BACKGROUND:Mirizzi syndrome is a rare complication of cholelithiasis,characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted...BACKGROUND:Mirizzi syndrome is a rare complication of cholelithiasis,characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct.In this study,we aimed to describe the clinical presentations,investigations,operative details,and complications of seven patients who underwent endoscopic retrograde cholangiopancreatography and were finally diagnosed with Mirizzi syndrome in our center. METHOD:We performed a retrospective analysis of the records of 7 patients with Mirizzi syndrome who underwent endoscopic retrograde cholangiopancreatography. RESULTS:The incidence of Mirizzi syndrome was 1.07% of 656 patients given endoscopic retrograde cholangiopan- creatography.Ultrasonography was able to diagnose one case.Endoscopic retrograde cholangiopancreatography suggested the diagnosis in five cases and helped further in the management of these patients.Four patients had cholecystectomy and T-tube placement,and two had cholecystectomy and choledochoduodenostomy.One patient with typeⅠMirizzi syndrome according to the Csendes classification successfully underwent laparoscopic cholecystectomy. CONCLUSIONS:In the study,the incidence of Mirizzi syndrome was 1.07%of patients who underwent endoscopic retrograde cholangiopancreatography. Preoperative diagnosis of Mirizzi syndrome by endoscopicretrograde cholangiopancreatography is important to prevent complications.展开更多
AIM:To investigate the therapeutic efficacy and safety of continuous autotransfusion system(CATS) during liver transplantation of hepatocellular carcinoma patients.METHODS:Eighty-three hepatocellular carcinoma(HCC) pa...AIM:To investigate the therapeutic efficacy and safety of continuous autotransfusion system(CATS) during liver transplantation of hepatocellular carcinoma patients.METHODS:Eighty-three hepatocellular carcinoma(HCC) patients who underwent liver transplantation with intraoperative CATS(n = 24,CATS group) and without(n = 59,non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively.Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein(AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals.Inter-group differences in recurrence and correlations between demographic,clinical,and pathological data were assessed by ANOVA and χ 2 tests.Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.RESULTS:Of the 83 liver transplanted HCC patients,89.2% were male and the overall mean age was 51.3 ± 8.9 years(range:18-69 years).The CATS and nonCATS groups showed no statistically significant differences in age,sex ratio,body mass index,underlying disease,donor type,graft-to-recipient weight ratio,Child-Pugh and Model for End-Stage Liver Disease scores,number of tumors,tumor size,AFP level,Milan and University of California San Francisco selection criteria,tumor differentiation,macrovascular invasion,median hospital stay,recurrence rate,recurrence site,or mortality rate.The mean follow-up time of the nonCATS group was 17.9 ± 12.8 mo,during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients.The mean follow-up time for the CATS group was 25.8 ± 15.1 mo,during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients.There was no significant difference between the CATS and non-CATS groups in recurrence rate or site.Additionally,no significant differences existed between the groups in overall or disease-free survival.CONCLUSION:CATS is a safe proce展开更多
AIM: To investigate whether serum levels of two soluble forms of extracellular cytokeratin 18 (M30-antigen and M65-antigen) may differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis in patients with ...AIM: To investigate whether serum levels of two soluble forms of extracellular cytokeratin 18 (M30-antigen and M65-antigen) may differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS: A total of 83 patients with suspected NAFLD and 49 healthy volunteers were investigated. Patients with suspected NAFLD were classified according to their liver histology into four groups: definitive NASH (n = 45), borderline NASH (n = 24), simple fatty liver (n = 9), and normal tissue (n = 5). Serum levels of caspase-3 generated cytokeratin-18 fragments (M30-antigen) and total cytokeratin-18 (M65-antigen) were determined by ELISA. RESULTS: Levels of M30-antigen and M65-antigen were significantly higher in patients with definitive NASH compared to the other groups. An abnormal value (> 121.60 IU/L) of M30-antigen yielded a 60.0% sensitivity and a 97.4% specificity for the diagnosis of NASH. Sensitivity and specificity of an abnormal M65-antigen level (> 243.82 IU/L) for the diagnosis of NASH were 68.9% and 81.6%, respectively. Among patients with NAFLD, M30-antigen and M65-antigen levels distinguished between advanced fibrosis and early-stage fibrosis with a sensitivity of 64.7% and 70.6%, and a specificity of 77.3% and 71.2%, respectively. CONCLUSION: Serum levels of M30-antigen and M65-antigen may be of clinical usefulness to identify patients with NASH. Further studies are mandatory to better assess the role of these apoptonecrotic biomarkers in NAFLD pathophysiology.展开更多
AIM： To determine the factors affecting mortality in pa- tients who developed graft-versus-host disease （GvHD） after liver transplantation （LT）. METHODS： We performed a review of studies of GvHD following LT pub...AIM： To determine the factors affecting mortality in pa- tients who developed graft-versus-host disease （GvHD） after liver transplantation （LT）. METHODS： We performed a review of studies of GvHD following LT published in the English literature and ac- cessed the PubMed, Medline, EBSCO, EMBASE, and Google Scholar databases. Using relevant search phras- es, 88 articles were identified. Of these, 62 articles con- raining most of the study parameters were considered eligible for the study. Risk factors were first examined using a univariate Kaplan-Meier model, and variables with a significant association （P 〈 0.05） were then sub- jected to multivariate analyses using a Cox proportional- hazards model. RESULTS： The 61 articles reported 87 patients, 58 male and 29 female, mean age, 40.4 ± 15.5 years （range： 8 mo to 74 years）, who met the inclusion criteria for the present study. Deaths occurred in 59 （67.8%） patients, whereas 28 （32.2%） survived after a mean follow-up period of 280.8 ± 316.2 d （range： 27-2285 d）. Among the most frequent symptoms were rash （94.2%）, fever （66.6%）, diarrhea （54%）, and pancytopenia （54%）. The average time period between LT and first symptom on- set was 60.6 ± 190.1 d （range： 2-1865 d）. The Kaplan- Meier analysis revealed that pancytopenia （42.8% vs 59.3%, P = 0.03）, diarrhea （39.2% vs 61.0%, P = 0.04）, age difference between the recipient and the donor （14.6 ± 3.1 years vs 22.6 ± 2.7 years, P 〈 0.0001）, and time From first symptom occurrence to diagnosis or treatment （13.3 ± 2.6 mo vs 15.0 ± 2.3 mo, P 〈 0.0001） were significant factors affecting mortality, whereas age, sex, presence of rash and fever, use of immunosuppressive agents, acute rejection before GvHD, etiological causes, time of onset, and donor type were not associated with mortality risk. The Cox proportional-hazards model, de- termined that an age difference between the recipient and donor was an independent risk Factor （P = 0.03; hazar展开更多
