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Background: Liver surgeries are treatment modalities that require careful pre- and postoperative follow-up for both the surgeon and the patient. Infections are the leading causes of morbidity and mortality after liver transplantation. Infections are the most frequent cause of death between 30 and 180 days after liver transplantation. We aimed to investigate the effect of the Enhanced Recovery After Surgery (ERAS) protocol on the prevention of infections in liver transplant patients. Patients and Methods: The study included patients who underwent liver transplantation in Ataturk University Organ Transplantation Center between 2017 and 2022. Two patient groups with and without ERAS were formed. Blood and urine cultures were collected retrospectively, and those with positive blood cultures for bacteremia were recorded as infection development. The development of infection between the two groups was statistically compared. Also, all patients' length of intensive care stay, length of hospital stay, and duration of antibiotic use were recorded. These parameters were compared between both groups. Results: There was a statistically significant difference between the two groups in terms of infection development (p: 0.01). There was a statistically significant difference between the two groups in terms of duration of antibiotic use and length of hospital stay (Mann-Whitney U test; p: 0.00, p: 0.04, respectively). There was no statistically significant difference between the two groups in terms of length of intensive care stay. Conclusion: We concluded that the introduction of an ERAS protocol was associated with fewer infections, thus shortening the duration of antibiotic therapy and length of hospital stay, although the standardization of the protocols is difficult, especially in liver transplants.

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INTRODUCTION: An incarcerated Obturator herniation is a rare external abdominal hernia. Abdominal CT-scanning is the first choice for the diagnosis of such an incarcerated Obturator hernia. Since intestinal incarceration leads to acute necrosis. Therefore emergency surgical treatment is required. However, due to the lack of specificity of the clinical manifestations of incarcerated Obturator hernia, a delay in adequate diagnostics may be higher than expected. PRESENTATION OF CASE: An 82 year woman was admitted to the hospital because of right hip joint pain. She was initially evaluated and admitted by orthopedics team for suspected arthritis. A CT-scan with contrast was ordered, which showed an intestinal ischemic obstruction in a right sided obturator hernia, an acute laparotomy was carried out. DISCUSSION: This case is important and differs from the well-known similar cases through the emergency admission at the orthopedic department because of the clear right hip pain and clinical history from the patient. An Obturator herniation (OH) is a rare external abdominal hernia accounting for only 0.07 %-1 % of all hernia cases. Because the female pelvis is wider which can lead to herniation of abdominal contents. The Howship-Romberg sign should be checked during physical examination. CONCLUSION: Obturator hernia is very rare and difficult to diagnose. Moreover when elderly women suffer from long-term chronic diseases, a very thin body, or a history of multiple deliveries. Howship-Romberg sign should be checked in these situations during physical examination. Early diagnosis and treatment significantly reduces the occurrence of intestinal perforation, necrosis, sepsis and/or other severe adverse events, thereby, a significant prognostic improvement of patients.

RESUMEN

Uterus transplantation is a novel approach in women whose uterus is absent or severely abnormal. However, it is still an experimental procedure that poses risks to both mother and baby. To date, 32 live births after uterus transplantation have been reported in peer-reviewed journals, with several maternal, fetal and neonatal complications. The most common complications were preterm delivery, hypertensive disorders and placenta previa. Four patients experienced episodes of transplant rejection during pregnancy. The appropriate management of complicated and non-complicated pregnancies following uterus transplantation is still unresolved. In this review, obstetric outcomes after uterus transplantation and optimal management during pregnancy are discussed in light of the available data. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Asunto(s)

Placenta Previa , Nacimiento Prematuro , Embarazo , Recién Nacido , Humanos , Femenino , Resultado del Embarazo , Estudios Retrospectivos , Útero/diagnóstico por imagen , Útero/trasplante , Nacimiento Prematuro/etiología

