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PURPOSE: Rapid diagnosis of genetic mutations is important for targeted therapies such as EGFR tyrosine kinase inhibitors. KRAS mutation and ALK rearrangement are also important in determining treatment. The purpose of our study was to evaluate the diagnostic value of 18F-FDG PET to predict KRAS mutation and ALK rearrangement in order to determine the frequency of these genetic markers in our lung adenocarcinoma cases and contribute to forthcoming meta-analysis studies. METHODS: A total of 218 patients with lung adenocarcinoma (EGFR analyzed) who were seen at our clinic between 2012 and 2014 were included in the study. The results of the 18 F-FDG-PET scans for each patient were retrospectively recorded with the associated medical documents. ALK rearrangements were analyzed in 166 of the 218 patients, while 50 of the 218 patients were analyzed for KRAS mutational status. SPSS 15.0 for Windows was used for statistical analysis. RESULTS: FDG avidity was higher in cases with KRAS mutations and ALK rearrangements than those without, but the difference was not significant. ALK rearrangements were more common in younger, female, and nonsmoking patients with lung adenocarcinoma. CONCLUSIONS: The small numbers of KRAS mutations and ALK rearrangements are the limitation of this study for evaluation of diagnostic imaging. The frequency of these genetic alterations was as reported in the literature. We believe that our work will contribute to future meta-analysis.

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OBJECTIVES: P-glycoprotein (P-gp) contributes to the disposition of a wide variety of drugs; therefore, single nucleotide polymorphisms (SNPs) in the P-gp coding gene might affect its activity. It is well known that personalized medicine, instead of empirical treatment, is a clinically important approach for enhancing responses among patients. Indeed, there is a need to evaluate the association between SNPs of P-gp encoded multidrug resistance genes (MDR1, ABCB1), and the dosage requirements of these drugs. In the present study, we evaluated the association between the dosage of Levothyroxine (L-T4) and three common SNPs (C1236T, G2677T/A and C3435T). METHODS: Genotyping was done using a real-time PCR platform with DNA samples isolated from the venous blood of ninety post thyroidectomy hypothyroid patients. Thyroid hormone levels were measured as routine biochemistry laboratories in the Medical School of Istanbul University. RESULTS: In the genotype analysis, the minor allele frequencies were 0.48 for C1236T, 0.51 for G2677T/A, and 0.51 for C3435T. In the haplotype-based analysis, T1236T2677T3435 and C1236G2677C3435 were observed as major haplotypes (50.2 and 32.6%, respectively), in agreement with previous studies. The administered dose of L-T4 to achieve physiological thyroid hormone levels was found to be similar in all genotypes and haplotypes, indicating that there is no significant association between MDR1 polymorphisms and L-T4 doses. CONCLUSION: Because of conflicted previous reports about the genetic contribution of MDR1 polymorphisms to drug disposition, further studies with large numbers of participants are required to clarify this influence.

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OBJECTIVES: The effect of subcostal transversus abdominis plane (TAP) block on postoperative pain is contradictive. The aim of this study was to evaluate the effect of subcostal TAP block on subacute pain in patients who have undergone inguinal herniography. METHODS: Patients aged between 18 and 75 years with American Society of Anesthesiologists 1-3 and who were to undergo elective unilateral inguinal herniography with mesh under general anesthesia were included. Fifty patients were under an intravenous analgesic regimen (group I) and 50 patients underwent subcostal TAP block postoperatively in addition to the intravenous analgesic regimen (group II). The primary outcome measure was pain scores 1 month postoperatively by comparing Numerical Rating Scale values with the Mann-Whitney U test between groups I and II. Secondary outcome measures were life qualification scores 1 month postoperatively and pain scores 24 h and 15 days postoperatively. RESULTS: Postoperative 15th-min; 1st-, 6th-, 12th-, and 24th-h; 15th-day (p=0.00); and 1st-month Numerical Rating Scale values were significantly lower in group II than in group I (p=0.02). No significant difference was observed between the groups in terms of LQS 15 days postoperatively (p=0.013). On group comparison, LQS was higher in the 1st month than at the 15th day postoperatively in group I (p=0.201). CONCLUSION: Subcostal TAP block provides an effective postoperative pain treatment in the acute period and in the 1st postoperative month in patients undergoing inguinal herniography.

