Nesrin Turan

Postmastectomy irradiation in breast in breast cancer patients with T1-2 and 1-3 positive axillary lymph nodes: Is there a role for radiation therapy?

BackgroundWe aimed to evaluate retrospectively the correlation of loco-regional relapse (LRR) rate, distant metastasis (DM) rate, disease free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients who are at intermediate risk for LRR (T1-2 tumor and 1-3 positive axillary nodes) treated with or without postmastectomy radiotherapy (PMRT) following modified radical mastectomy (MRM).MethodsNinety patients, with T1-T2 tumor, and 1-3 positive nodes who had undergone MRM received adjuvant systemic therapy with (n = 66) or without (n = 24) PMRT. Patient-related characteristics (age, menopausal status, pathological stage/tumor size, tumor location, histology, estrogen/progesterone receptor status, histological grade, nuclear grade, extracapsular extension, lymphatic, vascular and perineural invasion and ratio of involved nodes/dissected nodes) and treatment-related factors (PMRT, chemotherapy and hormonal therapy) were evaluated in terms of LRR and DM rate. The 5-year Kaplan-Meier DFS and OS rates were analysed.ResultsDifferences between RT and no-RT groups were statistically significant for all comparisons in favor of RT group except OS: LRR rate (3%vs 17%, p = 0.038), DM rate (12% vs 42%, p = 0.004), 5 year DFS (82.4% vs 52.4%, p = 0.034), 5 year OS (90,2% vs 61,9%, p = 0.087). In multivariate analysis DM and lymphatic invasion were independent poor prognostic factors for OS.ConclusionPMRT for T1-2, N1-3 positive BC patients has to be reconsidered according to the prognostic factors and the decision has to be made individually with the consideration of long-term morbidity and with the patient approval.

ROSIGLITAZONE, AN AGONIST OF PEROXISOME PROLIFERATOR-ACTIVATED RECEPTOR-GAMMA, PREVENTS CONTRALATERAL TESTICULAR ISCHAEMIA–REPERFUSION INJURY IN PREPUBERTAL RATS

1 Rosiglitazone plays a positive role in the reparation of ischaemia–reperfusion (I/R) injury in different tissues. Thus, we examined its biochemical and histological effects on the contralateral testes to determine whether exogenous rosiglitazone affords any protection against testicular damage. 2 Forty‐eight prepubertal male Wistar‐Albino rats were divided into six groups. Testicular torsion was created by rotating the right testis 720° in a clockwise direction for 5 h in all groups except group I, which was the sham‐control group. In group II, bilateral orchiectomy was performed following the torsion period. After detorsion both testes were removed in the fifth hour in group III and on the seventh day in group IV. In group V, one‐shot rosiglitazone (4 mg/kg) was administered 40 min before detorsion and both testes were removed following the torsion period. In group VI, rosiglitazone was administered (4 mg/kg) 40 min before detorsion and for 7 days, and then both testes were harvested. The tissue levels of malondialdehyde (MDA) were measured and mean testicular biopsy score (MTBS) and mean seminiferous tubule diameter (MSTD) were examined. Immunoexpression of endothelial nitric oxide synthase (eNOS) in testes tissues was investigated by immunohistochemical studies. 3 In the contralateral testis, the MTBS and MSTD values of group VI were significantly higher than those in group IV. Immunohistochemically, mild eNOS immunostaining was present in the germ cells of the contralateral testes in group IV after I/R. In group VI, intense eNOS immunoreactivity was seen in the contralateral testes. 4 Rosiglitazone reduces contralateral testicular damage formed after unilateral testicular torsion and alleviates the oxidative events.

Effect of Curcumin on Ipsilateral and Contralateral Testes after Unilateral Testicular Torsion in a Rat Model

Objective: The aim of the study was to determine the protective effect of curcumin on testicular ischemia-reperfusion (I/R) injury. Materials and Methods: 32 male rats were divided into four groups (n = 8): group 1: control; group 2: ischemia; group 3: I/R, and group 4: I/R+CUR. Curcumin (150 mg/kg, p.o.) was administered before 30 min of reperfusion in group 4. Malondialdehyde (MDA) levels, Johnsen’s testicular biopsy scores, and mean seminiferous tubule diameter measurements were evaluated in testes. In addition, endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expressions were evaluated immunohistochemically. Results: MDA levels in control groups were significantly lower than other groups in ipsilateral and contralateral testes. Johnsen’s scores in the control group were significantly higher than in other groups. MDA levels and Johnsen’s scores in the I/R+CUR group were similar to the ischemia and I/R groups in ipsilateral and contralateral testes. The immunoreactivity of iNOS and eNOS were increased in I/R ipsilateral testicular groups. After I/R, iNOS and eNOS expression increased slightly in contralateral groups. Additionally, the curcumin treatment decreased iNOS and eNOS immunoreactivity in ipsilateral and contralateral testes. Conclusion: The results suggest that curcumin did not protect the unilateral nor contralateral testes. This observation may depend on inhibition of iNOS and eNOS due to inhibition of the antioxidant, anti-inflammatory effects of nitric oxide.

