an ex vivo experimental study, we aimed to compare the effects of the Ho: YAG laser Virtual Basket (VB™) modulation and a Thulium fiber laser (TFL) on kidney tissue in different environments and using laser configurations. The 100 W Ho: YAG (Cyber Ho, Quanta System, Italy) and 60 W TFL (Fiber Dust, Quanta System, Italy) laser devices were used. The following laser settings were selected: power in the range of 10-60 W, frequency of 20-40 Hz, and energy of 0.5-1-1.5 J. A medium pulse duration of 600 µsec was used for VB™, while short (spdTFL; 50 µsec) and long (lpdTFL; 15,000 µsec) were used for TFL. The tissue's incision depth (ID), vaporization area (VA), coagulation area (CA), total laser area (TLA = VA + CA), surface section (SS), and lateral effect (LE) were measured. In total, 108 experiments were conducted. No statistically significant difference in mean VA, TLA, ID, LE, or SS was observed between VB™, spdTFL, and lpdTFL in the low-power output group in saline (p > 0.05). However, the mean CA was statistically significantly higher for VB™ (p = 0.005). In saline and high-power output group, the mean VA, CA, TLA, LE, and ID were higher when using lpdTFL than other pulse durations (p = 0.001, p = 0.001, p = 0.001, p = 0.006, and p = 0.001, respectively). Similar to lpdTFL, VB™ may provide controlled dissection and incision as well as haemostasis. At different laser settings, the individual effects of laser properties (such as pulse length, energy and frequency) on tissue may be more significant.

Prevalence, distribution, and prognostic significance of morphological variants of neuroendocrine tumors of the gastrointestinal tract - a multicenter study.

The incidence and prevalence of neuroendocrine neoplasms (NENs) in many organs are increasing. Although such NENs have similar grades, they may exhibit quite different behaviors. In this multicenter study, we aimed to investigate the prevalence and distribution of different morphological NEN variants in the non-pancreatic gastrointestinal (GI) tract and determine whether they can guide prognosis prediction. Two hundred and fifty-six patients diagnosed with NENs originating from the GI tract from 7 different centers were included in the study. In 89 (36.6%) cases, different morphological variants were detected. When the variants were grouped according to their aggressiveness as described in the literature, a statistically significant relationship between aggressiveness and the variables organ and age was found ( p < 0.05). The oncocytic variant was found to metastasize more than the other aggressive types (42.9%). The paraganglioma-like variant was found to have a smaller size, lower proliferation index, and a more benign clinical course. This study demonstrated that well-differentiated GI neuroendocrine tumors (GI-NETs) have considerable morphological diversity. Generally, case reports of rare morphological variants of GI-NETs are available in the literature. We believe that our study contributes to a better understanding of the prevalence, localization, and significance of morphological variations in GI-NETs.

Effect of Ho:YAG laser on kidney tissue with Virtual Basket™ and Bubble Blast™ pulse modulation: an experimental ex vivo study.

PURPOSE: There is a lack of studies in the literature on effects of Virtual Basket™ (VB) and Bubble Blast™ (BB) laser pulse modulations of the Ho:YAG laser on tissue. We aimed to compare the effects of standard modulation (SM), VB, and BB pulse modulations of Ho:YAG laser on kidney tissue. METHODS: An ex vivo experiment was conducted using veal kidneys. The Quanta System Cyber Ho 100W laser generator with a broad setting spectrum at 15-80 W, 10-40 Hz, 1.5-2 J, and medium pulse duration were tested. Incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA = VA + CA) were evaluated. Histopathological measurement outcomes were grouped as a low-power group (15, 20, and 30 W) and a high-power group (40, 60, and 80 W) according to the power outputs used. RESULTS: A total of 108 experiments were performed. In saline and high-power output (40, 60, 80 W), mean VA, TLA, and ID, histopathological measurements were higher in BB pulse modulation than VB and SM pulse modulations (p: 0.03, p: 0.001, and p: 0.003, respectively). In contrast, mean CA and LE measurements were higher in SM than in VB and BB pulse modulations (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference in mean histopathological measurements of VA, CA, TLA, and ID, among SM, VB, and BB pulse modulations in the low-power output group in saline (p > 0.05). CONCLUSION: VB can allow controlled dissection, as it does not create a large VA during surgical procedures. BB should be used in a controlled manner in soft tissue surgery due to its strong effect on tissues.

