Predictive Importance of Ultrasonography and Anti-Thyroid Antibodies in the Management of Thyroid Nodules in Indeterminate Cytology

Objectives: The aim of this study is to examine the effects of ultrasonography and serum anti-thyroid antibody (ATAb)levels in predicting malignancy in cases where molecular tests cannot be performed in indeterminate thyroid nodules. Methods: Ultrasonographic features of the dominant thyroid nodule of a total of 228 patients who were operated for nodular goiter were analyzed and preoperative serum ATAb levels were examined. Especially in Bethesda category 3 nodules correlation of these parameters with malignancy rates and Hashimoto’s thyroiditis (HT) was investigated. Results: Malignancy was detected in 24.5% (12/49) Bethesda Category 3 nodules. Anti-thyroglobulin (Anti-TG) and-or anti-thyroid peroxidase (anti-TPO) positivity in serum 36.5% (72/197) was correlated with histopathologically proven HT (p=0.001). Poor prognostic factors were found to be less common in HT-associated papillary thyroid cancer (PTC). Ultrasonographic characteristics such as hypoechogenicity, microcalcification, and border irregularity were significant in predicting malignancy in indeterminate nodules (p=0.038- 0.003- 0.004, respectively). The central vascularization pattern remained in the background compared to other parameters (p=0.059). In the presence of ultrasonographic halo, 92.7% (51/55) of the nodules were benign (p=0.001). Conclusion: In the management of thyroid nodules in indeterminate cytology, suspicious ultrasonographic features and Hashimoto's thyroiditis should be encouraging in making the surgical decision

Platelet-lymphocyte ratio predicts poor prognosis in stage II / III colon and rectum cancer

Objective: There is an increasing number of studies in the literature reporting that serum platelet/lymphocyte ratio (PLR) can provide useful prognostic data for various cancers. In the present study, the effects of platelet-lymphocyte ratio on survival in stage II/III colorectal cancers (CRC) were examined. Material and Method:A total of 106 Stage II/III CRC patients who underwent curative surgery 2015-2020 were included in the study. Emergency cases and patients diagnosed with other than adenocarcinoma were excluded from the study. The demographic data of the patients, preoperative imaging and laboratory results, postoperative pathology reports, and patient follow-up examination data were obtained from hospital records. The relations between demographic, histopathological, hematological values and the prognosis was analyzed in terms of statistical significance. Results:Among the 106 patients, 62 (58.5%) were male and 44 (41.5%) were female. The mean age was 64.3±12.01 (23-89). The mean follow-up period was calculated as 24.6±15.8 (2-63) months. When the pathology reports were reviewed, it was found that the mean tumor diameter was 5.3±2.33 cm (2-17) and the mean metastatic lymph node was 1.8±2.4 (0-10). The PLR ratio was determined as a poor prognostic factor affecting survival in the cox regression analysis, in which preoperative complete blood count, c-reactive protein and albumin values, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and PLR were compared, and was separated from other variables (P=0.002 CI= 95%). When variables such as age, clinical stage, and tumor diameter were included in the model, PLR was similarly found to be an important predictive variable (P= 0.002). When only NLR, LMR, and PLR were evaluated, PLR again came to the forefront with a significance value of P=0.01. Also, high neutrophil count, increased platelet distribution volume (PDW), advanced age, and perineural invasion (PNI) were found to be significant factors in predicting poor prognosis. Conclusions: High PLR is a poor prognostic factor for CRC patients. For this reason, it may be necessary to follow a more aggressive strategy in the management of postoperative treatment in patients who have high PLR

The relationship between body-mass index and Helicobacter pylori infection: a case-control study

Objective: Helicobacter pylori infection is one of the most common infections worldwide. There are different opinions in the literature aboutthe relationship between H. pylori and obesity. In this study, we investigated the relationship between body-mass index (BMI) and H. pyloriinfection.Material and Method: A cross-sectional study was conducted among patients who underwent endoscopic examinations at Tekirdağ NamıkKemal University Faculty of Medicine Hospital in 2019. The prevalence of H. pylori infection was examined by biopsy. The relationshipbetween BMI and H. pylori infection was analyzed.Results: 51.8% of the cases in our population were positive for H. pylori infection. On histopathological examination, acute and chronicinflammation findings were higher in H. pylori-positive cases compared to H. pylori-negative cases. The prevalence of H. pylori infectionwas higher in patients with high BMI than those with low BMI. Statistical analysis showed a significant relationship between BMI and theprevalence of H. pylori infection (p<0.001), and there was a positive linear correlation between these two parameters (r=0.542). When therisk factors were examined univariable, BMI was found to be a significant risk factor for H. pylori infection (p=0.008). Multivariable analysisresults revealed that BMI is an independent risk factor for H. pylori infection. (OR=1.32 (1.09-3.46), p=0.025).Conclusion: Our results showed that there is a significant relationship between BMI and H. pylori infection, and high BMI is an independentrisk factor for H. pylori infection