RESUMEN

This study investigated the effects of changes in the gap index on fracture displacement during follow-up. Patients who underwent closed reduction and casting with a diagnosis of unstable paediatric both-bone forearm fractures and a cast index < 0.8 were retrospectively evaluated. Patients were divided into Groups 1 and 2 based on their gap index (<0.15 and >0.15, respectively). Anteroposterior and lateral displacements of the radius and ulna and the gap index of the cast were measured on the X-ray after the first reduction and on the last X-ray before plaster removal. The mean patient age (n = 94, 74 boys and 20 girls; 51 in Group 1 and 43 in Group 2) was 7.09 ± 2.66 years. Fracture union times (plaster removal) were 38.8 ± 7.1 days. The mean cast index was 0.76 ± 0.05 (0.59-0.8). Both groups had similar distributions in terms of age, sex, fracture side, anatomic location and plaster removal time (p > 0.05). No significant differences were observed in either group in any radial or ulnar angulation values at any time point or the difference between the first and last values (all p > 0.05). Moreover, the gap index difference between the first and last measurements was significantly different in both groups (p = 0.002). If the cast index remains <0.8, despite the increase in the gap index in both groups, the amount of fracture displacement was small and acceptable.

Asunto(s)

Antebrazo , Fracturas Óseas , Masculino , Femenino , Humanos , Niño , Estudios Retrospectivos , Extremidad Superior

RESUMEN

BACKGROUND: The benefit of end-tidal carbon dioxide (ETCO2) and inferior vena cava collapsibility index (IVCCI) in predicting fluid responsiveness in mechanically ventilated patients has been demonstrated. However, the data on spontaneously breathing patients is controversial. This study aims to investigate the accuracy of variations in the ETCO2 (∆ETCO2) and IVCCI (∆IVCCI) gradient in predicting volume responsiveness in spontaneously breathing patients with hypovolemia. METHODS: This was a prospective observational study conducted in an academic emergency department (ED). Spontaneously breathing patients who required fluid resuscitation due to hypovolemia were included in the study. Cardiac output (CO), IVCCI and ETCO2 were measured before and after the passive leg raise (PRL). A change in the CO of ≥15% after the PLR were considered volume responsive. The difference in the ∆ETCO2 and ∆IVCCI were compared between the volume responsive and nonresponsive groups. RESULTS: A total of 31 patients were included in the study, of whom 15 patients were volume responsive. The difference in the ∆ETCO2 was 4 mm Hg in the volume responsive and 2 mm Hg in the nonresponsive group (p = 0.02). There was no significant difference in ∆IVCCI between the groups. A moderate correlation was detected between the difference in ∆ETCO2 and CO (0.585; p = 0.001). CONCLUSION: ∆ETCO2 can be an alternative method in predicting volume responsiveness in spontaneously breathing patients with hypovolemia.

Asunto(s)

Dióxido de Carbono , Fluidoterapia , Gasto Cardíaco , Humanos , Estudios Prospectivos , Vena Cava Inferior/diagnóstico por imagen

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BACKGROUND: Due to its many variations, the scapula is among the most frequently examined bones. Especially the acromion can be of different shapes and sizes. Measurements of the morphometric structures in the shoulder joint make it easier to explain the cause of the various shoulder problems. The objective of this study is putting emphasis on the importance of acromion types, os acromiale presence and acromial morphometric measurements in the aetiology and diagnosis of shoulder pain. MATERIALS AND METHODS: A retrospective study, based on 100 patients of both genders who presented with the complaints of shoulder pain and underwent magnetic resonance imaging, was conducted. Within this scope, types of acromion, slope of acromion, length of acromion, length of coracoid process, the distance between acromion and coracoid process, lateral acromial angle (LAA), critical shoulder angle (CSA), acromial index (AI) and acromiohumeral distance were measured. The data were analysed considering the gender and acromion types and the presence of os acromiale is investigated. RESULTS: The most common acromion was type II (curved) (frequency rate 62%) while the rate of type I (flat) and type III (hooked) acromions were 21% and 17%, respectively. The length of acromion and coracoid process were found to be significantly longer in males, while no significant difference between genders in terms of the distance between acromion and coracoid process were observed. Furthermore, while negative correlation between LAA and AI as well as LAA and CSA were observed; positive correlation between AI and CSA was found. In addition, there was negative correlation between slope of acromion and acromiohumeral distance. Besides, acromiohumeral distance was significantly higher in males. Regarding the presence of os acromiale, it was observed in 3 women out of 59 and 2 men out of 41, which indicated no significant difference between genders. CONCLUSIONS: It is evaluated that the morphometric measurement is of importance in contributing clinically in distinguishing the problems that may occur according to gender and acromion types.