[Isolation of Cystic Echinococcosis Causative Agents of Echinococcus equinus and Echinococcus ortleppi Species from Humans in the Central Anatolia Region of Türkiye]. / Türkiye'nin Iç Anadolu Bölgesindeki Insanlardan Kistik Ekinokokkoz Etkeni Echinococcus equinus ve Echinococcus ortleppi Türlerinin Izole Edilmesi.

Cystic Echinococcosis (CE) caused by Echinococcus granulosus sensu strico is neglected in Türkiye despite being one of the common diseases due to agriculture being at the forefront, low socioeconomic status and unhygienic animal slaughter. Considering the morbidity, mortality, and difficulties in treatment, more studies and precautions are needed regarding this disease. In this study, it was aimed to genotype Echinococcus isolated from CE patients in the Central Anatolia region. DNA isolation from tissue samples taken from 60 CE patients was performed using the QIAamp DNA FFPE tissue kit. Cytochrome c oxidase subunit gene region of Echinococcus was targeted and JB3/JB4.5 primers were used for genotyping. Polymerase chain reaction (PCR) products were purified according to the instructions for use of the QIAquick PCR purification kit. PCR products were prepared using the ABI Prism BigDye Terminator V3.1 Cycle sequencing kit and the nucleotide sequences in the samples were evaluated with the ABI 3100 sequencing device. The nucleotide sequences obtained in the study were analyzed using MetaPIGA2, MRBAYES v.3.1.2, phyogenetic analysis using parsimony, Unigen programs, maximum likelihood, Bayesian and parsimony methods. It has been found that 88.4% (53/60) of Echinococcus isolates were E.granulosus s.s. in this study. It has been genotyped as 41.7% (25/60) G1, 30.0% (18/60) G3 and 16.7% (10/60) G2 genotype. It has been determined that 6.6% (4/60) of the other Echinococcus isolates were E.equinus and 5.5% (3/60) were E.ortleppi. It was observed that E.equinus and E.ortleppi were isolated from atypically located cysts and from those living in rural areas. The E.equinus and E.ortleppi species were not found in CE patients living in urban areas. CE cases are common in the Central Anatolia region due to dog and cattle breeding, and the disease agent Echinococcus species vary. Genotyping of Echinococcus species is effective in the development of CE treatment and control strategies. Study results can play an active role in the fight against CE, which has formed the basis of the "one health" approach in the world and in Türkiye in recent years.

The prognostic effect of immunohistochemical staining rates in patients with non-muscle-invasive bladder cancer.

Context: Despite the follow-up protocols developed in non-muscle-invasive bladder cancer patients, progression and recurrence could not be prevented. Aims: We aimed to investigate whether proteins such as OCT-4, CD47, p53, Ki-67, and Survivin, which increase in bladder cancer cells, can be used as prognostic markers for patients with non-muscle-invasive bladder cancer. Settings and Design: The study included a total of 89 patients with newly diagnosed non-muscle-invasive bladder cancer between January 2015 and December 2020. Materials and Methods: Levels of OCT-4, CD47, p53, KI-67, and Survivin proteins in cancer cells were determined with a semi-quantitative immunohistochemical experiment. Pathological data and survival rates were compared according to the staining rates. Statistical Analysis Used: Data obtained in the study were analyzed statistically with SPSS 22.0 (SPSS, Chicago, IL, USA). Results: The mean age of the patients was 64.25 ± 9.91 years, and the median follow-up period was 55 months. Recurrence rate was determined to be 36% (n = 32), and the rate of progression at 40.4% (n = 36). The staining rates were stronger for each marker in the progression group and advanced-stage tumors (p < 0.001). The findings of the multivariate analysis carried out as part of the study showed that older age and higher tumor stage were independent risk factors for recurrence-free survival (HR = 1.048 and 7.074, respectively; P = 0.02). Also, higher tumor stages, diameters, and grades were associated with reduced progression-free survival (HR = 0.105, 0.395, 0.225, respectively; P < 0.05). Conclusions: Although immunohistochemical staining rates are promising, it is more appropriate to use tumor characteristics when assessing survival rate in patients with non-muscle-invasive bladder cancer.

