Background/Aims: Gastric neuroendocrine tumors (G-NETs) are rare tumors, but their incidence is gradually increasing. Despite the
existence of many classification systems, determining prognosis and planning treatment in patients with G-NETs remains a clinical
challenge. In this study, the prognostic value of the World Health Organization (WHO) 2017 grading system and the effect of surgery on
survival in low grade neuroendocrine tumors were investigated.
Materials and Methods: G-NETs who were diagnosed between January 2000 and May 2017 were included in the study. Patients’ demographic characteristics, treatment details, and survival data were obtained from medical charts. Pathological samples were re-classified
according to the WHO 2017 grading system.
Results: Of the total 94 evaluated patients, 50 (53.2%) were classified with G1 NETs, 37(39.4%) with G2 NETs, 4(4.2%) with well-differentiated G3 NETs, and the remaining 3 patients with poorly differentiated G3 neuroendocrine carcinoma (NEC). The median follow-up
time was 83.2 months. There was a statistically significant difference in 5-year progression free survival (PFS) between G1 tumors
(100%) and G2 tumors (76%) (p<0.001). However, there was no statistically significant deference in 5-year overall survival rate (OS) for
G1 (97%) and G2 (82%) tumors (p=0.141). When G2 and G1 NETs were compared according to their surgical approach, radical surgery
was more frequently performed in patients with G2 tumors (p<0.001). However, radical surgery did not improve PFS in G1 and G2 NETs.
Conclusion: The WHO 2017 NET classification system may have low prognostic value for determining the prognosis of patients with G1
and G2 tumors. Radical surgery for G1 and G2 NETs did not improve PFS in our study.
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Background/Aims: The interaction of CD40 ligand (CD40L) and CD40 triggers the induction of pro-inflammatory cytokines. It has been
proposed that vitamin D deficiency might be an important factor, which causes or aggregates the autoimmune situations. The aim of
the present study was to assess the effect of vitamin D on CD40L gene expression in patients with ulcerative colitis (UC).
Materials and Methods: Ninety mild-to-moderate UC patients were randomized to receive a single injection of 7.5 mg cholecalciferol or
1 mL normal saline. At baseline and 90 days following the intervention, RNA samples from whole blood were obtained. Fold changes in
CD40L mRNA expression were determined for each patient using the 2-ΔΔCq method. The data were analyzed.
Results: The serum levels of vitamin D and calcium increased only in the vitamin D group (p<0.05). Relative to baseline values, the CD40L
gene expression fold change was significantly lower in the vitamin D group compared with the placebo group (median±interquartile
range: 0.34±0.30 vs 0.43±1.20, respectively, p=0.016).
Conclusion: The results of this study showed that vitamin D administration in mild-to-moderate UC patients led to the downregulation
of the CD40L gene, which is an essential part of inflammatory pathways.
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Background/Aims: Two-dimensional shear-wave (2D-SWE) elastography is one of the noninvasive methods for the evaluation of liver
fibrosis. The purpose of this study is to investigate the changes in liver stiffness (LS) by employing 2D-SWE as well as its correlation
with noninvasive fibrosis markers in patients with chronic hepatitis C (CHC), who are undergoing direct-acting antiviral (DAA) therapy.
Materials and Methods: The researchers included all the patients with CHC who are scheduled for DAA treatment in this study. 2D-SWE
measurements were performed at baseline, end of treatment (EOT), and 12 weeks after the treatment. According to the latest EFSUMB guidelines, elastography measurements were performed during the ultrasonographic evaluation and recorded in kilopascals (unit). The correlation
between biochemical and viral responses, and noninvasive fibrosis scores (FIB-4, AST-to-platelet ratio index (APRI)) was also evaluated.
Results: This study employed 230 patients who underwent treatment with DAAs between September 2016 and September 2017. However, 131 patients were able to complete the study, of which 48 (36.6%) were male and 83 (63.4%) were female. The mean age was 65.0
(±11.18) years. Both EOT and sustained viral response (SVR) had the same rate of 99.2% (130/131). The SWE measurement (mean) values at pretreatment, EOT, and 12 weeks after treatment was 12.92, 10.45, and 9.07 kPa, respectively (p<0.05), whereas the APRI scores
were 0.76, 0.39, and 0.30, respectively (p<0.05). Additionally, the FIB-4 scores at pretreatment, EOT, and 12 weeks after treatment were
2.98, 2.43, and 2.03, respectively (p<0.05). The results of liver stiffness measurements (LSM) were similar in all the groups of cirrhotic,
noncirrhotic, treatment-experienced, and treatment-naive patients.
Conclusion: DAA treatments in the patients with CHC led to almost a complete SVR and a considerable decrease in LS in a short time.
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Necati ÖRMECİ ,
Murat Taner GÜLŞEN ,
Orhan SEZGİN ,
Sevda AGHAYEVA ,
Mehmet DEMİR ,
İftihar KÖKSAL ,
Rahmet GÜNER ,
Elife ERASLAN ,
Özgün Ömer ASİLLER ,
AYHAN BALKAN ,
Serkan YARAŞ ,
Aysun ÇALIŞKAN KARTAL
Background/Aims: Hepatitis C virus (HCV) infection is a common disease that causes liver cirrhosis, hepatocellular carcinoma, and
extra hepatic manifestations with high mortality and morbidity rates. This study aimed to present real-life experiences and results of
treatment of HCV infection with direct-acting antiviral agents (DAAs) from the Euro-Asian region, including Turkey and Azerbaijan.
