Chronic pancreatitis(CP)is a condition characterized by persistent and often severe pain resulting from the inflammatory disease of the pancreas.While pharmacological treatments play a significant role in palliative p...Chronic pancreatitis(CP)is a condition characterized by persistent and often severe pain resulting from the inflammatory disease of the pancreas.While pharmacological treatments play a significant role in palliative pain management,some patients require non-pharmacological methods.This review article focuses on non-pharmacological approaches used to alleviate pain in CP.The article examines non-pharmacological palliation options,including surgery,endoscopic approaches,neurostimulation techniques,acupuncture,and other alternative medicine methods.The effectiveness of each method is evaluated,taking into consideration patient compliance and side effects.Additionally,this article emphasizes the importance of personalized pain management in CP and underscores the need for a multidisciplinary approach.It aims to summarize the existing knowledge on the use of non-pharmacological palliation methods to improve the quality of life for patients with CP.展开更多
AIM: To evaluate the accuracy of red cell distribution width(RDW) to platelet ratio(RPR) to predict in-hospital mortality in acute pancreatitis(AP).METHODS: Between January 2010 and June 2012, 102 patients with AP wer...AIM: To evaluate the accuracy of red cell distribution width(RDW) to platelet ratio(RPR) to predict in-hospital mortality in acute pancreatitis(AP).METHODS: Between January 2010 and June 2012, 102 patients with AP were recruited to the study. In this retrospective cohort study, for all subjects, demographic data on hospital admission, AP etiology, comorbid diseases, organ failure assessment, laboratory parameters and length of hospital stay were examined. Additionally, we used a non-invasive prediction method in addition to the RPR to evaluate the disease severity. Multivariate logistic regression analyses were used to evaluate the impact of RPR on hospital admission to predict mortality.RESULTS:The male-female ratio(59/43)was 1.37with a median age of 56.5 years(17-89 years).In both univariate and multivariate analyses,RDW and RPR were presented as independent and significant variables on admission to predict mortality.The RPR obtained on hospital admission was persistently higher amongnon-survivors than among survivors(P<0.0001).The median RPR was 0.000087 in the non-survivor group and 0.000058 in the survivor group.RPR with a cutoff value of 0.000067 presented an area under the curve of 0.783(95%CI:0.688-0.878)in receiver operating characteristic curves and could predict the mortality of approximately 80%of the patients.展开更多
Gastric cancer is the second most common cancer worldwide and the second most common cause of cancer-related deaths. Despite complete resection of gastric cancer and lymph node dissection, as well as improvements in c...Gastric cancer is the second most common cancer worldwide and the second most common cause of cancer-related deaths. Despite complete resection of gastric cancer and lymph node dissection, as well as improvements in chemotherapy and radiotherapy, there are still 700 000 gastric cancer-related deaths per year worldwide and more than 80% of patients with advanced gastric cancer die of the disease or recurrent disease within 1 year after diagnosis. None of the treatment modalities we have been applying today can influence the overall survival rates:at present, the overall 5-year relative survival rate for gastric cancer is about 28%. Cellular metaplasia due to chronic inflammation, injury and repair are the most documented processes for neoplasia. It appears that chronic inflammation stimulates tumor development and plays a critical role in initiating, sustaining and advancing tumor growth. It is also evident that not all inflammation is tumorigenic. Additional mutations can be acquired, and this leads to the cancer cell gaining a further growth advantage and acquiring a more malignant phenotype. Intestinalization of gastric units, which is called "intestinal metaplasia"; phenotypic antralization of fundic units, which is called "spasmolytic polypeptide-expressing metaplasia"; and the development directly from the stem/progenitor cellzone are three pathways that have been described for gastric carcinogenesis. Also, an important factor for the development of gastrointestinal cancers is peritumoral stroma. However, the initiating cellular event in gastric metaplasia is still controversial. Understanding gastric carcinogenesis and its precursor lesions has been under intense investigation, and our paper attempts to highlight recent progress in this field of cancer research.展开更多
