Acta Medica Ruha
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Son Dönem Böbrek Yetmezliği Hastaların Hematolojik Parametre Düzeyleri ile Hemodiyaliz Arasındaki İlişkisi: Araştırma Makalesi
No full textIntroduction: To be able to detect proinflammatory response with cytokines such as CRP, IL-1,IL-6 in chronic renal disease patients; it is showed in some recent studies that neutrophil lmyphocyte ratio could be just as useful as other inflammatory markers.
Aim: This study purposes to show possible changes and likelyhood of inflammatory response in patients with end stage renal disesase who either follows renal replacement therapy or conservative therapy without hemodialysis within using neutrophil lmyphocyte ratio as a denovo marker.
Metods: In our study group some of these patients rejected to enter hemodialysis programme. We examined retrospectively the patients who applied during 2013-2018 to nephrology policlinics of an university hospital. It is included a to a total number of 115 patients: 59 patient who rejected RRT, so only get followed with conservative approach; 56 patient who enters hemodialysis programme. The data obtained retrospectively through patient files and and includes: levels of urea, uric acid, creatinine, GFR, MCV, parathormone, protein/creatinin ratio in spot urine test.
Results: Our Study showed no significant difference within these biochemical parameters in these two group. Although when the complete blood counts of these patients are taken into consideration, the MCVwere significantly higher in the group who followed with conservative treatment (p=0.002). When we tried to examine other possible parameters which can interfere with NLR ratio, there were no significant statistical correlation within.
Conclusion: As a final statement, it should be considered that MCV could be used to evaluate the progression of renal disease, taken account of there was significant difference between our two study groups.Giriş: Son Dönem Böbrek Yetmezliği olgularında böbrekte oluşan inflamatuar yanıtın belirlenmesi amacıyla son yıllarda kullanılan CRP, IL-1, IL-6 ve TNF-alfa gibi belirteçlerin yanısıra hemogramdan elde edilerek kullanılan platelet nötrofil oranı ve lenfosit nötrofil oranı gibi inflamasyonda yol gösterici olabilecek belirteçler üzerine çalışmalar yapılmaya başlanmıştır.
Amaç: Çalışmamızda RRT alan ve almayan iki grup arasında nötrofil lenfosit oranı kullanılarak inflamatuar yanıtın karşılaştırılması amaçlandı.
Yöntem: Çalışmamızda Balıkesir Üniversitesi Tıp Fakültesi, nefroloji polikliniğine başvuran hastaların 2013-2018 yılları arasındaki verileri retrospektif olarak irdelendi. RRT alan 59 olgu ile RRT almayan 56 olgu; toplamda 115 olgu çalışmaya dahil edilmiştir. Hastaların üre, ürik asit, kreatinin, glomerüler filtrasyon hızı, ortalama platelet hacmi, parathormon, spot idrarda protein/kreatinin oranı, hemogram değerleri dosyalarından retrospektif olarak elde edildi.
Bulgular: Çalışmamızda SDBY olgularında RRT alan ve almayan grupta parametrelere göre farklar incelendiğinde; biyokimyasal tetkikler açısından her iki grupta anlamlı farklılığa rastlanmadı. Hemogram parametreleri değerlendirildiğinde ise RRT alan ve almayan hastalar arasında MCV değerleri RRT almayanlarda 92,35 bulunmuş olup RRT alanlarda 88,8 saptandı anlamlı olarak daha yüksek bulundu (p:0,002). Nötrofil/lenfosit oranını etkileyebilecek diğer sayısal parametreler incelendiğinde, biyokimyasal parametreler ile nötrofil/lenfosit oranı arasında, istatiksel olarak korelasyon izlenmedi.
Sonuç: Son dönem böbrek yetmezliği olgularında MCV değerlerinin RRT alan ve almayan grupta istatiksel olarak anlamlı olarak farklı saptanması olgular için faydalı bir progresyon belirteci olabilir
İskemi-Modifiye Albümin Akut Koroner Sendromda Tanısal Belirteç Olarak Kullanılabilir mi? Araştırma Makalesi
No full textIntroduction: Acute coronary syndromes (ACS) are the main cause of mortality and morbidity worldwide. Appropriate management of patients presenting to emergency departments (ED) with suspected ACS depends on early detection of signs of cardiac ischemia.
Aim: In this study, we aimed to investigate the diagnostic value of ischemia modified albümin (IMA) in ACS.
Metho: The study included 169 patients admitted to the ED between October 2012 and April 2013 with chest pain. Albumin, troponin-T and IMA were measured in the patients. 21 patients were included in the Non–St-Segment Elevation Myocardial İnfarctions (NSTEMI) group and 49 patients were included in the unstable angina pectoris (UAP) group. The control group included 99 patients. At the end of the study, the parameters of the three groups were compared.
Results: The IMA level of NSTEMIgroup was higher than the control group (0.33±0.03, 0.24±0.04, p<0.001). Similarly, the IMA level of UAP group was higher than the control (0.29±0.011, 0.24±0.04 p<0.001). IMA and IMA/Albumin levels of the ACS group were also higher than the control group (0.30±0.029, 0.241±0.041 p<0.001).
Conclusion: IMA levels were higher in both NSTEMI group and UAP group compared to the control group in the early periods when other myocardial damage markers were negative in patients admitted to the ED with chest pain. This suggests that IMA level may play a more important role than troponin in risk assessment and determination of treatment strategy in patients admitted to the ED with suspected ACS in the early hours. Giriş: Akut koroner sendromlar (AKS) Dünya’da mortalite ve morbiditenin ana sebebidir. AKS tedavisi kardiyak iskemi bulgularının erken dönemde belirlenmesine bağlıdır. Klasik kardiyak belirteçlerin erken tanı için klinik kullanımda bazı kısıtlılıkları vardır. Bu nedenle yeni kardiyak belirteçlere ihtiyaç vardır.