AIM:To determine the relationship of pulmonary abnormalities and bowel disease activity in inflammatory bowel disease(IBD).METHODS:Thirty ulcerative colitis(UC)and nine Crohn's disease patients,and 20 control subj...AIM:To determine the relationship of pulmonary abnormalities and bowel disease activity in inflammatory bowel disease(IBD).METHODS:Thirty ulcerative colitis(UC)and nine Crohn's disease patients,and 20 control subjects were enrolled in this prospective study.Detailed clinical information was obtained.Extent and activity of the bowel disease were established endoscopically.Each patient underwent pulmonary function tests and high-resolution computed tomography(HRCT).Blood samples for measurement of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),angiotensin converting enzyme and total IgE were delivered by the patients.RESULTS:Ten(25.6%)patients had respiratory symptoms.A pulmonary function abnormality was present in 22 of 39 patients.Among all patients,the most prevalent abnormalities in lung functions were a decrease in forced expiratory volume in 1 s(FEV1),FEV1/forced vital capacity(FVC),forced expiratory flow(FEF)25%-75%,transfer coefficient for carbon monoxide(DLCO),DLCO/alveolar volume.Increased respiratory symptoms score was associated with high endoscopic activity index in UC patients.Endoscopic and clinical activities in UC patients were correlated with FEV1,FEV1/FVC,and FEF 25%-75%.Smoking status,duration of disease and medication were not correlated with pulmonary physiological test results,HRCT abnormalities,clinical/endoscopic disease activity,CRP,ESR or total IgE level or body mass index.CONCLUSION:It is important that respiratory manifestations are recognized and treated early in IBD.Otherwise,they can lead to destructive and irreversible changes in the airway wall.展开更多
AIM: To investigate efficacy and safety of cetuximab combined with two chemotherapy regimens in patients with unresectable metastatic colorectal cancer (mCRC). METHODS: Randomized patients received cetuximab with 5-fl...AIM: To investigate efficacy and safety of cetuximab combined with two chemotherapy regimens in patients with unresectable metastatic colorectal cancer (mCRC). METHODS: Randomized patients received cetuximab with 5-fluorouracil (5-FU), folinic acid (FA) and oxaliplatin (FOLFOX) 6 (arm A, n = 74) or 5-FU, FA and irinotecan (FOLFIRI) (arm B, n = 77). KRAS mutation status was determined retrospectively in a subset of tumors (n = 117). RESULTS: No significant difference was found between treatment arms A and B in the progression-free survival (PFS) rate at 9 mo, 45% vs 34%; median PFS, 8.6 mo vs 8.3 mo [hazard ratio (HR) = 1.06]; overall response rate (ORR) 43% vs 45% [odds ratio (OR) = 0.93] and median overall survival (OS), 17.4 mo vs 18.9 mo (HR = 0.98). Patients with KRAS wild-type tumors demonstrated improved PFS (HR = 0.55, P = 0.0051), OS, (HR = 0.62, P = 0.0296) and ORR (53% vs 36%) and in arm A, improved PFS (HR = 0.49, P = 0.0196), OS (HR = 0.48, P = 0.0201) and ORR (56%vs 30%), compared with patients with KRAS mutated tumors. In arm B no significant differences were found in efficacy by KRAS mutation status. Treatment in arms A and B was generally well tolerated. CONCLUSION: This study confirms that combinations of cetuximab with FOLFOX6 or FOLFIRI are effective and significantly improve clinical outcome in KRAS wild-type compared with KRAS mutated mCRC.展开更多
AIM:To investigate the effects of bombesin (BBS) and neurotensin (NTS) on apoptosis and colitis in an ulcerative colitis model. METHODS:In this study, a total of 50 rats were divided equally into 5 groups. In the cont...AIM:To investigate the effects of bombesin (BBS) and neurotensin (NTS) on apoptosis and colitis in an ulcerative colitis model. METHODS:In this study, a total of 50 rats were divided equally into 5 groups. In the control group, no colitis induction or drug administration was performed. Colitis was induced in all other groups. Following the induction of colitis, BBS, NTS or both were applied to three groups of rats. The remaining group (colitis group) received no treatment. On the 11th d after induction of colitis and drug treatment, blood samples were collected for TNF-α and IL-6 level studies. Malondialdehyde (MDA), carbonyl, myeloperoxidase (MPO) and caspase-3 activities, as well as histopathological findings, evaluated in colonic tissues. RESULTS:According to the macroscopic and microscopic findings, the study groups treated with BBS, NTS and BBS + NTS showed significantly lower damage and inflammation compared with the colitis group (macroscopic score, 2.1 ± 0.87, 3.7 ± 0.94 and 2.1 ± 0.87 vs 7.3 ± 0.94;microscopic score, 2.0 ± 0.66, 3.3 ± 0.82 and 1.8 ± 0.63 vs 5.2 ± 0.78, P < 0.01). TNF-α and IL-6 levels were increased significantly in all groups compared with the control group. These increases were significantly smaller in the BBS, NTS and BBS + NTS groups compared with the colitis group (TNF-α levels, 169.69 ± 53.56, 245.86 ± 64.85 and 175.54 ± 42.19 vs 556.44 ± 49.82;IL-6 levels, 443.30 ± 53.99, 612.80 ± 70.39 and 396.80 ± 78.43 vs 1505.90 ± 222.23, P < 0.05). The colonic MPO and MDA levels were significantly lower in control, BBS, NTS and BBS + NTS groups than in the colitis group (MPO levels, 24.36 ± 8.10, 40.51 ± 8.67 and 25.83 ± 6.43 vs 161.47 ± 38.24;MDA levels, 4.70 ± 1.41, 6.55 ± 1.12 and 4.51 ± 0.54 vs 15.60 ± 1.88, P < 0.05). Carbonyl content and caspase-3 levels were higher in the colitis and NTS groups than in control, BBS and BBS + NTS groups (carbonyl levels, 553.99 ± 59.58 and 336.26 ± 35.72 vs 209.76 ± 30.92, 219.76 ± 25.77 and 220.34 ± 36.95;caspase-3 level展开更多
AIM: To research the etiology, portal vein thrombosis and other features of Budd-Chiari syndrome (BCS) patients prospectively. METHODS: A total of 75 patients (40 female, 35 male) who were diagnosed between January 20...AIM: To research the etiology, portal vein thrombosis and other features of Budd-Chiari syndrome (BCS) patients prospectively. METHODS: A total of 75 patients (40 female, 35 male) who were diagnosed between January 2002 and July 2004 as having BCS were studied prospectively. Findings from on physical examination, ultrasonography, duplex ultrasonography and venography were analyzed. Hemogram and blood chemistry were studied at the time of diagnosis and on each hospital visit. Bone marrow examination and immune phenotyping were performed by a hematologist when necessary. Protein C, S, antithrombin Ⅲ, activated protein C resistance, and anticardiolipin antibodies, antinuclear antibodies, and anti ds-DNA were studied twice. The presence of ascite, esophageal varices, and portal thrombosis were evaluated at admission and on every visit. RESULTS: At least one etiological factor was determined in 54 (72%) of the patients. The etiology could not be defined in 21 (28%) patients. One etiological factor was found in 39, 2 factors in 14 and 3 factors in 1 patient. The most common cause was the web (16%), the second was Hydatid disease (11%), the third was Behcet’s disease (9%). Portal vein thrombosis was present in 11 patients and at least one etiology was identified in 9 of them (82%). CONCLUSION: Behcet’s disease and hydatid disease are more prominent etiological factors in Turkey than in other countries. Patients with web have an excellent response to treatment without signs of portal veinthrombosis while patients having thrombofilic factors more than one are prone to develop portal vein thrombosis with worse clinical outcome.展开更多