Colorectal carcinoma(CRC)is the third most common cancer,and approximately 35%-55%of patients with CRC will develop hepatic metastases during the course of their disease.Surgical resection represents the only chance o...Colorectal carcinoma(CRC)is the third most common cancer,and approximately 35%-55%of patients with CRC will develop hepatic metastases during the course of their disease.Surgical resection represents the only chance of long-term survival.The goal of surgery should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma.Although resection remains the only chance of long-term survival,management strategies should be tailored for each case.For patients with extensive metastatic disease who would otherwise be unresectable,the combination of advances in medical therapy,such as systemic chemotherapy(CTX),and the improvement in surgical techniques for metastatic disease,have enhanced prognosis with prolongation of the median survival rate and cure.The use of portal vein embolization and preoperative CTX may also increase the number of patients suitable for surgical treatment.Despite current treatment options,many patients still experience a recurrence after hepatic resection.More active systemic CTX agents are beingused increasingly as adjuvant therapy either before or after surgery.Local tumor ablative therapies,such as microwave coagulation therapy and radiofrequency ablation therapy,should be considered as an adjunct to hepatic resection,in which resection cannot deal with all of the tumor lesions.Formulation of an individualized plan,which combines surgery with systemic CTX,is a necessary task of the multidisciplinary team.The aim of this paper is to discuss different approaches for patients that are treated due to CRC liver metastasis.展开更多
AIM To evaluate the prognostic significance of neutrophilto-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), lymphocyte-to-monocyte ratio(LMR), and prognostic nutritional index(PNI) and other clinicopathologi...AIM To evaluate the prognostic significance of neutrophilto-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), lymphocyte-to-monocyte ratio(LMR), and prognostic nutritional index(PNI) and other clinicopathological factors in patients undergoing curative resection of colon cancer.METHODS183 patients with histologically proven colorectal cancer who had undergone potentially curative resection between 2010 and 2016 at Ankara Numune Training and Research Hospital were retrospectively analyzed and clinicopathological characteristics included age, sex, tumor type, grade, size and localization, the number of metastatic and total number of lymph nodes removed, vascular and perineural invasion of the tumor, TNM stages, tumor marker levels(CEA, CA19-9, AFP, CA-125, CA15-3), complete blood counts, albumin levels, overall survival(months), NLR, PLR, LMR and PNI ratios were retrospectively reviewed and analyzed from the electronic database. The primary outcome measure was overall survival.RESULTS Regarding overall survival, on univariate analysis the following variables were significantly associated with poor outcome following resection: T-stage(P = 0.037), lymph node invasion(P = 0.037), cancer stage(P = 0.034), CEA(P = 0.042), CA19-9(P = 0.004), and PNI(P = 0.001). To evaluate the independent prognostic value, multivariate Cox proportional hazard analysis to control for other prognostic factors was used. Using cancer-specific death as an end point for NLR, PLR, LMR, PNI and CA19-9 the optimal cut off values were calculated by ROC analysis. Regarding overall survival, on multivariate analysis high CA19-9(HR = 1.001, 95%CI: 1.00-1.002, P = 0.012) and low PNI(HR = 0.938, 95%CI: 0.891-0.987, P = 0.014) were the only variables independently associated with shortened overall survival. Patients with a PNI < 35 had a median OS of 52.25 mo. In contrast, patients with an PNI > 35 had a median OS of 66 mo. Patients with a CA 19-9 < 17 had a median OS of 66 mo and in patients with a CA19-9 > 17 had a median OS of 53.76 mo.CONCLUSION This study shows that decrease in the PNI and increase in CA 19-9 is associated with poor survival in patients with resectable colon cancer.展开更多
BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19%in critical and elderly patients.Percutaneous cholecystostomy(PC)can be considere...BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19%in critical and elderly patients.Percutaneous cholecystostomy(PC)can be considered as a safer option with a significantly lower complication rate in these patients.AIM To assess the clinical course of acute cholecystitis(AC)in patients we treated with PC.METHODS The study included 82 patients with GradeⅠ,ⅡorⅢAC according to the Tokyo Guidelines 2018(TG18)and treated with PC.The patients’demographic and clinical features,laboratory parameters,and radiological findings were retrospectively obtained from their medical records.RESULTS Eighty-two patients,45(54.9%)were male,and the median age was 76(35-98)years.According to TG18,25 patients(30.5%)had GradeⅠ,34(41.5%)GradeⅡ,and 23(28%)GradeⅢAC.The American Society of Anesthesiologists(ASA)physical status score wasⅢor more in 78 patients(95.1%).The patients,who had been treated with PC,were divided into two groups:discharged patients and those who died in hospital.The groups statistically significantly differed only concerning the ASA score(P=0.0001)and WBCC(P=0.025).Two months after discharge,two patients(3%)were readmitted with AC,and the intervention was repeated.Nine of the discharged patients(13.6%)underwent interval open cholecystectomy or laparoscopic cholecystectomy(8/1)within six to eight weeks after PC.The median follow-up time of these patients was 128(12-365)wk,and their median lifetime was 36(1-332)wk.CONCLUSION For high clinical success in AC treatment,PC is recommended for high-risk patients with moderate-severe AC according to TG18,elderly patients,and especially those with ASA scores of≥Ⅲ.According to our results,PC,a safe,effective and minimally invasive treatment,should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.展开更多
Objective: We aimed to identify the ratio of Surgical Site Infection (SSI) and also the validity of the National Nosocomial Infection Survellance (NNIS) and Study on the Efficacy of Nosocomial Infection Control (SENIC...Objective: We aimed to identify the ratio of Surgical Site Infection (SSI) and also the validity of the National Nosocomial Infection Survellance (NNIS) and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk indexes in colorectal surgery, among Turkish population. Background: Some problems have been reported with the power of NNIS risk index to predict the risk of surgical site infection. We aimed to validate theNNIS and SENIC risk indexes in colorectal surgery. Methods: Between January 2003 and December 2006, surgical site ?nfection survellance was performed to 107 patient who undergo colorectal surgery with NNIS and SENIC risk scales. The mean patient age was 48 years (range, 17 to 86), and 61.7% of the group (66) was female. For this patient cohort, 6 (5.6%) were diagnosed with incisional SSI. While the mean Body Mass Index (BMI) of all patients was 26.6;mean value of BMI among the patiens with SSI was 27.8.Results: 6 insicional surgical site infection were observed during the study. According to Receiver Operating Characteric (ROC) curve analyze neither NNIS with avalue of 0.70, nor SENIC with a value of 0.67 are perfect risk indexes. Conclusion: As a result both NNIS and SENIC ?s a good risk indexes but not perfect. Scarcely when NNIS and SENIC is used together to predict the SSI they forecast the development of infection better. But there is a lot of other factors that effect the development of SSI, so for excellent surveillance risk index those factors known by everyone must be added to risk index scales.展开更多
1|INTRODUCTION We can see the fractals in our environment every day(trees,snowflakes,broccoli,etc.).Even the shapes of the DNA helix and anatomical structures are fractal,for example,the branching of blood vessels,bro...1|INTRODUCTION We can see the fractals in our environment every day(trees,snowflakes,broccoli,etc.).Even the shapes of the DNA helix and anatomical structures are fractal,for example,the branching of blood vessels,bronchi,and cell membranes[1].Unlike euclidean geometry,fractal geometry reveals how an object with irregularities in many dimensions can be identified by examining how the number of features in one dimension relates to the number of similarly shaped features in other dimensions[2].展开更多
Over the last 30 years,a new actor in the area of ecology and evolution has emerged:niche construction theory(NCT).The fundamental premise of NCT is that organisms may actively influence evolutionary processes by modi...Over the last 30 years,a new actor in the area of ecology and evolution has emerged:niche construction theory(NCT).The fundamental premise of NCT is that organisms may actively influence evolutionary processes by modifying their circumstances[1].According to Trappes et al.,[2]the concept of niche construction should only be applied to species that alter their environment,which they believe to be its intuitive scope.They add two more terms to describe the ways that organisms engage with their surroundings and so influence their niches:when organisms choose their environment,this is known as niche choice,and when they adapt their phenotype to fit their environment,this is known as niche conformance.These three concepts are often referred to as niche-altering mechanisms,or NC3 mechanisms:niche conformance,niche construction,and niche choice.This is in line with definitions of mechanisms developed in scientific philosophy[2].展开更多
