Objective: RNA modification of 5-methylcytosine (m5C) has been discovered in diverse kinds of RNA and plays a vital role in gene regulation and cellular functions; however, how m5C regulates oral squamous cell carcinoma (OSCC) progression remains unclear. Design: Bioinformatics analysis and validation Setting: Stomatological Hospital Subjects: Transcriptome and clinical data of OSCC samples (including 201 tumors and 18 normal samples) were downloaded from The Cancer Genome Atlas. Interventions: Not applicable Main Outcome Measures: Subjected to analyze m5C regulators expression and prognostic value. GSEA and immune infiltration analysis were conducted. Finally, NSUN2 expression in OSCC cell lines was validated by western blot. Results: Of the 21 m5C regulators, 15 were significantly up-regulated (including NSUN2) in tumor tissue and only two were down-regulated, compared to normal tissue. Furthermore, among the 17 m5C regulators, univariate and multivariate cox regression analyses revealed that only NSUN2 was an independent prognostic risk factor for OSCC. GSEA revealed that pathways associated with immune response were enriched in the NSUN2-low expression group and pro-tumor pathways were enriched in the NSUN2-high expression group. Moreover, NSUN2 negatively correlated with active immune cell type, including CD8+T cells, B cells, NK cells, monocyte and gamma delta T cells, but positively correlated with myeloid-derived suppressor cells. NSUN2 expression was up-regulated in seven OSCC cell lines relative to normal cells. Conclusion: In conclusion, m5C modification was active in OSCC tumor tissues and NSUN2 was a prognostic marker of OSCC, possibly by inhibiting immune reaction against tumor.
Saddle pulmonary embolism (PE), which is a rare form of acute PE, can cause sudden hemodynamic deterioration and death. In this case, we present a female patient who presented to the emergency department with complaints of back pain and was found to have sinus bradycardia on electrocardiogram, ultimately diagnosed with saddle PE. A chest computed tomography was ordered to evaluate for a possible lung infection. Although no evidence of pneumonia was found, the imaging showed an enlarged diameter of the pulmonary artery measuring 3.22 cm. Saddle PE is a condition that should be considered in the diagnosis in the Emergency Department as it can lead to serious mortality and morbidity, and may not always present with typical symptoms. In cases with atypical presentation where PE is not initially suspected, the high diameter of the main pulmonary artery detected on chest CT scans should be associated with diseases with right ventricular overloading such as PE.
Achalasia is esophageal motor dysfunction caused by impaired relaxation of the lower esophageal sphincter. A 77-year-old female patient was brought to the emergency department with complaints of nausea, vomiting and chest pain. Thorax computed tomography (CT) imaging was performed because there was no abnormality in troponin and electrocardiogram (ECG) follow-ups; approximately 7 cm diameter megaesophagus was detected. Endoscopy was performed for advanced diagnosis and treatment. Diagnosis of achalasia was confirmed by endoscopy. The distal end of the esophagus was widened by dilatation. The patient was discharged after 24 hours of service follow-up. Although it is a rare condition in elderly patients presenting to the emergency department, it should be noted that achalasia will constitute a non-cardiac chest pain clinic.
Objective: This study aimed to determine the value of netrin-1 in epithelial ovarian cancer (EOC), which has high morbidity and mortality. Design: This research is a cross-sectional type descriptive study. Setting: The study was carried out at the Gynecological Oncology Department of Sakarya University Training and Research Hospital. Subjects: Female patients with a diagnosis of adnexal mass Interventions: Serum netrin 1 levels of patients with benign (n=43) and malignant (n=40) histopathology operated in our clinic with the diagnosis of suspected adnexal mass were evaluated. The netrin 1 levels of both groups were compared and the receiver operating characteristic analysis was carried out. Main outcome measures: Serum netrin-1 levels in patients with a diagnosis of ovarian cancer. Results: While netrin-1 level was found to be higher in patients with EOC, the cut-off value was found to be 325 pg/mL. AUC=0.690, p=0.003 (95%CI:0.571-0.809) was determined to be able to differentiate between malignant and benign adnexal masses by means of the netrin 1 level. The sensitivity of the netrin-1 level for the diagnosis of EOC is 60%, and the specificity is 83.7%. Conclusion: Serum netrin-1 may be a potential biomarker in patients with EOC.
