FGF–2 is required to prevent astrogliosis in the facial nucleus after facial nerve injury and mechanical stimulation of denervated vibrissal muscles

Recently, we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking. Using gene knock outs, we found a differential dependence of manual stimulation effects on growth factors. Thus, insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements, whereas FGF-2 is not. The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally, i.e. within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows "synaptic stripping". We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein (GFAP) as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2 (FGF-2^-/- mice). There was no difference in GFAP-Cy3-fluorescence (pixel number, gray value range 17–103) between intact wildtype mice (2.12± 0.37×10⁷) and their intact FGF-2^-/- counterparts (2.12± 0.27×10⁷) nor after facial-facial anastomosis +handling (wildtype: 4.06± 0.32×10⁷; FGF-2^-/-: 4.39±0.17×10⁷). However, after facial-facial anastomosis, GFAP-Cy3-fluorescence remained elevated in FGF-2^-/--animals (4.54±0.12×10⁷), whereas manual stimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice (2.63± 0.39×10 ). We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction, but it is required to minimize astrogliosis in the brainstem and, by implication, restore synaptic coverage of recovering facial motoneurons.     

The Role of Steroid Sulfatase as a Prognostic Factor in Patients with Endometrial Cancer

PurposeThe aim of the study was to determine steroid sulfatase (STS) expression in endometrial cancer patients and its correlation with disease prognosis.ResultsSixteen of the 59 patients (27.1%) were positive for STS expression. Disease free survival (DFS) was 129.83±8.67 [95% confidence interval (CI): 112.84–146.82] months in the STS positive group (group A) and 111.06±7.17 (95% CI: 97.01–125.10) months in the STS negative group (group B) (p=0.92). Overall survival (OS) was 129.01±9.38 (95% CI: 110.63–147.38) months and 111.16±7.10 (95% CI: 97.24–125.07) months for the groups A and B, respectively (p=0.45). Univariate analysis revealed that FIGO stage and adjuvant therapy are significantly associated with DFS and OS. However, in multivariate analysis, FIGO stage and adjuvant therapy did not show any statistical significance with DFS and OS. STS was also not significantly associated with DFS and OS in univariate and multivariate analysis.ConclusionSTS expression was not significantly associated with DFS and OS, despite positive STS expression in 27% of endometrial cancer patients. Therefore, the role of STS as a prognostic factor in patients with endometrial cancer remains unclear and requires further research.     

Peripheral blood lymphocyte subsets (CD4+, CD8+ T cells), leptin level and weight loss after laparoscopic greater curvature plication in morbidly obese patients

Introduction

The aim of the study was to detect the effect of laparoscopic greater curvature plication (LGCP) on peripheral blood lymphocyte subsets (helper and cytotoxic T lymphocytes – CD4+ and CD8+ T cells respectively), leptin level and weight loss in morbidly obese patients.

Material and methods

Morbidly obese patients (n = 20, age range: 25–50 years, body mass index (BMI) range: 37–45 kg/m²) who underwent LGCP were enrolled in a prospective study to determine the percentages of their peripheral blood T cells (CD4+ and CD8+) before and 4 months postoperatively using flow cytometry. Also, the level of their leptin before and 4 months postoperatively was established using enzyme-linked immunosorbent assay (ELISA). The data are expressed as the percentage of total lymphocytes ± the standard error of the mean.

Results

A decrease in the BMI and loss of weight (31.20 ±1.2%) were confirmed 4 months postoperatively since BMI was 44.71 ±4.3 (range: 37–45) kg/m² preoperatively, and decreased to 31.80 ±1.1 (range: 24–33) kg/m² after surgery. The mean percentage of CD4+ and CD8+ T lymphocytes significantly decreased postoperatively (38.2 ±1.5 before and 29.3 ±2.6 after operation for CD4+, 17.3 ±1.8 preoperatively and 9.5 ±1.7 postoperatively for CD8+, p < 0.05). The mean leptin level was 43.01 ±22.01 preoperatively while postoperatively it was 24.8 ±11.1 (p < 0.05), so the leptin level substantially decreased compared to its preoperative values.