文摘Chronic pancreatitis(CP)is a condition characterized by persistent and often severe pain resulting from the inflammatory disease of the pancreas.While pharmacological treatments play a significant role in palliative pain management,some patients require non-pharmacological methods.This review article focuses on non-pharmacological approaches used to alleviate pain in CP.The article examines non-pharmacological palliation options,including surgery,endoscopic approaches,neurostimulation techniques,acupuncture,and other alternative medicine methods.The effectiveness of each method is evaluated,taking into consideration patient compliance and side effects.Additionally,this article emphasizes the importance of personalized pain management in CP and underscores the need for a multidisciplinary approach.It aims to summarize the existing knowledge on the use of non-pharmacological palliation methods to improve the quality of life for patients with CP.
基金Supported by Ankara Numune Education and Research Hospital
文摘AIM: To evaluate the accuracy of red cell distribution width(RDW) to platelet ratio(RPR) to predict in-hospital mortality in acute pancreatitis(AP).METHODS: Between January 2010 and June 2012, 102 patients with AP were recruited to the study. In this retrospective cohort study, for all subjects, demographic data on hospital admission, AP etiology, comorbid diseases, organ failure assessment, laboratory parameters and length of hospital stay were examined. Additionally, we used a non-invasive prediction method in addition to the RPR to evaluate the disease severity. Multivariate logistic regression analyses were used to evaluate the impact of RPR on hospital admission to predict mortality.RESULTS:The male-female ratio(59/43)was 1.37with a median age of 56.5 years(17-89 years).In both univariate and multivariate analyses,RDW and RPR were presented as independent and significant variables on admission to predict mortality.The RPR obtained on hospital admission was persistently higher amongnon-survivors than among survivors(P<0.0001).The median RPR was 0.000087 in the non-survivor group and 0.000058 in the survivor group.RPR with a cutoff value of 0.000067 presented an area under the curve of 0.783(95%CI:0.688-0.878)in receiver operating characteristic curves and could predict the mortality of approximately 80%of the patients.
文摘Gastric cancer is the second most common cancer worldwide and the second most common cause of cancer-related deaths. Despite complete resection of gastric cancer and lymph node dissection, as well as improvements in chemotherapy and radiotherapy, there are still 700 000 gastric cancer-related deaths per year worldwide and more than 80% of patients with advanced gastric cancer die of the disease or recurrent disease within 1 year after diagnosis. None of the treatment modalities we have been applying today can influence the overall survival rates:at present, the overall 5-year relative survival rate for gastric cancer is about 28%. Cellular metaplasia due to chronic inflammation, injury and repair are the most documented processes for neoplasia. It appears that chronic inflammation stimulates tumor development and plays a critical role in initiating, sustaining and advancing tumor growth. It is also evident that not all inflammation is tumorigenic. Additional mutations can be acquired, and this leads to the cancer cell gaining a further growth advantage and acquiring a more malignant phenotype. Intestinalization of gastric units, which is called "intestinal metaplasia"; phenotypic antralization of fundic units, which is called "spasmolytic polypeptide-expressing metaplasia"; and the development directly from the stem/progenitor cellzone are three pathways that have been described for gastric carcinogenesis. Also, an important factor for the development of gastrointestinal cancers is peritumoral stroma. However, the initiating cellular event in gastric metaplasia is still controversial. Understanding gastric carcinogenesis and its precursor lesions has been under intense investigation, and our paper attempts to highlight recent progress in this field of cancer research.
