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Background: The accurate indication for level IV dissection is crucial for preventing complications such as phrenic nerve damage and chylous fistulas in clinically N0 tongue cancer. Although the depth of invasion is an established independent risk factor for occult lymph node metastasis in tongue cancer, its relationship with level IV metastasis has not been evaluated. This study investigated the relationship between the depth of invasion and level IV nodal metastasis in clinically N0 tongue cancer., Methods: We retrospectively investigated clinical N0 patients who underwent glossectomy and level I-IV neck dissection. We examined lymph node metastasis, risk factors, and the relationship between depth of invasion and metastasis., Results: Our study included 58 patients, and no patient had isolated level IV metastasis. Additionally, there was no level IV metastasis in well-differentiated tumors. Tumor size, depth of invasion, differentiation, and perineural invasion were significantly associated with level IV neck metastasis. We found a critical tumor size of 2.5 cm and depth of invasion of 8 mm for level IV neck metastasis., Conclusion: Based on our findings, we recommend that level IV dissection should be considered for poorly differentiated tumors, tumors greater than 2.5 cm in size, and those deeper than 8 mm. This study highlights the importance of depth of invasion as a prognostic factor for predicting level IV metastasis and suggests that our findings can be used to prevent unnecessary level IV dissections that may lead to complications in tongue cancer surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: In clinical practice the assessment of the "vocal cord-arytenoid unit" (VCAU) mobility is crucial in the staging, prognosis, and choice of treatment of laryngeal squamous cell carcinoma (LSCC). The aim of the present study was to measure repeatability and reliability of clinical assessment of VCAU mobility and radiologic analysis of posterior laryngeal extension., Methods: In this multi-institutional retrospective study, patients with LSCC-induced impairment of VCAU mobility who received curative treatment were included; pre-treatment endoscopy and contrast-enhanced imaging were collected and evaluated by raters. According to their evaluations, concordance, number of assigned categories, and inter- and intra-rater agreement were calculated., Results: Twenty-two otorhinolaryngologists evaluated 366 videolaryngoscopies (total evaluations: 2170) and 6 radiologists evaluated 237 imaging studies (total evaluations: 477). The concordance of clinical rating was excellent in only 22.7% of cases. Overall, inter- and intra-rater agreement was weak. Supraglottic cancers and transoral endoscopy were associated with the lowest inter-observer reliability values. Radiologic inter-rater agreement was low and did not vary with imaging technique. Intra-rater reliability of radiologic evaluation was optimal., Conclusions: The current methods to assess VCAU mobility and posterior extension of LSCC are flawed by weak inter-observer agreement and reliability. Radiologic evaluation was characterized by very high intra-rater agreement, but weak inter-observer reliability. The relevance of VCAU mobility assessment in laryngeal oncology should be re-weighted. Patients affected by LSCC requiring imaging should be referred to dedicated radiologists with experience in head and neck oncology., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Rosewood (Aniba rosaeodora Ducke), which has a great demand due to its essential oil globally, is an evergreen tree of the Amazon forests. Rosewood natural stands have been depleted through deforestation and the destruction of habitat. Currently, rosewood is included in the ICUN red list of endangered species., Methods and Results: The 11 highly polymorphic primers amplified total 305 bands of which 301 (98.69%) were polymorphic. The number of effective alleles (Ne), Shannon's information index (I), overall gene diversity (Ht), gene diversity (h), and polymorphism information content (PIC) were (1.562), (0.505), (0.330), (0.337) and (0.343), respectively. These diversity indices explored high genetic diversity in rosewood germplasm. Among studied germplasm, the Santa Marta population was found most diverse by reflecting higher values of diversity indices while the Zungarococha population was found least diverse. The analysis of molecular variance (AMOVA) revealed that 79% of the genetic variation was within the populations. The STRUCTURE algorithm, unweighted pair group with arithmetic mean (UPGMA), and principal coordinate's analysis (PCoA) separated all germplasms into different population groups according to their geographic locations. Santa Marta population was found more diverse by reflecting higher values of diversity indices. The maximum genetic distance (0.868) was found between the Huajoya-10 and Nanay-3. In this investigation, iPBS- retrotransposon marker system was used to explore the genetic diversity of Peruvian rosewood germplasm., Conclusions: The results in this study such as higher genetic diversity indices, AMOVA (79%) within population and PIC value (0.343) showed the utility and reproducibility of iPBS-retrotransposons in this species successfully. The STRUCTURE algorithm separated the germplasms into six population groups according to their geographic locations. These results have valuable information for the conservation, management strategies and future breeding activities of rosewood., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To report the results of the endovascular treatment of acute-massive head and neck bleeding in a single center and underline the value of computerized tomography-angiography and endovascular treatment of this desperate patient group., Methods: Forty-eight patients who suffered from acute-massive head and neck bleeding and in whom conservative treatment options had failed were included in the study. To localize the site of the bleeding, computerized tomography-angiography was obtained above the supra-aortic level. Depending on the type and site of bleeding, an urgent angiographic evaluation and appropriate endovascular treatment procedure were performed in the same session immediately. Complete control of all active bleeding was determined as "technical success" at the end of the procedure., Results: The majority of the endovascular treatment indications were tumoral mass bleedings in this study. Eight patients, all of which had head and neck tumors as the cause of the bleeding underwent repeated interventional procedures due to acute re-bleeding. All patients left the angiography unit with technical success and dramatic clinical improvement. Two patients had procedure-related severe complications, such as contrast-induced nephropathy and acute cerebrovascular accident. One patient died due to massive re-bleeding during the follow-up period., Conclusion: Computerized tomography-angiography is a successful imaging method to reveal the location and cause of bleeding. Endovascular treatment of acute-massive head and neck bleeding is an effective and life-saver treatment option that can be used successfully with relatively low-risk potential., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The powerful fusion of on-surface synthesis and effect-directed analysis was introduced as novel tool for synthetic drug discovery, all on the same high-performance thin-layer chromatography plate. Precise automated sample application allowed both, high-throughput chemistry of 60 reactions at once and reaction miniaturization down to the 15-nmol scale. The antibiotic activity of all on-surface synthesized compounds was evaluated on the same surface via the Gram-positive Bacillus subtilis bioassay. For one product, synthesis (reaction, purification and identification) took 5.3 min and semi-quantitative biological evaluation took 2.8 min. Out of 60 on-surface reactions 10 products (17%) were identified to be more active than a well-known antibiotic reference. The concept was transferred to the Gram-negative Aliivibrio fischeri bioassay. For the first time, a new analytical platform was shown for a streamlined workflow at the most miniaturized scale from synthesis, purification, identification and quantification to semi-quantitative biological activity evaluation (all on the same chromatography plate)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Epidural hemostasis needs to use small, adapted material in minimally invasive surgery, including bilateral decompression via a unilateral approach for lumbar spinal stenosis. Most surgeons avoid external material for hemostasis because of possible neural tissue damage or complications. We compared epidural hemostasis in minimally invasive surgery by fat graft versus gelatin sponge., Methods: The design was a prospective randomized controlled in-vivo human experimental study. The 24 levels operated on for lumbar spinal stenosis were evaluated in two groups: Group A (control group: gelatin sponge) and Group B (experimental group: fat graft). International Normalized Ratio and Prothrombin Time were assessed preoperatively. Number of cotton hemostats and systolic and diastolic blood pressure were assessed intraoperatively. Epidural hemorrhage area, spinal cord size and ratio of epidural hemorrhage area to spinal cord size were evaluated on early postoperative lumbar MRI., Results: Mean epidural hemorrhage area in groups A and B was respectively 1.3±0.5 and 1.2±0.6cm 2 , and mean spinal cord size 1.2±0.6 and 1.8±0.6cm 2 on early postoperative axial lumbar MRI. The two groups did not significantly differ in ratio of epidural hemorrhage/spinal cord size or number of intraoperative hemostats (P=0.36, and P=0.71)., Conclusions: The autologous fat graft ensured sufficient and safe epidural hemostasis without serious adverse events in minimally invasive spinal surgery, and is preferable as autologous tissue is easily and quickly harvested. The surgeon feels safe with this technique and does not need external hemostatic agents., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Intramedullary tumors are uncommon neoplasms which, without treatment, can cause neurologic morbidity or mortality. The goal of the treatment is complete surgical resection with a minimally invasive approach while preserving neurological status and also spinal stability. Out of 1972 patients with tumors of the spinal canal treated between 1994 and 2017, 168 intramedullary tumors of 417 intradural tumors have been presented. All patients had undergone one surgical resection. The mean age is 43 ± 12 years (range 11-67 years). Tumors were subdivided into 4 groups: cervically located-tumors (n = 43), cervicothoracic-region-tumors (n = 32), thoracic-region-tumors (n = 57), and lumbosacral-region-tumors (n = 36). The mean follow-up time was 37 ± 29 months. Gross-total resection rate was higher in cervical located intramedullary tumors compared to the thoracic intramedullary tumors. Cervical intramedullary tumors showed better postoperative functional outcome than the thoracic intramedullary lesions. In intramedullary tumors, extending more than 3 spinal segments, postoperative worsening was significantly increased. A minimally invasive approach (the bilateral decompression via unilateral hemilaminectomy) was used to remove the tumor while preserving spinal stability. Perioperative permanent morbidity was very low. Intramedullary tumors should be surgically treated as soon as neurological symptoms appear. Patients with thoracic intramedullary tumors and tumor extension of more than three segments were at a higher risk for permanent morbidity. The minimally invasive approach allowed complete removal of the intramedullary tumors, and adequate preservation of vertebral stability while providing a good postoperative course., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background:  Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy-partial facetectomy, and to evaluate mid-term surgical outcomes., Methods:  107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests., Result:  58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant, p  = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant, p  = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes., Conclusions:  The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability., Competing Interests: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper., (Thieme. All rights reserved.)