Conclusions

This study found that weight loss after LGCP in morbidly obese patients led to decreases in levels of leptin and circulating immune cells compared to their preoperative values.     

Comparison of greater occipital nerve and greater occipital nerve + supraorbital nerve block effect in chronic medication overuse headache

Background /aimIn this study, we aimed to compare the efficacy of greater occipital nerve (GON) block alone and GON combined with supraorbital nerve (SON) block in the treatment of medication overuse headache (MOH).Material and methods82 patients were divided into two groups: 41 patients were administered bilateral GON block while the other 41 patients GON + SON block. Nerve blocks were administered every 10 days for a total of 5 sessions. After each administration and 20 days after the last injection, information on pre and post treatment numerical rating scale (NRS) score, number of painful days, analgesic intake, duration of pain were collected.ResultsThe decrease in headache evaluation parameters was similar in both groups after the block. The NRS scores in the GON and GON + SON groups before the treatment was (8.2 ±  0.7, 8.5  ± 0.7), the number of painful days in a month was (21.4 ±  6.9, 21.2 ± 4.6 days), the number of analgesics taken monthly was (45 ±  25.6, 47.5 ±  29.9), the duration of pain was (44.9 ±  24.6, 41.7 ±  22.8 h), respectively. On the 60th day of treatment, the NRS scores in the GON and GON + SON groups were found to be (6.8 ±  2.5, 4.8 ± 2.3), the number of painful days in a month was (4.2 ±  3.3, 2.2 ±  1.5), respectively. The number of monthly nalgesic consumption was (4.4 ±  3.8, 0.9 ±  1.2), and the duration of pain was (28.4 ±  19.3, 19.4  ± 16.1 h).ConclusionThis study showed significant reductions in headache parameters in both groups. However, NRS score, analgesic intake, number of painful days, and pain duration significantly better improved in the GON block added SON block group.     

Assessment of fragmented QRS formation and its relationship with left ventricular hypertrophy in nonhypertensive acromegaly patients

Background/aim It is known that the presence of fragmented QRS (fQRS) on electrocardiography (ECG) is associated with cardiovascular events. The aim of this study was the evaluation of fQRS formation and its relationship with the left ventricular hypertrophy (LVH) parameters in acromegaly patients. Materials and methods In total, 47 previously diagnosed with non-hypertensive acromegaly patients and 48 control subjects were included in the study. ECG and transthoracic echocardiography (TTE) were performed for each participant. Acromegaly patients were divided into two groups according to the fQRS formation on the ECG. Left ventricular wall thicknesses, and left atrial diameter (LAD), left ventricular mass (LVM), left ventricular mass index (LVMi), and relative wall thickness (RWT) were obtained. Results In control group 5 (10.4%) and in acromegaly group 17 (36.2%) patients had fQRS on ECG (p = 0.003). LAD [36.0 (34.0–38.0) vs. 38.0 (35.0–41.0) mm, p < 0.001], LVM [155.27 ± 27.00 vs. 173.0 (153.0–235.0) g, p < 0.001], LVMi [83.12 ± 13.19 vs. 92.0 (83.0–118.0) g/m², p < 0.001] and RWT [0.39 ± 0.03 vs. 0.43 (0.41–0.45), p = 0.001] were significantly higher in patients with acromegaly. Disease duration was significantly higher (11.59 ± 1.3 vs. 8.2 ± 1.8 years, p < 0.001) in the fQRS (+) group. LAD [41.0 (39.0–42.5) vs. 37.0 (34.7–38.0) mm, p < 0.001], LVM [219.0 (160.5–254.5) vs. 164.0 (153.0–188.0) g, p = 0.017], LVMi [117.0 (92.5–128.5) vs. 86.0 (82.0–100.2) g/m², p = 0.013] and RWT [0.44 (0.42–0.49) vs. 0.43 (0.40–0.44), p = 0.037] were significantly higher in fQSR (+) acromegaly patients. In multivariate logistic regression analysis, disease duration (odds ratio: 10.05, 95% CI: 1.099–92.012, p = 0.041) and LAD (odds ratio: 2.19, 95% CI: 1.030–4.660, p = 0.042) were found to be the independent predictors of fQRS formation.Conclusion The results of our study revealed that fQRS (+) acromegaly patients had increased LVH parameters compared to fQRS (-) patients.     