Materials and Methods: A total of 1224 patients with chronic HCV infection were treated with DAAs in accordance with the international guidelines for the management of HCV infection. The mean age was 58.74±14.75 years, with 713 (58.25%) females. The genotypes
of the patients were as follows: genotype 1b, 83.36% (n=1024); genotype 1a, 8.08% (n=99); genotype 2, 2.85% (n=35); genotype 3,
3.34% (n=41); genotype 4, 1.71% (n=21); and combined genotypes, 0.32% (n=4). Approximately 808 patients were treated with sofosbuvir-based DAAs with or without Ribavirin for 12 or 24 weeks, whereas 416 patients were treated with the Paritaprevir, Ombitasvir,
Ritonavir.Dasabuvir (PROD) regimen with or without Ribavirin for 12 weeks or 24 weeks.
Results: At the end of follow-up examinations, 1183 patients (97.93%) had sustained virological response (SVR), 17 (1.40%) died of reasons unrelated to the treatment regimen, 12 had recurrence after treatment, and 129 (10.67%) had adverse events like anemia, itching,
and weakness.
Conclusion: In this large cohort of HCV-infected patients, treatment with DAAs yielded a high overall SVR rate of 97.93%. DAAs were
safe and well-tolerated. Thus, the elimination of HCV infection is no longer a dream worldwide.
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Background/Aims: Proton density fat fraction (PDFF) magnetic resonance (MR) imaging can be a useful technique for volumetric measurements of liver fat. The purpose of our study was to evaluate the correlation between liver fat fraction (LFF) and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in children who are overweight and obese.
Materials and Methods: Overall, 25 children, aged 9-17 years, were included. Patients with a body mass index (BMI) z-score between
85-95th percentile (12 of 25 patients) were assigned to the overweight group, and those with BMI z-score above 95th percentile (13 of 25
patients) were assigned to the obese group. The control group comprised 12 healthy children with BMI z-score below 85th percentile. Liver
fat fraction measurements were performed on 3D volume measurement workstation by using PDFF magnetic resonance (MR) images.
Spearman’s correlation coefficients between liver fat fraction and AST and ALT levels were evaluated individually for overweight, obese,
and control groups. Receiver operator characteristics (ROC) analysis was also performed.
Results: In the overweight and obese groups, the liver proton density fat fraction and AST levels had a strong correlation (r=0.716,
p<0.001). In addition, the LFF and ALT levels demonstrated a strong correlation (r=0.878, p<0.001). ROC analysis ascertained an optimal
liver fat fraction threshold of 114 for predicting AST level (sensitivity=75%, specificity=89%). ROC analysis ascertained an optimal LFF
threshold of 114 for predicting ALT level (sensitivity=80%, specificity=90%).
Conclusion: Our results indicate a strong correlation between LFF values and AST and ALT levels in children who are overweight and
obese
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Acute and chronic pancreatitides carry a significant disease burden with no definite treatment. They are associated with local and
systemic inflammation and lead to numerous complications. Stem cell therapy has been explored for treating other diseases and has
gained momentum due to its implications for acute and chronic pancreatitis. Stem cell therapy not only has the potential to aid regeneration but can also prevent pancreatic injury, injury to other organs along with the resultant complications. Stem cells appear to
have immunomodulatory properties and clinical potential as evidenced by numerous studies conducted on animal models. This review
discusses commonly used stem cells and their respective properties that show promise for treating pancreatitis.
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Background/Aims: The occurrence of gastrointestinal symptoms and the presence of small intestinal bacterial overgrowth (SIBO) could
be determined after ingestion of substrate with highly concentrated glucose for glucose breath test (GBT), after which endoscopic images for acute gastric injury have not been clarified. The aims of this study were to investigate the prevalence and relationship of acute
gastric injury with SIBO after GBT.
Materials and Methods: A cohort of 235 patients with functional gastrointestinal symptoms undergoing breath test with 50 g glucose
solution, immediately followed by upper endoscopy were surveyed. The acute gastric injury in endoscopic images and the GBT for hydrogen (H2) or methane (CH4) were assessed.
Results: The prevalence of acute gastric injury was 28.1% (66/235) after GBT. There were significant differences in GBT positivity (+)
with and without gastric injury (25.8% vs 40.8%, p=0.03). In subtypes, GBT (H2) + was significantly lower in group with gastric injury than
in the group without. No differences were seen in GBT (CH4) + between two groups. On multivariate analysis, the subtype of GBT (H2) +
(Odds ratio (OR)=0.42; 95% Confidence interval (CI)=0.20-0.90; p=0.03) inversely and female (OR=2.11; 95% CI=1.11-4.00; p=0.02) were
significantly related with gastric injury. Whereas gastric injury was the only independent related factor for GBT + inversely (OR=0.51;
95% CI=0.27-0.97; p=0.04).