Clinical studies demonstrated that nonalcoholic steatohepatitis is associated with liver-related outcomes in chronic hepatitis B. Furthermore, primary biliary fibrosis and biliary atresia occurred in patients with HBV infection. Interestingly, hepatitis B virus surface protein (HBs) transgenic mice spontaneously develop hepatic steatosis. Our aim is to investigate the effect of Abcb4 knockout-induced cholestasis on liver steatosis in HBs transgenic mice. Hybrids of HBs transgenic and Abcb4 -/- mice were bred on the BALB/c genetic background. Lipid synthesis, storage, and catabolism as well as proteins and genes that control lipid metabolism were analyzed using HPTLC, qPCR, western blot, electrophoretic mobility shift assay (EMSA), lipid staining, and immunohistochemistry. Hepatic neutral lipid depots were increased in HBs transgenic mice and remarkably reduced in Abcb4 -/- and HBs/Abcb4 -/- mice. Similarly, HPTLC-based quantification analyses of total hepatic lipid extracts revealed a significant reduction in the amount of triacylglycerols (TAG), while the amount of free fatty acids (FFA) was increased in Abcb4 -/- and HBs/Abcb4 -/- in comparison to wild-type and HBs mice. PLIN2, a lipid droplet-associated protein, was less expressed in Abcb4 -/- and HBs/Abcb4 -/- . The expression of genes-encoding proteins involved in TAG synthesis and de novo lipogenesis (Agpat1, Gpat1, Mgat1, Dgat1, Dgat2, Fasn, Hmgcs1, Acc1, Srebp1-c, and Pparγ) was suppressed, and AMPK and CREB were activated in Abcb4 -/- and HBs/Abcb4 -/- compared to wild-type and HBs mice. Simulating cholestatic conditions in cell culture resulted in AMPK and CREB activation while FASN and PLIN2 were reduced. A concurrent inhibition of AMPK signaling revealed normal expression level of FASN and PLIN2, suggesting that activation of AMPK-CREB signaling regulates hepatic lipid metabolism, i.e. synthesis and storage, under cholestatic condition. In conclusions, in vivo and mechanistic in vitro data suggest that cholestasis reduces hepatic lipid storage via AMPK and CREB signaling. The results of the current study could be the basis for novel therapeutic strategies as NASH is a crucial factor that can aggravate chronic liver diseases.