Systolic stretching of the ascending aorta

IntroductionLongitudinal stretching of the aorta due to systolic heart motion contributes to the stress in the wall of the ascending aorta. The objective of this study was to assess longitudinal systolic stretching of the aorta and its correlation with the diameters of the ascending aorta and the aortic root.Material and methodsAortographies of 122 patients were analyzed. The longitudinal systolic stretching of the aorta caused by the contraction of the heart during systole and the maximum dimensions of the aortic root and ascending aorta were measured in all patients.ResultsThe maximum dimension of the aortic root was on average 34.9 ±4.5 mm and the mean diameter of the ascending aorta was 33.9 ±5.4 mm. The systolic aortic stretching negatively correlated with age (r = –0.49, p < 0.001) and the diameter of the tubular ascending aorta (r = –0.44, p < 0.001). There was no significant correlation between the stretching and the dimension of the aortic root (r = –0.11, p = 0.239). There was a statistically significant (p < 0.001) difference in the longitudinal aortic stretching values between patients with a normal aortic valve (10.6 ±3.1 mm) and an aortic valve pathology (8.0 ±3.2 mm in all patients with an aortic valve pathology; 7.5 ±4.3 mm in isolated aortic stenosis, 8.5 ±2.9 mm in the case of isolated insufficiency, 8.2 ±2.8 mm for valves that were both stenotic and insufficient).ConclusionsSystolic aortic stretching negatively correlates with the diameter of the tubular ascending aorta and the age of the patients, and does not correlate with the diameter of the aortic root. It is lower in patients with an aortic valve pathology.     

Induction chemotherapy plus nimotuzumab followed by concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma

IntroductionThis study investigated the best mode for the application of nimotuzumab (Nimo) in combination with chemoradiotherapy to treat nasopharyngeal carcinoma (NPC).Material and methodsData were prospectively collected from 168 patients with NPC from September 2009 to February 2014. One hundred twelve patients received 2–3 cycles of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), and 56 patients with well-matched propensity scores received IC + CCRT + Nimo. Patients were divided into 3 subgroups according to the application schedule of Nimo: group A, IC + CCRT; group B: IC (combined with Nimo) + CCRT; and group C: IC + CCRT (combined with Nimo). The 5-year overall survival (OS) and progression-free survival (PFS) and adverse events were investigated.ResultsWith a median follow-up of 61.4 months (range: 1.7–96.5 months), the 5-year OS and PFS for group A vs. groups B + C were 74.8 ±4.1% versus 87.0 ±4.6% (p = 0.043) and 72.7 ±4.3% vs. 83.1 ± 5.1% (p = 0.243), respectively. The 5-year OS of group B was significantly improved over that of group A (93.0 ±4.8% vs. 74.8 ±4.1%, p = 0.038); however, there was no benefit to the 5-year PFS (89.3 ±5.9% vs. 72.7 ±4.3%, p = 0.144). The 5-year OS and PFS for group C were 80.4 ±7.9% and 76.4 ±8.5%, respectively, and there was no statistically significant difference from group A (p = 0.257 and p = 0.611, respectively). No significant increase in toxicities was observed with the addition of Nimo.ConclusionsNimo administered with chemoradiotherapy is effective for NPC. Nimo concurrent with IC followed by CCRT could be the optimal mode of sequential treatment.     

