Epithelial-Mesenchymal Transition in Tumor Microenvironment Induced by Hypoxia

A tumor microenvironment contains various noncancerous cells including adipocytes, fibroblasts, immune and inflammatory cells, neuroendocrine cells, pericytes, vascular and lymphatic endothelial cells, and the extracellular matrix that surrounds cancerous cells. In the tumor microenvironment, cancer cells interact and cross talk with noncancerous cells and orchestrate different mechanisms of cancer such as tumorigenesis, angiogenesis, and metastasis. Moreover, the expansive nature of cancer cells and chaotic angiogenesis affect microcirculation as well as alter the oxygen concentration progressively. Hypoxia, a key player in the multistep process of cancer metastasis, is important in different regions of the tumor microenvironment. Hypoxia may transform cancer cells to become more aggressive and invasive by triggering overexpression of several hypoxia-related factors that activate epithelial-mesenchymal transition (EMT). Herein, the current knowledge of how hypoxia-driven EMT is presented in the tumor microenvironment of solid cancers is discussed

Lip segmentation using adaptive color space training

In audio-visual speech recognition (AVSR), it is beneficial to use lip boundary information in addition to texture-dependent features. In this paper, we propose an automatic lip segmentation method that can be used in AVSR systems. The algorithm consists of the following steps: face detection, lip corners extraction, adaptive color space training for lip and non-lip regions using Gaussian mixture models (GMMs), and curve evolution using level-set formulation based on region and image gradients fields. Region-based fields are obtained using adapted GMM likelihoods. We have tested the proposed algorithm on a database (SU-TAV) of 100 facial images and obtained objective performance results by comparing automatic lip segmentations with hand-marked ground truth segmentations. Experimental results are promising and much work has to be done to improve the robustness of the proposed method

Diagnostic Concordance Characteristics of Oral Cavity Lesions

Purpose. The objective of this study was to evaluate the diagnostic concordance characteristics of oral cavity lesions by comparing the clinical diagnosis of the lesions with the histopathologic diagnosis. Material and Method. A retrospective analysis was conducted on the patients, who were admitted with oral cavity pathology and underwent biopsy procedure between 2007 and 2011. The oral cavity lesions were classified into 6 different groups as odontogenic cysts, nonodontogenic cysts, odontogenic tumors, nonodontogenic tumors, malignant tumors, and precancerous lesions in accordance with the 2005 WHO classification. The diagnoses were also recategorized into 3 groups expressing prognostic implications as benign, precancerous, and malignant. The initial clinical diagnoses were compared with the histopathologic diagnoses. Data were analyzed statistically. Results. A total of 2718 cases were included. Histopathologic diagnosis did not match the clinical diagnosis in 6.7% of the cases. Nonodontogenic tumors and malignant tumors had the highest misdiagnosis rates (11.5% and 9%, resp.), followed by odontogenic tumors (7.7%), precancerous lesions (6.9%), and odontogenic cysts (4.4%). Clinicians were excelled in diagnosis of benign and precancerous lesions in clinical setting. Conclusion. The detailed discordance characteristics for each specific lesion should be considered during oral pathology practice to provide early detection without delay

Treatment and follow up results of patients with monosymptomatic enuresis nocturna

Objective: To evaluate the treatment results of patientswith monosymptomatic enuresis nocturna.Methods: 97 patients with monosymptomatic enuresisnocturna were included. First, motivation and behavioraltreatment have been applied to the patients for 3 months.60-120 mcg desmopressin has been applied to 79 patientswho did not want to continue to the motivation andbehavioral treatment or who did not have benefit from motivationand behavioral treatment or whose disease haverelapsed. It is accepted as “full response” if the numberof wetting decreases 90-100%, “middle response” decreases50-90%, “failed response” decreases less than50%. Treatment and relapse rates were evaluated basedon the response to therapy at the time of controls.Results: Mean age of the patients was 7.75±1.96 (5-12)years. 20 of 97 (21%) patients who have taken motivationand behavioral treatment have been cured. Two (%10)of these patients’ diseases have relapsed. Desmopressinhas been applied to79 patients who did not have benefitfrom motivation and behavioral treatment or whosediseases have relapsed. Full dryness has been providedin 36 (46%) patients who have taken desmopressin andcame to the control visit. “Middle response” has been obtainedin 22 (28%) patients. “Failed response” has beenobtained in 21 (26%) patients. Relapse has been seen incase of quitting desmopressin in 35 (60%) patients whohave benefit from desmopressin.Conclusion: Although, Desmopressin is the most preferredmethod in monosymptomatic enuresis nocturna,because of easy usage and fast response, relapse ratio ishigh following discontinuation of the drug.Key words: Monosymptomatic enuresis nocturna, desmopressin,treatmen