Purpose: To investigate the relationship between CD133 positivity and radiotherapy (RT) response in early stage glottic laryngeal cancers., Methods: Thirty seven patients with early-stage glottic laryngeal carcinoma who were treated with primary RT were evaluated. Patients with regular follow-up of at least 3 years were included in the study. Patients who had previously received chemotherapy for laryngeal surgery or underwent surgery were excluded. The patients were divided into two groups as recurrent and non-recurrent. These two groups were compared in terms of CD133 expression by immunohistochemical method., Results: There were 37 patients in the study. Ten patients had recurrence and seven (70%) had CD133 positive and three had CD133 negative. Of 27 patients who had no recurrence, 16 (59%) had CD133 positive and 11 (41%) had CD133 negative. 7 (70%) of ten patients with recurrence were found to be positive for CD133; There was no statistically significant difference between recurrent and non-recurrent patient groups in terms of CD133 positivity (p > 0.05). There was no correlation between the final CD133 score and recurrence status as well (p > 0.05)., Conclusion: There was no relationship between radiotherapy response and CD133 staining in early-stage glottic laryngeal cancers. It is the largest study about CD133 and RT sensitivity in early stage glottic carcinomas.

High-performance thin-layer chromatography (HPTLC) combined with 1 H nuclear magnetic resonance (NMR) spectroscopy has only been demonstrated over a small spectral range so far. The self-printing of chromatographic plates with a modified 3D slurry printer allowed the operator to influence the composition of the adsorbent slurry and thus the purity of the adsorbent layer. The combination of such self-printed, binder-free HPTLC plates with inkjet-driven sample application made possible submicromole-scaled analytical 1 H NMR spectroscopy. This was proven using pure HPTLC adsorbents. For comparison, commercial silica gel HPTLC plates were purified by pre-development with solvents for spectroscopy, whereas commercial silica gel HPTLC particles were self-printed on the glass plate after purification under solvent pressure in a recycled HPLC cartridge. Evaluating the signals from different treatments, seven background signals disappeared in the proton spectra and three were reduced to a minimum by use of pre-developed commercial HPTLC plates. In the case of the self-printed, binder-free HPTLC plates made of purified adsorbent, most of the spectral background signals were reduced to a minimum, thus these spectra showed the highest cleanness and most pure analyte proton spectra. For the first time, the full 1 H NMR spectroscopy range was made available after an HPTLC separation. This proof of principle opens the avenue for submicromole-scaled analytical 1 H NMR spectroscopy., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: The most common peripheral neuropathy is carpal tunnel syndrome. The present study aims to describe our minimally invasive open surgical approach for carpal tunnel syndrome and evaluate surgical outcomes., Methods: We included 217 patients who were operated in our clinic for carpal tunnel syndrome by minimally invasive open surgical approach. Visual Analogue Scale and Functional Outcome Scale scores were obtained preoperative, postoperative at one month and three months to determine surgical outcomes., Results: The mean age of the patients was 55.4±12.8 years (32 to 69), 175 (80.6%) were women and 42 (19.4%) were men. The assessment of carpal tunnel syndrome's etiology showed that 189 (%87.1%) of the cases were idiopathic, 19 (8.8%) had hypothyroidism, 5 (2.3%) had rheumatoid arthritis and 4 (1.8%) were due to pregnancy. The average improvement of VAS between preoperatively and late postoperatively was 5.41±1.05. The average improvement FOS was 17.44±3.06. They were statistically significant., Conclusion: The minimally invasive open surgical approach for carpal tunnel syndrome (an average of 1 cm skin incision) is performed with local anesthesia and successful surgical outcomes are achieved., Competing Interests: Conflict of interest: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this study., (Copyright: © 2019 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Upper lumbar disc herniation (ULDH) is described mostly in levels L1-2, L2-3 and L3-4 of the lumbar spine in the literature and accounts for less than 10% of all disc herniations. The aim of our study was to evaluate the clinical characteristics and surgical results of ULDH., Methods: In all, 367 patients treated for upper lumbar disc herniation and 2137 treated for lower lumbar disc herniation (LLDH) between January 2008 and January 2017 were included. They were followed up postoperatively at 12 months by radiological investigations, back and leg pain Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Preoperative data comprised age group (20-40, 40-60, 60-80 years), gender (male, female), lumbar level (L1-2, L2-3, L3-4), side of disc herniation (left, right) and symptom duration (0-3, 3-6, 6-9 months)., Results: ODI and VAS scores improved significantly postoperatively for all patients. Of the 367 ULDH patients, 169 were female (54%) and 198 male (46%), with a mean age of 55.8±10.1 years (range, 35-71). In 174 (47.4%) patients symptom duration was 3 months, in 99 (27.0%) 3-6 months, and in 94 (25.6%) 6-9 months. At 12 months, ODI, back and leg pain VAS scores showed a significant difference in improvement according to ULDH symptom duration<3 months and to LLDH symptom duration<6 months., Conclusion: Microdiscectomy in ULDH provided sufficient and safe decompression of neural structures, with significant reduction in symptoms and disability. We suggest that early surgical treatment is an important factor for good outcome in ULDH., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Laryngocele is the cystic dilatation of laryngeal ventricle. Most cases are asymptomatic and incidentally diagnosed in radiologic examinations. Although the etiology is unclear, obstruction, laryngeal pressure, congenital defects are possible risk factors. Computed tomography is the best method for diagnosis. Endoscopic, external or combined approaches have been described in the surgical treatment. Laryngocele should be kept in mind in patients with acute upper airway obstruction. Such patients may require tracheostomy. Some patients with laryngocele can also have laryngeal cancer, in which case direct laryngoscopy must be performed. This report presents a case with respiratory distress associated with bilateral laryngocele, and his management in the light of the literature., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