Asunto(s)

Dolor de Hombro , Hombro , Femenino , Humanos , Masculino , Hombro/diagnóstico por imagen , Estudios Retrospectivos , Dolor de Hombro/patología , Acromion/diagnóstico por imagen , Acromion/patología , Escápula/diagnóstico por imagen

RESUMEN

BACKGROUND: Specific prognostic models for intracerebral hemorrhage (ICH) have short and simple features, whereas intensive care unit (ICU) severity scales include more complicated parameters. Even though newly developed ICU severity scales have disease-specific properties, they still lack radiologic parameters, which is crucial for ICH. AIMS: To compare the performance of the Simplified Acute Physiology Score (SAPS) III, Acute Physiology and Chronic Health Evaluation (APACHE) IV, Logistic Organ Dysfunction Score (LODS), ICH, max-ICH, ICH functional outcome score (ICH-FOS), and Essen-ICH for prediction of in-hospital and one-year mortality of patients with ICH. METHODS: A single-center analysis of 137 patients with ICH was conducted over 5 years. The performance of scoring systems was evaluated with receiver operating characteristic analysis. The independent predictors of one-year mortality were investigated with a multivariate logistic regression analysis. The SAPS-III score was calculated both in the emergency department (ED) and ICU. RESULTS: Among the independent variables, the need for mechanical ventilation, hematoma volume, the presence of intraventricular hemorrhage, and hematoma originating from both lobar and nonlobar regions were found as the strongest predictor of one-year mortality. For in-hospital mortality, the discriminative power of SAPS-II, APACHE-IV, and LODS was excellent, and for SAPS-III-ICU and SAPS-III-ED, it was good. For one-year mortality, the discriminative power of SAPS-II, APACHE-IV, LODS, and SAPS-III-ICU was good, and for SAPS-III-ED, Essen-ICH, ICH, max-ICH, and ICH-FOS, it was fair. CONCLUSIONS: Although all three ICH-specific prognostic scales performed satisfactory results for predicting one-year mortality, the common intensive care severity scoring showed better performance. SAPS-III scores may be recommended for use in EDs after proper customization.

Asunto(s)

Cuidados Críticos , Unidades de Cuidados Intensivos , APACHE , Hemorragia Cerebral/diagnóstico por imagen , Mortalidad Hospitalaria , Humanos , Pronóstico , Curva ROC , Estudios Retrospectivos

RESUMEN

Bacterial laccases are very stable at high temperature and high pH values, and have many biotechnological and industrial applications. Here we describe how we cloned, expressed and purified the laccase from Bacillus subtilis (B. subtilis). The enzyme molecular weight has been determined as 34 kDa in SDS-PAGE analysis. The activity of the recombinant enzyme has been proved by guaiacol oxidation. The KM and Vmax values of the enzyme were at 1.1077 mM and at 19.3 µmol/min/mg, respectively. The recombinant laccase was effective in the decolorization of Turquoise blue HF6, Remazol red 106, Remazol brilliant orange 3R, and Brilliant blue, thus, possessing the characteristics necessary for its possible application in textile and environmental industries.

