Mehmet Buğra Bozan

Transient Receptor Potential Ankyrin 1 (TRPA1) is a membrane cation channel activated by oxidative stress products that are chronically elevated in class III obesity. Although tissue-level TRPA1 biology is increasingly well described, the biological meaning of circulating immunoreactive TRPA1 remains poorly established. This single-centre, prospective, controlled observational study compared preoperative serum TRPA1 between adults with class III obesity scheduled for laparoscopic sleeve gastrectomy and contemporaneous controls, and explored metabolic and inflammatory correlates of the circulating signal. Serum TRPA1 was quantified by enzyme-linked immunosorbent assay (ELISA) in 42 consecutive surgical candidates and 36 controls. The primary analysis used continuous (log-transformed) TRPA1 with age- and sex-adjusted logistic regression; ROC-derived dichotomisation was retained only as an exploratory analysis. Serum TRPA1 did not differ between groups (median 309.8 vs. 340.5 pg/mL; Mann–Whitney U, p = 0.323; Hodges–Lehmann median difference [obesity − control] −30.8 pg/mL, bootstrap 95% CI −227.43 to 43.02). After adjustment for age and sex, continuous log-TRPA1 was not independently associated with obesity status (OR per log-unit 0.88, 95% CI 0.46–1.69; p = 0.699), and discrimination was poor (AUC 0.435; 95% CI 0.305–0.562). Established inflammatory and metabolic markers differed between groups, but serum TRPA1 did not track them. In this cohort, preoperative serum TRPA1 did not distinguish class III obesity from controls. The negative circulating finding should be interpreted as lack of evidence for a large between-group difference in ELISA-measured serum TRPA1—and as a potential translational disconnect from tissue TRPA1 biology—rather than as the definitive exclusion of any tissue-level role for the channel.

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel prognostic biomarker that reflects a patient’s immune-nutritional status. This study aimed to evaluate the diagnostic and prognostic value of the HALP score in patients undergoing emergency versus elective inguinal hernia repair. This retrospective study analyzed data from 235 patients who underwent inguinal hernia surgery at a single center. The patients were categorized into emergency (n = 97) and elective (n = 138) groups, with the emergency group further divided into intestinal resection (n = 12) and non-resection (n = 85) subgroups. Preoperative HALP scores were significantly lower in the emergency group than in the elective group ( P < .001). Subgroup analysis revealed that HALP scores were significantly lower among patients who required intestinal resection compared with those who did not require resection in the emergency group and those who underwent elective surgery ( P = .004 and P < .001, respectively). Univariate analysis showed that the HALP score was associated with small bowel resection. Receiver operating characteristic curve analysis demonstrated that a HALP score cutoff value of < 2.31 yielded 75% sensitivity and 90.2% specificity for predicting intestinal resection in incarcerated inguinal hernia. The accessibility and cost-effectiveness of the HALP score support its use as an adjunctive tool for risk stratification in inguinal hernia management, particularly in resource-limited settings.

Historically, regional anesthesia has evolved from a simple procedure of “halting nerve transmission” into a strategic discipline that modulates the surgical stress response and accelerates perioperative recovery. This chapter examines the transformation of regional anesthesia from paresthesia-based blind techniques to a high-precision “visual science” practiced under ultrasound guidance. In particular, the integration of ultrasound technology has enhanced safety by providing real-time visualization of anatomical structures and local anesthetic spread, paving the way for the emergence of novel techniques such as “Fascial Plane Blocks” (TAP, PECS, ESP, etc.) and advanced extremity blocks. Furthermore, the use of perineural catheters allows for prolonged analgesia, bridging the gap between hospital and home recovery. These modern approaches have become fundamental components of ERAS (Enhanced Recovery After Surgery) protocols, reducing opioid consumption, minimizing side effects, and accelerating patients’ functional recovery. Regional anesthesia is no longer merely an intraoperative comfort tool but a holistic treatment modality that prevents the chronification of acute pain and directly improves patient outcomes.

