Neuronal let-7b-5p acts through the Hippo-YAP pathway in neonatal encephalopathy

Despite increasing knowledge on microRNAs, their role in the pathogenesis of neonatal encephalopathy remains to be elucidated. Herein, we identify let-7b-5p as a significant microRNA in neonates with moderate to severe encephalopathy from dried blood spots using next generation sequencing. Validation studies using Reverse Transcription and quantitative Polymerase Chain Reaction on 45 neonates showed that let-7b-5p expression was increased on day 1 in neonates with moderate to severe encephalopathy with unfavourable outcome when compared to those with mild encephalopathy. Mechanistic studies performed on glucose deprived cell cultures and the cerebral cortex of two animal models of perinatal brain injury, namely hypoxic-ischaemic and intrauterine inflammation models confirm that let-7b-5p is associated with the apoptotic Hippo pathway. Significant reduction in neuronal let-7b-5p expression corresponded with activated Hippo pathway, with increased neuronal/nuclear ratio of Yes Associated Protein (YAP) and increased neuronal cleaved caspase-3 expression in both animal models. Similar results were noted for let-7b-5p and YAP expression in glucose-deprived cell cultures. Reduced nuclear YAP with decreased intracellular let-7b-5p correlated with neuronal apoptosis in conditions of metabolic stress. This finding of the Hippo-YAP association with let-7b needs validation in larger cohorts to further our knowledge on let-7b-5p as a biomarker for neonatal encephalopathy

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Two cases with thyroglossal duct carcinoma

Tiroglossal duktus kistleri boyun orta hattında sık rastlanan kistik kitlelerdir; tiroglossal duktus karsinomları ise nadir görülür. Bu makalede, tiroglossal duktus karsinomu saptanan iki kadın hasta (yaşları 31 ve 25) sunuldu. Bir hastada ameliyat öncesi yapılan ince iğne aspirasyon biyopsi sonucu benign olarak bildirilmişti. Her iki olguya da tiroglossal duktus kisti öntanısı ile Sistrunk operasyonu uygulandı. Histopatolojik inceleme sonucu tiroglossal duktus papiller karsinomu ile uyumlu idi. İzlem sırasında her iki hastanın sağ tiroid lobunda hipoaktif nodül saptanması üzerine sağ tiroid lobektomi yapıldı. Tiroidektomi materyalinde karsinoma rastlanmadı. Hastaların 21 ve 35 aylık takipleri sırasında hastalık bulgusu görülmedi.Thyroglossal duct cyst is a common midline cystic mass in the neck, whereas thyroglossal duct carcinoma is rare. We present two female patients aged 31 and 25 years, respectively, with thyroglossal duct papillary carcinoma. Fine needle aspiration biopsy performed in one patient showed a benign cystic lesion. Both patients underwent Sistrunk operation following a diagnosis of thyroglossal duct cyst. Histopathologic examination revealed papillary carcinoma of the thyroglossal duct. Right thyroid lobectomy was performed in both patients upon detection of hypoactive nodules on follow-up examinations. Thyroid specimens were free of carcinoma evidence. No disease-associated complications occurred during follow-ups of 21 and 35 months, respectively