A rare breast tumor; Adenomyoepithelioma: a case report and review of the literature

Adenomyoepithelioma is rare benign breast neoplasia characterized by the proliferation of both epithelial and myoepithelial cells of themammary lobules and ducts. This tumour, which does not have specific risk factors and radiological findings, is mostly seen in advancedages. This tumour, which occurs with the biphasic proliferation of epithelial and myoepithelial cells, also contains normal breast lobules andducts. This tumour is very difficult to diagnose and includes many radiological and pathological pitfalls. Although malignant degenerationhas been reported in the literature, it is a rare condition. In this study, we present a rare case with radiologically suspicious findings andpathologically reported as adenomyoepithelioma

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Clinical role of CD274 (PD-L1) and CD3+ lymphocytes in predicting high risk in advanced colorectal cancer patients receiving neoadjuvant chemotherapy

In cancer research, the mechanism underlying the immune response to a tumour has been of great interest. In this study, we investigated the role of CD274 (programmed cell death-ligand 1 – PD-L1) and CD3+ tumour-infiltrating lymphocytes (TILs) in the prognosis of advanced colorectal cancer (CRC) patients treated with neoadjuvant chemotherapy. We retrospectively examined primary tumour specimens from stage III/IV CRC patients operated on between 2008 and 2018. We found a significant association between these biomarkers and pT stage (PD-L1, p = 0.020; CD3+TILs, p = 0.025), tumour grade (PD-L1, p = 0.005; CD3+TILs, p = 0.004), positive surgical margin (PD-L1, p = 0.001; CD3+TILs, p = 0.001), MSI (PD-L1, p < 0.001; CD3+TILs, p < 0.001), etc. We also discovered that these biomarkers are independent risk factors for MSI (PD-L1, OR = 1.84 [1.27–4.02], p = 0.003; CD3+TILs, OR = 1.92 [1.31–4.35], p = 0.008). Univariate analysis results revealed that patients with high PD-L1, low CD3+TIL, and both showed poor relapse-free survival (RFS) and poor overall survival (OS) (PD-L1: RFS, p = 0.008 and OS, p = 0.001; CD3+TILs: RFS, p = 0.003 and OS, p = 0.005; PD-L1 and CD3+TILs: RFS, p < 0.001 and OS, p < 0.001). The results of the multivariate analysis showed that the combined use of high PD-L1 and low CD3+TILs was a better predictor of poor RFS and OS (PD-L1 and CD3+TILs: RFS, hazard ratio – HR, = 2.85 [95% CI: 1.36–3.84], p < 0.001); OS, HR = 2.74 [1.32–3.71], p < 0.001). We also found a high PD-L1 parameter as another independent overall and relapse-free survival parameter. Our findings suggest that a combination of high PD-L1 and low CD3+TIL can reliably predict poor survival in CRC patients receiving chemotherapy. Therefore, these biomarkers may be promising for the planning and execution of appropriate targeted therapies

The Proportion of Tumour-Stroma in Metastatic Lymph Nodes is An Accurately Prognostic Indicator of Poor Survival for Advanced-Stage Colon Cancers

Benek, Suat/0000-0003-0774-7695WOS:000551024800001PubMed: 32696416The importance of tumour microenvironment in tumour behaviour has now become clearer. This study aimed to determine the prognostic effect of the proportion of tumour-stroma (PTS) in metastatic lymph nodes of advanced-stage colon cancers (CCs). We investigated PTS in positive lymph nodes of stage III-IV CC patients who underwent surgical treatment between 2004 and 2014. We used a standard approach in methodology. PTS was significantly associated with prognostic factors in the metastatic lymph nodes (perineural invasion [p = 0.031], lymphatic invasion [p = 0.032], invasive margin [p = 0.043], advanced pT [p = 0.020], and margin involvement [p = 0.034]). In addition, the correlations between PTS estimates (R = 0.704 to 0.617,p < 0.001), the reproducibility of the research (Kappa appa = 0.72-0.68) and the usefulness of the cut-off value (ROC: 50.33%; AUC = 0.752 [0.667-0.857]) were successful. In univariate analysis, 5-year survival was poor for RFS (p < 0.001), OS (p = 0.001) and LR (p = 0.013) in high PTS patients. Multivariate analysis confirmed that high PTS was an independent worse parameter for RFS (HR = 1.32, 95% CI: 1.17-2.55,p = 0.001) and OS (HR = 1.37, 95% CI: 1.25-1 - 2.56,p = 0.009). In this study, we showed that high PTS in metastatic lymph nodes was a successful prognostic marker for advanced-stage CCs. Also, the standard approach we used for the methodology was successful.Scientific Research Projects Coordination Unit of Kirikkale UniversityKirikkale University [2020/052]This work was supported by Scientific Research Projects Coordination Unit of Kirikkale University. Project number: 2020/052