A case of systemic lupus erythematosus presenting with intestinal lymphangiectasia-associated protein-losing enteropathy accompanying hyperinflammation.

Systemic lupus erythematosus (SLE) has the potential to affect virtually every organ; however, gastrointestinal system manifestations are relatively rare compared to other autoimmune diseases such as systemic sclerosis and inflammatory bowel disease. A 29-year-old female patient attended to the emergency room with abdominal distention, acute onset abdominal pain and constipation. She had watery chronic diarrhea (4-5 times/d) and weight loss (6 kg, 12%) for 4 months. While there was increased intestinal wall thickness, air-liquid levels were shown on abdomen computed tomography scan. The patient underwent abdominal surgery due to diagnosis of ileus. Ileocecal resection was performed and pathologic evaluation revealed intestinal lymphangiectasia. Autoimmune serology was performed with the following resulats: anti-nuclear antibody 1/3200 with homogenous pattern, anti-DNA antibody and anti-Sm/ribonucleoprotein antibodies were positive in addition to low complement levels (C3: 0.28 [0.9-1.8 g/L], C4: 0.06 [0.1-0.4 g/L]) indicating diagnosis of SLE. Development of intestinal involvement in SLE (lupus enteritis) is mainly grouped into 3 headings such as mesenteric vasculitis, pseudo-obstruction, and protein-losing enteropathy. Although the pathogenesis of intestinal lymphangiectasia remains unknown, it has been reported that immune complex-mediated visceral vasculitis may result in bowel wall and mucosal edema. To our knowledge this is the first case report accompanying hyperinflammatory response in addition to intestinal lymphangiectasia in SLE. On the other hand, clinicians should be alert for other reasons for hyperinflammatory syndromes rather than COVID-19, even during the pandemic.

Could Testicular Tissue Be a New Arena for the Holmium Laser?

Introduction We aimed to observe the effects of holmium:yttrium-aluminum-garnet (Ho:YAG) laser on testicular tissue. Methods An ex vivo experiment was conducted using calf testicles. A 100 W laser generator with broad-spectrum settings of 10-80 W, 20-40 Hz, and 0.5-2 J, with a medium pulse duration, was tested. The laser effects on testicular tissues with and without the tunica layer were evaluated histopathologically by calculating the incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA=VA+CA) of the specimens. Results A total of 48 experiments were conducted. In testicular tissue without a tunica layer, the highest mean ID was determined at 1 J-20 Hz (0.247±0.0208 mm) and with a tunica layer at 2 J-40 Hz (2.673±0.032 mm). In the testicular tissue without a tunica layer, the highest mean VA was determined at 1.5 J-40 Hz (0.029±0.0016 mm2) and in tissue with a tunica at 2 J-40 Hz (6.173±0.114 mm2). The highest mean TLA in tissue without a tunica was detected at 2 J-20 Hz (0.038±0.0008 mm2) and in tissue with a tunica at 2 J-40 Hz (7.292±0.07 mm2). The mean ID, VA, CA, and TLA values of all the power outputs used were found to be statistically significantly higher in the testicular tissue with the tunica layer than in that without it (p<0.001). Conclusion The Ho:YAG laser has different effects on testicular tissue with and without a tunica layer. In testicular tissue without a tunica, the laser's effect was minimal on the surrounding tissue, especially in terms of the ID, VA, and TLA. This minimal effect of the laser can be an advantage in testicular surgery procedures such as testis-sparing surgery (TSS) or testicular sperm extraction (TESE).

Expression of nectin-4 in prostate cancer.