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OBJECTIVE: Pooling is an alternative method to achieve in vitro fertilization outcomes. This study was to investigate the effect of pooling method on pregnancy outcomes in poor responder patients according to Bologna criteria. MATERIALS AND METHODS: Two hundred-fifty five poor responder patients were enrolled in this study. Pooling embryo transfer (ET) group had 110 and fresh ET group had 145 patients. RESULTS: Although, age was similar between both treatment groups (p=0.31), antral follicle count (p<0.001), total number of retrieved oocyte (p<0.001), total metaphase II oocyte count (p<0.001), number of stimulation cycles (p<0.001), were significantly different between the groups. The day of ET were similiar between two groups (p=0.72) but the number of ET procedure was significantly higher in pooling ET group compared to fresh ET (p<0.001). Positive pregnancy test [35/110 (32%) vs 53/145 (37%)] (p=0.43) and clinical pregnacy rates [31/110 (28%) vs 49/145 (34%)] (p=0.33) were similar between groups, whereas, implantation [31/191 (16%) vs 49/198 (25%)] (p=0.03) and live birth rates [15/110 (14%) vs 36/145 (25%)] (p=0.04) were significantly higher in fresh ET group. Despite that, abortion rates were significantly higher in pooling ET group [16/31 (52%) vs 13/49 (27%)] (p=0.04). Binary logistic regression analyese has revealed no effect of variables on live birth rates. CONCLUSION: Even though, pooling strategy seems to have a slight positive effect on pregnancy outcomes, there is no benefical effect on live birth rates. Furthermore, this strategy is increasing the abortion rates in parallel with clinical pregnancy rates.

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AIM: Esophageal cancer is one of the most aggressive tumors of the gastrointestinal tract. In this study, we quantified the serum vascular endothelial growth factor-3 (VEGFR-3) expression in patients with esophageal squamous cell carcinoma (ESCC) to evaluate the role of VEGFR-3 in ESCC. MATERIALS AND METHODS: Ninety five patients with ESCC were studied. Pre-therapy and preoperative samples were stored and ELISA was used to designate the concentrations of VEGFR-3. RESULTS: The serum values of VEGFR-3 were significantly higher in patients with ESCC than in healthy donors (p<0.0001). CONCLUSIONS: The results imply a very good sensitivity of VEGFR-3 in ESCC. VEGFR-3 may be a good diagnostic biomarker for ESCC. KEY WORDS: Biomarker, ESCC, VEGFR-3.

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Introduction Genetic mutations such as C599T polymorphism in glutathione peroxidase [GPX1] gene and polymorphisms in potassium channel (KCNJ11) genes have recently been proposed in the etiopathogenesis of new onset diabetes mellitus after renal transplantation (NODAT). We aimed to examine the association of GPX1 and KCNJ11 polymorphisms in NODAT. Materials and Methods This is a monocenter case-control study with a total of 118 renal transplant recipients who were divided into 2 groups; NODAT and normal glucose tolerance. Relation of GPX1 and KCNJ11 polymorphisms were investigated between these groups. PCR-RFLP method was used for genotyping of polymorphisms in the GPX1 (rs1050450) and KCNJ11 (rs1805127) genes. Two alleles were visualized for each gene (C/T for GPX1 and A/G for KCNJ11). Results NODAT was correlated with age at transplantation (p<0.001, r=0.380), post-transplant systolic blood pressure (BP) (p=0.02, r=0.211), post-transplant non-HDL cholesterol levels (p=0.01, r=0.803), degree of weight change at the end of the first year (p=0.01, r=0.471), presence of pre-transplant hypertension (HT) (p=0.02, r=0.201), family history of diabetes (p=0.01, r=0.29) and dyslipidemia (p=0.012, r=0.362). GPX1 polymorphism of TT (mutant) allele was significantly more frequent in patients with NODAT (p<0.001, r=0.396) independent from other diabetogenic risk factors. KCNJ11 polymorphisms were similar in both groups and did not show any significant association with NODAT (p=0.10). Conclusions In addition to several diabetogenic risk factors, C599T polymorphisms in GPX1 gene might also contribute to the development of NODAT. Further studies on larger patient series are necessary in order to reach definitive suggestions.