文摘Colorectal carcinoma(CRC)is the third most common cancer,and approximately 35%-55%of patients with CRC will develop hepatic metastases during the course of their disease.Surgical resection represents the only chance of long-term survival.The goal of surgery should be to resect all metastases with negative histological margins while preserving sufficient functional hepatic parenchyma.Although resection remains the only chance of long-term survival,management strategies should be tailored for each case.For patients with extensive metastatic disease who would otherwise be unresectable,the combination of advances in medical therapy,such as systemic chemotherapy(CTX),and the improvement in surgical techniques for metastatic disease,have enhanced prognosis with prolongation of the median survival rate and cure.The use of portal vein embolization and preoperative CTX may also increase the number of patients suitable for surgical treatment.Despite current treatment options,many patients still experience a recurrence after hepatic resection.More active systemic CTX agents are beingused increasingly as adjuvant therapy either before or after surgery.Local tumor ablative therapies,such as microwave coagulation therapy and radiofrequency ablation therapy,should be considered as an adjunct to hepatic resection,in which resection cannot deal with all of the tumor lesions.Formulation of an individualized plan,which combines surgery with systemic CTX,is a necessary task of the multidisciplinary team.The aim of this paper is to discuss different approaches for patients that are treated due to CRC liver metastasis.
文摘AIM To evaluate the prognostic significance of neutrophilto-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), lymphocyte-to-monocyte ratio(LMR), and prognostic nutritional index(PNI) and other clinicopathological factors in patients undergoing curative resection of colon cancer.METHODS183 patients with histologically proven colorectal cancer who had undergone potentially curative resection between 2010 and 2016 at Ankara Numune Training and Research Hospital were retrospectively analyzed and clinicopathological characteristics included age, sex, tumor type, grade, size and localization, the number of metastatic and total number of lymph nodes removed, vascular and perineural invasion of the tumor, TNM stages, tumor marker levels(CEA, CA19-9, AFP, CA-125, CA15-3), complete blood counts, albumin levels, overall survival(months), NLR, PLR, LMR and PNI ratios were retrospectively reviewed and analyzed from the electronic database. The primary outcome measure was overall survival.RESULTS Regarding overall survival, on univariate analysis the following variables were significantly associated with poor outcome following resection: T-stage(P = 0.037), lymph node invasion(P = 0.037), cancer stage(P = 0.034), CEA(P = 0.042), CA19-9(P = 0.004), and PNI(P = 0.001). To evaluate the independent prognostic value, multivariate Cox proportional hazard analysis to control for other prognostic factors was used. Using cancer-specific death as an end point for NLR, PLR, LMR, PNI and CA19-9 the optimal cut off values were calculated by ROC analysis. Regarding overall survival, on multivariate analysis high CA19-9(HR = 1.001, 95%CI: 1.00-1.002, P = 0.012) and low PNI(HR = 0.938, 95%CI: 0.891-0.987, P = 0.014) were the only variables independently associated with shortened overall survival. Patients with a PNI < 35 had a median OS of 52.25 mo. In contrast, patients with an PNI > 35 had a median OS of 66 mo. Patients with a CA 19-9 < 17 had a median OS of 66 mo and in patients with a CA19-9 > 17 had a median OS of 53.76 mo.CONCLUSION This study shows that decrease in the PNI and increase in CA 19-9 is associated with poor survival in patients with resectable colon cancer.
