Comparison of Posterior and Antero-Lateral Renal Tumors in Retroperitoneal Laparoscopic Partial Nephrectomy: A Propensity Score Matching Analysis

This study aimed to compare the antero-lateral and posterior localized renal masses in laparoscopic partial nephrectomy with the retroperitoneal approach in terms of operative, functional, and oncological outcomes. Patients who underwent retroperitoneal laparoscopic partial nephrectomy by a single surgeon between January 2013 and January 2021 were included in the study. A one-to-one propensity score matching (PSM) analysis was conducted to obtain two balanced groups. The patients were divided into two groups as posterior and antero-lateral according to the localization of the mass. A total of 239 patients were included in the PSM analysis, with 65 patients allocated to each group. The mean operative time was 79.2 ± 11.2 min in the posterior group, while it was 90.0 ± 11.6 min in the antero-lateral group (P < 0.001). Warm ischemia time was 15.9 ± 2.4 min in the posterior group and 18.6 ± 2.7 min in the antero-lateral group (P < 0.001). The median decrease in eGFR at 1 year was 4.8 (IQR, 2.9–6.9) mL/min in the posterior group and 5.0 (IQR, 2.8–11) mL/min in the antero-lateral group (P = 0.219). The warm ischemia time and clamping technique were found to be significant factors for predicting eGFR change after surgery (β:0.693, 95% CI: 0.39–0.99, P < 0.001; β:6.43, 95% CI: 1.1–11.7, P = 0.017, respectively). We report that retroperitoneal laparoscopic partial nephrectomy provided longer warm -ischemia and operative time for antero-lateral renal masses than posterior masses. However, long-term oncological and functional results were similar for both localizations

Effect of nonoperative concomitant intraarticular pathologies on the outcome of arthroscopic capsular release for adhesive capsulitis of the shoulder

Objective: The aim of this study was to investigate whether coexistent intraarticular lesions are negative prognostic factors for the results of arthroscopic capsular release in frozen shoulder patients. Methods: Seventy-two patients who met inclusion criteria and underwent arthroscopic capsular release between March 2011 and August 2015 for the frozen shoulder were retrospectively evaluated. The patients were divided into two groups according to existence of concomitant intraarticular pathologies detected during arthroscopy. Preoperative and postoperative functional results were assessed with Constant score and shoulder ranges of motion; and the amount of pain was evaluated using visual analog scale (VAS). Results: Group I consisted of 46 patients (mean age 47.2 years and mean follow-up 26 months) without concomitant shoulder pathologies and group II consisted of 26 patients (mean age 48.6 years and mean follow-up 15 months) with coexistent lesions (SLAP lesions, n ¼ 8; SLAP and partial rupture of the RC, n ¼ 4; SLAP, partial rupture of RC and impingement, n ¼ 10; SLAP and impingement, n ¼ 2; and AC arthritis and impingement, n ¼ 2). Preoperatively, the mean ranges of forward flexion (p ¼ 0.221), abduction (p ¼ 0.065), internal rotation (p ¼ 0.564), Constant (p ¼ 0.148) and VAS (p ¼ 0.365) scores were similar between the groups. After a minimum 12 months of follow-up, all patients significantly improved but no statistically significant difference was detected in the mean ranges of forward flexion (152 vs 150; p ¼ 0.902), abduction (137 vs 129; p ¼ 0.095), external rotation (45 vs 40; p ¼ 0.866), internal rotation (5 vs 5 point; p ¼ 0.474), Constant (82 vs 82.3; p ¼ 0.685) and VAS (1.2 vs 1.2; p ¼ 0.634) scores between the groups. Conclusion: The presence of concomitant shoulder pathologies does not appear to affect the clinical outcomes in patients undergoing arthroscopic capsular release for frozen shoulder

Biofabrication of in situ self assembled 3D cell cultures in a weightlessness environment generated using magnetic levitation

Magnetic levitation though negative magnetophoresis is a novel technology to simulate weightlessness and has recently found applications in material and biological sciences. Yet little is known about the ability of the magnetic levitation system to facilitate biofabrication of in situ three dimensional (3D) cellular structures. Here, we optimized a magnetic levitation though negative magnetophoresis protocol appropriate for long term levitated cell culture and developed an in situ 3D cellular assembly model with controlled cluster size and cellular pattern under simulated weightlessness. The developed strategy outlines a potential basis for the study of weightlessness on 3D living structures and with the opportunity for real-time imaging that is not possible with current ground-based simulated weightlessness techniques. The low-cost technique presented here may offer a wide range of biomedical applications in several research fields, including mechanobiology, drug discovery and developmental biology.Scientific and Technological Research Council of Turkey (215S862