The reoperation for recurrent lumbar disc herniation (LDH) causes difficulties and low surgical outcome. The operation technique which was preferred in the first surgery has gained importance in reoperation for recurrent-LDH. The aim of our study is to evaluate the efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum (LF) for recurrent lumbar disc surgery. 149 patients were evaluated in two groups in our study, who were treated for single level recurrent-LDH in our clinic. The first group contains 86 patients who were treated by lumbar microdiscectomy without preserving LF during first surgery in other clinics, the second group contains 63 patients who were treated by lumbar microdiscectomy with preserving of LF during first surgery in our clinic. We investigated age, weight, gender, recurrence-time, level-side of recurrent-LDH, the surgical outcomes and hemorrhage, complications, operation-time. The mean-age was 45,9 ± 12,9, 44,1 ± 11,6 years and mean-weight was 73,4 ± 14,4, 77,3 ± 14,2 kg in two groups. 29 patients were treated for L3-4, 63 patients for L4-5, 57 patients were treated for L5-S1 recurrent LDH. The preoperative and follow-up back-leg pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores decreased significantly in all patients (p < 0,05). The average operation-time was 70,9 ± 5,2 and 42,3 ± 4,6 min and the average surgical hemorrhage was 91,1 ± 11,3 and 50,3 ± 7,4 ml in 1. group and 2. group respectively. Preserving of LF in first surgery is gaining importance for recurrent lumbar disc surgery with protected anatomical structures. Our technique decreases complication, operation time, surgical hemorrhage and provides good surgical outcomes in recurrent lumbar disc surgery., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To evaluate long-term outcome and reoperation rate for microsurgical bilateral decompression via unilateral approach of lumbar spinal stenosis, a common degenerative spinal disease of the lumbar spine., Methods: In this observational prospective study, 918 patients were treated for single-level or multilevel lumbar spinal stenosis by bilateral decompression via unilateral approach between January 2002 and January 2016. Of 918 patients, 180 underwent microdiscectomy with decompression. Follow-up consisted of radiologic investigations, Oswestry Disability Index questionnaire, and 36-Item Short-Form Health Survey at 6 and 12 months postoperatively., Results: There were 492 female patients (53.6%) and 426 male patients (46.4%) with a mean age of 63.83 ± 10.16 years (range, 43-79 years). Symptom duration was 4-49 months. Average follow-up time was 98 months (range, 25-168 months), and reoperation rate was 2.5%. Oswestry Disability Index scores decreased significantly (from 30.65 ± 7.82 to 11.32 ± 2.50 at 6 months and 11.30 ± 2.49 at 12 months), and 36-Item Short-Form Health Survey parameter scores demonstrated a significant improvement in the early and late follow-up results., Conclusions: Bilateral decompression via unilateral approach for lumbar spinal stenosis allowed a sufficient and safe decompression of the neural structures, resulting in a highly significant reduction of symptoms and disability, acceptable reoperation rate, and improved health-related quality of life., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To investigate the relationship between the cell percentage of T regulator (Treg) cells of patients' specimens and disease severity, survivability, recurrence and metastasis in patients who were diagnosed with nasopharyngeal carcinoma (NPC)., Design, Setting and Participants: Sixty patients who were diagnosed as NPC and treated by the same protocol were enrolled to the study. Patient files were reviewed retrospectively and their clinical and pathological results were recorded. Deparaffinized samples of nasopharyngeal carcinoma patients were stained immunohistochemically with anti-FoxP3 monoclonal antibody. All patients's Anti-FoxP3 stained slides were evaluated by the same pathologist. Stained Treg lymphocytes around the tumoral foci were investigated. Patients were divided into two groups according to the total anti-FoxP3-stained Treg cell counts of the specimens; that is, less than 20% of the total or more than 20% of the total. These groups were compared statistically., Main Outcome Measures: Intensity of FoxP3 which is related to negative tumor response was the main outcome measure. It was evaluated in terms of stage, survival, recurrence and metastasis., Results: The study group consisted of 42 male patients (70%) and 18 female patients (30%). The mean age was 47 ± 14.9. NPC subtypes among the patients were undifferentiated non-keratinized type in 54 patients (90%), differentiated non-keratinized type in 4 patients (6.66%) and keratinized type squamous cell carcinoma (SCC) in 2 patients (3.33%). When the two groups were compared in terms of pathological subtype, there was no significant variation between the two groups. There was also no significant variation between the two groups when compared on the basis of tumor stage (P = 0.36 for T phase, P = 0.122 for N phase), early stage, late phase (P = 0.15), survival rate (P = 0.69 for general survival), recurrence (P = 0.2 for local recurrence, P = 0.37 for regional recurrence) and distant metastasis (P = 0.3)., Conclusion: There was no significant relationship between the concentration of these cells in the stained specimens and the disease stage, survival rate, recurrence and distant metastasis discovered., (© 2019 John Wiley & Sons Ltd.)