文摘BACKGROUND Although cholecystectomy is the standard treatment modality,it has been shown that perioperative mortality is approaching 19%in critical and elderly patients.Percutaneous cholecystostomy(PC)can be considered as a safer option with a significantly lower complication rate in these patients.AIM To assess the clinical course of acute cholecystitis(AC)in patients we treated with PC.METHODS The study included 82 patients with GradeⅠ,ⅡorⅢAC according to the Tokyo Guidelines 2018(TG18)and treated with PC.The patients’demographic and clinical features,laboratory parameters,and radiological findings were retrospectively obtained from their medical records.RESULTS Eighty-two patients,45(54.9%)were male,and the median age was 76(35-98)years.According to TG18,25 patients(30.5%)had GradeⅠ,34(41.5%)GradeⅡ,and 23(28%)GradeⅢAC.The American Society of Anesthesiologists(ASA)physical status score wasⅢor more in 78 patients(95.1%).The patients,who had been treated with PC,were divided into two groups:discharged patients and those who died in hospital.The groups statistically significantly differed only concerning the ASA score(P=0.0001)and WBCC(P=0.025).Two months after discharge,two patients(3%)were readmitted with AC,and the intervention was repeated.Nine of the discharged patients(13.6%)underwent interval open cholecystectomy or laparoscopic cholecystectomy(8/1)within six to eight weeks after PC.The median follow-up time of these patients was 128(12-365)wk,and their median lifetime was 36(1-332)wk.CONCLUSION For high clinical success in AC treatment,PC is recommended for high-risk patients with moderate-severe AC according to TG18,elderly patients,and especially those with ASA scores of≥Ⅲ.According to our results,PC,a safe,effective and minimally invasive treatment,should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.
文摘Objective: We aimed to identify the ratio of Surgical Site Infection (SSI) and also the validity of the National Nosocomial Infection Survellance (NNIS) and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk indexes in colorectal surgery, among Turkish population. Background: Some problems have been reported with the power of NNIS risk index to predict the risk of surgical site infection. We aimed to validate theNNIS and SENIC risk indexes in colorectal surgery. Methods: Between January 2003 and December 2006, surgical site ?nfection survellance was performed to 107 patient who undergo colorectal surgery with NNIS and SENIC risk scales. The mean patient age was 48 years (range, 17 to 86), and 61.7% of the group (66) was female. For this patient cohort, 6 (5.6%) were diagnosed with incisional SSI. While the mean Body Mass Index (BMI) of all patients was 26.6;mean value of BMI among the patiens with SSI was 27.8.Results: 6 insicional surgical site infection were observed during the study. According to Receiver Operating Characteric (ROC) curve analyze neither NNIS with avalue of 0.70, nor SENIC with a value of 0.67 are perfect risk indexes. Conclusion: As a result both NNIS and SENIC ?s a good risk indexes but not perfect. Scarcely when NNIS and SENIC is used together to predict the SSI they forecast the development of infection better. But there is a lot of other factors that effect the development of SSI, so for excellent surveillance risk index those factors known by everyone must be added to risk index scales.
文摘1|INTRODUCTION We can see the fractals in our environment every day(trees,snowflakes,broccoli,etc.).Even the shapes of the DNA helix and anatomical structures are fractal,for example,the branching of blood vessels,bronchi,and cell membranes[1].Unlike euclidean geometry,fractal geometry reveals how an object with irregularities in many dimensions can be identified by examining how the number of features in one dimension relates to the number of similarly shaped features in other dimensions[2].
文摘Over the last 30 years,a new actor in the area of ecology and evolution has emerged:niche construction theory(NCT).The fundamental premise of NCT is that organisms may actively influence evolutionary processes by modifying their circumstances[1].According to Trappes et al.,[2]the concept of niche construction should only be applied to species that alter their environment,which they believe to be its intuitive scope.They add two more terms to describe the ways that organisms engage with their surroundings and so influence their niches:when organisms choose their environment,this is known as niche choice,and when they adapt their phenotype to fit their environment,this is known as niche conformance.These three concepts are often referred to as niche-altering mechanisms,or NC3 mechanisms:niche conformance,niche construction,and niche choice.This is in line with definitions of mechanisms developed in scientific philosophy[2].
