Aim: Gastric cancer is one of the leading causes of cancer-related deaths. Tumor budding has been
shown to be a prognostic factor in many cancers. In this study, we aimed to evaluate the prognostic
significance of tumor budding in intestinal-type gastric adenoc arcinoma.
Patients and Methods: A total of 152 cases diagnosed as intestinal type gastric adenocarcinoma in
the Pathology Clinic between 2015 and 2021 were included in the study. Tumor budding was grouped
as low, medium and high. Hematoxylin and eosin-stained slides were re-evaluated in terms of tumor
differentiation, lymphovascular invasion (LVI), perineural invasion (PNI), lymph node involvement, depth
of invasion (pT) and tumor budding.
Results: Tumor budding was low in 30.9% (n=47) of the subjects included in the study, moderate in 37.5%
(n=57) and high in 31.4% (n=48). Statistically, as tumor budding increased, tumor size increased (p<0,05),
follow-up times were shortened, survival time (p<0,05), and tumor differentiation (p<0,05) decreased. A
statistically significant correlation was observed between tumor budding and LVI (p<0,05), PNI (p<0,05),
pT(p<0,05), lymph node involvement(p<0,05), and mortality of the cases (p<0,05). No statistically
significant correlation was observed between tumor budding and gender, age, tumor localization and
operation type (p>0.05).
Conclusions: Tumor budding is associated with poor prognostic factors. As it may be important to guide
the treatment modality and follow-up, tumor budding status may be mentioned in routine pathology reports.

Aim: Gallbladder cancer is an uncommon, but aggressive tumor. Its prognosis is poor and the most cases are incidentally detected in histopathological examinations of cholecystectomies due to benign diseases. With the era of laparoscopic cholecystectomy, the number of cases detected in early stage is increasing. In this study, we aimed to evaluate the rate of cancer encountered and the distribution of non-cancer diagnoses in cholecystectomy materials sent to our department, together with the literature findings.

Materials and Methods: The results of the cholecystectomy materials sent to the pathology laboratory and examined routinely in 2016-2017 were retrospectively evaluated by forming diagnostic groups. Clinical preliminary diagnoses, demographic informations (age, sex), and pathology reports of the patients were reviewed.

Results: We included a total of 1000 cholecystectomy materials into the study. Two of the 7 patients who presented with malignancy were incidentally diagnosed and underwent laparoscopic cholecystectomy with the preliminary diagnosis of cholelithiasis, with the primary focus was gallbladder in one patient, and the other was compatible with colonic adenocarcinoma infiltration. Preoperative and / or perioperative malignancy was detected in the remaining 5 patients. A large proportion (> 90%) of the other cases had chronic or chronic active cholecystitis and low rate of acute cholecystitis included gastric heterotopia found in 2 (0.2%), tubular adenoma in 1 (0.1%), tubulovillous adenoma in 1 (0.1%), adenomyoma / adenomyomatosis in 4 (0.4%), polyp in 6 (0,6%) and dysplasia (Biliary intraepithelial neoplasia, BilIN) in 5 (0.5%) patients.

Background: We aimed to investigate the neurodevelopmental outcomes and school success of 11- to 12-year-old children born as moderate/late preterm infants and identify risk factors affecting prognosis.

Methods: Moderate/late preterm infants followed in the neonatal intensive care unit between January 2004 and December 2004 were included, and the children were examined again in our pediatrics outpatient clinic in 2016. Perinatal and neonatal histories were obtained from the hospital database. Physical growth characteristics were interpreted. Neurodevelopment was evaluated using the revised Wechsler Intelligence Scale for Children (WISC-R). The Pediatric Symptom Checklist (PSC) was also applied. The effect of socioeconomic level on neurodevelopmental outcome was examined. School performance was evaluated using report card grades.

Results: Forty-one children with a mean age of 11.6 years were evaluated. Risk factors associated with physical growth outcomes were maternal age of >35 years, fetal distress, and patent ductus arteriosus. Sepsis was associated with a decrease in verbal intelligence while periventricular leukomalacia had negative effects on both verbal and performance intelligence. Socioeconomic level showed a medium correlation with performance and full-scale intelligence. The intelligence quotients of the children with positive PSC scores were significantly lower.