Fibrin Glue's Intraabdominal Adhesion Creation Potential:Experimental Study

AMAÇ: Çalışmamızda abdominal operasyon yapılan sıçanlarda, hemostatik ajan olarak kullanılan Fibrin Glue(Tisseel)'nin operasyon sonrası intraabdominal adezyon oluşturma potansiyelini değerlendirdik.GEREÇ VE YÖNTEMLER: SB Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği'nde planlanan çalışmada, 30 (otuz) adet Wistar Albino cinsi dişi rat kullanıldı. Ratlar randomize olarak, 10'ar ratdan oluşan 3 gruba ayrıldı. Sham grubuna; laparotomi çekumun dışarı alınması ve yeniden batına gönderilmesi işlemi uygulandı.Kontrol grubuna; çekal abrazyon karşı peritondan 1x1 cm eksizyon işlemi, Fibrin Glue grubuna ise; çekal abrazyon karşı peritondan 1x1 cm eksizyon ve çekum üzerine Figrin Glue uygulaması yapıldı. Postoperatif 21. Günde ratlar yüksek doz anestezik verilerek sakrifiye edildi. Laparotomi esnasında adezyon skorlaması; yaygınlık, görünüm ve uygulanan kuvvete karşı direncin temel alındığı adezyon skorlaması; gruplar hakkında bilgisi olmayan bir cerrahi ekip tarafından; yaygınlığın, görünümün ve uygulanan kuvvete karşı direncin temel olarak alındığı bir yöntemle yapıldı. Periton ve çekumdan alınan doku örnekleri histopatolojik incelemeye gönderildi.BULGULAR: Adezyon skoru değerlendirmesinde, tüm gruplar Kruskal -Wallis Testi ile genel karşılaştırıldığında; Sham, Kontrol ve Fibrin Glue grupları arasında istatistiksel anlamlı fark bulundu (p 0.003). Mann-Whitney Testi ile yapılan ikili karşılaştırmalarda; Sham ve Kontrol grupları arasında istatistiksel anlamlı fark olduğu (p 0.013), Sham ve Fibrin Glue grupları arasında da anlamlı fark olduğu görüldü (p 0.001). Ancak Kontrol ve Fibrin Glue grupları arasında anlamlı istatistiksel fark bulunmadı (p0.05). Fibrin Glue grubunun adezyon skor ortalaması, Kontrol grubundan daha yüksek idi. Histopatolojik değerlendirme sonuçları için tüm gruplar Kruskal-Wallis Testi ile genel karşılaştırıldığında; Sham, Kontrol ve Fibrin Glue grupları arasında inflamasyon ve fibrozis açısından anlamlı fark olduğu (Fibrozis için p0.001, inflamasyon için p0.014) tespit edildi. Mann-Whitney Testi ile ikili grup karşılaştırılmalarında; Sham ve Kontrol grubu arasında anlamlı fark görüldü (inflamasyon için p0.022, fibrozis için p0.001), Sham ve Fibrin Glue grupları arasında da anlamlı fark görüldü( inflamasyon için p0.006, fibrozis için p0.002). Kontrol ve Fibrin Glue grupları arasında anlamlı fark yoktu (p0.05). Ancak, Fibrin Glue grubundaki inflamasyon ve fibrozis skor ortalamaları Kontrol grubundaki değerlerden daha yüksek idi. SONUÇ: Fibrin Glue (Tisseel)'nun intraabdominal yapışıklık oluşturma potansiyeli deneysel olarak değerlendirilmiş, makroskobik ve mikroskobik olarak yapılan karşılaştırmalarda; Sham, Kontrol grubu ve Fibrin Glue (Tisseel) grupları arasında istatistiksel olarak anlamlı fark bulunmuştur. Ancak, insanlardaki abdominal cerrahilerde olası adezyon potansiyelinin değerlendirilebilmesi için denek sayısının fazla olduğu daha kapsamlı çalışmalara ihtiyaç olduğu kanaatindeyiz.OBJECTIVE: In our study, we evaluated the potential of intraabdominal adhesion of fibrin glue (Tisseel), which is used as a hemostatic agent in rats undergoing abdominal surgery.MATERIAL AND METHODS: Thirty (30) female Wistar Albino rats were used in the study which was planned at the General Surgery Clinic of the Ankara Training and Research Hospital. The rats were randomly divided into 3 groups, each consisting of 10 rats. Sham group: Laparotomy withdrawal of the graft and resuscitation was performed. Control group: 1x1 cm excision process from cecal abrasion counterperiton. Fibrin Glue group; cecal abrasion 1x1 cm excision from the peritoneum and Fibrin Glue were applied on the cecum. On postoperative day 21, the rats were sacrificed by high dose anesthetic. Adhesion scoring during laparotomy; the prevalence, appearance, and resistance to applied force are based on adhesion scoring; by a surgical team without information about the groups; the appearance, and the resistance against the applied perspiration were used as a basis. Tissue specimens taken from the peritoneum and cecum were sent to a histopathological examination.RESULTS: When all groups were compared with the Kruskal-Wallis test in evaluating the adhesion score. There was statistically significant difference between sham, control and fibrin glue groups (p 0.003). In the binary comparisons made with the Mann-Whitney Test; There was a statistically significant difference between sham and control groups (p 0.013), and there was also a significant difference between sham and fibrin glue groups (p 0.001). However, there was no statistically significant difference between Control and Fibrin Glue groups (p> 0.05). The adhesion score average of the fibrin glue group was higher than the control group. When all groups were compared with Kruskal-Wallis test for histopathological evaluation results; There was a significant difference between the sham, control and fibrin glue groups in terms of inflammation and fibrosis (p 0.001 for fibrosis, p 0.014 for inflammation). Mann-Whitney test was used to compare the two groups; There was a significant difference between sham and control group (p 0.022 for inflammation, p 0.001 for fibrosis) and a significant difference between sham and fibrin glue groups (p 0.006 for inflammation and p 0.002 for fibrosis). There was no significant difference between control and fibrin glue groups (p> 0.05). However, the mean scores of inflammation and fibrosis in the fibrin glue group were higher than those in the Control group.CONCLUSION: Fibrin glue (Tisseel) has been experimentally evaluated in terms of the potential for intraabdominal adhesion formation, macroscopically and microscopically, There was a statistically significant difference between sham, control group and fibrin glue (Tisseel) groups. However, we believe that there is a need for more extensive studies to assess the potential adhesion of abdominal surgeons in humans