Amaç: Bu çalışmamızda İskemi modifiye albümin (IMA)’nin Akut Koroner Sendromdaki tanısal değerini araştırmayı amaçladık.
Yöntem: Çalışmaya Ekim 2012 ile Nisan 2013 tarihleri arasında göğüs ağrısı ile acil servise başvuran 169 hasta dahil edildi. Hastaların kan örneklerinden albümin, troponin-T, IMA ölçümleri yapıldı. Hastalar EKG bulguları, klinik muayene ve troponin değerlerine göre üç gruba ayrıldı. Hastaların 21 tanesi ST yükselmesiz miyokart enfarktüsü (STYzME) grubuna, 49 tanesi kararsız angina pektoris (KzAP) grubuna dahil edildi. Kontrol grubunda ise 99 hasta yer aldı. Çalışma sonucunda üç grubun parametreleri karşılaştırıldı
Bulgular: Acil servise ilk başvurduğu anda STYzME grubunun IMA düzeyi, kontrollere göre yüksekti (Sırasıyla 0,33±,0,03, 0,24±0,04, p<0,001). Benzer şekilde KzAP grubunun IMA seviyesi de kontrollere göre daha yüksek saptandı (Sırasıyla 0,29±0,011, 0,24±0,04, p<0,001). AKS grubunun IMA ve IMA/Albümin düzeyleri de kontrol grubuna göre yüksek saptandı (Sırasıyla 0,30 ± 0,029, 0,241±0,041 p<0,001).
Sonuç: Göğüs ağrısı ile acil servise başvuranlarda diğer miyokart hasar belirteçlerinin negatif olduğu erken dönemlerde IMA seviyesi hem STYzME grubunda hem de KzAP grubunda kontrol grubuna göre yüksek bulundu. Bu durum AKS şüphesi ile acil servise erken saatlerde başvuran hastalarda IMA düzeyinin risk değerlendirilmesinde ve tedavi stratejisinin belirlenmesinde troponine göre daha önemli rol oynayabileceğine işaret etmektedir. Bunun doğrulanması için daha büyük örneklemli çalışmalara ihtiyaç vardır
6 Aylık Bebeklere Hemşire Tarafından Yapılan Ev Ziyaretlerinin Bebeklerin Hemoglobin Değerine Etkisi- Bir Nonrandomize Kontrollü Çalışma: Araştırma Makalesi
No full textBackground: Iron-deficiency anemia has a high prevalence among infants across the world including our country and contributes substantially to the global burden of disease. Therefore, it is a priority to develop preventive strategies to protect and promote infant health. This study sought to investigate the effect of home visits for 3 months by nurses on the hemoglobin levels of 6-month-old infants measured at 9 months.
Methods: This study adopted a quasi-experimental design in accordance with the TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) checklist. The study sample consisted of 100 6-month-old infants, 50 in the intervention group and 50 in the control group. Infants in the intervention group received home visits three times in total, once every month. Control group infants received routine care. Data were collected using the questionnaire form and home monitoring and care form for 6–9-month-old infants. Data were analyzed using descriptive statistics, independent samples t-test, chi-square test, and Fisher’s exact test.
Results: Mean hemoglobin levels were higher in infants in the intervention group compared with that of the control group (p < 0.05). Hemoglobin levels were <11 g/dL in 48.0% of the infants in the intervention group and 68.0% of the infants in the control group (p < 0.05).
Conclusions: This study showed that iron-deficiency anemia remains a serious public health concern in the infants included in the study and home visits by nurses are effective in protection against and prevention of iron-deficiency anemia. Further research is warranted to gather a more robust evidence base.Giriş: Dünyada ve ülkemizde süt çocuklarında demir eksikliği anemisi yüksek prevalansa sahiptir ve küresel hastalık yüküne önemli bir katkı verir. Bu nedenle bebeklerin sağlığını korumak ve geliştirmek için koruyucu stratejilerin geliştirilmesi önceliklidir. Bu araştırmanın amacı, 6 aylık bebeklere 3 ay boyunca hemşire tarafından yapılan ev ziyaretlerinin bebeklerin 9. ayda ölçülen hemoglobin değerine etkisini belirlemektir.
Metod: Bu çalışmada, Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) kontrol listesine uygun olarak yarı deneysel bir tasarım benimsenmiştir. Çalışmanın örneklemini, 50 deney, 50 kontrol grubu olmak üzere toplam 100 6 aylık bebek oluşturmuştur. Deney grubunda olan bebeklere ayda bir 3 defa ev ziyareti yapılmıştır. Kontrol grubu bebeklerine ise rutin izlemler yapılmıştır. Veriler tanımlayıcı istatistik, independent samples t-testi, ki-kare testi ve fisher’s exact testi kullanılarak analiz edilmiştir. Tüm analizler için 0,05’in altındaki p değeri anlamlı kabul edilmiştir.
Bulgular: Araştırma bulgularında; deney grubundaki bebeklerin hemoglobin ortalaması kontrol grubuna göre daha yüksek bulunurken (p<0.05), deney grubundaki bebeklerin %48.0’nın, kontrol grubu bebeklerin %68,0’ının ise hemoglobin değerinin 11 gr/dl’nin altında olduğu görülmüştür (p<0.05).