Eating patterns of Turkish adolescents: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Adolescence is a crucial period for development of dietary behaviors that continue into adulthood and influence the risk of chronic diseases later in life. The aim of this study was to determine the eating patterns of adolescents' and their compliance with the Food Guide Pyramid.</p> <p>Methods</p> <p>625 students, aged between 11-15 years, from an elementary school in Istanbul, Turkey were enrolled in this cross-sectional survey. A questionnaire of eating patterns (QEP) was administered to all participants. QEP is consisted of questions assessing the knowledge and behaviors on healthy eating, factors affecting food choice, physical activity status and demographical variables. Height and weight of all participants were measured. Physical activity status was determined by questioning about participation in regular sport activities, how much time spent watching TV, playing computer games or doing homework.</p> <p>Results</p> <p>The mean age of the participants was 12.15 ± 1.15 and 50.5% were female. According to body mass index (BMI) percentiles, 8.3% (52) were obese and 10.2% were overweight. 51% had breakfast every day and only 1.9% met all the recommendations of the Food Guide Pyramid. Among the participants, 31% have fast food at least once every day and 60.8% skip meals. When participants were asked to rate the factors effecting their food choice according to a 10 point Likert scale, the highest mean scores (high impact on food choice) were for the factors; family, health, body perception, teachers and friends; 7.5 ± 3.1, 7.4 ± 3.1, 6.1 ± 3.2, 4.8 ± 3.3 and 4.2 ± 3.0 respectively. Total mean time spent on all passive activities (TV, computer, reading homework etc) per day was 9.8 ± 4.7 hours.</p> <p>Conclusions</p> <p>In this study we have demonstrated that, adolescents do not have healthy eating patterns. Educational interventions should be planned to decrease the health risks attributable to their eating behaviors.</p

Complications of Robotic Surgery in Urology: Our Experience of 342 Procedures Including the Learning Curve

Objective:The aim of this study is to analyze the complications of all robot-assisted surgeries performed in our clinic and to investigate the effect of the learning curve on complications occurred.Materials and Methods:Data on a total of 342 robotic surgeries performed in our clinic between March 2015 and February 2018 was retrospectively analyzed. Two surgeons, who performed the surgery, were experienced in urological laparoscopic procedures. Intraoperative and postoperative complications were evaluated. According to the experience of robotic surgery, the complications were divided into two groups as those occurred in the first 18 months (March 2015-August 2016) and in the second 18 months (September 2016-February 2018). The complications were classified according to the Clavien-Dindo classification.Results:A total of 32 complications occurred in 31 of 342 patients undergoing robot-assisted surgery. The overall complication rate was 9.4%. The number of minor complications was 20 (62.5%), and the number of major complications was 12 (37.5%). Among all, 6.2% were intraoperative complications, 62.5% were postoperative complications, and 31.3% were medical complications. It was observed that the number of complications was plateaued after August 2016 and there was a statistically significant difference between the first and the second 18 months (p<0.05).Conclusion:Laparoscopic surgery experience alone is not enough to reduce complications in robot-assisted surgery and learning continues with every case. An experienced surgeon and robotic surgery team are needed for complex robotic surgeries

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

Evaluation of predictive and prognostic factors affecting molecular subtypes and clinical outcomes in patients with locally advanced breast cancer receiving Neoadjuvant chemotherapy