Thoracic disc herniation (TDH) surgery carries risks of neurological worsening due to thoracic cord retraction injury. Multiple approaches have been developed aiming for resecting the disc herniations of the thoracic segment. We have conducted a prospective observational study to evaluate the mid-term outcome of thoracic microdiscectomy with bilateral decompression via a unilateral approach (BDUA). Patients were checked pre-operative, post-operative, and late follow-up by Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and radiological images. Twenty-three patients were treated for TDH by microdiscectomy with BDUA between January 2010 and January 2015. Nine patients were female, fourteen were male, and all of those mean age was 51,2 ± 8,3 (range 29-64 years). The mean follow-up time was 22,04 ± 8,59 months (range 13-58 m). The ODI and VAS scores decreased significantly in both postoperative and late follow-up evaluations. Microdiscectomy with BDUA for thoracic disc herniations allowed sufficient and safe decompression of the neural structures and resulted in a significant reduction of symptoms and disability., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Optimization of the ionization parameters in mass spectrometry does not guarantee a sufficient response and successful signal assignment when analyzing unknown compounds presenting signals of low intensity. The interpretation is difficult as the mass signals of degradation products are often less intense than background signals. Important information may be overlooked. Such critical and time consuming data analysis was overcome by developing a new strategy and open-source software called eicCluster offering unsupervised machine learning algorithms and powerful interactive visualization tools that made data processing fast and intuitive. Using eicCluster for high-performance thin-layer chromatography coupled with high-resolution mass spectrometry, mass signals of degradation products were highlighted in a stressed formulation, which were hardly found until linked to the new software. Owed to (1) preprocessing leading to intensity-agnostic signals and (2) the t-SNE algorithm, clustering mass signals based on their similarity, even compound ions present at low intensities were separated in subclusters from background signals (in silico highlighting). The resulting 2D maps allowed a new view on the data set to target molecules (degradation products) in complex mixtures. In addition to this new source of information, targeted on-surface synthesis of degradation products (in situ highlighting) was shown to support a fast structure elucidation when standards are not commercially available. It allowed a better understanding of the proposed degradation reactions in the formulation. As proof of principle, an original example formulation, its stressed samples as well as the proposed degradation products of on-surface synthesis were compared. In silico and in situ signal highlighting substantially eased data processing in structure elucidation., (Copyright © 2018 Elsevier B.V. All rights reserved.)