CTP synthase is compartmentalized within a subcellular structure,termed the cytoophidium,in a range of organisms including bacteria, yeast,fruit fly and rat.Here we show that CTP synthase is also compartmentalized int...CTP synthase is compartmentalized within a subcellular structure,termed the cytoophidium,in a range of organisms including bacteria, yeast,fruit fly and rat.Here we show that CTP synthase is also compartmentalized into cytoophidia in human cells.Surprisingly,the occurrence of cytoophidia in human cells increases upon treatment with a glutamine analog 6-diazo-5-oxo-L-norleucine（DON）,an inhibitor of glutamine-dependent enzymes including CTP synthase.Experiments in flies confirmed that DON globally promotes cytoophidium assembly.Clonal analysis via CTP synthase RNA interference in somatic cells indicates that CTP synthase expression level is critical for the formation of cytoophidia.Moreover,DON facilitates cytoophidium assembly even when CTP synthase level is low.A second glutamine analog azaserine also promotes cytoophidum formation.Our data demonstrate that glutamine analogs serve as useful tools in the study of cytoophidia.展开更多
A central issue in the understanding of the pathogenesis of nonalcoholic fatty liver disease is the problem of the underlying mechanisms which are not fully understood.In the setting of excessive central adiposity,ins...A central issue in the understanding of the pathogenesis of nonalcoholic fatty liver disease is the problem of the underlying mechanisms which are not fully understood.In the setting of excessive central adiposity,insulin resistance is the major underlying cause of fat accumulation in hepatocytes.Because of the difficulties with human trials,several animal models have been developed for this purpose mainly characterized as follows:genetically disturbed or murine fatty liver,methionine-choline deficient diet fed or murine steatohepatitis,and high-fat or sucrose diet fed models.Although these animal models have provided useful information,none of them accurately reflect genetic,metabolic and biochemical characteristics of the human disease.展开更多
This study presents an application of artificial neural network(ANN)and Bayesian network(BN)for evaluation of jamming risk of the shielded tunnel boring machines(TBMs)in adverse ground conditions such as squeezing gro...This study presents an application of artificial neural network(ANN)and Bayesian network(BN)for evaluation of jamming risk of the shielded tunnel boring machines(TBMs)in adverse ground conditions such as squeezing grounds.The analysis is based on database of tunneling cases by numerical modeling to evaluate the ground convergence and possibility of machine entrapment.The results of initial numerical analysis were verified in comparison with some case studies.A dataset was established by performing additional numerical modeling of various scenarios based on variation of the most critical parameters affecting shield jamming.This includes compressive strength and deformation modulus of rock mass,tunnel radius,shield length,shield thickness,in situ stresses,depth of over-excavation,and skin friction between shield and rock.Using the dataset,an ANN was trained to predict the contact pressures from a series of ground properties and machine parameters.Furthermore,the continuous and discretized BNs were used to analyze the risk of shield jamming.The results of these two different BN methods are compared to the field observations and summarized in this paper.The developed risk models can estimate the required thrust force in both cases.The BN models can also be used in the cases with incomplete geological and geomechanical properties.展开更多
Severe pulmonary disease caused by the novel coronavirus[severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)],has devastated many countries around the world.It has overwhelmed the medical system.The priorities...Severe pulmonary disease caused by the novel coronavirus[severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)],has devastated many countries around the world.It has overwhelmed the medical system.The priorities of many institutions have changed to manage critically ill corona virus infectious disease-2019(COVID-19)patients,which affected the working style of many departments.Hepatologists and transplant surgeons look after a very sensitive patient group.Patients with liver disease need special attention and continuous follow-up.Similarly,transplant candidates also need special care.Healthcare professionals in the field of hepatology face the overwhelming task of taking care of COVID-19 patients with hepatic complications,liver disease or transplant patients who are SARS-CoV-2 positive,and the patients on routine surveillance who do not have COVID-19.This review will evaluate COVID-19 from the perspective of its effect on the liver and its possible effects on patients with liver disease.Furthermore,the level of care for liver transplant recipients during the pandemic will be discussed.展开更多
AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data ...AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.展开更多
Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor...Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.展开更多
AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided ...AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori （H pylori） and CRF status. Groups were labeled as follows： la： normal renal function, H pylori negative （n = 12）, lb： normal renal function, H pylori positive （n = 11）, 2a： CRF, H pylori negative （n = 10）, 2b： CRF, H pylori positive （n = 11）. Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation, antral biopsy specimens were taken from each patient. In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen （PCNA） labeling indexes （LI） were assessed with immunohistochemical staining method. RESULTS： For groups la, lb, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5, 60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22, respectively. When the one-way ANOVA test was applied, statistically significant differences were detected between the groups for both Bax LI （P = 0.004 〈0.01） and PCNA LI （P = 0.009 〈0.01）. When groups were compared further in terms of Bax LI and PCNA LI with Tukey＇s HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups la and 2b （P = 0.006 〈0.01）.CONCLUSION： In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.展开更多
AIM:To evaluate the levels of preoperative serum matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gastric cancer.METHODS:One hundred gastric cancer patients who underwent gast...AIM:To evaluate the levels of preoperative serum matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gastric cancer.METHODS:One hundred gastric cancer patients who underwent gastrectomy were enrolled in this study.The serum concentrations of MMP-1 and TIMP-1 in these patients and in fifty healthy controls were determined using an enzyme-linked immunosorbent assay.RESULTS:Higher serum MMP-1 and TIMP-1 levels were observed in patients than in controls (P < 0.001).Serum MMP-1 and TIMP-1 levels were positively associated with morphological appearance,tumor size,depth of wall invasion,lymph node metastasis,liver metastasis,perineural invasion,and pathological stage.They were not significantly associated with age,gender,tumor location,or histological type.CONCLUSION:Increased MMP-1 and TIMP-1 were associated with gastric cancer.Although these markers are not good markers for diagnosis,these markers show in advanced gastric cancer.展开更多
AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia.METHODS: One...AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia.METHODS: One hundred and eighty Helicobacter pyloripositive patients with peptic ulcer disease or non-ulcer dyspepsia were included in the study. One hundred and fourteen patients had non-ulcer dyspepsia and 66 had peptic ulcer disease (32 with gastric ulcers and/or erosions and 34with duodenal ulcers). Each patient was tested for serum antibody to H. pylori cagA protein by enzyme immunoassay.RESULTS: The total frequency of serum positive cagA in the study group was 97.2 %. The rates in the patients with peptic ulcers and in those with non-ulcer dyspepsia were 100% and 95.6%, respectively. These results were similar to those reported in Asian studies, but higher than those that have been noted in other studies from Turkey and Western countries.CONCLUSION: The high rates of serum positive cagA in these patients with peptic ulcer disease and non-ulcer dyspepsia were similar to results reported in Asia. The fact that there was high seroum prevalence regardless of ulcer status suggests that factors other than cagA might be responsible for ulceration or other types of severe pathology in H. pylori-positive individuals.展开更多
Severe shield jamming events have been reported during excavation of Uluabat tunnel through adverse geological conditions, which resulted in several stoppages at advancing a single shielded tunnel boring machine(TBM)....Severe shield jamming events have been reported during excavation of Uluabat tunnel through adverse geological conditions, which resulted in several stoppages at advancing a single shielded tunnel boring machine(TBM). To study the jamming mechanism, three-dimensional(3D) simulation of the machine and surrounding ground was implemented using the finite difference code FLAC3D. Numerical analyses were performed for three sections along the tunnel with a higher risk for entrapment due to the combination of overburden and geological conditions. The computational results including longitudinal displacement contours and ground pressure profiles around the shield allow a better understanding of ground behavior within the excavation. Furthermore, they allow realistically assessing the impact of adverse geological conditions on shield jamming. The calculated thrust forces, which are required to move the machine forward, are in good agreement with field observations and measurements. It also proves that the numerical analysis can effectively be used for evaluating the effect of adverse geological environment on TBM entrapments and can be applied to prediction of loads on the shield and preestimating of the required thrust force during excavation through adverse ground conditions.展开更多
H pylori is etiologically associated with gastritis, gas-tric and duodenal ulcers, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. Eradicating H pylori may convert rapidly the outcome of ...H pylori is etiologically associated with gastritis, gas-tric and duodenal ulcers, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. Eradicating H pylori may convert rapidly the outcome of related diseases with the use of more accurate diagnostic molecular tests. Indeed some of the tests cannot give the evidence of current infection; H pylori can be detected by noninvasive and invasive methods, the latter requiring an endoscopy. Eradication failure is a big problem in H pylori infection. Recently, clarithromycin resistance in H pylori strains is increasing and eradicati-on therapy of this bacterium is becoming more difficult. Molecular methods have frequently been applied besides phenotypic methods for susceptibility testing to detect clarithromycin resistance due to mutations in the 2143 and 2144 positions of 23S rRNA gene. Fluorescence in situ hybridization (FISH) method on paraffin embedded tissue is a rapid, accurate and cost-effective method for the detection of H pylori infection and to determine clarithromycin resistance within three hours according to the gold standards as a non-culture method. This method can also be applied to fresh biopsy samples and the isolated colonies from a culture of H pylori, detecting both the culturable bacillary forms and the coccoid forms of H pylori, besides the paraffin embedded tissue secti-ons. This technique is helpful for determining the bac-terial density and the results of treatment where clarith-romycin has been widely used in populations to increase the efficacy of the treatment and to clarify the treatment failure in vitro.展开更多
AIM:To evaluate the red cell distribution width(RDW)as an indicator of the presence of non-alcoholic steatohepatitis(NASH)and its association with fibrotic scores.METHODS:A retrospective study was carried out that inc...AIM:To evaluate the red cell distribution width(RDW)as an indicator of the presence of non-alcoholic steatohepatitis(NASH)and its association with fibrotic scores.METHODS:A retrospective study was carried out that included sixty-two biopsy proven NASH,32 simple steatosis patients and 30 healthy controls.The correlation between the clinical and histopathological features of NASH patients and RDW values was evaluated.Liver fibrosis scores were measured using a 0 to 4 point scale and were divided in to two groups;fibrosis scores0-1 were termed mild and fibrosis scores 2-4 were termed advanced fibrosis.RDW values were compared between NASH,simple steatosis and healthy controls.Univariate and multivariate analyses were performed to evaluate the independent predicting factors for the presence of liver fibrosis caused by NASH.RESULTS:Patients with NASH had higher RDW values compared with simple steatosis and healthy control groups[14.28%±0.25%vs 13.37%±0.12%,12.96%±0.14%(P<0.01),respectively].Patients with advanced fibrosis had higher RDW values than the mild fibrosis group(15.86%±0.4%vs 13.63%±0.67%,P<0.01,respectively).RDW also correlated with fibrotic scores(r=0.579 andP<0.01).The variables that were significant in the univariate analysis were evaluated in multivariate logistic regression analysis,and RDW was an independent predicting factor of NASH(OR=1.75,95%CI:1.129-2.711,P<0.05).CONCLUSION:RDW a new non-invasive marker that can be used to demonstrate the presence of NASH and indicate advanced fibrotic scores.展开更多
文摘BACKGROUND:Mirizzi syndrome is a rare complication of cholelithiasis,characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct.In this study,we aimed to describe the clinical presentations,investigations,operative details,and complications of seven patients who underwent endoscopic retrograde cholangiopancreatography and were finally diagnosed with Mirizzi syndrome in our center. METHOD:We performed a retrospective analysis of the records of 7 patients with Mirizzi syndrome who underwent endoscopic retrograde cholangiopancreatography. RESULTS:The incidence of Mirizzi syndrome was 1.07% of 656 patients given endoscopic retrograde cholangiopan- creatography.Ultrasonography was able to diagnose one case.Endoscopic retrograde cholangiopancreatography suggested the diagnosis in five cases and helped further in the management of these patients.Four patients had cholecystectomy and T-tube placement,and two had cholecystectomy and choledochoduodenostomy.One patient with typeⅠMirizzi syndrome according to the Csendes classification successfully underwent laparoscopic cholecystectomy. CONCLUSIONS:In the study,the incidence of Mirizzi syndrome was 1.07%of patients who underwent endoscopic retrograde cholangiopancreatography. Preoperative diagnosis of Mirizzi syndrome by endoscopicretrograde cholangiopancreatography is important to prevent complications.