Hypothyroidism, new nodule formation and increase in nodule size in patients who have undergone hemithyroidectomy

Introduction: The current medical literature has conflicting results about factors related to hypothyroidism and nodular recurrences during follow-up of hemithyroidectomized patients. We aimed to evaluate factors that may have a role in new nodule formation, hypothyroidism, increase in thyroid lobe and increase in nodule volumes in these patients with and without Hashimoto’s thyroiditis (HT), and with and without levothyroxine (LT4) use. Material and methods: We enrolled 140 patients from five different hospitals in Ankara and evaluated their thyroid tests, autoantibody titre results and ultrasonographic findings longitudinally between two visits with a minimum 6-month interval. Results: In patients with HT there was no significant difference between the two visits but in patients without HT, thyroid stimulating hormone (TSH) levels and nodule volume were higher, and free T4 levels were lower in the second visit. Similarly, in patients with LT4 treatment there was no difference in TSH, free T4 levels, or lobe or nodule size between the two visits, but the patients without LT4 had free T4 levels lower in the second visit. Regression analysis revealed a relationship between first visit TSH levels and hypothyroidism during follow-up. Conclusions: Patients who have undergone hemithyroidectomy without LT4 treatment and without HT diagnosis should be followed up more carefully for thyroid tests, new nodule formation and increase in nodule size. The TSH levels at the beginning of the follow-up may be helpful to estimate hypothyroidism in hemithyroidectomized patients

Skin Cancers of the Auricle: A Retrospective Analysis of 41 Patients

Objective: Skin cancers of the auricle usually present with challenges because of the unique anatomy and topography of the auricle and the behavior of the tumor. The purpose of this study was to evaluate the clinical and histopathological characteristics and the surgical outcomes in patients with skin cancer of the auricle.Methods: Medical records of patients who underwent surgery for a skin cancer of the auricle at two different tertiary medical centers during 2010 to 2020 were reviewed retrospectively. Sociodemographic data of patients, tumor location and size, histopathological type and subtype, T-stage, recurrence, and reconstructive technique were evaluated.Results: The study included 41 patients with skin cancers of the auricle. Thirty-six (87.8%) were male and five (12.2%) were female; with a male-to-female ratio of 7.2:1. The mean age of the patients was 71.4 (46-92) years. Eighteen (43.9%) tumors were basal cell carcinoma (BCC) and 17 (41.5%) tumors were cutaneous squamous cell carcinoma (cSCC). The most common subunit for tumor location was the helix (n=17, 41.5%). Wedge resection plus primary closure was the most common surgical technique (58.5%). Recurrent disease was detected in five patients (12.1%).Conclusion: The frequency of the skin cancers of the auricle was remarkably high in men, and the helix was the most common subunit. Both BCC and cSCC were the most common histopathological types. Poor prognostic factors such as lymph node metastasis, perineural invasion, and recurrence were relatively common in patients with cSCC of the auricle