On-surface reactions were introduced as a new strategy for rapid structure elucidation. This strategy is illustrated by the miniaturized synthesis-guided identification of two new degradation products (impurities) occurring in a pharmaceutical formulation of the anti-cancer drug ifosfamide, especially in the presence of urea. Synthesis on the silica gel surface bypassed the need for solvents, as the large nm-porous surface favoured a fast conversion of the reaction partners. For the on-surface synthesis of the impurities, the respective reagents were accurately and automatedly applied in the nanomole scale on a high-performance thin-layer chromatography (HPTLC) silica gel plate. After a fast reaction, the workup of the reaction mixture was performed by development of the HPTLC plate followed by online high-resolution mass spectrometry. As proof of concept and for benchmarking, a reaction mixture obtained from conventional preparative synthesis in a round-bottom flask was analysed in parallel as well as different formulations. The use of adsorbents as inert layer turned out to be highly efficient for a rapid generation and confirmation of impurities, as the synthesis on the HPTLC layer revealed them within 10 min. Image evaluation was simply performed by videodensitometry. The advantageous combination of all steps on one HPTLC plate and its resulting efficiency made surface synthesis on chromatographic phases an optimal tool for signal highlighting in mass spectrometry, and thus for the assignment of impurities in drugs. The chemistry process scale was miniaturized down to the μg-level per synthesis (in total 30-60 μg chemicals/reaction), setting a new state-of-the-art standard. All material savings clearly contribute to green chemistry, and this strategy substantially reduces the consumption of chemicals and greatly enhances the analytical efficiency, when adapted by scientists for the quality control of any other chemical product. The combination of synthesis, workup and detection in a miniaturized process, contributes to optimized workflows in a lean laboratory., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The photoinduced dynamics of two DTE-BODIPY conjugates A, B with carboxylic acid anchoring groups coupled to the surface of TiO 2 were studied by ultrafast transient absorption spectroscopy. For compound A, with an orthogonal orientation of the BODIPY chromophore and the photoswitchable DTE unit, a charge separated state could not be reliably detected. Nevertheless, besides the energy transfer from the BODIPY to the ring-closed DTE-c, indications for an electron transfer reaction were found by analyzing fluorescence quenching on TiO 2 in steady state fluorescence measurements. For compound B with a parallel orientation of chromophore and photoswitch, a charge separated state was conclusively identified for the coupled dyad (TiO 2 ) via the observation of a positive absorption signal (at λ pr   >  610 nm) at later delay times. An electron transfer rate of 7  ×  10 10 s -1 can be extracted, indicating slower processes in the dyads in comparison to previously published electron transfer reactions of DTE compounds coupled to TiO 2 .

High-performance thin-layer chromatography (HPTLC) coupled with effect-directed analysis was used for non-targeted screening of sunflower leaf extract for components exhibiting antioxidant, antibacterial and/or cholinesterase enzyme inhibitory effects. The active compounds were characterized by HPTLC-electrospray ionization-high resolution mass spectrometry (ESI-HRMS) and HPTLC-Direct Analysis in Real Time (DART)-MS/MS. The latter ambient ionization technique (less soft than ESI) resulted in oxidation and fragmentation products and characteristic fragment ions. NMR spectroscopy after targeted isolation via preparative normal phase flash chromatography and semi-preparative reversed phase high-performance liquid chromatography supported the identification of two diterpenes to be (-)-kaur-16-en-19-oic acid and 15-α-angeloyloxy-ent-kaur-16-en-19-oic acid. Both compounds found to be multi-potent as they inhibited acetylcholinesterase and butyrylcholinesterase and showed antibacterial effects against Gram-positive Bacillus subtilis and Gram-negative Aliivibrio fischeri bacteria. Kaurenoic acid was also active against the Gram-negative pepper pathogenic Xanthomonas euvesicatoria bacteria., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy., Objective: To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation., Methods: In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years)., Results: Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score., Conclusion: This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse., (Copyright © 2017 by the Congress of Neurological Surgeons)

Introduction: Leiomyosarcoma is a tumor which is rarely seen in the thyroid gland. The diagnosis may be difficult and the treatment is controversial., Objective: The objective of the study is to review the literature about a rare malignant disease of the thyroid gland which has high mortality., Methods: Two cases of thyroid leiomyosarcoma are presented and the previous 23 cases in the current literature are reviewed., Results: A total of 25 cases of thyroid leiomyosarcoma are reviewed; the most common complaint was rapidly growing anterior neck mass, and ten of the 25 patients had distant metastasis at the initial admission. Fifteen of the 25 patients died with the disease in the first 12 months after the diagnosis., Conclusion: The differential diagnosis of thyroid leiomyosarcoma is important and should be performed with other malignancies of the gland, especially with anaplastic carcinoma. The prognosis is poor and there is no consensus regarding the treatment., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

A fast and reliable quality control is important for ink manufacturers to ensure a constant production grade of mixtures and chemical formulations, and unknown components attract their attention. Structure elucidating techniques seem time-consuming in combination with column-based methods, but especially the low solubility of pigment formulations is challenging the analysis. In contrast, layer chromatography is more tolerant with regard to pigment particles. One PLC plate for NMR and FTIR analyses and one HPTLC plate for recording of high resolution mass spectra, MS/MS spectra and for gathering information on polarity and spectral properties were needed to characterize a structure, exemplarily shown for an unknown component in pigment Red 57:1 to be 3-hydroxy-2-naphtoic acid. A preparative layer chromatography (PLC) workflow was developed that used an Automated Multiple Development 2 (AMD 2) system. The 0.5-mm PLC plate could still be operated in the AMD 2 system and allowed a smooth switch from the analytical to the preparative gradient separation. Through automated gradient development and the resulting focusing of bands, the sharpness of the PLC bands was improved. For NMR, the necessary high load of the target compound on the PLC plate was achieved via a selective solvent extraction that discriminated the polar sample matrix and thus increased the application volume of the extract that could maximally be applied without overloading. By doing so, the yield for NMR analysis was improved by a factor of 9. The effectivity gain through a simple, but thoroughly chosen extraction solvent is often overlooked, and for educational purpose, it was clearly illustrated and demonstrated by an extended solvent screening. Thus, PLC using an automated gradient development after a selective extraction was proven to be a new powerful combination for structural elucidation by NMR., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: We have compared conventional Color Doppler (CD) and Power Doppler (PD) techniques, which are used for evaluating the testicular blood flow in small children, and the Superb Microvascular Imaging (SMI), which is a new technique. We have also investigated their contributions to testicular evaluations., Patients and Methods: We evaluated blood flow in testicles using a grading system with CD, PD and SMI techniques. We determined the average duration of the three techniques., Results: There was a statistically significant difference between the SMI and CD techniques for all patients (p < 0.001, p = 0.001). When we compared the PD and SMI, either as much or more vascular information was obtained (p = 0.106). There was a statistically significant difference between the application durations of the tests (p < 0.05)., Conclusions: Superb Microvascular Imaging yields more detailed vascular information in blood flow in testicles in small children, than either CD or PD. Furthermore, this technique decreases the duration of the examination at a significant level. Superb Microvascular Imaging may represent an alternative method that can be used safely for evaluating blood flow in the testicles of small children. Additional studies may increase the reliability of SMI.