PCSK9 immunization using nanoliposomes: preventive efficacy against hypercholesterolemia and atherosclerosis

IntroductionThe aim of the study was to study a nanoliposomal anti-PCSK9 vaccine as a novel approach for cholesterol lowering via PCSK9 inhibition.Material and methodsAn immunogenic peptide construct termed immunogenic fused PCSK9-tetanus (IFPT) was displayed on the surface of liposome nanoparticles (L-IFPT) and mixed into alum adjuvant (L-IFPTA+). The manufactured vaccine formulations IFPT, L-IFPT, L-IFPTA+, IFPTA+, and free nanoliposomes were subcutaneously injected four times with bi-weekly intervals in C57BL/6 mice on a severe atherogenic protocol.ResultsAmong the formulations, L-IFPTA+ vaccine was found to elicit the highest IgG response against PCSK9 peptide. The induced PCSK9 antibodies inhibited PCSK9-LDLR interaction through binding to PCSK9 in vaccinated mice. Liver low-density lipoprotein receptor (LDLR) protein was increased in vaccinated mice. L-IFPTA+, L-IFPT and IFPTA+ vaccines reduced total cholesterol by up to –38.13 ±3.8% (p = 0.006), –23 ±4.1% (p = 0.027) and –19.12 ±3% (p = 0.038), and low-density lipoprotein cholesterol (LDL-C) by up to –57 ±7.7% (p = 0.0003), –41.67 ±4.2% (p = 0.03) and –36.11 ±5% (p = 0.02) in hypercholesterolemic mice, respectively, versus control mice after 8 weeks. Long-term assessment indicated that the vaccine formulations could stimulate a long-lasting humoral immune response against PCSK9 peptide, which was associated with a marked reduction of total cholesterol in L-IFPTA+, L-IFPT and IFPTA+ vaccine groups by up to –82.5 ±7.3% (p = 0.002), –70.54 ±6.2% (p = 0.013) and –72.02 ±8.7% (p = 0.004), respectively, and LDL-C by up to –88.14 ±5.6% (p = 0.002), –55.92 ±8.3% (p = 0.003) and 54.81 ±9.3% (p = 0.003), respectively, versus the pre-vaccination time point adjusted to the control group. Anti-inflammatory Th2 cells and IL-4 cytokine were considerably increased in splenocytes of vaccinated mice.ConclusionsL-IFPTA+ vaccine can induce long-lasting, functional and safe PCSK9-specific antibodies in hypercholesterolemic C57BL/6 mice, providing a long-term protective impact on dyslipidemia and atherosclerosis.     

Folfirinox versus gemcitabine-cisplatin combination as first-line therapy in treatment of pancreaticobiliary cancer

Background/aim The purpose of this study was to compare efficacy and safety of a combination chemotherapy regimen consisting of oxaliplatin, irinotecan, fluorouracil, and leucovorin (FOLFIRINOX) and gemcitabine-cisplatin as first-line therapy in patients with pancreatic cancer.Materials and methods Pancreaticobiliary cancer patients who had Eastern Cooperative Oncology Group performance status score of 0 or 1 (on a scale of 0 to 5, with higher scores indicating greater severity of illness) were evaluated to receive folfirinox or gemcitabine plus cisplatin. The primary endpoints were progression-free and overall survival time. Safety analysis was also evaluated as secondary measures.Results There were 32 patients in the folfirinox group and 36 patients in the gemcitabine-cisplatin group. The median overall survival was 18.1 months (7.5–28.7) in the folfirinox group as compared with 9.7 months (6.5–13) in the gemcitabine-cisplatin group (p = 0.009). Median progression-free survival was 16.2 months (9–23.4) in the folfirinox group and 6.9 months (6.1–7.6) in the gemcitabine-cisplatin group (p = 0.001). Conclusion Folfirinox is an option for the first-line treatment of patients with pancreatic cancer and good performance status.     