Treatment of renal stones with flexible ureteroscopy in preschool age children

WOS: 000336383500008PubMed ID: 24374900The aim of the study is to evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) to treat renal stones in preschool age ( 4 mm, a second-stage RIRS was performed. The pre-operative, operative and post-operative data of the patients were retrospectively analyzed. A total of 65 patients with a mean age of 4.31 +/- A 1.99 years (6 months-7 years) were included in the present study. The mean stone size was 14.66 +/- A 6.12 mm (7-30 mm). The mean operative time was 46.47 +/- A 18.27 min. In 5 (7.69 %) patients, the initial procedure failed to reach the renal collecting system and ended with the insertion of a pigtail stent. The stone-free rates were 83.07 and 92.3 % after the first and second procedures, respectively. Complications were observed in 18 (27.7 %) patients and classified according to the Clavien system. Post-operative hematuria (Clavien I) occurred in 6 (9.2 %) patients, post-operative urinary tract infection with fever (Clavien II) was observed in 10 (15.4 %) patients, and ureteral wall injury (Clavien III) was noted in 2 (3 %) patients. RIRS is an effective and safe procedure that can be used to manage renal stones in preschool age children

Ultrasound Guided Infraclavicular Block for Pain Control After Upper Extremity Surgery

Background: Opioids added to local anesthetics for peripheral nerve blocks may intensify analgesia and prolong analgesic and sensorial block duration. These agents may also cause potentiation and prolongation of motor block. Objective: This study compared the postoperative effects of 30 mL of 0.25% bupivacaine +50 mcg fentanyl and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl solutions for the ultrasound-guided infraclavicular block in patients undergoing elbow and forearm surgery. Methods: In this randomized double-blind study, thirty-six patients with risk of ASA class I-III were randomly allocated into 2 randomized groups. Ultrasound-guided infraclavicular blocks with 30 mL of 0.25% bupivacaine + 50 mcg fentanyl for group 1 and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl for group 2 were performed before patients emerged from general anesthesia. After surgery, pain levels at rest and during movement were evaluated using the 10-cm visual analog scale (VAS) at recovery room admission, at the 15th and 30th minutes in the recovery room, and at the 2nd, 6th, 12th and 24th hours postoperatively. Both morphine and rescue analgesic requirements were recorded. Sensorial and motor block durations, patient satisfaction, and complications related to the infraclavicular block were recorded. Results: In both groups, no significant difference in VAS pain scores, total morphine and total rescue analgesic requirements, duration of sensorial and motor block, or patient satisfaction were observed. None of the patients experienced any complications. Conclusion: The mixtures of 0.25% bupivacaine + 50 mcg fentanyl and 0.25% bupivacaine + 100 mcg fentanyl showed similar postoperative effects

The Effect of Obturator Nerve Blockade on Oncological Outcomes of Patients with Lateral Wall Localized Non-Muscle Invasive Bladder Cancer

Objective:To investigate the effect of obturator nerve blockade on oncological outcomes of patients with a diagnosis of lateral wall localized non-muscle invasive bladder cancer.Materials and Methods:One hundred six patients diagnosed with lateral wall localized non-invasive bladder cancer were evaluated between January 2015 and March 2020 in this retrospective, cross-sectional observational study. The patients were divided into two groups: patients receiving only spinal anesthesia and those receiving spinal anesthesia combined with ultrasound-guided obturator nerve blockade. Oncological outcomes of the groups were compared statistically.Results:We observed recurrent tumors in 25 patients (45.5%) in Group 1 and 11 patients (21.6%) in Group 2. Additionally, we observed tumor progression in eight patients (14.5%) in Group 1 and two patients (3.9%) in Group 2. We observed statistical significance in differences between groups regarding tumor size, recurrence rate, adequate muscle tissue sampling, ability for complete resection, and persistent obturator reflex. The efficacy rate of obturator blockade was 92.1% in Group 2. One-year recurrence-free survival (RFS) was 98.0% and 5-year RFS was 23.5% for Group 1, while for Group 2, they were 97.4% and 57.2%, respectively.Conclusion:The obturator reflex is a common and challenging reflex that may cause major complications and result in unintended consequences, such as incomplete resection or tumor recurrence with transurethral resection of bladder tumors. In this study, we demonstrated that combining spinal anesthesia with obturator nerve blockade for lateral wall localized non-muscle invasive bladder cancer may prevent tumor recurrence and reduce peroperative complications