Background: No cases have been reported in which the contralateral breast was treated with conventional whole-breast irradiation (WBI) while the ipsilateral breast was treated with hypofractionated WBI and a hypofractionated boost. Case report: A 58-year-old woman with breast cancer underwent WBI and a boost to the tumor bed. She had a history of early-stage breast cancer on the contralateral side, for which she received conventional WBI with a total dose of 50 Gy in 25 fractions. She received a total of 39 Gy in 13 fractions and a boost with a dose of 9 Gy in 3 fractions. Mild dermatitis occurred during treatment, and mild hyperpigmentation developed 3 months after boost irradiation, which worsened over time and was considered a grade 2 late adverse event. Six years later, no recurrence or additional adverse events occurred. Conclusion: Hypofractionated boost irradiation after hypofractionated WBI carries a risk of hyperpigmentation and should be treated with caution, even if conventional WBI did not cause late skin damage.
Despite the fact that there have been numerous instances of minor replantation, only a small number of reports of wrist level amputation replantation have been published. The technical specifics of two successful replantation of wrist level amputations in a 26-year-old and 36-year-old male patient, both of whom worked as carpenters for the same furniture manufacturing company using the same computerized numerical control milling machine, are reported in this case report. Both patients retained elbow and hand muscular integrity. The most important factors in achieving success are proper fixation of the amputated part in a manner that mimics the original anatomy, radical and aggressive debridement of the soft tissues, reconstruction of the defect using vein grafts, if necessary, and neural repair while maintaining proper integrity. When the requirements are met, replantation of wrist level amputations results in a superior outcome in terms of both function and appearance.
Objectives: To examine the clinicopathological characteristics of diffuse large B-cell lymphomas (DLBCL) and doubleexpressor lymphoma (DEL) and to determine the prevalence rate of DEL among patients with DLBCL. Design: Retrospective study Setting: University hospital in Saudi Arabia Subjects: Patients diagnosed with DLBCL between January 2015 and February 2022 were identified from the hospital laboratory database. We excluded patients with primary DLBCL of the central nervous system, primary testicular DLBCL, Epstein-Barr virus-positive DLBCL or Burkitt lymphoma. Intervention: Immunohistochemical stains assessment for CD3, CD20, CD10, CD5, Cyclin D1, Ki-67, BCL2, BCL6, MUM1 and c-MYC. Main Outcome Measures: Clinical and immunohistochemical characteristics of DLBCL and DEL patients including the mean age, the involved site, sex distribution, proportions of CD30, BCL6, MUM1, c-MYC, BCL2, mean proliferation index (by Ki-67) and cell-of-origin subtypes. Identify the proportion of DEL within DLBCL patients and compare the differences between DEL and non-DEL groups. Results: A total of 93 patients were included. The average age of DLBCL patients was 57 years. Forty-three cases (46%) were germinal center-origin DLBCL, and 50 cases (54%) were non-germinal center-origin DLBCL. Twenty patients (21.5%; average age, 59 years) had DEL phenotype. The average Ki-67 index was higher in the DEL group than in the non-DEL group. DEL was mostly associated with the germinal center-origin subtype. Conclusion: We found a significant proportion of DEL cases among DLBCL cases. Therefore, immunohistochemical staining for c-MYC and BCL2 is recommended to identify this phenotype.
Objective: This research was to investigate the relationship between the levels of microvascular density (MVD) and vascular endothelial growth factor (VEGF) and the efficacy of microwave ablation combined with Anlotinib in treating hepatic oligometastases in gastric cancer. Design: 110 patients with hepatic oligometastasis of gastric cancer diagnosed in our hospital from 2019 to 2021 were rolled into a control group and an observation group under random number expression method, with 55 cases in each group. Setting: All patients in the control group received total gastrectomy or subtotal gastrectomy, and some patients were combined with D2 lymph node dissection after surgery. Subjects: 61 male patients and 49 female patients, aged 50-75 years old. Intervention: The subjects in the observation group were additionally treated with Anlotinib hydrochloride capsules. Main Outcome Measure: MVD and VEGF levels Results: The total effective rate was 69% in the observation group and 34% in the control group after 3 months. After 3 months of treatment, the serum VEGF level in the observation group was 52.86 +/- 9.32 pg/mL and MVD was 67.54 +/- 7.11 strips/200 times of field of vision, while the serum VEGF level in the control group was 60.34 +/- 10.34 pg/mL and the MVD was 75.23 +/- 8.05 strips/200 times of field of vision. The postoperative survival time of patients in the observation group was 15.79 +/- 3.21 months, while that of patients in the control group was only 13.54 +/- 2.36 months (P <0.05). Conclusion: Microwave ablation combined with Anlotinib treatment can effectively reduce the levels of MVD and serum VEGF in patients with hepatic oligometastases of gastric cancer and improve the therapeutic effect.
