Kamil, Pehlivanoğlu; Süleyman, ÖzKan; Gazi, Şahin Azad; Gökben, Yasli; Erdal, Karavaş; Cengiz, Aydin

Objective: Recent studies show that the number of excised lymph nodes is an independent prognostic factor for colorectal cancer. Based on this information, lymph node ratio (the ratio of metastatic lymph node number to the total excised lymph node number) is a reliable marker for determining prognosis in colorectal cancer. In this study, we aimed to study the prognostic effect of lymph node ratio in non-metastatic colorectal cancers from patients who underwent surgery in our hospital between January 2008 and January 2013. Materials and methods: In this study evaluated the prognostic value of lymph node ratio in non-metastatic colorectal cancer patients who underwent surgery for immediate causes or elective causes in our hospital between January 2008 and January 2013. The study group consists of 352 patients and includes pathology reports, laboratory data, clinical observations. Results: When we stratified 204 (58%) men and 148 (42%) women, s according to LNR, we found that group 1 (LNR = 0) included 195 patients (55.4%), group 2 (LNR = 0.01-0.17) included 56 patients (15.9%), group 3 (LNR = 0.18-0.41) included 56 patients (15.9%), group 4 (LNR = 0.42-0.69) included 27 patients (7.7%), and group 5 (LNR ≥ 0.70) included18 patients (5.1%). Increased LNR was associated with a significantly greater mortality risk. However, LNR stratification was not significantly associated with clinical outcomes. Conclusion: Our results demonstrate that elevated LNR is associated with a higher rate of recurrence and poorer long-term prognosis. As is the case with many types of cancer, presence of lymph node metastasis is a significant component of tumor staging. TNM classification, which is currently the most commonly used staging system for colon cancer, does not include the total number of excised lymph nodes. We believe that future studies on LNR will draw attention to this shortcoming of the current staging system and provide evidence for LNR to be included as a standard of staging.

Karakeçili, Faruk; Cilo, Burcu Dalyan; Akin, Hicran; Agca, Harun; Sinirtas, Melda; Özakin, Cüneyt; Yilmaz, Emel; Akalin, Halis

Introduction: Early identification of vancomycin-resistant enterococci (VRE) colonization by screening patients is necessary in terms of preventing spread and development of infection. The purpose of this study was to investigate the presence of VRE using and real time polymerase chain reaction (RT-PCR) and to compare the results and costs. Materials and methods: Patients in the risk group attending our hospital and planned for treatment with hospitalization were included. Two rectal swab specimens were taken. One swab specimen was inoculated into enterococci broth for CCSM. Resistant gene investigation was performed with the other specimen by using RT-PCR. The costs of the two methods were then compared. Results: VRE were detected in 75 (6.63%) of the 1130 patients screened using the two methods. Resistance gene was determined in 69 (6.1%) patients using RT-PCR and 32 (2.8%) with CCSM. RT-PCR results were negative in 6 patients with VRE growth determined using CCSM. VRE was detected with CCSM in all 26 patients in whom vanA genotype VRE were determined using RT-PCR, but no growth was determined with CCSM in any of the 43 patients in whom vanB genotype VRE were detected. Results obtained in 3 days using CCSM and within 4 hours using RT-PCR. Costs were 58 $ with CCSM and 46 $ with RT-PCR. Conclusion: VRE colonization being detected faster with RT-PCR than CCSM. When the costs in isolation of patients until VRE screening test results emerged were compared, VRE screening with RT-PCR was cost-effective. RT-PCR was markedly superior to CCSM in determining VanB type resistance. Due to the late results from CCSM and its failure to detect VanB type resistance, we think that RT-PCR can be an alternative to CCSM or that the two techniques can usefully be combined depending on the hospital conditions.

Karakecili, Faruk; Cilo, Burcu Dalyan; Karagoz, Alper; Jefferies, Meryem; Cikman, Aytekin; Akalin, Halis; Ozakin, Cuneyt

Introduction: Arbitrarily Primed-Polymerase Chain Reaction (AP-PCR) and Pulsed-Field Gel Electrophoresis (PFGE) are widely used genotyping methods for investigating outbreaks of infections. The aim of this research is to compare AP-PCR with PFGE, which is known as the gold standard method, and to determine if AP-PCR is suitable for use in outbreaks.Materials and methods: Between 2001 and 2009, 664 isolated vancomycin resistant enterococcus (VRE) strains were determined at the Bacteriology Laboratory, Department of Medical Microbiology. During nine years study 5 peak periods were identified. In each peak period of 3 months, 83 VRE strains were selected from the 664 for this research. For all isolates a comparison of AP-PCR and PFGE using 83 VRE strains was performed.Results: Enterococcus faecium was found to be the dominant species in all VRE isolated from hospitalized patients. 83 strains of E. faecium were included in the study, which were isolated from 5 different possible epidemic periods over 9 years. 15 different clonal strains were collected using the AP-PCR method and 11 using PFGE.Conclusion: PFGE was found to be repeatable and had a better separation power than AP-PCR. AP-PCR though is a simpler,cheaper and faster method and can be used for VRE epidemics as an alternative method. In future epidemiological outbreaks the comparative molecular methods are more reliable than a single method.

Arisoy, Arif; Memic, K.; Diken, O.E.; Karavelioglu, Y.; Demirelli, S.; Topcu, S.; Değirmenci, H.; Bakirci, E.M.; Altunkaş, F.; Karaman, K.

Aims: Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of cardiac arrhythmia. While many studies have examined the development of atrial fibrillation (AF) in COPD patients, there is insufficient data about atrial conduction time (ACT) and its relationship with the Neutrophil to Lymphocyte ratio (NLR) in these patients. The aim of the present study was to evaluate atrial conduction features and its relationship with NLR. Materials and methods: The study groups comprised 40 patients with COPD and 40 healthy subjects, who were subjected to pulmonary function tests, 12-lead surface electrocardiograms, echocardiographic examinations and blood sample tests. ACT was measured through tissue Doppler imaging, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Results: Pulmonary function values were significantly lower in COPD patients than in the control group, as would be expected (p<0,001). According to the ACT measurements, tricuspid ACT was significantly longer in COPD patients than in the controls (26.4 ± 11.4 ms vs 17.7 ± 7.7 ms, p<0.001). Also, NLR was higher in COPD patients than in the control group (2.4 ±1.2 vs 1.94 ±0.8 p=0.009). A negative correlation was observed between tricuspid ACT and the percent of forced expiratory volume in one second (FEV1 %) (r = - 0.45; p <0.001), and a significant positive correlation was identified between tricuspid ACT and NLR (r=+0.38; p< 0.001). Conclusion: Our study revealed prolonged tricuspid ACT and increased NLR in COPD patients, and the existence of a relationship between these parameters was identified. Previous studies claim that hypoxia and chronic inflammation may be the underlying mechanisms explaining arrhythmia in patients with COPD, while many studies also show that a prolongation of ACT and increased NLR is associated with atrial arrhythmias. In the light of our findings and previous data, the assessment of ACT and NLR can be considered a clinically useful approach to detecting the risk of AF development in the population.