Meme kanseri dünya genelinde kadınlarda en sık görülen kanser türüdür. Günümüzde çalışmalarda neoadjuvan tedavi almış meme kanserli hastalarda tedaviye yanıtın moleküler alt tiplere göre farklılık gösterdiği, bunun tedavi ve prognoz üzerine etkili olabileceği gösterilmiştir. Çalışmamızda neoadjuvan kemoterapi alan lokal ileri meme kanserli hastalarda moleküler alt tiplere göre yanıt oranları ile klinik sonuçlar üzerine etkili prediktif ve prognostik faktörlerin geriye yönelik gözden geçirilmesi, özellikle bu faktörlerin hastalıksız sağkalım (HSK) ve genel sağkalım (GSK) üzerine etkilerinin gösterilmesi amaçlandı. Çalışmaya İstanbul Medipol Üniversitesi Tıp Fakültesi, Tıbbi Onkoloji Kliniğinde takip ve tedavi edilen, lokal ileri meme kanseri tanısı konulup neoadjuvan kemoterapi almış ve sonrası cerrahi uygulanmış 139 kadın hasta dahil edildi. Hastaların klinikopatolojik özellikleri ve moleküler özellikleri hasta dosyalarından kaydedildi. Mevcut verilere göre hastaların HSK ve GSK'ları analiz edildi. Vakaların 13'ü (%9.4) luminal A, 47'si (%33.8) luminal B-HER2 negatif, 22'si (%15.8) luminal B-HER2 pozitif, 25'i (%18) HER2 eksprese eden, 32'si (%23) triple negatif alt tip olarak saptandı. Neoadjuvan kemoterapiye cerrahi sonrası histopatolojik değerlendirmede patolojik tam yanıt oranları luminal A alt tipte %38.5, luminal B HER(-) alt tipte %27.7, luminal B HER(+) alt tipte %68.1, HER2 eksprese eden alt tipte %56 oranında, triple negatif alt tipte ise %68.7 olarak saptandı. Diğer bir ifadeyle, HER2(+) alt tipler ve triple negatif alt tipte neoadjuvan kemoterapiye patolojik tam yanıt oranları luminal A ve HER(-) alt gruplara göre anlamlı olarak daha fazla bulundu (p=0.013). HSK için yapılan çok değişkenli analizde tümör lokalizasyonu (p=0.028, HR:9.84; %95 CI:1.27-21.3) ve patolojik tam yanıt varlığı (p=0.03, HR:0.54;%95 CI: 0.10-4.25) bağımsız prognostik faktörler olarak saptandı. Çok değişkenli analiz GSK için yapıldığında ise, yalnızca neoadjuvan kemoterapiye patolojik tam yanıtın bulunup bulunmaması bağımsız prognostik gösterge olarak bulundu (p=0.011, HR:0.34; %95 CI:0.09-2.13). Patolojik tam yanıtı predikte eden bağımsız faktörlerin saptanması için lojistik regresyon analizi yapıldığında; neoadjuvan kemoterapiye PET yanıtı değerlendirmesinde tam metabolik yanıt veya tam metabolik+anatomik yanıt bulunması patolojik yanıtı predikte eden bağımsız faktör olarak anlamlı bulundu (p<0.001, OR:4.55;%95 CI:2.34-8.82). Yine tümörün HER2 eksprese eden alt tipte olması (p=0.03, OR:1.24; %95 CI:0.10-2.57) veya triple negatif alt tipte olması (p=0.011, OR:3.25; %95 CI:0.08-4.98) patolojik tam yanıtı predikte eden istatistiki olarak anlamlı diğer faktörler olarak saptandı. Çalışmamızda moleküler alt tipin neoadjuvan tedaviye yanıt oranlarını doğrudan etkilediği ve prediktif bir faktör olduğu, ayrıca tedaviye patolojik tam yanıt elde edilmesinin prognostik bir gösterge olduğu gösterilmiştir.Breast cancer is the most common type of cancer in women worldwide. Nowadays, it has been shown that the response to treatment in breast cancer patients receiving neoadjuvant therapy varies according to molecular subtypes and this may have an effect on treatment and prognosis. In this study, we aimed to evaluate the predictive and prognostic factors that effect clinical outcomes and response rates according to molecular subtypes in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy, and show the effects of these factors on disease-free survival (DFS) and overall survival (OS). The study included 139 female locally advanced breast cancer patients who received neoadjuvant chemotherapy and underwent surgery. These patients were followed up and treated at Istanbul Medipol University Medical Faculty, Department of Medical Oncology. Clinicopathological features and molecular characteristics of the patients were recorded from the patient charts. According to the available data, DFS and OS of the patients were analyzed. Thirteen (9.4%) of the patients were luminal A, 47 (33.8%) were luminal B-HER2 negative, 22 (15.8%) were luminal B-HER2 positive, 25 (18%) were HER2 expressing and 32 (23%) were triple negative subtypes. Pathological complete response rates to neoadjuvant chemotherapy after surgery were 38.5% in luminal A subtype, 27.7% in luminal B HER (-) subtype, 68.1% in luminal B HER (+) subtype, 56% in HER2 expressing subtype and 68.7% in triple negative subtype. In other words, pathological complete response rates to neoadjuvant chemotherapy in HER2 (+) and triple negative subtypes were significantly higher than luminal A and HER (-) subtypes (p=0.013). Multivariate analysis for DFS indicated that tumor localization (p=0.028, HR:9.84;%95 CI:1.27-21.3) and pathological complete response (p=0.03, HR:0.54;%95 CI: 0.10-4.25) were found to be independent prognostic factors. When multivariate analysis was performed for OS, the presence or absence of pathological complete response to neoadjuvant chemotherapy was an independent prognostic indicator (p=0.011, HR:0.34;%95 CI:0.09-2.13). When logistic regression analysis was performed to determine independent factors predicting pathological complete response, complete metabolic response or complete metabolic + anatomical response in PET scan after neoadjuvant chemotherapy was found to be an independent factor predicting the pathological response. (p<0.001, OR:4.55;%95 CI:2.34-8.82). Moreover, HER2 (-) expressing (p=0.03, OR:1.24; %95 CI:0.10-2.57) or triple negative subtypes (p=0.011, OR:3.25; %95 CI:0.08-4.98) of the tumor were the other statistically significant factors predicting the pathological complete response. In our study, it was shown that molecular subtype directly affects the response rates to neoadjuvant therapy and is a predictive factor, and a complete pathological response to treatment is an important prognostic factor