Objectives: Optic nerve sheath diameter (ONSD) is an indicator of intracranial pressure. This study aimed to examine the role of intraoperative ONSD measurements for predicting postoperative cognitive dysfunction in patients undergoing laparoscopic hysterectomy in Trendelenburg position with pneumoperitoneum. Design: Prospective observational study Setting: Marmara University medical faculty, Istanbul, Turkey Subjects: Forty patients who underwent laparoscopic hysterectomy under long-standing Trendelenburg position (>2.5 hours) were included in this study. Interventions: In addition to routine intraoperative monitoring, ONSD was measured intraoperatively at five time points. Its predictive role for postoperative cognitive dysfunction was assessed. Main outcome measures: The role of intraoperative ONSD measurements for predicting postoperative cognitive dysfunction in patients undergoing laparoscopic hysterectomy in long-lasting (>2.5 hours) Trendelenburg position. Results: ONSD gradually increased in association with pneumoperitoneum and Trendelenburg position. No significant correlation was found between ONSD measurements and postoperative changes on cognitive function at the early postoperative period, day 3 and day 7. Patients who exhibited cognitive decline at day 7 (>2 point reduction in Mini-Mental State Examination score compared to baseline) did not differ in terms of ONSD measurements and other tested variables. Conclusions: Our findings suggest that intraoperative ONSD measurements do not seem to serve as a predictor for postoperative cognitive dysfunction in patients who underwent laparoscopic gynecological operations in long-standing Trendelenburg position and pneumoperitoneum.
The rapid integration of artificial intelligence (AI) into digital health ecosystems has sparked a paradigm shift in how the public accesses, interprets and acts upon medical information. Generative models, such as ChatGPT and symptom-checking tools, now shape public knowledge of disease, diagnosis and treatment, which are often outside the supervision of health authorities, thus raising concerns regarding trust, accuracy and patient safety. This brief communication reframes a previously published study on AI and public trust to present a Kuwaiti-centric analysis. It proposes a strategic framework that aligns with Kuwait's centralized healthcare system, high digital penetration and strong institutional trust. The paper advocates for national standards on AI-mediated health messaging, critical health literacy interventions and clinician education to ensure responsible innovation rooted in ethical governance.
Encysted papillary carcinoma of the breast (EPC) is one of the papillary breast tumor (PTB) variants that may pose a diagnostic difficulty, particularly on core needle biopsy. It shows overlapping cytological features with other PTB leading to diagnostic pitfalls; more so with invasive papillary carcinoma, which is an aggressive malignancy with a less favorable prognosis. Histopathological examination helped us to diagnose and characterize this rare and intriguing entity. We also emphasize the need for early and accurate diagnosis of EPC because of its indolent nature, conservative management and favorable outcome.
Objectives: This study aimed to measure the diagnostic value of rapid on-site evaluation (ROSE) of samples obtained using ultrasound-guided fine-needle aspiration (FNA) of thyroid lesions by cytotechnologists. Design: Retrospective observational study Setting: Department of Pathology, King Saud University Medical City, Riyadh, Saudi Arabia Subjects: Patients who underwent ultrasound-guided thyroid FNA between January 2015 and July 2020 were enrolled and reviewed. Interventions: None Main outcome measure: Diagnostic material deemed satisfactory according to the 2017 Bethesda System for Reporting Thyroid Cytopathology criteria Results: Out of the 1400 cases investigated, ROSE wasperformed on 1011 cases. The non-diagnostic samples in cases with ROSE comprised 6.82% of all samples in cases with ROSE while the non-diagnostic samples in cases without ROSE comprised 12.34% of all samples in cases without ROSE. Thus, the number of thyroid FNA cases with non-diagnostic samples identified using ROSE was significantly lower than that without using ROSE (P <0.002). In addition, less samples were identified as atypia of undetermined significance in cases with ROSE (15.63%) as compared to those without ROSE (17.74%). Conclusions: ROSE is an effective method for decreasing the number of cases with non-diagnostic samples resulting in unsatisfactory diagnosis as well as the number of cases with borderline results, thus increasing the diagnostic value of thyroid FNA.