Different Seasonal Variations of Potassium in Hemodialysis Patients with High Longitudinal Potassium Levels: A Multicenter Cohort Study Using DialysisNet

PurposeTo determine seasonal variations in serum potassium levels among hemodialysis patients.Materials and MethodsThis was a multicenter cohort study of patients whounderwent hemodialysis and were registered in DialysisNet at our four associated general hospitals between January and December 2016. Month-to-month potassium variability was quantified as SD/√ {n/(n−1)}, and a non-hierarchical method was used to cluster groups according to potassium trajectories. Seasonal variations in potassium levels were analyzed using a cosinor analysis.ResultsThe analysis was performed on 279 patients with a mean potassium level of 5.08±0.58 mmol/L. After clustering, 52.3% (n=146) of patients were included in the moderate group (K⁺, 4.6±0.4 mmol/L) and 47.7% (n=133) in the high group (K⁺, 5.6±0.4 mmol/L). The mean potassium level peaked in January in the moderate group (4.83±0.74 mmol/L) and in August in the high group (5.51±0.70 mmol/L). In the high potassium group, potassium levels were significantly higher in summer than in autumn (p<0.001) and spring (p=0.007). Month-to-month potassium variability was greater in the high group than in the moderate group (0.59±0.19 mmol/L vs. 0.52±0.21 mmol/L, respectively, p=0.012). Compared to patients in the first quartile of potassium variability (≤0.395 mmol/L), those with higher variability (2nd–4th quartiles) were 2.8–4.2 fold more likely to be in the high potassium group.ConclusionDifferent seasonal patterns of serum potassium were identified in the moderate and high potassium groups, with potassium levels being significantly higher in the summer season in the high potassium group and in winter for the moderate potassium group.     

Longer Weekly Sleep Duration Predicts Greater 3-Month BMI Reduction among Obese Adolescents Attending a Clinical Multidisciplinary Weight Management Program

AimsTo determine whether baseline levels of self-reported sleep and sleep problems among obese adolescents referred to an outpatient multidisciplinary family-based weight management program predict reduction in BMI 3 months later.MethodsA retrospective medical chart review was conducted for 83 obese adolescents. The following baseline variables were extracted: self-reported sleep duration (weekdays and weekends), and presence of snoring, daytime fatigue, suspected sleep apnea, and physician-diagnosed sleep apnea. Anthropometric data at baseline and 3 months were also collected.ResultsOn average, adolescents reported significantly less sleeping on weeknights (7.7 ± 1.3 h) compared to weekend nights (10.0 ± 1.8 h), t(82) = 10.5, p = 0.0001. Reduction in BMI after 3 months of treatment was predicted by more weekly sleep at baseline (R² = 0.113, F(1, 80) = 10.2, p = 0.002). Adolescents who reduced their BMI by ≥1 kg/m² reported greater weekly sleep at baseline compared to adolescents who experienced <1 kg/m² reduction (60.7 ± 7.5 h vs. 56.4 ± 8.6 h; F(1, 80) = 5.7, p = 0.02).ConclusionFindings from this study, though correlational, raise the possibility that increased duration of sleep may be associated with weight loss among obese adolescents enrolled in a weight management program. Evidence-based behavioral techniques to improve sleep hygiene and increase sleep duration should be explored in pediatric weight management settings.Key Words: Obesity, Adolescent, Sleep, Weight loss, Treatment     

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

PurposeMany epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma.ResultsEleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively.ConclusionOur meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.     

Does previous open or percutaneous renal stone surgery affect retrograde intrarenal surgery outcomes?