Background and Objectives: Human data on obesity and type 2 diabetes mellitus (T2DM) remain limited and inconsistent, particularly with respect to adiposity-related phenotypes and renal involvement. We aimed to assess PNX-14 across body mass index (BMI) categories and to investigate its associations with BMI, insulin resistance indicators, and proteinuria in adults with T2DM. Materials and Methods: In this prospective cross-sectional study, participants were classified into four groups according to World Health Organization body mass index (BMI) thresholds: 18.5–24.9, 25.0–29.9, 30.0–34.9, and ≥35.0 kg/m². Serum PNX-14 was measured using a human ELISA kit. Group comparisons, trend analysis, false discovery rate-adjusted Spearman correlations, HC3-robust multivariable regression, and parsimonious structural equation modeling were performed. Results: PNX-14 differed significantly across BMI categories and increased monotonically with increasing BMI (p < 0.001 for both the overall comparison and the trend). PNX-14 showed a positive correlation with BMI (ρ = 0.491; qFDR < 0.001), whereas no significant relationship was observed with insulin or HOMA-IR after FDR correction (qFDR = 0.795 for insulin and qFDR = 0.793 for HOMA-IR). In the model adjusted for age, sex, and BMI, higher PNX-14 was independently associated with lower proteinuria (β = −0.326, 95% CI −0.584 to −0.067; p < 0.05), whereas BMI was positively associated with proteinuria (β = 0.407, 95% CI 0.132 to 0.682; p < 0.01). Structural equation modeling supported positive BMI→PNX-14 and BMI → proteinuria paths, a negative PNX-14→proteinuria path, and a non-significant PNX-14→HOMA-IR path. Conclusions: In adults with T2DM, PNX-14 appears to be more consistently related to adiposity than to glycemic or insulin resistance indicators. However, when evaluated together with proteinuria, it may offer a testable framework for phenotyping based on renal involvement within the obesity spectrum. Nevertheless, this approach needs to be validated in studies from different centers and with repeated measurements.

Objectives: Obesity is a significant health problem with increasing prevalence worldwide and is associated with numerous comorbidities. In this prospective controlled study, the relationship between changes in platelet-to-lymphocyte ratio(PLR), neutrophil-to-lymphocyte ratio(NLR), and pan-immune-inflammation value(PIV)-calculated from complete blood count parameters on the preoperative day and the first postoperative day-and early major surgical complications following laparoscopic sleeve gastrectomy(LSG) was investigated. Materials and Methods: Patients scheduled for LSG due to morbid obesity at the Department of General Surgery, Kahramanmaraş Sütçü İmam University, and Elazig Private Eastern Anatolia Hospital were prospectively included in the study. Preoperative and postoperative (24-hour) complete blood count (CBC) parameters were recorded, including white blood cell count (WBC), neutrophil count, lymphocyte count, monocyte count, and platelet count. PLR, NLR, and PIV were manually calculated. Patients were divided into two groups based on whether postoperative complications developed. Results: In the preoperative period, significant differences were observed in WBC count, neutrophil count, and PIV values between patients with and without complications ( p = 0.001, p < 0.001, and p < 0.001, respectively). In the postoperative period, significant differences were found between the two groups in WBC count, neutrophil count, platelet count, PLR, NLR, and PIV ( p = 0.001, p < 0.001, p < 0.001, p = 0.047, p = 0.001, and p < 0.001, respectively). When preoperative and postoperative values were compared, NLR, PLR, and PIV showed a statistically significant increase ( p = 0.001, p < 0.001, and p < 0.001, respectively). Conclusion: Our study demonstrated that among inflammatory markers calculated from CBC parameters, the PIV-assessing the overall immune-inflammatory response-provides higher specificity and sensitivity than NLR and PLR in predicting early postoperative major complications following LSG.

Aims: This study aimed to evaluate the association between preoperative derived neutrophil-to-lymphocyte ratio (dNLR) and negative appendectomy in patients undergoing surgery for acute appendicitis. The secondary aim was to investigate the diagnostic value of preoperative dNLR by examining its differences across the histopathology-based groups. Methods: This retrospective observational study included 669 adult patients who underwent appendectomy for a preoperative diagnosis of acute appendicitis between August 2018 and December 2023 at our hospital. Based on the histopathological results, the patients were categorized into negative appendectomy and positive appendectomy (complicated and uncomplicated) groups. Preoperative complete blood count parameters, including dNLR, were compared between the groups. The diagnostic performance of dNLR was assessed using receiver operating characteristic (ROC) curve analysis.Results: The rate of negative appendectomy was 20.3%. The negative appendectomy group had a significantly lower dNLR, leukocyte count, neutrophil count, and NLR (p