文摘AIM:To investigate the therapeutic efficacy and safety of continuous autotransfusion system(CATS) during liver transplantation of hepatocellular carcinoma patients.METHODS:Eighty-three hepatocellular carcinoma(HCC) patients who underwent liver transplantation with intraoperative CATS(n = 24,CATS group) and without(n = 59,non-CATS group) between April 2006 and November 2011 at the Liver Transplant Institute of Inonu University were analyzed retrospectively.Postoperative HCC recurrence was monitored by measuring alpha-fetoprotein(AFP) levels at 3-mo intervals and performing imaging analysis by thoracoabdominal multidetector computed tomography at 6-month intervals.Inter-group differences in recurrence and correlations between demographic,clinical,and pathological data were assessed by ANOVA and χ 2 tests.Overall and disease-free survivals were calculated by the univariate Kaplan-Meier method.RESULTS:Of the 83 liver transplanted HCC patients,89.2% were male and the overall mean age was 51.3 ± 8.9 years(range:18-69 years).The CATS and nonCATS groups showed no statistically significant differences in age,sex ratio,body mass index,underlying disease,donor type,graft-to-recipient weight ratio,Child-Pugh and Model for End-Stage Liver Disease scores,number of tumors,tumor size,AFP level,Milan and University of California San Francisco selection criteria,tumor differentiation,macrovascular invasion,median hospital stay,recurrence rate,recurrence site,or mortality rate.The mean follow-up time of the nonCATS group was 17.9 ± 12.8 mo,during which systemic metastasis and/or locoregional recurrence developed in 25.4% of the patients.The mean follow-up time for the CATS group was 25.8 ± 15.1 mo,during which systemic metastasis and/or locoregional recurrence was detected in 29.2% of the patients.There was no significant difference between the CATS and non-CATS groups in recurrence rate or site.Additionally,no significant differences existed between the groups in overall or disease-free survival.CONCLUSION:CATS is a safe proce
文摘AIM: To investigate whether serum levels of two soluble forms of extracellular cytokeratin 18 (M30-antigen and M65-antigen) may differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS: A total of 83 patients with suspected NAFLD and 49 healthy volunteers were investigated. Patients with suspected NAFLD were classified according to their liver histology into four groups: definitive NASH (n = 45), borderline NASH (n = 24), simple fatty liver (n = 9), and normal tissue (n = 5). Serum levels of caspase-3 generated cytokeratin-18 fragments (M30-antigen) and total cytokeratin-18 (M65-antigen) were determined by ELISA. RESULTS: Levels of M30-antigen and M65-antigen were significantly higher in patients with definitive NASH compared to the other groups. An abnormal value (> 121.60 IU/L) of M30-antigen yielded a 60.0% sensitivity and a 97.4% specificity for the diagnosis of NASH. Sensitivity and specificity of an abnormal M65-antigen level (> 243.82 IU/L) for the diagnosis of NASH were 68.9% and 81.6%, respectively. Among patients with NAFLD, M30-antigen and M65-antigen levels distinguished between advanced fibrosis and early-stage fibrosis with a sensitivity of 64.7% and 70.6%, and a specificity of 77.3% and 71.2%, respectively. CONCLUSION: Serum levels of M30-antigen and M65-antigen may be of clinical usefulness to identify patients with NASH. Further studies are mandatory to better assess the role of these apoptonecrotic biomarkers in NAFLD pathophysiology.