METHYLENE BLUE INCREASES CONTRALATERAL TESTICULAR ISCHAEMIA–REPERFUSION INJURY AFTER UNILATERAL TESTICULAR TORSION

1 Testicular ischaemia–reperfusion injury is commonly seen in childhood. Infertility occurs in 25% of patients after unilateral testicular ischaemia. It is has been reported that methylene blue has a positive effect in the reparation of ischaemia–reperfusion injury in different tissues. Therefore, we hypothesized that methylene blue may prevent the hazardous effects of ischaemia–reperfusion injury in testicular tissue after unilateral testicular torsion. 2 Thirty‐two prepubertal Wistar‐albino rats were divided into four groups. Testicular torsion was created by rotating the right testis 720° in a clockwise direction for 5 h in all groups except for Group C, which was the sham control group. In Group T, bilateral orchiectomy was performed following the torsion period. In Group TD, both testes were removed 5 days after the torsion period. In Group MB, methylene blue (1 mg/kg, i.p.) was administered 40 min before detorsion and once daily over 5 days; then, both testes were harvested. Tissue levels of malondialdehyde (MDA), serum levels of creatine kinase (CK), mean testicular biopsy score (MTBS) and mean seminifer tubule diameter (MSTD) were determined. 3 There was a significant difference in MTBS between Groups T and TD (P < 0.05) in both ipsilateral and contralateral testes. In the contralateral testis, treatment with methylene blue decreased MTBS and MSTD (P < 0.05) and increased MDA levels (P < 0.05). In Group T, mean serum CK concentrations were higher than in any of the other groups (P < 0.05). 4 After 5 h of unilateral testicular torsion and a 5 day reperfusion period, serious tissue damage occurred on both the ipsilateral and contralateral sides. Serum CK concentrations may be an indicator for ischaemia, but not for ischaemia–reperfusion injury. Contrary to our hypothesis, methylene blue increased contralateral testicular damage after unilateral testicular torsion and exacerbated oxidative events.

Endotrakeal tüp kafının doğru basınçta şişirilmesinde anestezistin deneyimi önemli mi

Objectives: Cuff pressure in endotracheal tubes should be in the range of 26–30 cm H 2 O. In this study we aimed to examine whether anesthesiologist’s experience is important while inflating the endotracheal tube correctly af ter the intubation. Materials and methods: The patients who were included to the study were intubated after the induction of general anesthesia. The patients were divided into 4 groups according to the training year of the anesthesia research assistant resident inflating the endotracheal tube (ET) cuff. Group I (n=64) the cuff pressure which were inflated by the first year residents; Group II (n=92) the cuff pressure which were inflated by the 2 nd year residents; Group III (n=144) the cuff pressure which were inflated by the 3 rd year residents; Group IV (n=93) the cuff pressure which were inflated by the 4 th year residents were measured by manometer. Results: When we compared the cases in which the cuff pressure were between 26-30cm H 2 O we found that the best results were in Group II and respectively in Group III and IV and the worst results were in Group I. The difference between Group II and Group I were statistically significant (p<0.05).

A Comparison of the Effects of Different Types of Laryngoscope on the Cervical Motions: Randomized Clinical Trial

BACKGROUND The rate of cervical injury among all trauma patients is 3.1%. The most important point during intubation of those patients is not to increase the cervical injury. AIMS In this study, we hypothesize that there will be a minimal cervical extension during a laryngoscopy with the use of optical view laryngoscopes. STUDY DESIGN Prospective, randomized clinical trial. METHODS One hundred and fifty adult patients with ASA physical status I to III were enrolled in our study. After routine anesthesia induction, we randomly assigned the patients into three groups according to the type of laryngoscope. Macintosh type, Truview EVO2(®) type and Airtraq® type laryngoscopes were used in Group DL (n=50), Group TW (n=50) and Group ATQ (n=50), respectively. After applying general anesthesia induction and mask ventilation, all of the patients were positioned in the neutral position. An inclinometer was placed on the forehead of the patients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured and the time to intubation was recorded. RESULTS One of the 50 patients in the DL Group, 2 of the 50 patients in the TW Group, and 4 of the 50 patients in the ATQ Group were excluded from the study because of the failure of intubation at defined times. The angle of cervical extension during laryngoscopy was found to be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degrees in the Groups DL, TV and ATQ, respectively; these differences also had statistical significance (p=0.000). The duration of intubation was found to be 13.59±5.49, 23.60±15.23, and 29.80±13.82 seconds in Groups DL, TV and ATQ, respectively (p=0.000). CONCLUSION A minimal cervical motion was obtained during tracheal intubation with the use of Truview EVO2® and Airtraq® types of laryngoscope compared with the Macintosh laryngoscope. (ClinicalTrials.gov Identifier: NCT02191904).

