Selim Ayhan

Background: Acute spinal cord trauma management necessitates understanding the primary and secondary injury mechanisms at different timepoints. Objectives: To characterize the cell death process by examining the temporal and spatial distributions of necrosis and apoptosis in an experimental spinal cord injury model. Methods: Wistar male rats were divided into trauma (n = 30) and sham (n = 6) groups, and a 50 g/cm weight drop contusion design was used. The rats were sacrificed 1, 6, 24, 48, 72, and 168 h after the injury. Every 0.5 cm spinal cord segment was examined cranially and caudally up to a total of 2.5 cm for neuronal and glial damage via the apoptotic count and DNA damage index via morphology and immunohistochemistry using an anti-ssDNA antibody. The results were mapped to visualize the damage extent, intensity, and distribution. Results: The central zone underwent hemorrhage and necrosis one hour after the injury. The apoptotic cells and DNA damage index increased with time (p < 0.001), and specific spatial alterations were observed among the segments (p < 0.001). Mapping the apoptotic cells and DNA damage clearly reflected the injury’s severity and extent. Conclusion: The DNA damage and the apoptotic cell count increase over time were well correlated with the morphology and could easily be elucidated using ssDNA immunostaining.

Background: Sugammadex is a modified gamma-cyclodextrin that has been developed with the goal of reversing the steroidal neuromuscular blocking agents. The aim of the present study is to investigate the effects of different sugammadex doses on embryologic and neural tube development in an early-stage chick embryo model. Methods: A total of 100 specific pathogen-free, fertilized domestic chicken eggs were randomly divided into five groups (n = 20, each), and placed in an automatic cycle incubator. The eggs in the "control (C)" group were incubated without administration of any drug till the end of the experiment. Subblastodermic administration of 0.9% NaCl as vehicle control (VC) and different doses of sugammadex solutions prepared with the latter [2 mg/mL (LD), 4 mg/mL (MD), 16 mg/mL (HD)] were performed at 30 hr of incubation. All embryos were removed from the eggs at 72 hr when they were expected to reach Hamburger-Hamilton (HH) stages 19-20, then they were fixed, and evaluated histo-morphologically. Results: Embryonic development was not observed in 11 eggs (1 in C, 1 in VC; 3 in LD, 3 in MD, and 3 in HD). All the developed embryos were compatible with the HH stages 19-20. A neural tube closure defect was detected in one embryo in the HD group. No statistically significant difference was found between the groups in terms of embryonic and neural tube developments. Conclusions: No significant association was found between the drug and adverse outcomes; however, a trend with dosing was seen. Further studies are required before conclude on safety and extrapolate these results to human beings.

Study Design: Retrospective cohort.Purpose: This study aims to evaluate the impact of anemia on functional outcomes, health-related quality of life (HRQoL), and early hospital readmission (EHR) rates after adult spinal deformity (ASD) surgery at the time of discharge from the hospital.Overview of Literature: Concerns with risks of transfusion, insufficient evidence for its benefits, and the possibility of associated adverse outcomes have led to restrictive transfusion practices. Therefore, patients are discharged according to patient blood management programs that are implemented in hospitals nationwide to reduce unnecessary blood transfusions. However, not many comprehensive kinds of studies exist on the effect of postoperative anemia on functional life and complications.Methods: Anemia severity was defined following the 2011 World Health Organization guidelines. All patients had HRQoL tests as well as complete blood counts pre- and postoperatively. EHR is the admission within 30 days of discharge and was used as the dependent parameter.Results: This study comprised 225 surgically treated ASD patients with a median age of 62.0 years, predominantly women (80%). Of the 225 patients, 82, 137, and six had mild, moderate, and severe anemia at the time of discharge, respectively. Seventeen of the patients (mild [11, 64.7%]; moderate [5, 29.4%]; severe [1, 5.9%]) were readmitted within 30 days. The mean hemoglobin values were higher in readmitted patients (p=0.071). Infection was the leading cause of readmission (n=12), but a low hemoglobin level was not observed in any of these patients at the time of discharge. Except for Scoliosis Research Society-22 questionnaire, HRQoL improvements did not reach statistical significance in early readmitted patients in the first year after surgery.Conclusions: The results of this study demonstrated that the occurrence and the severity of postoperative anemia are not associated with EHR in surgically treated patients with ASD. The findings of the current research suggested that clinical awareness of the parameters other than postoperative anemia may be crucial. Thus, improvements in HRQoL scores were poor in early readmitted patients 1 year after surgery.

Aim:This study aimed to determine whether there is a significant difference between the results of a standard biopsy and Doppler ultrasonography-guided biopsy of the temporal artery, which showed low preoperative pulse pressure. Material and Methods: Data from 21 patients, who received preliminary diagnosis of temporal arteritis at the neurology clinic were retrospectively investigated. Patients were divided into two groups depending on the method with Doppler ultrasonography and without ultrasonography. Results: Results from a total of 21 patients were evaluated. The first group consisted of 11 patients who underwent standard temporal artery biopsy, while the second group consisted of 10 patients who underwent ultrasonography-guided biopsy. Six patients in the group without the ultrasonography guidance showed insignificant results. Furthermore, the samples were insufficient in four of these six patients. In contrast, four patients from the Doppler ultrasonography-guided group were diagnosed with arteritis, in addition to the fact that an insufficient biopsy sample was not encountered in these patients. Statistical analysis showed that there was no significant difference between the pathology results of the two groups. Conclusion: Although we failed to find a significant difference between the groups, we believe that the Doppler ultrasonography-guided biopsy should be used as a supportive tool rather than diagnostic tool per se, as the Doppler ultrasonography-guided group did not provide insufficient biopsy samples in the pathology results as opposed to the standard group.