Asunto(s)

Bacillus subtilis/enzimología , Proteínas Bacterianas/metabolismo , Lacasa/metabolismo , Bacillus subtilis/genética , Proteínas Bacterianas/genética , Clonación Molecular , Colorantes/metabolismo , Concentración de Iones de Hidrógeno , Lacasa/genética , Temperatura

RESUMEN

Radiomics features extracted from oncological PET images are currently under intense scrutiny within the context of risk stratification for a variety of cancers. However, the lack of robustness assessment poses problems for their application across institutions and for broader patient populations. The objective of the current study was to examine the extent to which radiomics parameters from oncological PET vary in response to manual contouring variability in lung cancer. Imaging data employed in the study consisted of 26 PET scans with lesions in the lung being created through the use of an anthropomorphic phantom in conjunction with Monte Carlo simulations. From each of the simulated lesions, 25 radiomics features related to the gray-level co-occurrence matrices (GLCOM), gray-level size zone matrices (GLSZM), and gray-level neighborhood difference matrices (GLNDM) were extracted from ground truth contour and from manual contours provided by 10 raters in regard to four intensity discretization schemes with number of gray levels of 32, 64, 128, and 256, respectively. The impact of interrater variability in tumor delineation upon the agreement between raters on radiomics features was examined via interclass correlation and leave-p-out assessment. Only weak and moderate correlations were found between segmentation accuracy as measured by the Dice coefficient and percent feature error from ground truth for the vast majority of the features being examined. GLNDM-based texture parameters emerged as the top performing category of radiomcs features in terms of robustness against contouring variability for discretization schemes engaging number of gray levels of 32, 64, and 128 while GLCOM-based parameters stood out for discretization scheme engaging 256 gray levels. How and to what extent interrater reliability of radiomics features vary in response to the number of raters were largely feature-dependent. It was concluded that impact of contouring variability on PET-based radiomics features is present to varying degrees and could be experienced as a barrier to convey PET-based radiomics research to clinical relevance.

Asunto(s)

Neoplasias Pulmonares/diagnóstico por imagen , Tomografía de Emisión de Positrones , Simulación por Computador , Humanos , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados

RESUMEN

We investigated the effects of Oenothera biennis L. and Hypericum perforatum L. extracts on brain tissue histopathology, myelin oligodendrocyte glycoprotein (MOG), myelin basic protein (MBP), total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) in mice with experimental autoimmune encephalomyelitis (EAE). Forty-seven C57BL/6J mice were divided into the following groups: multiple sclerosis (MS), control (healthy mice), MS + H. perforatum treated (MS + HP), MS + O. biennis treated (MS + OB). All groups except the control group were immunized by EAE methods. Two weeks after the immunization, the mice in the MS + HP group were fed normal food containing 18 - 21 g/kg H. perforatum extract, the mice in MS + OB group were fed normal food containing 18 - 21 g/kg O. biennis extract, and the mice in control and MS groups were fed normal food for six weeks. Brain tissue samples were collected from all mice for histopathological and biochemical analysis. Clinical signs of the disease were scored using functional systems scores (FSS) daily. The H. perforatum and O. biennis extracts ameliorated the increased brain tissue MOG and MBP values for animals with MS. H. perforatum and O. biennis extract decreased the TOS and OSI values for brain tissue and increased TAS levels in brain tissue of animals with MS. In addition, H. perforatum and O. biennis extracts decreased the clinical signs at the end of the experiment compared to the beginning of extract administration. We found that myelin was lost in MS group vs. control group. H. perforatum and O. biennis extract treatments decreased the amount of myelin loss in the MS + HP and MS + OB groups. We also observed amyloid deposition on vascular walls, in the cytoplasm of the neurons and in the intercellular space in the MS group. O. biennis and H. perforatum treated groups exhibited neither abnormal amyloid deposition nor obvious cell infiltration. The beneficial effects of O. biennis and H. perforatum for attenuating myelin loss and amyloid deposition suggest their therapeutic utility for treatment of MS.