文摘AIM： To determine the factors affecting mortality in pa- tients who developed graft-versus-host disease （GvHD） after liver transplantation （LT）. METHODS： We performed a review of studies of GvHD following LT published in the English literature and ac- cessed the PubMed, Medline, EBSCO, EMBASE, and Google Scholar databases. Using relevant search phras- es, 88 articles were identified. Of these, 62 articles con- raining most of the study parameters were considered eligible for the study. Risk factors were first examined using a univariate Kaplan-Meier model, and variables with a significant association （P 〈 0.05） were then sub- jected to multivariate analyses using a Cox proportional- hazards model. RESULTS： The 61 articles reported 87 patients, 58 male and 29 female, mean age, 40.4 ± 15.5 years （range： 8 mo to 74 years）, who met the inclusion criteria for the present study. Deaths occurred in 59 （67.8%） patients, whereas 28 （32.2%） survived after a mean follow-up period of 280.8 ± 316.2 d （range： 27-2285 d）. Among the most frequent symptoms were rash （94.2%）, fever （66.6%）, diarrhea （54%）, and pancytopenia （54%）. The average time period between LT and first symptom on- set was 60.6 ± 190.1 d （range： 2-1865 d）. The Kaplan- Meier analysis revealed that pancytopenia （42.8% vs 59.3%, P = 0.03）, diarrhea （39.2% vs 61.0%, P = 0.04）, age difference between the recipient and the donor （14.6 ± 3.1 years vs 22.6 ± 2.7 years, P 〈 0.0001）, and time From first symptom occurrence to diagnosis or treatment （13.3 ± 2.6 mo vs 15.0 ± 2.3 mo, P 〈 0.0001） were significant factors affecting mortality, whereas age, sex, presence of rash and fever, use of immunosuppressive agents, acute rejection before GvHD, etiological causes, time of onset, and donor type were not associated with mortality risk. The Cox proportional-hazards model, de- termined that an age difference between the recipient and donor was an independent risk Factor （P = 0.03; hazar
文摘AIM:To determine the relationship of pulmonary abnormalities and bowel disease activity in inflammatory bowel disease(IBD).METHODS:Thirty ulcerative colitis(UC)and nine Crohn's disease patients,and 20 control subjects were enrolled in this prospective study.Detailed clinical information was obtained.Extent and activity of the bowel disease were established endoscopically.Each patient underwent pulmonary function tests and high-resolution computed tomography(HRCT).Blood samples for measurement of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),angiotensin converting enzyme and total IgE were delivered by the patients.RESULTS:Ten(25.6%)patients had respiratory symptoms.A pulmonary function abnormality was present in 22 of 39 patients.Among all patients,the most prevalent abnormalities in lung functions were a decrease in forced expiratory volume in 1 s(FEV1),FEV1/forced vital capacity(FVC),forced expiratory flow(FEF)25%-75%,transfer coefficient for carbon monoxide(DLCO),DLCO/alveolar volume.Increased respiratory symptoms score was associated with high endoscopic activity index in UC patients.Endoscopic and clinical activities in UC patients were correlated with FEV1,FEV1/FVC,and FEF 25%-75%.Smoking status,duration of disease and medication were not correlated with pulmonary physiological test results,HRCT abnormalities,clinical/endoscopic disease activity,CRP,ESR or total IgE level or body mass index.CONCLUSION:It is important that respiratory manifestations are recognized and treated early in IBD.Otherwise,they can lead to destructive and irreversible changes in the airway wall.
文摘AIM: To investigate efficacy and safety of cetuximab combined with two chemotherapy regimens in patients with unresectable metastatic colorectal cancer (mCRC). METHODS: Randomized patients received cetuximab with 5-fluorouracil (5-FU), folinic acid (FA) and oxaliplatin (FOLFOX) 6 (arm A, n = 74) or 5-FU, FA and irinotecan (FOLFIRI) (arm B, n = 77). KRAS mutation status was determined retrospectively in a subset of tumors (n = 117). RESULTS: No significant difference was found between treatment arms A and B in the progression-free survival (PFS) rate at 9 mo, 45% vs 34%; median PFS, 8.6 mo vs 8.3 mo [hazard ratio (HR) = 1.06]; overall response rate (ORR) 43% vs 45% [odds ratio (OR) = 0.93] and median overall survival (OS), 17.4 mo vs 18.9 mo (HR = 0.98). Patients with KRAS wild-type tumors demonstrated improved PFS (HR = 0.55, P = 0.0051), OS, (HR = 0.62, P = 0.0296) and ORR (53% vs 36%) and in arm A, improved PFS (HR = 0.49, P = 0.0196), OS (HR = 0.48, P = 0.0201) and ORR (56%vs 30%), compared with patients with KRAS mutated tumors. In arm B no significant differences were found in efficacy by KRAS mutation status. Treatment in arms A and B was generally well tolerated. CONCLUSION: This study confirms that combinations of cetuximab with FOLFOX6 or FOLFIRI are effective and significantly improve clinical outcome in KRAS wild-type compared with KRAS mutated mCRC.
基金Grant (SBAG-105S338) from the Scientific and Technical Research Council of Turkey (TUBITAK)
文摘AIM:To investigate the effects of bombesin (BBS) and neurotensin (NTS) on apoptosis and colitis in an ulcerative colitis model. METHODS:In this study, a total of 50 rats were divided equally into 5 groups. In the control group, no colitis induction or drug administration was performed. Colitis was induced in all other groups. Following the induction of colitis, BBS, NTS or both were applied to three groups of rats. The remaining group (colitis group) received no treatment. On the 11th d after induction of colitis and drug treatment, blood samples were collected for TNF-α and IL-6 level studies. Malondialdehyde (MDA), carbonyl, myeloperoxidase (MPO) and caspase-3 activities, as well as histopathological findings, evaluated in colonic tissues. RESULTS:According to the macroscopic and microscopic findings, the study groups treated with BBS, NTS and BBS + NTS showed significantly lower damage and inflammation compared with the colitis group (macroscopic score, 2.1 ± 0.87, 3.7 ± 0.94 and 2.1 ± 0.87 vs 7.3 ± 0.94;microscopic score, 2.0 ± 0.66, 3.3 ± 0.82 and 1.8 ± 0.63 vs 5.2 ± 0.78, P < 0.01). TNF-α and IL-6 levels were increased significantly in all groups compared with the control group. These increases were significantly smaller in the BBS, NTS and BBS + NTS groups compared with the colitis group (TNF-α levels, 169.69 ± 53.56, 245.86 ± 64.85 and 175.54 ± 42.19 vs 556.44 ± 49.82;IL-6 levels, 443.30 ± 53.99, 612.80 ± 70.39 and 396.80 ± 78.43 vs 1505.90 ± 222.23, P < 0.05). The colonic MPO and MDA levels were significantly lower in control, BBS, NTS and BBS + NTS groups than in the colitis group (MPO levels, 24.36 ± 8.10, 40.51 ± 8.67 and 25.83 ± 6.43 vs 161.47 ± 38.24;MDA levels, 4.70 ± 1.41, 6.55 ± 1.12 and 4.51 ± 0.54 vs 15.60 ± 1.88, P < 0.05). Carbonyl content and caspase-3 levels were higher in the colitis and NTS groups than in control, BBS and BBS + NTS groups (carbonyl levels, 553.99 ± 59.58 and 336.26 ± 35.72 vs 209.76 ± 30.92, 219.76 ± 25.77 and 220.34 ± 36.95;caspase-3 level
文摘AIM: To research the etiology, portal vein thrombosis and other features of Budd-Chiari syndrome (BCS) patients prospectively. METHODS: A total of 75 patients (40 female, 35 male) who were diagnosed between January 2002 and July 2004 as having BCS were studied prospectively. Findings from on physical examination, ultrasonography, duplex ultrasonography and venography were analyzed. Hemogram and blood chemistry were studied at the time of diagnosis and on each hospital visit. Bone marrow examination and immune phenotyping were performed by a hematologist when necessary. Protein C, S, antithrombin Ⅲ, activated protein C resistance, and anticardiolipin antibodies, antinuclear antibodies, and anti ds-DNA were studied twice. The presence of ascite, esophageal varices, and portal thrombosis were evaluated at admission and on every visit. RESULTS: At least one etiological factor was determined in 54 (72%) of the patients. The etiology could not be defined in 21 (28%) patients. One etiological factor was found in 39, 2 factors in 14 and 3 factors in 1 patient. The most common cause was the web (16%), the second was Hydatid disease (11%), the third was Behcet’s disease (9%). Portal vein thrombosis was present in 11 patients and at least one etiology was identified in 9 of them (82%). CONCLUSION: Behcet’s disease and hydatid disease are more prominent etiological factors in Turkey than in other countries. Patients with web have an excellent response to treatment without signs of portal veinthrombosis while patients having thrombofilic factors more than one are prone to develop portal vein thrombosis with worse clinical outcome.