Objective: Ovarian cancer (OC) is one of the most common malignant tumors in women, with the highest mortality rate of all gynecological tumors. OC cells are able to upregulate PD-1/PD-L1 checkpoint and autophagy which could be in close and significant interaction. The aim of the study was to analyze the expression of PD-L1 immunosuppressive and autophagy markers p62, LC3 and Beclin1 in OC and evaluate their prognostic potential. Design: Retrospective cross-sectional study Setting: Tertiary university hospital Subjects: The study has included 122 subjects with OC. Intervention: The expression of PD-L1, p62, LC3 and Beclin1 was analyzed by immunohistochemistry combined with tissue microarray. Main outcome measures: Four categories were defined: negative (0) without positive cells or with a single positive cell (<1%); low (1+) expression with less than 10% positive cells; moderate (2+) expression with 10-50% positive cells; and strong (3+) expression with more than 50% positive cells. Expression levels of analyzed markers were correlated with histopathology parameters. Results: High grade serous carcinoma showed significant level of PD-L1, p62 and LC3 expressions, compared to all other histology types. Advanced International Federation of Gynaecology and Obstetrics stages were associated with increased levels of PD-L1, p62 and LC3 expressions. Beclin1 expression did not show significant correlation with analyzed parameters. Conclusion: The combined presence of PD-L1, p62 and LC3 expressions indicates simultaneous activation of immunosuppressive and autophagy mechanism in ovarian cancer cells. It could suggest synergistic therapy with PD-L1 and autophagy inhibitors in OC treatment.
Objectives: Scarce data exist about the complete blood count of preterm newborns with small for gestational age (SGA). It is not known how SGA affects systemic inflammatory indices in preterm infants. The aim of our study was to compare the levels of six systemic inflammatory indices in preterm infants with SGA and appropriate for gestational age (AGA). Design: A retrospective cohort study Setting: A tertiary neonatal intensive care unit Subjects: Data of preterm infants <32 weeks of gestational age were evaluated. Interventions: No intervention was performed. Main outcome measures: Six systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune ratio inflammation index (SII), pan immune inflammation value (PIV), and systemic inflammation response index (SIRI) values, were calculated from the results obtained from the complete blood count. Demographical features and clinical outcomes, complete blood count and systemic inflammatory indices were compared between the AGA and SGA groups. Results: 895 infants were included in the study: 103 preterm infants with SGA and 792 preterm infants with AGA. There was no difference between the groups regarding leukocyte, monocyte, lymphocyte count, MLR and SIRI values (P>0.05). Neutrophil, platelet count, NLR, PLR, PIV and SII values were significantly lower in SGA infants than in AGA infants (P=0.001, P<0.001, P<0.001, P<0.001, P=0.016 and P<0.001, respectively). Conclusions: We found that NLR, PLR, PIV and SII values were lower in SGA preterm infants than those in AGA preterm infants. Additional studies are required to evaluate the clinical significance of these values.
Osteopetrosis is a rare hereditary bone disease that causes osteoclasts dysfunction resulting in insignificant radiological density increase. There is a defect in calcified cartilage and primitive bone resorption. In this case, we presented the clinical and radiological signs of an uncommon form of adult osteopetrosis.