Asunto(s)

Sistema Nervioso Central/inmunología , Hypericum/inmunología , Vaina de Mielina/metabolismo , Oenothera biennis/inmunología , Estrés Oxidativo/inmunología , Animales , Sistema Nervioso Central/patología , Modelos Animales de Enfermedad , Encefalomielitis Autoinmune Experimental/inmunología , Ratones Endogámicos C57BL , Esclerosis Múltiple/tratamiento farmacológico , Esclerosis Múltiple/inmunología , Glicoproteína Mielina-Oligodendrócito/inmunología , Neuronas/inmunología

Asunto(s)

Resinas Acrílicas/uso terapéutico , Embolización Terapéutica/métodos , Gelatina/uso terapéutico , Glomeruloesclerosis Focal y Segmentaria/terapia , Arteria Renal , Adulto , Femenino , Humanos

RESUMEN

PURPOSE: We aimed to compare two digital nerve block techniques in patients due to traumatic digital lacerations. METHODS: This was a randomized-controlled study designed prospectively in the emergency department of a university-based training and research hospital. Randomization was achieved by sealed envelopes. Half of the patients were randomised to traditional (two-injection) digital nerve block technique while single-injection digital nerve block technique was applied to the other half. Score of pain due to anesthetic infiltration and suturing, onset time of total anesthesia, need for an additional rescue injection were the parameters evaluated with both groups. Epinephrin added lidocaine hydrochloride preparation was used for the anesthetic application. Visual analog scale was used for the evaluation of pain scores. Outcomes were compared by using Mann-Whitney U test and Student t-test. RESULTS: Fifty emergency department patients ≥18 years requiring digital nerve block were enrolled in the study. Mean age of the patients was 33 (min-max: 19-86) and 39 (78 %) were male. No statistically significant difference was found between the two groups in terms of our main parameters; anesthesia pain score, suturing pain score, onset time of total anesthesia and rescue injection need. CONCLUSION: Single injection volar digital nerve block technique is a suitable alternative for digital anesthesias in emergency departments.

Asunto(s)

Anestésicos Locales/uso terapéutico , Traumatismos de los Dedos/cirugía , Lidocaína/uso terapéutico , Bloqueo Nervioso , Heridas Penetrantes/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/administración & dosificación , Esquema de Medicación , Servicio de Urgencia en Hospital , Femenino , Hospitales Universitarios , Humanos , Inyecciones Subcutáneas , Laceraciones/cirugía , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven

RESUMEN

OBJECTIVE: The aims of this study are the identification of differences in the diameter, length, area and branching angles of the trachea and bronchi with gender and age, and the identification of trachea types by using MDCT images. PATIENTS AND METHODS: The thoracic MDCT images of 253 patients (0-74 years old, 142 male and 111 female) were evaluated. Tracheal diameter, tracheal cross-sectional area, diameter and length of bronchi, and several angles of the bronchial tree [e.g. subcarinal angles (SCA), interbronchial angles (IBA)] were measured. RESULTS: Average anteroposterior and transverse diameter of the trachea in adult patients were measured as 15.8 ± 2.9 mm and 17.5 ± 3.7 mm respectively. Average tracheal cross-sectional areas in adult patients were calculated as 160.7 ± 41.3 mm² in females and as 275.7 ± 57.3 mm² in males. Four types of trachea were identified as circular (68% in adults, 73% in children), oval (13%, 15%), rectangular (11%, 5%) and horseshoe shaped (8%, 7%). The average right and left SCA were calculated as 34.5º ± 8.1º and 38.1º ± 8.9º respectively. The average right and left IBA were calculated as 32.4º ± 7.7º and 35.2º ± 8.1º respectively. CONCLUSIONS: The findings of this study may be helpful during bronchoscopy and tube and stent application procedures. MDCT seems to be a convenient technique for the evaluation of the bronchial tree.

Asunto(s)

Tomografía Computarizada por Rayos X , Tráquea/patología , Bronquios , Femenino , Humanos , Masculino , Caracteres Sexuales

RESUMEN

Uterine clear cell carcinoma (UCC) is an aggressive variant of endometrial cancer. Comprehensive surgical staging is strongly recommended for these patients as an upstaging to Stage 3-4 occur in 35-50% of patients. Stage 1A (no myometrial invasion) according to FIGO 1988 staging system are seen very rarely in patients. In most of the studies, regarding adjuvant treatment, clear cell carcinoma were all evaluated with papillary serous carcinoma (PSC). Studies on clear cell histology are low in number and also a limited number of patients were included. Proportion of patients with complete surgical staging, number of lymph nodes excised, and rate of omentectomy were all heterogenous and were not presented uniformly in studies. There is no concensus regarding adjuvant treatment for Stage 1A patients. Some authors suggest only close observation. Vaginal brachytherapy is also strongly recommended in some studies of this review. Multi-institutional studies with homogenous patient characteristics with homogeneous surgery is warranted.