Objective: To evaluate the value of E-cadherin and epithelial cell adhesion molecule (Ep-CAM) expression in laryngeal biopsy materials for predicting cervical lymph node metastasis in patients with supraglottic laryngeal carcinoma., Methods: All patients participating in the study were selected from among the surgically treated patients at the department of Otolaryngology, Head and Neck Surgery, Erciyes University School of Medicine between 1991 and 2005. The study consisted of thirty patients who had pathologically metastatic lymph nodes (pN+ group) and 30 age-, sex-, T value- and differentiation matched patients without pathologically metastatic lymph nodes (pN0 group). Immunohistochemical studies were performed with E-cadherin and Ep-CAM antibodies on representative tumor sections collected from paraffin sections of laryngeal biopsy materials. The expression of E-cadherin and Ep-CAM was compared between the pN0 and pN+ groups. The association between immunostaining of E-cadherin and Ep-CAM was also evaluated., Results: There was no significant difference between the two groups in terms of E-cadherin and Ep-CAM expression. There was also a very poor agreement between the expression of E-cadherin and Ep-CAM., Conclusion: Multi-institutional and multidisciplinary immunohistochemical studies conducted with standardized methodology and also with more patient participation may help to obtain more specific results., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: The purpose of this study was to investigate the functionality of autotransplanted thyroid tissues immediately or after cryopreservation in rabbits., Methods: The study was completed with 12 rabbits randomized in 2 groups. Preoperative scintigraphies were performed for all subjects. The rabbits underwent total thyroidectomy. The first group underwent immediate thyroid autotransplantation. Thyroid tissues of the second group were cryopreserved and autoimplanted at the eighth postoperative week. The free triiodothyronine (fT3) and thyroxine (fT4) levels were monitored for 8 weeks. Postoperative scintigraphies were performed at the eigth week after autoimplantation., Results: The subjects in the first group reached euthyroid levels at the eighth week while none of the second group reached that level, but all showed continuous increase. Although implanted thyroid tissues of 5 of the 6 rabbits in the first group were demonstrated during the first scintigraphy, the number was only 1 in the second group., Conclusion: Thyroid autografts were found to be functional and thought to have a potential preventing postoperative hypothyroidism., (© 2014 Wiley Periodicals, Inc.)

In this study, the correlation between neck metastasis and recurrence was investigated by studying specimens of tongue squamous cell carcinoma patients immunohistochemical with survivin antibodies in the primary biopsy. A retrospective review was conducted at the Academic University Hospital. 46 patients who had squamous cell carcinoma of the tongue, who underwent various types of glossectomy and neck dissections between 1991 and 2008, were evaluated. The patient's sex, TNM staging, differentiation and recurrence rates were analyzed. There were 20 T1 patients and 26 T2 patients; 27 of the patients were N0 and 19 had metastatic lymph nodes in the neck. Survivin antibodies were applied with streptavidin-biotin method to the sections that were prepared from the primary tumor biopsy specimens of the patients. The correlation between neck metastasis and recurrence and survivins' immunohistochemical staining was analyzed with statistical methods. There were no significant differences between the patient's age, sex, tumor's T stage, tumor differentiation and survivin staining density. Survivin staining was positive in 15 (79 %) of 19 patients with neck metastasis, while it was positive in 16 (59 %) of 27 patients without neck metastasis. Eleven (79 %) of the 14 patients who had recurrence and all 6 patients who had neck recurrence only were stained by survivin. Expression of nuclear and cytoplasmic survivin can be a useful marker for predicting cervical lymph node metastasis in T1-T2 tumors in tongue SCC.

Laryngeal chondrosarcoma (CS) is a very rare entity. It is usually seen in 50-80-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature.