Background/aim Open or percutaneous renal stone surgery can have an adverse effect on the collecting system of the kidney. We evaluated retrograde intrarenal surgery outcomes in patients with ≤30 mm renal stones who had open or percutaneous renal stone surgery history.Materials and methods A total of 707 patients who underwent retrograde intrarenal surgery treatment were included in this study. Fifty-six patients had open or percutaneous renal stone surgery history (Group 1) and the remaining did not (Group 2, n = 651). The groups were compared in terms of age, stone size, stone-free rates, and complications.Results The mean age of the patients was 51.16 ± 14.8 and 45.95 ± 14.6 years in Groups 1 and 2, respectively (p = 0.008). The mean stone size was 14.97 ± 6.1 mm and 16.47 ± 6.9 mm in Groups 1 and 2, respectively (p = 0.107). The stone-free rates were 71.4% and 84.1% in Group 1 and 2 respectively and it was significantly higher in Group 2 (p = 0.013). The overall rate of postoperative complications was higher in Group 1 (p = 0.019), but there was no difference between the two groups in terms of Clavien 1–2 and 3–4a complication rates.Conclusion Our results showed that having a history of open or percutaneous renal stone surgery has a negative effect on the success and complication rates in retrograde intrarenal surgery. Therefore, patients should be well informed before this operation.     

Effectiveness of Online Video Instruction on Time to Start Ambulation and Duration of Hospital Stay,Satisfaction and Functional Recovery in Patients Undergoing Total Hip Arthroplasty

BackgroundAt the end of 2014, we implemented an online video to inform patients of the entire process from admission to rehabilitation after total hip arthroplasty (THA). In this study, we investigated the effectiveness of online video instruction in THA patients.MethodsElectronic medical records of 184 patients undergoing THA in 2014 (pre-video group) and 182 patients in 2015 (post-video group) were reviewed. We compared 1) the time to start wheelchair ambulation, 2) walker or crutch ambulation, 3) the length of hospital stay, 4) postoperative satisfaction using visual analogue scale (0–10 points), and 5) modified Harris Hip Score (mHHS) at postoperative 6 weeks.ResultsIn the post-video group, the time to start wheelchair ambulation (1.8 ± 0.6 vs. 2.4 ± 3.2 days, P = 0.021) and walker/crutch ambulation were faster (2.9 ± 1.2 vs. 3.8 ± 1.0 days, P = 0.016), and the hospital stay was shorter (8.2 ± 4.7 vs. 9.9 ± 7.8 days, P = 0.001) compared to the pre-video group. The visual analogue scale for satisfaction (7.84 ± 1.62 vs. 7.68 ± 1.85 points) and mHHS (89.59 ± 9.47 vs. 89.58 ± 8.59) were similar.ConclusionOnline video instruction is an effective tool to expedite ambulation and reduce the hospital stay without compromising the clinical outcome and postoperative complications after THA.     

Obstructive sleep apnea syndrome and erectile dysfunction: does long term continuous positive airway pressure therapy improve erections?

ObjectivesThe aim of this age-matched, controlled, prospective clinical study was to investigate frequency and degree of erectile dysfunction (ED) in patients with obstructive sleep apnea syndrome (OSAS) and to evaluate the results of only continuous positive airway pressure (CPAP) therapy on ED in patients with OSAS.ResultsWhen compared to the control group, a decrease in IIEF-5 scores was found in patients with OSAS. However, this decrease was not statistically significant. After 3 months of CPAP usage in patients with mild to moderate and severe degree OSAS, improvement in IIEF-5 scores was statistically significant. Mean value of IIEF-5 score was 16.63±5.91 before CPAP and were improved up to 20.92±6.79 (P=0.001).ConclusionIt is not certainly possible to say that OSAS is clearly associated with ED. However, after 3 months of regular CPAP usage, ED complaints in patients with OSAS might improve positively. Trials with larger series may give more conclusive data.     