Asunto(s)

Adenocarcinoma de Células Claras/terapia , Miometrio/patología , Neoplasias Uterinas/terapia , Adenocarcinoma de Células Claras/patología , Terapia Combinada , Femenino , Humanos , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias Uterinas/patología

RESUMEN

AIM: Cardiopulmonary bypass (CPB) is associated with the release of S100ß and neuron-specific enolase (NSE) indicating cerebral cell injury. The purpose of the present study was to evaluate the effect of propofol and sevoflurane on S100ß and NSE levels in patients undergoing coronary artery bypass grafting (CABG). MATERIALS AND METHODS: Twenty male patients undergoing CABG were randomly allocated into two groups. One group received sevoflurane (GS) and the other received propofol (GP). Arterial blood samples for analysis of S100ß and NSE levels were taken preoperatively (T1), 30 min after initiation of CPB (T2), at the end of CPB (T3), 1 (T4), 6 (T5) and 24 h (T6) postoperatively. RESULTS: S100ß level was significantly higher compared to all analyzed times at T3 in both groups (P < 0.001). S100ß level was significantly higher in GP than GS only at T2 (P = 0.002). NSE level was significantly higher at T3, T4 and T5 than T1 in the GP (P = 0.001, 0.002 and 0.023, respectively), while a significant increase was seen at T3 and T4 in GS group (P = 0.001 and 0.047, respectively). CONCLUSION: Our findings showed that both S100ß and NSE levels similarly increased during CPB and immediately after CPB during sevoflurane and propofol based anesthesia.

Asunto(s)

Éteres Metílicos/uso terapéutico , Fosfopiruvato Hidratasa/sangre , Propofol/uso terapéutico , Subunidad beta de la Proteína de Unión al Calcio S100/sangre , Anciano , Anestesia , Anestésicos por Inhalación , Lesiones Encefálicas , Puente Cardiopulmonar , Puente de Arteria Coronaria , Femenino , Humanos , Masculino , Éteres Metílicos/sangre , Persona de Mediana Edad , Fosfopiruvato Hidratasa/efectos de los fármacos , Propofol/sangre , Subunidad beta de la Proteína de Unión al Calcio S100/efectos de los fármacos , Sevoflurano

RESUMEN

OBJECTIVE: The transfer of the obstetric patient to the intensive care unit is considered as an indicator of maternal morbidity. The most important two indications for admittance of the obstetric patient to the intensive care unit are postpartum hemorrhage and hypertensive disorders. The purpose of this study was to determine maternal morbidity and mortality rates in patients diagnosed with hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome who required intensive care. MATERIALS AND METHODS: The charts of 34 patients who were diagnosed with HELLP syndrome and treated in intensive care unit between the years 2005 - 2013 were evaluated retrospectively. RESULTS: During the study period, a total of 151 patients were diagnosed with HELLP syndrome and 34 patients were admitted to the intensive care unit. Mean age of the patients was 28.97 ± 7.26 years and there was no significant difference be- tween survivors and non-survivors (p = 0.442). There were no significant differences between survivors and non-survivors in terms of gestational age, parity, and multiparity rates (p > 0.05). There was 31.2% mortal cases and 77.8% of living cases had received regular antenatal follow-up and the difference was statistically significant (p = 0.006). 30 patients (88.2%) required invasive mechanical ven- tilation. The average Glasgow Coma Score (GCS) of patients was 6.47 ± 4.34. There were significant differences between patients who lived and who died in terms of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) score, and duration of invasive mechanical ventilation (p < 0.05). Twenty-two patients (64.7%) required transfusion of blood and blood products. Maternal mortality occurred in 16 patients (47%). The causes of death were: intracerebral hemorrhage in six cases, acute respiratory distress syndrome (ARDS) in three cases, disseminated intravascular coagulation (DIC) in three\cases, sepsis/multi- ple organ dysfunction syndrome (MODS) in two cases, hepatic rupture in one case, and massive pulmonary embolism in one case. Con- clusion: HELLP syndrome is still one of the most serious and life-threatening complications of pregnancy. Mortality rate can be reduced by regular antenatal follow-up and transfer of pregnant women who carry risk to the intensive care unit without delay.

