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Can NLR/PLR/CEA be a marker for predicting a complete pathological response in locally advanced rectal cancer?

Aim: The standard treatment for locally advanced (T3-4 and/or N +) rectal cancer (LARC) is Total Mesorectal Excision (TME) and adjuvant chemotherapy after neoadjuvant chemo-radiotherapy (n-CRT). Various clinical or pathological complete response (pCR) rates after neoadjuvant therapy have been reported in the literature. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) or carcinoembryonic antigen (CEA) levels are used as prognostic markers for many tumors.The aim of this study is to investigate the relationship between treatment response and the above markers in patients receiving n-CRT for LARC.

Material and Methos: The pathology results of 113 patients who underwent TME after n-CRT were divided into 4 groups according to the modified ryan tumor regression grade (TRG) classification. Among these groups, NLR, PLR and CEA levels, which are considered prognostic markers in response evaluation, were compared with their changes before and after neoadjuvant treatment.

Results: While 11 (9,7%) patients had pCR (TRG 0), 41 (36,3%) patients had good response (TRG 0 and 1), 72 (63,7%) patients had a poor response (TRG 2 and 3) to n-CRT. While the initial prognostic markers were similar between the groups, post-n-CRT values were found to be significantly lower in the group with good response.

Discussion: It is not possible to predict n-CRT response in LARC patients at the time of diagnosis, but NLR, PLR or CEA values and changes in these values may be useful in predicting treatment response.

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How does the obstetric anesthesia in cesarean section affect the wellbeing of the newborn?

Aim: The well-being of newborns after a cesarean section (CS) is the main important point when choosing anesthetic methods. APGAR score, cord blood gas levels, and early feeding of the newborns after CS are indicators of the newborn’s well-being.

In this study, it was aimed to evaluate the effects of different anesthesia methods (regional and general) on Apgar score and cord blood gas, and the second aim is to evaluate the onset time of breastfeeding after CS with  different anesthesia methods.

Material and Methods: A total of 364 mothers who underwent CS in our hospital, between January 2020 and April 2020 and their newborns’ records were evaluated retrospectively.

Results: General anesthesia(GA), regional anesthesia (RA) anesthesia were applied during CS to 50% (n = 182), 50% (n = 182). There were no significant differences between the two groups (all p>0.05) in terms of APGAR score, umbilical cord arterial blood gas. The rate of breastfeeding in the first hour in the RA group was significantly higher than in the GA group (p <0.001).

Discussion: Two anesthesia (RA and GA)  methods could be preferred safely for newborns in terms of APGAR score and umbilical cord blood gas, however, the timing of breastfeeding initiation was earlier with RA than GA.

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Fragmented QRS on hospital presentation is independently associated with no-reflow in patients with first anterior ST-elevation myocardial infarction

Aim: No-reflow, that is the absence of sufficient myocardial perfusion after stent implantation, is associated with increased mortality in patients with ST-elevation myocardial infarction (STEMI). There is no definitive treatment, although there are some preventive approaches. Therefore, it is important to predict the patients at risk of no-reflow. Fragmented QRS (fQRS) is the presence of different RSR’ patterns without a bundle branch on electrocardiography. Both fQRS and no-reflow share similar pathophysiological mechanisms. Thus, we thought that the presence of fQRS on admission to hospital may reflect an increased risk for no-reflow. The aim of the study was to assess the possible relationship between fQRS on admission and the development of no-reflow.

Materials and Methods: The study included patients with first anterior STEMI who underwent primary percutaneous intervention.  fQRS was evaluated at the time of admission to the hospital. No-reflow was diagnosed by thrombolysis in myocardial infarction flow grade (< 3) after stent implantation. A multivariable model was created to determine factors independently associated with no-reflow 

Results: The study included 259 patients, including 56 (20.3%) with no-reflow and 203 (73.6%) without no-reflow. fQRS was more frequent in patients with no-reflow than in those without (71.4% vs 42.4%, p<0.001). In the multivariable model, fQRS (OR:3.731, 95% CI: 1.912-7.279, p>0.001) and male gender (OR:2.351, 95% CI:1.025-5.391, p=0.043) were independently associated with the development of no-reflow.

Discussion: The presence of fQRS on admission is independently associated with no-reflow in these patients. It can be used as a simple and non-invasive tool to predict the patients at risk for no-reflow.

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