Kinematics of the East Anatolian Fault Zone between Turkoglu (Kahramanmaras) and Celikhan (Adiyaman), eastern Turkey

In this study we determined the stress regime acting along the East Anatolian Fault Zone between Turkoglu (Kahramanmaras) and Celikhan (Adiyaman), from the Neocene to present-day, based on the inversion of striations measured on faults and on the focal mechanisms of earthquakes having magnitudes greater than 5.0. The inversions yield a strike-slip stress regime with a reverse component (i.e., transpression) operative in the Neocene to present with a consistent N-to NW-trending or, axis 156 +/- 11 degrees and an E- to NE-trending sigma(3) axis, sigma(7) 9 degrees sigma(3), producing left-lateral motion along the East Anatolian Fault Zone. The inversions of focal mechanisms yield a strike-slip stress deviator characterized by an approximately N-S (N1 degrees W)-trending sigma(1), and an approximately E-W (N89 degrees E)-trending sigma(3) axis. Both the kinematic analysis and structural observations indicate that the stress regime operating in the study area has had a transpressional character, giving rise to the Mio-Pliocene compressive structures (reverse faults, thrusts and folds) observed in the study area. Field observations allow estimation of a Pliocene age for the strike-slip East Anatolian Fault Zone

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Giant mucinous cystic neoplasm of the pancreas

Mucinous cystic neoplasms (MCN) of the pancreas occur mostly in females and are potentially sex hormone-sensitive. MCNs are more common in women with a peak incidence in the fifth decade. They are usually located in the distal pancreas, and frequently grow up to a size of 8–10 cm. We report a case of giant MCN of the pancreas in a 31-year old female patient, occupying entire left abdomen, successfully treated with distal pancreatosplenectomy. Histology demonstrated MCN with low-grade dysplasia. At 4 year of follow-up, the patient is free of disease.</jats:p

TRANSUMBILICAL LAPAROSCOPIC CHOLECYSTECTOMY VERSUS STANDARD 4-PORT LAPAROSCOPIC CHOLECYSTECTOMY – RESULTS FROM PROSPECTIVE RANDOMIZED TRIAL AND 7 YEARS OF FOLLOW-UP

PURPOSE: Laparoscopic cholecystectomy is a standard of care for patients with benign gallbladder disease. Recently single-incision techniques gained popularity in order to decrease surgical trauma and to improve cosmetic results and patient satisfaction. The aim of this study is to compare the results of our own modification of transumbilical cholecystectomy versus standard 4-port cholecystectomy in patients with uncomplicated gallstone disease. METHODS: 80 patients (14 male, 66 female) at a mean age of 35±2,5 years (range 18-80) were randomly assigned to either standard 4-port cholecystectomy (n=40) or transumbilical cholecystectomy (n=40). Operative times, intraoperative complications, conversion rate, postoperative complications, pain, vomiting and cosmetic results were compared between two groups. RESULTS: The total mean operative time in the SILC group was 43.63 ± 7.49 min., while in the SLC group it was 37.95 ±8.06 min., (p=0.002). Intraoperative complications and conversions were not recorded in this series. The mean postoperative pain assessed by VAS was: at 6th hour 3.35 (2-5) vs. 3.53 (2-6) (p=0.439), at 24th hour 2.58 (1-4) vs. 2.2 (1-5) (p=0.04), at 48th hour 1.63 (1-3) vs. 1.78 (1-5) (p=0.544). The mean 10-point pain scores for SILC patients at 6 hours was 5.78 (3-9) vs. 6.33 (1-10) in SLC (p=0.161), at 24 hours 4.05 (1-7) vs. 3.58 (1-5) (p=0.122), at 48 hour 2.83 (1-5) vs. 2.4 (1-5) (p=0.093). Postoperative vomiting was observed in 2 (5%) of patients with SILC and 3 (7.5%) of those with SLC by the end of the second hour after surgery. In the early postoperative period up to 72h, no complications were reported. In the late postoperative period up to 7 years 1 (2.5%) operative wound surgery in the area of umbilical incision was reported in the SLC group and the presence of an umbilical hernia in 2 (5%) of patients with SILC. Results of the cosmetic result evaluation at the end of the first month - Body Image Score - mean score of 10.35 ± 1.48 (min. 7, max. 12) for SILC and 10.38 ± 1.41 (min. 6, max. 13) for SLC (p = 0.776). Cosmetic score - mean of the sum of points 20 ± 1,87 (min.17- max. 24) for SILC and 19.08 ± 2,1 (min. 14-max. 23) for SLC (p = 0,577). On a scale of 1 to 10, where 1 is "very ugly" and 10 is "almost imperceptible" (question N8), the mean for patients in the SILC group is 8.3 ± 0.79 (min. 7-max. 10) and at SLC 7.93 ± 0.73 (min. 6-max. 9) (p = 0.125). CONCLUSION: The results of this study demonstrated that both transumbilical cholecystectomy and standard 4-port cholecystectomy are equally safe and effective in the treatment of uncomplicated gallstone disease