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Purpose Rapid diagnosis of genetic mutations is important for targeted therapies such as EGFR tyrosine kinase inhibitors. KRAS mutation and ALK rearrangement are also important in determining treatment. The purpose of our study was to evaluate the diagnostic value of 18F-FDG PET to predict KRAS mutation and ALK rearrangement in order to determine the frequency of these genetic markers in our lung adenocarcinoma cases and contribute to forthcoming meta-analysis studies. Methods A total of 218 patients with lung adenocarcinoma (EGFR analyzed) who were seen at our clinic between 2012 and 2014 were included in the study. The results of the 18 F-FDG-PET scans for each patient were retrospectively recorded with the associated medical documents. ALK rearrangements were analyzed in 166 of the 218 patients, while 50 of the 218 patients were analyzed for KRAS mutational status. SPSS 15.0 for Windows was used for statistical analysis. Results FDG avidity was higher in cases with KRAS mutations and ALK rearrangements than those without, but the difference was not significant. ALK rearrangements were more common in younger, female, and nonsmoking patients with lung adenocarcinoma. Conclusions The small numbers of KRAS mutations and ALK rearrangements are the limitation of this study for evaluation of diagnostic imaging. The frequency of these genetic alterations was as reported in the literature. We believe that our work will contribute to future meta-analysis.

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PURPOSE: The study aims to determine the effects of mesenchymal stem cell (MSC) therapy and a combination therapy of MSCs transfected with vascular endothelial growth factor (VEGF) for liver regeneration after major resection. METHODS: Thirty-eight rats were divided into four groups: group 1: control (sham operation); group 2: control (70 % hepatic resection); group 3: 70 % hepatic resection + systemically transplanted MSCs; and group 4: 70 % hepatic resection + systemically transplanted MSCs transfected with the VEGF gene. MSCs were injected via the portal vein route in study groups 3 and 4. Expression levels of VEGF, fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), transforming growth factor (TGF), hepatocyte growth factor (HGF), and augmenter of liver regeneration (ALR) were analyzed in the remnant liver tissue. We investigated the levels of angiogenic factors, VEGF-receptor, angiopoietin-1 (Angpt1) and Angpt2. Biochemical parameters of liver function in blood samples were measured and a histologic assessment of the livers was performed. The postoperative liver weight and volume of each rat were measured 14 days after surgery. RESULTS: The expression levels of all measured growth factors were significantly increased in groups 3 and 4 compared to the control groups. The levels of Angpt1 and Angpt2 correlated with levels of VEGF and thus were also significantly higher in the study groups. There were significant differences between the estimated liver weights and volumes of group 4 and the resected controls in group 2. With the exception of portal inflammation, levels of all histological parameters were observed to be higher in MSC-treated groups when compared with the resected controls in group 2. CONCLUSIONS: Transplanted stem cells and MSCs transfected with VEGF significantly accelerated many parameters of the healing process following major hepatic resection. After the injection of MSCs and VEGF-transfected MSCs into the portal vein following liver resection, they were engrafted in the liver. They increased bile duct and liver hepatocyte proliferation, and secreted many growth factors including HGF, TGFß, VEGF, PDGF, EGF, and FGF via paracrine effects. These effects support liver function, regeneration, and liver volume/weight.