Asunto(s)

Hemorragia Cerebral/mortalidad , Coagulación Intravascular Diseminada/mortalidad , Síndrome HELLP/mortalidad , Insuficiencia Multiorgánica/mortalidad , Síndrome de Dificultad Respiratoria/mortalidad , Sepsis/mortalidad , APACHE , Adulto , Transfusión Sanguínea , Causas de Muerte , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/terapia , Coagulación Intravascular Diseminada/epidemiología , Coagulación Intravascular Diseminada/terapia , Femenino , Escala de Coma de Glasgow , Síndrome HELLP/terapia , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Mortalidad Materna , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/terapia , Embarazo , Respiración Artificial , Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Dificultad Respiratoria/terapia , Estudios Retrospectivos , Sepsis/epidemiología , Sepsis/terapia , Índice de Severidad de la Enfermedad , Turquía/epidemiología , Adulto Joven

RESUMEN

Current treatment regimens for rhabdomyosarcoma (RMS), the most common pediatric soft tissue cancer, rely on conventional chemotherapy, and although they show clinical benefit, there is a significant risk of adverse side effects and secondary tumors later in life. Therefore, identifying and targeting sub-populations with higher tumorigenic potential and self-renewing capacity would offer improved patient management strategies. Hedgehog signaling has been linked to the development of embryonal RMS (ERMS) through mouse genetics and rare human syndromes. However, activating mutations in this pathway in sporadic RMS are rare and therefore the contribution of hedgehog signaling to oncogenesis remains unclear. Here, we show by genetic loss- and gain-of-function experiments and the use of clinically relevant small molecule modulators that hedgehog signaling is important for controlling self-renewal of a subpopulation of RMS cells in vitro and tumor initiation in vivo. In addition, hedgehog activity altered chemoresistance, motility and differentiation status. The core stem cell gene NANOG was determined to be important for ERMS self-renewal, possibly acting downstream of hedgehog signaling. Crucially, evaluating the presence of a subpopulation of tumor-propagating cells in patient biopsies identified by GLI1 and NANOG expression had prognostic significance. Hence, this work identifies novel functional aspects of hedgehog signaling in ERMS, redefines the rationale for its targeting as means to control ERMS self-renewal and underscores the importance of studying functional tumor heterogeneity in pediatric cancers.

Asunto(s)

Carcinogénesis , Proteínas Hedgehog/metabolismo , Rabdomiosarcoma Embrionario/patología , Transducción de Señal , Humanos , Pronóstico , Rabdomiosarcoma Embrionario/metabolismo , Células Tumorales Cultivadas

RESUMEN

Gypsophila L. is the 3rd-largest genus of Caryophyllaceae in Turkey, a country that includes 60 taxa belonging to 56 species of the 126 recognized in the genus. A total of 35 taxa are endemic to Turkey, with an approximately 60% endemism ratio. In this study, the genetic diversity of 14 Gypsophila species from Turkey was analyzed using random amplification of polymorphic DNA (RAPD) and inter-simple sequence repeat (ISSR) markers. Sixteen RAPD and 6 ISSR primers produced 132 polymorphic bands. RAPD, ISSR, and RAPD + ISSR primers for the 14 species showed 92.7, 93.8, and 92.9% polymorphism, respectively. Our results indicate that RAPD and ISSR markers are reliable and effective for assessing the genetic diversity of Gypsophila species. Gypsophila species studied were separated into 2 clusters. Our analysis shows that the clusters correlated with geographic and phytogeographic regions.