Prognostic value of oxygen saturation and heart rate during a six-minute walk test in pediatric pulmonary hypertension

Background/aimTo evaluate the pre and post-treatment heart rate and oxygen (O₂) saturation values measured before, during and after 6MWT in children who received PAH-specific treatment and to determine the effect of these variables on prognosis.Materials and methodsThis retrospective study included 29 patients who were diagnosed as PAH and treated. The transcutaneous O₂ saturationand heart rate levels were recorded before the test: baseline (Sat0, HR0), at the end of the test: exercise (Sat1_, HR1)and 5 min after the test: recovery (Sat2_, HR2). The increase in heart rate was defined as HR1-HR0 and the decrease in saturation as Sat0-Sat1. The results obtained before and after the PAH-specific treatment were analyzed and their effect on survival was assessed. Results Fifteen of 29 patients were female (51.7%). The mean age was 127.2 ± 44.8 months and the median follow-up time was 60 (12–156) months. Only pre-treatment HR1 was found associated with survival. The mean HR1 value of survivors was 122.8 ± 18.4 and that of deceased 94.3 ± 19.1 (p = 0.03). Post-treatment 6MWT was associated with survival. It was 453.3 ± 96.5 m for survivors and 250 ± 135.2 m for deceased (p = 0.02).Conclusion Post-treatment 6MWT, FC and proBNP had prognostic value in pediatric patients with PAH. The decrease in saturation and increase in heart rate were not found to have a prognostic value. Pre-treatment HR1was associated with survival. Identification of these prognostic factors at the beginning and throughout the treatment may be a guide for detecting the severity of the disease and follow-up.     

Weight Loss,Type 2 Diabetes,and Nutrition in 355 Patients with Obesity Undergoing Sleeve Gastrectomy with Transit Bipartition: Two-Year Outcomes

IntroductionThis study examined whether 355 obese patients with type 2 diabetes (T2D) of varying duration and severity experienced equivalent weight loss and T2D remission following a newer sleeve gastrectomy (SG) procedure − SG with transit bipartition (SG-TB).MethodsPrimary outcomes were changes in body mass index (BMI), total weight loss (TWL), excess BMI loss (EBMIL), A1C, and diabetes medication use through 24 months.ResultsBetween December 2015 and December 2019, 399 patients who underwent SG-TB reached the 2-year time point. Follow-up was possible in 355 patients (89.0%): 206 females (58.0%), mean age 51.5 years (24.0–73.0), BMI 34.0 kg/m² (28.0–50.5), and T2D duration 12.0 years (4.0–37.0). At 2 years, total sample respective mean TWL and EBMIL were 20.2 ± 6.1% (95% CI: 19.5, 20.8) and 87.7 ± 35.2% (84.1, 91.4) corresponding to mean BMI change of 7.0 ± 2.7 kg/m² (6.7, 7.3) (p < 0.001). T2D duration and severity subgroups experienced comparable BMI and A1C change from baseline (p < 0.001); 281 (79.2%) maintained complete remission. ANOVA showed significant mean increases in vitamin D, calcium, and albumin: overall complication rate, 10.2%; no mortality.Discussion/ConclusionIn 355 patients with obesity who underwent SG-TB, excellent weight loss, T2D, and nutritional outcomes were seen at 2-year follow-up regardless of preoperative T2D duration and severity.     

Efficacy and safety of ruxolitinib in patients with myelofibrosis: a retrospective and multicenter experience in Turkey

Background/aimThe aim of this study is to assess the efficacy and safety of ruxolitinib in patients with myelofibrosis.Materials and methodsFrom 15 centers, 176 patients (53.4% male, 46.6% female) were retrospectively evaluated.ResultsThe median age at ruxolitinib initiation was 62 (28–87) and 100 (56.8%) of all were diagnosed as PMF. Constitutional symptoms were observed in 84.7%. The median initiation dose of ruxolitinib was 30 mg (10–40). Dose change was made in 69 (39.2%) patients. Forty seven (35.6%) and 20 (15.2%) of 132 patients had hematological and nonhematological adverse events, respectively. The mean spleen sizes before and after ruxolitinib treatment were 219.67 ± 46.79 mm versus 199.49 ± 40.95 mm, respectively (p < 0.001). There was no correlation between baseline features and subsequent spleen response. Overall survival at 1-year was 89.5% and the median follow up was 10 (1–55) months. We could not show any relationship between survival and reduction in spleen size (p = 0.73).ConclusionWe found ruxolitinib to be safe, well tolerated, and effective in real-life clinical practice in Turkey. Ruxolitinib dose titration can provide better responses in terms of not only clinical benefit but also for long term of ruxolitinib treatment.     