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Surgical excision and lay-open is a well-known technique for the treatment of sacrococcygeal pilonidal disease, which impairs a patient's quality of life considerably since wound healing takes a substantial amount of time. It is known that with this method total healing period is longer, but recurrence rate of the disease is lower. The beneficial effects of hyperbaric oxygen (HBO2) therapy on wound healing have been well established since it was first put into in clinical use. The purpose of this prospective randomized clinical trial was to investigate the effects of HBO2 therapy on wound healing in the patients who had sacrococcygeal pilonidal disease and surgical treatment. Total epithelialization times of 12 patients (Group 1) who received surgical intervention were compared with those of 10 patients who had surgical intervention and HBO2 therapy (Group 2). In both groups excised tissue volume, excised skin area, body mass index, blood hemoglobin, albumin levels, ages and duration of the complaints were recorded and there was no statistically significant difference in these parameters except albumin levels when compared. The complete epithelialization time was significantly shorter in Group 2 (50 ± 11 vs. 83 ± 18, p⟨0.001). We conclude that HBO2 had beneficial effects on wound healing, in the patients who had sacrococcygeal pilonidal disease and were treated with surgical excision applying lay-open technique.

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OBJECTIVE: Lyophilized drug manufacturing and intra-articular (IA) applications have increased to address gastrointestinal side effects resulting from chronic treatment with non-steroidal anti-inflammatory drugs (NSAIDs) for degenerative joint disease. Accordingly, we histologically examined joint and stomach tissues from rats to determine and compare the effects of long-term treatment with an IA corticosteroid (methylprednisolone acetate), lyophilized NSAID (tenoxicam), and non-lyophilized NSAID (diclofenac) following application to the knee joint. METHODS: One hundred Wistar albino rats were divided into 4 groups of 25 rats: control, methylprednisolone, tenoxicam, and diclofenac. Ten IA injections were administered at 1-week intervals. Rats were sacrificed at 48 h and 1, 2, 4, and 8 weeks after the tenth injection. Histomorphologically, knee joint samples were examined for osteoarthritic changes and stomach tissue samples for gastric changes. RESULTS: Unlike methylprednisolone, diclofenac and tenoxicam caused increased fibrosis and fibroblast production; furthermore, chronic methylprednisolone use had no negative effects on the synovium or cartilage. CONCLUSION: Chronic tenoxicam and diclofenac use affects joints more negatively than chronic steroid treatment.

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OBJECTIVE: To compare the effects of fresh embryo transfers (ET) and elective frozen/thawed embryo transfers (eFET) on implantation, clinical pregnancy, and live birth rates in poor ovarian responders, as defined by the Bologna criteria. MATERIALS AND METHODS: All electronic databases of embryo transfers between January 2011 and January 2014 were retrospectively reviewed. Two hundred fifty-nine of all the fresh ET and 96 of all eFET were included into the study. An antagonist protocol with letrozole was used for the controlled ovarian hyperstimulation (COH) in all participants. RESULTS: The mean age was 36.9 years (range, 21-43 years) in the fresh ET arm and 37.2 years (range, 21-43 years) in the eFET arm (p=0.45). The clinical pregnancy rate was 35% (90/259) versus 29% (28/96); the abortion rate was 27% (20/75) versus 36% (9/25); and the live birth rate was 21% (55/259) versus 17% (16/99). There were no significant differences between groups and p values were 0.32, 0.52, and 0.42, respectively. The mean E2 level was 389 (range, 50-2055 pg/mL) in the fresh ET group (on hCG day) and 418 pg/mL (range, 121-3073 pg/mL) in the eFET group (on day 14 of cycle) (p=0.122). No differences were found between the two groups with respect to the total number of retrieved oocytes (p=0.55) and number of metaphase II (MII) oocytes (p=0.81). The number of embryo transfers was statistically different (p=0.005). The effects of age, total number of retrieved oocytes, number of MII oocytes, type of treatment, number of ET, and the day of ET and E2 level to live birth outcomes were investigated using binary logistic regresion analyses, and no stastical effect was determined by any of the parameters. P values were p=0.50, 0.66, 0.45, 0.30, 0.30, 0.08, and 0.90, respectively. CONCLUSION: E2 levels tend to be lower in poor responders, thus the receptivity of the endometrium may be damaged less than normal, which may explain why pregnancy results are the same between eFET and ET groups.