Conclusions: Moderate/late preterm infants lag both neurologically and developmentally due to incomplete maturation of the brain and natal problems. Similarly, to early preterm infants, these children should be monitored for extended periods, and family support, rehabilitation, and special education needs should be met.

Aim: The aim of this study was to evaluate the demographic characteristics, emergency care needs and prognosis of patients aged 65 years and older who presented to our Emergency Medicine Clinic with abdominal pain for a period of one year.

Patients and Methods: In this single-center, retrospective, observational study included patients aged 65 years and older who presented to the emergency department with abdominal pain between June 15, 2015 and June 14, 2016. The related variables were recorded from the patients' electronic and written files. The general patient population and the differences of variables in the 65-74 age group, 75-84 age group and ≥85 age group were investigated.

Results: A total of 1330 patients were included in the study. The mean age of the patients was 75.2 ± 7.2 years and 582 (43.8%) were male. While 58.8% of the patients were discharged from the emergency department, the most common hospitalization wards were General Surgery (14.1%) and Gastroenterology (11.4%). The ICU admission rate increased with age (p<0.001; 3.3% - 5.8% - 11.6%). The mean length of stay in hospital was 5.9 ± 7.1 days and the in-hospital mortality rate was 3.4%. While 50.1% of the patients in the 65-74 age group were discharged from the emergency department without consultation, this rate decreased to 36.6% in the ≥85 age group and the difference was statistically significant (p<0.001). Abdominal ultrasound was performed in 34.1%, abdominal tomography in 20.0% and both of them in 7.5% of the patients.

Conclusion: The patients aged 85 years and older with abdominal pain are more likely to be characterized by more examination needs, more consultation needs, more hospitalization rates and higher mortality rates. Taking these differences into consideration during the management of the elderly patients with abdominal pain in emergency department will help to reduce morbidity and mortality rates while improving patient care quality.

Aim: Glioblastoma is the most frequent, and fatal brain cancer in adults. Toll-like receptors are cell surface receptors comprised of 10 receptors (Toll-like receptor 1−10) related to triggering innate immunity by recognizing pathogens. However, some studies suggested that the expression of Toll-like receptors might be related to cancer cell proliferation and progression in some tumors including glioblastoma with some contradictory results. Thus, we aimed to investigate all ten members of the Toll-like receptor expression profile in glioblastoma for the first time in the literature to contribute additional data to the literature.

Patients and Methods: Quantitative real-time polymerase chain reaction was applied to formalin-fixed paraffin-embedded tissues of 25 glioblastoma patients, diagnosed between January and December 2018, to evaluate the mRNA expression of Toll-like receptors. Also, the expression of each Toll-like receptor was investigated by cell culture analysis using five different cell lines of human glioblastoma (T98G, U87-MG, U373, LN18, and A172). The results were compared statistically.

Results: Toll-like receptor 1, Toll-like receptor 6, and Toll-like receptor 7 mRNA levels were significantly increased in the formalin-fixed paraffin-embedded tissues of the glioblastoma group (p<0.001, each) whereas the expression of Toll-like receptor 4 and Toll-like receptor 10 was downregulated compared to the control group (p=0.023, p<0.001, respectively), by qPCR analysis.  Additionally, Toll-like receptor mRNA expression profiles differed among the cell lines.

Conclusion: In our study, many Toll-like receptor members seemed to display different expression level in the glioblastoma microenvironment and affect it diversely.  Further comprehensive studies are required to confirm the endogenous protein level of each Toll-like receptor in glioblastoma, to clarify their precise role in the pathogenesis and prognosis of glioblastoma, and to shed light on new target therapies.