OBJECTIVE: Nectin-4 is a transmembrane protein belonging to the nectin family of immunoglobulin-like molecules which is found in the placenta and trachea under physiological conditions and its expression has been shown in many cancer types. We aimed to investigate for the 1st time nectin-4 expression in human prostate cancer tissues. METHODS: We retrospectively analyzed the prostate pathology specimens of 82 patients who underwent initial transrectal ultrasound-guided prostate biopsy or transurethral prostate resection and were found to have atypical small acinar proliferation (ASAP) and incidentally prostate cancer. Tissue samples with prostatic cancer were used as a control for alpha-methylacyl-CoA racemase (AMACR), and benign prostatic glands in the same tissue provided the negative control. The intensity and extent of nectin-4 expression were determined microscopically using the histochemical scoring system which was defined as the product of the staining intensity (score: 0-3) and percentage of stained cells (0-100) at a given intensity. RESULTS: We conducted immunohistochemical analysis of nectin-4 and AMACR expression in all 82 samples. While AMACR expression was positive in prostate cancer tissues with a GS of <7 (n=24, 100%), 7 (n=18, 100%), and ≥8 (n=15, 100%), it was negative in all ASAP samples (n=25, 100%) (p<0.001). Nectin-4 expression was not detected in any of the GS <7, GS 7, or GS ≥8 samples but was found in benign prostatic gland tissues and all 25 (100%) ASAP samples (p<0.001). CONCLUSION: We found that nectin-4 was not expressed in prostate cancer tissues but was expressed in ASAP-and benign prostate gland containing tissues. We believe that prospective studies with more patients and samples including radical prostatectomy materials will reveal the relationship between nectin-4 and prostate cancer more clearly.

Extra-Articular Nonhemophilic Hemosiderotic Synovitis of the Hand: A Case Report.

Hemosiderotic synovitis is a rare distinctive type of synovial proliferative disorder. Hemosiderotic synovitis develops in men with hemophilia who are at risk of hemarthrosis, especially of the knees, associated with severe degenerative articular cartilage disease. It appears to be exceedingly rare in individuals without hemophilia and has been reported in case reports. We describe a case of trauma-related nonhemophilic hemosiderotic synovitis, located in the hand in an otherwise healthy young male construction worker, with no systemic illness, inflammatory arthritis, or any bleeding disorder. We report the first case of nonhemophilic hemosiderotic synovitis located in the hand. To the best of our knowledge, a case of extra-articular nonhemophilic hemosiderotic synovitis has not been previously described in the literature.

A Comprehensive Analysis of Histopathologic Examination Results of Tonsillectomy Specimens.

Objective This study aims to review the histopathologic results of tonsillectomy specimens, determine the rates of the tonsillectomy indications, and investigate the characteristics of asymmetric hypertrophy. Materials and Methods Medical records of 484 patients who underwent tonsillectomy were reviewed retrospectively. Descriptive data of adult and pediatric patients were presented as percentage. Comparisons between asymmetric and symmetric hypertrophy groups were performed to determine the features of asymmetric hypertrophy. Results The mean age of 484 patients who underwent tonsillectomy was 13 years (range: 3-69 years). While 372 (76.85%) patients were operated for infection, 100 (20.66%) were operated for tonsillar hypertrophy, 1 (0.21%) for a suspicion of malignancy, and 11 (2.27%) for other various reasons. Asymmetric hypertrophy was seen in 25 (5.16%) patients, whereas symmetric hypertrophy was seen in 75 (15.49%) patients. Malignancy was detected in three (0.61%) adult patients with asymmetric hypertrophy. Tonsillar tuberculosis was observed in one foreign patient with asymmetric hypertrophy. The presence of malignancy was higher in the asymmetric hypertrophy group (three patients [12%]) compared with the symmetric hypertrophy group (none) (p=0.002; X2=9.27). Median maximum specimen diameter was 3 cm (range: 1.15-5.5 cm) in the asymmetric hypertrophy group and 2.4 cm (range: 1.25-4.8 cm) in the symmetric hypertrophy group (p=0.08). The Friedman grade was significantly (p<0.001), positively, and strongly (r=0.885) correlated with the maximum specimen diameter. Conclusion Routine histopathologic examination of the tonsillectomy specimens might not be necessary for all patients, but it is recommended for the patients with a real asymmetry.