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OBJECTIVE: We aimed to investigate the SUVmax of primary tumor and metastatic lymph node in predicting survival in patients with esophageal cancer. METHODS: We retrospectively analyzed patients with esophageal cancer between 2009 and 2011 who had FDG positron-emission tomography (PET)/computed tomography (CT). All patients were followed-up to 2013. Clinical staging, SUVmax of primary tumor and metastatic lymph node were evaluated. RESULTS: One hundred seven patients were included in the study. All patients were followed-up between 2 and 49 months. The mean SUVmax of primary tumor and metastatic lymph node were 19.3±8.8 and 10.4±9.1, respectively. Metastatic lymph node SUVmax had an effect in predicting survival whereas primary tumor SUVmax did not have an effect (p=0.014 and p=0.262, respectively). Multivariate Cox regression analysis showed that clinical stage of the disease was the only independent factor predicting survival (p=0.001). CONCLUSION: Among patients with esophageal cancer, the value of primary tumor SUVmax did not have an effect on survival. Clinical stage assessed with FDG PET/CT imaging was found to predict survival in esophageal carcinoma. Additionally, lymph node SUVmax was identified as a new parameter in predicting survival in the present study.

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BACKGROUND: Screening for biochemical markers is important for diagnosing colon cancer. In this study, the reliability of serum mesothelin levels as a potential diagnostic and screening instrument was evaluated concerning colon cancer. METHODS: Ninety-five patients who had undergone colonoscopic examination and who were diagnosed with colon cancer were included in the study. The serum mesothelin levels were measured with the ELISA kits and were evaluated in terms of significant difference when compared between colon cancer and control group. RESULTS: Patients with colon cancer had significantly higher mesothelin serum levels (P < 0.001) than the control groups. We found significant associations between serum levels and tumor grade, perineural invasion, and vascular invasion (resp., P < 0.001). CONCLUSION: Evaluating the serum levels of mesothelin has a potential to detect and screen the colon cancer in affected patients. Our data suggest that mesothelin exhibits effects towards colon cancer and serves as a biomarker for this deadly disease.

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Thromboembolic events represent a major cause of morbidity and mortality in patients with inflammatory bowel disease and they may occur both at the gastrointestinal tract and at extraintestinal sites. This study aimed to examine the alterations in coagulation parameters involved at different steps of hemostasis in patients with Crohn's disease and ulcerative colitis, in comparison with healthy individuals. Fifty-one patients with inflammatory bowel disease and 26 healthy controls were included in this study. Plasma levels of PT, APTT, AT III, plasminogen, fibrinogen, D-dimer, factor V, factor VIII, protein C, protein S, and APCR were measured and factor V Leiden mutation was examined in both patients and controls. Two patients with ulcerative colitis had a history of previous thromboembolic event. Inflammatory bowel disease was associated with significantly higher levels of fibrinogen, PT, factor V, factor VIII, plasminogen and thrombocyte. Protein S, fibrinogen, plasminogen and thrombocyte levels were associated with disease activity, depending on the type of the disease (Crohn's disease or ulcerative colitis). The coagulation abnormalities detected in this study seems to be a secondary phenomena resulting from the disease process, which is more likely to be associated with a multitude of factors rather than a single abnormality.

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OBJECTIVE: The aim of our study is to determine the general intestinal parasite prevalence in Istanbul University Istanbul Faculty of Medicine Hospital, which is located in European and Asian geographical features of Turkey. METHODS: Between January 1988 and December 2012, a total of 111,889 stool samples from patients who were admitted to the Istanbul University Istanbul Faculty of Medicine Hospital were examined microscopically by using native lugol and formalin-ether concentration technique; in addition, the cellophane tape test technique was used to examine the perianal area. RESULTS: The prevalence of intestinal parasites was found to be 5% (5486/111,889) in Istanbul. Giardia intestinalis was the leading parasite (62%), and the prevalence of the rest of the intestinal parasites was as follows: Enterobius vermicularis, Ascaris lumbricoides, and Blastocystis hominis: 16%, 7%, and 6%, respectively. Between 2000 and 2012, a highly significant reduction in general parasite prevalence was determined, compared to the 1988 and 2000 time period (p<0.001). CONCLUSION: Socio-economic conditions might be related with the both the lower prevalence of intestinal parasites in our hospital, which is located in Marmara region, and the steady decrease of the prevalence ratio in the 2000s. The results indicate the necessity of further studies to develop effective parasitic disease control measurements.