Sonuçlar: Bu çalışma kapsamına alınana bebeklerde demir eksikliği anemisinin ciddi bir halk sağlığı sorunu olmaya devam ettiğini, bebekleri demir eksikliği anemisinden koruma ve önlemede hemşire tarafından yapılan ev ziyaretinin etkili olduğunu göstermiştir. Daha sağlam bir kanıt temeli sağlamak için daha fazla araştırmaya ihtiyaç vardır
Kardiyovasküler Hastalıklarda ve Diyabette Fenofibratların ve Statinlerin Önemi: Derleme Makale
No full textThe prevalence and development of CVD is negatively influenced by behavioral, environmental and metabolic risk factors. The top three cardiovascular risk factors are high levels of low-density lipoprotein cholesterol (LDL-C) with 11%, dietary risks with 17% and high systolic blood pressure with 25% (1). Individuals with diabetes are in the higher risk group in terms of CVD. Therefore, it is desired to reduce LDL cholesterol. Statin support is initiated to reduce LDL cholesterol. This is because statin support has been shown to reduce lipid density, matrix metalloproteinase expression transferred to the environment through macrophages and inflammatory cell density in atherosclerotic plaques, prevent LDL oxidation and increase collagen fiber density. However, despite statin support, CVD risk persists in patients with diabetes. In addition, another objective for reducing this risk and preventing/improving CVD together with LDL cholesterol is triglycerides (TG). Because it has been explained that there is a causal link between high TG levels and CVD. Fenofibrate is a peroxisome proliferator-activated receptor alpha (PPARa) activator and has lipid, especially TG-lowering activity. However, the function of fibrates is controversial and still not clearly explained. Fibrates are recommended for patients with dyslipidemia who have high triglycerides despite statin administration. Fenofibrate has therefore primarily been considered as an alternative to statins for lowering TG levels in patients with diabetes.KVH prevalansı ve gelişimi davranışsal, çevresel ve metabolik risk faktörleri tarafından olumsuz yönde etkilenmektedir. Kardiyovasküler risk unsurlarının ilk üçünü %11 ile yüksek seyreden düşük yoğunluklu lipoprotein kolesterol (LDL-C) seviyeleri, %17 ile diyet riskleri ve %25 ile yüksek sistolik kan basıncı oluşturmaktadır (1). Diyabeti bulunan bireyler, KVH yönünden daha fazla riskli grupta yer almaktadır. Bu yüzden LDL kolesterolü azaltılmak istenir. LDL kolesterolün düşürülmesi için ise statin desteği başlanır. Çünkü statin desteği ile lipid yoğunluğunun, makrofajlar aracılığıyla ortama aktarılan matriks metalloproteinaz ekspresyonunun ve aterosklerotik plaklarda yer alan inflamatuvar hücre yoğunluğunun düşürülmesi, LDL oksidasyonunu önlediği ve kolajen lif yoğunluğunu fazlalaştırdığı ortaya konulmuştur. Ancak statin desteğine rağmen diyabetli hastalarda KVH riski devam etmektedir. Ayrıca bu riskin azaltılması ve LDL kolesterol ile birlikte KVH' nin engellenmesi/iyileştirilmesi için diğer bir amaç trigliseritlerdir (TG). Çünkü TG seviyesinin yüksekliği ile KVH arasında nedensel bir bağlantının olduğu açıklanmıştır. Fenofibrat, peroksizom proliferatörü ile aktive edilen bir reseptör alfa (PPARa) aktivatörü olmasının yanı sıra lipid, özelliklede TG düşürücü etkinliği bulunmaktadır. Ancak fibratların işlevi tartışmalı olup halen daha net bir şekilde açıklanamamıştır. Statin uygulanmasına karşın yüksek trigliseriti bulunan dislipidemili hastalara fibratlar tavsiye etmektedir. Bu yüzden, her şeyden önce diyabetli hastalarda TG seviyelerinin azaltılması amacıyla fenofibratın, statinlere bir alternatif olabileceği düşünülmüştür
Kişilik Özellikleri İle Gebelik Uyumu Arasındaki İlişki: Primigravida Gebe Kadınlar Örneği: Araştırma Makalesi
No full textIntroduction: Adaptation to pregnancy is essential for expectant mothers who will have their first experience. It includes personality traits and thus contributes to shaping the role of motherhood.
Objective: This study investigated the relationship between personality traits and pregnancy adjustment in primigravida pregnant women.
Method: This cross-sectional study was conducted with 280 women in a province in the south-eastern Anatolia region of Turkey between January and June 2024. Participants were selected randomly. The data were collected using the “Introductory Information Form,” “Ten-Item Personality Inventory (TIPI),” and “Prenatal Self Evaluation Questionnaire (PSEQ).” The data were analyzed using number, percentage, mean, correlation, and regression analysis in the SPSS program.
Results: The mean scores of the participants' TIPI sub-dimensions of openness to experience, conscientiousness, extraversion, agreeableness, and emotional stability were 9.62±2.32, 10.89±2.05, 9.52±2.44, 11.43±2.88, 10.51±2.15, respectively. The mean total score of the PSEQ was 178.50±26.54, and pregnancy adjustment was moderate. There was a moderate negative relationship between pregnancy adjustment and openness to experience (r=-0.615, p=0.003), conscientiousness (r=-0.625, p=0.015), agreeableness (r=-0.605, p≤0.001), and emotional stability (r=-0.630, p≤0.001) personality traits. According to the results of the multiple linear regression model, openness to experience (β=-2.718, p=0.001) and conscientiousness (β=-3.35, p=0.004) variables are important determinants of pregnancy adjustment, and these variables explain 27.6% of the total variance in pregnancy adjustment.
Conclusion: Women who are not open to experience and have low responsibility personality traits are at-risk groups in terms of pregnancy adjustment in their first pregnancy.Giriş: İlk deneyimini yaşayacak olan anne adaylarında gebeliğe uyum, kişilik özelliklerini içeren ve dolayısıyla annelik rolünün şekillenmesine katkı sağlayan önemli bir süreçtir.
Amaç: Bu araştırmanın amacı primigravida gebelerin kişilik özellikleri ile gebelik uyumu arasındaki ilişkinin incelenmesidir.