Non-puerperal uterine inversion is an uncommon clinical condition, which has been reported. The management was difficult for most gynecologists because of the rare nature of the condition. We present a rare case of non-puerperal uterine inversion due to endometrial stromal sarcoma. A 62-year-old postmenopausal female was admitted with irregular vaginal bleeding for one month. Vaginal examination showed the presence of a large red mass of size 9 x 9 x 8 cm protruding into the vagina with no obvious pedicle. A mass biopsy was done and histology revealed a endometrial stromal sarcoma. At the time of surgery, the patient was placed at supine position and an inverted uterus was observed at laparotomy. Total hysterectomy with bilateral adnexectomy was performed. Histopathological evaluation showed endometrial stromal sarcoma. Uterine inversion rarely occurs outside the puerperal period; however, when it does occur, the possibility of an underlying malignancy should not be neglected.
Situs inversus totalis (SIT) is a rare autosomal recessive genetic disease in which the major visceral organs of the thoracic and abdominal cavities are inverted like a mirror image. We present a rare case of a patient with SIT and sepsis. A 55-year-old man was hospitalized because of suffocation, wheezing, coughing, fever and general weakness. He was normotensive, tachycardic, tachy-dyspnoeic and acyanotic. Auscultatory weakened respiratory sound, prolonged exhaling, diffuse polyphonic whistling. He had congenital dextrocardia and ventricular septal defect. Electrocardiogram, lung X-ray, echocardiogram of the heart and abdomen, multislice computed tomography chest were undertaken in accordance with the diagnosis of SIT. Positive quick sequential organ failure assessment criteria for sepsis on admission, positive Systemic Inflammatory Response Syndrome criteria during hospitalization, and laboratory results of slightly elevated inflammatory markers caused by isolated Staphylococcus epidermidis confirmed the diagnosis of sepsis. Early suspicion of the association of SIT and infective endocarditis or sepsis with urgent targeted diagnostic and laboratory analyzes is of paramount importance, as well as the application of adequate therapeutic measures in the first hours afterwards, in order to increase the chance of a positive treatment outcome.
Objective: To investigate the relationship between clinicopathological variables of patients with lung cancer and Alpha-L-fucosidase (AFU) serum levels and to examine AFU usability in distinguishing between early-stage and advanced-stage lung cancer. Design: This was a prospective observational study. Setting: Van Yuzuncu Yil University Department of Thoracic Surgery, between June 2020 and December 2020. Subjects: Fifty healthy volunteers as the control group and seventy-five lung cancer patients confirmed and staged by imaging methods. Interventions: The patients' demographic (age, gender) and clinicopathological characteristics were determined by physical examination, biochemical tests, pathological examination and imaging studies. The TNM staging system is used in cancer staging. Main outcome measures: Serum AFU levels were measured in both the control and lung cancer groups. Results: The mean AFU level of lung cancer patients was 13.35 +/- 0.61 ng/mL, while the mean AFU level of the control group was 1.86 +/- 0.35 ng/mL (P<0.001). AFU levels were significantly higher in the lung cancer group with increasing depth of invasion, lymph node metastasis, distant metastasis and TNM stages (P<0.001). Conclusions: This study is the first to show that AFU can detect lung cancer early and predict the cancer stage. AFU can be an essential diagnostic and stage discriminative marker for lung cancer.
Infective endocarditis (IE), an infection of the endocardium, is an infection with serious complications such as heart failure, valvular diseases and systemic embolism. It has risk factors such as intravenous drug use, poor oral hygiene and dental intervention, and infectious symptoms such as fever, tremble, loss of appetite and weight loss. It is an infection with high morbidity and mortality that affects various organs and systems such as heart, skin and retina. Coronavirus disease (COVID-19), which can have a similar clinic with both IE and various infections, can also be seen at the same time with other infections, which causes a delay in its diagnosis and treatment. There can be similar clinical symptoms between COVID and IE during their cardiac involvement. This is another factor that creates difficulties in diagnosis. It should always be considered that COVID-19 may coexist with IE and/or other infections. Our case presented here is a patient with diabetes mellitus for 20 years and using oral antidiabetic drugs. Progressive speech disorder has occurred for two days and the patient has no history of any surgical or dental intervention, intravenous drug or drug use. IE was not considered in the initial diagnosis, and the patient was admitted to the emergency department with a prediagnosis of cerebrovascular disease and diabetes mellitus. After hospitalization in the intensive care unit, IE and septic embolism were detected with the presence of COVID-19 infection.
