Şahin Kaymak

Oxidative stress from ischemia-reperfusion (IR) injury severely compromises erythrocyte deformability, a critical factor that disrupts microvascular flow and thereby exacerbates reperfusion injury. This study provides a novel perspective by directly investigating the protective effects of 6-Gingerol, known for its potent antioxidant properties, on erythrocyte function in a rat model of lower-extremity skeletal muscle IR. Twenty-four Wistar albino rats were divided into four groups: Sham (n = 6), DMSO (n = 6), IR (n = 6), and 6-Gingerol-IR (6G-IR, n = 6, 6 mg/kg i.p., 1 h before ischemia). Ninety minutes of ischemia were followed by 90 min of reperfusion. Compared to the IR group, the 6G-IR group exhibited a significant improvement in erythrocyte deformability (Rrel 2.13 ± 0.36 vs. 3.29 ± 0.40; p = 0.002, Cohen’s d = 3.9), a substantial reduction in lipid peroxidation (MDA 16.23 ± 2.11 vs. 22.14 ± 5.78 nmol/ml; p = 0.002, Cohen’s d = 1.3), and an apparent increase in antioxidant capacity (SOD 11.36 ± 2.25 vs. 6.93 ± 2.54 U/ml; p < 0.001, Cohen’s d = 2.0). Furthermore, 6G-IR significantly attenuated morphological damage (MGG score) and suppressed eNOS expression (H-score) compared to the IR group (Cohen’s d = 1.7 and d = 1.4, respectively). These findings provide strong preliminary evidence that 6-Gingerol preserves microcirculatory function through SOD-mediated neutralization of superoxide, thereby preventing peroxynitrite-induced erythrocyte membrane damage. Further power-calculated studies are warranted to explore its clinical translational potential.

Anal canal stenosis is a functionally disabling condition that results in impaired continence, constipation, and decreased quality of life. Although most cases arise after anorectal surgery, high-energy blast trauma (HEBT) represents a distinct etiology characterized by extensive tissue loss and neuromuscular injury. Long-term outcomes of anoplasty in this setting remain insufficiently described. This retrospective study evaluated functional and quality-of-life outcomes following flap anoplasty for anal stenosis of both postoperative and trauma-related origins. All patients who underwent anoplasty between 2008 and 2015 with ≥12 months of follow-up were included. Functional status was assessed preoperatively and at 12 months postoperatively using the Modified Wexner Score, Wexner Constipation Scale, and the Fecal Incontinence Quality of Life (FIQL) questionnaire. Sphincter morphology was evaluated using endoanal ultrasonography. Statistical analyses included paired tests, effect size calculations, and multivariable logistic regression to identify independent predictors of good continence (Wexner score ≤5). Thirty-seven patients met the inclusion criteria: 27 with postoperative stenosis and 10 with blast-related trauma. Anoplasty resulted in overall improvement in continence, constipation, and FIQL scores. However, functional recovery differed significantly by etiology: postoperative patients experienced substantial improvement, whereas blast-injured patients achieved only modest gains, reflecting persistent neuromuscular and fibrotic damage. Trauma cases demonstrated lower FIQL scores (14.7 vs. 16.8), higher constipation scores (8.1 vs. 7.2), and increased rates of fecal incontinence (20% vs. 11.1%). Sphincter integrity and shorter stricture length independently predicted good continence, while blast mechanism and advanced age were associated with reduced improvement. Anoplasty provides meaningful functional benefits in patients with anal stenosis; however, recovery is significantly attenuated in survivors of high-energy trauma. These findings underscore the importance of etiology-based planning, thorough sphincter evaluation, and realistic patient counseling.

Small bowel obstruction in virgin abdomen (SBO-VA) is rarely encountered and there is no standard treatment strategy. Even though nonoperative management is advocated in recent studies, studies evaluating the outcomes and results of laparoscopic surgery in these patients are lacking. This study aimed to compare the results of laparoscopic and open surgeries in SBO-VA patients. Thirty-five patients, ≥18 years old, who were admitted to the Hacettepe University Faculty of Medicine, General Surgery Department between January 2018 and December 2023 with virgin abdomen intestinal bowel obstruction and underwent open surgery and laparoscopic surgeries, were analyzed retrospectively. The demographic and clinical characteristics of patients were analyzed from hospital records. For 19 patients, laparoscopic surgery was conducted; for 16 patients, open surgery was conducted. Adhesions (60%) were the most common underlying etiology followed by Meckel diverticulum (17.4%). Pathological examination revealed malignancy in 4 (11.43%) patients. The diagnostic accuracy of computed tomography performed preoperatively was calculated as 34.3%. In the laparoscopic surgery group, the length of incision, Clavien-Dindo Classification score, pain score 24 hours after surgery, and length of hospital stay were statistically significantly lower compared with open surgery group ( P < .001, P = .01, P < .001, P = .001, respectively). Although it was statistically insignificant, median time to oral intake after surgery was shorter in laparoscopic group when compared with the open surgery group (48 hours [48–72] vs 72 hours [48–72], P = .056). Laparoscopic surgery in SBO-VA seems to be more advantageous than open surgery due to its favorable postoperative outcomes as well as diagnostic and therapeutic effectiveness.