Yöntem: Bu kesitsel çalışma, Ocak-Haziran 2024 tarihleri arasında Türkiye'nin Güneydoğu Anadolu Bölgesi'ndeki bir ilde 280 kadın ile gerçekleştirilmiştir. Katılımcılar rastgele seçilmiştir. Veriler “Tanıtıcı Bilgi Formu”, “On Maddelik Kişilik Ölçeği (OMKÖ)” ve “Doğum Öncesi Öz Değerlendirme Ölçeği (DÖÖDÖ)” kullanılarak toplanmıştır. Veriler SPSS programında sayı, yüzde, ortalama, korelasyon ve regresyon analizleri kullanılarak analiz edilmiştir.
Bulgular: Katılımcıların OMKÖ alt boyutları olan deneyime açıklık, sorumluluk, dışadönüklük, yumuşak başlılık ve duygusal dengelilik puan ortalamaları sırasıyla 9,62±2,32, 10,89±2,05, 9,52±2,44, 11,43±2,88, 10,51±2,15'tir. Prenatal Öz Değerlendirme Ölçeği toplam puan ortalaması 178,50±26,54 olup gebelik uyumu orta düzeydedir. Gebelik uyumu ile deneyime açıklık (r=-.615, p=.003), sorumluluk (r=-0.625, p=0.015), yumuşak başlılık (r=-0.605, p≤0.001) ve duygusal dengelilik (r=-0.630, p≤0.001) kişilik özellikleri arasında negatif yönde orta düzeyde ilişki tespit edildi. Çoklu doğrusal regresyon modeli sonuçlarına göre; deneyime açıklık (β=-2.718, p=0.001) ve sorumluluk (β=-3.35, p=0.004) değişkenlerinin gebeliğe uyumun önemli belirleyicileri olup bu değişkenleri gebelik uyumu üzerindeki toplam varyansın %27.6’sını açıklamaktadır.
Sonuç: Deneyime açık olmayan ve düşük sorumluluk kişilik özelliklerine sahip kadınlar ilk gebeliklerinde gebelik uyumu açısından riskli gruplardır
Mesane Kanserinde Tümör Tomurcuklanmasının Prognostik Önemi: Moleküler Perspektifte Bir Çağrı: Editöre Mektup
No full textDear Editor,
We wish to share our insights on the critical prognostic significance of tumor budding (TB) in bladder cancer (BC) and underscore the urgent necessity for further molecular-level investigations in this domain, prompted by recent studies. Tumor buds, also referred to as “sprouts,” are defined as isolated single tumor cells and/or small clusters comprising fewer than five tumor cells, which originate from the invasive tumor margin and infiltrate the stroma. These entities were first characterized by Imai in the 1950s (1). The TB scoring system, established by the “International Tumour Budding Consensus Conference” (ITBCC) in 2016, has been validated as an independent predictor of lymph node metastasis in pT1 colorectal cancer cases and poor survival outcomes in stage 2 colon cancer cases, and it is now routinely reported by pathologists (2). Tumor buds are intimately associated with epithelial-mesenchymal transition (EMT) and engage in interactions with the tumor microenvironment (TME), tumor stroma, and immune system cells (3). This dynamic interaction at the molecular level in budding tumor cells establishes a distinctive signature characterized by: upregulation of MMP-7 and MMP-9 expressions, which play a role in extracellular matrix degradation; anoikis resistance through the enhanced expression of TrkB; frequent upregulation of stem cell markers such as LGR5, ALDH1, and CD44; immune evasion facilitated by the loss of MHC class I expression; increased TGFβ expression and regulation of TGFβ signaling; regulation of WNT signaling; a decrease in miRNA-200 expression, accompanied by the epigenetic upregulation of EMT-associated transcription factors, including ZEB, TWIST, and SNAIL; reduced expression of E-cadherin, particularly at the cell membrane, and β-catenin; an increase in mesenchymal markers like Vimentin, alongside a reduction in Cytokeratin expression; low levels of Ki-67 and Caspase-3 expression; and a relatively spindle-shaped morphology with podia formation (3). While it is generally accepted in solid tumors that “an increase in tumor buds correlates with a poorer clinical outcome” (3), the body of research examining TB as a prognostic marker in non-gastrointestinal tumors—particularly in BC—remains limited. As of August 8, 2024, a PubMed search using the MeSH terms “tumor budding AND bladder cancer*” yielded 34 studies, of which only 10 were found to be directly relevant to this subject.