Wilm’s tumor, the most common childhood renal cancer, is a heterogeneous renal tumor in which diffuse anaplastic or negative histology represents poor prognosis. In Wilm’s tumor pathogenesis, a large number of factors remain uncertain. For this reason, the disease continues to be the focus of further research. MicroRNAs are small, protein-encoding RNA molecules that regulate gene expression at post-transcriptional stage. The role of microRNAs in cancer onset and progression has been demonstrated in most solid cancers. MicroRNAs also have a diagnostic potential, and microRNA-targeted treatment is a candidate for an important role in cancer treatment. In Wilm’s tumor, dysregulation of certain key oncogenic or tumor suppressor microRNAs, such as miR-17 ~ 92 cluster, miR-185, miR-204, and miR-483 has been documented. In this study, we will summarize the current evidence about the role of dysregulated microRNAs in the development of the Wilm’s tumor. The possible effects of MicroRNAs on the clinical diagnosis and prognosis of the Wilm’s tumor will also be discussed. Thus, an overview of the future place of microRNAs in the implementation of new treatment options will be presented.

Objective: Most of the renal neoplasms are the epithelial and malign ones. The renal cell carcinoma (RCC), which is the most frequently seen malign renal tumor, consists of 2-4% of all the malign tumors seen among adult individuals and 80-90% of all the malign renal tumors. RCCs peak at sixties and seventies and its prevalence among males is two folds of its prevalence among females. RCCs have bad prognosis. The recurrence is seen in 40% of the cases, and the metastasis despite the early diagnosis was detected in 50% of cases. In present study, it was aimed to distribution of renal tumors in our hospital, discuss the prognostic factors such as the, pathological stage, nuclear grade and tumor diameter accompanied by literature information.

Patients and Method: By retrospectively scanning the records of Pathology Department of Medical Faculty, Fırat University, for the period between 1988 and 2009, 140 renal tumor cases were determined and the previous diagnoses, histological degrees, pathological stages of these cases were evaluated and the final diagnoses were taken as base in the present study. In pathologically staging (pT) of RCCs, TNM classification was used, whereas Fuhrman nuclear grading (FNG) was used in nuclear grading procedure. The patients were divided into different groups based on their genders and ages. The statistical analyses were performed in SPSS-12.0 software by using Chi-Square and Correlation tests.

Results: When compared to the literature in terms of the mean age, the present study involves relatively young population (mean age 57), and the majority was male (male/ female:1.1). The distributions of renal tumours, malign and benign subtypes, and RCC subtypes show similarities with the general literature. When examining the RCCs statistically, no significant relationship was found between diagnosis and age, and between nuclear grade and tumor diameter (p>0.05). In the present study, the RCCs with largest diameter were papillary type (9,78cm) ones, whereas the RCCs with lowest diameter values were classic type. A statistically significant relationship was observed between the benign, borderline and malign tumor diagnoses and diameters (p= 0.023). It was determined that approximately one-four of RCC cases were in highly pathological stage (21,6%, pT3a-3b). A direct proportional and statistically significant relationship was found between nuclear grade and diameter (p=0,002).

Conclusion: RCCs have poor prognosis and their frequency is increasing. Pathological stage, nuclear grade and diameter are the leading factors affecting the prognosis. As in our study, in retrospective studies involving old ages and not enough sampling, tumor diameter may be used as an alternative prognostic factor for pathological staging in tumors with a stage above pT2.

\r\n Objective: Early diagnosis of cutaneous squamous cell carcinomas (CSCC) is the most important factor affecting prognosis and most patients have a good prognosis. Some patients defined as high-risk group have high rates of regional recurrence and distant metastasis, and follow an aggressive course. In addition, recently numerous studies have being performed for determining the importance of sentinel lymph node sampling, and sentinel lymph node (SLN) positivity has been associated with a poor prognosis. In this study, we aimed to determine prognostic importance of SLN outcomes in patients with high-risk patients diagnosed with CSCC.

\r\n Patients & Methods: A total of 29 patients who underwent excisional operation in various body regions with the diagnosis of CSCC between 2009 and 2017, with available complete clinical and pathologic data were included in the study. At least 9-month clinical follow-up results, high risk factors and sentinel lymph node biopsy outcomes of the patients were recorded and analyzed. Patients with at least one of the American Joint Committee on Cancer (AJCC) criteria were considered as high-risk group.