Asunto(s)

Caryophyllaceae/genética , Cartilla de ADN , Variación Genética , Repeticiones de Microsatélite , Filogenia , Técnica del ADN Polimorfo Amplificado Aleatorio/métodos , Especificidad de la Especie , Turquía

RESUMEN

BACKGROUND: The cause of congenital lobar emphysema (CLE) is unknown and characterized by hyperinflation of one or more lobes of the lung. The purpose of this retrospective study was to present the anesthetic management of children with congenital lobar emphysema (CLE) receiving treatment in our center. METHODS: Ten children underwent CLE-related surgical treatment in our center between March 1995 and August 2014. All cases were diagnosed on the basis of postero-anterior chest radiography and computerized tomography. Age, sex, preoperative clinical findings, location of lesions, surgical and anesthetic procedures, results of anesthesia and duration of hospitalization were evaluated. RESULTS: Six patients were male (60%) and four female (40%). Their ages ranged from 40 days to 6 years. Dyspnea was present in all cases and severe in four of them. Four patients had emphysema in the left upper lobe, three in the right middle lobe, one in the right upper lobe and one in the left lower lobe. All patients were extubated in the operating room and none experienced post-operative respiratory distress. Post-operative analgesia was provided via the previously placed intrapleural catheter. All the patients were extubated in the operation room. There was no post-operative mortality or morbidity. CONCLUSIONS: Anesthetic management of patients with CLE is challenging. In these patients the surgical team and -anesthetists should collaborate closely and the time between anesthesia induction and thoracotomy should be as short as possible.

Asunto(s)

Anestésicos por Inhalación/uso terapéutico , Anestésicos Locales/uso terapéutico , Bupivacaína/uso terapéutico , Enfisema/congénito , Enfisema/cirugía , Dolor Postoperatorio/prevención & control , Extubación Traqueal , Niño , Preescolar , Desflurano , Disnea/etiología , Femenino , Humanos , Lactante , Cuidados Intraoperatorios , Intubación Intratraqueal , Isoflurano/análogos & derivados , Isoflurano/uso terapéutico , Masculino , Éteres Metílicos/uso terapéutico , Quirófanos , Dimensión del Dolor/métodos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Sevoflurano

RESUMEN

This study explores the relationship between clinical cardiovascular risk factors and clinical androgen excess, with direct comparison to radial artery intima media thickness (rIMT). rIMT of 91 patients with polycystic ovary syndrome (PCOS) were compared with 72 healthy women. Patients were divided into three groups with regard to body mass index (BMI). Group1 = 56 women (31 controls and 25 PCOS) with low BMI(18-22.49 kg/m(2)), Group2 = 36 women (15 controls and 21 PCOS) with normal BMI (22.5-24.99 kg/m(2)) and Group3 = 71 women (26 controls and 45 PCOS) with high BMI (25-30 kg/m(2)). rIMT was significantly higher in patients with PCOS (p = 0.007). rIMT was significantly higher group1 and group3 in patients with PCOS compared to controls (p = 0.007 and p = 0.042, respectively). There was a significant positive association between rIMT levels and fT in women with PCOS in group1 (r = 0.24, p = 0.04). rIMT levels correlated to fT levels in women with PCOS in group3 (r = 0.32, p = 0.03). Modified Ferriman-Gallwey (mFG) scores demonstrated a positive association with free testosterone, total testosterone, free androgen index, waist circumference (WC), LH levels, insulin levels, Homeostasis Model Assessment index(HOMA-IR), rIMT and a negative correlation with sex hormone binding globulin in group1 and group2. mFG scores demonstrated a positive association with free testosterone (r = 0.33, p = 0.029) in group3, but no association was found between mFG and WC, HOMA-IR in group3. Our findings indicate that clinical androgen excess may be associated with cardiovascular disease in patients with PCOS.

Asunto(s)

Andrógenos/sangre , Grosor Intima-Media Carotídeo , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/diagnóstico por imagen , Arteria Radial/diagnóstico por imagen , Adulto , Femenino , Humanos , Adulto Joven