Fukumoto and colleagues investigated the prognostic effects of TB in 121 cases of pT1 non-muscle-invasive bladder cancer (NMIBC) and demonstrated that TB positivity was statistically significantly associated with pT1 sub-staging (microinvasion/extensive lamina propria invasion) (p=0.002), tumor architecture (papillary/nodular) (p=0.023), and lymphovascular invasion (LVI) positivity (p=0.001) (4). Additionally, it was reported that the 5-year progression-free survival rate was statistically significantly higher (p=0.001) in TB-negative pT1 BC cases (88.4%), and that TB was an independent risk predictor for progression to muscle-invasive bladder cancer (MIBC) in both the entire pT1 BC cohort and the subgroup receiving intravesical BCG instillation according to Cox regression analysis (4). Building on these findings, the researchers also observed that in 86% of TB-positive cases, E-cadherin immunoexpression in the tumor center was higher than in the TB areas, highlighting the relationship between TB and EMT in pT1 BC cases (4). While Fukumoto et al. focused on the clinical implications of TB, Miyake and colleagues delved into the underlying molecular mechanisms. In their comprehensive study, they used MGH-U3, UM-UC-14, and UM-UC-3 cells in an orthotopic bladder tumor model in SCID mice and suggested that COL4A1 and COL13A1 might play a primary role in the formation of the infiltrative pattern of TB (5). However, as accurate TB analysis can be complicated by peritumoral inflammatory infiltrate or reactive stromal cells, Brieu and colleagues adopted a different approach by targeting cytokeratin, which had previously been shown to effectively distinguish TBs. They enhanced their analysis by applying machine learning and automated image analysis to IF-stained samples, thereby achieving more accurate quantification in a sample of 100 MIBC cases (6). In addition to these efforts to improve prognostic assessments, Liu and colleagues conducted a bioinformatics-based study in which they evaluated the tumor stroma ratio (TSR) and TB together in MIBC cases. By developing a TSR-TB scoring system, they reported that increased TSR-TB might be an independent poor prognostic factor for overall survival (7). In contrast, in the study conducted by Kucuk and colleagues on a sample of 60 MIBC cases, no statistically significant relationship was found between TB and tumor necrosis (p=1.000), LVI (p=0.114), or perineural invasion (p=0.712) (8). However, a different perspective is offered by Seker and colleagues, who, in their study involving a sample of 108 MIBC cases, found that TB was statistically significantly associated with overall survival (p=0.004) (9). The researchers reported that TB could be a useful parameter for predicting prognosis in MIBC cases (9). Further emphasizing the prognostic importance of TB, Soriano and colleagues quantified TB in a sample of 108 MIBC cases that had undergone pancytokeratin staining and reported that TB is an independent risk predictor for mortality (10). The researchers further noted that MIBC cases with 14 or more TBs were associated with an increased risk of mortality as well as a higher tumor stage, suggesting that each additional TB increases the cancer-specific mortality risk by approximately 2% in these cases (10). Expanding on these findings, Busquets and colleagues, in their study involving 168 high-grade stage pT1 NMIBC cases, reported that TB (when present with a count of 6 or more) (p=0.032, HR: 2.1), along with the presence of carcinoma in situ (CIS), endoscopic tumor pattern (papillary/solid), and the absence of BCG induction, was significant in predicting disease progression according to multivariate variance analysis (11). The researchers also emphasized that the inclusion of TB in the TNM staging system should be carefully considered and that it could assist in the decision-making process for early radical cystectomy in high-grade stage pT1 NMIBC cases (11). Eckstein and colleagues built on this by studying 92 pT1 NMIBC cases with pancytokeratin staining. They reported that, according to Kaplan–Meier analysis, TB was statistically significantly associated with worsened recurrence-free survival (p=0.005), progression-free survival (p=0.017), and cancer-specific survival (p=0.002) (12). The researchers also found that the presence of TB was associated with multifocal tumors (p=0.003) and extensive lamina propria invasion when pT1 sub-staging was performed (p<0.001) (12). Interestingly, among the cases that received BCG instillation, those without TB not only had better recurrence-free survival (p=0.012), progression-free survival (p=0.011), and cancer-specific survival (p=0.022), but also no progression or disease-related deaths were observed in this group (12). Finally, Yang and colleagues contributed further by conducting a retrospective study involving 80 BC cases (36 NMIBC and 44 MIBC) (13). They investigated the prognostic effects of EPDR1 immunoexpression and TB quantification (13). The researchers quantified TB in 44 MIBC samples, considering those with six or more TBs as positive. The study found that EPDR1 immunoexpression varied statistically significantly (p<0.05) with tumor stage, and MIBC cases with high EPDR1 immunoexpression were statistically significantly more likely to have increased TB (p<0.05) (13). Furthermore, an increased TB count was associated with a tendency toward a worse clinical status in MIBC cases (p<0.001) (13).
The scoring of TB varies depending on the type of solid tumor. As a result, following the development of a standardized scoring system that can be adapted to BC, the inclusion of TB as a prognostic marker in routine histopathological evaluation could provide clinicians with significant advantages in risk stratification and treatment planning, particularly in managing patients with high-grade stage pT1 NMIBC who require accurate progression prediction. Although TB scoring is more easily and reliably performed on slides stained with pancytokeratin IHC, the fact that it can also be commonly done on routine H&E stained slides makes this cost-effective marker an attractive option for clinical use in BC as well. Since tumor budding is biologically closely related to EMT and the TME, detailed investigation of the underlying molecular mechanisms holds promise for the development of actionable targets. In this context, we believe that further multicenter prospective studies and more detailed molecular analyses are necessary to validate the clinical utility of TB and evaluate its integration into existing prognostic models. These investigations could not only validate the clinical utility of TB but also pave the way for more personalized treatment strategies in BC.
Sincerely.Dear Editor,
We wish to share our insights on the critical prognostic significance of tumor budding (TB) in bladder cancer (BC) and underscore the urgent necessity for further molecular-level investigations in this domain, prompted by recent studies. Tumor buds, also referred to as “sprouts,” are defined as isolated single tumor cells and/or small clusters comprising fewer than five tumor cells, which originate from the invasive tumor margin and infiltrate the stroma. These entities were first characterized by Imai in the 1950s (1). The TB scoring system, established by the “International Tumour Budding Consensus Conference” (ITBCC) in 2016, has been validated as an independent predictor of lymph node metastasis in pT1 colorectal cancer cases and poor survival outcomes in stage 2 colon cancer cases, and it is now routinely reported by pathologists (2). Tumor buds are intimately associated with epithelial-mesenchymal transition (EMT) and engage in interactions with the tumor microenvironment (TME), tumor stroma, and immune system cells (3). This dynamic interaction at the molecular level in budding tumor cells establishes a distinctive signature characterized by: upregulation of MMP-7 and MMP-9 expressions, which play a role in extracellular matrix degradation; anoikis resistance through the enhanced expression of TrkB; frequent upregulation of stem cell markers such as LGR5, ALDH1, and CD44; immune evasion facilitated by the loss of MHC class I expression; increased TGFβ expression and regulation of TGFβ signaling; regulation of WNT signaling; a decrease in miRNA-200 expression, accompanied by the epigenetic upregulation of EMT-associated transcription factors, including ZEB, TWIST, and SNAIL; reduced expression of E-cadherin, particularly at the cell membrane, and β-catenin; an increase in mesenchymal markers like Vimentin, alongside a reduction in Cytokeratin expression; low levels of Ki-67 and Caspase-3 expression; and a relatively spindle-shaped morphology with podia formation (3). While it is generally accepted in solid tumors that “an increase in tumor buds correlates with a poorer clinical outcome” (3), the body of research examining TB as a prognostic marker in non-gastrointestinal tumors—particularly in BC—remains limited. As of August 8, 2024, a PubMed search using the MeSH terms “tumor budding AND bladder cancer*” yielded 34 studies, of which only 10 were found to be directly relevant to this subject.