\r\n Results: Twenty-five of the 29 CSCC patients were in the high-risk group. SLN positivity rate was 12% (n: 3/25) in the high-risk CSCC patients, all patients in the low-risk group had negative SLNs. All patients with SLN positive underwent local complementary lymphadenectomy, and all of these patients were re-operated due to recurrence. The rate of recurrence was found as 100% (n= 3/3) in high-risk CSCC patients with positive SLN, and 18% (n= 4/22) in high-risk CSCC patients with negative SLN. High recurrence rates (41.6%) and SLN positivity were observed in patients with hand-foot localizations.

\r\n Conclusion: High rates of local recurrence may be seen during progression of the disease in SLN positive patients. Hand-foot localization of CSCCs can be considered as a high risk factor regardless of a tumor diameter should be above 0.6 cm.

Objective: Mucormycosis is an infrequent opportunistic fungal infection which may cause an aggressive and invasive soft tissue necrosis. It is usually developed in patients with immune system deficiency, and rarely seen in immunocompetant patients.  We report prognosis and treatment of the immunocompetant patients that developed facial cutaneous mucormycosis after short term corticosteroid therapy.

Material and Method: The patients who were admitted to Manisa Celal Bayar University Hospital after multitrauma and given short term corticosteroids due to cranial and spinal injuries and became immuncompromised and diagnosed as facial cutaneous mucormycosis between 2016 and 2018 were included in the study. Prognosis, medical and surgical treatment outcomes of therapy is reported.

Results: One patient with malar and maxillary involvement was treated with medical therapy and serial debridements and infection was cured. Reconstruction with free flaps were done, acceptable functional and aesthetic results were achieved. Two patients had adequate therapy and reconstructed with local flaps.   One patient was not operated due to recurrent fungal osteomyelitis and intracranial inflammatory findings, and regression in MRI was seen.

Conclusion: Mucormycosis should be kept in mind in contaminated wound infections in patients who have been treated with corticosteroids even for a short time after multitrauma. Rapid, repetitive and aggressive debridemants should be performed and reconstruction should be planned after cure of the fungi.

Backround: Myocardial infarction with coronary artery disease (MICAD) is the leading cause of myocardial injury. Myocardial injury non-related to atherosclerotic plaque disruption (non-MICAD) is a rare and heterogeneous diagnosis. Although MICAD is well studied, non-MICAD was not thoroughly identified in young patient population. We aimed to investigate the frequency, main etiologies, and five-year mortality of patients with non-MICAD younger than 40 years.

Methods: We retrospectively enrolled 292 patients with acute myocardial injury younger than 40 years between January 2010 and December 2014. Clinical, demographic, laboratory, angiographic features, and five-year all-cause mortality were compared between patients with non-MICAD (n=78) and MICAD (n=214).

Results: Median age of patients was 36. Non-MICAD group was younger than MICAD group [32 (28-37) vs 37 (34-39)]. The frequency of female patients with non-MICAD was higher than those with MICAD (24.4% vs 10.3%). Most of the patients with MICAD presented with STEMI (77.1%), while most of the patients with non-MICAD presented with non-STEMI (89.7%). Most common etiologies of non-MICAD in were myocarditis (32%) and vasospasm (9%). Age, female sex, no smoking and, absence of dyslipidemia were independent predictors for non-MICAD. Five-year all-cause mortality in non-MICAD group was significantly lower than MICAD group (2.6% vs 10.3%) (log-rank test p=0.04).

Conclusion: Non-MICAD represents a heterogeneous group of patients who had varying etiologies at different ages. Despite the lower mortality rate of non-MICAD group, different diagnostic and treatment strategies are required for management of patients with non-MICAD.