PD-1 and PD-L2 expression predict relapse risk and poor survival in patients with stage III colorectal cancer

Background Immune responses have long been an area of interest in cancer research. In this study, the effects of programmed cell death-1 (PD-1) and its ligand (PD-L2) on the prognosis of colorectal cancer (CRC) were investigated. Methods Primary tumour specimens of stage III CRC patients operated between 2002 and 2013 were assessed for PD-1 and PD-L2 expression and various clinicopathological and prognostic factors. Results We observed a significant relationship between poor prognostic factors and PD-1/PD-L2 expression. These biomarkers were also found to serve as independent risk factors for LIR and MSI. In univariate analysis, relapse-free survival (RFS) and overall survival (OS) rates were found to be poor in PD-1 and PD-L2 positive patients. In multivariate analysis, these biomarkers were found to serve as independent poor prognostic factors for RFS and OS. Conclusions Our data indicate that PD-1 and PD-L2 may serve as independent prognostic survival parameters for CRC patients and may be employed for the design of targeted theapies.Kirikkale Universit

Assessment of the Pre-operative Nutritional Status of Patients who were Scheduled for Elective Surgery and Determination of Nutritional Support Requirements

Aim: We aimed to evaluate the nutritional status with clinical, antropometric and laboratory methods in patients who were scheduled for elective surgery. Methods: Retrospective evaluation of 90 patients in a period of 4 years was performed. Patients with tumors (group 1) were compared with controls (group 2) in regard to nutritional status. Student t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results: The mean age of patients in group 1 (3 males, 8 females) and group 2 (35 males, 44 females) was 62.8±11.0 and 47.7±16.2 years, respectively. The mean body mass index (BMI) was 30.1±6.6. Triceps thickness and circumference of the upper mid-arm were 2.2±0.8 and 28.6±4.2 cm, respectively. All patients had a Subjective Global Assessment (SGA) score A, but two patients were classified as having moderate nutritional risk according to Nutritional Risk Screening (NRS) 2002. The mean length of hospital stay was 2.6±2.4 days. Complications were observed in four patients of group 2 and in two patients of group 1. Gender, SGA score, albumin, prealbumin, BMI, triceps thickness, circumference of the upper mid-arm and complication rates were statistically similar between the groups. There was a statistically significant difference in age, NRS 2002, gastrointestinal system findings, length of hospital stay, sedimentation and fasting blood glucose levels between the groups. Conclusion: Patients with nutritional risk can be detected using the NRS 2002. Nutritional support was necessary in 2% of all cases and in 18% of group 1 patients. However, advantages of antropometric measurements, biochemical tests, BMI and SGA could not be shown

The Comparison of Anterior and Posterior Herniorraphy Operations in Recurrent Inguinal Hernias

Aim: The incidence of recurrent hernia after primary repair of the inguinal hernia ranges from 1% to 20%. There is still controversy over the selection and use of anterior versus posterior approach in the repair of recurrent inguinal hernias. The present study evaluated the outcomes achieved in patients who were operated on using the two methods. Methods: This retrospective study included a total of 109 patients, who underwent an operation due to recurrent inguinal hernia in a period of 15 years. Posterior preperitoneal mesh repair was performed in 60 patients and anterior approach using Lichtenstein technique was used in the remaining 49 patients. Polypropylene mesh graft was used in the repair and the patients were compared after control visits at one week, one month, six moths and one year. The chi-square test and Student’s t-test were used in the statistical analysis. Results: The mean length of hospital stay was 1.9 days in the posterior approach group and 1 day in the anterior approach group. Of the patients who underwent repair using posterior approach, 57 were male and three were female with a mean age of 55.2 (range 25-80) years. Of the patients who underwent repair using anterior approach, 46 were male and three were female with a mean age of 56.6 (18-82) years. The rate of postoperative complications was 8.3% in the posterior approach group and 6% in the anterior approach group. Conclusion: Surgical procedures involving anterior approach are commonly preferred in the repair of inguinal hernias due to short procedure time, favorable safety profile and lower morbidity rates, however, these procedures pose the disadvantages of difficulty of accessing the recurrent hernia area and being time consuming surgery due to inflammation secondary to previous surgery as well as the risk of injury to the cord elements. Anterior approach can be used despite all these risk factors, but placement of mesh into the intact preperitoneal area can also be used as a safe procedure