Fukumoto and colleagues investigated the prognostic effects of TB in 121 cases of pT1 non-muscle-invasive bladder cancer (NMIBC) and demonstrated that TB positivity was statistically significantly associated with pT1 sub-staging (microinvasion/extensive lamina propria invasion) (p=0.002), tumor architecture (papillary/nodular) (p=0.023), and lymphovascular invasion (LVI) positivity (p=0.001) (4). Additionally, it was reported that the 5-year progression-free survival rate was statistically significantly higher (p=0.001) in TB-negative pT1 BC cases (88.4%), and that TB was an independent risk predictor for progression to muscle-invasive bladder cancer (MIBC) in both the entire pT1 BC cohort and the subgroup receiving intravesical BCG instillation according to Cox regression analysis (4). Building on these findings, the researchers also observed that in 86% of TB-positive cases, E-cadherin immunoexpression in the tumor center was higher than in the TB areas, highlighting the relationship between TB and EMT in pT1 BC cases (4). While Fukumoto et al. focused on the clinical implications of TB, Miyake and colleagues delved into the underlying molecular mechanisms. In their comprehensive study, they used MGH-U3, UM-UC-14, and UM-UC-3 cells in an orthotopic bladder tumor model in SCID mice and suggested that COL4A1 and COL13A1 might play a primary role in the formation of the infiltrative pattern of TB (5). However, as accurate TB analysis can be complicated by peritumoral inflammatory infiltrate or reactive stromal cells, Brieu and colleagues adopted a different approach by targeting cytokeratin, which had previously been shown to effectively distinguish TBs. They enhanced their analysis by applying machine learning and automated image analysis to IF-stained samples, thereby achieving more accurate quantification in a sample of 100 MIBC cases (6). In addition to these efforts to improve prognostic assessments, Liu and colleagues conducted a bioinformatics-based study in which they evaluated the tumor stroma ratio (TSR) and TB together in MIBC cases. By developing a TSR-TB scoring system, they reported that increased TSR-TB might be an independent poor prognostic factor for overall survival (7). In contrast, in the study conducted by Kucuk and colleagues on a sample of 60 MIBC cases, no statistically significant relationship was found between TB and tumor necrosis (p=1.000), LVI (p=0.114), or perineural invasion (p=0.712) (8). However, a different perspective is offered by Seker and colleagues, who, in their study involving a sample of 108 MIBC cases, found that TB was statistically significantly associated with overall survival (p=0.004) (9). The researchers reported that TB could be a useful parameter for predicting prognosis in MIBC cases (9). Further emphasizing the prognostic importance of TB, Soriano and colleagues quantified TB in a sample of 108 MIBC cases that had undergone pancytokeratin staining and reported that TB is an independent risk predictor for mortality (10). The researchers further noted that MIBC cases with 14 or more TBs were associated with an increased risk of mortality as well as a higher tumor stage, suggesting that each additional TB increases the cancer-specific mortality risk by approximately 2% in these cases (10). Expanding on these findings, Busquets and colleagues, in their study involving 168 high-grade stage pT1 NMIBC cases, reported that TB (when present with a count of 6 or more) (p=0.032, HR: 2.1), along with the presence of carcinoma in situ (CIS), endoscopic tumor pattern (papillary/solid), and the absence of BCG induction, was significant in predicting disease progression according to multivariate variance analysis (11). The researchers also emphasized that the inclusion of TB in the TNM staging system should be carefully considered and that it could assist in the decision-making process for early radical cystectomy in high-grade stage pT1 NMIBC cases (11). Eckstein and colleagues built on this by studying 92 pT1 NMIBC cases with pancytokeratin staining. They reported that, according to Kaplan–Meier analysis, TB was statistically significantly associated with worsened recurrence-free survival (p=0.005), progression-free survival (p=0.017), and cancer-specific survival (p=0.002) (12). The researchers also found that the presence of TB was associated with multifocal tumors (p=0.003) and extensive lamina propria invasion when pT1 sub-staging was performed (p<0.001) (12). Interestingly, among the cases that received BCG instillation, those without TB not only had better recurrence-free survival (p=0.012), progression-free survival (p=0.011), and cancer-specific survival (p=0.022), but also no progression or disease-related deaths were observed in this group (12). Finally, Yang and colleagues contributed further by conducting a retrospective study involving 80 BC cases (36 NMIBC and 44 MIBC) (13). They investigated the prognostic effects of EPDR1 immunoexpression and TB quantification (13). The researchers quantified TB in 44 MIBC samples, considering those with six or more TBs as positive. The study found that EPDR1 immunoexpression varied statistically significantly (p<0.05) with tumor stage, and MIBC cases with high EPDR1 immunoexpression were statistically significantly more likely to have increased TB (p<0.05) (13). Furthermore, an increased TB count was associated with a tendency toward a worse clinical status in MIBC cases (p<0.001) (13).
The scoring of TB varies depending on the type of solid tumor. As a result, following the development of a standardized scoring system that can be adapted to BC, the inclusion of TB as a prognostic marker in routine histopathological evaluation could provide clinicians with significant advantages in risk stratification and treatment planning, particularly in managing patients with high-grade stage pT1 NMIBC who require accurate progression prediction. Although TB scoring is more easily and reliably performed on slides stained with pancytokeratin IHC, the fact that it can also be commonly done on routine H&E stained slides makes this cost-effective marker an attractive option for clinical use in BC as well. Since tumor budding is biologically closely related to EMT and the TME, detailed investigation of the underlying molecular mechanisms holds promise for the development of actionable targets. In this context, we believe that further multicenter prospective studies and more detailed molecular analyses are necessary to validate the clinical utility of TB and evaluate its integration into existing prognostic models. These investigations could not only validate the clinical utility of TB but also pave the way for more personalized treatment strategies in BC.