Conclusion: Highly concentrated glucose might provoke acute gastric injury, which could predict the absence of SIBO.
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Background/Aims: A novel medical device based on hyaluronic acid, chondroitin sulfate plus aluminum hydroxide [GERDOFF® (SOFAR
S.p.A., Trezzano Rosa, Italy), melt-in-mouth tablets] showed efficacy in reducing gastroesophageal reflux (GER)-related symptoms. This
exploratory, open-label study aimed to evaluate symptomatic effects of a 14-day treatment with GERDOFF® in gastroesophageal
reflux disease (GERD) patients.
Materials and Methods: GERD Impact Scale (GIS) questionnaire was filled at baseline visit and after 7 and 14 days of treatment; patients’ global satisfaction was evaluated at the final visit. Primary endpoint was the reduction of heartburn episodes per week; secondary
endpoints were GERD-related symptoms, patients’ satisfaction, and safety.
Results: A total of 40 patients were included, of which, 22 were on stable therapy with proton pump inhibitor (PPI). Compared with
baseline, the days with heartburn episodes and the GIS score progressively decreased during the first (p<0.0001) and the second weeks
of treatment (p<0.0001). Heartburn episodes per week (p<0.0001) and the GIS score (p<0.0001) decreased in the first and the last 7 days
of the 14-day treatment and did not differ between patients on and off PPI. The treatment was safe and well-tolerated, and it was rated
as very good (46.2%) or good (43.6%) on the satisfaction questionnaire.
Conclusion: GERDOFF® could effectively treat GER symptoms in patients not responding to PPI or alginate-based formulation. ISRCTN_15143752.
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Background/Aims: Intraoperative blood loss of more than 400 ml during gastrointestinal surgery is an independent predictor of mortality. Desmopressin acetate (1-deamino-8-D-arginine vasopressin [DDAVP]) could reduce perioperative blood loss. Few studies have
prompted concerning the effects of DDAVP on gastrointestinal surgery. This study aimed to investigate whether DDAVP can decrease
blood loss in patients with massive hemorrhage undergoing gastrointestinal surgery.
Materials and Methods: A multiple-center, double-blind clinical trial was conducted; patients who underwent gastrointestinal surgery
were recruited from three hospitals and were randomly assigned to two different groups. Patients in the treatment group received
desmopressin in a dosage of 0.3 μg kg–1, 30 min once a day after the surgery; patients in the control group received 50 ml saline for 30
min. The primary outcome was the changes of hemoglobin at 24 h after the surgery, and the secondary outcomes included coagulation
function, urine volume, serum creatinine, and safety.
Results: There were 59 patients enrolled between June 1, 2015, and June 1, 2017. At 24 h after the surgery, the decrease in hemoglobin in
the DDAVP group was significantly lower than that in the Normal Saline (NS) group (–5.0±6.9 g l–1 versus –10.2±9.3 g l–1, p=0.03). Sonoclot® showed that the platelet function in the DDAVP group was higher than that in the NS group at 24 h (2.56±0.59 versus 1.91±0.72,
p<0.05). There was no difference in urine volume and serum creatinine at 24 h between the two groups.
Conclusion: DDAVP could reduce post-operation blood loss in patients with massive hemorrhage undergoing surgery by improving the
platelet function. We observed no difference in urine volume and serum creatinine in two groups.
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Background/Aims: Bladder and bowel dysfunctions are both prevalent health problems in pediatric population. The Childhood Bladder
and Bowel Dysfunction Questionnaire (CBBDQ) is a parent-reported tool to evaluate and quantitatively assess bladder and bowel dysfunction symptoms in pediatric patients. This study aimed to translate the CBBDQ into Turkish language and culturally adapt it for use
among 5-12-year-old children. Moreover, this study was also aimed to determine the reliability and the construct validity of the Turkish
version. The main hypothesis of our study was that the CBBDQ would be translated into Turkish and culturally adapted so that Turkish
parents could understand it. Additionally, we estimated that the Turkish version would have eventual internal consistency and test-retest reliability and admissible construct validity.
Materials and Methods: The CBBDQ was translated into Turkish language as per the guidelines and given two times to the parents of
children with one-week interval to assess the test-retest reliability. The internal consistency was determined using the Cronbach’s α value and the test-retest reliability was calculated using the inter-rater correlation coefficient. In the estimation of the construct validity,
the dysfunctional voiding and incontinence scoring system (DVISS) and the pediatric quality of life inventory (PedsQL) in 5-12-year-old
children were used as the external criteria.
Results: The participants were parents of 5-12-year-old children. The internal consistency was 0.83, that was the Cronbach’s α value,
which reflects a good result. The Turkish-CBBDQ5-12y and the DVISS showed a satisfactory correlation (r=0.64 p<0.001). There was no
correlation between the Turkish-CBBDQ5-12y and the PedsQL-General Health and PedsQL-Psychological Health (r=–0.17, p=0.1 and
r=0.12, p=0.25, respectively).
Conclusion: The Turkish-CBBDQ5-12y is a reliable and valid instrument in terms of content and construction and can be safely used in
clinical practice.
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