This study aimed to determine whether surgical multiple-choice questions generated by ChatGPT are comparable to those written by human experts (surgeons). The study was conducted at a medical school and involved 112 fourth-year medical students. Based on five learning objectives in general surgery (colorectal, gastric, trauma, breast, thyroid), ChatGPT and surgeons generated five multiple-choice questions. No change was made to the ChatGPT-generated questions. The statistical properties of these questions, including correlations between two group of questions and correlations with total scores (item discrimination) in a general surgery clerkship exam, were reported. There was a significant positive correlation between the ChatGPT-generated and human-written questions for one learning objective (colorectal). More importantly, only one ChatGPT-generated question (colorectal) achieved an acceptable discrimination level, while other four failed to achieve it. In contrast, human-written questions showed acceptable discrimination levels. While ChatGPT has the potential to generate multiple-choice questions comparable to human-written ones in specific contexts, the variability across surgical topics points to the need for human oversight and review before their use in exams. It is important to integrate artificial intelligence tools like ChatGPT with human expertise to enhance efficiency and quality.

Objective: This study aimed to examine the association between blood groups and clinicopathological factors that could affect the prognosis of patients with gastric cancer. Material and Methods: In this retrospective single-center study, patients with gastric adenocarcinoma were obtained from a prospectively maintained database. The association between blood groups and clinicopathologic characteristics including sex, age, tumor location, tumor size, tumor stage, metastatic lymph node ratio (MLR), lymphovascular invasion, and perineural invasion were analyzed. Results: The study included 91 female and 221 male patients. The blood group distribution was A>O>B>AB both in the patients and healthy donors. Non-O blood types were more common in cancer patients than in healthy donors (p= 0.038). However, there was no significant association between sex, age, tumor location, tumor stage, lymph node status, lymphovascular invasion, and perineural involvement and blood groups. ≥7 lymph node involvement and MLR of >0.6 were significantly more common in patients with blood group A than in those with non-A blood groups (p= 0.034 and p= 0.018; respectively). Conclusion: The findings of this study suggest that blood group A patients are associated with higher MLR and N3 involvement, so it is possible that these patients with gastric cancer have a poorer prognosis.

Background: Although surgical treatment is curative for colorectal cancers, erectile dysfunction (ED) is one of the complications that affect the patient quality of life. The present study aimed to evaluate sexual dysfunction in patients who underwent anterior resection (AR) and low AR (LAR) surgery secondary to rectosigmoid pathologies in our clinic, to analyze the effective variables, and to compare the results. Methods: In the retrospectively designed study, male patients who underwent surgery for malignancy or other surgical pathologies in the General Surgery Clinic between January 2017 and December 2022 were examined. Female gender, patients under 18 years of age, and patients who refused to participate in the study were excluded. Results: The high age of the patient increased the risk of severe ED in the postoperative period. However, surgical technique, alcohol use, American Society of Anesthesiologists (ASA) score, and Clavien-Dindo class were not determinants in the presence of severe ED. Conclusion: ED is an emerging medical problem that affects patients who undergo colorectal surgery adversely both in social and psychological aspects. Discussions on the issue are still ongoing. Clinicians’ concerns can be addressed in the future as the number of prospectively designed studies involving more homogeneous and larger populations increases.

BACKGROUND: Bleeding remains the leading cause of potentially preventable deaths both in military and civilian pre-hospital trauma settings. Conventional extremity tourniquets do not control bleeding if an iliac artery or a common femoral artery is injured. Stopping junctional bleeding is particularly challenging and requires the use of specifically designed junctional tourniquets. SAM (R) Junctional Tourniquet (SJT (R), United States of America) and Tactical Abdominal Junctional Tourniquet (T-AJT (R), Fora Group Turkiye) have been actively used by Turkish security forces. This study questioned the effect of training on combat medics' successful junctional tourniquet applications and application times (AT). METHODS: Our research on two different junctional tourniquet models was designed as a prospective randomized, crossover, single-blinded study. All 40 participants in the study were attendees of a 12-week combat medic training course with updated medical approvals, which were used as an eligibility criterion. Randomization was performed by drawing T-AJT (R)-SJT cards. The study consisted of pre-training and after-training tourniquet application phases. In each study phase, all participants' AT and the presence or absence of arterial flow were recorded for each group. Finally, the combat medics were presented with a 6-question survey. RESULTS: Although training increased successful T-AJT (R) application rates, training was not statistically significantly associated with successful applications for any tourniquet types (p>0.05). The pre-training phase ATs for SJT (R) and T-AJT (R) were 55 +/- 11.8 and 93.8 +/- 2.9 seconds, respectively, and the difference was statistically significantly different (p<0.001). Likewise, after-training phase ATs for SJT (R) and T-AJT (R) were 49 +/- 22.6 and 79.2 +/- 17.5 seconds, respectively, and participants' SJT (R) ATs were significantly shorter (p<0.001). Overall, when participants' applied any of the tourniquet unsuccessfully, the odds of participants' lower Visual Analogue Scale scores were 0.2 (95% CI [0.08, 0.49]. p<0.001). CONCLUSION: Our study basically investigates the effects of training on effective tourniquet application. Unfortunately, our after training success rates remained unsatisfactory when compared to other studies. This is also the first study on T-AJT (R) tourniquet application, and further studies on its efficacy are also required.