Sincerely
Detrüsör Aşırı Aktivitesi Olan Hastalarda Sodyum Nitroprussid’in Etkisi: Araştırma Makalesi
No full textIntroduction: Detrusor instability is a common cause of urgency and urge incontinence in neurologically normal patients. Nitric oxide, relaxes the smooth muscles of the detrusor, prostate, and urethra.
Aim: We aimed to explain the therapeutic effects of sodium nitroprusside on detrusor overactivity in patients with detrusor overactivity.
Methods: A total of 21 patients with detrussor overactivity have been enrolled in this research. The patients were divided into 3 groups according to their sodium nitroprusside dosage, as low-dose, medium-dose, and high-dose. Hydrostatic pressure in the bladder was measured and at the same time, intra-abdominal pressure was measured with a catheter inserted into the rectum. Cystometry results have been evaluated in terms of sensation (first sensation, first desire, strong desire), detrusor compliance, maximal detrusor pressure, maximal cystometric bladder capacity and instability index parameters.
Results: No statistical significance has been achieved between nitroprusside groups in terms of first sensation, first desire, and strong desire values (p>0.05). When the patients' maximal detrusor pressure, maximal cystometric bladder capacity and compliance values were interpreted, no significant difference was found between the isotonic and SNP groups and their doses. There was no significant difference between the groups in the duration of contractions. Additionally, no difference has been observed between the groups in the blood pressure values of the patients at the end of the study compared to the baseline.
Conclusion: This study indicated that SNP did not exhibit any positive or negative effects in individuals with detrussor overactivity. The reason for this could be stated as: first, the urothelium acts as a barrier to the passage of sodium nitroprusside and prevents it from reaching the detrusor and the latter may be due to the lack of effect of sodium nitroprusside on detrusor function.Giriş: Detrüsör instabilitesi nörolojik açıdan normal hastalarda sıkışma ve sıkışma inkontinansının yaygın bir nedenidir. Nitrik oksit, detrüsör, prostat ve üretranın düz kaslarını gevşetmektedir.
Amaç: Detrüsör aşırı aktivitesi olan hastalarda sodyum nitroprussidin detrüsör aşırı aktivitesi üzerindeki terapötik etkilerini açıklamayı amaçladık.
Yöntem: Bu araştırmaya detrüsör aşırı aktivitesi olan toplam 21 hasta dahil edildi. Hastalar sodyum nitroprussid dozajına göre düşük doz, orta doz ve yüksek doz olmak üzere 3 gruba ayrıldı. Mesanedeki hidrostatik basınç ölçüldü ve aynı zamanda rektuma yerleştirilen kateter ile karın içi basınç da ölçüldü. Sistometri sonuçları duyu (ilk duyum, ilk istek, güçlü istek), detrusor kompliyansı, maksimum detrüsör basıncı, maksimum sistometrik mesane kapasitesi ve instabilite indeksi parametreleri açısından değerlendirildi.
Bulgular: Nitroprussid grupları arasında ilk duyum, ilk istek ve güçlü istek değerleri açısından istatistiksel olarak anlamlı bir fark bulunamadı (p>0,05). Hastaların maksimum detrüsör basıncı, maksimum sistometrik mesane kapasitesi ve kompliyans değerleri yorumlandığında izotonik ve SNP grupları ve dozları arasında anlamlı fark bulunamadı. Kasılma süreleri açısından gruplar arasında anlamlı fark yoktu. Ayrıca hastaların çalışma sonundaki kan basıncı değerlerinde başlangıca göre gruplar arasında bir fark gözlenmedi.
Sonuç: Bu çalışma SNP'nin detrüsör aşırı aktivitesi olan bireylerde herhangi bir olumlu ya da olumsuz etki göstermediğini göstermiştir. Bunun nedeni; öncelikle ürotelyumun sodyum nitroprussidin geçişine engel olarak etki ederek detrüsöre ulaşmasını engellemesi, ikincisi ise sodyum nitroprussidin detrüsör fonksiyonu üzerine etkisinin olmamasından kaynaklanabilir
Alkol ve Uyuşturucu Bağımlılığının Tedavisi Nasıl Daha Etkili Olabilir? Editöre Mektup
No full textDear Editor,
The aim of this letter is to highlight the low success rate in alcohol and substance addiction treatment in psychiatric clinics and to initiate a brief discussion about whether there are other treatment options. While hundreds of studies emphasize the importance of spiritual and religious support for the treatment of substance addiction, this situation is still ignored in psychiatric clinics in our country. İn order to increase the success rate in the treatment of alcohol and substance addiction and to reduce the frequency of relapse, it would be an appropriate approach for psychiatric clinics to work in coordination with associations by leaving all prejudices aside.Dear Editor,
The aim of this letter is to highlight the low success rate in alcohol and substance addiction treatment in psychiatric clinics and to initiate a brief discussion about whether there are other treatment options. While hundreds of studies emphasize the importance of spiritual and religious support for the treatment of substance addiction, this situation is still ignored in psychiatric clinics in our country. İn order to increase the success rate in the treatment of alcohol and substance addiction and to reduce the frequency of relapse, it would be an appropriate approach for psychiatric clinics to work in coordination with associations by leaving all prejudices aside
Göğüs Cerrahisinde Kılavuzlar Günlük Pratiğimizi Ne Kadar Etkiliyor? – Mevcut Rutinin Gözden Geçirilmesi: Derleme Makale