Anesthesia protocol for ear surgery in Wistar rats (animal research)

ObjectiveTo formulate an anesthesia protocol for safe and satisfactory anesthesia for ear surgery in rats.MethodsThe rats were anesthetized with xylazine (10 mg/kg body weight) and ketamine at doses of 80, 50, 40, and 30 mg/kg body weight or with isoflurane anesthesia (2%–3.5% in 100% oxygen; maintenance dose 1.5%–3.5%). The anesthesia induction, surgery, and recovery time were recorded.ResultsIn total, 17 rats were induced by varying doses of ketamine‐xylazine and 28 rats with isoflurane. Mean induction time with ketamine‐xylazine was 6 ± 2.9 min compared with 3.8 ± 1.1 min with isoflurane. Mean recovery time with ketamine‐xylazine was 142.6 ± 49.3 min compared with 4.1 ± 1.2 min with isoflurane. A mortality of 4 animals after developing dyspnea was recorded with ketamine‐xylazine.ConclusionIsoflurane anesthesia offers appropriate induction and recovery times and low mortality rates for the surgeries performed. Isoflurane anesthesia offers reliable results for ear surgery in rats. However, more equipment and technical skills are needed.     

Status of Weight Change,Lifestyle Behaviors,Depression, Anxiety,and Diabetes Mellitus in a Cohort with Obesity during the COVID-19 Lockdown: Turk-Com Study Group

IntroductionThe coronavirus disease 2019 (COVID-19) pandemic led to a lockdown period. Confinement periods have been related to unhealthy lifestyle behaviors. Our study aimed to determine weight change, changes in eating and exercise habits, the presence of depression and anxiety, and diabetes mellitus (DM) status in a cohort of patients with obesity.MethodsThe study was undertaken in nine centers of Collaborative Obesity Management (COM) of the European Association for the Study of Obesity (EASO) in Turkey. An e-survey about weight change, eating habits, physical activity status, DM status, depression, and anxiety was completed by patients. The International Physical Activity Questionnaire (IPAQ) score was used to determine physical activity in terms of metabolic equivalents (METs). A healthy nutrition coefficient was calculated from the different categories of food consumption. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) Questionnaire were used for determining depression and anxiety, respectively.ResultsFour hundred twenty-two patients (age 45 ± 12.7 years, W/M = 350/72) were included. The healthy nutrition coefficient before the pandemic was 38.9 ± 6.2 and decreased to 38.1 ± 6.4 during the pandemic (p < 0.001). Two hundred twenty-nine (54.8%) patients gained weight, 54 (12.9%) were weight neutral, and 135 (32.3%) lost weight. Patients in the weight loss group had higher MET scores and higher healthy nutrition coefficients compared with the weight gain and weight-neutral groups (p < 0.001). The PHQ and GAD scores were not different between the groups. Percent weight loss was related to healthy nutrition coefficient (CI: 0.884 [0.821–0.951], p = 0.001) and MET categories (CI: 0.408 [0.222–0.748], p = 0.004). One hundred seventy patients had DM. Considering glycemic control, only 12 (8.4%) had fasting blood glucose <100 mg/dL and 36 (25.2%) had postprandial BG <160 mg/dL. When patients with and without DM were compared in terms of dietary compliance, MET category, weight loss status, PHQ-9 scores, and GAD-7 scores, only MET categories were different; 29 (11.7%) of patients in the nondiabetic group were in the highly active group compared with 5 (2.9%) in the diabetic group.ConclusionThe COVID-19 lockdown resulted in weight gain in about half of our patients, which was related to changes in physical activity and eating habits. Patients with DM who had moderate glycemic control were similar to the general population in terms of weight loss but were less active.