Aim: This study aims to investigate the possible role of H. pylori as a cause of laryngeal squamous cell carcinoma., Method: This controlled study was performed with 31 consecutive laryngeal cancer and 28 cancer-free patients who underwent direct laryngoscopy and biopsy of laryngeal lesions. To document the previous H. pylori infection, serological analysis of the antibody titers was done. Immunohistochemical analyses were applied to the tissue samples., Results: Serology was found positive at the 90.3% of the laryngeal cancer patients and 96.4% of the benign group. There were no statistically significant differences between the two groups (P > 0.05). Immunohistochemical analysis results were determined as negative at all of the specimens of laryngeal cancer patients and patients with benign lesions., Conclusion: There were no signs of colonization of H. pylori in laryngeal tissues of both groups' patients. It is thought that no relationship exists between the H. pylori infection and laryngeal squamous cell carcinoma.

Background: We conducted a prospective study to investigate the clinical and radiological outcome in a surgical case series of 176 patients with 203 unruptured intracranial aneurysms (UIA)., Methods: The success of aneurysm obliteration was assessed within 2 weeks after surgery by digital subtraction angiography (DSA). Patients also underwent angiography 5 years after surgery. Clinical outcomes were assessed using the modified Rankin Scale (mRS). All predictors of poor surgical outcomes were assessed using an exact logistic regression., Results: Overall, 83 % of the patients had a good outcome (mRS score 0 or 1); 10.8 % of the patients had a slight disability (mRS score 2), and 6.2 % of the patients had a moderate or moderate-severe disability (mRS score 3 or 4). The mortality rate was 0 % overall. The most important predictors of outcome were presence of history of ischemic cerebrovascular disease and postoperative stroke. Complete aneurysm occlusion was achieved in 93.5 % of all aneurysms. Sixty percent of treated aneurysms were checked with late follow-up DSA. No cases of hemorrhage from a surgically obliterated UIA were documented in this series during the 7.3 ± 1.4 (SD)-year follow-up period., Conclusions: If patients are carefully selected and individually assigned to their optimum treatment modality, IUAs can be obliterated by surgery with a low percentage of unfavorable outcomes.

Object: The aim of this study was to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of lumbar degenerative spondylolisthesis (DS)., Methods: Operations were performed in 84 selected patients (mean age 62.1 ± 10 years) with lumbar DS between the years 2001 and 2008. The selection criteria included lower back pain with or without sciatica, neurogenic claudication that had not improved after at least 6 months of conservative treatment, and a radiological diagnosis of Grade I DS and lumbar stenosis. Decompression was performed at 3 levels in 15.5%, 2 levels in 54.8%, and 1 level in 29.7% of the patients with 1 level of spondylolisthesis. All patients were followed up for at least 24 months. For clinical evaluations, a visual analog scale, Oswestry Disability Index (ODI), and Neurogenic Claudication Outcome Score (NCOS) were used. Spinal canal size and (neutral and dynamic) slip percentages were measured both pre- and postoperatively., Results: Neutral and dynamic slip percentages did not significantly change after surgery (p = 0.67 and p = 0.63, respectively). Spinal canal size increased from 50.6 ± 5.9 to 102.8 ± 9.5 mm(2) (p < 0.001). The ODI decreased significantly in both the early and late follow-up evaluations, and good or excellent results were obtained in 64 cases (80%). The NCOS demonstrated significant improvement in the late follow-up results (p < 0.001). One patient (1.2%) required secondary fusion during the follow-up period., Conclusions: Postoperative clinical improvement and radiological findings clearly demonstrated that the unilateral approach for treating 1-level and multilevel lumbar spinal stenosis with DS is a safe, effective, and minimally invasive method in terms of reducing the need for stabilization.

The objective of the study is to report 33 cases presenting with neck masses later diagnosed with tularemia and to raise attention to this rare zoonotic infection. A retrospective analysis of 33 patients, who were diagnosed with tularemia and treated at Erciyes University Department of Otorhinolaryngology between January 2010 and December 2010 was conducted. In conclusion, because tularemia is a rare infection, its diagnosis is frequently delayed and the symptoms of the patients may last for months without any appropriate treatment. The diagnosis of tularemia rests on clinical suspicion. For the patients, who carry risk factors for tularemia and having cervical lymphadenopathies with or without oropharyngeal symptoms and who do not response to treatment with beta-lactam antibiotics, tularemia must be kept in mind.

Aim: The aim of this study is to evaluate the role of CD44 and matrix metalloproteinase (MMP)-9 expression in predicting neck metastasis of supraglottic laryngeal carcinoma., Materials and Methods: Two hundred ninety-four supraglottic laryngeal cancers were treated surgically from 1991 to 2005. Ninety-four of the 294 patients had pathologically metastatic lymph node (pN+). Among the 94 patients, 30 pN+ patients were selected via random sampling. Sex-, T value-, and differentiation-matched 30 patients who had pathologically negative neck were also selected. CD44 and MMP-9 antibodies were applied to the tumor representative sections that were derived from paraffin sections by using the streptavidin-biotin method. The association between immunohistochemical results and histopathologic lymph node metastasis was analyzed statistically. The association between immunostaining of CD44 and MMP-9 was also analyzed., Results: Overexpression of CD44 and MMP-9 was found to be significantly higher in pN+ patients. There was fair concordance between immunostaining of CD44 and MMP-9., Conclusion: Although wider multiinstitutional and multidisciplinary studies are needed to draw specific conclusions, CD44 and MMP-9 can be useful in the prediction of neck metastasis in the supraglottic laryngeal carcinoma., (Copyright © 2011 Elsevier Inc. All rights reserved.)