No full textGuidelines are formulated based on the results of randomised clinical trials, other non-randomized studies, and expert opinions (i.e., the opinions of most guideline committees). A randomised, multicenter, controlled trial is the ideal study to determine a patient population's mean values. However, some diseases and populations do not lend themselves easily to this format, and therefore, studies with less stringent design and enrollment criteria are often used. The latest guidelines have more reliable data and distinct subgroups and carry a higher risk of misinterpreting results than older models. Guidelines are part of a continuous educational program to facilitate a more homogeneous approach to all patients with the same disease, reduce inappropriate and unnecessary testing, ineffective treatments, and health costs, and ultimately improve care. As a result, guidelines are allegiant. The surgeon should question why and how this guideline was prepared, who supported its creation, who is on its organisation committee, and what it represents. Within the scope of this review, recommendations to improve the guidelines will be presented.Kılavuzlar, randomize klinik araştırmaların, diğer randomize olmayan çalışmaların sonuçlarına ve uzman görüşlerine (yani çoğu kılavuz komitesinin görüşlerine) dayanarak formüle edilir. Randomize, çok merkezli, kontrollü bir çalışma, hasta popülasyonunun ortalama değerlerini belirlemek için ideal çalışmadır. Ancak bazı hastalıklar ve popülasyonlar bu formata kolaylıkla uyum sağlamamaktadır ve bu nedenle daha az katı tasarım ve hasta alım kriterlerine sahip çalışmalar sıklıkla kullanılmaktadır. En yeni kılavuzlar daha güvenilir verilere ve farklı alt gruplara sahiptir ve öncekilere göre sonuçların yanlış yorumlanma riski daha yüksektir. Kılavuzların, aynı hastalığa sahip tüm hastalara daha homojen bir yaklaşımı kolaylaştırmak, uygunsuz ve gereksiz testleri, etkisiz tedavileri ve sağlık maliyetlerini azaltmak ve sonuçta bakımı iyileştirmek için sürekli bir eğitim programının bir parçasını oluşturduğu iddia edilmektedir. Sonuç olarak, yönergeler sadıktır. Cerrah bu kılavuzun neden ve nasıl hazırlandığını, oluşturulmasına kimlerin destek verdiğini, organizasyon komitesinde kimlerin bulunduğunu, neyi temsil ettiğini sorgulamalıdır. Bu inceleme kapsamında kılavuzların iyileştirilmesine yönelik öneriler sunulacaktır
Hemşirelerin Deprem Sonrası Sağlık Algısı, Deprem Stresi ile Baş Etme ve Uykusuzluk Durumlarının İncelenmesi: Araştırma Makalesi
No full textIntroduction: Earthquakes occur suddenly. In the subsequent process, it causes physiological, psychological and social problems in individuals. Nurses, on the other hand, try to find solutions to both their own problems and the problems of the individuals they care for in earthquake situations.
Objective: The study aimed to determine nurses' health perception levels after the earthquake, their coping strategies with earthquake stress, and their insomnia.
Method: It is a descriptive type study. It was conducted on nurses working at Training and Research Hospital. The study was carried out between April 2023 and June 2023. There are 601 nurses in the sample. An introductory information form, Health Perception Scale, Earthquake Stress Coping Strategies Scale and Insomnia Severity Index were used to collect data. In the analysis of the data, t test, analysis of variance and Pearson correlation analysis were performed in independent groups.
Results: It was found that health perception was affected by marital status and educational status, and sub-dimensions of the earthquake stress coping strategies scale were affected by educational status (p<0.05). It was determined that 44.3% of the nurses were at the lower threshold of insomnia. A weak relationship was found between health perception and the religious coping sub-dimension of the earthquake stress coping strategies scale (r =-.199, p = .000).
Conclusion: It is recommended to carry out interventional studies that will increase nurses' health perception, enable them to use coping strategies effectively in earthquake situations, and help them cope with sleep problems.Giriş: Depremler aniden meydana gelir. Sonraki süreçte bireylerde fizyolojik, psikolojik, sosyal sorunlara sebep olmaktadır. Hemşireler ise deprem durumlarında hem kendi sorunlarına hem de bakım verdikleri bireylerin sorunlarına çözüm üretmeye çalışmaktadırlar.
Amaç: Çalışmada hemşirelerin depremden sonra sağlık algı düzeylerini, deprem stresi ile baş etme stratejilerinin neler olduğunu, uykusuzluk yaşama durumlarını belirlemek amaçlanmıştır.
Yöntem: Tanımlayıcı tipte bir çalışmadır ve bir Eğitim ve Araştırma Hastanesi’nde çalışan hemşirelerde yapılmıştır. Çalışma Nisan 2023 – Haziran 2023 tarihleri arasında gerçekleştirilmiştir. Örneklemde 601 hemşire yer almaktadır. Verileri toplamak için tanıtıcı bilgi formu, Sağlık Algısı Ölçeği, Deprem Stresi ile Başetme Stratejileri Ölçeği ve Uykusuzluk Şiddeti İndeksi kullanılmıştır. Verilerin analizinde bağımsız gruplarda t testi, varyans analizi ve pearson korelasyon analizi yapılmıştır.
Bulgular: Sağlık algısının medeni durum ve eğitim durumundan, deprem stresi ile başetme stratejileri ölçeği alt boyutlarının eğitim durumundan etkilendiği bulunmuştur (p<0.05). Hemşirelerin %44.3’ünün uykusuzluk alt eşiğinde olduğu saptanmıştır. Sağlık algısı ile deprem stresi ile başetme stratejileri ölçeği dini başetme alt boyutu arasında zayıf bir ilişki saptanmıştır (r = -.199, p = .000).
Sonuç: Hemşirelerin sağlığı algılama durumlarını yükseltecek, deprem durumlarında başetme stratejilerini etkin kullanmalarını sağlayacak, uyku sorunları ile başetmeye yardımcı olacak girişimsel çalışmaların yapılması önerilmektedir