基金the TRiP at Harvard Medical School(NIH/ NIGMS R01-GM084947)
文摘CTP synthase is compartmentalized within a subcellular structure,termed the cytoophidium,in a range of organisms including bacteria, yeast,fruit fly and rat.Here we show that CTP synthase is also compartmentalized into cytoophidia in human cells.Surprisingly,the occurrence of cytoophidia in human cells increases upon treatment with a glutamine analog 6-diazo-5-oxo-L-norleucine（DON）,an inhibitor of glutamine-dependent enzymes including CTP synthase.Experiments in flies confirmed that DON globally promotes cytoophidium assembly.Clonal analysis via CTP synthase RNA interference in somatic cells indicates that CTP synthase expression level is critical for the formation of cytoophidia.Moreover,DON facilitates cytoophidium assembly even when CTP synthase level is low.A second glutamine analog azaserine also promotes cytoophidum formation.Our data demonstrate that glutamine analogs serve as useful tools in the study of cytoophidia.
文摘A central issue in the understanding of the pathogenesis of nonalcoholic fatty liver disease is the problem of the underlying mechanisms which are not fully understood.In the setting of excessive central adiposity,insulin resistance is the major underlying cause of fat accumulation in hepatocytes.Because of the difficulties with human trials,several animal models have been developed for this purpose mainly characterized as follows:genetically disturbed or murine fatty liver,methionine-choline deficient diet fed or murine steatohepatitis,and high-fat or sucrose diet fed models.Although these animal models have provided useful information,none of them accurately reflect genetic,metabolic and biochemical characteristics of the human disease.
文摘This study presents an application of artificial neural network(ANN)and Bayesian network(BN)for evaluation of jamming risk of the shielded tunnel boring machines(TBMs)in adverse ground conditions such as squeezing grounds.The analysis is based on database of tunneling cases by numerical modeling to evaluate the ground convergence and possibility of machine entrapment.The results of initial numerical analysis were verified in comparison with some case studies.A dataset was established by performing additional numerical modeling of various scenarios based on variation of the most critical parameters affecting shield jamming.This includes compressive strength and deformation modulus of rock mass,tunnel radius,shield length,shield thickness,in situ stresses,depth of over-excavation,and skin friction between shield and rock.Using the dataset,an ANN was trained to predict the contact pressures from a series of ground properties and machine parameters.Furthermore,the continuous and discretized BNs were used to analyze the risk of shield jamming.The results of these two different BN methods are compared to the field observations and summarized in this paper.The developed risk models can estimate the required thrust force in both cases.The BN models can also be used in the cases with incomplete geological and geomechanical properties.
文摘Severe pulmonary disease caused by the novel coronavirus[severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)],has devastated many countries around the world.It has overwhelmed the medical system.The priorities of many institutions have changed to manage critically ill corona virus infectious disease-2019(COVID-19)patients,which affected the working style of many departments.Hepatologists and transplant surgeons look after a very sensitive patient group.Patients with liver disease need special attention and continuous follow-up.Similarly,transplant candidates also need special care.Healthcare professionals in the field of hepatology face the overwhelming task of taking care of COVID-19 patients with hepatic complications,liver disease or transplant patients who are SARS-CoV-2 positive,and the patients on routine surveillance who do not have COVID-19.This review will evaluate COVID-19 from the perspective of its effect on the liver and its possible effects on patients with liver disease.Furthermore,the level of care for liver transplant recipients during the pandemic will be discussed.
文摘AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.
文摘Alveolar echinococcosis(AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins(R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy(ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for marginnegative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.
文摘AIM： To evaluate the effects of Helicobacter pylori infection on gastric epithelial cell kinetics in patients with chronic renal failure （CRF）. METHODS： Forty-four patients were enrolled in this study and divided into four groups with respect to their Helicobacter pylori （H pylori） and CRF status. Groups were labeled as follows： la： normal renal function, H pylori negative （n = 12）, lb： normal renal function, H pylori positive （n = 11）, 2a： CRF, H pylori negative （n = 10）, 2b： CRF, H pylori positive （n = 11）. Upper gastrointestinal endoscopy was done in all the patients involved in the study. During endoscopical investigation, antral biopsy specimens were taken from each patient. In order to evaluate the cell apoptosis and proliferation in gastric epithelial cells, Bax and proliferating cell nuclear antigen （PCNA） labeling indexes （LI） were assessed with immunohistochemical staining method. RESULTS： For groups la, lb, 2a, and 2b, mean Bax LI was identified as 34.4±13.7, 44.1±16.5, 46.3±20.5, 60.7±13.8, respectively and mean PCNA LI was identified as 36.2±17.2, 53.6±25.6, 59.5±25.6, 67.2±22, respectively. When the one-way ANOVA test was applied, statistically significant differences were detected between the groups for both Bax LI （P = 0.004 〈0.01） and PCNA LI （P = 0.009 〈0.01）. When groups were compared further in terms of Bax LI and PCNA LI with Tukey＇s HSD test for multiple pairwise comparisons, statistically significant difference was observed only between groups la and 2b （P = 0.006 〈0.01）.CONCLUSION： In gastric epithelial cells, expression of both the pre-apoptotic protein Bax and the proliferation marker PCNA increase with H pylori infection. This increase is more evident in patients with uremia. These findings suggest that uremia accelerates apoptosis and proliferation in gastric epithelial cells.