Abstract

Aim: Since clinical and prognostic heterogeneity is observed in diffuse large B-cell lymphoma (‎DLBCL) patients, it is vital to determine its prognostic and predictive factors. The frequency of these factors varies geographically and ethnically. We aimed to reevaluate and discuss the prognostic and predictive ‎factors of DLBCL patients who have been treated with R-CHOP in our ‎center based on the WHO 2017 revised 4^th edition.‎ We also investigated the incidence of EBV in DLBCL-NOS.

Patients and Methods: Patients with DLBCL-NOS diagnosed previously in our hospital between 2007-2017 and treated with ‎R-CHOP were included in the study. We evaluated the expressions of CD10, CD5, CD30, BCL-2, BCL-6, MUM-1, MYC, LMP-1, EBNA-2, Ki-67, and p53, by immunohistochemistry, and EBV encoded RNA by in situ hybridization in 104 cases of DLBCL-NOS. The Revised International Prognostic Index (R-IPI) score and the overall survival time ‎was ‎calculated.

Results: The study included 56 men (53.8%) and 48 women (46.2%). The median age was 64.5 years. In 59.6% of the patients, the disease had a nodal beginning, whereas in 40.4% of the patients it had an ‎extranodal presentation. High ‎stage (III-IV) was present in 26.5% of the GCB subtype and 43.6% of non-GCB subtype (p=0.049). A high ‎R-IPI score was observed in 40% of GCB subtype and 54.5% of non-GCB subtype (p=0.028). Survival was significantly lower in the non-GCB subtype (log-rank test p=0.003).‎ The EBV frequency was about 3% as it is reported in Western populations. The frequency of DEL status was 8.7%, indicating that it was associated with inferior survival (p=0.045). De novo CD5⁺ DLBCL ratio as 13% and it was also associated with inferior survival (p=0.013).  We also found CD30⁺ DLBCL ratio as 11.5%, but we could not establish a significant relationship with prognosis.

Conclusion: DLBCL-NOS requires detailed subtyping and elaboration of prognostic factors. ‎The frequency of DEL status and De novo CD5⁺ DLBCL indicated that it was associated with inferior survival. However, we could not establish ‎a meaningful relationship of CD30⁺ DLBCL with prognosis.‎ Three EBV positive cases were identified and two of them were classified as ‘EBV positive large B cell lymphoma’ according to the WHO 2017 revised 4^th edition.

Keywords: Diffuse Large-Cell Lymphoma; Prognostic Factors; Survival

Aim: In the present study, the aim is to determine whether centromere protein H (CENPH) gene expression levels change in prostate carcinoma (PCa).
Materials and Methods: Prostate tissue sample of 40 patients with primary prostate cancer was used in the study. Hence, transcriptional analysis of the CENPH gene was conducted in the total paraffin embedded prostate tissues extracted from patients diagnosed with prostate cancer. The expression analyses were obtained from the comparison of the expressions within the tumoral and non-tumoral areas in the prostate tissue of the same patient.
Results: Separate RNA isolation was performed. Subsequent qRT-PCR analyzes were repeated three times and quality controls of the Ct values were performed on the obtained data. The Ct values of the expression of the housekeeping gene GAPDH and the target gene CENPH gene were compared in tissue (tumor and normal) and technical repeat groups. There was no statistically significant difference in CENPH gene expression between tumor and normal tissue specimens in prostate cancer. Moreover, on investigating the causes of death, in none of the patients PCa related death was determined. 
Conclusion: In our study, we could not find any relationship with prostate cancer tumorogenesis in CENPH gene expression anomalies. However, some cancers (non-small cell lung cancer, colon cancer, etc) with high CENPH gene expression are associated with tumor aggressiveness, poor prognosis and drugresistance. More studies are needed on CENPH gene expression and its effect on prostate cancer.