Purpose: In laparoscopic appendectomy, stabilization of the appendix is required during knot-tying for stump closure. In the literature, additional ports or instruments have been used to achieve this stabilization. In our study, we employed a technical variation of intracorporeal knot-tying for appendiceal stump closure. This technique has not previously been used for this purpose. It does not require additional ports or instruments. The aim of our study was to evaluate the impact of this knot-tying technique on operative time and safety. Materials and methods: This study was conducted in adult patients, who were prospectively randomized into two groups and subsequently underwent laparoscopic appendectomy. First group included patients with single-instrument intracorporeal ligation, whereas second group included patients with polymer clip closure. Neither group employed any instruments other than the standard laparoscopic instruments. The operation time of the patients, the time from the completion of the dissection to the removal of the specimen (closure time) and complications were compared. Results: A total of 68 patients received laparoscopic appendectomy during the present study. There were 39 patients (57.4%) in the clip group and 29 patients (42.6%) in the ligation group. Of the 68 patients included in the study, 25 were women (36.8%) and 43 were men (63.2%). The median age of the patients was 34 (IQR:24–44) years. The mean body mass index (BMI) of the patients was 27.4 ± 4.5. Three patients were diagnosed with perforated appendicitis. Histopathological examination revealed acute appendicitis in 41 patients (60,3%), phlegmonous appendicitis in 26 patients (38.2%), and a normal appendix in 1 patient. The median operative time was 19 (IQR 13–28) minutes in the clip group and 35(IQR 30–45) minutes in the ligation group. Additionally, the median closure time was 3(2–9) minutes and 7 (4–13) minutes, respectively. Operative and closure times were longer in the Ligation Group (both, p = 0.00001). In the clip group, three patients developed wound site infections and one patient developed intra-abdominal abscess. In the ligation group, two patients developed wound site infections and one patient developed intra-abdominal abscess. There was no difference in total complication rates. ( p = 1) Conclusion: Closure using single-instrument ligation prolonged the procedure time compared to clip closure and resulted in similar complication rates. This technique, previously unused for closing the appendiceal stump, can be performed with standard laparoscopic instruments without requiring additional surgical instruments or incisions. The method employed could be regarded as a technique that ought to be included in a surgeon’s repertoire of skills for various clinical scenarios. Trial registration: Clinicaltrials.gov (NCT06443749), 29.05.2024.

Background: Isthmin-1, a recently discovered adipokine, was first characterized for its role in early brain development. Subsequent studies have demonstrated that isthmin-1 is involved in a broad range of biological processes, including metabolism, immunity, tumorigenesis, cellular proliferation, endothelial permeability, and organ development. Aims: This study aimed to evaluate isthmin-1 immunoreactivity in tumor tissues obtained from gastric cancer patients using immunohistochemistry and to assess its usefulness in the diagnosis and histological evaluation of gastric cancer. Methods: The patients were divided into three groups: adenocarcinoma, intestinal metaplasia, and healthy controls. Endoscopic biopsies, obtained according to the Sydney protocol, were examined for the control group and patients diagnosed with intestinal metaplasia. In contrast, surgical resection tissues were used for patients diagnosed with gastric adenocarcinoma. Results: All materials were examined histopathologically. No significant difference in isthmin-1 levels was detected between the control and intestinal metaplasia groups, based on immunohistochemical staining. However, when gastric adenocarcinoma cases were compared with the control and intestinal metaplasia groups, a significant decrease in isthmin-1 immunoreactivity was observed in adenocarcinoma cases. Patients with adenocarcinoma were grouped as well-differentiated, moderately differentiated, and poorly differentiated, and then staged according to the TNM staging system. Histopathological examination revealed no significant differences in the degree of differentiation or TNM stage. Conclusions: We believe that isthmin-1 can be used as a biomarker in the diagnosis of malignant gastric diseases in the future. However, more comprehensive and extensive scientific studies are needed to determine its usefulness in tumor staging or prognosis monitoring.

Background/Aims: The HALP score, a scoring method that has demonstrated effectiveness in inflammatory clinical conditions and is increasingly used in clinical practice, can be utilized to distinguish between complicated and uncomplicated cases of acute appendicitis. Additionally, it may serve as a reference for initiating medical treatment at an earlier stage. Materials and Methods: Patients who were diagnosed with acute appendicitis and operated on were included. Patients who underwent conventional open appendectomy and laparoscopic appendectomy as surgical procedures were examined retrospectively by scanning their files. Preoperative CBC and biochemistry values of the patients were recorded by scanning their files retrospectively. From here, preoperative hemoglobin‐albumin‐lymphocyte‐platelet (HALP) Score [hemoglobin (g/L) × albumin (g/L) × lymphocyte count (/L)]/platelet count (/L)], neutrophil–lymphocyte ratio (NLR) [neutrophil count (/L)/lymphocyte count (/L)] and platelet–lymphocyte ratio (PLR) [platelet count (/L)/lymphocyte count (/L)] were calculated manually. Results: There were statistically significant differences between patients with and without complications in terms of preoperative WBC, neutrophil counts and lymphocyte counts in the preoperative period ( p values; 0.015, < 0.006 and < 0.004, respectively). There was no statistically significant difference in terms of other preoperative blood values ( p > 0.05). There was a statistically significant difference between the groups in terms of NLR, PLR, and HALP score calculated from preoperative CBC parameters. Conclusion: HALP score is an important biomarker, like other biomarkers, in the early diagnosis of complications, initiating antibiotic therapy earlier, gaining time during transport, and preventing complications that may arise due to exacerbation of the disease. Trial Registration: NCT07002671