TRANSUMBILICAL LAPAROSCOPIC CHOLECYSTECTOMY VERSUS STANDARD 4-PORT LAPAROSCOPIC CHOLECYSTECTOMY – RESULTS FROM PROSPECTIVE RANDOMIZED TRIAL AND 7 YEARS OF FOLLOW-UP

PURPOSE: Laparoscopic cholecystectomy is a standard of care for patients with benign gallbladder disease. Recently single-incision techniques gained popularity in order to decrease surgical trauma and to improve cosmetic results and patient satisfaction. The aim of this study is to compare the results of our own modification of transumbilical cholecystectomy versus standard 4-port cholecystectomy in patients with uncomplicated gallstone disease. METHODS: 80 patients (14 male, 66 female) at a mean age of 35±2,5 years (range 18-80) were randomly assigned to either standard 4-port cholecystectomy (n=40) or transumbilical cholecystectomy (n=40). Operative times, intraoperative complications, conversion rate, postoperative complications, pain, vomiting and cosmetic results were compared between two groups. RESULTS: The total mean operative time in the SILC group was 43.63 ± 7.49 min., while in the SLC group it was 37.95 ±8.06 min., (p=0.002). Intraoperative complications and conversions were not recorded in this series. The mean postoperative pain assessed by VAS was: at 6th hour 3.35 (2-5) vs. 3.53 (2-6) (p=0.439), at 24th hour 2.58 (1-4) vs. 2.2 (1-5) (p=0.04), at 48th hour 1.63 (1-3) vs. 1.78 (1-5) (p=0.544). The mean 10-point pain scores for SILC patients at 6 hours was 5.78 (3-9) vs. 6.33 (1-10) in SLC (p=0.161), at 24 hours 4.05 (1-7) vs. 3.58 (1-5) (p=0.122), at 48 hour 2.83 (1-5) vs. 2.4 (1-5) (p=0.093). Postoperative vomiting was observed in 2 (5%) of patients with SILC and 3 (7.5%) of those with SLC by the end of the second hour after surgery. In the early postoperative period up to 72h, no complications were reported. In the late postoperative period up to 7 years 1 (2.5%) operative wound surgery in the area of umbilical incision was reported in the SLC group and the presence of an umbilical hernia in 2 (5%) of patients with SILC. Results of the cosmetic result evaluation at the end of the first month - Body Image Score - mean score of 10.35 ± 1.48 (min. 7, max. 12) for SILC and 10.38 ± 1.41 (min. 6, max. 13) for SLC (p = 0.776). Cosmetic score - mean of the sum of points 20 ± 1,87 (min.17-max. 24) for SILC and 19.08 ± 2,1 (min. 14-max. 23) for SLC (p = 0,577). On a scale of 1 to 10, where 1 is "very ugly" and 10 is "almost imperceptible" (question N8), the mean for patients in the SILC group is 8.3 ± 0.79 (min. 7-max. 10) and at SLC 7.93 ± 0.73 (min. 6-max. 9) (p = 0.125). CONCLUSION: The results of this study demonstrated that both transumbilical cholecystectomy and standard 4-port cholecystectomy are equally safe and effective in the treatment of uncomplicated gallstone disease.</jats:p

Assessing Changes in Oral Health-Related Quality of Life Following Dental Rehabilitation under General Anesthesia

WOS: 000337336200014PubMed: 25095323Objective: To determine whether dental treatment under general anesthesia (GA) improved oral health-related quality of life (OHRQoL) in pre-school children, to evaluate the sensitivity and responsiveness of the Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS) and to examine parental satisfaction with the care received Study design: The parents/caregivers of 120 pre-school children receiving dental treatment under GA, were asked to complete the ECOHIS before and after treatment. Participants were also asked a global transition judgement concerning change in their child's condition after treatment. Global transition judgement and distribution changes in ECOHIS scores were used to assess the sensitivity and responsiveness. Results: 98 children completed the follow-up survey Between pre- and post-treatment ECOHIS scores, significant reduction was observed (p<0.001). The effect sizes were moderate and large (0.36 to 1.63). Global transition rating groups were compatible with statistical differences between pre- and post-treatment scores, supporting the responsiveness of the ECOHIS. 91% of parents regarded the experience to be positive. Conclusions: Children's OHRQoL showed significant improvement after treatment. The majority of parents reported a high degree of satisfaction. Also, Turkish version of the ECOHIS was sensitive to dental treatment under GA for pre-school children and responsive to treatment-associated changes

Case report: intratesticular tetrathyridiosis in a cat

This report provides histological information on the incidental finding of tetrathyridium in the testicles of a three-year-old cross-bred cat. The cat was chemically castrated by intratesticular injection of calcium chloride (CaCl2). Bilateral orchiectomy was performed and no gross lesions were seen in the testicles. Histological evaluation of right testicle revealed tetrathyridium with convoluted borders and a thick eosinophilic cuticle. The stroma of the parasitic body was composed of a loose mesenchymal network with widely scattered parenchymal and muscle cells, and numerous clear vesicles (calcereous corpuscles). Thus, the case was evaluated as intratesticular tetrathyridiosis. To our knowledge, this is the first descriptive report of intratesticular tetrathyridiosis in a cat