Aim: Convalescent plasma (CP) therapy has been used for treatment, although it has not been Corona
Virus 2019 Disease (COVID-19) specific antiviral agent so far. However, the effectiveness of CP treatment
on prognosis and mortality is still a matter of debate. In this study, we aimed to share our experiences
about the ef fectiveness of CP treatment in COVID-19.
Materials and Methods: The study was conducted in 126 patients diagnosed with COVID-19 who received
CP treatment in addition to standard treatment between May 2020 and February 2021. 126 patients were
divided into two groups as those who underwent SP within the first five days (Group A) and after five days
(Group B). The patients in these two groups were evaluated in terms of laboratory parameters, clinical
and mortality.
Results: A total of 126 patients were identified (86 patients in Group A and 40 patients in Group B). 119
(94.4%) patients were discharged with recovery, 7 (5.5%) patients died. The mean days of hospitalization
were found to be 11.4±0.7 in Group A and 18.4±1.7 in Group B (p<0.001). Treatment-related lymphocyte,
PLT, fibrinogen and CRP main effect of change was significant (p<0.001). However, the results were
marginally significant when the two groups were compared in terms of D-dimer. When the simple effect is
evaluated; Group A as not significant, while group B was significant. Starting CP treatment 5 days before
or 5 days later did not change the laboratory parameters. However, D-dimer was marginally significant
(p=0.058).
Conclusion: In our study, it was shown that early initiation of CP treatment reduced the hospitalization,
but had no ef fect on mortality and laboratory parameters.

Aim: Hypoxemia is a vital criterion used to determine prognosis in coronavirus disease (COVID-19)
cases. This study thus examined the effectiveness of capillary refill time (CRT) in defining hypoxiadependent
disease severity in COVID-19 patients.
Patients and Methods: This prospective study was conducted with COVID-19 patients and an agematched
healthy group. The optimum test ambiance was provided, and a stable smartphone platform
was used to record the measurements (in ms) to standardize our method. The captured videos were then
evaluated using a video processing program.
Results: In total, 39 patients with COVID-19 and 40 control groups participated in this study. The patients
were further divided into the moderate (n = 25) or severe group (n = 14) according to disease severity.
The mean oxygen saturation of both moderate/severe groups was above 94%. Per disease severity, the
CRT measurements were higher in the severe group than in the moderate group (p = 0.009). In patients
without lymphopenia (n = 18), CRT values were found to be increased in the severe group (p = 0.008).
The use of CRT in patients with Covid-19 was practicable (AUC: 0.91; 95% CI 0.848-0.978; P = 0.001).
Conclusions: Our results show that CRT prolongation can occur in patients with COVID-19. In patients
without lymphopenia and with normal O2 levels, detecting CRT prolongation may be a criterion for early
admission to ICU.

Abstract

INTRODUCTION

Acute mesenteric ischemia (AMI) is an acute abdominal disease which is age-related with possible bad prognosis; and while its morbidity and mortality rate is 10% in early diagnosis and treatment it may progress with 100% mortality when diagnosis and treatment are delayed.The aim of this study was to unearth the efficiency of neutrophil-to-lymphocyte ratio (NLR) which has recently been started to be utilized in the prediction of AMI prognosis and used as a prognostic factor in many diseases.

MATERIALS and METHODS:

The data of a total of 111 patients, who had undergone surgical procedures and diagnosed with mesenteric ischemia intraoperatively at Necmettin Erbakan University Meram Medical School’s General Surgery Clinic between 2005 and 2013 and whose diagnoses had later on been confirmed pathologically, were retrospectively evaluated within the scope of the study.

The demographic data of all patients (age, sex) were recorded. The hemogram results of the patients, analyzed with peripheral blood, were reviewed for preoperative evaluation. The surgical procedure performed, the part and length of the resected bowel based on pathology results, the duration of hospitalization, survey, presence of comorbidity, white blood cell count, creatinine values, and NLR of the patients were determined. The data were statistically analyzed.

RESULTS:

The patients who did not survive had a mean NLR of 24.77 ±10.38, while the same ratio was found to be 17.6±10.65 for survivors. The NLO value was found to be high in cases with mortality.

CONCLUSION:

AMI still proves to have high mortality in spite of the developments in imaging techniques and laboratory analyses. There is no specific laboratory analysis for early diagnosis. High preoperative NLR in patients suspected to have AMI may indicate bad prognosis.