文摘AIM:To evaluate the levels of preoperative serum matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in gastric cancer.METHODS:One hundred gastric cancer patients who underwent gastrectomy were enrolled in this study.The serum concentrations of MMP-1 and TIMP-1 in these patients and in fifty healthy controls were determined using an enzyme-linked immunosorbent assay.RESULTS:Higher serum MMP-1 and TIMP-1 levels were observed in patients than in controls (P < 0.001).Serum MMP-1 and TIMP-1 levels were positively associated with morphological appearance,tumor size,depth of wall invasion,lymph node metastasis,liver metastasis,perineural invasion,and pathological stage.They were not significantly associated with age,gender,tumor location,or histological type.CONCLUSION:Increased MMP-1 and TIMP-1 were associated with gastric cancer.Although these markers are not good markers for diagnosis,these markers show in advanced gastric cancer.
文摘AIM: To investigate and compare frequencies of serum positive cagA in patients from two separate regions of Turkey who were grouped according to the presence of peptic ulcer disease or non-ulcer dyspepsia.METHODS: One hundred and eighty Helicobacter pyloripositive patients with peptic ulcer disease or non-ulcer dyspepsia were included in the study. One hundred and fourteen patients had non-ulcer dyspepsia and 66 had peptic ulcer disease (32 with gastric ulcers and/or erosions and 34with duodenal ulcers). Each patient was tested for serum antibody to H. pylori cagA protein by enzyme immunoassay.RESULTS: The total frequency of serum positive cagA in the study group was 97.2 %. The rates in the patients with peptic ulcers and in those with non-ulcer dyspepsia were 100% and 95.6%, respectively. These results were similar to those reported in Asian studies, but higher than those that have been noted in other studies from Turkey and Western countries.CONCLUSION: The high rates of serum positive cagA in these patients with peptic ulcer disease and non-ulcer dyspepsia were similar to results reported in Asia. The fact that there was high seroum prevalence regardless of ulcer status suggests that factors other than cagA might be responsible for ulceration or other types of severe pathology in H. pylori-positive individuals.
基金Alexander von Humboldt-Foundation (AvH) for the financial support as a research fellowthe financial support of the Scientific and Technological Research Council of Turkey (TüB_ITAK) under Project No. MAG-114M568
文摘Severe shield jamming events have been reported during excavation of Uluabat tunnel through adverse geological conditions, which resulted in several stoppages at advancing a single shielded tunnel boring machine(TBM). To study the jamming mechanism, three-dimensional(3D) simulation of the machine and surrounding ground was implemented using the finite difference code FLAC3D. Numerical analyses were performed for three sections along the tunnel with a higher risk for entrapment due to the combination of overburden and geological conditions. The computational results including longitudinal displacement contours and ground pressure profiles around the shield allow a better understanding of ground behavior within the excavation. Furthermore, they allow realistically assessing the impact of adverse geological conditions on shield jamming. The calculated thrust forces, which are required to move the machine forward, are in good agreement with field observations and measurements. It also proves that the numerical analysis can effectively be used for evaluating the effect of adverse geological environment on TBM entrapments and can be applied to prediction of loads on the shield and preestimating of the required thrust force during excavation through adverse ground conditions.
文摘H pylori is etiologically associated with gastritis, gas-tric and duodenal ulcers, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. Eradicating H pylori may convert rapidly the outcome of related diseases with the use of more accurate diagnostic molecular tests. Indeed some of the tests cannot give the evidence of current infection; H pylori can be detected by noninvasive and invasive methods, the latter requiring an endoscopy. Eradication failure is a big problem in H pylori infection. Recently, clarithromycin resistance in H pylori strains is increasing and eradicati-on therapy of this bacterium is becoming more difficult. Molecular methods have frequently been applied besides phenotypic methods for susceptibility testing to detect clarithromycin resistance due to mutations in the 2143 and 2144 positions of 23S rRNA gene. Fluorescence in situ hybridization (FISH) method on paraffin embedded tissue is a rapid, accurate and cost-effective method for the detection of H pylori infection and to determine clarithromycin resistance within three hours according to the gold standards as a non-culture method. This method can also be applied to fresh biopsy samples and the isolated colonies from a culture of H pylori, detecting both the culturable bacillary forms and the coccoid forms of H pylori, besides the paraffin embedded tissue secti-ons. This technique is helpful for determining the bac-terial density and the results of treatment where clarith-romycin has been widely used in populations to increase the efficacy of the treatment and to clarify the treatment failure in vitro.
文摘AIM:To evaluate the red cell distribution width(RDW)as an indicator of the presence of non-alcoholic steatohepatitis(NASH)and its association with fibrotic scores.METHODS:A retrospective study was carried out that included sixty-two biopsy proven NASH,32 simple steatosis patients and 30 healthy controls.The correlation between the clinical and histopathological features of NASH patients and RDW values was evaluated.Liver fibrosis scores were measured using a 0 to 4 point scale and were divided in to two groups;fibrosis scores0-1 were termed mild and fibrosis scores 2-4 were termed advanced fibrosis.RDW values were compared between NASH,simple steatosis and healthy controls.Univariate and multivariate analyses were performed to evaluate the independent predicting factors for the presence of liver fibrosis caused by NASH.RESULTS:Patients with NASH had higher RDW values compared with simple steatosis and healthy control groups[14.28%±0.25%vs 13.37%±0.12%,12.96%±0.14%(P<0.01),respectively].Patients with advanced fibrosis had higher RDW values than the mild fibrosis group(15.86%±0.4%vs 13.63%±0.67%,P<0.01,respectively).RDW also correlated with fibrotic scores(r=0.579 andP<0.01).The variables that were significant in the univariate analysis were evaluated in multivariate logistic regression analysis,and RDW was an independent predicting factor of NASH(OR=1.75,95%CI:1.129-2.711,P<0.05).CONCLUSION:RDW a new non-invasive marker that can be used to demonstrate the presence of NASH and indicate advanced fibrotic scores.