RADIATION-INDUCED CHRONIC-OXIDATIVE RENAL DAMAGE CAN BE REDUCED BY AMIFOSTINE

In the current study, amifostine is evaluated for its radioprotective role in serum and kidney tissue by oxidative (malondialdehyde-MDA, advanced oxidation protein product-AOPP) and antioxidative markers (catalase, glutathione-GSH, free-thiols-F-SH). Thirty Wistar albino 3–4 months old, female rats, were randomly divided into Group I (n = 10): Control, Group II (n = 10): Irradiation-alone, Group III (n = 10): Amifostine before irradiation. In Group II and III, right kidneys of the rats were irradiated with a single dose of 6 Gy using a 60Co treatment unit. Rats in Group III received 200 mg/kg amifostine intraperitoneally, 30 min prior to irradiation. Following sacrification at 24th week, blood and kidney tissue samples were collected. Statistical analysis was done by One-way ANOVA, Post hoc Bonferroni, Dunnett T3, and Mann–Whitney U tests. Administration of amifostine significantly decreased the serum AOPP and MDA levels when compared to the irradiation-only group (P = 0.004, P = 0.006; respectively). Also amifostine significantly increased serum catalase activities and GSH levels, when given 30 min prior to irradiation (P = 00.02, P = 0.000; respectively). In the kidney tissue, administration of amifostine significantly decreased AOPP and MDA levels (P = 0.002, P = 0.016; respectively). Tissue GSH activity was increased following amifostine administration (P = 0.001). There was no statistically significant result on histopathological evaluation. Amifostine may reduce radiation-induced nephropathy by inhibiting chronic oxidative stress. Biomarkers of oxidative stress in serum and kidney tissue may be used for evaluation of the radiation-induced nephropathy.

Association between Beta-Sympathomimetic Tocolysis and Risk of Autistic Spectrum Disorders, Behavioural and Developmental Outcome in Toddlers

AIM: To investigate whether maternal intravenous beta-mimetic tocolytic therapy increases the risk of autistic spectrum disorders (ASD) and poorer behavioural and developmental outcomes. METHOD: Our study is a prospective case-control study among 90 children between 1.5 and three years old. Cases (n = 46) were toddlers with betamimetic tocolytic exposure; control group toddlers (n = 44) were tocolytic untreated. Treated and untreated groups were also divided into subgroups: term and preterm delivered. The gestational age of tocolytic treatment start, the dose and duration of exposure in hours were obtained from obstetric medical records. The Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Modified Checklist for Autism in Toddlers (M-CHAT) and the Denver Developmental Screening Test (DDST) tests were applied for evaluation of social, emotional problems, autism and developmental disorders. RESULTS: Term and preterm born toddlers treated tocolytically in utero didn’t demonstrate a higher risk of autistic disorders or poorer behavioural and developmental results than controls. In the preterm group, the earliest start of tocolytic treatment was correlated with toddlers lower score of the Competencies Scale (p = 0.009) and a higher score of the Problems Scale (p = 0.048). Also, we concluded that preterm membrane rupture was associated with higher ASD risk in the untreated group (p = 0.043). CONCLUSION: Exposure to betamimetics during pregnancy was not associated with an increased risk of autism, behavioural and developmental disorders.

The probable Prevalance and Sociodemographic Characteristics of Specific Learning Disorder in Primary School Children in Edirne

Introduction The aim of this study was to research the probable prevalence of Specific Learning Disorder (SLD) in primary school children in Edirne City and the relationships with their sociodemographic characteristics. Methods The sample of our study was composed of 2,174 children who were educated in primary schools in second, third, and fourth grades in the academic year 2013-2014 in Edirne City. The teachers and parents of these children were given Specific Learning Difficulties Symptom Scale, Learning Disabilities Symptoms Checklist (teacher and parent forms), and sociodemographic data forms to fill in. Binary logistic regression analysis was used to assess the risk factors for SLD. Results Our study revealed that the probable prevalence of SLD was 13.6%; 17% for boys and 10.4% for girls. Reading impairment was 3.6%, writing impairment was 6.9%, and mathematic impairment was 6.5%. We determined that consanguineous marriages, low income, history of neonatal jaundice were found as risks for SLD; born by caesarean, developmental delay of walking, and history of neonatal jaundice were found as risks for mathematic impairment. A history of learning difficulties of parents was a risk factor for forming SLD and subtypes. Conclusion Our findings were consistent with other study results about the prevalence of SLD. The relationships between the probable prevalence rates and sociodemographic data were discussed.