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OBJECTIVES: To see if high-sensitivity C-reactive protein levels increase even in the early stages of asthma, and to evaluate if corticosteroid therapy affects the levels in asthma patients. METHODS: The case-control pilot study was conducted at Yedikule Chest Disease and Surgery Education and Research Hospital, Turkey, from February to April 2011. Patients newly diagnosed with asthma who reported symptoms that occurred six months before diagnosis were included in the study.The protein levels were measured pre-treatment and one month post-treatment. In addition, pulmonary function test and total Immunoglobulin-E measurements were taken and the prick test was performed. Statistical analysis was done using SPSS 15. RESULTS: There were 15 cases; 8 (53%) females and 7 (47%) males. Besides, there were 19 Controls; 9 (47%) females and 10 (53%) males. The mean age of the Cases was 29.13+/-10.30 years, while for the Controls it was 28.9+/-5.35 years. The difference was not statistically significant (p<0.54). The difference in protein levels pre and post-treatment was not significant. However, a higher level in the pre-treatment period was found compared to the Controls. Posttreatment levels in the Cases were not significantly different than the Controls. CONCLUSION: Elevated high-sensitivity C-reactive protein levels in asthmatic patients may indicate an increased risk for cardiovascular disease. Future studies in asthma patients should focus on this relationship.

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AIM: To detect telomerase reverse transcriptase (TERT) expression in tissue and metastatic and non-metastatic lymph node samples from patients with non-small cell lung cancer; to evaluate whether TERT expression is correlated with pathological and clinical features, and/or patient survival times; to determine differences between TERT expression in metastatic and non-metastatic lymph nodes. PATIENTS AND METHODS: Tumor tissue samples from 17 patients with squamous cell lung cancer and 11 patients with adenocarcinoma diagnosed between 2003 and 2004 were included in this study. All patients were diagnosed at our hospital and had samples stored in the pathology archive. Additionally, dissected lymph node samples, with and without metastases, were studied. Telomerase Gene Tex, Inc, Irvine, CA USA (TERT (2C4) antibody), Universal Kit (Lab Vision, Newmarket, UK) were used for immunohistochemical staining. Statistical analyses were performed using SPSS 17.0 statistical software. RESULTS: TERT was positive in 18/28 of the samples, regardless of the histological tumor type. There was no significant correlation between TERT expression in lymph nodes with metastasis and clinical stage, histological type, tumor differentiation, or survival time. CONCLUSION: TERT expression may be used as a target for therapy. It may also be helpful in predicting metastasis but not in predicting survival time.

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BACKGROUND: The treatment of ingrown toenail is usually bothersome for patients and doctors. OBJECTIVES: To compare two treatment techniques of ingrown toenails-phenol matricectomy (PM) and nail-splinting using a flexible tube (FT)-in terms of efficacy, postoperative pain, postoperative cosmetic satisfaction, amount of tissue damage, and recurrence. METHODS AND MATERIALS: One hundred twenty ingrown toenails were randomized and divided into PM and FT groups. All cases were evaluated 2 days and 1 and 6 months after treatment. Postoperative pain, cosmetic satisfaction, time to recovery, and recurrence rate were measured. RESULTS: Postoperative pain was less and cosmetic satisfaction was good in both groups (p <.001). Our recurrence rate was 8.4%. There were no statistical differences between groups in these measures. Tissue improvement rate was 6% in the PM group and 93% in the FT group 2 days after the procedures (p <.001). CONCLUSIONS: Although FT provides faster recovery and less postoperative morbidity than PM, the techniques are equally effective in treating ingrown toenails.

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OBJECTIVE: To evaluate the predictive value of gestational age and maternal serum ß-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. METHODS: This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum ß-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). RESULTS: There was a significant difference in maternal serum ß-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum ß-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. CONCLUSION: The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum ß-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high ß-hCG concentrations.

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